Not So Black: Ablixa and Homicidal Side Effects

If you don’t want to know what happens in the movie Side Effects – do not read further. The post does not reveal all but does reveal important details.

So now we know Soderbergh’s movie Side Effects is not so Black/Noir after all – more Fifty Shades of Grey. Emily Hawkins (Rooney Mara) is put on Ablixa by her psychiatrist Jonathan Banks (Jude Law) and while on it kills her husband. She apparently murders him while sleep-walking triggered by Ablixa and sleep walking being a perfect defense against murder she is acquitted.

The first part of the movie is an expose of the pharmaceutical industry and greedy doctors. But in fact the industry and greedy doctors are the victims of wicked lesbians Hawkins and her former shrink, Victoria Siebert (Catherine Zeta Jones), who helps construct her alibi while both make a killing in the stock market by investing against Ablixa.

Not so noir

Do they get away with it – I’m not telling you. Their attempt to do so though is a twist in the tale that’s supposed to be Noir.

One of the best definitions of Noir comes from the humorist Tom Sharpe, who describes an incident in the South African navy when he and colleagues were scrubbing a ship, and one of their colleagues fell overboard just as an Admiral walked up the gang plank. Everyone had to stand-to for an inspection by the Admiral, and while they did so the sailor who had fallen overboard drowned.

In real life suicides and homicides on the SSRIs have almost certainly boosted the sales of these drugs. Far from a verdict against Ablixa leading to a collapse in its share price, the publicity would have increased sales, not least among women who might want to murder their husbands.

In real life mass homicides such as school shootings even when the press in the best traditions of pantomime try to draw the attention of the cast and politicians to the drugs in the background, produce more mental health screening programs, leading to more drugs being prescribed and more school shootings. That’s Noir.

So why should an investor worry? In real life the “girls” would have lost their shirts on this one – their play should have been on the share price going up.

Antidepressants and violence in Holland

Side Effects launched in a week that saw a Dutch court hear evidence that paroxetine (aka Aropax, Paxil, Pexeva, Seroxat, Sereupin) can cause violent behavior.

“The suspect bashed in his girlfriend’s head using a fire extinguisher and then shot a police officer. Other law enforcement officers then shot the suspect 5 times, but they still had a lot of trouble trying to restrain the suspect.

“The officers stated that they shot the suspect in the chest but it did not seem to have any effect. After the suspect had also been shot in the leg and shoulder, the suspect was still able to resist arrest. He still managed to hit another officer in the head using his gun. Officers even used pepper spray but that too did not yield any results. The officers stated that the suspect acted like a zombie.

“Court experts stated that it was highly likely that the behavior of the suspect had been caused by the use of Paroxetine”.

Why would a distinguished journal publish this?

In some jurisdictions such as Canada companies are legally obliged to say their drug can cause violence, a recent article in Psychopharmacology by Dutch academics Paul Bouvy and Marieke Liem denied the possibility of a link.

Bouvy and Liem correlated data on lethal violence in Holland between 1994 and 2008 against sales of antidepressants. The drug sales went steadily up and the number of episodes of lethal violence fell, leading the authors to claim that “these data lend no support for a role of antidepressant use in lethal violence”.

This is a marvelous example of an ecological fallacy, which is when someone claims that if an increase in the number of storks parallels an increase in the number of births that storks must be responsible for births.

Storkology

The best known example of storkology in recent years were the graphs produced by tobacco companies showing rising life expectancies and even reduced deaths from respiratory illnesses in line with rising cigarette consumption. These were produced as part of a Doubt is our Product strategy to deny the risks of smoking.

Recent sightings of storks include claims that increased SSRI use is linked to falling national suicide rates. The articles making these claims offer data from the late 1980s but disingenuously omit some key facts. One is the fact that suicide rates in most Western countries were falling before the SSRIs were launched. Another is the fact that both suicide rates and antidepressant use rose during the 1960s and 1970s when antidepressants were being given to the most severely ill people at the greatest risk of suicide. This was when suicide rates should have fallen if antidepressants have any effects on national suicide rates (Reseland et al 2008).

Autopsy (post mortem) rates are also left out. The more autopsies done the more suicides and homicides are detected. Autopsy rates rose in the 1960s and 1970s and fell from 1980 before antidepressant consumption began to escalate dramatically. The rise and fall in autopsy rates perfectly mirrors the rise and fall in suicide rates (See Reseland et al 2008).

Why not the same argument for alcohol and violence?

Why would Psychopharmacology, a prestigious journal, take an article like this? Alcohol use has increased in Holland during this period but no-one is making the argument that increased alcohol use has led to a decline in acts of lethal violence or the further Bouvy and Liem argument that this means alcohol cannot cause violence.

SSRIs slow growth in children. During this period SSRI consumption among children has increased in Holland but the Dutch have become the tallest people in the world and are getting taller. Where is the article saying that the increasing height of the Dutch proves that SSRIs don’t retard growth?

In the case of violence, the published trials show antidepressants cause it, at a greater rate than alcohol, cannabis, cocaine or speed would be linked to violence if put through the same trial protocols that brought the antidepressants on the market.

And there is at least one clear and well-known factor, just like autopsy rates that can account for the findings – young men. Violence is linked to young men, and episodes of lethal violence are falling in all countries where the numbers of young men are declining.

Antidepressants and school shootings

School shootings were almost unheard of before the SSRIs appeared on the scene. Correlation is not causation but in between this and the next blog post I will be laying out the evidence that antidepressants cause violence up to and including homicide at two lectures in Chicago – including the evidence that real life antidepressants as opposed to Ablixa can in fact cause sleep walking and murder. A video of the lecture will be posted on RxISK.org as soon as possible afterwards.