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Sunday, March 29, 2015

Andreas Lubitz - The Drugs Don't Work.

Following on from my previous post, Co-pilot, Andreas Lubitz Germanwings, where I suggested that the media should have been asking questions about the role psychiatric drugs may have played, its now being reported that medications (to treat mental illness) were found in the apartment where Lubitz lived by German authorities. The Australian writes...

"Large quantities of prescription medicines used for treating mental illness were found in his flat."

What's striking here is the plural, 'medicines.' If the press are correct in reporting that there were a number of psychiatric medicines then this story can go one of two ways.

First off, the press can focus on his medical condition, something they have already been reporting on. Most media outlets are suggesting that Lubitz was suffering from “severe overload syndrome.” Other newspapers are running with the term, "psychosomatic illness."

It's also being reported that Lubitz may have had vision problems but tried to hide this, and his psychosomatic illness from his employer.

So, a psychosomatic illness is defined as concerning or involving both mind and body. According to HealhGrades, a website aimed at professionals, psychosomatic illnesses can be classified in three general types.

They write...

"The first type includes people who have both a mental (psychiatric) illness and a medical illness, and these illnesses complicate the symptoms and management of each other. The second type includes people who have a psychiatric problem that is a direct result of a medical illness or its treatment, such as having depression due to cancer and its treatment.
"The third type of psychosomatic illness is somatoform disorders. Somatoform disorders are psychiatric disorders that are displayed through physical problems. In other words, the physical symptoms people experience are related to psychological factors rather than a medical cause."

Crystal clear, huh?

Now, if the media are reporting that this man had a psychosamtic illness and it appears he was being treated with prescription medications then one has to ask why?

Medscape, another website aimed at healthcare professionals, write...

"Based on studies of somatization disorder, medication approaches rarely are successful for this condition. Physicians should search for evidence of psychiatric comorbidity, such as depression or an anxiety disorder. If present, medication interventions specific to the diagnosis can be attempted. Successful treatment of a major depression or an anxiety disorder, such as panic disorder, also may produce significant reduction in somatization disorder."

I find the above quite laughable. On one hand medication for a diagnosed psychosamtic illness rarely works and, it appears, that healthcare professionals should search for evidence that points to another disorder. Once they find this other 'disorder' they can then, if they wish, medicate. Isn't this a bit like searching for something and just not accepting that what you are searching for isn't there?

A paper, published last year in PubMed, suggests that "there exists no systematic review or meta-analysis on the efficacy and tolerability of these medications." (1)

Furthermore, the authors found that "Adverse effects produced by medication can have amplifying effects on symptom perceptions, particularly in people focusing on somatic symptoms without medical causes."

Am I painting the picture for you here?

So, the media can focus on the psychosomatic illness that Lubitz allegedly had or, like me, they can start asking questions. Namely, why was Lubitz prescribed medications for his 'illness' when;

a, medication approaches rarely are successful for this condition.
b, there exists no systematic review or meta-analysis on the efficacy and tolerability of these medications
c, Adverse effects produced by medication can have amplifying effects on symptom perceptions, particularly in people focusing on somatic symptoms.

The German authorities have a duty to name the drugs this man was taking. The world press have a duty to ask the questions regarding the treatment of this illness.

Why was Lubitz on medication when published papers in high profile medical journals suggest that drug treatment doesn't really help?

I am kind of skeptical about the whole diagnosis. It's basically a psychiatric disorder diagnosed when no other psychiatric disorder can be found. It's a bit like your psychiatrist on a fishing trip. He throws his net into the water and catches just three fish. He then makes the net bigger and, voila, he lands more fish!

Judging by the media reports Lubitz was a troubled man. It would appear that his dream of flying and one day making Captain had been dashed. This could be because he had visionary problems or maybe because he had this ongoing psychosomatic illness.

I'm betting that the media will focus on his background and the illness and will not entertain the fact that the drugs he was prescribed may have contributed to his heinous act.

The jury's out folks.

Bob Fiddaman.

(1) Pharmacological interventions for somatoform disorders in adults.
Kleinstäuber M1, Witthöft M, Steffanowski A, van Marwijk H, Hiller W, Lambert MJ.