I had to give some workshops a few years ago to media students and either while thinking about what to say or in the middle of saying it, or soon after, it hit me that good doctoring has a lot in common with good journalism.
Both hinge on getting the story right and key to that is having a real person whom others can contact to check out the story they have been told about an adverse event, for instance. To do this, others need to know the name of the person. If an article about a problem mentions an anonymous source, editors and other journalists have to feel pretty confident they could contact this person if need be.
In May 2003, Jayson Blair, a New York Times journalist, was fired for inventing a story with the additional charge that he had plagiarised material. My reaction back then was that we would all be a lot safer if the reports of company trials for drugs or vaccines were reported in the NYT rather than the New England Journal of Medicine. I am less sure of the NYT or other legacy media now.
NYT seemed a lot more concerned about the integrity of their story than NEJM – who regularly tolerate a ghostwritten literature, that commonly makes fraudulent claims about efficacy and safety, based on trials in which the patients might not always exist or if inconvenient have been made to disappear, along with a lot plagiarism about lowered serotonin levels and anticholinergic drug effects. The repeated plagiarism plays a huge part in leading the public and doctors to believe a lot of things that have no basis in reality.
Decades back books like Toxic Sludge is Good for You made it clear that pressures on journalists and media companies mean that many journalists find it easier to just work from copy already written for them by the marketing departments of pharma or other life sciences companies.
At the centre of RxISK’s mission and the PSSD story is the idea that Your Name Counts.
The PSSD Network have since done amazing work to bring this point home to people with PSSD who have been very reluctant to let anyone else know they have the condition. This has helped bring PSSD out in the open. Recently they have also reached out to a lot of media aimed at getting articles in print – ahead of a BBC program about antidepressants that will bring PSSD into the frame.
Part of the PSSD Networks outreach to media like the Guardian in the UK – something like the UK equivalent to the NYT – led to the correspondence below.
Rachel Hall Guardian to S, R and DH
Thanks for this S. I’ve got a commission from our editors now. We might hold the piece while I do more research, or if I have enough we’ll run it on Monday.
To that end, I wondered whether R and David might be able to respond to the following questions by email by the end of Saturday?
What evidence is there that permanent PSSD is a problem and is caused by SSRIs?
What is the connection between PSSD and emotional blunting/anhedonia – do most/all sufferers experience both in tandem?
Why is it not more widely recognized and discussed? Why do some sufferers feel their concerns have been dismissed by medical professionals?
What needs to be done to raise awareness help sufferers, in terms of guidance to GPs/psychs, the research base, wider policy changes? (David, would be grateful for answers from a UK perspective)
S to DH
Hi David,
Hope you are well.
Just checking if you will get a chance to answer Rachel at The Guardian’s questions on PSSD by the end of tomorrow.
Thanks,
DH to S, R and Rachel
S
This is tricky.
I never respond to journalists who send questions by email and ask me to write their article for them. A bit like giving meds, there should be a relationship before the other person sends an email question and will be able to interpret my answer properly.
There is an outsourcing going on here that loses important detail at every step of the way – from the Guardian to Rachel to me or whoever. Outsourcing from pharma to companies who run trials to ghostwriters and key opinion leaders is what leads to you guys having PSSD. PSSD is not a unique side effect – it’s part of the system that is leading to more and more side effects and more and more denial – with the Guardian a leading denier. The only way to combat this is to insist on relationships with all parties taking responsibility for treating the other party fairly.
Chances are the longer any email answers the more the G will leave on the cutting room floor and the more the final version will seem to me and likely you to be terribly unsatisfactory.
David
Rachel to S, R and DH
Hi David,
Thanks for making your preferences known. For clarification, I sent the questions by email because I only have Sunday available to work on this article if we are to meet the deadline and I didn’t wish to ask you to speak then.
I’m not aware of any internal stance on the issue you describe so I’m not able to comment. If you’d like to discuss it with our readers editor I’m happy to send you the contact details.
Best, Rachel Hall
Rachel to S
Hi S
I think it might be better not to speak to David as I am a little confused by his views about the Guardian, which don’t reflect my understanding of how we operate, and they suggest some hostility. When we are pressed for time we often send questions via email, and all the academics I’ve worked with previously have been satisfied with this arrangement, so I’m surprised by his reaction.
I will need to speak to a UK-based academic for this piece though, is there anyone else you would recommend?
