Harvard Psychiatrist Puts Blame on Patient and Family

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Davis-Murder-3By Charmayne Schmitz

The trial of Daniel Marsh continued on September 23 as Douglas Jacobs, M.D., took the stand. The doctor was adamant that drugs and doctors could not be blamed for Daniel’s violent acts. Instead, he threw a variety of reasons at the court during the morning session.

Dr. Jacobs is a psychiatric specialist, and Associate Professor at Harvard University Medical School. In 1991, Jacobs founded the non-profit National Depression Screening Day, which was later expanded to include screening for other psychological issues. His non-profit received funding from various organizations, including a Department of Defense grant. At one point, 70-80% of the financial support came from pharmaceutical companies.

Over a period of 25 years, the doctor has testified in a number of cases as a prosecution witness, often where a defendant claimed that prescribed medications were the cause of a crime. Dr. Jacobs averages three to four court appearances per year, and 75% of his income is from giving expert testimony along with legal consultations. He was paid $15,000 to review the medical records of Daniel Marsh and testify about his findings. He did not personally speak to Daniel.

In 2004, the Food and Drug Administration asked nine pharmaceutical companies to relook at the drug trial records of anti-depressants. There had been reports coming in about suicidal behavior in patients on these medications. Dr. Jacobs testified that the black box warning emerged after this study and now all anti-depressants have it. The black box warning emphasizes the requirement for regular follow-up by a physician or psychiatrist while taking the drugs. The review of the drug trials claims the “drugs themselves don’t cause suicide or violence.” The black box warning is the same for all anti-depressants. Dr. Jacobs believes the FDA would remove the drug from the market if there existed any scientific evidence of homicidal tendencies.

Dr. Jacobs saw no evidence of malpractice in his review of the documents. Zoloft and Wellbutrin are a common drug combination. There is no scientific evidence connecting Zoloft with violence. Psychiatrists can’t predict suicidal or homicidal behavior. Some patients do not improve on the medications – sometimes they get worse.

Daniel reported taking the medications and the prescriptions were filled, but Dr. Jacobs said “we don’t know if he actually took them.” The doctor continually stressed that people with underlying mental illness can have the symptoms of aggression, violence, suicide. The symptoms may get worse but they aren’t “caused” by the drug itself. Families should be aware of the possibilities and report to a physician if there are any changes.

Dr. Jacobs talked about other causes for violence. In this case, the record shows that Daniel had no memories of affection from his parents. He had no relationship with his father and a hostile one with his mother. There were problems in his development that explain his behavior, not the drugs.

The doctor even raised the issue that some physicians believe the generic anti-depressants are not as effective as brand name ones (Daniel was taking generic).

Afternoon Session

On cross-examination, Deputy Public Defender Ron Johnson questioned Dr. Jacobs about the process of self-reporting. In psychiatry, patients are given written surveys and asked to score themselves on their moods and thoughts. Dr. Jacobs said the clinician should then observe the patient for symptoms and signs to confirm the patient’s status.

The doctor expressed that Daniel’s self-reporting was deceptive or incomplete, and he blamed Daniel for failing to raise an alarm with his clinicians, despite Johnson presenting the witness with examples to dispute that assertion – which sometimes contradicted the testimony. Johnson cited records where Daniel expressed aggressive or homicidal tendencies to his clinicians, yet Dr. Jacobs continued to assert that Daniel’s self-reporting was deficient, consistent with the observations of a previous witness, court-appointed clinical psychologist Deborah Schmidt.

Johnson asked about some of Daniel’s other medical records. Dr. Jacobs said if Daniel had been “more forthcoming with his thoughts,” the doctors could have a better indication of his condition. Later, during questioning of the doctor’s National Depression Screening Day, Dr. Jacobs told the court that “young people communicate suicidality to other young people” and not to others.

Johnson asked about the period in 2012 where Daniel went off the medications. Dr. Jacobs explained that, during that time, Daniel gave more specific details of possible violent threats which resulted in a 5150 detention (an involuntary psychiatric hold, pursuant to Health and Welfare Code section 5150).

Johnson then asked about the medical record from Daniel’s hospitalization in 2012. Dr. Jacobs testified that the discharge records were only a summary. The full record would not have been sent to Kaiser. If Daniel wasn’t forthcoming (with his thoughts), it’s not the Kaiser physician’s fault.

