Furious Seasons

The Useless FDA

I don't often post on the weekend, but I am ripshit mad about the pet food killing dogs and cats story that clearly won't go away. And, now, I have a very personal take on it which I'll get to in a second.

What's new is that the FDA is now saying that an ingredient in the wheat gluten used in many pet foods--including some of the allegedly "healthy" ones--may have poisoned dogs and cats and given them kidney failure and killed them. The ingredient was sourced from a Chinese company. The FDA refuses to name the company.

I am so fucking done with the FDA refusing to release information about food and drugs by calling the information a "trade secret" or demanding a FOIA for every little bit of information. The agency has acted this way with psych meds for ages. If these are the regulations the FDA operates under, then the regulations need to be changed tout suite. My interests as a patient paying the freight for meds and as a taxpayer far outweigh the needs of companies such as Eli Lilly, to use one prominent example, to hide the results of clinical trials and such from the very public who is taking the drugs made by these companies. And is paying the taxes that are supposed to fund a decent safety monitoring system.

Why the FDA and Congress have such a tough time wrapping their minds around these basic principles is far beyond me. (BTW, to be fair, Lilly does have a site that goes into its clinical trials. I haven't probed it enough to know too much of what it covers and in what depth.)

I am also done with American companies outsourcing so many of a product's ingredients or parts from countries that have poor manufacturing processes and where the employees have no cultural connection to the US. It's starting to cause us problems.

On the personal front, it now appears that one of the recalled pet foods killed one of my parents' cats, a wonderful 13-year-old cat named Lute. He'd been eating the MD dry food--only available from vets--for a year. He was in great shape when I saw him in late December. He began to get ill in February and my parents had to put him down a couple of weeks ago, right around the time the tainted pet food story broke. This has gone down very rough for my parents and especially for my father.

So this whole business of the FDA refusing to name shabby manufacturers is now damn personal. At least the agency did force Zelnorm off the market this week after it was found to cause heart problems. I'll miss all the exposed tummy commercials. Not.

03-30-2007 Media Madness

Corrupt medical school fits right into the New Jersey zeitgeist.

CL Psych explores the science of early-onset bipolar disorder. And questions the fear-mongering charges out there.

Parents using an electric shock device on an autistic son.

Another bipolar, a hockey fan to boot, pines for spring.

Fascinating bit from Pharmalot on pharma's advertising quandaries. Now, where's that "Depression Hurts" doggie?

Liz Spikol on the new anti-depressant study.

Yet another cheerleader pharma rep.

Someone is in Seroquel Hell.

Sun In Seattle, But Not Spring

After months of hearing me bitch about the weather in fair Seattle, a friend of mine challenged me to write about the sun yesterday. It was sunny yesterday. And warm. So nice that I took a drive on our city's viaduct, an odd elevated waterfront freeway that, strangely, offers the best views in the city. At times, you could see the snow-capped Olympics and, to the East, the snow-capped Cascades. I enjoyed the sun. It was good for my mood. Today began sunny as well.

It will begin raining again before the day ends and rain throughout the weekend. Sadly, we don't get a real spring here until late-April and summer doesn't begin until after the Fourth of July.

But yesterday was sunny. Duly noted.

Implications Of New STEP-BD Study On Anti-Depressants

As I noted yesterday, a new NIMH-sponsored study of anti-depressant use in bipolar disorder (or bipolar depression, if you prefer) showed that placebo outperformed anti-depressants in treating bipolar depression in patients already taking a mood stabilizer. Twenty-seven percent of patients getting a placebo held off depression for at least 8 weeks during the 26-week study while anti-depressants only worked in 23.5 percent of patients. The study was just published in the New England Journal of Medicine. If you want to read it for yourself, it's actually a freebie for now.

It's as big a landmark study as the initial CATIE paper and drives a stake through the heart of the clinical practice of giving an anti-depressant to people with bipolar disorder. We've known for at least a decade that that's not likely to produce good results, but it's nice to have some academic cred for such assertions.

We'll see how that translates into the real clinical world, but it is very bad news for anti-depressant makers. A lot of their sales come from bipolars. Meanwhile, I'd guess that there were high fives 'round the offices of Glaxo Smith Kline and AstraZeneca. GSK makes Lamictal and AZ makes Seroquel. Both have been marketed heavily as bipolar drugs that work on bipolar depression. I'll avoid nit-picking on either for now, especially since AZ is the focus of a Congressional investigation for its handling of Seroquel (as is Eli Lilly).

Enjoy your day of good news and new market segmentation opportunities! No phone booth ads though guys, OK?

My small complaints about the study are that it didn't break out response rates between Paxil (ironically, made by GSK in its patented form) and Wellbutrin. Nor did the study present data on how many of the people who saw an 8-week remission on either drug later relapsed. Maybe such data will be in a forthcoming paper.

I've long been leery of the argument that depression in bipolar disorder is so wildly different from unipolar depression, especially since the 23.5 percent remission rate here is not so much different from the 30 percent remission rate in the first STAR*D round. But then again those weren't BPI or II patients. So maybe there is a difference of some kind after all.

03-29-2007 Media Madness

Halle Berry talks of a near-suicide attempt. Proof once again that love makes people do crazy shit. (Via The Blemish.)

Epix Phamraceuticals begins a trial of an experimental anti-depressant. Says the company, "We believe there is a significant unmet need for a depression treatment that is at least as effective as the current standard of care, but with a much improved tolerability and side-effect profile." Confidence inspiring.

CL Psych's perspectives on Rebecca Riley's parents possibly making up her symptoms of bipolar disorder. As well he has news of yet another failed anti-depressant, RU-486 in this case.

Liz Spikol also has some very strong views on the bipolar child business and the Riley case. Like me, we have another older bipolar who is very concerned about dragging kids into all of this. Good.

An interesting perspective on off-label marketing.

A very intense bashing of psych docs from the wild blog Bipolar Chicks Blogging.

Medical students get very little training in psych care. No wonder they are dupes for pharma reps who convince them to treat bipolar disorder and depression in a PCP setting.

Interesting views on homelessness from a pal of mine.

Isn't it funny how much coverage a rock star's wife doing crazy shit due to a reaction to meds gets when the rest of us get ignored? This story is all over the place. And yet if someone wacks themselves on an SSRI, say, then it was the disease's fault.

Some very kind words about my recent radio appearance. Thanks. And sorry about the bad phone connection we had. Too many radio towers in my neighborhood apparently.

Anti-Depressants Nuked By Placebo In Bipolar Disorder

News of a yet-to-be-released study came out yesterday asserting that anti-depressants offer no advantage to patients with bipolar disorder who are already taking a mood stabilizer such as Lithium. In fact, the anti-depressant used performed worse than a mood stabilizer plus a placebo. The full study, which is NIMH-sponsored and sounds to be another round of STEP-BD study, will be released next week.

By the numbers, 23.5 percent of patients taking anti-depressants stayed well for at least 8 weeks versus 27.3 percent of those taking a placebo. This news created a bull market on Wall Street for sugar pills (j/k). Actually, it is startling that placebo beat anti-depressants by so much. What's also interesting is that that 23.5 percent figure isn't too far off the roughly 30 percent of patients with depression in the separate STAR*D study who saw a benefit from an anti-depressant.

It's amusing to me that researchers have finally come to this conclusion after 15 years or more of using anti-depressants as add-on treatments for bipolar disorder and seeing very poor results with patients including the inducement of mania and little relief for the depressive side of things. Does this throw the bipolar treatment game squarely back on mood stabilizers alone? Hopefully. Although I wouldn't be surprised if researchers started pressing for a mood stabilizer plus atypical antipsychotics for bipolars with nasty depression. As long as antipsychotics are only used short-term (an old-fashioned approach), then I have no objection. But if researchers begin pushing for long-term use of atypicals, then we are going to have a problem. The evidence is not there for the atypicals' safety used long-term or for their ability to prevent future episodes of depression.

Basically, depression in bipolar disorder is going to be something patients are going to have to find a way to address on their own. Which is good. I suppose the pharma companies aren't going to be very happy with this news since a good chunk of the $19 billion market for anti-depressants comes from bipolars.

I'll have more on this study next week.

McManamy Talks Bipolar Child Paradigm Again

Back when news of Rebecca Riley's death and its circumstances first surfaced in early February, I had a hunch that the story would get a lot of attention--and it has--and I sensed that battle lines would develop in the mental health community and the broader culture over the bipolar child paradigm. And so they have.

As he did recently, John McManamy has taken another swipe at people who question the bipolar child paradigm. The occasion for McManamy's new gibe is because he is Back East, talking before NAMI groups and chilling with the Papaloses, who authored The Bipolar Child.

"We’re rolling down the Merit Parkway, with me in front, as Dr Papolos in the driver’s seat gives me a private master class on the fine points of temperature regulation in the brain and how it affects sleep (which in turn does a number on mood), not to mention genetics, diagnostics, and novel treatments he is working on."

Novel treatments? And dosing kiddos on atypicals isn't novel enough?

"There is a lot of uninformed discussion out there on early-onset bipolar, but none of it is coming from the Papoloses. All their work is concerned with rigorous examination in both the lab and the real world, and on enlightening and educating clinicians, researchers, educators, parents, and the general public. The misguided fear-mongers who criticize them invariably have proved to be too lazy to talk to parents of bipolar kids, much less read their book."

That's pretty defensive and aggressive talk, but then the Papaloses did help McManamy land an agent for his book. It is also talk filled with some fairly reckless assumptions. I cannot speak for anyone else in the mental health blogosphere or for the newspaper columnists who've bitten off the topic, but, lazy or not, I have interviewed the parents of bipolar children as well as actual working psychiatrists--and they weren't just ones I met at NAMI and DBSA meetings either. I haven't read the book, but then why would I spring for the book when its precepts are spelled out at the Papaloses foundation? Besides, there are a few doctors out there who are willing to publicly question the bp kiddos who-ha. Here's one, here's another. And another.

