Former Duke Psychiatry Chair Calls for BMJ to Retract Article about Antidepressant Black Box Warnings

Dr. Bernard Carroll, scientific director of the non-profit Pacific Behavioral Research Foundation and a former chair of Duke University’s psychiatry department, is suggesting the British Medical Journal should retract last month’s article that linked the FDA’s black box warnings about increased suicidality in youth taking SSRIs to increases in adolescent suicide attempts. The BMJ article by Christine Lu et al reached its conclusions by using drug poisonings as a proxy for suicide attempts. “A substandard article with large policy implications slipped through their review and editing process and it was trumpeted in the world media,” writes Carroll in his second critical letter to BMJ about the article. Carroll points out that many letters have exposed the profound flaws in the study, but “the coup de grace” was the recent letter to BMJ from Barber, Miller and Azrael from the Harvard School of Public Health, reported yesterday in Mad In America. Those authors provided direct evidence that suicide attempts had not increased, and also disavowed Lu’s citation of their study as proof that drug poisonings were a valid proxy for suicide attempts. “Certainly, a retraction would shine a stronger public searchlight on the compromised validity of the Lu report than just the Rapid Responses can do,” writes Carroll.

The American Psychiatric Association’s Psychiatric News today published an article about the Lu study, and reproduced many of the flaws and omissions which were publicly exposed weeks ago. Only one critic is quoted.

Mad In America has been following the story closely and has compiled links to critiques and a summary analysis of the issues here.


Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.


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  1. Don’t hold your breath.

    Bernard Carroll belongs to the group of psychiatrists like Mickey Nardo and Allen Frances who “on the surface” seem to care about holding psychiatry accountable for its excesses.

    When you dig deeper, however, they are just as guilty of promoting pseudoscience and quackery to pass for “genuine science”.

    I had an online debate with Bernard Carroll here . People are welcome to read the debate in its entirety to have the full context but, before bailing out he made statements like this,

    “To your Question 1: the issue of a disease model is a red
    herring. The foundations of pragmatic psychiatry are descriptive nosology, diagnosis, and therapeutics. You want Popperian falsifiability? Fine, just look at all the negative clinical trials of candidate psychotropic drugs. They are legion. You tell us all areas of medicine except psychiatry have achieved the precision of air travel or of rockets to Pluto? Dream on. When was the last
    time you checked on standards for blood pressure control or fasting plasma glucose or Number Needed to Treat for mammography screening? Hint: it’s over 2000.”

    “On your earlier point 2, please don’t play rhetorical games and please don’t be disingenuous. You must know perfectly well that my examples were not single case anecdotes. I expected better from you as a serious interlocutor. And please quit the hand waving about no benefit from psychiatric interventions. Remember lithium? Remember benzodiazepines for catatonia? Remember the original antidepressant drugs? They had a NNT of 3 compared to 10 for the commercially favored newer agents.”

    The “NNT” metric he keeps mentioned is this .

    The reason I think Bernard Carroll is being a hypocrite in his letter to the BMJ is because the main reason the study by Christine Lu et al was criticized is that it used dubious proxy metrics to measure suicide attempts, as well as other numerous methodological failings.

    Bernard Carroll, in the debate above said “the issue of a disease model is a red
    herring. The foundations of pragmatic psychiatry are descriptive nosology, diagnosis, and therapeutics” and that metrics like NNT -which is also a proxy metric on the efficacy of a so called “therapy” – are a good measure of how good psychiatry is.

    Bernard Carroll’s hypocrisy boils down to this: he is fine with using proxy metrics to measure the efficacy of a psychiatric intervention or things like the impact of black box warnings as long as he likes them but it is not OK when he disapproves of them. Bernard Carroll doesn’t shy away from admitting that psychiatry doesn’t have a scientifically valid disease model, so, like Mickey Nardo or Allen Frances, he settles for arguing about distractions. Scientology anyone???

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    • CS,

      I agree with you about Dr. Carroll and Dr. Frances but have to disagree regarding Dr. Nardo. I don’t agree with him on everything but in my opinion, he gets it in many ways. And on the issues he doesn’t, I think he would definitely listen to what we had to say without the condescension that we all are familiar with when dealing with some of his colleagues.

