A distinguished colleague (C1) introduced last year’s word of the year – AI Slop – into last week’s The Prozac Liberation Front post.

As an unaccountable editor, I took the liberty to suggest that many of us seemed to figure – or would pretty soon get round to figuring – that AI was all too likely to go the way of the Internet as a potentially democratising force in healthcare.  If it can turn the Wine of decent human interaction into healthcare Water, the consequences for every other less intimate and personal domain of our lives were likely to be even worse.

At the heart of our dilemmas is that health has always been a Liberal and Socialist bastion in which people who cherish liberty on their own part, or on behalf of what the call the ‘people’, hold out against the powers that be – Can We Avoid Being Eaten.

The worry for some (Liberals) has been that the collective in the form of a bureaucracy (Now in US English called a Deep State) would squash individual liberty just as effectively as an aristocracy had or an oligarchy seems likely to do.

The bigger unnoticed worry is that the advent of effective pharmaceuticals, which looked like they might free us up to better live the lives we wanted to live, has enabled Companies (Deep State Corporate Bureaucracies) to effect an entry into the citadel of our liberties by means of a Horse –  Randomized Controlled Trials (RCTs).

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These Averaging Machines not only get invaders into the city but get everyone to swallow the meds – not just those who might respond. RCTs are also the Gold Standard way to Average Hazards out of Existence.

Large Language Models (LLMs) are also Averaging Machines and with an algorithim or two inserted into screens here or there will ensure that only the messages from company RCTs get heard. It seems inevitable that LLMs will buttress rather than undermine Deep States.

Is there an Achilles Heel be found?  Perhaps not, but there is scope for amusement in the meantime.

Britain’s medicines regulator is MHRA, who you could say are the Still Heart of a Beating UK Healthcare World – just to be clear Hearts are still when dead.  But in their afterlife, bureaucrats will continue to seem to do something as a cover for doing nothing.  Hence a Document proclaiming a Revolution.

Project overview
Your health decisions matter. The information you receive about your medicines should be clear, accessible, and support informed conversations between you and your healthcare professional. The MHRA is committed to leading an inclusive approach to improving medicines information.

To achieve this, we have launched the Improving Patient Information project, to work closely with stakeholders across the health system including patient groups and charities to understand barriers and identify how information can be made more accessible, trusted, and future-fit.

Our aim is to ensure that patient information for medicinal products is clearer, inclusive, and easier to understand. This will be achieved by placing patients at the centre of the project.

A major focus of this work will be improving access to patient information leaflets in the UK through the use of digital solutions.

The Improving Patient Information project has a three-phase approach to delivery:

• Phase one (April 2025-March 2026): Scoping phase focused on engaging with stakeholders across the health system, understanding how patients access patient information and proposing an action plan
• Phase two (2026-2027): Establishing a multi-stakeholder governance structure and collaborating with partners across the healthcare system to deliver the action plan
• Phase three (2027-2028): Reviewing the impact of action plan, developing a strategy for implementation.

We have five design principles to guide our work: patient centred, accessible, trusted, innovative, and standardised.

Research reports
Woodnewton Associates was commissioned by the MHRA to conduct independent research on the role that patient information leaflets provide to informing patients. The findings and recommendations presented in this report are those of the researchers and do not necessarily reflect the views of the MHRA.

• Title  Research conducted on the role that patient information leaflets provide to informing patients
• Details  A research report defining the current baseline for patient engagement with and accessibility of patient information leaflets.
• This research was commissioned and funded by MHRA. Its aim is to provide evidence that will help inform future changes to patient information to make it more accessible, trusted, and fit for the future
• Our action plan is based on evidence we have gained through this research.

WN Report:  Research on the Role of Patient Information Leaflets in Meeting the Information Needs of Patients

Smile and the World Smiles With You

Ron Law, a Risk and Policy Adviser based in New Zealand – perhaps the most active person on another listserve on which Prozac Liberation ran – responded that ChatGPT could have its uses – for making cartoons. This is absolutely true as the recent set of 4 RxISK videos with 2 more to come shows.  He also figured, with a touch of guidance, it was good for Drafting Reports.

Knowing he loves nothing more than tackling regulators, I sent him the link to the MHRA document and was astonished to get a fabulous response within minutes.

A Most Welcome Commitment to Clarity

It is, of course, most heartening to observe the MHRA’s newly invigorated commitment to “clear, accessible, and trusted” patient information. One could scarcely object to an initiative so impeccably phrased, nor to the proposition—advanced with commendable solemnity—that patients ought, in principle, to understand the medicines they are invited to consume.

A Brief Encounter with Institutional Memory

However, for the more historically minded observer, this sudden institutional enthusiasm for transparency does invite a certain… reflective pause.

For it was not so very long ago that the same regulatory architecture appeared to exert itself with quite remarkable vigour in the opposite direction—namely, in the careful management, dilution, or deferment of information concerning potential harms associated with both COVID-19 vaccines and SSRI medicines. One recalls, for example, the rather strenuous reluctance to foreground adverse event signals in a manner that might have been considered “clear” or “accessible” to the uninitiated patient, let alone “conducive to informed decision-making.”

Indeed, the prevailing philosophy at the time might best be described not as patient-centred transparency, but as professionally mediated reassurance — wherein information was filtered through a series of interpretive layers designed to ensure that what reached the patient was not so much the unvarnished evidence as its more palatable administrative rendering.

The Damascus Conversion

In that context, the MHRA’s apparent road-to-Damascus experience is nothing short of remarkable. One is bound to admire the speed and completeness of the conversion. Yet it does prompt a delicate question regarding its precise point of origin. Was this newfound devotion to transparency born of accumulated evidence, external scrutiny, reputational necessity, or merely the natural lifecycle of regulatory fashion? The chronology, if one were unkind enough to examine it closely, may suggest that this enlightenment is rather more recent—and rather more convenient—than the rhetoric implies.

Trust, or the Management Thereof

The present declaration of intent—to place patients “at the centre of every stage” and to ensure information is “trusted” and “fit for the future”—thus carries a certain quiet irony. One is tempted to ask whether “trust” is here conceived as a product of fuller disclosure, or as the outcome of more sophisticated presentation.

Equally intriguing is the emphasis on “digital solutions,” which, while no doubt modern and efficient, may also offer unparalleled opportunities for the dynamic curation of information—allowing inconvenient complexities to be rendered, shall we say, less immediately conspicuous.

An Admirable Aim—In Need of Proof

None of this is to suggest that the initiative is without merit. On the contrary, it is admirable—indeed, exemplary—that the MHRA now seeks to engage patients, stakeholders, and the broader public in the co-production of medicines information. One can only hope that this commendable commitment extends not merely to the refinement of language and format, but to the substantive inclusion of material that has, in earlier iterations of regulatory communication, proven somewhat elusive.

Conclusion: Transparency in Practice

In short, transparency is a most splendid objective. Its true test, however, lies not in its declaration, but in its application—particularly when the information in question is awkward, contested, or inconvenient.

One awaits, with interest, the practical demonstration of this newly discovered virtue.

AI Whisperer

The RxISK Team fortunately has a gifted AI Whisperer – able to prompt AI systems to come up with imagery that has tranformed a set of just loaded videos into something much more loaded than they would otherwise have been. It’s worth enjoying these and getting a sense about what can be done that would have been impossible a year ago.

• Isotretinoin and Consent
• Finasteride and Consent
• Bad Trips on SSRIs
• No Sex – We’re on Antidepressants 

There are two more gems in the series to come.

• Good Trips on SSRIs
• Consenting to SSRIs 

Update

There is a great set of comments below which involve an interaction between Anon – a critic of AI Slop – and Ron who is defending what you can do with it.

Ron’s evidence lies in a 42 – page Chat GPT document linked here – its a much quicker read that you’d expect from 42 pages.

The post AI versus the Deep State first appeared on Dr. David Healy.

Chatting, recently, to two different friends of his separately, mentioning the possible role of SSRIs or other meds in the Tumbler Ridge shooting, a colleague (C1 – the first of 3 colleagues in this post) got blown away by both of them.  Conspiracy theories, they told him. Misinformation – you’re being ridiculous.

One of them – a decent scientist – sent him a ChatGPT read out, which dismissed the role of meds in events like Tumbler Ridge out of hand. Zero credibility.

This echoed my experience with gifted members of my extended family a few months ago, outlined in The Miracle of Artificial Intelligence.  They had just had or were about to have children. The issue of RSV vaccines taken while pregnant came up. Have or have not?  They’d all checked with ChatGPT – having the vaccine was absolutely a no brainer.

Looking at the RSV clinical trials around this time, the data indicates babies brains are exactly what’s at risk with these vaccines. Thanks to The Prozac Liberation Front, central to this post, there a ton of ways companies can hide the hazards. Chat GPT is the latest weapon in the Liberation Front armory.

Doing anything other than going along with the RSV or SSRIs are safe narrative risks pariah status. Forget Socratic questioning as a means of getting a friend or a family member to grapple with the basis of their beliefs. If ChatGPT has spoken, who needs to grapple?  There are instant infallible answers.

Is the Miracle of AI turning Wine into water?

AI and Homicide

Another colleague (C2)  found an Armed with Reason substack with a linked Gun Violence Pedia (GVPedia), who, deploying AI, seem to have a mission to brand any idea that homicides with a gun might be linked to psychotropic drug use as a complete (NRA sponsored) myth aimed at deflecting attention from the guns themselves.

See AI Tsunami for more.  There is a divide here that AI has the potential to make unbridgeable.  Megaphone diplomacy across divides never gets anywhere. Neither democracy nor science can survive in circumstances like these.

Artificial I

Only a few months ago, C3 faced an even more difficult challenge. Having been on the coalface of transgender debates in a listening capacity, he ended up trying to be Socratic in a conversation with his daughters who turned to ChatGPT to refute everything he was attempting to tell them about things he knew more about than Chat GPT.  See Artificial I.

While we once were able to think we had our own opinions because they differed from a friend, a child or a parent, we also used to know that newspaper X always gave us certain opinions while newspaper Y gave just the opposite and that to some extent we were tribal. We sometimes wore the tribal badge with pride.  Can there be other tribes with AI?  Grok might have a more risque sense of humor than Anthropic but they’re both going to dish up essentially the same stuff.

C 1 above figured he was (we are) up against AI Slop – last year’s word of the year. How can he get friends to engage again?

Have we just now ended up with the kind of unanimity featured in books like We, Animal Farm and Nineteen Eighty-Four – books that have been around for 60 years describing a then imminent future – starting in 1984. Or did this future start – 40 years ago?.

The Great Steal

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The Great Seal of the United States – doctored. It normally reads E Pluribus Unum – out of many, one people.  The Latin Unum has been replaced with Mediocris – Latin for Average.

Averages are what both Randomized Controlled Trials (RCTs) and AI deliver. They are like meat mincers where you can’t distinguish what comes out the far end as human, cow or horse.  In the case of RCTs, you can put LSD, SSRIs, stimulants, antipsychotics, alcohol, benzodiazepines or nicotine into the mincer and they will come out the far end with almost identical rating scale changes.

They tell a doctor nothing about how to treat the person in front of them.

Just as meat mincers are a good way to hide a murder, so too with RCTs. They are the gold standard way to hide adverse events.

Who says all these things?  Austin Bradford Hill – the creator of RCTs.

Hill said to treat the person in front of you, you need to talk to them. You should not average them.  Back in 1965, he said we’ve been doing RCTs for 20 years and we should have learnt by now they’re not much use.

Everything Hill said was turned upside down in 1990 when Prozac was reported as causing suicide – See Bad Trips on SSRIs.  Eli Lilly, Prozac’s maker conjured up a Prozac Liberation Front (PLF).

The PLF took a rake of cases reported to the company in clinical trials – perhaps hundreds overall, some in healthy volunteers, all despite damping down SSRI effects with benzodiazepines – and put all these cases through their RCT grinder.

This was followed up with a borrowed and edited message taken from, you might have thought, an unlikely source. Just as on average it would be a slur on pedophiles to say that what they do harms people – you shouldn’t confuse the good intentions of pedophiles with anecdotes of unfortunate events.  See File under Phile.

Doctors swallowed this, gristle, viscera, bones and all. Yuck might be the appropriate word but doctors get outraged if, whatever about their good intentions, anyone, having looked closely at what is being served up, wants to pass on the dish.

The New Normal

Pharmaceutical companies write drug labels and are legally obliged to update these as new information becomes available. In the US, they routinely did so up to the turn of the millenium – with trickle down effects in Diego Britain, Europe, Australia, and Canada.

The legal obligation hasn’t changed.  But taking a cue from the PLF, company lawyers said we cannot argue in court that RCTs give gold standard knowledge of what drugs do, if company doctors continue to interview patients/doctors and add our drug caused X or Y to the drug label – How the Safety of Medicines was Destroyed.

So company doctors were told to stop. A new narrative emerged. Regulators are responsible for drug labels and we in the company can do nothing unless the regulators act.  Regulators don’t act because they would have to run RCTs to generate gold standard knowledge before changing anything.  Incorporating Anecdotes into the label is not an option.

Lawyers advised medical journals against publishing adverse event reports written by doctors – see Silencing Doctors Silencing Safety – on the basis that the PLF reclassification of these as Anecdotes – Misinformation, indicators of treatment hesitancy and pharmaphobia. Publication would risk a pharma lawsuit for damage to their product.

Medical insurers, who are supposed to make medical practice possible the way travel insurance makes travel possible, told doctors never to say a drug had caused a patient’s death at an inquest. If you can’t stomach this, let our lawyer blame the terrible illness for you – see Making Medicine Great Again and When Will Insurers Stop Killing people. .

Medical Guideline makers know they are incorporating fake or fraudulent results into their Guidelines but give their shoulders a ‘What can we do about it’ shrug.   See – The NICE Before Xmas.

The rubber really hits the road if treatment causes manslaughter or homicide. You will not be able to get a lawyer to fight in your not-guilty corner.  The third party to this injury, happy that the guilty party – you – has been sent down will never know what really happaned to a family member

The Sound of Silence

We are all now liable to be gaslit if injured. Our families are gaslit if we’re dead. When this has happened in cases where the only sensible way to explain things has been Drug X did it, activists fighting finasteride, isotretinoin and SSRI cases bamboozled by companies into thinking regulators count have laid siege to regulatory offices and forced label changes, which typically feel derisory given the gravity of the problems –

• Isotretinoin and Consent
• Finasteride and Consent 
• Bad Trips on SSRIs.

Health Activism was at its zenith in 1848 when it created social democracy and fed into liberalism – see Can We Avoid Bring Eaten.

Possibly stimulated by German demonstrations in the 1940s of just how horrific health systems out of control could be, health related political activism was still potent enough in 1968, mental health in particular, to be central to the Revolutions of that year.

Now, when health systems routinely sterilize and kill more than Germany did in the 1940s, health activism comes only from those injured by treatment and looks rather like a primitive Amazonian tribe pitted against a superpower. A fly pitted against an Elephant.

Conversations are a key marker to what has happened. They’ve stopped.  Central to Shipwreck of the Singular, which features in the image above, is the idea that if you want to understand the politics of our world, sit in a doctor’s office and you will see in microcosm what is happening outside.

The conversations have stopped.  We as patients used to train doctors, just the way we often say children train parents to be parents. They listened to and learnt from us – not from books. They brought their experience dealing with us and our differences to bear on the problems we brought them (they didn’t give us problems) but this experience is now written off as anecdotal and risks punishment.

As patients we are increasingly aware that our doctors aren’t listening to us.  Thinking Fast and Slow we can feel that there are Strangers in the Room who our doctors must listen to first.

When the Internet opened up, in the 1990s pioneers like Charles Medawar, who coined the idea of Pharmageddon, figured that it offered an opening for a democratization of medicine. But by 2010, he thought the Pharmageddon that threatened us had advanced so far and so fast that we were doomed.