But to tag people as "misguided fear-mongers" sounds like something from a pharma company's press release. Yes, those of us who've tackled the bipolar child paradigm are all ignorant of the scientific truth and are trying to scare kids off their meds. Please. Such talk is about like me calling all child psychiatrists murderers (and I won't because I have no reason to). It's intended to buffalo people like me into silence (not gonna work) or marginalize us as irresponsible wack jobs.

There are plenty of parents out there who are truly pissed off about bipolar disorder and their kids and the treatments that are available and the cultural assumptions that are made about their kids. And so on. Here's one of them. Others have left numerous comments on this site. I don't think that all the scientific rigor of the Papaloses and the Harvard bipolar child mafia has done them a lot of good. And that's sad.

The big problem that people like McManamy and the Papaloses are running into in the real world and the marketplace of ideas is that declaring a child bipolar at two-years-old--or, heck, six-years-old--sounds absurd to many people, even to people like me who know a decent amount about the medical science around bipolar disorder (adult version) and how the disorder plays out in real human lives. They are also running into a public that is waking up to the fact that all the promised cures for bipolar disorder, depression and schizophrenia are pretty much bunk. That's a tough environment in which to make headway.

Some of my own critique comes from those places. It also comes from my own experiences as a nearly-analogous kid back in the days before the bipolar child paradigm. And it comes from something I got into on a recent radio interview (no transcript available) wherein I basically said that I had a lot of conceptual problems, as a longtime bipolar, of taking a diagnostic and treatment paradigm that doesn't work too well in adults, causes serious problems in some adults and results in very mixed outcomes for millions of human beings and slapping it onto childhood behaviors. That the game of psych research is run more for the benefit of pharmaceutical companies and doctors and pharma-sponsored advocacy groups than it is for real-world patients also makes me extremely skeptical of the science of bipolar disorder, particularly when it is applied to children who have no say in the matter. To trust them would be about like trusting Enron's accountants with your taxes.

But McManamy is welcome to his opinion. I certainly wouldn't call it med-mongering for him to defend the bipolar child paradigm. But I find it a bit weird that he is willing to make so much noise on this subject on his blog and take a swing at so many people who are either thinking out loud or doing journalistic legwork, when he's been completely silent on his blog about the Zyprexa scandal, NAMI touting Risperdal and the looming Congressional investigation of Eli Lilly and AstraZeneca among other pressing issues before patients, child or adult, in the real world.

03-28-2007 Media Madness

Liz Spikol has a good post about MHA's call for some noise to be made about a forthcoming advertising campaign for the movie Wristcutters. Ads will apparently feature suicidal imagery. Visit her site for what you can do about this.

A great column in the Guardian on a dumb mental health services survey and a patient's response to it.

Anna Nicole Smith was on Lexapro and Zoloft. I doubt that those drugs did her in although interacting with seven other meds had to be part of the equation. Weird that someone so wealthy would get such awful healthcare.

Post partum depression defense not valid in Iowa.

Rock star's wife has bad reaction to meds for bipolar disorder, loses it, smashes up hotel room and burns clothes.

Me On "Madness Radio"

My appearance on Freedom Center's "Madness Radio" is now available online right here. The show was pretty wide-ranging and includes a fair amount on the Zyprexa scandal. Let me know how it came out.

A Bipolar Child Murdered: Prosecutors Allege Parents Made Up Symptoms

The case of Rebecca Riley, a Boston-area four-year-old who died in December due to an overdose of psych meds, keeps getting weirder and weirder. Not that it wasn't already. Riley was diagnosed with ADHD at two-years-old and, later, with bipolar disorder. The case is getting a lot of national attention due to the controversial psych diagnoses in children so young. The implications of this case are rather large, as you'll see.

Prosecutors now allege that Riley's parents made up their daughter's symptoms of hyperactivity and combativeness as a scam to get their daughter on disability. Two older kids of theirs had been diagnosed with bipolar disorder and were on SSI. The family's psychiatrist diagnosed the girl with ADHD based upon the mother's account of her behavior. Then the Rileys applied for SSI. After being examined by two other doctors, the girl was denied SSI, as the doctors asserted that they couldn't find symptoms to back up the ADHD diagnosis.

Don't read too much into the SSI denial yet--the feds often deny people SSI benefits once or twice before finally granting them. But still. And next:

"Carolyn [the mom] then took her back to Kifuji [the psych doc] and said the girl had "mood swings" and was "driving me crazy," Middleton [the prosecutor] said. Kifuji then diagnosed her with bipolar disorder at age 3. Carolyn Riley "continued to feed Dr. Kifuji fabricated symptoms," Middleton said. He said Rebecca's teachers, the school nurse, mental health therapist and neighbors and adults who lived with the Riley's all told the grand jury that "Rebecca showed none of these behaviors."

A second application for benefits was rejected after a doctor said she didn't have signs of the disorder, Middleton said."

If true, that's beyond belief that parents would do all of this to their kid. But, God knows, this was one messed-up family, according to press accounts. Keep in mind, however, that this was a bail hearing and prosecutors regularly allege the most outrageous stuff in order to keep the accused in jail pending trial. Both parents are now held without bail and face murder charges. The psychiatrist has temporarily suspended her practice.

The family's lawyers allege that the doctor killed Rebecca by over-medicating her. We'll see, but I am beginning to doubt that.

But there's something more troubling in all of this that the Boston media didn't bring up in the press accounts I've read.

If, as prosecutors allege, the parents made up symptoms and could convince an experienced psychiatrist of their presence and veracity, then what does that say about how psych docs do diagnostic work-ups of children? Do parental reports about behaviors become the standard of gauging symptoms? Are the symptoms properly related to abnormal behaviors in the first place or are they a convenient place to stuff childhood problems? How, if outside doctors didn't observe ADHD/bipolar symptoms in Rebecca, was the family's doctor able to make these observations?

What does this say about a profession and a treatment paradigm for adults, teens and kids that relies upon self-reporting of symptoms? Can would-be patients or families dupe doctors like this all the time? How many more of the millions of kids diagnosed with ADHD and bipolar disorder carry their diagnoses as a result of parental reporting alone, with whatever biases might be present? Is there a way for child psychiatrists to filter out parental bias?

Two million or so children are running around these days on multiple psych meds in the US. Assuming ADHD and early-onset bipolar disorder are legitimate diagnoses in children so young, how many of them are on meds for the right reasons and how many are on meds to satisfy their parents or schools or as a result of duped doctors?

I am not making assertions here. I am just asking questions. Everyone should be asking questions. And the child psychiatry academy should be asking the most questions and doing the most soul-searching of anyone.

As I've noted before, I suspect we'll be hearing about this case and its implications for a long time.

03-27-2007 Media Madness

Decision Resources, whom I've dinged before, is back at it again with their gold standards. Brandweek and CL Psych have the details. Man, DR flings gold around more than Snoop Dogg.

Intueri goes to the Washington State Psychiatric Association's convention. Is pressed by senior psych docs to visit pharma reps' booths.

John McManamy on Fred Goodwin's bipolar spectrum challenge to the DSM-IV. Not sure what that buys anyone in terms of treatment and so on, but it might be interesting conceptually. I worry that it's such a broad definition that many more people could be declared bipolar. So we'll see.

Here's an utterly gorgeous account of depression as well as depression and smoking, which may have led to a doctor upping a patient's dose of an anti-depressant. So smoking is now taken as a sign of aberrant behavior requiring meds? Oy vey.

An interesting article in the New York Times on legal controversies around pain management. It involves the DEA, so you know it's gonna be a party. I only wish the feds were half as aggressive on the mental health world as on the pain management world, but whatever.

Depression now linked to impaired spatial ability.

Just finished taping an appearance on the Freedom Center's "Madness Radio" talking mental health and the Zyprexa scandal. It will air tomorrow night Back East and I will link to the archived version when it goes up. I was interviewed by Will Hall, who was one of the bad bad people whom Eli Lilly got a court injunction against over the Zyprexa documents. Good work, Will!

Q-Bombs And Kentucky Prozac

There's a Raymond Chandler quote I've loved since I first read it:

"There was a desert wind blowing that night. It was one of those hot dry Santa Anas that come down through the mountain passes and curl your hair and make your nerves jump and your skin itch. On nights like that every booze party ends in a fight. Meek little wives feel the edge of the carving knife and study their husbands' necks. Anything can happen."

When I was younger, I lived in San Diego and Los Angeles and Chandler is right about the big desert winds from the East that blow down the canyons and dry everything out and make the cities smell slightly of sage. We'd get these winds a few days at a time, a few times a year. After living in Southern California for several years, you knew that when the winds clocked around, then crazy shit was bound to happen. Big grass fires lighting up the hills and earthquakes. They always correlated with the Santa Anas.

But more than Nature itself, there was something about human nature that came unglued with the winds and that's what Chandler's getting at. People went slightly crazy and got bitter with one another over the smallest things. A San Diego cop once told me that crime always jumped during those times and that if he could schedule his vacations around the winds, then he would.

In Seattle, it's not the hot winds. It's the gray skies without end and, this year, the rain that won't stop. We are already 40 percent or so ahead of normal rainfall for the season and lately people have been getting squirrely. When the rains keep coming a week at a time, you spend about 95 percent of your life indoors--at home, at the office, in a car or bus, at a coffee shop and so on. Five or six months of that straight will eat you up. Even the city's third places are no refuge from it. A few nights ago, I was at a bar and I damn near had to break up a fight between guys who weren't drunk, but were peeved at one another over an imagined insult. Do I even need to tell you that it was over a woman?

