This is definitely not good news for the Senate health care reform bill, which I still cannot find a working copy of (yes, that is weird):
"The report, prepared at the request of Sen. Evan Bayh, found that those obtaining insurance on their own or through the government-run exchanges could expect to pay 10 percent to 13 percent more for insurance in 2016 than they would under current law. In dollar terms, in 2016 an individual policy would cost $5,800 and a family policy would cost $15,200 if the Senate bill were enacted, according to the CBO, compared with $5,500 and $13,100 under the status quo."
I thought this bill was supposed to be lowering costs. The fact that insurance bought through government exchanges would cost more than private insurance certainly makes me skeptical of the package as a whole. With analyses like the above coming to the fore, I bet it's going to be even tougher for moderate Democrats in the Senate to support this legislation.
Stay tuned.
I'm intrigued by these press accounts that keep cropping up concerning parents turning to medical marijuana to address their children's autism irritability. From what I gather, it's pretty clear that these kids aren't responding to atypical antipsychotics such as Risperdal and Abilify, both approved for autism irritability and the parents are turning to marijuana out of desperation. The pot is usually ingested as opposed to being smoked.
In the most recent account I've run across, a mother claims that medical marijuana saved her son's life.
I doubt very much that any of us in California who voted to legalize medical marijuana in 1996 (I still lived in my native land then) had any idea that the day would come when kids would be ingesting pot for autism and, even more unexpectedly, ADHD. We thought it would all be about helping AIDS and cancer patients and people with glaucoma. But if pot works for autism, then it works for autism. And for people who are concerned over giving kids pot, I'd remind them that the antipsychotics used on these same kids are well known to cause all manner of health problems.
It sure would be nice to see some research on all of this--a Risperdal versus pot clinical trial--but as things stand now the feds will never permit it.
Eli Lilly today announced that the FDA has approved its anti-depressant Cymbalta as a maintenance treatment for generalized anxiety disorder. That marks the sixth indication for the multi-billion selling drug, which is also approved for use in depression, anxiety, fibromyalgia and diabetic neuropathic pain.
After the weekend, the winter fundraiser stands at a total raised to date of $910 from 21 people. And that leaves $3,090 from 79 people to go to reach the overall goal of $4,000 from 100 people by sometime around December 18th. Thanks to everyone who's contributed to date and is helping to support work that is not elsewhere in the mainstream media, not often at any rate. And it'd be great if this is the week the fundraiser really picks up and begins its inexorable march towards reaching its goal.
If you'd like to contribute, the PayPal button is on the right. Or if you prefer snail mail, send me an email and I'll send you my mailing address.
I'll back later in the morning with more posts.
I know quite a few readers had a very strong, negative response to a New York Times article on Friday which examined psychosurgery--or brain surgery for psychiatric issues--because it showed up on the front page of the paper and to some seemed like promotion of latter-day lobotomies. I disagree. And let me state from the get-go that I am not a fan of the various psychosurgeries out there. They are fraught with tons of risk, the outcomes are unpredictable and sometimes people who undergo the techniques wind up with little relief or permanent brain damage.
I think Ben Carey's article captured that pretty well and also captured the extreme desperation some people with OCD who are willing to try psychosurgery after anti-depressants and psychotherapy have failed and they are essentially non-functional from the disorder. He got into how psychosurgery is pretty tightly controlled by the medical profession and how it is voluntary for the patients. These aren't the days of forced, involuntary lobotomies and I don't think there was anything in the article to raise the specter of those days returning. Still, I do get where people would respond strongly to such an article. I think any journalist who's thoughtful knows that simply writing about a controversial topic can seem as if you are promoting one side or another of the controversy, even if you're writing a fairly neutral, dispassionate piece such as Carey did.
Besides, Carey has no control over where the article appears in the paper. That's a decision made by editors a few rungs above him just as it always has been for me when I was at a paper. Besides, it's good for Carey internally to have an A-1 story and I suspect people who know his work have enough respect for him to want him to do well and do other fine work in the neuroscience and psychological realms.
What does fascinate me is how many of these psychosurgery cases seem to be connected to people with OCD, very severe disabling OCD. I've seen some of these cases firsthand--there's a man who lives in my part of Seattle who has literally dozens of restraining orders against him because his very severe OCD leads him to repetitively harass people very aggressively, especially women--and it's so painful to watch that I cannot describe it. If someone like him has been through various rounds of psychotherapy and meds and is in a position to consent to voluntary neurosurgery (and knows the risks), then I wouldn't want to stand in their way. And just to be clear, I am talking about adults, not children or teens.
