November 20, 2009Abilify Gets FDA Approval For Autism IrritabilityThe FDA today approved the atypical antipsychotic Abilify for the treatment of irritability associated with autism in pediatric patients aged 6 to 17 years old. I'll leave it at that. Geodon Gets New ApprovalAs an adjunct treatment for bipolar disorder combined with either Depakote or Lithium. No comment. Winter Fundraiser, Day ThreeYesterday, $40 came in from one person came in bringing the total raised so far to $315 from five people. That leaves $3,685 from 95 people to go to reach the overall goal of $4,000 from 100 people somewhere around December 18th. Thanks to all of you for your contributions and support. If you'd like to make a contribution, the PayPal button is on the right or, if you prefer snail mail, send me an email and I'll send you my mailing address. I appreciate the contributions that have come in so far, especially since it's boosted my mood a bit during a very tough couple of days with my cat, Katie. I managed to get an entire, huge (6 ounces) can of prescription cat food down her via syringe, 20 mls. at a time. I lost track of how times I fed her and how many times she scratched me. She's better than she was on Wednesday, so we'll see how things go over the next few days. I'm utterly exhausted. So is Katie. Thanks to all of you for your support. British National Health Service Goes After American WebsiteA few of you likely know of Dr. Bonkers, the Bonkers Institute and its website. Bonkers--aka Ben Hansen--has tirelessly catalogued pharma ads for psych meds for four years and recently posted some National Health Service brochures he obtained that are alarming. In them, children, teens and young adults are basically told to shut up and take their meds--Zyprexa, Risperdal and Strattera (links are to the brochures). In making them publicly available, Hansen has apparently angered the NHS which contact him and asked him to edit out much of the brochure from his website. Hansen refused (see the exchange below). Some of the language in the brochures is interesting. I'll focus on the Zyprexa brochure. "Your Medicine is called Olanzapine. Pronounced 'o-lan-za-peen.' Here's a question for NHS: On what basis do you argue that Zyprexa--oops, Olanzapine--keeps children healthy? What randomized clinical trial proves this in children? Is it even approved for use in children and teens in the UK? If so, for what? Even Lilly's UK website doesn't say. Or are you in essence helping off-label market to kids and teens? Then: "When you first start taking olanzapine it may make you feel a bit sleepy, but this should wear off after a few days. It may make you feel like eating more food. If this happens, try not to eat more than usual, and talk to an adult or your doctor about this. That kind of rot speaks for itself. The other brochures strike a similar tone. Now check out what the NHS's deputy chief pharmacist told Hansen: "Could I please request that you amend the site so that it is no longer possible to access the whole leaflet -- the front page and our contact details would be appropriate. I'm sure you appreciate that the only way that we will be able to produce more materials for patient benefit is by recouping the cost from other organisations which want to use them -- our objective is provide written materials to support the verbal counselling given by healthcare professionals -- they are not meant to stand alone as sources of information. We charge a reasonable fee for full access to all the children's leaflets and so it not in our interest, or necessarily, patients and parents to have access to them on your website without the professional support intended." Wow, the British government charges for these brochures? I wonder what groups use them and under what circumstances. And don't you just love the irony of the British government trying to censor an American website? Good luck with that! Hansen replied: "We posted the NHS leaflets to stimulate public scrutiny of your agency. We call upon the NHS to stop promoting harmful psychotropic drugs for children. In a spirit of full disclosure and transparency, we have now posted your letter as well." You can read the emails at the bottom of each link above. (Via opednews.com.) I call upon Hansen to continue to make such advertisements and brochures available. If any of you have "interesting" brochures and whatnot from the US, UK, Canada, Australia or wherever, feel free to pass them along to me or Dr. Bonkers. Tragic Anti-Depressant Withdrawal, Murder Case In UKLet me start by saying that it's well-known that withdrawal from anti-depressants (and other psych meds) can make some people act anywhere from oddly to violently, even in cases where people have carefully withdrawn from said meds. Fortunately, the instances of true violence are rare, but they do go on and should be a constant reminder to all of us--irrespective of where we stand on the on-meds/off-meds divide--that withdrawal can be dangerous and must be approached with respect. Now, here's news of a tragic and ugly case in the UK where a husband allegedly strangled his wife after coming off a Parkinson's med (given to him to control vivid nightmares) and two unnamed anti-depressants. "Dr Paul Skett, an expert in prescription drugs, said Mr Thomas would have experienced nightmares after coming off the drugs, two antidepressants, and one to control both Parkinson's Disease related hand tremors and nightmares. While I'm not arguing that the meds made him do it, I am arguing that they are deeply entangled in the tragic outcome, which argues that patients and doctors have got to take the withdrawal process much more cautiously. Take a swing through ssristories.com and do a find in your browser under "withdrawal." November 19, 2009Academic Researchers Fail To Report ConflictsAn article today in the New York Times simply blows my mind. I'll just quote from it: "Few universities make required reports to the government about the financial conflicts of their researchers, and even when such conflicts are reported, university administrators rarely require those researchers to eliminate or reduce these conflicts, government investigators found. That should shake everyone up because these universities, collectively, take in billions a year in federal research funding yet apparently refuse or are too lazy to monitor whether the researchers getting federal funds are also getting unreported pharma monies. The whole thing is downright Nemeroffian. I'm not sure what needs to happen to clean this system up but I think it's outrageous that these same researchers are the types of "experts" the media quotes in health stories that instruct the public in how to behave and these are the same folks who would likely claim to be "highly ethical" (and probably teach medical students in medical ethics) yet they're violating research ethics all over the place. It's stories and reports such as the above that make me deeply distrustful of our health care system and the pronouncements of