When is a Drug Guilty?

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September 24, 2014 | 16 Comments

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  1. Most excellent post and an even better question to put out there. How, indeed, would one persuade a jury?

    I guess a jury can only go on the evidence submitted, defence lawyers are very good at suppressing that kind of evidence, unless, of course, they are defending someone accused of homicide who happened to be taking a drug that induced psychosis.

    When do we know that the defence is genuine?

    You may have 12 jurors already convinced that antidepressant type drugs can induce homicidal acts but how do they determine whether the defence being used is genuine?

    Joe Bloggs could be accused of killing his parents.

    Defence argues he was taking a drug that induced the homicidal act.

    Prosecution, however, argues that although the drug is linked to acts of homicide, it played no part in this particular crime. They argue that the defendant is just trying to get a lesser sentence.

    How do the jury, who remember are already convinced that the drug induces psychosis, decide if it played a part in this case?

    So, if I were on the jury, how would I convince others that it was the drug?

    That would be extremely difficult if they already knew the drug could have induced the homicidal act. It would be far easier to convince the other 11 if they didn’t believe these drugs induced violence etc.

    Sadly, those up in front of the beak on charges of assault, battery, shoplifting and other major to minor crimes are now using “the drug made me do it” excuse…or at least their lawyers are.

    To recap, convincing a jury that the meds may have induced the crime would be pretty easy.

    To convince them that they induced the act in the case the jury was reviewing would prove more difficult.

    Hope this makes sense?

  2. I have been judging by my own personal experience I am not a doctor or pharmacologist or criminologist or detective I was just giving a personal opinion.

    I personally think its hard to compare the Clancy case with the Michelle Millikan because like you said Shane was Frenzied and sadly killed himself horrifically afterwards, it has all the hallmarks of someone not in their right state of mind but with the Michelle Millikan case I do find it harder to understand because she did clean up afterwards and lie. If I was on a jury I would struggle with that unless it was fully explained to me why and how it could be the medication but isn’t that why you have “expert witnesses s” so they can explain that to a lay jury?

  3. This is a a huge problem, particularly as there seems to be an infinite amount of psychiatrists and doctors who will deny that prescription drugs can cause homicide. In my son Shane’s case (as mentioned above), Professor Timothy Dinan spoke to the Irish media and said “I can say with 100% certainty, without any fear of contradiction, that modern anti-depressants such as the drug Citalopram … do not cause people to commit murder”. The drug company (Lundbeck) also released a similar Press statement denying that their drug can cause any harm.

    So in the face of such opposition, it’s understandable that a jury would find it extremely difficult to believe that prescription drugs can cause one person to kill another. In Shane’s case we were very lucky to have Dr David Healy on board, along with a brilliant lawyer, James McGuill. It would be great if more independent, unbiased, medical experts came forward. Sadly, few are willing to expose themselves to the wrath of their peers or the pharmaceutical industry.

    The only way that I can see a jury believing that prescription drugs can cause serious harm is if similarly affected family members were allowed to testify. As shown in the 2004 FDA advisory committee meeting, which resulted in the black box warning being put on all SSRIs, people power prevails over any doctor’s expertise. Tragically, there are plenty of us willing to share our stories.

  4. To use an obvious analogy, if a person drinks a bottle of whisky, he/she is well capable of using a firearm or doing something extreme like suicide if in a depressed state. The basic most obvious reasoning is that the natural barriers to doing this after imbibing, are greatly reduced. If a person takes a drug like Paxil/Seroxat it distorts the mind to a hallucinogenic and often angry state. At this point it becomes capable of very distorted ‘reasoning’. The normal restraints are no longer there.
    I know this because I took Seroxat for 10 months and entered a very dark world due to the drug. Going cold turkey from it was the hardest thing I have ever endured in my life. It had me hallucinating many years afterwards. The feelings I had to cope with were something I would never wish to experience ever again. Under any circumstances. I appreciate that the company GSK who manufacture this drug make billions from it, but could they not set up re-hab programs for the people who have had nightmare responses to it. It seems the least they could do. A small humanitarian gesture. They don’t even have to admit culpability, just do something human.