It took about 20 minutes for shit to settle down and, then, people who pretty much get along with each other started laying into one another behind their backs. Gnarly, chippy shit about how so and so behaves or how so and so is a cry baby or how so and so likes to go home and cut the back of her legs and watch the blood in a mirror when she feels bad. The kind of talk that makes me order a double. I'm not disgusted by it--that would be too easy--but sometimes you need a little help while watching our simian, tribal behavior go down.

I've run into most of the folks from the debacle over the last few days and everyone agrees with me that the endless winter has made us slip a gear or two. And that it's pretty normal to play the primitive and so on. There's no other way to get it out and it's got to come out. There's got to be a break at some point.

I mention this because a couple of weeks ago, I had one of the shittiest weeks I've had since quitting my job last year. It was dark and raining during times when it should been at least half-light, I was getting nowhere fast as a reporter/writer, my parents had just euthanized one of their wonderful 13-year-old cats and, well, life sucked big time. I felt awful psychologically, slept a lot (by my standards) for a couple of days and I knew that if I had a few more days of this slippage then I could wind up in a nice little episode of depression and who knows where that might take me.

When I was newer to the psych game, I'd be sitting up with the self-tests and psych books and making appointments with my shrink when I got that way. I'd go in and tell the doctor the score. Whatever dose of whatever meds I happened to be on at the time would get upped or sometimes switched to something else and, of course, I went along. Who was I to argue against science and medicine, both of which I hold in high regard? I had to break whatever horse shit was in my head and soul. The trouble was that the docs would never back you off the meds a few weeks later when things got back to normal. The meds had done their job at whatever dose you'd gone to and so it made good clinical sense to stay right there. Later, the meds themselves would go south on me, but that's a story for another day.

Over the years, I've learned that if I can engineer a break in pending depression for a day or two, then things return to normal much faster than with, say, Prozac back in the day and I go on fine for another three to six months, longer if I am lucky. I snap out of it, literally, although maybe not biochemically.

So, recently, I began to run through my options since I figured I was a few days out from having to drop a Q-Bomb. That's a smallish dose of Seroquel that just fogs the brain for a day or two and reorients the internal solar system, but I like to avoid that route because the fifth of whiskey head the next day is too much. My options at that point were limited and it had been raining too much to go sit in the woods or stare at the Sound or do like a friend of mine does and go shoot hand guns in the forest when he gets all wintery in his mind. I didn't have any Ativan and I hate Xanax and I was getting to the point where I couldn't listen to music of any kind. And that's always a bad sign for me.

So, I did something pretty unconventional (well, at least medically, but folks go this way all the time) and I sure as hell don't recommend it to anyone else. I scrounged around and found some old marijuana, shake in the bottom of a long-forgotten baggie tossed in a kitchen drawer, and I smoked it. Then I went out and bought myself a few bourbons at a bar near my neighborhood. Yeah, I caught a buzz and walked home, the streets empty because it was a Monday night.

I haven't been depressed since. Kentucky Prozac worked its magic. Somehow that feels like a better--or at least an equally-efficacious--tactic than slamming a Q-Bomb or letting things drift further and going to the doctor weeks later in such dire shape, as I once did, that I'd be begging for whatever he was handing out.

Or maybe I am a complete fool. But I've never run into an combination of meds that buffers me against similar bouts of looming depression, so I have a low incentive to stick them in my head long-term. Same as with whiskey and weed.

3-26-07 Media Madness

I am beginning a new feature for this site called "Media Madness." Inspired by Mind Hacks' "Spike Activity" feature, it will collect mental health news, but without my usual rambling commentary. I suspect it'll appear a few times a week. If anyone wants to suggest another name for it, let me know.

That said, here goes:

Anna Nicole Smith died with 9 prescription drugs in her system. Including chloral hydrate and lorazepam. Poor lady. I bet we've not heard the last of this story.

Children who spend more daycare time without their parents have more behavioral problems in class later on.

The Boston Herald weighs in on the use of prisons as psych wards.

Mind Hacks on a child psychiatrist in Iraq. Amazing.

And, Sonic Youth's brilliant "Schizophrenia" performed by a nursing home choir. Link is to YouTube video.

UPDATED: DSM Author Says Many Diagnoses Incorrect

Much credit to Vera Sharav at AHRP for unearthing a BBC documentary wherein Robert Spitzer, godfather of the current DSM and lead author of the revolutionary 1980 DSM-III (the one that shifted psychiatry to the biologically-based model), admits that 20 percent to 30 percent of mental disorder diagnoses are incorrect. Sharav writes that he even admits that ADHD is "an erroneous made up diagnosis." If so, that's major news.

I've got to track down this documentary, which obviously I haven't seen.

UPDATE: Spitzer now says his comments were twisted. He was, instead, speaking of adult anxiety disorders. Apparently, flacks for the BBC misunderstood him and attached his comments to ADHD, which of course the European press ate up. Funny how incorrect information can blow up on the Net. I hope the news organizations that reported the incorrect statement issue the appropriate correction.

Meanwhile, while I am still interested in what Spitzer actually said in the documentary, I am leaving the initial post above as a record of this odd incident.

The Hearing Voices Network

There is an excellent article in this week's New York Times Sunday Magazine about the Hearing Voices Network, a British group (yes, I am feeling like the paper's publicist today). It's run by patients and focuses on trying to help people who hear voices cope with their situation and benefit from it. HVN, as it's called, is often castigated as being anti-psychiatry and anti-medication, but I think people who do so are missing its point. Many people, diagnosed as schizophrenic or not, hear voices. The question is what do you do with that experience. It's all more complicated than that, of course, but that's the basic gist.

The article's author also goes into various British studies of using CBT to address psychosis. There seems to be an emerging mini-consensus in the UK that CBT is of some use in helping schizophrenics control their voices--or auditory hallucinations--and delusions and of coping with them as well. There's been minimal research on that front in the US. It's time for that to change. It's also time for Aaron T. Beck, CBT's grandfather, to get a Nobel Prize in Medicine.

I was a bit surprised that the author didn't note the efforts of MindFreedom International (and especially its Mad Pride campaign) and others to undertake loosely-analogous work in this country. Either way, it has become clear to me over the last few years that we need a reformation of sorts in how we address schizophrenia and psychosis in American culture. I don't say this as an anti-psychiatrist--because I am not one--but as someone who's come to recognize certain uncomfortable facts.

Antipsychotics aren't working especially well for schizophrenics in addressing their core symptoms and the medications are intolerable for too many people. Intolerable is putting it lightly, of course. What's more, the American psychiatric establishment's embrace of Big Pharma--and its claims that atypicals have effectively treated millions of schizophrenics--makes it impossible for me to accept the voices-are-always-bad, medicate-them-away-always paradigm. It's just not working out and I see this on the streets of Seattle every day.

What's more, the hype around current treatments is that they are so effective that they've allowed hundreds of thousands of schizophrenics--people with schizophrenia or voice-hearers, if you prefer--to leave the nasty old state hospitals in our country for happy lives in the community. In the last 30 years or so, state hospital populations in the US have gone from about 500,000 people to about 50,000 people. The trouble is that many of those people have ended up being discharged to the streets or jails. As hateful as both of those housing options are (this is one place where TAC and I actually agree), many more schizophrenics wind up living their lives in nasty old residential treatment facilities where they are medicated much the same as in state hospitals. Many of these facilities are fire traps, dirty, underfunded and the patients receive poor psychosocial supports. I don't question that the agencies that run these places are trying the best they can in very trying circumstances--the employees aren't paid well yet their compassion is often boundless--but I have been inside enough of these facilities and seen enough of the patients to where I have to question just how much we have gained as a society and how well we are serving people who are in desperate need of our help. I don't see too many of their charges getting well. I am sick and tired of seeing this state of affairs. I am sick and tired of seeing this state of affairs and hearing the powers-that-be call it good and the best we can do. That's bullshit.

I am not calling for a re-opening of state hospitals or anything of the sort. But the current solution, which we've been leaning on very hard for a few decades, just isn't producing the kinds of results patients have a right to expect, especially given the very high price they pay every day with their brains and bodies. We need to be doing something else. Or something elses. And blending these approaches--such as CBT and DBT--with more conventional approaches. I don't even know what such a system would look like, but I know that the early promise of the now-defunct Soteria House in San Jose, Calif. (kind of a big HVN meeting) ought to serve as inducement to trying something other than what we are doing now.

Not long ago, I reached out to some sources of mine in the psych world in Seattle. I know a very high functioning schizophrenic, but like many schizophrenics she doesn't exactly have a peer group. I wondered if these sources knew of any local group of patients she might attend or if they knew of other high functioners I might introduce her too. The answer was "No." In 2007, no one has come up with some way for schizophrenics to hang out together in Seattle and just be together and make sense of their situation. Bizarre. (Yes, I am well-aware of the various "club houses" and such out there, but they'd hardly meet her needs.)

MindFreedom and PsychRights and other groups are very busy trying to get what they consider basic human rights carved into America's mental health system (and those of other nations) and legal system, so I am not sure that they have the resources to take this on. I'm not sure who does. I've heard rumbles of other Soteria kinds of approaches in this country, so if anyone has information on them, please pass it along.

Anyone got any ideas on any of this? Or on HVN?

Thanks to Sara for pointing me to the article on HVN before I'd bumped into it myself.

Health Insurance Parity And Slime

On Saturday, the New York Times' editorial page called for passage of insurance parity for mental health by Congress. The paper favors the Senate version. I suspect the Senate version will end up getting the nod over the House bill. President Bush will sign it into law.

I don't know all the details of the bill but I suspect, as is common with these things, that it will be phased in over time. Meaning that insurance companies will be free to screw over patients in the meantime. No sense taking away their favorite hobby too quickly, eh?

In an article in today's Times, it is revealed that some long-term care insurers are denying payments owed to the elderly:

"In depositions and interviews, current and former employees at Conseco, Bankers Life and Penn Treaty described business practices that denied or delayed policyholders’ claims for seemingly trivial reasons. Employees said they had been prohibited from making phone calls to policyholders and that claims had been abandoned without informing policyholders. Such tactics, advocates for the elderly say, are becoming common throughout the industry.

