This post follows Janet Lagerloef’s Marilyn Lemak’s Trial and Punishment and Johanna Ryan’s Marilyn Lemak Then and Now. Jo was the first person I ever heard talk about this case. Janet has done more than anyone to get Marilyn’s case to a Clemency Hearing. She prevailed on several lawyers to pick up the case and got places when she persuaded Andy Vickery to take up the case, who got me involved and Jed Stone a Chicago lawyer with a track record of success at these Hearings.
On June 15, Marilyn’s was one of the cases put to a Clemency Hearing in Chicago. My contribution was Zoom recorded. The Text is Below and contains one important detail which the recording missed. The Clemency Recording is in the link and is better.
We will hear the outcome at the end of the Year.
Ladies and Gentlemen
You are about to hear things unprecedented in a Clemency Hearing.
I have a PhD in the serotonin system on which Zoloft acts – the drug Marilyn Lemak was taking. But you are not going to hear about serotonin.
I am a psychiatrist, but you are not going to hear about mental illness.
I am here because 32 years ago, two men I was treating became suicidal on Prozac, which also acts on the serotonin system. When I stopped Prozac, their problem cleared up. When put on another serotonin drug, each became suicidal again. The only way to explain these cases was that drugs like Prozac, clearly helpful for many others, made these two men suicidal.
I was working closely with all major pharmaceutical companies at this time and one of them Eli Lilly, the company who made Prozac, said their Clinical Trials showed no evidence that Prozac can make people suicidal.
So, I was faced with compelling evidence it did make people suicidal and apparently compelling evidence that it can’t make people suicidal.
I had seen industry practices at close hand. Pretty well all the whistleblowers who have told us about what can go wrong in company trials have worked in industry not in medicine. Arvid Carlsson who made the first SSRI and won a Nobel Prize says plainly that SSRIs can make people suicidal or homicidal.
Marilyn and Zoloft
How does this apply to Marilyn Lemak?
Marilyn Lemak did not have a mental illness. She had relatively minor problems in the early 1990s linked to childbirth. She was tired after the birth of her second child and had gained weight. She was put on a low dose of Prozac because of its reputation then as a weight loss drug, but a classic weight loss drug seems to have done more for her wellbeing than anything Prozac did.
Five years later, feeling the way many women with a job, 3 children and a busy husband feel, and possibly peri-menopausal, thinking about separation or divorce, she consulted Dr Hubbard. He initially prescribed nothing. Two months later he put her on a low dose of Zoloft.
This dose was increased over 3 months from 50 to 150 mg and she began to show clear signs of Zoloft toxicity like jaw clenching.
Dr Hubbard threw a tranquilizer, Ativan, into the mix. Lilly and Pfizer used drugs like this in their clinical trials to hide the problems Zoloft and Prozac cause. In Marilyn’s case, Ativan helped with some things but caused its own problems.
So, in early 1999, Marilyn had no mental illness, but she had two sets of drug induced toxicity.
Less than two months before the homicide, her Zoloft was increased to 200 mg per day. On this high dose, she was fatigued, losing weight, sleeping poorly but she never said depressed.
In 1982, 16 years before the homicide, Pfizer gave 200 mg of Zoloft to a set of healthy volunteers, all women. All of them dropped out within a week because they had become fatigued, agitated, suicidal and aggressive. In a report on this study, no doctor ever saw, Pfizer said our drug caused this and other drugs like Zoloft are known to do the same.
I know the doctor who wrote this report – its Attached Here. The full details of this trial are also available.
One of the volunteers was 40, slightly younger than Marilyn. Here is an entry in her diary on Day Four.
Where is Dr Hubbard in this? Well Marilyn tied his hands when she said, or at least his notes say she said, that Zoloft is working for her. So, our problem is not just where is Dr Hubbard, but where is Marilyn?
No one can look at this record and say Zoloft is working for Marilyn. Some doctors might say Dr Hubbard should have put the dose up higher or added other drugs into the mix.
But she was not depressed to begin with. With every increase she gets worse. Over 6 months there is no improvement. There is a good case to reduce and maybe stop Zoloft.
This is not Dr Hubbard’s area. He didn’t push to give Marilyn drugs as quickly as some doctors might. Now faced with a woman who seems to be getting worse it is difficult for him to stop digging in this hole especially when no-one has told him these drugs can become the problem rather than the answer to the problem. No one has shown him the Pfizer 1982 report on what this dose of Zoloft can do.
I have read the transcripts of the trial and think Mr Ruggiero handled the witnesses very skillfully – asking if they saw any features of mental illness in this woman in the days leading up to the deaths. And nobody did.
Mr Ruggiero and I agree Marilyn wasn’t crazy. But the killings made no sense. It is not plausible they were a revenge on her husband.
The killings do make sense when you bring Zoloft into the frame. This is a drug that makes you care less. Making you care less is central to what it does. There never was an abnormality in the serotonin system that it corrects.
