Quacks detest science-based medicine (SBM) in general, but there are certain specialties that they detest more than others. For instance, you won’t find too many quacks attacking trauma surgery because even they know that when a person’s body has been on the losing end of a confrontation with a bullet or a car, no amount of laying on of hands, homeopathic nostrums, “energy healing,” or herbal remedies are going to stop the hemorrhage, mend broken bones, or repair holes in various internal organs. That’s why even homeopaths will concede that “allopathic medicine” is good for emergencies. It’s also why sketches like this one resonate:
However, from there the distrust of promoters of unscientific and pseudoscientific medical systems and treatment modalities for SBM appears to increase in direct proportion to the urgency and need for direct physical repair of damaged organs, with the possible exception of cancer, for which the standard physical treatment (surgery) is attacked nearly as much as chemotherapy.
Be that as it may, arguably the specialty most attacked by quacks is psychiatry. Many are the reasons, some legitimate, many not. For example, the Church of Scientology in particular despises psychiatry, even going so far as to maintain through its anti-psychiatry front group the Citizens’ Commission on Human Rights (CCHR) a risibly nonsensical “museum” in Hollywood dedicated to psychiatry that they charmingly call Psychiatry: An Industry of Death. It’s so ridiculously, painfully over-the-top, a veritable self-parody of anti-psychiatry hyperbole, that it inadvertently undermines the very attacks on psychiatry frequently leveled by Scientologists and quacks that it’s meant to reinforce. Indeed, not having visited its website for several years, I notice that the CCHR has totally revamped it, now including a virtual 3D tour of the museum, along with video clips from its many “exhibits” available online. I’ll have to file that away for later blog fodder, because the misinformation, cherry picking, and pseudoscience flow freely, as one would expect from a Scientology propaganda project. In the meantime, suffice to say that it’s not just the Church of Scientology that despises psychiatry. It’s founder L. Ron Hubbard and his disciples merely represent the most ridiculously over-the-top and vociferous anti-psychiatry group that I’m currently aware of.
Let’s face it, psychiatry hasn’t always had the best history. It’s a very hard to study human behavior and disorders of human behavior in a rigorous fashion, but to my mind that didn’t excuse the the widespread acceptance for many decades of the ideas of Sigmund Freud, which were little removed from pseudoscience in many respects. Also, psychiatry has not always had the best history, particularly in the early part of this century. Too often, psychiatry has been used as a tool of control rather than a means of helping people who are suffering. Perhaps the worst example is the misuse of psychiatry by various totalitarian regimes, be it the Nazis using it as a primary tool of its T4 euthanasia program or the Soviet Union declaring enemies of the state to be mentally ill and shipping them off to Gulags.
Although there is a ways to go, however, psychiatry in 2012 is much better than psychiatry, say, 50 or 75 years ago. It wasn’t so long ago that, popularized by Walter Freeman, thousands of “ice pick lobotomies” were performed for all manner of indications, few of which had what we would consider to be compelling scientific support to back them up. Over the last half-century, better psychiatric drugs to treat different conditions have been developed, leading to their widespread use for a number of indications.
There are, of course, legitimate criticisms of psychiatry to be made, but that’s not what quacks are interested in. Their hatred of psychiatry is particularly pure, to the point where they look for any excuse to attack psychiatric medications. Indeed, there is even a phenomenon known as “mental illness denial,” which denies that mental illnesses even exist and, therefore, that psychiatry can possibly be a legitimate branch of medical science. Again, Scientologists are the most prominent proponents of mental illness denial, but such “thought” (if you can call it that) permeates many areas of “alternative medicine.”