Dr. Jacobs agreed that Daniel’s symptoms were worsening in the spring of 2013, but that the physicians were on top of the treatment. This is evidenced by the increase in dosage. Also, the patient was aware that a crisis center was available.

Johnson asked about the baseline in the record – that Daniel had passive homicidal tendencies, as documented in December, 2012. Dr. Jacobs replied there was no identification of a specific victim. Johnson asked the doctor, “Were there worsening signs?” Jacobs answered, “To a degree, yes,” but clinicians can only use what they are told.

There were further questions about the black box warning. Dr. Jacobs said the warning is to inform the parents what could be in the list of side effects. The black box warning was added after 2004, as noted above. After more discussion, Dr. Jacobs said side effects come from the clinical trial. Violence is not one of them. Violence has been reported, it’s in the medical guide, but the medical community does not believe it. The medical guide goes to the physician. They should be aware of the possibility, but that doesn’t mean the medication caused it. The FDA would only investigate if there were enough reports of adverse effects.

Johnson asked how you build a study to know if people kill each other on while on a medication. Dr. Jacobs said the FDA would have to think it was important and they would do something.

Dr. Jacobs was asked to list symptoms & characteristics of depression. The last one was homicidal tendencies in 10-13% of the people. He said it is understood in the field that these occur and “adverse reports are different from reports of adverse effects.”

What do doctors do when they see signs of worsening? Prescribe more medications, was the doctor’s response.

Johnson mentioned that Dr. Bynum testified he reduced a medication when Daniel came out of the hospital in 2012. Dr. Jacobs said, “Yes, one approach could be to decrease the medications.” He was asked how one would know. “Use clinical judgment and experience with patients.” There’s “no cookbook to follow.”

The doctor spends 45% of his time and earns 75% of his income on court cases, primarily in medical malpractice defending doctors.

Johnson then raised the issue that Dr. Jacobs was paid by a drug company, Roche, about $30,000 to $40,000 in 1998. He also testified at a Congressional Hearing in 2000 for Roche, about a relationship between the drug Accutane and suicidal tendencies. Afterwards, the FDA issued a black box warning for Accutane. Dr. Jacobs also worked on two other cases of wrongful death for Roche.

Eli Lilly and Company was one of the contributors to his non-profit. Lilly makes Prozac. Up to 200,000 people were screened by the program. 60% of those would have possibly seen a physician, so Lilly stood to gain 120,000 patients.

Zoloft is not approved for pediatric patients, except for OCD (obsessive-compulsive disorder). This is stated in the black box warning. Jacobs said in clinical trials children have a high placebo response. So, there is no stated evidence that Zoloft works for pediatric patients. When questioned, Jacobs said the clinical experience has shown it to be beneficial.

Dr. Jacobs said there isn’t a lower dosage of Wellbutrin for a 15-year-old. It would be the same as for an adult.

Johnson raised the issue of the medical guide again. It mentions anger, violence and aggression. The doctor treating Daniel “made a clinical judgment.” Daniel was asked about these symptoms and said he had none. Daniel did tell the therapist, but he wasn’t explicit.

Trials of drugs are usually 16 weeks. There are no trials for combinations of drugs. The only evidence is from case reports. The case reports are not evidence of causation unless the FDA gets a large number of them. The doctor then dismissed a case study mentioned by Johnson from a medical journal, stating that “young kids have violent thoughts” on Prozac. The doctor said there weren’t a lot of them reported.

The day ended with the brief testimony of a radiologist, Dr. Mitchell. The DA’s office requested an MRI of Daniel in May of 2014. Dr. Mitchell subsequently performed the test, and no irregularities were found. On cross-examination, Johnson asked if Dr. Mitchell had brought a copy of the MRI. The doctor and the prosecutors appeared to be surprised at the request, then a spectator produced it from a large briefcase.

Update: The author has provided some additional detail to the testimony of Dr. Jacobs, regarding self-reporting, and to the testimony of Dr. Mitchell.

