The latest in the 'passing of the buck' regarding the death of Oakville teenage, Sara Carlin, should not come as any surprise for those of you that have ever had the misfortune of dealing with GlaxoSmithKline and the medical profession.
On Monday, Sara's family physician, Dr. Tom Stanton and Psychotherapist Dr. Mary Alexander took the stand to, basically, shirk any responsibility they may have had in Sara's behavioural change and subsequent death.
As far as I can ascertain, by reading the latest from the Oakville Beaver, both Stanton and Alexander accept no responsibility in, firstly prescribing a teenager a drug that could cause suicide and secondly, not particularly bothered with regard to Sara's apparent taste for alcohol consumption.
It's all well and good blaming the patient after the event but what were these two medical professionals thinking?
Firstly, and by Stanton's own admission, he never once warned Sara about the possible side effect of suicide when he first prescribed her Paxil. This from the Oakville Beaver:
When asked by the Coroner's Counsel Michael Blain, and later Carlin lawyer Gary Will, if he had told Sara that Paxil could produce suicidal thoughts in people under 18, Stanton said he told her how the drug worked and that she should contact him if it made her feel worse.
The possible increased risk of suicide was not mentioned.
"The person is in a pretty vulnerable state at that point and I find that if you say to the person, 'This could cause you to commit suicide,' it's really hard to engage the person with the medication," said Stanton.
"I find that a better way to say that is that sometimes it can make you feel worse and if there are any side-effects or anything that you notice is different, than you need to talk to me about those."
It's basically covering his own ass.
Stanton had previously prescribed Sara Paxil after he diagnosed her with suffering from both a panic disorder and depression. This diagnosis was based on a 30-minute visit to Stanton's surgery by 17 year old Sara Carlin.
When Stanton questioned Sara about the stress in her life, Stanton said that Sara had told him she had a heavy workload at school, she was having trouble with her boyfriend and there was a lot of tension at home.
So, your average teenager then?
Not according to Stanton, who then went ahead and prescribed Sara Paxil, a drug that had already been slammed with a warning regarding children and adolescents of Sara's age taking it.
According to Stanton, he prescribed Sara 10mgs of Paxil and a sedative, Ativan, to help Sara deal with panic attacks.
Neither Neil or Rhonda Carlin, Sara's parents, were informed by Stanton that he had given their daughter a drug known to cause suicide, a medical confidentiality law that becomes binding at the request of any patient over the age of 16 in Canada.
This from the Oakville Beaver:
A follow-up appointment with Sara in March 2006 indicated the medication appeared to be helping somewhat, said Stanton, with Sara experiencing less panic and sleeping more.
Since the medication appeared to be working, Stanton said he doubled the Paxil dose from 10 mgs to 20 mgs and prescribed Imovane to help her sleep.
So, Sara's medication seemed to be working according to Stanton - why increase the dosage then?
Once again, from the Oakville Beaver:
When asked if he'd consider more frequent, perhaps weekly monitoring, Stanton said he did not think it was necessary, because he was not hearing anything from Sara he didn't like.
April and June appointments were also positive, Stanton said, with Sara stating the Paxil was helping her and that she was happier, sleeping more, crying less and experienced less sadness.
All seemed good then? A drug that, by it's manufacturers own [late] admission, that could give rise to suicidal thoughts, was, in Stanton's eyes, working very well.
Sara was later seen by Stanton's colleague, Dr. Lynne Benjamin, who increased Sara's dose of Paxil from 20mg to 30mg.
Are we to assume here that the Paxil had worn off?
Why, did Lynne Benjamin increase Sara's dose of a potentially lethal drug.
A study, submitted to the FDA, the American medicines regulator, in 2008, showed that compared with placebo, the new-generation antidepressants do not produce clinically significant improvements in depression in patients who initially have moderate or even very severe depression, but show significant effects only in the most severely depressed patients.
Sadly, this came approx one year after Sara Carlin killed herself.
Once again, the Oakville Beaver:
At an appointment in October with Benjamin, Stanton testified Sara said school was terrible and she was going to quit.
She also reported sleeping poorly and increased panic when she was driving.
At this point, the Paxil dose was increased to 40 mgs per day.
So to recap:
Sara was prescribed 10mg of Paxil. By Stanton's own admission, it seemed to be working - what does he do? Increase the dosage.
