So New Year's is approaching and I wanted to thank all of you for your readership and support of this site in 2007, especially during my fracas with Lord Google and the very heated controversies around the bipolar child debate.
Personally, I cannot wait to get 2007 out of my life. It has been one of the most trying years of my life, personal victories mixed with a lot of struggle, more struggle than I would care for of course. But even-numbered years are almost always very good to me, so I cannot wait for midnight.
Speaking of struggle, you haven't heard the last of my struggle with Lord Google. I'll tell you more when I can.
For those of you interested in such things, here's a list of the five most popular posts on the site in 2007:
1. Love American Style: Web 2.0 And Narcissism
2. Snorting Seroquel, Dependence And Smoking
3. Youth Suicide Rates Study Deemed Dubious
5. Making The New Media: Google Punishes Blog For Obeying Web 2.0 Ideals
It amuses me no end that two of these posts have little to do with mental health issues and everything to do with the Internet.
Happy New Year's to all of you.
I'm a bit hazy on all the details and accusations, but GlaxoSmithKline, AstraZeneca and Eli Lilly have all received requests from Britain's Serious Fraud Office to turn over documents related to their participation in the UN's oil-for-food program for Iraq. The program has been the source of much controversy and corruption in the past (including former UN Secretary-General Kofi Annan's son if I recall), but it's not clear to me what the three drugmakers are being investigated for. Except you know that it involves money, and lots of it.
All the same, it warms my heart any time these three companies are made to sweat a little over their business practices. Stay tuned.
I hope all of your had a nice Christmas. I've been working my butt off at the shelter and haven't had much time for writing per se. But I wanted to pass along a few items that caught my eye recently.
First, CBS News took on the whole Chantix suicidality connection the other day, and encountered one woman without a mental health history who suddenly tried to kill herself while on the stop smoking pill. I hope the FDA plans to rule soon on whether the drug requires black box warnings in the US, as both Europe and Australia have already determined that it does. Why the FDA moves slower than other nations' regulatory bodies is beyond me. Or do they allow their own data to be used to protect citizens of other countries but not of our own?
Remember that paper I posted last week in which a researcher had analyzed Lilly's pain alleviation data for Cymbalta and found that the company inflated the effects of the drug and that its pain-treating effects were almost nil? I had a hunch we'd hear more about that paper and I was right. The Wall Street Journal's Health Blog has taken on the topic and quotes Lilly as defending the drug and its data. It also quotes the study's author referring to Lilly's pain alleviation claims: "I think it’s certainly misleading at best, and completely false at worst." I guess the real question that needs to be asked now--in light of what seemed to me to be an authoritative analysis of Lilly's data--is how the drug could have been approved for treating neuropathic pain and whether Lilly is making any marketing claims for the drug that aren't bolstered by data.
Several readers have passed along news in the last week of electric shocks being used on youths at a school, the Rotenberg Center in Massachusetts. The kids are some of the toughest behavioral and dysfunction cases going, openly attacking strangers for example. They've flunked out every other conventional unconventional therapy and medications too, so they are now treated with shocks. New York State is trying to break its association with the center, but is meeting resistance from the parents of some of these kids. The New York Times has a good article on this.
What bugs me is that these kids have no rights in the process, as the shocks are approved of by their parents and a court, and that just doesn't sit square with me since our society long ago shunned such treatments as barbaric and does not use them on terrorists for example (at least as far as I know). So why wouldn't these kids get similar consideration?
Thanks to all of you who passed along articles on this center. I appreciate the nudge to write about it.
In other news, it would be impossible for me to close out the year without noting that the great, great jazz pianist Oscar Peterson's death was recently announced. He was 82 and in failing health. The guy was a monster player, combining classic impulses with jazz improvisation in ways that usually left me gasping for breath.
I ran into this recording of him on YouTube in which he is just stunning and his bassist is as good. Enjoy.
Here's the second installment of my year-end wrap up. So much happened in mental health news this year that I broke it into two posts. 2007 was that busy of a year. The first part is here and now for the second.
July
News of hundreds of deaths related to atypical anti-psychotics in Australia.
I go off the last of my bipolar meds, Lamictal, at my doctor's urging.
Then, I run into Lamictal withdrawal, previously unknown to me, my doctor and apparently the FDA.
August
Somehow, this blog winds up involved in the case of Rita Pal, a British psychiatrist.
September
The diagnosis of bipolar disorder in kinds and teens is up 4,000 percent.
Much doubt is cast upon a study of suicide rates and anti-depressant use.
The FDA adverse events database reveals that Zyprexa, Risperdal, Clozaril and Paxil have killed thousands of Americans.
A Dallas musician was killed after an adverse reaction to Chantix.
BMS settles allegations of payoffs and other wrongdoing with the feds for $515 million. Some of the allegations involved Abilify.
October
News that a new generation of anti-psychotics have not improved outcomes for people diagnosed with schizophrenia.
Many readers continue to comment on problems with Lamictal withdrawal.
November
I ask speculatively if depression is even a mental illness. That leads to this site's longest comment thread ever.
Anti-depressants implicated in the death of an Australian newscaster.
The CATIE study establishes that anti-psychotic use in dementia is not medically warranted.
The very ugly Megan Meier/MySpace case first appears.
Soon after studies appear casting doubt on treatment and outcomes for ADHD kids, New York Times columnist Judith Warner goes to bat for researchers and Big Pharma.
Just how ugly the use of anti-psychotics is in nursing homes in Florida is revealed.
The State of Arkansas sues the maker of Risperdal and alleges that the drug was defective when it was put on the market.
Hundreds of reports of suicide and suicidality related to Chantix are revealed.
December
I give a lecture in Florida.
The Wall Street Journal goes after anti-psychotic use in nursing homes in New York State.
After yet another mass murder, it appears that the young male shooter was on anti-depressants.
Google screws me over and I lash out at the company.
After years of doing well, my doctor refuses to undiagnose my bipolar disorder. I reflect upon the moment.
Two British psychiatrists rip apart the rise in bipolar disorder.
A huge public backlash erupts around the so-called Ransom Notes campaign.
News that Lilly's claims that its anti-depressant Cymbalta treats pain are apparently wildly overstated.
Here's the first installment of my year-end wrap up. So much happened in mental health news this year that I broke it into two posts. 2007 was that busy of a year. The second one will be up tomorrow.
January
More bad news on deaths from Zyprexa use.
A former Seattle area cop, diagnosed with bipolar disorder, gets a settlement for discrimination from her former employer.
February
The first news of the Rebecca Riley case--an allegedly bipolar child allegedly murdered by her parents--came out this month.
I made the Zyprexa documents available to the public.
I catch NAMI National trying to help Lilly cover up its Zyprexa mess.
A federal court judge rules on the Zyprexa documents.
I use the Zyprexa documents to reveal how Lilly wanted to turn Zyprexa into the new Lithium.
March
Former Senator and former Vice Presidential candidate Thomas Eagleton died.
The State of Montana sued Lilly over Zyprexa, alleging kickbacks on the part of the company.
A very significant finding came out of the STEP-BD study: anti-depressants don't work for people with bipolar disorder.
April
A mentally ill student at Virginia Tech committed a massacre. Many commentators tried to call him schizophrenic, but the evidence pointed elsewhere.
May
Researchers claim that 4.5 percent of Americans have bipolar disorder. I used the occasion to smash what passes for bipolar disorder in our culture.
The State of Utah sues Lilly over Zyprexa.
June
Starbucks pays for discriminating against a barista diagnosed with bipolar disorder.
One of the chief proponents of the child bipolar disorder is profiled.
A huge fight breaks out amongst psychiatrists over bipolar disorder in children.
The Census Bureau yesterday released its 2008 Statistical Abstract of the United States, a publication that is almost always fascinating for what it tells America about itself by the numbers. Pharmaceutical drugs stand out in the new abstract--which if you've never read, I suggest that you look it over sometime online or at the library because it is nothing if not revealing--but then if you read this site, then that's probably not a shocker. Some numbers:
"Prescriptions have increased over the past decade to 3.4 billion annually, a 61 percent increase. Retail sales of prescription drugs jumped 250 percent from $72 billion to $250 billion, while the average price of prescriptions has more than doubled from $30 to $68."
I had too long of a day--I worked two eight-hour shifts inside of 24 hours and then was stranded downtown at midnight in 28 degree weather by Seattle's terrible bus system and finally had to give up and take a cab 45 minutes later--to dig into whether the report actually broke out the psych meds component of this. My rough estimate is that all anti-depressants, anti-psychotics, ADHD drugs, mood stabilizers, and so on sold in the US amount to $35 billion to $40 billion a year, almost 20 percent of all pharmaceuticals sold. Why consumers don't have more market power is beyond me. There are, after all, some very bad psych meds on the market which continue to ring up multi-billion dollar sales each year.