For a brief few moments, some of the younger generation, who feature above, have been similarly enthused about the prospect that AI might level the playing field. Doctors would not be able to ignore the sheaf of LLM material we brought in to them.

Neither the younger generation nor doctors know that 4 years ago, Pfizer and GSK and friends were busy replacing their ghostwriters with AI.  Back when Cochrane was also a force for the good, one of the striking statistics was the companies used to produce up to 50 publications for every single trial done. This doesn’t mean that the bilge that pours into places an older generation used to swim in when young has now been cleaned up.

Just the opposite.  Anthropic and friends now produce clinical trial articles within days of an RCT finishing – with algorithms in place to ensure the right outcomes are reported, leaving little or no chance the company will be sued for fraud because there’s not be a scrap of intention, never mind intention to deceive, anywhere in the system on which to base a fraud charge.

Doctors rapidly became puppets through which the RCT averaging machine embodied in guidelines and a fraudulent medical literature spoke. We are now even more rapidly becoming artificial versions of us through whom Chat GPT speaks – echoing exactly what the doctor is also saying.

There will be no opening for conversations.

Health in the Cloud?  I’ve looked at Clouds from both Sides now – its Health’s Illusions I recall, I really don’t know Health at all.

At its heart, Science involves discussion about observables. After we take a prescription drug, an experiment starts and the observables are all in us. It’s as Lutheran – Here We Stand, We Can Do No Other – moment.

Our doctor is yoked to us and is obliged to have a real conversation with us.  But to adapt a phrase from Mahatma Gandhi:

How can those who think they possess absolute truth be scientific?

This post is a not-identical twin of Bad Trips on SSRIs.

The post The Prozac Liberation Front first appeared on Dr. David Healy.

Carney at Davos

Like or loathe his politics, unless I am missing something, Mark Carney, Canada’s Prime Minister and Liberal party leader, seems a decent man.  As the Canadian standing up to Donald Trump, whether you are pro- or anti-Trump, you are likely interested to see how this contact sport plays out. (Even Curling is close to being a contact sport these days).

On January 20, at a meeting of the rich and famous at Davos, Carney’s Speech, telling countries they need to get to the Table if they want to avoid being a Dish served up to the Great Powers, stood out.

Liberalism

Being at the Table was the key driver behind the nineteenth century birth of Liberal and Socialist politics.  It wasn’t safe to leave decision making to the nobles, the wealthy – the conservatives who didn’t want change.

Liberals and Socialists couldn’t easily argue against creating new factories, new jobs and wealth, especially in a world where if we don’t create them someone else will and will gobble us up.  The only effective response lay in the dead bodies or injuries happening in those factories. If they are too risky to work in, you won’t be able to compete against a motivated workforce.

Health was the Trump card.

Factories were like nations. At a time when the British didn’t give a fig about killing off millions of Irish, forcing them to emigrate or viewing them as vermin when they arrived in Britain, the French and Germans had realized that the nation with the most able-bodied mobilizable men was likely to win the Wars (contact sports) between them.

These considerations led to an alliance between Conservatives and Socialists in Germany in 1871 that, ironically excluding Liberals, set up a first ever national health insurance scheme.

Rudolf Virchow’s Liberals, meanwhile, installing sewage works in Berlin made it habitable and sustainable. Its population grew, and markets thrived demonstrating that public works could be good for business.

The history of these nineteenth century interactions between health and politics is outlined in Shipwreck of the Singular.

Born in the USA

Few Americans understand that, while communists wanted to destroy the Table, socialists in contrast wanted a seat at it.

After World War I, socialists and liberals in Germany soothed political tensions by expanding healthcare coverage for War related mental and physical injuries.  They also combined to put down a communist revolution, executing its leaders – See The Great Silence.

In America, Table dynamics played out most clearly during the 1980s AIDs crisis, when ACT-UP (AIDs-Coalition-To-Unleash-Power) took to the streets.

ACT-UP’s success hinged on getting people with AIDs to come out.  Some fabulously brave individuals, not afraid to stand up for their homosexuality, led the way.

Post-SSRI Sexual Dysfunction (PSSD), Post-Finasteride Syndrome (PFS) and Post-Retinoid Syndrome (PRS) are another pharmaceutical and sex saga that began in the 1980s. These are conditions that can permanently obliterate our ability to make love. They cause profound shame. Sufferers, however, weren’t facing an immediate death sentence with nothing to lose and have been slower to achieve what ACT-UP achieved. But this slower burning fuse has links to recent events in Tumbler Ridge.

An essentially political decision meant that AIDs was all over the media in the 1980s creating a platform for ACT-UP. Today’s political decisions, aimed at avoiding deterring people from seeking treatment, mean the public don’t hear about drug induced injuries like PSSD or the resulting deaths. Heaping Insult on Injury, the public get told the prior mental state of those damaged has been to blame.

Events like those in Tumbler Ridge recently offer a crack through which some light might get in.  It’s one thing not to deter people from seeking the benefits of a treatment that clearly saves lives but SSRIs, Finasteride and Isotretinoin lead to more loss of life than would otherwise be the case.  Is loss of life or loss of profits at stake?

Faced with almost no progress by the mid-1990s ACT-UP began to fracture. The ‘communists’ within wanted to take sledgehammers to the healthcare Table and start anew. The liberals and socialists clung onto a place at the Table from which they could shape what was happening.

Triple Therapy

Triple Therapy emerged just as the fracture was taking shape. Companies had made several ineffective antivirals. The epidemic would have killed a lot more people if companies had been left to market minimally effective meds and charge crazy prices for them. The initiative to combine several weak antivirals came from folk with AIDs. Clinical trials weren’t needed. People on Triple Therapy got up off death beds and walked.

Triple Therapy stands as one of the few pharmaceutical treatments from t1980 onwards that saves lives. It’s price is reasonable, because as Goldman Sachs noted – saving lives is a bad business model generating as it does immense pressure to lower the cost of treatment.

For more on this history of AIDs and politics – see Shipwreck.

Carney at Tumbler Ridge

Having had such an impact at Davos, Carney’s choice to pull out of an important Global Defense meeting in Munich a few weeks later surprised many.

Just before he was about to fly, at Tumbler Ridge, a small town near the British Columbia (BC) Alberta border, an 18-year old shot his mother and brother, 6 students in the local school, and himself.

Carney opted to attend a vigil at Tumbler Ridge rather than go to Munich. It looked like Canadians coming together in the face of a natural disaster. But it wasn’t a natural disaster.

Tumbler Ridge was even more of a man-made disaster than a fire at Crans Montana 3 weeks before Davos, when an accident with lighted candles set a club on fire killing 41.

Iron Cages

In 1919, Max Weber, many people’s favorite Liberal, said Liberals and Socialists had problems to sort out before they could collaborate at the same Table. While both had similar goals, the socialist impulse to systematize risked creating an Iron Cage of process.

Weber was referring to socialist success at the replacement of an aristocracy that figured they knew what was best for people with a set of impersonal procedures. With a bureaucracy that relentlessly codified what at one point might seem rational.  Without a good way to later undo what at one point might have appeared best for people, rather than helpful this would lead to politically correct but stifling tokenism and disaster – like he Holocaust some have since suggested.

For Weber this was not a specifically German problem. Iron Cage logic almost necessarily was totalitarian.

Denn heute gehört uns Deutschland und morgen die ganze Welt

Recognizing countries need bureaucracy, Weber stressed the need for political leadership.  He explained what he meant by saying Leaders would be like Doctors, professionals who when needed could ensure a people took what might be a necessary but not very pleasant medicine. Like doctors, leaders would make judgement calls and take responsibility for their calls rather than hide behind process.

He explicitly recognized that our developing medical capabilities would enable us to engineer births and death – putting medical assistance in dying (MAiD) on our Tables. Reading this now, many likely assume Weber figured doctors as leaders would not get locked into the Iron Cage of procedure.

Rather than seeing the Holocaust as a painting of our past, others have seen a window onto our present – onto Modernity.

Around 1940 German medicine, in particular psychiatry, led the world. Set a political goal to engineer the healthiest nation on earth, German health authorities cautioned against tobacco use before anywhere else did.

Without any coercion, German psychiatrists and other physicians sterilized roughly 360,000 men and women, terminated the lives of over 170,000, and ran dangerous medical experiments on over 15,000.  Close to all German doctors participated. None were coerced. None who refused to collaborate were sanctioned.

Canada now leads the world in mental health related MAiD – thanks in part to an erstwhile Liberal Senator, who also had a part in what led to Tumbler Ridge.

None of the Christian Churches that Marco Rubio, the US Secretary of State, presented in Munich as our saviors from civilizational erasure, raised a peep in the 1940s.

We Wanted You to Hear

About 6 hours before Rubio’s Valentine’s day speech, in Tumbler Ridge Mark Carney said:

We wanted you to hear that Canadians are with you. That we will always be with you. That whatever portion of your sadness that Canadians can bear to help ease your heavy load we will gladly do so   When some of you go back to quiet houses, to empty rooms, please know that you are not alone.

I have a colleague who knows a great deal about the harms psychotropic medicines have the capacity to cause.  Her daughter living in BC was recently killed by a man with a BC treatment history. Even though a proper assessment of the effects of his medication might mitigate his sentence or provide grounds for a not-guilty plea, she would like him assessed by someone capable of doing so. Not knowing what happened makes sitting alone in a quiet house more difficult.

Neither my colleague nor I know any physician in Canada with the forensic skills to make an assessment of the effects of this man’s drugs. It would mean going outside Canada.

Her request for an assessment to the prosecutor she is dealing with, for whom she has great respect, comes up against current procedures which make no accommodation for something as obviously sensible as this.

On the other side, even if this man could afford the best lawyers money can buy, and they were handed a report with good grounds to bring the medication he was taking into play, they almost certainly would not attempt to plead not guilty. They would pressure their client instead to accept a plea deal – his own lawyers in other words would make him a felon and downplay the hazards medication poses.

The doctor who prescribed the medicines will be told by his/her medical insurers than on no account can the medication be blamed for what happened.  S/he must blame the terrible illness and if s/he doesn’t feel capable of this, s/he needs to let the insurer’s lawyer make that case – See When Will Medical Insurers Stop Killing People.

The system in other words systematically conceals what is happening in cases like the one that drew Carney to Tumbler Ridge.

Another colleague lived with his two sons just over the BC border in Alberta. Unbeknownst to his father, one of his boys was put on an SSRI by a BC family physician, with the dose elevated to double the toxic levels. The first the father knew about any meds was when his son shot himself. This lack of knowing could not legally have happened if a BC child was prescribed treatment by an Alberta family physician.

For several years now, my colleague has come home to an empty house shorn of its shining light sensing that Canadians want nothing to do with his pain.

In France 16 year old Romain Schmitt was put on paroxetine by his doctor. When it was raised beyond toxic levels, Romain stepped in front of a high speed train.  His family have similarly had the light go out on their lives. Their case that paroxetine killed their son is compelling but just as in Canada it seems to be close to impossible to get a medical expert, even from among those who claim to be critical of the pharmaceutical industry, to agree to undertake a report.

French Experts claim not to have the expertise to write such a report, which begs the question as to whether they are fit to practice medicine – See Clinical Details Confuse Expert Doctors.

Homicides

Woody Witczak lived just over the Alberta border in Minneapolis with his wife Kim. He had no health problems of any sort. He and Kim had good jobs. They were planning a family and had booked trips away.

Woody went to a decent doctor in need of something for a few nights good sleep. He was given Zoloft, an SSRI. He became agitated and told Kim she wouldn’t believe the thoughts going through his head. In line with process based practice, his doctor told Woody to persist with treatment. Trusting his doctor, he did. Soon after, he hung himself.

After his death Kim learnt that killing her was among the thoughts in his head – Health, Care and Science in Real Life..

We have known for 70 years that for healthy people taking drugs acting on serotonin systems:

“the first few doses frequently made them anxious and apprehensive… they reported increased feelings of strangeness, verbalized by statements such as ‘I don’t feel like myself’… or ‘I’m afraid of some of the unusual impulses that I have”.

These reports come from people with no mental history being treated for raised blood pressure.

Companies making SSRIs have known for over 40 years that these drugs can cause healthy volunteers to become suicidal and commit suicide, as well as aggressive and homicidal and can obliterate sexual function permanently even after stopping in some cases.  Investigators on company trials, like me, were told not to ask about sex.

Everyone agrees the unusual impulses above included suicide. Cases like Woody’s make clear that while the drugs cause suicidality sometimes the suicides may be completed in order to avoid worse happening.

My colleague in Alberta and friends in France mourn the loss of a child without being aware that this loss may have been occasioned in part because of their children’s horror at what they might do to their parents. We cannot know if this was the case for these two boys, but it certainly can be the case, as might have been the case in Tumbler Ridge.

Asexual

Besides the direct drug induced suicidality, the two boys above were not told they would have a loss of sexual function while on treatment, with an impossible to ignore profound genital numbing. This is not the kind of thing a teenager can discuss with his parents. Did either wonder about homosexual or transgender issues? Did either find out from the web that this loss can be permanent?  Romain inexplicably smashed his phone before stepping in front of a high speed train.

The Eating Process

At present in Canada, SSRIs are de facto sterilizing more Canadians than German doctors did in the 1940s[1].  These drugs have almost certainly medically assisted more Canadian deaths than German doctors ever assisted.

The difference between the 1940s and today is that people are not dying in intentional medical experiments now. Their deaths are process driven, but the suffering inflicted on fellow citizens is no less excruciating.

Coercion and sanctions are more likely to brought into play today against physicians who refuse to adhere to our health service processes than was the case in Nazi Germany – See Gaslighting, Milgram, Madness.  While there may have been criminals among doctors in Germany, and there may be among doctors today, the root problem is political.

We have a process in which doctors and other healthcare staff, most of whom are decent and we have no reason to think weren’t decent in Germany in the 1940s, are trapped. Running fraudulent studies and portraying hearsay as evidence has been central to creating this process.

Stan Kutcher, a former Liberal Senator, has played a significant part in this process. He is listed on the authorship line of a ghostwritten article about Study 329, a GlaxoSmithKline (GSK) trial of paroxetine in adolescent depression, that transformed a statistically significant excess of suicidal and related behavioral events on paroxetine into a Safe drug. Documents indicating the article was fraudulent led New York State to take a fraud action against GSK and factored into a Department of Justice action against GSK that resulted in a USD 3 Billion settlement.

Paroxetine is almost certainly a pharmaceutical sibling of one of the drugs the Tumbler Ridge shooter was on, all of which have the capacity to cause homicide.

No one should assume that the medical literature on our medicines is anything but ghost-written and de facto fraudulent or shaped by the fact that medical journals are too scared to run anything other than material supporting treatment benefits. Even a former CEO of Britain’s NICE Guideline process recognized that the ‘evidence’ treatment guidelines involving psychotropic drugs is based on is deeply flawed but asked what alternative did guideline makers have?  See The NICE before Xmas.

I make these points as a physician convinced our use of SSRI and related medicines could not just be much safer, but their sensitive use also could reveal important aspects of our subjectivity, currently hidden, if, like Triple Therapy, their use is not bent solely to making a profit – See I Come to Praise SSRIs.

Healthcare needs Leadership. In a reversal to Weber’s metaphor, given that pharmaceutical companies believe few doctors have a thought in their minds not put there by them, Leadership seems unlikely to come from medicine.

Socialists sitting at the healthcare table are predisposed to gorging themselves on the edibles – refusing to let anyone deny them any of the 12 psychotropic drugs a day ‘their industry’ provides them with. As a result Western Life Expectancy and Healthy Life Expectancy is falling. This is not sustainable.

