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Response to Charles Krauthammer's Op-Ed Another massacre, another charade suggesting that psychosis, not guns, is the real cause of mass shootings in America.


On the one hand, Mr. Krauthammer suggests that more aggressive psychiatric intervention might make a difference; and on the other he states that Roseburg shooter Christopher Harper-Mercer "had no psychiatric diagnosis beyond Asperger's."

First, apparently Mr. Krauthammer missed the memo that Asperger's is no longer a psychiatric diagnosis - it was voted out of the latest version of the American Psychiatric Association (APA) Diagnostic and Statistical Manual (DSM-5), published in May 2013.  Many people don't realize that so-called mental disorders are voted in or voted out of American psychiatry's "bible," not scientifically discovered or undiscovered.  Another prominent example of a so-called mental disorder going the way of the dodo by popular vote of American psychiatrists is homosexuality, first included in, then excluded from the DSM.  Referring to the DSM-5, Dr. Thomas Insel, Director of the National Institute of Mental Health (NIMH), declared,"The weakness is its lack of validity.  Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure... Patients with mental disorders deserve better... That is why NIMH will be re-orienting its research away from DSM categories." ( http://www.nimh.nih.gov/about/director/2013/transforming-diagnosis.shtml

American psychiatry's inability to determine with scientific clarity what does or does not constitute a mental disorder is compounded by the fact that the United States is one of only two countries in the world, New Zealand being the other, that allows direct-to-consumer advertising by pharmaceutical companies.  Big Pharma does such a good job of disease-mongering -- often inventing then selling a disorder and creating then funding corresponding "grassroots" advocacy groups (aka "astroturfing") in order to sell their drugs -- that it makes it difficult to take back a mental disorder once it has been invented and sold to the American public. 

The first and most obvious flaw with the wishful thinking that more aggressive psychiatric intervention might make a difference (read prevent) mass shootings in America is that American psychiatry cannot reliably define what a mental disorder is, let alone agree upon and recommend its efficacious treatment.

Second, Mr. Krauthammer can't possibly know for a fact that Mr. Harper-Mercer's only psychiatric diagnosis was Asperger's.  This is a classic example of jumping to conclusions, based on a report of out-of-context online posts by a relative.  It has also been reported that Mr. Harper-Mercer's online alias was "Lithium_love."  It should be noted that if in fact Mr. Harper-Mercer was taking lithium, that drug is indicated for Bipolar Disorder, not Asperger's (or Autism Spectrum Disorder/ASD).  So if Mr. Harper-Mercer was prescribed lithium, he was either diagnosed with Bipolar, or the drug was prescribed to him off-label.  To be sure, off-label prescribing, as well as polypharmacy (ie. prescribing multiple drugs), is rampant in American psychopharmacology, a symptom of the shoot first aim later, trial and error prescribing habits of an industry that has a tough time defining mental illness, much less deciding on how to effectively treat it.  The reality is we will probably never know the extent of Mr. Harper-Mercer's psychiatric diagnoses, or the name, number and doses of the psychotropic medications prescribed to treat them.

Third, Mr. Krauthammer invoked the Naval Shipyard shooter Aaron Alexis as an example of someone whom he suggests did not receive needed psychiatric help.  In fact, Mr. Alexis received psychiatric care from the Department of Veterans Affairs, in the form of a prescription for the antidepressant drug Trazodone ( https://www.washingtonpost.com/national/health-science/trazodone-antidepressant-used-by-aaron-alexis-described-as-very-safe/2013/09/18/4336c044-20ae-11e3-966c-9c4293c47ebe_story.html ).  Mr. Alexis went voluntarily to the VA for help with a psychiatric symptom, and pills are what he was given.  This is where we get to the root of the problem, as well as expose one of the biggest myths about mass shooters.

The fact of the matter is that most mass shooters in recent history were under psychiatric care and were prescribed psychotropic medications: e.g. Joseph Wesbecker (Prozac, lithium, trazodone, temazepam), Eric Harris (Luvox), Edward Lutes (Luvox), Jeffrey Weise (Prozac), Steven Kazmierczak (Prozac, Xanax, Ambien), Robert Stewart (Celexa, Xanax), Kipland Kinkel (Prozac, Ritalin), Aaron Alexis (Trazodone), James Holmes (Zoloft, Klonopin), Ivan Lopez-Lopez (Celexa, Wellbutrin, Ambien, Lunesta), Aaron Ybarra (Prozac, Risperdal), Bradley Stone (Risperdal, Trazodone), Elliot Rodger (Xanax), Myron May (Vyvanse, Wellbutrin, Seroquel), etc.

The suggestion that the aforementioned mass shooters were not receiving psychiatric care, and if only they had access to needed psychiatric care then perhaps the tragedies might have been averted, is misleading.  The problem is that in America -- where doctors are paid handsome consulting fees by pharmaceutical companies to pitch their drugs to other doctors, and where the pharmaceutical industry spends approximately $230M per year to influence Congress --  psychiatric care has become synonymous with psychotropic drugging. 