What's more troubling to me is that I've spent many hours working somewhere where I can legitimately point to the failure of the anti-depressants, anti-psychotics, ADHD drugs, mood stabilizers, and so on sold in the US. The shelter where I work is literally an all-comers situation--we take people other shelters won't touch because they are straight from a psych unit or the streets or detox or jail or just drift in from God knows where--and I can tell you that there's a lot of raw mental illness on display. There are also loads of people who are current or recent abusers of crack cocaine and alcohol as well as a few who are victims of sheer bad luck and economic hard times. The failure of the war on drugs and the presence of economic disparities in our culture are likely more prevalent in what I see at the shelter than is mental illness.
At any time, there are about 180 residents in the shelter, about 50 women, the rest men. Many of the residents, or clients, are over the age of 60, which disgusts me in so many ways. Much of my work involves trying to keep the place reasonably clean, dishing out food, and keep a lid on behavior. Two highlights: I had to clean feces from one of the women's toilets (not in the job description, but had to be done); and, I had a nice little chat with a young man with schizophrenia who keeps playing with himself in front of other residents. Generally, that gets people booted from the shelter (even all-comers shelters have limits), but the guy is so vulnerable that if he goes to the streets (no other place will take him outside of a psych unit and they are pretty much maxed out anyway) he'll either wind up in jail or dead, so we are trying to slowly work with him. There are only four of us working with almost 200 people, so we are kind of busy trying to keep a lid on everything else. I can assure you that the psychopharmacological revolution sure isn't helping matters.
Anyway, I could go on for days, but I won't. Christmas is in a few days, and I'll be away from this site until Dec. 26 or so, when I'll do a year end wrap up and shoot off my mouth about how the City of Seattle recently made the decision to clear out homeless encampments (ie, out of doors camps) in this city right before Christmas.
In the meantime, John Grohol at Psych Central has already done his year-end post. It's a very good one which you should read.
Before I dash off to the graveyard shift at my on-call, part-time gig I wanted to thank readers for the $75 in contributions that came in yesterday, bringing the total of the fundraiser to $750. If anyone else wishes to make all of my cats' Christmas wishes come true, there's a Paypal button on the right, or shoot me an email and I'll send you a snail mail address.
Thanks again for your support.
BTW, I wrote yet another appeal to Lord Google on Monday, asking the company to reinstate my account and pay me the monies it already owes me for my Adsense account. The company says it takes 48 hours to process appeals but they are already way beyond that time, so who knows, perhaps a human is actually reading my plea this time out. We shall see.
For those of you who have no idea what I am talking about, the saga of a wee blogger versus Lord Google is here.
I just ran across an interesting abstract in the current Psychotherapy and Psychosomatics--I'm still trying to get the full paper, so if anyone has access pass it along please--in which a psychology professor went back through various studies where Cymbalta--Eli Lilly's latest blockbuster anti-depressant--was alleged to have an effect on pain in depression and found that the claims were inflated. I have never, ever heard of Lilly making overstated claims for their medications before, so I am shocked (shocked!) to learn that this might be the case:
"Results: Across five trials, the results indicate a very small (d = 0.115) and statistically nonsignificant (p = 0.057) analgesic effect for duloxetine. Additionally, some of the relevant data on duloxetine's effects have not been reported fully, making it likely that the obtained results reflect an overestimate of its true impact on painful physical symptoms in depression. Discussion:The current analysis is based on a small number of studies; further trials may yield significant results favoring duloxetine. Based upon the currently available evidence, the marketing of duloxetine as an antidepressant with analgesic properties for people with depression does not appear to be adequately supported."
So I guess that "Depression Hurts" TV ad campaign which Lilly spent hundreds of millions of dollars on is bogus too.
Ironically, the Journal of Clinical Psychiatry just published a paper on Cymbalta in which the authors claim:
"These results support duloxetine's efficacy and tolerability in the treatment of pain and depression in patients with at least moderate pain associated with depression."
Based upon Cymbalta's approval for depression and depression maintenance much less the treatment of neuropathic pain and the claims about physical pain relief that the company makes as well as a new level of dispute in the academic literature about those claims, I think the FDA needs to examine Lilly's claims and decide whether the company is making legitimate claims in its marketing.
From what I know in the patient community, people who were given Cymbalta for chronic back problems--which seems to be the rage amongst some docs lately--experienced no relief, but plenty of side effects including liver damage, agitation, suicidality and withdrawal symptoms. They were being given the drug because some pain management docs are running scared of the DEA's anti-opiate campaign.
Thoughts?
Apparently, the currently-available injectable is short-acting, so Lilly has developed a new long-acting version of its diabetes-inducing, fat producing anti-psychotic. It's set for review by the FDA's psychopharmacologic drugs advisory committee on Feb. 6.
BTW, did you all know the psych drugs committee currently lacks a consumer representative? It does. Did you know the general public can submit nominations for said representative? It can. Did you know that the committee didn't even meet in 2007 despite all manner of bad news on the psych med front and all manner of FDA approvals of psych meds for various new indications? It's true.
I think this committee needs a consumer representative, and certainly not a rubber stamp person approved by the likes of NAMI National. Is this something readers would like to see? Is it something the autism community would like to see? Is it something parents of kids diagnosed with some kind of mental disorder would like to see?
Let me know.
I just learned that the controversial "Ransom Notes" ad campaign in New York City has been halted in response to much public outcry within the mental health community over its tone much less its accuracy. The campaign was the brainchild of Harold Koplewicz, head of the Child Study Center at NYU and co-author of Paxil Study 329. I wrote about the campaign here and here.
Koplewicz told the Wall Street Journal's Health Blog that “'the debate began to become focused on the ads themselves.'” Looks like Koplewicz has learned a lesson and I bet the media in New York has learned about Koplewicz and the lengths some mental health advocates will go to to generate attention for their cause and how conflicted their pasts can be.
I know some readers of this site wrote to Koplewicz and others and I thank them for doing so. Much of the credit for giving this campaign the attention it deserved must go to people in the autism community among them The Autism Self Advocacy Network and Kristina Chew at AutismVox. I know a lot of other groups were involved as well. Congrats to all.
BTW, there is a growing comment thread at the Journal's Health Blog, so go join in the fun if you wish.
Update: According to this later New York Times account, Koplewicz and his critics are talking and the co-author of Paxil Study 329 is trying to bring them into the tent to work on a subsequent round of ads slated to appear in about three months. The paper reports that they will also be done by the BBDO ad agency, which the paper fails to note has been the ad agency handling Paxil ads in the past. Gee, I wonder why they are doing this pro bono.
A decent piece by a psych doc about seasonal affective disorder appeared in the New York Times the other day. it covered the basics of light therapy, which I am sure are familiar to most readers, and added some interesting points on the timing of phototherapy. Very early for early risers, later for late risers and so on.
At the least, it's interesting to read a psychiatrist talking about non-medication treatment for something for a change.
I seriously had zero plans to turn December into "problems with anti-depressants" month, but the issue has been in the news lately, and I sure don't avoid a good news hook when I can get it.
That said, just under a year ago, I told you all about "Uncomfortably Numb," a documentary about one man's misadventures with Paxil. It looks as though Phil Lawrence is done with his project as a preview is now on YouTube. I can't tell enough from it to see how far he's going to take the documentary, but I'm sure we'll know soon enough. He was given Paxil after being diagnosed with social anxiety disorder.
Lawrence's website is here. Let me know what you think of the clip and I'll pass your thoughts along to Lawrence.
Not long ago, I had lunch with a psychiatrist I know and I brought up the subject of Paxil. "I cannot believe people are still prescribing that drug," she said.
Yesterday I got a check from a reader along with a nice note, which I thought I'd pass along.
"I value access to your blog--wonderful information, clearly laid out. I lost 10 years to meds and illness and abuse from those claiming to help. I want to change, expose, do anything to help people avoid what I went through. I am at a loss on what to do to convince the nation (world?) that we are sensitive, sentient human beings, not boogiemen."
Well, we sure aren't boogiemen. And, I think the best way to avoid people getting into trouble with the mental health industry--by which I mean avoiding the downside to it all--is to recognize that psychiatry, as it's now practiced in the US, is one of many technologies to help human beings with psychological and emotional crises, and its technologies should be used sparingly and with caution, especially in the long-term. The only place where I'd alter my view is when it comes to schizophrenia, and even there I have a hard time building an ethical case for the long-term use of anti-psychotics. The meds are just too troublesome and too dangerous for too many people and have not been proven to be effective preventative agents. So it's hard to say that everyone with schizophrenia should be taking them forever. But that's just the ethical case. The medical and legal cases are a bit different.
As for other disorders, the British psychiatrist David Healy has been very upfront in writing that there is almost zero evidence that anti-depressants and mood stabilizers prevent future episodes of various disorders. The implications of that are fairly clear to me. Lithium alone seems to have preventative power, but even there I can only think of one person I know with bipolar disorder who's taken Lithium for years and never had another episode. Balance that with another person I know who played by the rules and took Lithium for eight years. She's on a kidney transplant list as a result.
Why the mental health industry has been able to claim preventative power for treatment with meds is beyond me. They can talk about greater delays to relapse and symptom suppression all they want, but I remain largely unconvinced. If I had only realized all of this years ago, I'd be in much better shape today.
