The future of happiness.
Steven Braun's preface to The Science of Happiness: Unlocking the Mysteries of Mood challenges readers to ask whether using drugs to enhance happiness is unnatural, possible, or even desirable. In the preface he describes how he came to write about the chemistry of happiness. Intrigued by an article in an airline magazine titled "Forget Money; Nothing Can Buy Happiness," Braun began to wonder if happiness, everyone's ultimate goal, might really be a more a product of our biology than of our circumstances in life. If so, are peoples' experiences and efforts to be happy largely irrelevant and futile?
Certainly both biological and external factors can affect one's level of contentment at any point in time, but what are the relative strengths of these factors for long term happiness? Braun argues that the answer to this question will guide the future of R&D within the pharmaceutical industry and also the paths persons will follow in their searching for happiness in the 21st century.
Braun is a medical writer with an interest and research experience in neuroscience. This background and information gained from interviews with scientists, psychologists, and many mood-modifying drug users lends credibility to his authorship of a book about the chemistry of happiness. Scientists' views appeal to our analytical side, while the personal stories evoke our compassion. These dual perspectives voiced in non-technical language make the book an enjoyable read.
Braun grabs our attention in Chapter 1, "Prozac: The Next Generation," with a quotation from Aldous Huxley's 1932 classic, Brave New World: "Two thousand pharmacologists and biochemists were subsidized ... Six years later it was being produced commercially. The perfect drug. Euphoric, narcotic, pleasantly hallucinant. All the advantages of Christianity and alcohol; none of their defects. Take a holiday from reality whenever you like, and come back without so much as a headache or a mythology. Stability was practically assured." And Braun brings us into the present: "We are in a revolutionary new age of pharmacology" (p. xii), and "the rapid pace of discovery in neuroscience and pharmacology makes the development of safer, more side-effect-free mood-altering drugs a virtual certainty" (p. 135). Braun is convincing. There are ethical issues here that need to be addressed immediately.
The corporate developer, manufacturer, and marketer of Prozac, Eli Lilly & Co. in Indianapolis, Indiana, has garnered 30% of its net sales from this anti-depressant in recent years. But in December, 2003, its 20 year patent expired, meaning that any pharmaceutical company can now manufacture and sell generic fluoxetine. So it is not Huxley's brave new world government that is now pushing Lilly and other drug companies to create a more perfect happiness drugs to displace Prozac, rather it is corporate competition for billions of dollars of profit. Critical to the development and future use of psychotropic drugs like Prozac is the concept of a happiness "set point," corresponding to one's normal level of happiness and derived from an individual's biological makeup.
In the second chapter, "Set Point," happiness is defined as a long term pleasure which people seek through various goals. Braun cites studies by psychologists Ed Diener and David Meyers that show no direct relationship between happiness and biologically external variables like money, social class, and career type. Happiness is obtained by internal factors such as outlook, temperament, and personality. The relevance of this finding for the pharmaceutical industry is apparent. If happiness is primarily biologically based, and if the crucial biology is brain chemistry, then all persons can live happier lives through chemistry. Braun adds further support for this view by citing surveys indicating that wealthier countries do not contain happier citizens, wealthier persons within the United States are not happier than the less wealthy, degree of happiness is unrelated to race, the college educated are no happier than high school dropouts, rising income levels are not accompanied by rising levels of happiness, and lottery winners do not report increased levels of happiness.
Because statistically married people are happier, Braun poses the question of whether this is due to happier people being more likely to marry or to the fact that marriage brings happiness. The underlying question is whether happiness drives life events or conversely, whether life events drive perceived levels of happiness. According to Braun, psychologist David Meyers has suggested that happier people may tend to marry earlier, leaving older, less contented people to marry later; however, surveys find no difference in the happiness levels between those who marry early and late (p.37). Happiness seems dependent upon a continuous interaction between one's environment and one's temperament.
Braun suggests that temperament is genetically based, stable over the long term, and has a determining influence upon happiness. Life events may cause temporary depression or euphoria, but one's mood then returns to its set point relatively quickly. Braun cites Diener to suggest that the more extreme the mood-provoking event, the longer it takes to restore the set point of mood (p.45). It is this set point that Braun believes can be influenced by chemical intervention with psychotropic drugs.
