Is Consent to an SSRI Possible

The idea that we had a right to know what our treatment options are and should be able to consent to the option that looks right for us – even if that conflicts with the views of the doctor we are seeing – arose in the 1950s linked to breast cancer treatment, electroconvulsive therapy (ECT) and treatment trials (research).

The original drug treatment trial consent forms informed us this was research and one of the treatments was not yet approved.  Now they explicitly tell us, companies will share nothing about us with anyone – in practice that includes not sharing key information with regulators like FDA.

Up till 1962 we did what doctors told us. Some informed us about their planned course of action but only in order to get us to do precisely as we were told. Suggestions that our view might be put in the balance and found as reasonable as our doctors’ left many of them incredulous.

See Chapter on Informed Consent.

In the pre-informed consent era, consenting to a treatment at the hands of a surgeon or psychiatrist seemed to imply that they knew what they were doing to the point that the outcome was pretty certain before the treatment was delivered. It was more a question of the optics of ECT versus a drug or mastectomy (an entire breast) versus lumpectomy.

Humankind cannot bear very much reality.  Delegating responsibility (our narcissism – the idea that we know enough to cope) to a doctor, in loco parentis (Dad), is more comfortable than taking a gamble with life or death stakes alone.

In a system that requires our consent to be informed rather than have consent decided for us, you might think we would be more aware of the gamble we are taking.  But in practice, this doesn’t follow .

Isotretinoin, Finasteride and SSRIs bring more than life and death into the mix – they involve our semi-eternal identities. We are being offered a choice between effortlessly having the identity we want (if we are lucky) or having to work for and settle for less than what we really want.  None of us are immune to temptation. Say Yes to the Apple – You’re worth it.

A Delusion and a Snare

In addition, if regulators didn’t exist, pharmaceutical companies would have had to create them. They need a group they can point to and blame when things go wrong.  The latest example of companies blaming regulators can be seen in the Failure of Regulators apparently to warn about dopamine agonists and impulse control disorders.

The BBC can publish this article about dopamine agonists and the terrible problems they can cause because the article blames regulators and not companies. They wouldn’t get to publish an article blaming companies – who say patient safety is their first priority and they are as dismayed as we are at a glitch that regulators missed that seems to have destroyed a lot of lives.

The politicians side with companies and in the UK and Europe are busy reframing the regulations governing the regulators of medicines to make (in the public interest, of course) countries like the UK and Europe attractive places for ex European now American pharmaceutical companies to do business. A bloated and flabby regulator rolling over and accepting blame for things going wrong is good for business but can only squash any of us in the bed beside them.

In the midst of all this, we, who are being courted to give our consent, seem to expect that properly informing us of the problems a drug can cause means they aren’t going to happen. If they happen, we figure we must not have been properly informed.

The idea of Informed Consent is a Delusion and a Snare.

Taking a Poison is always a Gamble. The Gamble is better taken with a doctor on your side (because you’re worth it) rather than in the form of a prescription from a double agent.

This is not a diatribe against pharmaceutical companies, many of whose employees could have written this post.  The idea of and original images for the Professional Suicide Note in this post’s video came from a company guy.  Not just the idea but the actual slides.

The document showing Study 329 was a Fraud came from a company gal.  The idea that doctors don’t have a thought in their head not put there by companies came from another company guy – saying exactly this to a bunch of doctors who prided themselves on being the bees knees in sophistication, but who managed not to hear what he was saying.

Forget Jehovah saying – Find me 10 just doctors and I will not Destroy Medicine – see  If I Find You Ten Just Doctors.  Today’s issues are simpler than a Biblical struggle beween Good and Evil.  A more reasonable Jehovah today would say – Find me 10 doctors with their eyes open as to where their real interests lie and I won’t Bomb Medicine back to the Stone Ages.

Gambling Transcript and Video

The Gambling on SSRIs transcript is here.

The Knotty Problem of Consent

Bad as Medicine now is as regards Consent, Law is worse.  When Informed Consent began playing out in the 1950s and 1960s, lawyers were cautious about the idea, recognizing that what was being brought in for one profession today might extend to their profession tomorrow.

You will not be told today that SSRIs can trigger homicides. Your doctor will definitely not take responsibility for prescribing the drug to you.  You may have a perfect Not-Guilty case – a case where most reasonable people would say if s/he had not been put on that drug, these events would not have happened.  But your lawyers will insist on making you a felon and a lunatic rather than fight that case for you.

This is the Prima Facie situation we face – transported from the Sexual Assault domain to Pharmaceutical Assault.  It’s one thing to take a Gamble on a Medicine. We should not also have to take a Gamble on our Doctors when we seek medical help and a further Gamble on our Lawyers when we seek justice.

This is the last post for the moment in our Consent Series

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

Idle Thoughts

Will we be able to solve these problems? Of course we will.

Zen

Short Clips

Birth of SSRIs

https://youtube.com/shorts/sByY3ZOKg1w?feature=share

https://www.instagram.com/p/DWqk-sVjB3M/

https://www.tiktok.com/@antidepeffects/video/7624425387166076182

Good doctor and misinformation

https://youtube.com/shorts/iHyL9JWMiwA?feature=share

https://www.instagram.com/p/DWqlIULDK-T/

https://www.tiktok.com/@antidepeffects/video/7624427514647170326

SSRIs can cause…

https://youtube.com/shorts/YKRzZQHVW6o?feature=share

https://www.instagram.com/p/DWqlQkbDO0N/

https://www.tiktok.com/@antidepeffects/video/7624432388759768342

@antidepeffects

Gambling and SSRIs at RxISK.org Blog https://rxisk.org/gambling-on-ssris/ https://youtu.be/jvolHEd-9R0 #ssri #antidepressant #sideeffect #doctor #rxisk

♬ original sound – Antidep Effects

Trustability Test

https://youtube.com/shorts/vqoSZvi98ZE?feature=share

https://www.instagram.com/p/DWqleMhDB1K/

https://www.tiktok.com/@antidepeffects/video/7624435352782048534

Simple Truths

https://youtube.com/shorts/VOjaQzwxV08?feature=share

https://www.instagram.com/p/DWqlokfDC1d/

https://www.tiktok.com/@antidepeffects/video/7624436743676235031

Trust and Consent

https://youtube.com/shorts/nDcxUa3cowQ?feature=share

https://www.instagram.com/p/DWq7FVzDHHg/

https://www.tiktok.com/@antidepeffects/video/7624511760619408662

The post Gambling on SSRIs first appeared on RxISK.

No Sex – We’re on Antidepressants mentions that this series of videos began with a recent gift from Britain’s Medicines Regulator – MHRA – and that RxISK is expecting another gift in April.

Turns out we are being spoilt for gifts.  On March 18, MHRA issued a fabulous new document about transparency. A colleague did something that would have been impossible a year ago – he put MHRA’s wonderful statement into ChatGPT who/which transformed it into something remarkable – ChatGPT made remarks readers are likely to remark on – See AI versus The Deep State.

This was an unexpected pre-Easter Egg.  We are still hoping for a post-Easter Egg.  This post on SSRI Good Trips is our appreciation for what MHRA have done and are doing.

It also surprisingly raises the bar for MHRA and their efforts to lead the world in being Transparent even more than the posts on SSRI hazards – Bad Trips on SSRIs and No Sex on SSRIs – which you might have imagined is primarily what MHRA have been trying to avoid being transparent about.

What Good Trips brings home is that our issues with medicines – SSRIs in particular – is not simply a matter of transparency about hazards. Potential takers of any medicine need a vision about what a medicine does and its appropriate use.

This post offers an SSRI vision completely at odds with the company vision MHRA are glued to and with the view you are likely to hear from critics of these and other psychotropic drugs.

MHRA claim to be trying to get to transparency base camp  about a set of company documents called Patient Information Leaflets. But the forked tongue version of hazards you get told about by companies and regulators come glued to something more important.

From one perspective, the missing piece of the jigsaw can be viewed as a laughably incorrect vision of what SSRIs do. From another perspective it is this false vision rather than the actual hazards the chemicals in SSRIs deliver that kills people like Woody Witczak – See Bad Trips on SSRIs.

