When Science and Anecdote Collide

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For decades, declarations by perturbed relatives that a loved-one’s death was iatrogenic (induced by medical treatment), were often dismissed as anecdotal. Accounts imparted by concerned loved-ones were likely to be rejected, albeit often kindly – yet thrust aside as the demented rantings of a grieving loved-one. Placated with persuasive words, relatives often slink away, suitably chastised by the medic’s evidential superior knowledge. The rantings of the grieving widow or mother will be controlled and placated, with the vociferator patronized and often pitied as misinformed dissidents. Thus, relegated to the anecdotal tray, rather than adverse-reaction tray, the iatrogenesis will likely continue, surfacing some time later to harm another. Many feel this practice is particularly pervasive within psychiatry, where protecting the medical model seems paramount over the safeguarding of patients.

The perception of the American ‘shrink’ listening attentively, while the horizontal patient spills his innermost torment, is one that persists today. In reality, this is far from the norm, with the prescribing of psychiatric drugs taking precedence over the tedium of treating a traumatised patient. Drugs that often mask the problem with disinhibition and emotional blunting are seemingly prescribed with wild abandon, yet only the families affected can see the harms done – while medics seem oblivious. When Cochrane Scientists and expert psycho-pharmacologists, are publicly stating that antidepressants and other psychotropic drugs are causing ‘more harm than good’ and many deaths, dismissive medics who continue to recklessly prescribe are walking a fine line between acting irresponsibly and negligently. However, a vast disparity still exists between scientific findings that psychiatric drugs are the third leading cause of death in Europe (and the U.S) and psychiatry’s Key Opinion Leaders (KOLs) declaring these drugs are safe – even declaring that ‘the public should have no concerns about these drugs’. 

When publicly challenged, KOLs usually retaliate with the mantra ‘correlation does not imply causation’. Pushed a bit further, their hackles will rise and they’ll state ‘these people are causing harm, by stopping people from taking life-saving medication’. Yet, even a utilitarian argument that these drugs provide ‘the greatest good for the greatest number’ has been debunked by Peter Gøtzsche (scientist and co-founder of the Cochrane Collaboration). He stated recently, to no small uproar, that these drugs are ‘doing more harm than good’ and that almost all psychotropic drug use could be stopped without deleterious effect (due to withdrawal, discontinuing is not advisable without medical supervision).

However, the problems run deeper than the KOLs defence of psychiatric drugs. An interesting article on MIA (Mad in America) tells the sorry tale of a dad who recently discovered that the American drug regulator (FDA) is ‘hiding reports linking psychiatric drugs to homicides’. It will be interesting to see what happens next within the FDA.

Furthermore, the statement that ‘the public should have no concerns about these drugs’ was made following an inquest in Ireland, where concerns were raised by the deceased’s family about a recent prescription of Sertraline (Zoloft/Lustral). However, as is common practice, the family’s concerns were dismissed. They had no way of knowing that in 1998, the Irish Drug Regulator (HPRA), following reports of Sertraline-induced suicide, had requested that the drug company in question (Pfizer) search its database for similar cases. There were 594 ‘suicide events’ reported from non-clinical sources, of which causality was not investigated. Of the 252 from clinical trial cases, Pfizer’s internal report concluded that 54 were directly related to Sertraline treatment. Interestingly, 11 of the ‘suicide events’ reported (from both sources) came from Ireland, with 2 found causally related to Sertraline. The latter were from ‘confidential’ documents released through court proceedings and provided by Kim Witczak who lost her husband Woody to Sertraline.

Nevertheless, it seems that science may be catching up with the anecdotal evidence, with some interesting studies published recently. Following the Study 329 debacle (as yet unretracted), the latest study by Jureidini et al ‘The citalopram CIT-MD-18 pediatric depression trial: Deconstruction of medical ghostwriting, data mischaracterisation and academic malfeasance’ shows how Forest Labs, through greed and fraudulent practices, actively ignored the prospective likely harms to children. The study concluded:

Deconstruction of court documents revealed that protocol-specified outcome measures showed no statistically significant difference between citalopram and placebo. However, the published article concluded that citalopram was safe and significantly more efficacious than placebo for children and adolescents, with possible adverse effects on patient safety.

Another study by Selma et al ‘The relevance of cytochrome P450 polymorphism in forensic medicine and akathisia-related violence and suicide’ expressed that a genetic predisposition to iatrogenesis can be traced back to pharmacogenetic interactions, namely the inability of some to metabolize prescribed drugs, making ordinarily ‘safe’ drugs, lethal for some. The study concluded:

“CYP450 status is an important factor that differentiates those who can tolerate a drug or combination of drugs from those who might not. Testing for cytochrome P450 identifies those at risk for such adverse drug reactions. As forensic medical and toxicology professionals become aware of the biological causes of these catastrophic side effects, they may bring justice to both perpetrators and to victims of akathisia-related violence. The medicalization of common human distress has resulted in a very large population getting medication that may do more harm than good by causing suicides, homicides and the mental states that lead up to them”.

