The Transit of Venus: Autonomy or Nurture?
Venus is the black dot in the upper right quadrant of the sun. The plan was to finish the I Can’t Breathe series with Magic is from Venus but then the word Nurture popped onto my radar. There is a Venus Rising to come.
The word autonomy starts appearing in medicine and in bioethics sometime in the 1950s, give or take a few years, linked to the emergence of Informed Consent. The idea of informed consent took shape in law suits around the treatment of breast cancer and the use of electroconvulsive therapy (ECT) – See Shock Therapy and The Swinging Pendulum. Autonomy originally meant that we had a right, or something like a right, not be interfered with in ways we didn’t agree with.
This was not absolute. Medicine at this time was largely about acute medical care – the treatments that were delivered when people were having heart attacks, strokes, had pneumonias, bowel obstructions or were psychotic. Few people were in much of a position to say ‘wait a minute I want to know all about the options before you do anything’. We took a lot on trust. Autonomy was something more like – we will continue to take most things on trust but we want you to recognise that there is a line you can’t cross without some kind of consent. ‘It may be after the event but get this wrong and we will sue you’.
Sometime in the 1990s, give or take a few years, linked to a rise in medical consumerism, autonomy changed meaning. It was no longer about there is a line you must not cross. It was more about ‘this is what we want even if you don’t think it’s a good idea, hand it over or we will sue you’. The boot was on the other foot.
Doctors were shocked when the first informed consent judgements came down. ‘They can’t be serious was a common response. How on earth can anyone figure that someone off the street can have a view worth taking into account compared with me who has 20 years of medical experience. Informing them – sure I’ll inform them but then they have to consent’.
Doctors more recently have been shocked when the Ontario Supreme Court has handed down verdicts that they have to agree to patients requests for terminations of pregnancy, and gender reassignment or make an effective referral – that is send the patient to someone who will agree. Otherwise, they should give up medicine or if they stay in medicine it should be in pathology or radiology where they will have no patient contact.
As with informed consent where the judgements were handed down for breast cancer treatment and ECT, the Ontario Court’s judgments will apply to Medical Assistance in Dying (MAiD) but also likely to patients coming wanting treatment for ADHD, young people who want antidepressants, and pretty well anyone who figures there is something out there that will enhance their wellbeing.
A change like this looks tectonic – deeper plates on which we are all sitting are shifting and when they butt up against each other they lead to volcanoes or earthquakes (law suits).
Patients to Citizens
Up till 1950, dependence on doctors was largely accepted. The image that appeals to all doctors was Fildes’ painting of the Good Doctor. The image conjured up wisdom, and someone on whom patients and families could depend. A parental presence – someone to step in when parents had reached their limit.
Then came an influx of new treatments – antibiotics after the War, cortisone and the steroid hormones came on stream in 1947, leading to oral contraceptives in 1957. Nitrogen Mustard drugs appeared for cancer (1947), antipsychotics (1952), tranquilizers (1955), anticonvulsants (1955), diuretics (1955), antihypertensives (1957), antidepressants (1957) oral hypoglycemics (1957), and lipid lowering drugs (1960) followed. Death from infection became rare. Mental hospitals began to empty. Unwanted pregnancies were about to plummet even as love became free.
The stigma of disease began to lift. We became citizens of the medical realm rather than subjects – patients. We became far more health literate.
There was an equally profound change in pharmaceutical companies who under new management began to change their mission from helping medicine treat the problems we sought help with to transforming medicine into a distribution channel through which we would get what we thought we wanted – relatively unaware that these wants had been planted in us by pharmaceutical companies.
Citizens to Consumers
We began changing from citizens to something very different – consumers.
The politics began changing as well. For a century, it had made sense for left leaning progressive parties to seek a seat at the capitalist table – the table where everything was being produced from automobiles to televisions to pharmaceuticals.
As the capacity of industries to produce ever more stuff grew, transforming us into an affluent society, it made even more sense for progressives to have a seat at the table. It made sense for industry that is to have progressives at the table as they represented the citizens who would have to become consumers to consume all that was now being produced.
We know the consequences of this in terms of climate change and plastics filling the oceans, the air we breathe, and the breast milk babies now drink.
What has been less obvious is the amount of chemicals we now put in our bodies every day. We have moved from having less than 1 medicine per person on average in the 1960s and then for only short periods of time to most of us having 3 or more every day of the year by the age of 50 and 5 or more every day of the year by the age of 65.
