Johanna Ryan in her post Dependence Day points to serious problems linked to psychotropic drug use in the military and what seem to be recent alarming developments, but there is a 60 year history here.
In the 1950s, the VA hospital system commissioned Norman Farberow to look at rising rates of suicides among veterans. He studied veterans hospitalized for either medical or psychiatric conditions during the periods 1950 through to the mid 1970s. The 3 figures below bring out the findings.
Figure 1 shows a set of fluctuating suicide rates year on year for veterans admitted to medical beds. The rates are higher than national suicide rates but these rates and their fluctuations are in keeping with what might have been expected in a set of younger men. The increases in the late 1950s and early 1970s may mirror the effects of the Korean and Vietnam wars, or perhaps other social factors or they may be entirely random.
Figures 2 and 3 are strikingly different to Figure 1. Figure 2 does not show the expected fluctuations linked to social factors or any randomness. It shows a steady rise in suicide rates in those who have been hospitalized for a mental condition. Until 1955 the rates are identical to the rates found in those hospitalized for a general medical condition.
But as of 1955, they start climbing in an uninterrupted fashion. The rises and falls we see in Figure 1 that might or might not be linked to social factors such as the Korean war are not there. This can be seen clearly in Figure 2 when the two sets of figures are superimposed and again in Figure 3 which show admissions to psychiatric beds on their own.
Why the bifurcation in 1955? This was the year of the introduction of chlorpromazine. Year on year after 1955 a greater number of tranquilizers (antipsychotics / neuroleptics) like chlorpromazine were consumed by veterans with mental health problems as an ever greater number of these drugs were marketed. These drugs were given to veterans who were depressed, anxious or psychotic – they were not as might be thought now restricted to veterans who were schizophrenic.
But as Johanna Ryan brings out, they were almost certainly not given at that time to soldiers returning to the theater of war. She calls on us to stand together and bring about improvements. We have to stand together but whether it will bring about improvements is another matter. The Department of Defense for instance know that the literature about most of the drugs being given to troops now is ghostwritten and that the excess of suicides and violent acts there have been in clinical trials of these drugs have been airbrushed out of publications. But even they seem hypnotized.
Patients complain that the wrong drug in the wrong dose makes them zombies, but it seems everyone else in the policy apparatus who has anything to do with authorizing the use of these drugs is also marching zombie like to the one tune – like North Koreans in fact.
When the wife of Randall Tobias who was CEO of Lilly at the time controversy first blew up about Lilly’s Prozac causing suicide gets put on Prozac and commits suicide and it makes no difference, it gets harder and harder to see a way out. Why so serious? Well even Heath Ledger has either committed suicide or died in the night from a drug interaction. Is this Batman’s stickiest moment?
Ominously there is no sign of Batman anywhere.
If Robin were still around he might say “Holy Healthcare Reform – someones killing our Veterans, what would Batman do now?”
The very last thing to do is what Batman offered Mr Freeze: “Give yourself up. We can get you help – medical help” (see So Long and thanks for all the Fish).
But the Cheshire Cat got the Robin. It left however a grin behind in a phrase that lingers – the opposite of a girl is a boy. For all complex problems, its better turn to Catwoman – Michelle, or Ann? Or maybe Angela?
Farberow N, Ganzler S, Cuttler F et al (1978). Status of Suicides in Veterans Administration Hospitals. Reports 2-4. Los Angeles, CA: Central Research Unit, V. A.Wadsworth Hospital Center.Share this:
Copyright © Data Based Medicine Americas Ltd.
I thought I should comment on this one as I have a house-full of Super-heroes, from Superman to Batman and even a Robin.
Who can save the world from a drug-induced Pharmageddon or will the Joker Janssen, Glaxo Green Goblin, Pfizer Penguin and Lex Lundbeck win out?
I am trying to be humorous here, despite the fact that my son was killed by Lex Lundbeck and his poisonous kryptonite, aka Citalopram.
I have learnt two amazing words that are new to me, in the past five minutes, Pharmageddon, and bifurcation.
I am sorry to learn about your son’s death, Leonie.
I’m afraid Catwoman would be in an even less advantageous situation than Batman. If you go to the US Veterans Administration Website, the section for women veterans focuses on PTSD that seems, according to the VA, to be confined to sexual abuse in the military. There is, of course, a very large problem in this area that is, as much as possible, hushed up.
