Compare this situation to that of antidepressants. On the basis of histrionics and flawed research design, the FDA urged that they not be used in children and mandated the dreaded ‘black box warning’ on the drugs’ prescribing information. I am not sure, but I fear these actions have had a discernible chilling effect on antidepressant prescribing rates, because doctors will be skittish about prescribing them to even urgently depressed patients, some whose lives are in jeopardy from their mental state.

Stimulants, on the other hand, are superfluously prescribed for a condition that is vastly, epidemically, overdiagnosed in a loosey-goosey, unsystematic, irresponsible way. Unlike antidepressants, anyone almost anyone prescribed a stimulant like Ritalin or Adderall, ADHD or not, will feel better and the shoddy diagnosis becomes a self-fulfilling prophecy because a medication is seen to have caused improvement. Again, unlike antidepressants, the drugs have enormous potential for abuse, diversion to the street trade, and addictiveness, because they feel so good to use. Tolerance accelerates use and creates escalating need for higher and higher doses over time. And the cardiovascular consequences, including sudden death, are far from trivial risks.

So one class of drugs with serious dangers prescribed for too little reason to far too many people, for which a ‘black box warning’ would almost surely be a public policy step in the right direction, and have the desireable effect of diminishing the volume of prescriptions, is given a free pass, while the applicability and acceptability of another urgently needed class of drugs for a life-threatening illness is hobbled needlessly. No matter how large the denominator, 51 deaths from stimulants certainly represents a much higher rate of morbidity/mortality than attributable to the antidepressants, and an effect magnified by the diminished necessity for and benefit of stimulants as compared to antidepressants.

Update: FDA Panel Recommends Warning on ADHD Drugs (New York Times )

Hume argues that Western societies encourage “all manner of groups to seek special status by defining themselves as victims and developing a heightened sense of grievance… Being offended or excluded in some way becomes a shortcut to claiming moral authority and demanding apologies and redress…” Hume suggests that the cartoons — admittedly offensive but obscure — were a convenient target for those looking for an occasion to become outraged.

And the protests have drawn their strength from the defensive reactions of the West. The reprinting of the cartoons in other European media, spun as arising from solidarity with the Danish paper, is less a principled stand on behalf of free speech than “another claim for victim status, this time on behalf of journalists.”

The opposing stance in the West, that of a politically correct condemnation of the offensiveness of the caricature, on the other hand, gives legitimacy to the protestors and actually fans the flames. Freedom of speech is not true freedom if only inoffensive speech is free, although on the other hand freedom does not oblige us to offend at any opportunity. Hume attempts to draw some distinctions, which I think don’t really work, about when it is worthwhile to be offensive, as opposed to merely frivolous or gratuitous: “For us, the right to be offensive is about the freedom to express ideas and opinions in which you believe, regardless of whether they offend existing orthodoxies or sensibilities. Cartoons like these, however, simply seem to cause offence as an end in itself.” In a sense, if we are to defend as fundamental the right of others to say things we do not like, far be it for us to judge if they are “just to offend” or said from conviction.

Islamic protestors have frequently drawn a contrast between the European toleration or (as it is viewed in more paranoid circles) encouragement of the anti-Muslim cartoons and the taboo against expressions of anti-Semitism. In the West, restriction of free speech, as e.g. prosecution of hate speech, has often been based on the principle that certain speech crosses the line to become action (“crying ‘Fire!’ in a crowded theater”). The history of persecution of Jews, including the West, means that anti-Semitic speech credibly creates a present danger of inciting violence. Especially in a society in which disenfranchised people seek opportunities to parlay trumped-up charges of victimhood into the advantages of the aggrieved, attempting to apply that litmus test seems worthwhile. I hope I am not being ethnocentric in saying that I am not sure the ridiculous Danish cartoons pass the test. I am closer to feeling, however, that some of the Islamic reaction does.

Related: “Iran’s largest selling newspaper announced today it was holding a contest on cartoons of the Holocaust in response to the publishing in European papers of caricatures of the Prophet Mohammed.” (news.com.au)