When Marilyn said to Dr Hubbard she cared less about the divorce now, he appears to have read this as a good sign. Was Marilyn really there when she said that?
If Zoloft makes you care less to just the right extent when you are stressed, this can help you cope. But chill you out too much so you care less about important things, and you can end up with problems.
Disinhibition and Delirium
When healthy volunteers are put on these drugs, some start having thoughts they never had before – like killing themselves and their children – malignant thoughts like skinning themselves or jumping out a 44th floor window, way beyond the thoughts that you and I might have, which might include thoughts like it would be better for my husband if the children and I whom he doesn’t really want were out of the way.
And in the case of either malignant thoughts or normal ones, Zoloft removes the anxiety that inhibits us from acting on them. Healthy volunteers, women, have committed suicide on these drugs. In 2004, Traci Johnson, below, a nineteen year old committed suicide while tapering from duloxetine in a healthy volunteer study.
Women with no mental illness being treated for urinary incontinence have committed suicide on these drugs. Duloxetine branded as Yentreve is use for this purpose in Europe. FDA rejected it because normal women were committing suicide on it. See In the Firing Line.
A famous 1991 paper described a wealthy Baltimore hostess, who brought drinks to her guests – topless. Other than this she appeared perfectly normal to people who knew her. She was on an SSRI. This gives you a feeling for the frontal-lobe like disinhibition Zoloft can cause.
People with a frontal lobe disorder caused by a brain tumor, whose behaviour returns to normal after a tumor is removed, have walked free from criminal charges because it is recognized that, when our frontal lobe is disturbed, we may not be able to conform our behaviour to social norms. Fix it and we are not guilty.
Dopamine agonist drugs are used to treat Parkinson’s disease, which affects judges, senior lawyers and politicians. Members of the judiciary who otherwise seemed quite normal to colleagues have walked free from charges of prostitution, gambling, and other deviant behaviour. Why? When the drug is removed, their impulses clearly come back under control.
The legal principle here was enunciated in 1676 by Lord Chief Justice Matthew Hale:
“If a person by the unskilfulness of his physician or the contrivance of his enemies, eat or drinks such a thing as causes such a temporary or permanent delirium (frenzy), as aconitum or nux vomica, this puts him into the same condition, in reference to crimes as any other delirium, and equally excuses him”.
Ever since then, the legal system in the UK and US recognized that a person, delirious from an illness, a fever, or a drug, might have an absolute defense against murder. This is not a mental illness defense. Our problems with the insanity defense began a century later, when Philippe Pinel described mental disorders without delirium.
There is a huge gulf between Can Zoloft play a part and Did Zoloft play a part.
The Lemak Case
None of us are now in an ideal position to say for certain that Zoloft Did play a part in Marilyn Lemak’s case. We would need to have been able to interview her then on and off these drugs.
Before agreeing to interview her, I would review her medical record to see what effect Zoloft had on her. If it was clearly helping, I would not get involved.
But that’s not the record we have. There are Zoloft fingerprints all over Marilyn Lemak’s record.
If the case was happening now, and I interviewed Mrs Lemak and thought the drug played a part, Mr Ruggiero and I would have had a conversation about – Did Zoloft cause her problem.
But we would also have talked about Can Zoloft cause homicide. Talked about the fact there is no access to the data from Zoloft trials, not even FDA have seen it. We would have talked about the ghostwriting of all Zoloft trials. Talked about publications of trials claiming Zoloft worked well and was safe – trials that FDA viewed as negative. Talked about FDA not even hinting to doctors that maybe they should not trust all that is printed in the academic literature.
We would have talked about coding adverse events. About the man made delirious by another of Pfizer’s drugs in a trial who poured petrol on himself and set fire to it but only died 5 days later – he was coded as death by burns rather than suicide.
This conversation would have shocked the jury. Bringing these points into a Clemency Hearing is unprecedented.
A Fair Trial?
Marilyn Lemak did not get a fair trial. She did not get a fair trial because the toxicity of the drug she was on was not brought into the frame.
A few months before Marilyn was found guilty, a Jury in Cheyenne Wyoming in the Tobin Case were faced with a choice between Did Paxil cause a man to kill his wife, daughter, grand-daughter and himself and GlaxoSmithKline’s argument that our clinical trials show this can’t happen. The Jury found GSK guilty. See Let Them Prozac for this and the Hawkins case.
A few months before Marilyn was found guilty, in an Australian court David Hawkins, who had murdered his wife, faced Judge O’Keefe. With the agreement of the prosecutor, Judge O’Keefe let Hawkins walk free, stating he would not have murdered his wife had he not been on – Zoloft.
The Hawkins and Tobin cases were more straightforward than Lemak. Despite its complexities, my view is that if evidence Marilyn Lemak was entitled to rely on had been brought into the frame, she would not have had the sentence she had – and perhaps not even the verdict.
To Be Continued next week.