An alternate title for this post could have been something like A Medical Yankee in King Charles’ Court or King Donald’s Court – your choice of Kings. The recent Eclipse makes this title timely. An Eclipse also features in the original A Connecticut Yankee in King Arthur’s Court – a take-down of both superstition and science.
Homicide on psychotropic drugs has badly eclipsed Science and Us.
January 24
On the same day and month as Lindsay Clancy, but 6 years earlier in Dublin, Deirdre Morley killed her 3 children.
The lawyers on either side in DM’s case appear to have agreed on a not-guilty by reason of insanity (NGRI) plea. LC’s prosecutors look more gung-ho but this may be a charade for the cameras. For observers both trials look choreographed. In DMs case to produce a pre-ordained outcome. The experts for DM’s defense and prosecution differed only on the diagnosis, one thought bipolar disorder and the other depression. Neither expert talked to the family.
Neither expert asked DM about or mentioned her drugs. Despite 18 months of treatment with SSRIs and other meds, D’s medical file, bar one mention of a possible drug-induced hypomania, records nothing about the drugs other than abrupt starts, stops and dose changes.
Neither sets of lawyers or experts, or the judge or the coroner at an inquest or likely whoever in due course chairs a judicial review, mentioned the medication or appeared to want to have anything to do with asking anything about it. If you’re a pharmaceutical company, you will argue this is as it should be – DM is on trial. The company isn’t and drugs can’t be.
In the Clancy case a ‘toxicologist’ got wheeled in to say her drug levels were too low to be causing anything. There has been a switch in the meaning of the word toxicologist and toxicity here. Back in 1990 it meant someone who dealt with the adverse effects of drugs. Now it means someone who checks drug levels – are they too high (toxic) – its only then apparently that you can get adverse effects,
The maybe hundreds of thousands or people with PSSD, PFS, Visual Snow Syndrome and Protracted Withdrawal Syndromes who have no drug in their body and have had none for years, even decades, know that this is baloney (originally an Irish word that became American). Lawyers get paid fortunes for noticing the possibilities in subtle shifts in word meanings like this.
In the Clancy case I expected more discussion of what gets called the ‘Science’ by which is meant what the clinical trials for various drugs show – another shift in the meaning of words. If there is an apparent Science War, pharma can line up more distinguished ‘scientific experts’ than the defense and chances are experts for the defense will come from outside not just Boston but New England. More likely both sides in practice agreed not to feature the meds, other than in passing.
‘Science stand-offs’ in cases like these are irrelevant. Juries might as well snooze through them. Nothing like this happens in a ‘normal’ murder trial.
In a normal murder trial, the defense don’t that claim whatever clinical trials or epidemiology could be done would show that men, even if they are under severe stress, have a prior criminal record, or a wife no-one likes, don’t on average murder them – therefore you can’t find this man guilty. (Besides this point, pharma trials are pure hearsay). It is not the job for a jury to pass a verdict on what happens in non-existent individuals on average. Their brief is to come to a consensus on whether this individual murdered that individual.
That mothers don’t murder children on average in RCTs and epidemiological studies is irrelevant. Jurors are asked whether DM or LC murdered their children?
When they raised a legitimate question in DM’s case about her intent, the judge who almost certainly couldn’t square a circle that the jurors were right to ask about, using a bunch of words effectively told them to stop asking pertinent questions.
If they can’t agree on a diagnosis (a label), the medical expertise in DM’s case has to be classified as xxxx. Medical students would be failed at their exams for getting a diagnosis wrong. Surely AI could be let swallow DM’s 2000 pages of records and settle the labelling – that could be risky, unless tightly programmed it might ask about the meds.
But getting to a consensus on the label doesn’t establish whether DM or LC was in fact insane and should be found not guilty. Later seemingly cut-and-paste claims in DM’s medical record that she was nihilistically deluded at the key time are at odds with the contemporary evidence for this at the relevant time, which record her as not psychotic.