I've been mum about last week's fundraiser for a few days due to the press of outside work and a back keeping me off the computer. As of now, the fundraiser is at $675, which I appreciate. Most of you know that I am doing this because Google screwed me out of monies they owe me for my Adsense account. For those of you who don't know the saga, the back story is here.
The fundraiser's goal is $1,200, so if any of you are in a position to give anything, I'd sure appreciate it. So would my cats. The PayPal button is on the right, or email me and I'll give you a snail mail address.
Oddly enough, my initial post on how Lord Google jacked me somehow made its way to Google's corporate HQ last Thursday and I watched as about 60 people from Lord Google's army read my account of being toyed with by the company. Did any of them reach out to me? Not a one. Nice nameless, faceless corporation Google has become.
Eli Lilly's CEO Sidney Taurel set to retire.
In other Lilly news, its Reconcile doggy Prozac makes Forbes' list of the dumbest products of 2007.
US Supreme Court asked to hear North Carolina "Zoloft Murder" case. Not clear if any of the SSRI-induced violence issues would be under review, but the 30-year sentence of a teen would be.
Danny Carlat points out that Medscape/WebMD sells its resource centers on its website to the highest bidder from pharma companies--perhaps as much as $500,000 a pop--who then get to choose who writes the articles.
Yet another celeb discusses their bout of depression. This time its Alicia Keys.
Counterpunch takes a swing at the "Ransom Notes" campaign.
Research shows serotonin may be tied to optimism.
I am late in passing this along, so apologies upfront. The National Institute of Mental Health is asking for public comments on its forthcoming strategic plan that will shape--to what degree I know not--how the agency marches forward with its research monies. According to the folks at MindFreedom, the current document is all about doing research for more pharmaceutical "innovations." That's nice, but I'm sure readers of this site might like to offer NIMH their two cents on NIMH ought to be putting its taxpayer funded resources.
You can get background on this here.
Or you can just email NIMH at strategicplanning2@mail.nih.gov.
Your comments need to be sent to them within the next three days, so take ten minutes or so and dash off a quick email with your thoughts.
Last night, Fox News ran a piece on the "Hannity's America" program, exploring links between violent behavior among teens on anti-depressants. It goes all the way back to Columbine and Kip Kinkel in Oregon. A mother describes how her son basically turned into a monster while coming off of Paxil, and Dr. Peter Breggin lends some medical expertise to the whole affair (I think he understates the risk of suicidality with anti-depressants, but I bet he was being conservative for TV). Other than that, I'll let the piece speak for itself, except to note that this is the first time in ages that I've seen a major TV network take this problem on in an aggressive fashion.
I am having a little go-round of back problems again, so I am going to be kind to myself and back off the computer until later today. In the meantime, read on:
Military suicides set a record.
The New York Times takes a look at the whole sordid Megan Meier saga.
You probably missed my little anniversary observance of the Zyprexa scandal yesterday. And a fine St. Petersburg Times article on how, despite the drug's many problems, Zyprexa is set for approval in kids. Includes a history of the scandal.
And CL Psych had an amazing roundup of links the other day, including some hilarious Pharma Giles items.
More later.
Thanks to a very attentive reader, who passed along a tip: the man behind the "Ransom Notes" campaign, Harold Koplewicz, is in fact a speaker for hire for a group called Grabow Entertainment. I wrote about the campaign the other day. While I generally roll my eyes at public awareness campaigns and their wildly overplayed messages on mental illness, this one goes beyond the pale and is particularly wounding to families of autistic kids much less the patients themselves. There is a petition calling for this campaign to be nixed which you can find here if you wish to add your name. Over 700 people have already.
I am very tired after my graveyard shift at the shelter, so let me just ask a few questions: Does this guy not make enough money already from private practice, running New York University's Child Study Center, and doing studies for pharma companies? Why has the media quoted this guy for years as an authority on mental illness and its treatment when he's a co-author of the discredited Paxil Study 329? Why does he appear on shows like "Oprah" to lend credibility to whatever Oprah is pushing that day? What else is Koplewicz involved in? If I had more time and energy, I'd spend hours poking around. Maybe some readers would like to do it and pass along what they find. Maybe some journalists out there might want to do some of their own and talk to their sources. Methinks, there's a deeper story here. I did a teensy bit of my own poking.
I'm not sure what the doctor's comedy routine is like, but here's a precis of his lecture topics:
"In his speeches, Dr. Harold Koplewicz fuses his roles as a child and adolescent psychiatrist and parent to educate the public on how real child mental disorders are, how common and how treatable by informing his audience with facts they can rely on delivered with empathy, some humor and relatively easy to follow directions. Dr. Harold Koplewicz has also delivered many non science presentations to parent groups, YPO, mental health association groups, school nurse associations and teachers. His lecture themes include: * Understanding Your Child's Mood * Raising a Successful Child in and Affluent Environment * Everything You Wanted to Know About Your Teenagers and Were Afraid to Ask * Raising Successful Girls * Raising Healthy Boys * Helping Your Child to Understand God."
I wonder what his science presentations are like. And, I roll my eyes at the idea that the likes of this doctor are telling American parents about how to raise successful kids and helping them understand God. Wouldn't the widespread use of anti-depressants and anti-psychotics in children and teens--especially the long-term use of these drugs which don't have particularly good success rates--tell you a whole lot about the place of God in the Universe? Would you trust a psychiatrist like Koplewicz to lay it all out there for you? Have we replaced one relationship with God and the infinite with another? Is any of this "the kids aren't alright" paradigm really that beneficial to us as a culture, especially when the leading gurus and medico-priests make so much money from it?
I'm sorry but I've had far too many philosophy and religion classes not to ask those kinds of questions. I've also been a reporter too long not to know that I smell something very weird here, as well.
I somehow have a hunch we haven't heard the last of this "Ransom Notes" campaign and of Dr. K. (Credit for the Grabow Entertainment link goes to AHRP which sent it out by email to its list-serv earlier today.)
Today is the one-year anniversary of Alex Berenson's New York Times article that made public internal Eli Lilly documents establishing that the company had told its sales force to downplay all manner of problems associated with Zyprexa. I remember seeing the article online the evening of Dec. 16 (it's datelined the 17th but was online earlier), and thinking to myself, "It's by Berenson and he's got documents. Wow." I linked to the article and, since I was headed out the door for the evening, offered this brief assessment:
This is major news. More later.
One year later, there is still more and more each day about this and other atypical anti-psychotics and how they have become big problems in our culture. Kind of stunning when you think about it.
But here's something even more stunning: despite over 1,000 deaths connected to the drug, despite thousands of cases of diabetes, despite all the weight gain this drug causes, despite the fact that it doesn't work so well either, despite about $1.3 billion in payouts to settle lawsuits brought by patients against Eli Lilly, despite all of that this drug is on the verge of being approved for use in children, as Rob Farley smartly points out in an article in today's St. Petersburg Times. The Zyprexa documents even make an appearance in the article.
How the hell does that happen? Read the article for more on the drug and its very weird history.
First, thanks to many readers for passing along an article from today's New York Times on the backlash against an ad campaign conceived by New York University's Child Study Center and its director, Harold Koplewicz. The campaign is to raise awareness around what Koplewicz calls “the silent public health epidemic of children’s mental illness.” It focuses on autism, depression, ADHD, OCD, Asperger's and bulima. It seems that the center had the good sense to steer clear of the bipolar child business, but many parents and mental health advocates are questioning the campaign's tone, which describes 12 million children as being held "hostage" to mental illness, and its overall message. The campaign, done pro bono by an ad agency, is only in New York for now, but may expand to at least four other cities.
I think the campaign is more than a little over the top. For example, the "ransom note" sent to a putative parent by ADHD reads: "We are in possession of your son. We are making him squirm & fidget until he is a detriment to himself & those around him. Ignore this & your kid will pay. ADHD" The ad's tagline is "Don't let a psychiatric disorder take your child."
The autism community is offering the most intense criticism of the campaign and has created a petition calling for an end to the campaign. I'm not even going to attempt to summarize what folks are saying. Read some for yourself here.
One mother told the paper:
"'The idea of an autistic person being held hostage is a very disturbing and backward image,' she said. 'Rather than promote public awareness, this reinforces stereotypes--that there is something damaged about the autistic person, something in need of a repair.'"
In a message on the center's website, Koplewicz claims that "fifteen million children in the U.S. have diagnosable psychiatric or learning disorders but nearly 70 percent don’t receive the help they need. These disorders rob children of the ability to learn, make and keep friends and enjoy life." Images from the ad campaign are here.
I'm not sure what the source of funding for the center is, but I've learned to be dubious of public awareness campaigns such as these because they too often don't serve the needs of patients, but instead serve the needs of doctors and pharmaceutical companies. That said, I am in no way minimizing mental disorders in kids or how parents might choose to treat them, but if there's one thing I've learned in my reporting on these issues, it's to be very skeptical when doctors use the E word--epidemic--and start waving the banner of public health problem and "diagnosable" disorder. I know this is very emotional territory, but I really have to question just who this campaign is really serving and why the center is using what amounts to fear tactics (ADHD takes kids hostage? Really?) in order to educate the public in the name of diagnoses that can be over-broad and treatments that don't work particularly well. Treatment success rates with bulimia, for example, run about 15 percent last time I checked, and ADHD kids seem to do just fine over time with or without treatment. And, let's keep in mind that many of these ADHD kiddos are in fact little boys who wind up being given anti-psychotics yet have no say whatsoever in their treatment.