The earlier choice of the words "in recent history" was not accidental, because this tragic mass shooting phenomenon has only been recent in America's history, since the clock tower shooter Charles Whitman (Valium, Dexedrine) killed 16 people on the University of Texas campus.  In an upcoming documentary, Dr. Jean Stolzer points out that "guns have always been in this country since the first Europeans stepped on American shores." (see also https://leoniefennell.files.wordpress.com/2013/05/the-systemic-correlation-between-psychiatric-medications-and-unprovoked-mass-murder-in-america2.pdf )  Likewise, President Obama has pointed out: "The United States does not have a monopoly on crazy people.  It's not the only country that has psychosis.  And yet we kill each other in these mass shootings at rates that are exponentially higher than any place else.  Well, what's the difference?" [NOTE: Most people missed the fact that Mr. Obama's above response was to a question about mass shootings posed via Tumblr by Nick Dineen, residential assistant to UC Santa Barbara mass killing victim George Chen - whom the coroner later determined was killed with a knife, not a gun, like two other of Elliot Rodger's victims.  Mr. Obama's response and Mr. Dineen's question can be viewed here: https://www.youtube.com/watch?v=NDVFs2l6-fo and the coroner's findings that Mr. Chen, Weihan Wang, and Chen Hong each died of multiple stab wounds can be viewed here: http://www.sbsheriff.us/documents/ISLAVISTAINVESTIGATIVESUMMARY.pdf .  This demonstrates how jumping to conclusions based on initial media reports can be problematic.]

Indeed, what's the difference?  Neither guns or psychosis are new or unique to America.  So what has changed? 

What has changed in America and what is unique to our country is the alarming increase in the number of Americans taking psychotropic drugs, which carry FDA-mandated label warnings of serious psychiatric adverse events, including suicidal and homicidal ideation.

For example, a recent study commissioned by the Louisiana Senate ( http://dhh.louisiana.gov/assets/ADHD/ADHD_DHH_RspnseRsltn39.pdf ) found that 35.8 percent of ten-year-old white boys were diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) and prescribed predominantly stimulant medications, which an FDA Center for Drug Evaluation and Research (CDER) medical reviewer found cause hallucinations, mania, and psychosis at a rate of two to five per hundred person years ( see http://www.fda.gov/ohrms/dockets/ac/06/briefing/2006-4210b_11_01_AdverseEvents.pdf and http://www.fda.gov/ohrms/dockets/ac/06/minutes/2006-4210m_Minutes%20PAC%20March%2022%202006.pdf ).  The FDA's medical reviewer also noted that the psychotic side effects of ADHD stimulants occur in regular doses, in children with no risk indicators or other psychiatric history besides ADHD, and at a rate that cannot be considered rare.

Whereas in some places in our country nearly two out of every five ten-year-old boys are being medicated with psychosis-inducing drugs for ADHD, the estimated rate of ADHD diagnosis in Europe is less than one percent ( https://www.psychologytoday.com/blog/suffer-the-children/201203/why-french-kids-dont-have-adhd ).  Over-diagnosis and over-medication of psychiatric disorders is a decidedly American problem.

Similarly, while Britain was banning antidepressants for kids due to an increased risk of suicidal thoughts and behavior associated with the drugs, the FDA threatened the same medical reviewer, Dr. Andrew Mosholder, with an internal investigation, and prevented him from presenting his findings that the drugs doubled suicidality in kids at a Pediatric Advisory Committee meeting ( http://www.gpo.gov/fdsys/pkg/CHRG-108hhrg96099/html/CHRG-108hhrg96099.htm ).

According to the DSM-5,"Between 7 percent and 25 percent of individuals presenting with a first episode of psychosis in different settings are reported to have substance/medication-induced psychotic disorder."

Big Pharma invented and has successfully marketed the unproven theory that mental illness is the result of a chemical imbalance in the brain.  Swallowing this marketing theory hook, line and sinker, Americans are also swallowing psychotropic pills -- and shoveling them into their children's mouths -- at rates dwarfing other nations. 

Ironically, there is evidence that psychotropic drugs derive their action precisely by creating a chemical imbalance in the brain, according to former NIMH Director Dr. Steven Hyman ( http://search.proquest.com/openview/5610c361a22516dda3dc72bb25f5371e/1?pq-origsite=gscholar ).  Psychiatric medications, he wrote, "create perturbations in neurotransmitter functions."  The brain must then compensate to adapt to "alterations in the environment."  Chronic administration of the drugs, he added, cause "substantial and long-lasting alterations in neural function." 

Referring to his own LSD trip, immediate past President of the APA, Dr. Jeffrey Lieberman, wrote: "My [LSD] trip did produce one lasting insight, though--one that I remain grateful for to this day...I marveled at the fact that [if] such an incredibly minute amount of a chemical...could so dramatically alter my cognition, the chemistry of the brain must be susceptible to pharmacologic manipulations in other ways, including ways that could be therapeutic."  ( http://www.huffingtonpost.com/dj-jaffe/book-review-shrinks-the-u_b_6924810.html )

We, as a nation, are reaping the fruits of this historically unprecedented, massive-scale experimentation on the chemistry of the human brain. 

When most mass shooters were taking psychotropic drugs, it's an insult to what's left of our collectively numbed intelligence to suggest that more psychotropic drugs are the answer to mass shootings.  If psychotropic drugs were the answer, then the astronomical increase in Americans' use of psychiatric drugs should have led to a dramatic decrease in the number of mass shootings, not an increase.  Experience shows that more mental health treatment with psychiatric drugs will lead to more mass murder, not less.

Take, for instance, the case of Bradley Stone.  Not unlike Charlie Gordon in Flowers for Algernon, Mr. Stone might once have been considered a darling example of the shining success of mental health diversion courts and Assisted Outpatient Treatment (AOT) of the kind advocated by Rep. Tim Murphy (R-PA) in his proposed Helping Families in Mental Health Crisis Act (HR 2646) - that is, until Mr. Stone shot and chopped up seven people, before poisoning himself with the Risperdal and Trazodone he was prescribed and then stabbing himself ( http://www.montcopa.org/ArchiveCenter/ViewFile/Item/2128 ). Or there's Spc Ivan Lopez-Lopez who in the months preceding the second deadly Ft. Hood shooting spree voluntarily met with a half dozen Army mental health providers at Ft. Bliss, Ft. Leonard Wood, and Ft. Hood on ten occasions, dutifully refilling prescriptions for psychotropic medications ( http://www.pharmabuse.com/blogs/98 ).

