Making medicines safer for all of us

Editorial Note: This post is from Sally MacGregor. In depositions and lectures I commonly state that I have had more support and information from colleagues working for industry than from clinical colleagues.

I loved the analysis of the derailment of medicine and research through the comparison between a Republican and Empire structure, and the take-over of the former by the latter (See Data Wars & Minions No Longer). It highlighted a moral/ethical dilemma that I thought about throughout the riveting unrolling of Study 329 and its re-write. How do good people become corrupted?

Unless you buy into the idea that every one of the million or more people who have ever worked for a drug company is inherently lacking any moral compass, then it is imperative to wonder what happens such that one giant corporation can ruthlessly and without any expression of regret kill people in the interests of profit. Corporations aren’t some weird, otherworldly entity, a life form that has developed somewhere in the outer reaches of the galaxy, like the Daleks that terrified me at the age of 8. Corporations are people. From the chief executive down to the people who make the products on a factory line – they are all human.

One might attribute hubris, overweening greed and psychopathy to those at the very top but not, I think, to all the tens of thousands of employees. Thoughts of Nazi Germany spring to mind – the millions of ‘ordinary’ Germans who kept quiet, or turned a blind eye to the persecution of the Jewish people and the Holocaust. Maybe there is something similar at work, but it doesn’t quite fit the whole picture for me.

I can describe the last throes of Republic and the transition to Empire from a personal perspective: when my husband was offered his first job after university in the early 1980s, with a now defunct American pharmaceutical company, we thought he was going to be putting his biochemical training to good, practical purpose – albeit in animal medicines. Dealing with problems like enteritis in pigs or finding better ways of managing flea infestations in cats and dogs. It wasn’t exactly noble – but it seemed a useful way of earning a crust.

At that time, in the early 1980s, the animal health division was headed by a veterinary surgeon and many of the older scientists at American HQ were exiles from Nazi Europe. One, Irv, long since dead, had escaped from Germany in 1939, and met and married a fellow escapee who had got out on the Kindertransport scheme, here in the UK. They’d settled on the East Coast of the US, near the company’s research HQ in Philadelphia when Irv began work for the company as a chemist. They stayed there for 50 years. He was a scrupulously honest person who sometimes drove his colleagues mad with his meticulous attention to small detail. He was a Democrat through and through, and utterly horrified by the corporate dishonesty revealed during the Enron scandal. Music was his first love but he was always ready to talk politics, books and the theatre. He and his wife were humane, cultured people. They were also deeply grateful and loyal American citizens. The only time we ever differed was when they were both shocked to the core by a spate of flag burning in the early 1990: some protest or other in the US, which seemed perfectly low key, and quite amusing to us but really shocked them both. I wish I could discuss what has now emerged about the embedded corruption of Big Pharma with Irv.

During the 1990s the pharmaceutical industry sank into turmoil: Rob’s company was, I think, the first to be the subject of a hostile take-over by another US giant. It wasn’t a pleasant way to lose your job: there were over 3,000 people working at the UK base alone. The managing director and division heads in the US knew about the bid from AHP and had been fighting secretly for the company’s survival. They lost.

Rob and everyone else turned up for work one Monday to be met by personnel (as Human Resources used to be known) and representatives from the invading forces. All the managers were asked for their car keys, escorted to their desks and watched while they collected the photos of the kids and any other personal items. Then they were escorted rapidly off the site and sent home. Rob was back by 10 am. They were watched as they cleared their desks, in case angry and upset (now ex) employees scooped up papers with data and information that could be used in revenge against the invading Empire, or those with IT know-how might bugger the computer system with a rapidly inserted virus.

Redundancy the American way was a humiliating experience. And nothing was ever the same again. No one ever felt secure from that point onwards.

The UK site was raped and pillaged by the invading hordes, its commercial assets split and sold off to other companies in a frenzy of ‘reorganisation’. The UK base had been the second biggest employer in a large area, which has never recovered, economically. The site was gradually torn down; the land sold piecemeal for housing and where Rob’s office building stood there is now a Drive-Thru Kentucky Fried Chicken outlet, which employs 30 people on zero-hours contracts.

Some like Rob found another job, some never did. Rob went to work for a Swiss company that, within 6 months had merged with another to make, at that time, in 1996, the biggest pharmaceutical company in the world. We’d faced redundancy twice within a year. At the time we had two children about to go to university, our house like many others in the UK was in negative equity due to soaring interest rates and a collapsing housing market. We were financially vulnerable – like everyone else. When he was offered a job at HQ we had little real choice, despite the fact that it was in Switzerland.

