The recent FDA Panel on SSRIs and Pregnancy attracted a scathing Media Response. See Unsafe Safety Systems for 25 responses including the American Psychiatric Association and Britain’s College of Psychiatrists.
For the most part the responses were remarkably similar, displayed complete amnesia for previously accepted facts, and downplayed any risks with phrases like earlier smaller studies hinted at a slight increase in risks but bigger more recent and better conducted studies have cast doubt on this so that nothing is firmly established whereas the fact that suicide is the leading cause of maternal death is established..
As Adam Urato one of the FDA panelists later put it:
This @wbur segment What is the risk of taking antidepressants during pregnancy? running for 6 minutes doesn’t clearly note ANY risks and even walk back Paxil concerns.
This is an example of what I mean when I say that the public is not being accurately informed about the risks of SSRIs in pregnancy.
Those risks are miscarriage, birth defects, preterm birth, low birthweight, preeclampsia, postpartum hemorrhage, & poor neonatal adaptation. The SSRIs also alter fetal brain development, with evidence showing long-term effects on the children including speech/language difficulties, depression, & other neurobehavioral issues.
Artificial Intelligence
The responses were so similar that I began to wonder if they’d all accessed Chat GPT, Co-Pilot or Grok and essentially let them write the piece. One report explicitly says it did this.
Besides the similarities in points made, there was a scripted, A.I. flavor, to the writing – something that Meghan O’Rourke in the New York Times picked out as a feature of A.I. in a recent New York Times article. (Thanks to Grace Jackson for sending this gift link).
It was hard to avoid my A.I. is driving all this impression for another reason. I ended up in a conversation with 4 very sensible, professionals in their early 30s, who are fans of A.I – as almost everyone I know of all ages is and Meghan was for a while.
They’d had reason to ‘do their own research’ on the wisdom of getting maternal vaccines in pregnancy, including RSV vaccines either maternally or in the form of nirsevimab – Beyfortus – the monoclonal antibody (drug not vaccine, which is often ‘sold’ to us as a vaccine) which is given just after birth.
My sensible professionals oral responses uncannily echoed the SSRIs in pregnancy written media coverage, in downplaying any risks with phrases like earlier smaller studies hinted at a slight increase in risks but bigger more recent and better conducted studies along with approval by regulators and widespread uptake have cast doubt on this so that nothing is firmly established whereas the fact that RSV is a dangerous virus and leads to hospitalizations with potentially fatal outcomes is firmly established.
American Chat GPTs don’t make anyone aware that the RSV Vaccine and Beyfortus Drug trials have shown increased rates of pre-eclampsia in the mother along with preterm births and significant jaundice and neonatal deaths in the infants – in order to manage a chesty condition that up till this almost never ever causes deaths in infants from developed countries unless they already have serious additional health problems.
No-one is likely to get any hint that suppressing RSV might lead to MPV infections – which likely killed Pope Francis, who had lots of doctors and widgets at his beck and call. See Who Knew Antibodies could have Antibodies.
Nor are any hints ever likely to come from A.I. that the big players in the field – in this case pharma – have a host of outfits working to them like Sense about Science, who trot out experts to face the media and rubbish anything that attempts to outline possible risks linked to treatments, or Chemrisk who infiltrate pharma partners, in this case APA or ACOG or the Society of Maternal and Fetal medicine, and get statements out that make it look like these organizations (stakeholders in pharma’s distribution channel) all support the fact that antidepressants or vaccines save lives.
I was left feeling that trying to stop young professionals today taking SSRIs or RSV vaccines in pregnancy would be like Canute trying to stop an approaching Tsunami. A.I. is going to lock the door on any possibility of change and make anyone who might demur sound like an anti-vaxxer.
The response of these impressive people could have been scripted by A.I. as Shawn Johnson and Andrew East’s responses about Beyfortus seem to have been.
Shawn:
When they can’t breathe, it’s the scariest thing a parent will ever go through
We definitely did a lot of research as parents having a baby about Beyfortus – whether we should get it or not. Beyfortus helps prevent a serious lung disease caused by RSV for babies under 1
I talked about the common side effects with my babies doctor, my Ob-Gyn, my pediatrician, every on-call pediatrician, they all highly encouraged it
Andrew
Even with food or the sleep-schedule, are you going to do sleep training or not, everyone has a lot of opinions but for us, the people we look up to, and the research we did, it [Beyfortus] was such an easy decision.
Chat GPT etc list the risks of Beyfortus as sore arms, with a hint that other things could happen and if they do consult a doctor. A doctor who is not going to have a clue as to what might be happening you – see Religion and Science.
A Time of Miracles
Back in the 1990s and 2000s we got the internet which caused a buzz quite like today’s A.I. buzz. It was slower to develop as this really was the start of a new era that had to lead through social media before we got to the point we are at now.