experts. It's simply not that hard to do the right thing and play by the rules and it's very telling that loads of researchers in various disciplines don't seem to care. Winter Fundraiser, A Good Start, Includes Katie UpdateYesterday, $275 from four people came in and that leaves $3,725 from 96 people to go to reach the overall goal of $4,000 from 100 people somewhere around December 18th. Thanks to all of you for your contributions and support. If you'd like to make a contribution, the PayPal button is on the right or, if you prefer snail mail, send me an email and I'll send you my mailing address. And if you want take a look at yesterday's post where I outline some of what I've covered on this site since September 1st. Let's just say there's a good amount of news there that the mainstream media either doesn't know about or won't touch. As for my dear 14-year-old cat Katie, she took ill again late last week with an upper respiratory infection, which made it difficult for her to eat, so the problem with her liver re-appeared. I spent much of yesterday at the vet and then feeding her prescription food via syringe. And giving her anti-biotics and closing her in the bathroom with me while I showered so the steam would help clear her nose. I've got to get as much food down her as I can and get weight back on her promptly or things won't work out too well. Getting a can of cat food down a cat by syringe takes multiple feedings and results in multiple scratches. Katie is tolerating the process as best she can, but there's not a cat alive who enjoys being fed that way. Hopefully, she'll be back to eating on her own in a few days when her nose clears up. She bounced back well enough after the problems in early October for me to trust that she's a fighter and that we can make this work. I sure hope so. Seroquel Lawsuits Back To Home Courts?Many of you are aware that there is a complex, class action lawsuit against AstraZeneca in federal district court in Florida. Yesterday, the judge in the case said she'd urge a panel of judges to send 6,000 lawsuits against AZ over various accusations involving Seroquel back to their original state courts. While this will slow down the litigation for plaintiffs, the reality is that this might be good news for injured parties, as the federal court judge was engaging in some wacky rulings and throwing out cases and evidence, according to a participant in the proceedings I've spoken with. We shall see. Overall, AZ faces 14,000 Seroquel-related lawsuits. November 18, 2009Senate Health Care Reform Bill ReleasedWell, not exactly since no one has seen the bill beyond the CBO, which has costed it at $849 billion over 10 years. That's an initial estimate and may change, but for now it does meet President Barack Obama's goal of a bill coming in at under $900 billion over 10 years. I won't have much more to say until I see the bill itself or at least see some thorough reporting on it. Army Suicides In 2009 to Top 2008One of the most consistently discouraging and gut-wrenching topics I write about on this site is suicide among active duty personnel in the US Army and today the news is awful. That's because yesterday the Army announced that active-duty suicides had hit 140 deaths for 2009, matching last year's total with six weeks left in the year. What's more, another 71 soldiers committed suicide after being taken off active duty. Like I said, discouraging. That this is likely mostly going on amongst non-commissioned personnel who are probably fairly young is doubly upsetting. I think we all know that the active duty military--especially the Army and Marines--are under epic amounts of stress and that many of our fighting men and women have been through multiple deployments in Afghanistan and Iraq. The Army did claim, however, that one-third of the suicides were among personnel who'd not seen action overseas. If we have so many suicides among Army personnel who've not been exposed to the stresses of war, then that does make me wonder what the hell is going on here. Because something is and it'd be good to know what that something is. John Grohol at PsychCentral.com had some sharp things to say: "When you’re threatening court martial to moms who can’t find child care for their 10-month old before deployment and have psychiatrists shooting up your training bases because you don’t acknowledge the inherent conflicts in service amongst your ranks (or your officers don’t have the stomach to discharge someone they clearly saw as problematic), then yes, you have some serious problems. And yes, they are related to the two wars you are currently fighting. I agree that this issue merits a lot of attention. The answers are bound to be ugly because we have very high rates of medication with psychotropics among our troops now and that clearly does not seem to be helping things. We have a military that pays more attention to mental health problems that it probably ever has in its history and yet things keep getting worse. We also have the problem caused by the military not keeping official suicide statistics before 1980 and, as a result, we've got no way to compare what's going on now with experiences in the Vietnam War and World War II. I don't pretend to know what any of the answers are here. I just know that I am tired of writing about this topic. Winter Fundraiser, An Early StartI'm beginning this site's winter fundraiser a bit earlier than I'd originally planned for a couple of reasons. One, the last few fundraisers have taken longer than the two weeks or so of the glory day of 2007 and 2008, so this one will run longer but needs to be over by December 18th when I know folks will be well into their holiday travel and plans. Two, it absolutely feels like winter in Seattle the last few days what with cold winds and lots of rain and the dark coming on at 4.15 p.m. Anyway, the overall goal for this fundraiser is $4,000 from 100 contributors over the next month, although the earlier contributions come in then the earlier I can end the fundraiser. As usual, the PayPal button is on the right. If you prefer using snail mail, shoot me an email and I'll send you my mailing address. Of course, I know intimately just how rotten the economy is right now. So what have I been doing around here since September 1? Continue reading "Winter Fundraiser, An Early Start"Reasons To Be Skeptical Of "Female Viagra" Drug, Big Pharma's Spanish FlySo yesterday results of a study of a drug called Flibanserin (its generic name) were rolled out at a conference in France. Flibanserin was designed as an anti-depressant, but failed its trials except in one key sense: female patients were reluctant to return the study drug at trial's end because they'd had a low libido pre-trial and experienced heightened libido while on the drug, which is made by a Germany pharma company called Boehringer Ingelheim. Since the company has run several phase 2 and phase 3 trials of the drug to treated so-called hypoactive sexual desire disorder or HSDD. Anyhow one study of the drug