Doctor Munchausen: Hear no, See no – What?

David Healy, MD
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Being Irish makes it possible to tackle certain things – or, now possible. The question of the Catholic Church, for instance, and its handling of children – whether their abuse at the hands of pedophile priests, or the appalling treatment of unwed mothers in Magdalene laundries, or the shipping of children born outside marriage out of Ireland for adoption.

There have been two Irish movies on these themes in the last year – Philomena and Calvary. From a distance of several decades it seems it has become possible to look at certain events and see what was wrong.  Similar stories have come from countries from North America to Australia.

These stories have tended to play down the complicity between doctors and the Church. In some Canadian and American settings, it was worth more to the Church to have orphans designated as psychiatric patients – the Church got paid more. In other settings, in Ireland perhaps, it looks possible that orphans were entered into vaccine trials by nuns liaising with doctors, when not being sold to wealthy foreigners.

The Pedophile Priest seems to incarnate the problem of evil in our day. Until recently it seemed like an evil that could be handled in that these priests appeared to be relatively rare. It was the past. We had learnt lessons. It was very disturbing but not deeply threatening. Until Jorge Bergoglio suggested that one in fifty priests might be problematic and Britain exploded with reports of mass sexual exploitation of young girls by predatory men in close to every city in the land it seemed. Maybe it wasn’t priests who had led to so many unwed young mothers in Ireland.

Doctors and the Church

Intersecting with this story was a disturbing interaction between the Church and medicine. Doctors it seemed could be found to make psychiatric diagnoses on orphaned children that led to treatment with antipsychotic drugs in the 1950s and 1960s, and one of the drivers of this seemed to be that the Church got more money from the State as a result. The doctors, of course, also got paid. This feels like a seriously corrupt nexus operating with near impunity on the basis that no one is going to be bothered to investigate the fate of some orphans.

Could doctors have really colluded in this way? One of the striking features of medicine in Ireland until recently is that in most official pronouncements on ethical or moral issues, medicine has been to the right of, more conservative than, the Catholic Church. Whatever about individual doctors and individual priests, medicine as a body has seemed at least as likely if not more likely to be inhumane and unresponsive to the needs of people than the Church. Talk of doctors and nuns or priests colluding doesn’t seem so far-fetched against this background.

But it’s all in the past. We have of course learnt lessons.

Doctors and Pharma

So who is now entering children into clinical trials like Study 329 – GlaxoSmithKline’s (GSK) famous trial of Paxil (Seroxat – paroxetine) compared to imipramine and placebo in adolescents who were supposedly depressed? Is the pharmaceutical industry wonderfully more ethical and concerned about children than the Catholic Church was? Does industry profit from this? Are the doctors reimbursed for each child entered? (Likely around $5000 per child).

Unlike the 1960s, there is of course informed consent now. In Study 329 you were informed that participation in the trial would not lead to any different treatment from standard clinical care. Well, standard clinical care for the use of imipramine in adults at that time would have been to use doses of around 150 mg or less. In their adult trials running at the same time, GSK were using a 150 mg dose. But in Study 329, the protocol from the get-go mandated pushing every child who got imipramine up to 300 mg if possible. It’s difficult to see any rationale for this other than by making imipramine look so toxic, Paxil might look good by contrast.

Who is Responsible?

When the trial was finished there was clearly a very marked increase in suicidal acts in the children taking Paxil. In normal clinical practice if someone becomes suicidal on an SSRI like Paxil, I would try to make sure afterwards that they understood that this was an effect of the drug rather than something inherent to them. This is important for their perception of themselves afterwards. I would also indicate that the same might happen on many other antidepressants, some of which also act on serotonin without being labeled SSRIs. It might also happen on painkillers like Tramadol, which is a serotonin reuptake inhibitor.

So whose responsibility was it to ensure good clinical practice was adhered to? GSK deny all responsibility – this is a treatment issue and it’s not our job to treat patients. This should be done by the doctors who know the patient best. The doctors can’t easily do it because GSK haven’t told them there is a issue and have ghostwritten a paper with their names on it saying that Paxil is wonderfully effective and safe for young people.

Driver on the Train to Auschwitz

In terms of responsibility, we don’t hold the train driver responsible for Auschwitz. Are doctors little more than drivers operating the train to Auschwitz?

Back in the 1950s or 1960s doctors were little gods. It would have been inconceivable to cast them in the role of train drivers. The men responsible for the medicating of orphans and giving them vaccines were closer to Doctor Munchausen figures or perhaps even had something in common with Dr Mengele – although this is a judgement made easier by the benefit of hindsight.

But today even Professors from Brown, Harvard or Oxford have so little real say that it is in some respects difficult to see them as any more than glorified train drivers.