People began to do their own research and formed groups like Paxil Progress or followed Charles Medawar’s Social Audit. It looked for all the world as though the internet was going to democratize medicine. It didn’t.
Just as it was new for patients, so too, it was new for companies, who took a little bit more time to find their footing on this new ground. But find their footing they did. When we searched the web for information on the drug we were on, we landed on company sites first, which sounded very patient friendly, even encouraging us to report any side effects to FDA.
These sites peddled the mantra of RCTs being Gold Standard Science. Not a hint that company studies are designed to hide the problems – a Gold Standard Way to Hide Adverse Events. No hint that neither you nor your doctor, nor the publishing journal, nor regulators have access to the data from the studies or can establish the patients even existed. A possible hint at the bottom in small print that the study was ghostwritten – disappearing fast now as A.I. moves in and is putting ghostwriters out of business.
Even I briefly figured that A.I. might be a good thing – it might let people coming to see me or other doctors do their own research and ask more penetrating questions and get decent information. As Adam Urato just 3 weeks ago said – ‘Information is Key’.
Rather than telling people to “do your own research” it’s beginning to look like it might be much better to tell them not to do their research. ‘Information is not Key’.
Religion or Science
It’s terribly difficult to know what to make of the supposed miraculous transformation of water into wine at the Wedding Feast at Cana – some 2000 years ago. This rabbit out of a hat trick stands almost completely at odds with everything Xt said.
Two thousand years later, in 1979, a important medical case unfolded. Raphael Osheroff, a successful nephrologist became depressed and was persuaded by his doctor and others to get admitted to Chestnut Lodge Hospital in Maryland. Over several months, he deteriorated badly, lost several stone in weight, became unkempt and disheveled with feet that were bleeding from agitated pacing. His family rescued him and brought him to Silver Hill Hospital.
Chestnut Lodge were true believers in Psychoanalysis for whom antidepressants might be a sticking plaster but were not a cure. The Lodge figured a true cure might take years.
After a few weeks in Silver Hill, where a much more pragmatic psychoanalytically trained doctor started Osheroff on amitriptyline, he was clearly recovering.
Osheroff took a legal action against Chestnut Lodge. This set up a celebrated but misleading debate. The debate lost sight of Osheroff and centered on what, if any, was the true science behind psychiatry. The leading lights of a biological psychiatry, then emerging in the US, were pitched against leading psychoanalysts. On the biomedical side Gerald Klerman framed the debate in terms of Evidence Based Medicine and the right of patients to have treatments proven by science to work.
Antidepressants had been proven to work using gold-standard scientific methods. On the other side, psychoanalysis had not been proven to work and didn’t look like it could ever be proven to work using scientific methods.
Klerman’s argument was the first iteration of the later Pfizer pandemic slogans – Follow the Science, along with Science will Win. This is as much a religious position as the Freudian position was, making biological psychiatry along with psychoanalysis the disease that each claims to be able to treat.
(With thanks for Eric Caplan for all his work on the Osheroff Case).
Following received truths is Religion not Science.
Science starts when the experiment to test a received truth starts. Science starts after you start a drug or a therapy. It aims at achieving a consensus between a doctor or doctors and you and your family or friends on the observables that appear after the experiment starts. Achieving consensus might in the process require a consensus testing of any interim views we have. When a beta-blocker causes a heart rate to increase rather than slow, stopping it might be a better test than doubling the dose.
This should have been easy to do in Raphael Osheroff’s case – a doctor talking to doctors – but the Chestnut Lodge ideologues systematically stripped away Ray’s identity as a doctor.
Science is about achieving a consensus between us on an event in front of us. It is always context dependent. It is not about applying or forcing acceptance of context free truths. ‘Information is not Key’.
The heart of clinical science lies closer to something else Adam Urato said:
“I’ve been taking care of pregnant women in my hometown for the past 20 years. I take care of my patients as if they were my neighbors, because they are my neighbors… A big part of care is giving patients the proper information about risks and benefits of treatment and then supporting their choices”.
It’s right that its her choice but not right if this is seen in terms of an autonomy that makes her liable for whatever goes wrong. Its more about shared consequences and continuity of care.
A.I. and the internet are fundamentally unscientific. They strip away context – they strip away our voice and our doctor’s voice also. Our doctors are increasingly becoming Follow The Science Badge wearing Puppets.
A.I. is a tool that we can access, just as nuclear energy, guns, and medicines are tools. The Magic, or the Miracles lie in us and our use of these tools – not in the tools.
To adapt a phrase from Mahatma Gandhi:
How can those who think they possess absolute truth be fraternal scientific?
The great risk is the Miracle of A.I. will turn the very best Wine into Water.
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