Try psychology before drugs for children with mental problemsBMJ 2006; 333 doi: https://doi.org/10.1136/bmj.333.7569.619-a (Published 21 September 2006) Cite this as: BMJ 2006;333:619
All rapid responses
Dr. Coyne and I clashed on the subject of Scientology in an earlier
BMJ rapid response (http://www.bmj.com/cgi/eletters/329/7465/529#73509)
and he has brought the topic up repeatedly on the Society for the Science
of Clinical Psychology (SSCP) listserve to which we both belong. From my
perspective, he tends to rely on arguments that use negative labels and
guilt by association rather than arguing about data so I have long ago
taken to ignoring what I regard as Scientology-baiting on his part.
However, his rapid response in the BMJ prompts me to look at this as an
opportunity to clarify my affiliations and to highlight an important
public relations strategy adopted by the drug industry, designed to
silence industry critics. My rapid response is actually a decidedly slow
response as I only recently noticed this latest entry. Here’s my
The implied logic seems to go something like this: David Antonuccio
was quoted by a reporter in a story that ran in an online Scientology
magazine called Freedom Magazine, therefore he must be a Scientologist and
he must agree with everything written in the article. This represents an
error in logic called an association fallacy (see
http://en.wikipedia.org/wiki?Guilt_by_association). The use of this sort
of reasoning is surprising and confusing from an accomplished researcher
like Dr. Coyne. His most recent online post came
in response to a scientific report (available at
www.apa.org/pi/cyf/childmeds.pdf) on psychotropic medications in children
that I coauthored with 8 other scientists and valued colleagues under the
auspices of the American Psychological Association.
First I will address the issue of my religious affiliation, something
nobody else has ever asked me about. I was raised Catholic though I no
longer practice. I currently attend a Methodist church in Reno a few
times a year. I have never set foot in a Church of Scientology and I have
never been a member because I have no interest. I am not even an official
member of the First United Methodist Church I attend, though I really do
like the values of kindness and forgiveness modeled for my young son
It is true that I was quoted in 1996 by a reporter in a story
(http://psychfraud.freedommag.org/page16a.htm) about an epidemiological
study linking human breast cancer to the chronic use of psychotropic
drugs. The epidemiological study was authored by Halbreich et al. (1996)
and published in the Archives of General Psychiatry, a highly respected
peer-reviewed psychiatry journal. The Halbreich et al. (1996) paper was
the first scientific study I had ever seen suggesting the possibility of a
cancer link in humans, as there were only animal studies available before.
As I explained in our last exchange
(http://www.bmj.com/cgi/eletters/329/7465/529#73509) the results from
Halbreich et al. (1996) and other more recent epidemiological studies are
correlational and do not establish a causal relationship. Here is what I
was quoted as saying by the reporter who wrote the Freedom Magazine online
story: “These drugs have been considered carcinogens in humans. This is
the first study I have seen.” While I don’t actually remember talking to
the reporter, I don’t doubt that I did and I don’t doubt that I said
something along the lines I am quoted to have said. In other words, the
quote sounds to me like something I would have said.
Of course, I have spoken to many reporters over the years, some of
whom have published articles online with quotes from me, and I do not
recall any reporter identifying himself or herself as a Scientologist. In
1996, it would never have crossed my mind to ask any reporter about his or
her religious affiliation, whether it be Catholic, Jewish, Methodist,
Muslim, or whatever. At the time I was interviewed, I would have had no
clue of Freedom Magazine’s connection to the Church of Scientology since I
had never read nor seen it. Even had I known that, I probably still would
have participated in the interview as long as the reporter stuck to
science and not religion.
I have since learned from media coverage and from discussions with
professional colleagues that the Church of Scientology has taken a strong
antipsychiatry position. I, of course, do not see myself in the
antipsychiatry camp as I am a Professor of Psychiatry and Behavioral
Sciences at the University of Nevada School of Medicine where I have been
on the faculty for more than 26 years. I have had the good fortune to
train many wonderful young psychiatrists and work with many brilliant and
kind psychiatric colleagues over that time period. I am fortunate to work
in a department and at a university that values intellectual diversity and
celebrates academic freedom, a place where even a drug industry critic
like me can thrive. I have felt privileged to be part of such a wonderful
group of colleagues. Most of my research has been devoted to helping
people overcome depression or stop smoking. Even though I have been
critical of certain drug industry practices (e.g., Antonuccio et al.,
2003), I believe the evidence shows psychotropic medications can sometimes
be helpful but I also believe that psychiatry is much broader than just
psychopharmacology and includes many scientifically validated
psychotherapies that have been pioneered by both psychiatrists and
psychologists (Antonuccio et al., 1999).