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      • We will have to agree to disasgree. In fact I think Mickey is the worst of them when it comes at playing the distractions game. Most of his blog entries are about Byzantine analyses of studies we know are corrupt. There is only so many ways you can beat a dead horse but he keeps coming up with new. On the few occasions in which he has addressed the core of the matter, the necessity of psychiatry as a profession, he is very clear that he sees it as a noble profession because despite its failings, he agrees with the idea of “MD degree holders know best”.

        He banned me from his website not because I said things that were over the top but for my continuous calls on his hypocrisy as he explains here .

        I despise E Fuller Torrey and the ideas he represents with a passion, however, at least he is a believer in psychiatry as a scientific discipline. Frances/Carroll/Nardo are the worst kind of critics of psychiatry. The defend it not because they are “believers” but because they see psychiatrists as the “wise men” of the modern world who deserve the powers theologians had a few centuries back. I find their paternalism despicable.

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          • Whatever.

            To give an analogy, it’s like the discussions about slavery. There were those who were anti slavery, and then there were those who said that the best that could accomplished was to “improve the working/living conditions of the slaves”. Similarly, before the passage of the 1964 Civil Rights Act, many thought that repealing the Jim Crow laws was impossible and that the best that could be done for blacks was to “improve” the conditions of those who were segregated.

            I am for equal treatment before the law. I see the distractions that Carroll/Frances/Nardo regularly engage in as obstacles to achieving that equality.

            Similarly, I see those who defend “affirmative action for the so called mentally ill” as obstacle for achieving said equality as well.

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    • It’s really a shame that so much legitimate criticism of psychiatry is ignored or minimized because this one slice, albeit very well-funded and famous slice, of the psych reform movement is so vocal.

      The irony is that Scientology has actually ended up promoting psychiatry because any serious critical writing gets tarred with the same brush. The esteemed E. Fuller Torrey wrote off Peter Breggin’s work largely on the basis that Breggin’s wife was a former Scientologist. Even respectable magazines like The New Yorker point to Scientologists as though they were representative of the movement against psychiatry.

      Note to public: Terrorists are not representative of Islam and Scientologists are not representative of psych reform.

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      • Can’t find the exact post by Steve McCrea but what he said regarding countering the scientology issues should be boiler plate language for anyone who deals with folks raising the issue. They are not the problem and for us to let that sidetrack us from our goals is simply not productive or useful.

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        • Scientology/CCHR is a pain in the ass and a huge problem for the antipsychiatry movement in the US (not so much in Europe). Why is abuse and violence by psychiatry bad, but abuse and violence by Scientology irrelevant?

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          • Abuse by Scientology is a separate subject that distracts from our purpose. There are other websites for that purpose. And the main reason CCHR is a problem for the antipsychiatry movement is because the psychiatric community embarked on an intentional PR campaign to discredit critics with the “Scientology smear” tactic. (Admittedly, CCHR did make themselves an easy target.) Perhaps you think it’s helpful for us to protect ourselves by saying “We hate Scientology, too, so we’re not bad like you say we are.” I most certainly do not think so. I think it helps them continue to divert attention from the real issues.

            So as AA alludes to, my recommendation is very simple. If it’s ever brought up, we say, “What does religion have to do with the effectiveness or ineffectiveness of the current psychiatric model? I thought we were talking about science here? Why are you trying to distract us from the topic by bringing up religion? Is it because you don’t have any facts that are relevant to the discussion?”

            Or words to that effect. That shuts down any discussion of Scientology or any other off-topic distraction and labels the tactics for what they are. Any intelligent person watching the conversation will easily see that one person is using facts, and the other is using rhetorical tactics.

            We should work to kill off the effectiveness of this tactic, not build it up by agreeing with the APA’s marketing tactics. In fact, ANY agreement with APA marketing tactics should be avoided like the plague, IMHO.

            — Steve

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          • ANY agreement with Scientology/CCHR marketing tactics should be avoided like the plague, IMHO. 😉

            I’m not sure I have read the word Scientology in APA / psychiatry / pharma articles, I only remember that I read the term antipsychiatry in several recent articles.

            Btw, I didn’t know that Scientology and Big Pharma (especially Eli Lilly) had this big fight in the 90s.



