After qualifying in Medicine in Dublin in 1980, I went to Galway on the West Coast of Ireland. Galway was very small compared to Dublin, but I’d heard the university had a new pharmacology professor, Brian Leonard, and interesting things might happen there.
The world in 1980, and Ireland in particular, looked very different to what it looks now. There was an Iron Curtain down the middle of Europe and almost no-one in Ireland except its natives.
It was a country with no pornography or contraception. University students had romances rather than sex. Galway had a new popular Bishop who seemed to be bringing a wind of change but the prior Bishop Brown, a few years before, had been reported approvingly as insisting some topless German tourists on Silver Strand beach got dressed.
In 1980, the Department of Pharmacology – above – was in a wooden hut. It transferred to a one story concrete hut soon after I left in 1985 with the grounds for the old wooden hut, and adjacent green space perfect for Frisbee throwing, commandeered to build a Millennium Building to house an Arts Department. When I first saw the Millennium Building in 2024, it brought a line in Joni Mitchell’s song Big Yellow Taxi to mind
‘They Paved Paradise and Put up a Parking Lot’.
Walking into Brian’s office for an interview, the first and most obvious thing was a very large picture of a gorgeous naked woman on his office wall. It illustrated how oral contraceptives work. The arrows, pointing to what hormones etc went where and their effects, took care not to interfere with any contours.
I had spent some time in Eastern Europe a few months before and it turned out Brian was a member of the Communist Party and had lots of Eastern European contacts. His Communist Party link may explain why Brian ended up in Galway. See his interview linked below.
Mine turned out to be the norm for Galway pharmacology interviews. People approached Brian, or later John Kelly, to have a chat and get a feel for things not realizing they’d been assessed and hired.
The Hut was a place of great fun. The support staff, Amby, Brendan and Danny were amazing. How antidepressants work was the main research interest. I was doing serotonin reuptake on people admitted with depression to the University Hospital across the road.
We now think of drugs like the antidepressants as treatments, but I was thinking of them as ways to probe how the mind fits into the brain, which was code for trying to understand girls as Walter Hess who won a Nobel Prize in Medicine in1949 was quick to note for the male students then doing neuroscience. See Who’s Afraid of Science.
Pharmacology in Galway was way ahead it’s time in being more female than male and more ethnically and internationally diverse probably than any other university department in Ireland.
Luck and Serotonin
I got lucky. Working on serotonin just as the SSRIs were about to be launched meant companies figured I was a perfect person to educate doctors about these new drugs. This educated me on Company Marketing – the goal is to ensure doctors do not have a thought in their head other than those put there by us or our competitors.
My lab background and company links meant the Guys – all guys back then – who had made the breakthroughs were happy to be interviewed by me. This included Julius Axelrod The Discovery of Amine Reuptake who won a Nobel Prize for this and another Nobel Prize winner, Arvid Carlsson The Rise of Neuropsychopharmacology who created the SSRI concept and the first SSRI. There are over 100 Published Interviews, giving a feel for how psychopharmacology looked back in the last millennium.
There is an interview with Brian Behavioural Pharmacology in Drug Development, which gives a feel for how Galway psychopharmacology astonishingly punched above its weight globally.
This background also meant I was quick to use the SSRIs when they came onstream and I immediately saw people become suicidal on them.
For the last 30 years I’ve worked mainly on what get called the side effects of medicines – even though the sexual effects of SSRIs are far more common than any mood effects. Within an hour of a first pill genitals are numbed or made more irritable in pretty well all people. These effects teach us things about vision, touch and where the mind, or wisdom or just plain common sense is located in our Mysterious Bodies than any dissecting of brains can.
Think Octopi – we see the bulbous head and 8 arms and think we know where the intelligence lies. It’s mostly in the arms.
Rather than trying to work out how the mind fits into the brain, we generally, and in Galway back then, have neglected the wisdom of the body – especially when it comes to sex.
Sacraments and Sex
Linked to a reporting website called RxISK.org I have ended up getting daily reports on different aspects of drug induced sexual changes. While Irish peri-teens equipped with smartphones probably now know more about sex than I knew in 1980, quite weirdly, given the background, I might know more about certain angles on sex than almost anyone else on the planet.
When it comes to sex (or other drug induced harms), the global medical world now resembles Catholic Ireland pre-1980. In the 1960s, medical journals and meetings were filled with references to the harms of medicines and how to manage these. Medicine dealt in poisons not sacraments – aiming to bring good out of the use of these poisons.
But no medical journals or academic meetings now want to talk about what our drugs reveal about the things that almost certainly will go wrong on treatment. With antidepressants more goes wrong for more people than goes right.