One of the more odious byproducts of mental illness denial is a depressing eagerness among the anti-psychiatry quack crowd to leap on any mass murder that occurs as an excuse to blame the crime on psychiatric medications. I first noticed this particularly disgusting phenomenon in the wake of the Virginia Tech shooting five years ago, and, unfortunately, I’m noticing it again now, in the wake of the Sandy Hook Elementary School mass shooting in Newtown, CT, which is not too far from where our fearless leader Steve Novella lives, as he discussed in his ruminations on this tragedy. Indeed, it’s hard to believe that it was only a week and a half ago when a mass murderer, Adam Lanza, walked into Sandy Hook Elementary School and callously gunned down 26 people, including 20 children between the ages of 6 and 7, before shooting himself. A mere two days after the shooting, for instance, Mike Adams, the proprietor of one of the most wretched hives of scum and quackery on the Internet, NaturalNews.com, wrote a post he entitled, Gun control? We need medication control! Newton elementary school shooter Adam Lanza likely on meds; labeled as having ‘personality disorder’, in which he ranted:
According to ABC News, Adam Lanza, the alleged shooter, has been labeled as having “mental illness” and a “personality disorder.” These are precisely the words typically heard in a person who is being “treated” with mind-altering psychiatric drugs.
One of the most common side effects of psychiatric drugs is violent outbursts and thoughts of suicide.
Note: The shooter was originally mid-identified as Ryan Lanza but has now been corrected to Adam Lanza.
The Columbine High School shooters were, of course, on psychiatric drugs at the time they shot their classmates in 1999. Suicidal tendencies and violent, destructive thoughts are some of the admitted behavioral side effects of mind-altering prescription medications.
Then, rather incoherently, Adams switches gears to the claims that prescription drugs cause 100,000 deaths a year and arguing that guns should’t be banned based on this shooting incident but rather psychiatric drugs are at the root of the violence:
For guns to be as deadly as medications, you’d have to see a Newton-style massacre happening ten times a day, every day of the year. Only then would “gun violence” even match up to the number of deaths caused by doctor-prescribed, FDA-approved medications.
Why does America grieve for the children killed in Newton, but not for the medical victims killed by Big Pharma? Are the lives of people on medication not valuable compared to the lives of children in elementary school? Will Obama shed a tear for the victims of Big Pharma, or are his tears reserved only for politically expedient events that push his agenda of unconstitutional gun restrictions?
If our goal us to stop the violence in America, we are completely dishonest if we do not consider the mental causes of violent behavior. And that starts with mind-altering psychiatric drugs which I believe have unleashed a drug-induced epidemic of violence across our nation.
This is a claim we hear frequently from quacks like Mike Adams. Of course, at the time he started making these charges he had no evidence that Adam Lanza was even on psychiatric medications, much less that they caused or contributed to his having turned a school into an abattoir. Of course, little things like facts and science never stopped Adams in his relentless quest to be the firstest with the craziest, and this was no exception. A couple of days ago, not to keep the crazy under check, Adams followed up his original article with one entitled The solution to the insanity: Ban all people on psychiatric medication from owning guns, driving cars or voting for President. In his “satire,” he advocated banning people on psychiatric medications from driving, owning guns, or running for public office, proclaiming that “medication makes some people go crazy with violence.”
Nice how Mike Adams so casually demonizes those with mental illness, throwing around terms like “crazy.”
Be that as it may, Mike Adams isn’t the only one doing this. For instance, Teresa Conrick, over at the antivaccine crank blog Age of Autism, wrote a post the other day with a title almost as charming as Mike Adams’, Pharmagunddon: School Shooters and Psych Meds. After correctly castigating some media reports that the shooter Adam Lanza had Asperger’s, a justified response to the implication in some of these reports that it was autism that lead Lanza to become so violent, unfortunately Conrick goes straight into an anti-psychiatry rant as bad as anything Mike Adams has done.
If there’s one thing antivaccinationists are good at, it’s confusing correlation with causation. After all, the entire antivaccine belief system involves correlating increasing prevalence of autism over the last 20 years with increases in the number of vaccinations in the recommended childhood vaccine schedule. So it’s not at all surprising that Conrick thinks she’s found a correlation:
“Despite 22 international drug regulatory warnings on psychiatric drugs citing effects of mania, hostility, violence and even homicidal ideation, and dozens of high profile school shootings/killings tied to psychiatric drug use, there has yet to be a federal investigation on the link between psychiatric drugs and acts of senseless violence.”