We live in an era when AllTrials, the BMJ, and GSK can all appear part of a cosy alliance.

It’s also an era when children in orphanages, foster care and in care generally, are getting vastly more psychotropic drugs given to them than ever before.

Thirty years from now if doctors escape judgement because it is deemed they were just train-drivers, it is as likely they will be a vanishing breed as priests are now, as much use as salt that has lost its bite.

Footnote

The Dr Munchausen series is here:

  • First  Dr Munchausen I Presume
  • Second  Dr Munchausen: Dying for a Cure
  • Third  Dr Munchausen: Dear Luise
  • Fourth   Fr Munchausen I Presume
  • Fifth  Dr Munchausen Sense about Science
  • Sixth  Dr Munchausen Judge and Jury
  • Seventh   Dr Munchause Pharmacophile

For the record, I personally see the problem of evil primarily as an absence of good – a system problem. It’s rarely if ever a case of evil people, although since Cesare Lombroso’s work a century ago the world has had to live with the problem that there are people who are morally deficient.

How this might apply to pharma and doctors was laid out in a series of posts:

The antidote was We have a Dream.

 

17 COMMENTS

  1. Yes, there is evil out there. The kind of evil and indifference and denial and outright lying that results in poor, vulnerable individuals being poisoned with neurotoxic drugs including antipsychotics, antidepressants, and mood stabilizers in the name of treatment after they have been labelled as mentally ill. If they withdraw from these poisons they can often reclaim their lives.

    However, when someone is permanently brain damaged by virtue of being given ECT, the possibility of returning to self or normal functioning is completely gone. I would like to know why Dr. Healy isn’t rabidly advocating a ban on this assault/torture at the same time he is so concerned about the damage caused by psychiatric drugs.

  2. I had forced on me a series of 15 bi lateral electric shock treatments one of them without sodium penathol . Terrifying and Horrific which is an understatement when I was almost 18 years old.

    I’ll give Healy my pick up truck if he’ll lay down for a series like was forced on me . That is if he remembers the offer after he gets the you know what . To tell you the truth it felt like and I saw an extended atomic bomb explosion from the center of my skull extending outwards . No one believed it . They don’t tell people about that nor do they teach it in school . I guess it’s time to get out the pitchforks .About 10 times more painful then the worse tooth ache . Believe it .

  3. Plausible deniability.

    Way it worked in the public sector. Pay someone to tell the lie you need to justify your action. Validate the lie with authority. Any actions you take from that point on you have the “good faith defense”.

    Not a soul ever going to be held accountable, ask Colin Powell.

    • …and they are all happily following orders. Btw, the driver to Auschwitz is just as responsible as anyone else if he is not forced to do that under extreme penalty and aware of where he’s taking the people on the train.

  4. “But that’s all in the past.” Unfortunately, that’s untrue. The “dirty little secret of the two original educated professions” (shipping people off to psychiatrists to defame, discredit, and turn into mental patients with their drugs to cover up medical and pastoral sins and mistakes) is not only alive and kickin’. The psychopharmacutical industries are making billions off creating mental illnesses with their drugs, especially in children – the “dirty little secret” has gone viral!

    Dr. Healy, I do appreciate your pointing out the impropriety of both religions that hypocritically harm, and doctors.

  5. And two days later, the BBC jumps in on it. Love is in the air, clearly:

    http://www.bbc.co.uk/news/magazine-29307705

    And of course nowhere in the article a reference to the level of poverty in Ireland back then – you’d think there was a welfare state running in parallel with these evil nuns. Why don’t you take a look at other countries with similar levels of poverty but without evil nuns (i.e. Eastern Europe) and see what happens/ed to teenage mothers and orphans there?

    Nothing like a bit of good old Catholic-bashing to give a boost to your career, is there Dr. Healy?

  6. Unfortunately, he is only stating the truth about the pedophile priests and how they were protected by their bishops so that they could continue to prey upon innocent kids. In my diocese there was a priest who was burning altar boys on their privates with cigarettes and cigars. He would threaten the kids if they told anyone about what he was doing. He also sexually abused them in addition to the torture. Nice guy. The family of one of the boys finally found out and threatened the bishop that they were going to go to the papers and reveal what his wonderful priest was doing to kids. The bishop sent the guy out of the diocese for a few years and when everything got quiet again he brought the guy back to the diocese and gave him free rein to all the kids in the parishes where he was stationed from then on. All the priests knew what was happening and yet did nothing about it. I wonder how many hundreds of kids this one damned priest was allowed to molest and torture? And he was only one of the priests who were up to shenanigans with the kids in their parishes. It’s horrible, disgusting, immoral, call it what you will and it was allowed to go on at the expense of the kids. So, the Roman Catholic Church does have a great deal to answer for along these lines.