got a ton of press attention yesterday. It involved 1,378 women in stable relationship who were diagnosed with HSDD. The drug was trialed against placebo over 24 weeks and study subjects reported more "satisfying sexual events"--a careful term if there ever was one--on the drug than on placebo. Before I get to the skepticism of my headline, let me address the two or three of you who might wonder why I'm writing about a purported treatment for HSDD on a mental health website. First, sex and relationships are obviously entwined with mood and, in many respects, overall mental health. Second, I'm endlessly fascinated by how anti-depressants have been repurposed over the years and this story is a big repurposing. Now for some skepticism: Continue reading "Reasons To Be Skeptical Of "Female Viagra" Drug, Big Pharma's Spanish Fly"November 17, 2009Medical Marijuana For Autism?This is the third time in two years that I've encountered a case of parents giving their kids with autism medical marijuana--usually in an ingested form as opposed to smoked--instead of antipsychotics and others meds. Reportedly, this novel treatment works fairly well. But there's the tricky problem of medical marijuana's legal status. "Respected LA-area pediatrician Chris Tolcher says we don't know enough about cannabis for kids. If the DEA wouldn't make such research impossible, then perhaps we might have some answers. AstraZeneca Whines About Chicago Tribune's Seroquel CoverageYesterday, a letter to the editor appeared in the Chicago Tribune, penned by AZ's chief spokesman Tony Jewell and critical of a recent article in the paper concerning the company's antipsychotic Seroquel. The paper had written about AZ giving $490,000 to a Chicago psychiatrist who prescribed tons of Seroquel, plenty of it off-label, and also authored a study claiming patients lost weight on the drug. In part, it reads (via Soulful Sepulcher): "Since first approved in 1997 for the treatment of schizophrenia, the U.S. Food and Drug Administration has approved Seroquel as safe and effective for three indications in bipolar disorder, as well as in a new formulation for additional treatments in schizophrenia and bipolar disorder. Today Seroquel and Seroquel XR are the only medicines approved as monotherapy by the FDA to treat both the acute depressive and manic episodes associated with bipolar disorder. OK, fine. But since Jewell is relying so much upon the FDA's blessing of the drug to make his case to the public that Seroquel is safe and effective and that AZ plays by the rules, then I need to point out that last December the FDA busted AZ for off-label marketing of Seroquel for depression. To date, the agency has refused to answer any questions about its finding or to reveal what sanctions it might impose on the company. It's almost one year later and high time the FDA did something. November 16, 2009Big Pharma's Sneaky TrickAn excellent piece in today's New York Times lays out how Big Pharma has been promising to cut costs of its drugs (to the tune of $8 billion a year) to help make health care reform happen while at the same time it's going around raising the prices of its drugs to the tune of $9 billion a year. That's such typical behavior by the drug companies that I'm hardly surprised. They are a truly brazen bunch. You just had to know that with Big Pharma openly supporting health care reform and alleged cost-cutting that something funny had to be going on. Now, we know what it was. Researchers Ignore Problems With Meds In Early Deaths, Blame Smoking, No ExerciseA new study out in General Hospital Psychiatry blames smoking and inactivity for heart disease related deaths among people with schizophrenia and other psychotic disorders. No mention is made of the role of antipsychotics and other medications in this dynamic. From Medicalnewstoday.com: "A large new study confirms that people with severe mental disorders - such as schizophrenia or other psychotic disorders - are 25 percent to 40 percent more prone to die from heart disease than people without mental illness are. The study was among people in the VA system. Interestingly, inactivity was a greater risk factor (66 percent higher risk) of a heart disease death than was smoking (32 percent higher risk). The study calls for smoking cessation programs and promotion of physical activity among veterans with psychotic disorders. How they plan on getting veterans zonked on Zyprexa to exercise is beyond me. There is no mention in the study of the role antipsychotics may be playing in all of this even though antipsychotics are well-known to boost blood lipids and cholesterol as well as to cause diabetes and weight gain--all risk factors for heart disease. What's odder about the omission is that atypical antipsychotics carry warnings of diabetes and cardiac problems, so why would researchers ignore the hazards presented by these medications? Oh, we know why. These are doctors in denial much as with this study from earlier this year which claimed that people diagnosed with bipolar disorder died early, but barely mentioned any connection to chronic use of medications. I'm not excusing smoking or inactivity, but for this current study to ignore meds altogether is inexcusable. Researchers' New Pediatric Bipolar Disorder Symptoms Include Bed Wetting, NightmaresThe folks at the Juvenile Bipolar Research Foundation--that's the Papaloses of "The Bipolar Child" book fame's organization--have really gone an done it now. They've fully crossed the Rubicon and now claim that kids having nightmares, wetting the bed and who are interruptive have so-called pediatric bipolar disorder. This is all from a JBRF "news flash," which I cannot locate on the group's website yet, but which I have in email form (if you want it, send me an email and I'll pass it along). The news flash, which is also a solicitation for contributions to JBRF, is entitled "Characteristics of Juvenile Bipolar Disorder: A New Phenotype." "What do the following have in common? Forget about alleged kiddie mania and kiddie depression (both of them extremely dubious) and forget about Biederman/MGH crowd who push irritability in kids as a proxy for mania. Forget about how psychiatrists elsewhere in the world find this whole kiddie bipolar disorder business hard to swallow. Forget about the recent Canadian study that shot down the existence of pre-adolescent mania. It's now about that list of alleged symptoms above. And a lot of biological and genetic determinism: "This more complete list of symptoms is reflective of the research progress JBRF has made by adopting the dimensional approach of defining psychiatric disorders: symptoms overlap between psychiatric conditions and one condition is differentiated from the other by how those clusters of overlapping symptoms come together. "Proceeding down this path, researchers have arrived at a novel perspective of the illness. While traits like mania and depression remain important, this analysis finds that they are not the central behavioral dimensions