Furious Seasons

Drive Over: KC, Katie Appear

Thanks everyone for your support of my work. The drive brought in $1,050. I am humbled by your generosity in ways I really don't have words for, but it's stunning to me. Seriously.

I apologize for not posting pics of my cats last evening, but I developed a truly nasty headache--I think I've been in front of too many computers for too many hours the last few weeks, and did quite a bit of intense reporting for outside work the last couple of days. I'm still lame however.

That said, here's KC who is about to turn 4-years-old.

And here's Katie who is 7-years-old. I had a better picture of her but for some reason I cannot get it to work.

Both of my office assistants thank you for your support.

BTW, the PayPal button will stay up permanently for anyone who missed this go-round and wants to contribute later. In addition, I am likely going to put AdWords--those annoying little Google text ads--on this site in the next few weeks. Mostly as an experiment in how this media-by-blogging paradigm is really shaking out for writers.

Again, thanks to all of you. I am now wrestling with myself trying to figure out whether to spend the proceeds on a brand new Mac or a used Mac (and that would depend on how long Apple plans to support the G4 chip) and other necessities for the "office." Going to a WinTel machine isn't really an option for me. I hate the Windows operating system.

Men Behaving Suicidally

Here's a shock: Richard Jeni, the comedian who killed himself in March, was mentally ill. That's according to the LA County Medical Examiner. Sad.

There's been quite the spate of celeb suicides this year, the most discouraging a recent murder-suicide involving Chris Benoit, a pro wrestler. He killed his wife and child, who was apparently retarded, over the weekend and then hanged himself. There have been various reports that this was a case of "roid rage" or insanity caused by steroids. Other reports have it that he suffered from depression. WWE claims that roids can't have been the cause and that deliberation was involved. Many on the Net also claim that steroid-induced rage doesn't exist.

I find it difficult to believe that a young man with a successful wrestling career would kill his wife and child--whatever familial difficulties they faced--without something else being afoot. As with Jeni, we can talk about depression and psychosis and mental illness all we want, but it's been clear to me for a long time that men in America simply do a horrible job of managing their own psychological well-being and turn on themselves and others in ways that are unmanly. That's for another day.

As for roid rage, I saw an example of it when I was in college in the 1980s. A guy I was friends with in the dorms took roids because he was a bodybuilder and one night he went completely insane at a party and trashed a dorm bathroom--he actually smashed a toilet with one kick--and withdrew from college a few days later. I've long wondered how life ended up working out for him.

Pledge Drive--Final Day

I had planned on doing a bunch of posts last evening, but ended up having a very long day doing some outside reporting as well as some work for the blog...and then some friends dragged me off to a dinner party. So I'll play catch up in the morning.

In other news, I interviewed Larry Diller--who's vocally criticized the bipolar child paradigm of late--yesterday, but have not had a chance to review my notes and turn it all into a posting yet. That will likely have to wait until Monday. But I'll have some other things later today.

As for the pledge drive, it's now at about $950, give or take, so the cats will make an appearance as soon as it hits $1,000 or late on Friday. Whichever comes first.

Two Sicko Reviews

As most of you know, Michael Moore's Sicko, his new rant on film--um, it's a documentary--about American's trainwreck of a health care system opens tomorrow. A couple of advance reviews from people I know have popped up. Here's Merrill Goozner's over at GoozNews (Merrill is one of the gods of economics reporting and works at the Center for Science in the Public Interest and does his own blogs as well):

"I could complain for hours about the inaccuracies, unfair comparisons, agit-prop stunts and questionable political judgments that went into the making of "Sicko." You'll read plenty such comments in the mainstream media when the reviewers get their hands on the film this weekend, and you may have a few of those thoughts yourself when you go see it.

But they pale by comparison to the larger point that Moore makes over and over again in this heartrending, brilliant and occasionally very funny film. Our patchwork private health insurance system is a tragedy for those whom it fails. But its failures are really just a metaphor for what a growing proportion of Americans recognize is wrong with this country."

I, too, get a little tired of Moore's stunts, but they do serve a larger purpose. Here's a former colleague of mine from Willamette Week in Portland, who now does his own film blog badazzmofo:

"It would be easy for the Moore haters to dismiss Sicko purely on principle. But, with a little luck, and some open-minded viewing by those that would otherwise turn a blind eye, maybe the film can help create the sort of outraged backlash that needs to occur if the medical industrial complex is ever to be reformed."

I probably won't get a chance to see the film until sometime next week.

Pledge Drive--Day 4

My little drive stands at about $800. Some contributions are coming via mail so I don't know what they amount to yet. Although it's obviously not so much the amount as it is the sentiment that counts.

Once again, let me tell you all how touched I am by your support of my work. My cats would like the total to hit $1,000 though before they will allow me to post their picture.

Personally, you can't know how important a boost this has all been to me the last few days. I got shot down for two jobs this week, one at a major paper--although in that case, they say they want to hire me but just can't do it right now. So i'll remain patient. And attempt to keep my spirits up.

And, yes, the PayPal button will stay up after this week, so feel free to contribute at a later date if it suits you.

The Bipolar Child: Biederman And Wozniak Are Heroes

That's the view of this op-ed from yesterday's Boston Globe, penned by Jerrold Rosenbaum, chief of psychiatry at Massachusetts General Hospital and Michael Jellinek, chief of child psychiatry at Mass Gen. That would make them Biederman and Wozniak's bosses. In part, their op-ed reads:

"These physicians are heroes to families of children with serious mental illness. Amid a firestorm of stinging and misdirected criticism, these physicians look to science to serve up hope. They use limited tools available to them--medications, talk therapies, behavioral strategies--to help children."

I've long found the tendency among researchers to describe one another's work as heroic and epic to be annoying and weirdly inhuman. Hate to let the Harvard kids in on a little secret, but I whenever I've interviewed researchers who've made such claims or talked that way, I've generally found it to be little more than self-laudatory BS. I mean, we all know you guys were the smartest--and most boring--kids in high school, but could you get over yourselves already and maybe drop the delusional talk before there's a diagnosis added to the DSM to describe it?

Here's more:

"Biederman is the most widely cited child psychiatry researcher in the scientific literature. He has moved the field of child psychiatry forward carefully, deliberately. Unlike his critics, his meticulous research has withstood intense peer-review scrutiny, and his work is backed up with rigorous science. He does not use dramatic claims or horrific allegations directed at others. He is not a self-proclaimed expert with a book to sell. Rather, he has earned--and continues to earn--the respect and admiration of his professional peers through his critical academic work and his outstanding clinical practice."

I'll let that graf stand, except to note that Biederman is given to making excessive statements. Remember this from a couple of weeks ago?

"Biederman has spread far and wide his conviction that the emotional roller coaster of bipolar disorder can start 'from the moment the child opened his eyes' at birth."

Nah, no drama there at all.

Pledge Drive--Day 3

The total now stands at $550. I am beyond flattered. I am also too tired from a long day at the part time gig to say anything more intelligent than that. I'll have more later today.

Oh, yes. A few of you have asked to see my cats. And you will--as soon as the drive brings in $1,000 total or it ends on Friday. Whichever comes first. Katie and KC would prefer the former route.

Anyway, more later.

Pledge Drive--Day Two

I cannot begin to thank readers enough for the $400 you contributed yesterday to me for my work here. I am humbled. But I'd like to be humbled some more. I'll leave that to you. The PayPal button is over on the right or, if you prefer snail mail, let me know by email and I'll shoot you my address. One interesting phenomenon: all of yesterday's contributors were women. I know this site has quite a few male readers. So come on guys.

For those who didn't catch my initial post yesterday, here's how I plan to use reader contributions:

"Aside from the nice idea of being compensated a bit for my time, I am using a 7-year-old G3 iMac, so being able to pay for an upgrade (even a used one) would be nice. As would buying myself a new office chair as I currently use an 8-year-old desk chair that is falling apart. In addition, my bandwidth, disk space and Movable Type license run to about $240 a year. I'd also like to be able to pay a designer for redesign work. It'd be nice to get some help covering some of that."

As they did yesterday, my office assistants Katie and KC (yes, they are cats) thank you. As do I.

That Guy: TAC Versus MindFreedom

There was a weird, gloating post on the Treatment Advocacy Center's blog yesterday:

"The anti-psychiatry crowd tried to use the Virginia Tech case to paint the frightening image that psychiatric medications caused Seung-Hui Cho to go on a murderous rampage. In an unsigned letter, one group issued a demand for the toxicology report under the Virginia Freedom of Information Act, threatening legal action.

Last week, the results of toxicology tests were released. But, the fearmongers won’t be pleased. The state medical examiner's office found no trace of prescription drugs or toxic substances in Cho's body.