So what do readers think is going on here?
UPDATE:
As it turns out, a tipster informed me and I have confirmed that Koplewicz is one of the co-authors of the infamous Paxil Study 329. As I noted earlier this year:
"Some very smart people have taken on many of the issues around Study 329 and Paxil/Seroxat and, based upon the evidence, I'd have to say that it's fair to assert that none of us in the patient world should trust anyone who had a hand in the study (unless they want to suddenly recant the work) on absolutely anything they say about mental illness. At a minimum, we should be wildly skeptical of any claims they make.
I stand by what I said then. The BBC's "Panorama" did an excellent show on Paxil and this study earlier this year.
Study 329 basically asserted that Paxil beat placebo in treating depression in teens when, in fact, it did not. In addition, there were instances of suicidality in this study which Glaxo somehow managed to deep-six. Healthy Skepticism has a heap of resources on this study and CL Psych has written about it as well.
UPDATE #2: The Wall Street Journal's Health blog is all over this ad campaign as well.
So the FDA just issued a warning letter to Wyeth, makers of the SNRI anti-depressant Effexor, over spurious claims made in an ad for the drug. In the ad, the company claims that Effexor remitted depression in 60 percent of patients who'd been taking an SSRI yet still had depression symptoms. The FDA claims in a letter to the company that such a claim in not supported by evidence and that the company used an open label trial (ie, not randomized or placebo-controlled) to back its claim. That's the wrong kind of study to use.
What's interesting is that just last year the NIH-funded STAR-D study reported that in patients taking an SSRI (Celexa) who then switched to Effexor only 25 percent saw remitted symptoms. So Pfizer's 60 percent claim is certainly a bold one.
Guess we'll be seeing a new Effexor ad soon. The ad in question is stunning for other reasons: it targets women (do men not get depression?) and shows the subject in a typical family setting in a prosperous-seeming home. If you know much about American culture these days (fewer than half of women married, and a much smaller percentage likely to be in prosperous homes in the 'burbs), you've just got to wonder exactly what kind of drugs Wyeth's marketing team and its ad agency are taking. You've also got to wonder why pharma execs think they can get away with this sort of excessive claim.
(Via Pharmalot.)
The other day Pfizer, maker of the stop smoking drug Chantix (Champix elsewhere), was ordered by Australian authorities to put warnings related to risks of suicide, suicidality and depression linked to the drug's use on its packaging before the drug goes on sale in Oz next month. Now, the European Medicines Agency is ordering Pfizer to put the same warnings on the drug in Europe. So far, the FDA has not ordered any label changes in the US. You have to assume they are in the offing for the drug which has been associated with hundreds of adverse events reports about suicide, suicidality, depression, agitation, and erratic behavior in the US.
To me, the big question is why does the FDA always seem to move slower than other drug regulatory agencies. And, for that matter, why does Pfizer still refuse to answer questions about reported problems with the drug.
As I noted last week, Robert Hawkins, who murdered eight people at an Omaha mall last week before killing himself, was on anti-depressants at the time of the shooting. Now, his mother has told Good Morning America that her son was put on Ritalin and Zoloft when he was five-years-old. in her interview, she doesn't go into too much about her son's mental health issues except to note that he'd been struggling with depression for years.
It's not possible to say what effect his care and the anti-depressants may have had on his behavior, good or bad, and I am surely not blaming them for the shooting. But it is one of those things you've got to wonder about, too, given the number of crazed shootings my teen males where they've been on anti-depressants that have occurred in the last decade or so. Isn't it precisely this sort of thing that mental health care and anti-depressants are supposed to be insulating us from?
And, why the heck is it that some people react so badly to anti-depressants? And, why in God's name was his father's rifle so easily accessible even though he didn't live in his father's home? Have these folks ever heard of a gun locker before?
Most of you are aware that the long-awaited Mitchell report on the illegal use of steroids and humane growth hormone in Major League baseball came out yesterday. The report names 80 current and former Major Leaguers as having used or possessed the banned substances, future Hall of Famers such as Roger Clemens and on down. It's a discouraging report, which also briefly mentions the suspected use of stimulants among ball players. That's something the San Diego Union-Tribune has been onto for a while, reporting in May that:
"Baseball players may have unabashedly used amphetamines hoping they wouldn't get caught and knowing even if they did, they'd get a free pass for the first positive test."Another variable is TUEs, or therapeutic use exemptions. The most common treatment for attention deficit hyperactivity disorder (ADHD) is amphetamines, and several sources have told the Union-Tribune that numerous baseball players had obtained such medical waivers allowing them to use amphetamines."
The basic idea of stimulant use in baseball is:
"Boosts energy, masks pain and fatigue, enhances alertness, sharpens focus, increases heart rate. Says BALCO doping guru Victor Conte: 'Reaction time, batting, focus, concentration--stimulants have a tremendously powerful effect on performance.'"
So an ADHD exemption allows some players to hide stimulant use in the MLB? Wow. I wonder what Robert Spitzer would say. I guess Pete Rose's legacy is looking better and better every day.
My emergency fundraiser to overcome the chink put in my armor by Lord Google is now at $410. There are a couple of checks I know of headed my way, so I'll report the new total when I get those. The overall goal is to hit $1,200 by the end of the week, so if anyone is in a position to contribute, however large or small, I'd appreciate it. I think I am offering content that is highly unique in the world of the 'Net, and it must be OK because even David Healy uses documents from this site in his published papers. I know of at least one other forthcoming academic paper that is based, in part, on the Zyprexa documents housed on this site.
As usual, the PayPal button is on the, or I can give you a mailing address by email.
David Healy and his colleague Joanna Le Noury have a new paper out, which examines the rise of bipolar disorder in both adults and children and puts it all in some kind of historical context. It's a lengthier examination of what Healy calls disease mongering than his PLoS paper of 2006. If you want to avoid my summary of this new piece, which I think is a withering attack on just about everyone in the mental health industry, then read their paper here (it's a .pdf file).
This is a lengthy post, but I think it's worth laying out the authors' key points since they are pushing back against some powerful forces in our culture and, at the end, asking if the bipolar child paradigm isn't a new form of Munchausen’s syndrome. I should also note that this site makes an appearance by inference in the article, which was published in the International Journal of Risk & Safety in Medicine.
BTW, I usually don't pinch this much copy from an article, but this is article is rather significant and worth the departure from my usual practice.
The two psych researchers begin with Depakote:
"Early market research was linked to the introduction of Depakote. In the form of sodium valproate, this anticonvulsant had been available and shown to be helpful in manic-depressive illness from the mid1960s. Abbott Laboratories reformulated it as semi-sodium valproate,2 which it was claimed formed a more stable solution than sodium valproate. This trivial distinction was sufficient to enable the company to gain a patent on the new compound, which as Depakote was introduced in 1995 for the treatment of mania. Depakote was approved by the Food and Drugs Administration on the basis of trials that showed this very sedative agent could produce beneficial effects in acute manic states. Any sedative agent can produce clinical trial benefits in acute manic states but no company had chosen to do this up till then, as manic states were comparatively rare and were adequately controlled by available treatments. Depakote was advertised as a “mood stabilizer”. Had it been advertised as prophylactic for manicdepressive disorder, FDA would have had to rule the advertisement illegal, as a prophylactic effect for valproate had not been demonstrated to the standards required for licensing. The term mood stabilizer in contrast was a term that had no precise clinical or neuroscientific meaning. As such it was not open to legal sanction. It was a new brand."
Healy and Le Noury aren't done.
"But in addition to branding a new class of psychotropic drugs, the 1990s saw the rebranding of an old illness. Manic-depressive illness became bipolar disorder. While the term bipolar disorder had been introduced in DSM-III in 1980, as late as 1990 the leading book on this disease was called ManicDepressive Disease [16]. It is rare to hear the term manic-depressive illness now. This combination of a brand new disease and brand new drug class is historically unprecedented within psychiatry."Lilly, Janssen and Astra-Zeneca, the makers of the antipsychotic drugs, olanzapine (Zyprexa), risperidone (Risperdal) and quetiapine (Seroquel), respectively sought indications in this area and the steps they have taken to market their compounds as mood stabilizers illustrate how companies go about making markets."
And, they do. They offer an example of disease mongering by Eli Lilly from a patient leaflet:
“'Bipolar disorder is a life long illness needing life long treatment; that symptoms come and go but the illness stays; that people feel better because the medication is working; that almost everyone who stops taking the medication will get ill again and that the more episodes you have the more difficult they are to treat.'"