Best, Rachel
DH to Rachel and S and R
PSSD is one of the most important stories in medicine today but it is not a breaking news story. There is no rush to get this done. Another journalist working with me on an important antidepressant story has been working on it solidly for a month. This is the kind of input needed.
It is bad journalistic ethics to start with a set of email questions. Fixing up a Zoom meeting and then sending an email saying these are the questions it would be good to answer is a better option but really something this important needs much more detailed input than the questions sent in this case.
I had contact from another journalist this morning about PSSD. Someone I know previously but who still felt that as it was a new subject for her, it needed a conversation. I made time – an hour. There will be follow up emails.
But to repeat it does not bode well for an article when the initial overture is a set of email questions.
DH to Rachel, S and R
Thanks to S for the note from him which does not feature here
Thanks for Rachel for responding also. Unfortunately this is the obvious answer to give and makes it impossible to know how genuine it is.
I have tried to alert the Guardian to PSSD for a decade but no joy. From being good on issues like the adverse effects of drugs and vaccines 20 years ago, the G is among the chief deniers of problems now. The Daily Mail’s health page is a lot better.
Tackling a question like PSSD and only having a day or two to do it and sending questions by emails is not the way to do this story which is one of the biggest in medicine in terms of what it might reveal about new mechanisms for drug actions, but also the devastation company approaches have inflicted on people – knowing about this hazard for nearly 40 years but doing nothing about it and compounding the problem to the point where people who mention it to doctors risk being detained under the mental health act.
I’ll be very happy to talk to any journalist from any source about these issues who has a brief to take this issue seriously
David
S to Rachel, DH and R
Rachel,
In the past, we have noticed a problem where the seriousness of PSSD is not accurately represented in articles. It is often downplayed as a mere “side effect”. We do have some concerns similar to those expressed by Dr. Healy regarding the tight deadline.
We also believe that a story about PSSD should not be hurried. It requires careful and thorough discussion with the individuals being interviewed, as this is a complex matter.
PSSD is an extremely sensitive and traumatic topic for sufferers and if the seriousness of PSSD is in any way misrepresented, this could be too much for some to deal with. Sufferers have a history of being gaslit by medical professionals which leads to repeated trauma.
PSSD is often dismissed as ‘the underlying depression’ even though this makes no sense as genital numbness is the most prominent symptom. Even after persistent sexual dysfunction post-discontinuation was acknowledged by the European Medicines Agency in 2019, some still try to blame ‘depression’ or mental illness in general.
PSSD is also a completely different beast, we’re talking about the complete removal of any arousal response in the body, as well as physical numbness in the genitals to the point where some can’t feel themselves peeing. People describe it as if they’ve completely lost all interest in the opposite sex, this is a far cry from what depression induced low libido is.
Rachel to DH, S and R
Thanks David, we certainly do intend to take the issue seriously, I haven’t come across any challenge in that respect. Can I ask who you’ve contacted previously? Different parts of the Guardian work very separately to each other.
In terms of our health reporting, I can confirm side effects are definitely of interest to our national news journalists as I work with them, though it’s worth mentioning that they are absolutely swamped covering an enormous volume of health news. There can be all sorts of reasons why a story isn’t picked up.
Would you like to speak by phone on Sunday? Let me know and I’m happy to arrange.
DH to Rachel, S and R
I’m happy to talk to anyone about PSSD. Sunday is possible… Good if you can let me know what times work for you – the earlier the better
Phone Goes Dead
A Time was set by Rachel – who later pulled out.
Josef Witt-Doerring
S’s initial suggestion to Rachel included contacting Josef Witt-Doerring. He gave a link to an Interview about PSSD that Josef and I had done
Josef was likely sent very similar email questions. He responded.
Although not directly asked I’ve got a few thoughts:
1) Evidence for the permanence of sexual dysfunction comes from the assessment of numerous case reports assessed by regulators. EMA and Health Canada have now updated the package insert labels as they believe this risk rises to the level where all physicians prescribing the drug inform patients about the risk.
2) The cognitive/emotional problems have been overlooked by many, this is because they “blur” in with the underlying condition the drugs may have been prescribed for. However, they are completely distinct from the typical depression/anxiety. For instances they can be states of severe emotional blunting (not feeling anything), there is also a complete absence of motivation/drive for many. This is a consistent pattern of observed symptoms. When you speak to suffers, these psychological symptoms are unique from the original symptoms that resulted in them taking the drug.