It’s more difficult to see MHRA getting permission to say any of the things in this Good Trips post than it would be for them to get permission to say – Yes SSRIs can cause Suicide and Yes SSRIs can wipe out your ability to make love forever.

If male readers of this post, and perhaps a few women who’ve withdrawn from public life, wonder where the phrase Say Yes to the SSRI comes from and why it’s linked to a woman in a wedding dress – check out Say Yes to the Dress.

The Good Trips on SSRIs Transcript is here.  The GT Video is here and embedded below along with shareable You Tube, Instagram and Tik-Tok clips.

YouTube clips

Instagram Clips

There will be one more post in the series next week:

Consenting to SSRIs

The post Good Trips on SSRIs first appeared on RxISK.

No Sex Please! (We’re on antidepressants). Based on 17th Century Kama Sutra and Ragamala paintings. © 2014 created by Billiam James.

Post SSRI Sexual Dysfunction (PSSD) was the first born sexual dysfunction – before its Finasteride and Isotretinoin siblings – Finasteride and Consent  – Isotretinoin and Consent.  This video and post give you the background to PSSD which opens up a bigger picture that takes in Finasteride and Isotretinoin.

Britain’s MHRA are working on Antidepressants at the moment and  apparently we will see White Smoke coming from some Chimney soon on both SSRI and Finasteride related issues.  FDA are working on these meds and issues also.

In terms of PSSD, RxISK somehow managed to get the European Medicine’s Agency to asknowledge the Risk of PSSD in 2019 – EMA Acknowledges Persistent Sexual Dysfunction After SSRIs and SNRIs.  Health Canada followed Suit – Health Canada Warns About PSSD – as have other countries in very minimal ways.

The petition that led to an EMA mention of PSSD was sent to FDA at the same and to date nearly 8 years later nothing has happened – even with the threat of a lawsuit – FDA Sued for Failing to Act. This is up there with the Catholic Church’s defense of child-abusing priests.  But then pharmaceutical companies spend a lot of time lobbying Healthcare Cardinals and who knows what else – Partnerships in Healthcare.

Trying to get ahead of MHRA and produce something quickly that might ‘inform’ would-be SSRI takers about PSSD led to this video – in the hope that Companies, Profesional Medical Associations and Regulators would stop and think before prematurely declaring ‘The War is Won – PSSD and SSRIs are sorted forever’ – we will not be back here next year.

You Tube Short Videos

1. PGAD https://youtube.com/shorts/q1qwRVLhvy8?feature=share
2. PSSD https://youtube.com/shorts/jLV2XpZj8W8?feature=share
3. PSSD Toxicity https://youtube.com/shorts/VXFGGY1rli8?feature=share
4. Asexual https://youtube.com/shorts/fDo5EpOIX_8?feature=share
5. RxISK Prize https://youtube.com/shorts/hZFxYOsnLH4?feature=share

Instagram Clips

1. PGAD https://www.instagram.com/p/DV7_ykbjLUj/
2. PSSD https://www.instagram.com/p/DV8AmqWjL9i/
3. PSSD is a Toxic Effect https://www.instagram.com/p/DV8A0_0DNKk/
4. Asexual https://www.instagram.com/p/DV8B2uMjJeo/
5. RxISK Prize https://www.instagram.com/p/DV8CESvjHIC/

Tik Tok

Notes on a Scandal

SSRIs do a host of other extraordinary things to our love lives besides PSSD.  Too many to fit them all into one brief PSSD video.

Notes on a Scandal was a compelling 2006 movie and book with (given Ocars weekend) 4 Academy Award nominations including Best Actress and Best Supporting Actress. What is little known is that the book’s author Zoe Heller was an early Prozac taker and defender of its benefits.

When SSRI Stories was alive and well it hosted an ever increasing amount of reports of female schoolteachers charged with seducing teenage male pupils – the plot of Notes on a Scandal. The teachers were often acquitted.  Courts have taken a very black or white approach to this – zero sympathy or clear recognitions of drug effects.

There seems little doubt that this happens more than we thought. There is little doubt that it was being reported more than ever before in the early SSRI era before the media stopped reporting on felonies linked to SSRI use. This doesn’t mean the SSRIs caused it in all cases but they certainy can contribute in some.

What’s going on?  Do the teachers have PGAD – see the video to find out more about this.  Or is this an SSRI induced disinhibition?  Or is the transgression an attempt to feel something – see Pfizer?

Pfizer and Eroticism

Way back in the late 1990s, pre-internet, a 13 year old boy Matt Miller was put on Zoloft and a week later he commited suicide – by hanging himself in a bathroom between his parents bedroom and his bedroom. Pfizer wheeled out an expert to say this was likely Auto-Erotic Asphyxiation gone wrong.

In the resulting legal case, the judge found this argument ludicrous. Back then drug company employees were often recruited to healthy volunteer trials of their drug to gauge its effects. I was left wondering who in Pfizer might have discovered Auto-Erotic Asphyxiation on Zoloft – See Addicted to Sex.  There may be a link.  SSRIs mute genitals and emotions – so much that takers have often gone to extremes in order to feel something – including watching ISIS beheadings live when these things were happening.

Orienteering

People who don’t blink an eye at the idea of respectable female school-teachers ‘educating’ young boys, think it completely impossible that we might change orientation on SSRIs – that homosexuals might become heterosexuals.  This, however, is precisely what Peter Kramer claimed in Listening to Prozac.

Imipramine launched in 1958 and it’s discoverer, Roland Kuhn, gave a lecture about it at the American Psychiatric Association meeting that year.  In the published version of the talk he mentions that he’s seen homosexuals convert to heterosexuality.  Imipramine acts on serotonin among other things.

We began to understand some of the possibilities behind these claims when the SSRIs came along and they were fingered as giving rise to impulse control disorders in some people – like the dopamine agonists for restless legs and Parkinsons – producing potentially groslly altered behavior.

Whether this includes a fundamental change in orientation is another matter.  If you have a Good Trip on an SSRI, you may feel Better than Well and, feeling invincible, you might opt to make life-changing moves.  The most likely one today among young people is to decide to change gender.  Gender dysphoria or gender identity disorder doesn’t suddenly develop – having a bright let’s-change-gender idea comes closer to impulsive acting.

Bill James

The art work in the video and below is by Bill James.

Frozen Venus

Frozen Venus © created by Billiam James 2021 is adapted from Sandro Botticelli’s “The Birth of Venus” and “The Outcast”.

Lost in Medication

Lost in Medication. Based on Adam and Eve painting by Lucas Cranach the Elder in 1526. © Billiam James 2014

Illustration: Is There Life After Meds?, © 2014 created by Billiam James

Along with No Sex, We’re on Antidepressants featured above.

The post No Sex – We’re on Antidepressants first appeared on RxISK.

Britain’s Medicines Regulator (MHRA), taking a very similar line to FDA in the United States, EMA in Europe, Health Canada and the TGA in Australia, has recently been trying to extricate itself from a corner into which lawyers crafting pharmaceutical industry strategies have painted all regulators.

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 for the rest of us.

Taking a cue from a ‘Prozac Liberation Front‘ – and below – company lawyers said we cannot argue in court that randomized controlled trials (RCTs) give gold standard knowledge of what drugs do, if company doctors continue to interview patients and their doctors and add our drug caused X or Y to the drug’s label – How the Safety of Medicines was Destroyed.

Ducking out of acknowledging their drug can cause a problem. companies have created the impression regulators are responsible for drug labels.   As a result we are all now liable to be gaslit if injured. Our families or entire communities like Tumbler Ridge are gaslit if we’re dead – See Prozac Liberation Front.

When this happens in cases where the only sensible way to explain things has been Drug X did it, activists fighting on finasteride and isotretinoin fronts have laid siege to regulatory offices and forced minor label changes, which to the activists feel derisory given the gravity of the problems. See

• Isotretinoin and Safety –
• Isotretinoin and Consent
• Finasteride and Consent
• Consenting to Finasteride and Isotretinoin Treatment – .

Activism though has led to these 4 posts which have been built on a ‘gift’ from MHRA. As part of an effort to show a touch of human decency, in association with the British Association of Dermatologists (BAD), MHRA produced a video which they seem to think solves the informed consent problem.