I think most of us recognize what a profound exaggeration that is on Lilly's part, as well as on the part of docs who subscribe to the lifetime illness business. The comes the hammer:
"[W]hen all placebo-controlled studies of Depakote, Zyprexa and Risperdal in the prophylaxis of bipolar disorder are combined they show a doubling of the risk of suicidal acts on active treatment compared to placebo. In addition, valproate and other anticonvulsants are among the most teratogenic in medicine. These claims about the benefits of treatment therefore appear misleading. No company could make such public statements without the regulators intervening. But by using patient groups or academics, companies can palm off the legal liability for such claims."
They go after those silly "look at the famous people with bipolar disorder" lists:
"A second aspect of the marketing of the drugs uses celebrities such as writers, poets, playwrights, artists and composers who have supposedly been bipolar. Lists circulate featuring most of the major artists of the 19th and 20th Century intimating they have been bipolar, when in fact very few if any had a diagnosis of manic-depressive illness."
They talk about the mood journals pressed upon patients which litter the Internet, and they briefly discuss, as I have at length, that 'the risks of suicide, alcoholism, divorce, and career failure are marketed.'
And:
"All of the above come together in a fifth strategy in North America – direct to consumer advertising. A now famous advertisement produced by Lilly, the makers of Zyprexa (olanzapine) begins with a vibrant woman dancing late into the night. A background voice says, 'Your doctor never sees you like this.' The advert cuts to a shrunken and glum figure, and the voiceover now says, 'This is who your doctor sees.' Cutting again to the woman, in active shopping mode, clutching bags with the latest brand names, we hear: 'That is why so many people being treated for bipolar disorder are being treated for depression and aren’t getting any better – because depression is only half the story.' We see the woman depressed, looking at bills that have arrived in the post before switching to seeing her again energetically painting her apartment. 'That fast talking, energetic, quick tempered, up-all-night you,' says the voiceover, 'probably never shows up in the doctor’s office.'""Viewers are encouraged to log onto bipolarawareness.com, which takes them to a 'Bipolar Help Center,' sponsored by Lilly Pharmaceuticals. This contains a 'mood disorder questionnaire.' In the television advert, we see our heroine logging onto bipolarawareness.com and finding this questionnaire. The voice encourages the viewer to follow her example: 'Take the test you can take to your doctor, it can change your life. Getting a correct diagnosis is the first step in helping your doctor to help you.'"
"No drugs are mentioned. The advert markets bipolar disorder. Whether this is a genuine attempt to alert people who may be suffering from a debilitating disease, or an example of disease mongering, it will reach beyond those suffering from a clearcut mood disorder to others who as a consequence will be more likely to see aspects of their personal experiences in a way that will lead to medical consultations and will shape the outcome of those consultations. 'Mood-watching' like this risks transforming variations from an emotional even keel into indicators of latent or actual bipolar disorder. This advert appeared in 2002 shortly after Zyprexa had received a license for treating mania, when the company was running trials to establish olanzapine as a 'mood stabilizer.'"
As I've reported before, Lilly saw Zyprexa as a new mood stabilizer, the new Lithium, way back in the mid-1990s. I've noted before that Lilly and BMS have both actively targeted women in their advertising and marketing. I don't know of any evidence that either drug is a mood stabilizer, but I know of plenty of evidence showing that using both drugs as if they were is not good for patients.
Then:
"The upshot of this marketing has been to alter dramatically the landscape of mental disorders. Until recently manic depressive illness was a rare disorder in the United States and Canada involving 10 per million new cases per year or 3300 new cases per year. This was a disorder that was 8 times less common than schizophrenia. In contrast bipolar disorder is now marketed as affecting 5% of the United States and Canada – that is 16.5 million North Americans, which would make it is as common as depression and 10 times more common than schizophrenia. Clinicians are being encouraged to detect and treat it. They are educated to suspect that many cases of depression, anxiety or schizophrenia may be bipolar disorder and that treatment should be adjusted accordingly. And, where recently no clinicians would have accepted this disorder began before adolescence, many it seems are now prepared to accept that it can be detected in preschoolers."
And, then, the authors go after the bipolar child paradigm and especially the role of some academics. They trace the early rise of bipolar disorder in the mid-1990s to Washington University researcher Barbara Geller (who I should note has said some of what's going on around bipolar in kids to be excessive) and figures at Harvard (or Mass General) who suddenly began offering "proof" that many ADHD kids in fact had bipolar disorder. Here's what the authors think of their evidence:
"In 1996, a paper from an influential group, based at Massachusetts’ General Hospital, working primarily on ADHD, suggested there were patients who might appear to have ADHD who in fact had mania or bipolar disorder. This study had used lay raters, did not interview the children about themselves, did not use prepubertal age specific mania items, and used an instrument designed for studying the epidemiology of ADHD. Nevertheless the message stuck. Cases of bipolar disorder were being misdiagnosed as ADHD. Given the many children diagnosed with ADHD who do not respond to stimulants, and who are already in the treatment system, this was a potent message for clinicians casting round for some other option."
Lay raters? Didn't interview the kids? That's fascinating. And then the two offer this rebuttal to Americans who complain about the DSM-IV being so rigid that of course kids can't be diagnosed with bipolar disorder:
"Another ambiguity that the framers of the American position fail to advert to is a problem with DSM-IV. Advocates of pediatric bipolar disorder repeatedly point to problems with DSM-IV that hold them back from making diagnoses. But in fact, DSM-IV is more permissive than the rest of world in requiring a diagnosis of bipolar disorder following a manic episode – in practice any sustained episode of overactivity. The International Classification of Disease in contrast allows several manic episodes to be diagnosed without a commitment to the diagnosis of bipolar disorder. The rest of the world believes it simply does not know enough even about the relatively well understood adult illness to achieve diagnostic consistency worldwide. DSM-IV in fact therefore makes it easier to diagnose bipolar disorder than any other classification system, but therapeutic enthusiasts want an even further loosening of these already lax criteria."Finally, we appear to have entered a world of operational criteria by proxy. Clinicians making these diagnoses are not making diagnoses based on publicly visible signs in the patients in front of them, or publicly demonstrable on diagnostic tests, as is traditional in medicine. Nor are they making the diagnoses based on what their patients say, as has been standard in adult psychiatry, but rather these are diagnoses made on the basis of what third parties, such as parents or teachers, say without apparently any method to assess the range of influences that might trigger parents or teachers to say such things."
And, then:
"Where one might have thought some of the more distinguished institutions would bring a skeptical note to bear on this, they appear instead to be fueling the fire. Massachusetts’s General Hospital (MGH) have run trials of the antipsychotics risperidone and olanzapine on children with a mean age of 4 years old. A mean age of 4 all but guarantees three and possibly two year olds have been recruited to these studies."MGH in fact recruited juvenile subjects for these trials by running its own DTC adverts featuring clinicians and parents alerting parents to the fact that difficult and aggressive behavior in children aged 4 and up might stem from bipolar disorder. Given that it is all but impossible for a short term trial of sedative agents in pediatric states characterized by overactivity not to show some rating scale changes that can be regarded as beneficial, the research can only cement the apparent reality of juvenile bipolar disorder into place.
"As a result where it is still rare for clinicians elsewhere in the world to make the diagnosis of manicdepressive illness before patients reach their mid to late teens, drugs like olanzapine and risperidone are now in extensive and increasing use for children including preschoolers in America with relatively little questioning of this development. Studies run by academics that apparently display some benefits for a compound have possibly become even more attractive to pharmaceutical companies than submitting the data to the FDA in order to seek a license for the treatment of children. Companies can rely on clinicians to follow a lead given by academics speaking on meeting platforms or in published articles. The first satellite symposium on juvenile bipolar disorder at a major mainstream meeting, the American Psychiatric Association meeting in 2003 featured the distinguished clinical faculty of MGH. The symposium was supported by an unrestricted educational grant. None of the speakers will have been asked to say anything other than what they would have said in any event. The power of companies does not lie in dictating what a speaker will say but in providing platforms for particular views. If significant numbers of clinicians in the audience are persuaded by what distinguished experts say, companies may not need to submit data to FDA and risk having lawyers or others pry through their archives to see what the actual results of studies look like. As an additional benefit, academics come a lot cheaper than putting a sales force in the field."
The following will be a controversial assessment on the part of the authors, at least for some who read this:
"If the process outlined here was one that could reasonably be expected to lead to benefits it could regarded as therapeutic. But given that there is no evidence for benefit and abundant prima facie evidence that giving the drugs in question to vulnerable subjects in such quantities cannot but produce consequent difficulties for many of these minors, one has to wonder whether we are not witnessing instead a variation on Munchausen’s syndrome, where some significant other wants the individual to be ill and these significant others derive some gain from these proxy illnesses."
OK, that's quite enough. What do you all think of the article and how Healy and his colleague have made their case?
I should note with a certain amount of pride that the authors note that Lilly saw opportunities for the use of Zyprexa in children back in 1997. The article's footnote (number 39) points to one of the Zyprexa documents, which was obtained from my site, as the source for their assertion.