3) The condition is not widely recognized because it was only recently acknowledged by drug regulators in the last few years. Even when they updated the labels, they didn’t enact a risk mitigation measure to get the work out (e.g., requesting that dear health care letters describing the new risk be sent to all family med docs/ psychiatrists). The reality is that most MD’s don’t frequently read drug labels so they would not be aware of the update.
4) Regulators should first acknowledge the risk, and then drug companies and regulators should initiate a risk mitigation campaign to tell physicians who use these drugs about the new risk so they can use the information to counsel patients on whether they should use the drug. I believe the correct measure would be a “dear healthcare letter” to all practicing GPs, gynecologists and psychiatrists.
Hope this helps,
What’s Wrong With This?
You could easily argue there is nothing much wrong here. Why couldn’t a journalist just cut and paste what’s hear.
I have a colleague I respect more than almost anyone else who insists on emailing his contribution rather than talking, figuring perhaps he can control the narrative that way. But it doesn’t work.
Its tricky for me to suggest anything might be wrong with Josef’s responses because he and I also get on well and have a joint mission to raise the profile of drug hazards. The last thing that would be helpful is for us to fallout. I should have, but haven’t, checked with him that he’s okay with me showing his response.
The problem is that the email questions set an agenda and Josef hasn’t responded by telling Rachel she has this all wrong and needs to dig deeper – or equally doesn’t give her the chance to challenge him and what we could call his ‘bias’ or her the chance to challenge me and my biases.
Rachel’s questions close the door to anyone telling her the media have played a big part in the problem. I and others have presented this story to the Guardian, the BBC, the NYT and other outlets on multiple occasions in the last decade. We’ve been brushed away with responses that we don’t want to put people off getting the benefit that antidepressants can give them.
Another door closed with her questions is that this is not just a mental health and antidepressant problem. Again and again even people suffering adverse events see the problem as a mental health one – this creates a mental health ghetto. Sufferers often make the problem worse by calling for their specific drug to be banned.
The problem we all have is that while the media are not too bad at rotten apple problems they are useless at rotten barrel problems. The challenge to Rachel has to be to work out how to avoid giving people the impression that now that this rotten apple (Great White Shark) is getting thrown out of the barrel (has been killed) you are all safe to go back taking drugs (get back in the water).
The so called left leaning, or liberal media, like the Guardian and New York Times are worst of all. This stems from a bias – it should not be a privilege of wealth to get on treatment to save your life. This was a laudable bias but is now a problem with the Left only seeing the cost of drugs as the problem when getting the price down only means we will end up on more drugs and die earlier from polypharmacide.
What used to be viewed as a more right wing media, like the Daily Mail in the UK, are now much better when it comes to laying out a balanced view of drugs and health issues in general.
Now – is a point in time where it has become a privilege of wealth to get off treatment in order to save your life or avoid disability.
When it comes to health, the idea of being able to hold two contradictory things in mind and still function – like bringing good out of the use of a poison – which used to be a sign of a sophisticated mind, is not something the Left can manage. They prefer official narratives that figure medicines can only do good – other than idiosyncratically.
And the job of a public health system is to get you more access to more drugs. Industry learned to milk systems like this ages ago.
A real investigative journalist – there are few around in health these days except in the Mail – just like a real doctor (few of them around too) would attempt to get to grips with this rapidly worsening situation, where life expectancy and reproductive rates are falling and handed a problem like PSSD would tell the editor, or service manager, that this is the story of the decade, even more than Covid and needs far more input than a few hours between here and Monday morning.
Especially as solving it looks like it stands a chance of giving us better antivirals and anti-cancer drugs.
To Be Continued
annie says
Side effect warning over powerful antidepressants taken by millions: SSRIs like sertraline can ‘destroy sex lives’ even years AFTER patients stop taking them – prompting one leading psychiatrist to say: ‘Don’t go anywhere near them’
Experts are worried about more and more Brits taking the sex-dampening pills
By JOHN ELY SENIOR HEALTH REPORTER FOR MAILONLINE
UPDATED: 14:46, 10 June 2023
https://www.dailymail.co.uk/health/article-12169059/Antidepressant-taken-millions-dished-men-struggling-premature-ejaculation.html#
‘Depending on who you ask, sertraline will either ‘save your life’ or morph you into something resembling a sexless zombie.
And it’s precisely that side effect sparking alarm among psychiatrists.’