In this day and age, it is hard to believe that there are still people who deny the existence of severe mental illnesses and point to everything but untreated psychotic symptoms as the cause of harmful behaviors. But, the research shows that schizophrenia and bipolar disorder are diseases of the brain. And as most people suspected, it was Cho’s untreated symptoms that caused so much devastation."

Did you ever get the feeling you were being lectured to by your Mother when reading TAC's posts? Thought so. And Mom doesn't allow readers to comment on her blog either!

Anyhow, TAC's anonymous poster is right that MindFreedom and others in the anti-psychiatry camp jumped all over the Virginia Tech massacre as an example of someone driven insane by meds. As I noted back in April, I felt that everyone ought to take a wait-and-see approach on Cho's meds. There was some evidence at the time--an interview with a roommate--that Cho may have taken medication at the time of his rampage. The toxicology report seems to shoot that down, but maybe not. As one reader told me in an email, it took more than one toxicology screen before Luvox was found in the system of one of the Columbine killers.

One regular reader of this blog is on one of the panels in Virginia looking into the many questions raised by the April 16 tragedy. I'd encourage this reader to request, in her official capacity, a copy of Cho toxicology report, his college psych records and copies of any evidence logs drawn up by police after combing Cho's quarters and effects. In addition, I think she's well within the scope of her authority to ascertain who the roomie was and talk to him about what he knew about Cho's treatment routine. Or non-treatment routine. She might want to look into the possibility of interviewing Cho's family as well.

Like some in the press Back East, I want to know each nugget of Cho's life. Why? Because I don't think that Cho's case is as open-and-shut as the fine folks at TAC think it is or as some in the media have allowed TAC's Fuller Torrey to paint it as. I think his is clinically a lot more complicated than "schizophrenia" or untreated psychosis. Even by the standards of abnormal behavior, something unusual was at work here. I'll leave it at that.

Pledge Drive

Hi. Many readers have suggested over the least several months that I put a PayPal button on this site and ask readers for money. I've held off for a longtime (I'm sheepish about asking people for money), but recently decided to listen to them. So please contribute what you can.

Why would you contribute to me? I'm sure you'll have your own reasons for doing so, or for not doing so. When a few curious sorts have asked me what I am proudest about with my work here (ie, "How do you justify your existence?"), I tell them it's over three things.

One, because I have worked my butt off on this blog for about two years--to the tune of about 250,000 words of text--and, two, because I made the Zyprexa documents publicly available when no one else in the US would--or could. I did so at great risk to myself financially and legally. Things worked out OK, but it was gnarly there for a while.

Since then, several hundred sets of the documents--the ones Eli Lilly fought to keep from public view--have been downloaded by readers. The complete set of documents is also now archived at two major universities--one, a medical school on the West Coast, the other an Ivy League institution Back East. I expect to see a few academic articles relating to these documents in the near future.

And, three, I began asking some hard questions about the state of the psychopharmacological revolution and its corporate masters when there was a dearth of such inquiries on both the Net and in the media. That's different now, thankfully.

I haven't a particular pledge drive total in mind. Let's just see what happens.

So what would I do with reader donations? Aside from the nice idea of being compensated a bit for my time, I am using a 7-year-old G3 iMac, so being able to pay for an upgrade (even a used one) would be nice. As would buying myself a new office chair as I currently use an 8-year-old desk chair that is falling apart. In addition, my bandwidth, disk space and Movable Type license run to about $240 a year. I'd also like to be able to pay a designer for redesign work. It'd be nice to get some help covering some of that.

There's a PayPal button over on the right. If you prefer snail mail, let me know and I'll shoot you my mailing address.

My office assistants Katie and KC thank you. As do I.

The Age Of Anxiety: Let's Medicate The Freshmen

Henry Nasrallah, editor of the journal Current Psychiatry, penned an editorial in the journal's current issue in response to the Cho rampage in April at Virginia Tech. Nasrallah is a psychiatrist at the University of Cincinnati. The Last Psychiatrist has already taken up some of the questions posed in the editorial, so I'd encourage you to read his thoughts. He respectfully disagrees with the editorial.

Me too, although perhaps less respectfully. Because these questions are all self-fulfilling prophecies, leading to incursions into the minds and souls and bodies of American students and fast-tracking young adults for admission into a paradigm of treatment that doesn't work very well and injures their bodies. Besides, how the hell are students supposed to read John Milton if they are doped on Seroquel?

The Last Psychiatrist rightly calls this mission creep.

Anyhow, I've snipped a few of Nasrallah's questions to give you a sense of what he's getting at.

"If the university administration had known about the student’s psychiatric disorder, would he have received better treatment and supervision? Or would he have been stigmatized or expelled, whether or not he responded well to medications and counseling?"

There are all manner of privacy concerns raised here. But, beyond them, in my experience, university admins are the last people on the planet who ought to know anything about a student's medical condition or who should direct anyone's care. Generally, these are folks who couldn't hack it as teachers, so we should trust them with medical information? And last time I checked it was university admins who chased a student with depression out of a college Back East a few years back simply over his condition not his behavior.

"How can roommates or teachers receive adequate information to help a mentally ill student or monitor for treatment adherence when HIPAA rules prevent even families from knowing details of mentally ill adults’ diagnosis or treatment?"

What right do roommates or teachers have to such information? Isn't that breaking a very serious ethical barrier between professor and student? You know kind of like having sex with a student except without the fun. As for roomies...nevermind. And, once Johnny is 18-years-old, what right do Mom and Dad have to his medical information? None. Or is Nasrallah advocating for a college health care system in which anything deemed a transgression of public health models gets reported to the folks? Would Nasrallah support a system where parents are called if their little Julie has sex (at any school other than BYU)? What if Johnny stays up late smoking dope and playing GTA3?

"Because the home-to-college transition can be very stressful, should colleges require freshman courses on how to recognize distress and seek help?"

A course? Maybe the university admins can teach it! I think human beings are pretty well armed with how to sense distress in their own lives without the help of all these traumatized public health officials getting in front of students to tell them that any swing in mood necessitates a trip to the counseling center.

Let's just skip the class and put Zyprexa in the college water supply. Medicate the freshmen!

"Given that schizophrenia, bipolar mania, and psychotic depression often emerge between ages 18 and 25, why have colleges and universities not adopted early screening and intervention?"

Oh, because of minor things like the US Constitution and civil liberties and privacy rights. If I had a kid in college and the school insisted upon "screening and intervention" as a condition of admission, then they could expect the lawsuit from hell. What's next? Lie detector tests for entering freshmen to determine if they've ever had sex or listened to hip-hop?

"Are mentally ill persons more dangerous than the general population, or is that perception based on highly dramatized media reports of isolated incidents?"

You've read Jeff Swanson's research on this matter, right, Hal?

"Why are alcohol and substance abuse—-which cause morbidity and death among college students—-not 'feared' as much as mental illness?"

Oh, boy. It's a good thing Nasrallah wasn't around for my college days. Seriously, though, he shares a bit of white lightning with many psych docs, but one has to wonder why he and the others don't "fear" the dependency and tolerance problems associated with Seroquel and Paxil. In the hands of some docs, those are clearly drugs of abuse and can cause morbidity. I look forward to Nasrallah's editorial on this matter.

"Given that >25% of the U.S. population has a diagnosable and treatable mental disorder, why is our mental health system so fragmented, so inadequate, and so underfunded? And why is there no public outcry to fix it?"

Nasrallah doesn't offer a cite for the 25 percent prevalence number. I assume it comes from the recent World Health Organization survey of American households and is far higher than the 20 percent figure former Surgeon General David Satcher used to cite (a number that included Alzheimer's and Parkinson's). Beyond the bizarre fact that an arm of the United Nations is trying to declare Americans all messed-up--what do you want to bet they don't try that number in France?--that 25 percent estimate could only include every screwed up little Axis II personality disorder in the DSM (IED anyone?) and its use by Nasrallah verges upon a religious statement. Or a political one. Or a religio-political one. Crazy.

Another thing that troubles me about that estimate is that you'll see it trotted out by researchers and advocacy groups within the context of discussing "serious mental illness"--as Nasrallah is in his editorial--by which they mean schizophrenia and wildly-manic bipolar disorder. As far as I know, schizophrenia and bad bipolar I might get you to a 2 percent prevalence, tops. Nasrallah needs to stop mixing apples and oranges.

If this is how the thought leaders in the psych world are thinking, then it's time for a new set of thought leaders. Or maybe it's time to turn the whole party over to the psychologists. At least, they don't fear human behavior.

And, as for Cho, there's still a lot more to be known about his situation before one can start asking the kinds of questions Nasrallah is.