I pass this along for what it's worth: Tom Alderman at The Huffington Post blames television for what he's dubbed the ADD generation. Does he mean Gen Y? Or Gen X? He doesn't say. While there's no doubt that both generations have been exposed to more stimuli than any in human history since a young age, I think it's a bit easy to blame the inattentiveness and ADHD of younger generations on television alone. There are just too many complex things going on at once in our culture these days--and we are supposed to be masters of them all--to hang the whole thing on the boob tube. I mean that sounds positively old-fashioned when there's so much else to blame. There's food, diet, lack of exercise, video games, iPods, Internet technologies and so on. But I guess we'll know a lot more in a generation or so. Or, maybe we'll know nothing because we have learned nothing.
Sen. Chuck Grassley (R-Iowa), the ranking Republican on the Senate Finance Committee, has been looking into the atypical anti-psychotics for a few months. Now he's asking Lilly, AstraZeneca and Janssen/J&J to provide details of how they've marketed anti-psychotics for nursing home use, despite the fact that the drugs are not indicated for use in dementia and carry black box warnings about their use in the elderly. It'll be interesting to see what he turns up. I bet it's plenty.
I'm off to take care of several things, so I wanted to pass along links to some interesting bits and pieces.
Apparently, AstraZeneca and a researcher in Texas have filed a patent application for curing cocaine addiction by using Seroquel.
The nice folks at J&J report positive long-term results in treating schizophrenia using Invega. I'm sure a few of my readers will poke through these stats and tell me just how effective it is.
Regular sleep routines help bipolars. Something I've been saying on this site like forever. Nice to see some more research on the matter.
More bad news about anti-psychotics and brain shrinkage.
John Grohol offers some kind thoughts about my recent post on whether bipolar disorder isn't in fact a personality disorder.
CL Psych on the American Psychological Association's new rules on handling funding and corporate influence of the organization.
Should Led Zepplin tour? Oh, hell yes.
My emergency fundraiser to replace the monies frozen--or stolen!--by Lord Google reached $361 last evening. Thanks to all for your kind contributions. I am trying to get to $1,200 by the end of the week, so please contribute what you can via the PayPal button on the right or by snail mail (email me for an address). I apologize for doing this so close to the holidays, but Lord Google made me do it.
For those of you who've missed out on the fun with Google, check this out. Also, we already have one entry in the "What Old Testament Prophet Does Lord Google Resemble" contest. Add your nomination today!
The fine folks at the Treatment Advocacy Center had a post yesterday about how homeless shelters and the streets have come to replace many of the former state hospitals and became de facto psych units along with jails and prisons. TAC estimates that "roughly 150,000 to 200,000 individuals with schizophrenia or bipolar disorder are homeless." (People with depression and PTSD don't count? Oh my.)
I share TAC's concern. Homeless shelters are not a place where more than a few people will ever get stable, regardless of whether they are being treated or not (keep in mind, homeless shelters have zero involuntary commitment powers over people staying at their facilities as far as meds are concerned, at least as far as I know). Many shelters are wildly underfunded, dirty and cramped. Very difficult places to sleep, according to clients I've interviewed at these places in the past. That's not a criticism of these places or the people running them--they simply don't have the resources to make things otherwise.
But implicit in TAC's concern and explicit elsewhere in its advocacy is a call for these folks to simply be redirected to a series of new state hospitals. Silly TAC: the state hospital system has not ever been nor will it ever be humane (they are far better than they once were, however). While TAC tries to play the community resources card, as if that's also an answer, whomever it is at TAC who writes these posts misses two very crucial points that continually undercut various attempts to end homelessness and end the game of cycling the mentally ill to the streets:
First, we have a treatment paradigm of anti-psychotics that is simply not working well at all, no matter how hard various advocates such as Fuller Torrey argue that black is actually white. Sorry, Torrey, but I've read the CATIE studies and I have to wonder about how deep you and your group's humanity toward the homeless really is if you insist that the answer lies in meds such as Risperdal, which the Attorney General of Arkansas alleges were defective and just as bad as bad old Haldol and Thorazine. Second, we have utterly decimated public housing in this country and that's why so many people are ending up homeless in the first place, regardless of their mental status. There is simply no safety net in our culture anymore. We simply need to build more housing for these folks. The various 10-Year Plans to End Homelessness that have been rolled out around the country in recent years simply aren't getting the job done.
For example, in Seattle we have a fairly decent network of homeless shelters. In recent weeks as the weather has turned colder, they've been turning away dozens of people each night. One shelter tells me that they've recently had families showing up looking for a place for the night (generally, families get absorbed by the system well before things reach the emergency shelter stage). It's pretty harsh out there. Two nights ago, a man in his 50s or 60s froze to death in a park a stone's throw from the Seattle Art Museum's schmancy sculpture garden and a block or so from the pricey condos of flashy Belltown.
Lovely.
I'll have more to say about homeless and mental illness in coming weeks. I am soon to start picking up part-time work as a social worker at one of the largest shelters in the country, a stop-gap thing to make some money before the writing thing picks up again after the New Year (I can assure you it's low paid work). Speaking of which, I will soon be beginning a new freelance relationship with a really good publication. More on that when things begin to jell into reality.
Hi. For those of you who missed it yesterday, I've had to begin an emergency fundraiser due to the actions of Lord Google last week (back story here for those who've missed the party so far). I am trying to raise $1,200 by week's end so that I can do things like pay my rent in January, which is what the Google money was for, but clearly Lord Google giveth and Lord Goolge taketh away. Yep, dealing with Google is like a weird mix of Kafka and the Old Testament.
The first day raised $181, which I appreciate more than I can get into. My cats appreciate it as well.
So, please give what you can. The PayPal button is on the right. For those who prefer snail mail, shoot me an email and I'll give you my mailing address.
Just for fun: what Old Testament prophet does Google most nearly resemble in its power and capriciousness?
When I was in Florida two weeks ago, one of the New College students asked how I felt about bipolar disorder and since it came near the end of a lengthy evening and is a complicated question to begin with, I punted and asked the questioner to email me. He did.
"My question was, how do you feel about the presence of BP? Have you felt that it is, in the terminology of Icarus [Project], a 'dangerous gift,' something to be cultivated and learned from (a personality trait for which this culture marginalizes you?), or is it an invasive agent to be kept at bay? Obviously the latter is how the mental health paradigm functions, which is why invasive drugs and policies are used to combat 'invasive' diseases."
This also tied in with a separate question I was asked during the Q&A: Is it possible that much of depression and bipolar disorder is, in fact, a personality disorder as opposed to a mental illness?
To start, I generally think the Icarus crew has done a great job of asking some very necessary questions around psych labels and how we view mental illness in our culture. In a way, they are picking up where the anti-psychiatry activist crowd from the 1960s and 1970s left off and giving it all a new twist, as they aren't anti-psych per se, but I think regard psychiatry as a technology to be used or ignored by people with psychological issues not as an end in itself. For those of you not familiar with the group, here's a link to an event they did at Virginia Tech recently. I think they also do a great job of coming up with apt metaphors, dangerous gift and mad gifts being two of them.
Before I answer, I should probably offer my experiences and built-in biases. I was diagnosed with manic-depression in 1989, five years before the fine madness was allegedly destigmatized in the 1994 DSM-IV by being reclassified as bipolar disorder and divided into subtypes (13 years later I am sure we all agree that the APA did an awesome job of destigmatization!). I have never been hospitalized, and I'm not sure that I have ever had a truly manic episode except perhaps short-lived ones. I've taken something like 18 different meds over the last 18 years and have ended up having bad reactions to most of them--suicidality, TD and EPS being among my reactions to the meds. At one time, I was on four meds at once. Somehow, I got it all down to one med in 2005 and this summer I got off meds altogether. After 18 years, that feels like a miracle, one I definitely wish upon others. I had an interesting chat with my own psychiatrist yesterday about what doing well off-meds--as I am doing despite very high levels of stress in my life that in the old days would've had me in panic--means for me in terms of a diagnosis. I didn't like his answer. More on that in a minute.
My point is that what I am throwing around here is what I know, punched through a deep set of personal biases, and should be considered in that light. I am doing that very scary thing: thinking out loud in public.
Which brings me to a larger point. I think bipolar disorder can be a personality disorder--and, nitpickers be warned, I am using the term very broadly--more often than it is a mental illness. I mean this both in a population-based sense and in an individual sense. I cannot prove this assertion by way of studies or surveys done by well-regarded academics. Most of the studies and surveys done on the question of long-term outcomes for people with bipolar disorder never ask about how well people are actually doing but lean to asking "How messed up are the bipolars?" and look for the answer in terms of economic units, hours worked, dollars earned, and whether we are even the slightest bit subsyndromal. Nice that a medical specialty with soul as its root word is more interested in how we interact with the economy than with how we are in our souls.
Ron Kessler at Harvard, a psychiatrist and public health muckety-muck, has turned this whole question into a cottage industry. He thinks bipolars are losers for life, victims of mood and brain who'll never amount to much. But his is an extreme view--he also claims 50 percent of America is mentally ill--so it surprises me that it carries so much weight within the mental health industry. Views like his largely control what doctors are told and how they are trained, how patients are instructed to view their diagnosis, how advocacy groups such as NAMI, MHA and DBSA talk about bipolar disorder, and how society views us in general. We are manic and crazy all the time or depressed and suicidal. And everyone knows it because that's all anyone ever bothers to talk about. And it sure leads to all sorts of visual riffs on websites a la the Greek tragedy and comedy masks.