Perhaps we will just have to wait for the hapless KOL to catch up, not only with the scientific evidence but with collective anecdotal evidence from families. It would seem that underestimating anecdotal evidence is unwise – not least as science often evolves from this very valuable source.

The citalopram CIT-MD-18 pediatric depression trial: Deconstruction of medical ghostwriting, data mischaracterisation and academic malfeasance.

The relevance of cytochrome P450 polymorphism in forensic medicine and akathisia-related violence and suicide

Family calls for more research into anti-depressants

The FDA Is Hiding Reports Linking Psych Drugs to Homicides


8 thoughts on “When Science and Anecdote Collide

  1. Brilliant as ever, Leonie. You raise serious issues, and draw deeper awareness of the false security and cultural disadvantages of leaning too heavily on KOLs when scientific evidence shouts otherwise. The historical evidence reflects that the FDA doesn’t care about lives lost in the past, and ever more so now that President Obama appointed former Monsanto CEO to the helm of the FDA….an even more worrying development and ever more important reason to sound the alarm. Thank you!

    Liked by 2 people

  2. Excellent article. I especially like the title. Anecdotal evidence could be a great starting point for a different type of scientific investigation than the usual (flawed) comparison of drugs to placebo.

    Liked by 1 person

  3. I never believe the chemical imbalance theory…and now with the education I got over the last 10 year gave me more determination to keep going.
    I want to give hope to people not labour them as bipolar or neurotic,psychotic.How do you become a caring person is everyone bussiness.A good caring doctor never incourage long term medication.
    It is a charade Psychiatrist do not treat any know organic disorders of the brain for which a definite treatable they are not brain experts ,they are not scientific.They can’t stand alongside neurology,cardiology and all medical specialist .I have questioned this during my time as a student and the seismic reaction I got did not impress me.

    I base of my experienced bully can be very damage luckily I possessed a strong character and I deal at the time by study the subject myself cognitive behaviour.There is no point seek legal support .Is all too expensive and lack of evidence.Educate yourself do not believe lies.You are a worthy person.You are not your mistakes.Psychotropic drugs are not the answer to the difficulties in life,love yourself.

    In a society such as ours ,we stridently refuse to face the hideous imperfections and failing of our judicial system with respect to the chemical imbalance theory .The vulnerable people feel abandoned by the political process and unprotected by the legal system.Shamelessness ,arrogance ,deceit and moralising thrives at the highest level and the ultimate authority is power ,money ,reputation and respectability.Thank you to Terry Lynch for sharing his expertise your country needs you.

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  4. Hi Leonie,

    I just found your blog and have spent the last few minutes reading some of your posts (particularly those on Cetalopram).

    I was on Cetalopram for about a year in 2013/14. I came off the drug after I started to experience adverse personality changes, including a diminishing emotional response.

    However, after a period of particularly bad anxiety/depression I have been proscribed the drug again. I have been on it for the past 2 weeks and it appears to have had only a negative effect. This is something I was told to expect so I have just tried to live with it.

    I was wondering whether there are better options than SSRI’s given the research you have cited?

    This is not a request for a prescription, merely a request for an expression of opinion.

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    1. Hi Alex,
      Sorry for the delay.. problems with WiFi for the last few weeks. I’d be careful going back on any drug that had previously caused problems. Talk to your GP and see what he/she can advise. Explain your previous experience. There are many alternatives to taking drugs, though it’s a personal choice and what works for one might not work for the other. Are you in Ireland? If so, I might be able to give you some contact details. If not, it depends on where you are.
      Leonie

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      1. Thank you for your reply. I live in England (West Midlands). I have received a mental health referral, so I will discuss things then. In the meantime I will have a look at some more of your posts.

        I would also like to thank the person who commented below for their advice.

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  5. Focus on your strengths
    Drugs can’t retrain you ,teach you how to manage your thoughts or solve social problems .Focus on your strengths think of a time when you did something you were proud of.Now think about the strengths ,and talents you used to make this happen.Embrace your strengths will give you confidence in your ability to handle any challenge that comes your way.Let nothing defeat you.

    Mental toughness can be cultivated. Think of it as a muscle which needs to be worked in order to grow stronger. Push yourself in small ways on daily .You must not allow your mind to acquiesce in defeat weakly giving up.What seems impossible one minute becomes through faith ,possible the next.
    No one is going to be immune from having problems.
    Mentally tough people are not more intelligent or talented than the average person;they’re more consistent .Practice on regular basis.Good things happen at the edge of your comfort zone .
    When you create peace and harmony and balance in your mind you will find
    Best wishes

    .

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