We have a probably then unforeseeable end-game to the dilemma Weber brought into view. Other than offer tasty soundbites, can a Liberal like Mark Carney do anything to stop us being served up as a Dish on Big Pharma’s Corporate Table?

Footnote

[1] SSRIs sterilize by depleting sperm counts and implantation hormones, through miscarriages and by causing neurodevelopmental delay in offspring – in addition to killing libido which may not recover to normal in up to 50% of us.

The post Can We Avoid Being Eaten first appeared on Dr. David Healy.

This image is from Wikipedia Gaslighting which gives the credit details.

The word Gaslighting comes from the 1944 movie Gaslight about a husband’s attempts to get his wife to doubt her sanity. It caught on slowly but as this graph shows in the last decade its use has taken off.

The greatest relative rise in its use may be in healthcare. Until recently it was inconceivable that patients would say their doctor was Gaslighting them. Now almost anyone suffering an adverse event on a drug reports medical gaslighting – see Gaslighting in Healthcare.

Authority

This image is from the Wikipedia entry on Milgram’s experiments.

In 1961, Stanley Milgram, an American social psychologist, recruited volunteers to participate in a study ostensibly about learning.  The teacher (T) had to shock a learner (L) if the learner gave the wrong answers to questions and was told by the Experimenter (E) to increase the doses of electricity in the event of wrong answers. While many volunteer Ts were agitated at what they were doing, two in three continued to do as they were told up to lethal levels.

Milgram’s experiment casts hypnosis in a new light. Supposedly only some of us are hypnotizable and do crazy things at the suggestion of a dominant other. But Milgram showed that most of us in response to Authority obey crazy orders.

Prior to World War II, few could have believed that Germany, perhaps the most cultured and scientifically advanced society in the world, with a large Jewish population contributing significantly to its culture and science, could possibly have descended into civilizational erasure.

Milgram, like all Americans, especially psychiatrists and psychologists, believed the Holocaust pointed to a fundamental flaw in the German character. It couldn’t happen Here. The psych view was that the Nazis were latent or closet homosexuals.  Psychoanalysis, a Judeo-German creation and immigrant to American shores, would make sure it couldn’t happen Here.

The recent movie, Nuremberg, based on The Nazi and the Psychiatrist by Jack El-Hai, outlines the encounters of US psychiatrist Douglas Kelley with Herman Goering that convinced Kelley it could happen Here. The dismissal out of hand of Kelley’s efforts after the War to tell Americans it could happen Here led to him developing an alcohol use disorder and to his suicide – 3 years before Milgram began his experiments.  It turned out that Germans, even concentration camp guards, were no different to Americans.

RxISK’s Guilty until Proven Innocent post dealt with prescription-drug abuses through the medium of sexual abuse. The injured need to follow the example of women who have got fed up being assaulted and have become more assertive, almost literally taking the law into their own hands. They, the women, and we, the drug abused, need to stop depending on the system, on authority, to be fair and deliver justice. The system is rigged. We are at risk if we fail to realize this.

The Magic of Medicine

While there have always been abuses in medicine especially in psychiatry, up until 1990 doctors behaved semi-decently. If we decided we had a problem, we brought it to ‘our’ doctor who even came to our house if need be.  They brought the magic linked to a wisdom borne from experience to bear on our problem.

From the 1950s, this magic came supplemented with new medicines. As the new drugs were viewed as unavoidably hazardous, they were made prescription only. Medical experience helped doctors bring good out of the use of these poisons by remaining observant and applying common sense.

Physicians then were professionals, which meant they prioritized our concerns – helping us to live the lives we wanted to live.  See  Getting Engaged to a Doctor and Who’s Afraid of Science. This was a forerunner of Relationship Based Medicine – more an experienced parent and inexperienced child then perhaps than the partnership of equals it needs to be now.

As professionals, physicians like lawyers were independent of Church, the First Estate, and State, the Second Estate (which had meant the aristocracy but increasingly came to mean a bureaucracy or Deep State) that from time immemorial had commonly wanted us, the third estate, to live the lives that suited them.  The Gutenberg Revolution followed by the French Revolution had brought a Fourth Estate into view – independent academic and lay media.

Doctors are still decent people, as are regulators, company people and the media, but they have now been recruited to a mass Milgram experiment and, in principle at least thanks to Milgram, we now know a lot more about what decent people are capable of.

Prozac 20 milgrams

With Prozac and other SSRIs, companies managed to relocate the magic of medicine into their pills. The poisons have become sacraments.

Any token magic left in doctors lies in their ability to write a prescription – not in their ability to engage with us

Rather than us taking our problems to an experienced doctor looking for help to live the lives we want to live, on pain of being denied coverage health systems summon us for screening and, giving us problems we didn’t know we had, administer ‘sacraments’ to us. On average now, we take more sacraments daily than any cloistered religious folk ever did.

The Fourth Estate has ceased to exist.  Doctors, regulators, and both academic and lay media are hemmed in by a ghostwritten, soon to be AI written flood of articles on the benefits of the sacraments.  Not even the most famous medical journals dare blaspheme and publish any hint, especially one written by a doctor, that one of the sacraments might come with hazards – Silencing Doctors, Silencing Safety.

Doctors have been forbidden to go by experience or use common sense. Their wisdom is dismissed as anecdotal – as misinformation.  The only acceptable truth about the sacraments comes from company publications, which extol their virtues to the point where Cardinals like Ian Hudson can tell juries that Evidence Based Medicine shows that paroxetine has no side effects whatsoever – See Gaslighting in Healthcare.

Guidelines rather than Angels bring us the Good News (Gospels) of Salvation.  Angels bearing Guidelines stand at the Gates of Heaven with flaming swords in hand – none who deviate from the Way, the Truth and the Light can enter here.  See – The NICE before Xmas.

The Angels bearing Guidelines take the place of Milgram. Doctors are caught between the patient whose body needs to learn to conform to the commandments and the Angels who insist the patient must stay on the treatment for at least 6 weeks and respond, or else the dose must be increased.

There are differences between the original Milgram experiment and now. For one, the patient (the learner) is real rather than an actor.

Another is that the electricity is real and rather than starting low and raising it in increments, the initial dose is at a lethal level – 20 milgrams of Prozac as the dose response curve below shows.

Lilly ran with a lethal dose of Prozac because it was proving very difficult to get Prozac licensed and they were taking no chances with their Golden Egg.  In order to run their trials at 20 milgrams they had to put a large number of subjects on concomitant benzodiazepines in order to damp down the agitation so much milgraming can cause.

Despite also running a trial of Prozac 5 milgrams and finding it just as good as 20 milgrams, Lilly did not bring the lower dose on the market. Why not? Because they figured it would be easier to capture the market if Prozac was the once a day antidepressant and doctors didn’t have to start low and go slow, monitoring their patients closely as they did.

Instead, once licensed, Lilly perversely encouraged us to use benzodiazepines to damp down the serotonin pick-up syndrome SSRIs cause. Perverse?  Well at the same time the central claim in SSRI marketing was the need to replace these hazardous benzodiazepines with safe antidepressants.

Thousands upon thousands of us are killed yearly because the system can now depend on decent doctors to do as they told. They gaslight their patients and in response to a real patient’s real agony right in front of them – not in a separate room as Milgram’s learner and teacher were –  they tell the patient they need to keep taking their SSRI, and keep raising the dose – 40 milgrams, 60 milgrams, 80 milgrams.

Family and friends, patients in mental health units and prisoners in prison can see the harm being done but decent doctors can’t.

Many of us have been bewildered by a script for an antidepressant from a decent doctor when, like Woody Witczak, we came in hoping for something to give us a few nights good sleep – See Are HealthCare and Science Compatible.

Bewildered too when finding that despite telling him that things were unimaginably bad on treatment he told us to persist.  Leaving everyone dear to us bewildered, when still operating on the basis of trust in a doctor they too perceived as decent, we did persist and ended up killing ourselves.

Worse again we have killed others. In cases like this, despite a cast iron not-guilty case, even with the resources to hire the best lawyers money can buy, there is no way to get a lawyer capable of fighting a not guilty case.  If things go wrong on the pills, we are Guilty without Hope of being Proven Innocent. It is becoming increasingly impossible to point the finger of blame at the Sacrament.

Premiers will skip meetings on the world stage aimed at preventing civilizational erasure, aimed at preventing us being eaten alive, but dare not question whether we are safe at the health service table or whether we have already become the food being served up.

Others have been seduced by marketing fantasies about being Better than Well, bringing out our inner Van Gogh, and were impervious to the advice of a doctor whose experience with these new wonder drugs counselled caution.

All too quickly, these doctors quietly adapted to a new reality – one in which they were forbidden to learn from experience.  When things go wrong for a patient like 15 year old like Dexter Johnson – In Memory of Dexter Johnson, whose doctor milgramed him up to 40 milgrams of Prozac  – or 16 year old Romain Schmitt – Clinical Details Confuse Expert Doctors – whose doctor milgramed him up to 40 milgrams of Paxil, doctors get told by their medical insurers never to blame the drug  – see Will Medical Insurers Stop Killing People and Tangled up in Bureaucracy and Who Will Make Medicine Great Again.

Authority

Between 1800 to 1900 in creating modern healthcare, doctors created public health and then indecently manned barricades in France and Germany in the 1848 Springtime of the Nations.  Politics is nothing but medicine on a grand scale Rudolf Virchow said then.  See Shipwreck of the Singular.

Instead since prescription status gave doctors power beyond the dreams of oligarchs, the ability for a few of us to control the supply of drugs for all and bend pharmaceutical companies to our will, this Script of Power, our Precious, has like Sauron’s Ring transformed us into Gollums, Smeadics (Smeagol) in this case, creatures of the night – See One Script to Rule Them All.

One Script to rule them all
One Script to find them
One Script to bring them all
and in the darkness bind them
in the Land of Mordough where the shadows lie

Our doctors are now employees of health services, even when apparently not. They are model doctors where a model is a shrunken replica of the real thing, practicing model medicine.  They are not made of The Right Stuff.

They dish out Probity Blockers in a Transmedicine that increasingly pushes us to transition from members of the third estate into what in these days is more likely to be called Real Estate – something we can charge rents for and make money from.

The word Authority contains the word Author. In any theocracy, whoever has the power to write the script, the sacred text, whether a Holy or an A.I. Ghost controls the people.

We are not doing science. See Health Care and Science in Real Life. We have been swept up by a religious broom into a dustpan and risk like Road Kill being put out with the rubbish.

Rather than reading the Ghostly Books, doctors need to get back to recognizing that when we come to them, rather than when we are commanded to attend, we are the books they need to decipher.  These days the harms of the probity blockers they give us are the most likely reason we will reach out to them.  The harms of probity blockers are increasingly likely to be the cause of our death if they don’t intervene.

They need to start doing science and that can only be done cooperatively with us.

The post Gaslighting, Milgram and Madness first appeared on Dr. David Healy.

This post features Letters from Peter Scott-Gordon to Lade Smith – the originals are in the link.  Readers outside Britain should assume that the gaslighting here applies to regulators and medical bodies in their country also and should not be fooled by this apparently polite correspondence.

4 February 2026

Dear Dr Lade Smith,

PATIENT SAFETY

I wanted to write to you to say thank you for engaging with me as President of the Royal College of Psychiatrists in relation to a number of matters. I particularly wanted to thank you for your kindness and professionalism in this. I am aware that your period as president is coming to an end (how time passes!) and that a democratic process is underway to find the next College president.

You will doubtless be aware of a number of current inquiries, right across the UK, into serious matters relating to patient safety. In one recent example, Fred Mackintosh, KC, Senior Counsel to the Scottish Hospital Inquiry, said to BBC Scotland on 23 January 2026:

“Senior leaders effectively need to know that if they show wilful blindness or complacency or don’t ask questions when patient safety issues arise, in due course they will be held to account”.

Given this context it is important that the College does not ignore patient safety issues, including in its forthcoming election process which is likely to face wider public scrutiny than ever before.

I hope that the election process, including the hustings, will include consideration of patient safety issues. I appreciate that this may be challenging for the College as it is primarily a membership organisation and supporting the interests of its members is understandably its priority. However, there is a very real risk that a defensive approach interferes with, or indeed impedes, College acknowledgment of, and support for, patients harmed by psychiatric treatments. Given the recent warning issued by Fred Mackintosh, KC, the College has to be aware that its long-term reputation could be at risk. Psychiatry, like all branches of medicine, is dependent on the trust that patients have in it.

It is disappointing that the College has made no official response to the First Do No Harm Cumberlege recommendations which were published in the summer of 2020. This is a missed opportunity to accept accountability and demonstrate a willingness to learn. This apparent defensiveness by the College may be one of the reasons why over 1 million people in the UK are seeking support from Facebook and other social media groups in relation to prescribed psychiatric drugs.

The risks and benefits of social media use are issues affecting all of society and continue to be widely debated. In this environment it is more important than ever that the online behaviour of College members adheres to the highest possible professional standards. The College needs to remember that social media contributions, both past and present, of its office bearers are open to scrutiny.

Thank you again for taking the time to listen to my concerns and I wish you all the best for the future. I do hope that the College can demonstrate genuine engagement with patient safety issues and that these can be openly discussed in the election process for the next office bearers of the College.

Yours sincerely,
Dr Peter Scott-Gordon

Copied to:
[1] Sonia Walter, CEO of RCPsych
[2] Wes Streeting, Secretary of State for Health and Social Care
[3] Patient Safety Commission/Commissioners
[4] Marion Scott, The Sunday Post

6 February 2026

Dear Peter,

I hope this finds you well.

Patient safety and the quality of care provided to people is a paramount concern for the College. Everything we do, including supporting psychiatrists in their work, is aimed at improving outcomes for people with mental illness.

As you know, mental health services have been underfunded for many years and suffer from chronic understaffing. This affects access to care, as well as the ability of staff to provide excellent quality care for all their patients. This is something the RCPsych advocates about constantly.

With respect to individual practitioners, we expect that all will do their utmost to provide the best quality care that is safe. We provide guidance, education and training to support them to do this.

Regarding the Cumberledge report, the College updated our Sodium Valproate Position Statement in light of the recommendations and reviewed and updated this again last year.

The Cumberledge report looked at 3 medical interventions that were not specific to mental health, nonetheless, we contributed to and signed up to a statement put out by the Academy of Medical Royal Colleges, of which we are a significant member. The statement was released on behalf of all Medical Royal Colleges and can be found here. In addition, we were part of the development of the 2021 Guidance document on the use of sodium valproate for women and girls (here).

I hope this helps to reassure you that we take patient safety very seriously. The hustings will focus on questions from the membership. There are always questions about patient care and the quality of mental health services, because this is what our members care about.

With all good wishes,

Lade

Dr Lade Smith, CBE
President of the Royal College of Psychiatrists

Academy of Medical Colleges

Below is the full statement by the Academy of Medical Royal Colleges that Dr Smith mentions in her letter to me. I am not aware that there has been any update to this initial statement, particularly in relation to the final paragraph: “We will work with colleges and other stakeholders to ensure that agreed recommendations are implemented as quickly and effectively as possible.” I would have expected a follow-up statement but have been unable to find any.

Primodos, sodium valproate and Vaginal Mesh

Baroness Cumberlege’s report, ‘First, do no harm’ is shocking and does not make for comfortable reading for the medical profession or the health system as a whole. A system which ‘has failed to listen to their [patients] concerns and when, belatedly, it has decided to act it has too often moved glacially’ is not delivering patient centred care for women. But, the report sends clear and powerful messages for change.

We offer our sympathy to all those who have suffered from these three interventions. Others should not have to face what they have faced in seeking to have their concerns taken seriously.