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          • E Silly,

            I did know that Scientology publicly confronted Prozac like 10 years before the FDA issued its now known warnings. This is one of the reasons I have so much respect for CCHR. They confronted (and confront) institutional psychiatry in times/places when/where nobody else does. For the people helped by them, this goes beyond an academic exercise about political allies.

            This is what CCHR was doing circa 1991 . It took the FDA 13 more years to mandate that “black box warnings” on suicide risk be added to antidepressants.

            Again, I am not a Scientologist or a CCHR member, but I salute the work CCHR does confronting institutional psychiatry.

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          • If you didn’t know that Scientology and Big Pharma had a big blowup in the 90s, you were either too young to notice or not paying attention. Whitaker writes about it in his book. It is when the psychiatric community went whole hog into the “antipsychiatry=scientology=antiscientific
            =evil” PR campaign. There was a front-page attack piece in Time around 1991 or so, which it appears likely to have been coordinated with this PR effort. It was quite intense, but of course, big pharma and the APA had the bucks and media on their side, and the outcome was the successful “Scientology Smear” campaign that you either inadvertently or intentionally seem driven to employ on our allies. CCHR would be a lot less of a pain in the ass if y’all would follow my simple advice and stop giving the tactic energy on this site.

            —- Steve

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      • Trying to expose contemporary psychiatry as Nazi medicine isn’t very helpful at all.

        I don’t know very much about psychiatry in Nazi Germany, but I do know that the places in they showed on the map in the video did exist and many many people where killed there.

        Today the psychiatrist are not trying to kill people deliberately in psychiatry. Of course people die because of the psychiatric medications, but this is happening for different reasons (like organized crime, driven by money).

        The story of Jana sounds like fiction to me. Jana doesn’t sound like she really made that experiences with psychiatry, more like a bad actor. The medications they showed where benzos (not neuroleptics). The story Jana told doesn’t sound like it would happen in Germany in that way. The footage was complete bullshit (who are these men in black overalls?). I think their were just too lazy to interview real psychiatric survivors or get an idea how the psychiatric systems in Germany looks like.

        And then they do the stunt where they talk about forced sterilization. This is total and utter rubbish. There is no legal way to sterilize a minor in Germany, even not voluntarily. Sterilization of minors is strictly forbidden without exception.

        I also don’t know why they are mentioning Wilhelm Wundt. Wtf does he have to do with eugenics or the unscientific models psychiatry invented?

        The Age of Fear is for me an example that Scientology/CCHR doesn’t give a shit about good journalism or truth. There only goal is to fight their enemy the psychs.

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        • It is not hard to find information about the work psychiatry did for the Nazis and its role as enabler of the Holocaust,

          Note that Wikipedia editors aggressively monitor for undue Scientology editing, so the above is pretty accurate,

          “The programme officially ran from September 1939[5][6] to August 1941 during which 70,273 people were killed at various extermination centres located at psychiatric hospitals in Germany and Austria”

          Bob Whitaker has also written extensively about how eugenic thinking pervades today’s psychiatry. Here is a talk on the matter he gave 2 years ago . The whole notion of “disorder” is a direct descendent of the eugenic concept of “unfit”.

          I haven’t watched the documentary mentioned above so I cannot speak to its accuracy, but I have watched a few times “The Marketing of Madness” . I have also researched the references it contains. I can tell it is the definitive documentary on psychotropic drugging: very accurate and very prophetic. Prophetic in the sense that it was produced in 2010 but many of the issues it deals with only made it to the mainstream 2 years later, like the Irving Kirsch study, the Study 329 that was mentioned in the GSK 3 billion dollar settlement, the DSM-5 controversy, etc.

          Maybe Scientology is a bit bombastic targeting the psychs, but to deny that psychiatry, as a discipline, is driven fundamentally by the desire of its institutional backers (the APA but also the politicians who back “mental health” programs or “denying civil rights to the mentally ill”) of having a legally sanctioned system of social control that can be presented as “acceptable” to the public outside the criminal justice system is to live in fantasy land.

          Of course, when you mix social control and money (ie, big pharma money), economic corruption will happen, but the biggest corruption psychiatry perpetrates everyday, even when there is no economic corruption, is intellectual.