of PBD. Other dimensions such as aggression, anxiety, sensory sensitivity, sleep/wake disturbance, attention/executive function deficit, and oppositional behavior also figure prominently. Of paramount interest is a dimension that establishes a link between obsessive fears and aggressive behavior. JBRF investigators have termed this correlation 'Fear-of-Harm' (FOH). This new characterization of PBD has been labeled the 'Core phenotype.' "The Core phenotype is a more complete and accurate description of what these children experience than what is offered by the Diagnostic and Statistical Manual for Mental Disorders (DSM). Investigators suggest that in the DSM, bits and pieces of this single disorder have been parceled out into numerous other diagnoses. It is likely that this fragmented perspective of the disorder has obscured a clear view of its actual presentation in children and stalled efforts to get at the underlying biology. I searched through the medical literature and the only mention I can find anywhere of this alleged FOH phenotype is in a 2007 Journal of Affective Disorders article by none other than Dimitri Papolos of the JBRF. I cannot find another reference to it anywhere, so this is clearly novel thinking. Bed wetting as a symptom of child bipolar disorder? We live in strange times. Thanks to the reader who made me aware of the above JBRF news flash. November 13, 2009Fort Hood Shooting: Was Psychiatrist-Shooter Psychotic Or A Terrorist?NPR did some excellent reporting on Wednesday, which I didn't have the stomach to write about yesterday (I needed a day away from the Fort Hood story), but some officials at Walter Reed Hospital and elsewhere in the area were concerned that Maj. Nidal Malik Hasan may have been "psychotic" or "schizoid." No one had any strong evidence of it aside from one official who is quoted as saying: "'Put it this way,' says one official familiar with the conversations that took place. 'Everybody felt that if you were deployed to Iraq or Afghanistan, you would not want Nidal Hasan in your foxhole.'" Nonetheless, it sounds as if Maj. Hasan may have had some issues, but no one proceeded to order a fitness for duty evaluation, reportedly out of concern for seeming insensitive to a Muslim. While I can appreciate that there may have been mental health issues underlying Maj. Hasan's actions at Fort Hood, I'm sticking with the terrorist interpretation of things, partly due to what my gut tells me, partly because of Maj. Hasan's contacts with an Al Qaeda-connected imam, and because a copy of Maj. Hasan's business card (presumably for private practice) has turned up. On it, Maj. Hasan declares in abbreviations that he is a "soldier of God" and adds "glory to God." Kind of odd for a doctor's business card. I know some readers have troubles with declaring Maj. Hasan a terrorist. Hell, yesterday, I had an argument over coffee with a friend in the neighborhood who told me that it was OK for Maj. Hasan to have contact with Al Qaeda, since the contents of the emails were allegedly benign. I argued back that Maj. Hasan was in the US Military and military personnel are expressly forbidden from having contact with the enemy (for obvious reasons) and "What part of al Qaeda is our enemy don't you understand." Fun stuff! That said, I kind of get peoples' reluctance to label Maj. Hasan a terrorist and it has nothing to do with his being a Muslim or trying to be gentle with Muslim-Americans as a whole. In all his pictures, he seems so kind and gentle somehow and I cringe when I see them on the Internet or TV. It doesn't change my mind about his motivations, but it does give me pause. For those of you who think Maj. Hasan looks too nice to be a terrorist, please take a look at the pictures of his 13 murder victims. They look far too nice to be murder victims. Yale Researcher Links Childhood ADHD To Adult Crime, Drug DealingA little noticed study came out in the obscure Journal of Mental Health Policy and Economics in September from a researcher at Yale University and a researcher at the University of Wisconsin, Jason Fletcher and Barbara Wolfe respectively. It's not the first time researchers have pushed this line of fear, but I'll just quote from the abstract while I scrape my jaw off the floor: "Results: The empirical estimates show that children who experience ADHD symptoms face a substantially increased likelihood of engaging in many types of criminal activities. An included calculation of the social costs associated with criminal activities by individuals with childhood ADHD finds the costs to be substantial. Isn't it nice that they are seeing such implications when their study cannot even establish whether or not study subjects were on-meds, off-meds or in psychotherapy? A Yale press release claimed that "crimes where ADHD is a factor cost society $2 to $4 billion annually." With a $14.2 trillion GDP for the US in 2008 that estimated "damage" to society doesn't strike me as particularly important, macroeconomically speaking. It strikes me as infinitesimal, even if the claim is correct. Certainly, it's not big enough to justify slamming every boy with ADHD with Ritalin. So why do researchers keep pushing on the benefits of ADHD treatment (you'll see how they are in a second)? Because they are trying to save a crumbling paradigm. In the UK, there's been an utter backlash against ADHD and its treatments and in the US there's been loads of evidence coming out that argues ADHD treatments are of limited effectiveness and that, developmentally, they aren't much help. They only produce minor test score increases, too. And a study earlier this year linked ADHD meds to a risk of sudden cardiac death. And the FDA recently linked ADHD stimulants to a risk of sudden death in otherwise healthy children. So the public health crowd and the fine folks at Harvard/MGH have been fighting like crazy and squirming real hard in their desk chairs and ruminating at their computers (all signs of ADHD!) about how to protect their hegemony over little boys' behaviors and lives. Last year, for example, Joseph Biederman and Timothy Wilens of Harvard/MGH and Congressional investigation fame, separately published studies claiming that ADHD meds don't lead to later drug abuse in young adulthood and that ADHD meds keep girls from smoking and drug abuse. In other words, they are grasping at straws. More from the press release: "Fletcher said the link between ADHD and criminal activity will be further investigated by examining whether pharmacological treatments may reduce the risk of illegal activities as an adult. He is also investigating the relationships between childhood ADHD symptoms and labor market outcomes, such as employment and earnings." Well, what wonderful reductionist public health researchers this pair is. I'll be honest and say that studies like this creep me out because the real world implications in public school could easily be schools demanding that disruptive boys (and girls) be medicated lest they turn into criminals of some kind