There was evidence recorded on DM’s phone of her driving crazily, not watching the road, with the radio turned up too loud and her 3-year old daughter telling her to turn it down. This is explicable as a drug effect.
On the day of the event DM crashed her car en route to killing herself and when interviewed by a policeman who knows what has happened says in automaton fashion that she felt she had to do what she did and has no idea why she couldn’t stop herself. This can be explained as a drug induced effect. It is not insanity.
She had to trick her oldest 9 year old child to kill him. He didn’t like what was happening and asked her to stop but she carried on. Not unreasonably the jury found this hard to reconcile with insanity. It does however speak to the destabilization SSRIs can cause.
The Eclipse of Science
There is likely much more evidence for a drug effect than this, by which I mean observations of DM’s behaviour which are the main thing that counts. But no-one seems to have looked in detail at the effects of her drugs on DMs behavior. In respect of the drugs (the possible weapon), and much else, both DM’s and LC’s trials have been close to evidence-free murder trials.
Command hallucinations telling her to kill her children and herself came up in LC’s trial. This is a drug effect that can happen at low doses and is much more common than healthcare staff realise. It was used to justify a diaagnosis of post-partum psychosis.
Science began with a mixture of people in a room observing (common sensing) a demonstration in front of them. Just like a jury in a murder trial, they had to leave all authorities out of the frame and could not appeal to any he-saids or she-saids (hearsay) from people who would not be brought into the room to be cross-examined.
Science and justice operate on the same template. The original consensus (verdict, diagnosis) can be overturned by fresh observables – we reserve the right to change our view if fresh Evident evidence comes to light. Evidence is Evident – See False Friends. Clinical trial datasets abstracted from people and put through a statistical mangle are not scientific evidence. People and the effects of drugs on them are the raw material of clinical science.
The gun that fired the bullet may be an exhibit and ballistics can be brought into the frame at a murder trial. But not clinical trials or biobabble about serotonin levels – still being spewed out in the Clancy case. The observables are SSRI linked sensory muting – jurors could even be put on the drug to demonstrate it – within minutes of swallowing Zoloft.
The consequences of sensory muting can be demonstrated by showing the effects of sensory deprivation tanks on individuals or appealing to a jurors experience of MRI scanners – even getting them to try a Ganzfeld test at home themselves.
People who are sensorily deprived – the central effect an SSRI has that may be helpful or not – don’t become insane but they can show a lot of strange effects, such as command hallucinatios – a voice telling them to kill their children and themselves – consistent with what happened to LC and others. These are effects that psychiatrists or psychologists who know almost nothing about the effects of SSRIs can misinterpret as insanity and don’t link to the meds if the person on treatment mentions them as a defendant – or as a patient.
Science was eclipsed in 1991. In 1990, Evident (scientific) evidence from close clinical observations that Prozac can cause intense suicidal or homicideal ideation that stops when the drug is stopped was reported – Vampire Medicine. In response, Lilly published a paper claiming this Science was baloney – just anecdotes, and the real science was what their clinical trials showed – Innocent Abroad.
The paper published in the BMJ in 1991 in fact shows the new Artefact (the so-called science article) looked at closely had data consistent with the real science – what people were seeing in front of them. These trials showed a statistically significant excess of suicidal events on Prozac compared to placebo.
But ever since then, doctors have looked at, listened to, and smelt us less and less. They now pay approaching zero heed to the observations of those who know us best and can spot changes in us. They think counting angels on the head of a company marketing pin is doing science.
Tom Kingston
Tom Lingston’s case might bring the key points home. See Kingston’s Rule. And Tangled up in Bureaucracy.
There is abundant clinical trial evidence that the drugs Tom was on are on average more likely to lead to suicidal attempts, completed suicides, homicidality and other problems than placebo in the same trials. And an FDA analysis or over 70,000 people in clinical trials shows less than 1 in 6 of us have an unequivocally good response to these treatments – See Good Trips on SSRIs.