“Self-Inflicted Deaths Among Women With U.S. Military Service: A Hidden Epidemic?” appears in the December 2010 issue of Psychiatric Services, a journal published by the American Psychiatric Association. According to the data, female veterans aged 18 to 34 are at highest risk and women veterans are more likely to complete suicide than nonveteran women. The study examined data on 5,948 female suicides committed between 2004 and 2007.
56 suicides among 418,132 female veterans (1 in 7,465).
1,461 suicides among 33,257,362 nonveterans (1 in 22,763).
Young women veterans have nearly triple the suicide rate of those who never served in the military.
Recently, women members of the RCMP have come out publicly about the same thing. The RCMP has scrapped a proposed program of treatment for PTSD which may not be such a bad thing considering what has happened with respect to methods of intervention. These women, at least as far as the US Veterans Administration is concerned, seem to be doomed because of the recommended treatment:
“Currently, the evidence base is strongest for the selective serotonin reuptake inhibitors (SSRIs). The only two FDA approved medications for the treatment of PTSD are sertraline (Zoloft) and paroxetine (Paxil). All other medication uses are off label, though there are differing levels of evidence supporting their use. This is especially true for fluoxetine (Prozac) and venlafaxine (Effexor) which are considered first-line treatments in the VA/DoD Clinical Practice Guideline for PTSD.”
Catwoman, be afraid, be very afraid.
When is suicide not suicide?
We live in Gotham City, with Batman, trapped, afraid, falsely betrayed. Robin is a small character, a side-kick to Batman. He will do what Batman tells him to do.
We have to get out – Nothing else is required.
I lost a son to the lethal cocktail of paxil, seroquel and analgesics. The VA doctors prescribed massive doses of paxil and seroquel to treat his PTSD. Since his death we have found about 300 military men and women who died in their sleep…why? We do not know the cause of death for most of these but of the 15-20 families we were able to contact each of these veterans were taking anti-depressants and anti-psychotics and most were also on analgesic drugs at the time of their deaths. Why is th VA and DoD still prescribing these drugs a first line treatment for PTSD when safer and more effective treatment methods are availible?
If you look at the US Veterans’ PTSD Facebook page, you will see many reports of desperate former servicemen and women stating they are taking up to 30 medications a day with either no improvement, or a worsening of their condition. It’s a terrible indictment on VA and DoD doctors.
Likewise, we are seeing Christchurch New Zealand becoming the most medicated city (in terms of antidepressants, antipsychotics and benzos) in this country. Ideal conditions for a research project, I would have thought.
There is a super hero deep within all of us— our pure, unlimited potential to achieve great good for the benefit of all humanity….
the 21st Century super- hero prototype looks to me like a scintillating combination of these three women: Rosa Parks ( Civil Rights USA), Marianne Pearl (“A Mighty Heart”) and Kate Bush (“Running up that Hill”) ; a synthesis of purity, tenacity, wisdom (educated intellect) and artistic genius.
The heroine of Pharmageddon has a mind that has synthesized the best of the best; a heart that has been forged with the spirit of burning to white ash for the sake of our children; our greatest treasure; OUR FUTURE. Such a woman will be grounded in Buddhist philosophy–confident that she cannot become extinct, much less harmed; only stronger and more beautiful with each act of fearless, selfless dedication … replacing the small ego of a Cat Woman prototype with the greater ego/self that is interconnected with all life, eternally throughout the universe…
The Movie rights have been claimed 🙂
Thinking about Stan White’s excellent question … one answer could be the money spread around by Pharma for lobbying, research etc. I read that the VA spent $124 million on Seroquel in one fiscal year (2009); think of the palms that would get greased for a $124 million helicopter contract, and I’m sure AstraZeneca would do just as well as Lockheed or Grumman.
Even more than that though, it says to me that the young men and women who go into combat are seen as disposable. The Pentagon has been obsessed with getting warm bodies into the field, and afraid to send the emotionally ravaged ones back to the States, for fear of opening a floodgate. So they keep up their numbers, and if there’s an “occasional” tragedy, too bad. (I’m sure suicides at the front are undercounted, as there are so many ways to just get yourself killed in a combat situation.) They care even less about the Iraqi women and kids who might have died at the hands of US soldiers who were paranoid, confused or drunk on their meds.