  5. Does the drug act to continuously keep you happy (antidepresssant). If so would the drug keep you happy while you were acting aggressively or shoplifting, etc. If yes, then it seems there is a good case for saying the drug removes inhibitions and could cause all sorts of violent and other wrong acts

  6. I offer my opinion here both as an ex lawyer and as an ex patient. From a legal viewpoint, in the UK we have very tight rules about what evidence is admissible before the court. It is therefore doubtful that a defendant would be able to “rustle up” a defence that a prescription drug caused her/him to commit murder. Because (Catch 22) such evidence as does exist about the effect of prescription drugs on mood/behaviour is hotly disputed and widely disbelieved. For every expert witness offering an opinion in support of the drug in question being likely to trigger homicidal anger – the prosecution would find 10 others willing to testify the opposite.

    More likely the defendant would have to rely on a defence of insanity/diminished responsibility or automatism (acting without conscious intent). This last defence rarely succeeds. And the former, if successful, requires him/her to be mad in order to be acquitted – which is not really the point?

    In the UK, our adversarial criminal trial system also means the best argument wins – not the same as the most just argument.

    We also have a deeply imbedded respect for doctors, combined with an equally embedded fear of madness and apparently irrational behaviour. The notion that doctors, by prescribing medication, could cause madness and murder runs counter to profound societal beliefs. The law itself grants doctors immunity from liability in civil cases of negligence (where the bar for responsibility for harm caused is set much lower). Doctors are the only profession for which this is the case – if it can be shown that a reasonable number of other doctors would have acted similarly – there has been no negligence and a claim for damages will fail. Only the most egregious examples of carelessness (amputating the wrong leg) are likely to succeed.

    So, there are historical and social reasons why the law is highly unlikely to find doctors liable either in criminal or civil cases.

    I am troubled as an ex patient too. Very shortly after being prescribed citalopram in 1998 my behaviour became turbulent, chaotic and aggressive. And this was a person who had been boringly good natured and compliant for the previous 42 years of my life! I’d been married for 23 years, had brought up two children, had a raft of close friends and was averse to any confrontation. I began cutting myself, took multiple overdoses and then hung myself whilst in hospital. I count myself lucky that I was violent only to myself – but can very, very easily understand that it may have been different and that my husband could have been the recipient. In which case I could well have been charged with murder….as it was, I very nearly died and that in itself caused appalling damage to my beloved family.

    I find it difficult now to believe that I behaved like that. A real Jekyll and Hyde transformation which astounded all my family and friends.

    A last point: if someone has been prescribed an anti psychotic drug I know, from bitter experience, that people’s thoughts go (instantaneously) from antipsychotic = psychotic person = violence = murder. This may be a factor for juries.

  7. Most likely these days a jury would hear a prosecutor insisting that the drug couldn’t possibly cause such violent behavior changes, and putting on an “expert” who would swear the science had confirmed this – at least for people aged 25 and over.

    Another reason why they’d tend to convict is the pressure not to be “soft on crime” or listen to “excuses” from criminals and their slick lawyers. This pressure exists even when the defendant offers some theory of brain dysfunction that’s far less controversial – like schizophrenia or head injuries. “Crime” is just too useful as a political boogeyman.

    Finally, Sally is dead right. Once you testify that you were in a psych hospital taking psychotropic drugs, the public tends to see you as “mad” and identify madness with violence. This stigma has grown stronger, not weaker, in the age of “chemical imbalances.”

    Thus in the case of Andrea Yates, the Texas woman who drowned her five children, the jury never got to hear about the possible role of Effexor in her sudden outburst of violence. The defense decided instead to go with an expert who blamed a postpartum psychosis, and the fact that she was taken off the antipsychotic Haldol when she left the hospital. I can’t judge them, really – they decided to throw in their luck with the more “mainstream” theory that had a marginally better chance of convincing the jury. Jurors did hear about her history of severe postpartum depression and her psychotic symptoms on the day of the crime – which included hearing the voice of Satan commanding her to kill the children.

    The prosecution psychiatrist, Park Dietz, then testified that even if Mrs. Yates was in a psychotic state, she still knew right from wrong. In particular, she knew that Satan was a bad, bad guy. If she’d hallucinated the voice of God telling her to drown her own children, he might find that her mental illness had kept her from realizing the criminality of her actions. But since it was Satan, she knew damn well that she should not obey THAT voice. She was as guilty as any non-psychotic murderer, he said, and should face the same consequences, up to and including the death penalty.