down the road otherwise schools are somehow shirking their responsibility. I hope we aren't there yet as a culture but I fear that we are close. Unless we start pushing back in the US the way they have in the UK. BTW, the write-up of the Yale study in the New Haven Register is so unquestioning and unbalanced with contrary information about ADHD treatments that it is biased by omission. Thanks to the reader who made me aware of this study. November 12, 2009Senator Wants Pentagon To Account For Troop Anti-Depressant Use, Suicide LinkMaryland Senator Ben Cardin (D-Maryland) today sent a letter to the Department of Defense seeking information how many anti-depressants are being prescribed to troops in-theatre (ie, not at home) and effectively questioned whether the record-high rate of suicide in the military might not be tied to anti-depressant use. (Letter here.) "On November 3, 2009, the Wall Street Journal reported that during the most recent month of October, 16 active‐duty American Soldiers killed themselves, bringing the total number of active‐duty suicides thus far in 2009 to 134. At this rate, it is expected that the total number of suicides in 2009 will eclipse last year’s total of 140 – the highest yearly number of suicides in Army history, and the first time that the rate of active‐duty suicides exceeded that of the U.S. population...." It'll be interesting to see what answers he gets. Via Pharmalot. British Government To Limit Antipsychotic Use For DementiaBloomberg today reports on the British government taking steps to drastically reduce the use of antipsychotics in treating elders with dementia. A recent report estimated that upwards of 1,800 Brits die each year after getting the drugs for dementia and another 1,620 suffer strokes. Keep in mind that all that dementia-Rxing would be off-label bother in the UK and USA. "About 180,000 elderly people with dementia in the U.K. are given the antipsychotic drugs each year, and just 20 percent improve because of the treatment, Banerjee said at a press conference in London. As many as two-thirds of the patients don’t derive any benefit from the pills, which boost the risk of early death and carry a range of side effects including sedation, stiff muscles, and trouble thinking and speaking clearly, the report found. I bet it's going to be really tough to turn that ship around. Here in the US about 25 percent to 30 percent of atypical sales are for off-label use in dementia even though the drugs carry black box warnings concerning their use in dementia. I'm glad the UK has caught some sanity on this issue. I hope the US is next. Child Psychiatrists Behaving Badly With ChildrenThe Maryland Board of Physicians has suspended the license of Miguel Frontera, a Towson, Maryland psychiatrist, for alleged improper conduct with five boys in his care. The boys were being seen for ADHD. "Allegations from each of the boys, ages 10 to 12 at the time they were patients, were similar and all involved improper conduct during physical exams in his office that the doctor himself called 'not, you know, necessary' and 'very out of the mainstream of psychiatry,' according to the suspension order issued by the Maryland Board of Physicians. Why this idiot isn't being charged criminally is beyond me, but one hopes the Board takes away his license permanently at a later hearing. This kind of behavior is so unacceptable that it's difficult to imagine a grown man, much less an MD, engaging in it. Besides, who's ever heard of a psychiatrist conducting a physical exam? Meanwhile, up in Quebec, the well-knwon and controversial psychiatrist Pierre Mailloux has had his practice limited to adults only by the Quebec College of Physicians after being found guilty or partly guilty of 13 charges of either mis-diagnosing young patients or of over-prescribing drugs to them. And in September the Quebec College of Physicians found that he had breached profession ethics by talking trash about black and aboriginals in the media. The doctor's Wikipedia entry has more fascinating details about his career and many controversies. Thanks to the readers who made me aware of these cases. November 11, 2009Utah Settles Zyprexa Claims For $24 MillionThe office of Utah's Attorney General Mark Shurtleff today announced that it had recently settled its illegal off-label marketing of Zyprexa claims with Eli Lilly for $24 million. Said Shurtleff's office in a press release: "It is a crime for pharmaceutical manufacturers to market their drugs for uses that are not approved by the FDA. Zyprexa was only approved for the treatment of schizophrenia and certain types of bipolar disorder in adults, but in 1999, Lilly's long-term care sales force, its marketing branch that focuses on doctors who treat the elderly, began encouraging doctors to prescribe Zyprexa for dementia, Alzheimer's, agitation, aggression, hostility, depression and generalized sleep disorder without prior FDA approval. The Attorney General's investigation showed that there were 1,769 Medicaid patients over the age of 65 who took Zyprexa but never had a diagnosis of either schizophrenia or bipolar disorder." If it's a crime why did Utah not pursue criminal penalties under state law? I wonder how many of those 1,769 elders died early as a result of Zyprexa use. Psychiatrist Got $490,000 Pimping For Seroquel, Engaged In Wide Off-Label UseBack in March, I wrote about a Chicago psychiatrist, Michael Reinstein, who was bugging AstraZeneca for money because he was such a heavy prescriber of Seroquel and who also authored a very dubious study asserting that Seroquel caused patients to lose weight. That's absolutely counter to most studies of the drug and most patient experiences. Anyway, today the Chicago Tribune and ProPublica are out with an article on Reinstein and his AZ connection. AZ gave the doctor $490,000 over 10 years to speak on behalf of the drug, even though the company was internally pooh-poohing his science. One researcher quoted in the article recommends that other studies of Reinstein's should be reviewed by journal editors, given his likely errors in the Seroquel-causes-weight-loss article. The reporters also found one woman who was given Seroquel and put on about 150 pounds and developed diabetes. Beyond that, take a look at the transcript of Reinstein's deposition in a lawsuit (it's on ProPublica's site). On pages 199 to 200 of the depo (page 51 of the pdf), Reinstein is questioned about off-label prescribing of Seroquel and admits to engaging in a lot of it. Reinstein specifically states that he prescribed Seroquel off-label for insomnia, bipolar depression, major depression and anxiety. Even more, Reinstein ran a study where he subjected patients to 2,000 mgs. a day of Seroquel, three to four times the highest FDA-approved dosage (600 mgs. a day). What human subjects committee would approve such high dosages? It's difficult to imagine. On an ironic personal note, back in the summer I spoke at-length with the ProPublica reporter on this story, Christina Jewett. I