As for the VA, they were on a shoestring budget back during Vietnam and they are underfunded and understaffed today. I heard a nurse at Jesse Brown, the local VA hospital, talk about having just two nurses to take care of thirty people on the psych ward! Just like in the civilian mental health care system, the bean counters at the top see pills as cheaper than people. Vets are getting ten minute appointments once a month if they’re lucky, and psychiatrists are so scarce that they are diagnosing and “treating” people via teleconference. Of course, this will not be cheaper in the long run … but the VA will not foot the bill for the damage that’s done. More likely it will be the crumbling public hospitals, the homeless shelters, the prisons, and the grieving families.
It took a decade of Vietnam vets raising hell to get the system to even admit the existence of PTSD, and to fund the freestanding Vet Centers. My best hope is that we can fight to get our vets the funding and support to commence healing each other, as a lot of Vietnam vets did, with some help from professionals who care. Just think what we could do with the $124 million a year they spend on Seroquel!
The moral maze.
When a pharmaceutical company, the size of Glaxo, pays out 3 bn in fines, fines for killing people, then there is a moral problem here.
When the financial world of banking, is all over the newspapers, and their corporate head, Bob Diamond, Chief Executive, Barclays, is publicly shamed and has resigned due to the press and public and governmental pressure, then it is time, Andrew Witty, Head of Glaxo, is subjected to the same pressure.
It is becoming the norm that Chief Executives pay the fine and carry on.
With the life-threatening drug fiasco unfolding, before our very eyes, are we going to let them get away with this or are we going to endevour to get back on track the moral question,
Andrew Witty, was knighted, for upstanding work for the pharmaceutical industry, yet, his company has actually killed people with their drugs.
Until this country gets a grip on morals then nothing will stop this.
It has become endemic in this country, not to have any, and get away with it.
The chances to live or die, due to prescription drugs, is Russian roulette, as has been said many times.
The ethics of military physicians appear to need retuning. The editors of the textbook “Military Medical Ethics” state that a military physician is a “Physician First, Officer Second” and that “instances of significant conflict” between civilian and military medical ethics are “very rare”. Controversy, however, has centered on the participation of physicians in prisoner interrogations and force feeding in hunger strikes in contravention of the Malta Declaration. Most recently, concern has focused on the use of psychotropic medications to retain soldiers in combat areas or return them for another tour of duty. Depression, post-traumatic stress disorder, and anxiety are being treated mainly with SSRIs. Some military psychiatrists have recommended that their colleagues in Iraq “should consider having one SSRI in large quantities, to be used for both depressive disorders and anxiety disorders . . . to ‘conserve the fighting strength.’” This is consistent with medical ethics only if the treatment is part of an overall treatment plan, is medically indicated, and is provided with the voluntary and informed consent of the soldier- an event that history tells is highly unlikely to happen.
Of: “instances of significant conflict” between civilian and military medical ethics are “very rare” … Some military psychiatrists have recommended that their colleagues in Iraq “should consider having one SSRI in large quantities, to be used for both depressive disorders and anxiety disorders . . . to ‘conserve the fighting strength.’” This is consistent with medical ethics only if the treatment is part of an overall treatment plan
Stop right there! Look, medical ethics make paramount the patient’s best interests, subject only to informed consent. Staying alive to the end of any battle his gets put into, is in the patient’s best interests. Therefore, it is entirely consistent with medical ethics to conserve a patient’s fighting strength, if that patient is likely to be sent into battle any time soon. Fighting strength could save the life, of somebody who is (let’s face it) fighting.
On the other hand, a soldier getting a sick note from the doctor excusing that soldier, the said doctor’s patient, from any or all duties that involve risk to that soldier, including being sent to fight in a battle, or his being so drugged-up that nobody of superior rank in his right mind would send that particular soldier into battle, are also perfectly adequate measures that a doctor can consider, with a view to advancing his patient’s best interests, namely, staying alive, an interest served well by not being ruled fit enough to do the job that soldiers typically do, a job that places them all at risk of being killed, which isn’t ordinarily in anybody’s best interests.
So, prescribing crippling medication that stops the soldier working in his occupation at all, and signing him off work, is in the patient’s best interests, when the patient is a soldier. Failing that, prescribe him medication that conserves his fighting strength, and sending him back to the front line, less likely to get himself killed.
How do you suggest “retuning” the ethics of military physicians, to help them to decide which of the two possible courses of action is more in the best interests of the patient than the other?
Apparently the batman massacre was the work of a deranged animal.
Have we been here before??