Which is just so annoying on so many levels. Research I've read plus what I know from years of talking to doctors and other patients leads me to believe that most people diagnosed with bipolar disorder are subsyndromal the vast majority of the time. That means instead of meeting definitions for mania or hypomania or major depression, they might have one or two of the symptoms but not anything approaching the full disorder. This seems to be true whether someone is on or off-meds (I'm not sure why that is either). Depression--and here I am not discussing major or clinical depression--is widely known as having a huge personality component. That's likely why CBT and other psychological therapies are largely as successful as anti-depressants in treating depression (someone get Aaron Beck his Nobel Prize now) over the long-term. (Keep in mind that therapy doesn't work particularly better than anti-depressants. It just has fewer side effects.)
Mania itself--and here I mean the bad old wild delusions, hallucinations and declarations of Godhead mania--is not a personality disorder. When it's in full flower, mania is straight-up insanity. If you've ever seen it in someone else (and I have), it's pretty obvious. The good news is that bipolars are only fully manic very infrequently. The other features that make up a manic episode according to the DSM (lack of sleep, increased energy, pressured speech, hypersexuality, spending sprees, irritability, risk taking and so) are clearly behavioral and personality issues, at least taken in isolation. The same goes for hypomania.
I know I am going out on a limb here that someone will likely chop off for me, but I believe that much of what we call bipolar disorder is in fact a personality disorder or constellation of behavioral issues. That's why I am so opposed to diagnosing kids with bipolar disorder and why I am so against the long-term use of anti-psychotics in treating bipolar disorder. In the latter case, it's like using a nuclear bomb to clear a field of stumps.
I do think--as the questioner asked--that these personality issues are used by society and the medical industry to marginalize humans and to engage them in a treatment paradigm that can serious consequences. I'm not opposed to the short-term medical treatment of bipolar disorder (provided it's done without the use of anti-psychotics except for brief periods) and am certainly not opposed to free individuals making their own choice about what kind of care they want, but at a certain point people have still got to come to grips with themselves and who they are and what their lives are about. There isn't a medication or drug in the world that can do that for you. You have to do that for yourself.
I regard bipolar disorder as more of weird gift than anything. Sure, it carries with it all manner of things "normal" people find annoying--but maybe that's their problem, especially among prog-libs who are always screaming about accepting diversity in our culture--but so what? There is so much genius and creativity associated with bipolar, be it a mental illness or personality disorder, that you'd practically shut down Western Society, the recording industry, the publishing industry and so on if bipolar were eliminated one fine day. The question is what an individual does with bipolar disorder: reach for the stars or reach for the Seroquel?
Speaking of Seroquel, I got this wonderful email from AstraZeneca yesterday since I signed up for their Seroquel email service:
"Mood disorders such as bipolar disorder are thought to be the result of chemical imbalances in the brain. While the exact causes are not known, there is one thing we know for sure: Your mood disorder is not your fault. Bipolar disorder is not caused by a character flaw or weakness. It is an illness that affects the brain and requires appropriate treatment by a qualified health care provider."
Wow, thanks for your help, AstraZeneca. Glad to see you guys are as interested in my soul as much as my psychiatrist is.
Speaking of psychiatrists, I saw mine yesterday as I do every two months or so. Despite being off-meds at his urging, I continue to see him just to be on the safe side. But I'm beginning to wonder how safe that side is. You see, I've had almost two years of not just being subsyndromal, but of being virtually non-syndromal and the last five months of that has been without the aid of medications of any kind and so I had to ask him if I even passed muster as someone with bipolar disorder anymore. His answer discouraged me.
"Once diagnosed, never undiagnosed. But once diagnosed, not always symptomatic."
We talked about this and my original diagnosis in 1989--that was eight psychiatrists ago--and how I think I never was anything more serious than perhaps a bipolar 2, but I was diagnosed in the days before bipolar 2 existed. We talked about bipolar disorder as a personality disorder and how that may be far more applicable to someone like me than the big old ugly diagnosis of bipolar disorder 1, manic-depressive and mentally ill. It became clear to me after a few minutes that there was no budging my doctor on his view of once-diagnosed, always-diagnosed. So I told him something.
"What's the point of treatment and going through years of agony and finally getting vastly better only to be told that there is no goal line I can possibly cross that will lead to me being undiagnosed?"
He didn't have an answer for me. Our appointment was over. But my concerns are not. How is it that I can go along with the rules of the mental illness paradigm for almost 20 years and actually meet almost every conceivable endpoint of recovery and still be told I have the disorder? That doesn't strike me as fair, logical or particularly humane. In fact, I am feeling rather screwed over by this whole process that has consumed my entire adult life. What if we, as a culture, told that to cancer patients? Would there be a movement of cancer survivors? Or would their be hoards of former cancer patients huddled in the corner, well but still diagnosed? You know the answer: we'd never stand for that.
I think it's high time we started examining what personality issues psychiatrists might have--and if you know anything about the history of the DSM, you know they have loads of issues of their own--and began a push to stop this nonsense of labeling people for life. Oh wait, there's already a movement like that. Is it any wonder it's had little success given that even fairly humane docs such as mine buy into the Dx'd for life nonsense and that there's a $250 billion industry very interested in keeping people like me sick for life even when I am more well than most normal people I can think of?
Or is it a symptom of mental illness that I am asking?
Nice essay here by Gwen Olson on her years as a pharma rep and her role in pushing a dicey anti-inflammatory drug (Suprol, a J&J drug, later recalled) on docs that later had many adverse events associated with it. As I once did, she also worked for Abbott Labs among others. The essay is a good read.
"Little did I know at the time, one of the doctors who had reported an adverse event, which eventually resulted in death due to dialysis complications, was in my territory. I was later contacted and instructed by management to have my doctor complete an Adverse Drug Reaction (ADR) report. Much to my surprise, the doctor referenced in my instructions was the Late Adopter/Skeptic, who had promised me his “most difficult patient” against his better judgment. Even more startling would be the discovery that the patient had been his very own mother. Of course, I didn’t find that out until I visited him to do the ADR. (By the way, the ADR was a daunting ream of paperwork that appeared to be designed to discourage busy doctors from reporting. That reporting process has since been streamlined online with MedWatch.) I will never forget the betrayed look on his face or his terse remark to me that “the company’s marketing strategy had obviously been more thoroughly tested than our drug!” I was devastated and riddled with guilt. I didn’t call on his office again for nearly six months. I didn’t have the nerve!"
Once when I was a sales rep for Abbott Labs--I sold cardiac catheters and pressure transducers for Abbott Critical Care--I had a cardiac surgeon scream at me that "You killed my patient!" He'd floated one of our catheters into the heart of a patient who soon developed ventricular fibrillation, went into cardiac arrest and couldn't be revived. I did exactly as told in sales training: I stood there and let the doctor scream at me, then told him I would turn the situation over to my sales manager.
I'll never forget his response: "Your boss isn't going to help that patient. She's dead."
Pretty rough all around. I was 25-years-old at the time, hired by Abbott because I was "smart, articulate and you look good in a suit," as one of my bosses once put it. In reality, the catheter likely hadn't caused the v-fib, but I'm sure it didn't help and the doc sure needed someone to unload on. That someone was me.
Back in early October, I held a fundraiser on this site which raised $2,200. I was gratified by the outpouring then, and had planned not to do another fundraiser until sometime in January. I had enough monies slated to be paid to me by Google at the end of December for clicks to ads on my site in the previous four months to help cover me in the meantime.
Unfortunately, Google canceled my Adsense account out of the blue last Tuesday--no warning, no nothing--after my site saw a large upsurge in ad clicks on Monday, Dec. 3. The back story is here. Google will not be paying me the $600 they owe me unless I somehow manage to get my account restored by proving to them that...well, I don't know what I am supposed to prove to them since Lord Google doesn't tell you what it needs to know and I am not web literate enough to know what to give them in the way of data to prove my case. All I know is that I am out a significant amount of money due to no fault of my own and Google is unwilling to work with me to resolve the situation.
Over the weekend, I heard from several bloggers who'd been similarly screwed by Google. Two managed to get their accounts restored after several weeks of appealing to Google, the others basically gave up and moved on. I have too much money at stake--not to mention all the principles at work here--to walk away from this and will continue to hound Google until it pays me what it owes me. That could take weeks or months and the outcome is highly unpredictable.
Until then, I have two favors to ask readers. One, if any of you are well-versed in websites, could you please contact me directly and help walk me through how I can use my site stats package to prove to Google that none of this was my fault (unless of course they are cutting me off over content in which case it is my fault!). Over the weekend, I became convinced (at least to the degree my ignorance allows) that my site had been the victim of one of those distributed attack thingys wherein some other site puts up a malicious script and goes off banging on others sites' ads hundreds of times. Somehow the other site makes money off this. I don't understand how that works (and I am not even fully sure that's what happened), so I am truly hoping that someone who reads this will reach out and help me. I have already appealed my case to Google once and been turned down, but then I don't even know what terminology or data to use to satisfy Lord Google that I didn't do anything to endanger its advertisers.
