I had no reply to the letter sent in September featured in last week’s post – Spotlight on the Politicians. Michelle O’Neill had a nothing response to a letter she sent the Northern Ireland Office. Vaughn Gething’s office (Wales Health Minister), when asked, acknowledged receipt of the letter but figured they had only been sent it for information – there was no need for them to do anything.
Hancock and Ashworth (Labour), Gething and the Northern Irish Office have been sent further letters stating that the original was not just for information – suggesting possible actions.
The driving force behind the O’Neill inquest are a family, especially its women. And this has been replicated in other Irish inquests. Celtic society was matriarchal – the image of Maeve ruler of Connacht above and as the featured image brings this out.
Shane Clancy, from Wicklow just south of Dublin in Ireland, was put on citalopram in 2009. Three weeks later he killed his former girlfriend’s new boyfriend, and injured her and her boyfriend’s brother, before killing himself in a grisly fashion. His mother, Leonie Fennel, was convinced that the citalopram he had been given after she took him to the doctor had changed him utterly and caused the carnage.
The grisly nature of what happened and Leonie’s efforts to make sense of it made this a high-profile case – helped no end by the Professor of Psychiatry in University College Dublin, Patricia Casey, who took to the airwaves to rebut the idea that antidepressants could ever cause anything like this. Casey took part in mobilising the other professors in Ireland to come out as a group saying antidepressants were great wonderful and marvellous – an extraordinary move for any professional body.
I had been raising concerns about SSRI and related antidepressants for several years prior to this, making similar points to those I made in the O’Neill inquest. Patricia Casey was to the forefront in complaining to every journal who published any of my articles.
In 2003, a debate was organised in Dublin on the topic of whether SSRIs can cause suicide. Casey and another colleague, in my opinion heavily briefed by the pharmaceutical industry, made a series of ad hominem attacks without grappling with the issues . They lost the debate.
In the course laying out the issues, I made the point that were any doctor in the audience to end up on the wrong side of a death or injury caused by an antidepressant they had prescribed, they could turn to me for expert input – that I would say they had been kept in the dark, there was no access to the trial data and all articles on the drugs in question where ghost-written, hyping the benefits and hiding the harms and this was not widely known. This was 2003.
After Shane’s death, there was an inquest in Wicklow in 2009. The coroner convened a jury of Wicklow townspeople – men and women with an average age in their 50s. I submitted a report and gave evidence. Casey was present but not called to give evidence. The jury returned a verdict that Shane Clancy had not committed suicide.
Following this, Leonie took her concerns to Irish politicians but got nowhere. She approached the Archbishop of Dublin and later Jose Mario Bergoglio – but got nowhere.
Ten years later, at the O’Neill inquest, Stephen’s family asked for a jury but were not granted one.
In 2013, Stephanie and John Lynch, from Dublin, found themselves facing an inquest, when their son Jake, aged 14, was put on Prozac and a few weeks later shot himself with a gun. They turned to Leonie for support. I offered a view that this would not have happened had he not been put on Prozac. The Dublin-based Health Service Executive (HSE) defended the input of their clinicians who had noted Jake’s mounting concerns on treatment but responded that this would wear off. The HSE argued simply that Prozac was an approved drug for children.
The Irish Medicines Board said there had been concerns about this group of drugs in 2004 but further results had shown Prozac to be safe. There are now 7 trials of Prozac – all of them negative, all of them showing increased suicidality – in one trial 34 suicidal events linked to Prozac versus 3 on placebo.
Jake’s inquest began at the end of May 2014. It ended in October 2015. A protracted process. The Lynches retained a well-known and costly lawyer who didn’t seem to me to have a good grasp of the issues.
Just before the end, the coroner was inclined to return a verdict of suicide but changed his mind after being shown an email Jake wrote to a friend the night before he died:
“They have me on anti anxiety stuff which they did not tell me was an antidepressant, I feel drugged out of my mind that I am trying to suppress all these bad feelings”.