Scientists and department heads were replaced by people with backgrounds in ‘business management’, and PhDs gave way to MBAs as the gold standard qualification for employment. Pressures grew to maximize profits: it would be foolish to pretend that loyalty to the company hadn’t always been a requirement, and that the profit margin had always came first – but from the mid 90s onwards the moderating influence of people like Irv just evaporated. The atmosphere at work became highly focused on meeting targets, deadlines, and budgets. There was simply no room for skepticism or questions: once you were perceived as awkward you knew you were likely to be kicked out.

The people who had to go out and sell the products on the frontline – the sales force – were probably subject to the most intense pressure of all. And were most vulnerable to being sacked. I read the Eli Lilly internal documents posted on Mad in America, detailing operation Viva Zyprexa! The Empire was out to conquer new lands – primary care physicians. The crib sheets detailing how the sales force were to lie about the fact that Zyprexa caused diabetes make grim reading (particularly grim for me maybe, as I developed diabetes and lipid dysregulation after years of Zyprexa/olanzapine). But as sickening is the appalling cheerleading at the ‘product launch’ meetings, the crude offsetting of one team against another and the psyching up of the reps to ‘Go out there and kick ass!’ OK, maybe reps aren’t the brightest people in the world but they were being groomed for aggressive selling, just as 16-year-old lads are groomed to kill when they enter the army. A macho, bullying environment where you either sink or swim. No room for people who might have qualms about the morality of what they are being asked to do and who have families to care for and mortgages to pay every month.

I asked Rob whether his company would have launched an internal damage limitation exercise like GSK/SKB did around the Panorama programs about paroxetine: Of course he said – and that it would have probably been successful. Employees would have been reassured that the company – their company- would never have deliberately harmed children. Success of the exercise would have been sustained partly through loyalty to the company but mainly because no one could afford to think too closely about whether it was true. Ask too many questions and you would be out on your ear with no chance of getting a reference for a future job.

If this sounds like an apologia for those working in the pharmaceutical industry – it isn’t. Some people do very bad things in any arena which are simply unforgiveable on any level: it’s hard to forgive the doctors and nurses who propped up a failing, abusive hospital in Mid Staffs by ignoring the pain and distress of patients. It’s very hard for me, remembering some of the casual brutality to which I was subjected as an inpatient in several mental hospitals. Even harder to think that the industry which bought our food and paid the bills wreaked such appalling damage on our family.

But unless you dig under the surface and wonder how such things happen, think about the context: the atmosphere of fear engendered by bullies who are probably being bullied themselves, then it’s too easy just to be angry. Anger is good – but not enough on its own. I think it’s important to put Study 329 in its cultural and economic context; try and peel away the layers of the onion and get at some understanding of why what happened, happened. Saying ‘oh that’s just capitalism in action’ is true, but in the end offers no chance of doing things differently at some point.

Empires fall, eventually, however powerful. I hang on to Abraham Lincoln’s words (although I prefer Bob Dylan’s version)

“You can fool all the people some of the time, and some of the people all the time, but you cannot fool all the people all the time”

Editorial Note: This is the final part of Laurie Oakley’s series on Pharmaceutical Rape. All six parts with better imagery (no-one is enthusiastic about the Martin Shkreli images) and extra text are available here as a PDF Download.

Pharmaceutical violence

Pharmaceutical violence is a social issue as well as medical problem that demands a social response and medical intervention. To address what is now an ongoing human rights catastrophe and to help survivors recover from what has happened to them, it is important that we shift all of our focus to the systems that perpetrate pharmaceutical rape. We need to ensure that full responsibility is taken for the practices that lead to these iatrogenic harms. The essential way of assuring systemic change is to have an organized community response. This can occur through petitioning for a governmental task force, the enactment of new legislation, remedial actions through the courts, the initiation of comprehensive educational programs, new training protocols for health care providers, and various community-based efforts. Government officials, the courts, educational systems, medical professionals, and the public need to work together in order to bring about systems accountability. As we begin to fully recognize how pharmaceutical violence affects all parts of society, we can develop comprehensive responses as well as individual approaches to end all forms of pharmaceutical violation. Patients along with supportive doctors can come together to make this happen.

Medical allies

A medical ally is someone who commits to working toward ending the systemic practices that perpetuate pharmaceutical violence. An ally becomes willing to:

• Educate oneself on the full scope of corporate pharmaceutical influence in government, academia, healthcare (including front groups), and the media;
• Listen to and learn from the stories of people who have experienced harms;
• Examine one’s own beliefs, prejudices, and assumptions about medical and mental healthcare systems, and the role of pharmaceuticals and pharmaceutical companies in healthcare;
• Recognize potential feelings of guilt, shame, and defensiveness and work toward understanding what might lay beneath them, taking time to grieve/heal as part of the process;
• Learn strategies for challenging the speech, behaviors, policies, and institutional structures that perpetuate iatrogenic outcomes via pharmaceutical influence;
• Act collaboratively with survivors to change the systems that support pharmaceutical rape and pharmaceutical rape culture.

