Editorial Note: This post follows from Vampire Medicines and Cisparency and Transparency and links to Relationship Based Medicine on Rxisk. The painting is of Joshua crossing the Jordan with the Arc of the Covenant – an image that catches the essential features of climactic scene of Raiders of the Lost Arc with Joshua in the Indiana Jones position.
In every generation, there is a slayer. In this generation, s/he will probably be female. She need not be a doctor. She might work for a pharmaceutical company. She could be a patient or a family member. She will likely be a woman, if only on a probabilistic basis, as more women are injured by medicines and more women are involved in the lives of people who have been injured and now more women are in medicine than men. And as the BMJ has recently shown even in medical specialities, such as surgery, where until very recently it was common to hear it said women were just not suited, in fact they now do a better job than men. She might be the editor of a medical journal.
In-Diana, besides, looks much more like a girl’s name than a boy’s.
The Slightest Slope
Just as water flows down the slightest slope, so drugs flow at the slightest hint of benefit – in both cases the flow is inevitable unless there are bumps in the way. It’s a bit like taking an apple off a tree. Difficult not to.
Difficult not to, short of seeing the tail of a worm sticking out of the apple and wriggling.
This is where the harms come in. There is no such thing as a Free Apple. Its only in paradise there are worm free apples. Down here at the very least they have pesticides on them.
Since the Fall, we have lived in a world of Good and Evil – where sometimes what seems like the greatest good turns out to be more harmful than helpful. We need to be alert and make judgement calls that balance harms. In medicine, we were making progress at balancing harms to the point where we could make a reasonable stab at using poisons to do good provided everyone knew what they were doing.
But since 1990 that balance has been lost and the divide between good and evil is getting more marked. This might sound like a good thing but its not. We are increasingly ending up with fistfuls of medicines branded as All Good Zero Harms – Vampire Medicines. The systems most people now work in or seek medical help from with would shrink in horror from the idea of bringing good out of the use of a poison. We have infantilized. The infantilization is worse by systems that are becoming increasingly brutal to those trying to work within them and those seeking care from them.
Suffer the Children
One of the best symbols is what we are doing to children. There have been roughly 30 controlled trials of antidepressants in children labelled as being depressed – all negative. The Prozac trials the most negative of the lot.
Yet prescriptions for antidepressants are soaring among teenagers, especially girls, so that they may now be the most commonly prescribed drugs in this age group.
This is because of hints of efficacy and a sustained campaign to turn the evidence that there are harms – every trial done shows an excess of suicidal events on active treatment over placebo – into a “controversy”. The average doctor has been led to believe this is just an arcane dispute among academics. Nothing of consequence in the real world.
In the real world children’s mental health services are close to collapse because, despite money being poured in, children are waiting so long to be seen that given antidepressants by family docs – to help tide them over – they are attempting suicide while waiting. They then get seen by services who have no sense the suicide attempts might be drug induced and they get treated for something they don’t have. Meanwhile, the money going into children’s services goes into screening, and auditors and managers rather than clinicians in an effort to ensure adherence to guidelines. The only reason things could be going wrong is non-adherence to the guidelines – guidelines that say give Prozac.
Get that Crucifix out of Here
Another place to see the problem is with vaccines. BMJ have just bravely run a piece by Peter Doshi on the funding of vaccine propaganda groups. Few people other than Peter could have pulled off something like this. Others would be too scared. Still the impression left is that everything would be fine if there were transparency about the sources of funding and conflicts of interest.
The real problem is that in vaccine-land its not possible to mention harms. There can be no discussion of the fact that HPV vaccine causes problems, flu vaccines are for the birds, the Swine Flu vaccine caused narcolepsy, hundreds are suing Merck as a result of the Shingles vaccine, and earlier iterations of the MMR were withdrawn because the authorities accepted they were causing problems.
Not only is there a denial that there could be any problems but vaccine proponents have become thuggish and fascist, with alt-health diatribes turning up in the most unexpected of places – the Guardian. It’s enough to make anyone who believes in vaccination despair. The analysis of the growing vaccine resistance in healthcare professionals pays no heed to this. It scolds us for not telling the public that the safety of vaccines is monitored thoroughly – when this is self-evidently not true.
American Women
Medical academics now discuss company creativity at gaming efficacy in clinical trials – the way scholastics once debated the number of angels that might fit on the head of a pin. But company creativity at gaming efficacy is like nothing compared to their creativity at gaming safety. One of their best tricks is to get doctors and patients to report harms directly and independently to regulators. You might have thought this would help but reporting adverse events to a regulator is like pouring water into sand.