The Zyprexa Chronicles: Judge Jack Wants A Trial

US District Court Judge Jack Weinstein has moved along many of the outstanding lawsuits against Eli Lilly over Zyprexa to such a point that he is now calling for a trial on many of the remaining suits beginning October 15. Some suits in the class action will be shipped back to their respective districts.

I personally hope some of these cases reach trial. I'd like to see as many of the 11 million pages of Lilly's internal documents introduced into the public realm as possible, so that the public then has a chance to assess Lilly's prior claim that the leaked Zyprexa documents in no way indicate how the company handled the drug and concerns about injuries caused by the drug. I bet a jury won't see things that way.

Something tells me Lilly will settle before trial.

BTW, if any of these cases goes to trial, I am going to try and find a way to get my butt to Brooklyn so I can cover the proceedings because there's no chance in hell that Court TV will cover them.

Updates

I updated some links to blogs and such on here today. As usual, let me know if something is amiss or missing altogether.

Also, quite a few readers have written me lately to let me know that I should put a PayPal link on my site for donations. So I did. I think I'll do a low-key fundraiser thing this week. If you don't like the PayPal method, then drop me an email or leave a comment and I can give you a mailing address.

Thanks for the suggestion people.

That Guy: More Obvious Sentiments On Cho

From The Huffington Post, which seems to have become home base for the obvious commentary crowd. OK, I'm being harsh--my obvious response. Anyhow, the latest to hold forth on Cho at HuffPo is Mary Beth Pfeiffer, a journalist who's just had a book come out called Crazy In America and its thesis seems to be right along the lines of Pete Earley's Crazy. Too many mentally ill folks ending up in prison--true, true--and lousy mental health systems for those on the outside--true, true. She spends a bunch of time banging on Virginia's mental health system which indeed does seem to be a disaster from what I can pick up on on this coast.

What confuses me is why there are such problems in Virginia because a screwed up mental health system isn't just a result of commitment laws--as TAC would have it--but it literally seems as if that state's programs are likely underfunded and understaffed. We sure don't have problems of such a scope in Washington State--and no our system is a disaster too. But something does seem to be working better out here. Not by much.

One thing Pfeiffer offers is BS as far as I am concerned:

"Had Cho received decent care for his obvious pathology...."

Again, this is a very obvious sentiment that many commentators in and out of the mental health world have thrown about--that Cho was obviously a disaster when he presented at the hospital in 2005 and that the system failed to treat him. But keep in mind that Cho must have presented to the docs on duty that night in semi-decent shape or they would've found a bed for him that night and medicated the hell out of him. That they didn't tells me something. But that's for another day.

The Bipolar Child: You Had To Know

That this was coming. Robert Goldberg over at DrugWonks takes a one-iron out on Larry Diller and the Boston Globe for Diller's op-ed criticizing Joe Biederman and the Harvard bipolar child mafia. He asks if someone on the paper's edit board is a Scientologist--um, I had better taunts in high school--and calls Biederman a caring, compassionate doc. Not sure how he'd know with one being in DC and the other in Cambridge, but whatever.

Then comes something that surprised me:

"As the parent of a child who responded to the regimens developed by Biederman and others I can attest to it."

The "it" being the existence of bipolar disorder in children. I'm going to leave it at that--and let you guys comment. I hope Goldberg will write more about his child--who I sincerely hope is doing well--and how he/she came to be diagnosed and how things have progressed since.

And courtesy of CL Psych, Danny Carlat calls for a bit of moderation in how people are handling Biederman.

TAC's Hate Speech

Fuller Torrey and his lapdogs at the Treatment Advocacy Center have made a career of lying about people with mental illnesses, claiming that they are ipso facto dangerous when in fact the scientific data on the matter points more towards a slight increase in violence and a huge increase in victimization. Here's TAC going at it again:

"A recent letter to the editor in the Frederick Free Lance-Star takes the politically correct stance that people with mental illnesses are no more violent than the general public. This myth is further asserted by claims that recognizing and trying to address the correlation between violence and untreated mental illness creates stigma which in turn is the greatest barrier to treatment. This is mental health sophistry."

I am done trying to put out the facts when these asshats distort the evidence and lie about the evidence and feed it to reporters who reprint it. This is hate speech pure and simple, as it leads to increased discrimination against people with mental illnesses--and I have seen otherwise progressive liberal neighborhood types cite TAC's inaccurate data in order to argue against any sort of mental health facility in their precious little urban yuppie neighborhoods.

If any of you are so inclined I suspect the fine folks at TAC would like to hear from you. Here's the email for their lying press person: press@treatmentadvocacycenter.org. Another email to use is: info@treatmentadvocacycenter.org.

I would also call on my fellow reporters who cover these issues to boycott TAC and its officials. Stop interviewing them. Stop using them as sources. Be highly dubious of TAC's allegedly scientific data (because it isn't scientific). Perhaps actually try contacting the people who have done the actual research on violence among the mentally ill.

Quoting TAC's stats or its officials now constitutes your active participation in spreading hate speech and discrimination. I will hold you accountable as often as I am able.

It's All Chimeric, Dude

I am not even sure why I find the following so interesting, except that it's written by a pretty good writer--a former psych doc who is a fellow bper:

"I sometimes think that part of manic-depression is a complete disconnect, in time, between the emotions one should naturally experience and a safe time to let them out. So, for example, I could go tight-lipped through a funeral and weep at a video arcade a month later. Once I even thought I had come closer to integrating my emotions better in regard to circumstances, but I fear for us bipolars this is a chimera. It's as if we build up mountains of rage and chasms of grief of which we are consciously unaware, and one day we smack into them and all hell breaks loose. Chemically, from the standpoint of the actual illness, this likely holds little scientific truth, but it is a useful metaphor for conceptualizing how the phenomenon sometimes feels. In the end manic-depression is really just bad genes and bad luck."

I don't necessarily buy the bad genes/bad luck formulation, but I know what he means. And, man, do I have chasms of grief lately courtesy of Craig Newmark--the founder of Craig's List and public enemy #1 to many journalists--and my good friends at Google and Microsoft. Enjoy the free five-star lunches guys!

Congrats Web 2.0 Proponents

You've just knocked another 60 reporters out of their jobs at the San Jose Mercury News. Add that to the 100 last month at the Chron and you guys at Google and elsewhere in the Bay Area have turned into stone killers. How does it feel for the webheads? Some retard at Wired.com offers:

Unleashing all those highly trained journalists on the world can hardly be a bad thing: I predict there will be more well-researched news blogs and podcasts in coming months, created by traditional reporters who've gone over to the Web side. The Merc's loss is our gain.

Oh sure the blogs and the podcasts will absorb them and instead of making, say, $60K a year they can now make maybe $100 a month in Ad Words. That's a gain for whom exactly? Their children? Their student loan payments? The information that a democracy needs to function? The kids at Wired have always been a very pompous, head-up-the-butt, trustafarian bunch, and they just reached a new level of stupidity.

Little Today

Hi. I've been very busy on other work this week and am wiped out, so I'm not sure if I'll post today. Have fun. Enjoy the first day of summer.

Oh, The Irony!

Funny that as a result of today's blog barf on the Web 2.0 I just got the 1,000th link to my blog, according to Technorati's six-month link counter. I am of the Web 2.0 and hate the Web 2.0. Thanks to Stephany for being the 1,000th linker.

In other news, I passed along my rant—or should I say "fiddyrant"?—to the blog editor who wrote to me yesterday. I heard back. Wish I could print what she told me. If I played by the ethical rules of the Web 2.0 (everything is like totally fair game, dude!), then I'd share. But I follow the rules of the evil old mainstream media, so I won't.

The Bipolar Child: Psych Docs At War

I really don't know how else to describe this, but Lawrence Diller, a psychiatrist in Walnut Creek, California, has declared war on Joseph Biederman and the Harvard bipolar child mafia. Recently, he told an audience at a bipolar disorder conference is Pittsburgh that Joe's crew was morally responsible in the death of Rebecca Riley. Now, he's gone that public moment one better and put his thoughts into an angry op-ed in the Boston Globe. He says that others in the psych world are afraid of Biederman and his fellow bipolar child docs because he's a Harvard man and everyone in the medical world must bow before anyone who teaches there. Props to Diller for speaking out.

"As a doctor, I did the nearly unthinkable at a recent conference on bipolar disorder in children. I charged another doctor with moral responsibility in the death last December of Rebecca Riley, a 4 -year-old girl from Hull. Naming names in medicine is just not done very often -- and I knew the personal and professional risks I was taking. Yet I felt compelled to name Joseph Biederman, head of the Massachusetts General Hospital's Pediatric Psychopharmacology clinic, as morally culpable in providing the 'science' that allowed Rebecca to die."

