> and the guys watching him were very lackadaisical about it.
Anyone who knows anything at all about suicide prevention is unsurprised by this. We know that observation does not work because staff cannot maintain it. This is true whether it's 15 minute obs, 5 minute obs, permanent line of sight obs, arms length obs, two to one arms length obs: they do not work.
There are countless examples of staff in hospital, on duty, doing obs, knowing their patient is at increased risk of suicide, falling asleep.
The different between those countless examples and Epstein’e case is that the latter involves perhaps the single most internationally famous and famously at-risk prisoner in human history — so while taking the standard statistics into account is good practice, it’s a bit like using the historical weather patterns to argue against the existence of a currently-happening hurricane.
The word “perhaps” allows for alternate opinions :). But I must say, both Cleopatra and Napoleon existing in a pre social media world suggests their infamy did not spread as far, and neither Napoleon nor Cleopatra had the ability to expose leaders around the world from within their jail cells — thus the “at-risk”.
But I’m curious to hear who you would suggest instead. One of those two? Someone else?
We're talking about the demographic fractions. The official Israeli counts support that they're killing militants to civilians at a ratio of 2:1 --- which is horrible, but better than warfare in urban areas usually achieves
It is probably not as favorable of a ratio as Israel states), but not as terrible as the Gaza Health Ministry numbers that imply substantially all of the casualties are civilians.
Unfortunately, Israel's adversary has chosen a set of tactics that put civilians in greater danger.
> The official Israeli counts support that they're killing militants to civilians at a ratio of 2:1 --- which is horrible, but better than warfare in urban areas usually achieves
Official counts by a party to the conflict also are invariably better than what the actual war they are prosecuting achieves.
Of course-- this is a point already made in my comment-- "It is probably not as favorable of a ratio as Israel states". We obviously cannot simply take the numbers from either Israel or Hamas.
> Depression and sucidides in first world countries, the ones that tick all the intial boxes, are a highs not experienced since WWII. [1] is just from a quick googling and US-only. You won't have trouble finding much more evidence to support this though, for many other 1st world countries.
It's difficult to compare suicide statistics over time, especially over decades, because definitions change. (For one example, in England a coroner used to need to be able to prove beyond all reasonable doubt that a person had died by suicide, and that changed to balance of probabilities in 2018).
It's also important not to use sources like media outlets for suicide statistics, because they often don't understand what's being counted or how it's being counted. Statistics are tricky, and media often get them wrong.
You say that it's easy to show that suicides are at an all time high in many first world countries, but that's not correct. In many countries rates peaked in about 2008 - 2010 because of world wide financial crash, and have been declining since then. We might see another peak because of the financial (and other) distress caused by pandemic, but so far we're not seeing a big increase.
> maybe it’s just me, but most of the new drugs seem to come from USA.
It's just you.
What we see from the US is re-patenting. Citalopram gets a minor change and becomes escitalopram, it gets a new patent and some bullshit sales pitch to make doctors switch from a cheap generic to a more expensive branded med. Or ketamine infusion becomes eskatamine nasal spray - moved from a generic and tricky to administer med to a branded and easy to administer med (and, it turns out, much less effective).
The other thing the US does is "Me too" drugs - someone develops an SSRI and the US is then able to spin up 8 different versions of SSRIs that are different enough to get their own names and patents.
Most of the funding in the US doesn't come from big pharmaceutical companies, but is government funding.
For the new meds that are developed in the US the funding normally comes from Government (NIHR) funding, and not direct from pharmaceutical companies.
It's also difficult to work out what to measure: do we look at GERD (gross expenditure on research and development) or do we look at GDP too? DO we look at the quantity of new meds, or the impact on quality of life or years of life lost to disability? Do we focus on meds aimed at diseases that affect wealthy countries (diabetes, breast cancer, etc) or on disease that mostly affects poorer countries? Because three meds that have moderate impact for a small population are "less" than one med that has a good strong impact on a large population.
Sorry, in hindsight my comment was unreasonably broad and unclear.
I think it's obviously true that someone might feel anywhere from "a bit weird" to "really quite unwell" for a couple of weeks after discontinuing an antidepressant. I don't know how effective GPs are in communicating that, but you're right that it's there in the patient information leaflet.
What I don't see as particularly plausible are the extremely long withdrawal syndromes reportedly lasting many months or years, or the extremely prolonged tapering regimes that involve tiny fractional doses. I cannot conceive of any plausible biological mechanism for these symptoms, or a plausible mechanism by which a tiny fraction of a clinically relevant dose might alleviate them. Prolonged post-withdrawal effects are reasonably common with GABAergic drugs, but the mechanism and mode of action of these drugs is radically different.
If someone has been taking 20mg of escitalopram, it's perfectly sensible to step down to 10mg and perhaps 5mg over a few weeks to allow their serotonin system to upregulate without too much drama. If they're a year down the line, they're taking 0.2mg and they feel suicidal if they miss a dose, I don't think there's a biochemical explanation for their symptoms.