    Would it surprise anyone to learn that Dr. Dietz, a star witness for the prosecution in criminal cases against people, is also a star witness for the defense in civil actions against drug companies?

    I don’t know if I could persuade a jury that a person who killed did so because of SSRI’s. Here’s what I might tell them for starters, however:

    In a civil court, where a plaintiff accuses a company’s product of causing harm, the only compensation she can seek is money. In order to win, she must only convince you that it’s more probable than not that the company is responsible for her losses. In other words, better than fifty-fifty. If you’re fifty-five percent sure she’s right, you may award her damages.

    But in a criminal trial, where the life or liberty of a human being is at stake, you must decide beyond a reasonable doubt that she is guilty before she is locked up in prison, perhaps for life. Fifty-five percent sure is not good enough. If the defense has put forth an alternate theory, a reason to find her not guilty, which is reasonable enough to make you wonder, then you cannot convict.

    Doctor Drugbot, and the prosecutors who hired him, are trying to flip the script in this case. They want you to consider the drug “innocent until proven guilty”! They think you should go through the evidence with a fine-toothed comb looking for any other reason besides the drug – however far-fetched – that drove the defendant to do what she did.

    In other words, they want you to give the thing, the drug, the corporate product, the sacred rights of a human being – and treat the human being in the dock like a thing. She can be condemned if the case against her sounds pretty good, but oh, the corporate product deserves special protection.

    Don’t be fooled. A criminal court, with its rules and standards, is set up to protect human beings. Not things, not products or the corporations that make them. Consider the evidence about the products, the pills my client swallowed, and decide if it’s possible they caused the harm she says they did.

  8. I don’t think you can fully convince a jury on this as the onus on medicine is really is to prove that the medication can cause such effects in a population not to prove it in individual legal cases.

    Why? Mainly because for most people prescription drugs are innocent until proven guilty as they are legal, have been intensively tested and they want to believe that they are not deliberately being sold a dangerous item. They won’t understand how prohibitive and financially damaging it is for a company to suggest there might be a problem so will assume that if there is a problem there will be a recall.

    So it really is for concerned medics to build a case instead against the drug/drugs concerned, looking at adverse effects reported and plotting this data to show numbers and incidences of reaction. Suicide for example is reaching epidemic proportions, so it is an epidemic rooted in stress, socioeconomic factors or medication? This is a medical case to solve not a legal one.

    However, back to a legal case, if a reasonable man can see on a chart that there have been x suicide/bad/violent reactions reported out of an estimated population of y placed on the drug for similar symptoms then that could be enough in a court case to say that even if it can’t be absolutely proved that the drug caused a bad reaction, the statistics and global data charted show that neither can it be proved that the drug didn’t cause a reaction.

    Also as a side issue, as long as these drugs continue to be prescribed doctors need to be better informed not only about possible side effects of antidepressant medications, but on when they should be prescribed, what conditions they should be prescribed for, how to monitor first weeks of use and even include family members to help monitor response.

  9. Thank you for a most thought-provoking post, and it’s encouraging to read this issue will be revisited in the future.

    As a new and naive RN in the ‘70’s I would have thought a drug impossible of guilt – physicians intrinsically prescribe (and nurses administer) medications to ameliorate, alleviate and assist the patient, not to cause harm. However, since being thrust in 1989 into a nether-world as a Lupron victim (with its attendant 25-year rollercoaster learning curve), my edict now is ‘always suspect the drug’, and do not leave suspicions of the researchers, research institutions, and FDA out of the equation.

    Inexplicably, in the case of Lupron, ‘simple’ adverse effects (such as bone pain) remain unaddressed, dismissed and/or denied after more than 3 decades of complaints (ie, see ‘Petition 2 Congress’: http://www.petition2congress.com/1902/investigation-lupron-side-effects-leuprolide-acetate/), therefore it is not possible for me to fathom how complex adverse scenarios such as a potential Lupron-induced Homicide could ever be addressed.