At the very least, we know psychotropic drugs do not prevent mass killings, since toxicology results for most of the aforementioned dead mass shooters revealed the prescribed drugs were still in their blood.  Moreover, the FDA has received 765 reports of homicide as a side effect of psychotropic drugs, many of which were multiple homicides.  Just as the now well-established link between antidepressants and suicidality, which prompted a black box warning, was once covered up, the extent of the temporal link between psychotropic drugs and violence toward others has been concealed from the American public.  Now, thanks to a recent Freedom of Information Act (FOIA) lawsuit filed against the FDA, we're obtaining the relevant adverse event report records, and they will be made public for the first time.

The FDA adverse event records support recent scientific studies finding a link between psychotropic medications and homicide ( see http://ki.se/en/news/study-analyses-link-between-psychotropic-drugs-and-homicide-risk and http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0015337 ).    

U.S. taxpayers should not spend more money on mental health programs promising to prevent mass shooting tragedies, because such undoubtedly costly programs, by the very nature of their promise, would be fraudulent.  If anything, Congress should investigate whether psychotropic drugs, which have been demonstrated time and time again as being incapable of preventing homicide, may actually be living up to their scary label warnings.

The guns versus mental health debate is a red herring.  They are two sides of the same coin - emphasis on coin, as in money.  The gun lobby and the pharma lobby are a marriage made in heaven (or, more aptly, hell).  We're hearing from the gun lobby that more guns would help victims protect themselves from psychotic mass shooters.  We're hearing from the pharma lobby that forced mental health treatment with psychotropic drugs, which the mass shooters were already voluntarily taking, would prevent mass shootings.    

The only lobby seemingly letting a crisis go to waste is the entertainment lobby.  We haven't heard that more violent video games and movies would prevent mass shootings -- yet.
Everyone can agree that smoking cessation is a good thing. But the admirable goal of getting more people to quit smoking does not justify biased research which potentially puts more lives in danger.

The media is asleep at the wheel again, running headlines about a recently published U.K. study, acquitting the smoking cessation drug varenicline -- marketed in the U.S. as Chantix and in the U.K. as Champix -- of earlier reports of the drug causing serious neuropsychiatric adverse events, such as changes in mood (including depression and mania), psychosis, hallucinations, paranoia, delusions, homicidal ideation, hostility, agitation, anxiety, and panic, as well as suicidal ideation, suicide attempt, and completed suicide. [The foregoing reported adverse events are verbatim from the drug's FDA-approved warning label.]

The FDA's concerns about Chantix were so serious that they prompted the agency to require the drug's manufacturer Pfizer to conduct and develop a Risk Evaluation and Mitigation Strategy (REMS), a rare step that has only been taken in a handful of cases.

Then, conveniently, along comes a study that absolves the drug once and for all of suspicion, clearing the way for millions more patients to be prescribed what cancer advocacy groups believe is a life-saving drug.  Whew, we can all breathe a collective sigh of relief, and wipe the worry from our brows, right?

Not so fast.

One of the more troubling aspects of the study is that it was funded in part by Cancer Research UK, an advocacy group that makes no bones about developing policy "to inform Government decisions related to cancer and research and communicates our views to key decision makers."  We should be wary of advocacy groups funding research that supports the biased points they're trying to make. Not to pick on any group in particular, but would anyone take seriously a study funded by Scientology that concluded psych drugs are bad?  Absolutely not.  Which is probably why the Church of Scientology, reported to have deep pockets, has not funded scientific research to that effect.  Yet there seems to be a double standard when it comes to advocacy groups that many deem to be worthy causes, whereby their sponsored research is taken at face value.       

Research shows that pharma-sponsored studies typically return results favorable to the sponsor.  Why would advocacy group-funded research be any different?

Then there is the thorny issue of trying to unravel the funding sources of Cancer Research UK, which does not acknowledge receiving corporate donations in its annual report.  The report acknowledges receiving £122 million in funding last year from direct giving, which the advocacy group says includes gifts from over a million people, further noting that "[m]ore than nine out of 10 of the donations we receive are less than £10."  It is understandable why the advocacy group would want to stress the quantity of donations rather than the identity of the larger donors, but doing so doesn't bring us any closer to understanding from whence they got their funding.  After all, if 900,000 [nine out of ten] people gave £9 [less than £10], then the group has only accounted for £8.1 million of the £122 million in direct giving it received last year.

The important issue of the group's funding sources and potential direct financial conflicts of interest with the pharmaceutical industry aside, there is no doubt that Pfizer's research objectives conveniently dovetail with Cancer Research UK's, as is evident by the drug makers web site proudly entitled "Working in Partnership with Cancer Research UK."  The term "evidence-based research" is as ubiquitous in the pharmaceutical world as "cloud services" is in the IT space.  But no amount of throwaway clichés can overcome the fact that sponsored so-called evidenced-based research is still biased.

Then there's the issue of where the study was published -- the Lancet, where two-thirds to three-quarters of the published trials are pharma-sponsored.  Reprints of pharma-sponsored and pharma-favorable trials are a vital funding source for medical journals in general. 

But wait, there's more.  Two of the study's authors, Daniel Kotz and Robert West, have received funding for a smoking cessation trial and other research directly from Pfizer, the manufacturer of the drug being studied, scratch that, being heralded as free of negative effects.  According to the study's credits, Daniel Kotz "
originally conceived the study and drafted its funding application, and drafted the report."
 
How do sponsored studies consistently achieve results favorable to their sponsors?  Through deliberately flawed (ie. rigged) study design.

