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Tony Clement appointed as dysfunction in patients with depression or obsessive compulsive disorder and, to Canada’s new health minister date, it has been elusive,” says Dr. Wayne Goodman, Chair of the US Food ormer Ontario health minister and Drug Administration (FDA) Psy- Tony Clement, once dubbed chopharmacologic Drugs Advisory Com- F “two-tier Tony” for his oft- mittee. Although an SSRI may work stated belief there must be “more well in an individual, this “doesn’t prove choice in health care,” was appointed that there is an underlying imbalance, federal Minister of Health in the new defect or dysfunction in the person’s Conservative government on Feb. 6. serotonin system,” he added. Clement’s duties include responsibil- Goodman was reacting to a recent ity for public health, a junior-minister article (December 2005, PLoS Medi- position that was axed in Prime Minister cine) about the growing body of med- Stephen Harper’s streamlined cabinet. ical literature that casts doubt on the s

Clement’s appointment is “quite s “serotonin hypothesis.” Co-author e r p shocking,” said Mike McBane, execu- a Jonathan Leo, associate professor of n a tive director of the Canadian Health C anatomy at Lake Erie College of Osteo- Coalition, an advocacy group for a pub- Clement’s first priority is to move forward pathic Medicine, says the FDA should lic health system. “It sends a very clear with a Patient Wait Times Guarantee. prohibit SSRI manufacturers from mak- signal, that the Prime Minister would ing these claims. appoint someone who is ideologically GlaxoSmith-Kline (GSK), for example, committed to privatizing the delivery of Agency of Canada and other public claims (www.paxil.com) that paroxetine the public health care system, someone health programming, “goes against (Paxil) can “help restore the balance of who was aggressively involved in dis- what I think a lot of the provinces have serotonin — which helps reduce the mantling the Ontario health care sys- learned,” says Dr. Carolyn Bennett, the symptoms of anxiety and depression.” tem, in firing nurses and shutting out-going minister. GSK officials refused to comment. down hospitals.” Having a separate minister with the In 2003, Ireland’s drug regulator During his tenure as Ontario’s health time to bring a public profile to health banned GSK from stating on its patient minister from February 2001 to October prevention and profile is critical in information leaflet that paroxetine 2003, Clement supported privatization combating the “other epidemics” of di- “works by bringing serotonin levels and deregulation of long-term care facil- abetes, cancer and heart disease, and back to normal.” Officials stated that ities and the creation of for-profit hospi- working with the provinces to improve “There is no scientific investigation to tals in Brantford and Ottawa. determinants of health, she said. measure what are normal serotonin lev- Clement also oversaw Ontario’s But Collins-Nakai says “the fact that els in the human brain receptors. As handling of the 2003 SARS crisis, dur- the Public Health Agency remains in such, claiming that a particular medici- ing which he was lauded for his able place gives us comfort in Canada’s abil- nal product works by bringing serotonin administration and candid admission ity to have a strong public health sys- levels back to normal is not accurate.” that the public health system was tem.” Having the agency reporting di- The claims do not appear on Cana- “close to collapse.” rectly to the minister of health is also dian product information, says Health The new minister’s top priority will be more “workable ... at least in raising is- Canada spokesperson Chris Williams. to implement the Conservative election sues,” she added. — Wayne Kondro, The Paxil monograph states it is promise to develop a Patient Wait Times Ottawa; Barbara Sibbald, CMAJ “thought to work by increasing levels of Guarantee, Clement told reporters. serotonin in the brain.” CMA President Ruth Collins-Nakai DOI:10.1503/cmaj.060180 Goodman would not comment on says unlike previous federal ministers whether the FDA should ban these claims. of health Clement already has an exten- While he accepts that claiming SSRIs sive knowledge of Canada’s health care SSRI ads questioned correct a serotonin imbalance goes “too issues. “This is a significant plus,” she far,” he says he has no problem if pa- told CMAJ. “We don’t have to spend as laims in drug monographs and tients are told that SSRIs normalize some much time briefing him... we can dis- advertising that selective sero- kind of chemical imbalance or distur- cuss the issues.” Topping the agenda C tonin reuptake inhibitor (SSRI) bance. “I think that is reasonable short- are wait times and health human re- antidepressants work by normalizing hand for expressing that this is a chemi- sources, she added. serotonin levels are not based on scien- cally or brain-based problem and that the Harper’s decision to abolish the tific evidence and should be prohibited, medications are normalizing function.” Ministry of State (Public Health) posi- says a leading US psychiatrist. — Colin Meek, Wester Ross, Scotland tion, established in December 2003 to “Biological psychiatrists have looked oversee the creation of a Public Health very closely for a serotonin imbalance or DOI:10.1503/cmaj.051634

CMAJ • March 14, 2006 • 174(6) | 754