Why the taboo? Websites and authorities say that they are reluctant to mention harms for fear of deterring people who might benefit from taking meds. This is the public facing view. Is it a velvet glove covering an iron fist? Underneath, physicians and their journals and professional bodies, advised by their lawyers, are petrified about being sued by pharma or having their research funds or perks dry up.
The New Religion
In terms that Irish folk of a certain generation may better understand than most others, our Meds have become sacraments – something that can only do good and cannot harm. The extraordinary thing is that what They Used to Call Psychiatry has to an increasing extent descended into Clinical Drug Delivery Systems and – here’s the extraordinary bit – has swapped places with the Catholic Church, who recognize that the gluten in the Eucharist can harm.
The Pope in recent years has agonized over this. These slivers of gluten really challenge Religious Belief Systems – they have landed in the world as it is and challenge what the books and authorities that Ireland once put store say is Real.
This shape-shifting suggests that, rather than being a Clinical Science, Medicine has become a Religious System. One of the functions of religion is to keep the herd together – this is not the role of science.
Medicine – all branches of it that have significant recourse to on-patent drugs – have fallen off the scientific path. The medical literature on drugs has become ghostwritten with no access to trial data. This is completely at odds with the norms of science.
Clinical care has got worse – there is little more personal touch to the delivery of drugs than a priest can afford to have when dishing out several hundred Eucharists in a few minutes.
We have a polypharmacy pandemic that is leading to a fall in Life Expectancies. Excepting Ireland where they are dropping rapidly, Western reproductive rates have fallen way below replacement rates and the SSRIs stand in the way of being able to turn this around. Without immigrants Western social structures will collapse.
These are among the most complex political issues of our time – they won’t come up in the Harris Trump debate on September 10th or in the election scheduled in Ireland for early next year pitting Simon Harris against whoever.
Galway is famous for its Swans. Wandering around at this time of the year you see parents with children who look more like Ducks. It is difficult not to think of the Ugly Duckling. The Harms of Drugs are today’s Ugly Ducklings. Can we not recognize some Beautiful Swans in the making?
Another metaphor that seems apt given the religious overtones of all this – the Stone the Builders Rejected has become the Cornerstone.
Finally it might be worth introducing IRL to the debate. IRL is the international code for Ireland – and a common abbreviation for In Real Life. What is happening in front of me or you in someone on a medicine is what is happening IRL. What books say about drugs, especially when they report the results of company studies and even RCTs done by angels, which give average effects in non-existent people, is not Real. The books may be helpful but Real Life should trump whatever the books from the Bible to the New England J of Misinformation says.
Brian Leonard
Brian died on December 27 2023. He had retired at the end of 1999. After several sets of Huts, he lived to see the Pharmacology Department relocate to the building above.
I got to see this building for the first time in August 2024 when it hosted the 50th anniversary of the foundation of the department. John Kelly, David Finn and others who have been leading it in recent years figured there was a lot to celebrate.
It was an extraordinary – and fun – day. John and Dave are keenly aware that something pretty unique in terms of a stimulating informality had been created back in the last millennium and their priority is to ensure this continues.
There is one little quirk to Brian’s interview worth adding to the details about naked women and membership of the communist party that might give some flavor of the informality.
The early interviews with the grandees of psychopharmacology were all typed by Bev Evans who never made a mistake. Except when it came to Brian’s interview. I had to nervously mention – Hey look you’ve got a few things wrong. She didn’t believe me.
So we replayed the tapes and yes she had made 5 mistakes. Every time Brian had uttered a cherished Irish expletive, she had made sense of the overall sentence without hearing the word.
The expletives were delivered with genial good humor but pointed to the passions that motivated him. (They have been removed but you can play a party game and see if you can spot where 5 expletives might have come into play – and email me with your suggestions).
Brian’s interview, showing a divide between what actually gets said and what we think we have heard, must offer a metaphor for something.
Very taken with the Brian Leonard interview.
Things that stand out for me –
Leonard:
When you are really out on the sticks, although theoretically they should be available, half the drugs are not available. Now what the heck do you do when you’ve got patients going mad and all the rest of it. So Ted and myself found it a real education. I would deal with the basic pharmacology, side effects, drug interactions and Ted would deal with the clinical applications. It was very labour intensive. We ran these courses over a 5 day period and then we would try to get some of the clinicians to gether to talk about research. Research which is relevant to the country, research which doesn’t require big aparatus and so forth. Get people thinking on how to use the material which is available. We did three years of this.
Big men hold the patient down – it’s One Flew Over the Cuckoo Nest stuff. This is the way things are done. So that’s the level you’re dealing with. In many cases, they don’t even see a psychiatric nurse; if the patient goes a bit mad you tie him to a tree until he calms down.