“These companies have essentially turned their bureaucracies into profit centers,” said Glenn R. Kantor, a California lawyer who has represented policyholders.

Yet these concerns have been ignored by state regulators, advocates say, and have gone unnoticed by federal lawmakers who recently passed incentives intended to promote purchases of long-term-care policies, in the hopes of forestalling a Medicare funding crisis.

Conseco and Bankers Life “made it so hard to make a claim that people either died or gave up,” said Betty J. Hobel, a former Bankers Life agent in Cedar Rapids, Iowa.

“When someone is 70 or 80 years old,” she said, “how many times are they going to try before they just give up?”

The insurance business is as slimy as used care sales or Big Pharma. I encourage you all to read the article.

A Bipolar Child Murdered: Associated Press Takes A Swing

I've banged on the AP--an organization I generally hold in high esteem--for its lame coverage of mental health issues. My, my, my how things change when a child is killed under bizarre circumstances. I refer to the Rebecca Riley case, of course. Here's the AP's look-see at the case and its implications. It's a good article and deep-down gets into criticism and defense of the bipolar child paradigm:

"Rebecca's death has inflamed a long-running debate in psychiatry. Some psychiatrists believe bipolar disorder, which was traditionally diagnosed in adolescence or early adulthood, has become a trendy diagnosis in young children.

"As a clinician, I can tell you it's just very difficult to say whether someone is just throwing tantrums or has bipolar disorder," said Dr. Oscar B. Bukstein, a child psychiatrist and associate professor at the University of Pittsburgh.

A study of mentally ill children discharged from community hospitals, published in January in the Archives of General Psychiatry, found the proportion of children diagnosed with bipolar disorders jumped from 2.9 percent in 1990 to 15.1 percent in 2000.

A report released by the Centers for Disease Control and Prevention in 2002 estimated that about 7 percent of elementary school-age children - or approximately 1.6 million youngsters ages 6 to 11 - have been diagnosed with ADHD.

The annual number of U.S. children prescribed anti-psychotic drugs jumped fivefold between 1995 and 2002, to an estimated 2.5 million, according to a study published last year by researchers at Vanderbilt Children's Hospital in Nashville, Tenn.

Some child psychiatrists say bipolar disorder may have been under-diagnosed in children for years, partly because several key symptoms are also symptoms of ADHD, including hyperactivity, distractibility and talkativeness.

Dr. Janet Wozniak, director of the Pediatric Bipolar Disorder Research Program at Massachusetts General Hospital, said early diagnosis and treatment are critical because the illness can cause social and academic problems, and lead to drug abuse, crime and suicide.

"What's commonly overlooked when considering diagnosing and treating children at such an early age is the risk of not treating and not intervening," Wozniak said."

Those numbers, which I've been citing for well over a year, remain startling to me. And Wozniak, whom I've banged on before, is part of the Harvard bipolar mafia, a group that has done more damage to odd-seeming people everywhere by creating an intellectual framework in which they are considered "sick" and in need of treatment in order to prevent future episodes of oddness. If these folks had their way...ah nevermind. Stupid preppies.

Dumb Bipolar Excuse #99, Links And Thanks

OK, some guy in Chicagoland has a child with his fiance while he's carrying on a year-long affair with his ex. He blames it on bipolar disorder. Please. Sounds like a case of Dumbass Disorder to me. I am so tired of people blaming their lapses in judgment on the overstated impulsiveness of the disorder. Doing so makes the rest of us look bad and creates an environment wherein employers won't trust bpers and families will actively work to keep their offspring from marrying bpers (yes, that happens).

CL Psych points out, in relation to AstraZeneca seeking a depression indication, that since depression rating scales include increased appetite as a factor, then Seroquel ought to count highly on that item, given its weight gain problems.

On Fridays, I usually link to all manner of bloggery I've read during the week. CL Psych already has a fabulous set of links up. See them here.

Many thanks to PsychCentral for saying nice things about my ramblings on medicating kiddos.

And, most especially, many thanks to all you readers who've been commenting on my Los Angeles Times post of the other day. It's a great comment thread.

I will be quite tied up over the weekend preparing "the Other Project" for something or other. As a result, Monday's posts will likely be pedestrian. Consider yourself warned.

The Zyprexa Chronicles: Lilly Helps Police State MedicAid Programs

The New York Times is out today with an article concerning Eli Lilly's advisory role to doctors seeing MedicAid patients in various state programs around the country. The gist is that, in order to keep Zyprexa from being pushed out of state formularies (ie, what drugs a state program will cover), Lilly devised a program in which the company monitored the prescribing patterns of doctors and sent them a warning letter if they prescribed Zyprexa outside of normal patterns. Whatever normal might be. And you'd trust a company such as Lilly to help hold down costs in exchange for giving it an intimate look-see into how doctors prescribe to patients?

"“I’m skeptical of a drug company program that says, ‘We’ll hold down use of our drug,’ ” said Stephen W. Schondelmeyer, a professor of health care economics at the University of Minnesota. He described such programs as thinly disguised marketing."

The idea is that the program would help states control costs. But some states took a pass on the program, while some liked the program.

"Lilly’s pitch in 2005 was, “ ‘we’ll fund this program if you put our product on the preferred-drug list,’ ” said David Beshara, chief pharmacy officer for Tennessee Medicaid.

Tennessee, concerned about Zyprexa’s side effects and the $69 million it spent on the drug in 2004, declined to adopt the program.

Mr. Beshara said the potential savings from the program were unclear. And he cited another concern: the program has been offered in lieu of rebates that companies often pay to states that place their drugs on preferred lists.

In Pennsylvania, the former state deputy secretary for medical assistance, James L. Hardy, said Lilly had offered to pay for a prescription-monitoring program instead of rebates before the state developed its preferred-drug list in 2005. He declined to go along.

“I didn’t like that commingling of service and rebates,” Mr. Hardy said. “I want to manage the benefit, and I want to get the best rebate deal I can. I don’t want to settle for half a loaf.”

Mr. Hardy said Pennsylvania eventually placed Zyprexa on a list of restricted drugs.

Some states, notably Michigan and Missouri, have publicized results showing that the Lilly program helped save money. And they generally praise the program.

“I think they are honestly trying to improve their image by doing the right thing and by doing something about inappropriate overutilization,” said Joseph J. Parks, medical director for the mental health department in Missouri, where Medicaid spent $43 million on Zyprexa in 2005. "

No matter what, why is a pharma company this deeply-intertwined with how states run their MedicAid programs? And, why is it, as I've noted before, that some pharma companies know details of doctors' prescribing patterns without said doctors permission? Creepy.

Credit to Pharmalot, and CL Psych all of whom had this story up before I dragged my butt out of bed.

Here We Go: Seroquel For Depression And Anxiety

Seroquel was approved by the FDA for bipolar depression in October. Since then, I've noted that AstraZeneca is trialing the drug for a host of conditions, clinical depression and anxiety among them (and it's for kids too!). Apparently, the trials have gone well for the FDA's lame efficacy hurdles because a British report has it that the company will move for approval of the antipsychotic for depression--and anxiety too--in 2008.

No antipsychotic has ever been approved for depression, although they are obviously used for psychotic depression off-label, but that's because of the psychosis. The total depression market is $16 billion or so and of course AZ wants a slice of the pie. Indications for depression and anxiety could increase sales from $3.5 billion a year to $5 billion. And this drug will be prescribed for long-term use. Short-term (as in days to a few weeks), it has its uses but I fail to see why a doctor would want a patient to take an antipsychotic for depression for anything more than short-term use.

The drug has really nasty side effects, especially cognitively. Here's an account of one patient who took a little extra Seroquel the other night and couldn't make it to work the next morning. The drug's weight gain problems are almost as legendary as Zyprexa's.

Diabetes? Off-label marketing? Well, there's a federal class action lawsuit afoot, states are suing and there's a Congressional investigation in the offing. Sounds like a drug with a clean history to me.

What's more, there continue to reports of people using Seroquel as a drug of abuse. You can get high--or maybe it's low--from a drug that knocks people out! In fact, a bus driver in Pennsylvania was busted for buying some from a teen who'd swiped it from his mom. And, of course, there are reports in psych journals of people using it in prison.

Given all of that, I foresee a train wreck in our culture if the drug ends up being widely used for depression and anxiety. There are plenty of bipolars who've been given the drug for agitation, for example, who've run into tolerance problems on the drug and all sorts of fifth of whiskey head in the morning problems. And let's not forget it's use as a sleeping pill.

But that sort of real world experience has no bearing on how the FDA considers the drug for supplemental approvals. The real world is anecdotal and unscientific. If the drug can beat a placebo by a little bit, well then that's rock solid science.

BTW, let's not forget about the study of Seroquel for public speaking. I swear, this drug will be in the water supply someday.

Brains, Depression And Booty

Here's a fascinating article about how a brain injury may turn off a person's moral judgment and make them susceptible to thinking violent thoughts, if not commit violent acts. Like a lot of neuroscience studies, I don't know quite what to make of its broader implications. If there are any.

And an interesting study is out on depression in caregivers of terminally-ill patients. Which, of course, is depressing enough on its face.

Remember all the noise about pharma rep cheerleaders? Well, it's now out that one Miss USA candidate is a pharma rep. Guess if she loses, she'll know where to turn for help.

On Quieting The In-Betweeners

Most of you know that I am opposed to giving psych meds to children except under extreme circumstances (autism is one, psychosis is another). No, this isn't a post about the bipolar child paradigm. It's something else. It's about questions, some of them without answers.