“At least fourteen recent school shootings were committed by those taking or withdrawing from psychiatric drugs resulting in 109 wounded and 58 killed (in other school shootings, information about their drug use was never made public—neither confirming or refuting if they were under the influence of prescribed drugs.) The most important fact about this list, is that these are only the shooters where the information about their psychiatric drug use was made public. To give an example, although it is known that James Holmes, suspected perpetrator of a mass shooting that occurred July 20, 2012, at a movie theater in Aurora, Colorado, was seeing psychiatrist Lynne Fenton, no mention has been made of what psychiatric drugs he may have been taking.
She then lists 14 more incidence of violence in which the perpetrator was taking psychiatric medications. As I said, confuse correlation with causation for vaccines, confuse correlation with causation regarding psychiatric medications for this issue. So what is the actual evidence? Clearly quackery supporters like Conrick and Adams are not interested in a balanced presentation; they’ve cherry picked their evidence to find only studies that suggest a link. The most prominent of these studies, which is referred to time and time again by those of Adams’ ilk is a study that was published in PLoS ONE a couple of years ago by Thomas J. Moore, Joseph Glenmullen, and Curt D. Furberg entitled Prescription Drugs Associated with Reports of Violence Towards Others.
Basically, this study was a review of adverse event reports from the Food and Drug Administration (FDA) Adverse Event Reporting System (AERS) from 2004 through 2009, searching for drugs with a disproportionate number of reports of AEs involving violence towards others. Disproportionality in reporting was defined as “a) 5 or more violence case reports, b) at least twice the number of reports expected given the volume of overall reports for that drug, c) a χ2 statistic indicating the violence cases were unlikely to have occurred by chance (p<0.01).” The authors identified 1,527 cases of violence reported disproportionately for 31 drugs. Some of the drugs included varenicline (used for smoking cessation), 11 antidepressants, 5 sedative/hypnotics, and three drugs for attention deficit hyperactivity disorder. Among the drugs, varenicline stood out.
Of course, those of you who’ve been reading my posts on vaccines will see the problem with this study. The AERS database is one letter removed from the VAERS database (i.e., the Vaccine Adverse Events Reporting System). In fact, these days, it’s known as FAERS, the FDA Adverse Events Reporting System, and it serves essentially the same function as VAERS, namely to serve as a post-approval surveillance system, to serve as the “canary in the coal mine,” so to speak. However, it also shares all the problems with VAERS. The biggest problem is that FAERS, like VAERS, is a passive reporting system to which anyone can report suspected adverse events:
Reporting of adverse events and medication errors by healthcare professionals and consumers is voluntary in the United States. FDA receives some adverse event and medication error reports directly from healthcare professionals (such as physicians, pharmacists, nurses and others) and consumers (such as patients, family members, lawyers and others). Healthcare professionals and consumers may also report adverse events and/or medication errors to the products’ manufacturers. If a manufacturer receives an adverse event report, it is required to send the report to FDA as specified by regulations. The reports received directly and the reports from manufacturers are entered into FAERS.
Scott Gavura recently wrote in depth about the strengths and weaknesses of adverse events reporting systems, including both FAERS and VAERS, reinforcing that the biggest problem with AERS, be it FAERS or VAERS, is that there is no denominator. We have no idea whether an increased number of reports indicates a true increase in incidence or represents an artifact of increased reporting. For instance, it’s been suggested that, thanks to trial lawyers wanting to sue vaccine manufacturers, the VAERS database has been hopelessly distorted with increased reports of autism being caused by vaccines, even though rigorous controlled epidemiological trials do not support this link. As a result, not surprisingly, I don’t take this study very seriously.
