Last weekend, I sat down to watch Side Effects, the recently released Steven Soderbergh thriller about a depressed woman who takes a new (fake) selective serotonin reuptake inhibitor called Ablixa to disastrous ends. Soderbergh, who previously brought us the medical thriller disaster film Contagion, is adept at subtly critiquing aspects of our healthcare system while still offering the classic Hollywood drama that fills movie theaters in the first place. Ultimately, Side Effects? does not dwell on the questionable ethics of healthcare (a la the investigative work of Steven Brill whose recent cover article in Time magazine viciously throws back the curtain on hospital bills), but the movie still manages to bring interesting topics into the public discourse which I hadn?t anticipated when I bought my ticket.

The movie's plot is meant to mimic the multitude of news stories of horrible acts of violence committed by individuals taking (real) SSRIs, such as Zoloft, Paxil, and Prozac. The medical community as a whole has yet to produce conclusive and validated medical research that connects SRRIs with increased rates of aggression and hostility to others, but all of these drugs do carry a black box warning of increased risk of suicidal ideation and behavior in children, adolescents, and young adults. To me, however, the more interesting question asked during the movie is not whether there is a connection between SSRIs and violence but rather ? in a therapeutic area like depression in which the prescribing pattern of a physician is heavily influenced by competing forces, how does a patient end up on a particular drug?

Since the heyday of paternalistic medicine (when doctor knew best), patients have had increasing ownership over their therapeutic and pharmacological treatments. Patient-centric and patient-driven practices have even become at least partially the norm in many therapeutic areas. Patients now have access to incredible amounts of healthcare information. These days, when I experience some sort of symptom I usually type it into Google and click through a short survey on WebMD to see if I can diagnose myself (I usually end up having a terminal cancer) before I ever consider going to the doctor's office. Coupled with a trend toward building an allegedly more knowledgeable patient base has been the spread of pharma's reliance on direct-to-consumer advertising to get patients to request particular drugs during their doctors? visits.

During Side Effects, the fake SSRI used in the movie has its own commercial (and website), which is so perfectly crafted to satire the real life versions of drug commercials (complete with despondent women being followed by rain clouds, a catchy nonsensical slogan ? ?Take back tomorrow!?, and the mumbled list of side effects that include suicidal thoughts and sleep disturbances) that if I saw it on television I wouldn?t think twice. But can we draw a broader implication of satirizing these commercials? Not only does it provide an interesting commentary on how little potential consumers actually learn from these commercials but it also highlights our own desire to be informed and active participants in our health. Is it wrong for patients to play such an active role in deciding treatment courses or are we placing too much trust in potentially inaccurate knowledge bases (remember when I said I usually have terminal cancer when I search WebMD)? Side Effects does not try to answer this question and I?m not sure I fully understand the magnitude of this implication on the healthcare system as a whole but it is still an important one to continue to ask.

If you are looking for an interesting movie that explores some of the gray areas of the healthcare system and has some great twists to boot, I would definitely recommend checking out Side Effects! It may be Soderbergh's last big screen movie after all.

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