The Academy Council will give the report full consideration when it meets on July 22 2020. We will work with colleges and other stakeholders to ensure that agreed recommendations are implemented as quickly and effectively as possible.

7 July 2020

In Another Part of Town

Peter is not responsible for what comes now, although he did introduce me to Harriet Vogt’s wonderful description of British Medical Bodies as the Royal College(s) of Carpet Fitters.

On the same day as Peter posted this correspondence, an email came from Two Old Geezers (TOG) – otherwise known as Carl Heneghan and Tom Jefferson who have recently been chasing safety aspects to Covid vaccines and GLP-1s – Wegovy and Mounjaro.

The TOG email included excerpts of the latest response they have had from Britain’s FDA equivalent – MHRA – from which they quote Alison Cave, MHRA’s chief safety officer, as saying:

“Patient safety is the MHRA’s top priority and we continually monitor the safety and efficacy of all licensed medicines. For the vast majority of patients who are prescribed GLP-1s, they are safe and effective medicines which deliver significant health benefits. The risk of developing these severe side effects is very small.”

The TOGs point out that every page of the MHRA’s Yellow Card Site (MHRA’s equivalent to FDA’s Medwatch), contains the statement:

“The existence of an adverse reaction report does not necessarily mean that the medicine or vaccine has caused the reaction.”

and comment that against a background of thousands of reports, many listing fatalities, these two statements sit uneasily together.

The TOGs failed to note that despite having a Chief Safety Officer title, Alison Cave is not a doctor and has no qualifications to decide whether a drug has the capacity to kill, maim or otherwise harm. Any reader taking a medicine, or their family and friends, is like Tom Kingston along with his family or friends, better placed to decide whether treatment is causing that person a serious hazard or not than Alison Cave is – Ants, Aunts and Regulators.

That patient safety is  MHRA’s number one priority is a soundbite not a reality. MHRA, FDA and EMA ‘look over’ (Cave into) drug labels that pharma companies write – companies who also claim patient safety is their number one priority.

Dr Ian Hudson was a Chief Safety Officer with GSK and later CEO of MHRA.  As a medical doctor he was better placed than Alison to decide if GSK’s paroxetine could cause serious problems – See Who Will Make Medicine Great Again – but despite almost certainly knowing what the results of Study 329 – a trial of paroxetine done in children – showed, in the Tobin v SmithKline Beecham legal trial Dr Hudson swore under oath paroxetine causes absolutely no side effects whatsoever.

It is difficult to imagine anything quite so psychotic as this.  The jury clearly thought so too.  MHRA and company personnel to this day, 25 years later, are just about obliged to parrot the same lines if called on to comment on safety issues in public or under oath.

After leaving MHRA, Hudson worked for the Bill and Melinda Gates Foundation, which brings the The Epstein Files files into the frame – Bill Gates has vigorously denied any link.

It appears Dr Hudson has had interests other than the safety of children.  See Former Head of UK Drugs Regulator Failed to Reveal.

Britain’s Guardian Newspaper, who have links to BMGF, refused to run this story.  The BMJ who, while also claiming patient safety is a priority, also opted not to cover the issue.  BMJ have mechanisms in place aimed at avoiding ever hinting a medicine might post hazards to patients – See Silencing Doctors, Silencing Safety.

Note

This post has put an emphasis on the role of doctors helping patients established what a drug has done or not done. There is no suggestion that you have to believe doctors.  Quite the contrary. They more than anyone have failed us – see Are Healthcare and Science Compatible.  To be Continued.

The post Gaslighting in Healthcare first appeared on Dr. David Healy.

This post was written 5 years ago.  It is a sequel to a lecture posted last week on RxISK with its comments – Are Healthcare and Science Compatible?  The comments brought out how we now have a system that gaslights both patients and doctors leading to tensions on all sides as this post illustrates.

It also links to RxISK’s – Guilty Until Proven Innocent – Prime Facie – this week.

Reducing Medication Burdens

Between February 2020 and 2021, I was one of four psychiatrists taking mental health referrals from 80 primary care physicians in an Ontario University city.

The most common referrals were people who were anxious or depressed, who had been on antidepressants for a decade or more. Some had started in their teens. For some the original drug had cascaded into cocktails.

Another group wondered if they had ADHD or Autistic Spectrum Disorder (ASD). This group included a number of people who could be described as extraverted or introverted in temperament rather than ill. Extraverts complain of lack of focus; introverts complain about too much focus. Extraverts take risks and are impulsive, introverts manage risks and ruminate.  Extraverts find the features of ADHD described in the lay media fit them perfectly. Many university students engineer ADHD or ASD diagnoses, believing the diagnoses or treatments can be used to good advantage.

Extraversion and introversion are biologically based elements that shape personalities. Medication can help but is not a cure and the treatment of ADHD by stimulants has been linked to an earlier onset of Parkinson’s disease.

A third group were under work stress linked to the management culture in factory, university and healthcare settings. These referrals asked if the person is depressed or anxious – conditions that locate the problem in the person. A neutral diagnosis is burnout or adjustment disorder, which tread the line between securing a disability payment and not locating the problem within the individual.  Sometimes the management dysfunction was so clear, it had to be the diagnosis.

Few referrals had prior admissions for mental illness, even though some had up to six diagnoses and were taking nine psychotropic drugs in addition to other medication.

Mild to Moderate ‘Mental Illness’

The superficial dynamic in referrals from primary care physicians is that these referrals are for minor mental illness and a serious mental illness expert will find these cases easy.  Primary care problems are not in general continuous with traditional mental illnesses.

Severe mental illnesses are relatively easy to diagnose, and the treatment options are more straightforward than many primary care cases. Primary care throws up a lot of anxiety and distress stemming from existential, or social issues, as well as conditions where the appropriate response is diagnostic and therapeutic uncertainty.

Aside from a small number of cases that may evolve into mental illness in need of secondary care or have neuropsychiatric features that specialist input can help with or may require a turn to off-label therapeutic options, primary care physicians will usually know the person, their family and circumstances, better than a psychiatrist could on the basis of a single meeting and without contact with family members or the ability to see changes over time.

There is, however, pressure on family doctors to do what specialists recommend.  The image here is of a Judas Goat – whom companies use to get family doctors onside.  See Partialists and Generalists.

SSRI Burnout

Some of the main treatments for primary care nervous problems, like the selective serotonin reuptake inhibitors (SSRIs), are now 30 years old. While their use has largely been proper, and helpful, professional bodies like Britain’s Royal College of Psychiatrists now accept these drugs can cause dependence and can be difficult to stop. In practice, this means some of the nervous problems patients bring to their family physician will be breakthrough anxiety and depressive symptoms, which are confronting for all concerned.

Each family doctor may only have a few cases like this, but where several doctors refer to the same psychiatrist s/he may end with many cases and no easy solution to offer. Switching to other antidepressants or adding meds is not a reliable answer and often causes further problems.

It can be difficult to offer a clear management plan. The patient’s agreement to any plan is important especially if they are likely to be faced with withdrawal difficulties. Opening up a space, therefore, where the patient, supported by a family doctor, can disagree with the ‘expert’ is important in these cases.

Family Doctor Centred

Family doctors complain specialists rarely consult them on a case. With every referral, I messaged family doctors to let them know there was an entry in the medical record. These entries often called for their input and made clear I was willing to engage further. Some doctors phoned. Many messaged back thanking me for the entry to the record and in some cases explicitly agreeing where for instance I had not supported an ADHD diagnosis.

ADHD diagnoses were never turned down flat. An alternative – you are extraverted and creative and stimulants risk inhibiting this – was offered.

Nevertheless, some family doctors may have been concerned that a willingness to recognise adverse effects caused by prior treatments might cause them problems should there be a complaint.

There is a difficult area here between the pragmatic ‘give us a view that will help us move this case forward’ and the medico-legally concerned ‘give us a view that has a basis in guidelines that will give us cover should things go wrong’.

Bureaucratic or Person Centred

Family physicians globally say they do not read reports from psychiatrists other than the closing diagnosis and treatment. The only person interested to read the full report is the person referred.

For over 30 years in Britain, I provided all outpatients with copies of all reports on them. These were framed with the person in mind rather than their doctor. They were light on medical jargon and where possible used the person’s own words.  No doctor in 30 years complained about this and the letters were appreciated by patients.

In the new clinic, I emailed my entry to the electronic medical record (EMR) to both doctor and patient.  The reports supported the courses of action initiated by family doctors, even where these had stopped working. I made it clear to the patient I would likely have taken the same approach in the first instance. Having asked about the relationship between patient and referring doctor, I phrased the report accordingly. The report invited patients to research things that arose in the interview including possible drug options and check these and other issues with their family doctor.

During this period, the services were operating in lockdown, which meant phone or video supplemented consults in addition to in-person meetings. A patent attempting to arrange follow-up appointments with other colleagues could take weeks, which was a problem for anyone having medication change difficulties.

My patients had their reports half an hour after a consult and were able to email me any time if they had problems. They were seen within hours or days.  The normal bureaucratic wall between them and me was not there.

Medical Consumerism

Working two days a week, I saw over 300 referrals. I suggested a survey aimed at assessing what physicians and patients made of this new way of working.

Instead, at a meeting I only knew about 15 minutes beforehand, my input to the team was terminated. An undetermined number of doctors (2 that I know of) and patients (possibly only I), I was told, had been unhappy at an apparently insufficient offering of further diagnoses and treatments. There was no complaint of malpractice or investigation of any incident. A separate clinic at which I was working in the same way were happy for me to continue.

The system claimed to be unable to stream patients to me who might want this approach. I was told the system must have a standard approach, and at present at least some doctors and patients expect more diagnoses and treatments. The default is to medical consumerism and an adherence to guidelines for diseases rather than guidelines for people.  None of the management team showed an interest in the idea that in the light of current evidence the first point in a guideline for people might be that no-one should be on more than five drugs.

Despite, growing discussion about deprescribing in University Departments, and among clinicians, in addition to patients interested to explore this option, as of 2021 nowhere in Canada offered sustainable treatment as part of its mix.

Where once access to treatment was a privilege of wealth, public health systems are now geared toward increasing access to medicines. Being able to reduce a medication burden it appears has become a privilege of wealth.

In North America referrals increasingly come from people approaching a family doctor claiming they have ADHD, ASD, or the latest fashionable diagnosis, expecting to be referred to a specialist who will confirm the diagnosis and initiate treatment.

These diagnoses can suck people in the way cults do. While some doctors will try to persuade patients that consumerism and poisons (medicines) or mutilations (surgery) are not natural bedfellows, and some patients can be persuaded, an increasing number complain if they are not given what they want. ‘We have the rating scale score, where’s our drug’?

There is a case for saying what a person demands, a person should get, and in the case of terminations of pregnancy, gender reassignment and medical assistance in dying, Ontario Courts have said that doctors unwilling to support these options must make an effective referral or consider switching to a non-medical career – hairdressing has been mentioned.

If we standardize processes to the point where everyone gets the diagnosis they want, based on rating scales they self-administer, we will end up with diagnostic and prescribing cascades, as demonstrated in the following example.

A brief upswing of mood diagnosed as bipolar disorder will lead to a mood-stabilizer, ultimately several, one of which will be an antipsychotic. When asked in clinic how they are, any mention of loss of focus, which antipsychotics are designed to produce, risks leading to an ADHD scale and diagnosis and prescription of a stimulant. A dopamine agonist is now chasing a dopamine antagonist, and both can produce depressive symptoms, leading to further antidepressants.

This is not an invented scenario.  It was common in this clinic and a year it was splashed all over both The New York Times and New York Post.

Medical consumerism hinges on the idea that medicines are sacraments (can do no harm). On this basis, the managers who run health services are increasingly turning to cheaper nurse and pharmacist prescribers. We have reached a point where professional discretion is no longer valued.

Pandemic

The turn to virtual consults as a result of the Covid pandemic may aggravate these risks.  Gone is the feel for someone else from a look or body language that may convey a message at odds with a patient’s words, especially when treatment is going wrong. This is a good reason for increased liaison between specialist and a primary care physician who is more likely to have laid eyes on the person before and to know how much their demeanor and deportment now differs.

The switch to new ways of working triggered by the pandemic has already led to more prepping of patients with questionnaires that shape later clinical interactions and diagnoses. An increasing number of clinical evaluations and treatment recommendations come from out-of-state doctors often through phone apps.

Our oversight of who is delivering care and the conversations between family doctors, patients, and mental health personnel necessary to good care are slipping away.

Rotten Barrel?

This state of affairs would have been inconceivable a few years ago. It stems directly from a ghost-writing of the medical literature for on-patent drugs and a total sequestration of clinical trial data. This change has confirmed the medicines in common use as sacraments.  The magic of medicine once lay in the doctor who brought good out of the use of a poison, but the magic now lies in pills and doctors risk being swept away in the rush to get sacraments.

The traditional script for rooting out unethical practice will only make this problem worse by reassuring both doctors and patients that a problem has been found and the barrel is now safer than it was. We have a system problem with no clear solutions.

This wording of this post does not reflect how wild the scenario described was/is.  The wording is mild because it was important to get a peer reviewed article published and this was something new for any journal – See Reducing Medication Burden.

There are other things that were happening around this time, which it may soon be possible to say something more about.

These more hard-hitting RxISK posts touch on similar themes.

• The Future of Health App-ointments
• Over-Diagnosing or Under-Diagnosing
• Repairing Ruptures in Clinical Care 
• Challenging My Doctor to Disclose 

Standardizing Psychiatry

Later that year, I gave a talk at a Royal College of Psychiatry Meeting covering the History of Psychiatry from 1960 to 2010. This was based on a hard-hitting book chapter in Mind State and Society that the books editors seemed to appreciate.

The audience at this talk, that I gave by video-link from Canada, included some of the luminaries of UK psychiatry. They were not so appreciative.  I revisited  See:

• The Standardization of Psychiatry 
• The Nature and Meaning of Psychiatry

One of them said the talk posed a blood pressure hazard.  Looking back at it now, it seems very very mild.  Peter Selley thought so too and emailed this cartoon.

It may point to a difference between the Irish and the English.  The English put things between lines and into tones of voice. Something that sounds mild to others can be read by other English as savage. Something that seems mild to an Irish person like me can be read by an English audience as wild – and maybe a Canadian one also.

The question the talk ends with is – are we creating a generation of doctors who, like salt when it loses its savor, are only fit to be thrown out?

The post Health a Privilege of Wealth first appeared on Dr. David Healy.

Emil Kraepelin’s famous Textbook created modern psychiatry a hundred and thirty years ago.  After the World Wars, Freud’s influence grew and his thinking dominated the US mental health scene after World War II.  Nearly 90 years after Kraepelin established his framework, US psychiatry dramatically swept Freud away under the influence of a group of psychiatrists branded as Neo-Kraepelinians. Their arguments for a return to the medical model, and an end to an implicit psychoanalytic assumption that everyone is mentally ill, led to the Neo-Kraepelinian epithet. In 1980, this revolution was embodied in DSM-III, whose later editions, ironically, make it possible for virtually everyone to be viewed as mentally ill.  Kraepelin got by on 10 categories, DSM is heading toward 1000.

Psychiatric Drugs Explained was published a decade after DSM-III. Its introduction placed the voice of people taking psychotropic drugs front and central. It asked – could we all think about becoming Kraepelinians?  This was not an invitation to become a Neo-Kraepelinian. Instead the call was to do what Kraepelin had been doing before 1896, when he became the Gold Standard Psychiatrist. When along with Wilhelm Wundt and many early psychologists, he created Pharmacopsychology.

Modern psychopharmacology is about where drugs go, what receptors they bind to or neurotransmitter levels they change. If you don’t know what LSD can do to you, showing you where it goes (mostly in the body), binding to serotonin receptors (in the gut) for instance, is going to tell you very little about what to expect when you take it.