Subsequent to our last exchange on the BMJ, I conducted my own
investigation and turned up something interesting. Calling someone a
Scientologist apparently is a McCarthy-like tactic developed as a public
relations strategy in some corporate board room to silence drug industry
critics. Below is an excerpt (from Espinoza & Espinoza vs. Eli Lily,
Oct. 30, 2000) from the public testimony under oath by Mitch Daniels, a
former executive for Eli Lilly, who acknowledged that the company spent
$49,000 in 1991 to purchase 700,000 copies of a Wall Street Journal
article detailing Scientology’s antipsychiatry activities, presumably to
distribute to physicians. This was part of an apparent attempt to
discredit legitimate scientists who raised data-based questions about
antidepressants by suggesting that almost all information critical of
Prozac came from the “Scientologists and the lawyers”. The questioner is
Andy Vickery, the first attorney to ever win a liability case against a
drug manufacturer for antidepressant induced suicide. Mr. Daniels is
responding to Mr. Vickery’s questions.
Q. On June 11, 1991, you were quoted as saying, "The source of
virtually everything you've heard bad about Prozac are the Scientologists
and the lawyers." Was that true?
A. Yes, that was true to the best of our knowledge at that time
and, really, to the best of any knowledge we've gleaned in the meantime.
Q. All right, sir, that's all I want to ask you about that one. In
August of 1991, you were still involved in the company strategy on how to
deal with this issue of Prozac and suicide, weren't you?
A. Yes, I was involved.
Q. In that month, Mr. Daniels, Eli Lilly spent $49,000 dollars
buying 700,000 copies of a Wall Street Journal article on Scientology.
Did you know that?
A. I don't remember specifically, but we certainly disseminated
information about the church, and that could well have been part of it.
Q. How many copies of the Teicher and Cole articles did you-all
disseminate to people?
A. None to my knowledge.
Q. Would you spend nearly $50,000 buying 700,000 copies of an
article that was in the Wall Street Journal for everybody to see?
A. We thought it was entirely appropriate and important that people
know where the charges were coming from so they could judge their
Q. More of this hoax from the cult business?
A. Unless informed, many people would have heard the charges, either
firsthand or through hearsay, and might have believed that they had some
grounding in scientific fact, instead of emanating, as most of them were,
from a group that, I think, most fair-minded people would find a fringe of
a fringe character, certainly not of a scientifically credible nature.
Q. What did you-all do with those 700,000 copies?
A. I really don't know. I don't recall. They could well have gone
to physicians, but they may have gone to others as well.
Based on Mr. Daniels testimony, it appears that the company was
promoting the idea that if someone were in any way critical of Prozac, it
was a virtual certainty that he or she was either a Scientologist or a
lawyer. A lot of people might be surprised to find themselves lumped into
one of those two groups. It is simply faulty logic.
Drs. Teicher and Cole referenced in the testimony above were among
the first to write about case studies of apparent antidepressant induced
suicidal ideation or behavior (Teicher et al., 1990). Since that time,
analysis of the raw FDA antidepressant data with the support of
researchers from Columbia University (Hammad et al., 2006) and other
independent analyses (Bridge et al., 2007; Garland, 2004; Jureidini et
al., 2004; Kendall et al., 2005; TADS, 2004; Whittington et al., 2004)
have documented a small but real risk that has prompted the FDA to issue
black box warnings for children about the induction of suicidal behavior
for fluoxetine (Prozac) and most other antidepressants, recently
recommended by the FDA to extend to adults up to the age of 25. What was
once a minority perspective, is now the prevailing wisdom (see
http://www.barryyeoman.com/articles/courtroom.html) and supported not only
by the FDA, but also by regulatory bodies in the United Kingdom, Europe,
Australia, and Canada. Applying the erroneous logic of the association
fallacy, one would have to conclude that virtually all of the researchers
and regulatory scientists around the world are lawyers or Scientologists,
something I seriously doubt (though I may be going out on a limb here!).
