Making medicines safer for all of us

Adverse drug events are now the fourth leading cause of death in hospitals.

It’s a reasonable bet they are an even greater cause of death in non-hospital settings where there is no one to monitor things going wrong and no one to intervene to save a life. In mental health, for instance, drug-induced problems are the leading cause of death — and these deaths happen in community rather than hospital settings.

There is also another drug crisis — we are failing to discover new drugs. [Read more...]

Author Archive for David Healy

Algorithms are from Mars

When God was in Heaven, our images of the Divine split between Justice and Mercy – the Shock and Awe figure of the Last Judgement or someone more like Portia letting us know the quality of mercy is not strained, that it droppeth as the gentle rain from Heaven upon the place beneath.  A person with the love of a Mother for her child.

Through to the 1750 or so, the Monarch stood in for God. Hierarchy means rule by the sacred (Hieros) or the sacred’s anointed – it does not mean rule by the powerful one. The monarch’s role was to dispense Justice and Beneficence, aimed at securing the people – the flock, Good Shepherd like (even if some monarchs took their flock to war). An important function was to protect the people against corporations (guilds or powerful cities with vested interests like London).  In 1542, for instance, Henry VIII passed an Act to curb an emerging medical monopoly – Original and Translation.

When we started decapitating our own monarchs, rather than other peoples’, we had to find a new way to ensure Justice and Beneficence. We turned to constitutions and procedures and ultimately insurance and welfare states. Those doing so saw themselves as progressive.

The progressives seemed to have history on their side because this move coincided with the rise of science, which led to material prosperity and later better health. It seemed that thinking for ourselves and claiming our rights rather than carrying out our duties worked.

Exit from Eden

Our exit from Eden into the Modern World came with an Original Default. The default was to procedure. Mercy or Care are, or can seem, arbitrary. Justice cannot be, or even appear to be, arbitrary. It requires procedures and adherence to procedures – to bureaucracy.

The problem is its difficult to place a limit on procedures. Once you start down a procedural route, how do you justify a procedure-free space? But a world in which the head always rules over the heart, to put it in first millennium language, is an inhuman one.

This is an age-old dilemma. Aristotle grappled with it and likely others before him. David Hume did too just before modern procedures began to take hold.  Max Weber, 2300 years after Aristotle, was greatly troubled by it. In 1920 he saw procedures crowding in on all sides. He worried we would trap ourselves in an Iron Cage of procedure – his worries were intense enough for some like Zygmunt Bauman to think he all but foresaw the Holocaust.

I Consume therefore I Am

A hundred years after the death of Weber from the Spanish flu, the last great pendemic, our subjugation by the knee of procedure pressing down on our throats has reached the George Floyd 9-minute level.

Procedures lend themselves to algorithms and operationalism, both of which focus on doing rather than thinking or making judgement calls.  In our day, Descartes ‘I think therefore I am’, which replaced Luther’s ‘I believe therefore I am’, has become I do therefore I am.

In the last two decades this has been internalised in the form of I shop therefore I am, where the shopping or consuming extends to medical procedures and even death.

We transited from being subjects with duties to citizens with rights and now to being consumers at the mercy of fashions. In the words of Herbert Marcuse, we became one-dimensional.  This happened as much in medicine, if not more so there, as in any other walk of life.

What were once political or philosophical matters in the world around us have migrated into us to be sorted by consuming some medical procedure.

Operationalising Ethics

With the medical breakthroughs of the 1940s and 1950s, a bunch of theologians spotted that, besides the nuclear bomb, the bulk of the ethical action in our new world was happening in medicine.  There were new and huge issues to rival the bomb from organ transplants and a trade in organs for transplanting to brain death to possible modifications of our genes and ultimately perhaps a capacity to engineer humans.

While we had dumped monarchs 150 years before and science had become the dominant driving force in history, engagement with ethical issues still took place in theology or philosophy departments. It was theologians who initially drew attention to the new dilemmas we were facing. By virtue of their background, they did so with what was viewed in the 1960s as an opening to the transcendent.  It might work better now to reframe this as an openness to something greater than our individual selves.

This openness quickly closed.  In the 1960s and 1970s, operationalism, which had begun in the 1930s and gained traction in the 1940s because it meshed with the needs of the US military, triumphed.

In the 1960s doctors, rather than engaging with the problems we brought them, began to measure our blood pressures, or glucose levels, or moods with rating scales.  This medical operationalism began to give us problems, where before we had brought ‘our’ problems to doctors.

This was an era, when in psychiatry we thought it made sense to bridge the divide between different visions of mental illness with operational criteria (DSM-III).

An era when we thought it made sense to bridge the divide between capitalism and socialism with an operation – manage the money supply, initially called monetarism and later called neo-liberalism.

When it came to the big ethical questions in medicine, philosophy and theology got operationalized and became bioethics.  Like figures and tick boxes for blood pressure or mood scales, the big ethical questions were reduced to tick boxes.

  • Does the person have capacity? If they do, they meet the principle of autonomy over their self and have rights to do whatever they decide for themselves.
  • Is the procedure being proposed something that offers what for this person is a good – if so it meets the principle of beneficence.
  • Is the procedure being proposing not unduly likely to do more harm than good – if so it meets the principle of non-maleficence.
  • Does the procedure meet the requirements of justice? No bioethicist feels comfortable denying something on the basis that there might be a bunch of poor people who can’t afford a procedure.

Somewhere in the midst of this, the progressive dream slipped off the rails. We had fought for rights to access abortion, gender reassignment and medical assistance in death but rather than having gained ground from which we can survey the advances made, these have now become consumer items and we seem diminished.

Boxes get ticked – yes we have capacity, and we regard these things as a good and don’t see a problem. The procedures go ahead.  What we don’t have any more is an opening to question what we are doing to ourselves.

Pretty well everyone who was given an antidepressant had capacity.  Who dares say then that we might now have a public health crisis with 15+% of the population on them and mostly unable to get off them? Where is even the white supremacist to ask why is it primarily white people on them and why are white birth rates falling?  Where are the anti-abortionists to ask why are so many women of child-bearing years on these drugs that cause miscarriages and are linked to increased rates of terminations and birth defects?

If these guys can’t spot a problem, its no surprise our doctors can’t either – especially given that its all good for business.

Everything has become a matter of bureaucracy and procedure. This was partly what Weber foresaw. It was us, the people, socialists mostly, who fought for rights but in order to hold what we had gained we wanted them enshrined in procedures – not realising that once this happens that those the deepest pockets and the most power can always make our procedures work for them.

We fought pharmaceutical companies for the rights of people in the developing world to access Triple Therapy for AIDs and are now tone-deaf to the fact that pharmaceutical companies love our continuing fight for access to costly medicines which leads to a polypharmacy that seems likely to be contributing to reductions in our life expectancies.

The Health of Drugs

The most ghoulish aspect of all is seen most clearly in drug wrecks.

We no longer operate on the rule of an eye for an eye, or on the basis of honour. We have agreed to trade these for due process. If a grieving parent now seeks to bring some good out of the death of a child at the hands of a drug that has destroyed his or her mind or a parent seeks to make sense when someone on an inexplicable manic killing spree shoots their child, they will find themselves up against what can only laughingly be called ‘due process’.

Their obvious truth is pitted against a ghost-written and fraudulent literature that Courts psychotically designate as science. At the very top of government and the top of the legal system, there is an awareness that when it comes to drugs the system will always find people to blame and will never blame the drug.

Pharmacovigilance which began life in the 1950s aimed at alerting us to risks of the poisons we took is now more concerned with the health of medicines – ensuring the sacramental status of our medicines is maintained (a sacrament is something from which only good can come). The powers that be go into overdrive to ensure that no Adverse Drug Reactions are accepted as credible.

Not a Drop of Blood

When it comes to a crunch in the Merchant of Venice, Portia invites Shylock to take his pound of flesh, noting the agreement does not specify an entitlement to a single drop of blood.

When it comes to a crunch, Justice hinges on people not procedures.  In Court, it is the story a person tells, or those who are witnesses on her behalf, and whether the story holds up under cross-examination that counts.

All the expert testimony in the world saying this drug never caused anyone to commit suicide or homicide or lose the ability to make love is worthless if 12 people listening to the story figure there is no other way to explain what happened except that this drug caused or played a huge part in that event.

They have to be brave people, as they will likely have to accept that in coming to this verdict they acknowledge that pretty well the entire medical literature on these drugs is ghost-written and there is no access to the clinical trial data and FDA or whichever medicines regulator they have is more concerned about the health of a drug than their health.

You can’t fool all of the people all of the time, especially when you collect them together in a jury or citizen’s assembly.  Especially when these are drugs their sons and daughters are taking in ever increasing amounts, and they see marriages being laid waste to, pregnancies compromised and lives lost.  Something will give.

