War on Civilization: What Would Happen if Patients Radicalize?

The day after the Charlie Hebdo shootings in Paris, Nicholas Sarkozy stood on the steps of the Elysee Palace and said

“This [the shootings] is a declaration of a war on civilization and it is the responsibility of civilization to defend itself.”

Twelve people had been killed.

Follow the Data

The issues at stake have been pitched in terms of an attack on the Enlightenment values that make modern civilization possible.  The greatest symbol of the Enlightenment is modern Science.  The distinguishing feature of Science as opposed to Religion or other forms of knowledge hinges on a willingness of people to follow data even if that data runs counter to their religious or other sectarian interests.

Before the French Revolution, France led the way in governing by data also.  Concerned that the country might lose out to Germany, the authorities kept a detailed census of the population and tracked birth, mortality and disease rates. These data, illustrating that certain areas of the country were healthier than others, helped pinpoint things that could be done to manage the conditions that gave rise to several diseases.  These data gave rise to the insurance industry and later the science of epidemiology.

In the midst of the Revolution, Pinel, who is famous for removing the shackles from the insane, insisted that all patients be tracked for outcomes and that the data should shape our views. After passionate debates about the role of data in medicine, largely conducted in nineteenth-century France, Pinel’s initiative ultimately flowered in Evidence Based Medicine – by which most people understand Data Based Medicine.

The use of data to overcome preconceptions and allow a rational ordering of human affairs had by this point given birth to modern democracy. The rule of the people by the people has always hinged on doing the rational thing – we will all be better off if we follow what makes the greatest number of people better off.  Anything else may be good in the short term for one section of society but not in the longer run.  Following what the data point to means being willing to take on sectional interests

These are ideas to celebrate and the huge crowds gathered in Paris over the weekend, protesting the killings at Charlie Hebdo, believed they were bearing witness to these ideals.

Dark Knight Rises

In July 2012, twelve people were shot dead in Aurora at a premiere of the Dark Knight Rises movie, with a further fifty-four injured.  In December 2012, twenty children were shot in Sandy Hook.  There have been other mass shootings in Virginia Tech and elsewhere.

We don’t know for certain the details of the psychotropic drugs that the shooters were on in any of these cases but there is enough information about these various events and enough clinical trial data linking antidepressant use to homicide and violence to make it possible to state pretty well for certain that some of these violent events have been triggered by treatment.

Where are the marches in support of civilization?

Ah you say, there is no effort to censor, to suppress the truth here.

The Economics of Truth

We have witnessed many newspapers and magazines across Europe in recent days refusing to publish Charlie Hebdo-related materials or other cartoons that feature the Prophet.  They make it clear they are self-censoring – they are putting the safety of staff before freedom of speech.  Many people find this capitulation shocking.  Its likely that many Muslims find the capitulation shocking. It is likely that many of those marching in Paris are doing so in part to stiffen the backbone of the media.

This capitulation by the media is shocking because it seems exceptional or has been made to seem that way.

Academic journals in medicine — in contrast — capitulate every day of the week. The shock would be to find them standing up for basic values. The basic value these journals capitulate on hinges on access to the clinical trial data without which science is not possible – the basic Enlightenment value. The worst journals are the ones that trumpet their commitment to Evidence Based Medicine. Worse again, once upon a time we all had access to the data but the journals have let this slip. We have gone back to a pre-Enlightenment era.

The missing data include the clinical trial data showing that not only do antidepressants, for instance, cause suicide and violence but that they cause more people to commit suicide or become violent than they prevent from doing so. These drugs raise absolute rates of violence and suicide. School or College shootings pretty well never happened before the antidepressants.

The work of Rachel Liebert shows how each of these events have led to a progressively ever tighter security apparatus, in much the way 9/11 did.  We are becoming more and more controlled, with more and more livelihoods devoted to security in its various guises, but without any evidence that this control is making us safer – indeed to the contrary.

