Mid-morning, on Tuesday September 24 2019, Britain was gripped. Lots of people stopped what they were doing and turned their TVs or computers to live feed from the Supreme Court.
Spider Woman (Brenda Hale) was taking on the Joker (Boris Johnson). She punched him in the nose. The Joker had suspended Parliament at a critical moment in the Brexit process. Spider Woman told him what he had done was null and void. Boris (aka the British Government) threatened to change the law to make sure the Supreme Court (Brenda) could never do anything like this again. (He hasn’t so far).
It’s unusual for the Brits to gasp. Even more so in a Court room. But they did. It looked like a cool evisceration by Spider Woman, who instantly became a lot of people’s favourite Super Hero.
I had met Brenda Hale nearly 20 years before when I gave a talk at a law and medicine meeting in Australia at which I presented a Spider Slide that has adorned many of my talks since. It had obvious implications for anything happening on the interface between medicine and law. Brenda was interested. At the time, no-one at the meeting had any idea she was likely to rise to the heights she did and become an honourable lady.
See Does My Bias Look Big in This for the latest incarnation of the Spider Slide.
I contacted Brenda again some years later on the topic of ghostwriting and the implications of this for legal processes. She remembered me and the issues and was still interested but not in a position to do anything.
Following the O’Neill Inquest, in September mulling over who to contact within legal systems who might be able to make a difference, Brenda appeared on my screen. Who better to follow up or get the wider legal system to consider the legal implications of medical ghostwriting for inquests and justice more generally?
Inquests or Show Inquests?
On October 1 2018, Brian who runs AntiDepAware posted Ten Years of Denial. It chilled me to the bone. The first page is reproduced here but the full text complete with photographs of those who died and their coroners is available on Brian’s site.
In October 2008, ten years ago this month, the inquest of 65-year-old Ian Fox, an ex-postal worker, was held at St Pancras Coroner’s Court. Ian had jumped in front of a train at Finchley Road tube station (right). An account of the inquest appeared in the Camden New Journal, under the headline: ‘Wonder drug’ played a part in man taking his own life – coroner.
Ian’s widow Maria told the court that Ian had been prescribed Citalopram for a month before his death, and “had expressed a wish to come off it, complaining of confusion and anxiety.” She said that “until he began taking Citalopram he had only been suffering from mild depression, brought on by retirement from his Royal Mail job and a foot injury. She added that Ian’s action was completely out of character, and said: “I felt Citalopram was to blame for my husband’s death.”
Delivering a narrative verdict, Coroner Andrew Reid (left) ruled that Ian had taken his life, adding: “I’m satisfied he did so while the balance of his mind was disturbed while suffering the adverse effects of Citalopram.”
What is significant about this inquest is that it is the most recent account that I have managed to find online where a British coroner has admitted that Lundbeck’s SSRI antidepressant Citalopram can induce suicide.
The reason why, for the past ten years, coroners have been in denial over the propensity of Citalopram and other SSRI antidepressants to induce suicide may well have emanated from events in Cumbria earlier that year.
In March 2008, an inquest in Cumbria heard that retired bank manager Nigel Woodburn had deliberately driven his car into a tree, four days after having been prescribed Citalopram. Coroner Ian Smith (left) told Nigel’s relatives that he would write to the Committee on the Safety of Medicines (CSM) as “he knew of several other suspected suicides involving the same group of antidepressants, known as selective serotonin re-uptake inhibitors (SSRIs).” He said: “I have to say this is probably the fifth, if not sixth inquest I’ve heard within a period of three years when somebody either just going on to Citalopram or Seroxat, or coming off it, have killed themselves one way or another, totally out of the blue, totally without expectation, without a history of suicidal thoughts in the past.”
The following month, Mr Smith presided over the inquest of 56-year-old farmer Philip Morton, who had been prescribed antidepressants a few days before his death by hanging. Once again, Mr Smith “criticised the use of antidepressants and expressed concerns over a pattern of people taking their own lives days after being prescribed the drugs.”