Healy
Right now let me be as awkward as I can. On the one hand, you do your work in Africa for WHO and your orientation as a Marxist seems to fit into this quite well. However, on the other hand you are very publically seen defending for instance the latest group of antidepressants, the SSRIs, vigorously, even though the evidence that they are really much better than the older generation of antidepressants doesn’t appear to convince most clinicians. For instance take the question of long term efficacy of antidepressants. This is important but studies on the longterm efficacy of the SSRIs becomes for the Marketing Department of a drug company just the way to sell their drug rather than the answer to a scientific question and people like you get used to put forward an industry 20 friendly point of view. What this leads to among many practicing psychiatrists is a perception that your doing the marketing of these drugs for companies better than they can do them themselves. It’s an ironic and ambiguous position it seems to me.
Such a succinct para, and the answers are as interesting –
I relate in the tiniest way to life as a ‘Pioneer’, hence my deep interest.
Off I was sent around 1980s, in my early 30s, to America to do the ‘hut thing’ and not only sell a product, which actually had an intrinsic flaw, but to send back the research to the UK boss. He was as the above describes. All over America I went, with a financial weight upon me, and responsibility to get it right. Pioneering is the greatest buzz there ever was.
‘I immediately saw people become suicidal on them.’
‘With antidepressants more goes wrong for more people than goes right.’
‘They Paved Paradise and Put up a Parking Lot’.
Like Annie, I was much taken with your Brian Leonard interview. He certainly was one of those he described as, ‘the grand old men with the vision – people with both experience and fantasy and that’s bloody hard to find now.’
Although I was also rather pleased when, having left the tough stuff till the end of the interview, you called out what felt like incongruent ‘commercial Marxism’ re SSRIs. I understood his point about SSRIs being less toxic than their predecessors, although he described them as equally effective – which I didn’t think was the case. Drug development for humankind based on lesser harms is a disturbing thought to us mortals. A point you’ve made about the sustained dominance of SSRIs, there is no, theoretically, less harmful drug to take their place, in the way the virtuous baton was passed from benzos.
I sort of cheered when he said this:
‘I’ve got many many criticisms of industry but one of them as a scientist is the pure scientific reductionism that what we are seeing now – you know mental illness equals an abnormality of a specific receptor type in a specific brain region. Now this is bullshit. The brain is much more complex than that. But if you take that philosophy to its logical conclusion, all you need to do is to have a laboratory devoted to in vitro cloning of receptors and targeting particular receptor types. Whether that has any relevance whatsoever you will only find out maybe four or five years down the line when you put the compound into man.’
It had echoes of the current, useful up to a point (the point being giving general practice a scientific rationale to go slow) limited focus on receptor occupancy as a totalitarian explanation of withdrawal. When of course it is the individual patient’s experience that really matters.
As you note, even a ferociously clever mind like Brian’s stopped at brain effects and seemed to forget the body that informs that lump of old grey matter. It’s significant that your professional preoccupation with the adverse effects of psychotropics on the whole person has led to enlightenment – whereas many of your peers, and probably medical education, are still banging on about brains and dismissing the bodily reality, airily, as ‘all drugs have side effects’. PSSD a ‘side’ effect? PGAD? Visual snow? Chronic akathisia? We could go on.
‘These effects teach us things about vision, touch and where the mind, or wisdom or just plain common sense is located in our Mysterious Bodies than any dissecting of brains can.’
I posted these words of yours on X – and Alto, aka Adele – identified instantly and made the same point about the study of withdrawal.
As the daughter of an Australian – albeit an extremely polite one – of the ‘would you be so kind as to f**k off’ variety – I am a failure. I tried to spot the spaces and places in Brian’s interview where the ‘cherished expletives’ had been vapourised by Bev Evans. There are gaps in the typing but… This led to a websearch for Irish expletives – and it being 1.31a.m – I give up. Please add the unedited version of the interview one day to quell the curiosity.
What a shame Brian Leonard died only months before he could have listened to this very important Webinar broadcast tomorrow
https://www.eventbrite.com/e/why-are-antidepressants-so-difficult-to-stop-tickets-976507017777?aff=ebemoffollowpublishemail&ref=eemail&utm_campaign=following_published_event&utm_content=follow_notification&utm_medium=email&utm_source=eventbrite
With all power to Dr. David’s elbow, this could be the game-changer we have been waiting for.
‘Well, b****r me’, Brian might have said, of the Webinar
Swanning around
https://journals.sagepub.com/doi/full/10.1177/02698811241234712
Ní bheidh a leithéid ann arís*.
*Irish to English translation: We won’t see his like again.
We got lucky –
Get the Ticket …