This was brought out in two posts some time ago – American Woman and American Woman2.
An entire science has been lost here – the science of adverse events/ drug wrecks. Doctors have no training in establishing when it is possible to say that drug X is causing problem Y. They are told that RCTs tell them what a drug causes.
The irony of this is that with most drug wrecks the causal chain is commonly so clear, so lacking in ambiguity, there is no need for an RCT – PSSD and PGAD offer great examples of this.
We Need to Medicalize
Many well intentioned people think they are contributing to a resolution of this epidemic by getting involved in campaigns against Overdiagnosis and Overmedication (ODOM). As things stand Overmedication Campaigns are like telling people they are a little Overweight – everyone agrees they need to change but, like Augustine of Hippo, they figure they will try to put it right but maybe not just yet. While everything works – is nutritious – or everything is good – like making a diagnosis – it’s difficult to stop feeding your diagnoses.
ODOM is like AllTrials – wonderful for industry. It gives the “good guys” the feeling they are doing something while behind the fig leaf industry get to hide ever more transformations of medical culture and practice. Centrally important to all this is that the proponents of ODOM or AllTrials be like BMJ and Fiona Godlee, its current editor, brave and beyond reproach and better again seen as trying to rein in industry.
But this won’t work. The only way the epidemic of treatment induced death and disability can be tackled is to return pharmacotherapy (not quite the same thing as medicine) to its roots which is that everything is a poison and physicians need to act accordingly.
We are Underdiagnosing the injuries being caused by treatment and Undertreating these injuries. We need to medicalize the problem. A campaign to recognize harms and manage them would require a lot more cojones from journal editors, scientific advisers and consultants than we are currently likely to get from any of these sources.
Relationship Based Medicine
But medicalization is not just about recognizing harms. It’s about managing harms in a relationship. We need to get back to a Relationship Based Medicine. The relationship used to be authoritarian. It needs to become consensual. It needs to harness the abilities of those of us who as patients take risks with medicines to contribute not only to our own wellbeing but to the wellbeing of all. A bunch of reasons why the slayer is likely to be a ….
Of course, doctors should probably also be told they are on the way out of business unless something like this happens. If drugs work wonderfully well and are so free of harms, nurses and pharmacists would be much cheaper prescribers.
And looming on the horizon are robots that can learn. Pretty soon putting a robot in charge of prescribing for patients, providing they were granted leave to learn by killing a few hundred patients first, would lead to fewer people being injured and fewer dying than is happening at now. If it was let learn rather than just follow a program, the first thing the robot would learn is to junk the evidence from RCTs.
1990 may have been the point at which the plan began to have traction. A critical episode was perhaps the US Vaccine Injury Compensation Act of 1986 in which in return for offering the chimera of freedom from infectious disease the pharmaceutical industry were granted freedom of liability for harm from their vaccine products. Another factor here is, of course, that vaccines are an impersonal to start off with, they are delivered en masse to people who don’t have the disease in the first place. A feature of the act was the creation Vaccine Adverse Event Reporting System which was in position by 1990 and now has collected above 600,000 reports – unfortunately because it is a passive reporting database this is like to be no more than one per cent of reality. The act – from its title – was sold as protecting the rights of citizens when in reality everyone was being sold down the river. Perhaps at the time no one cared to think where this might lead, but fundamentally those in the industry knew that they would just have to keep denying everything – it was never to the advantage of anyone inside to acknowledge what it was doing to people outside. In practice their may have been an increasingly conspicuous overlap but everyone had to keep on pretending. It was like the Trojan horse, it was like the Pied Piper of Hamlyn, it was like the Emperor’s new clothes, it was like a beast out of control devouring children – and no one took any notice.
Are movements against over-diagnosis and over-medication really just propping up the system? Are they a means of pushing fake “reforms” like the toothless data transparency policies that AllTrials has apparently fallen for?
I’d say, it depends. I definitely see how they can get used that way. Especially if the onus is put on the patient to “stop insisting on excessive care.” (Those who criticize over-diagnosis and over-treatment can be made to look indistiguishable from the budget-cutters and greedy insurance companies.) Or, even worse, if the issue of harm is whitewashed out, so that the problem is reduced to patients and ratepayers being burdened with “unnecessary” or “useless” care.