I am opposed because, having worked in an inner-city school in the mid-1990s when the medication of kids and teens began in earnest, I have a lot of trouble, conceptually and practically, with applying a treatment paradigm that doesn't work very well with adults to children. We don't, for example, give kids two martinis after school to help them settle down. I can assure you all this medicatin' didn't work a bit with the kids I used to take down the hall to the nurse's office and monitor as they took Prozac (we only had a nurse two days a week). Over a period of a year, I watched one 13-year-old boy become more and more scrambled, for example. I think it says a lot more about who we are as adults--we want controlled, quiet kids and we want them in a world that is increasingly frantic, where the pressures on adults to perform economic tasks are massive and, therefore, problematic kids become more problematic because no one has the time or psychic headroom to deal with them--than it does about kids. It also tells us much about the state of our culture.

The weirdest and most bizarre examples of the quiet kids phenomenon come from back East. In New York, a man who'd alleged murdered his child by shaking it to death last year, killed himself in jail the other day. He'd also been popped for blowing PCP-laced marijuana into the child, reportedly in an effort to keep the child quiet. Enjoy your stay in Hell, pal.

And, second, you've probably all heard about the video that surfaced a few weeks back (it really made the rounds on cable TV and YouTube) of a couple of young men blowing pot smoke into a toddler. It's not clear if they did so as a sick joke or in an attempt to chill out a bratty child. I won't link to the video since I find it so repugnant.

Those are two bizarre extreme examples, as is the case of Rebecca Riley. Why is it that parents, abusive or not, so desperately want quiet, compliant-in-every-way kids? Kids who don't fight? Kids who get straight A's? And so on. I don't even know the answer to this one, but it bugs me that noisy and outrageous behavior by kids has now become a sign of mental illness. I am not talking psychosis here or the intense combativeness of some autistic kids to use two easy examples. I am talking about the kids in-between--in-between "normal" behavior and derangement.

The in-betweeners. I was one of those. Really noisy and really good. Accomplished in every youth sport I played (not an exaggeration, FYI), A-minus/B-plus in school, 95th percentile-plus on most standardized tests, getting into fights at school, climbing the cyclone fence behind school to go play in a creek, messing around with a little girl at the bus stop when I was a little boy (we were in the advanced reading group and got to go into school later), on occasion punching holes in sheet rock at home, taking huge risks jumping bicycles (because it was there!), all wrapped up in a big-for-the-age kid with a very, very bad temper. My inability to sit still in school was even something I was aware of. When I was 8-years-old, I struck out 24 kids in a baseball game. The others grounded out. That year I also threw my first bean ball--at a kid who'd been lipping off at me from the dugout.

The only thing I didn't have trouble with on behavioral scales was sleeping. I could always sleep.

These days, I'd be considered a walking pathology. Teachers calling home and suggesting that the parents medicate me (this goes on now). Thrown out of the baseball league. On Risperdal, Ritalin and Lithium or whatever by the time I was in 5th Grade. But that didn't go on.

My parents never once took me to a psychologist or school counselor and certainly not to a doctor. That was hardly ever done in those days, the early-1970s, and this was in the Bay Area which has always been ahead of the national curve.

One day, Eben Ham (he's in the IMDB now) and I were playing softball with our 5th Grade class. We had an unusual teacher that year, Mr. Croskey. A whole pile of us had gone to school together since kindergarten (including, OK I am now bragging, the now-coach of the Houston Rockets who I played basketball, football and baseball with) and Mr. Croskey was our first male teacher. He was a couple of years out of Vietnam and built like a fire plug. This day, Eben and I heckled Mr. Croskey who, unlike other teachers, actually played sports with us. Mr. Croskey got seriously pissed at us and ordered us to crawl back to our classroom like "good little babies." So we crawled. (It was Eben's idea, I swear!)

Maybe 20 yards before the class door, Eben and I suddenly went airborne. Mr. Croskey had picked us up by our necks. Then we hit a wall, damn hard. Eben and I never gave Mr. Croskey shit again.

That night, I told my Dad what had happened. My hope was that he'd go storming into school and demand action against the teacher. Instead, he said "Good" and left it at that.

Nowadays, well you know I'd likely be in special ed classes and explaining to schoolmates that I had early-onset bipolar disorder ("It's a brain disease, Eben.") or ADHD. Mr. Croskey would have been sued and fired. My parents would be pulling their hair out trying to figure out what to do with their troubled child. But none of that was an option back then. Now that there's what a smart friend of mine calls the "chemical swaddling" of children, it is an option big time. Not that adults haven't been trying to quiet the in-betweeners for eons. But there is big money in it, intense debates on all sides of the issue, media coverage, researchers demanding more money for more research because they cannot quite pin down what the hell is going on. Kids are noisy and misbehaving and now that we can pathologize that, gasp, we simply must pay attention to every wrinkle of their behavior because we have these diagnoses.

Guess what? We had the same kinds of diagnoses for behavioral abnormalities back then (the diagnoses were much broader and fewer in number of course), but we simply didn't use them so much. Guess what? My life has worked out fairly well. There have major bumps along the way and, as an adult, major psych diagnoses and medications aplenty. But I am OK, paying taxes and more-or-less abiding by most social codes and norms. And I am not bothered a bit by the fact that I wasn't medicated as a kid. I am not enamored of claims that if I had been, then I would have been more stable earlier in life. So what? I've ended up in the same place.

And, can anyone make the argument to me that our society is functioning any better now that we medicate millions of kids with mixed results? Or were we better then? Depends on how we measure the results. But, for me, not having antipsychotics pumped into my head in 5th Grade strikes me as a pretty decent measure.

This post doesn't have a point. It's question-without-answer time. But some bloggers out there have been nipping on my criticisms of medicating children. And I have been musing on these questions for years, playing my childhood over again in my head and wondering "What if?" I don't have a final answer. Yet.

But I have two ideas. One is that someone has got to a follow-up, retrospective study of all those kids who were diagnosed and medicated in the 1990s. What's their status today? How did this all work out for them? I have my hunches.

And, two, I have got to track down Mr. Croskey and thank him.

Conflict Of Interest O-Rama, The Zyprexa Documents And A Blogging Note

First, I am having a bear of a time posting today. Juggling too much other reportorial work on the one hand--my phone has literally rung a dozen times this morning and that's good--and trying to find something intelligent to say about the mental health world on the other. So, instead of me scrambling to say something smart, I'll link to other smart folks.

The New York Times has an excellent article today on just how much money Big Pharma is giving to doctors in Minnesota, some of whom are influential researchers. It's lots and some of it is going to psychiatrists. A sales rep goes on the record admitting that this money is essentially buying off docs and creating markets for drugs that otherwise wouldn't exist. The paper's reporting is based on reports that have to be filed with the State under a unique law. All states should have this law. Because transparency is a good thing for the public. Much credit to the Times for staying on these issues. Much shame to the rest of the media for being lazy reporters on these issues.

AHRP has an excellent post up about some legal analysis of the Zyprexa documents ruling last month, which, among many other effects, effectively muzzled AHRP on some of the issues around Zyprexa and has prevented the group from linking to this here blog because I have the documents on my site. The basic legal analysis is that Judge Jack Weinstein's seal on some of these documents was stupid to begin with since they were hardly trade secrets. And so on. Read it here.

On Monday night, my good pals at Johnson & Johnson hosted a blogger summit on pharma blogging in NYC. Although the idea of a pharma company hosting a blogging event strikes me as bizarre, they had the good sense to invite Ed Silverman of Pharmalot (one the best blog names going and a damn good blog). BrandweekNRX has an account of the affair.

I was not invited. Neither was CL Psych who has a hilarious parody of a hypothetical pharma blog. Some might say that was because I am too much the critic or would have insisted that the J&J executives look at my drivers license pic, taken mere days after I had a bad reaction to Risperdal (their product) and Lexapro (Andrew Solomon's daddy's product). But, no. I think it was because the event featured an open bar and much wine was consumed. And, well, let's just say the pharma folks would have seen their profit margins collapse if I had been able to go through said wine list. French wine and I are an expensive combination.

The event also featured a blog consultant. Oh, my. Glad to see someone is making money off the blogosphere's back.

Tick Tock, Redux

As I noted last year, some basic researchers--those would be the dorks who work with animal modules and molecules and such--have believed for some time that flawed/missing genes that regulate circadian rhythms are at the root of mania and bipolar disorder. I heartily agree, especially since street-level experience for most bipolars is that there first big grand episode was accompanied by a long period of sleeplessness. So this makes sense.

And, now, another study is out lending more credence to this theory. The study was done in mice, so I'd really like to see it replicated in primates--not that they can play the knockout gene game there as easily as with mice--before I put too much faith in it. But it supports the same basic theory. Read about it here.

Oh, yes, the manic mice also responded to Lithium. But I'm sure Zyprexa or Seroquel would work even better!

I Love Spam

First, I was busy with a lot of non-blog related job crap yesterday well into the evening, so I won't have any posts until later today. Second, I appreciate all the comments yesterday which were great and really spanned the poles of where we are in this country with mental health care, to grossly oversimplify. Thanks.

Third, I've been amused by how tricky the various spammers in the Netosphere have gotten with what they leave for comment spam these days in hopes that I--or any other blogger--will see the benign first bit of the entry and approve it, leaving links to porn and cheap Ativan all over the place. To whit:

"I feel like a complete blank. That's how it is. I can't be bothered with anything recently. "

There are other ones that are far more depression specific. Fascinating eh?

Thanks For The Comments

Yesterday, this here blog got 32 comments. I think that's a record for me, aside from the one-day explosion back in December on my Web 2.0 musings. Always nice to know I've touched a chord somewhere in the Universe, or pissed someone off. For this, I thank you all.

In other news, this is the 700th post on this blog, which is rapidly approaching its 2,100th comment. That's, like, whoa.

