The only thing necessary for the triumph of evil is for good men to do nothing – Edmund Burke. I know, I know, this quote is painfully overused, but I couldn’t think of a more appropriate one here.
So, yesterday myself (and himself) went to Seanad Éireann (the Irish Senate) to witness the second stage of a bill to amend the Coroner’s Act (called Jake’s Amendment). Jake Lynch is the forever-14 year old child at the centre of all this. His parents, Stephanie and John Lynch, assisted by Senator Pádraig Mac Lochlainn, have worked tirelessly on this bill since 2015 – a proposal to amend the Coroner’s Act to include a verdict of ‘iatrogenic suicide’ (treatment-induced suicide). Sadly, the bill failed at a vote of 12-19. However, there were many surprising elements to yesterday’s Seanad Shenanigans. Firstly, few showed surprise (or denied) that antidepressants can cause suicide; that is a major shift in opinion in a few short years. Secondly, among the senators who voted for Jake’s Amendment, several were willing to put their heads above the parapet and publicly support Jake’s Amendment. Lastly, the only one who argued a ‘causal’ link was the Minister for Justice, Charlie Flanagan, and he seemed to be directly quoting from Irish Psychiatry’s statement following Shane’s inquest – so hardly a surprise. Indeed, it seems all may not be lost with him either – as following the vote, he approached Jake’s family and expressed an interest in meeting up to discuss the issue. I have a feeling that little Jake Lynch (and his parents) will make a difference – and I for one, am very proud to call them my friends.
You may remember that Jake Lynch was a 14 year old boy (diagnosed with Aspergers syndrome) who was prescribed fluoxetine, aka Prozac, to ‘help with his exams’. Five weeks after being precribed fluoxetine (where the dosage was doubled without his or his parents’ knowledge), off-label and with nil informed consent, Jake ended his own life. As his mother Stephanie said – the only thing that changed in his short life was the prescription for fluoxetine. Available literature from the Irish Drug Regulator (the HPRA), provides that ‘Prozac is not for use in children and adolescents under 18’, due to the increased risk of side effects such as ‘suicide attempt, suicidal thoughts and hostility’. However, it provides that in the case of a child aged 8-18 with ‘moderate to severe depression’, a doctor may prescribe it off-label (not licenced for that indication) – if he/she decides it is in the child’s ‘best interest’. While the pros and cons of off-label prescribing have been oft-debated, it should be remembered that Jake did not have depression and was prescribed the drug ‘to help with his junior certificate’. Clearly, as he is now dead, it seems that Prozac proved to be in ‘his worst possible interest’.
Notably, Jake had no history (or diagnosis) of depression and his death came out-of-the-blue to all who knew him – seemingly inexplicable. Indeed, after a long and protracted inquest, the coroner concluded that Jake was not in his right mind on the night he died (resulting from the prescribed fluoxetine) and returned an ‘open’ verdict. This was largely due to an email that Jake sent shortly before he died, saying he felt ‘drugged out of his mind’ and further (demonstrating a shocking lack of consent), he expressed that he was never told that the drug was an antidepressant.
While the Seanad vote was disappointing, it was hardly surprising. Although 12 Senators voted to support the bill, the majority (19) voted against. The general reasoning was that an inquest cannot apportion blame and thus, a prescribing physician might be held accountable (imagine the horror!). However, this was addressed in the proposed bill and was not the intent of Jake’s Amendment. Indeed, this particular reasoning does not explain why ‘medical misadventure’ or ‘unlawful killing’ are permitted – and surely a ‘suicide’ verdict blames the deceased? It was also mentioned that there were other alternatives in circumstances where medical treatment causes harm, such as taking the legal route. However, this failed to consider that in Ireland (and indeed, Europe), taking a case against a pharmaceutical company or medical establishment means that a plaintiff must have the means to meet the costs of the defence if the action fails. Thus, for the majority of plaintiffs with relatively ‘normal’ means (who haven’t won the lotto), a legal action is nigh on impossible. This is not justice.
It was both humbling and inspiring to see
ordinary extraordinary family members, stand firm with the courage of their convictions, in the face of any establishment. Senators like David Norris, Francis Black, (the very kind) Maire Devine, Trevor Ó Clochartaigh and Rose Conway-Walsh, were all thoroughly inspiring.
While Senator (and doctor) James Reilly was among the opposers – it was hardly a revelation. Indeed, he took umbrage with Senator Norris stating that Prozac was contraindicated in ‘those with Aspergers’ – which he said was untrue. Hmm, let’s see, shall we?
Definition of contraindicate –
According to a 2010 Cochrane literature review ‘Selective serotonin reuptake inhibitors (SSRIs) for autism spectrum disorders (ASD)’ – There is no evidence of effect of SSRIs in children and emerging evidence of harm (I have full text if required).
According to the NICE guidelines (section 1.4.22) – Do not use antidepressant medication for the routine management of core symptoms of autism in adults.
And again, per NICE (reviewed in 2016) – Do not use antidepressants for the management of core features of autism in children and young people.
It seems pretty clear to me that Senator Norris was actually correct when he said that the SSRI prozac was contraindicated for ‘those with Aspergers’. What is not clear, is why Dr Reilly was unaware of the NICE guidelines or the Cochrane review.
So, back to business as usual, the families fight on for justice and Jake, the 14 year old child at the centre of all this, remains irrevocably and needlessly dead. There is little doubt that this is not over – at least until the
fat skinny lady sings (aka Stephanie).