January 30, 2009Doctors Not Monitoring Vast Majority Of Patients They Are Slamming With Dangerous Atypical AntipsychoticsThis paper (pdf here) in the American Journal of Psychiatry should be a big wake up call to patients (your doctor simply isn't very thorough or doesn't have the time to be thorough) and doctors who prescribe atypical antipsychotics, a class of drugs that is well-known to cause diabetes and heart problems. That's because this study asserts that patients getting these drugs are barely being monitored for either blood glucose or lipids. Roughly 10 percent of patients got lipids monitoring and about only 20 percent of patients got blood glucose monitoring. Outrageous. I've long contended that psychiatrists are routinely lax when it comes to their patients' physical health (not once when I was on these awful atypicals did a doctor inquire as to my body weight or lipids, even though it was obvious my weight was ballooning on these drugs) and I'm sure some folks thought I was excessive in my assessment. Looks like some doctors agree with me. Said lead study author Dan Haupt of Washington University (St. Louis): "'Possibly many psychiatrists do not feel comfortable performing metabolic monitoring, because they were not trained to consider the effects of mental illness and treatment on the whole patient, and many practice in environments that are physically separated from the rest of the healthcare system,' he said. I could care less whether or not psychiatrists feel comfortable performing such monitoring, they absolutely have got to do it if they are going to give patients these drugs and patients should demand such monitoring or tell the psychiatrist to go take the drug for themselves and see how it all work out. It's worth noting that one of the study authors is John Newcomer of Washington University (St. Louis). It was he who back in 2004 was a consultant to Eli Lilly and had some thoughts about the company's attempts to discount links to diabetes for its drug Zyprexa: "Lilly is playing a language game with the FDA pronouncements. Because the FDA class warning is about diabetes, Lilly can claim that there is no direct link with diabetes--which is true in one sense. But there is a direct link with weight gain, visceral fat, insulin sensitivity, and thus diabetes, stroke, and myocardial infarction. So while Lilly is technically correct, this is whitewash. They are, however, doing an outstanding job of politicizing and language games." This news brought to you courtesy of the Zyprexa documents, which Rolling Stone apparently used in reporting its recent lengthy story on Zyprexa, but didn't attribute to the appropriate source. They are just referred to as "internal documents" in the article, completely ignoring the very substantial risks some folks went to to make those documents public. Yes, the RS article is now online and I've read it. I want to re-read it before deciding whether to take out a plinging gun or a .50 caliber machine gun. Despite giving the reporter loads of help for his story and going unmentioned and unattributed, one thing I'll tell you right now is that the article is entitled "Bitter Pill." Ironically enough, last year I wrote an article for Willamette Week on how negative anti-depressant clinical trials data had been suppressed for decades. The article's title was "Bitter Pill." While article titles are up for grabs, it just charms me beyond belief that RS chose, coincidentally I'm sure, a title I'd already used. Classic. Posted by Philip Dawdy at January 30, 2009 12:05 AM
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Re RS: Sue. Posted by: Lilly NC at January 29, 2009 09:46 PMI'm glad you've been able to see what we all did re: the RS article. They missed the boat with the "internal document" reference, missed the place to refer to this website for exactly what they are and the profound importance of what the documents mean to consumers. The first thing I was shocked to see, frankly was the title "Bitter Pill". I sat back and thought, Oh no, wait until Philip sees this. I'm sorry your valuable knowledge was abused for this article, after reading here for 3 years and following intensely the "Zyprexa Chronicles" it was a smack in the face to see "Bitter Pill" used and the info snagged in such a way. It's time to move on from Zyprexa, hold your ground firm with taking AstraZeneca to the carpet...they are next up to bat and I am sure someone has internal documents waiting to be added to the public viewing, their off-label use, pharma rep promotions etc. are over the top, and now that XR is entering the market for depression and anxiety this will be another example of marketing antipsychotics as benign drugs, when in fact they are deadly chemicals. Screw Rolling Stone. (I get it in the mail from a college student subscription that expires soon, one thing that's been great about it is the DTC ads for Abilify I was able to use in articles I write on my blog; way to go RS, pharma, sex, rock and roll. What the world is running on. Posted by: Stephany at January 29, 2009 11:05 PMI'm just relieved they put it in the Politics section. This is from pp 8: But the new markets only served to amplify the drug's side effects. If schizophrenics gained more weight than they were supposed to, Stovall points out, no one really complained — schizophrenics, after all, have bigger problems to worry about. "But if you've got your soccer mom who comes in, and the doctor gives her Zyprexa, and suddenly she goes from 110 pounds to 200 pounds — well, it could be a problem." We don't get to partake, that's not what schizophrenics are for. I have no words. Posted by: flawedplan at January 30, 2009 03:36 AMWhat this report proves is that psychiatrists are not the healing doctors they claim to be. What part of the body is the psychiatrist treating? How can the individual and collective psychiatrist be so delusional about the physical health consequences in their patients to the chemicals they prescribe? The psychiatrist is the single judge for applying chemicals to the mind and body of their patient. The psychiatrist weights the cost benifit ratio, not the uninformed patient. The psychiatrists power is too great. There is no doctor advocate for the physical health of the patient to counter balance the need for