And:

"Biederman shocked the child psychiatric world in 1996 by announcing that nearly a quarter of the children he was treating for attention deficit hyperactivity disorder also met his criteria for bipolar disorder. Up until then bipolar disorder was rarely diagnosed in teenagers and unheard of in prepubertal children. Biederman could justify his findings by simply broadening the semantic definitions of a previously more circumscribed condition contained within American psychiatry's bible -- the 'Diagnostic and Statistical Manual of Mental Disorders'." (Emphasis mine.)

And:

"While the manual provides helpful clinical guidance in adults, it begins to unravel with its assumptions about discrete and specific disorders in children and ignores the families and environments in which children live."

Oh my. Such talk will get a nice little academic gang fight going on. And it's high time that happened. I've been sick of banging on the bp kiddos paradigm the last couple of years and being called out-of-control and excessive for doing so. God knows, none of the answers to what's up with the kids these days are easy, but they sure as hell aren't contained in a dose of Seroquel.

The Web 2.0: Content Creators Starve While Techies Eat Free Lunches

I had planned on posting some more on the whole bipolar child business percolating in the blogosphere today (and I owe a reasoned reply to someone asking me smart questions about my critique of the bp kiddos realm), but an email I received on an-already-crappy late Monday sort of changed my whole outlook on blogging and the journalism thing that I've poured much of my adult life into, so I thought I'd share. Because that is what the Web 2.0--blogs, social networking sites and such--is all about: sharing.

Sharing your thoughts on the world, your life, the state of the nation, what your baby urped on the floor this morning and what hinkey-dinkey Paris Hilton is up to in jail so that no one ever again has to be dependent on the corrupt mainstream media for their news and views of the world. Yep, we've got us a whole world of sharing content out there courtesy of the Web 2.0. The mind of mankind is better for it. Go off in the corner you bad old mainstream media print types and don't come back until you've cleaned the ink from your hands. You can't share with dirty hands.

But some folks in the Web 2.0 world aren't game for sharing. And that brings me to the email I got on an already-crappy-late Monday, one of those days where I am wondering about just-losing-my-health-insurance and how-I'll-make-August's-rent because I-can't-find-full-time-reporting-work-in-Seattle. It was from the editor of a health care website which focuses on chronic conditions:

"I'm the blog editor for HealthTalk, a Seattle company whose site focuses exclusively on living with chronic illness (www.healthtalk.com). I found "Furious Seasons" while researching blogs about mental illness, but I've also read some of your work in the [my former employer, Seattle] Weekly.

In July we plan to launch three new "networks" covering bipolar disorder, depression and schizophrenia, and I'm looking for bloggers who would be interested in creating an audience and community around each of those topics. The blogs (http://healthtalk.com/blogs/), most of which we aim to update 2-3 times per week, are a blend of personal experiences and reactions to news.

Do you think that writing a blog for HealthTalk would interest you? The work is unpaid, but the site could help attract an even larger audience for your work and views. I think an authoritative, thoroughly informed writer is crucial to building a strong following. (As an example, please see Trevis Gleason's "Life with MS" blog: http://blog.healthtalk.com/multiple-sclerosis/life-with-ms/)

If you aren't interested in writing for HealthTalk, I wonder if you can recommend other potential bloggers to cover bipolar disorder, depression or schizophrenia.

I really appreciate any help you can offer."

My response:

Dear Blog Editor:

Thank you for your email and interest in my work. It's been a long-standing dream of mine to write for free. I have 13 years as a paid professional print journalist who specializes in investigative reporting and has won two dozen or so awards for my work. I have graduate degrees from UC-Berkeley and the University of Utah and studied for a semester at Cambridge University as well. My work has been published in national, regional and local newspapers and magazines.

But I know the world has turned due to the Web 2.0 paradigm of sharing and readers just don't like print media anymore because they can read wonderful content on sites like yours--or, paradoxically enough, on my blog--for free. And their hands stay clean! So I think it's time for me to stop pretending that I need to make a living from this kind of work and blog for free for a corporation whose executive suite features former Web MD employees, former Real Networks employees (can they introduce me to Sen. Maria Cantwell?) and former FDA officials. I am sure they are working for free too--in the interest of sharing information with the world.

I have such a keen interest in working for free that I began this blog almost two years ago. Unlike the Health Talk blog you recommended I browse, mine isn't even semi-popular. To whit, our competing Technorati rankings:

Life With MS: Authority: 6. Rank: 863,169.

Furious Seasons: Authority: 180. Rank: 25,886.

So I can totally see why it would make sense for me to stop what I am doing here and blog for you for free, especially since my average of 2,500 readers a day have no sense of community and the academic researchers who write to me or link to my work have no respect for me. Besides, Seattle is so expensive to live in now that it's actually free!

You know, the Web 2.0 and its gracious thought leaders are providing all sorts of freebies these days like the five-star food Google's Seattle employees get for free and all the other perks that go with the high-tech Web 2.0 share-o-sphere. It's well-known that the snide 20somethings working in high-tech who I bump into in my travels throughout Seattle didn't work for that cash they are slinging around like baby gangtas at a strip club. Nope, they got it for free. And all for creating algorithms to push around content created by over-paid, under-worked, corrupt reporters and mainstream media companies who just don't get that information is free and that the world will be saved by bloggers working for free.

I want in on the free stuff.

I once saw an interview with Bob Woodward and Carl Bernstein and as one they said, "We would've reported on Watergate for free. If only there were blogs in 1972 and 1973! Nixon would've resigned in five minutes if we'd broken that story on Daily Kos. But we were trapped in an old media paradigm, where people expected to make a living wage, that wasn't intent on sharing. We regret the error!" And I know for a fact that David Halberstam's dying words were, "I want to write for free. I regret the error!"

I want to be like Woodstein and Halberstam. So, when do I start?

Some of you who've been around for six month's or more (may God make your every wish come true), may remember that I opened up a can of rhetorical whoop-ass on the Web 2.0 paradigm and how it is fucking up the media, especially print media in this country, and how that's a bad idea for us as a culture and part of a general drift into cultural narcissism that amuses, and frightens, the hell out of me.

Web 2.0 proponents often point out that the media, and especially print media, in this country only tell the truth when it is convenient for them and that democracy of the unhinged-Internet, American-style is best served by an army of Davids who will, as their civic duty, undertake to tell their fellow citizens what really matters in their worlds via blogs and the like. Google and others will paste up their ads on the resulting sites and mint money for themselves and make sure their algorithm-writers (or whatever it is they are up to over at that Fort Knox in Kirkland) always get a free lunch. Dinner and breakfast, too, from the sound of things.

Meanwhile, the people who actually create the content in the media world--here comes that word the Web 2.0 dorks really hate: reporters--are getting pushed out of their jobs in numbers that can't have been around since TV started sticking it to newspapers in the 1950s. And where they aren't losing their jobs, they are discouraged and running scared and concerned about how they will make ends meet in a post-print world--because that's where the economics of the game are pushing the information space ship--and puzzled about how it is exactly enough people will be able to be employed to undertake the professional task of producing precisely the content and the depth of content the Web 2.0 entrepreneurs need in order to push varied content around enough in their big old electronic library of mankind for them to become as rich as oil sheiks. And gift their employees three squares each workday, gratis.

My thoughts back in December 2006 were:

The Web 2.0 and the Net in general have been disasters for my profession, which is print journalism—-a vastly different beast from broadcast journalism such as TV and NPR which are too often news presentation packaged as real reporting. Newspapers are dying. Talented people are being forced into public relations work. In Seattle, the speculation is that we will lose one of our two daily newspapers in the next year or so. The sad fact is that no one will care too much because no one knows the difference anymore between intelligent reporting and regurgitated information repeated endlessly in little echoes around the Net by people who have no fucking idea what they are talking about (this may be true of me sometimes, as well) and would have no idea how to hold the government or big corporations accountable if their lives depended on it.

Part of my argument then was that no one will do for free the kind of journalism the Web 2.0 crowd thinks it's creating. Journalism costs money. If you're talking investigative reporting, it'll cost more especially if there are loads of public records and lawyers at the party. If you just want to slap content around that sort of sounds like it's floating around the truth in the half-informed commentary that the blogosphere is heir to--instead of being able to legitimately offer said truth--then I guess you can get it for free. But I'm not blogging for free for someone else. I can do that for myself quite nicely. And, who knows, if Google ever gets interested in creating original content--as opposed to the amateurish tripe of tens of thousands of blogs and YouTube vids--maybe I can get a free lunch out of the deal.

Until then, the purveyors of the Web 2.0 need to start offering the same kind of cold hard cash they offer the people who are allegedly steering their business models unless they simply plan on rewriting, repackaging, reformulating and re-shuffling content produced by an ever-shrinking cadre of reporters.