Within RxISK the consensus was the BAD video did more to tell people how great dermatologists and isotretinoin are than it did to inform takers about serious hazards and how poor dermatologists are at spotting them and how impotent at remedying them.

Sabotaging Hamlet we felt forced to make an alternate video.
Thoughts fly up but thoughts without words never change things on Earth 

Isotretinoin and Consent features the BAD and our Not-BAD videos. As Finasteride and Isotretinoin share key problems – suicide and sexual wipe-out – we borrowed the Not-BAD template for Finasteride and Consent

The SSRI antidepressants share these suicide and sexual problems. As MHRA have an Expert Working Group earworming on a way to ensure consensual relations between us and our family doctors and psychiatrists, it makes sense to return the favor and give them a video template shorn of a droit de seigneur ethos.

But SRI links to Suicide and Sexual wipe-out go back way before isotretinoin or finasteride were a gleam in Roche or Merck’s eyes. There is so much material that SSRIs and Suicide and SSRIs and Sex each need their own 6 minute video slots.  So does the equally complex story of the very real benefits SSRIs can have.

The challenge then will be to assemble all these bits into one 6 minute feature.

Bad Trips on SSRIs

Today’s post features Bad Trips on SSRIs. In our increasingly polarized world, calling it Suicide on SSRIs risked it being banned.

Some of the imagery in the video needs a comment.

1. The dramatic image above is the root of Rauwolfia Serpentina, the plant from which Reserpine comes. In the early 1950s, this Indian herb made a dramatic entrance into Western medicine lowering the raised blood pressure that had killed Franklin Roosevelt.  Just like Prozac it was good psychotherapy in pill form making some feel Better than Well. Others committed suicide.
2. Fighting back against compelling evidence that Prozac can cause suicide, Eli Lilly the makers of Prozac, borrowed a phrase in use by the Pedophile Liberation Front – Anecdotes are not Science.  See File under Phile and Prozac Liberation Front.  Anyone who thinks Anecdotes are Science is just plain Pharmaphobic and should be No Platformed. See Probity Blockers and Transmedicine.
3. For more on the 1 in 10 healthy volunteers becoming suicidal see Let Them Eat Prozac.
4. The Red Dots story is covered in more detail in Did Regulators Fail Over SSRIs.  The background story here is that BMJ were too scared to publish exactly the same article except for one work difference in the title – the original was Did Companies Fail — but Regulators don’t sue. The article was held up for a year over this. The Red Dot maneuver breaches FDA regulations and would probably qualify as fraud – it can’t be done innocently – except that the companies claimed FDA knew exactly what they had done and had no problem with it.
5. The Fraudulent Article is Study 329 – see Children of the Cure. An ongoing legal action aims at getting this 25-year old article which has been built into guidelines retracted.
6. Another of the Prozac Liberation Front ‘tricks’ was to claim there were fewer suicidal events on Prozac compared to placebo.  This was managed by keeping a few people doing well on Prozac in the trial for months and months while everyone on placebo dropped out after 6 weeks.  If you divide time all trial participants spent on the drug by the number of events this can make Prozac look safer.  Presenting the data this way was probably intentionally deceptive – it’s hard to think of any other explanation for this regulation breaching move,  In the same way NASA could claim travel on a Space Shuttle is the safest form of travel in the universe if you count deaths per mile travelled.  Deaths per trip is an entiely different matter. This Prozac Shuffle maps onto the Shuttle story – shockingly..
7. Scarecrow – this Model Doctor is from the Wizard of Oz. See Medical Care Medical Science.  We need a Dorothy or a bunch of them.

This is a Sister post to the Prozac Liberation Front post.

We also have a new RxISK You Tube channel which features a host of video clips from Isotretinoin, Finasteride and Bad Trips on SSRIs.  it would  be great if these could be spread on Instagram and Tik-tok etc

The post Bad Trips on SSRIs first appeared on RxISK.

In the Isotretinoin and Consent and the Finasteride and Consent posts we encouraged readers to make their own videos.

Our aim was to contrast the BAD Isotretinoin video with something more decent.  But lots of those whose lives or families have been badly damaged by isotretinoin or finasteride want something more.  They often call for these drugs to be banned.

We don’t have to agree on points like this.  In fact if we don’t agree and noisily make competing videos the rising noise level may help both points of view and make life more difficult for the many medics who, astonishingly, have never seen a case of anything go wrong on either of these two drugs.

Bob Fiddaman was among the people who created blogging about the adverse effects of meds – over 20 years ago.  He was focussed then on SSRIs and withdrawal and was blogging from personal experience. Bob had and still has a go-for-the-jugular style.

Beyond blogging he has been a researcher on pharma and its meds and has dug up some key information that has helped support many of us who are concerned about safety.

He still researches but has mostly left blogging behind and moved into making music about pharma and their meds with videos to go with his creations.

Bob responded to our call for competing and noisy videos and produced two – one on Finasteride and one on Isotretinoin along with a Song  – Pills for the Mirror which features below.

Finasteride

Isotretinoin

This post opens with a slide from Bob’s Isotretinoin video that will likely resonate with most people concerned about these two meds and which many readers may view as missing from the RxISK Videos.

It’s one of the many points to debate – as noisily as possible.  The RxISK view is these drugs do not cause Psychosis or Depression.  They trigger a toxic reaction better called Delirium.  Do the words matter?  Well – psychosis and depression give pharma a stick to beat people with.

Psychosis and depression imply the fault lies in the person’s prior mental state in a way delirium doesn’t.  In a number of recent legal cases, experts have claimed isotretinoin has caused psychosis. This is a losing gamble – a gamble that has lost. Mental illness (psychosis) might mitigate the severity of a sentence but it does not deliver a not-guilty verdict.  Delirium implies a toxic reaction to a drug – the drug was guilty.

If we get the words right people can walk free from court – if they have a lawyer who understands the critical difference.

There are probably many other points in Bob’s videos that people would prefer to the RxISK versions.  These are all points to make noise about.

Meanwhile here is —

Pills for the Mirror

Contacting Bob might offer a good way forward for readers who have seen and worry about the terrible harms these drugs can cause and really would like to try and reach the post-2000 generations.  He turned these two videos and the song around in a matter of hours.

Bob is listed as Author/Blogger/Researcher – fiddamanwork@gmail.com and on @fiddaman.  You will have a friend for life if you tell him you have a soft spot for Aston Villa football club.

The post Consenting to Isotretinoin and Finasteride Treatment first appeared on RxISK.

Finasteride, a treatment for Hair Loss, shares hazards in common with Isotretinoin given for acne. These include Suicide, Sexual, vision, bowel and balance problems and notably sexual, suicidal, visual, balance and bowel problems that can begin after stopping treatment and endure indefinitely.

The problems that start on stopping Finasteride are termed Post-Finasteride Syndrome (PFS).  PFS shares a lot of features in common with Post-SSRI-Sexual Dysfunction (PSSD) and Post Retinoid Sexual Dysfunction (PRSD) also called Post Accutane Syndrome (PAS).

There are a host of peer reviewed publications outlining the features of these syndromes, diagnostic criteria, articles on epidemiology and consent that can be accessed from the RxISK PSSD page  along with a large volume of media coverage of the conditions.

Finasteride raises different questions about consent to Isotretinoin’s use for Acne. Acne is seen as a disease and we have to engage with the medical profession to access Isotretinoin – Isotretinoin and Consent. In contrast Hair Loss in younger men is seen as a cosmetic issue. Cosmesis opens a door to online retailing and concerns that unscrupulous retailers may deceive us. But it also reveals that we may not be any safer with doctors.

The issues involved with these medicines are far from simply being solved by discriminating between health and beauty issues.  Identity issues and misfortune – whether we are among the Elect or not – come into play – See The Seductive Charm of Pharmacology.

We have based the Finasteride Benefits and Hazards video embedded here on the template the British Association of Dermatologists (BAD) and the British medicines regulator (MHRA) laid down for Isotretinoin,

The Video Transcript is here.

The key messages in this Finasteride video and our Isotretinoin video are similar and we think contrast with the messages in the BAD video.