          Bernard Carroll’s letter asking for the retraction of the article is a good example of said corruption. I just cannot imagine for the life of me writing a letter like that but on the other hand continuing to claim that psychiatry is wonderful because NNT is a good way to measure the efficacy of its interventions. The criminal justice system has a great NNT value: most people have never been incarcerated, so the NNT for these people is 0. As a mechanism to prevent crime, the criminal justice system works wonders. So sure, if involuntary commitment and forced drugging were to be in the US as easy as it is in countries like Norway, most people would go out of their ways to show that “psychiatry works”, just as in most theocracies, people go out of their ways to show their religious values. Geez, Ahmadinejad went as far as saying that there were no homosexuals in Iran. And probably if the government of Iran were to conduct a public survey about the prevalence of homosexuality, the result of said survey would back what he said. Is threat of punishment by death a good “treatment” of homosexuality? Give me a break.

          Psychiatry is an intellectually corrupt discipline. Arguing the issues on psychiatry’s terms/distractions instead of attacking psychiatry’s lack of scientific basis only serves to validate psychiatry’s role in society.

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          • :

            On the subject of Scientology’s status as a religion, the German government has pointed to a 1995 decision by the Federal Labor Court of Germany.[13] That court, noting Hubbard’s instruction that Scientologists should “make money, make more money – make other people produce so as to make more money”, came to the conclusion that “Scientology purports to be a ‘church’ merely as a cover to pursue its economic interests”.[13] In the same decision, the court also found that Scientology uses “inhuman and totalitarian practices”.[13] Given the lessons of Germany’s 20th-century history, in which the country came to be dominated by a fascist movement that started from similarly small beginnings, Germany is very wary of any ideological movement that might appear to be seeking a position of absolute power.[13][14][15] References in Scientology writings to the elimination of “parasites” and “antisocial” people who stand in the way of progress towards Scientology’s utopian world “without insanity, without criminals and without war” evoke uncomfortable parallels with Nazism, and have led to Scientology being classified as an “extremist political movement”.[17]

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          • E Silly,

            Still don’t get it. You might not like Scientology, fine. But you are attacking the messenger and refusing to deal with the message: German institutional psychiatry was an important enabler, specially intellectually, of the Nazi extermination campaigns.

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          • Think you might be being very generous there cannotsay.

            The numbers of psychiatrists who joined the Waffen SS gives me a fair indication ofntheir role as being a little more than just intellectually enabling. They actively selected those destined for extermination, and developed them best methods.

            I did read a very good article about how if mental illness was genetically or biologically based, then why did the numbers of mentally ill increase in Germany after the war? I mean they got rid of all the genetically biologically defective elements, surely the numbers should have dropped.

            This might be a means of getting the message across to those biological determinists that their thinking is flawed lol.

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          • I think it is highly problematic to state that “tbe holocaust might not have taken place without psychiatry” [1]

            CCHR and Peter Breggin suggest that psychiatry is responsible for Holocaust and they kind of used Hitler and the Nazi Party (NSDAP). Of course they played a big part in killing people, but it’s an oversimplification and distortion of history to state that the Holocaust could only happen because of psychiatry.

            This PDF describes how the killing was organized within the totalitarian system in Nazi Germany:


            When Scientology/CCHR is writing about totalitarian Nazi Germany there is a conflict of interest, because the Church of Scientology has a totalitarian structure, too.

            [1] Breggin, 1993

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          • Good article E Silly.

            I agree entirely that it is problematic to state the holocost wouldn’t have occured without psychiatry.

            The way I view it is that the killing would not have been as efficient without their input.

            Its particularly interesting when one delves a little deeper into the documents of the time. I have read documents which gave instructions to stop exterminating people of certain trades because of the difficulties being experienced by those dealing with the slave labour for example.

            Anyhow, putting that history aside, i would ask who it is that is responsible for developing the torture methods being used in places like Guantanamo Bay, and during extraordinary renditions.

            I keep coming back to the saying “volpes pilum mutat non mores”. The wolf may change its fur, but not its nature. These people need to be watched very carefully, because they have shown their nature.