Two, I am now doing an emergency fundraiser to replace the money Google owes me and to give me a small cushion above that. I hadn't planned to ask readers for money until sometime in January, but I've got no choice and need to ask for your help now because reader traffic will absolutely plummet next week through the end of the year. That said, I'd like to raise $1,200 by the end of this week so that I can go into the holidays with some level of security that I won't be evicted from my apartment come the New Year. Seriously, my little go-round with Google has put me up against the wall like that.
There's a Paypal button on the right. Or if you prefer good old fashioned snail mail, then shoot me an email and I'll give you an address.
I apologize for having to do this at all, especially right before the holidays kick in, so just keep in mind that Google made me do it.
OK, this is weird. There are hundreds of reports of suicide, suicidality and depression connected to the stop smoking drug Chantix (Champix elsewhere) among people who've taken the drug in the US. They've been reported to the FDA, which presumably will act upon them once it's gotten off its butt and its lawyers and Pfizer's lawyers have had nice little go-round, or however it is the game actually works when a newish drug is under a safety review. Meanwhile, Australia's Therapeutic Goods Administration (their FDA) has already acted before Chantix even goes on the market in Oz next month. According to this press account, the TGA is using the same reports that were submitted to the FDA. So far, the FDA isn't doing much to safeguard the American public and, to be honest, neither is the media in this country (outside of some smart coverage in the Dallas area).
The TGA will require Pfizer to add a warning to the drug's packaging advising of links to suicidality in users of the drug. It's also making the company send a Dear Doctor letter out as well. That's something that needs to be done in this country, as I noted last week. Or does the FDA want another Zyprexa situation where in 2002 the Japanese government required Lilly to 'fess up about diabetes and hyperglycemia and the FDA sat on its thumbs for another two years? Has the FDA learned from that experience? I'm beginning to think not. Apparently, the FDA thinks it's OK for Americans to die so that Aussies can be properly warned, as opposed to using the evidence to address the need where it's greatest--you know, in America.
As for Pfizer, one wonders when they are going to get smart and get ahead of the game by addressing the drug's problems now instead of later. I'm still waiting for some answers.
ABC News had an interesting piece last week in which counselors working with Iraq vets with pain, PTSD and depression issues accuse the military of overmedicating troops. In some cases, soldiers are ending up addicted to painkillers. Here's one soldier's experience:
"Spc. Alan Hartmann, a helicopter gunner in Iraq, was also prescribed a laundry list of antidepressants and painkillers to treat his emotional and physical pain after returning to Fort Carson."'They put me on some medications that caused me to flip out and do some pretty crazy things,' says Hartmann. 'It's just, the medication just kind of took over.'"
It's the height of disrespect and flat-out stupid to think we can medicate away the pains of war--short-term maybe, long-term no way--and it's interesting that one former Marine has turned to medical marijuana to treat his PTSD. Yes, there is actually research done by the Israeli Army showing that pot is useful for PTSD.
Speaking of marijuana, since soldiers have virtually zero access to weed or alcohol while in Iraq, a couple of Iraq vets I interviewed a few weeks ago told me that the most common prescription drug that soldiers like to zone out on in Iraq is Seroquel. "It's easy to get," one told me. As people do stateside, soldiers crush or chop the pills and then snort them.
War is hell.
I'm glad to see that smaller papers are poking into questions around diagnosing small children with mental illnesses and giving them medications that don't perform well for adults and are damn near unresearched altogether in children. Here's what the Rochester Democrat & Chronicle found among its area's foster children:
"In 2002, about a third of the county's foster care population, 327 children, were prescribed one or more common psychotropic drugs. By the end of 2006, the number had increased about 40 percent to 457 foster children, or almost half of the county foster care population....2006 records show that more than one of every eight foster children in Monroe County is on some kind of drug to combat psychosis, a severe form of mental illness characterized by lost contact with reality."
How much you want to bet that the kids on anti-psychotics aren't schizophrenic--an extremely rare condition in small children--but are being diagnosed with alleged child bipolar disorder and ADHD? On what medical grounds are docs medicating these children with anti-psychotics? American's struggle to silence its rowdy youngsters, foster kids or not, seems to be as out of hand in the Rochester area as anywhere else.
The details of all of this are wild: "a 1-year-old foster child was prescribed the antipsychotic drug Risperdal, and two 4-year-old foster children were prescribed Depakote." A 1-year-old on Risperdal? That's insane and amounts to child abuse in my mind. Keep in mind the kid would barely be old enough to walk and likely isn't even speaking, so how would a doctor legitimately diagnose them with anything and then stick them on what the Arkansas AG alleges to be a defective drug?
Fortunately, not all the docs in the area are playing along with the Harvard bipolar child mafia's playbook:
"'I have no doubt that many, many kids are overmedicated,' said Dr. Martin Irwin, a Syracuse-area psychiatrist who has been contracted by counties and treatment centers around the state to help decrease the use of psychotropic drugs for foster children."'It's out of control in general, but the worst problems are in foster care because there's basically nobody advocating for the kid.'"
Read the entire article, which is quite well done, for more.
To be fair to the other side, here's one parent who seems perfectly happy to have her child on Abilify and asks an interesting questions about the Abilify TV ad.
I wanted to thank all of you for the kind support, suggestions and so on you've offered during my little go-round with Lord Google. I plan to switch to another ads vendors soon, but plan to continue pressing Google to pay me the $600 they owe me. I am apparently far from the only blogger who has been jammed up by Google in such fashion. Most of them give up and slink away, but the ones who've fought back have eventually gotten their accounts and monies restored. It takes quite a while though. This whole dealing with Google thing is like the whole reading Franz Kafka thing in college.
Many thanks to the following for linking to my initial post on this situation:
And especially to two bloggers who basically canned their Google accounts over my treatment. Thanks to Soulful Sepulcher and Tenuous At Best.
To those readers who've written to ask how do I make a go of this site without Google ads, the truth is I haven't seen a penny from Google yet. They cut me off right before my first check was set to go out. But I also pull in money through reader contributions, which is what that the PayPal button on the right is about. Readers are so much more reliable than big companies like Google.
So I was minding my own business Tuesday morning when I got an email from Google Adsense telling me they were disabling the ads on my site and my account with the company. Their explanation went:
"Hello Philip Dawdy,"While going through our records recently, we found that your AdSense
account has posed a significant risk to our AdWords advertisers. Since
keeping your account in our publisher network may financially damage
our advertisers in the future, we've decided to disable your account."Please understand that we consider this a necessary step to protect the
interests of both our advertisers and our other AdSense publishers. We
realize the inconvenience this may cause you, and we thank you in
advance for your understanding and cooperation."
There had been a large uptick in ad clicks--as I think they are called--the previous few days, taking me from about $15 a day in average revenue from Google ads to a high of about $30 a day on either Sunday or Monday. I don't know what day that was since Google won't let me look at my stats anymore. So there was an email from Google saying I was up to no good, see ya' later, dude. Had I been going onto my own site and clicking ads? No. Had I had any weird, unusual patterns of traffic to my site? None.
The big uptick in clicks on my ads was the result of a lecture I gave at a college in Florida last week as near as I can tell, but there's Google treating me like I am some spam blogger sitting offshore creating phony porn blogs and hair treatment sites to milk Google's ad dollars. I don't like that insinuation very much since I've played by the rules right down the line since I put up their text ads in August. Also, I've been playing by the rules of the Web 2.0 for over two years...and this is what I get?
This is how Google and all the other twerps in the Bay Area are making the new media? This is how they are monetizing the Web? By cutting off legitimate content providers when they have a sudden uptick in popularity and leaving them in fear that they can't make next month's rent while the founders and CEOs of companies like Google fly around in private 767s and their wives are out playing tennis and their employees get free transit to work and free meals in the office? If so, take me back to the days when newspapers will still linotyped. Because this is nonsense and has some obvious implications for others who provide content on the 'Net: Don't you dare get popular. But more on this nonsense in a minute.
I appealed Google's action, giving them my best guess as to what led to the click increase (I couldn't detect any malicious hacking as some readers had suggested), and the company has already exceeded its own 48-hour response time. I've contacted the press office twice and have gotten no reply.
OK, Google, it's time for some Adsense customer feedback, and since you are not responding to my queries, then you are going to get it right here. Your customer service stinks. Your press office is useless. Dealing with your company is like talking to a black box. Your monitoring algorithms are set way too tight. You seem to be a company run by computers and not humans, and if there happens to be a human being working at Google, then give me a call. You owe me at least $600--for accumulated clicks from August through November that was to be my first payout from Google at the end of December--and you owe it to me pronto. You also owe me an apology for treating me like a scab. You guys are the ones making billions off the original content of others such as my colleagues in the journalism business and your values for how you reward content providers seem to me to be a bit out of whack--because as near as I can figure you guys cut me off over a lousy $40 o