psychiatric pharmaceuticals. The 25 year shorter life span of the seriously mentally ill is unjust. Why would the early death of the seriously mentally ill change? No reason here. No one knows or cares about it. And the psychiatrist has no shortage of new patients as more and more percentage of the population are being judged mentally ill. I guess the answer would be a group of psychiatrists that would reverse the trend of increasing mental illness. But they wouldn't have billions of dollars (in pharma Co $) behind them to support their efforts. Posted by: mark p.s.2 at January 30, 2009 05:26 AMMy biggest gripe against psychiatrists is the fact that despite their hollow credentials as MDs, they are the least likely group of "helpers" in Mental Health Land to deal with anything physical. This includes a discussion of side effects and withdrawl. And let's not forget menopause, hypothyroidism and Vitamin D deficiency in my case. Treating the latter two conditions has cured my depression. But I'll never get back the 25 years of lost earnings, self respect and dignity. I'll never be rid of their silly, stigmatizing, damaging labels, either. Heck of a job, Drs. Brownie. What a bunch of losers. Posted by: Sherry at January 30, 2009 09:15 AMThe way that it was explained to my by my Psy-doc was that was what I had a primary care doc and endocrinologist for - to manage the physical side effects. Posted by: Stiff Man at January 30, 2009 12:06 PMIn the Medicaid system (biggest pusher of atypicals) psychiatrists don't even have a SCALE. Referrals to primary care are RARE. And in 2001 referrals for blood glucose were ZERO. As long as we're thinking t-shirts, how about something special for this profession? Could be a busy print loaded with one each of all the freebies handed out by Pharma? Or another print just loaded with psyc. pills all over it? Or just the big letters FAKE DOCTOR? I'm sure there are other ideas more creative than mine. These just come to mind. Posted by: Sorrowful at January 30, 2009 01:37 PM"Dan Haupt of Washington University (St. Louis): What a crock of shit. They're not comfortable performing metabolic monitoring? They don't know how to order labs? Weigh the patient? Get the patient's blood pressure? If they're giving out drugs that make people fat, then they need to make sure this is being monitored. If they're not going to do it, then at least refer the patient to a physician who can. Posted by: Lisa at January 30, 2009 04:51 PMFAKE DOCTOR? I'd buy one right now! Posted by: Paul at January 30, 2009 06:01 PMre"If they're giving out drugs" The doctor has to fix those unbalanced brain chemicals you know? Alot different situation from the street illegal-drug dealer, where consumption is totally voluntary (in the start). Posted by: mark p.s.2 at January 31, 2009 03:37 AMHave you contacted the writer and RS and directly asked WTF? Posted by: Andrew at January 31, 2009 04:06 AMDr. Newcomer is scheduled to speak at the NAMI convention in July in San Francisco: Here's his presentation: Addressing Metabolic Syndrome Metabolic syndrome – a set of risk factors that includes obesity, hypertension, and unhealthy lipid levels – that can lead to heart disease and/or diabetes. Research has shown that some psychiatric illnesses tend to predispose patients to metabolic syndrome, and its is considered a major risk factor in depression and other mental illnesses. Some psychiatric medications can also heighten susceptibility to metabolic syndrome. This presentation will present the latest scientific research into the relationship between metabolic syndrome and psychiatric illness, its impact on the lives and lifespan of people with mental illness, and what we can do to prevent it. Sounds a great deal more mealy-mouthed than his reported remarks in the internal Zyprexa documents. Wonder what he'll say? Can we get Phil in there on a press pass? Back to t shirts and demos for a sec. I have one vote for FAKE DOCTOR (should it say PSYCHIATRIST on the back?) The big white cotton ones, inscripted, look like they are 14.95 at Cafe Press. Any other suggestions? Pharmas = Death? Get Pharma out of Congress? Big Pharm to Jail? PSYC DRUGS KILL? Looks like Cafe. Press will print up even a few of one kind, as long as you tell them what to say. I see these handy for any demo, especially my dream of another such event at Lafayette Park. And I'd be happy to buy a bunch and send them out if you send me a check. Posted by: Sorrowful at January 31, 2009 11:04 PMI work in the MH system, I am a person in recovery, I work along side case managers Psch Doctors and the RN's and its not in the Case managers offical training to be alert for these issues. O.k Raymond Re: "Research has shown that some psychiatric illnesses tend to predispose patients to metabolic syndrome" Interesting. I guess that's how they justify the risks. When convenient, the "illness" was putting the patient at risk anyway. I just read the Vyvance (ADHD Med) label which said; "Aggressive behavior or hostility is often observed in children and adolescents with ADHD, Sorrowful, I've been really obsessing over t-shirts... Normally, I confine this to Harley-Davidson t-shirts, but I simply must have a FAKE DOCTOR shirt. Fantastic idea - kudos to Sorrowful!! I wonder if Philip ever considered selling a few Furious Seasons items? T-shirts, coffee mugs, dildos, etc... I'd certainly buy at least one of each. Paul, the FAKE DOCTOR! Posted by: Paul at February 2, 2009 01:24 PMWith most psychiatrists (other than Paul) being so desperate to be considered "real doctors," I would think they would jump at any chance to lay off the "biological brain disease" bullshit and do some archetypically doctorly things like weigh people, puff up those blood pressure cuffs, and order lab tests. Posted by: UnderTheThresher at February 2, 2009 05:21 PMRaymond, One of the problems with monotoring is that it requires more often office visits or playing phone tag, both of which are infefficient. We've been using an on line service www.housedoc.us, to keep closer tabs with our patiets. Its free, HIPAA compliant, and easy to use. Its an example of how technology can be used to solve these types of problems. Posted by: George at February 7, 2009 01:48 PMPost a comment
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