Magic is from Venus offers a view on what might make a difference

Coda

This Algorithm is from Mars post has been delayed because it grew and grew and will be revisited in posts to come.  To my surprise there have been previous similar posts – see

What Happened?

Something Happened to Science and to Us

Something Happened to Science

Something Happened Neo-Medicalism

Decernimus ergo Summus

 

To The Last Breath

This photo is of Terence MacSwiney, in 1920 Lord Mayor of Cork in Ireland. The featured photograph on the blog front page is also of MacSwiney in October 1920.

The plan was to end this series of posts starting with Being Black and Janet’s email to me I can’t Breathe with a final post Drawing Breath. The series with its promised completely unrealistic but only possible denouement will now run on to one more post – Agorithms are from Mars, Magic from Venus.

Sarah

One of the most telling comments on any post in this blog since it began in 2012 or so was from Sarah under I Can’t Breathe II . The full comment is worth reading, the punch line is here:

What is the point if the perpetrator of our distress is at home in a blister pack on the bedside table?

A perpetrator who is commonly white – definitely not black.  A perpetrator who must be male as everyone is obsessed with his potency, which is viewed with awe and is allowed to sweep aside all other considerations

Annie

This was followed up with a comment by Annie after I Can’t Breathe III who noted Emma Walmsley, CEO of GlaxoSmithKline – a company that began making baby milk:

“Since February, the highest levels of our company have been working to understand and address what happened,” GSK CEO Emma Walmsley wrote in a note to employees. “Protecting the woman who came forward and her privacy has been a critical priority throughout this time. This will continue. I respect and admire her courage and strength. I’ve spent many nights lately putting myself in her shoes. More than anything, this simply should not have happened.”

We are in an age of progress with a female CEO, growing ranks of female leaders, new commitments to diverse representation, and a culture that values speaking up,”

On a personal level, I am shocked and angry about all of this, but I’m resolute,” Walmsley added. “I want to be clear that sexual harassment is strictly prohibited and will not be tolerated.”

Walmsley added that GSK will rename its Slaoui Center for Vaccines Research in Rockville, Md.  See Silverman report in Stat on a senior GSK employee who had abused women.

It would have been wonderful if Witty, the former CEO, and then Walmsley spent the occasional night putting themselves in the shoes of all the people who have committed suicide on their drugs – bupropion, paroxetine and lamotrigine – or the shoes of those whose lives have been destroyed by voracious sexual promiscuity caused by ropinirole marketed for restless legs.  Perhaps they figure they’ve evened the risk-benefit balance by wiping out sexual function completely for so many with paroxetine.

As Micky Nardo put it in Sex, Lies and Videotape:

The most obscene version was GSK settling a $3B suit and signing this agreement – then writing a response in a letter to the Chronicle of Higher Education that denies admission of guilt [see the only enduring contract…]. The way this China-gate story is going, it doesn’t at this point look like that’s going to be an option. This is just plain old crime, and one that has the Chinese up in arms [as it should].

Crazy Shrink

Being Black asked is there a way to end this lunacy and imagined one of the scenarios facing a black man, arbitrarily picked on by the police as so many are.

The very best therapy for the homicidal thoughts that would result would be to go down to a police station, walk in, tell them you have been left feeling homicidal by what they have done but thanks for this chance to get it off your chest.  Almost no-one who knows about these things, black, white, male, female figures that doing something like this is a recipe for anything other than disaster.  The system just will not work for a black man.

The most sensible comment I got was there might be mileage to be made from someone going to the police-station and getting themselves videoed and explaining at the door its just too dangerous to go inside and outlining what would be likely to happen before trying to leave and walk home. This might bring some relief.

Would a video like this trigger a useful response – by which I mean help change anything more than marching up and down behind a Black Lives Matter banner?

The system doesn’t work for women either.  I’m not in a position to tell if its worse for Black men or for White women.

The trick for both is knowing what to do that might make a difference.

This is the same problem faced by those who are Drug Wrecked – who may be the most unfortunate group.

People with Enduring Sexual Dysfunctions get openly sneered at by healthcare professionals.

Grieving parents seeking to bring some good out of the death of a child at the hands of a drug destroying the mind of their own child, or someone else’s child leading to a manic killing spree, find themselves up against what can only laughingly be called ‘due process’.

They find their obvious truth pitted against a ghostwritten and fraudulent literature that Courts psychotically designate as science.  See There is no Sanity Claus.

If any family members ever participated in a clinical trial, they may now realise that in so doing they put their family, friends and communities in a state of legal jeopardy.  They did so when they signed a consent form that lets some company claim it has a duty never to show their data to anyone.

A Reverse Boycott

When grappling with the English, the Irish invented a few things such as the boycott. A few posts from 2013 put the idea of a Reverse Boycott on the map – see Let’s do the Abbvie again.

A reverse boycott means as many people as possible writing to companies with names attached and indicating a willingness to come into court and testify that there was no other way to explain this death.

There is no point sending a report on a drug or vaccine to regulators (anyone sending any Covid vaccine reports to CDC or EMA or MHRA – forget it its pointless).  The regulator will simply file all reports away in cabinets or on hard drives but will never make a judgement about cause and effect.

As Stephen O’Neill’s case and others documented extraordinarily on AntiDepAware show, there is no point having coroners assess a death that involves a drug at an inquest. They do not routinely note the drugs a person is on at the time of death and are too scared to make the obvious call themselves.

Much better to send any report to the company, who have a legal duty to assess and make a judgement of cause and effect.  See American Woman 1 and American Woman II.

Over a decade ago, some corporate lawyers began telling some company personnel never to make a judgement of cause and effect. But the law hasn’t changed, so instead companies now try to get you to report to regulators like FDA or EMA rather than to them – and, stupidly, we have been falling for this in ever greater numbers. These seemingly enlightened companies know exactly what they are doing when they encourage us to report to regulators rather than to them –  avoid the conflict of interest of sending it to us.  This is getting us to pour water into sand rather than leading to a determinations of cause and effect that might end up in the drug label.

Half-truths are more dangerous than lies

Illustration: Humira: Half-Truths, © 2013 created by Billiam James .

Hunger Strike

The Irish also invented the hunger strike.  Whether reverse boycotts or hunger strikes, the drug wrecked among us and our families need some very public gestures like these now.

There are countless families like the O’Neill’s where a family member has clearly died a horrific death as a result of an SSRI, doxycycline or one of over 100 other drugs given to her or him a short while before that can cause suicide. See The Death of Stephen O’Neill and The Perfect Killing Machine.

In all cases, there is a doctor who fails to step up to the plate and support the family in forcing regulators and politicians to acknowledge that drugs are poisons out of which good can come if used with great care. Someone who has the guts to say unfortunately in this case there has been a poisoning and I feel obliged to tell my colleagues, other prescribers of poisons like me, they need to know about this.  See High Noon and Do not Forsake me Oh my Doctor.

Instead, the efforts of regulators, and politicians, geared to letting companies hide the fact that the blister-pack contains a poison within, can continue unhampered by doctors and coroners. Not surprisingly, an ever increasing number of people are getting poisoned, including more and more young people.

It needs something like a hunger strike.

Terence MacSwiney pictured above, was the Lord Mayor of Cork in 1920, when Ireland were trying to pull away from England. He was sentenced to two years in prison in Brixton, London, for having Irish Republican articles in his possession. He went on hunger-strike. The British State became catatonic. Shamed by world opinion from Australia to South America, with a boycott of British goods by America, the Brits were petrified to let him go and unable to do anything. He died after 74 days on hunger strike, giving rise to a new mantra of Irish nationalism as he did:

It is not those who can inflict the most, but those who can suffer the most who will prevail

MacSwiney’s assumption here is that suffering in silence at home is worthless as the following quote brings out and as the people of Myanmar understand.

I am confident that my death will do more to smash the British Empire than my release

Ireland became a Free State seventeen months after his death.

George Floyd didn’t go out of his way to suffer but owing to his family’s efforts on his behalf and the quick wittedness of 17-year old Darnella who turned on her video camera, perhaps in death he too will prevail.

MacSwiney influenced many people. Among them was Ho Chi Minh, who went on against extraordinary odds to liberate Vietnam.

Another was Gandhi, who liberated India.

Another Hunger Strike made Michelle O’Neill deputy first minister of Northern Ireland – maybe the O’Neill’s need to think about this if Stephen O’Neill’s death is to smash the conspiracy of silence that surrounds the number of deaths from drug wrecks each year which is vastly greater than, multiples of, the numbers of women murdered each year by men.

Or do politicians end up like Lilly CEO Randall Tobias whose wife Marilyn committed suicide four weeks after going on Prozac didn’t stop him continuing to act as the sales front for Prozac.  Kathryn Taurel, the wife of Lilly’s subsequent CEO also appears to have committed suicide.  (Randall lost a later senior Washington job in the Bush administration for his involvement with an escort service).