Let me know if that strikes anyone as a good idea.

The Bipolar Child: Meet Joe Biederman

Following up on my post of yesterday, here's a link to the Boston Globe's excellent piece on the Harvard bipolar child mafia and the controversy around the diagnosis and treatments. I'm a bit confused why one blogger deems this the reporter's attempt to put a "positive spin" on the bipolar child paradigm. Maybe the article doesn't go far enough for the anti-psych crowd, but I think it's reasonable, judicious and quite deadly.

My usual practice is not to quote from others' published material at length, but this time I am pinching more copy than usual. The article is just too juicy.

"From his perch as one of the world's most influential child psychiatrists, Biederman has spread far and wide his conviction that the emotional roller coaster of bipolar disorder can start "from the moment the child opened his eyes" at birth. Psychiatrists used to regard bipolar disorder as a disease that begins in young adulthood, but now some diagnose it in children scarcely out of diapers, treating them with powerful antipsychotic medications based on Biederman's work.

"'We need to treat these children. They are in a desperate state,' Biederman said in an interview, producing a video clip of a tearful mother describing the way her preschool daughter assaulted her before the child began treatment for bipolar disorder. The chief of pediatric psychopharmacology at Mass. General, he compares his work to scientific break throughs of the past such as the first vaccinations against disease."

Seroquel research is comparable to Salk's polio vaccine? Please. I don't doubt that Biederman and the other Harvard mafiosi see kids who are in pretty rough shape. That's very typical of big public health hospitals. Why their skewed patient base gets to guide an entire field is beyond me however. Biederman and his crew are very influential.

"'They are by far the leading lights in terms of providing leadership in the treatment of children who have disorders such as bipolar,' said J. W. Carney Jr., lawyer for Dr. Kayoko Kifuji, a Tufts-New England Medical Center psychiatrist who temporarily gave up her medical license after Riley died on Dec. 13, 2006. 'Dr. Kifuji subscribes to the views of the Mass. General team.'"

I'd say that's a pricey subscription. The Riley referred to is Rebecca Riley, who was killed in Decemeber 2006 by an overdose of Clonidine, while also taking Seroquel and Depakote. She was diagnosed with ADHD at two-years-old and with bipolar disorder a little later.

Enter critics within the psych world.

"Psychiatrists too often prescribe these medications, which carry side effects such as weight gain and heart disease risk, without addressing problems in the children's lives, said Dr. Gordon Harper, director of child and adolescent services at the state Department of Mental Health. He likened the approach to 'tuning the piano while the subway is going by'.

"Biederman's critics chide him for not speaking out against misuses of a diagnosis that he has helped inspire. Among leading authorities on bipolar disorder, the Mass. General team has proposed the most aggressive treatment for the broadest group of children, they say, and Biederman should take responsibility when treatment goes wrong. At a conference on bipolar disorder at Pittsburgh's Point Park University last weekend, one speaker, Dr. Lawrence Diller, a California behavioral pediatrician, contended that Biederman bears some blame for Riley's death.

"'I find Biederman and his group to be morally responsible in part," said Diller, whose popular book, "Running on Ritalin," accused psychiatrists of over treating another childhood condition, attention deficit hyperactivity disorder. 'He didn't write the prescription, but he provided all the, quote, scientific justification to address a public health issue by drugging little kids.'"

Wow, in the polite little world of medicine, that's some hardcore talk. Biederman to the defense:

"Biederman rejects the idea that Riley's death is a cautionary tale, accusing critics of exploiting a tragedy to fan fears about psychiatry, a profession that has long faced prejudice. 'The fact that she had XY drug or XY treatment is irrelevant to what happened....If this child had the same outcome from treatment for asthma or seizures, we wouldn't have this frenzy,' said Biederman in an interview at Mass. General's Cambridge mental health clinic.

"Though Biederman acknowledges that distinguishing bipolar disorder from ordinary crankiness and flights of fancy in young children is challenging, he insists there is no ambiguity in the patients at his practice. 'People have to wait a long time to see me or my colleagues....It's not that somebody comes to me after their child has a temper tantrum. They do things for years that are dangerous. These are things that profoundly affect the child,' said Biederman, putting them at risk of academic failure or even suicide.

The drug's are irrelevant to what occurred? Maybe Biederman could use some meds himself. You know the ones that tamp down narcissistic tendencies:

"Biederman dismisses most critics, saying that they cannot match his scientific credentials as co author of 30 scientific papers a year and director of a major research program at the psychiatry department that is top-ranked in the "US News & World Report" ratings.

"The critics 'are not on the same level. We are not debating as to whether [a critic] likes brownies and I like hot dogs. In medicine and science, not all opinions are created equal,' said Biederman, a native of Czechoslovakia who came to Mass. General in 1979 after medical training in Argentina and Israel. He now lives in Brookline.

I've always been staggered by the arrogance of researchers in all branches of science throughout my career. Biederman takes the cake. His talk is a bit like a prostitute bragging on how many tricks he or she turned a year, which is to say it's not impressive at all. Here's Biederman's Google Scholar round-up and here's his list of publications from the Mass General website. And here's how Biederman talks after a short term study of Zyprexa in kids.

"Biederman was disappointed that he could not do more comprehensive studies, but he saw no reason to delay treatment. 'At least the line of drugs I'm talking about gives some relief,' he said. 'The only way to understand the side effects is in the context of the seriousness of the illness.'"

"As bipolar disorder received increasing media attention, Biederman and Wozniak's research was often cited as the scientific rationale for diagnosing and treating the disease aggressively. Another leading researcher, Dr. Barbara Geller of Washington University in St. Louis, adopted a more restrictive view, requiring that children have a series of specific symptoms such as reduced need for sleep before she would diagnose the disorder. But the Mass. General team used broader categories, saying that children who are extremely irritable or aggressive might be bipolar. Skeptics said those symptoms were too common, leaving too much room for dispute over who is really sick."

Diagnostic criteria you could drive--or diagnose--a Mack truck through. Here comes another critic, tellingly from a top medical school on the West Coast, where psych docs seem a bit more cautious about the bipolar child paradigm. I guess only prestigious docs give 200 mgs. of Seroquel to four-year-olds.

"Dr. Biederman's staff 'can do the same diagnostic interview on 100 children and come up with five or 20 bipolar disorders, and I might do the same thing and find only one or none,' said Dr. Jon McClellan , a psychiatrist at the University of Washington who chaired a panel of the American Academy of Child and Adolescent Psychiatry that recently concluded there is no proof that children under 6 can be diagnosed with the disorder. He says he has received no money from the pharmaceutical industry for years."

And here's another skeptic, from Harvard no less:

"Dr. Steven Hyman, who was then director of the mental health institute and is now provost at Harvard University, said he remains very concerned about the growing use of 'big gun' antipsychotic drugs such as Zyprexa, Risperdal, and Seroquel on children. In the Massachusetts Medicaid program, the number of people under 18 receiving at least one of the 'atypical antipsychotic' drugs rose from 6,943 in 2002 to 9,123 in 2005, a 31 percent jump, before declining to 8,343 in 2006. Hyman says that none of the drugs has the approval of the Food and Drug Administration for use in bipolar children, and doctors prescribe them based on their individual judgment.

"'We don't know the first thing about safety and efficacy of these drugs even by themselves in these young ages, let alone when they are mixed together,' said Hyman."

Enough said.

Medicating Falstaff

If you even vaguely pay attention to sports in North America or the UK, then you know who John Daly is. If you don't, suffice to say that he is one of the best golfers on the PGA Tour, has won majors, but hasn't done so hot in recent years. He's legendary, of course, for being a man of considerable appetites--women, drugs, alcohol, gambling, all the fun stuff. For the last decade or so, people have spent a lot of time trying to make Daly into a clean-cut role model and his moodiness ended up with him being on anti-depressants. Here's what Daly had to say about that on 60 Minutes last night:

"He says his life began to turn around after he decided to ignore all of the advice to go back to rehab, to quit gambling and taking anti-depressants.

"I took myself off all this medication I was on, that doctors were putting me on. Prescribing, 'You gotta do this, you gotta do that.' And I looked in the mirror one day, I said, 'One thing you gotta do, John, let's take care of John for now,'" he recalls. "I used to look in the mirror and flip myself off, and now I can look in the mirror and say, 'Hey, you're alright, you're alright today, man.'"

As a nation, America likes to luck its tongue at people like Daly. Bad boy. He must be reformed and so on. Yet, what was most striking about the bit on Daly--aside from his annoyance with meds--is how honest he is about himself, how little he cares about winning big tourneys and how comfortable he is with being himself, despite being what many tongue cluckers would consider a loser. Besides, isn't the idea of medicating someone like Daly a bit like trying to medicate Shakespeare's Falstaff?