1. These Suicidal and Sexual Hazards are a toxic reaction to the drug and not part of any mental illness the taker has or may have had.
2. The Patient Information Leaflets – Package Inserts – are designed to get people on treatment, not to inform consent or help manage any of the problems that arise.
3. Doctors are not able to remedy the damage these drugs can cause and may negligently dismiss the risks.

Influence Day

This year the United States of America will be 250 years old.  The combined ages of the small group behind RxISK come to more than the age of this US youngster.  Like many youngsters, however, the US wields tremendous influence – way beyond the dreams of RxISK.

We are told Influence needs the briefest of video clips. Here are some clipped out from last weeks’ Isotretinoin Video

Isotretinoin You Tube video clips

Finasteride Video Clips

We are more on the front foot now, so we have some Finasteride clips ready to go

Finateride You Tube Clips

• Not a mental disorder https://youtube.com/shorts/8CKEFluK0Vo
• PFS https://youtube.com/shorts/_YmlIe9p544
• PIL https://youtube.com/shorts/5kvMBoHNNBw

Finasteride Instagram Clips

• Not a mental disorder https://www.instagram.com/eel/DVEnOnCDCy-/
• PFS https://www.instagram.com/p/DVEnjawDHQH/
• PIL https://www.instagram.com/p/DVEnr2-jH7v/

Finasteride Tik Tok Clips

1. Not a mental disorder
https://www.tiktok.com/@antidepeffects/video/7609777084302396694
2. PFS
https://www.tiktok.com/@antidepeffects/video/7609777410698906902
3. PIL
https://www.tiktok.com/@antidepeffects/video/7609777670376819991

If any of our readers who are of the same vintage as us have access to anyone less than one-tenth of the age of the US, who has an Instagram or Tik Tok account and might know how to clip things from an original video, or how to get the clips above into circulation or in some way able to influence folk, please get in touch.  We’d be happy to turn over the raw materials.

We would love anyone who thinks they can do better to do so and maybe send their superior versions along in the comments section or link into anything that looks RxISKy on any medium.

Of course we would also welcome input from influencers much older than the US like Ukraine or Persia.

Previous Finasteride Posts

• Drugs and Sex and Fertility
• Post-Finasteride Syndrome PFS
• The Seductive Charms of Pharmacology
• Post-Finasteride Syndrome and Amino Acids
• Post Minoxidil Syndrome
• RxISK and Sharks

The post Finasteride and Consent first appeared on RxISK.

Isotretinoin and Safety outlines the efforts people disabled by Isotretinoin (Accutane, Claravis) and their families have been making for a decade to get medicines regulators in Britain (MHRA) as well as in Europe (EMA) and America (FDA) to make Isotretinoin use safer.

Some of those who have been injured or who have lost children or partners think nothing short of banning the drug can be safe.

Many dermatologists view Isotretinoin as extremely effective and some of them fiercely resist acknowledging that it causes any problems blaming any issues on the prior mental state of person taking the treatment.  They also give out about regulators, faced with grumbling families, deserting Evidence Based Medicine.

Regulators are bureaucrats who review paperwork. They have no training in establishing whether a drug causes a problem or not.  They are up against Company Based Medicine, which peddles any claim their drug comes with hazards is an anecdotes, that only company studies can tell what their drug does and self-respecting doctors and scientists should pay no heed to anecdotes – misinformation – conspiracy theories.  The media in particular should pay no heed as misinformation will deter people from seeking the benefits of treatment.

The testimony from US families on the hazards of Montelukast and Isotretinoin and of UK families on Isotretinoin in recent years has been so compelling, however, that the MHRA, acting within the severe constraints of its job description, has been nudged into efforts to improve things.

As outlined in Isotretinoin and Safety, among the steps MHRA have taken, in cooperation with the British Association of Dermatologists (BAD), has been to support the production of an Isotretinoin Video to brief people on when Isotretinoin should and should not be used along with some mention of what BAD call its side effects. The Video Transcript is here.

You should watch this BAD video before accessing the video that comes next.

Some families, unaware it is not MHRA’s job to keep us safe, still see a regulatory conspiracy with companies.  What they don’t see is that it is primarily the job of doctors to keep us safe.

Looking at the BAD video, some of us in RxISK found it hard not to see doctors status quo-ing.  The video seems designed to keep us taking Isotretinoin rather than keep us safe.

1. There is little recognition of the suicidality and suicides or permanent sexual dysfunction that concern those Isotretinoin and prescribing dermatologists have injured.
2. There is no recognition that dermatologists are not trained to recognize the most important hazards, nor manage them once they have happened.
3. No-one seems to have even begun to think we should research what goes wrong in order to be able make a meaningful difference.

Consensual?

A video that lacks these elements did not seem to us designed to support consensual treatment.

Against a background of Guilty until Proven Innocent, the RxISK post prior to Isotretinoin and Safety, it might seem shocking to say but the BAD video has a Droit de Seigneur tone. Despite good intentions, jingly music, recognition of diversity and other tokenism, it will feel semi-assaultive to some.

This prompted us to try our hand at an alternative video aimed at enabling a more consensual treatment of acne that would inform those thinking of opting for Isotretinoin of some this drugs very real hazards.

A key difference between RxISK and BAD is that we are not constrained by regulators, drug labels or treatment guidelines all of which have been captured by company articles

Our video is Isotretinoin Benefits and Hazards.. The Video Transcript is linked here. We’ve removed the jingly music and, while not Jodie Comer, a real Broadway actress has done the voiceover.

We welcome all and any comments – whether your views are that our efforts are misguided and dangerous or that we haven’t gone for enough.

It would be wonderful to have some comments in the form of other short Isotretinoin videos. What should a video for people out there contemplating acne treatment think would help them?  What should they or folk they know with acne be told?

(You don’t need to tell us that You Tube titles are spelling Isotretinoin incorrectly.)

More Videos

MHRA are involved in a program that we expect will lead to other videos on SSRIs and Finasteride. These drugs can also cause suicide and permanent sexual dysfunction and neither companies nor doctors will want these to be mentioned.  It is difficult to see MHRA, likely liaising with the College of Psychiatrists, approaching the issues with these drugs in anything other than the way they have done with Isotretinoin.

Given this, we hope to move on and use the BAD Isotretinoin template to tackle Finasteride and SSRIs. So you can expect more from us soon and to this end all comments on tone, style, and what you think are mistakes, or what there should be more of, would be most welcome.

What does anyone taking or thinking of taking Finasteride or SSRIs think they should be told prior to starting treatment?  Do you think videos like this will leave us with blood on our hands – or leave people badly scared and scarred who would otherwise have clear skin and be leading a happy life?

Unsafety Systems

Words and labels and guidelines are not what keep us safe.  What keeps us safe are the judgement calls we as patients make and the judgements our doctors make. We are safest when these coincide. In efforts to keep us safer, well intentioned people, including doctors, have put ever more words in place in the form of guidelines etc.

Rather than keeping us safe, these efforts to improve the system have given us an increasingly Unsafe Safety System – see also Unsafe Safety at FDA.

We lack a Patient Safety Body. A body that everyone can see really does have our safety at its heart.  No country has one.  What would such a body look like?  What might a video it made look like?  Let us know if you have thoughts.

There is a companion set of posts on dh.org

• Gaslighting in Healthcare
• Gaslighting, Milgram and Madness

See also

• Isotretinoin and the Usual Guff
• Trading our Sex Lives for Clear Skin
• Heather Roberts Heroine
• Post Retinoid Sexual Dysfunction
• Roche and the Perfect Circle
• RoAccutane and the Perfect Circle
• His Chemicals, My Imbalance

The post Isotretinoin and Consent first appeared on RxISK.

On January 22, Britain’s Medicines Regulator convened a meeting on consent to Isotretinoin (Accutane, Claravis), whose dynamics map straight onto Prima Facie.

Families whose children died from Isotretinoin triggered suicide, or whose sexual function is potentially wiped our forever have clamored for reform for over a decade. In 2023, MHRA rewrote the Rules of Evidence on consent and were reporting on progress.

In 2020, concerned parents in the US got FDA to put a Black Box Warning on Merck’s Montelukast (Singulair) for neuropsychiatric effects.