From my perspective, this rapid response is an opportunity to shine a
light on an important public relations strategy born inside the drug
industry. The strategy seems to involve negatively labeling scientists
who use data to criticize an industry practice or product. Such negative
labeling was a failed strategy of Senator Joe McCarthy. I believe it will
ultimately fail in this instance. My hope is that Dr. Coyne’s apparent
preoccupation with Scientology is just a case of Scientology-baiting and
not a more serious case of academic stalking
(http://www.healyprozac.com/AcademicStalking/default.htm). From my
perspective, whether or not he can let go of the Scientology issue will be
the ultimate test of which case it is. I believe science is more likely to
move forward when scientists argue about the data instead of who belongs
to what church. In that spirit, I would be willing to author an exchange
with Dr. Coyne or another scientist in an appropriate peer reviewed
journal on the subject of antidepressants in children, a topic that is
worthy of continued dialogue (e.g., Antonuccio & Burns, 2004).
Antonuccio, D.O. & D. Burns (2004). Adolescents with depression.
Journal of the American Medical Association. 292, 2577.
Antonuccio, D.O., Danton, W.O., & McClanahan, T.M. (2003).
Psychology in the prescription era: Building a firewall between marketing
and science. American Psychologist, 58, 1028–1043.
Antonuccio, D.O., Danton, W.G., DeNelsky, G.Y., Greenberg, R.P.,
& Gordon, J.S. (1999). Raising questions about antidepressants.
Psychotherapy and Psychosomatics, 68, 3-14.
Bridge, J.A., Iyengar, S., Salary, C.B., Barbe, R.P., Birmaher, B.,
Pincus, H.A., Ren, L., & Brent, D.A. (2007). Clinical response and
risk for reported suicidal ideation and suicide attempts in pediatric
antidepressant treatment: A meta-analysis of randomized controlled
trials. JAMA, 297, 1683-1696.
Garland J. (2004) Facing the evidence: Antidepressant treatments in
children and adolescents. Canadian Medical Association Journal, 170, 489-
491.Retrieved from http://www.cmaj.ca/cgi/content/full/170/4/489.
Jureidini, J.N., Doecke, C.J., Mansfield, P.R., Haby, M.M., Menkes,
D.B., & Tonkin, A.L. (2004). Efficacy and safety of antidepressants
for children and adolescents. British Medical Journal, 328, 879-883.
Retrieved from http://bmj.bmjjournals.com/cgi/content/full/328/7444/879.
Hammad, T.A., Laughren, T., & Racoosin (2006). Suicidality in
pediatric patients treated with antidepressant drugs. Archives of General
Psychiatry, 63, 332-339
Kendall et al. (2005). Are the SSRIs and Atypical Antidepressants
Safe and Effective for Children and Adolescents?, Current Opinions in
Psychiatry, 18, 21-25.
Teicher, M.H., Glod, C., & Cole, J. (1990). Emergence of
intense suicidal preoccupation during fluoxetine treatment. American
Journal of Psychiatry, 147, 207-210.
Treatment for Adolescent Depression Study (TADS) Team (2004).
Fluoxetine, cognitive-behavioral therapy, and their combination for
adolescents with depression. Journal of the American Medical Association,
Whittington, C.J., Kendall, T., Fonagy, P., Cottrell, D., Cotgrove,
A., & Boddington, E. (2004). Selective serotonin reuptake inhibitors
in childhood depression: systematic review of published versus unpublished
data. The Lancet, 363,1341-45.
University of Nevada School of Medicine; Reno V.A. Medical Center; author of smoking cessation book Butt Out; past recipient of NIDA and NCI funding for smoking cessation research; past recipient (1995) of funding from Marion Merrill Dow for research on the nicotine patch; workshops on the treatment of depression; expert witness on depression or PTSD
Competing interests: No competing interests
One has to ask whether this report was based on a balanced
consideration of the evidence. Try Googling the members of this task
force. One of them, David Antonuccio, can be found at a Scientology
describing antidepressants as carcinogenic in an article that also
claims that additional “federal funds poured into psychiatric research are
not needed and only exacerbate endemic problems of waste and fraud.”
Competing interests: No competing interests