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          • Just to add to that – I was “treated” (read: abused and tortured) in the former Nazi psych ward which now is an ordinary good psych ward of a democratic state. Except that there were kids dying there from abuse and neglect till 80s and since then it’s been full of scandals involving deaths of patients in restraints and all formed of psychiatric abuse imaginable. Try googling “Otto Wagner Spital Psychiatrie” and scandal and you may get a feel. From personal experience – it’s a top of the mountain.
            So yeah, they don’t commit mass genocide, just an occasional homicide and a lot of horrific abuse. I feel much relieved.
            I think they totally continue their awesome traditions.

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          • Oh yeah E Lie,

            No harm in asking if we can do it though. The mere fact that they tried to include such outrageous powers is a signal to me as to their real agenda.

            Think they did manage to get ECT for 14 year olds. Without parental consent that is.

            I’m also worried about the “unreasonable refusal” clause they wish to insert. A huge loophole with little if any oversight.

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          • Yes, ECT for 14 year olds is in, but it’s an improvement (“ECT is prohibited on children under 14. Under the current Act children can have ECT at any age.”)

            I never heard about Emergency ECT before. Are they nuts?

            “Emergency ECT can be provided to an adult involuntary patient to save the person’s life, or in circumstances where there is an imminent risk of the patient behaving in a way that is likely to
            result in serious physical injury to the patient or another person. Rather than waiting for an approval from the Tribunal, ECT can be performed with the approval of the Chief Psychiatrist.”

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          • Far out, you seem to know a fair bit about the Act here in WA.

            Do you know whether a psychiatrist needs to be a psychiatrist, or will any old doctor do lol

            The Minister has been avoiding some serious questions about the old Act, which to me suggests there are aspects of the new Act she doesnt want to discuss for fear that the public becomes aware there are no protections.

            And the new Commissioner seems to want to make a wide sweep of the community to clean up the streets. Stopped short of a declaration of war lol

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          • Emergency ECT? Who the hell came up with that one? How about “Emergency head battering with a baseball bat?” Or “Emergency pushing in front of a Mack Truck?”

            There’s an emergency – a person is feeling distressed. I know! I’ll electrocute him! That’s always helpful!

            —- Steve

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  2. If it actually was true then how many youths need to be put on drugs to save that one kid from suicide ?

    10, 100, 1000, 10000 or maybe 100,000 kids put on the path of psychiatric drugs with awful ‘side’ effects to save just one from suicide.

    In The Wrath of Khan (1982), Spock says, “Logic clearly dictates that the needs of the many outweigh the needs of the few.” Captain Kirk answers, “Or the one.”

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    • If the laws look bad you should see the way they are being implemented anonime.

      From outside there is a need to make it appear like there are protections. Inside the State though Mental Health workers are simply ignoring the laws and doing literally whatever they want. There are simply zero consequences for any sort of abuse, and believe me abuse is the rule not the exception.

      Corruption state wide has had a major effect. Would think that all the money pouring in from mining would improve the situation, its done the opposite. Brought a bunch of pickpockets who are bleeding the system dry, and covering the damage they are doing until they exit with the loot.

      End up looking for short cuts, which in effect is drag as many in as you can, drug em, and get em back out in the community on CTOs. No worries aboit quality of care that way, because there isnt any lol.

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      • Normal day in psychiatry land. Nothing short of a complete ban is going to prevent any abuse. Leave one little emergency, danger to self/others loophole and they can do whatever the hell they like and fix the documents later.

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        • It’s much worse than that B.

          The Chief Psychiatrist who is responsible for ensuring the protections of the Act are enforced doesn’t even know what those protections are. Or he might be pretending to not know, rather than deal with the criminal behaviour of mental health workers.

          Either way I’ve seen vicious assaults on patients, and if you have valuable jewelry going into ECT you sure won’t have it when you come out. Investigations are done to ensure that the evidence is disposed of so that no action can be taken.

          I spent some years hanging out with criminal gangs, and I am not kidding you they had morals superior to many of those I met at the hospital that detained me unlawfully. I was absolutely shocked that these so called mental health professionals could behave in such a manner.

          At least criminal gangs have the decency to deal with the thieves within their ranks. There is actually some accountability.

          Professionals? Hah, that makes my Biker friends child care workers. At least I’m not in any doubt about who is enabling the corruption, and corrupting what good there is in the system.

