Debating the evidence : oral contraceptives containing drospirenone and risk of blood clots

Skepticism is an essential quality in science. We doubt, re-examine and demand the highest quality of evidence. However, sometimes this puts us in an awkward situation. How much evidence do we need before we act? This dilemma is a constant problem in drug safety. Treatment decisions are always a balance of risks and benefits and there may be a paucity of evidence about rare or very rare adverse events.

Introduction: secularization and its discontents

Sigmund Freud’s 1927 work The Future of Illusion expresses the great psychoanalyst’s most whiggish assessment of the situation of Western, post-enlightenment societies. In it, Freud reanimates the ancient tradition of the materialist-Epicurean criticism of religion, with its skepticism concerning all invisible powers. For Freud, famously, the religious belief in higher, supernatural deities—particularly, the monotheistic God—represents a wish-fulfillment and illusion (Freud 1927: 30, 43). This illusion takes its particular shapes from our earliest childhood experiences of helplessness, and the longing for an all-protecting, omnibenevolent father. With the progress of science, and its benefits in technology, Freud opined that the period of the cultural pre-eminence of religion in the West was over. Civilization and its Discontents, written 3 years later, expresses a similarly sceptical assessment of religion. Whether founded in an oceanic, mystical sentiment of oneness, or the refined language of the theologians, religion remains for Freud ‘patently infantile’ (Freud 1930: 86). Between 1927 and 1930, however, Freud’s assessment of the wider prospects of modern Kultur shifted, if it did not entirely reverse. With the fortunes of fascism rising, and the first clouds of renewed European war forming on the horizon, Freud now argues that the psychological price demanded by the modern world’s manifold civilizational advances is perhaps too high. The sexual and aggressive impulses modern society demands subjects renounce must return in the forms of organized violence, collective and individual neuroses—and in the same form of unconscious guilt Freud had argued elsewhere animated the totems and taboos of the great religions (Freud 1913, 1938). Although Freud did not draw the conclusion, the logic of his wider Kulturpessimismus points to the claim that the psychologically deep-set ‘illusions’ of religion could expect a long and viable future.