I also can’t resist pointing out that what’s good for the goose is good for the gander. Critics of big pharma frequently castigate studies by investigators with conflicts of interest involving big pharma; so the conflicts of interest of the authors of this study are fair game in my book. They’re doozies, too:
Mr. Moore has received consulting fees from litigators in cases involving paroxetine, and was an expert witness in a criminal case involving varenicline. Dr. Glenmullen has been retained as an expert witness in cases involving varenicline and psychiatric drugs including antidepressants, antipsychotics, benzodiazepines, mood stablizers, and ADHD drugs. Dr. Furberg has received consulting fees from litigators in cases involving gabapentin.
Kind of like Andrew Wakefield being funded by trial lawyers, isn’t it?
Speaking of Andrew Wakefield, I also can’t resist mentioning that last Friday Wakefield himself decided to throw himself into the fray by publishing a tirade on the antivaccine crank blog Age of Autism that is just as misguided, wrong-headed, and inept as anything that Mike Adams, or Teresa Conrick has written entitled Patterns In Chaos: Child Psychiatry, Violence and Autism. Like Conrick, he begins by correctly countering the misinformation rampant in the media in the wake of the Sandy Hook shooting that Lanza had Asperger’s syndrome and correctly asserting that there is no good evidence of a link between autism or autism spectrum disorders and an increased propensity for violence and mass murder. Unfortunately, Wakefield then does what antivaccinationists do so well and proposes an alternate explanation that involves the same confusion of correlation with causation that Mike Adams and Teresa Conrick fell for, tying them to vaccines:
And for those at risk – young people receiving off-license mind-bending drugs, an urgent overview of individual indication, efficacy, compliance, and adverse effects must be undertaken, funded by the relevant players in the pharmaceutical industry and conducted independently of any other input from them.
Tragically, predictably, there will be more events like that at Sandy Hook Elementary. The vast number of individuals with developmental disorders presages such events. This is not because of their diagnosis, per se, but rather I would suggest, because they may be at increased risk for adverse reactions (due to pre-existing conditions) and are being inappropriately medicated with drugs for which violence is a recognized adverse reaction. These drugs are being prescribed by a “mainstream” medical system that, through clinical neglect, has run dry on alternative treatments for autism spectrum disorders while enjoying Parma’s inducements way too much to look for any.
My opinion is neither mine alone, nor is it new. In attempting to make sense of the “senseless” it offers both tangible reasons and approaches to prevention. It is not enough that our hearts break for those affected; we are compelled to act. Perhaps inevitably, I am left with a mental image of Pharma lobbyists scaling Capitol Hill like an army of Orcs closing on Helm’s Deep. It’s a hideous sight.
No, the hideous site is someone like Wakefield, who has arguably done more than any single person in the world to endanger public health than any living person through his dubious, trial lawyer-funded research that sparked the anti-MMR scare that spread from the U.K. to the world, lecturing anyone on anything having to do with vaccines or drug safety. Wakefield then goes on, like Adams and Conrick before him, to list violent crimes and mass murders in which the perpetrator was taking psychotropic medication. It’s not for nothing that Wakefield richly deserved being awarded the Golden Duck Award by the the Good Thinking Society for lifetime achievement in quackery. Truly, Wakefield is in the good company of quacks when one of his articles is indistinguishable in anything other than tone from an anti-psychiatry rant by Mike Adams or Gary Null.
But back to the study and conflicts of interest.
One notes that Dr. Glenmullen has also written books about “solutions” to getting off of antidepressants and castigating antidepressants as causing violence and all sorts of other horrific symptoms. One wonders what Conrick or Adams would say about studies showing these drugs not to be linked with violence if any of the study authors had been paid by a pharmaceutical company to sing the drugs’ praises or had written books about how great the drugs were. I think not. Of course, a COI alone does not mean that the study isn’t a good one or that it should be dismissed out of hand, nor am I advocating that. I do, however, marvel at how closely the competing interests line up with the findings of the study and am pointing out that the authors do have an ax to grind, which should color your interpretation of their results, along with one’s knowledge of how FAERS is like VAERS. Granted, it appears to be more rigorously administered than VAERS in that there is more medical moderation to assess potential plausibility, but it suffers from the same basic issues that VAERS does. Also, in all fairness, the majority of reports to FAERS come from health care professionals and pharmaceutical companies, which are required to report all AEs reported to them to FAERS within a short time period.
