I started medical school at the University of Illinois in Chicago in 1972. Robert Mendelsohn was my adviser and I spent a few evenings at his dinner table learning things about the institution of medicine not safely repeated to anyone if I wished to continue medical school (1)(2).
After a full year listening to basic science lectures and taking exams, our class was released into the hospital wards to start clerkships. This involved making rounds with the intern and resident team examining patients and doing the “scut work” which maintained the University teaching hospital (3). Doing rounds was a daily ritual, and we methodically worked our way up and down the long corridors which had the distinctive smell of alcohol and pseudomonas.
My first rotation was internal medicine, and we saw the usual litany of diseases: diabetes, rheumatoid arthritis, GI bleeding, congestive heart failure, cancer, and various bacterial and viral infections. After examining each patient, we convened in the hallway wearing our long white coats and stethoscopes as in a football huddle to discuss the diagnosis and treatment. Actually, the discussion was between the intern and resident, while the rest of us listened in. The two of them routinely had a running debate punctuated by brief forays into the rooms to examine patients. Both of them were armed with a pocket notebook inscribed with references to the medical literature which was brandished to support their decisions regarding testing or treatment. On a good day, I endeared myself to the intern by starting a difficult I.V., or by making a diagnostic coup like homonymous hemianopsia or acute intermittent porphyria.
In those days, the medical literature was rock solid truth and trustworthy beyond question. It was inconceivable to us that any doctor would ever falsify or distort the results of a medical study or research. After all, people’s lives were hanging in the balance. This gradually changed over time. I am not sure when awareness of problems with the medical literature emerged and it became sadly obvious that much of medical science is up for sale. After this revelation, I became skeptical and I now tend to believe the data more than the written conclusions of any medical study. A recent example of this fraudulent conduct in medical research is given in the BBC documentary on the SSRI drug Seroxat (Paxil) and pediatric prescriptions (4)(5).
We have previously discussed the adverse risks of SSRI drugs including agitation, suicidal or violent behavior, movement disorders, and chemical dependency (6) in adults. We might imagine their "side effects" in children are no less, but what about their efficacy? Surely they must be magic pills against a debilitating "illness" to risk such terrible consequences. However, Jon Jureidini in a comprehensive review of the available data found only minimal benefit from the SSRI drugs in children. He writes, ” The magnitude of benefit is unlikely to be sufficient to justify risking those harms, so confidently recommending these drugs as a treatment option, let alone as first line treatment, would be inappropriate.” (7)
According to Irving Kirsch in Prevention & Treatment , “there is now unanimous agreement that the mean difference between response to antidepressant drugs and response to inert placebo is very small. It is so small that, despite sample sizes involving hundreds of participants, 57% of the trials funded by the pharmaceutical industry failed to show a significant difference between drug and placebo. Most of these negative data were not published and were accessible only by gaining access to US Food and Drug Administration (FDA) documents. The small difference between the drug response and the placebo response has been a "dirty little secret". It was not known to the general public, depressed patients, or even their physicians”(8).
Various methods were used to manipulate the results of SSRI drug studies to insure a favorable outcome:
1) Responders to the placebo are eliminated at the beginning of the study. (Placebo washout)
2) Benzodiazepine sedatives were given to mask the SSRI induced agitation.
3) Unfavorable drug studies are buried in the file cabinet and not disclosed to the public.
4) Miscoding suicidal events as "emotional lability", and homicidal events as "aggression" to hide suicidal events from regulators.
5) False attribution of suicide to the placebo arm.
6) Hiring ghost writers to make the medical articles more favorable.
7) Cash settlements for SSRI drug litigants which seals records and withholds unfavorable drug studies from the public.
Using these and other gimmicks, the drug industry managed to gain FDA approval for the SSRI class of drugs. Since the FDA approval is the foundation of our medical system, the first step in restoring integrity is to halt the “waiver system” which gives doctors immunity from prosecution for conflicts of interest. The system allows doctors to deliberate on FDA advisory committees while receiving money from the drug industry, a conflict of interest that is also a federal crime (9)(10).
The harm caused by consumer drug advertising was discussed in a previous report (11). Direct to consumer advertising of SSRI drugs presents the message that depression is a disease caused by a chemical imbalance in the brain, namely a deficiency of serotonin, which is cured by the SSRI drug (12). The precursor to the neurotransmitter serotonin is tryptophan (5-HTP), a naturally occurring amino acid. Unfortunately, the serotonin deficiency concept as presented by the DTC advertising is poorly supported by medical science (13). In addition, it is well known that brain serotonin can be increased safely with ingestion of a food supplement, 5HTP, available at the health food store. Why risk the adverse side effects of SSRI drugs when a safer alternative is available? (14)
The unfortunate soul who loses his job, gets divorced or experiences the grief of a death in the family now has a “disease” caused by a chemical imbalance which requires him to be prescribed an SSRI drug. This is not a description of a disease state. This is a description of a life event which makes anyone depressed, and the treatment is the support of friends and family through a difficult time. Perhaps the depressed individual bears inner turmoil of unresolved conflicts with work or family, and the SSRI drug “numbs” the individual to this unbearable inner conflict, allowing continuation of the job or unhappy home. Perhaps this is the true utility of SSRI drugs in our society.
We have known about SSRI drug induced suicide since Teicher’s landmark article in 1990 (15). Where is the overpowering sense of public outrage that should have banned these drugs in children years ago? The drug industry, the FDA and the medical profession continue the widespread drugging of our children with addictive toxic placebos in an uncanny similarity to the classic Lucas film THX 1138, a science fictional remake of Orwell’s 1984 which paints a totalitarian world of enslaved citizens controlled by drugs (16)(17).
Child sacrifice is an important theme of the three major, monotheistic religions (18). Abraham’s intended sacrifice of Isaac took place at the “Dome of the Rock” on the temple mount, near the “Wailing Wall” in the old city of Jerusalem. Isaac’s life was spared at the last minute by an angel who ordered Abraham to sacrifice a ram instead. We know today's Abrahams and Issacs well enough, but the horizon seems frighteningly devoid of any signs of angels.
Jeffrey Dach M.D. is board certified in interventional radiology and a member of the Board of the American Academy of Anti-Aging Medicine. He retired from radiology two years ago, and is currently in private practice focusing on bio-identical hormone treatment.