Furious Seasons

January 08, 2009

Likely Surgeon-General Appointee Sanjay Gupta Claimed No Suicides Among Children On Anti-Depressants

Yesterday, I noted that CNN's chief medical correspondent Sanjay Gupta, a neurosurgeon, was expected to be named Surgeon-General of the US by President-Elect Barack Obama. I noted that I had concerns because Gupta struck me as a lightweight as a reporter--and I am in a position to make that kind of judgment--and that he had openly supported the use of the HPV vaccine Gardasil, well in advance of its FDA approval, and that he downplayed the risks of Vioxx, months before the drug's maker took the drug off the market and months before thousands of lawsuits erupted around the drug and how its risks were hidden by Merck.

I noted that I didn't want Gupta anywhere around mental health issues if he had such a track record of being wrong and intellectually incurious, but I hadn't been able to track down how Gupta had handled issues like depression and anti-depressants and suicide while at CNN. I've now rectified that and it is clear that Gupta screwed up his reporting on anti-depressants and suicide in 2004, ignoring evidence that was available to him before he went on-air.

In late 2003, Britain banned the use of anti-deperssants, excepting Prozac, in children under 18 years due to reports of suicides and suicidality. But nine months later, here's our Surgeon-General-to-be claiming children haven't committed suicide on these drugs. From Sept. 15, 2004 on CNN's "American Morning:"

"[HEIDI] COLLINS [CNN ANCHOR]: ... this pamphlet will come once you get the drugs from the pharmacy -- they'll be in the bag, right?
[SANJAY} GUPTA: That's right. I mean, it's more stuff to read, but it's going to talk specifically about the studies, specifically about the increased likelihood of suicidal behavior.

COLLINS: So, how do these drugs end up going from depression to suicide? Quickly.

GUPTA: You know, it's interesting, because the disease itself, depression, can be linked to suicide. So, it's been a real battle for people to try and distinguish between the two.

The way they think it works is that if you are severely depressed, you take the medication, it may make you feel well enough to feel suicidal -- you know, where you have enough energy to actually commit -- carry out a suicide. No one has committed suicide on these drugs, children-wise, but they think about it a lot.

COLLINS: All right. Dr. Sanjay Gupta, thanks so much for that.

GUPTA: Thank you." (Emphasis mine.)

As I noted yesterday, as a reporter Gupta strikes me as a lightweight outside of neuroscience and neurosurgery, who either gets his information straight from pharma companies and establishment doctors or is too incapable or incurious as a reporter to look for contrary information. Or his producers at CNN are totally misserving him by not doing an appropriate amount of digging on his behalf.

If Gupta was referring to the oft-used argument by SSRI-suicidality deniers that there were no recorded suicides in clinical FDA approval trials of SSRIs and other modern anti-depressants, then he'd be correct. But Gupta doesn't cite his evidence base, clearly doesn't care about other anecdotal evidence, doesn't care about studies like the infamous Paxil Study 329 (which was in children, and included instances of profound suicidality that Brown University psychiatrist Martin Keller, the study's lead author, worked to cover up) which was published in 2001 and had a storm of controversy around it not long after (someone vaguely attentive to the medical press should've been semi-aware), and simply handled the story in a pharma-friendly, journalistically-lazy manner. I dislike lazy journalists, especially when they are making big TV money and have reams of producers and interns working under them who can do the digging someone like Gupta doesn't have the time for.

Besides evidence has been trickling out since Gupta's 2004 piece on how GlaxoSmithKline, Paxil's maker, worked to cover up suicides and suicidality from FDA approval trials. From the New Scientist in February 2008:

"However, GSK researchers submitting data on Paxil to the US Food and Drug Administration in the late 1980s and early 1990s included suicides and suicide attempts from the washout period in the results for the placebo arms of trials, but not from the Paxil arms. Glenmullen alleges that these extra "placebo" suicides negated suicides attributed to Paxil in the trials, making the drug appear safer than it really was. He says that if the washout results had been excluded, the data would have showed that Paxil increased eightfold the risk of suicidal behaviour in adults."

Of course, Gupta couldn't have known about those documents in 2004, but why wouldn't he choose to do a piece about new evidence that had emerged around suicides and SSRIs since? It's kind of hard to imagine why he wouldn't unless he flat out wasn't interested or was, inexcusably for a medical reporter, unaware of the efforts of Sen. Charles Grassley (R-Iowa) and others to reveal the real issues afoot here, including suicides on SSRIs and other anti-depressants plus all the other hubub of news around psychiatry these days. He could've reported on the 2004 suicide of healthy volunteer Traci Johnson, a 19-year-old woman who hanged herself at an Eli Lilly clinical trials facility while taking Cymbalta in a trial of the drug for stress urinary incontinence (Johnson didn't have a history of depression). That would've made for some interesting TV news.

If Gupta's going to handle such complex, tricky issues in such a careless manner, then how's he going to handle other public health matters? With 30 million people a day in America taking an anti-depressant of some kind for some reason, the issue of suicide, suicidality and anti-depressants is an actual public health issue. If Gupta and CNN don't get that, then they need to have their heads examined.