The Los Angeles Times Falls Flat On Forced Medication Story

There was an interesting and compelling--and, in many respects, flawed--article in the Los Angeles Times on March 16. It told the tale of a man named Kanuri Qawi, a schizophrenic who'd been in and out of jail and in and out of California's state hospital system throughout his adult life. Qawi set a legal precedent in 2004, when the California Supreme Court ruled that he had a right to refuse medication while being held in a state hospital. Later, Qawi was released from a state hospital and began living in a residential facility. Now he stands accused of murdering his roommate.

You can read the main article for yourself and draw your own conclusions about Qawi and the strange paradox of his case, as well as the tragic end of his roommate. I find it odd that Qawi, who has a documented history of violence toward others was not in a strictly-monitored outpatient commitment arrangement. Those of you familiar with this blog know that I am not warm to the idea of outpatient commitment in most instances (the evidence is mixed on how well it works). But Qawi's case seems to meet the necessary legal hurdles under California law. The article offers no explanation as to why the alleged murderer wasn't under an outpatient commitment order. And why he wasn't being administered an injectable antipsychotic given his track record of cheeking meds.

But that's one of several problems with the article and of the Los Angeles Times' lazy mental health reporting over the last few years. Or maybe it's lazy editing. Keep in mind that I am not a fan of playing journalism police, but in cases like this I have little choice.

The article contained no contextual information concerning rates of violence amongst the mentally ill and schizophrenics in particular (the rate is a bit higher than the general population, but not as high as groups such as TAC claim). That's kind of an important omission since the article is speaking to the broader question of forced medication of the mentally ill and, as written, it leaves the public with an incomplete picture of the issue. Conversely, the article never broaches the question of the state's outpatient commitment law and why it wasn't applied here. Again, that's a serious omission, one that leaves the fearmongers in the mental health advocacy world licking their chops. They can use this article to try and overturn the 2004 supreme court ruling in the legislature.

What's more, it's an article that screams for an examination--hell, a sidebar at a minimum--of why psych patients go off meds and why treatment conditions haven't improved for the mentally ill with the use of atypical antipsychotics. Those are as much the central burning issues at work in the paradox of the Qawi story as is the question of an off-meds alleged murder. It's disappointing to see talented professionals claim that they are exploring the implications of this tragic event yet leave most of the implications unexplored.

What really bothers me is that the paper has a long-running assumption that newer antipsychotics are far more benign than first generation antipsychotics. From one the paper's editorials which won it the 2002 Pulitzer Prize for Editorial Writing:

"On any given day, about 50,000 severely mentally ill homeless people roam California's streets, rummaging through trash bins, doing battle with invisible demons and occasionally inflicting harm on very real citizens. They do so largely because laws crafted decades ago put their 'civil right' to be free ahead of society's right to compel them to be treated.

These well-intentioned laws made some sense when they were passed, in the 1960s. Then, the awful side effects of some psychiatric medications turned patients into virtual zombies, blurring their vision, stiffening their muscles and dulling their memories. Better medications are available today; as a result, lawmakers will have a chance soon to make California safer and saner."

Don't you just love it when newspapers refer to the rights of the mentally ill in quote marks, as if those rights are different from those of other citizens?

If the paper's reporters are stupid enough to put the "new meds are better" claim in their notebooks without checking out the assertion with other sources, then they are little more than shills for pharmaceutical companies. Sadly, the newer meds aren't much better in either treating the symptoms of schizophrenia or in their side effect profiles. This is well-known and is now documented in numerous clinical studies (yes, the new meds still cause zombieism only not as much as before). You'd expect whomever edits the health section of the paper to also be highly aware of the CATIE study and of the recent revelations around Zyprexa, for example. No sign of that here. And so on.

I have about had it with how the media covers serious mental illness and the treatments available to patients. It's always a one-sided story. But I may have a method to address it. At most big media outlets, when a reporter is new to the police beat, for example, they have to go on ride-alongs with the police and many cop reporters willingly get pepper-sprayed and Tasered at some point while on the beat. That's partly to show their cop sources how tough they are and partly to gain an understanding of how these devices work. Often, they'll also get to go to the police shooting range and bust off some rounds from a Glock or an AR-15. It's a good way to get perspective on your job since you'll often be called upon the report on cops shooting criminals, cops Tasering suspects and it's a good idea to have an idea how it all works. It leads to deeper, more mature reporting.

In that spirit, I think reporters who cover mental health in this country should undergo an analogous form of immersion in their beat. They should take 10 mgs. of Zyprexa, say, or 300 mgs. of Seroquel a day for a few weeks. They'll have a new appreciation of the tradeoffs patients face every day and a richer understanding of the complicated reasons that patients go off their meds. (I think all doctors and advocates who press for the compulsory use of these meds should undergo a similar immersion.) They should spend a few hours restrained in a seclusion room, too. And so on.

And as for the meds, don't worry. They are safer and saner. I read that in the Los Angeles Times, so it must be true.

Psych Docs Screws Up Medical History

Here's a fascinating post by Mental Mommy, a fine blog by the way, which captures just how poorly some psych docs listen to patients. No idea what the consequences of this were, but it's interesting nonetheless.

McManamy Talks Bipolar Child Paradigm

Somehow, I missed John McManamy's blog post a couple of weeks back on early-onset bipolar disorder or juvenile bipolar disorder or whatever the hell we are going to end up calling it, aside from a failed a social experiment, when all is said in done. When I write "failed social experiment," I refer to the reach of the bipolar child paradigm, which is being pushed on children as young as two-years-old, leading to them being given antipsychotics and, in some very tragic instances, injury (yes, there are stray reports in the literature of kiddos getting hyperglycemia from antipsychotics) and death.

Anyhow, McManamy largely delivers a historical account of the development of the paradigm (as he did in his newsletter in late February), and also adds this about some critics of the bipolar child paradigm:

"There is a lot of misunderstanding on the topic. Some people think that diagnosing young kids with a mental illness is a plot by drug companies. Others deny that kids can even get bipolar. Others call it a fad diagnosis.

Many of these individuals are pushing an antipsychiatry agenda. Others are narcissistic bloggers who specialize in interviewing their own keyboards. But even the most rabid in their midst do raise legitimate concerns about putting kids on dangerous meds for a diagnosis we know very little about."

Narcissistic bloggers? Rabid? Hm, I wonder to whom he's referring. McManamy doesn't single out anyone, but I'll consider myself dinged by implication since I have written quite a bit on my doubts about the bipolar child paradigm.

McManamy spends much of his post and newsletter crediting the Papoloses for creating the paradigm.

McManamy states that in the 1990s America was, in essence, beset with moody, misbehaving children and that the Papoloses were staring into a research void when they went about researching their book. Although it's not like there weren't plenty of studies on bipolar disorder in children aged 0 to 12 years old, according to PubMed:

0-12 years old: 583 in the 1990s (58 articles per year) 0-12 years old: 917 in the 2000s (147 articles per year to March 15, 2007)

I am far from the only person questioning where the hell this diagnosing and medicating is leading us. The New York Times has poked at the issue, fairly aggressively by mainstream media standards. Judith Warner, a columnist at the paper, has written two columns defending the medication of children, which led to gobs of comments on her blog (which is sadly behind the Times Select subscription firewall). CBS's evening news also had a piece on medicating children recently, which led to a recent comment by a psychologist at PsychCentral:

"My philosophy is that being overly-cautious to diagnose and prescribe for children is a smart route to take. Certainly there are cases that are very serious and need creative methods of treatment. But otherwise I hold some concern about the issue primarily because of the lack of research."

Both CL Psych, an actual psychologist, and Maria at Intueri, an actual psychiatrist, have raised serious questions about diagnostic criteria. So have others in the field.

I agree that there are likely a small number of cases that justify treatment of some kind, but I think that the Papoloses, the Harvard bipolar child mafia and others have over-stepped the proper boundaries of their profession by pressing for the legitimacy of the bipolar child paradigm and its application to millions of children. To hit a kiddo with a diagnosis that will lead to a lifetime of social discrimination is unethical and mean. To medicate children with drugs that are known to cause a reduction in brain volume in research monkeys and diabetes, hyperglycemia, cardiac problems, boosted cholesterol levels and, yes, early deaths in adults is also unethical. This isn't a plot by Big Pharma. No, it is the result of overlapping interests of pharmaceutical companies who want to maximize profits, research psychiatrists hungry for the academic prestige of publication, advocacy groups convinced of their righteousness, an FDA that is asleep at the switch and parents who are, in my opinion, backing off their responsibilities as protectors of their children's physical and psychological liberties.

I have to question the social imperative behind all of this--it's not like these kids are shooting off guns in the street or threatening the well being of America at large. Maybe I am too much the social libertarian, but I think it is madness for our society to demand that anyone--child, teen or adult--be medicated unless they are a clear and present danger to the physical liberty and bodily integrity of other members of society. If an adult wants to address a flaw of mood and feeling and personal behavior by taking meds, then go right ahead. (I have for 18 years with mixed results.) But to force Seroquel, Risperdal and Zyprexa, for example, upon innocent tempermental, moody children who have little control of their own individual liberty is delusional. It smacks of the kind of social control that once led to forced lobotomies in adults.

This is a controversial matter in adults, I know, and there are people like Fuller Torrey and the editorialists at the Los Angeles Times who disagree with me and passionately so. The Times won a Pulitzer Prize a few years ago for editorializing that homeless people in Los Angeles should be, in essence, forced to take psych meds, for example.

But now that we are talking about children, I have to be skeptical. The current dominant paradigm in psychiatry, the psychopharmacological biologically-based one, is not producing appropriate results for adults who embrace its precepts, as I once did, so we are insisting upon the legitimacy of medicating children for what reasons. Or is it because we have already forgotten Rebecca Riley?

If it's narcissism for anyone to question the bipolar child paradigm, then color me the king of self-love.

Kennedy V. Kennedy On Mental Health Parity

There are two mental health parity bills before Congress. One is authored by Sen. Ted Kennedy, the other by his son, Rep. Patrick Kennedy. The basic difference between the two bills is that Patrick's would cover alcohol and substance abuse treatment while his father's would not. You can read the New York Times article and decide which you prefer.