This article ‘morphs’ from scarifying to the usual non-stuff from RCP and is not a particularly learned piece of journalism, printed on Saturday before Sunday gave us ‘I think it might be better not to speak to David as I am a little confused by his views about the Guardian, which don’t reflect my understanding of how we operate, and they suggest some hostility.’
It sounds like the Guardian wanted a splashy, headline grabbing article done in double-quick time to catch-up with the Daily Mail’s article.
‘I will need to speak to a UK-based academic for this piece though, is there anyone else you would recommend?’
Joanna Moncrieff obliged in the Daily Mail article.
EVERYONE – Tell The Guardian about your experiences of PSSD
https://www.pssdforum.org/viewtopic.php?t=1157
I get the feeling that the Guardian feel they are ‘late to the party’, and are in a hurry to catch up, despite having ignored it when they have had ample opportunity.
Taking wrong turns in the media, might lead to some undoing of all the effort and research that this blog has shared and this is why the path should be trodden carefully and thoughtfully, to protect, yet enhance, PSSD.
Sarah Browne says
Initially I was sad that the Guardian have pulled their article, but I now think it was a blessing in disguise.
In the past, I’ve spoken to journalists about PSSD. I’ve told them about my symptoms and how it’s ruined my life. But I’ve also told them HOW PSSD has flown under the radar for decades. I’ve talked about trials where these side effects were seen but unreported, how UK psychiatrists have all but given up on reporting adverse events via the Yellow Card scheme (something I’ve personal experience of), how the MHRA have ‘responded’ but did not put an alert out to prescribers, how the phrase ‘PSSD’ will not be seen on any leaflet or NHS material until the BNF use it, how the BNF’s wording has to be agreed with by pharmaceutical companies…
I didn’t expect journalists to take my word for it; I can provide references and they can look at these things themselves.
Journalists do not seem to want to get to grips with this scandal. It’s far bigger than SSRIs- the Cumberlege report would be a great place for journalists to start. People should be outraged that the medical establishment has missed the fact that one of the most widely used class of drugs has a terrible side effect for over 30yrs. Pharmacovigilance has failed: the EMA/MHRA/FDA are not keeping people safe! We have allowed pharmaceutical companies to mark their own homework for years.
There’s no embarrassment over this amongst Drs and regulators alike- it’s almost accepted that it’s up to harmed people to campaign for acknowledgment of their conditions. The authorities have perfected the non-response response. There is no way a patient or Dr can read the updated side effects of SSRIs and know what PSSD is: there is no mention of genital numbness, no mention that it can APPEAR after cessation or that it might persist indefinitely. Journalists are not reporting this.
Instead, journalists have ignored the corruption, incompetence, apathy and unethical practices highlighted by PSSD. Instead, they’ve gone for ‘balance’ and interviewed pro-SSRI Drs who will always say that ‘sexual dysfunction is symptom of depression’. A responsible journalist would point out that genital numbness is not a symptom of depression, that people prescribed SSRI for off-label uses are still getting PSSD.
It seems that by seeking ‘balance’, the days of investigative journalism are all but over.
Dr. David Healy says
S
Great comment – thanks.
Cumberledge wasn’t really interested to engage with harms – not just PSSD
D
Andy says
Maybe you are right David but I can’t help but feel like your response just pushed the journalist away. This was someone who was open to hearing about PSSD and willing to spread awareness about it. If one person read that story in the Guardian and decided not to take an SSRI, they might have been saved from PSSD.
If your ultimate goal is to spread awareness of the significant problems within medical science then I think you could use opportunities like this better. People need to be persuaded one step at a time. It might start by explaining why PSSD is not more widely known about and then you can use that to further elaborate on the underlying root problems.
That one story was not necessarily the end. It could have led to further stories and a larger investigation down the line.
annie says
Maryanne Demasi, reports
Antidepressants can cause ‘chemical castration’
Patients are not being warned of persistent, irreversible sexual dysfunction caused by SSRIs
MARYANNE DEMASI, PHD
13 JUN 2023
https://maryannedemasi.substack.com/p/antidepressants-can-cause-chemical?utm_source=post-email-title&publication_id=1044435&post_id=127330334&isFreemail=true&utm_medium=email
Antidepressants can cause severe, sometimes irreversible, sexual dysfunction that persists even after discontinuing the medication.