The Protocols of the Elders of Harlow

How do the many hundreds of family members left bereaved by these shootings react? Most of them with resignation — Like most Jews during World War II or Muslims today bewildered by Middle Eastern carnage. Some begin to research, begin to pick at the threads that are out there suggesting a cover-up on a scale that would leave most people figuring you’d succumbed to a paranoid fantasy if you attempted to voice what you thought was going on.

Among the few who become active, some will become murderous.  Many of those who blog or lobby – decent people – will almost certainly have had fantasies of wreaking violence on the executives of GSK, or Pfizer, even on paragons of data transparency such as Patrick Vaillance and Andrew Witty, when they find that in some sense these executives “knew” of the capacity of drugs like the SSRIs to cause suicide – often of the most blood curdling kind – or violence  – often of the most horrific kind – or a range of birth defects and mental handicaps.

But it’s as difficult to imagine succeeding in an effort to get at a senior pharmaceutical executive as it is to imagine getting to Barack Obama, Francois Hollande or David Cameron.

In lieu of a senior company person, what about a journal editor?  These are the people who are responsible for letting pharma have whatever they want published without having to provide data. These are the people who publish articles that state certain drugs work well and are safe when in fact the hidden data shows that the drug didn’t work and wasn’t safe. These are the people who encourage industry to use ghost-writers. These are the people who buckle at the first hint of industry displeasure about an article about the adverse effects of a drug.

Many in industry find what these editors do quite shocking. If medical journals were run by people who had previously worked for pharma, they would likely show a lot more backbone than they do now.

So if one those who have been bereaved by the latest brand name wonder drug were to storm an editorial meeting of the New England Journal of Medicine or the British Medical Journal and shoot as many dead as possible, would we call that person a criminal, an extremist or a crazed fundamentalist?

This is Not Who We Are

A few weeks ago Barack Obama justified the release of a report on the activities of the US in torturing suspects in the war on terror, saying that it was important that the truth come out. Things had to change. What the US had done should not be repeated – because “this is not who we are.”

And because the data shows it doesn’t work.

What did we do?  Well, among other things we borrowed some tricks from the Soviets and used the akathisia that psychotropic drugs can cause to torture suspects into submission.

We have great reason to suspect that much of the violence linked to psychotic patients that sparks popular calls to lock these people up is triggered by the exact same drugs.

We know that some of the horrific shootings by military personnel in Iraq and elsewhere can be linked to soldiers taking the same or related drugs.

When it comes to the physical beatings celebrated in dramas like 24 and Zero Dark Thirty, we left many people in much the same state as they might be in after a course of statins – aged, crippled and cognitively impaired.

But are there any medical voices raised trying to make sure this doesn’t happen again because “this is not who we are”?

Revenge

In 1844 Alexandre Dumas’s powerful revenge fantasy The Count of Monte Cristo was published. The Catholic Church immediately banned it – probably ensuring its success. Revenge is immoral, they said.

Dumas’ hero Edmond Dantes was locked up on false charges in the Chateau d’If, the Alcatraz of its day, to rot forever while one of those who framed him stole his lover and place in society, another became a pillar of the banking establishment, and the third became the senior judicial figure in the country. Dantes escaped after eighteen years and, gifted a fortune by a fellow prisoner, set about the destruction of those who framed him.

Watching Gerard Depardieu as Dantes, it is close to impossible not to delight in the unfolding of his plans, as he contrives the suicide of the man who stole his wife, the destruction of the banking system, and the crushing of the judge who jailed him.

There are people falsely imprisoned for eighteen years after Prozac or other SSRIs led them to kill the people they held most dear. For the most part, they show an extraordinary generosity of spirit — seeking despite this to turn what happened to them to a greater good.

This will probably never make a novel or a movie, but then truth is stranger than fiction because fiction has to make sense.

Brisdella: Countess of Monte Cristo

Jane Fonda starred in the movie version of a French comic strip – Barbarella – who was entrusted with a mission to save the Earth.  It involved lots of being sexy, with Fonda ending up “the most iconic Sex Goddess of the 1960s” as a result, according to the New York Times.