It doesn’t have to be a Hunger Strike but we do have to have something that will reach the doctors who are currently failing us to at least as great an extent as the police are failing black people.

It should be win-win because if doctors don’t step up this plate, they are likely to go out of business pretty soon.  Any doctor sitting comfortably, who doesn’t spot why they are all but certain to go out business if they keep going on the way they are, should read Shipwreck.

I can’t breathe III

This post follows on Being Black, I can’t breathe and I can’t breathe II and will be followed by Drawing Breath (I and maybe II).  Patsy Stephenson has managed to wriggle her way in again, see comments on I can’t breathe II.  Whether she managed to stage this photo or not, as a red-head Patsy has had to live with a terrible stigma – although perhaps not as bad for a woman.

Another Game in Town

I can’t breathe II features women and antidepressants.  Why the mass consumption of numbing agents?  With benzos, it was men handing them out.  With SSRIs its other women handing them out.  (While more likely to get headline abuse from their fathers, daughters are more likely to be trapped in an ongoing struggle with their mothers).

Women and ADHD is another game in town.  This used to be a disorder of young boys until Lilly started to market Adult ADHD.  Adult ADHD is not the same condition as hyperactivity in young boys.  People with childhood ADHD do not become Adult ADHD. See NZ ADHD.

Over 80% of childhood cases are boys, easily recognisable by their bee in a jam-jar activity level.  But over 60% of cases in adults are women.  Adult ADHD is not a disease – there is no disease in medicine that changes sex ratio like this, never mind so dramatically.

There is no disease in medicine where it was possible to run a simple back of an envelope experiment in 2010 in North Wales, a part of the world that had no Adult ADHD then, where doctors responded saying they didn’t believe there was such a thing, but at the same time indicating they expected that in five years from then they would be diagnosing this condition and prescribing for it. And they are.  See Adult ADHD.

There are other ways to frame things like ADHD. It can be seen as extraversion, something to cherish, an indicator of creativity.  Why would women not want to be creative?  Success in life is about finding the right relationship and work niches to make the gifts we have work for us and others rather than Stepfordizing ourselves.

It seems many of us view being damaged as the way to go. Especially women. Granted there is the possibility of weight loss on stimulants and society puts tremendous pressure on women to be svelte.

Whether extraverted or introverted, women are supposed to be able to multi-task.  Having a stimulant induced increase in focus, an increase in stereotyped looping, sounds like giving up on a birth-right.  Unless being a woman has lost its appeal.

Rapid Onset Gender Dysphoria

One of the most striking phenomena of recent times is Rapid Onset Gender Dysphoria.

Transgender states have been around for a long time. Men, mostly older men, have figured that being a woman, or something like a woman, was very appealing. And for some men, the switch seems to work well.

There are profound poorly understood issues here.

What is novel and unprecedented is a surge in the last decade of teenage girls who want to be…  It’s not even want to be boys. It seems more just don’t want to be girls.  Teenage girls are now transitioning in ever increasing numbers, unchecked by anyone – their parents, the culture, medicine, anyone.

See Transgender Meds and Snakes in a Love Drug 2.

They are also detransitioning in ever increasing numbers, leaving both themselves and the transgender community pretty confused.

Rapid Onset Death Wish

The most confusing of all is the young women seeking medically assisted dying in Belgium and the Netherlands supposedly for Treatment Resistant Depression (TRD) and soon in Canada and elsewhere.  TRD is not a real illness – See MAiD in Canada and M.A.D. Treatment Resistant Depression.  TRD is primarily caused by the psychotropic treatments these young women have been previously given.

Antidepressants are now the second most commonly taken drugs by adolescent women, who migrate into their early twenties on them – with heading toward 25% of women in their twenties on them.

The clinical trials of antidepressant drugs for ‘depressed’ adolescents are the greatest concentration of negative trials for anything ever in human history.  Essentially 30 out of 30 trials done are negative, including the two trials that got Prozac (fluoxetine) licensed.  Prozac has more negative trials in this age group than any other drug.  See Adolescent Antidepressant Trials.

In the Treatment of Adolescent Depression Study (TADS), a supposedly independent study of fluoxetine compared to placebo, there were 34 suicidal events on Prozac compared to 3 on placebo in the trial.  All written out of the script – saved in an obscure hiding place by Goran Hogberg. It appears that the data for this trial, sold as an independent, supposed National Institute of Health trial (conducted on Lilly forms and paper) has now been destroyed.  A euphemistic way of saying….

Young women given antidepressants for the last twenty years in ever increasing amounts stood very little chance of being helped.  Not being helped these days is not a recipe for your drug being stopped at some point.  Instead, mood stabilisers and stimulants get added into the mix.  The upshot of this is Treatment Resistant Depression and Medically Assisted Death.

Young White women go along with this while Black and Muslim women have so far been more cautious but are now coming under pressure, from members of their own communities sent to medical school, to drop their stone-age attitudes. Black and Muslim women are now doing it to Black and Muslim women.

Consumerism?

We have moved into a world of Medical Consumerism. MAiD, medical assistance in dying, is an ultimate expression of this.

Gender dysphoria seems like another. Medical advances appear to make it possible for the health industries to do anything to us and our bodies.  Change sex?  Sure, step this way.  Become invulnerable like Achilles?  No problem

There has always been some degree of medical consumerism, albeit against a background of things that were more readily distinguishable from current fashions. The Treatment Resistant Depression that now leads to MAiD, which according to industry is close to epidemic, is not a fashion.  It is caused by meds and before MAiD used to lead to ECT and still does.  Some services turned requests for ECT for these patients down on the basis they were unlikely to respond but this becomes more difficult if both doctor and patient are signed up to the idea. And its women mainly. If we are willing to fry the brains of people unlikely to benefit from ECT, if they insist on it, are we going to say no to MAiD?  Maybe a few times, until we get used to it.

This scenario portrays women as helpless – consumed by Vampires. Is this all there is to it?

Young women have also been ignored visionaries from Cassandra in Troy, to the young women in Fatima who put sexual abuse on the radar for the Catholic Church and didn’t back down where Freud did, and the young women who seem to have prophesied the Rwandan massacres.

Greta Thunberg now looks more like a leader for our times than pretty well anyone in political office at the moment.

While some young women lead, others are left choking on the air they breathe, or perhaps today its their pills, inhaled on the cultural air they breathe.  What would have to happen for them all – Black, Muslim, Asian, and White – to breathe more freely?

 

I can’t breathe II

This post continues a sequence that began with Being Black and I can’t breathe. and will be continued with I can’t breathe III and Drawing Breath. 

The picture features Patsy Stephenson, one of a well-heeled group of women, including Kate Middleton – likely there for the photo-op – protesting the death of Sarah Everard in London, killed for walking down a suburban street at the wrong time. Whether they are black or white, young or old, Muslim, Christian, Jew or nothing, women like Sarah Everard are in a similar position to George Floyd.  Patsy isn’t in this position but the photo is eye-catching. 

If someone in a group said they had AIDs, others would likely get nervous.  If they add, they are on Triple Therapy everyone relaxes.

If someone said they have epilepsy but manage it without anticonvulsants, everyone would get nervous. If they say ‘only joking, I’m taking an anticonvulsant’, everyone relaxes.  (Even though lots of epilepsy can be managed without meds and the meds double the risk of suicidal or homicidal outbursts).

If a woman says she is taking an SSRI, everyone relaxes.

As though this demonstrates her competence and reduces the threat to everyone else – the men anyway, perhaps other women. In the case of other women, the reassurance may lie in ‘she’s one of us, she’s on the pills.’

It was a woman explained this to me, a psychiatrist, who was taking meds.

Forty years ago, saying you were on Valium was an admission of weakness. Feminists fought against the subjugation of women by drugs.  Ironically the benzodiazepines were more likely to lead women to rebel against the patriarchy than any SSRI does.

SSRIs are Stepford drugs blunting awkward emotions – all emotions that is.

But saying you take an SSRI, if you are a woman, is a statement of competence.

Among a younger generation of white women taking an SSRI has moved beyond being a statement of competence.  Good for you if along with eating the right foods, spending hours in the gym, you not just admit but declare you are taking Zoloft, Lexapro or whatever.  Their 800,000 followers cheer Influencers on Instagram who make declarations like this.

The word depression may slip in somewhere, but SSRIs don’t treat depressive illness. As Joe Davis in Chemically Imbalanced explains, really what is being said is I am treating a glitch – just like I wear glasses – that is holding me back from seeing and being seen properly. Holding me back from being my true self.

SSRIs numb us, ease the pain. They make us more authentically us in the way alcohol does.  At the moment, non-white and non-Christian groups are less likely to buy into this, just as they are less likely to buy into alcohol.  You are supposed to have a community for times like this when you need support.

SSRIs though give lots of people the impression they treat an illness.  They do treat an illness – it’s called dependence.  Miss your pills for a few days, and we feel desperately ill, which getting back on our pills magically relieves.  The extreme form of this illness is called Treatment Resistant Depression.