Take for instance the laundry list of neuropsychiatric adverse events that the FDA requires Pfizer to include on the drug's label.  Cancer Research UK's hand-picked doctors (it should be noted that only one of the study's six listed co-authors is actually a medical doctor) cherry-picked depression and self-harm as the only two neuropsychiatric adverse events to study -- to the exclusion of mania,
psychosis, hallucinations, paranoia, delusions, homicidal ideation, hostility, agitation, anxiety, and panic, as well as suicidal ideation, suicide attempt, and completed suicide.

Incredibly, whereas completed suicide is a reported adverse event, the study's designers "
censored patients who were lost to follow-up because they left the practice or died."  For all we know, some of the patients who died during the study may have committed suicide.

Likewise, of the 51,450 patients taking varenicline the study's authors identified, 1,287 or 2.5% were excluded from the study.  For all we know, the excluded patients using varenicline may have experienced neuropsychiatric events (and cardivascular, which the study also examined).

The reason given for the exclusion?  No match with patients using Nictotine Replacement Therapy (NRT).  The study compared patients taking varenicline to NRT and bupropion (marketed as Zyban and Wellbutrin).  The study identified 106,759 patients using NRT.  Even though the NRT group's sample size was more than double the size of the varenicline group, the study's authors want us to believe that among patients using varenicline there was no match with patients using NRT 1,287 times.  Then, as if by some cosmic coincidence, the study's authors excluded exactly 2.5%, or 164 out of 6,557 patients using bupropion for the same reason.  Though the bupropion sample size is dramatically smaller than the NRT and varenicline groups, the amount of bupropion patients excluded for no match with NRT is the exact same percentage as varenicline.

The identical 2.5% exclusion rate for bupropion and varenicline patients is not a mathematical coincidence.  The 2.5% exclusion rate for bupropion patients was most likely done to match the percentage of varenicline patient exclusions, so the study's authors could say, "See, we excluded the same percentage of bupropion patients as varenicline," to distract your attention away from the fact that they just made 1,287 varenicline patients disappear.  Classic magic trick.

As if to confirm that the study is advocacy-sponsored research in support of advocacy policy, the study's authors conclude, "These findings suggest an opportunity for physicians to prescribe varenicline more broadly, even for patients with comorbidities, thereby helping more smokers to quit successfully than do at present."

The media is either woefully stupid (unlikely), or deliberately has its head in the sand.  One can only wonder to what extent pharma ads buy media looking the other way when such blatantly biased studies are paraded out.

Meanwhile, more credible research into reported varenicline adverse events concluded "that acts of violence towards others are a genuine and serious adverse drug event that is associated with a relatively small group of drugs. Varenicline, which increases the availability of dopamine, and serotonin reuptake inhibitors were the most strongly and consistently implicated drugs."



   
   
The Congressional Energy and Commerce Health Subcommittee held a hearing on Rep. Tim Murphy's Helping Families in Mental Health Crisis Act (HR2646) earlier this week.

Paul Gionfriddo, CEO of non-profit Mental Health America (MHA), was among the witnesses called to testify.  It should be noted that MHA, formerly known as National Mental Health Association or NMHA, has received millions of dollars of funding from the pharmaceutical industry.

Mr. Gionfriddo testified that two-thirds of individuals screened on MHA's website screen positively for mental illness.  If true, this is an alarming percentage, and is less indicative of a mental illness epidemic than it is of the inaccuracy of screening tools used to diagnosis mental illness.  Referring to the latest version of psychiatry's Diagnostic and Statistical Manual of Mental Disorders, National Institute of Mental Health Director Thomas Insel, M.D. wrote, "The weakness is its lack of validity... Patients with mental disorders deserve better... That is why NIMH will be re-orienting its research away from DSM categories."

With the unreliable and inaccurate diagnostic tools available today, increased early identification screening of children for mental disorders proposed in HR2646 would almost certainly exacerbate already out-of-control misdiagnosis and over-medication of children in our country.  This is a decidedly American problem, with the rate of diagnosis of ADHD among children twenty times higher than in other developed countries.  Geographic disparities in diagnosis rates are attributable to subjective, unscientific diagnostic tools.  In the U.S., according to the CDC, children in Florida are almost twice as likely to be diagnosed with and medicated for ADHD than children in California, Nevada or Colorado.

Nowhere does the disturbing trend of misdiagnosis and wrongful medication of children seem more manifest than in Mr. Gionfriddo's own family story.  In the Washington Post, Mr. Gionfriddo wrote, "The school’s evaluations suggested [my son Tim] had what was then called attention deficit disorder... And it turned out that Tim probably didn’t really have attention deficit disorder."  Nonetheless, Mr. Gionfriddo also wrote in his book, "The pediatric neurologist started Tim on Ritalin... It turned out that neither Tim's teacher nor we could see any difference in his behavior, attention, or focus when he was on Ritalin.  The reason, as we would discover later, was that ADHD wasn't really his problem."

In what has now become an all-too-familiar and sad refrain involving people put on perhaps unnecessary, the wrong or harmful psychotropic medications, Mr. Gionfroddo reported, "On Wednesday, November 20, 1996, my son Tim brought a gun to school."  Like Mr. Gionfriddo's son who was put on the ADHD drug Ritalin, attorney Myron May was on the ADHD drug Vyvanse when he brought a gun to his alma mater and began shooting FSU students on November 20, 2014.

While fortunately neither Mr. Gionfriddo's son or other students at his school were harmed during that particular firearm at school incident, after starting on methylphenidate, Tim was later reportedly arrested in a meth lab bust.  Like methamphetamine, methylphenidate (Ritalin) is also a Schedule II controlled substance.  Methylphenidate carries an FDA-mandated Black Box warning - the strongest possible - for drug dependence.