Be that as it may, this study is clearly based on finding correlations. It is preliminary, but that doesn’t mean the authors might not be on to something. After all, given the psychotropic effects of certain drugs it’s not implausible that some of them might be linked with violent behavior, and there is certainly other evidence that suggests that certain drugs can make violence more likely. On the other hand, one big problem with studies of this sort is that they rarely control for obvious confounders, such as measuring the baseline rate of violent behavior in patients with the condition who are not treated with the drug in question. As one commenter after a post about this study put it, “Did they screen for people being violent before they took medication? Violent? No, no I was neveeeer violent until I took this pill…” Again, it’s all correlation in a database not well equipped to provide anything but preliminary hypotheses to test in more rigorous trials, and there is no control group. An excellent review article points out some of these difficulties:
A number of epidemiological studies suggest that drugs can induce aggression, unfortunately many fundamental limitations exist in these types of studies linking crime to drugs. Most crimes are the result of a combination of factors such as economic, cultural, genetic, environmental, and interpersonal.8,13 Even when the drug is the cause it is often one of many factors that played a part in the event.8 The definition of “drug related” varies from study to study and among individuals. Many epidemiological studies rely on urine testing for drugs of abuse. Standard urine tests are often limited to a handful of substances.16 Certain substances, such as lysergic acid diethylamide (LSD), are difficult to detect by standard urine drug testing methods.16 Additionally, reports by offenders may minimize or exaggerate the contribution of drugs to the given crime, leading to complications in reporting. Most forensic cases involve illicit drugs rather than prescription drugs. These drugs often come from clandestine sources, so the purity and authenticity of the substances cannot be certain. Direct human studies related to drug-induced aggression are limited and animal studies may provide as background information as to whether a drug can cause violence, for example cocaine.17
Psychiatric conditions associated with criminality include delirium, delusional disorder, dementias, impulse control disorders, bipolar disorder, depression, schizophrenia, schizoaffective disorder, paraphilias, and traumatic brain injury.18 It is important to emphasize that most persons with mental illness are not violent and just having a diagnosis does not create additional risk for aggression. One could extrapolate that if a drug causes delirium or delusions (especially paranoid delusions) then it could result in violence. Unfortunately, mental illness is often a confounding factor in case reports both clinical and forensic. Mental illness may or may not be addressed in epidemiological studies.
The review article also points out that many drugs have been linked with violence based on various evidence but that it’s really hard to demonstrate in any given case that a specific drug contributed to a specific act of violence. Unfortunately, that’s exactly what Adams and Conrick are doing: Trying to blame psychiatric medications for Lanza’s rampage, even though it’s not even clear whether he was on psychiatric medications, and, if he was it’s not known which one(s). A previous report allegedly from Lanza’s uncle that he was on Fanapt was apparently highly dubious.
In any case, regardless of whether Lanza was taking medications of any kind, psychiatric or other, there is no evidence that it was medications that caused his murderous child-killing rampage, any more than there is evidence that mental illness caused him to kill. Indeed, apparently he was assigned a school psychologist because of his social awkwardness and fear that he would be bullied by others or might harm himself. At this point, we just don’t know, and all too often people without a definable mental illness do truly evil things for reasons known only to themselves. While I can understand why a clueless wonder like Mike Adams is so anxious to blame evil acts on the products of big pharma. He thinks big pharma is the root of all evil and that the only answer are his “natural” cures. Conrick, on the other hand, has a special needs children. In correctly castigating writers who tried to imply that autism somehow led Lanza to kill, she turns right around and implies that it was medications associated with psychiatric conditions, thus demonizing those with psychiatric conditions as potential killers through their medications.
Such is the fruit of the anti-psychiatry misinformation spawned by groups like the Church of Scientology: The demonization of those with mental illnesses coupled with making it even harder than it already is for them to get treatment and live lives that are as normal as possible.