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About The Author

The Vanguard Court Watch puts 8 to 12 interns into the Yolo County House to monitor and report on what happens. Anyone interested in interning at the Courthouse or volunteering to monitor cases should contact the Vanguard at info(at)davisvanguard(dot)org

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34 thoughts on “Harvard Psychiatrist Puts Blame on Patient and Family”

  1. South of Davis

    Charmayne wrote:

    > Harvard Psychiatrist Puts Blame on Patient and Their Family

    It is popular these days to “blame” everyone but the guy that actually committed the crime, but ultimately it was Daniel that killed his neighbors (and should have 100% of the “blame”)…

    Just like guys that have a lot to drink get in close all bar (and pizza parlor) fights and kids on psychotropic drugs are responsible for close to all school shootings the booze and drugs should not be “blamed” (since 99.99% of all drunk guys don’t get in bar fights and 99.99% of kids on psychotropic drugs don’t bring a gun to school and kill their classmates).

    We also know that just about everyone that beats their wife and kids grew up in an abusive home, but since plenty of guys grew up in abusive homes and don’t knock their wife out in elevators or beat their kids with a stick we can’t “blame” screwed up parents (we can however reduce the number of screwed up kids by forcing parents to support their kids and punish parents that abuse their kids).

    1. TrueBlueDevil

      You wrote: “99.99% of kids on psychotropic drugs don’t bring a gun to school and kill their classmates).”

      While this may be true, there also seems to be a high rate of kids who shoot up schools being on prescribed drugs. Both can be true.

      1. South of Davis

        TBD wrote:

        > While this may be true, there also seems to be a high rate of kids who shoot
        > up schools being on prescribed drugs. Both can be true.

        I’m not a defender of giving so many kids psychotropic drugs but “both” are true.

        We have about 74 million kids in the US (from childstats.org) and about 1 in 10 is on some kind of psychotropic drug (way more than 1 in 10 in CA) and pushing the “school shooting” as high as we can (to include suicide and robbery) we have 74 (according to the link below).

        74 shootings out of 7.4 million kids taking drugs means that 99.999% of the kids in America are not shooting people (if only 1% of the kids in America are on drugs it would be 99.99%

        http://www.politifact.com/truth-o-meter/statements/2014/jun/13/everytown-gun-safety/have-there-been-74-school-shootings-sandy-hook-clo/

        1. KonaOhana

          Is your point that ANY percentage of children killing others is acceptable ? Sighting one or many sources to describe a miniscule percentage as if it’s acceptable in and of itself is inexcusable. There are hundreds of doctors world wide that sight many research cases where these psychotropic drugs cause as many as 1/3 of the patients to have extremely suicidal & homicidal reactions. These reactions being beyond their control. Many have reactions they aren’t aware of until later. To name a few of these very well know doctors that have for years fought for the truth & halt of the manufacture of these drugs based on 25+yrs of research. Yet doctors like Dr Jacob who are obviously paid propagandists aka mouth pieces to dissuade any negative truths rising to the surface. It was reported as must as 80% of his income is from him testifying on behalf of the BIGPHARMA not on behalf of the truth. Try reading the books published since 1970 by Dr Ann Blake Tracy, Prozac panacea or Pandora, in which it is disclosed the constant efforts by BIGPHARMA to bury the negative effects of these drugs. At over a billion dollars each month of profit on each separate drug each an ssri it’s quite easy to bury the truth behind a wall of cash. By planning people like Dr Jacob $30,000 each trial & 4 trial a year. Plus the salary he’s paid as as doctor on their drug consultant staff yrly. This man is obvious a biased paid propagandist should never be given any respect as an honest doctor. His testimony should have not been allowed unless his oblivious monetary bias was made exceedingly clear.
          Where as the Dr James Merikangas is an honest practicing professor & doctor without being paid bribes.

  2. Biddlin

    “He did not personally speak to Daniel.”
    Wouldn’t have mattered, he probably wouldn’t have listened, anyway.
    Could be a Harvard “thing,” but no one else listened either.
    ;>)/

  3. Rich RifkinWDE 73

    “The day ended with the brief testimony of a radiologist, Dr. Mitchell. This doctor performed an MRI on Daniel in May of 2014. No irregularities were found.”

    An earlier discussion focused on the possibility that Daniel Marsh may have psychopathy. Due to how he spoke to his friends about why he killed the elderly couple and his total lack of empathy for them and his lack of remorse for his actions, I thought this malady was likely in him. However, if “no irregularities were found” on the MRI, I guess that suggests his prefrontal cortex is normally formed, and that suggests he does not have psychopathy.