Anyway, in addition to the British ban, by the time Gupta went on-air in September 2004, there were several known cases of anti-depressant-induced suicides among children and, in fact, some of those parents had already spoken out publicly and would've been available for an interview.

Here are a few:

July 1997 suicide of Matt Miller, 13, in Kansas. He was taking Zoloft. His father blamed the drug.

July 2003 suicide of Julie Woodward, 17, of Pennsylvania. She hanged herself, seven days after beginning Zoloft. Parents blamed the drug and testified at FDA hearing.

January 2004 suicide of Candace Leigh Downing, 12, of Virginia. She hanged herself soon after a dosage increase of Zoloft. Parents blamed the drug and testified before the FDA.

January 2000 suicide of Caitlin McIntosh, 12, of Texas. She hanged herself weeks after being started on Paxil and, then, switched to Zoloft. Parents blamed the drug and testified at a February 2004 FDA hearing.

What's more, British psychiatrist David Healy had, by 2004, estimated that 500 American children had killed themselves on SSRIs. Healy is an authority on these issues. Given Gupta's account of no suicides of kids on anti-depressants, it's obvious neither he or anyone at CNN could have spoken with Healy.

I simply believe that someone who displays such a lack of curiosity as a reporter and alleged medical expert offers much to worry about as Surgeon-General. As I noted yesterday, Gupta has openly pimped for Gardasil and was dead wrong about Vioxx and now it is clear that he was very wrong about anti-depressants and suicide.

His appointment as Surgeon-General should be reconsidered.

Posted by Philip Dawdy at January 8, 2009 12:03 AM

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Comments

"No one has committed suicide on these drugs, children-wise, but they think about it a lot."

And we all know that thinking about suicide--even a little--is a wonderful improvement in a person's life, right. Right?

Posted by: Sherry at January 8, 2009 05:39 AM

Fierce post and analysis Philip. Keep it up.

Posted by: JC at January 8, 2009 05:39 AM

Great piece Philip- should be mandatory reading for every American old enough to read it.

But when I think of the majority of Surgeon Generals in my life time- the one who stands out is Koop. And I am assuming President Elect Obama wants someone very handsome and photogenic. He got that in Mr. Gupta. However the more I learn about Mr. Gupta, that seems to be the only thing he has going for him. He is very good looking and photogenic. But if that is his only criteria, a doctor who is good looking, and knows how to work a television camera,- He would have been better off to nominate Dr. Will Kirby, or Dr. Travis Stork.

So what do we do know? Write to President elect at the White House and complain as a US citizen who has voted in ever election since I was 18?

Posted by: susan at January 8, 2009 06:00 AM

Damn, and Sanjay is so cute. Oh well, I'm with you. Does anyone know of any other potential nominee that might be worth being enthusiastic about?

Posted by: Sally at January 8, 2009 07:44 AM

Sally-

the future first pup. He/She is still out there waiting in a shelter I hope for his new parents......

Posted by: susan at January 8, 2009 10:09 AM

I think Dr. Gupta appeals to that celeberty side of Obama. The new president is a very smart guy, but I think there is a part of him that likes the stage. Dr. Gupta seems to fit that role.

I don't know Dr. Gupta personally, but it seems like we need a heavy hitter in there if healthcare reform is really one of the major themes of the new administration.

Posted by: Andrew at January 8, 2009 11:44 AM

Good to know, Philip. I haven't bothered to follow the news lately but I wonder how in the world Gupta ended up for consideration as a Surgeon General.

Posted by: Marissa at January 8, 2009 01:05 PM

Thanks for getting on this Philip! I think Sanjay Gupta may lack more than just depth. I just read that he's a cohost on Accent Health, that doctor's-office "news" program that blatantly advertises the latest drugs to the folks in the waiting room. I'd be REAL suspicious of anyone who takes that kind of work.

If Obama wants someone media friendly for surgeon general, he could try Dr. Andrew Weil. He's gotta be a hell of a lot more independent than Gupta, knows more about public health, and he has a great beard. Fat chance though.

Posted by: Johanna at January 8, 2009 06:02 PM

Damn right we should worry about him as SG. And this is from a 'fellow faculty member' at Emory. He doesn't do any real critical analysis of medical studies and therefore becomes a shill for the pharmaceutical industry. What is most concerning to me is that he hosts the TV show that plays in doctors offices and is full of pharma DTC ads. I am sorry but this is a violation of my Hippocratic oath.

http://www.beforeyoutakethatpill.com/2009/1/SG.html

Posted by: Doug Bremner at January 8, 2009 06:12 PM

With the exception that we live in Maryland and not Virginia, you are dead on about antidepressants being killers. At least with the initiation of the Black Box warning on October 15, 2004, we now have awareness, something not made available to us when Candace died. Tell Gupta to try looking on the Drug Awareness website to view over 2800 documented cases of death by antidepressants. We actually learned of the true dangers by attending the FDA Hearings held in February, 2004, just three weeks after Candace died. The testimony of Mark and Cheryl Miller about their son, Matt, was what opened our eyes. Tell Gupta to talk to me. I'll set him straight, at least on this issue........