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          • Maybe I just ended up at a bad hospital.

            Do male nurses at hospitals usually expose themselves to the young female patients? Do nurses sell meth to patients in the locked wards?

            They did deal with these incidents mind you, by having a quiet word to them. Don’t get caught.

            No wonder they are having trouble getting good staff, who would want to work with such folk.

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  3. E Silly,

    In case you care, here is the 1991 Time Magazine article referred to by Steve above . Look at what kind of destructive behavior Time Magazine accused CCHR of,

    “The disingenuously named Citizens Commission on Human Rights is a Scientology group at war with psychiatry, its primary competitor. The commission typically issues reports aimed at discrediting particular psychiatrists and the field in general. The CCHR is also behind an all-out war against Eli Lilly, the maker of Prozac, the nation’s top-selling antidepression drug. Despite scant evidence, the group’s members — who call themselves “psychbusters” — claim that Prozac drives people to murder or suicide. Through mass mailings, appearances on talk shows and heavy lobbying, CCHR has hurt drug sales and helped spark dozens of lawsuits against Lilly.”

    I’d say that CCHR was 20 years ahead of everybody else in the survivor movement at the time!!!

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    • Gosh, they claimed that Prozac drove some people to murder or suicide? How could they SAY such irresponsible things! Not only that, they hurt Lilly’s drug sales and brought on these totally unwarranted lawsuits (many of which Lilly settled out of court with “gag orders” so no one could see the actual evidence against them). The NERVE of these people!

      Who might the real evildoers be in this scenario? The ones who are marketing a drug that they know sometimes leads to murder and suicide but are trying to cover it up with media attack articles? Or the ones who are calling BS and holding them to account?

      Criminals don’t like watchdogs much, but those being burglarized like to have them around…

      —- Steve

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      • For the sake of completeness, here is perhaps the most famous of those lawsuits that involved judicial corruption helping Elli Lilly

        “An internal document purportedly from Eli Lilly and Co. made public Monday appears to show that the drug maker had data more than 15 years ago showing that patients on its antidepressant Prozac were far more likely to attempt suicide and show hostility than were patients on other antidepressants and that the company attempted to minimize public awareness of the side effects.

        The document was provided to CNN by the office of Rep. Maurice Hinchey, D-New York, who has called for tightening FDA regulations on drug safety.”

        “The journal said the documents disappeared in 1994, during the case of Joseph Wesbecker, a printing press operator who had killed eight people at his Louisville, Kentucky, workplace five years before, while taking fluoxetine. He then shot and killed himself.

        Each of the four pages of the paper obtained by CNN is stamped “Confidential” and “Fentress,” the name of one of Wesbecker’s victims.

        In a civil suit against Eli Lilly, victims’ relatives contended the company had long known about the side effects of fluoxetine, including its alleged role in increasing a user’s propensity to violence.

        Lilly initially won the case, but was later forced to admit that it had made a secret settlement with the plaintiffs during the trial, which meant that the verdict was invalid, the journal said.”

        So yeah, I think that the continuous use of the Scientology smear shows how successful the APA and big pharma were distracting the public to cover up their own corruption.

        God bless CCHR for being the lonely voice supporting people who had the courage to confront the corrupt APA/big pharma machine.

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      • Additionally, I’ve never heard anyone say: you’re a catholic so you can’t be advocating for LGBT right because your organisation abuses kids and homosexuals (which is true) or you’re a Muslim so you can’t advocate for peace because Al-Qaeda is also an Islamic organisation involved in terror. And therefore anyone advocating for peace and LGBT rights or peace in the world must be associated with a fringe religious group.
        I am not religious myself, I hold all deep distrust for organised religions but I find this guilt by association stupid and manipulative. And I don’t want to fall into a trap of having to defend myself for faults of others.

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  4. An SSRI probably saved my life when I was 15 (long before the warnings). We had tried everything else we could think of (therapy; exercise; nutrition) because we were already wary of ADs. I’m so glad we didn’t wait any longer. On the one hand, I’m for the warnings. However, I know most people won’t use the information rationally (we don’t think statistically), realizing suicide from a severe depression is still the biggest risk. Hopefully this is where docs can help people understand the pro and cons.

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