    I still wonder what he would score on the Hare Psychopathy Checklist-Revised? I wonder if someone like Robert Canning would say about Marsh having a normal MRI, if that means what it sounds like it means.

    1. Davis Progressive

      it means he doesn’t have schizophrenia or bipolar disorder. it also probably means that whatever is wrong with him is environmentally based rather than physiologically based. but i’m a lawyer not a doctor.

      1. Rich RifkinWDE 73

        “whatever is wrong with him is environmentally based rather than physiologically based”

        Perhaps so. However, those two factors are not mutually exclusive.

          1. Antoinnette

            Well, that was one opinion, the other was that it did show a longer space between the legions, if I am not mistaken?

            DP…a lawyer? wow, all this time you have been posting and I never heard you say what you did…that is good to know.

            I too would love to hear feedback from the doctors on their analysis of this case.

          2. David Greenwald

            I saw a presentation last year in San Francisco where research out of the University of New Mexico put MRI’s up and were able to show the difference in the MRI’s between someone with a normal brain, schizophrenia, and bipolar disorder.

          3. Elizabeth Bowler

            In most cases, the abnormal brain scans are of individuals with schizophrenia and bipolar disorder who have been on psychiatric medications for many years, so it is impossible to know if the brain changes were due to the underlying psychiatric disorder or to the medications themselves. These days it is very difficult to find a sufficiently large group of affected individuals who have never been exposed to medication to compare their brain scans to normal controls.

          4. David Greenwald

            Appreciate the additional information. It was a fascinating presentation but obviously the research is early.

          5. Elizabeth Bowler

            very early indeed, but the implication of all this for the Marsh case is that a normal brain scan tells us absolutely nothing about a possible underlying psychiatric disorder.

        1. KonaOhana

          From the reading I’ve done these MRI tests only can be interpreted by doctors that have extensive experience with these mental abnormalities such as Dr J. Merikangas. Certainly not a local who has no clinical experience in the effects of these ssri drugs. Try reading the 30+ yrs of experience of Dr Peter Breggin at Breggin.com. His work in random with Dr Ann Blake Tracy testifying at the FDA are who were able to force them to induce the BLACK box warning LABEL. Dr Jacob and others like him were testifying against the warning. He wanted to stop any and all earnings. His testimony want clear in court. He only makes money while these drugs are available to continue doing permanent damage to society & deaths to innocent victims and children who are too immature to express themselves no matter their intelligence. Let’s not let the ignorant or stupid confuse intelligence in children as wisdom of the ancients. This bit was just that a child placed in a medical& legal system attempting to force .fraudulent assumptions onto him. No one should expect a child no matter the age to express the correct verbage to instigate the programmed response by these inept doctors that incisive stopped the ball. There’s no excuse for this level of ineptitude.

    2. Robert Canning

      Thanks for asking Rich. No one should be administering the PCL-R to Mr. Marsh. He’s too young. It is not designed for adolescents and the results would be invalid. The PCL-R needs more life experience to make a judgment about psychopathy – multiple relationships, diverse and repeated criminality, etc. Characteristics that take time.

      What about his normal MRI? It doesn’t seem to mean much in my mind. If it was grossly abnormal, that would be one thing. But it was normal. One thing about MRIs is that they only show structural aspects of an organ. What may be happening (as in the study that Rich cited in the article from Psychology Today) is that there are changes in the patterns of nerve transmission between areas of the brain. But often, in my experience, MRIs are not very helpful. Here is an abstract from an article that I particularly like: “The seductive allure of neuroscience explanations” Journal of Cognitive Neuroscience, 2008:

      “Explanations of psychological phenomena seem to generate more public interest when they contain neuroscientific information. Even irrelevant neuroscience information in an explanation of a psychological phenomenon may interfere with people’s abilities to critically consider the underlying logic of this explanation. We tested this hypothesis by giving naıve adults, students in a neuroscience course, and neuroscience ex- perts brief descriptions of psychological phenomena followed by one of four types of explanation, according to a 2 (good explanation vs. bad explanation)

    3. tj

      I’m not a doctor but I know a bit about MRI’s and head injury. Even very serious head injuries may not be evident on the most sophisticated, newest, high intensity MRI’s.

