Invited by the Nevada Psychological Association I gave a lecture in Reno on October 4 – see Health, Care and Science. The lecture centered on the death of Woody Witczak on a Zoloft Big Dipper ride and what can be done to save us from a fate like his.
Two days later the Southern California Psychiatry Society and an AstroTurf group no-one had heard of before, the Committee to Protect Public Mental Health, issued statements covering similar themes to those I had covered, specifically mentioning the FDA panel on SSRIs and pregnancy in which I participated – See Unsafe Safety Systems. As reported in NPR KQED, these groups came to quite different conclusions to mine – their solution is the removal of the Health Secretary, which is not mine.
Two days later again, on October 8, Jamie Dimon, Chair of J.P Morgan Bank, covered come of the key themes that concerned me, emphasizing economics rather than health. Dimon framed the issues in terms of stock market exuberance at the prospects of AI and the likelihood of and need for a market correction. Jamie is not the only person concerned – it appears clear that Silicon Valley is very aware of the risks we are all running – see Bubble-Bursting theme.
Do Health Bubbles Burst?
In the 1960s, Americans had the best life expectancies in the world and a health system that was viewed as the most innovative and the best.
But U.S. Life Expectancies have now fallen way below those of other developed countries. Reproductive rates have been consistently below the replacement rate for decades and would likely be worse if not for immigration.
Disability rates are escalating and most worryingly now affect younger (15-35) age groups and involve mental health claims rather than older folk in their middle (40-60) years claiming on the basis of musculoskeletal problems. – see The Great Silence and Damsels in Distress.
This is a predictable outcome if close to the entire literature on the medicines we use in healthcare is ghostwritten, if there is no access to the data (the people) who participated in company licensing assays to find out what really happened to them, if a large proportion of the assays are effectively fraudulent and if we insist that to mention any of this stigmatizes patients.
Back in the last weekend in August 2022, both the New York Times (Democrat) and New York Post (Republican) agreed our adolescents are suffering from a poly-psychotropic drug pandemic – see Trust Truth and Health. A cross-party agreement like this in the absence of any substantive grappling with the problem makes a market correction seem increasingly likely.
The SoCal psychiatrists and the AstroTurf group claim to be very concerned about stigma, and seem to think a market correction will stigmatise.
It does not stigmatize patients to claim their illnesses may not be real. It stigmatizes us to label our normal variations as illnesses. To transform extraversion into ADHD and introversion into ASD. It stigmatizes us to remove the risks from medicines available on prescription-only precisely because they are hazardous, which means that if anything then goes wrong on the treatment it must be our fault.
It stigmatizes women if many of them feel that those in social company relax when women convey an impression of control by saying they are taking an SSRI.
European countries like Sweden and Britain are de-diagnosing ADHD and ASD, in part because it is clearly crazy to have an illness like Adult ADHD appear from nowhere and become epidemic, or have Autism Spectrum Disorders increase a thousand-fold, with everyone affected entitled to claim disability benefits. This way social welfare systems, or even welfare nets, will inevitably collapse.
These pandemics are made in American laboratories – pharmaceutical company marketing departments. In 1962, the new regulatory framework for medicines put in place following the thalidomide crisis, positively incentivized companies to make us diseased in order to sell their medicines. To give you Prozac, I first have to make you depressed.
Jamie Dimon and the Real Economy
Can America afford to remain behind this de-diagnostic curve? This is where Jamie Dimon’s arguments come into the frame. Dimon contrasts the Real Economy with the Stock Market. Stock Markets love the exuberance that creates Bubbles. In the Real Economy people get hurt and lose livelihoods unless the fundamentals are solid.
Rather than stocking up on AI, whose value Dimon thinks is overblown, in an increasingly dangerous world, and specifically mentioning China, he argues America should be building up stockpiles of missiles, bombs and bullets.
From the American Civil War onwards, however, it has been clear that the country that loses the least soldiers to injuries or disease wins Wars – See American Veterans and Healthcare.
This spurred militaries, especially the US military, to become the primary sponsors of modern healthcare in the form of surgery, public health and, in World War II early pharmaceuticals imported from Europe. After the War, a program was put in place to make Pharma Big and relocate it to the US.
America and its military, however, are also the home of Big Propaganda and this has been deployed highly effectively by pharmaceutical companies. Aided by the fact that, as these drugs are prescription-only, doctors are the consumers of modern pharmaceuticals not those of us that put the pills in our mouths, pharmaceutical companies have been able to spend far more dollars on marketing these products to each American consumer (doctor) than any other company spends marketing all other products combined to the each individual member of the entire population of the United States.
The money is not spent on trinkets, or free lunches and does not end up in brown paper envelopes, all of which doctors deny being influenced by. It goes on what doctors say does influence them – the evidence.
This evidence consists almost entirely of company studies. There is no access to the data from these studies – not even to FDA. This means that legally these studies are Hearsay not Evidence.