But the fact remains that the harm is real. Overdiagnosis kills and maims people every day. And very often over-medicalization is the club used to beat people down until they are afraid to say no to a treatment that’s hurting them, with no appreciable benefit. What else can you call it when patients are warned that their meds are “neuroprotective” and they may incur irreversible brain damage if they stop taking them? Or when families are told that a loved one’s (very real) depression is a permanent brain disease that can lead to suicide if drugs are not maintained for life — even though their loved one doesn’t seem anywhere near suicidal? What else can you call it when a fundamentally happy man with a case of job-stress nerves ends up dead?
Any cry of protest can be co-opted. Even Relationship Based Medicine. We just have to get used to that. But a whole lot of ordinary people have woken up to the harms of overdiagnosis and overmedication, and I am not ready to write them all off as obstacles to progress. Or even tell them that they’re being seduced into supporting the system they think they’re opposing, unless I have good hard-nosed evidence that this is happening. Especially when so many people are dying from these problems.
At the very point that we need unity so much, we are branding a whole new layer of people as our opponents–or at best, as hopeless dupes. We can’t hesitate to do that, if it’s truly necessary. But I don’t think it is. Plenty of good people are using this terminology to express their outrage, which is exactly the right kind of outrage. (I’ve done it myself, and I don’t see what’s intrinsically wrong with it.) By using the issue of harm, we can drive a wedge between them and the charlatans.
I couldn’t agree more. The point is simply focusing on overdiagnosis won’t get us far. Telling people the evidence for SSRIs or Statins is weak doesn’t stop people taking them. Overdiagnosis would shrink back if we embraced the fact that treatments can harm. But this cannot be a notional embrace – of course we all know treatments can harm. It means being able to take the side of a patient on a statin who says they feel week and tired since starting this pill. It means reminding women with pelvic floor issues that every surgery, even something as innocent sounding as a mesh, is a mutilation. It means getting out of the hospitality business where staff are monitored to ensure they are brainwashing people into having a nice day and into the hospital business where caring involves recognizing when what we do to you is bloody awful.
D
A couple of weeks ago the NHS sent out leaflets with some useful but some very infantalising advice about how to keep well in winter including not to forget to make an appointment to get ‘my’ flu vaccine. It doesn’t become ‘mine’ until I have been given trustworthy information and decided whether to have it or not. The flu message relies partly on generating guilt . Similar messages have been sent by services carrying out smear tests using information from GP lists and similarly worded – an appointment has been made for ‘your’ smear test…unasked for/unwanted. It makes it seem as though there is an obligation rather than a choice. HRT has been pushed onto women when the safety has been contested and the debates are not shared with women who have not been in a position to inform themselves , simply as personal preference of GPs . Few people know how extra payments are made to GPs for certain, what it seems, are now deemed as extras rather than part of the job.. The over-diagnosis brigade was for several years comprised only of a self appointed group of people, some in past or present to some extent influential positions , some quite worrying organisations. See the publicity already for the August 2018 Over-diagnosis Conference in Denmark. They miss the mark by thinking adding a few public representatives to the mix will engender more trust- they are not solving any problem when the message is still not just paternalistic but maternalistic – we know best, we will have yet another conference to decide how to get our message out . The simplistic messages have actually generated fear amongst some older people who catch their publicity on the media – older people are worried they will not get the medication they need Quote ‘why don’t they just push us out on an iceberg’. We’ve paid in we should be taken care of…the over diagnosis and end of life campaigners who are often the same crowd rack up worry for too many people. Another example of infantalising ‘the public” is positioning us until recently as ‘demanding’ antibiotics from doctors. Yet many prefer not to use them – and others have got used to expecting them on the basis of advice from medics. Now there is another infantalising message telling people to do what your doctor tells you re antibiotics – but at the same time contradictory messages show how often much advice is simply wrong . Some confusion is expected maybe in a complex situation like medicine but to deny the evidence before their eyes of serious harms being caused by the adverse effects of anti depressants is scandalous – there are thousands of reports by now of people reporting serious harms on blogs and elsewhere,there are papers published as far back as 2006 in Pub Med admitting the long term effects causing genital numbness and other harms – but there it stops – no next steps to looking for a cure which should have been the next scientific project of the companies who produce the drugs. Over diagnosis messages avoid talking of this. There is surprisingly a Wikepedia site on Anti depressants – have added an edit to publicise RxISK. It’s not a site for personal accounts but edits are more likely to be included if there is reference to say – a book on pharmacology…
Last thing – is it not worth reporting adverse effects to Yellow Card Scheme – not expecting them to change much about prescribing but to have some evidence of which drugs are most reported and where – even if of course only a minority will be reported
‘Suffer little children’…..