Doctors in the US and dermatologists in the UK complained. The new warnings were not ‘evidence-based’ by which they meant not based on controlled clinical trials (RCTs) linking suicidal, sexual or neuropsychiatric hazards to Isotretinoin or Montelukast.

The US families kept lobbying and in 2023 New York’s Attorney General wrote to FDA stating that the flood of mental health problems linked to Montelukast, particularly among children, was growing not diminishing. What did FDA propose to do about this? Nothing it seems.

The fact that FDA and MHRA bowed to family pressure is momentous. But it doesn’t solve our drug assault problems. These are not something regulators can solve.  We need to tease out the different elements involved and nail down who needs targeting for what.

World Leading?

MHRA say the 2023 Risk Minimization Meeting led to agreement on these points.

1. Better information
2. Better monitoring of mental health and sexual hazards
3. Better Consent to benefits and hazards
4. Better Communication re hazards
5. Better Knowledge of what is happening on the ground.

They have since introduced Risk Management Materials

• A patient card
• Consent forms acknowledging risk
• Specific Pregnancy Warnings
• Prescriber and Pharmacist involvement
• Counselling re hazards requirement
• Assessment and monitoring of hazards requirement
• Initial prescriber should have relevant expertise requirement
• First appointment should be face to face

In 2023, MHRA required two Independent doctors to approve prescriptions for under-18s. As dermatologists never disagree, this has been dropped.  MHRA now say people should have access to a second opinion.

In association with the British Association of Dermatologists (BAD), MHRA have put Audits in place, and have had 358 audit responses which they say show positive changes

In association with BAD and ‘comms’ companies, MHRA supported the production of an Isotretinoin Video to explain the hazards (BAD call side effects) and when Isotretinoin should and should not be used. The Video Transcript is here.

MHRA have also produced a Drug Safety Update article.

MHRA view what has been done as the best safety system there is internationally.

Valid Consent or Drug Assault

Harriet Vogt, RxISK’s communications (‘comms’) consultant, has views on the BAD video. There is a contrast between Benefits and Hazards.  Benefits sound close to invariable.  Hazards are translated into Side Effects which are mentioned as possible but rare.  There is no hint Isotretinoin can have sexual or suicidal Hazards. If anything in these nameless areas should happen – the hint is your mental make-up is the likely source not the pill.

There is a wishy-washy hint sexual dysfunction may continue after stopping but no mention your ability to make love may be wiped out forever. Faced with a choice between mentioning risks of death and having a cheery soundtrack – the soundtrack seems to have sounded more sound.

Response:  MHRA haven’t offered thoughts on what they think of this video – other than saying it was put together by experts.

The video reflects the views of many good dermatologists that the benefits of Isotretinoin have been so convincingly linked to isotretinoin that they accept hazards need to be mentioned but they do not want to deter people from seeking treatment.  It is not clear any ‘good’ dermatologist has met a case of suicidality or sexual dysfunction they convincingly link to Isotretinoin.

Q and A Involving Families

1. Where is the Research on what can happen and is happening?

• MHRA mentioned an ‘Acne Isotretinoin Dosing’ trial

This is not unimportant. Doses have been far too high in the past but the questioner almost certainly meant research on suicide and sexual issues.

2. The warnings are small print, is this right?

• MHRA say warnings about Hazards are primarily down to the doctor to mention.

MHRA don’t do Black Boxes the way FDA does

3. Are Dermatologists assessing Hazards?

• MHRA suggest the Audit suggests they are. The video says Nurses may ask about your ‘mood’ and it is important you mention changes.

Can dermatologists or nurses do more than a superficial check?

4. What is being done to treat the profound injuries caused?

• MHRA advise consulting your doctor/clinic nurse.

Nothing.

5. Dermatologists or nurses are supposed to Monitor – Then what?

• MHRA indicate that is down to the doctor/nurse

Nothing.  Dermatologists have no experience managing these states.

6. Second Opinion?

• MHRA say this is lieu of a second independent view before starting treatment

Do Injuries after starting treatment warrant a second opinion?

7. What is being done about Disability Payments

• MHRA say disability payments are not their department

8. Can MHRA decide if the Drug is causing a problem or not

• MHRA say if you have problems you can consult the Samaritans

Samaritans are prohibited from linking a problem to a drug – from practicing medicine.

MHRA or NHRA

This Q and A precis misses the disappointment, close to disgust, of family members asking questions apparent in a parallel set of back and forth emails among listeners.

There was a mismatch between the good job MHRA believe they are doing and families who saw a NHRA (No Help Regulatory Agency) in action. Families used words like whitewash, gaslighting and conspiracy.

This gulf illustrates public, medical and political misunderstandings about the role of regulators – See Are Healthcare and Science Compatible. And perhaps MHRA misunderstanding of or failure to communicate their role clearly to families.

MHRA washed their hands of drug induced injury and disability questions. In terms of their job description, this was correct. It is not clear if their job description means they can’t name resources able to help on these points.

Part of the problem is families, patients, and increasingly doctors delegate narcissism to FDA/MHRA, as the Freudians used to say, or fetish MHRA/FDA, as social scientists often say.  We do not see this.  Nor apparently do regulators – Narcissistic Doctor Disorder.

MHRA are a bureaucracy. They are not a Patient Safety Body (PSB) or scientists. Their minimal input to safety is linked solely to the words in a drug’s label – and as far as they are concerned the words have changed.

Doctors are the safety professionals. They decide whether a drug has the capacity to cause a problem and has or has not caused the problem in the case of a particular patient.  Doctors used to be able to force companies to update drug labels accordingly but their powers to do so are now limited by medical journal unwillingness to publish reports of Hazards for fear of company lawsuits – see Silencing Doctors Silencing Safety.

On top of that, medical insurers advise doctors against making a link between a medicine and hazards – Making Medicine Great Again.

In the case of cross-boundary hazards like suicidality or permanent sexual dysfunction, the most dermatologists can be expected to do is recognize there might be a problem. They should make a referral at that point just as a psychiatrist or genito-urinary specialists would if a patient came back with a rash after starting a treatment. No one would want a psychiatrist managing skin issues,

With a rash or photos, a psychiatrist or family doctor cannot readily deny the problem exists but in the case of suicidality, homicidality or persistent sexual dysfunction there is nothing to show or take a picture of.  Some of the experiences are so disturbing that the doctor has to open the door to hearing about them in order to make it possible for us to talk about them – See Guilty until Proven Innocent. Psychiatrists have been shamefully poor at this.

There is no hint MHRA or dermatologists have any feel for this aspect to the problems Isotretinoin poses.  In failing to recognize the complexity involved, dermatologists are failing patients. It is not the role of regulatory bureaucrats to lead professionals.

Disabilities and Research

The recognition of disabilities and questions of disability payments also hinges on this point.  Regulators do not advise on whether a disability exists that might warrant support with benefits.

Disabilities are a job for a doctor, who may be convinced their patient has a real and enduring disability and be willing to report that opening the door to seeking a benefit.  The next step is a Disability Benefit Application – which goes to a board on which there are doctors and lawyers.  For a missing leg, this is easy.  For enduring sexual dysfunction claim, a board, or politicians may say “Yes, but if we grant this are we opening the door to a flood of applications based on people’s say so?  We will review this when there is a reliable test to confirm the disorder”.

Having said this, the system manages to hand out disability payments for ADHD and mood disorders without a test to show they are real.

This brings the question of research into the frame.  There is effectively no research going on to test for the existence of SSRI/Isotretinoin/Finasteride induced suicidality or sexual dysfunction that is likely to lead to a Test or Treatment soon.  If we get a Test or Treatment it will be by accident.

Regulators have no role in doing or commissioning research that might remedy this situation.  The most they can do is note Hazards in drug labels. This you’d imagine should lead to research but hasn’t and seems increasingly less likely to lead to progress.

The only progress in these areas has come from the efforts of affected individuals or their families.  This is likely to remain the case.

The Art of the Possible

For people with drug-induced injuries or bereaved families, regulators like MHRA or FDA look the obvious port of call.  And Isotretinoin families in the UK and Montelukast in the US have taken the regulators out of their comfort zone, which may bear long term fruit for all of us.

In the short term, we all can do with a degree of thinking outside the box by folk with Skin in the Game.

