A century ago Freud and Jung made us aware of the biases underpinning what patients say. Not everything should be accepted at face value. In particular claims of abuse may not be based on reality. We needed experts – analysts – they claimed, to tease out what is real from what is not.
The Catholic Church was once intensely hostile to Freud, but when it came to child abuse adopting a Freudian approach was very convenient. But while Freud essentially denied that real abuse was taking place and got away with it in his life-time, the Catholic Church has learnt to its cost that many claims of abuse are real.
This intensely dramatic picture shows a former Pope convening the US cardinals in Rome. They were ostensibly there to put the problem of child abuse in the Church to right but it now seems that the meeting was about managing the consequences for the Church rather than for any of its victims.
There is no pope in medicine. The Presidents of National Associations perhaps once came close. Now someone like Andrew Witty comes closest to fitting the bill.
Whatever about a Pope, there are lots of Cardinals. These usually come with the title professor. Just as with the analysts, these professors have had a training that stresses that you cannot believe everything you are faced with. In this case it’s more a matter of not believing the evidence of our own eyes as it is doubt about what someone says. We see patients balloon in weight in front of us or voice suicidal thoughts that clear when the treatment is stopped but the Cardinals are the people who on behalf of the Pope tell us this is not happening.
How often eagerness to see a positive response can mislead
The primary training these Cardinals now get is in evidence based medicine (EBM). Psychoanalysis was once a significant advance, as was EBM. Both made us keenly aware of the biases that both doctors and patients bring to therapy – how often their eagerness to see a positive response to a treatment can mislead them as to what is going on.
Psychoanalysis made us more aware of the importance of fetishes – especially sexual fetishes. A fetish is a part that substitutes for a whole. Adherence to psychoanalysis ultimately itself became a fetish that impaired many doctors’ abilities to engage with the real complaints of their patients.
EBM has fetished RCTs in a way that endangers our ability to handle many of the real problems our patients have and our ability to tackle the abuse to which they are subject.
If the skepticism that underpins controlled trials were applied primarily to the claimed benefits of treatments – the original purpose of these trials – there would be little problem. But instead these trials have become a means to deny the harms that drugs cause. Your observation that your patient has been injured by treatment is an anecdote, we are told. There is no evidence here.
Our Cardinals feel sympathetic for your problems but advise you in the interests of the Church at large to keep quiet. You will be doing the Devil’s work if you speak out about things you know nothing about.
Remaining Quiet for How Long?
We have reached a critical juncture. On the one hand we have evidence from company run trials, up to half of which remain unpublished and over 80% of which are ghostwritten, and close to 100% of which the data are unavailable for independent scrutiny. On the other hand we often have evidence of a problem appearing on a drug, that clears when the drug is stopped and reappears when it is restarted.
This kind of evidence until recently was thought to be the strongest causal evidence there was in clinical practice. In over 80% of cases evidence like this turns out retrospectively to have been right. So which is the more dependable when treatments go wrong, the evidence from company trials or the evidence from doctors and patients own eyes?
When they hear Evidence Based Medicine most people think they are hearing Data Based Medicine. It is an irony that trials are used to drown out good observations from individual case studies when such case studies are often the one group of studies in modern medicine where we actually have the data – the person who was injured and their clinical record.
It seems, if only for rhetorical purposes, we need a way to demonstrate how unreasonable it is not to take such reports seriously. If the Church is to survive, we need some Cardinals to take up this cause.
Meanwhile back in the Church of GSKology . . .
In the Church of GSKology, the striking parallels between the way the Catholic Church is handling abuse cases in the Archdiocese of Minneapolis and GSK are handling access to clinical trial data were pointed out.
The legal system in Minneapolis though seems to be sorting the Catholic Church out. Judge van de North has just ordered the Archdiocese of St Paul and Minneapolis and the Diocese of Winona to release the names of 58 priests “credibly linked to episodes of child abuse”. (Although the story seems to have vanished from the Star Tribune site – you can see it here).
The legal system is not getting to grips with the Church of GSKology or with Astra-Zeneca in Minneapolis in anything like the same way.
In the case of Study 329, GSK got patients to sign consent forms saying they would not receive treatment that differed from standard clinical practice, when in fact the plan was to force titrate these children up to imipramine 300 mg per day.
At the end of the study there was a statistically significant increase in the rates of suicidality on Paxil compared to placebo.
Children have been abused. Whose duty is it to inform these now grown children. Pope Andrew?
Or the doctor involved in the trial or their institutions?
- Marty Keller, or if not him, Brown University?
- Barbara Geller from St Louis?
- Rachel Klein from New York?
- Neal Ryan from Pittsburgh?
- George Papatheodorou or CAMH where he was working then?
- Stan Kutcher from Dalhousie?
