The value of ignorance: Antidepressant drugs and the policies of objectivity in medicine.

This thesis explores the strategies of ignorance and uncertainty employed by UK regulators, practitioners and policymakers during the controversy over whether selective serotonin reuptake inhibitor (SSRI) antidepressants such as Prozac contribute to suicidal and homicidal reactions in some users. Empirically, the thesis is based on archival research, textual analysis, and interviews with UK policymakers and clinicians involved with efforts to determine the safety of SSRIs. By analyzing these materials with methodological and conceptual tools from the fields of science studies and the sociology of reason and objectivity, the thesis demonstrates the following four findings. First, drawing on the case of SSRIs, I demonstrate that many policymakers within the UK's National Health Service are frustrated with their inability to access clinical trial data necessary for developing treatment guidelines. Second, I argue that problems surrounding access to clinical trial data illustrate weaknesses within evidence-based medicine, a model of medicine that has become dominant in the UK and internationally over the past three decades. Third, I argue that when practitioners and policymakers wish to criticize the socio-political factors that make it difficult to access clinical trial data, their dissent must be limited to the universe of numbers, a phenomena which I term the "moral authority of objectivity" in medicine. Fourth, drawing on interviews with expert advisors to the MHRA, I argue that, in the case of SSRIs, regulators employed a strategic use of ignorance in order to absolve themselves of liability in not disclosing the knowledge of adverse effects when they first learned of them. This final finding has theoretical implications for recent studies of uncertainty and ignorance. I suggest that the SSRI controversy illuminates the regulatory value of inconsistent, uncertain and contradictory facts. The usefulness of uncertainty lies in its performative nature: uncertainty creates a demand for solutions to the ambiguity which it perpetuates, often consolidating the authority of those who have advanced a position of uncertainty to begin with