I have been following these Blogs for a couple of years now, since a good friend alerted me to them. This post surpasses all others for me. Reading it I want to jump up and down yelling ‘yes, yes, YES!’ Especially this section on what is being and has been done to our children, and why. Additionally about where all the money is going, money which should be there for giving mentally worried youngsters helpful supportive care to allay their fears and heal their confused minds which are in turmoil. And why more girls than boys? Could it be that social media’s attention on appearance being all important, that having enough ‘friends’ and of being hounded by cyber bullying at school and at home, puts many into a state of fear where they are losing touch with reality.
And yes the money is going into screening and auditors and managers and not into clinicians, which should be going into children’s services. We have personal experience in our family on the attitude of managers. Their mind set, whilst purporting to ‘care’ is actually based on more and more self congratulatory bureaucratic hierarchy, of salaries and pensions which sound like Monopoly money, being awarded to people who sometimes wouldn’t have the insight or brain power to succeed in private industry. But cushioned by the financial power they have amazingly been gifted by the unaware NHS, they dictate their ever changing logo driven latest new look policies, spewing out paper and patting the heads of the underlings whilst they rise to dizzy ridiculous heights and often get the accolades of Honours from the monarch for doing the dirty business of Government, who are afraid to (or, to be fair, do not have the financial clout to) stand up to Big Pharma and it’s money making machine. Money drives it all, in the end, and meanwhile our children struggle and many die, whilst parents struggle to be believed, and their hearts break with the frustration of it all.
I am daily reminded of the difference of how things were back in the 1950’s and before, when I look at a photo near my bed on waking. It is of my dear grandfather, Dr George Briggs of Hull, who died when I was 5. His obituary in the Lancet was wonderful. He was loved and revered by patients and fellow medics. He died leaving very little money. It was because in preNHS days, he never charged anyone who he felt might have a struggle to pay, he dispensed placebos at first to see if a reported illness would respond to a gentler intervention. He held a patient’s hand if they reached out to him, he drew cartoons of penguins for children on the children’s wards when he visited them in Hull Royal Infirmary.. Above all, he listened, they knew he cared. He gave them all the time they needed because he HAD time, and no jumped up manager without the same ethos, would have dared to stop him.
Alex Azar to head US HHS – Azar who was previously deputy head of HHS under George W Bush became President of Eli Lilly but left his post in January “to pursue other career opportunities” presumably in a fit of pre-cognition.
http://www.msnbc.com/rachel-maddow-show/trump-taps-former-pharmaceutical-industry-executive-lead-hhs?cid=sm_fb_maddow
https://www.prnewswire.com/news-releases/lilly-to-adjust-organization-and-leadership-structure-to-better-align-with-growth-opportunities-300386251.html
This seem somewhat comparable to Andrew Witty leaving GSK in February in time to head the UK’s new fast track medicines licensing agency.
David, re your reference to Peter Doshi’s recent feature article in The BMJ about the lack of transparency for vaccine advocacy organisations: http://www.bmj.com/content/359/bmj.j5104
You say “Few people other than Peter could have pulled off something like this. Others would be too scared.”
So how grim is this? It is absolutely gobsmacking that governments around the world are implementing compulsory and coercive vaccination policies, i.e. mandating medical interventions, and we have had little or no analysis of this startling assault on bodily autonomy by academia or the media because people are “too scared”.
You say that “vaccine proponents have become thuggish and fascist, with alt-health diatribes turning up in the most unexpected of places – the Guardian.” Yes, there’s a broad and often sinister network behind the aggressive development of the global vaccine market and it’s way past time this was investigated. As I know from personal experience, e.g. on the academic website The Conversation, questioning of vaccination policy is being outright censored, this is a deplorable situation in our liberal democracies.
Over-vaccination is emerging as an extremely serious matter. Children are now being subjected to numerous vaccinations and revaccinations, at least 46 doses in Australia at the current time, and with more in the pipeline with lobbying by industry. We have no idea of the long-term consequences of this increasing vaccine load and, as far as I’m aware, no independent vaccine ‘experts’ to rely upon for objective analysis of vaccination, many seem to be in bed with industry.
And there is a massive problem with the ‘regulation’ of vaccine products. The Australian regulator, the Therapeutic Goods Administration (TGA), is conflicted as it receives funding from industry to assess medical products, and appears to simply rubber-stamp industry data.