- Gabrielle Carlsson from Stony Brook?
- Graham Emslie from Dallas?
- Karen Wagner from Dallas?
- Michael Strober from UCLA?
- Greg Clarke from Portland?
- Elizabeth Weller from Columbus?
There were lots of others pulled in to the exercise, pleased perhaps to get their name on a paper. Boris Birmaher for instance.
Rumor has it there are a bunch of bioethicists and lawyers who have got greatly exercised about things going wrong in a St Paul and Minneapolis Astra-Zeneca clinical trial. Perhaps some of them could weigh in on the issue of what should happen next in the case of 329. GSK and A-Z are both British companies – perhaps this is a British thing.
What are the duties of companies, doctors, universities and clinical institutions in a situation like this?
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See more at DavidHealy.org
I had a Methodist pastor confess, after reading a chronologically documented listing of my and my child’s documented “concerns of child abuse” medical records, admit that I dealt with the “dirty little secret of the two original educated professions.” I was drugged up unnecessarily because an ELCA pastor wanted to cover up the sexual abuse of my 3 year old child , at the home of a wealthy potential parishioner and best friend of his. And unfortunately for my family, our PCP oversaw the making me sick with major drug interactions, to cover up her husband’s “bad fix” on a broken bone, and her cover up, and denial of common adverse reactions to wrongly prescribed drugs. Thankfully, her partners became disgusted by her lack of ethics, and handed over my family’s medical records.
The bottom line is the “dirty little secret of the two original educated professions” – how doctors and pastors have historically covered up malpractice and pastoral sins, has apparently gone viral. And the religions are now supporting the mass drugging of children with neuroleptics, because this is profitable for all the religion owned hospitals. This is disgusting.
I think the most striking analogy is between scientific procedures and the political process. Not too long ago last century it was recognized that due to the inordinate power of the corporations and the corruptibility of the individual– in particular of beneficiaries and employees of the corporations– there needed to be a countervailing force to protect the public interest, the common good. The democratic state was the agency that ostensibly buffered the power of the corporations, of the “power elite” (Mills) or the “ruling class”(Marx). The ideology held that the democratic political process preserved the state as a representative of the pubic interest that would constrain the power of large corporate interests. The fatal flaw of Marxism, it was argued in the 20th century, was that it failed to realize that the autonomy of the democratic State was a constraint upon capitalist interests. Of course this is no longer(if ever) the case. The measures that once ensured (to some degree) the autonomy of the state are today mere rituals creating an illusion of autonomy. US national elections are a dramatic example of this: Campaigning is based upon lies and propaganda and “impression-management” of the public based upon the manipulation of the cosmetic qualities of the candidates whereas voting is determined by these advertizing campaigns. On the other hand private ownership of the candidates–no longer restrained by spending limits–now ensures that the State, despite appearances to the contrary, is an instrument of naked corporate rule. This exploitation of the political process today has reached such a degree of turpitude that the even the polemics of Karl Marx sound like understatements.
The same thing has now happened with “science” and medicine. Due to the potential venality of corporate private interest, Science had developed procedures and methods to ensure that medicine would advance by serving the interests of scientific progress and subordinating private interests to the public good. Science itself still has a halo of heroic truth-seeking and dispassionate devotion to the public good due to Science’s identification with the Enlightenment during the days when the Church represented the forces of obscurantist superstition which sought to suppress truth lest it undermine the religious ideology and dogmas upon which Christendom was based for centuries.(And also due to pockets of scientists not in the employ of private interests.) Thus Richard Dawkins represents himself as a modern day Galileo, an apostle of rationalism, seeking to topple the last bastion of religious superstition.
But today David Healy is the real iconoclast-–he has demonstrated in Pharmageddeon and his current articles that “science” has been reduced to a public relations operation carried out by the psychiatric-pharmaceutical industrial complex whose rise in the 1980s was first chronicled by Peter Breggin. In order to work, i.e., to deceive the public, Science(subordinated to corporate interest) retains and “fetishizes” (as Healy notes) the procedures and methods that have been associated with it for years, and that used to serve the quest for truth. But like the political process the methods now have been corrupted (by the stratagems Healy documents) and thus like the political process they also have no more value than optical illusions designed to lull the public into false complacency based upon trust in Psychiatry’s concern for the public and its ostensible devotion to scientific progress. In reality as Healy has documented the psychiatric-pharmaceutical industry cares about nothing other than increasing its profits.It cares nothing about the corpses, the collateral damage generated by the marketing of its products. There are no longer any constraints upon the turpitude and venality of corporatized medicine (particularly the bogus medical specialty of Psychiatry) aided and abetted by the corporatized State.
Seth Farber, Ph.D., THe Spiritual Gift of Madness: The Failure of Psychiatry and the Rise of the Mad Pride Movement