Braun uses Cartesian plots to illustrate mood fluctuations. On the y-axis is a range of moods, while time is plotted on the x-axis. The happiness set point is represented by a straight line parallel to the x-axis. Sample plots illustrate differences between typical and dysfunctional mood profiles. Autistic persons have little emotional reactivity due to minimal levels of perception and response to the emotional cues from the people around them; therefore, their mood profiles are relatively flat. By contrast, manic-depressives have mood profiles with extreme amplitudes. Yet, in all cases, a set point about which moods oscillate is discernable.
The average human set point does not appear to be at a neutral spot midway between euphoria and depression. Rather, most peoples' set points are slightly above neutral. In other words, most people are moderately happy (p.47). Recently identical twins have been studied to explore the genetics of a happiness set point. Lykken and Tellegen at the University of Minnesota estimate the heritability of the set point to be about 80% (p.51). Braun writes that drugs such as Prozac, Zoloft, and Remeron raise the happiness set point, and in Chapter three, "The Machinery of Mood," he gives some insight into the mechanisms of how this might be accomplished.
In Chapter 4, "Listening to Depression," we learn of the work of Emmy Gut, a Swedish psychotherapist, who argues that depression is adaptive. Depression may have been selected for during evolution because it alerts us to problem areas in our life; therefore, depression is only a symptom and not something we should strive to cure. The problem needs to be cured, not the depression. In the final chapter of the book this is countered with several specific case examples where antidepressants appear to have enriched people's lives by helping them fall in love, raise children, overcome debilitating depression, or find a spiritual connection. In fact, throughout the book, Braun does an admirable job of presenting both the pros and cons of drug use to influence mood.
Chapter 5, "Selling Happiness," warns that psychotropic drugs are not as good as drug companies may claim. Hundreds of millions of dollars are invested in R&D for every new drug that gets to market. The process of gaining approval from the U.S. Food and Drug Administration to sell a drug, convincing doctors to prescribe the drug, and convincing patients to buy the drug are also monumentally expensive challenges (p.109). The pressure of competition between drug companies falls squarely on the shoulders of each company's employees, from top to bottom with salespeople supporting the entire structure. It is no wonder that boiler rooms of deception and the promulgation of incomplete information often emerge from such an environment, with the consumer as the victim. Several such instances are detailed in Chapter 5. For example, since drug companies are allowed to select the scientists who conduct drug trials and to control the use of the data, the stage is set for data manipulation to emphasize drug safety and effectiveness and to de-emphasize negative results and undesirable side effects. Also, marketing efforts may include attempts to redefine an illness to broaden the pool of potential patients. Braun tells of five cases in which drug companies have wrongfully pushed their drugs onto the market. He claims that people are more naive when it comes to purchasing drugs because they tend to trust doctors and do not exercise the degree of skepticism they would toward a car sales person. It is an eye opener to hear how easily drug companies like Eli Lilly can exploit loopholes in FDA regulations to see that their drug gets to market. Anybody considering taking a psychotropic drug should read Chapter 5 before purchasing their prescription.
Throughout his book Braun provides specific examples and references several surveys to support his points. At the end of the book he includes a list of references by chapter, which is valuable for persons wishing to delve deeper into the issues.
All of this considered, Stephen Braun still favors the continued development of psychotropic drugs and urges more research aimed at understanding how these mind-altering chemicals work. This book is undoubtedly among the first of many more to come that will address ethical issues surrounding neuropharmacological research and drug marketing. Francis Fukuyama, a member of the President's Council on Bioethics, warns that neuropharmacology is the most urgent of all of the new biotechnologies to control because, unlike reproductive cloning and genetic enhancement, it is upon us now and apt to soon become an important means for controlling human behavior (Our Posthuman Future: Consequences of the Biotechnology Revolution, 2002, p.42). Braun himself points out one of the main reasons for this urgency. Psychotropic drug use has a unique ethical dimension in that it involves self-administration of a chemical that affects the very same organ that must be used in order to decide whether to use that chemical.
Auburn, AL 36849
Lynne Sanders has a B.S. degree in Biomedical Sciences from Auburn University. This review was written for an undergraduate Bioethics Research course with mentorship and editing by James T. Bradley, Department of Biological Sciences, 331 Funchess Hall, Auburn University, AL 36849.
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|Publication:||Journal of the Alabama Academy of Science|
|Article Type:||Book Review|
|Date:||Jan 1, 2004|
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