Inquests are an important venue. Coroners have no box to tick to say a prescription drug caused a death. Families have no reason to think they need a lawyer going to inquests but they stand no chance without both a lawyer and an expert.

The Death of Stephen O’Neill (see also The Perfect Killing Machine) and Thomas Kingston – see Tangled up in Bureaucracy – bring the points home.

Stephen’s problems began with doxycycline a drug often given for acne, which can cause suicide and the suicides it causes have been weaponized to defend against the idea Isotretinoin is uniquely bad (it is worse than doxycycline).  His inquest led the NICE Guidelines apparatus to agree that their guidelines are based on a ghostwritten often fraudulent literature – The NICE Before Xmas.

In Thomas Kingston’s case, the Coroner wrote to the Royal College of Psychiatrists and General Practitioners which may have played a part in MHRA setting up a working group like this successful dermatology one – that will likely also be regulatorily perfect but frustrating for anyone interested in patient safety.

These bodies, along with the BAD guys, who are supposed to keep us safe will of course say they can’t go against MHRA labels or NICE Guidelines.

It is also worth engaging with journals like BMJ (and BMA) who opened the door to dermatologists dismissing the 2023 warnings on Isotretinoin.

Engaging with medical insurers who warn doctors at inquests not to link suicides to a drug a patient was on is also worth doing – See Will Medical Insurers Stop Killing People.

There is a further limitation to MHRA’s abilities to contribute to safety that the families of those who have committed suicide or now have permanent sexual dysfunction or other problems linked to Isotretinoin (or finasteride or SSRIs) do not take into account when calling for more stringent precautionary measures on labels along with calls for the drug to be removed from the market.

No Drug is an Island.  Any precedent established with one drug risks toppling over into all other drugs. Companies have armies of lawyers lined up monitoring every change in a dot on an i or cross on a t in order to exploit it.

In addition to that even FDA’s Bazooka – Black Box Warnings – are now widely viewed as and ignored by doctors as May Contain Nuts labels. Companies have colonized doctors in ways very few doctors can spot. Doctors see themselves practicing according to the evidence.

Words and labels and guidelines are not what keep us safe.  What keeps us safe are the judgement calls we as patients make and the judgements our doctors make. We are safest when these coincide. In efforts to keep us safer, well intentioned people, including doctors, have put ever more words in place in the form of guidelines etc. These have given us an increasingly Unsafe Safety System – see also and Unsafe Safety at FDA.

We lack a Patient Safety Body – that we agree really does have our safety at its heart.  What would such a body look like?  What might a video it made look like?

The post Isotretinoin and Safety – Destiny or Mirage? first appeared on RxISK.

Prima Facie – on the face of it – it is clear who the legally guilty party is – until (perhaps) it is proven otherwise.

Prima Facie is a play by Suzie Miller. She tells the story behind it and the changes to the law around sexual assault it has brought about, along with her Australian and legal background in this Women’s Podcast.

Prima has won multiple awards – as has Jodie Comer, who features in one of its one-woman iterations.  Tickets to a live performance are impossible to get. Every so often a video version is available to rent from the National Theatre. In the meantime here is the Prima Facie Transcript.

Prima Facie sets a legal stage very like the stage on which drug induced injuries and assaults play out – see Are Healthcare and Science Compatible.

On the courtroom floor a process, its participants believe to be rational and fair, plays out. Tessa Ensler, a good lawyer knows the process is not always rational or fair but goes along with a system, which may have its failings but every system has blind spots. She is good at using the process, the system, to get sexual assaulters off the hook.

Despite the problems, 99% of us agree anarchy would be worse. As a defense against anarchy, we turn to systems (a greek word), which all too easily (can) become system-archy.

When drawing up the The Healthcare Lecture, I knew (intellectually) and I imagine lots do, that we have an increasingly rigid health system that has got to the point of being all too willing to mandate treatments despite the evident harm they can cause.  We saw visible hard mandates with Covid but mostly miss the host of soft mandates, especially linked to what can be branded as mental health, which slide in beneath our radars.

Pointing out the mismatch between our reality and the semi-religious healthcare formulae that give a pleasing look of truth by virtue of repetition and solemn intoning to the truths of the system is a recipe for rejection. The good thing about the Midlands lecture was the questioners didn’t reject. They articulated the difficulties the mismatch poses for them.

This openness was quite unlike Canadian and British responses to the same messages some years ago – see Health a Privilege of Wealth.

A Witness in Court

Tessa Ensler comes up against this rigidity when she herself is sexually assaulted. In sexual assault cases, the woman, the victim, becomes the guilty party. She is up against an – archy – patri-archy.

The process asks juries to decide between the answers of two people. He just has to say he didn’t know she wasn’t consenting.  She had consented a short time before.  She can be quizzed about minor details it may be hard to get right when you are being assaulted.

Consistency and body language are key to the verdict. The process has been set up by men who have never been sexually assaulted and can’t understand why asking a woman for details of the assault which she may not be able to recall clearly is not the way to go.  Putting a woman who is the victim in the witness box and interrogating her as though she were trying to get an innocent man convicted for some perverse female reason, and then not convicting him on the basis that her testimony has more holes in it, brings out the bias.

A Witness in Clinic

In the Clinic Witness Box there is often no way to tell your interrogator what is, or might be, or you hope is not going on.

You might get as far as James Holmes, the Aurora Batman Rises gunman, who told Dr Feinstein if she knew the thoughts going through his head she’d lock him up.  As part of standard clinical process, she told him he was responsible for the thoughts going through his head. Holmes’ lawyers chose not to mention sertraline even though they had a report saying his sertraline did it.  See Prescription for Murder.

A husband like Woody Witczak on sertraline might tell his wife Kim that she would not believe the thoughts going through his head but will likely be unable to tell her that these include killing her – see Healthcare and Science.  See also The Man Who Thought He Was a Monster,

Within days on an SSRI, David Rule confided thoughts he was going mad and was scared of what he might do – to his diary.  But not to anyone else. He battered his wife to death a few days later.  No one who knew her and him thought he was guilty.  In jail, off meds, he came back to normal and couldn’t remember much of the week on meds. Despite a complete not-guilty defense, his lawyers bottled it, advised a plea deal that transformed him into a monster – see Odysseus Come Home.

Many a woman, hypnotized by sertraline or another SSRI, has finally seemed to her doctor to be calmer, leaving him thinking her pills are working and there’s no need to ask questions – a few days before she killed her children – See Marilyn Lemak.

Many a person made delirious at night by their meds has been jailed because their lawyer, rather than seeing someone with a perfect not-guilty case because of his poor memory for the key event, sees an unreliable historian (witness), who the lawyer views as standing no chance with the legal process as is.

The lawyer above gets the person to plead guilty even though, as far back as 2001 the prosecutor and judge looking at David Hawkins case who had pleaded guilty figured that but for the sertraline he took, Hawkins would not have murdered his wife.  They could do so because Hawkins Australian lawyer, whose initials curiously were T.E. made is possible for them. She had a medical expert report saying he had a mitigating mental illness but T.E. figured prima face this was wrong.  He was no more mentally ill than she was – there must be something else involved. She got a report on the effects of his medication and the prosecutor and judge agreed.

Healthy medical and nursing staff participated in a 1999 study run in the unit pictured here. It aimed at exploring what sertraline does. Two became suicidal and hostile (code for homicidal). Thinking as James Holmes did, one later said if she’d told us what she was thinking when on the drug we’d have locked her up – even though ordinarily we gossiped and shared coffee on a daily basis.

Sexual and Drug Assault cases share a common difficulty – putting in words what has happened in a way that a jury can get to grips with.  There are still vanishingly few sexual assault convictions or, to put it the other way around, cases where the woman walks out of court exonerated (not guilty).

But the number of sexual assault successes swamp the number of successful not-guilty verdicts in drug assault cases, which can be counted on the fingers of a hand or two.

Changing Legal Systems

We say women who are sexually or otherwise assaulted but end up seen as guilty just by virtue of being a woman illustrate a deep-seated misogyny.

Telling good stories is central to Suzie M’s view on changing systems. Staging Prima Facie did more to bring about change than the discussions she had with colleagues and others over years.