    Commenters here have offered especially germane points to this matter: As Leonie states “It would be great if more independent, unbiased, medical experts came forward. Sadly, few are willing to expose themselves to the wrath of their peers or the pharmaceutical industry.” In illustration of the relevancy and impact of this very pertinent conundrum, as it specifically concerns Lupron, I would like to relate the following assortment of disturbing facts …

    In contrast to the historically present “dueling medical experts”, in 1992 when I attempted to bring a lawsuit in the US related to medical adverse Lupron events, there was not one medical expert to be found willing to publicly acknowledge Lupron’s adverse effects. Later I would learn of Senate hearings in 2000 in which internal memos were publicized showing Lupron’s manufacturer’s scheme for physicians to earn more than $105,000 annually through prescription of Lupron (see http://www.lupronvictimshub.com/home/TAP_RTP_Memo001.pdf ), and the company would eventually pay the highest criminal and civil fine in history at that time – $875 million for bribing doctors to prescribe Lupron.

    Fast forward to today, where there can be found only a handful of ethical, moral, brave physicians who are willing to stand up and speak out. (A few of these medical expert witness statements on the dangers of Lupron can be found @ http://www.lupronvictimshub.com/lawsuits.html). Most tellingly, court (PACER) documents in the 2014 case of ‘Paulsen v. Abbott, Takeda, TAP’ (US District Court, N. District of Illinois, Eastern Division – Case No. 11-CV-4860; Dkt. No. 135) evidence the overt and outrageous attempts at character assassination and reputation smear that Lupron’s manufacturer (now known as ‘AbbVie’) undertook in attempts to discredit and intimidate Paulsen’s medical expert witness. (And it is worth noting that in a non-Lupron matter, a 2010 Senate Committee revealed a memo from Abbott in which “one Abbott official suggested that local connections or the “Philly mob” should intervene to silence Baltimore Sun columnist Jay Hancock for his coverage of the [Abbott stent] scandal, saying “someone needs to take this writer outside and kick his a** “ … see: http://articles.baltimoresun.com/2010-12-06/health/bs-md-senate-stent-report-20101205_1_midei-stent-abbott-laboratories .) A corrupt corporate ethos is clearly on display here.

    Only after my Lupron ‘treatment’ would I learn that my renowned Boston hospital’s Lupron-prescribing physician was in fact a lead Lupron investigator (conducting hundreds of Lupron studies), a funded Lupron Opinion Leader, and a paid lecturer for Lupron’s manufacturer, who would ultimately be found guilty of “fabricating and falsifying approximately 80% of Lupron data” in 4 studies (2 of which were published and required retraction from the medical literature – see http://www.lupronvictimshub.com/home/FedRegister5_1_96.doc ). When I naively sought care at this institution’s Rheumatology Clinic for my post-Lupron bone pain, I was unaware that the Director of this Clinic was a decades-long paid consultant for Lupron’s manufacturer – and I would later locate copies of these signed contracts and agreements which flat-out dictated and delineated this renowned physician’s allegiance and duty to protect Abbott’s products. (Was it mere coincidence this Clinic/Institution was dismissive of my [and others’] post-Lupron bone complaints and was of no help?)

    In the 2011 ‘Klein v. TAP, Abbott’ trial (involving a 17 year old who experienced thyroid disease and bone density loss post-Lupron), Abbott’s medical expert committed perjury (on the stand, under oath, and in front of the jury) by declaring “[I]t’s simply biologically impossible for Lupron to affect the thyroid gland”. This false statement is easily refuted by a PubMed search, results of which evidence ample examples of Lupron adversely affecting the thyroid gland (ie, see “the first report to demonstrate the association of thyroid disorder with leuprolide [Lupron] injection”, published in 2000 – http://www.ncbi.nlm.nih.gov/pubmed/11228054). The jury was not allowed to hear the known and published evidence of Lupron’s adverse effect upon the thyroid, and jury was thus unaware of the perjury of Abbott’s expert witness, and the jury ruled in favor of the company and against Klein – and the US Supreme Court refused to hear Klein’s appeal.