Because so many figure the pills are saving their lives (by relieving withdrawal), if anyone questions these pills, without any bidding from pharma or their doctors, millions of defenders will march out to say these pills saved their lives.  Close to 15% of the population at the latest estimate.

The Dark is for Mushrooms

Close to 25% of the population of women of child-bearing years are defenders. The last group you’d expect to insist on access to meds they might not be able to get off. Meds that double the rate of miscarriages, and double the rate of birth defects. They also drastically lower libido and make love-making a chore, so maybe miscarriage and birth defects are not an issue.

The defenders of the meds, decent progressive women, portray comments like this is an attack on a woman’s right, duty, to look after herself.  Women are too quick to sacrifice themselves for others and this has to stop.  Calls for women to think twice before taking drugs that will make them feel better are now a touch twentieth century, second millennium even, we are told.  Time to move on.

This is today’s equivalent of Edward Bernays organizing for women to march down the street smoking – as a sign of liberation, equality and access to opportunity.  See

The Dark is for Mushrooms

Preventing Precaution 

Mumsnet

Herding Women

Looking after themselves conflicts with the instincts of many women (instincts put there just by the patriarchy?) to take themselves off drugs when they find out they are pregnant, even when male ObGyns are telling them its fine to stay on treatment and an untreated illness can harm their baby more than the meds.

The ObGyns are offering quintessential neo-Medicalism (aka neo-Liberalism) as outlined in Shipwreck of the Singular. There cannot be any clearer divide between how we once thought and the neo-Medical/Liberal way of thinking than the question of taking drugs in pregnancy.  It runs smack into Margaret Thatcher’s ‘there is no such thing as society’.

A pregnancy is either an embryonic society or a weird and inexplicable weight gain that happens to some chromosomally compromised individuals.

That progressive women in particular should buy into the no such thing as society mantra shows how much the Left or progressivism has lost its way.

There is a lot going on in between the lines here.  Sure there are women who have to insist they are diseased and need treatment, maybe never taking the drugs, in order to get benefits.  Telling them they are not depressed is like whipping a lifebelt away from them.  And it’s not sin to trumpet a disorder which you are now treating in order to maintain some self-respect.  And there are times when the termination of a pregnancy may be the best option.

But there is very little sign of the women’s movement saying to women – sure play the game but remember it is a game. The women’s movement now buys into Evidence Based Medicine and believes the Fake literature (entirely ghost-written literature on drugs with zero access to clinical trial data) is the best evidence we have. Our Bodies Ourselves is now an outsourced marketing arm of Pharma. The movement is petrified of being branded Anti-Vaxx or Anti-Science. Settle for anything other than the full scientific deal – Us? No Way!

A Seat at the Table

The medical model emerged around the same time, or just before capitalism – a movement that figured on making money out of producing goods. Capitalism was and is different to mercantilism or Free Trade and has nothing to do with neo-Liberalism. See Shipwreck of the Singular.

Capitalism was novel and successful – leading to great increases in wealth and goods so much so that, while some of us rejected capitalists, most of us who weren’t capitalists figured it was worth having a seat at this table.  All could benefit from this engine which did seem to driving us ‘forward in an acceptable direction’.

Socialism (including trade unionism) was all about having a seat at the table. The communists in contrast figured we needed a completely new set up.  Socialists figured there was absolutely no point in not being at the table – so much so they executed communists like Rosa Luxembourg.

The medical model was the Table within health.  It produced solid advances in our understanding putting us in a position to correct things and able to choose whether to take a poison or undergo a mutilation in order to correct something that would otherwise kill and disable us.  It gave us new abilities to investigate things and intervene so that for most of us having a seat at this table was a no brainer.

Through to 1980 – 1990, medicine and capitalism increased health and wealth.  Within medicine the AIDs pandemic is the best example of what could be done.  An intense mobilization by activists (lay people with the disease who mostly believed in the medical model) led in remarkably short time to a life-saver if not a complete cure. The activists split into two groups – those looking for a seat at the table (mostly male) who went into FDA and got clinical trial rules and FDA culture changed and those who rejected the entire way medicine was going and called for a totally new set-up (many more women in the mix).

AIDs activism was the final flourish of medicine as was.  The vast majority of people now taking poisons have nothing wrong with them – something inconceivable in medical model terms.

Medicine has given way to a neo-Medicalism just as Capitalism has given way to neo-Liberalism.  Now financialization leads to money chasing money while poverty rises, and pharmaceuticalization has led to drugs chasing drugs while life expectancies fall.

Socialists hung around at the table too long and embraced the operationalism that made neo-Liberalism, figuring as Maggie said ‘there is no alternative’.

The Vanished

Now that the table has vanished – neither wealth nor health is increasing – socialists have no idea what do.  Their ongoing defence of the once very reasonable idea that it is important to have a seat at the table now validates a system that is causing increasing harm.

The idea of a medical model that underpins the giving of a poison or performance of a mutilation within a relationship that is at least semi-genuine still offers a glimmer of what a table we could all get around might look like.

As things stand women seem among the most likely to get cut by the cutting edge of the operationalism that underpins both neo-Medicalism and neo-Liberalism. Their music, art and science vanishes as though written on water. They too can vanish and no-one much is bothered.

Women though may be better placed than men to work out what needs to happen next. For centuries, they have been forced to figure its better have a seat at the table the men are seated around than not. Even when the cost is getting abused, or vanishing while walking down suburban streets in daylight

We can’t go back to the 1980s.  We have to go forward.  We need to redefine what a seat at the table should look like and unless the table and seating works for women, black, white and brown, rich and poor, old and young, its not likely to be a table worth sitting at.

Drawing Breath in two posts time will offer what seems to me a crazily idealistic proposal about what the table might look like – but the only viable proposal.

 

I can’t breathe

On Wednesday February 10, I gave a lecture at the Therapeutics Initiative (the T.I.) in Vancouver about the Permanent Sexual Dysfunctions SSRIs and other drugs can cause.  See Sex and Evidence Based Medicine.

The damage done by these drugs often extends beyond a total and complete inability to feel sexual desire and pleasure to a total inability to feel pleasure of any sort and a profound loss of identity – a living death.

These Enduring Sexual Dysfunctions affect black, brown, yellow, and white.  They affect rich and poor.  Women and men. Young and old.  No group on earth is spared – although at the moment white people are bearing the brunt of this plague.

The February lecture makes clear that, while the conspiracy theories some white people have that they are being replaced are crazy, the enduring sexual dysfunctions are bringing about just this in reality.

White people are replacing themselves because so many of them are taking these drugs that close to 1 in 5 of them can no longer make love or when they do if they get pregnant the drugs double the rates of miscarriage, and double the rates at which any children born will be autistic, hyperactive, debilitatingly anxious from a young age or have serious cardiac or other physical defects.

White people are in the firing line because of their collective and individual belief in the promise of technical progress.  Black people are still more likely to turn to their people, a community, for support, and Muslims turn to the Ummah, which means roughly what The Invisible Body used to mean for Catholics.  No Protestants and probably few Christians of any sort under the age of 40 have any sense of what an Invisible Body might be.

I’m not bothered by White people being replaced.  I am bothered by the people with enduring sexual dysfunctions who are in touch with me who kill themselves or seek Medical Assistance in Dying for this or the related Treatment Resistant Depression.

The February lecture has introduced a censorship into the T.I. because 2 of the 300 people in attendance objected to one slide featuring the Real President of the United States. The version of the lecture now on the T.I. site no longer features the original slide (number 10). For weeks until a compromise was reached, T.I were happy to cut the slide and with it the chunk of lecture that went with it without which the lecture doesn’t make sense – this was one of the two ventricles that kept the heart of this talk beating.

They are now planning to join the pharmaceutical industry in screening everybody’s slides before they give a talk.

A slide that once would probably have given Donald fond memories – available on Sex and Evidence Based Medicine. – caused more concern than the serial and increasing deaths of young people who die because of their accurate perception that no-one gives a fuck and the system is going to do nothing to try and solve the problem.  Die because they get laughed at by doctors, and other healthcare staff.

I can’t breathe

On Wednesday February 10, as I gave this lecture, Janet, a mother in America, working in a senior healthcare post, found herself unable to breathe.  She had been emailing me regularly for over a year saying this day would come.  She emailed me when she caught a breath.

I can’t breathe my baby is gone due to medicine that was supposed to help him. He is in God’s arms but I want him here.

Her 20 year old son, Jordan, who had Post-SSRI Sexual Dysfunction (PSSD) had taken his own life as she had known for over a year he would.

If it was my son, I’d imagine I’d have homicidal thoughts, like many black people have after encounters with the police, Being Black, and I can imagine it might be difficult for me not to act on them.

Medical Kidnap

S, a young woman, somehow plucked up the courage to come to me some years ago, trusting her parents who both worked in healthcare.