Pharmacopsychology is about reporting what we notice on a drug and doing tests to check the effects of the drug on how we are functioning. In the 1880s that meant caffeine, alcohol, cocaine and opioids.  Kraepelin and Wundt thought this new science would be an important part of our future.

Pharmacopsychology & Psychopharmacology

In the early 1950s, the discovery of chlorpromazine, the first antipsychotic, appeared to put the future of Pharmacopsychology on solid ground.  Chlorpromazine and later imipramine, the first antidepressant, were discovered by noticing the effects they had on people when they had been given for something else.

For a decade after their discovery, the emerging neuroscience was in the hands of behavioural psychologists rather than physiologists or pharmacologists.  The science lay in paying heed to the functions chlorpromazine and diazepam and other new drugs affected and the possibility of using these changes to shape behaviour. It was possible to get the right dose of chlorpromazine or haloperidol by comparing the size of a person’s handwriting before and after starting on treatment.  It was possible to screen for new antipsychotics and tranquilizers by putting animals on the new drugs and monitoring the effects on their unconditioned and their conditioned reflexes these drugs had on their abilities to learn.

But starting in 1965, the Catecholamine Hypothesis of Depression and Dopamine Hypothesis of Schizophrenia side-lined pharmacopsychologists and brought psychopharmacologists into being.  Side-lined our understanding of what these drugs did and how best to use them. These hypotheses gave rise to the idea that if the person was not cured, something biological had not yet been fixed and the answer was to vastly increase treatment doses. It is no surprise that we have made virtually no progress in 60 years.

Our drugs now are replicas of the original antipsychotics and antidepressants – astonishingly given that we can screen thousands per day. The trouble is we put them in test tubes to see what they bind to or what epigenetic effects they have.

Our abilities to use them in a meaningful way have atrophied. Clinical practice has dumbed down.  We used to get good responses from haloperidol or flupentixol 1-2 mg per day but ended up giving them in doses over a 1000 mg per day

The Capsule in the Room

The introduction to Psychiatric Drugs Explained spelt out my astonishment at the disappearance of Pharmacopsychology. The book called on everyone taking medicines from healthy volunteers to patients to help restore it.

My astonishment then has given way to complete disbelief now that we cannot explain in plain language to the public or to patients what it is antipsychotics do and how this differs from what tranquilizers do and what these drugs do that differs from what SSRIs and anticonvulsants do.  These drugs are all anxiolytic in one sense of another, but they differ dramatically – anyone tested with one of them blind could tell you which it was.

The inscription reads your name may be forgotten but your work remains

Despite being immediately aware of differences between these meds, and despite the fact that so many people are taking them, no-one has been able to put in plain language what the key differences in the experience of taking these drugs are, what people can expect to notice if they take one or another and which of our multiple functions will be changed by them. We should be able to put people in a position to decide if they are getting this or that hoped for effect from a treatment so that they can tell us whether they are getting it or not. We should be able to put people in a position to decide whether what they have been told a treatment is likely to do in order to get them well, which might suit someone else, sounds like the right kind of thing to help them.

Putting people in a position to know what the mission is when taking this pill as opposed to that pill doesn’t just apply to mental health meds.  The same holds true for the different kinds of antihypertensives, hypoglycemics, cancer chemotherapies or other drugs along with non-drug options – See Why Depression IS like Diabetes (forthcoming).

Nobody can say No to a treatment we are assured will get us well.  But this is saying Yes to a lie. If the prescriber doesn’t know and can’t tell us how a treatment might help improve things, and help us to help improve things, the chances of it actually helping drop dramatically – well below 50:50.

A prescriber like this is locating the magic in the pill rather than in her or him and definitely not in US. S/he is dangerous and you should change prescriber.

Instead of a solid grounding in what we might expect, we have the appearances of science. Doctors increasingly hiding behind rating scales, blood tests or other measures.  The scales or tests generate figures which generate doctors who say this drug will get your figures back to normal – as if by magic without telling us what this drug will do to change the figures.

If we stuff stimulants, benzodiazepines, antipsychotics, SSRIs, drugs with no actions on serotonin, anticholinergics, nicotine, alcohol, microdosed LSD or mushrooms into clinical trials for nervous disorders, all can change rating scale scores to exactly the same extent. In the case of nicotine and alcohol, however, we know exactly what they can do to us and when that effect might be useful for us. We also know their hazards, but doctors can’t tell us a thing about what scientifically researched prescription meds specifically do.

E Pluribus Mediocris – as this doctored Great Seal of the United States says.  Mediocris is Latin for Average.  Clinical Trials are averaging machines – putting a pig, cow, horse or man through a mince meat grinder would produce a comparably similar outcome without us being able to tell one from the other.

Companies earn billions of dollars from these drugs every year but we who take them are none the wiser about how this drug as opposed to that drug might help us.  Our job is to just take them, without contributing from the position of a privileged observer on the question of whether the treatment is helping or not or what exactly it is doing.  This is a recipe for a doctor stubbornly sticking to the wrong treatment for us and perhaps doubling or tripling the dose in order to force ‘our’ figures to behave themselves.

Listening to us instead would be a recipe for changing this pill to a different treatment approach not just switch one SSRI for another – Most of the patients in the original Teicher group who became suicidal on Prozac, got better when switched to an MAOI.

Practicing What?

Bruce Springsteen in Born to Run gives better descriptions of akathisia, one of the most serious hazards of our meds, than any medical account has given since the 1950s when drug-induced akathisia was first described.  See I Come to Praise SSRIs for the description.  Most of our meds give rise to Akathisia, but here again we seem unable to pinpoint the differences between antipsychotic akathisia, SSRI akathisia and anticonvulsant akathisia.

Our 70 year fixation on dopamine and serotonin has shed no light on akathisia. We know antipsychotic akathisia can be pretty instant and can lead very quickly to suicide or homicide.  SSRI akathisia seems to have a slower onset and suicidal trajectory. Mirtazapine akathisia seems to have the same timeframe as SSRI akathisia, but it differs – we don’t know how – from SSRI akathisia.  Ditto Anticonvulsants. These are just as likely to lead to suicidality as SSRIs but over a much slower timeframe – giving us a much better chance to spot warning signs, except we have almost no sense what to look for or ask people about.

Shouldn’t it be possible to get us and our psychiatrists and psychologists to share insights on these issues.  The more people who have a sense of what might be going on, the better the chances we can save lives.  Doctors and psychotherapists knew far more 60 years than they do now. Their combined observations back then led to the creation of SSRIs.

A psychotherapist seeing a patient today might spot changes in their patient after being put on a drug but will generally not explore this with the patient for fear of an email turning up from a belligerent doctor telling them they are not licensed to practice medicine.

Whatever about practicing medicine, doctors who are not open to reports on medication – induced observables are not practicing science – See Narcissistic Doctor Disorder.

Material Me, Material Us

Behavioral pharmacology didn’t disappear entirely. It survived in an abuse colony few doctors ever want to visit – substance use disorders – where motivation is the big story.

Motivation sounds very personality or character based. Our appetites, however, the prototype of our motivations are body based rather than brain based.  Prompts from our circadian clock nudge us to imagine food and seek it out or to imagine sleep. Feeling chilly prompts heat-seeking behavior. Being driven by internal sensory signals like this led to a recognition of the importance of interoception – the ability to notice cues in a manner that enables us to manage them – See Intrepid Interoceptors Needed.

Homeostasis, the process of balancing our internal milieu, operates largely through small sensory nerves, which lay the basis for a Material Me, and the basis for a Material Us – many of our hormones readjust in the presence of others.

We have typically translated all this into a brain based biobabble about ‘Dopamine Hits’, almost all of which is badly wrong.  ‘Dopamine hits’ crop up in conversations about sex addiction or shopping addiction, as though our original sin was The Dopes need Hits.

The capacity of SSRIs to cause alcohol use disorder (AUD) helps illustrate the extent to which invoking dopamine side-steps the kind of work that needs doing.  Work?  Yep – talking to people.  Asking questions.

Even though the ability of SSRIs to cause AUD has been firmly on the radar for nearly a decade, we don’t know why or how SSRIs lead to AUD.  Nerds have looked at serotonin transporter genes to explain it, rather than ask people.  When you talk to people who have the problem, they offer several different explanations, each of which may be hold true for some of us but not for the rest of us.

1. When on an SSRI, or suffering from post SSRI sensory numbing, some folk claim not to be able to get drunk. They do end up blacking out so they do get drunk. Not being able to get drunk appears to mean they do not experience the sensory cues linked to becoming drunk. Giving a S-3 receptor antagonist can restore sensitivity to these cues. This muting is consistent with the core actions of SSRIs – I Come to Praise SSRIs.
2. Other folk, including medical doctors acting as healthy volunteers, have taken alcohol to subdue the akathisia or restlessness that psychotropic drugs can cause. Alcohol is one of the very best treatments for some forms of akathisia, possibly because it has diuretic properties which counteract the fluid producing effect of SSRIs, which is one candidate for a possible cause of akathisia. This happens because SSRIs are carbonic anhydrase activators leading to fluid production in confined spaces where it should not be giving rise to an abnormal irritating sensation.  See Psychiatric Drugs Explained.
3. Finally, another experience is more manic or closer to the traditional account of AUD disorder – I knew I didn’t want to do this, but it was there and I couldn’t stop. This echoes a ‘hypnotic’ effect SSRIs can have. When sensory muting reduces the flow of images to our brain, we are more vulnerable to one image becoming dominant and in control of our behavior.

There may be more SSRI effects that people with SSRI linked AUD can point to, but we aren’t going to know what these are unless we ask questions. At present we just lump everyone with an SSRI-linked AUD together and expect to find something in the genetics. This is not a recipe for finding something that may be there.

Sensory Power

It’s time to reinvent Pharmacopsychology.

Gen Z or Millennials, able to access SSRIs from online platforms like Hims and Hers, and uninhibited by prescribing doctors from noticing and sharing what these meds are doing to them are in a great position put this on the map.  Hundreds of millions of older folk, scared by their doctors, and not feeling entitled to research these drugs even though they are or have been in a positive of privilege to observe their effects, have been unable to do so.

Starting on very low doses will give the clearest signals. Sharing experiences is key but you have to bear in mind the differences among us.  Women may be hypersexual pre-menstrually or hyposexual  or just normal. If a variation like this can happen on our normal hormones, even greater variation can be expected with an explosive thrown into the mix.  It will take skill to map out what the drugs are doing. Given our brain bias, it will take great skill to notice all the bodily changes from smell to subtle visual effects that we have spent 30 years ignoring.

Emil Kraepelin and the early pharmacopsychologists would have died for drugs like the SSRIs. Through their effects on our sensory systems, SSRIs are extraordinary tools to explore our emotions (feelings) and subjectivity – even more than the psychedelics.

The science made possible by SSRIs needs doing has not been done.

Doctors are too hidebound by paperwork and scared by bureaucrats as well as just not curious about anything their prescribees might do or think or say, so the science won’t be done by them.  Millions of older folk are too scared of their doctors to say boo, so the science won’t be done by them either.  Governments are too rattled by pharmaceutical companies threatening to move their operations out of ‘your’ country, so they won’t support it.  Lawyers have advised medical journals that having anything to do with pharmacopsychology risks getting sued by drug companies.

It’s going to take a new and intrepid generation of explorers to open this Pandora’s box and let us see what is in there.  Time for Sensory Power to Flower.

This post links to to

• I Come to Praise SSRIs not to Bury Them
• Interoception needs Intrepid Interoceptors
• Treating Narcissistic Doctor Disorder

The post The Once and Future Pharmacopsychology first appeared on Dr. David Healy.

This talk was given in Maastricht at the invitation of David Linden, Scientific Director of the Mental Health and Neuroscience Research Institute on November 27 and again to a group of Primary Care Doctors in Sweden at the invitation of André Marx on Nov 28.  There were some great questions afterwards.  This post gives the text of the talk along with the slides and links to related posts.  There is a video of the talk below but so much more in the text including the outline of a new condition Narcissistic Doctor Disorder than in the live talk. 

Slide 1.  In 1958, Imipramine (in the middle above) was the first tricyclic antidepressant (TCA). By 1959, European psychiatrists, semi-Freudian mostly, agreed it could replace ECT in the treatment of melancholia. But even in these severely ill, often suicidal, patients, doctors could spot imipramine causing suicide. Doctors today can’t spot SSRIs causing suicidality in mild non-suicidal depressions.  Why not?

Frank Ayd discovered Amitriptyline’s benefits in melancholia in 1959, which meant he wouldn’t have to continue giving his father ECT on the kitchen table. Melancholia kills libido and Ayd had no wish to create treatment hesitancy but he said amitriptyline caused a sexual dysfunction distinguishable from the effects of melancholia on sex. Doctors can’t now spot SSRIs causing even clearer sexual effects in patients with no prior libido problems. Why not?

By 1961 Julius Axelrod had established the 3 drugs on top here all inhibited norepinephrine reuptake, for which he won a Nobel Prize. This gave rise to Schildkraut’s Catecholamine Hypothesis, the original low neurotransmitter or chemical imbalance hypothesis.

Slide 2. Was melancholia a deficiency disorder like Parkinson’s disease? Would a pure norepinephrine reuptake inhibitor be more effective and free of terrible anticholinergic side effects? There was a snag. Benzodiazepines immediately did something clearly helpful. Ditto antipsychotics and stimulants. But tricyclics seemingly had lots of immediate side effects but no beneficial effect and catecholamine reuptake inhibition was immediate.

Slide 3. This is what melancholia, a disorder of middle or older years, looked like then. After 2 weeks treatment with ECT or TCAs it showed a response. But if there was no immediate and obvious drug effect, what was driving this?  Did the drugs cure a lesion?

Slide 4. Fridolin Sulser’s catecholamine receptor hypothesis took over. These proteins might need chiseling for two weeks to come right.  We now know receptors respond almost instantly but the weeks of chiseling notion legitimized the idea that TCAs took 2 weeks to correct a lesion. Like the Cheshire Cat, Sulser’s Receptors and then BDNF Biobabble left a Grin behind – we have to wait up to 6 weeks now for something to happen, even for much milder problems than melancholia, before people get well. In the meantime. they just have to put up with side effects.

Slide 5. I have over 100 interviews with early psychopharmacologists including Axelrod, Ayd, Kuhn, Schildkraut, Sulser and Carlsson. It costs over $1000 to buy the books these are in, but you can download all interviews for free from the Samizdathealth.org website, linked to Shipwreck of the Singular – See Shipwreck The Psychopharmacologists. Email me if you can’t find them.

Slide 6. All of the TCAs here except trimipramine inhibit norepinephrine reuptake. But in the 1960s psycho-analysts claimed Imipramine, Amitriptyline and Clomipramine had an impact on transference reactions which desipramine didn’t have. The impact was immediate.

Slide 7. Listening to this, Arvid Carlsson linked the changes in transference reactions to serotonin reuptake inhibition – desipramine doesn’t. He made a dedicated serotonin reuptake inhibitor to explore this further – Zelmid.  This and later SSRIs mute sensory/emotional reactivity – they are Serenic – Anxiolytic.

Slide 8. Zelmid was not an anti-melancholic drug, it and later SSRIs are Serenics.  But it became an antidepressant even though anxiolysis is where the money is because it was almost impossible at the time for a new anxiolytic to compete with benzodiazepines.

Slide 9.  It was obvious 35 years ago that SSRI Marketing needed to shape-shift Valium cases into cases of Prozac, cases of anxiety into depression. Companies platformed doctors claiming depression lay behind many cases of anxiety and treating it would offer a real cure not a drug crutch – besides which antidepressants didn’t cause dependence.