As much as I think mental health care and treatment is a disaster on every level, I fully support parity legislation. If someone wants to follow society's push to medicalize mood and feeling and behavior, then I don't think they should receive lesser coverage than for other physical ailments. Mental health care is already unfair enough without adding an inequitable financial burden to patients.

That said, I find it amusing that the article omits an reference to Patrick Kennedy having bipolar disorder or his Ambien-induced driving adventure last year. The article also ignores Ted Kennedy's alcohol-induced auto accident--you know, the one that killed an aide in the 1960s--much less his long history of alcoholism. The article also ignores that Ted's sister, Rose, was mentally ill herself and had a botched lobotomy which left her institutionalized for much of her life. She died in 2005.

Leaving out such context is, well, very interesting. But, then, the rich are very different from you and me.

Bobby Kennedy Murdered Marilyn Monroe?

There was quite a flurry of overseas press coverage of this little tidbit over the weekend: Marilyn Monroe allegedly murdered by Bobby Kennedy. Here's the gist:

"Marilyn Monroe may have been tricked into killing herself as part of a plot hatched with the knowledge of the former US attorney general, Robert Kennedy, according to a secret FBI file.

The document, uncovered by an Australian film director, Philippe Mora, suggests Monroe was "induced" to make a suicide attempt, in the belief she would be found in time, and her stomach pumped. Instead, it suggests, she was left to die by staff and friends, including the actor Peter Lawford, who was married to Kennedy's sister, Patricia."

I have no idea what credence to attach to this, but it has been picked up by some reputable news agencies. What's interesting is that, as of last night, it had been picked up by no one in the mainstream media in this country aside from a TV station in North Dakota. That's odd.

Behold Abilify Phone Booth Ad!!!

As I noted in January, ads for Abilify have popped up around Seattle. The one I saw in my part of town disappeared, but apparently the one in the University District didn't. Thanks to a reader tip and another reader heading over with a camera, you can now behold the glory that is direct-to-consumer marketing of psych meds.

Back in January, I tried to ask the fine folks at Bristol-Myers Squibb what the hell they were up to. They didn't answer. But, now, I think I know. The Capitol Hill ad was located blocks from a large community college and the one above is located close to the University of Washington. So, um, BMS is targeting college kids. Which to me is further proof that these DTC psych meds ads have got to go. All of them. Cymbalta's "Depression Hurts" TV ad, the Seroquel banner ads on the Net, the Abilify ads on phone booths.

I hope that Waxman's committee takes up the issues around DTC advertising of psych meds.

Thanks to Michael for the tip and Stephany for the pic. Man, I simply must get a camera.

The Zyprexa Chronicles: Big Pharma Apologist Trots Out Lamest Argument

Ever. Yep, CMPI's founder Robert Goldberg makes the following point over at Drug Wonks concerning Zyprexa's static sales:

"Except people don't switch to something else. They just stop taking drugs. Period. Or, as with the case when the media fed the SSRI scaremongering, they don't take drugs at all. As with depression, untreated, schizophrenia and manic depression can lead to violence, self-mutilation, substance abuse and suicide.

I am afraid that the slowing sales is a signal of tragedy to come. Lilly has been warning of weight gain and diabetes for years. Coming up with something other than trial and error before starting with meds is what we need to shoot for and is best for all. But others have fanned the flames of fear."

I am not sure where Goldberg picks up his information on the patient world, but patients generally don't stop taking drugs due to media coverage (media coverage of psych meds is pretty scant to begin with). They do it because the drugs don't work especially well and are mean as hell to their bodies and brains. When Goldberg's homies at Big Pharma begin making tolerable meds that actually works as advertised for the majority of patients, as opposed to a minority, then maybe I'll be sympathetic to his point.

I'm not sure, also, where the hell he's getting "scaremongering" in the media's coverage of these issues. If anything it's been restrained, and the item that set Goldberg off was business coverage of Eli Lilly's CEO talking about Zyprexa sales. Nothing more.

His contention that Lilly has warned of diabetes and weight gain associated with the drug for years, an assertion he's made before, is only correct after 2003. Prior to that, Lilly was staring doctors and patients square in the face and saying, "Diabetes? What diabetes?" As they did in June 2002, weeks after the Japanese (and Europeans) forced them to add warning to Zyprexa. Meanwhile, here in the US, Lilly reps were instructed to go into PCPs' office and tell them they could assure "Donna" that Zyprexa was safe. It's not flaming fear to report those simple, documented facts.

Back to you, Dr. Goldberg.

CNN Needs Wake Up Call

Last night CNN's "Anderson Cooper 360" spent a bunch of time on the new FDA warnings on sleeping pills, going into the medical issues and the experiences of one man who got busted for a DUI while on Ambien. They even had video. According to reports, 100 people have sleepwalked off into their cars and such on sleeping pills. It's an important issue and I am glad CNN, and others in the media have spent time on it.

But let's compare this with the Zyprexa affair and the meltdown of the whole class of atypicals. Hundreds of people have been killed after taking these drugs. As in dead. As in unable to take a sleeping pill and sleep-drive much less watch CNN. Thousands more have been injured taking Zyprexa, Seroquel, Risperdal, Abilify and Geodon. The makers of these drugs have either settled numerous lawsuits--in Eli Lilly's case for $1.2 billion--or face numerous more lawsuits and are being sued by numerous states and face a Congressional investigation. The accusations, once again, revolve around off-label marketing of the drugs, kickbacks to doctors, undue influence of state health systems, downplaying risks of the drugs and so on. And targeting agitated, mildly depressed women and men and pressing PCPs to turn them into patients. Oh, yes, they are also being given to a million or more children.

Why isn't this a story for CNN? Is it because these drugs are called antipsychotics and therefore the editorial assumption is that these must be for "crazy people?" Or is it because CNN and others in the broadcast media have swallowed Big Pharma's Soma and just instantly assume that all psych meds are good and, if they don't work, well gosh there isn't much we can do except say,"Too bad?"

If CNN can devote time to sleeping pills, they can devote time to this. Because this is bigger.

Richard Jeni And Brad Delp

As some of you probably know, a couple of prominent entertainers have killed themselves in the last few days. Richard Jeni, a very successful comedian, had recently been diagnosed with chronic depression and paranoid psychosis at age 49. He shot himself. Brad Delp, lead singer of the band Boston, killed himself in his apartment by carbon monoxide poisoning at age 55. It's less clear what may have been going on with Delp.

I cannot figure this shit out. Both couldn't have had financial problems and both had stable relationships--and those are sometimes key drivers of suicide among men and depressive episodes wherein people do unfortunate things. I'm sure you could make a very good case for depression in and of itself being the root cause.

While I don't doubt that, there's something here that doesn't pencil out for me. Perhaps, I view these events too much through my own struggles with depression and suicide (and meds, to be honest) and, maybe, the fact that I managed to push through all of that bad business makes me unable to comprehend the meta-why of it all. Except that I have been at the same kind of brink several times in my life--long ago, thankfully--and I always found a way to keep on pushing. Sometimes, I think I know how I did it. Other times, I haven't a clue.

But, right now, my own experience matters not. Life and death, despite all of our culture's knowledge and technology, remain profound mysteries.

Speaking of mysteries, I failed to mention the second anniversary of Hunter S. Thompson's suicide a few weeks back and I also forgot to appropriately memorialize the moment. That was an oversight, which I shall rectify in a bit with a drink and a cigar.

BTW, I found it discouraging that, following Newsweek's cover story on men and depression last month, several female commentators lashed out at the idea of men receiving special attention. Here's an example of one of those moment's when feminist media critics embarrass themselves. I am so not surprised that it was in The Huffington Post. Perhaps, the author would like to contact Jeni and Delp's families and ask for their perspectives.

Another "Suicide Ad" Gets The Hook

It's been interesting to see suicide ads--I don't know what else to call them--getting the beat down since Toyota's Super Bowl ad flamed out earlier this year. Here another ad bites the dust. The whole suicidality as metaphor for desperate people in TV commercials thing is old, tired, dead and done. There must be a better way to convey human desperation in a 30-second ad and I am sure ad execs are smart enough to figure it out. But, then, maybe I am giving them too much credit. They still haven't gotten beyond the hot chicks sell beer paradigm, as it happens.

Banging On The Bipolar Child Paradigm, And A Few Interesting Bits On Schizophrenia, Plus Lilly's CEO Says Reps Help Docs ID Zyprexa Candidates

I am glad to see that my colleague CL Psych is slapping around the silly diagnostic criteria of early-onset bipolar disorder, especially its vague cousin bipolar disorder NOS:

"Of course, the upshot to a bipolar diagnosis is that it requires treatment, so should we really be breaking out Zyprexa, Depakote, or Risperdal for Johnny? As the diagnostic criteria become increasingly liberal, medication will be dispensed more frequently to those who need it less or not at all. Yet this passes for scientific progress in some circles. Kids who are now "bipolar" were labeled as having conduct disorder and/or ADHD (or were not given a label--God forbid!) a few years ago, but the bipolar child/adolescent paradigm is now sweeping across parts of the nation despite the rather meager data that this disorder exists to any meaningful degree or that treatment yields much benefit, especially in the longer-term."

Yee haw.

Psych Central has this fascinating item looking into how the common scientific assumption around schizophrenia's prevalence worldwide is now being challenged. I only wish it were good news.

Here, a pharmacist writes about akathisia in patients treated with first and second-generation antipsychotics. Among the atypicals, she only singles out Abilify, but let's face facts: Geodon sucks for this reason. And agitation can happen from taking Risperdal and, less commonly, Seroquel (despite what the company claims in its "paid editorials" in clinical journals). This is one of the few times when Zyprexa doesn't come off badly.