She had been shy and anxious starting a new job and mentioned this to a family doctor who showed more wisdom than most and reassured her that he would support her. But on another visit to the clinic a different doctor supported her in a different way – giving her an SSRI.

She disintegrated rapidly, ending up in hospital, diagnosed as schizophrenic and given a cocktail of drugs every one of which made her worse.  Her father, a doctor, was powerless to help. He rapidly became viewed by the system as part of the problem rather than the solution which he sensed lay in the opposite direction to what the system seemed hellbent on pursuing.

There are nearly 30 posts under the Medical Kidnap heading on the RxISK blog all powerful and some of the earliest ones in particular featuring Teresa Pocock and S in Kidnapped Daughter, Kidnapped Daughter 2 are chilling.

Her parents finally got S back.  Badly damaged.  They figured they had no option but to take her out of the country and finally to bring her to see me.

She has remained drug free ever since and has slowly recovered from a lot of physical damage and even more damage to her confidence.

Years later, she remains as unwilling to see any doctor for anything as Barack Obama in shabby clothes, or Joe Biden if he were black, or any real black man would be to walk into a police station and mention they were having homicidal thoughts after being jumped on by some policemen a few weeks before – see Being Black.

She is just one of many people I know in a similar situation – people who might make a bad mistake in response to an invitation to come along and see one of our doctors, and say ‘I’d sooner die than go to see Dr X’.  Its not safe dealing with health systems these days.  Most people don’t know this.  A growing number have learnt the hard way.

Discarded by GSK

Last week, RxISK told Shane Cooke’s shocking story in Discarded by GSK.  Here was a young man driven into a delirious state by a drug.  It should have been clear to those treating him the drug was causing his problem.

An idiot of a judge jailed him for two years when he had done relatively minor damage to the property of a service who said they would help him, but made everything worse at every step, and in the end refused to help at all despite every wall of its buildings being festooned with slogans like We Help because We Care.

Shane’s case echoes that of the Guildford Four – four innocent Irish people jailed by a corrupt English police and legal system that wanted to be seen to have caught and incarcerated people no matter – any Irish fucker would do.

Gerry Conlon, one of the four, the hero of the movie In the Name of the Father never recovered even after they won their freedom 15 years later despite the very heights of the British legal system making it clear that they should stay in prison, even if innocent, in order that the public doesn’t lose confidence in the police.

Shane was imprisoned in order that the public doesn’t lose confidence in its drugs.

Most Irish people know where they were when the Guildford Four were released just as most Black people (and lots of others) know where they were when Barack Obama came out on a Chicago stage as President Elect. But Irish people, as my Black arm-wrestler made clear to me (Being Black) have never had to put up with anything like what Black people have to put up with.

The one moment my arm wrestler showed some discomfort was when I mentioned that the horrors the Irish have been through haven’t made us nice people – we are among the most bigoted, and racist people on earth in my opinion. He couldn’t accept that this might be true for Black people also – even some of them.

In my opinion Black people in general are a lot more decent than white people but being oppressed does nothing good for the soul.  Being an oppressor does nothing good for the soul either.

Shane’s life was destroyed by prescription drugs.  If I were him I’d have been very inclined to give the system a legitimate reason to jail me.  But what Shane is now doing shows that somehow some of us rise above unimaginable setbacks and get to a point of doing things to help others.

Black, or Indian, or Part of the System?

Some will never get a chance to give back – see The Man who Thinks he is a Monster.

James Holmes was put on Zoloft for shyness by a University shrink, who cranked the dose up as he tried to intimate that things were going badly wrong. She told him anything that happened was his responsibility.

What happened was 12 people died and 70 were badly injured at a premiere of Dark Knight Rises in Aurora Colorado in 2012.

Holmes was innocent (in my opinion – having spent time with him). But he is now serving the third longest sentence in US history because his public defenders felt they couldn’t persuade a jury that the entire literature on which all doctors depend is a Fake Literature, ghost written, sometimes claiming a drug works well and is entirely safe when FDA know the trial data is negative and points to serious problems but they say nothing.

How do you take a jury to a point like this.  In New South Wales in 2001, a prosecutor (like Kamala Harris once was) told the judge it was obvious this man, David Hawkins, didn’t kill his wife. The Zoloft he was on was responsible.  Hawkins walked free.

My Black man and every one else featured in this post and me and many of the rest of us figure we have to stick to due process – take our grievance to the law rather than take the law into our own hands.  Pretty well no-one knows that when it comes to the effects of drugs the legal system is entirely corrupted and will jail us rather than let people lose confidence in their drugs.

Rather than let a jury and the media hear that the entire literature on these drugs is ghostwritten etc, prosecutors like Kamala Harris do a deal with the defence to lock someone away till after the earth has burnt to a cinder in exchange for not-executing them – even when someone like James Holmes would have preferred to be executed.

The families and friends of everyone killed or injured in Aurora are being denied the truth of what led to these deaths and injuries.

Kamala – are you Black or Indian or part of the System?  What about you Alexandria?

Brenda Hale, a.k.a Spiderwoman, until recently the Chair of the UK Supreme Court was  viewed as the bravest women in Britain in 2019 when she faced down the government.  But when it comes to the Holmes, Cooke and O’Neill issues which call into question the capacity of the justice system to do what it is supposed to do without fear or favour, Brenda is a System woman – see  The Perfect Killing Machine and There is no Sanity Claus.

Shipwrecked Heroines

There are many heroines, and a few heroes, in Shipwreck of the Singular. Right up there at the top of the list is Anne-Marie Kelly.  (This post might have worked well for International Woman’s Day except that tokenism is exactly what these issues do not need).

Put on an SSRI she became alcoholic, lost her job and ended up with a criminal record and jail sentence for annoying the police. She figured the Paxil she was on was causing the problem but got laughed at by her doctor and then by Alcoholics Anonymous, who told her that her thinking proved she was an alcoholic.

As things fell apart, without any background in healthcare, and even though an early school drop-out, she began researching SSRIs and worked out exactly what was happening and how to put it right – teaching me things about the Serotonin system in which I have a PhD.

Leaving me figuring that Motivation counts for more than Expertise.

She too was jailed by a miserable magistrate and had her appeal to have her criminal record overturned by an equally miserable and self-righteous judge who paid no heed to the fact that while almost no-one else agreed with her, the pharmaceutical industry did agree and were developing drugs based on her ideas as her expert report pointed out.  The failure of her Appeal made it impossible to get a job.

Reflecting on an unbelievable nightmare, kept going perhaps to some extent by the fact that telling her story has saved hundreds of others, helping them to pull themselves out of a downward spiral into chaos and disaster, her view is

I think we are all here to learn about the difference between love and hate. Our existence is to teach love to one another‘.

Shipwreck takes on the issues in Being Black and makes the claim that whether we are Black or White, Female or Male, Old or Young, Rich or Poor, the most profound divide between us is the divide between the Fortunate and the Unfortunate.

Not even losers like the company of losers. The ultimate losers in our society are the Drug Wrecked. They have had acid thrown in their face.  They need to find an Ummah, a People, an Invisible Body.

Even more than those afflicted with AIDS in the 1980s and 1990s, the pioneers in doing this have been the Indian women disfigured by acid thrown in their faces who have found each other and provide a support they can get from nowhere else.

This world desperately needs heroism like this, leadership like this – from the bottom up – rather than looking to experts or those who claim to represent ‘us’ but increasingly make vassals of us.

Being Black

You’re a black man walking down a street with a friend.  A cop car pulls up and two cops get out and spread-eagle you and your friend up against the car or a wall. They rough you up while they search you.  You ask why have they stopped you and they say they don’t need to tell you.

[There are moves toward having police wear bodycams that record exactly what happens but you can learn to be threatening in more subtle ways than the transparent ways we once had].

Okay you don’t look like you’re a doctor but you are in your early 50s so you’re not likely to be up to much that the cops would be interested in.

Worse still, a few weeks later two cops call to your house by mistake. Spread-eagle you on the floor.  When you ask what is going on, they say White Privilege.  We can do this to any black fucker we want to.

Leaves you feeling homicidal.  This is a problem for you because you do have a background.  Where you came from insults like this get sorted out and its not by due process.

Maybe because you know you have retaliated in the past, in lets say a manly way, you are now worried.  Homicidal thoughts are no good.

You go along to the ER where a doc assesses you. He’s not white which may play a part in his difficulty. He doesn’t think you’re mad.  No voices, no delusions, no craziness. He offers you some Seroquel which gets dished out by the bucket load in prison.

You get bounced to a shrink.

Crazy Shrink

Just your luck, you meet a crazy shrink.  The dude listens and says hey you’re not crazy.  Homicidal thoughts in a situation like this are not a crime and not a sign of insanity.