All of the above happens on average. The issue at Tom’s inquest was did these drugs cause what happened him. He had been prescribed duloxetine some time before for pain but it hadn’t suited him and he didn’t take it for long. Months later, he was prescribed sertraline, which overlaps with duloxetine. He had a significant adverse response to it, stopped it and came back and told his doctor it didn’t suit him.
She, a doctors catering for people with links to Royality, seemingly oblivious to what SSRIs do – other than magically get people well – acted in a very similar way to the nurse practitioners in Boston treating Lindsay Clancy – she and they stuck to the Pathway. She prescribed citalopram, another SSRI, to which Tom had a catastrophic reaction and he stopped after 1 or 2 pills.
His response to citalopram, a few days before he died, included sitting in a room with business colleagues on a cold and wet winter’s day, clearly looking unwell and asking for the window to be opened. This striking event is a feature of serotonin syndrome. Having details like this is key to making the case that the facts are that these drugs did not suit him and were producing the kinds of reactions that can lead to suicide – or homicide.
People might put Tom’s death down to a high stress job like his or Deirdre Morley’s problems down to being bullied at school. Psychotherapists are the worst for asking about irrelevant childhood events and recording them in files that Pharma read with glee. But these stresses or past events are there all the time for all of us including jurors who will figure they like most of us managed to manage them. The DM, LC, TK question – is why did this event happen now?
Even if there were no clinical trials for these drugs, a jury or an observer should be able to pick out the fact that drugs acting on serotonin did not suit this man. A scientific observer would have looked at, and listened to him, and checked with family – in a way his doctor didn’t. Being able to tell Tom that he was right – and not going insane – that he was suffering from a toxic drug effect and he’d be okay once off the treatment for a few days might have saved his life – and in other cases the lives of others.
Probably stonewalled by companies, regulators like FDA and MHRA tell us they don’t want to warn us, have decided not to tell us something like this can happen, for fear of deterring us from seeking a treatment that doesn’t save lives. They don’t warn us, even though the result might not be our death but the death of our children, the rest of our family, friends or others – along with the death of clinical observing (medical science). MHRA said exactly this to Tom’s parents who might well have been the victims. It’s ludicrous – and illegal in the sense that MHRA have no brief to make judgement calls like this.
What good is a Guideline/Pathway adhering doctor who can’t see what the drug she prescribes is doing to her patient. Who has no curiosity about the effects of these drugs? Se Who Will Make Medicine Great Again.
Another man who killed someone in a car crash was complaining about having to hold a book further away to read it since he went on the pill. Could this be linked? Yes it could, especially if the crash was at night, when pupils which normally constrict when facing car headlights don’t do so. But there is barely a doctor around who seems capable of putting 2 and 2 together.
In addition to sexual problems, SSRI healthy volunteer trials are stuffed full of reports of vision and balance problems. But doctors and the rest of us have got used to calling these side effects, accidental, anecdotal when they are the core action of SSRIs. If there is a benefit for mood or managing stress, this is accidental. SSRIs act on all our sensory receptors. We only have SSRIs because back in the last millennium doctors could see older drugs having these sensory effects. Doctors since 1991 have gone blind.
Giving a drug to a person will always be an experiment. We need our doctors to rediscover their inner clinician and stop being apparatchiks. We need them to observe us (be scientists) again and to recruit those who know us best and us to join in the observing.
Eclipsed
Not only is science being eclipsed along with an ability to spot the bedside perpetrator (the medicine) lurking in the background, but people like Deirdre Morley, Lindsay Clancy, Tom Kingston and others are being eclipsed.
Justice is being eclipsed. Both the legal trials and the treatment trials that take place increasingly look like a Charade (post to follow on RxISK tomorrow).
Mark Twain writing about an irreverent Yankee in the King’s Court over 150 years ago used mumbo-jumbo about an Eclipse to parley his way into royal favor. Eclipses pass.
Thirty-five years after the current Eclipse began we are in a deepening darkness. Is it time to designate this as a new Dark Age, where we can get neither good healthcare nor justice? The two go hand in hand.
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