Posted by: mathy milling downing at January 8, 2009 07:22 PM

Remember Pfizer paid $$$a million $$$ for box seats at the Democratic National Convention! But who was paying attention to those details?

Posted by: Stephany at January 9, 2009 03:07 PM

5.Problems with Seroxat and other SSRIs
Prozac and Seroxat are the best-known examples of SSRI and related antidepressants, but others are widely used. The introduction of SSRIs led to a threefold increase in antidepressant prescriptions between 1990 and 2000.Prescriptions for antidepressants now match those of the benzodiazepine tranquillizers at their peak, 25 years ago.
Almost from the outset, there was concern about two main problems with SSRIs. First, there was suspicion (initially centred on Prozac) that these drugs could induce suicidal and violent behaviour – infrequently, but independently of the suicidal thoughts that are linked to depression itself. There was also concern (centred on Seroxat) about a risk of dependence; some users found it impossible to stop taking SSRIs because of severe withdrawal symptoms. The MCA/CSM formally reviewed these problems on several occasions.The suicidality problem was first investigated in 1990/1; withdrawal reactions were investigated in 1993,1996 and 1998.In 2002,the MCA organised a further intensive review of both problems. This review was abandoned in April 2003, following criticism about conflicts of interest involving key figures on the review team.

Excerpt from "The Influence of Pharmaceutical Industry" review

http://www.publications.parliament.uk/pa/cm200405/cmselect/cmhealth/42/42.pdf

I've already said here that I had drug-induced suicide ideation while tapering Effexor.
It's something totally different from really WANTING to die. This is not evidence, I know, it's not even anecdotal because I didn't kill myself.
I believe that we need experts from other area to explain suicides under SSRIs.
Forensic scientists, social scientists, lawyers? I don't know.
The words of patients are not enough, the words of parents who are advocating for their children are not enough.
Psychiatrists that are seen as "dissidents" books and statements are not enough.
This is the man who will be named Surgeon-General of the US by President-Elect Barack Obama?
Where is the CHANGE Mr. Obama?
I'm a Brazilian citizen and I don't like to talk about American politics.
However I've been dedicating my life this year doing my tiny little task to help Americans like Philip Dawdy and many others who are trying to raise awareness not only on mental health but also on the abusive use of psych-drugs and other drugs.
I'm also concerned with my country and many other countries because these drugs are from American Labs (some from UK and other countries, I know)
It's impossible not to look at American politics when it has a huge impact on the rest of the world.
FDA regulates drug marketing in many countries.
If you don't take care of your own children I don't know what else can I (we) wait from this side of America that is haunting the world.
I'm very sorry being so passionate and write in such a way but I could not help myself.
I'm looking forward seeing who will be at FDA.

Posted by: Ana at January 10, 2009 12:09 PM

The suicide-anitdepressant issue isn't as cut and dried as it sometimes seems. Black box warnings are used in medication whenever a correllation is seen, but it doesn't mean that the entire medical community has conclusively determined that anti-depressants cause suicidailty in children, simply that there is enough evidence to merit caution. It is still possible that completely scientifically valid methods will show no such connection between antidpressants and suicide in coming years.

We know, for example, that severely depressed people sometimes do not develop suicidal tendencies until they feel they have enough energy to kill themselves. The antidepressant meds may simply be elevating patients to that point where suicide becomes an increased threat on the path to recovery. But even that is just one unproven theory as to why there appears to be a correlation between the meds and suicide right now.

Posted by: CB in DC at January 12, 2009 02:58 AM

Well, Phillip got it WRONG.
Antidepressants have NOT led to additional suicides. In fact, since the warning emerged in the PDR, and the rate of prescription for antidepressants for teenagers dropped, the RATE OF SUICIDES AMONG TEENAGERS INCREASED.

If you go back 25 years, to when the new generation of AD's (that are much safer than previous AD's) emerged, and doctors became more comfortable prescribing them, the suicide rates among those diagnosed with serious depression DROPPED.

There has not been a single study that showed a Casue-Effect link between antidepressants and increased suicides among teens or young adults. The FDA didn't do ANY due diligence when imposing the warnings and studies since the warning have overwhelmingly concluded the OPPOSITE of the FDA warning.

Gupta got it RIGHT.

Philip Dawdy responds: you're welcome to your opinions scott, but data that's come out in the last year or so show that, on a population-wide basis, that anti-depressant use and suicide rates appear to be independent of one another. for example, in britain, after anti-deps were largely banned for under 18s, the rate of suicide went down among that age group. as for suicidality induced by anti-deps in kids or adults, my opinion is you are so off-base that it's not even funny. as for your contention that the advent of second-generation anti-deps dropped suicide rates among those with 'serious depression,' please cite your source for that. the overall suicide rat in america has dropped a bit since the late-80s but not so much as you seem to suggest. but i'm open to seeing your evidence.

Posted by: Scott W at January 26, 2009 01:35 PM