The progressive politicians – Tony Blair and Bill Clinton – got roped into persuading us all to take statins, osteoporosis drugs for minimal bone thinning, blood sugar lowering drugs for what was called Type II Diabetes, along with anti-hypertensives, SSRIs and other drugs – many of which can be almost impossible to stop.
The progressives stood by while industry filled our medical journals with plastic (ghost-written) articles about their drugs while at the same time sequestering clinical trial data. So complicit have the progressives been in this – so at the table while it was happening – it almost impossible for them now to back away from it and deny responsibility.
The result of this was to internalize political problems within each of us – a privatization of public problems. If we were unhealthy it was not down to the fact that 90% of cancers are environmentally caused or that Type II diabetes is down to obesity, bad diets and sedentary lifestyles. The answers to these problems became take a pill. Health has swallowed up religion and politics – or politics has hidden behind health.
This is most obvious in what is called ‘mental health’. To have problems with your mental health now means having a negative emotion. Catatonia, puerperal psychosis, schizophrenia and melancholia, old-style mental illnesses, are no more a matter of having a negative emotion or of being traumatised than dementia paralytica (GPI- tertiary syphilis) was. But just as with these illnesses, if you have a mental health problem now, the number one answer is an antidepressant.
A Crisis
There is a lot of news about sea levels rising and other environmental changes but almost nothing about Life Expectancy stalling or falling as it has been in the US for 10 years before Covid.
A report last week pointed to declining Birth Rates in the US. The commentary was about Covid – some women at least are saying they are holding off getting pregnant because of pandemic uncertainties. This may be true but the decline antedates Covid.
The fall in birth rates in some groups stems back 3 decades and coincides with the introduction of the SSRIs. Besides birth control, antidepressants are now the commonest drugs used by women of child-bearing years. These drugs inhibit sex, increase miscarriages and voluntary terminations. Taken prepubertally or with exposure in utero, they appear capable of producing asexuality. Taken by men, they reduce sperm counts of which we also hear a lot of these days.
While we possibly don’t want more people on earth just at the moment, aggravating climate change, the factors producing this decline in white people (its primarily white people living shorter lives and being less likely to reproduce) are the same factors that are leading to climate change
It’s the belief in technical solutions allied to technical means of evaluations that lose sight of the bigger picture (controlled trials in the case of drugs) and an industrialization process that leads to pretty well the entire medical literature on these drugs being ghost-written and all of the clinical trial data being sequestered, allowing companies to portray their drugs as sacraments – something that can only benefit and cannot harm.
This logic was very clear back in 1995 when The Antidepressant Era was being written. Near the end of the book there is the following:
As with other aspects of the modern marketplace, therapeutics at present seems to be leading to an atomization of distress. Just as the ideal market arrangements would have everyone living in a single’s apartment, each complete with washing machine, dishwasher, fridge-freezer, so also treatment development disconnects individuals from their social milieu.
Followed by this:
For example, in 1982 Jachuk and colleagues looked at the perceptions of doctors, patients and relatives of the effects of antihypertensives. They found the doctors reported 100% efficacy – blood pressure was reduced. The patients were mixed in their views, some reporting benefits and others reporting problems with the medication. Three quarters of the relatives, however, reported that treatment was having an adverse effect – the patient was now complaining of side-effects and the process of diagnosis and treatment had made them hypochondriacal. Whose view is most ecologically valid? If treatment of a disease which wasn’t affecting a family up till then has more effects on a family than the disease itself, who should be making the risk-benefit assessments and what should be put in the equation?
This brings out the social features that were being stripped away. One of the greatest ironies of all was a major study a few years later using the same drugs Jachuk was studying that showed that while the blood pressure figures were going the right way, no lives were being saved.
It’s the same with the antidepressants. There is a net loss in lives from suicide and other causes. It’s one thing to put up with adverse effects if you stand a chance of having your life saved – its quite another if you don’t.
Nurture
Health needs a Greta Thunberg. It needs someone young or Green, or both, who has not been part of the system and can point out the growing lunacy.
It also needs to reject the bait and switch that was autonomy. We have less autonomy now than we once had. None of us make ourselves in splendid isolation. We make and get made in relationships in which we depend on and nurture each other. It takes nurturing to make a citizen.
The problem we are up against is operationalism. This is not a feminist issue as such. It can even co-opt feminism by appearing to promote autonomy (even for women). A recent book Uberland by Alex Rosenblatt (a woman) brings this out beautifully.
When it first appeared operationalism billed itself as a branch of philosophy but it isn’t. It’s pretty well the antithesis of philosophy. It replaces reflection and judgement with operations and reflexes. See Algorithms are from Mars.