Hubs for support and activism

The RxISK Community

RxISK is an organization committed to breaking the silence around the social injustice of pharmaceutical violation. It is a go-to website for reporting and researching the adverse effects of medicines for patients, healthcare providers, and pharmacists. It is also a place where people can tell their stories, find support, and learn from the stories of others. The Data Based Medicine organization that sponsors RxISK was formed by an international team of medical experts who recognize the dangers inherent in medicine when public access to clinical trial data has not been granted by the multinational pharmaceutical companies. RxISK is a free, independent drug safety website where prescription drugs can be researched to see what side-effects have been reported in the 5.9 million reports submitted to the FDA, Health Canada, and RxISK. Users are able to download a RxISK Report to take to their doctors to discuss whether the effects they are experiencing might be linked to the prescriptions they are taking.

Mad In America

The Mad In America (MIA) Online Forum was launched in 2012 and is a growing international community of people interested in a plethora of topics surrounding the rethinking of psychiatry, including psychiatry’s embrace of medication prescribing. Central to MIA’s mission is to provide a platform for the voices of those with lived experience within psychiatry, voices that have historically been stifled. MIA offers professional continuing education (CEUs) and continuing medical education (CME) courses that are based on research that is free from commercial interests. Topic areas include psychiatric medications, long-term effects, and alternatives that promote long-term recovery and better overall outcomes. The project operates under the non-profit umbrella of The Foundation for Excellence in Mental Health Care.

Grief Recovery Institute Educational Foundation

The Grief Recovery Institute Educational Foundation (GRIEF) is a 501(c)(3) organization specializing in helping people who are dealing with grief. The organization is headquartered in Sherman Oaks, California, with locations in Canada, England and Sweden. Its mission focuses on disseminating accurate and helpful information about grief and the possibility of recovery from the impact of death, divorce, and other significant emotional losses. Grief Recovery outreach programs are facilitated by individuals who become certified specialists in this particular method and groups can be made available in all parts of the world.

Because the Institute’s founders, John James and Russell Friedman, recognize that sadness and grief are predictable and natural human responses to loss, they have spoken out against the medicalization of grief that often leads to the use of pharmacological treatments soon after a loss.

I include Grief Recovery here because of the significant losses many of us have experienced as a result of taking prescribed medications: the loss of health, loved ones, careers, dreams, trust, sense of safety, and more. Whether through the Grief Recovery Institute or some other method, it’s important that we take time to grieve. By joining with others who are also grieving we break our isolation and, not insignificantly, our sharing may inform others of risks in medicine everyone deserves to know about. 

Ed Note: This is the fifth and penultimate post in Laurie Oakley’s Pharmaceutical Rape series.

Pharmaceutical violence is a social injustice that can intersect with every other type of oppression and form of discrimination. Dehumanizing in its own right, pharmaceutical rape (and the cultural/medical denial of it) compounds the distress already experienced by persons in socially marginalized groups as well as in individuals who are dependent, frail, or otherwise in their most vulnerable states. Many (but not all) who experience other forms of institutionalized oppression turn to healthcare systems where they are too often subject to retraumatization and further stigmatization.

This includes:

• Women – Pharmaceutical harms could be considered a structural form of violence against women alongside domestic violence and sexual assault. Women are specifically targeted with advertising for SSRI anti-depressants marketed as several different medications (that are not outwardly identified as SSRI’s) for common issues such as premenstrual discomfort and hot flashes. Certain birth control products, hormone replacement therapy drugs, medications to prevent osteoporosis, and other medications are encouraged for widespread, routine use while the FDA’s post-marketing surveillance system (MedWatch) is failing. Risks of harm are therefore downplayed and patient reports of harms are often met with skepticism. The life-injuries resulting from cavalier prescribing practices, and especially the systemic denial and trivialization of harms, have a deleterious effect on women, and reinforce the overall oppression of women in society.
• Pregnant Women (and the unborn) – Anti-depressant use in pregnancy is known to double the risk for miscarriage and to cause birth abnormalities. These risks are downplayed and anti-depressants are routinely prescribed to pregnant women. Narcotics are also commonly prescribed to women for pregnancy-related back pain leading to neonatal complications for newborns. Where adverse-effects of medications are haphazardly overlooked while prescribing is encouraged, gross physical violation is occurring. Industry failure to disclose known drug dangers affecting the unborn child can be considered a covert attack against the bodies of women and children for the purposes of monetary gratification.
• Children – The widespread and routine, off-label prescribing of psychiatric medications to children when no tests have been performed in this population results in pharmaceutical injury that is difficult to quantify. While some harms are obvious, the full effects of these drugs on large numbers of children in their crucial stages of development are unknown. In 2009, approximately 1% of children in the general population in the U.S. were prescribed psychotrophic medicines for conditions like attention deficit disorder and depression; 2% of children in families receiving Medicaid were prescribed these drugs, compared to an estimated 12 to 13% of children in the foster care system who are medicated with powerful antipsychotics and other mind-altering medicines. Since 2009, these numbers have only continued to rise. This structured pattern of chemically treating the emotions of children in lieu of alternatives (such as seeking to understand the root of behavior and supporting children non-pharmaceutically), constitutes a form of child abuse that is a moral injury to individuals, their families, as well as to whole societies. A critical mind will also note that all children are being targeted with an ever growing list of vaccination requirements that are developed by and financially lucrative for the industry-government-medical trade alliance that is routinely failing to warn the public and patients about known, significant risks.
• Individuals with Disability – Pharmaceutical violation against the disability population is common as the medicalization of disability has led to increased prescribing in this subset. Societal structures and attitudes toward disability impose daunting barriers that these individuals struggle against daily. Pharmaceutical harms add to the struggle and impair one’s ability to address these and other institutionalized oppressions. Those with developmental disability in particular are subject to the systemic, gross overprescribing of psychiatric and other drugs that can tragically end one’s quality of life and in many cases lead to an early death.
• Persons of Minority Race or Ethnicity – Racial and ethnic minorities within the dominant society are subject to institutionalized oppression that can result in profound, insidious trauma. Both obvious and not-so-obvious aggressions have significant health effects for individuals who end up in medical and mental healthcare systems where many receive additional blows. Unacknowledged pharmaceutical violation is a compounding factor in the physical and psychic trauma affecting minorities. It lends to the further destruction of family and community bonds that are essential for addressing and healing from massive social injustices.
• Persons Identifying under the LGBTQIA Umbrella – Inequity and discrimination affecting transgender and gender non-conforming people make them particularly vulnerable for multiple types of structural violence, including pharmaceutical violation. Familial and/or societal rejections culminate in both physical and mental health consequences for which individuals are often prescribed medications. Many are further disempowered by adverse out-comes while receiving medical treatments. This often unrecognized harm has an overall dampening effect on the collective health and political will necessary for group members’ ongoing struggle for social justice and equality.
• The Elderly – Persons become increasingly vulnerable with age: many older people face neglect, risks of elder abuse, and exploitation. The systemic prescribing of multiple medications (polypharmacy) in this population amounts to an additional serious form of abuse that is rampant and ongoing. Many lives are severely altered and/or prematurely ended by such prescribing. Though medications like anti-psychotics and benzodiazepines are known to put the elderly at risk, these and other questionable drug treatments are still being used at alarming rates. Serious abuses in their own right, these practices make the elderly (if they survive) more vulnerable to all other risks.
• The Incarcerated (including nursing facilities and psychiatric hospitals) — Pharmaceutical rape in institutional settings is especially insidious as power imbalances are intensified and harms are often delivered through systemic coercion and forced medicating. Medication compliance is often a requirement for one to be considered to have “good behavior.” Many elderly in nursing facilities have been routinely prescribed dangerous, antipsychotic medications to control behaviors for the convenience of agency staff. Psychiatric survivors tell harrowing stories of having to endure the adverse effects of psychiatric drugs (including discontinuation syndromes after cessation) when medications have been forced upon them in institutionalized settings.
• Persons labeled Mentally Ill (including victims/survivors of other abuses or violence) – Those who are prescribed psychiatric drugs are generally the hardest hit by pharmaceutical violence. Psychiatric drugs often have effects on cognition that make it difficult for the person to recognize the full scope of what is happening to them. Many are lost in mental healthcare systems for years while suffering the effects of multiple drugs. The stigma attached to being labeled with mental illness often causes one to lose esteem in the eyes of society, medical professionals, and even family members who may deem one less credible. This dehumanizing reality locks an individual into a cycle of further distress and additional treatments with psycho-tropic medications. Tragically, many feel helpless to address this injustice as these medications can wreak havoc on the mind and body, therefore leaving one with little agency with which to advocate for change.
• Disabled Veterans – Prescribing rates are high for active military members and veterans alike as doctors attempt to treat service related conditions like chronic pain and post-traumatic stress. There have been serious concerns about sky-rocketing suicide rates in returning veterans in connection with high levels of psychotropic drug prescribing as well as concerns about the over-prescription of powerful narcotics in the absence of offering alternatives. Many veterans who had looked forward to returning to the safety of home have ended up spending their post-active duty years overwhelmed with effects of medications.
• Men with “Middle Age” Issues – While not a minority group, it is worth mentioning that drugs developed and targeted to men dealing with things such as hair loss and erectile dysfunction can carry significant risks that cause damage far exceeding the original problem. For instance, Propecia (finasteride) has led to permanent sexual dysfunction in some individuals. A recent study strongly suggests that men who take drugs like Viagra for sexual performance have a doubled risk of developing malignant melanoma, an aggressive skin cancer. Too often, the dangers of these medications become clear years after they have been approved for use, which is too late for many individuals.
• Participants in Clinical Trials – Again, not a minority group per se, however those who participate in pharmaceutical research studies pay for the advancement of science with their health and sometimes with their very lives. The violation occurs when the clinical trial data gained from those harms is altered or hidden in favor of more positive data. This positively spun science is then used to get medicines approved and widely prescribed to the general public. The flagrant mishandling of scientific data, from tampering in clinical trials to its central role in the ongoing education of doctors, is the very back-bone of pharmaceutical rape.