Slide 10: For Carlsson SSRIs were a Therapeutic Principle that allow us to compensate for a problem. They were not Magic Bullets that fixed a lesion. Like LSD, working on a normal serotonin system, SSRIs could cause good and bad trips. Bad enough to cause suicide? Yes.

What’s a Therapeutic Principle?  There are 4 kinds of constipation and 4 laxative principles. You can add fluid or bulk, stimulate or relax the gut. The wrong principle for your constipation can make things worse. But a company licensed to use the word Laxative would prefer you to be on 4 laxatives provided one is theirs rather than the right one for you. This way treatment resistant constipation lies.

Most medical problems from hypertension to type 2 diabetes, pain, and nervous problems have several potential therapeutic principles – getting it wrong can create treatment resistance. Euthanasia increasingly is the only way out of SSRI induced treatment resistance.

Slide 11. You might expect Therapeutic Principles for nervous problems to act on the brain, but benzodiazepines relax muscles, and beta-blockers slow heart rates, which fools our brains into thinking we are not anxious. But beta-blockers can increase heart rates for some creating anxiety. At this point we need someone who is working with us rather than from a book.

Slide 12. Therapeutic principles ask us to adjust a function to compensate for a lesion not correct it. Walter Hess, a 1949 Nobel Prize winner, directing his male students to think of functions asked them what their work could reveal about why they fell in love with a girl.

They were all guys back then. The girls were using anticholinergic drops to dilate their pupils which left guys thinking a girl liked them causing them to fall in love with her.

Slide 13. What function do SSRI work on?  In 9 out of 10 of us, SSRIs cause genital numbing within 30 minutes of a first pill, at a fraction of the antidepressants dose. The degree of genital numbing correlates closely with reports of reduced emotional reactivity. Reduced sensory reactivity has face validity as a therapeutic principle in nervous disorders – and SSRIs work better for anxiety disorders than for depression and don’t work for melancholia.

Slide 14. In healthy volunteer trials, dizziness and balance effects are relatively immediate on starting and stopping SSRIs.  These are not Side Effects. Balance and touch are sensory effects and show the core action of SSRIs are their sensory effects.

This slide shows balance problems reported to FDA on SSRIs. Only 1 in 100 get reported, so SSRIs have significant effects on our sense of balance for millions of us. PRRs  (Proportional Reporting Rates) measure the rate this problem is reported compared to all problems on this drug balanced against the rate this problem is reported on all drugs compared to our drug. A PRR over 1.0 indicates a link, over 2.0 a strong link, and higher again points almost to certainty. These are stronger data than you get from RCTs.

Slide 15.  Reports to FDA show visual issues on SSRIs in hundreds of thousands of us. There are less reports to FDA because ophthalmologists don’t report them as you’ll hear.

Slide 16. The idea that an action on sensory functions might be Serenic fits with the James-Lange Theory of the Emotions put forward in the 1880s which said our body senses/feels – it thinks fast – what we call emotions are cognitive interpretations/misinterpretations of these feelings.

Slide 17. For a century after 1832 when reflexes were first discovered. research established a series of gate controls up through the spinal cord enabling all animals, including us, to function without any mental or spiritual input.

These gates are topped out by a vigilance nucleus – the blue norepinephrine locus coeruleus and the green serotonergic raphe nucleus which damps down vigilance. The locus coeruleus needs the sensory hum to be gate-controlled in order to pick out salient actionable features. The serotonergic Raphe nucleus damps vigilance down. But we can empty out the 5% of serotonin in our brains, which is in the Raphe Nucleus, without causing problems.

Slide 18.  I am only semi-saying we don’t need brains at all to work out what SSRIs are doing. I’m trying to get you to see us as more like Octopi than we normally see ourselves. In contrast to appearances, Octopi have Distributed Knowledge Centers in their arms – not in the bulbous head.

Slide 19. Acting on serotonin LSD opens our sensory gates, floods awareness, and overwhelms our heuristic – thinking fast – capabilities. The action on serotonin in humans was shown first in our gut. Very early on spiders, who like octopi have Knowledge Centers in their 8 legs and 8 eyes, given LSD wove weird webs.

Slide 20. SSRIs mute these sensory gates. This Brain Scan shows the effects of one dose of an SSRI in healthy volunteers – the sensory input from the body is diminished. Sensory Deprivation Tanks do something similar. This muting might seem to make interpretations easier but in practice muting can compromise our interpretations as you will see.

Slide 21. This quote gives you a sense of how sensorily deprived people can be.

The mental state is literally an altered state of consciousness that one absolutely cannot comprehend if he didn’t experience it. No words can explain such a thing. I am shocked such a state is even possible.

The best way to describe it is mental anesthesia. Everything in the mind is tuned down so low, even thoughts, emotions so muted they are barely relevant.

It’s the opposite of what psychedelics do. They enhance and amplify whereas SSRIs completely mute. One has the impression everything has been wiped out and there is no mind anymore.

Slide 22. Just as Cartoonists have known for decades about the biobabble doctors spout, they have also known for decades what SSRIs really do.

Slide 23. Some years ago in this unit we randomized 20 medical and nursing healthy volunteers to a norepinephrine reuptake inhibitor or an SSRI for 2 weeks, then crossed over to the other for 2 weeks. 48 hours into the study a patient asked me if Dr X, who he said was more mellow than usual, was on an SSRI. When we broke the blind – Dr X was on an SSRI. Patients are expert at observing people in a way healthcare staff no longer are.

The Grin of the Catecholamine Cat inhibits our ability to spot the obvious. Uninhibited patients, cartoonists and psychoanalysts see Good or Bad Trips within hours. Two of our volunteers became dangerously suicidal on the SSRI. Becoming suicidal on an SSRI is not a step on the way to an eventual Good Trip.

Slide 24. One of the main reasons why SSRIs go wrong is that worried SSRIs might not work in antidepressant licensing studies, as this graph shows companies dosed them at the toxic end of the dose range – 20 mg for Prozac.  At 20 mg, a range of problems had to be covered with concurrent benzodiazepines. No trials show SSRIs working on their own.

Giving a benzo would not be a problem in cancer chemotherapy trial because we don’t expect Benzos to be anti-cancer. But using Benzos to damp down agitation in trials of a drug being brought to market to replace hazardous Benzos is perverse.

Looking at this dose response curve. you’d say a 5 mg dose would be optimal. After licensing Lilly published a 5mg Prozac trial. It worked better at a 5 mg dose.  It’s lead author Lilly’s Joe Wernicke asked colleagues what do we tell people about this?

Again and again, when someone is not doing well on an SSRI, doctors increase the dose beyond 20 mg rather than lowering it.

Slide 25: Unlike LSD, which we take occasionally and recover from bad trips, we remain on SSRIs for months or years in toxic doses. Unsurprisingly, things break – sensory things break.  PSSD (Post-SSRI Sexual Dysfunction), which can last for the rest of your life, points to the profound effects broken sensation can have – see PSSD Podcast .

Bryn:   Getting PSSD undermines your faith in the whole system of science as we have it – its not some vague feeling.  Losing your libido is equivalent to going blind or deaf, its that level of sensory impairment

Roy:    The same can be said for losing your emotions – I felt I lost two senses – my sexuality and my emotions

Bryn:   If we want to be believed we have to remember how incredible our story sounds … My Dad says its not possible a drug could cause these effects, it wouldn’t be on the market

Slide 26.  A decade ago criteria for a new syndrome Persisting Postural Perceptual Dizziness (PPPD) were put on the map. This dizziness involves vestibular, visual and proprioceptive input – all of which have a serotonergic component. See Balancing our Bodies and our Selves.

Vertigo is a better word for this. For a tightrope walker vertigo would trigger a panic attack and panic is common in people with PPPD. Both starting and stopping an SSRI can cause PPPD and like PSSD or akathisia PPPD can endure for years.  Vestibular Rehabilitation Therapy can help but while waiting folk get referred for trauma therapy and get given SSRIs.

This is not just a matter of negotiating things like climbing some steps, we live on a tightrope and our senses our emotions disturb our internal balance.  Sensory disturbances like these strike at the very heart of us and fuel a turn to medical assistance in dying.

Slide 27. This fabulous image brings home a key point that disrupting embodied knowledge. as in VSS and PPPD has profound effects beyond just sensory issues. We’ve just published the largest series of cases of VSS linked to one drug group – SSRIs.  Like PSSD, PPPD, VSS can start on starting or stopping SSRIs and can endure for years afterwards and people often figure they are going mad – especially with the response they get from health systems.

See Juggling Our Selves and Our Bodies.

Slide 28. Ophthalmologists and others looking into our eyes and not seeing a lesion, tell people this is a brain or mind problem – made easier to say of course if the person is on or has been on an SSRI.  They may babble about thalamo-cortical dysrhythmia – a neuro equivalent to chemical imbalance.  The patient gets referred for trauma therapy or has an SSRI recommended.

But comparatively speaking there is more serotonin in our eyes relative to their size than there is in our brains.

Slide 29. SSRIs achieve the effects we want by acting on our primary knowledge generators – our sensory systems. In the toxic doses prescribed they disrupt embodied knowledge. When this happens, patients complain about Brain Fog. They are certain their brains are broken but cognitive tests don’t show this.

When embodied knowledge breaks, we try to fix it by attending or concentrating more which is effortful and frustrating because that’s not the way to repair embodied knowledge – a complaint of Brain Fog almost proves the point.

Slide 30. Embodied knowledge gets made and repaired by blunt repetition. Trying to instruct bodies doesn’t work. The enduring sensory problems after SSRIs explain why withdrawal is so difficult. There is linked damage that does not go away with tapering.

Slide 31.  In 1992, I chaired a UK launch meeting for Sertraline – Zoloft – for Pfizer.  I told the audience serotonin was more primitive than estrogens or androgens and drugs acting on it would produce effects we had never seen before – good and bad. Science is about paying heed to new observations like these – even bad effects can open the door to new drugs.

You also need to know small molecules are promiscuous – they may have 100 effects. If you want precision you need a big, fat protein. Julius Axelrod who rediscovered acetaminophen – paracetamol, often said serotonin was a relic of our marine past. SSRIs act on something even more primitive than serotonin – they activate carbonic anhydrase enzymes – this produces fluid in confined spaces like our eyeballs giving us glaucoma.

Slide 32: This quote from Bruce Springsteen’s Born to Run captures sensory drivers behind his SSRI linked akathisia.

I was profoundly uncomfortable in my own skin. I just wanted OUT.  It feels dangerous and brings plenty of unwanted thoughts. I couldn’t live like this…

I understood what drives people toward the abyss. There was no life here, just an endless irritating existential angst embedded in my bones. It was demanding answers I did not have.

Slide 33.  Now adding weird new sensations that need interpreting to sensory muting opens a door, as this person hints, to dominant imagery and the consequences of that.

Just as my vision lost depth – it was more like a 2-dimensional videogame – there was a loss of depth to my thinking.  I was reacting to things on the surface rather than able to see through to the consequences. 

If I had an impulse to drive, I would go rather than consider the time or whether I had work the next day. If I had an impulse to go out for a walk, I might simply go without my phone – or shoes  

Slide 34. Or this woman who ended up in an almost hypnotic state.

I was thinking I wanted to stop, that I didn’t want to do it, but I had to. 

Why did you have do it? 

Because I had started it – I can’t explain it.

Slide 35. I hope you can see we know what SSRIs do – they mute sensation. We know this from evidence going on them, coming off them, and from the functions they can break in us. Our right hand knows this.  Our left hand doesn’t as you will see from Woody Witczak’s case. What happened to Woody has become the norm today.

This is Kim and Woody Witczak. He had just begun a dream job, they were happily married, thinking about a family, had booked trips. After a few nights poor sleep, Woody’s doctor gave him Zoloft. He became agitated. One minute he’d be fine, then lying on the floor saying Kim wouldn’t believe the thoughts he was having. Woody had a good doctor who said this was normal – SSRIs may not start working for 6 weeks. Hang in there. In the fifth week Woody hung himself.

If we are dealing with LSD, we don’t say this Bad Trip you are having will any moment flip over into a Good Trip. Why do we say it about SSRI Bad Trips?

The Grin of the Catecholamine Cat is partly to blame but there is another perverse source.

Slide 36. I’ve doctored the Great Seal of the United States. E Pluribus Unum – from many individuals, one people – now reads Mediocris – the Latin for Average.

Companies do Randomized Controlled Assays (RCAs) mislabeled as RCTs to get products licensed and claim these offer Gold Standard Science on what their drugs do. They brand Evident PSSD, VSS, PPPD, Suicidality or Homicidality as Anecdotes not Evidence.

Like Chat GPT or Grok, RCAs (even RCTs done by angels) are averaging machines. At best they allow us to say this drug is not totally without benefits, but they tell a doctor nothing about how to treat the person in front of them.

The averaging effect means SSRIs don’t differ much from placebos in the mild depression assays they were tested in.  Averaging LSD trials would give the same outcome but no-one says this about LSD. The idea SSRIs are nothing more than placebos kills people.

Less than 50% of SSRI trials were positive but, with adverse SSRI effects damped down with benzodiazepines, a bunch of coding and statistical tricks and clear fraud, companies could pull out a result that allowed FDA at 6 weeks to license SSRIs as antidepressants.

These licensing linked maneuvers are the basis to the idea SSRIs may take 6 weeks to work. No lesion clears up. There is no evidence in these trials that a Bad SSRI Trip can finally morph into a Good Trip.  

Based on 100,000 patients in company assays, FDA found less than 1 in 6 have a Good Trips on SSRIs. These 1 in 6 Good Trips allowed SSRIs to be licensed as antidepressants.

If companies had sought a license as a Serenic, the trials could have been as short as a week long and would have yielded a marked difference from placebo. Marketing got in the way of this. A Serenic license would have left too much to the discretion of doctors.

There is a further problem with RCTs. Not only do they average good and bad trips on one drug but if LSD and SSRIs and benzodiazepines and stimulants and antipsychotics were all put into trials of mild depressive disorders, although entirely different treatments doing completely different things, they would all end up looking the same – giving the same 3 points difference on a depression rating scale score.

I’m not sure we can blame FDA for this. The drugs have the capacity to work just like they have the capacity to cause suicide. Back around 1990, FDA may have expected doctors to work out how in practice to use these drugs to better effect than company assays suggested.

Slide 37. RCAs allow companies to create a Wonderland. The label attached to their drug acts like the labels Alice faced in Wonderland where food and drink were labeled Eat Me and Drink Me leaving her incapable of not doing this. FDA labels have this effect on sophisticated women who won’t take soft cheeses, or processed meats but consume prescribed SSRIs in ever greater quantities when pregnant.

Freudians who spotted serotonergic impacts on transference reactions can explain what’s going on. Companies have nudged doctors and an educated elite into Delegating Narcissism to FDA .

Slide 38. Mark Anthony said he came to Bury Caesar not to Praise Him. I thought about starting this talk with I’ve come to Praise SSRIs not to Bury Them.  SSRIs work – it’s doctors who are not working.

The hazards you’ve heard about may leave you figuring we need to bury SSRIs.  Listen up. Unless we realize how valuable a scientific and therapeutic tool SSRIs can be, Doctors risk being Buried.

Slide 39. The Federal Aviation Authority (FAA) licenses planes the way FDA licenses drugs – by looking over paperwork. FAA don’t keep you safe in the air – pilots do. They have an incentive – if you don’t get to New York, they don’t either.

Doctors are health pilots, not FDA. But if the door flies off a healthcare plane and you draw attention to this the incentives tell doctors to throw you through the opening for spreading Treatment Hesitancy.

Slide 40. This is an inevitable consequence of Doctors Delegating Narcissism to bureaucrats. Journalists researching adverse events hear doctors telling them people claiming to know they have PSSD, for instance, have Narcissistic Personality Disorders.