Sara went to see Stanton in April and June - no increase.
In September, Sara is seen by Stanton's colleague, Dr. Lynne Benjamin. Benjamin increases Sara's dose from 20mg to 30mgs.
One month later, Sara's dosage is increased to a massive 40mg.
Now, for the record, I have never blamed doctor's or psychiatrists for prescribing Paxil. They, like the patient, prescribe it in trust - in other words - they believe what the manufacturer tells them, in this case, GlaxoSmithKline.
Let's look at the above increases for a second.
The February introduction to Paxil was shortly followed by Sara being barely able to get out of bed during a family Palm Springs trip.
The March increase was followed by Sara quitting her job at an optometrist’s office for no real reason. Drug and alcohol abuse also became a problem during this period.
The September increase was followed by Sara writing a letter very close to a suicide note, that was not found until after her death.
The October increase was followed by Sara visiting the London emergency room after mixing sleeping pills, cocaine and alcohol.
Coincidence?
What I find staggering is the failure here of the medical profession or may be they were just ignorant of the facts about medicating adolescents with GlaxoSmithKline's Paxil.
Psychotherapist Dr. Mary Alexander also gave evidence on Monday, once again there was no admission that she had any part to play in Sara's death.
This from the Oakville Beaver:
Alexander was the psychotherapist Stanton referred Sara to in March 2006 with the actual appointment taking place in July of 2006.
During that appointment, Alexander said Sara told her that she had been fine until Grade 6 when her older brother Brendan died.
Sara said she had bottled up feelings of heartbreak, anger and sadness, but in the last two years had begun to experience anxiety and sadness, which steadily began to increase.
Alexander said this got so bad Sara began to avoid going out and doing things because she was afraid of having panic attacks.
Alexander claimed that she did discuss drinking with Sara. She said she was concerned as Sara told her she had been drinking a 26-ounce bottle of alcohol every weekend with friends for the last two years.
Alexander said she warned Sara about drinking while taking Paxil because alcohol is a depressant and can make depression worse to the point where it could cause her to think about harming herself.
Sara stopped coming to see Alexander after the first session.
Alexander, at no point, thought it wise to contact Sara's doctor regarding Sara's drinking.
She added: Stanton was not contacted about this because at that time Sara did not appear suicidal.
I find it hard to believe that a teenager as young as Sara could consume such a large amount of alcohol every weekend for two years. If an adult consumed that much over a two year period, I'd still find it hard to believe.
If Alexander was telling the truth regarding Sara's drinking habit then why did this not raise alarm bells? If, according to Alexander, drinking while taking Paxil can make depression worse to the point where it could cause her to think about harming herself, then why on earth did she not contact Sara's doctor - she must have been concerned?
This latest evidence clearly highlights the need for change the way Paxil is prescribed to children not only in Canada but other countries too.
The jury at this inquest have digested a series of failures - these failures, have been masked by lawyers claiming Sara Carlin was some sort of juvenile delinquent hooked on alcohol and recreational drugs.
In truth, Sara Carlin, was your run of the mill teenager. Okay, she had had to deal with the death of her brother, she had done so for 7 years, without the need for Paxil. She was faced with attending attending Western University and was apparently having panic attacks and feeling more anxiety. A normal reaction?
I'm left wondering whether or not Alexander, Stanton and Benjamin slept on Sunday night, the eve of their evidence or whether they tossed and turned because they felt anxious and slightly panicky about standing up in a room full of strangers.
They failed Sara Carlin in life - and now, it would appear, they are failing her in death too.
That's my take on the latest article that has appeared in the Oakville Beaver.
More coming soon.
I have no trouble making difficult decisions. I do not agonize too much just ask around. I sleep well at night.
Jean-Pierre Garnier
Chief Executive Officer, GlaxoSmithKline
4/5/2004
On May 6, 2007, Sara Carlin, a beautiful 18-year-old girl with everything to live for, grabbed a piece of electrical wiring, fashioned a crude noose and hanged herself in the basement of her parents house while under the influence of the antidepressant drug Paxil (Seroxat in the UK). Paxil/Seroxat is an antidepressant documented by international drug regulatory agencies as causing worsening depression and suicide particularly in children and young adults.
Please help inform others of the risks of these drugs. Forward this video to everyone you know.
RIP Sara Alison Carlin
Nessun Dorma
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