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physicians directly in the gun sights of the most sophisticated marketing on the planet. All the while, doctors seem be shrinking as did Gollum, the figure in J. R. R. Tolkien's novel who, under the influence of the Ring, became a twisted shadow of what he should have been. Given this, it is unbelievable that there does not appear to be a single medical course anywhere that offers physicians any education on marketing. The only doctors who seem to know something about marketing are those who have worked in the pharmaceutical industry. In the Lord of the Rings , in true market style, it was ultimately the self-interest of Gollum that saved everyone else. But that was only a fable—and while saving us, Gollum's self-interest destroyed him.
    If we are to continue with prescription-only status as we have it now, our safety depends critically on doctors stepping up to the plate. They need to report on hazards and need to find a way to ensure their reports aren't airbrushed out of existence. They need to insist on companies undertaking adequate studies of drugs. Moreover, if companies are to be allowed to market their drugs under the banner of science, doctors need to ensure that companies adhere to the norms of science and make the data from these studies available, or else they need to undertake the appropriate studies themselves. They do, after all, report on the hazards of over-the-counter medicines and, funded by federal monies, doctors have undertaken research on drugs like tobacco, aimed at nailing down its hazards. Prescription-only arrangements once seemed like a mechanism to enhance the ability of medicine to interrogate the companies producing these “ethical” drugs. If it has become instead a mechanism that neuters medicine, it is time for medicine to take stock and then take action.
    There are alternate arrangements to the current ones. We could make new medicines available by prescription only for a limited period before a decision was made as to whether they could be sold over the counter, during which time doctors would work hard to establish all the hazards of the new drugs. Alternatively, rather than have all new drugs available by prescription only, we could opt to make just highly toxic drugs available indefinitely by prescription only. We might distinguish between drugs used for traditional medical purposes and drugs for something closer to lifestyle enhancement, with the first group being available by prescription only and the second not.
    The SSRIs offer an instructive example of what happens when essentially the same drugs are available by prescription only and over the counter. The SSRIs are antihistamines that inhibit serotonin reuptake. Available by prescription only, one set of selective serotonin reuptake inhibitors lead to agitation and suicidality, while very similar SSRIs available over the counter for allergies have occasionally been linked to irritability but appear in general to cause fewer problems than their prescription-only cousins. In part the differences likely stem from the difficulties described in chapter 7 in the case of Victor Motus: it is not easy to stop a treatment that doesn't suit a particular patient when a doctor has told that patient they need to remain on the treatment for several weeks before it “works.”
    Doctors like Dr. Trostler, whom Victor Motus went to for help, have no training in the many things they do, aside from issuing a prescription for medication, that may enable or disable the people for whom they are trying to care from contributing to that care. They appear to have no feel for the fact that prescription-only arrangements put them in the position of a Roman emperor, with their patients in the role of tasters.
    At a time when pregnant women have learned to shun over-thecounter drugs, even down to coffee, doctors have for over a decade dramatically increased their patients' prenatal consumption of SSRIs in the face of growing evidence these