Pulitzers and Prozac

It's been a bad year for American journalism, given fourth estate gullibility re Bush's WMD claims, plus fictioneering at the New York Times and USA Today.

I'd been hoping (with the dulled, hopeless hope that people on Death Row clutch to their bosoms) that maybe this year the Pulitzer Board would give its prizes a pass, at lest so far as the press is concerned.

But the Pulitzer industry, eternally clubby and corrupt, is designed in part to reassure the citizens that, all available evidence notwithstanding, the press is a vigilant watchdog for our liberties and fully deserves those Constitutional protections that guarantee it a 20 percent rate of return on capital invested.

People are dying in Fallujah and other towns across Iraq in part because the US press didn't do its job and mostly swallowed hook, line, sinker, reel, and rod the WMD claims of Bush, Powell, Rumsfeld, Wolfowitz, and others. Right now US forces, either in uniform or disguised as civilian contractors, are hunting for Sadr the Shia cleric on the grounds his newspaper is telling lies. There's an idea! Send the troops into the New York Times newsroom and arrest Judith Miller! Then run across town and arrest the editor of the New Yorker for printing Jeffrey Goldberg's endless fictions about the Saddam/Al Qaeda connection.

The year after 9/11 they gave the New York Times seven Pulitzers, a ridiculous number. The Times' coverage was mostly maudlin tripe. The idea was to proclaim to the world that the Twin Towers may have fallen but New York City still could boast a titan to tell the tale. This year the Los Angeles Times scoops five, which is still ridiculous. I guess the idea was to distract attention from the New York Times' fall from grace by whooping up a new titan at the other end of the country.

You want another example of the press lumbering about a decade behind reality? Try the saga of antidepressants. Six years after Kip Kinkel, dosed up with Prozac, killed his parents and two students at Thurston High in Oregon; five years after Eric Harris, dosed with Luvox, embarked on his day of slaughter at Columbine; well over a decade after naysayers including Dr. Peter Breggin, the Scientologists, and this columnist raised the alarm about links between antidepressants and violence, the FDA has issued a warning that ten antidepressants can cause deeper depression and, for gosh sakes, even AGITATION, MANIA, and other forms of VIOLENT behavior, even SUICIDE! Who says government doesn't work?

Ten years ago it was hard to get any editor to print a news story about the abundant evidence that antidepressants carried serious, even lethal side effects.

The FDA issued this ruling on March 21, and it applies to Prozac, Zoloft, Paxil, Luvox, Lexapro, Effexor, Wellbutrin, Serzone, Remeron, and Celexa. Since the FDA cocks a nervous eye at such important constituencies as the pharmaceutical industry and that industry's political reps in the White House and Congress, it is cautious about over-hasty and tasteless prying into cause and effect. The FDA says it isn't yet clear whether antidepressants contributed to the emergence of suicidal tendencies, such as those that prompted Bill Forsyth, after several days on Prozac, to kill his wife, then himself.

To move towards any conclusions on this issue the FDA will be reanalyzing data compiled by analysts who conducted the original clinical trials for each of the products (technically, selective serotonin reuptake inhibitors, or SSRIs) about which warnings have now been issued.

So there'll be a pause, during which time the FDA can fend off concerns with comforting talk about "a thorough-going review" and the drug companies can continue to mine their usual extortionate mark-ups from the antidepressants, for which 213 million prescriptions were issued in the US in 2003. One estimate has 30 million Americans on antidepressants, with Zoloft in the lead at 32.7 million dispensed prescriptions in 2003 and Prozac loping along in second place with 22.2 million.

The actual review will probably end up with a ringing affirmation of the diligence of the FDA's procedures. In an excellent article in Insight (Feb. 17-March 1) Kelly Patricia O'Meara quoted an attorney, Karen Barth Menzies, who has represented victims of SSRIs. According to Menzies, the FDA's planned methodology will be to go back and look at the number of "suicide events" recorded during the drug companies' clinical trials. "The only thing that can come from this panel's review of the data is that they get the same number or FEWER (my caps) incidents of suicide events which will now be based on the panel accepting that the researchers' evaluation was correct." You follow?

And no, the FDA will not release the names of the "independent experts sitting on the panel who may or may not have ties (i.e., boatloads of research funding) from the pharmaceutical companies whose procedures they are scrutinizing. On one advisory committee mustered over a decade ago by the FDA to take a look at Prozac, five of the eight members had serious conflicts of interest, including financial backing from Lilly, the drug company selling Prozac.

The FDA only lifted its backside momentarily off the cushion of indifference because the British Committee on Safety of Medicines concluded last year that the "risks of treating depressive illness in under 18s with certain SSRIs outweighs the benefits of treatment." Zoloft, Celexa, Paxil, and Effexor were found to increase the rate of self-harm. Prozac got a thumbs-up as having a favorable benefit-risk ratio, a conclusion that some have found astounding. A large-scale study of 2,770 patients on antidepressants featured in the British Journal of Psychiatry found that fluoxetine (Prozac) had the highest risk of deliberate self-harm. Menzies told Insight that in her view Prozac got excluded by the British Committee because Eli Lilly has been dealing with the issue a lot longer and "they're a lot better at hiding evidence of a causal link between suicidality and Prozac."

On this point Menzies knows what she's talking about. At the Forsyth trial her law firm got hold of internal Lilly documents displaying a distinct aversion to truth on the vexing business of suicidal ideation. Back in 1986, a draft of a proposed "Precaution and Adverse Reactions" on a Prozac package contained this sentence, briskly edited out of the final version: "Mania and psychosis may be precipitated in susceptible patients by antidepressant therapy." Another memo in 1992 showed one Lilly employee confiding to another: "re Adverse Drug Event Reporting--Suicide Fluoxetine: 'I personally wonder whether we are really helping the credibility of an excellent ADE system by calling overdose what a physician reports as suicide attempt and by calling depression what a physician is reporting as suicide ideation.'"

I don't see any way the pharmaceutical antidepressants will take any serious long term hit from the FDA warning and impending review. It's like going after the cement and highway lobby. There's just too much money involved. In the case of "depression," a vast new territory opened up for exploitation after the economy peaked in the mid-60s and people stopped drinking dry martinis. The money is strung out along a golden conveyor belt that stretches all the way to the American Psychiatric Association's definitions of neurotic and psychotic conditions in the periodically issued Diagnostic and Statistical Manual, which ends up sanctioning medical reimbursements for drug therapy.

Now there's meat for lots of good investigative reporting. But I doubt we'll read much about it in the corporate mainstream press. Aside from anything else, the pharmaceutical industry spends a lot of money on advertising, and there's always that little matter of the Constitutional guarantee of a 20 percent rate of return.