I'll take one Falstaff over 100 tongue cluckers any day. Falstaffs are more fun. And more human when it's all said and done.

The Zyprexa Chronicles: Lawsuits Down Under

Via Psychdata, here's an initial bit on a class action lawsuit in Australia field against Eli Lilly (or its Aussie subsidiary I'd assume) over injuries allegedly caused by the company's star drug, Zyprexa. I know squat about the legal system in Oz, but in light of Lilly's vigorous settlements (about $1.3 billion and counting) in the US, you have to wonder if the Australian suit will ever see the inside of a court room. As far as I know, there haven't been any patient lawsuits outside the US, so this will be interesting to watch and may have ramifications for the UK.

The Bipolar Child: Backlash In Boston

Today's Boston Globe has an excellent article on the bipolar child controversy and the Harvard bipolar child mafia. One of that group's chief critics is a psychiatrist at the University of Washington right here in Rain City. I'll say more about this article in coming days, but, for now, I am convinced that Joe Biederman, a Harvard psych doc and one of the prime movers in the bipolar child world, is one of the most arrogant docs I have ever read an interview with. His critics just aren't as smart as he is! He brags of having published 30 papers a year! His boss defends him from conflicts of interest since his work is Big Pharma-funded! His colleague Janet "We Work in Uncharted Waters" Wozniak ducks the reporter! Fun all around.

More later.

Watch Sicko Now

Michael Moore's Sicko, a documentary look at our screwed up health care system and the powerful forces who prefer it stays screwed up, opens June 29. However, the movie has leaked out to the Net--probably on purpose--and YouTube. So you can watch much of it by following this link to YouTube. I've only watched a bit of it so far and found it to be your usual expose of non-coverage coverage health insurance. I have no idea whether the documentary gets into the psych world.

Anyway, I pass it along for what it may be worth to anyone. Oh, yes. Moore told the press he was fine with his work being shared on the Net for free.

Depression And Concussions

I meant to link this the other day, but here's yet another article on a doc doing post-mortem examinations of ex-NFL players who'd had many concussions and later experienced depression. He found another example in a deceased member of the Pittsburgh Steelers. Fascinating stuff.

And worrying stuff. I've suffered four concussions in my life. None of them from football, but it makes you wonder.

That Guy: Panel Gets Cho's Medical Records

At least the ones from the year or so before he went on a shooting spree at the Virginia Tech campus in April. I appreciate the Cho family's willingness to hand the records over. It should help answer some questions. But the panel wants as much of his medical history as it can get, going back to his childhood. In particular, the panel chair says that he'd like to know all about Cho's high school years. So would I. As I've noted before, I have a hunch that something weird went on with him in high school.

I also hope the panel will make these records available to the public in some fashion. I know that's an unusual hope, but Cho's mental status has already been used to political ends by speculating psych docs and it would be nice if this information can be as transparent as possible.

The Bipolar Child: "60 Minutes" Is On It

A source of mine informed me yesterday that CBS' long-running news program is both doing a piece on the controversy around the bipolar child paradigm and was recently in the Seattle area talking with experts in the field who are critical of the paradigm. I'm sure the Harvard bipolar child mafia will make a star turn in the piece when it airs as well.

I suspect the piece will air once there is a next bit of big news in the Rebecca Riley case.

Anyway, there sure are others in the Seattle area who would love to chat with CBS. It'll be interesting to see who the reporter is on the piece, although to be honest "60 Minutes" isn't quite the aggro investigative reporting unit it once was.

Does anyone else hear a paradigm going "tick tick tick?"

Starbucks Pays For Discrimination Against A Bipolar Barista

$75,000 to be exact. To a Seattle barista the Seattle-based McCoffee chain discriminated against--including a manager berating the barista in front of customers. All over depression and bipolar disorder. Glad to see another win for our side. Maybe between this and cases like the bipolar cop's, things will actually change. But I doubt it. I've been in the game too long for me to see America changing at anything other than glacial speed. Congratulations to Christine Drake for having the guts to go to the EEOC in the first place and to the EEOC, which doesn't push enough of these cases, for pushing on this one. Where were you in 1994?

An account from the Seattle Post-Intelligencer last year summarizes what went on:

"The EEOC said Drake, now 34, began working at Starbucks in September 2001, and for two years had two different managers who accommodated her by giving her additional time to study to make drinks. They also would let her practice making drinks in the Queen Anne store, and she didn't have to make coffee during peak business hours.

However, when a new manager took over in August 2003, that person -- who is not identified in the suit -- no longer provided those accommodations, the EEOC said. Drake said she was told by that manager that she was "not Starbucks material" before she was fired in May 2004."

Yesterday, I took a survey on employment issues around mental illness that the State of Washington is conducting. The questions were open-ended and I unloaded about how bad I think things still are out there. (Via Starbucks Gossip.)

Conflict Of Interest And CMEs

The New York Times had a fine op-ed yesterday (thanks to Anders for passing it along) about the massive conflicts of interest inherent in pharma companies sponsoring continuing medical education courses (CMEs as they are known) in the world of medicine. The op-ed is by Daniel Carlot, who authors the fine Carlat Psychiatry Report. You don't need me to summarize his words, so just go read it with the following context: In order to keep their state and board certifications, docs have to do a certain amount a CME units each year. These CME courses are often sponsored by companies, allegedly to offer doctors unbiased information about how to treat a particular disorder. Trouble is the courses are often not unbiased and lean heavily to supporting said sponsor's view of the disorder and how it should be treated. That's a problem.

For those of you have been through the Zyprexa documents, you'll remember that Lilly was lining up some very big names in the psych world to go out and teach CMEs concerning maintenance treatment of bipolar disorder using Zyprexa well in advance of that drug's FDA approval for that indication in 2004. I wonder how the researchers who taught those courses feel now that the drug has turned into a disaster for patients.

CL Psych has been banging on this issue over at his blog for sometime now, and it's good to see this matter getting the broader attention it deserves.

Anyhow, Carlat has a solution:

"The solution could hardly be simpler: any continuing medical education that is paid for by the drug industry should not be accredited. Drug companies could still pay for any educational event, article or pamphlet they choose, but their courses and materials would no longer bear the imprimatur and implied credibility of accreditation."

I heartily agree. While, we're at it, did anyone catch that Lilly sponsored a survey that found many psych docs reporting that their patients went of Zyprexa after seeing ads for plaintiff's attorneys on TV? In essence, Lilly is arguing that ads scare patients off meds. I actually know of one case where this happens to have occurred here in Seattle. I don't particularly care for DTC ads by lawyers. I utterly hate DTC ads for pharma products, especially psych meds. I think both sets of ads should be banned. Period.

And that's coming from one of the biggest free speech supporters you'll ever meet.

The Minnesota Payola For Docs Documents Now Online

At Stir Crazy, where Christin Light did a great job of requesting the documents under Minnesota public records law. These same documents underlie recent reporting by the New York Times, which I have posted on before. I haven't looked these documents over myself--haven't the time--but based upon the paper's reporting, I really think we have a payola system going on here. Just like in radio. Something along those lines at any rate.

Keep in mind that these documents report on all medical doctors not just psych docs. Christin reports that Eli Lilly--King of the Psych Meds--had over 1,300 payments for $4.2 million over nine years. Someone ought to take a look at these documents and figure out how much of Lilly's dough went straight to psych docs.

The Zyprexa Chronicles: Lilly Settles For Settlements Again

Eli Lilly, maker of Zyprexa, has settled another 900 lawsuits against itself by patients alleging that the company downplayed risks associated with the drug. This comes five months after Lilly settled a second round of lawsuits for $500 million and swore up and down that any remaining suits would be vigorously defended. Financial details of the settlements were not revealed, but I'd estimate them to be between $50 million to $100 million. That would bring Lilly's total for Zyprexa settlements to about $1.3 billion.

The company did not admit any wrongdoing. It told the Indianapolis Star:

"'While we continue to believe we would have prevailed had we gone to trial, resolving these claims will help Lilly return its focus to addressing unmet medical needs for patients and physicians,' said Michael J. Harrington, Lilly's deputy general counsel, in a statement."

Given how the company handled Prozac lawsuits, I'd call this folding their hand and moving on. About 750 lawsuits remain to be resolved. Still outstanding are lawsuits by eight states and a pending Congressional investigation. We'll see if any other states attorneys general file lawsuits against the company.

Carr Crash

David Carr, a media columnist for the New York Times, former alt-weekly editor and one of the genuine good sorts in the journalism world, had an interesting piece yesterday wherein he examined his first brush with the health care blogosphere after all the news 'round Avandia the last few weeks. Carr, a diabetic, describes himself as a "in the sweet spot for a cardiovascular event." Hence, his visit to the blogosphere, seeking information and insight on cardiac problems reportedly linked to GSK's drug. (I'm following the Avandia story with interest, but have squat to offer by way of info and analysis. So my lip is shut for now.)