Said he’d felt this way often about the management in his hospital.  Usen’t to be like this but was getting more like this every day in schools and universities and healthcare and he figured loads more people were getting to know what it was like to feel homicidal.  Better to know what it was like to have homicidal thoughts before he died than not, he said.  Silver lining to the cloud.

And with all that black lives stuff going on, he said, you’ve got to deal not only with what happened but also with constant reminders of it.

Black Lives crap you say.  They march up and down.  They preach.  But they ain’t getting anywhere are they?

No he agrees.

Ultimate Crazy

Then out comes the ultimate crazy.

What he says if you were to go down to the cop-shop and go in and say to the guy behind the counter in the lightest way you can with a gentle, open kind of smile –

‘Hey man, this is going to sound crazy but I’m doing it on my doctor’s instructions.  He said the next time I have the homicidal thoughts to come down to you guys and tell you.  They started happening after two episodes a while back and come in waves.  He said I should just mention them to you and then walk back home again and I’d feel much better.  So I’ve done it and I’ll head home now and see if he’s right’.

Crazy man. He did say, though, check it through with some friends before doing anything.

He also said he’d give me a letter on University headed notepaper with my name on it and his signature at the end of it saying that he had indeed said just this.  I was welcome to show it to the cops if they looked like they weren’t pleased at the idea of switching jobs from cops to therapists.

There’s some White Privilege thinking.

Hey dude even if nothing went wrong, they’d put a note in my record saying black dude turned up saying he was homicidal.  Next time the guys jump on me in street they’d see it there in my record.  I might be shot in self-defence before any questions are asked.

They almost certainly wouldn’t let me walk out.  They’d call the Regional Assertive Community Team specially put in place for homicidal people who would have no option but to lock me up in hospital for observation.

That didn’t stop him – you’d have my letter with my phone number on it.  They’d have to call him, he said.

He keeps telling his friends who are also homicidal about the management, he said, never let them refer you to occupational health.  Occie health are not going to say its managements fault – they will locate the problem in you, give you pills, sign you off work. That will be the end of you.  No-one will pay any heed to you again ever. You might as well kill yourself – hey the pills might even prompt you to do just this.

What, he said, if you got away with it – you have a friend with you and we have a camera crew, well maybe just one guy with a phone, to record what you are doing and you do get back out the door in one piece and can record what happened?  This could go viral.  Think of it – every cop-station in America might be ‘visited’.  They might become therapy centres.

What Next

You tell him he’s been very helpful and has given you a lot to think about and now you have to go get some messages for your daughter.

Handy thing about Covid.  It all happens on the phone.  If it was in his office, it could be more difficult to get away.

So what do you do?  Take him up on his offer?  Is there a way to do this without coming out of the cop-shop feet first?

Maybe tell the cops there’s this crazy doc trying to kill you and can they do anything about him.  He said he had homicidal thoughts about the managers of his hospital.  Why didn’t he go down to the cop-shop to relieve his thoughts or into the management office?

Comments

McMaster University like many other institutions in Canada and elsewhere has been responding to the Black Lives Matter movement and looking to get to grips with racism.

In the course of my University work in the last year, I have met and had conversations with many amazing people.  Among them, three black men were unforgettable.  One had Barack Obama levels of reasonableness and generosity of spirit and a deep calmness in the face of extraordinary difficulties.

A second was the one I felt I could most identify with – very human.

The third was maybe the healthiest. Talking to him was like arm-wrestling, with him grinning because he figured there was no way he could lose.  He would not concede the Irish experience at the hands of the English was remotely like the Black experience. Nor that black women had it any harder or even as hard as black men.

All three have shaped this post which is not about any one person.

This blog gets some marvellous comments from people who have tuned into its quirks.  It would be great if regular contributors could save any comments for next week.  This post needs comments from people who have never been near here before.  A follow up post will be open to all and will bring up similar issues.

The issues here lie at the heart of Shipwreck of the Singular  which asks if being black is the worst thing that can happen someone.

 

 

Medically Assisted Death in Canada

Policy Options, a Canadian forum, published the piece below by Jocelyn Downie, David Wright and Mona Gupta, all of whom I know, as a contribution to a wider debate on the Medical Assistance in Dying (MAiD) legislation currently under review in Canada, and especially the question of where does mental illness fit into this mix.  The Downie and colleagues published piece is HERE.

The focus in this debate so far has been on the individual seeking MAiD which the Downie piece brings out.  Mental Illness does bring individual irrationality into the frame.  But is it just the person with a so-called mental illness.  What about their doctors?  While there are many great people in Healthcare, the experience of people with ‘mental disorders’ is often that those ‘caring’ for us can be far more murderous – in practice if not by intention – than anyone imagines.  Those caring for us are not always angels – a series of posts on RxISK tagged Medical Kidnap bring this point out.

Policy Options invite submissions but never acknowledged this submission.  I contacted them directly nearly a week later and they said they would pass on this one.  Which left little option but to post here.

What’s the Relationship between Suicide & MAiD?

Jocelyn Downie, David Wright, Mona Gupta

Should people with mental illness as their sole underlying medical condition be allowed to have access to medical assistance in dying (MAiD)? That’s a question in front of Parliament right now. The House of Commons has passed a Bill that excludes MAiD for persons suffering from mental illness as their sole underlying medical condition. The Senate amended that Bill to put a sunset clause on the exclusion (it will cease to have any force and effect 18 months from the coming into force of the Bill). Soon the amended Bill will be back before the House, which will have to decide whether to accept the amendment.

Notably, in its report on Bill C-7, the Senate standing committee on legal and constitutional affairs wrote that some witnesses “underscored that an exclusion and strong safeguards are needed to protect Canadians with mental illness under a MAiD regime, especially given that suicidality may often be a symptom of certain mental illnesses.” Unfortunately, this way of thinking about the relationship between suicide and MAiD confuses more than it clarifies.

Suicidality is associated with certain psychiatric diagnoses, but by no means all or even most of them. Furthermore, not all persons who are suicidal have a mental illness. Rational suicide – the desire for individuals not suffering from a mental illness to end their own lives – has always existed. Indeed, the entire project of MAiD is premised on the idea that there are individuals who under certain circumstances have justifiable reasons to end their own lives. In addition, Parliament has already taken the position that the presence of a mental illness itself does not exclude the possibility of a rational desire to die, as there are people who have already legally accessed MAiD who suffer from both mental illness and physical conditions concurrently. (See the Feb. 2 testimony of Dr. Derryck Smith at the Senate standing committee, at the18:02:40 mark.)

From a clinical point of view, decisions to try to prevent someone from dying are not motivated by the mere presence or absence of a diagnosable mental illness. Rather, we intervene in order to try to modify their specific circumstances, such as a personal crisis, or the acute symptoms of their illness. Our actions also depend on whether the person is able to act in their own interests. We are likely to intervene to prevent the death of a person who is considering suicide when they lack decision-making capacity, for instance when they are severely intoxicated, even if they have no psychiatric history.

By contrast, we do not necessarily intervene to prevent the death of a person who wants to refuse life-sustaining treatment or to access MAiD due to a physical condition even if this person has a concurrent serious, and chronic, psychiatric condition. The answer to the question –does this person have a mental illness? – does not tell us whether we should prevent or assist the person ending their life.

When it comes to mental illness and MAiD, therefore, we must determine whether an individual seeking to bring an end to their life should be prevented from doing so, or not. Trying to decide whether the person is “suicidal” is simply shorthand for talking about the kinds of circumstances previously mentioned – personal crisis, acute episode of illness, incapacity, among others – where collectively, we have already determined that we should intervene to prevent a person from acting. The possibility of permitting some individuals with mental illness to make a request for MAiD does not impede suicide prevention efforts in these kinds of circumstances.

Thus, the statement “suicidal behaviour can often be a symptom of mental illness” is at once too broad and too narrow. It misuses the idea ofa symptom as a proxy for situations in which we want to act to prevent death. And by focusing on only those circumstances in which suicidality is a symptom of a mental illness, it simultaneously ignores the fact that there may also be situations in which we want to prevent death amongst those with no diagnosed mental illness at all.

By legalizing MAiD, Canadian Parliament has already decided that, in certain circumstances, it is acceptable to assist someone to die. Instead of excluding mental illness through a reflexive association between mental illness and suicide, we propose reframing the debate about MAiD and mental illness by asking: In which circumstances do we, as a society, wish to prevent death? In which circumstances, and under what safeguards, are we prepared to assist its arrival? By avoiding the shortcuts of medical terms, we can clarify what’s at stake and focus the debate on what criteria and safeguards will prevent those deaths that we should prevent.

Assisting Consumerism in Dying (ACiD)

Downie, Wright and Gupta’s points about MAiD centre on issues of capacity and consumerism.

Opting to end a life can indeed be quite rational. The role of medicine in their model is primarily to decide whether the person deciding to end their life has the capacity to do so.  The focus is on the consumer of a medical service.