Equally disturbing, years after Ritalin was approved and Mr. Gionfriddo's son was placed on the drug, the FDA released a post-marketing review, in 2006, of adverse event reports to the agency, warning that the data demonstrated children with no risk indicators, on regular doses of any of the stimulants approved for ADHD, experienced hallucinations, psychosis and mania.  According to minutes of the March 22, 2006 FDA Pediatric Advisory Committee meeting, Dr. Andrew Mosholder of the FDA's Division of Drug Risk Evaluation noted that "symptoms of psychosis or mania were estimated to occur [on ADHD stimulants] at a rate of 2 to 5 per hundred person-years... This rate (greater than 1%) cannot be considered rare..."  Like other children seemingly misdiagnosed with ADHD and put on psychosis-inducing stimulants, Mr. Gionfriddo's son would eventually be diagnosed with schizophrenia, a condition often involving hallucinations and psychosis.

It's time for America to step off the misdiagnosis and over-medication roller-coaster.  Due to the profit motive of some and despite the good intentions of others, early mis-indentification of mental illness and wrongful interventions are worsening, not solving the problem.  During a mental health forum sponsored by Rep. Gus Bilirakis on December 16, 2014 in Land O' Lakes, FL, the bill's author Rep. Murphy stated, "Forty percent of the time a person with psychiatric problem [sic] is on the wrong types or level of medication."

HR2646 is old wine (HR3717) in a new bottle.  It's bad for America, and it's bad for our kids.  Parents are intelligent enough to make the right mental health decisions and seek the right mental health care if needed for their children.  They do not need more intrusive, wildly inaccurate and unscientific diagnostic screening thrust upon them or their children.

Our nation's over-reliance on pharmacological answers to life's challenges is manifestly not working for our veterans and military personnel, either.  The Army's report on the 2 April 2014 Fort Hood shootings concluded that the mental health care Spc Ivan Lopez received did not deviate from the standard of care.  Time to rethink the standard of care, which included in Lopez's case an untested polypharmacy cocktail of the psychotropic medications Celexa, Wellbutrin, Ambien and Lunesta.  Our service personnel and veterans deserve better than being treated as guinea pigs, experimented upon with risky, ineffective psychotropic polypharmacy. 

On the topic of Evidence-Based Treatment (EBT), can we agree that four dead and twelve others shot is not evidence of a good outcome of medication management?  It should be noted that Army records indicate that Spc Lopez attended at least ten counseling sessions dutifully over ten months prior to the shooting; met with a social worker therapist, four psychiatrists, and a nurse practitioner; sought multiple medication refills voluntarily on a walk-in basis (Jan 14, 2014; March 6, 2014; March 10, 2014), had psychotropic medications in his blood stream at the time of death per his autopsy, and had even scheduled a follow up mental health appointment prior to his death during a walk-in visit seeking medication.

The problem is not a lack of access to mental health care, a lack of access to medications, anosognosia, medication non-compliance or treatment non-compliance.  The nature of the problem is American psychiatry's fascination with an as yet unproven chemical imbalance theory whereby mental illness is genetically hardwired into individuals.  Dr. Jeffrey Lieberman's exuberant hearing testimony espousing the benefits of psychotropic medications, suggesting they can prevent or eliminate mental illness, should be tempered by his comments that his faith in pharmacologic manipulations is rooted in his first LSD trip.  Patrick Kennedy's impassioned testimony eschewing any moral component of mental illness ignores man's soul, argues fatalistically that we're all just chemical soup, and removes the element of free will.  It's no wonder depression can turn into despair, when psychiatrists tell patients fate has dealt them a hopeless genetic hand.

Harvey Rosenthal testified in the hearing that people need to be offered a promise of hope and recovery, and that Assisted Outpatient Treatment (AOT) is synonymous with medication.  Nowhere is this more evident than in the push to erode the privacy rights of patients. Undermining confidentiality, so long a foundational tenet of mental health care, is a chilling indicator that the page is indeed being turned, some would say forcibly, away from proven yet more time-consuming psychotherapeutic and recovery modalities, in favor of quick but ineffective medication management.  In light of Rep. Murphy's stunning admission that doctors are wrong about psychiatric medications forty percent of the time, we're now going to take away patient privacy in the name of medication compliance?  To comply with the wrong medications?  So that caregivers - often parents who previously forced their children to take the wrong medications under poor medical advice - can continue to harm their kids well into adulthood?

Let parents parent their minor children without intrusion.  Let adults make mental health care decisions for themselves.  We need less, not more, government intrusion into mental health care.

In his determination to erode privacy rights as well as the centuries-old legal protection against false imprisonment afforded by habeas corpus - based upon shaky psychiatric diagnoses and worrisome doctor prescribing habits -  Rep. Tim Murphy claims with great dramatic effect that the mentally ill are dying with their rights on. 

Actually, they're dying with psychotropic medications in their corpses, and often taking others with them.  Spc Ivan Lopez died with antidepressants and sedatives in his body, and took three others with him.  Elliot Rodgers died with Xanax (alprazolam) in his body, and took six others with him.  Myron May died with Vyvanse in his veins, almost taking six others with him.  Andreas Lubitz, Germanwings co-pilot, took 149 other souls with him when, according to the BEA's preliminary report, he committed suicide by intentionally crashing a plane into the Alps, after being prescribed antidepressants.

In the U.S., antidepressants carry an FDA-mandated Black Box warning for increased risk of depression and suicidal thoughts.  Again, on the topic of EBT, can we agree that 150 lost souls is not evidence of a positive outcome of antidepressants?  Can we agree that the aforementioned deadly mass shootings are not evidence of positive outcomes of psychotropic medications?