Sufferers have described it as ‘chemical castration’ – a type of genital mutilation caused by antidepressants, mainly selective serotonin reuptake inhibitors (SSRIs).
The condition is known as post-SSRI sexual dysfunction (PSSD), a condition largely unrecognised, and the true incidence of which is unknown.
David Healy, psychiatrist and founder of RxISK.org said, “I saw my first patient with PSSD in 2000, a 35-year-old lady who told me that three months after stopping treatment, she could rub a hard-bristled brush across her genitals and feel nothing.”
Josef Witt-Doerring, psychiatrist and former FDA medical officer said, “This condition is so devastating that it will cause serious changes to your life and to those around you.”
It happened to Rosie
In 2020, during protracted covid lockdowns in Melbourne, 23-year-old Rosie Tilli felt an increasing sense of anxiety and depression.
Her psychiatrist prescribed a low dose of Lexapro (escitalopram), an SSRI to help Rosie calm down, assuring her that if she experienced side effects, they’d go away once she stopped the medication.
Soon after taking the medication Rosie felt emotionally blunted, but took it as a positive sign.
“At first, I thought it was great because it felt like the medication was working. But then I couldn’t feel my emotions, I couldn’t cry, I had no sexual desire, and my genitals went numb.”
After four months, Rosie decided to slowly wean herself off the medication. Some of her symptoms improved and the fog lifted, but over the next two years her libido faded to nothing.
“It has been two years of hell. Now, I have no sexual function. I’m numb down there. I can’t have an orgasm. It feels like my soul has just been vacuumed out of my body. I feel completely asexual,” said Rosie.
She sought help from various professionals, but none believed it could be the antidepressant because the drug had already left her system. They concluded it was all in her mind.
Rosie went to a local youth centre for help, but they ended up sectioning her under the Mental Health Act with an Involuntary Treatment Order, insisting she take antipsychotic medication.
“I refused to take an antipsychotic because I knew I wasn’t psychotic. Instead, they forced me to take another antidepressant against my will in order to leave the facility,” said Rosie.
“It was the most traumatic thing I’ve ever been through in my life. I felt helpless and my parents just looked on and said, ‘trust the professionals, they know what they are doing’.”
In her clinical notes, the doctors wrote that “Rosie exhibits fixated beliefs of a delusional intensity about ongoing sexual side effects from Lexapro”.
“One psychologist actually asked me if I’d tried seeing a male sex worker to help bring back my libido. I was shocked. They said it would reduce my anxiety and help me get in touch with my body,” said Rosie.
“I’m chemically castrated, and no one believes me. In retrospect, my original anxiety was not even a problem compared to this. This has absolutely ruined my quality of life. I feel trapped inside my own body,” she added.
Doctors don’t get it
“Most doctors are not familiar with enduring side effects following antidepressants and believe side effects end after the drug is discontinued,” said Witt-Doerring.
“There’s a lot of shame wrapped up in sexual functioning, especially in young persons. Even older persons don’t want to talk about it and so they’re not reporting it, or they are minimising the sexual aspects of their symptoms to their doctors,” he added.
Healy says PSSD is often dismissed as the person’s ‘underlying depression’ and patients are gaslighted by their doctors leading to repeated trauma.
“I’ve known many patients who’ve gone on to commit suicide because of the condition. Others have asked for referrals to Dignitas, which is access to assisted dying in Switzerland,” said Healy.
PSSD has been discussed in the medical literature for about 15 years, but very few studies focus on the issue.
In a study from 2001 involving >1000 patients with no previous history of sexual problems, 59% reported sexual dysfunction after commencing an antidepressant.
For the five most commonly used drugs, 46% experienced no orgasm or ejaculation.
A 19-year retrospective cohort analysis recently published in the Annals of General Psychiatry, found that 1 in 216 males taking a serotonergic antidepressant (80% took an SSRI) experienced erectile dysfunction long after discontinuing their medication.
Sufferers have gone to extreme lengths to find a treatment, or even an explanation, for their condition.
Some have had biopsies to see if the medication has damaged their sensory nerves – others have had plasmapheresis, to mop up rogue antibodies in their system.
None of it works.
“The truth is, there’s no unifying, readily agreed upon cause for why these people are experiencing these symptoms. It remains unknown,” said Witt-Doerring.
Drug regulators
In 2018, Healy led a group of physicians and researchers who petitioned the US Food and Drug Administration (FDA) “to immediately require the addition of boxed warnings and precautions on the product’s label.”