      1. Tia Will

        I think that Robert Cannning and tj have this one right. The lack of structural abnormality does not mean that there is no functional abnormality. I think far too much is being made about brain imaging at a time when we know far too little about it. I would like to elaborate on this with an example from my field.

        US is very, very good at detecting structural abnormalities of the ovaries. It can tell with great accuracy the measurement of the ovary and its texture. US is very accurate in detection of ovarian cysts ( fluid filled sacs) which are usually normal findings on the ovary. What it cannot tell you is anything at all about whether the ovaries are producing hormones appropriately. Imaging while it can be very useful in establishing anatomic normality, is almost useless in assessing functionality. Hope that helps rather than further muddying the waters which are truly very, very murky in this case.

  4. Elizabeth Bowler

    I always find it interesting to hear the pharmaceutical industry’s response to incidents like the Marsh case. But despite Dr. Jacob’s assertions to the contrary, we unfortunately can no longer rely on the FDA to protect the American public from dangerous drugs as this latest FDA approval illustrates:
    http://www.usatoday.com/story/news/nation/2014/09/24/addiction-painkillers-fda-margaret-hamburg/16150421/

    The ongoing revolving door between industry and the FDA has left the regulatory agency unable to perform the important public safety oversight function that is its mandate. In recent years the FDA seems to have been more concerned with protecting the pharmaceutical industry than American consumers.

    1. Tia Will

      Elizabeth

      I read with interest the article you linked. I agree with you that there is too close a connection between industry and regulators does not serve the public well and I certainly share the concern about over use of opiates. However, as a surgeon, I would like to offer a slightly different perspective. During the
      30 or so years I have been practicing, I have watched this pendulum swing several times. It was not so many years ago that doctors were being pressured to prescribe more, not less opiates, to better manage their patient’s pain. Now we are on the opposite end of the swing. Opiates of varying strengths are certainly necessary for the management of acute short term pain such as that induced by accidental or surgical trauma. They need to be available as part of the armamentarium for the management of severe intractable pain in some cancer patients. However, there is no doubt that there are times when they are over prescribed or when doctors fail to appreciate that patients are receiving multiple prescriptions from multiple providers although the growing ability to share electronic records is helping with the latter problem to some degree. We clearly have much more to do to find a balance between the extremes of allowing needless pain to go unalleviated and the inappropriate use of opiates for conditions better managed by other modalities.

      1. Elizabeth Bowler

        At the risk of getting too far afield here, I don’t tend to see people who are acutely post-operative, where the use of opiates would be appropriate and necessary for pain control. But I see many people who are chronically prescribed opiates for things like “arthritis”, “low back pain” and even “osteoporosis” and who subsequently develop symptoms such as depression, anxiety and cognitive impairment. So from my perspective, these are terribly overprescribed and abused drugs that should not be used for chronic conditions except by experienced pain specialists.

        1. Tia Will

          Elizabeth

          “I see many people who are chronically prescribed opiates for things like “arthritis”, “low back pain” and even “osteoporosis””

          I am going to join you in the far outfield.
          I may be naive, but I found this shocking.
          As you know, but others may not, unless there is an acute fracture, osteoporosis is a painless condition. In my opinion, anyone prescribing narcotics for osteoporosis in the absence of fracture is committing malpractice. As for
          “low back pain”, this is not a diagnosis and should never itself be treated with opiates without determination of the underlying condition.
          Back to relevance. Prescribing medications is easy when a patient is post operative or has a certain diagnosis. It becomes immensely difficulty when there is uncertainty about the diagnosis or best approach. Imaging can be one way to help us determine a diagnosis, but it is very important to understand that a negative or normal image does not mean that the patient does not have the diagnosis ( some breast cancers exist for years before becoming visible on any kind of imaging study) and having the classic findings does not always mean that the patient has or will suffer any harm from the diagnosis.
          Diagnosis is particularly complicated in the areas of mental illness where diagnosis are frequently based on impressions derived from the history provided by the patient and family and in office observation without objective support from physical exam, laboratory or imaging studies. Given the amount of uncertainty in my own field where this kind of evidence is frequently available to guide me, I can only empathize with those trying to alleviate the suffering of those with mental illness in the face of almost no objective evidence or certainty.