This neglects physicians. Medicine is the perfect place for a murderer to hide and medicine may have or have had more doctors who murder their patients than the Catholic Church has had paedophile priests.  See Robert Kaplan’s Medical Murder – the image above is Harold Shipman, one of the cases he deals with.  For these doctors, MAiD will be a godsend. There have always been physicians who find the removal of a healthy limb in someone with apotemnophilia technically satisfying. For the technician in some doctors, MAiD will be also satisfying.

Some physicians opt to do labioplasties and sculpt breasts rather than repair perforated duodenal ulcers but most distinguish between plastic and cosmetic surgery. The wider public view it as in the public interest to financially support the restoration of someone disfigured, perhaps while working on our behalf as a firefighter for instance, to something more like their normal self.  We hope that in so doing s/he will be better able to contribute to the greater good. We sense, in contrast, that individuals seeking cosmesis should pay for themselves.

MAiD in the case of someone with terminal Motor Neurone Disease is something many doctors and a wider public would quietly support, but can we avoid paving way to cosmetic or romantic deaths?

For some decades, bioethicists have been concerned that doctors exercise ever less discretion in their dealings with us. Pharmaceutical corporations certainly believe that few doctors have a thought in their minds not put there by them or their competitors.

Company control has extended from the primary consumer, the doctor, to us who go to doctors having diagnosed ourselves with ADHD, ASD (autistic spectrum disorder) or other conditions, based on marketing materials put in our way by pharmaceutical companies. These diagnoses are fashionable and can suck people in, young people in particular, in the way cults do. While some doctors will try to persuade us that consumerism and poisons (medicines) or mutilations (surgery) are not natural bedfellows, and some of us can be persuaded, an increasing number of us complain if we are not given what we want. We have the rating scale score, where’s our drug?

We are now in a world of medical neo-liberalism. Health services have replaced Healthcare.  We face Margaret Thatcher’s phrase of the 1980s – there is no alternative to the logic of the market. While clearly every case must be dealt with on its merits, are we saying anything goes? If anything goes, the strongest players in the game will give us as many disorders as they can and hook us into as many medical services as possible, even assisted dying.

In the case of patients with significant disabilities induced by treatment such as Enduring Sexual Dysfunction or Treatment Resistant Depression, who seek MAiD, will the panels see it as their brief to do anything about this? It’s difficult to imagine MAiD panels raising concerns about companies in the case of patients with lung or other cancers caused by tobacco or other carcinogens. Who benefits from viewing the administration of lethal agents in these circumstances as just a technical operation without entailing wider obligations?

MAiD as a health service contrasts with Healthcare which traditionally has been about relationships that enable people to endure and ‘heal’ – even when the condition is terminal. This is not something technicians or panels can deliver.

It has seemed appropriate to reserve the extreme form of caring that MAiD involves to illnesses rather than distress and extreme illnesses rather than just any disorder.

It has seemed appropriate to have a sanction of murder in place when a doctor supports a patient in this way requiring others to decide if this constituted care. It makes sense not to drag all doctors caring in this way through a murder trial, but by exactly how much do we want to loosen this sanction? Do we want doctors to simply carry out a technical procedure without engaging in the wider issues on behalf of their patient?

Coda

This is where the submission to Policy Options ends.  The original submission had Robert Kaplan’s book in mind but did not mention it.

MAiD can be an act of caring – it can also be the ultimate symbol of the Medical Consumerism whose rise and growing force Shipwreck of the Singular charts and attempts to tackle

Having walked across Sydney Harbour Bridge yoked to Jocelyn Downie I have a permanent attachment to Jocelyn and I know both David and Mona from 20 years ago when I was having difficulties in Toronto – so this comment is not aimed at them in any way.  It reflects my surprise at what seems to be a blind spot in the debate so far.

Finally one of the main driving force behind the debate in Canada – or perhaps that should be braking force is Trudo Lemmens who has been raising concerns for several years about these issues – see Here for his latest.  I know Trudo from 20 years ago also – when Jocelyn, David, Mona and both he and I were all on the same side as I’m sure most people in these debates actually are.  The trick is to avoid one more instance of good intentions leading to a nightmare.

 

MAiD in Canada: Enduring Sexual Dysfunctions


See accompanying MAiD in Canada and TRD.
Illustration: Lost in Medication © created by Billiam James

Canada put Medical Assistance in Dying (MAiD) legislation in place in June 2016. This allowed for medical assistance in dying in cases where death was reasonably foreseeable. In 2019, in Truchon v Attorney General of Canada, the Superior Court of Québec declared the “reasonable foreseeability” criterion unconstitutional. This decision forced a review of the original legislation.

The original legislation required an individual to have a “grievous and irremediable medical condition,” meaning that a person:

  • has a serious and incurable illness, disease or disability,
  • is in an advanced state of decline in capabilities that cannot be reversed,
  • experiences unbearable physical or psychological suffering from an illness, disease, disability or state of decline that cannot be relieved under conditions that the person considers acceptable,
  • is at a point where their natural death has become reasonably foreseeable, taking into account all medical circumstances, and not requiring a specific prognosis as to how long they have left to live.

The review proposed to:

“retain all existing eligibility criteria but would remove the requirement for “reasonable foreseeability of natural death”. It would also expressly exclude persons suffering solely from mental illness”.

An amendment eliminating the exclusion of people with mental illness was proposed by Senator Stan Kutcher, arguing that mental illness is as real as physical illness, that it can lead to great distress and routinely leads to people attempting to take their own life.

The arguments against this amendment express concerns that people with mental disorders may be pressured to opt for death, essentially for the convenience of others and of services that are not adequately funded.

MAiD and Sexual Dysfunction

On February 10th 2021, the Therapeutics Initiative in Vancouver hosted David Healy from McMaster University in a webinar entitled Sex and Evidence Based Medicine.

The full lecture, with text and slides are available Here.

Post SSRI Sexual Dysfunction (PSSD) is one of a number of enduring sexual dysfunction syndromes that include Persistent Genital Arousal Disorder (PGAD), Post Finasteride Syndrome (PFS) and Post Retinoid Sexual Dysfunction (PRSD).  These states are triggered by treatment and will endure for decades after treatment stops in most cases.

Enduring sexual dysfunction does not convey the horror of the conditions, which typically produce numb genitals, an inability to orgasm, a profound loss of libido and a more general emotional disconnection or anhedonia.

In the case of PGAD, women faced with the opposite problem of irritable or painful genitals resort to having the nerves to their pudendal area cut or to clitoridectomy to manage the discomfort. None of these options help.

There are no cures for these conditions. The distress is great. There are no remedies for the distress. Medical services do not recognize the conditions, even though as of 2020 drug labels do, and healthcare staff routinely ridicule patients adding to the distress. Aware that there are no cures and no prospects of a cure, some patients know to me have committed suicide. Others known to me have explored the possibility of medically assisted dying.

Pharmaceutical companies have known about the risks for decades.  Regulators had reports of these conditions in the mid-1980s. Neither warned the public or doctors. As a result, hundreds of thousands have ended up taking antidepressants, isotretinoin (for acne) and finasteride (for hair loss), many very young, who in many instances did not need these treatments and might not have opted to take them if decently informed.

At present there are approaching 100 Canadians with known PSSD and over 700 with known PGAD and a further cohort of people with either PFS or PRSD.

This is a significant underestimate of the numbers who likely have these conditions but don’t yet know about them.  PSSD and PGAD typically declare themselves when patients stop treatment and on-treatment sexual dysfunction continues and often gets worse.

Roughly 15% of Canadians take antidepressants (5 million people), a majority of whom do so because they cannot stop (c 3 million). If they could stop, many would expect the sexual dysfunction caused by being on treatment to improve but just the opposite is likely to happen for some people.

MAiD & Enduring Sexual Dysfunction 1

The Enduring Sexual Dysfunction Syndromes are serious and incurable physical illnesses.

They are not mental disorders. They are the physical consequences of treatments some of which are given for mental disorders and others for physical conditions.

The distress they cause appears to be as intense as is the distress caused by conditions that have hitherto led people to seek out MAiD when death is reasonably foreseeable.

There are at present no prospects of a cure for these conditions or for relief from distress.  Well-intentioned efforts to help are likely to compound the problems and sap rather than support the resilience of those affected.

MAiD & Enduring Sexual Dysfunction 2

In addition to concerns about poor services that might push people toward MAiD, the Enduring Sexual Dysfunction Syndromes suggest another factor should be considered.

These illnesses result in part because the medical literature on on-patent drugs is ghost-written and there is no access to the data from healthy volunteer and clinical trials that were undertaken to bring these drugs on the market.

Access to the trial and related data might have made these hazards clear and made for different conversations between doctors and patients.

The distress patients with Enduring Sexual Dysfunctions experience stems not just from ridicule at the hands of healthcare personnel but from a profound sense of being deceived. This sense of being deceived underpins a perception that our institutions have no incentive to find a remedy.  For pharmaceutical companies to research the problems would require an admission their treatments and practices cause the problem. Tobacco and recent finasteride litigations have shown they are unwilling to do this.