broke my own don't help the media rule because I've known Jewett's work for years (she was at the Sacramento Bee) and because I have a good friend who's a reporter at ProPublica. Probably the most useful thing I told Jewett was that Reinstein's above-referenced study had to be deeply flawed (hell, even AZ was admitting as much) and that she ought to press on that and there sure is plenty about the study in the article. The irony is that yesterday I got a rejection email for a job at ProPublica, which told me I wasn't a good "fit" for them. How could I be a good fit when offering one of their reporters my expertise on atypicals but a bad fit when it comes to reporting? Lame. Jewett left ProPublica this summer to return to California where she now works at the California Watch, which I guess is a ProPublica for the Golden State. I'm not good enough to be working anywhere of course. Certainly no one in the mainstream media links to my work although a reporter at a major newspaper I won't name spent about 10 minutes poking through a bunch of my posts on Monday. I have no idea what they were looking for but it will lead to neither credit or a job or anything that will benefit me. Yesterday afternoon, I got my second job reject of the day, this one for a policy analyst position with the Washington State Senate Democratic Caucus. Hell, they aren't even going to interview me. It's like this website has made me toxic when it comes to employment. Discouraged? Oh yes. Glad I have two graduate degrees? No. They are useless. Why Auto Insurance And Health Insurance Aren't The Same, Mr. PresidentOn Monday, President Barack Obama did an interview with ABC News' Jake Tapper wherein he was pressed on the penalties contained in the House health care reform bill, which passed the House 220 to 215 on Saturday night. The bill contains financial fines and even jail time for Americans without health insurance who refuse to get insurance. It's not clear to me if this business will be incorporated in the Senate's version of health care reform or if it will be in whatever eventual House-Senate bill is agreed to in conference. It's a controversial measure of the House bill, but it's something President Obama defended to Tapper, arguing as he has before that forcing people to have health insurance is just like when the several states force car owners to have auto insurance. Specifically, the President said: "What I think is appropriate is that in the same way that everybody has to get auto insurance and if you don't, you're subject to some penalty, that in this situation if you have the ability to buy insurance, it's affordable and you choose not to do so, forcing you and me and everyone else to subsidize you, you know, there's a thousand dollar hidden tax that families all across America are--are burdened by because of the fact that people don't have health insurance, you know, there's nothing wrong with a penalty." I've never heard him make that $1,000 claim before and it strikes me as a stretch. But his larger claim that forcing people to have health insurance just like states force them to have auto insurance is a surprising one coming from a former Constitutional law professor. I was going to write about this back in September when he used the auto insurance analogy in an address to Congress, but things were so heated in the wake of that speech that I decided to wait. Anyway, as I understand the law, driving a car on public roadways is not a Constitutional right but a privilege controlled by the states. Each state can determine its own conditions for extending that privilege to its citizens, and 49 states do require auto insurance for car owners. But health insurance mandated by the Feds is not a power enumerated to either the Congress or the President under the Constitution. What's more, the Feds would be forcing you and I to buy a service that affects our bodies and minds and thus crashes right into our rights to personal liberty and privacy. I know there are Constitutional scholars out there who agree and disagree with me on this point (the LA Times has a round up of opinions here) and I know the insurance mandate will get tested in a court somewhere in 2013 or so, but I keep coming back to the language of Roe v. Wade, the landmark 1973 Supreme Court decision that legalized abortion in the US. In it, the Supreme Court found the (I'm using the Wikipedia entry for Roe v. Wade): "'[R]ight of privacy, whether it be founded in the Fourteenth Amendment's concept of personal liberty and restrictions upon state action, as we feel it is, or, as the District Court determined, in the Ninth Amendment's reservation of rights to the people, is broad enough to encompass a woman's decision whether or not to terminate her pregnancy.'" If Constitutional guarantees of personal liberty and privacy are broad enough to protect citizens from governmental interference in terminating a pregnancy, then I think those same rights are broad enough to trump the government's ability to force you and I into buying health insurance. But that's just my opinion. Either way, I wish the President would ditch the auto insurance analogy since it flat out doesn't work. It's interesting to me that the mainstream media--aside from Fox News--hasn't called the President out on this. I wonder why. November 10, 2009I'll Just Do A Round UpI'm in no mood to write today. My headache is gone, but I got yet another reject email from yet another media organization I'd applied to and I am simply not in the mood to put too many sentences together. The NY Times has an op-ed today arguing against lumping together Asperger's syndrome and autism in the forthcoming DSM-5. It's interesting that the paper would choose to highlight that issue since it's been fairly quiet on developments around the new DSM. I wonder why. The Chicago Tribune and ProPublica have a piece out on a Chicago psychiatrist who was prescribing tons of Clozaril to his patients (almost unheard of these days) as well as Seroquel. I was a source for the ProPublica reporter on this series (part two runs tomorrow and is allegedly "eye popping") and it's deeply ironic that the media organization that shot me down today is ProPublica. They don't see a "fit" for me with them. Please. Go fuck yourselves, ProPublica. Forest Labs and the feds have reached a tentative settlement over allegations that the drugmaker illegally marketed Lexapro and Celexa to kids and that it paid kickbacks to doctors. Is there a single maker of psychotropics who has not entered into a legal settlement with the feds in the last few years or who isn't currently being investigated? Nope. That ought to tell you something. Bad HeadacheI don't often get headaches but last evening I developed a doozie of one. I hope to catch up with posts later this morning. Fort Hood Shooting: Psychiatrist-Shooter A Domestic TerroristI'll just take a deep breath here because I wasn't far wrong when I opined yesterday that this story was bound to get uglier: the alleged shooter at Fort