Like a bad penny, this one just keeps coming back.
By Patrick D Hahn
As youth prescriptions for antidepressants have skyrocketed, so have youth suicides. A recent diatribe in MedPage Today by Stephen Soumeri and Ross Koppel is the latest attempt in an ongoing campaign to blame soaring rates on youth suicides not on the drugs but on the FDA black box warning linking these drugs to youth suicide – an idea was first put forth by statistician Robert Gibbons in 2007. It was easily refuted by data then, and it is just as easily refuted now.
At the beginning of the piece, Drs. Soumeri and Koppel try to hook readers by tying the matter to the current pandemic:
COVID-19 heralds a second, insidious pandemic affecting mental health, as isolation, fear, and economic devastation become near-universals in the American experience.
Few would argue these points, but it does not follow that any or all of these problems with living are properly regarded as drug-treatable brain diseases. But never mind that for now. What is their basis for arguing that the black box warning increased youth suicide rates?
A study published Wednesday based on 28 years of U.S. death certificate data beginning in 1990 suggests how the FDA’s warning increased suicides, potentially by many thousands, at least for the first several years.
Note the coy, mincing language: “… suggests how the FDA’s warnings increased suicides.” (Emphasis added.) Does science proceed by suggestions, or by rigorous falsification of hypotheses? But again, never mind that for now.
The new study they refer to was authored by Dr. Soumeri and several of his colleagues and is available here. And examination of the authors’ own data knocks the props out from under their argument. Figure 2 shows that antidepressant use for adolescents dropped in 2005, the first full year after the FDA black box warning. It dropped again in 2006, and again in 2007 (the year the Gibbons paper was published), after which it began to climb upward once more.
What about youth suicides? They dropped in 2005, and again in 2006, and again in 2007. As prescriptions for antidepressants rose once more, so did youth suicides. How do the authors then reach the conclusion the FDA black box warning caused the increase in youth suicide? By drawing a trendline for the years 2004 through 2017. But there is no logical justification for their doing so.
Drs. Soumeri and Koppel made all of these points in a 2018 article in STAT, which was then completely debunked by the author Robert Whitaker in his Mad in America blog (as discussed in Chapter Seven of my book, Prescription for Sorrow) – but this bad penny keeps circulating.
This time around, Drs. Soumeri and Koppel also sound a dire warning about the scourge of “nonfinancial conflicts of interest” – their pejorative term for any expert opinion that runs counter to the financial interest of the drugmakers. This is a pristine example of flipping the script. The drug companies have at their disposal a multibillion-dollar propaganda machine which Stalin probably would have envied, while in the opposing corner are mainly unpaid citizen activists, along with a handful of courageous doctors and litigators, who often have paid a heavy personal price for opposing the industry titans.
The problem with using interrupted time series studies to answer this kind of question is that the null hypothesis is overly specific. There could be any number of other confounding factors affecting suicide rates besides the study intervention (in this case, the black box warning) – like, for example, the 2007 Gibbons paper purporting to demonstrate that the black box warning increased suicides. But that possibility seems to escaped the notice of these eminent doctors.
Patrick D Hahn is the author of Prescription for Sorrow: Antidepressants, Suicide, and Violence, recently released by Samizdat Health Writer’s Cooperative, as well as Madness and Genetic Determinism: Is Mental Illness in Our Genes? (Palgrave MacMillan). Dr. Hahn is an Affiliate Professor of Biology at Loyola University Maryland.
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