Ironically, as the HR2646 hearing was closing, testimony of Aurora theater shooter James Holmes' psychiatrist Dr. Lynne Fenton was just getting underway in Colorado.  She testified that Holmes was on a psychotropic cocktail of 150 mg of Sertraline (Zoloft), .5 mg of Klonopin (Clonazepam), and 10 mg of Propanolol.  DA: "Did he ever tell you that he wanted to stop Sertraline?" Dr. Fenton: "No."

The assertion that medication non-compliance is the reason people with a mental illness become violent is simply not true. Medications are not the panacea that Rep. Murphy portrays them to be, and in fact there is credible scientific evidence to suggest that they may be doing more harm than good.

Perhaps Murphy's bill would be more aptly named the Helping Big Pharma and Mental Health Industry Act.
Piecing Together Polypharmacy Regimen of Mass Shooter Despite Heavy Report Redaction

On January 23, 2015, the Army released its long anticipated report on the second fatal mass shootings at Fort Hood that occurred on April 2, 2014. In support of the report, the Army simultaneously released five appendices contained in nineteen other files pertaining to Specialist Ivan Lopez's deadly shooting rampage.

In its findings, the Army concluded, "There was no evidence that any medication, or combination of medications, caused suicidal and/or homicidal thoughts in SPC Lopez-Lopez."  The Army continued: "There was no evidence that SPC Lopez-Lopez’s polypharmacy positive status would have triggered a high-risk flagging..."




In a very literal sense, there was no evidence contained in the report that any medication or combination of medications, known as polypharmacy, caused suicidal or homicidal ideation in Spc Lopez - because the Army made sure of it, seemingly redacting from its report every shred of evidence that could possibly point to such a conclusion.  Or did they?

Names of prescribed medications are obscured in the section of the report discussing Spc Lopez's behavioral health, with entire paragraphs blacked out.  As with Spc Lopez's medication history, the Army did not want to reveal which medications showed up in Spc Lopez's toxicology results.  Rather than stating that there were no medications present in Spc Lopez's post-mortem, the Army stated that the presence of medications was not abnormal, ie. expected and at therapeutic levels: "The autopsy results did not reveal any illegal drugs or the abnormal presence of any other medications in SPC Lopez-Lopez's blood."



In addition to large portions of the report and accompanying appendices being blacked out, notably missing from the redacted evidence was the entire Exhibits Tab "H" of Appendix 4, relating to Spc Ivan Lopez's psychiatric diagnosis, mental health treatment, and prescribed medications.



Undoubtedly, Exhibits Tab "H" contains evidence related to Spc Lopez's prescribed medications, since Exhibit H-14 is referred to in a footnote as "Lopez-Lopez Prescriptions (Recent to Oldest)."



Likewise, Exhibit H-11 is referred to in a footnote as "Lopez-Lopez Polypharmacy Timeline."



From comments by Lt. Gen. Mark Milley in a press conference shortly after the shootings, we know that Spc Lopez had been diagnosed with depression and anxiety, and had been prescribed and was taking Selective Serotonin Reuptake Inhibitor (SSRI) antidepressants.  Given Lt. Gen. Milley's loose lips in the immediate aftermath of the tragedy, it is unclear why the Army would then go to such lengths to conceal - from the families of the fallen, the survivors, our brave military personnel, and the American public - which, what combination of, and what doses of psychotropic medications Ivan Lopez was taking leading up to and at the time of his shooting rampage.

Regardless of the Army's motivation for going to such lengths to hide information that people living in a free country have a right to know, one conclusion is unavoidable: the Army was not exhaustive enough in its efforts to suppress the facts behind the second Fort Hood shootings.

From footnotes in the report and a supporting appendix, concerned parents intent on unveiling the hidden temporal link between psychotropics and mass shootings in America have pieced together the polypharmacy regimen prescribed to Spc Ivan Lopez.

Army records indicate that Spc Lopez was prescribed the following four psychotropic medications: Celexa (citralopram hydrobromide), Wellbutrin (bupropion hydrochloride), Ambien (zolpidem tartrate), and Lunesta (eszopiclone).

Perhaps not unlike a criminal who subconsciously wants to get caught, the Army left a bread crumb trail of clues for anyone bothering to sift through thousands of pages of evidence (which apparently excludes most, if not all, of the media).

Four footnotes in the section of the Army's report discussing Spc Ivan Lopez's Behavioral Health (BH) refer to Exhibits H-7 through H-10, describing the exhibits as FDA labels for drugs.

Exhibit H-7 is referred to as "FDA Label - Celexa."



Exhibit H-8 is referred to as "FDA Label -" followed by the first letter "W" or "V" with the remainder of the drug name redacted.  So now we know to keep an eye out for a second medication that starts with either a "W" or a "V".  Exhibits H-9 and H-10, respectively, are referred to as "FDA Label -" with the names of the medications completely redacted.



In Appendix 3, the Army painstakingly defined the plethora of terms used elsewhere in the report.  Among the definitions include descriptions of Ambien, Ambien CR, Bupropion, Celexa, Citalopram, Lunesta, Polypharmacy (ya think?), Wellbutrin, and Zolpidem.

The appearance of Celexa/Citalopram in the list of definitions is consistent with the footnote referring to Exhibit H-7 as "FDA Label - Celexa."  The appearance of Wellbutrin (bupropion) in the list of definitions is consistent with the footnote referring to H-8 as "FDA Label -" followed by a mostly redacted medication name starting with the letter "W" or "V".  Not surprisingly, there are only two other psychotropic medications, Ambien and Lunesta, appearing in the list of definitions, corresponding presumably to Exhibits H-9 and H-10, FDA drug labels for the two other unnamed drugs.