Relationships have a basis in something else – that almost dares not speak its name – affection. Care or affection plays a key role in steering us away from reflexes and toward reflection and the kinds of judgement calls that make people.
Autonomy is from Mars, Nurture from Venus. See The Girl who was not Heard.
Illustration: The Doctor’s Nightmare (from Fildes), © 2012 Billiam James
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The line that has been acceptably crossed (or Vallance and Witty would not be courted by GOV.UK and got on one knee with a sword dangling over them)
A nice little series to set the spine-tingling
https://canadafreepress.com/article/the-ghost-writer
Patrick D Hahn author of Prescription for Sorrow – his earlier work :
Series:
Part 1: “I tried killing myself thirty times”
Part 2: “Remarkable efficacy and safety”
Part 3: “An effective drug treatment”
Part 4: The Ghost Writer
Part 5: It’s shameful”
I got something I didn’t know I wanted –
He drew a big circle on an A4 sheet of paper, in a cupboard, in a hospital room – dark green lavatorial green, one small desk, two small chairs, so small our shoulders were almost rubbing.
This is anxiety at the top of the circle, this is depression at the bottom of the circle, and then swish he drew a line across half-way down the edge of his circle – Seroxat, this will break the cycle.
So he had become a salesman for a condition I was unaware of having.
How useful this diagram might have been for me when I was selling and marketing electronic goods in Canada and the US.
Here is your problem Mr. Customer, you at the top, me at the bottom, let’s draw a line across the line of the circle and voile, you know my product is something you need –
Shelley Jofre
This has been described by British psychiatrist Dr. David Healy as “the biggest medical scandal since thalidomide.” Dr. Healy, rather than the regulatory authorities charged with monitoring the safety of medicines, was instrumental in uncovering the evidence at the heart of the scandal. It was a series of U.S. legal actions that led Dr. Healy, as an expert witness, and the legal team with whom he was working, deep into GSK’s secret archives, where they found a series of damning internal documents.
https://corpwatch.org/article/doctoring-evidence-glaxosmithkline-pushes-depression-drug
Far better than Drudge…
Does your Autonomy give Rise to Nurture or even to a bit of – irony…
As someone who worked for years to push for rights to informed consent and the autonomy linked to it I affectionately disagree with some of your points and sincerely hope things won’t go backwards even though there are kickbacks from doctors . The war mongering Tony Blair and co. brought in some control over medics who could until then practice in the way they were taught decades ago without proof of updating knowledge. Hence the norious, amongst campaigners, anger about ‘in my clinical judgement’.They could practice according to their own person value judgments not just clinical judgements whether political; religious; views on family matters ,morals and so on. The idea that people could or can get a second different opinion though is not taking account of the power imbalance wich is still weighed in favour of doctors. I think you over estimate the power of the citizen.Even if just by holding knowledge needed to claim a right – eg in England people were supposed to have the right to choose a service or clinician when mental health was to be treated equitably but studies showed they didn’t inform of that or any other ‘right’.Countless numbers of people have been harmed or died as a result of what is termed ‘poor communication’ rather than more honestly lack of informed consent.. A classic example being a doctor having the right to refuse a termination of pregnancy. They still can refuse to take part as a matter of conscience which few would disagree with.The disagreements about transgender mean one medic can counsel against it ,another prescribe major drugs to teenagers. There doesn’t seem to be an obligation to provide those services or be disciplined if refusing in UK. Affection as akin to caring is not what all doctors feel towards people who consult them though – it’s hard to understand why they go into medicine – maybe affection is too woolly, maybe they can’t stretch the benevolent feeling far enough to want to have a relationship, maybe it’s too much to ask of 10minute consultations . And maybe the public no longer want relationships with doctors as much as before especially when they were part of the same community and known as persons themselves not just doctors It takes two at least to have an affectionate relationship .If the doctors also feel this rlationship is not there any longer the quality of life of a doctor who goes into medicine for the hopefully partnership as well affection with people are likely going to feel angry and confused by the reality of practicing medicine. I guess the next generation won’t change much when they are being led more and more into tech and tele medicine And young people are the ones most into tech and tele – they will understand and accept a different style of practice more easily – Already there are loads of private businesses set up to practice psychiatry mainly by video but also which most of us have no awareness of – in partnership with the NHS. The NHS has already become big business – which has no affection for us
Playing on BBC SOUNDS Anyone who reads the DH Blog will know about the contents of this book Not sure if the author has benefited from what’s already been published but he gave a comprehensive account of the issues So another book and a spot of the radio has alerted more of the public But whether the producer would take it further and interview some who have been harmed is another thing.