Industry decision makers and those who collude with them deflect attention from the systemic practices that lead to pharmaceutical rape by pointing to the life-enhancing and lifesaving potential of treatments that have been developed to benefit millions. It is true that nearly all of us have benefited from the innovations of modern medicine. It is also true that a failure of adequate warning, as well as system-wide refusal to acknowledge common adverse outcomes, has led to destructive, life-altering consequences for millions. Those who are injured have become a hidden class, a forgotten and often persecuted minority. Given that so many had been seeking relief from the effects of other oppression and marginalization, this constitutes nothing less than a reprehensible humanitarian disaster. Meanwhile, the medically privileged do not have to think about the ways the systems that benefit them deliver life-altering outcomes to others, and this willful oblivion is the basis upon which all social injustice thrives. While this type of injury can happen to anyone, it is not always recognized when medication is making one sick.

Internalization of pharmaceutical oppression

Internalization occurs when people who experience adverse events believe in the misdiagnoses of their symptoms and end up embracing additional labels and further treatment for their medication side-effects. Those who have internalized pharmaceutical oppression alter their attitudes, behaviors, speech, and self-concept to reflect an acceptance of a pharmaceutically-induced and medically-maintained sick role. The internalization of this manufactured reality can create low self-esteem, self-doubt, and even self-loathing as the individual continues to experience perpetual and worsening illness despite one’s commitment and efforts to become well. (Especially true with diagnoses of a stigmatizing nature, e.g. psychiatric labels). Internalization of pharmaceutical oppression can also be projected outward as fear, criticism, and distrust of survivors and others who speak out and/or challenge the systems in which they receive care.

Statistics

Peter Gøtzsche, co-founder of the Nordic Cochrane Collaboration in Denmark, the world’s foremost body in assessing medical evidence, has estimated that adverse-effects of medications that are used as prescribed are the third leading cause of death in the United States and Canada after heart disease and cancer. Known cases are believed to account for hundreds of thousands of deaths each year.

Serious harm seems to be 10 to 20 fold more common than lethal harm. An estimated 700,000 events are reported per year, less than one third of the estimated actual occurrences. While drug side effects are said to be a leading cause of death, disability and illness, it is estimated that only 1 – 10 percent of adverse events are ever reported.

Reporting

The FDA’s post-marketing surveillance system is underused, underfunded and in serious disarray. While MedWatch is said to be an important tool for monitoring the effects of medications after limited studies and quick FDA approval, doctors are not trained to utilize this as an important aspect of their work. Only 1 to 10 percent of adverse-effects are ever reported. Reasons doctors cite for not reporting include uncertainty as to whether the drug caused the symptoms, not wanting to look foolish for reporting, and a feeling that they are already too busy. Because the missing information does not get shared and acted upon within the medical system, patients end up reporting to one another “underground” via internet message boards and other forums set up to support patients who cannot find help within medical and mental healthcare systems.

Investigating

When an individual reports a life-altering outcome, very rarely is there any kind of investigation. Pharmaceutical injuries that are not denied as such are simply regarded as flukes or mistakes. There has been no effort made for a serious and thorough investigation into the systems-wide problems that enable and encourage widespread pharmaceutical harms. No governmental task force or entity has taken responsibility for uncovering the full extent of the problem, advocated for the passing of legislation, or for any other changes to address these ongoing harms. Instead, pharmaceutical companies are occasionally found guilty of various errors, are made to pay fines, and then go on to rape again and again.

Prosecution and conviction

Justice is rare to non-existent for victims of pharmaceutical violence. Legal actions to date have done little to significantly alter the industry-government-medical behavior that is so devastating to individual patients and their families. The structured practices that systemically deliver harms remain in place while drug companies pay occasional fines and continue to earn billions.

Prevention

Currently there is nothing in place for the prevention of widespread pharmaceutical harms. Despite the appearance of drug industry cooperation, efforts for prevention via full transparency in the sharing of clinical trial data have been met with resistance by pharmaceutical companies. For this and other reasons, the process of informed consent in the medical setting fails. Alternatives to drugs, devices, and medical procedures are not lucrative options from a business standpoint and so doctors, by and large, have little incentive to focus on the safer alternatives they could be offering patients.

