1. THE ECLIPSE OF MEDICAL CARE

2. FILDES - 1891

3. In the case of an attractive 7 year old in whom the disease had invaded the larynx, I inserted a tube which gave relief for several hours; then it was evident that the tube was becoming clogged. The parents begged me not to let the child strangle. I explained the desperate nature of the trouble… they understood. The mother left the room, the father took the child in his arms, and with little difficulty the tube was removed. As the father uttered “Thank God” the child gave a feeble gasp and was gone. In memory I can still see the room, the exact location of the bed, the chair, the limpid child in the father’s lap, the adjustment of the light James Herrick 1890

4. GOYA 1819 El Garrotillo

5. Night after night, sometimes for a week in succession, I would be called to get up and go to some residence, there to cut up some child’s windpipe therein to introduce a tube through which it might be able to breathe until it should be able possibly to throw off the terrible infection. Even then, not infrequently, the child died, because the false membranes continued to form - lower and lower, deeper and deeper, into the airways, until at length it had reached beyond the lowest extremity of our air passing tube. Thomas Shastid 1894

6. “I found the boy very ill, the whole back of his throat being like white velvet. I had never used the new remedy before, but determined to try it to save the boy’s life. I injected a small quantity under the skin of the stomach and watched the throat. I can only compare the marvellous result to the disappearance of snow beneath a hot sun. After the second dose, every trace of the membrane disappeared and the boy soon recovered” Alfred Schofield 1896

7. 1947 Antibiotics Antihypertensives Antipsychotics Enhance productivity

9. FILDES - 1891

12. Thalidomide Product Patents

13. PRODUCT PATENTS Zantac 1985 Prozac 1991 Lipitor 1997 WEIGHT In GOLD

14. February 7, 1990 Leigh Thompson Memo “I am concerned about reports I get re UK attitude toward Prozac safety. Leber (FDA) suggested a few minutes ago we use CSM database to compare Prozac aggression and suicidal ideation with other antidepressants in UK. Although he is a fan of Prozac and believes a lot of this is garbage, he is clearly a political creature and will have to respond to pressures. I hope Patrick realizes that Lilly can go down the tubes if we lose Prozac and just one event in the UK can cost us that.”

15. Thalidomide Prescription Only Status

17. Stockholm Syndrome Kreditbanken – August 1973 1 Isolation 2 Threat to Life 3 A Kind Captor Triangle of Karpman Victim - Persecutor - Savior

18. Thalidomide Randomized Controlled Trials

20. Evidence-based medicine is the integration of best research evidence with clinical expertise and patient values Sackett & Rosenberg 1995

21. Clinical Trial “Evidence” Administrative Data Clinical Expertise Anecdotes

27. From:James P McCafferty To:Sally Laden 19 th July 1999.. Safety. It seems incongruous that we state that paroxetine is safe yet report so many Serious Adverse Events. I know the investigators have not raised an issue... I am still not sure how to describe these events. I will again review all the SAEs to make myself feel comfortable about what we report in print.

28. Breakdown by drug -- Journal view

30. Breakdown by drug -- FDA view

31. “The American Psychiatric Association believes that antidepressants save lives.”

32. “The American Psychiatric Association believes that psychiatrists save lives.”

34. FILDES - 1891

35. Good doctors treat patients not just diseases or symptoms. Diagnosis is their key to selecting the most appropriate treatments… They know that ever more effective and safer drugs are indispensable to progress in medicine

37. NO PSYCHIATRY WITHOUT PSYCHOPHARMACOLOGY

38. An Invisible Plague 4 th Leading Cause of Death Astronomic Treatment Costs No Guidelines No Evidence Base

39. Pharmacosis polypharmacosis acute, chronic… DSM V? Guidelines for People? Evidence Base for Managing Adverse Events? CARE – CURE?

41. If they stop telling lies about me, I’ll stop telling the truth about them. David Lange

43. Clinical Trial Evidence Administrative Data DATA + Gene ANECDOTE?

44. “ The RNZGP & GPNZ believe that general practitioners save lives.”

46. It is an art of no little importance to administer medicines properly, but it is an art of much greater and more difficult acquisition to know when to suspend them or altogether to omit them. Philippe Pinel 1800

47. G Koren 2007 The Way Women Perceive Teratogenic Risk Can J Clin Pharmacology 14, e10-e16

48. “The New Zealand College of General Practitioners believes that general practitioners save lives.”