Search the BBC
BBC Radio 4
Start the Week
Listen now
The opioid crisis and erosion of trust
Start the Week
The Sackler name is more often associated with philanthropy and lavish donations in the arts and sciences. But the investigative reporter Patrick Radden Keefe tells another story in Empire of Pain. He questions how much of the Sackler wealth was made from the making and aggressive marketing of the painkiller, Oxycontin. He tells Amol Rajan of the misery that has unfolded in today’s opioid crisis – an epidemic of drug addiction which has killed nearly half a million people in the US.
The direct marketing to GPs and advertising campaigns in the US helped to make Oxycontin a hugely popular drug. But in the UK too there are concerns about the over-prescribing of painkillers for long periods of time. Dr Zoe Williams is a GP in South London and presenter of the BBC show, Trust Me I’m a Doctor. As a founding member of the British Society of Lifestyle Medicine she’s pioneering changes to reduce dependency on drugs, and increase take-up of alternative treatments, like exercise.
What happens when people start to mistrust medical authorities is at the heart of Heidi Larson’s work as Director of the Vaccine Confidence Project at the London School of Hygiene & Tropical Medicine. In her latest book, Stuck, she looks at how vaccine reluctance and refusal is no longer limited to the margins of society. As mistrust of the official message and messenger grows so does rumour, conflict and hesitancy.
Producer: Katy Hickman
We’ll Never Walk Alone. Too many of us did. We’ve come far but too many are still walking alone.
Mental Health System: Open Letter to the Media
We, a group of people with first-hand experience of the mental health system, write to express our concern about what we see as one-sided coverage of this system in the media and to draw the attention of civil rights organizations to the systemic discrimination that we witnessed and experienced. We, our loved ones, or inmates in the facilities where we worked, were exploited for monetary gain and victimized in various other ways. We saw how abuse, corruption, and exploitation were covered up, while victims and critics of the system were silenced and marginalized.
EVERYONE WHO BELIEVES THAT THE PROBLEMATIC ASPECTS OF THE MENTAL HEALTH SYSTEM ARE NOT ADEQUATELY REPRESENTED IN THE MEDIA, ARE INVITED TO SIGN THIS LETTER.
Journalists or human-rights activists wishing to confirm the stories reported below are invited to email the contact person listed at the end of this letter. To achieve a balance between protecting our privacy and providing evidence for our statements, we designated this person to serve as mediator. In the text below, we will use initials marked with asterisks to refer to the letter signatories. The contact person will help the interested parties to meet with the relevant people and to procure the documentation supporting our allegations.
Some of us had the rare fortune to encounter a psychiatrist who treated us or our loved ones with kindness, respect, and integrity; some of us saw patients who were helped, not harmed, by the mental health care they received. However, our experiences led us to believe that such cases are exceptions rather than the norm. We believe that the mental health services suffer from deep, systemic problems, and we want to draw public attention to them, to break the wall of silence, and to initiate a discussion as a step towards creating a humane and efficient system.
WE INVITE THE MEDIA, CIVIL RIGHTS ORGANIZATIONS, SUPPORTERS AND CRITICS OF THE CURRENT PSYCHIATRIC SYSTEM, AND THE GENERAL PUBLIC TO DISCUSS THE FOLLOWING POINTS.
Read the entire letter:
https://drive.google.com/file/d/1y8T1tUOax7zdF6Y57e0_kgwq8L4veavs/view?usp=sharing
There’s a bigish list of international signatories with comments already and growing
I went along the second vaccine conyer belt up at Lister House which is the new healthcare center they have put up at Staple Tye here in Harlow Town. I tried to give my books away or at least the ones I own to do with this issue, Pharmaggedon, Anatomy of an Epidemic and others. The doctor fella just took some pictures of said books and gave them back to me in the Coop bag. I’ve read them once I don’t need them any more you can have them I said but they gave them back to me. I mentioned RxISK and Medicating Normal a bit to those present in the building who appeared to have some semblance of medical authority. That’s enough work for me today I hope this second jab doesn’t make me really tired again next week. It’s time for your lunch time supplements Mr. Oxley.
‘Jigsaw Identification’ –
‘The Paroxetine Investigation Case’ – Page …
Michael Grenfell, the CMA’s Executive Director of Enforcement, said:
https://www.gov.uk/government/news/cat-upholds-infringement-decision-for-pay-for-delay-pharma-deals
We welcome the Tribunal’s findings that GSK and a number of generic suppliers broke competition law. These agreements can cost the NHS and taxpayers millions of pounds. Today’s judgment sends out a strong message that agreements between pharmaceutical companies aimed at delaying generic entry are unlawful and won’t be tolerated.