Treatment

There are no systems in place for treating those who report harms. Treatment begins with listening and recognition. Medical systems in denial currently offer victims very little in the way of validation, let alone knowledgeable and compassionate care. Many of these manufactured illness require immediate medical intervention which is sadly non-existent in most places. Person-centered protocols for discontinuing psychiatric medications are urgently needed for patients who want and/or need to stop taking them. Many mainstream doctors remain unaware of the dependency potential of several medications they routinely prescribe.

Editorial Note: This is part 4 of Laurie Oakley’s series on Pharmaceutical Rape.

Many who experience life-altering, adverse outcomes after taking their medicines as prescribed do not receive acknowledgment of what they have experienced, let alone the medical care they need. Medical systems do not recognize many treatment related outcomes and patients are therefore denied knowledgeable, compassionate treatment for the iatrogenic illnesses they experience after following doctors orders. While health practitioners can generally make a good living within healthcare systems, thousands of patients end up on disability after adverse pharmaceutical outcomes. Without the support of a doctor to verify one’s condition, there are others who, tragically, end up on the streets.

Pharmaceutical privilege

The privilege of one who benefits within a system that uses pharmaceutical products to improve one’s own life and well-being while denying or remaining oblivious to harms suffered by others within same system.

Pharmaceutical oppression

Deriving benefit from and/or being complicit with healthcare systems while refusing to consider or acknowledge pharmaceutical harms suffered by others; routinely ignoring, denying, and/or explaining away harms reported by others.

Medical fragility

In regard to pharmaceutical rape, this is an emotionally reactive, often arrogant stance that is taken when an individual (medical professional or otherwise) is exposed to suggestions of widespread iatrogenic drug induced harms. It is defensiveness on the part of the individual who often exhibits behaviors that include automatic skepticism, extreme unease, an unwillingness to listen, impatience, condescension, anger and argumentativeness.

Persons who demonstrate this fragility are unable to consider or acknowledge a medical reality that challenges a status quo that benefits them. They automatically discount information or ideas that make them uncomfortable and often attack those who are making claims. This stance is rooted in deeply ingrained ideas about the power of science and the prestige of the medical profession, as well as in the “goodness” of modern medicine. For many, one’s very identity as a doctor or as a patient depends upon viewing the systems in which one gives or receives care as safe places of care. Reflecting on or seriously considering the many ways people are harmed by pharmaceutical products is intolerable, as one believes these kinds of things “just don’t happen” in modern medicine.

Medical professionals who think in this way dissociate themselves from the idea of systemic, iatrogenic harms, and instead think of the injuries they do recognize as solitary incidents resulting from the “bad” behavior of others (whether the patient, drug industry or other medical professional). Doctors tend to be high achievers with a perfectionist bent. While attaining the high degree of competency required to practice medicine, many also acquire a deep sense of earned superiority. Any challenge to this core identity, or to the systems in which one is enmeshed, is intolerable.

Story: doctors in denial

I never set out to become a medical heretic. That job was ascribed to me by certain pharmaceuticals that are said to work wonders for the majority of the human race, but not for me: miracle drugs like the SSRI anti-depressants and the ever safe benzodiazepines. So when I described to doctors all that had happened to me while on these medications, most stared at me as if I’d just grown a second head. My report, it seemed, was over-the-top.

One doctor congratulated me for kicking my “benzo habit” even though I had told her I’d taken only a small dose as prescribed by my doctor. When I tried to explain how tolerance withdrawal symptoms had been repeatedly misdiagnosed as somatization, and for that I had been given more psychiatric drugs over a period of several years while my physical and mental health deteriorated, she may as well have plugged her ears and shouted, la la la la la! Instead, she said, “uh huh,” before opening my chart and recording my history with benzodiazepines in the illicit drug use category.

After she left the agency, I started seeing a different doctor who listened to my stories in utter amazement. My experience was unlike anything he had ever heard in his many years of prescribing psychotropic medications. When I suggested that my ongoing, chronic insomnia might be a residual effect from having been prescribed a benzodiazepine for eight full years, he responded by saying there was no way of knowing for sure, and at one point even asked, if the benzodiazepine had helped me to sleep, why didn’t I just keep taking it?

Time for a new doctor.

I jumped from the frying pan into the fire. This new psychiatrist had a penchant for sighing and rarely looked at me. He mostly just shuffled papers and wrote things down. He wasn’t interested in knowing what my experiences with medications had been, my complex history, or anything else about me. He was interested in prescribing a certain medication for my insomnia which he pushed even after I had educated myself about side-effects and informed him I didn’t want to risk it. I did finally end up trying the medicine, which I didn’t like and didn’t continue. Then his impatience with me turned into disgust as he no doubt thought my fear of taking medications was irrational. He went on to tell me that millions of dollars and years of study went into the research and development of the drugs he prescribed and he was confident that they were safe.