In addition to inadvertently divulging, despite significant black ink expended, how many and which psychotropic medications Spc Lopez was prescribed and taking (remember the toxicology results revealed the normal/expected, ie. not abnormal, presence of medications plural), the Army perhaps again unwittingly disclosed in Appendix 5 just how extensive Spc Lopez's mental health treatment actually was, and the myriad of Army mental health providers who examined and/or treated Spc Lopez.

Appendix 5 indicates that investigators reviewed "[m]edical records notes by the following providers constitut[ing] the majority of Specialist Lopez-Lopez's significant medical events," then lists a number of mental health providers at Fort Bliss, Fort Leonard Wood and Fort Hood, and footnotes the dates from medical records notes corresponding to when Spc Lopez met with each of the respective mental health providers.

Over a ten month period from June 14, 2013 to March 10, 2014, Spc Lopez appears to have met with a half dozen mental health providers on at least ten occasions, possibly meeting with two providers on the same date on two of those occasions.  Records show Spc Lopez met with a Social Worker therapist, four psychiatrists, and a nurse practitioner who refilled prescriptions. 

Army records indicate Spc Lopez visited an Embedded Behavioral Health (EBH) Social Worker therapist at Fort Bliss on June 14, 2013, July 31, 2013, October 2, 2013, and October 28, 2013; an EBH psychiatrist at Fort Bliss on June 20, 2013; an EBH psychiatrist at Fort Bliss on July 31, 2013, and August 27, 2013; an EBH psychiatrist at Fort Bliss on September 24, 2013, October 28, 2013, November 15, 2013, and November 19, 2013; a nurse practitioner at Fort Leonard Wood on 24 January 2014 to refill prescriptions; and a psychiatrist at Fort Hood on March 10, 2014 to evidently request more medication.  At the time of the shootings, Spc Lopez had a follow-up BH appointment scheduled for May 19, 2014.







During his last BH appointment on March 10, 2014, according to the Fort Hood psychiatrist interviewed as part of the investigation, Spc Lopez "requested [redacted] and [redacted]."  Predictably, the Army blacked out what medications Spc Lopez requested and was provided during this last visit only two weeks prior to his shooting rampage.



Army records demonstrate that Spc Lopez sought mental health care of his own accord, followed up with mental health treatment as prescribed (both on a scheduled and walk-in basis), and requested refills of prescribed medications. 

These facts run counter to the narrative oft posited by Pharma-funded politicians whereby mass shooting tragedies are preventable - if only the shooters had access to mental health care, cooperated with their treatment, and complied with prescribed medications. 

What also emerges from the Army's selective redaction of its report and appendices is that they were only concerned with redacting a certain type of PHI - Pharma Harmful Information, as opposed to Protected Health Information.  In Appendix Tab "E," for example, SPC Lopez's wife stated that he "had a physical profile which expired, but he still suffered from pain on his back and he would still have to conduct physical training per the chain of command's orders."
  


It says a lot about how invested the Army is in its close relationship with Big Pharma when it does not bother redacting references to Spc Lopez's physical injury and pain, but does everything in its power to conceal Spc Lopez's mental health diagnoses and prescribed medications.

The Army's findings, based on thousands of pages of evidence, are a stinging indictment of the failings of medicalized psychiatry in America, which could alternatively be referred to as chemical mood/behavior management.  The Army's conclusion that Spc Ivan Lopez received the best possible mental health care was emphatic: "After an independent review of the medical and behavioral health care and treatment provided to SPC Lopez-Lopez, no deviation from standard care occurred in any component of the medical treatment continuum."

 

In other words (ATTENTION TAXPAYERS): Psychiatry's standard of care cannot prevent mass shooting tragedies. 

If the determination of independent psychiatrists that no deviation from the standard of care occurred in the case of Spc Lopez is correct, then it must also follow logically that psychiatry's standard of care cannot prevent mass shooting tragedies. 

The fact that American psychiatry - with its almost singular reliance on chemical mood/behavior management - cannot prevent mass shootings has not prevented Rep. Tim Murphy (R-PA) and other Pharma-funded politicians from attempting to force American taxpayers to part with billions of dollars under just such a false promise.  With the pharmaceutical lobby now the largest by far in the U.S., spending over $230M last year to pitch their agenda to Congress, some have begun to question whether we're now living in the United States of Pharma. 

In addition to revealing the impotence of psychiatry and its chemical mood/behavior management to prevent mass shootings, the Army's report and appendices shed more light on who Ivan Lopez was as a person.

Spc Lopez's wife described her husband as "a calmed person who was always quiet and she was the one in the relationship who was outspoken... [She] stated that SPC Lopez-Lopez was not confrontational and when he was mad he just kept it to himself."  Spc Lopez's wife further stated that her husband "was not a violent person.  [She] stated in one occasion she punched him after an argument and he did not hit her.  She stated he was a calmed person."



A childhood friend who knew Ivan Lopez since the seventh grade told investigators that "he did not think Specialist Lopez-Lopez would do something like this.  He said on multiple occasions that Specialist Lopez-Lopez never joked about hurting himself or others... [He] did not see anything that would suggest Specialist Lopez-Lopez would take the actions he did."



When asked to describe Ivan Lopez, another person who knew him since he was fourteen years old described him as "Humble, honest, kind, good father, loving, for me he was like a son."



A Private at Fort Hood who was friends with Spc Lopez told investigators: "He was always a happy guy.  Every time I talked to him, he never had anything bad to say.  I never saw him angry and he never talked about violence."



A Sergeant who got to know Spc Lopez during a reclassification course at Fort Leonard Wood told investigators: "To me, nothing stood out about Spc Lopez that would make him a high risk Soldier.  I never saw him get mad or angry during our time together. Sometimes I would ask if everything was alright, but he never seemed angry.  He did not seem depressed."