Healy said the petition sought to highlight the harms of SSRIs by adding warnings about harms such as ‘genital anaesthesia’ and requested that the FDA send ‘Dear Doctor’ letters to all medical professionals about the significant public health concern these drugs pose.
However, to date, the FDA has not responded to the petition. Nor has the agency responded to follow up enquiries. Healy says he had more success with the European regulator.
In June 2019, the European Medicines Agency updated the ‘Special Warnings and Precautions’ section on the label of SSRIs to warn that sexual dysfunction can persist even after treatment stops.
In 2021, Health Canada also did a review of the evidence and “found rare cases of long-lasting sexual symptoms persisting after stopping SSRI or SNRI treatment” and updated the product label for Canadians.
“The problem is that doctors in Europe and Canada might not be checking the drug labels now that the warnings have been updated. And there were no letters sent to medical professionals to alert them of the new warnings,” said Witt-Doerring.
In Australia, the product label of Lexapro (the drug that Rosie was prescribed) does not have any warnings about permanent or long-lasting sexual dysfunction.
A spokesperson for the TGA said that the agency was aware of the actions taken by EMA and Health Canada to update the product labels in those countries. It stated:
The TGA is actively considering appropriate regulatory actions in response to our own review of the evidence, noting that the Australian PIs of some SSRI and SNRI products have already been updated by the relevant sponsors.
Lack of informed consent
“There’s a massive epidemic of a lack of informed consent,” said Witt-Doerring.
“For most people, they would want to know about reports of persistent and enduring sexual dysfunction; it would weigh on the decision for them to take this medication,” he added.
Rosies’s doctor failed to warn her about PSSD, despite EMA’s label update in 2019.
“It has been two years since I stopped the medication, and all the symptoms are progressively getting worse. I am unable to feel myself peeing, I can’t feel a crush or romantic emotions, I can’t feel love, happiness, joy, or euphoria,” said Rosie.
“I would have been OK to have difficulty with orgasm or low libido while I was on the drug, but I never thought that I could lose all sensation in my genitals, and that it would be permanent. I would never have touched the drug if I’d known it was a possibility,” she added.
A website has been dedicated to increasing awareness of PSSD and gives people the opportunity to tell their stories.
susanne says
See new Tweets
Conversation
Mark Horowitz
@markhoro
Looking forward to this documentary on
@BBCPanorama
at 8pm on the 19th of June about antidepressant withdrawal and how its effects have been minimised by the companies that manufacture them and their academic spokespeople:
bbc.co.uk
BBC One – Panorama, The Antidepressant Story
Investigative documentary.
3:57 pm · 11 Jun 2023
·
27.5K
Views
susanne says
‘Where is the evidence’ Right here on the blogs .
They don’t explain how they have compiled the set of questions. What is their source . They are almost accusatory and there are very few . if answered in this format they could not possibly do justice to the issue.If David answers such pin down questions it could well backfire just as when individuals are given questions from a check list by a psych consultant the result is often very damaging.. What they pick out suits the questioner. If they publish material which goes against the established stuff put out by such as colleges of psychs that would likely cause a furore they wouldn’t want to cope with. Be interesting to find out who they have in mind.’is there anyone else you would recommend?’ (other than DH). And consequently what they come up with in any article. It could be damaging if they play safe and the ‘wrong’ person is chosen to belittle the truth..
The reason for the rush right now is not explained but is not to get at the truth but to reach a deadline. And unwittingly they reveal how academics collude with shoddy publications ‘When we are pressed for time we often send questions via email, and all the academics I’ve worked with previously have been satisfied with this arrangement, so I’m surprised by his reaction’. Academics such as DH are not so easily manipulated for an article in a shoddy newspaper.
Peter Selley says
Rachel is fundamentally lazy, she is not alone and can probably be forgiven.
The medium is more important than the message and “investigative journalism” ain’t what it used to be.
But doctors come out of this badly as well.
I wrote to the British Medical “Journal” a couple of months ago:
“It is an interesting sign of the times that analysis of the problems in the clinical trial industry has been achieved by journalists, while the pharmaceutical industry and the medical profession seem unwilling or unable to put their own houses in order.”
https://www.bmj.com/content/380/bmj.p686/rr
Administrasi Bisnis says
Both hinge on getting the story right and key to that is having a real person whom others can contact to check out the story they have been told about an adverse event, for instance.