When growing up, we Delegate our Narcissism to father figures. Later when confused we may delegate it to dictators, or gurus. Delegating it to bureaucrats suggests extreme vulnerability. Managing Treatment Hesitancy for life-saving treatments is one thing but as Goldman Sachs have told us, making drugs that save lives is a bad business model – the pressure to push down the price of life-saving drugs is huge. Companies make cosmetic or identity disorders to sell profitable drugs, using doctors who they view as devoid of a thought in their heads not put there by them as the front of house sales force.

We are not dealing with a Big Pharma making life-saving drugs, but with Big Propaganda, whose propaganda has become invisible. Behind EBM and Follow the Science labels, and a chorus line of Narcissistic Disordered Doctors, singing Let’s Do the Narcissistic Tango Again we no longer see this.

If their defenses are challenged, as doctor’s are when someone turns up with very Evident adverse effects, narcissists get aggressive and pick on victims. This system breeds violence. Clinical psychologists seeing the same patients as doctors are mostly too scared to hint that obvious side effects are treatment related for fear of a threatening email or worse from a Medic telling they are not licensed to practice medicine.  This isn’t just bad healthcare – it flies in the face of Science.

A note of caution is needed here. I am not talking about Bad People. I am talking about a Bad System. You may need to be as close to the pharmaceutical industry as I’ve been to see how the System works.

Slide 41. In The Antidepressant Era 30 years ago, I offered a thought experiment.  What if these drugs were over the counter (OTC) rather than prescription only. This wasn’t a policy proposal. I was drawing attention to the fact that since 1962, to give you Prozac FDA regulations require me to give you Depression. I need to disable you. If I do this, we have to be sure we are going to bring good out of this injury.

Switching to OTC bears thinking about as a policy proposal now. The molecule on the left is a potent SSRI that can cause all the problems SSRIs cause but if Woody Witczak had taken it and not Zoloft he would be alive today. Why?  Because chlorpheniramine is OTC, and if it didn’t suit Woody, uninhibited by a good doctor, he’d have stopped it. Do doctors add value here?

If our drugs work as well as we are told and are as free of problems, doctors aren’t needed. Nurses and pharmacists are cheaper prescribers and maybe safer than a narcissistically challenged doctor. Doctors deserve to be and are rapidly being buried.

In The Antidepressant Era I also said that if these drugs were OTC companies would ensure all of us – not just doctors – wouldn’t have a thought in our heads not put there by them. The use of Tylenol in Pregnancy, is a great example of this.

Hims and Hers, and other platforms, now sell prescription drugs OTC – see Authenticity Inc. Telehealth and Influencers.  The Creation of Psychopharmacology 25 years ago spelt out how companies like this would ambush us. They use instruments, like rating scales, blood tests or bone scanners, to create figures which their drugs can put right for us.

Slide 42. Checking the figures for our weight began in France in the 1860s.  A decade later a new disorder was born – anorexia nervosa.  Fasting had been a way to holiness, but became a health and beauty matter. Figures can hypnotize us as easily as icons or incense can.

Companies now create Food Noise scales – See Authenticity Inc – designed to show Glyp-1 agonists muting distracting food noise.

Social Media is full of Apps generating figures, Treating figures gives the appearance of science rather than the appearance of a Neurotic Disorder.

Weighing scales and rating scales hypnotizes us. Scans and blood tests hypnotize doctors.

Slide 43.  Here are rarely seen figures for rates of starting SSRIs among Australian women. The Green line shows figures for women in the 45-54 age bracket who are representative of all older women.  The red line shows the rate for 18-24 year olds and the blue line is for 10-17 year olds.  In 1990, Antidepressants were rarely prescribed other than to people of middle years but driven by social media they are rapidly becoming drugs for younger folk.

The prevalence of SSRI use for middle aged women is 4 times higher than the incidence figures – breaking up with SSRIs is hard to do – and so prevalence increases with age. The prevalence for 10-24 year olds can never catch up because unlike Peter Pan they do grow up – even so prevalence rates in this age group are rising faster than for any other age – up 110%.

These incidence figures above are for prescribed drugs. How would they look with Hims and Hers online supplies added?

Slide 44. The gray line is for suicide rates among 15-24 year old males over the last decade.  They are 4 times higher than the blue female 15-24 year old rates but both are rising at the same rate.  And we now have the first legal cases for suicides after contact with Hims and Hers – Authenticity Inc Meets Grok.

Slide 45. The blue line shows the most solid finding in all of the social sciences – 600 studies showing unhappiness with life is most marked in the 40-60 age bracket and until 2018 least marked in under 24 and over 64s.

But the redline shows a dramatic shift – unhappiness is now most marked among 18-40 year olds. Are these canaries telling us this mine is about to collapse?

We now have a social welfare crisis with this generation branded Generation Sicknote and talk of countries collapsing beneath the burden of disability payments – See The Great Silence and Damsels in Distress.

Slide 46. Science began in London in 1660, when a bunch of men began holding events at which they did things like transfused the blood of a young dog into an old dog and observed – it seemed invigorated.  Or looked down a microscope to see what they called microbes – were these animals?

These Events produced Observables about which the witnesses, like a jury, were challenged to come to a consensus. Science like a legal trial is an experimental process – it is not something to be followed. It is not a religion – See Health, Care and Science in the Real World.

A Case Report was made for the event and its consensus. No industry or regulators branded these as Anecdotes. This anecdotal process put men on the moon, decoded the human genome and extended life expectancies.

Medical journals came 200 years later. RCTs and their statistics 300 years later. The 1950s was the stellar decade for drug discovery when almost all classes of medicine we have now came into being. None of these breakthroughs involved RCTs. Many of these drugs, like imipramine, which people could see in real life had the capacity to work even if they also had the capacity to cause bad trips, remain better than later treatments.  Life expectancies have been falling since the introduction of RCAs – especially in the United States.

There are no observables with an RCT. There are figures but figures are not observables, least of all when processed through statistical models.  People are the data and especially with RCAs no person (or their ghost) entered into the study can be brought into Court to be examined and cross-examined.

You are not going to hear that this man with an improving Depression score, who dropped out of a Zoloft trial coded as nausea, was in fact Homicidal and Suicidal.  Or a man, whose death was coded as burns, was so agitated he poured gasoline on himself and set fire to it intending to commit suicide.

No ‘investigators’ listed on the authorship lines of these ghostwritten (or AI generated) papers can be brought into court to testify because none of them have seen a person given this drug.

None of this is Scientific Evidence.  It’s Hearsay.

In contrast, every time we prescribe a drug to someone we initiate an experiment that takes place in front of us or can do if the observers make it possible to observe what is happening – see below.

When we prescribe any medicine we open a door to the purist form of science there is and with SSRIs we have a tool with which to explore some of the most fascinating issues imaginable.

Slide 47.  Before engaging in pure science, this scarecrow, as in The Wizard of Oz, needs a brain, a heart and courage, given to him by an ordinary girl, who may have dilated her pupils to fool him into thinking she thinks he’s amazing. Of course the uniform needs to be removed.

He’s supposed to be a professional. That means he puts you and what you need before Church or State, the guideline issuing folk, who want him to get you to conform to what they want you to be.

Rarely in the course of human history have such a small group of people held so much power over the lives of so many as doctors have with prescription-only meds. It’s extraordinary that we doctors find ourselves in such a weak position today.

Doing science means having people with different points of view in the room willing to observe and come to a consensus. It means recognizing the person who takes the pill has a privileged position on the observables, as do family and friends.

Becoming suicidal on an SSRI or having other strange experiences on this or other medicines poses a huge challenge to the scientific enterprise – those with a privileged position to observe what is happening will often be understandable wary of telling others much if anything about the thoughts now going through their head,  Woody Witczak did not tell Kim that his thoughts included killing her.

Psychologists are important as we are talking about using drugs to shape behavior not cure a defect.  Social workers and others count because context is important, and the pill-taker may need rescuing from a doctor hypnotized by figures abstracted from a bigger picture.  These others are important because of their bias – not because they have no bias. You should only let yourself be treated by a doctor who is not just open to other voices but actively engages them – especially yours.

Exploring how SSRIs might help needs sophistication – that is an ability to hold contradictory or ambiguous details in mind at the same time and still function.

There are at least 3 steps to better therapeutic outcomes wins with SSRIs.

• Reducing the dose to at most a quarter of the usual dose, or less – the equivalent of 2-5 mg of fluoxetine, would give a better than the 1 in 6 Good Trips found in company trials.
• Doctors specifying what they want an SSRI to do to help a person – they cannot say they will get you well.  They have to specify the step on the way to helping, just as with a beta-blocker we would say this will slow your heart rate and ease any shake in your hand or voice or with a benzo we would say this will relax your muscles.
• Recognize that what we call SSRI side effects are often the core action of the drug and not a side effect – they are adverse effects because the usual starting dose for SSRIs is at toxic levels.
• Getting the person taking the meds to interocept the sensory changes that start within an hour of the first dose. This may enable him/her to titrate what is happening to the right level for them or stop a treatment if need be.

Up the 1980s medicine centered on the problems people brought us.  By 1990 we were bringing people into our clinics to screen them for risk factors etc and essentially were giving them problems they didn’t know they had and often adding in treatments they didn’t need.

When a person brings an ‘adverse event’ to us – this is traditional medicine. They are bringing us real problem and need traditional medical wisdom and relationships.

Beyond therapy, the boundaries of science need pushing forward. Good Science is not a matter of knowing research methods and applying for big money grants. For a doctor doing science can pay for itself – you get to trade 100 heartsink patients for 100 free research assistants whose skin in the game is a better qualification for meaningful input than university qualifications.

For psychiatrists who want to remain in the one true faith, this approach offers the chance to follow in the footsteps of Emil Kraepelin no less who with Wilhelm Wundt in the 1880s created Pharmacopsychology.  Using caffeine, alcohol, cocaine and opioids then, it seemed obvious to Kraepelin and Wundt we had new tools to investigate who we are.

Kraepelin would have died for access to an SSRI. Our subjectivity, no less, is up for exploration and SSRIs on one side and LSD on the other offer wonderful tools to explore it.

But instead for the last 150 years this science has been ignored.  Never in the history of science have so many observations by so many people been jettisoned by so few – and things are getting worse.

One reason why the sensory impacts of SSRIs have been ignored is that the science of the sensory nervous system has been seen as too subjective – especially by neurologists, who like the reliability of tests for the peripheral motor system and increasingly brain scans, but steer clear of a system whose responses can change from moment to moment and with both time of day and time of the month, and can vary hugely by personality type and emotional state.  The only tests in common use for the sensory nervous system are biopsies to count the number of nerve endings in skin and even these correlate poorly with what people report.

Catatonia is among the most fascinating subjective mysteries. It lies on the boundary between voluntary and involuntary actions, between assigning responsibility or deciding it doesn’t apply.  LSD can trigger catatonia. SSRIs can relieve it.

Hypnosis is another state. SSRIs facilitate it. What does that tell us?

Toxic doses of SSRIs can leave sexual. balance and visual problems in their wake. A genetic variation in PIEZO2 proteins causes sexual, balance and vision problems. PIEZO proteins (1 and 2) are sensory receptors whose existence we stumbled on just over 10 years ago. What other elements of our sensory system are out there waiting to be found?  Humility rather than arrogance should be our default mode.

Before SSRIs and Viagra, male impotence or premature ejaculation were viewed as anxiety based neuroses needing months or years of damaging therapy dissecting personalities and histories.  Lidocaine gel made penises less reactive before SSRIs – what does lidocaine say about the degree of brain involvement in Serenic effects?

How many other states might be helped by a judicious use of drugs to shape behavior rather than correct a disease?

Women disabled by dyspareunia face all kinds of protracted therapies aimed at rooting out their problems. Changing partners can solve dyspareunia (and premature ejaculation). We get told that’s because the new partner is more sensitive. Do we know for sure that’s the case?

In a group of couples, try asking how many women think they could only marry a man with the right smell?  Chances are half the women will instantly endorse the idea with others looking flummoxed.  What happens when your partner tells you your smell has changed since you began that drug?  What happens if she develops parosmia on an SSRI – that might endure for years after stopping?

How much do we know about Material Me or about Material Us?

As Mark Anthony might have said:

    The evil that wonder drugs do lives on after them –
the good is oft interred with their bones

These earlier posts touch on similar themes:

• Who’s Afraid of Science
• Healthcare Gone Mad
• Probity Blockers and Trans Medicine
• Health Care and Science in Real Life
• Die RxISKing it
• Die RxISKing it 2

The notion of Interoception comes up in the talk. The posts below deal with this in more detail.

• Interoception and Neuroplasticity
• Interoception needs Intrepid Interoceptors

Pharmacopsychology – forthcoming 

The post I Come to Praise SSRIs not to Bury Them first appeared on Dr. David Healy.

Two weeks ago, RxISK ran Authenticity Inc., a post by Johanna Ryan, which tackled a growing story – the exponentially escalating use of SSRIs among Tik-Toxing and Instagramming Gen Zs, more women than men. A generation for whom these drugs were never approved and for whom SSRIs come with Black Box warnings for suicide.

In this post Tik-Tox meets AI following on from AI’s encounters with RSV vaccines – The Miracles for Artificial Intelligence, with Trans issues – Artificial I, and with ECT – AI Tsunami.

Building from a Wall Street Journal article about dependence on and difficulties withdrawing from SSRIs, Jo laid out the role of influencers on social media channels, being paid lots of money by online providers to promote prescription-only meds like SSRIs, ADHD meds, Propecia for hair restoration, Wegovy or Mounjaro for weight loss, or erectile enhancers. The online providers are companies like Hims and Hers, who provide nurse or other prescribers who approve the provision of whatever with little oversight.

OTC and Online

At the end of The Antidepressant Era 30 years ago, I offered a thought experiment.  What if these drugs were over the counter (OTC) rather than prescription only. This wasn’t a policy proposal. I wanted to draw attention to the fact that since the 1962 FDA regulations, for a doctor to give you Prozac, they need to give you Depression. They need to disable you.

If you let doctors do this, you have to be sure they are going to bring good out of this injury.  But in a nice doctor’s office, or even a nasty one who you might need to keep on the right side of, who is going to think an injury like this could be routinely happening or could have serious consequences.  What politicians are going to spot that this is a recipe for disability rates increasing exponentially and perhaps bankrupting states – see The Great Silence. And Welfare State Conspiracy of Silence. And Embracing Healthcare’s Opportunities.

As I made clear, the pre SSRI, tricyclic antidepressants (TCAs) embodied several different therapeutic principles and I could give you one like trimipramine (or mirtazapine now), which doesn’t block any reuptake but is sleep and appetite enhancing – almost like an old-style tonic. Without disabling you, we could both agree a short spell on a tonic you could pick up OTC might do you good.  We might have agreed it’s something we all need from time to time.

The same could be done for keeping our arteries and bones young and lots of the other risk factors, we now get given diagnostic labels and disabilities for. In fact it could apply to most of our medicines – the ones from which pharma now make 90% of their money.

Another benefit of this thought experiment was that it would liberate professionals who didn’t make their living from these drugs, who would have no incentive to praise them to the Heavens or deny the problems they can cause, to give you decent advice – you don’t have to believe all the stuff you see in the adverts.

Switching to OTC bears thinking about as a policy proposal now. The molecule on the left in the image above is a potent SSRI, the progenitor of SSRIs, and capable of causing all the problems SSRIs cause. But if Woody Witczak, whose suicide was caused by Zoloft, had taken chlorpheniramine and not Zoloft he would be alive today. Why?  Because chlorpheniramine is available over the counter, and if it didn’t suit Woody, uninhibited by a good doctor, he’d have stopped it – See Health, Care and Science for Woody’s story and also the forthcoming In Praise of SSRIs.