A few days into Prima Facie’s run in London, she had a call from a British Judge who had been at the play the previous night and wanted to talk to her.  S’s initial reaction was the play was about to be pulled but the Judge, a woman, was responsible for writing the Rules for Juries in cases and wanted to liaise about changing the Rules. A good example of the need to get women into positions where they can make a difference.

Things are changing but the legal system is still a problem for women in assault cases. Women however are taking things into their own hands and rather than be ashamed into staying quiet, they are speaking out and naming the man.

Changing Clinical Systems

Does Prima Facie offer leads for those injured by a prescription medicine, who are guilty by virtue of their infirmity. Mis-infirmity is too mild a word.  The Damned is closer to the mark.

Few likely figure that someone injured by a prescription medicine is more disadvantaged than a woman or someone with the wrong skin color. See I can’t Breathe, along with I can’t Breathe II and I can’t Breathe III, and Being Black.

The bias is profound and hidden from view.  As one woman in To The Last Breath put it.

The perpetrator of our distress is at home in a blister pack on the bedside table.

A perpetrator who is commonly white – definitely not black.  A perpetrator who must be male as everyone is obsessed with his potency, which is viewed with awe and is allowed to sweep aside all other considerations

As many women can tell you, mentioning you take an SSRI can help a social group relax the way telling them you have epilepsy but are taking anticonvulsants or have had all your vaccines, can.

The sigh of relief on hearing you are not just taking SSRIs but doing what a doctor tells you reflects two deep-seated fears. One is the fear we only get a disease like epilepsy if we, or perhaps a parent, has sinned. We may have moved on from sin to bad luck, today, but essentially the diseased are not part of the Chosen People, the lucky ones, the Saved.

The other is the patriarchal fear of emotional women, who are all too liable to invent stories designed to harm innocent men.

Treatment that’s working shrinks our fears to a manageable size. Bad reactions – disinhibition, agitation, homicidality or asexuality on an SSRI – rattles the Chosen People. Will these wounds, like those of the dead Caesar, cry Havoc and let slip the dogs of war?

See the papers on Consent, Pharmacological Abuse and Liability. These have been on the RxISK site for 15 years and in Psychiatric Drugs Explained for 30 years.  To no effect.

There is a series of 7 posts from 2015 to 2016 by Laurie Oakley starting with Pharmaceutical Rape and ending with Ending our Tolerance.  But we are still being raped – maybe even more so.

As regards stories making a difference, contributors to RxISK have told and tell dramatic stories. But so far, these have had more effect compiled into publications quantitatively linking treatments to hazards rather than in accounts that make the assault live.

Shamed by Post-SSRI Sexual Dysfunction (PSSD), most sufferers spent decades, some over 3 decades, concealing their identities in the way folk with AIDs once did. In 2022, a group of them magnificently came out, publicly sharing their photos with names – I am Joseph, I am Mary etc and I have PSSD.  See PSSD Podcast Episode 2. Despite this, sufferers are still dismissed in clinics – and can even be detained for Prima Facie madness.  See Patient Experiences.

Thirty-five years ago, Eli Lilly, facilitated by FDA, leading medical journals (BMJ, NEJM) and presidents of psychiatric associations (APA, RCP etc), branded compelling stories of Prozac induced suicides and homicides as Anecdotes. The system lined up behind Lilly’s mantra that randomized controlled trials (RCTs) offer the Science of Cause and Effect. The only way we can, supposedly, know what a drug does is by doing an RCT.

Whatever about the failings of legal systems, legal processes created a middle ground between Church and State that prioritized us. The Rule of Law and an independent judiciary created a degree of freedom – ultimately capable of tackling misogyny.

Legal processes were also adopted by and created what we call science and these processes are central to the science of clinical medicine born in Paris in 1800. Few lawyers are aware of this.  When it comes to clinical issues, many lawyers have swallowed the mantra that scientific proofs, as in RCT evidence, are more objective than the verdicts legal processes deliver – See Are Healthcare and Science Compatible.

RCTs are cryptonite to the super-powers legal systems at their best can deliver.  On average (in RCTs) men don’t murder (or kill) their wives but what this case and this jury have to decide is did this man murder his wife.  Saying men don’t murder wives (on average) is different to deciding if men have the capacity to murder their wives (or wives their husband). Legal trials (Cases) not clinical trials establish this.

To return to story mode – these points came to a head some years ago in Chile, where Jorge Bergoglio, the Pope, told people who had been sexually abused by priests that in order to believe them he had to have evidence but they had to believe in him and the Church.

Jorge here was going along with Eli Lilly’s strategy in 1990 and both ironically were using a defense deployed by the Pedophile Liberation Front in the 1970s – show us the evidence that pedophilia harms. Jorge apparently later recanted. Lilly and pharma haven’t.

Jorge was the first head of state to hard mandate Covid vaccines despite knowing pharma sequester study evidence, ghostwrite negative studies into positive publications, and personally knowing people badly damaged by the vaccine. The story of this man, who seemed decent in many ways, appears to have ended ironically. An RSV vaccine looks like it may have done for him.

We haven’t had Suzie Miller’s access to the Judge who writes the Jury Rules, but Brenda Hale, Spiderwoman, the recent Chair of the British Supreme Court has known about these issues for 24 years or so.  I wrote to her in the wake Stephen O’Neill’s death – see The Death of Stephen O’Neill and The Perfect Killing Machine. There was no response.

I also wrote to the then CEO of the Nice Guideline committee – The NICE before Christmas – who accepted their guidelines were based on fake literature but asked what else could NICE do?

Stephen was related to Northern Ireland’s First Minister who has done nothing despite being handed a bunch of vote winning cards.  If the literature on these drugs is all ghostwritten and fraudulently writes hazards out of the scripts, its no surprise that people cannot get justice when this literature is portrayed in court and the stellar science.  It is also no surprise that health service costs spiral out of control and life expectancy starts falling.

After Tom Kingston, the husband of Lady Gabrielle Windsor, a member of the extended Royal Family, died by his own hand following a malignant reaction to sertraline, she said: “if this can happen Tom, it can happen anyone”.  

The coroner’s verdict at his inquest clearly implicated the drug. Coroners can finger a drug at inquests and juries can in familicide cases. Doing is easy it seems when everyone in the final act is dead. But it makes no difference. It doesn’t reduce the death rate linked to these medicines.    

Another option Suzie mentioned was to reject the stigma and transfer it to the assaulter. Who in this case does that mean? You might figure it must be the prescribing doctor but the prescriber is in a similar position to the assaulter’s defense lawyer whose job is to defend him.

The legal system might indeed wake up if defense lawyers got pilloried as adjuncts to sexual assaults but instead they get clapped on the back. The trouble is we still need defense lawyers. Should prescribers be pilloried as adjuncts to drug assaults?

This posts links to Health a Privilege of Wealth on DH

Continued Next Week

The post Guilty Until Proven Innocent – Prima Facie first appeared on RxISK.

MEDICAL CARE MEDICAL SCIENCE

This talk was given at the request of Professor Ilana Crome to healthcare staff and students linked to the UK’s Midland’s Partnership University on January 12, 2026.

Slide 1: In the US, the term medical model translates to a pharmaceutical, model – a giving meds model. The term medical model began in Paris in 1800 and linked medical disorders, like tuberculosis or raving insanity in folk confined to asylums, to disordered biology rather to the whole person..

For Americans, claiming the suicide, homicide or sexual dysfunction SSRIs can cause validates the medical model does not compute. Or that knowing when not to give drugs rather than dishing them out is a supreme medical virtue.  This is a medical model – not a pharmaceutical model – talk.

Slide 2.  In 1958, Imipramine (in the middle on top) was the first tricyclic antidepressant (TCA). By 1959, European psychiatrists, semi-Freudian mostly, convened at a meeting in the UK, 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 could spot and say that amitriptyline caused a sexual dysfunction distinguishable from the effects of melancholia. Doctors can’t now spot SSRIs causing even clearer sexual effects in patients with no prior libido problems. Why not?

In 1961 Julius Axelrod established the 3 drugs on top here all inhibited noradrenaline reuptake, for which he won a Nobel Prize. This gave rise to Schildkraut’s Catecholamine Hypothesis, that the disordered biology in melancholia is low noradrenaline and if we just produce pure noradrenaline reuptake inhibitors, which the tricyclics weren’t, we would have better antidepressants free of side effects.