Speaking of dear old olanzapine, Eli Lilly's CEO Sidney Taurel admitted that Zyprexa's sales will likely be flat this year at $4.4 billion or so. And, then, he said:

"'The positioning of the drug is for our sales reps to help physicians identify those patients for whom the efficacy of the drug offsets the potential concern for side effects, and those are, in particular, the urgent patients,' said Taurel."

Sales reps help identify patients? What the fuck? That's the most bizarre thing to say for so many reasons that I won't even get into it. And "urgent?" I've never heard the term used in psychiatry. Is Sid Vicious so out of touch that he's not heard the terms "acute" and "critical" before? Kind of makes me want to buy some Lilly stock so I can show up at a shareholder's meeting one day and heckle Taurel.

If any of my faithful readers at Lilly or at Lilly's two outside law firms want to clarify Sid's point on Lilly's reps, you know where to find me.

The Zyprexa Chronicles: Montana Alleges Kickbacks And Off-Label Marketing

As I noted the other day, the State of Montana has sued Eli Lilly for its marketing of Zyprexa. I obtained a copy of the complaint yesterday (1 MB .pdf here) and the allegations are intense and mostly revolve around off-label marketing of the drug for use among elderly patients. Here are some key portions of the complaint:

Lilly "put users at risk for developing severe and harmful health conditions including, but not limited to, hyperglycemia, acute weight gain, diabetes mellitus, exacerbation of of diabetes mellitus, pancreatitis, cardiac problems and death. Furthermore, Defendant has been aware of studies linking Zyprexa to these conditions since 1996 and has known since at least 1999 that Olanzapine causes diabetes at a rate far in excess o fthe risk of most atypical antipsychotics, yet has failed to fully and adequately warn the State, physicians, and consumers of these risks."

The state further accuses Lilly of off-label marketing of Zyprexa for Alzheimer's, dementia, Tourette's, pervasive developmental delay, autism, anorexia nervosa and general depression. And there's more:

"Lilly's sales force concentrated on primary care physicians, rather than pyschiaitrsts, and focused upon marketing and selling the drug as treatment for depression and anxiety, rather than the psychotic conditions for which Zyprexa had been approved."

The state also alleges that Lilly "created a 280-person sales force exclusively for off-label uses especially for long-term care facilities." And:

"Lilly gave promises of financial benefits, in cash and in kind, to numerous physicians who attended the elderly to cement this unlawful marketing of Zyprexa."

And:

"Lilly management participated, encouraged and authorized the unlawful payment of illegal kickbacks to physicians in order to continue generating sales of Zyprexa."

The state also alleges that Lilly paid off the long-term care sales manager in Florida in 2006 (page 12 of complaint), who had apparently threatened to go public with what he knew of the company's marketing activities, in order to keep him quiet. Also, according to the complaint, Lilly budgeted $100,00 annually for a sales rep to spend on speaker fees and honoraria. The company paid huge amounts for speakers' travel, first-class lodging, extravagant meals and entertainment for doctors and their spouses.

The complaint states that Lilly gave gifts to doctors in the form of chartered fishing trips for doctors and their friends, sporting events, expensive dinners and entertaining in order to induce doctors to write off-label prescriptions of Zyprexa among the elderly.

Wow. More to come, you can be sure of that.

Thought You'd Heard Every Bipolar Disorder Excuse?

Well, listen again. A Michigan woman claims that she went into a car dealership for an oil change for her car and walked out after signing a $444 a month lease for a new Mazda CX-9.

"[Her] husband says the dealer agreed to take the car back if it got a doctor's letter detailing Berner's [the wife's] condition. He says the letter was sent, but the dealer delivered the CX-9 anyway, and left the keys in the mailbox."

She and her husband are now suing the dealership. While I suppose it's possible that the woman has problems with "impulsivity and difficulty in decision-making," I have real problems believing that could completely excuse her purchase. She did drive to the dealership to get another car serviced after all. So if she has that much trouble with impulsivity, then why is she driving in the first place?

Either way, the dealer should be a good sport and take the car back. This is one of those things that shouldn't clog the courts and shouldn't wind up stimatizing others diagnosed with bipolar disorder. It's stupid and should just go away.

Author Dubs Seroquel "Miracle" Drug

Author Robert L. Shook, best-selling author of such classics as Hardball Selling, has a new book out on various "miracle" drugs and the glorious triumph of Big Pharma to develop them and bring them to market. (Press release here.) The book is called Miracle Medicines. Among these miracle drugs is Seroquel.

No word on whether Shook actually interviewed any patients or at least ones not provided to him by AstraZeneca's PR department. But, then, I suppose it would wreck the old storyline to have to quote patients who would call the drug "poison" and "garbage," or to have to include an account of how AZ may well have off-label marketed the drug, or to report on how Seroquel ended up being handed out as a sleeping pill or how it's turned into a drug of abuse on both the street and in prisons, or to detail studies with shaky statistics and naked conflicts of interest. Oh, yes, Big Pharma is so heroic.

Actual quote from Shook: "Breakthrough medicines can only occur in an environment that promotes harmony among science, industry and government."

And allows off-label marketing. And injures patients. And allows for a slip-shod adverse events reporting system. And rips off taxpayers. And covers-up for sloppy "science." And spurs Congressional investigations.

B. Gets Housing And Many Interesting Items

I'm happy to report that B., whom I wrote about last week, has found new housing. It's a building that already has a couple of other Vietnam-era veterans with mental illness living in it, so B. should be OK. More or less. The better part is that, although it's about one mile from his current apartment, he'll remain in the Capitol Hill neighborhood in Seattle, a part of town that's much more open to openly-different sorts wandering its streets. The big fear I'd had was that he'd wind up in one of the dicier parts of town and end up in a fight (not good for a 61-year-old on Haldol) or that he'd be forced to move into one of our city's many trendy green bloc neighborhoods and, what with B.'s cigarette smoking and "abnormal psychology," the Gore-Tex'd neighbors would be on the cell phone to 911 before you could say "Pilates." So we'll see how this works out.

Otherwise, there has been a flood of interesting items in the Netosphere the last couple of days. Here goes:

My friend Tim Harris started a blog recently. It's entitled Apesmaslament, named for a Captain Beefheart song I'd never heard of. Here, Harris--who's been doing advocacy for the homeless for two decades--writes about his recent ADHD diagnosis. What's nice is that it's not one of those "Yay, I'm diagnosed, life now makes sense" bits, but is a lot more measured.

Someone else has started a mental health blog recently. This one is called Off Label. Its purpose should be self-evident. Here's a sample.

BTW, there has been a mini-plosion of mental health blogs in the last few months. People should feel free to pass those along as they bump into them since I don't catch everything or often space what I do catch.

Evelyn Pringle, a freelance journalist who's been banging on psych issues for a time, has this fine account of the Zyprexa affair and the murder/unintentional overdosing/psychiatric overreach-induced death/whatever it is exactly of Rebecca Riley. Both are obsessions of mine and I am glad someone else in the media sees these stories for what they are. Which is to say motherfucking outrages.

Mental health officials in Singapore, not content with caning teens for chewing gum, claim that 25 percent of teens have some mental disorder and are going to engage in some kind of diagnosis and treatment plans that I haven't the stomach to talk about anymore. That's some kind of country they've got there.

Britney Spears is officially bipolar, according to impeccable gossip news accounts. Apparently, she's barfing up her meds because she is bulimic as well. So was she depressed or manic when she agreed to marry K-Fed?

The ever-overwritten Pitchfork rock mag has this interesting story about indie pop riff-raff singing the psych meds blues. A tradition that began, more or less, with Nirvana's "Lithium." The article also summarizes the history of drug songs. I've always been a big fan of the Reverend Horton Heat's "Marijuana." The Rev. is one helluva of a redneck-stoner-gitar-player. In other news, the editors at Pitchfork need to stop editing with forks and bust out the blue pencil. Put it behind your ear and it'll be a hipster trend.

Useless trivia contest: The reader of this blog who can tell me from whence Pitchfork gets its name will win my admiration.

The Zyprexa Chronicles: Montana Sues Eli Lilly

The Indianapolis Business Journal today reports that the State of Montana has filed a lawsuit against Eli Lilly, maker of Zyprexa. "The lawsuit alleges the Indianapolis drugmaker owes the state for drug costs and harming patients after promoting the drug to sedate nursing home patients and giving kickbacks to doctors, according to Bloomberg. Zyprexa, which turned nearly $4.4 billion in sales last year, is only approved for treating schizophrenia and bipolar disorder. Brought March 7, the Montana suit also claims Lilly launched a sales force with 280 people to market the drug for off-label uses."

The lawsuit brings to seven the number of states suing Lilly over various claims connected with Zyprexa.

I assume the 280-person sales force was nationwide. If it were restricted to Montana, well, then, that'd be quite the sales effort.

J&J Gets A Threesome

And not the good kind, but three subpoenas from US Attorneys in Boston, San Francisco and Philadelphia. The subpoenas are related to ongoing investigations of sales and marketing of Risperdal. Which is to say off-label marketing. Although Zyprexa and Eli Lilly get most of the press due to problems with the drug and corporate behavior, I'd say J&J/Janssen is in just as much trouble and merits just as much press coverage. The State of Texas is suing J&J, California's AG is investigating and so is the Inspector General from the federal Office of Personnel Management.

Between the Risperdal investigations, the Zyprexa lawsuits, the Seroquel lawsuits, BMS's recent mysterious settlement with the US Attorney in New Jersey (it's not clear if that was related to Abilify, but I bet it was), plus the pending Congressional investigation of Zyprexa and Seroquel, it looks like the wonder drugs are in a world of trouble. In my adult life, I cannot recall a class of drugs that have ended up in such a pickle before. Nor have I seen such a class of drugs that were once touted as cures turn into such duds. The whole thing is just weird.

In othe