The report concluded with this extraordinary sentence: “Mr. Smith went on to say that he had dealt with six to eight cases in a short period where people had taken their lives days after starting antidepressant drugs and he had reported these concerns to the health authorities, despite coming under criticism for speaking out.”
I suspect that we will never find out the identity of the person or the organisation that was in such a position of influence that it was able to criticise one of the country’s leading coroners. However, what I do know is that, from that point in time until his retirement in 2014, I found no more reports of Mr Smith’s admitting to the link between SSRIs and suicide, although he was presented with opportunities to do so.
Even at the inquest of 10-year-old schoolboy Harry Hucknell (right) in 2011, Mr Smith decided to “hit out at the pressures placed on youngsters by today’s society,” rather than to blame the lethal combination of Fluoxetine and Ritalin prescribed by a psychiatrist who had clearly flouted NICE Guidelines but, according to Mr Smith, “had acted appropriately”.
Coroners have no box to tick for a prescription drug induced death. Street drug induced death yes but prescripticide no. They don’t collect details of the drugs people were on at the time of their death, an issue that is becoming increasingly important as even before Covid-19 struck, life expectancies were falling and drug induced death had become a leading cause of death – more than Covid-19.
Fair Trials or Show Trials?
This is a much bigger problem than just inquests. The living are in as grim a position as the dead. You cannot now get a fair trial in the UK or anywhere else if a prescription drug is involved.
This was brought home to me in the Holmes case, where a young man facing the death sentence, despite having a very strong drug defence, didn’t have lawyers with the guts to run this defence for him. See Prescription for Murder and The Man who Thinks he is a Monster.
This affects you – not just people in the extreme position James Holmes was in. Whether you die at the hand of someone made delirious by a drug, or by your own hand after you become delirious or die from a drug induced heart attack or stroke, our legal and medical systems are incapable of recognising that when we prescribe we risk killing you or someone you love and in some way the system needs to recognise this.
If we kill or injure you, we will fall over congratulating ourselves on only using MHRA, EMA or FDA approved drugs and for having kept to NICE or other Guidelines, as the coroner and doctors did after the death of Stephen O’Neill – see The Death of Stephen O’Neill and The Perfect Killing Machine.
The idea that the drug we gave you might have killed you is now more unthinkable to those doing any root cause analysis of what happened to you – after your death or injury – as the idea that you might have been poisoned by a Eucharist put in your mouth by a Catholic priest – in lots of places the Church is now producing gluten free Eucharists.
Medicine now shares an increasing amount in common with religion. It deals in sacraments – things that can only do good and cannot harm – where once it had the maturity to deal in poisons.
This problem is getting steadily worse as Brian’s post and Stephen O’Neill’s inquest reveals.
Broach the Brooch
The NICE before Xmas ends with advice for anyone looking for input on the management of SSRI toxicity or toxicity from any drug – don’t bother. You’d be better asking Santa Claus than MHRA or FDA or NICE or any of the other bodies you might instinctively have thought of turning to.
Most of you don’t have access to a Super Hero. But I do. I figured Brenda would be a good person to broach these issues with – if only to find out who she thought might be best placed to take things further.
Her office replied that she would not be responding. This was her response – not an automatic response.
The times are badly out of joint, when taking on the Government looks like an easier thing to do than grappling with such a blatant and scandalous wrong as led to the death of Stephen O’Neill.
We have woven a web from which almost no-one – not the Supreme Court, not the Government, not the Knights of the Realm, not the flower of the medical profession – can see an escape. To escape would involve the Supreme Court, the Knights of the Realm, the Joker and their counterparts throughout the Western world owning up to some inconvenient truths they have been not just party to but worse – made honourable for their efforts in setting up this system.
This is the key dilemma of the times we live in. There is no Escape/Sanity Clause.