    2. TrueBlueDevil

      Is the FDA out to lunch on a number of issues? We have lax laws / enforcement of companies selling weight-loss cures, vitamins, etc, that seem to get a whole lot of leeway. We have what you describe. Then, as far as medical advances (which involves other agencies), we seem to have a laborious, painful, and costly system that prevents innovation from coming to the market / hospital. Our systems seem outdated.

  5. WesC

    Douglas Jacobs, Associate Clinical Professor of Psychiatry, Harvard Medical School, is the Founder and President of Screening for Mental Health (SMH). He is a consultant to McNeil Pharmaceuticals and Pfizer. In 2002, The Wall Street Journal reported how SMH was helping Wyeth Pharmaceuticals to market “Depression in College: Real World, Real Life, Real Issues,” a 90-minute forum designed to introduce students to the antidepressant Effexor (made by Wyeth). “The nation’s 15 million college students are an important market for drug companies looking to build antidepressant sales,” WSJ reported. Wyeth joined with Pfizer (Zoloft) and Eli Lilly (Prozac) to help underwrite the National Depression Screening Day to also take place at campuses. It prompted The Boston Globe to report “the biggest drug dealer on campus” is Big Pharma. Up to 2008, SMH had received nearly $5 million from pharmaceutical companies.
    Jacobs devised the idea of a national Depression Screening Day, which was held in 1991, funded by a grant from Eli Lilly.
    Thousands of sites in hospitals, corporations, and universities around the country provided free depression screening, which involved people answering a modified version of the Zung Self-Rating Scale, a subjective questionnaire lasting less than five minutes. By 1998, more than 60 million prescriptions for antidepressants had been written for 10% of the American population, including half a million children.

    Other board members of SMH…
    Dr. Jefferson Bruce Prince, Harvard Medical School, Consultant for Abbot, AstraZeneca, Cephalon, McNeil Pediatrics, McNeil Consumer Healthcare, Ortho-McNeil, Novartis, and Shire; speaker’s bureau for Janssen, Ortho-McNeil, Eli Lilly, and Forest Labs, and has received honoraria from Abbott, Cephalon, Novartis, and Shire and list significant financial interest or other affiliation in GSK, Shire, Organon, Lilly Research Labs, Alza Pharmaceuticals and Celltech.
    errold F. Rosenbaum, Chief of Psychiatry, Massachusetts General Hospital: Consultant or on the Advisory Boards for Bristol-Myers-Squibb, Cyberonics, Eli Lilly, Forest Labs, Organon Pharmaceuticals, Pfizer, GSK, Somerset Pharmaceuticals, Novartis, Roche, Sanofi-Aventis, Sepracor and Wyeth, Speaker’s bureau for Forest, Janssen, Organon, Eli Lilly, Wyeth and Forest Labs. Significant financial interest or other affiliation with US Pharmaceuticals, Pfizer, Sanofi, Lichtwer Pharma, Parke-Davis, Janssen Pharmaceutica & Research Fdn, Pharmacia & Upjohn Inc.
    James Henry Scully, Medical Director and CEO of the APA, with 30% of its funding from pharmaceutical companies.
    Leonard Freedberg M.D.: psychiatrist in private practice and founding partner of Newton-Wellesley Psychiatry in Newton, MA and Harvard Faculty member.

    Golly. You think it is possible that Jacobs just might be a teeny bit biased in his support of pharmaceuticals?

    1. Elizabeth Bowler

      This is very disturbing to read. It shows just how thoroughly and completely the pharmaceutical industry has infiltrated our academic institutions and their affiliated teaching hospitals.

  6. DavisBurns

    The other day we heard from the defense doctor who is paid by the defense. Today we heard from a doctor who is paid to defend other doctors. Marsh’s doctors failed to listen to what he did say and failed to be alarmed. I wouldn’t want to be in their shoes.

    Also, if he had an attachment disorder, it is not necessarily the parents fault. Some children fail to bond despite all efforts by the parents.

    1. Robert Canning

      With all due respect, I think that’s an oversimplification (they failed to listen and failed to be alarmed). My business is mostly in suicide prevention. This is the kind of thing that often gets said after a suicide – “The doctor missed the cues and if he/she had only listened better the person would be alive today.”