Today the Sydney Morning Herald published a report about the TGA titled: “Australia’s health watchdog accused of ‘too close’ relationship with industry”: http://www.smh.com.au/national/australias-health-watchdog-accused-of-too-close-relationship-with-industry-20171105-gzf5vb.html
The scandal about the pelvic mesh devices prompted the story, which argues the TGA “needs a complete overhaul to distance it from the health industry and allow consumers to sue it for negligence…”
Needless to say, vaccine products approved by the TGA need to be part of this overhaul, including highly questionable vaccine products such as the HPV vaccines Gardasil and Cervarix, and the Bexsero meningococcal B vaccine.
We need an overhaul of the entire process, and this includes the Pharmaceutical Benefits Scheme which is so easily manipulated by industry, see for example this article published in the Sydney Morning Herald in February 2010: The other drug war – the politics of big business: http://www.smh.com.au/business/the-other-drug-war–the-politics-of-big-business-20100226-p8zi.html
Couldn’t agree more Elizabeth – How on earth has a health service (or any other service) in a supposed democratic country have allowed a situation to develop based on fear…users/survivors/victims afraid of doctors and other health workers – doctors and nurses and others afraid of top doctors who are hand in glove with politicians and drug companies..who are afraid of managers – who are afraid of politicians…. who are afraid of skewed media stories…and so on. Some speak out but mainly behind closed doors – you can bet any critical article will get responses but they won’t dare to publish openly or they will be barred by editors. More should Be afraid – and still speak out – it is not right to leave the few to shoulder the burden As an ex whistleblower I know how destructive the collective attempts to undermine and silence people can be – but if anybody just stands by without trying to defend vulnerable fellow human beings from known harms , which to some extent is maybe understandable it is not easily forgivable. Hopefully another quote from the bible will not be the cries of those from any religion or none -who have been left to suffer – My god, my god, why hath thou forsaken me’. I honestly believe the situation is that shocking.
“I Know an Old Lady”
The old lady swallowed a fly, followed by a spider to catch the fly, a bird to catch the spider, a cat to catch the bird, a dog to catch the cat, a goat to catch the dog, a cow to catch the goat, and finally a horse – “she’s dead, of course.”
http://antidepaware.co.uk/i-know-an-old-lady/
In her book The Pill that Steals Lives, Katinka Blackford Newman (left) tells how, during a spell of a few months in the Nightingale Hospital, she was given a whole selection of drugs, including antidepressants Mirtazapine, Sertaline, Fluoxetine and Venlafaxine, anti-psychotics Risperidone and Olanzapine, anti-convulsant Lamotrigine, mood-stabiliser Lithium and sedative Zopiclone.
“Psychiatry in a Nutshell” ..
“At a time when the United States pays, by far, the highest prices in the world for prescription drugs, the last thing we need is to put a pharmaceutical executive in charge of the Department of Health and Human Services,” Sen. Bernie Sanders (I-Vt.) said of Azar’s nomination.
Pointing to statements from Azar that reflect many of the industry’s positions, Public Citizen President Robert Weissman went further.
“If Alex Azar’s nomination is confirmed,” he said, “then Big Pharma’s coup d’etat in the health care sphere will be virtually complete.”
Azar is the first person nominated to the health secretary post with such a direct path from industry.
https://www.statnews.com/2017/11/16/pharma-trump-administration/?utm_source=STAT+Newsletters&utm_campaign=308ed7d47a-Pharmalot&utm_medium=email&utm_term=0_8cab1d7961-308ed7d47a-149674737
DEFCON alert
https://fiddaman.blogspot.co.uk/2017/11/business-as-usual-means-bad-news-for.html#.Wg6dboXXKZ9
“Seroxat, I think” ..
https://truthman30.wordpress.com/2016/09/12/ian-hudson-of-the-mhra-ex-gsk-employeebluffs-and-blunders-his-way-through-a-grilling-by-andy-vickery-at-a-paxil-induced-suicide-trial-2000/
Offering ‘marmalade sandwiches’ does not a ‘Paddington bear’ .. make ..
Kristina K. Gehrki @AkathisiaRx 3h3 hours ago
Kristina K. Gehrki Retweeted Suicide Prevention
You can easily reduce suicides & grief simply by posting a list on your website of prescription drugs that carry the @US_FDA Black Box suicide warning. Informed Consent is a basic human right my now-dead child was denied.
#SurvivorDay ..
Where is the black box site for UK – is it open access?
There is a quote from Carl Jung from a New York Times interview of 1912 where he notes that America is an overly sentimental society and brutal. He goes onto say that prudery is the cause of the brutality. Is that an analogue to ‘infantilizing.’ Sentimentality I can understand as a psychopathic type can be mushy over his dog and totally unfeeling.