In the Nov/Dec 2023 issue of Tactical Life magazine, there is an article entitled “GUNS or DRUGS?” by Lee Williams. The main thrust at the end of the article is a call to conduct further research on Selective Serotonin Reuptake Inhibitors (SSRIs), a class of anti-depressants, and links to mass shootings. I certainly have no qualms about the conclusion. However, the article doesn’t do enough justice to the complexity of this problem. In fact, presenting it as a choice between guns or drugs only makes the solution seem simple. I aim to show there isn’t a simple solution.
There is a particular class of problems that have hung around for a long time: violence, drug addiction, suicide, homelessness, and the like. In many cases, people jump on a single cause as the reason for the complex problem. Let’s take a look at violence. There is a class of people who believe that if guns are banned, violence goes away. If you read my book, you can see clearly that for injurious violent crimes (injurious aggravated assault, injurious robbery, and rape), firearms are used infrequently (keep in mind that aggravated assault, robbery, and rape make up 98 percent of violent crimes). Therefore, non-firearm violence would continue even if the policy of banning guns was successful. Furthermore, the latest statistics on Defensive Gun Use (National Firearms Survey 2021) show that they happen an estimated 1.6 million times a year, meaning that 1.6 million violent victimizations were avoided because of the victim being armed with a firearm. Of note is that 82 percent of the time, the firearm is not discharged, which is why surveys are necessary because the crime is not reported to law enforcement (see my book for reasons why). In short, a successful gun ban would dramatically increase violent crime by an estimated 1.6 million incidents per year over our existing violent crime rate while having a lot less impact on existing crime since most injurious violent crime doesn’t use firearms. In short, violence is a complex problem, and if you care about injurious victimization, banning guns is a simple but far worse answer, even if it could be done without sprouting up its own violent black market trade.
Let’s get back to SSRIs and violent crime. What type of study would be needed to determine a causal link? Let’s brainstorm a bit.
- We would want to look at patients who were diagnosed with depression and prescribed SSRIs. There are many variables here. For one, we may only want to look at psychiatrists who prescribed them rather than non-psychiatrists. Based upon looking around the Internet, the most significant percentage of people prescribed SSRIs are older men and older women, with older women being the top category. Right away, we can see a challenge in that the top two categories of people prescribed SSRIs are not typically violent crime offenders (see my book).
- We would need at least three groups: Control Group 1: People who have been evaluated and do not need SSRIs. Their age, race, sex, and ethnicity will need to match the test group. Control Group 2: People who have been evaluated and would be prescribed an SSRI but have not been (and will not be during the study). Their age, race, sex, and ethnicity will need to match the test group. This control group may be considered unethical due to being diagnosed and not prescribed. This may be mitigated via other treatment options, such as therapy, depending on if it will compromise the results. Test Group: People who have been evaluated and are prescribed an SSRI.
- We would evaluate the violent crimes of all three groups over different periods of time.
- Some Complications
- SSRIs often have an adjustment period where different medications are tried until one works best for the patient. This time period should be handled separately from the time period when a single SSRI is used.
- Some age groups, I’m thinking the younger age groups, may stop taking their medications and start back up again. This period of time could be in the adjustment period or after an SSRI is found to work best. Going on and off medication could be problematic.
- Mixing alcohol and other drugs with SSRIs will need to be taken into account.
- Some depressions are genetic. A group member whose family relatives have been diagnosed with depression along with violence (e.g., suicide or violent crime) may have to be handled with care in the results.
These are just some of the things that need to be considered. Assuming a well-designed study was performed, what could statistically significant results tell us? Here are some results that are possible:
- Violent crime victims are more numerous for Control Group 2 than for the Test Group.
- Violent crime victims are the same for Control Group 2 and the Test Group.
These results would be difficult to act on because they are of the “damned if you do, damned if you don’t” variety. Lack of SSRIs could contribute to victimization in depressed individuals just as much as SSRI use may contribute to victimization. In short, there is a lot to unpack in such a study. I agree with the author – a quality study needs to be done. Unfortunately, I don’t think it will happen in the US for various reasons, some of which the author and I concur. Let’s look at these reasons:
BigPharma trades on the distinction between “evidence of absence” and “absence of evidence.” The two are not the same. Not doing studies and showcasing that there is no “evidence” for harm is not a substitute for quality studies whose conclusion is that there is no evidence of harm. In short, as long as such studies are avoided, BigPharma can claim that there is no “evidence” for harm. Unfortunately, most Americans look to their evening news or government websites for information. Independent auditors of studies are needed for any SSRI study.
BigPharma also promotes studies that look at selective dates or evidence to advance their position. These studies are then crushed when a meta-analysis is done, which, unfortunately, happens years later. One can look at the Cochrane review on mask studies, which shows that there is no quality mask study showing masks work. Why is that important? I suspect an extensive correlation between mask use and mRNA vaccination. Fear helps sell. Another particularly horrible problem was the distinction between Vaccinated and Unvaccinated for COVID-19, where Vaccinated meant the two original shots had been completed. Everything else was considered “Unvaccinated.” Recent research from Italy has shown that between the first and second shots, the patient is actually more vulnerable to COVID-19 (this pattern continues with the boosters). What this means is that people who had one shot and got COVID-19 were considered Unvaccinated. It is an excellent way to downplay risks with your product but a horrible way to uphold public health, especially when studies are using your definitions. Some of the considerations I mentioned above could be manipulated to hide problems with SSRIs.
The Food and Drug Administration (FDA), the National Institute of Health (NIH), incentives for hospitals and doctors around prescribing drugs, and BigPharma are not pursuing the good of public health. Personnel from the FDA often land BigPharam jobs. This pattern is typical of regulatory capture by private entities. It is a promise of a bribe after the work is done. This work is not in the public’s interest but in BigPharma’s interest. Also, BigPharma has incentives for doctors and hospitals to prescribe drugs. For example, the vast majority of prescriptions for anti-depressants are not written by psychiatrists. One wonders what the incentives are for a primary care provider (non-psychiatrist) to prescribe antidepressants.
Lastly, NIH funds a lot of scientific research in the US. Scientists must be very watchful about what type of studies they request funding for. If NIH feels that these studies undermine BigPharma, scientists could find their funding dry up, and no new funding for other projects will be approved either. For example, quality studies of mRNA impacts on the body are not being done in the US but in other countries. BigPharma and the NIH have US scientists running scared when it comes to quality studies on the impact of mRNA on the human body. It shouldn’t be a stretch to consider the large market for SSRIs to be protected in similar ways.
For further elaboration of these points, see the books:
- Empire of Pain by Patrick Radden Keefe]
- The Great American Healthcare Scam by David Belk, MD and Paul Belk, PhD
- Political Capitalism by Randall G. Holcombe.