Well, perhaps Earth will have to be saved by Brisdella, the Sex Goddesses featured in the latest stunning Direct to Consumer Advert for Brisdelle.  This is GSK’s paroxetine, Paxil, repackaged for peri-menopausal hot flashes.

A series of women are featured as transformed from Women on the Verge of a Nervous Breakdown to Lara Croft, Purdy from the Avengers, or Brisdella.

See here.

There are the usual rushed-small-print  disclaimers.  You’d never guess that Brisdelle is Pregnancy Category X for birth defects and carries a Black Box warning for suicide.

When one of these women finds she can’t get off Brisdelle because the withdrawal is too horrific, and faced with the prospect having her bones rot because of enforced SSRI intake, a greater risk of stroke because of her enforced SSRI intake, a greater risk of burning hands and feet in perpetuity because of her SSRI intake, what will she do?

What will she do when she finds she has become Nearly Invisible, as Moyra Peralta puts it one of RxISK’s manifestos  Nearly Invisible: Drug Traffic Accidents, or as one of the women in Women on the Verge of a Nervous Breakdown sings

“Though things are pretty much the same
As how they used to be
the doctors still are smiling
they just never smile at me
At first I thought they must be blind
like love or gravity
but then I realised

I feel like supergirl! I’ve become invisible
I’m a magic trick.  Isn’t it wonderful?
Like a character in a comic book
I can see what you’re thinking but I don’t care

So if you’re on an  empty street
and you hear the tapping of high heeled feet
Or you hear a heart like a phantom beat
or the screams of a woman left incomplete
well don’t fear what you can’t see
the odds are good that its only me
I’m invisible”

Will she, cloaked in invisibility, and with the emotional numbness (albeit drug induced) of a contract killer, avenge the children, the parents, the partners who have died a death more common than deaths in war, even when civilian casualties are counted in: Brand drug-induced death?

Or having worked it out, will she take pleasure in waiting and watching the West fall without having to fire a bullet – as the numbers of mentally handicapped swell and healthcare costs balloon in the absence of the data that would make what we are doing economic and rational. The only way to survive is on an all-for-one and one-for-all basis. But this is not how the boys are playing the game.  So it should be only a matter of time till they hang separately – except there is always the risk that this time the Empire might get too strong.

Asterix

Deep in European and American hearts is a memory of the collapse of Rome. Impregnable empires can come to an end. Ironically, few have celebrated the demise of Rome more than the French, where a cartoon series featuring Asterix the Gaul taking on the might of Rome is a national identifier.

Asterix and his companion Obelix feature as the mascots of Prescrire, the only French voice calling for Data Based Medicine. Prescrire are one of the few medical groups in the world who continue to publish in the face of threats of legal action from Pharma.

In Paris today we have a lot of people mouthing words that come easily: “Je Suis Charlie.” For anyone who wants to be Charlie, who wants to get to know what modern politics is all about, by feeling it in your marrow, try reporting an adverse event on treatment to your doctor.

Outside your doctor’s surgery/clinic/ consultation room you can believe you are operating in a democracy.  Inside the room you may be treated with courtesy and apparent friendliness but you are being treated in an arrangement set in place to police addicts.  This is not a domain in which ideals of Liberty, Equality or Fraternity are welcome.

And just as Stalin once put it to France’s future leader, Pierre Laval, who thought it important to get the Pope onside against Germany, “How many divisions does the Pope have?”, so your doctor is likely to be thinking when faced with someone mentioning Prescrire or RxISK – “How many Corporate Lawyers does Prescrire or RxISK have?”

In Rome today there are almost certain to be people considering how we would manage the radicalization of patients if it ever happened.  What shall we  do with Prescrire?

No one except those who have lost a loved one or had someone badly injured on treatment realizes that Terror has become the new Normal: That we are living in a Reign of Terror. (See Brand Fascism.)

And yet, almost by definition, the only kind of business that will be sustainable in the longer run — at least on Earth, in democratic societies (See Data Wars) — is one that is science-based, which means data-based. How many Republics will rise and fall before we get the Promised Land?

What would happen if three million French people demanded access to their data?

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This is a slightly revised version of a blog on David Healy’s website.