—Rxisk. January 13, 2015

Pharmaceutical rape apology

An umbrella term for arguments suggesting that serious pharmaceutical violation does not exist or that it is not a widespread cause for concern. “Apology” in this context means defense or justification, like in Christian apologetics, not as a statement expressing regret.

Pharmaceutical rape apologists frequently view patients and doctors who recognize serious adverse events as misguided persons who are anti-science, conspiracy theorists, anti-vaccinationists, or some other type of deviant. Pharmaceutical rape apologists disbelieve pharmaceutical harms because evidence of harm is not forthcoming in the scientific literature. They deny any adverse outcome that does not conform with harms already commonly noted within the medical establishment, and dismiss reports of adverse effects when they have witnessed the drug in question work well for others.

Pharmaceutical violations are dramatically under-recognized. There is an enormous amount of misunderstanding and stigma associated with people who claim to have been harmed. Physician skepticism and outright denial prevents victims from having their claims validated, let alone officially reported to regulatory agencies. Instead of gaining support from a doctor to make sense of what has occurred, adverse effects are often trivialized or misdiagnosed as separate conditions (usually needing additional treatments).

Allegations of false reporting of injury often occur (within the realm of childhood vaccine administration, for instance). The medical establishment maintains that most pharmaceuticals, with rare exception, are safe and effective when taken as prescribed. There is very little room left for discussion of even the known risks of harm. Serious adverse events are said to be “rare,” yet when they occur, victims and/or their families often find it difficult if not impossible to convince medical authorities that the event is related to medication.

Pharmaceutical rape myths

• The FDA protects the public.
• Drug safety is assured through hard science.
• Doctors have access to clinical trial data and are aware of all known risks.
• Serious adverse events are extremely rare.
• Development of drug dependence or addiction is unrelated to accepted prescribing protocols.
• Adverse events are always recognized by doctors and a connection to the drug is normally made.
• Harmful drugs are always recalled.
• “Safe” drugs are always safe.
• Pharmaceutical injury occurs only as a result of medication error or malpractice.
• All vaccines are completely safe and effective.
• A good relationship with one’s doctor protects one from a pharmaceutical injury.
• Individuals who make claims about pharmaceutical harms are against all medications and do not value the contribution of pharmaceuticals to society.
• Those who warn about pharmaceutical products are anti-science, refusing to listen to reason or to think rationally.

Secondary victimization

Secondary victimization is the re-traumatization of the pharmaceutically injured through negative social responses from medical, mental health and/or legal professionals, as well as from others (sometimes including one’s own family). This is a nearly universal experience for those who have been harmed and may be especially insidious for those who are diagnosed with mental illness, chemical dependency, as well as the vaccine injured (and their families). Behaviors associated with secondary victimization include:

• Societal as well as individual denial of pharmaceutical harms. The tendency to remain oblivious in the face of evidence of harm.
• The trivialization of pharmaceutical violation. A response to harm denying that real damage was done.
• Skepticism and distrust of those who report harms instead of recognizing the harm potential of the treatment.
• The misdiagnosis and false labeling of individuals who have experienced adverse effects from their medicine.
• Reducing the patient to an “unusual anecdote.” Accepting evidence from controlled clinical trials only, to the exclusion of what the patient says about effects of a drug treatment.
• Failure to report a patient’s adverse events.
• Victim blaming: when the victim of a crime or any wrongful act is held entirely or partially responsible for that harm. It is your fault you were hurt because you did x, y, z. If you hadn’t done x, y, z, you would not have been harmed. You went to the doctor, you asked for medication, you consented to the treatment, you kept going back to the doctor, you didn’t do your homework, you should have known better, you should have listened to your body, I knew better and I didn’t do those things.
• or, what you experience is your own illness: caused your poor diet, your lifestyle, your lack of exercise, your use of alcohol or other drugs, your age, your family genetics, etc. Claims are easily neutralized or discredited because health is subjective and adverse effects are easily attributed to other causes.
• or, you are at fault because you are a drug addict, (even though the addiction came about through or was aided by what is considered legitimate prescribing).

Pharmaceutical violence typically leaves the individual with an array of new problems that were not present when the treatment in question was first initiated. Many hurtfully deny or disbelieve the iatrogenic nature of the person’s condition, and additional physical and/or mental effects caused by treatments often bring about additional stigmatization. The alienation suffered as a result of these acts is deeply felt:

“I am a wreck after 8 years on Effexor, but of course once on the drugs your credibility is gone, so who listens to a person with a psychiatric “label” even though the label is false? Not only victims, we are totally ignored, while the psychiatrists somehow get put on a [false] pedestal. Challenge them at your own risk of getting a “label.” No other doctors on earth have this sort of irrational power; just because they judge someone as this or that, often in a 10 minute appointment. I would like to know of just one person who ever went to a psychiatrist and didn’t get [labeled].”