Slide 2. This was the original low neurotransmitter or chemical imbalance hypothesis. Cartoonists didn’t pay any heed back then because so few people were depressed and taking antidepressants.  But 30 years later when SSRIs made depression common, cartoonist spotted the problems with this idea.  There were two snags. Benzodiazepines, antipsychotics and stimulants immediately did something clearly helpful. TCAs had lots of effects but apparently no immediate beneficial effect. Noradrenaline reuptake inhibition was immediate but not curative.

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 beneficial drug effect, what was responding?  Did the drugs cure an illness?

Slide 4. Fridolin Sulser’s catecholamine receptor hypothesis replaced the low amine idea. Receptor 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 TCAs were curing something. Like the Cheshire Cat, Sulser’s Receptors and then BDNF Biobabble left a Grin behind. We are now told to wait for up to 6 or 8 weeks for something to happen, even in mild problems and we just have to putup with side effects in the meantime.

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. In the 1960s some psychoanalysts in both Europe and the US 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 these changes in transference reactions to serotonin reuptake inhibition – desipramine doesn’t. He made Zelmid, a serotonin reuptake inhibitor with no noradrenaline effect to explore this further.  This and later SSRIs are not anti-melancholic.  Changing transference reactions means muting emotional reactivity – their Serenic effect means your analyst finds it harder to provoke you.  They are Anxiolytic.

Slide 8. Zelmid was not an anti-melancholic drug 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 36 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 not a Magic Bullet correcting a problem in the serotonin system.  Zelmid offered a Therapeutic Principle that allowed us to compensate for a problem. 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.

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 are part of the core sensory effects of SSRIs.

This slide shows balance problems reported to FDA on SSRIs. Only 1 in 100 serious problems get reported, so SSRIs have significant effects on our 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.

Slide 15.  Reports to FDA also show visual issues on SSRIs in hundreds of thousands of us – even though 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 – a blue noradrenaline locus coeruleus and the green serotonergic raphe nucleus which damps down vigilance. The locus coeruleus needs our 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 the Raphe Nucleus, without causing problems.

Slide 18.  I am only semi-saying we don’t need brains to work out what SSRIs do. I’m trying to get you to see us as more like Octopi who in contrast to appearances 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 thinking slow 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 knew for decades about chemical biobabble, this Peanuts cartoon shows you Lucy could spot changes in Charlie Brown’s transference reactions as well as any analyst.

Slide 23. Some years ago in this unit we randomized 20 medical and nursing healthy volunteers to a noradrenaline 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 and agreed it made him Serene. 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 a 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.  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 manage our subjective balance – disturbances like these strike at our subjectivity.

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 mental 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 their effects by acting on our primary knowledge generators – our sensory systems. In toxic doses they disrupt embodied knowledge. When this happens, people complain about Brain Fog and are certain their brains are broken but cognitive tests don’t show this.

When embodied knowledge breaks, we try to fix it by attending more which is effortful and frustrating because that’s not the way to repair embodied knowledge – a complaint of Brain Fog 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 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 the 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.  Adding weird new restless sensations to sensory muting opens a door, as this person hints, to having imagery dominate our behavior and to 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 essentially 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.

When our brains have to interpret weirdly dominant sensations terrible things can happen – its like having command hallucinations.

Slide 35. We know SSRIs mute sensation from evidence going on them, coming off them, and from what they break in us. Our right hand knows this.  Our left hand doesn’t as you will see from Woody Witczak’s case.

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 – Unum 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 some 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 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.

Not only do RCTs average good and bad trips on one drug but if LSD, SSRIs, benzodiazepines, 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 in 1990, FDA likely 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. 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 doctors are incentivized to throw you out through the opening for spreading Treatment Hesitancy.

Slide 39. 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.

This is the diametric opposite to William Osler’s famous phrase:

“Listen to your patients they are telling you what the problem is”.

When growing up, we Delegate our Narcissism to father figures. In uncertain times we may delegate it to dictators, or gurus. Professionals delegating it to bureaucrats is weird.

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 doctors singing Let’s Do the Narcissistic Tango Again.

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 40. 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 regulations require me to give you Depression. If I disable you like this, shouldn’t we be sure we can 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 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. What value do doctors add?

If our drugs work well and are free of problems, we don’t need doctors. Nurses and pharmacists are cheaper prescribers and maybe safer – doctors risk 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 41. 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 an appearance of science that hypnotizes us.

Slide 42.  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 age group and the blue line is for 10-17 age group.  In 1990, antidepressants were rarely prescribed other than to people of middle years but driven by social media they are rapidly becoming drugs for young folk.

See Australian Figures for the Source of these data.

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 the 10-24 age group 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%.

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

Slide 43. The gray line is for suicide rates among 15-24 year old males over the last decade.  The blue line female 15-24 year old rate.  See – Damsels in Distress for the source of these figures.

And we now have the first legal cases for suicides after contact with Hims and Hers – Authenticity Inc Meets Grok.

Slide 44. 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.  Links to source data in Damsels in Distress.

But the redline shows a dramatic shift – unhappiness is now most marked among ages 18-40. 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 45:  Since 2015 we have also had falling life expectancies and in addition falling health expectancies.  The Source is an NHS Integrated Performance Data December 2025.

Slide 46:  The small print on the graph above and the NHS Performance Report says we will turn these falling healthy life expectancy data around by focusing on health prevention – which means giving chemicals to healthy people.  Doing more of exactly what has caused life expectancy and health expectancy to fall and is bankrupting health systems across the Western world.   Lets Do the Time Warp Again.

Slide 47. Science began in London in 1660, when a bunch of men began holding events at which they transfused the blood of a young dog into an old dog and observed – it seemed invigorated.  Or looked down a microscope to observe what they called microbes.

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 these events and the consensus as to what was happening. 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 company studies no person 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.

Back when the chemicals we gave were dangerous, Oliver Wendell Holmes famously said:

I firmly believe if all of our medicines were sunk to the bottom of the sea it would be the better for mankind and the worse for the fishes 

Our chemicals are still dangerous but today the journal articles, drug labels and guidelines that are supposed to make them as safe as possible to use are even more dangerous.  Would he have been forced to say;

I firmly believe if all of our journals, drug labels and Guidelines were sunk to the bottom of the sea it would be the better for mankind and the worse for the fishes 

In contrast, every time we prescribe a drug to someone we initiate an experiment that takes place in front of us.  We open a door to the purest form of science there is and with SSRIs we have a tool with which to explore some of the most fascinating issues imaginable.

You may say you are in medicine to care for people not to do science – but if you cannot Care if you are not doing Science.

Slide 48.  Before engaging in 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 can see the courage in him.

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. How have we allowed ourselves to end up in such a weak position as we are in 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.

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.

• Consider micro-dosing SSRIs –  dosing to 2-5 mg fluoxetine or less.
• Specify what you want an SSRI to do that might help – name the step on the way to helping.  For a beta-blocker we’d say slow your heart rate and ease any shake – not make your anxiety vanish.
• Recognize immediate SSRI effects as their core action not side effects – they are adverse effects at toxic starting doses.
• Support interoception of the sensory changes that enable people to titrate treatment to the right level for them or stop it 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 and essentially were giving them problems they didn’t know they had and putting them on 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.

Good Science is not a matter of knowing research methods and applying for big 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 a university degree.

See Pharmacopsychology. Emil Kraepelin would have died for access to an SSRI. SSRIs allow an exploration of our subjectivity, no less. Instead, we have returned to a Dark Age. Never in the history of science have so many observations by so many people been jettisoned by so few.

One reason why the sensory impacts of SSRIs have been ignored is that the sensory nervous system has been seen as too subjective by neurologists, who prefer the reliability of tests for the peripheral motor system and brain scans to variable responses that can change from moment to moment, time of day and time of the month, and can vary 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 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?

Note

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 and related points in more detail.

• Interoception and Neuroplasticity
• Interoception needs Intrepid Interoceptors
• The Once and Future Pharmacopsychology
• Narcissistic Doctor Disorder

The post Are HealthCare and Science Compatible? first appeared on RxISK.