Hood, Maj. Nidal Malik Hasan, is a terrorist, domestic terrorist even. The AP reports: "The officials also say Maj. Nidal Malik Hasan communicated 10 to 20 times with a radical imam overseas who in the past came under scrutiny for possible links to terror groups. They say the communications began last year and continued into this year between Hasan and the imam, Anwar al-Awlaki, and that U.S. officials had been aware of them since last year." So much for the PTSD-victim line of thought. How was this freak even in the military? If the feds knew of his activities, why the hell was this guy not just discharged from the Army? For the larger meaning of it all, the New York Times has a decent round-up of opinionistas. I'm afraid I've got to line up with the more hardline voices out there who argue that there are some radical Muslims here in America who want to commit acts of terror against us (the Fort Dix plot, for example) and that Maj. Hasan is far from alone in his hatred for the US. Where you take that kind of thing I don't know, but I do know that as a citizen I have the right to be protected from these kinds of losers, all of us do. I know some readers and Peter Breggin himself have speculated that Maj. Hasan was on anti-depressants. Right now, that's nothing but guesswork. We'll know more down the road. November 09, 2009Fort Hood Shooting: Psychiatrist Calls Psychiatrist-Shooter "Terrorist"And that psychiatrist is none other than Peter Breggin writing on the Huffington Post. "Before I begin to look at his role as a psychiatrist, I want to confirm that Major Nidal Malik Hasan was driven by religious ideology. For years he openly claimed that the War on Terror is a war on Muslims. He announced on the Internet and to his fellow soldiers in a course on public health that a Muslim suicide bomber should be praised for killing a hundred soldiers. It's reported that fellow soldiers warned his superiors that he was a ticking time bomb. I know some feel that the term "terrorist" is a bit much for Maj. Hasan's murderous rampage, but given all that was tangled up in his motivations I can understand why some people are tossing the term around. Breggin also tosses several other bombs: stating that psychiatrists at Walter Reed are only interested in medication and that the military has been deluded by modern psychiatry and so on. And this: "The odds are that Dr. Hasan was self-medicating with antidepressants and tranquilizers that were causing his increasing disinhibition, at least in his pronouncements, until his final Allahu Akbar before he began shooting." We shall see someday if Maj. Hasan was medicated in some fashion since the Senate will likely investigate the very tragic events of last Thursday. The New York Times has photos of the 13 murder victims here. The AP is now reporting a story first reported by the (London) Telegraph that: "The alleged Fort Hood shooter apparently attended the same Virginia mosque as two Sept. 11 hijackers in 2001, at a time when a radical imam preached there." Oh, boy. This story is going to continue to get uglier and uglier. Orlando Shooter Shouldn't Have Had A GunNews is out that the alleged shooter in Friday's tragedy in Orlando, Florida has a diagnosis of schizophrenia. Jason Rodriguez allegedly killed one man and wounded five others when he shot up the offices of his former employer. The man who died was 26 years old and had a young child. Lovely. I feel for all the victims of this crime. The big question to me in all of this is why did Rodriguez have a gun. "Mr. Rodriguez periodically took medication for what his former mother-in-law, America Holloway, said was schizophrenia. When he was not taking the medication, Ms. Holloway said, he was unbearable to live with — angry, jealous, paranoid and controlling. You can argue about on-meds, off-meds all you want with schizophrenia and other psychotic disorders, but none of that really matters here. What matters is that Rodriguez had a gun or access to the same and there's no way he should've been able to lay hands on a firearm. Each state's laws differ a little bit on the details of who can legally own a firearm, but it's fairly consistent nationwide that people judged "mental defectives" (and that's the language of federal and most state laws. It covers mental illnesses and development disorders) cannot own a firearm unless a judge later restores that right. In Washington State, it boils down to anyone who's been involuntarily committed for 14 days loses their gun ownership rights. I suspect Florida's laws are somewhat similar. So Rodriguez either brought a gun years ago, stole someone's gun, someone have him a gun years ago or he somehow managed to slip through the cracks and buy a gun (doesn't sound like he had the money). It'll be interesting to learn how he got his hands on a gun. Over the years, I've run into enough tales similar to this one--someone diagnosed with schizophrenia running amok with a gun such as in Fairfax, Va in 2006--and I always wonder how the hell their families and friends could be stupid enough to let them own or access a firearm. There's got to be some way to prevent this kind of crap from happening again and again. That said, I know and know of people diagnosed with schizophrenia who have to carry knives and other weapons to protect themselves on the streets of Seattle because they've been robbed and assaulted so many times that, as one told me, "I go nowhere without my knife." I suppose I can't blame him. Obviously, there are some tradeoffs here. Thoughts? BTW, I'm not blaming schizophrenia for what went on in Orlando. It's too early to know if he was a "sane" man who cracked under the press of life or whether he was "insane" at the time of the shooting. That we'll know some other day. In Which I Coin The Term "Nemeroffian"I got to thinking over the weekend that the well-known conflicts of interest and dubious science of Charles Nemeroff--late of Emory University, soon of the University of Miami--deserve their own adjective, one that could be used to describe others in academic psychiatry who transgress similarly in the future. And so I have coined the term "Nemeroffian" to describe excesses and "science pimping" on a scale that Nemeroff himself can only achieve. (My Nemeroff back catalogue is here for those who wonder what I mean.) Howard Brody at the Hooked blog had some thoughts on Nemeroff getting a job as chair of the psychiatry department at Miami. "Miami's response? 