The articles purporting to represent the results of company studies are ghostwritten, even those appearing in the New England Journal of Medicine, from which the patients injured in these studies have vanished.
Even when company studies are shown to be fraudulent and lead to Billon dollar fines, these studies remain unretracted and built into Standards of Care.
As a result, companies are confident that few if any doctors (consumers) have a thought in their head not put there ‘by us or our competitors’.
The main company marketing weapon is essentially an early version of AI – randomized controlled trials (RCTs). RCTs, like Large Language Models (LLMs), are algorithmic averaging machines.
Widely portrayed now as the gold standard way to evaluate a drug, their creator, Austin Bradford-Hill, and the man responsible for incorporating RCTs into the regulatory process for medicines, Louis Lasagna, both said RCTs tell a doctor nothing about how to treat the patient in front of them.
They both thought the best way to evaluate what a drug is doing for or to you or me is to sit down with us and interview us.
They both thought that if RCTs ever ended up being thought of as the Gold Standard Way to evaluate a drug – as companies repeat all the time – we would have gone stark raving mad.
RCTs are, in particular, a Gold Standard way to Hide Treatment Harms – as you might have suspected when it is primarily companies who proclaim how useful RCTs are.
In recent weeks, the selective serotonin reuptake inhibiting (SSRI) antidepressants and Tylenol have emerged as the battleground on which these issues are playing out.
Should doctors in Southern California, or elsewhere, be taking sides in this battle in favor of what has been a dominant, company-framed, narrative?
If our treatments are as effective and free of harms, as claimed, doctors will be out of business. Cheaper prescribers, like nurses, will and are already putting doctors out of business.
Wake up and small the coffee is the phrase that comes to mind or perhaps a variation on Leonard Cohen’s savage anthem:
Partnerships
It is unlikely that all psychiatrists in Southern California are behind this statement apparently issued on their behalf. For decades, pharmaceutical companies have been adept at a well-known political tactic called ‘entryism’ – getting one or two well placed physicians in bodies that companies called partners, like APA or ACOG or SFMF, to frame and get published statements that seem to come from the organization as a whole but may in fact represent the views of perhaps no more than a fraction of their members.
See American Psychiatric Association and FDA and Request for American Psychiatric Association Assistance to which there has been no reply. But especially see Partnerships in HealthCare.
Companies groom Judas Goats to lead the Medical Sheep to their doom.
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How do we solve these problems? More regulation or less?
In a recent Face the Nation interview, FDA’s Commissioner, Marty Makary said we need to make it possible for doctors to be doctors, implying that less rather than more regulation might be a better way forward. We once viewed our doctors as better placed to help us with our healthcare issues than bureaucrats within bodies like FDA. Our doctors also saw things the same way.
The change of attitude from seeing medical professionals to seeing bureaucrats as our savior is a great instance of what many on both the Left and the Right from Max Weber a century ago have viewed as a hazard of both governmental and corporate Deep States (bureaucracy).
Even if China were not a looming threat, and positively licking its lips at sight of the entire United States becoming disabled, Makary’s Back to the Future of Personal Care vision has to the way to go.
Only way to go for what? Only way to save us, especially younger people who are committing suicide in ever increasing numbers, from a fate like Woody Witczak’s. Following a ghostwritten fraudulent literature might keep pharmaceutical companies alive and well, but how on earth can it save either us – the people who end up with pills in our mouths – or us – doctors like me who consume and believe in this bilge?
My hope from the lecture in Reno was to get ideas from the 200+ College folk there about how their generation might be able to help. But so far there has been silence.
Faced with these issues, doctors in training all go limp. What can we depend on if we have no guidelines, they ask?
Call it authoritarian perhaps, but it’s going to take a leader not a bureaucrat to get us out of this mess.
The distinction between a leader and a bureaucrat is that a leader, like an old-style doctor, knows when and how to help a people to take a corrective medicine, even if unpleasant, when it is called for.
Back in the USA
There is a strange backdrop here. Back in the USA in the early 1960s, when the US had the best life expectancy in the world and was taking a lead in pointing out the hazards of America’s and the world’s favorite tranquilizer, nicotine, JFK was elected in part on a promise to close the missile gap with the USSR.
In the 1964 election, LBJ faced a Californian Republican – Barry Goldwater. Almost all of American medicine voted Republican at the time – all except psychiatry, which was Freudian and Democrat. Leading psychiatrists took to the airwaves to tell us that Republicanism, like Nazism, was underpinned by a latent homosexuality. They promised that even Wars could be stopped if only everyone was analyzed.
This brand of Freudian thinking viewed close to all claims of sexual abuse as fantasies.
Pharmaceutical companies are today’s Freudians. Exploiting our willingness to delegate our narcissism they have led us to think that the abuse Woody Witczak suffered on Zoloft points to something wrong in him, some fantasy he had, rather than abuse by Pfizer. A fantasy the Southern California and other psychiatrists, not knowing the Pfizer settled the lawsuit Kim Witczak took against them to avoid their documents coming to light, can continue to indulge.
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