Carr comes away from the adventure feeling underwhelmed:

"When it comes to meta-analysis on breaking issues, the Web seems better-suited to Paris Hilton than patient safety."

Possibly on Avandia. We'll see. But on Zyprexa, the other atyicals, the bipolar child paradigm and such matters, Carr has no idea just how wrong he is. All the same, it was nice to see him quoting Peter Rost--whose spectacular Question Authority--is giving Big Pharma a big old case of dyspepsia and Pharmalot, the excellent pharma biz blog by Ed Silverman at the Newark Star-Ledger. Rost nicely sums up some of my views on health care blogging:

"Dr. Peter Rost, an industry whistle-blower and the author of the Question Authority blog, said there was extreme value in consumers using the Web as a health resource, even if it is noisy and all over the road.

"'Yes, you have to sort it out and you have to evaluate, but all of the information used to belong to the moneyed and the powerful,' he said. 'Those barriers don’t exist on the Web, so people have access to all sorts of information about Avandia.'"

And Zyprexa, Risperdal, Seroquel, Prozac, Paxil (Seroxat), Zoloft, Abilify and on and on. Which is exactly the point of health care blogging right now, especially in the mental health world. There has been a void of critical information around these medications and treatment paradigms since the advent of Prozac 20 years ago. For too long most mental health websites and blogs have been blowing big wet kisses at Big Pharma and researchers and questioning very little. Just questioning the dominant medical paradigm in the mental health world counts as insight--the kind Carr went searching for initially--and things will only get better over time.

If the Net had been in widespread use in the early-90s, I sure as hell would've addressed my own depression far more skeptically than I was able to do at the time. Because there was no critical information and, as a result, no insight. And I sure paid a mighty price for that. But that's for another day.

Isolating A New York State Of Mind

Eliot Spitzer, New York's governor, has on his desk a bill from that state's Legislature that would reform how the mentally ill are treated in New York's prisons. The basic story is that they don't get appropriate treatment--what's lacking seems to be mostly of the psychological kind--and, as a result, end up in isolation cells far more than your average con. Amazingly, Spitzer is against this bill's reforms, claiming they'll cost too much money. Liz Spikol has an appropriate response and the New York Times' editorial board is calling on Spitzer to sign the legislation. As he should. If not, perhaps some isolation time might be in order for the Guv.

Isolation is bad for humans, even prisoners, and people simply fall apart without some level of human contact. More to the point, isolation units in prisons are more commonly known as "seg" as in segregation. Or "the hole." There's a reason for that, of course, and I'm sure no one here needs to guess very hard at it. I've actually seen seg units at a couple of different prisons--in a professional capacity of course. You don't want to spend five minutes in one.

Interestingly, the fine folks at the Treatment Advocacy Center have nothing to say about any of this. But plenty to say about some deranged fellow in Rome who tried to have a personal audience with the Pope. They especially fancied the forced treatment he was to receive at the hands of the Vatican's docs. "Although perhaps not in the way he expected, Roberto Sperling’s encounter with the Pope may have resulted in a minor miracle after all," notes the blog. Nice TAC-y touch there.

Thanks to Anders for passing along the link to the editorial.

We Love Astroturfing Groups!

Actually, we don't. And neither does Bob Fiddman at Seroxat Sufferers, who has run across GSK ginning-up an obesity advocacy group ahead of the company's launch of an alleged diet pill. He's tagged the post as a "fiddyrant"--one of the most apt terms I've run across in ages.

It always amuses me that Big Pharma companies and their apologists will tout a free market approach to health care and the use of pharma products, but then get all pissy when anyone nips at them for doing stealth marketing and market creation through non-profits and public health groups such as the World Health Organization. I suspect I am more of a capitalistic, cowboy-hat-waving free market of ideas advocate than they ever will be. After all, Big Pharma doesn't believe in a free market of ideas--remember how bitterly Lilly fought to get its publicly-available Zyprexa documents returned to a judge's seal?--but I do.

Speaking of ideas, I wonder if it's more than mere coincidence that GSK and Lilly always seem to be the biggest astroturfers of them all in the psych med world. Or am I wrong about that?

Nothing Today

Or least this morning. I am finishing up a longish freelance piece for someone, so need to put my efforts there instead of here. I might post something later on on Monday.

Another Parody

Untreated schizophrenia causes global warming. Funny stuff.

A Reader Comment On Reconcile

Sara left a great comment on today's posting on Lilly and Support Partners. So I am posting it here, because it captures some of my concerns about our medicated nation.

"One interesting sidenote to this. People who have been in this game for awhile realize that drugs are rarely really for the benefit of the patients but rather for the caregivers, parents, school/hospital administrators -- you name it -- anyone but the actual patient. This new drive to medicate pets is really dramatic evidence of this practice carried to a ridiculous level. It's all about seducing owners with some supposedly quick fix and has nothing to do with the long term wellness of the pets."

Lilly's Bark Bad As Bite

A few months ago, my friends at Eli Lilly (they unwittingly gave me a nice award, so I've decided we are pals now. Bros even) introduced Reconcile, an anti-depressant for dogs. Such a world we live in: major pharma company reformulates Prozac to go after depression and anxiety in canines because it is apparently a pressing need in American society that dog owners dope up their pets. Apparently, there are enough owners of dogs with separation anxiety to create an actual market for such a product. Nevermind that dogs shouldn't be left home alone for extended periods of time in the first place. Product launches with very little of the public sniggering that trickled forth a decade ago when vets started giving actual Prozac to dogs.

In a socio-cultural kind of way that's pretty messed up and says a whole lot about who we are as a country these days. But that's only the beginning.

Lilly is now sponsoring Support Partners--the precise arrangement and monies aren't clear--which is apparently a grassroots advocacy group promoting the idea that dogs make helpful companions for people with depression.

"The nonprofit works with mental-health consumers who wish to train their dogs to assist with the management of depression. 'Taking your dog for a walk can help you get some exercise,' said society president Joan Esnayra in a statement issued today. 'Teaching your dog a new trick can give you a sense of accomplishment. Even petting your dog can help with your recovery by relieving stress and anxiety.'"

I'm not sure why that notion needs an advocacy group and publicity and money, but in our culture even the obvious needs its very own spokesmen and voices. I mean, how difficult is it for someone with depression to go to the local animal shelter and adopt a nice dog? Exactly. Which means something else must be at work.

And that is Lilly's need to create and/or co-opt advocacy groups that stand up for any psychological ills suffered by humans in ways that enhance the company's publicity and soften inherent human resistance to medicating a psychological problem into oblivion. Now, the company has crossed the human-animal barrier. But of course it's all about benefitting humans on some level.

I know that a dogs-for-depression group must seem like a poor target, but I've grown weary of the way Lilly and other pharma companies use these groups (such as NAMI National) to legitimize themselves and jam the channels of communication--that'd be the media--with their messages. This is true in the marketplace of ideas for human psych products where there are virtually no countering forces against the barking of pharma companies--"Where does depression hurt?" goes the Cymbalta ad. And that's not because there aren't legitimate criticisms to offer in response to a nation medicated. It's not because there is no audience for such criticism. It's because there is little money to be made in offering such criticism. Otherwise, you'd hear a tidal wave of criticisms crashed on Big Pharma's butt every day and the bookstores would be jammed with books taking on our nation's dominant psychological treatment paradigm.

I'm not even pretending that Lilly's sponsoring of Support Partners is connected with Reconcile in some way (it obviously is). I'm just a bit troubled that few in the media and the blogosphere have let this kind of soft marketing go on for well over a decade with little notice. But, then, we live in a truly strange country, don't we?

CATIE Study Shows Small Cognition Gains

Yet another slice of the CATIE study is out in the Archives of General Psychiatry. This time investigators were out to measure cognitive improvement in schizophrenics taking either Zyprexa, Risperdal, Seroquel, Geodon or perphenazine, a first-generation anti-psychotic. Although researchers measured improvements in cognitive functioning, they determined that the difference between baseline--and it's not clear whether that would be an unmedicated baseline or what--and a few months on an anti-psychotic was small. The study also found that patients did a bit better on the older anti-psychotic.

I haven't read the full study, so I don't know how researchers accounted for what must have been a surprise. Researchers have long touted anti-psychotics as improving cognitive functioning in schizophrenia and especially noted that the atypical anti-psychotics were better than older anti-psychs in this regard. In fact, some researchers have argued that cognitive improvement alone justifies outpatient commitment laws because it's humane to give people back their cognitive abilities and, so, denying schizophrenics medications would be inhumane. I wonder what they are thinking right about now.