Senator Kutcher was an ‘author’ on a famous study of paroxetine given to children commonly referred to as Study 329. The paper was ghostwritten. It is unlikely he has had access to the trial data other than the patients he himself entered into the study. Study 329 led New York State to file a fraud action against GlaxoSmithKline, the makers of paroxetine. Based on Study 329, the US Department of Justice later took an action against GlaxoSmithKline that in 2012 resulted in the then largest sum handed over to resolve a corporate case of this kind – $3 Billion (USD).

The process of ghostwriting articles and sequestering clinical trial data began in earnest a little over 30 years ago. Since then, the time between doctors becoming aware of and generally accepting that the treatments they use come with specific hazards has increased from roughly a year or two to several decades. For PSSD, PGAD and related conditions this interval between first description and recognition is now three decades and counting.

Canadian patients with Enduring Sexual Dysfunctions are certain to seek MAiD because of the distress occasioned by their condition. They have been put in this position by practices that prioritize commercial considerations over scientific, moral, or clinical considerations.

When considering MAiD for PSSD if this is the patient’s wish, perhaps doctors should be willing to support death by hunger strike outside the headquarters of the company making the drug that caused the condition, or the university/hospital that condones practices like those Senator Kutcher engaged in.

David Healy MD         February 17th 2021.

This post is one of two attachments to a letter to 3 Canadian Members of Parliament.

For those new to the Enduring Sexual Dysfunctions – PSSD, PGAD, PFS and PRSD – there is a page about them on RxISK.org along with a good deal of published literature that can be downloaded.  There are many additional posts on RxISK about both these conditions and Treatment Resistant Depression.

 

 

 

 

Sex and Evidence Based Medicine

The University of British Columbia in Vancouver hosts The Therapeutics Initiative an independent group who evaluate all medicines for effectiveness, harms and value in a regular series of Drugs Bulletins dealing with new drugs or emerging problems with older drugs.

They were set up in 1994 just when evaluations of this type and Drugs Bulletins were falling out of favour.  When we were only going to be allowed Good News about drugs in Guidelines with major medical journals increasingly scared to publish about the harms. We would all be in trouble without T.I. who do the world a favour not just people in British Columbia.

Alan Cassels, who will be known to many as the author of Selling Sickness, Seeking Sickness and many other ahead of their time books is a key member of the T.I. group producing many of the Drugs Bulletins.  Alan became aware of Post SSRI Sexual Dysfunction (PSSD) and related sexual problems through the efforts and bravery of Canadian sufferers like Emily Gray, who has helped set up a network of Canadian PSSD sufferers, whose efforts helped prompt Health Canada to recognize the condition.

On the back of this, Alan invited me to talk at one of the regular educational sessions T.I. run. The talk happened on February 10th and the video will be on the T.I. site imminently.

It is also here and on the Shipwreck of the Singular site
Sex and Evidence Based Medicine.

The Text for the talk that contains a little bit more than appeared in the lecture is here – Life is a Bidet Old Chum.

The Talk Slides are here – Evidence Based Medicine Shipwrecked.

Sex and Evidence Based Medicine is an element of the broader Shipwreck of the Singular argument, which is that Evidence Based Medicine is leading us astray.

It would be great if any readers having listened to the lecture can disseminate the material as far and wide as possible.  Better again, disseminate everything and then listen.

David Healy

 

High Noon: Do Not Forsake Me, Oh My….?

In early December 2020, Ian and Tania Morgan had to attend the inquest of their son Samuel in Swansea, South Wales.  Sam died in January 2020, a week after he had been put on citalopram by his family doctor, Dr Adams.

Sam was pretty close to a healthy volunteer. A 25 year old, sporty, successful at College, with a girlfriend – there was very little wrong with him.  He likely went through a week of excruciating torture before hanging himself in the stairwell of his parents house where his mother found him.

Ian Morgan approached me and I offered to write a report for them.  The Morgans were initially surprised that Sam might even think about an antidepressant for a degree of exam related anxiety.  After his death, they found that NICE Guidance recommends review after a week.  They met with Dr Adams and became aware Sam had not be scheduled for a follow-up visit at a week. They were inclined to blame Dr Adams.

My view was that from the medical notes I’d seen, Dr Adams appeared to be a good doctor and they would do better getting him onside. If both he and they blamed the drug someone might have to do something.  I emailed Dr Adams inviting him, given the clarity of this case, to bring some good out of a grim situation.

He responded which suggests he is a decent man.  The response was non-committal – as advised by his defence lawyer.  See Email, Dr Adams Response, Healy Rejoinder.

I wrote a report stating that it seemed very clear that his antidepressant had killed Samuel Morgan. Morgan Inquest Report. The report also noted that many healthy volunteer trials of SSRIs in the 1980s had taken place a few miles away from where the inquest was happening, that young men in those became suicidal and that the Welsh Health Secretary Vaughan Gething had been told about this on more than one occasion – I recognise these constraints.

The Coroner, Colin Phillips, also seemed a decent man.  He listened closely to Tania Morgan’s impassioned contribution and didn’t pay too much heed to Dr Adams’ lawyer whose efforts to save his client (and the insurance company money) appear to have consisted primarily in trying to blame Samuel.

Mr Phillips wrote to the family afterwards saying he would submit a Regulation 28 Report to the British drugs regulator, the MHRA.  which coroners can submit when a case suggests to them someone somewhere needs to look at what has gone on and do something.

MHRA had a few weeks to respond.

Dr Adams wrote to NICE, who issue Guidelines for antidepressants suggesting that their advice about review in a week needs to be much more clear.

Mr Phillips letters to the family around this time I am sure were designed to console. They failed.

The MHRA Response from June Raine was entirely predictable.  Depression is a terrible illness and some people after being put on treatment will be at even higher risk (from their illness is implied).

I wrote to Dr Adam’s and Mr Phillips mentioning that while they were likely well-intentioned, their efforts had made a bad situation worse.  Healy to Adams and Phillips.

Until MHRA and NICE who know that drugs can make healthy volunteers suicidal state this clearly, a doctor like Dr Adams faced with someone like Sam coming back after a week, will likely double the dose of his treatment.

A colleague got in touch about another inquest just happening after what may have been a mirtazapine induced suicide where the doctor brought this point home when stating:

It is not uncommon for a patient to notice that their symptoms may get worse before they get better and so we start with a low dose, monitor and get feedback from the patient in order to titrate the dose if tolerated. 

The lowest doses of citalopram and most SSRIs are in fact staggeringly high – they block the system pretty completely from the get-go.

What doctors need to be told is they should take a lot of care when adding the suicide inducing effects of a drug into the mix for someone who is depressed or anxious.  If they get worse, it is highly likely to be caused by the drug.  It is unlikely to be their illness.

I copied my letter to Dr Adams and Mr Phillips into June Raine of MHRA and to Gillian Leng (CEO) and Sharmila Nebhrajani of NICE.

Mr Phillips has said the matter is closed.

Dr Adams has not replied.

June Raine has been impossible to access.

Nice have said the letter has been forwarded to Gillian and Sharmila.  Both the former CEO and Chair of NICE have been accessed about this before and done nothing – The NICE Before Xmas.  They were men however and one can always hope that women might have more balls than men.

This Town Needs a Sherriff

Alexandria Ocasio-Cortez has just ridden into town across on RxISK – Alexandria Ocasio-Cortez: Courageous, Charismatic, Attractive?

The RxISK post was triggered by her calling out the mob who invaded Capitol Hill for their Abusive behaviour at the time and especially afterwards when their behaviour seemed typical of Sexual Abusers more generally.

She and one or two other politicians seem to have the attractive ability to spell out the obvious – an ability most politicians lack – and attract people to them by doing so.

Vaughan Gething, despite having a picture of the very attractive Martin Luther King on the wall behind his desk, seems devoid of this ability.

I’ve been told its bad form to called AOC or any woman Attractive.  I added that Yannis Varoufakis, one of the people behind the new European political party DIEM, seems Attractive in this sense.

In the sense of being able to attract people to them on an important issue, Michelle O’Neill and Mary-Lou McDonald of Sinn Fein aren’t coming over as very Attractive on this issue at least – even though they had the incentive of the death of a family member –  Stephen O’Neill that featured in these pages earlier this year – The Death of Stephen O’Neill and The Perfect Killing Machine.

If Sinn Fein aren’t going to be just a clone of the other Irish political parties, if DIEM aren’t to just be a clone or other fringe groups on the European political scene or if the Green Parties that Shipwreck appeals to aren’t going to be just the same as the centre right and centre left, someone needs to pick up the gauntlet thrown down in Shipwreck.

Maybe I’m just not Attractive enough – Attractive to Politicians anyway.