We note that the Tribunal recognises that significant fines were warranted, but are disappointed that it has reduced the fines imposed by the CMA for these serious breaches of competition law. We will now take stock of today’s judgment and carefully consider next steps.
More information on this investigation can be found on the Paroxetine investigation case page.
Ethics Unwrapped
Scandals Illustrated
https://ethicsunwrapped.utexas.edu/video/curbing-corruption
How many ‘Paroxetine Pages’ would they like …
It is surely a noble aim to ‘Nurture’ Doctors – “why did they kill themselves?”
https://blogs.bmj.com/bmj/2021/05/10/clare-gerada-suicide-and-the-myth-of-sisyphus/?utm_source=twitter&utm_medium=social&utm_term=hootsuite&utm_content=sme&utm_campaign=usage
“Some doctors seem to have killed themselves impulsively—made arrangements to meet friends for Sunday lunch, booked courses or holidays, yet instead suddenly changed plans and taken their own lives.”
“ Working as a doctor provides meaning akin to a religious vocation, as emphasised in the Hippocratic oath where doctors pledge to dedicate their life to the service of humanity.”
“often lurking in the background is a trigger –
Medicating Normal was aired last night followed by a Panel Discussion. Miranda Levy, journalist, suffered so badly she has written a book about it, Stevie Lewis, suffered so badly she is an ardent campaigner, Mark Horowitz, suffered so badly he went the extra-mile and mentioned “Pill-Shaming” exposing it as a ‘cheap shot’.
David Healy was a Panel Member.
I’ve never come across a Doctor who needed nurturing, but then again I’ve never come across a Doctor who didn’t play around with deadly drugs.
I don’t think we can even meet in the middle with this when it is the medical profession who have created the current SSRI Epidemic and go about their business as a business without any form of protection for their patients:
People need to be called out when there is a ‘Transit of Venus’ …
James Moore @jf_moore
Join us on May 14 for the next in @Mad_In_America’s series of discussions on psychiatric drug withdrawal. We will be discussing protracted post-withdrawal experiences and our panel is Adele Framer, Will Hall, David Healy and Nicole Lamberson. Register
Certainly did James and it was well worth joining. I think you’ll need a two hour slot next time! Thanks for all your work in this area.
Professor/Dr Healy, you have been on fire, even more than usual these last few weeks. Your writing, and panel discussions have been hard hitting, passionate, shocking. You tell the truth with very little sugar coating.
Watching Dr Healy, Mark Horowitz, Miranda Levy and Stevie Lewis the other night was like watching ‘The Four Muskateers’ all fighting for Justice. There was a unity of purpose which conveyed ‘All for one and one for all. A point was made by’ Maddie’ that Frankie, from the Saturdays, told her 2 million Instagram followers not to miss an AD dose, detailing how awful she felt when she did. Frankie has also publically stated that ADs cause sexual dysfunction. But as she sees the pills as ‘Life saving’ and depression as a life long condition does this infer this is a price worth paying to remain on them?. Also at 30, what might happen should Frankie want children? Will she risk a pregnancy by continuing to stay on theses ‘Life saving Medications…?
Many of us stuck on these pills for 5+,10+15+even 20+years have been enduring sex less relationships, we no absolute hope that if we are brave enough to endure the brutality and uncertainty of withdrawal we can get our libido back. For many of us we were told we had a chemical imbalance, if Insulin caused sexual dysfunction would one still take it to control diabetes? In 2005, a year after I was prescribed Sertraline, having experied complete genital numbing and numbness in my previously sensitive nipples, I asked my young female GP if this feeling of the machine having no battery was down to the Sertraline? I was assured not, it was either my depression or my relationship or both. No amount of mindfulness, date nights, even sex toys could alter a physical deficiency. The Vibrators battery worked, but not yours, your partner doesn:t understand why you dread oral stimulation. You feel totally humiliated and confused as everything, including by now your heart feels numb.dead as a dodo. You can manage sexual intercouse, but it hurts and is pleasure less and your partner feels bad.. He can’t win.. If he makes advances you don’t want sex, if he doesn’t you feel rejected. This goes on week in month in, year in. Until you both stop trying……
Thank you David for calling out the stench of deceit, corruption and greed pervading all areas of ‘The Medical Profession’ and beyond. Once one might have expected honesty, co-operation and benevolence. ‘The poisoners have to Try to have a semblance of a relationship with the poisoned, How true is that… He or she that dares wins… Thank you for being determined to do what is just, and fair… X