    During the Klein trial, Klein’s medical expert had access to thousands of pages of raw, unpublished Lupron endometriosis clinical trial data, and conducted a close review of this data – and ultimately this physician wrote a 300-page report to the FDA detailing the concealed and hidden data that he had uncovered. This physician found that the raw clinical data (used to approve Lupron for pain management of endometriosis by the FDA in 1990) actually revealed that “62.5% of subjects had failed to return to baseline estrogen levels one year after stop of study” (indicating damaged ovarian function, with resultant body-wide adverse effects). Yet for 30 years and to this day, Lupron’s manufacturer asserts in its product label that the Lupron-induced low estrogen levels are “reversible on discontinuation of drug therapy.” In 2014, within 2 small paragraphs, the FDA thanked this physician for his 300-page report, made no mention whatsoever of the hidden data or of the manipulated, false outcomes, and the FDA concluded that no change in Lupron’s label was necessary. (For further info, see http://impactethics.ca/2014/05/02/hidden-clinical-trial-data-about-lupron/#more-1297 ). And of note is the fact that these thousands of pages of raw clinical trial data are now under a court seal, per request of Lupron’s manufacturer – and are unavailable for public scrutiny. Unbelievably, nearly all Lupron-for-endometriosis prescribing physicians are unaware that serious Lupron endometriosis clinical trial data has been hidden from them, the FDA, and their patients for more than 30 years; nor are they aware that upon the FDA learning of such concealed data and altered outcomes, the FDA chose not to act and chose not to inform physicians and consumers.

    And should you wish to learn the incidence of Lupron and depression/suicide – you cannot: the results are censored as “disclosure would be prejudicial to commercial interests” (‘see’ the redacted findings @ http://www.lupronvictimshub.com/home/GPRD_Study_of_GnRH_analogues_and_depressionsuicide_Redacted.pdf ).

    The above details, a tip of the iceberg, indicate there exists an alarming and nefarious corruption of ‘the system’, with inherent powerful profit ‘machines’ that have been enabled to override, endanger, and thwart public safety, and in which US federal and consumer protective agencies and courts are either totally indifferent, inept or complicit – and with no apparent medico-legal recourse available for the sick, injured victim. How can one ever attempt to prove Lupron “guilty” (for *any* adverse event) when the data itself has been made to morph or disappear at the manufacturer and/or its agent’s whim in order for Lupron’s well-choreographed ‘appearance of innocence’ to maintain the status quo?

    As a final note, I wish to address a commenter’s statement that she had difficulty understanding ‘Michele Millikan cleaned up after [the homicide] and lied’. It should be noted (including by the sentencing judge) that Michele was deemed by the psychologist to be in a dissociative state – a condition in which there is a detachment from reality. It cannot and should not be assumed that Michele’s cognitive reasoning was functionally intact at this point in time. The psychologist’s report states “all indicators are that Ms. Millikan was in a dissociative state of mind immediately prior to and during the death of [her husband]. Thus, Ms. Millikan cannot be said to have intended to cause the death.”

    Lynne Millican (no relation to Michele Millikan)
    http://www.LupronVictimsHub.com
    9-26-14

  10. How might I persuade a jury that a prescription drug could cause violence?

    I might ask jurors to examine their own experiences with medications, prescription or over-the-counter. Does the juror ever remember taking an antihistamine, for example, and feeling jittery or tearful or irritable or sleepy or unable to sleep? If an antihistamine, available over the counter and considered relatively benign, can cause such psychological symptoms, what might other more powerful medications do? Ask them to multiply that feeling in their minds. That is the kind of thing that can happen on some prescription medications like antidepressants.

    David Antonuccio, Ph.D.
    Emeritus Professor of Psychiatry and Behavioral Sciences
    University of Nevada School of Medicine
    Reno, Nevada, USA

  11. I’m picking up this thread again – because I think it’s a really interesting and important debate – which might help future defendants. I went on, a bit lengthily, about the importance of evidence in my earlier post. Mainly because that is what a jury will hear, and will be instructed to make their guilty/not guilty decision on.

    I have just obtained my medical records (a huge box…). I wanted them because I am writing a book about my experience in the mental health system in the UK. I needed to check very basic facts: what drugs I was on, and when – as well as dates on which various hospital admissions and suicide attempts were made.

    I have been very struck by the strong correlation between the drugs, increasing polypharmacy and ECT – and my deteriorating behaviour. And the astonishing transformation, over nine months, of me: from an almost boringly well behaved person, stable marriage, many friends, good job – to a frenzied wreck.