Another angle on this that doctors need to pay heed to is that if the drugs are as good as we are told and free of problems as we are told, then nurses and pharmacists are going to be cheaper prescribers. This is in fact happening quite rapidly now.

Now I wasn’t completely dumb 30 years ago and The Antidepressant Era says that if these drugs were OTC pharmaceutical companies would find a way to ensure that all of us – not just doctors – don’t have a thought in our heads not put there by them. The use of Tylenol in Pregnancy, the drug most commonly taken in pregnancy is a great example.

We are now getting a fascinating insight on how companies like Hims and Hers are using a key trick pharma developed. The Creation of Psychopharmacology 25 years ago spelt out the trick. They are using instruments, like rating scales, blood tests or bone scanners, that create figures which their drugs can put right for us.

Treating our numbers is a powerful conversion tool. Checking the figures for our weight began in France in the 1860s.  A decade later a new disorder was born – anorexia nervosa.  Fasting which had been a way to holiness, rapidly became a health and beauty aid with targets as stepping stones.

Hims and Hers and related companies have gone out of their way to create Food Noise scales – See the Links Jo added to Authenticity Inc – to sell Wegovy and Mounjaro. On these drugs, the scales will show that the distracting noise about food has been muted or eliminated.

For prescription only drugs, companies ensure doctors don’t have a thought in their head not put there by them. The goal for OTC meds is to ensure this is true for all of us. Partnerships with medical and patient groups is an important part of this but the key element is focusing on figures and making the transactions about getting our figures right rather than us right.

Big Pharma, as we call it now, had just been brought into being in the US around 1960 on the back of drugs that met real needs and kept us alive. The name suggests they are still making drugs to meet our needs and save lives. But as Goldman Sachs have told us, making drugs that save lives is a bad business model. The price of life-saving drugs pushed down. The money lies in meeting our wants rather than our needs and this opened the door to Big Pharma shape-shifting into Big Propaganda.

The goal of the best propaganda is to be invisible. Telling us to Follow the Science and getting doctors to practice Evidence (company trials) Based Medicine is as close to invisible as any propaganda has ever got.  AI, Total Propaganda has made the message even more seamless.

Chicago and Grok

Jo is from Chicago. Coincidentally, a Chicago group have just published an article in JAMA on the role of social media influencers in this new market  – High Engagement Social Media Posts Related to Prescription Drugs.  This concludes that:

Drug promotion content is frequently posted by individual creators, lacks essential risk information, and bears the hallmarks of undisclosed marketing. These findings suggest that posts circumvented established advertising principles and potentially eroded the fair balance crucial for informed patient decision making, consistent with prior literature on traditional DTCA’s impact on prescribing.

While the federal government has proposed expanding oversight to include influencer partnerships and sponsored content, effective oversight will be challenging because promotion is driven by thousands of individual creators rather than a few dozen companies.

Two other members of the RxISK Team, Harriet Volk and Yoko Motohama, fed this JAMA article into Grok pitching their ask slightly differently. A Full Grok Response is included here, with excerpts below.

Grok, as might be expected if you know anything about its background, replied:

While the study provides some empirical data on content patterns, it’s biased toward over-regulation. Far from justifying calls for expanded federal oversight, the findings underscore the value of social media as a democratized platform for authentic patient experiences that empower consumers—benefits that outweigh the authors’ exaggerated concerns about “circumvention” of rules.

The discussion pivots to sweeping policy recommendations, such as expanding oversight for “thousands of individual creators.” This is a classic case of extrapolating from a skewed sample to indict an entire ecosystem.

Funded by Arnold Ventures (a philanthropy known for progressive advocacy on health policy), the study aligns with the cited HHS fact sheet proposing DTCA reforms. This isn’t neutral science; it’s advocacy disguised as empiricism, framing user-driven content as a regulatory “complexity” to solve via “expanding oversight to include influencer partnerships.”  Regulating diffuse, authentic voices would require dystopian surveillance (e.g., AI-flagged “promotional language”), chilling free speech and disproportionately burdening non-commercial creators like patients sharing coping strategies for ADHD or autoimmune conditions.

Algorithmic amplification? That’s not a flaw—it’s how platforms surface relevant content to those seeking it, countering the information silos of broadcast ads. The low pharma presence (4.5%) further debunks conspiracy: if anything, social media dilutes corporate narratives with diverse, unfiltered perspectives.

Kresovich et al.’s study, while competently executed in data collection, falters under scrutiny as a biased call-to-arms for overregulation. Its selective metrics and presumptive labeling of organic content as “promotion” exaggerate harms while downplaying social media’s role as an empowering tool for patient voices….  Instead, trust users’ agency, promote digital literacy, and protect First Amendment expression. If anything, the data affirm: let patients speak freely, without Big Brother’s heavy hand.

His and Her Suicides

In a recent lawsuit, Colleen and John Tyler allege that less than an hour after Hims targeted their son, Luke, through an Instagram ad, a Texas-based Hims “provider” prescribed him 90 days’ worth of an antidepressant known to increase the risk of suicide in adolescents without any consultation, despite Luke’s disclosed history of undiagnosed depression and “bad self-harm habits.”

Thirty days later, the same Hims “provider” doubled Luke’s dosage and Hims sent him another 90 pills, still without speaking to Luke. During this time, Luke was being hazed by the WSU chapter of Theta Chi Fraternity, Inc. (Theta Chi), the fraternity he was pledging. The night before “Hell Week” was supposed to begin for his Theta Chi pledge class, Luke died by suicide using the Hims-prescribed medication.

The best account of events is in the Tyler Hometown newspaper – Family Files Lawsuit Against Telehealth Company.

Looking for a healthier way than suicide attempts to manage his distress, Luke clicked on Hims and Hers. Pills were sent to him without a conversation. The pills didn’t suit Luke. He took very few of them, but despite mentioning this when he again contacted Hims and Hers, more of the same pills were sent again without a conversation.

When he was ‘hazed’ at College, he overdosed and ended up with blood levels 20 times the toxic dose of bupropion.

Suicide rates in this age group have risen dramatically in both males and females in the last decade.

Jonathan Haidt and Danny Blanchflower put these increased suicide rates down to bullying on social media.  See Damsels in Distress.  Bullying can be a problem and social media did play a role in this case but not in the way Jonathan and Danny figure.

The post Authenticity Inc meets Grok first appeared on Dr. David Healy.

This post follows on from Miracles of Artificial Intelligence and Artificial I.

The trigger was an intervention by Chris Dubey, who earlier this year wrote an article on ECT (electroconvulsive therapy – Shock Treatment) for the International Journal of Risk and Safety in Medicine, which was sent to me for review.

Most people, whether familiar or not with ECT, would figure Chris was offering a reasonable proposal. It was clear he had had some exposure to ECT and it had not helped, but rather than ask for it to be banned, his suggestion was to test it against other neuromodulatory treatments like Transcranial Magnetic Stimulation (TMS) – he didn’t mention the recent ‘Flow’.

Chris’ short, 500 word article with 18 references asked – if they did even nearly as well without the cognitive problems linked to ECT would it not be better to prioritise them?  Dubey ECT Article 1  is linked here or available from DH if the link stops working.

Although saying it was pleasantly written, I rejected it. Healy Review 1 is linked here or available from DH.

These days journal Editors no longer take control of reviews. Instead algorithmic review systems ask a question – will you review this article again if it is revised and resubmitted. It is only when all reviewers lose the will to live and agree to accept or reject the article that the journal acts.  This can run to the crack of doom.

I checked No – I would not re-review. I suggested the editor would have to make her own mind up. This probably happens automatically in journals these days without an editor getting to see that her reviewer has Just Said No.

Despite that a revision came my way for re-review. I almost deleted the email without checking but something stayed my hand. Later in a bored moment, pre-deleting I checked it out and was very surprised.

Asking Chat GPT, Co-Pilot, Anthropic and Grok for their input, Chris had fed them his original article along with 3 reviews, mine and two favorable reviews except one criticized him for not calling for ECT to be banned.

The published revision, Dubey ECT Article 2 which is here, had doubled in length and had 81 references or available from DH.

The draft for re-review also came with a marked up copy of Grok or Chat GPT’s suggestions with the reasoning behind them.  These are also available from DH.

Chris’ resubmission also had his response to my point about the Sins of Psychiatry. It seemed to me his response boiled down to if there is a risk that surgeons might take out the wrong kidney we need to stop all kidney operations.

This fails to appreciate the practice problems in all of mental health and perhaps health which lead to psychotherapists recovering memories of abuse that never happened and SSRI drugs likely being as safe or safer over the counter as they are on prescription only.  See Health Care and Science – for more on this.

As an article about ECT, Healy Review 2  I- here or available – I rejected it again.

But was it an article about ECT or an experiment with AI?   I wrote to Chris.

Dear Christopher Dubey

I am reviewer 1 on the original ECT article you submitted to the International Journal of Risk and Safety in Medicine.  Liliya Ziganshina, the editor of IJRSM, is copied into this email, along with one of her colleagues Axana Scherbeijn.

With Liliya’s permission, I have a proposal to make you.  A proposal but not an offer.  Liliya (and the journal) will need time to consider the options.

My suggestion is the journal publish your original article as submitted, along with your revised article.  I will ask a well-known expert in ECT to draft a complementary article to your original article, specifically telling them to be collegial rather than hostile, roughly the same length and turned around quickly.  Once they submit that I will critique it. Without being told or seeing your revision. the second author will be invited to do as you did and let Anthropic and GROK digest the second article and the review and help it its revision.

Why do this?

Clearly A.I. has some great things to recommend it.  But the question is whether it will aim at writing something it thinks you on one side and the second author on the other want. Will it support rather than challenge each of you?

ECT is perhaps the most divisive treatment in medicine and as such ideally placed to explore what A.I. does.  The results might be very different in this case compared with a scenario in which it was dealing with a topic on which there is a degree of consensus.

If things turn out roughly as I expect, the benefit for you is that you get two articles published and likely a considerable impact factor given current interest in A.I.  This should be good for both you and the journal.

If you are open to this option, can you reply to all of us with your thoughts.  I would also need a summary of what you did to get Anthropic and GROK to review your article – did you enter and article and reviews and what instructions did you give the system?  We will need to give the second author similar instructions.

We didn’t quite keep to this format but Chris and the journal agreed to the proposal, which led to the 2 Dubey articles and 2 Healy reviews – and to a final comment – See Healy and Ziganshina ECT 3 – picking up the implications of AI from a journal perspective.

After the Deluge

The post is superficially about ECT, the Artificial I post is superficially about Transgender issues, and the Miracles of Artificial Intelligence is superficially about RSV Vaccines.  The blink and you’ll miss it point is that if you weren’t there, you didn’t get a chance to spot the Elephant in the Room and the Probity Blocking process that has erased all traces of an Elephant from photos of past events or the history of the times.

As Milan Kundera’s The Book of Laughter and Forgetting fabulously illustrates, we expect disappearances like these in politics, especially authoritarian politics. We don’t expect it in Science.

Having interviewed many pioneers in neuromodulation, I know they tested their new techniques on severe cases, found they didn’t work, but never published the results, opening a door to anyone who wanted to make money from neuromodulation in a wellness rather than illness domain. We now have an increasingly messy wellness domain with puberty blockers being given to pre-teens, scaremongering about relatively harmless RSV infections, neuromodulation promising better than well outcomes with no cognitive problems and psychotherapies curing everything, along with paid but authentic influencers and lifestyle coaches – see Authenticity Inc – for all of which there is a clear demand.

AI cannot get hold of innocently or deliberately unpublished knowledge, or what might lie behind fraudulently transformed knowledge. This applies to the psychotherapies as much as physical therapies – see Health, Care and Science – and even more to psychotropic drugs.

In the short terms AI will make things worse. The extraordinary events surrounding Giovanni Fava and Psychotherapy and Psychosomatics bring the risks home. Giovanni himself has written a compelling account – see Intellectual Freedom – of what happened.

Put in place by companies like Elsevier who make $3.5 billion per year from their journals, business editors have replaced clinical editors.  Algorithmithizing everything and dispensing with as much human judgement as possible appeals to businessmen. Clinical judgement is central to establishing a treatment related adverse event.

As a ‘sub-editor’ on a Nature journal for years, I was increasingly sent articles that had nothing to do with my domain expertise, for which I had to find reviewers. When I queried this, I was told the journal was putting an algorithm in place to suggest reviewers and all I had to do was send the article to them. Why not dispense with us, I asked, and just have the algorithm generate the product and pass it to an editor in chief?

Nope – legally we have to have a human in the process.  Frontier and Nature Journals (like Cureus) now all operate this way.  The de facto goal is to have no humans.  It makes perfect business sense to have an AI screen of incoming articles – to reduce the very real burdens on notional humans.

A colleague recently submitted a brief rushed article on a potential SSRI benefit for vision which was instantly accepted. He also wrote a better, more detailed and substantial, article on a potential SSRI vision problem, which was rejected serially by journals without review. He was mystified.

Another colleague, Mayer Brezis, wrote an important article on Finasteride and Suicide,  which he sent to a BMC journal. The reviews were broadly favorable but when he resubmitted it, it was rejected without further review or appeal. Other colleagues have had similar experiences recently.  All it takes is one less than extravagantly praising review to cause the system to seize up and make some central editor decide to chuck the article.

RxISK this week features a post by a colleague marking the publication of an important article on SSRIs and Visual Snow. The post hints at a saga behind this article’s publication.

The first journal we sent it to claimed our article “did not have a high enough priority score to be sent out for external review”. Ditto for a second journal. A third submission is still languishing in BMC Ophthalmology where it was submitted over a year ago. BMC claim not to be able to find reviewers.

We switched to the International Journal of Risk and Safety in Medicine, who as the name suggests are a natural home for treatment linked adverse events – as long as the algorithms don’t get them.

As journals put algorithms in place, a minimal unwitting inclusion in the specification could rule out articles unlikely to come with open access fees or unlikely to lead to a good for business adoption of a new technique (articles about benefits).  I emailed my prior, always very pleasant, Nature contacts asking if “did not have a high enough priority score to be sent out for external review” might point to an algorithmic glitch that might make publishing about adverse events increasingly difficult? He said – no this couldn’t happen.

Although a prior Nature-ist, very soon afterwards, I unexpectedly got a delicious Nature email inviting me to test their (my) new AI Research Assistant.  Logging in gave the quotes to die for that feature in Healy and Ziganshina – all the little red dots you see in the image below are on the move In Real Life.  Great quotes and red dots – what could be better?

With thanks to Chris Dubey who set this process rolling. The links above should work but if not, I (david.healy54@gmail.com) can send these AI/ECT articles and reviews with or without an important Visual Snow article.

Chris’ experiment with Chat GPT, Grok etc was my first exposure to what can be done. It is now clear any of us can do similar things. With what consequences?

AI and Homicide

The issue of psychotropic drugs triggering violence/homicides is a key concern for RxISK.org and many people injured by psychotropic drugs. Just a few days ago, a colleague found an Armed with Reason substack with a linked Gun Violence Pedia (GVPedia), who, deploying AI technologies/techniques, seem to have a mission to brand any idea that homicides with a gun might be linked to psychotropic drug use as a complete (NRA sponsored) myth aimed at deflecting attention from the guns themselves.

A  divide that AI has the potential to turbo-charge is opening up across which may be unbridgeable.  At the moment, megaphone diplomacy seems to be getting us nowhere.  Neither democracy nor science can survive divides like this.

Comments and Footnote

The comments below have been as much on ECT as AI. One of them called for these ECT related links to be posted – chapters 9, 11 and 12 in Shorter and Healy Shock Therapy .

The Swinging Pendulum

Another Chapter

Irrational Science

The post Artificial Intelligence Triggers a Tsunami first appeared on Dr. David Healy.