—Commenter, DavidHealy.org. May 14, 2015

Post traumatic stress reactions and pharmaceutical violation

Unlike sexual rape, pharmaceutical violations almost always occur over a more prolonged period of time. Where a sexual assault survivor may experience a post traumatic stress reaction in the months and/or years following the event, pharmaceutical victims oftentimes experience these physical and psychological symptoms as adverse-effects while taking psychotrophic medications. Prolonged discontinuation syndromes upon stopping some medications are common and may overlap with a post-traumatic stress reaction from taking psychotropics. The trauma experienced from pharmaceutical violation can include disruptions to normal physical, mental, emotional, cognitive, and interpersonal behavior. Whether from a discontinuation syndrome or from the medications themselves (which are often reinstated to avoid this withdrawal-like condition), pharmaceutical survivors end up suffering, often for many years, with symptoms identical to PTSD.

Effects associated with both sexual rape and pharmaceutical violation include but are not limited to:

• Diminished alertness
• Numbness
• Dulled sensory, affective and memory functions
• Disorganized thought content
• Vomiting
• Nausea
• Paralyzing anxiety
• Pronounced internal tremor
• Hysteria, confusion and crying
• Bewilderment
• Acute sensitivity to the reaction of other people
• Profound inner turmoil
• Poor health in general
• Sense of helplessness
• Hypervigilance
• Inability to maintain previously close relationships
• Experiencing a general response of nervousness known as the “startle response”
• Persistent fear and or depression at much higher rates than the general population
• Mood swings from relatively happy to depression or anger
• Extreme anger and hostility
• Sleep disturbances such as vivid dreams and recurring nightmares
• Insomnia, wakefulness, night terrors
• Flashbacks
• Dissociation
• Panic attacks
• Reliance on coping mechanisms, some of which may be beneficial (e.g., philosophy and family support), and others that may ultimately be counterproductive (e.g., self-harm, drug or alcohol abuse)
• Sense of personal security or safety is damaged
• Feel hesitant to enter new relationships
• Unable to re-establish normal sexual function
• Discontinue previously active involvements, social groups
• Acute somatoform disorders (physical symptoms with no identifiable cause)
• Physiological reactions such as tension headaches, fatigue, general feelings of soreness or localized pain in areas of the body
• Dissociation and trying to get back to life before the assault
• Fears and phobias
• Nightmares, night terrors
• Violent fantasies of revenge may arise
• A fear of being in crowds
• A fear of being left alone anywhere
• A fear of going out at all, agoraphobia
• Paranoia
• Suicide

Oliver’s story

Prior to taking Seroxat (Paxil), I had symptoms of tiredness and nausea. My general practitioner (GP) diagnosed me with anxiety and prescribed an anti-psychotic drug. Within 3 days I couldn’t eat or sleep due to severe agitation. I was vomiting, pacing the floors, and crying uncontrollably. My GP diagnosed this as an anxious state and started me on Seroxat. (During this time it was discovered that I was badly anemic and needed a hysterectomy due to severe blood loss. This was more than likely the cause of the original tiredness and nausea). Even though I had informed my GP of heavy bleeding, etc., it seemed easier for him to give my symptoms a label of anxiety and start me on a roller coaster of dangerous psychiatric drugs .

I remained on Seroxat for 6 years as every follow up I was just given more prescriptions. I decided to take myself off the drugs during my 6 years of use with disastrous consequences. I became obsessed with trying to hang myself and couldn’t function due to multiple horrendous symptoms, both mental and physical. Needless to say, I admitted myself to hospital as I had no idea what was happening to me. [I] felt better after Seroxat was reinstated.

I then decided to wean off again with instructions from my GP to taper for 9 months using alternate days[…]That was September 2004. I am now 8 years drug free and still living with damage incurred from taking Seroxat. The first 3 years of quitting were hell. Symptoms included anxiety, panic attacks, paranoia, agoraphobia, hives, itching, tingling, agitation, aggression, suicidal thoughts, homicidal thoughts, weak muscles, vision coordination issues, cognitive problems, dizziness, nausea, headaches, manic behaviour, racing thoughts, gastric upset, balance problems, burning sensations, heartbeat irregularities, palpitations, night sweats, insomnia, and total feelings of despair.

Eight years later to date I still have all these symptoms randomly. They come and they go, and although not as intense as the first years, it still gets pretty scary at times. Is this anything like prior to taking the drugs? No. I felt tired and nauseous. Was it worth taking this drug? No. The side effects of insomnia, muscle pain, blurred vision, weight gain, and feeling null and void of everything was worth nothing. Zero. Zilch. Will I ever recover? Who knows? GP’s offer no validation or support. Will anyone be accountable for the damage I have? No. Everything is denied.

—Rxisk.org. August 29, 2012