    So, a good barrister, could I think build a convincing defence based on the evidence in my records. Date when I started a new drug (or had another one added). Date when I cut myself (as evidenced by the discharge record from A&E). In my case there is plenty of such evidence. It would be more difficult when a person starts an SSRI for instance and 10 days later kills someone.

    However, it has occurred to me that medical records may be a source of compelling evidence – from which a jury may well be able to see the impact of powerful psychotropic medication. And which may be more persuasive than the prosecution supplying papers/research suggesting that the link between suicide/violence and meds has never been properly established….just a further thought .

  12. Seriously, why are consumers not questioning if pharmaceutical companies are making random flawed batches? There IS NO SUCH THING AS ROBUST! No systems or processes are bullet proof

  13. We all have to be mindful of how mind altering drugs impact the brain. Scientist understand and are fully aware that these drugs ‘IMPAIR’ some of the normal processes in the brain. If one understands this concept, they do not need any further explanation/proof or evidence to help them reach some understanding that the drugs are causing some people to do irrational things. Like alcohol affects the brain, we must ask our self this question: What makes SSRI’s or any other medicines which are ‘deemed safe’ any different from alchol that impairs the brain? Just because we can not see what they put in these drugs, it does not mean that they are incapable of causing so much harm to the ‘logical thinking’ part of the brain. Some drugs interfere with neurotransmitters in the brain. These ‘mind-altering’ drugs change our interpretation of the world, our behaviour, and our mood. These drugs may mimic the serotonin action in the brain, which seems to explain some inappropriate mental behaviours. The fight or flight response is put in action. If some of these drugs are creating violent, anti social, suicidal behaviour in many, there must be something in the drug that is amplifying it to escalate to a dangerous level, in some. Many know this but how long can we keep turning a ‘blind eye’.

  14. I am very worried when professionals write up antidepressant scripts for every ailment under the sun?
    How can a doctor measure the serotonin levels in the brain?
    There is no test to prove that the serotonin levels are low.
    There is no such theory, as far as I am concerned.
    Just like diabetes patients need insulin to keep them alive, is it true that depressed individuals need antidepressants to keep them alive?
    If we want to protect people from these ‘mind altering medicines’ and equip them with tools to make their mind stronger, those who have suffered should play a pivotal role in educating and making people aware of the ‘perils’ of antidepressants.
    The professionals don’t inform patients of what can really happen once you ingest these medicines and try to come off them.
    There are so many individuals that have tried to come off them, ‘cold turkey’ and have suffered terrible withdrawal symptoms.
    I am very worried that professionals can hand out these scripts to anyone and if in the wrong hands, they can cause more ‘harm’ than ‘good’.
    Now, I have witnessed, time and time, again, how the media plays a role in promoting these medicines.
    They always seem to focus on the benefits, but never have I seen a ‘real debate’ on the pros and cons, of these medicines.
    If these medicines are so beneficial, WHY are we seeing so many people becoming violent, having severe anxiety attacks, having suicidal thoughts, turning to alcohol and other psychotropic drugs?
    Can you see the link= it is inducing all these problems.
    These medicines may have been around for a long time however, I am very worried about how it is impacting the minds of those who ingest them.
    I am very suspicious when people say that ‘it is an individual response’ especially, when an individual experiences an adverse reaction.
    If we care about our fellow human beings, we must strive to educate people about the dangers of these medicines.
    Just because professionals dish them out like ‘soap on tap’, it does not mean they know much about these medicines. Reading and listening to too much ‘wish washy’ information from glossy magazines to pharmaceutical reps enticing the professional with so many ‘trinkets’, does not seem so inspirational to me. Highlighting the benefits and withdrawing the negative clinical trials, is FRAUD, at it’s best! For many, it has ended up being their worst nightmare.

  15. When a health professional speaks up about the RISKS of medicine, it is credible.
    When an individual who has experienced harm speaks up, they are labelled ‘crazy’.
    Eventually, truth outweighs the ‘naysayers’.
    This ‘conspiracy theory’ mentality has to be banished, in order for POSITVE CHANGES to take place.
    How can we educate the IGNORANT if they are quite comfortable with the ‘status quo?’

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