Editorial Note: We desperately need you to undertake some jury duty – we need you to explore why we react so strangely when it comes to changes on behavior linked to prescription drugs?
In the last two posts Doctor Faces Marriage-Buster and Homicide of a Husband, there were two scenarios where drugs were involved and the questions were – can a drug change a person so they leave a marriage or can a drug cause homicide?
Both scenarios were deliberately ambiguous. We gave a much more convincing treatment induced wife leaving husband account a while back in Boy with a Ponytail. There are unquestionably much more convincing treatment induced homicide scenarios than the Michelle Millikan one.
It would be easy to select the details of a story to all but force the stories to come to only one possible conclusion. But even with cases of treatment related homicide that seem absolutely clear cut, where the jury as in the Pittman trial agree the drug had a bad effect on a twelve year old, many find it almost impossible to accept that a prescription drug could cause a homicide.
The innocent drug
The typical response is to look for any other possible cause. And it can be very easy to find other explanations. In the case of husband leaves wife scenario, we expect this to happen relatively often so for her to blame his drug or vice versa doesn’t wash. In the case of a homicide, well the Michelle Millikan case gives a feel for how the tapestry of a person’s life becomes fair game for scrutiny and anything that might have happened in the past can be mobilized to cast doubt on a link to treatment.
Homicide cases can lead to extraordinary bitterness and incomprehension. The responses in the Shane Clancy case were typical. The family of a young man who was killed in this case refuse to accept that the drug could have played a part even though Shane Clancy was clearly frenzied and killed himself horrifically as well. See here and here. In the Clancy case anyone who wants can find material that might sound as lurid as in the Millikan case – except in this case a jury of shop-owners and other townspeople in rural Ireland thought there was enough to implicate the drug.
The doctor is innocent
But there is a difference between marriagecide and homicide. If we ask a jury should a doctor faced with a husband or wife giving credible reports that their partner has changed personality and asking for a drug holiday to check this out – we feel he should. If he refuses, many of us feel this is wrong. Why?
This points to something important about what is going on. It’s not that we don’t believe a drug can cause marriagecide or homicide, it’s that we don’t think doctors cause marriagecide or homicide. So when the doctor gets a chance to intervene and prove she is the wise person we think doctors are, if she refuses, some of us at least are dismayed.
The guilty drug
Where’s the evidence that in fact we do think drugs can cause homicide. Take them off prescription, put them on the street, and put a homicide happening at the hands of someone on speed or LSD in front of a jury and they almost fall over themselves to blame the demon drug. If the person’s drink was spiked with the street drug they probably get to walk free from court.
If one partner in a marriage is on a drug of abuse, we have no doubt it will poison the relationship and lead him or her to leave – or lead their partner to leave them. It’s only when it’s on prescription that one partner gets trapped in a situation out of their control.
It seems that prescription drugs are Innocent until proven Guilty and almost no-one attempts to prove them Guilty. Street drugs on the other hand are Guilty with no-one ever bothering to prove them Innocent.
The issue here is something about our view of the social order and the role doctors have in this.
There is another aspect to this. Anne-Marie who did the digging on the Millikan case didn’t instinctively think the drug had caused the problem. Now this is significant. Anne-Marie is one of the people who has had the greatest impact on RxISK by all but proving single-handedly that SSRIs can cause alcoholism when no one believed her. So she has had the personal experience of drugs doing things that most people think impossible but still found it hard to accept the role of Lupron in this case.
I on the other hand have had the experience of close colleagues taking Lupron who had many of the experiences you can find on RxISK and outlined in Homicide of a Husband as linked to Lupron, so I found it easier to believe.
Is it then a matter of being able to put your hand in the wound?
Or is there another difference? I come at this figuring all drugs are poisons. We can do wonderful things with them but they remain poisons and liable to poison us if we are not vigilant. But for most people pharmaceutical marketing has turned prescription drugs into glorious panaceas and the idea that they might do harm is threatening to an appealing worldview. We do not want to see the world as a dangerous and hostile place, where the medication you get could poison you.
So what are people passing a verdict on? And here is the challenge, how would you persuade a jury that a prescription drug could cause violence? The science unquestionably shows SSRIs in particular can, but what would it take to overcome whatever it is that holds back most groups of 12 men or women from accepting a drug did cause violence in this case?
All ideas welcome. This is something we will return to.