      Forecasting self- or other-violent events is one of the most difficult tasks for mental health clinicians. Clinicians can do an excellent job evaluating risk and the patient can still kill themselves. Patients often do not share their intentions or inner states with therapists. The rates of violence (particularly the kind in this case) among adolescents is so low as to be almost off the radar. But voicing violent thoughts is not all that uncommon. But the number of kids who voice violent fantasies and then go on to commit a violent act (killing an animal or harming someone) is quite small. There is no way that these clinicians could have anticipated that Marsh would violently and maniacally attack and kill two elderly neighbors. The idea that he would harm himself was much more in their minds, given that suicide is the third leading cause of death in 15-24 year olds.

      1. DavisBurns

        I think I didn’t make myself clear. The witness was there to defend the doctors who treated Marsh or perhaps the medications they prescribed. The defense countered by blaming the doctors (as they earlier blamed the medication):

        ” Johnson cited records where Daniel expressed aggressive or homicidal tendencies to his clinicians..”

        “Johnson raised the issue of the medical guide again. It mentions anger, violence and aggression. The doctor treating Daniel “made a clinical judgment.” Daniel was asked about these symptoms and said he had none. Daniel did tell the therapist, but he wasn’t explicit.”

        Marsh was under the care of doctors and they did miss it. Usually a miss doesn’t have horrific consequences like this. I can even agree they didn’t have much to go on. But I would have a hard time giving myself a pass if I was one of the doctors or therapists hence I wouldn’t want to be in their shoes.

        I keep coming back to Marsh’s guilt. He has confessed to the crime but I don’t believe he can be found NGI and then I think it isn’t possible for a sane 15 year old to murder two people. It wasn’t a crime of passion. It wasn’t revenge or retribution. I guess we understand overwhelming emotion as a motive. He went out alone looking for someone to murder. It is criminal but at his age what makes that happen? Do any of those doctors involved have a diagnosis now that he does have their attention.

  7. Elizabeth Bowler

    “Dr. Jacobs said there isn’t a lower dosage of Wellbutrin for a 15-year-old. It would be the same as for an adult.”

    Wellbutrin is only approved for pediatric use for the treatment of ADHD. It is not approved for the treatment of depression in children.

  8. KonaOhana

    It seems to me these discussions are missing the point that this young man is not a man he was a boy at the time of his treatment with these drugs. These drugs are not recommended for use with children. They’re banned in the UK for use with anyone under 25. They were stopped in 1980 by the FDA until PRES Bush Sr forced a release in that ruling. It was disclosed he owned a very large portfolio of Eli Lilly stock the manufacturer of Prozac. The primary ssri of the day.

    The revolving back door between FDA & BIGPharma has been an obvious tool for new drug launches & gov’t policy changes. This behavior is absurd. These people should be PROSECUTED for this fraudulent behavior. Plus this job switching and financing of drug
    Approval tests of 2 -4 weeks for drug approvals based on the drug companies own tests rather than independent tests is obvious fraud. Or gov’t is complicit is these ridiculous approvals. Approvals that if they are processed must be done independent of BIGPharma & their billions of $ & promises of high paying jobs.
    tests

  9. KonaOhana

    To compare the. Comments of Dr Jacobs an obvious puppet of BIGPHARMA who has been publicly admonished by his own state of practice as being infantile in his assumptions. He’s Not even thought of well enough to consider his thoughts to be conclusions or pertinent but to be assumptions and thus his input discarded. To allow this obvious tilted& biased testimony in a trial that is so heavily rested onto credible learned abilities & knowledge is Ludicrous. The defenses doctor is.a well thought of, honest & respected man. At least this article should have included an even balance of coverage rather than the polar opposite.
    The article is obviously biased in favour of the prosecution rather then a balanced journalistic view these men’s testimonies will have on this boys life. I it seems apparent to me the DA has been out for revenge not to consider justice or the law or the possibility that a child given exceedingly poor medical care the wrong drugs. In fact drugs that are not recommended for ANYONE under 25 especially a child of 13 when they started. This case should have been handled in the juvenile courts. But this DA has used it as a platform for his political torch. This kind of grand standing is inexcusable.
    I hope this behavior comes to force a change in the views of ALL courts to champion justice and fair treatment for children not fodder for the careers of the ignorant.

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