I'll admit to a bit of cognitive impairment on this matter myself. The CATIE study has really caused me to scratch my head about how we are currently treating schizophrenia in America--and elsewhere, of course. The atypicals were supposed to be the wonder drugs, but now I wonder how they maintain any luster. They are no more effective than older meds, cause injuries like the older meds and, to judge by this study, they don't do much for the minds of seriously ill people.

So what do we do now, especially if our aim is to be humane?

3,000th Comment!!

Earlier today, a reader left this here blog's 3,000th comment. That feels like a milestone of some kind. Thanks, Alison. And thanks to all of you.

When Forced Treatment Just Ain't Enough

Then you've got to go for the old forced exorcism. It's highly efficacious for chasing off demons, according to four out of five Popes whose views were recently dug up in a new meta study. The study's result were shouted on the streets of New York by the Rev. Cotton Fullafit.

"A common myth these days is that people who have been possessed by demons oppose assisted exorcism. Some of the most outspoken support for assisted exorcism (AE) actually comes from people who have experienced the ravages of demonic possession firsthand. These people support the idea of imposing exorcisms on people who don't know that they want them. They hope that if they ever become possessed again, their friends and relatives will be able to call upon the services of an exorcist to free them, no matter how much the demons inside may cause them to object."

Fuller Torrey of the Treatment Advocacy Center couldn't have put it any better.

And, yes, I am just goofing around. For some reason, my email was down and I couldn't retrieve my day's Google alerts for fodder. Happily, a reader who seems to get my sense of humor had just passed along a link to a very inventive spoof piece.

But What About Covenant Marriages?

So a wee study is out, claiming that marriage improved life even for people with depression. Although I have to scratch my head over the methodology--1980s data and marriage measured only in its first five years--I guess there's a certain amount of horse sense to the study's conclusion. Frankly, I've long felt that most people with depression would see better results if the illness--and some of the treatments--didn't result in so much isolation and such little sex. Seriously. Assuming that marriage is good for the sex life. I haven't the faintest if the study's authors even tried to control for sex, but that'd be an interesting little marriage/depression study.

Corrupt New World

One decade ago when I began my career as a reporter, I was drawn to writing about science and medicine as much as I could. I had worked as a pharma rep and held docs in very high esteem. What's more, I had a decade under my belt as a psych patient and while I wasn't in awe of psych docs the same as I was cardiac surgeons, I nonetheless held them in high esteem as well and figured that patients and commentators who criticized them didn't know what they were talking about and were a danger to other patients. There was a time when I could've written some of the "we love SSRIs" articles that used to appear in the New York Times. Not that I felt SSRIs worked based upon my personal experience, but because I was part of the big old American groupthink on meds and couldn't bring myself to face the ugly reality that the system of care in the mental health world--and indeed my own personal mental health care--was deeply corrupt in many of its intellectual precepts and much of its evidence. Really.

I'm not sure when my thoughts on psych docs and patients and our screwed up mental health system and state medical boards turned more skeptical and critical. It was an evolution, hard won at that--both personally and professionally.

I mention this in connection with an article in yesterday's Times wherein the paper notes that psychiatrists who've been disciplined by Minnesota's state medical board have nonetheless been hired by pharma companies to recruit patients for studies, run clinical trials and give marketing talks about psych meds to other doctors. The reason the paper was able to uncover this situation in Minnesota is because of a unique public records law in that state which--if I recall--requires docs to report what companies give them money. All states should have this system. Patients, especially those with chronic conditions, have a right to know. That right is absolute especially if, like me, you believe in a free market of information in the medical world instead of the ginned-up world of denial and fudged research we now have.

I cannot even get into how massive I consider the ethical breaches on the parts of docs and pharma companies--Lilly, J&J and AstraZeneca are all at the party--uncovered by the Times. PhRMA, a trade group, declined to comment for the article. The FDA said it clearly needed to overhaul its system of monitoring who gets to do clinical research. No kidding.

Tellingly, one medical ethicist who commented for the article said:

"Dr. David Rothman, president of the Institute on Medicine as a Profession at Columbia University, said the Times analysis revealed a national problem. 'There’s no reason to think Minnesota is unique,' Dr. Rothman said.

“'Clinical trial investigators must be culled from only the finest physicians in the country,' he said, 'since they work on the frontiers of new knowledge. That drug makers are scraping the bottom of the medical barrel is an outrage.'"

Outrage is putting it mildly. And you almost don't know where to start with some of these docs who were getting over $300,000 in payoffs from pharma companies while being in a heap of legal trouble. Read the article for the details.

Of course, if pharma companies have been this successful in ginning-up the mental health world, it almost makes you wonder how clean their hands are with, say, cardiac care, diabetes care and so on. We already know how they've cobbled up the pain management world (i.e., Vioxx). But, then, maybe I am being a bit too skeptical.

On another front, let me once again congratulate the paper for continuing to investigate the psych med world. There's much more there and I look forward to seeing it. However, I am confused as to why much of the rest of the print world and all of the television news world has been silent on these matters. If this is going on in Minnesota, then it's going on...everywhere. It's the press' job to look into such things even if the Times got there first.

Black Box Warning In The Offing For Cymbalta?

A recent post on CafePharma--where pharma reps often have anonymous conversations about whatever in the pharma world--asked if anyone knew of pending black box warnings coming Cymbalta's way due to reports of liver problems in patients who use the anti-depressant.

Someone replied:

"I have not heard we were getting close to a "black box" but I have started hearing problems when Cymbalta was used with statins. It seems to trigger rocketing liver enzymes according to a couple of Drs."

Lilly issued a Dear Doctor letter regarding liver problems in 2005. Where does depression hurt? Um, maybe in the liver.

It will be interesting to see where this leads. For once, it'd be nice if it led someplace warm and cozy.

BTW, Cymbalta seems to be very much the "it" anti-depressant all of a sudden. The MySpace bipolar groups are filed with queries about the drug and I heard from a younger friend of mine over the weekend that damn near everyone in her 20something universe seems to have tried the drug.

Dept. Of Self Promotion

This weekend, I won first place in science and health reporting in an SPJ competition among alt-weekly papers in five states. It was for a story I did last year in Seattle Weekly, my former employer, and involved a crusading lawyer going after Washington State's ineffective medical marijuana law. Kind of ironic that it appeared in the last issue that was edited by my old bosses before the new folks from New Times took over the Weekly.

The Times Scores Again

I'll say more about this on Monday, but for those of you swinging through this weekend, check out this piece by Gardiner Harris and Janet Roberts in tomorrow's New York Times wherein they write about a psych doc with a dubious past who is still doing clinical research at the behest of pharma companies while his research subjects end up in bad shape. As in dead.

Congrats to the paper for staying on these stories and mining the treasure trove that exists due to Minnesota public records law. I bet there is more to come.

Docs Find Pediatric Drop In Depression Diagnosis Depressing

An editorial in the new issue of the American Journal of Psychiatry takes on what it sees as a troubling dynamic: a decrease in depression diagnoses in kids following FDA advisories leading to lees use of anti-depressants in kids.

"The FDA’s advisories had the well-meaning intent of providing information about the safety of antidepressants in pediatric use, and the agency recommended a black box warning to improve treatment safety. However, these policy actions may have had the unintended effect of discouraging the prescription of antidepressants for pediatric patients and pediatric utilization of antidepressants without compensatory increases in other specific treatments. If so, this may have resulted in the lower rates of diagnosing and treating new-onset pediatric depression seen in this study, which may well have meant that many pediatric patients received less psychiatric treatment than needed, which in turn may be a factor in the increased rates of youth suicide reported in previous epidemiological studies."

I'm sure the editorial and accompanying study will be controversial amongst readers. I'm not sure I buy the alleged causal relationship between less use of anti-depressants in kids and a modest bump in suicides among age groups in which suicide isn't particularly prevalent. But that's just me.

CBT Good For Severe Depression

According to a new study in the British Journal of Psychiatry, CBT beats interpersonal therapy in severe depression. I'm not surprised, but wish that the journal abstract would list the absolute recovery rates of both methods. So if anyone has access to BJP articles, pass it along please.

Elsewhere on the CBT front, I've recently seen the modality's use in treating domestic violence offenders and it seems to be remarkably effective. So Aaron Beck is getting a Nobel Prize when?

Let's Steal Psych Meds

Someone down South stole a semi-truck filled with prescription meds including Lamictal, Paxil and Wellbutrin. There's a black market in these drugs? Yikes. Who the hell would buy Paxil from a dealer? Is this some kind of response to the lack of insurance millions of Americans face? All I know is we sure live in a strange country.