'Pascal Goldschmidt, dean of UM medical school, called Nemeroff "an exceptional psychiatrist and an exceptional scientist who has one issue in which he recognizes he made a mistake," in not telling Emory how much he was getting from drug makers.' Classic. November 07, 2009The House Dems, Pres. Obama Have Lost Me On Health Care ReformWatch what goes down with this House health care reform bill being voted on over the weekend (unless it stalls) because something very tricky is going on. President Barack Obama went up to Capitol Hill today to personally lobby for votes yet he's asking legislators to pass a bill that doesn't even meet his deficit-neutral goal of $900 billion or less over 10 years. I'm very suspicious of why President Obama would now support the bill because it's now costed out at $1.2 trillion over 10 years. And how did the bill's cost jump from $872 billion last week to $1.2 trillion this week (the New York Times claims it's $1.1 trillion)? I cannot support this bill because of its cost (there are other reasons to oppose the bill)--and keep in mind that I've not had health insurance in two and a half years and would technically "benefit" under this bill. What's more, there's word of various amendments being tacked onto this bill late in the game and, as we know from the Medicare Part D nonsense of a few years ago, that type of chicanery is not to be trusted, regardless of which party is pulling the strings. November 06, 2009Nemeroff Accused Of "Science Pimping"A big piece in the Miami Herald today on the University of Miami's hiring of controversial psychiatrist Charles Nemeroff to head its psychiatry department. Here's some of the fun stuff. "The former head of psychiatry at Duke University told The Miami Herald Thursday that Nemeroff was 'economical with the truth' and his work can't be trusted, while the leader of the Columbia University psychiatry program said Nemeroff was a top-flight scientist and he had never seen any bias in his work...." I think Lieberman needs to re-review some of Nemeroff's work and his CME pimping. Feds Investigating Abbott Over Depakote MarketingNews is out that the federal Department of Justice is investigating Abbott Labs over questions about its marketing of Depakote, its anti-seizure drug that's also approved for bipolar disorder. It's not clear what the scope of the investigation is, so stay tuned. Fort Hood Shooting: Army Psychiatrist Kills 12, Wounds 31, Fuller Torrey SilentWith all due respect to the profession of psychiatry, I need to ask why the "world's most famous psychiatrist," E. Fuller Torrey, and his group the Treatment Advocacy Center are so far completely silent on the tragedy at Fort Hood, Texas. That's where an Army psychiatrist, Maj. Nidal Malik Hasan, shot up an Army building, killing 12 and wounding 31 before being captured. Maj. Hasan was wounded and is reportedly in the custody of the Army at a hospital. Often, when a person in the mental health system loses it (for whatever reason) and commits violence, Torrey and the fine folks at TAC are quick to post (anonymously, of course) on their blog the details of the crime and to use it as a springboard to argue for forced outpatient commitment and forced medication for people diagnosed with serious mental illnesses and play their vomit-inducing game of arguing that bad behavior by one person diagnosed with schizophrenia, say, proves that pretty much anyone with a "serious mental illness" needs to be medicated into the ground. Now, that a psychiatrist has blown away a bunch of outstanding Americans what does TAC have to offer on its blog? Silence, the telling kind. The kind that says they are hypocrites because Hasan clearly had psych issues (whatever his political and religious issues with America may or may not have been) and yet he did what he alleged to have done. TAC should at least say something. Silence. What does the American Psychiatric Association have to say? Nothing. It's silent, too. It'll be interesting to read what psychiatrists have to write about this bizarre and unacceptable tragedy. For those of you who read this site who are psychiatrists, feel free to email me your thoughts or leave them in comments. Maybe it's not fair to read Maj. Hasan's act in the context of his being a psychiatrist. After all, who's ever heard of a doctor much less a psychiatrist committing mass murder? Almost never, excepting cases of genocidal killers like Nazis Josef Mengele and Aribert Ferdinand Heim and Radovan Karadzic (a psychiatrist. Thanks for the reminder, Qwerty). So inevitably this story will be treated as the multi-layered, conflicted beast that it is and there won't be much moment made of his being a psych doc, except to the extent where one might ask, "Why couldn't someone who did psych evaluations realize he had lost it and seek help?" But, then, Torrey and TAC are never so fair to the people they write about. They never have complete lives and souls, their motivations are never complex. They are just schizophrenics and bipolars, bad boys and girls who didn't take their medicine. Are You Reading A Top 100 Health Blog?Oh, yes you are, according to Technorati, which I happened to check in with yesterday and was surprised to see a Top 100 Health Blog badge next to this here website's name. In fact, yesterday this site was #33 among health blogs tracked by Technorati, sandwiched between Herbal Water and That's Fit. Among the tracking services Top 100 health blogs are only a few mental health ones: PsychCentral.com's blog at #3, Postpartum Progress at # 16 and Psychiatric News at #36. Mind Hacks at #23 is more neuroscience-y than mental health-y although it often dips into the psych world (and quite well, too). Health Care Renewal at #43 also deals with mental health issues, amongst other things. Psychiatric News is a "chronicle of human rights violations and crimes by the psychiatric industry." And people call me anti-psychiatry!? Technorati's rankings are based on how many blogs and websites link to a particular blog, so if you want to see me get up there with Postpartum Progress, then link to this site. Or should I go out and get a glamor shot for my site like PPP's author has up? (What is it with some bloggers and photos of themselves?) November 05, 2009Army PTSD Psychiatrist Suspected Shooter At Ft. HoodUPDATE: 6.29 p.m. PST. Following an Amry press conference, I've update this a bit and correct some repprting that was out there in media land. The AP is now reporting that Army Maj. Nidal Malik Hasan, an Army psychiatrist, was the suspected shooter at Ft. Hood, Texas earlier today. The tragedy left 12 soldiers dead and 31 wounded and there were reports of other shooters. Two soldiers were taken into custody but later released. Maj. Hasan was said to be upset about his pending deployment to Iraq. The New York Times reports that Maj. Hasan was a "Fellow, Disaster and Preventive Psychiatry, Department of Psychiatry, F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences." In other words, it sounds like Maj. Hasan had a specialty in PTSD. Said Lt. Gen. Robert Cone at a press conference this evening: "The shooter is not dead but in custody." Gen. Cone declined to answer other questions about Maj. Hasan. I really don't have anything reflective to offer on this at the moment, but I'd ask commenters to not play "trash psychiatry." Maj. Hasan must've had something really ugly going on inside to pull this off. It's one of the first instances I can remember of an officer--a senior officer, no less--opening fire on soldiers. |
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