The coroner said,
“this changes everything, this child does not meet the criteria for suicide so I cannot record a suicide verdict. Jake was not in his right mind but I will not elaborate on the medication”.
He asked the family if they would like an Open or narrative verdict. They asked for and got an Open verdict but the death certificate underneath that stated “Self inflicted gunshot wound to head”.
After the inquest, the Lynches approached Sinn Fein, the only political party that has representation in both the North and South of Ireland, who worked with them to introduce “Jake’s Amendment” into the Irish Senate in 2018.
The amendment wanted to add an option to make possible the recognition of treatment induced death – a reasonable option if the labels of these drugs now state in some countries that these drugs can cause death. And of course there are many deaths other than death by one’s own hand these drugs can cause.
When first introduced the amendment had cross-party support. The second reading however appears to have been ambushed and the amendment failed. The then Minister of Health, James O’Reilly, was a doctor and it appears that his view was that the amendment would open doctors to lawsuits.
Stephanie and John later met the Minister for Justice, Charlie Flanagan, and the lead coroner who both informed them there would never be such a verdict, as it leaves prescribers open to lawsuits, even though the amendment states ‘without apportioning blame’. The verdict they wanted is covered under medical misadventure, they were told. It was also suggested that if it was money the family were after, they could take a civil case.
The role of doctors in what’s going on here is perhaps best brought out by Patricia Casey. In addition to speaking out about the unalloyed benefits of antidepressants, for years Casey was perhaps Ireland’s most prominent pro-life medical campaigner. Several years ago following verdicts in a series of birth defect cases involving paroxetine in the USA, leading GSK to hand over more than a billion dollars to families, I drew her attention to the literature showing that SSRIs could cause miscarriages, birth defects and increased rates of voluntary terminations, inviting her to help me raise awareness of these issues. When asked to choose between her Catholicism and her Psychotropism, the psychotropics won out.
Knights in Shining Armour
These issues all feed into the O’Neill inquest covered in these recent posts. In all these cases, it is families, commonly their womenfolk taking the lead, who pick up the gauntlet the system has thrown down.
It seems they can’t depend on politicians, or the clergy but then almost by definition people who go into politics or the clerical life do so because they are not pickers up of gauntlets.
In the English speaking world (not the Irish), damsels in distress once used to be saved by Knights, champions, who picked up the gauntlet for them. If it is not to be women alone, where might these Knights come from?
Doctors are the obvious candidates but when you need them they somehow manage to be hidden behind the arras or wherever.
A doctor, Erling Oksenholt, however, gave a great example of just what a doctor could do if they summoned their courage to the sticking point.
In 1981, Oksenholt, based in Seattle, was sued by a patient who went blind after he put her on Myambutol for tuberculosis. After settling with her for $100,000, he sued Lederle Laboratories for withholding information their drug could cause blindness. He won $50,000 in damages, an unspecified amount for future loss of earnings and $5 million in punitive damages.
It needs the Dr Brannigans of this world, who prescribed to Jake McGill Lynch, Shane Clancy and Stephen O’Neill to agree at inquests and elsewhere that it looks like the drug they put their patients on caused a death – and a horrible one at that – and that these deaths in great part stemmed from the fact that critical information was withheld from the doctor and patient – information that might have made all the difference.
When Shane Clancy died there were a lot of treatment induced deaths every year but now our life expectancy is falling. At some point soon, doctors if they are going to continue in business are going to have to come out from behind the arras and screw their courage up to the sticking point.
But as we’ve seen there is something about becoming a doctor (knight), now, perhaps shrinks especially, that can trump Catholicism and pretty well every other deeply held belief, and perhaps even trump the courage of women.
Maybe knights are a bit twentieth century:
The BBC Spotlight on the Troubles series on which this series of posts is based had 7 episodes and then an astonishing behind the scenes episode that must have left everyone who saw it wondering whose side any of the participants in the Troubles were really on.
Nest week Spotlight on the Suicides: Behind the Scenes.