According to people who lived and worked with him, Ivan Lopez was not an angry, violent, or depressed person, but rather a decent human being.

So what could compel an even-tempered individual to go on a deadly shooting rampage?

A peek inside Ivan Lopez's medicine cabinet tells the story...

Spc Lopez took bupropion hydrochloride, better known by its brand name Wellbutrin, which is prescribed for depression and off-label for smoking cessation.  The label for Wellbutrin contains a black-box warning of increased risk of suicidal thinking and suicidal behavior, lists agitation and hostility as being among the most common adverse reactions, and warns families and caregivers to immediately report emerging agitation or irritability to healthcare providers.

Bupropion hydrochloride, when prescribed for smoking cessation under the lesser-known brand name Zyban, also carries an FDA-mandated warning of homicidal ideation.

It was reported that former Assistant District Attorney Myron May was also prescribed a cocktail of psychotropic drugs including the antidepressant Wellbutrin prior to his mass shooting rampage on the campus of Florida State University on November 20, 2014.

Andrea Yates was also on a cocktail of psychotropic drugs including the antidepressant Wellbutrin when she drowned her five children -John, Paul, Luke, Mary, and Noah - on June 20, 2001.

Homicide has been reported to the FDA as a side-effect of Wellbutrin and bupropion hydrochloride seventeen times.

Likewise, the label for citalopram hydrobromide, better known by the brand name Celexa, which Spc Lopez was prescribed, carries a black-box warning of increased risk of suicidal thinking and suicidal behavior, agitation, aggressiveness, hostility and impulsivity.

Homicide has been reported to the FDA as a side-effect of Celexa and citalopram fifty-eight times.  There have also been forty-three reports to the FDA of homicide as a side-effect of its chemical cousin, escitalopram oxalate, better known as Lexapro.

Spc Lopez was also prescribed zolpidem tartrate, better known as Ambien, to treat insomnia.  The Ambien label states that "worsening of depression and suicidal thinking may occur."  According to the Ambien label, other reported side-effects include agitation, hallucination, abnormal thinking, and aggressiveness.

Homicide has been reported to the FDA as a side-effect of Ambien and zolpidem tartrate over one hundred times.

In addition to Ambien, Spc Lopez was also prescribed the sleep-aid eszopiclone, better known as Lunesta.  Like Ambien, the Lunesta label warns that "worsening of depression and suicidal thinking may occur."  The Lunesta label also contains the following chilling warning: "A variety of abnormal thinking and behavior changes have been reported to occur in association with the use of sedative/hypnotics.  Some of these changes may be characterized by decreased inhibition (e.g., aggressiveness and extroversion that seem out of character)... Other reported behavioral changes have included bizarre behavior, agitation, hallucinations, and depersonalization."

Homicide has been reported to the FDA as a side-effect of Lunesta and zopiclone five times.

Three of the four drugs prescribed to Spc Lopez (Celexa, Wellbutrin, Ambien) appear on a list of 31 drugs Harvard and Wake Forest doctors identified as being associated with an elevated risk of violence based on a study of FDA Adverse Event Reporting System (AERS) reports.

Each of the psychotropic drugs prescribed to and taken by Spc Lopez carry warnings of increased risk of suicidal behavior and suicidal thinking, depression, agitation, aggressiveness, irritability, hostility, etc.  If any one of the aforementioned psychotropic drugs could cause someone to act aggressively out of character and/or suicidally, one can only imagine what they could drive a person to do if taken concomitantly.

The fact of the matter is that we are left to our imagination as to the possible adverse effects of such reckless polypharmacy, because these psychotropic drugs have never been tested to see if they can be taken together safely.  What the Army is doing effectively amounts to experimentation on our soldiers.

From the Army's report and appendices, there is no doubt that Spc Lopez was on a multi-drug regimen qualifying as polypharmacy by their own definition.  The most conservative interpretation of the available data would be that Spc Lopez was on at least one antidepressant and one sleep medication at a time, and that the Army either prescribed a different antidepressant and a different sleep aid because the first ones prescribed were not achieving the desired results, or worse that the Army prescribes different drugs in the same class (e.g. antidepressants or sleep aids) interchangeably. 

In either of the above two scenarios, there would be a period of increased risk withdrawing from the old antidepressant and the old sleep aid while starting a new antidepressant and a new sleep aid, since both stopping and starting a psychotropic drug increases the patient's risk profile.  Of course, the increased risk is further multiplied with the stopping and starting of multiple psychotropic drugs.

Another nightmare scenario is that the Army doubled up on the antidepressants and/or sleep aids when they were not working by themselves.

Odds are that we will never know which of the above three scenarios produced the horrific tragedy that occurred at Fort Hood on April 2, 2014, due to the Army's lack of transparency.

What we do know for sure is that the Army's management of psychotropic polypharmacy is haphazard at best.  "After the shooting incident," wrote a psychiatrist and Program Director of the Center for Forensic Behavioral Sciences, "only two commanders recalled having ever seen a polypharmacy list of names.  The hospital is again short staffed on managing the polypharmacy project because the pharmacist in charge deployed."  

  
 
Classic.  A psychiatrist blaming polypharmacy mismanagement on a pharmacist.  Can pharmacists write prescriptions?  Don't think so. 

Our fighting men and women deserve better than a whitewash and psychiatric blame-shifting. 

Parents Against Pharmaceutical Abuse (PAPA) calls on the U.S. Army to release Exhibits Tab "H" of Appendix 4.

RIP: SFC Daniel M. Ferguson,
SSG Carlos A. Lazaney-Rodriguez, SGT Timothy W. Owens, SPC Ivan A. Lopez-Lopez