Diagnosis, Verdict, Conclusion, and Causality

This article presents two clinical scenarios based on antidepressant-induced deaths, which make clear that there are a number of intervening processes in between the valuable data Read and colleagues present and the verdicts that come out of inquests. The manner in which inquests and court cases are structured means that it is very rare for even clearly-proven prescription drug induced deaths to result in a verdict that the drug has caused the death. Instead, a growing number of drug-induced deaths fuel perceptions of a need for more and better drugs.

Central to this situation is a question about how to determine causality in drug-induced injury cases. The idea that randomized controlled trials are the way to establish causality needs to be revisited. Unless there is reform, people caught in situations like the two described here would be better placed holding their own inquests, and finding ways to promulgate the resulting verdicts, rather than “trusting” in a process that is biased against them.