I feel the same about the various depression treatment devices that have hit the world in recent years. While I think the jury is still very much out on the vagus nerve stimulation system, deep brain stimulation and transcranial magnetic stimulation, if someone wants to try it, then go for it. It's their brain after all.
I just wanted to do an update on where the ongoing fundraiser is at following the holiday and the tumult of last week. Since last Monday, $465 has come in from 13 people and that brings the total raised to date to $910 from 21 people. And that leaves $3,090 from 79 people to go to reach the overall goal of $4,000 from 100 people by sometime around December 18th.
I truly appreciate the contributions that have come in to date, especially since it was during one of the most trying stretches I've ever experienced in my personal life.
If you'd like to contribute, the PayPal button is on the right. Or if you prefer snail mail, send me an email and I'll send you my mailing address.
So late this morning I was walking across the parking lot of a drug store in my neighborhood, when a woman who lives in my apartment building shouted for me. She was holding a large orange cat and standing next to a trash can. She told me that she'd just tossed an empty cigarette package into the trash, heard a cat meow at her, looked back in and found this orange cat trying to get out of the can, which is fitted with a slotted roof-like structure. So she lifted him out and was basically staring at me going "Like what the Hell?"
We walked back to our building and took the cat into her apartment. Kitty was pretty freaked and we discussed whether he'd been dumped by some idiot or gotten into the can some other way. I printed up "Found Cat" signs and stapled them to a few telephone poles in the area and also posted an ad on Craigslist. The cat, a sweet 25-pounder who I soon dubbed "Oscar," hung out at my neighbor's apartment. She has a cat already and can't have another, so we both hoped whomever owned the cat would run into one of the signs and that this wasn't a dumped cat.
Fortunately, around 2.30 pm my neighbor's phone rang and the owner was on the other end. She came over soon to retrieve her cat named Boots, who'd somehow gotten out of her apartment and into the street that morning. Lucky woman, lucky cat. No word on what Boots was chasing into that garbage can. Possibly one of his nine lives. I'm glad my neighbor and I were able to help him out.
There's so much odd karma for me around cats lately. I know of two friends of mine who've had to put down their old cats in recent weeks and I know three other people who are all on the verge of having to do the same thing with their old cats. That's a very odd convergence.
I'll apologize for not offering hard numbers, but I've been too rattled to keep on top of the fundraiser the last couple of days. As on Monday, about $100 came in yesterday from three people, so the fundraiser has pulled in about $650 to date from about 12 people. That leaves about $3,350 to go from 88 people to reach the overall goal of $4,000 from 100 people somewhere around December 18th. Thanks to all of you who've contributed so far.
If you'd like to join them, the PayPal button is on the right. If you prefer snail mail, send me an email and I'll send you my mailing address.
I suppose I've been expecting some news along these lines concerning the accused Fort Hood shooter, an Army psychiatrist. The Wall Street Journal is now reporting:
"Maj. Hasan's lawyer, John P. Galligan, separately said he was considering an insanity plea for his client. 'Based on my preliminary assessment, it's very clear that mental responsibility issues will play a very important part of the case,' he said in a telephone interview."
If Maj. Hasan has mental health issues, then it might certainly bolster the case some readers have made that they suspect he was on anti-depressants and that those may be connected with his behavior. I have my doubts, but we shall see.
The other thing is that if Maj. Hasan had problems, then why didn't his psychiatrist colleagues pick up on them and push for a fitness-for-duty evaluation?
I appreciate the literally dozens of kind comments that have come in about the passing of my cat Katie (and her appearance on the Cat Blogosphere). 2009 has been a very bad year for me, ranking right up there with 1978 and 1988 as the worst year of my life, and this November has been unusually bad in an unusually bad year. A woman I was dating who I'd just gotten to the relationship point with bailed out on me on November 1 (it was her not me, I assure you) and at 2.30 a.m. this past Saturday I was twice pushed down a flight of stairs in my apartment building by a couple of very drunk, drugged out 20somethings who were making a ton of noise and who I'd simply asked to be quiet. I was lucky that I didn't break anything and they were lucky I didn't press charges. But I wanted to put all my energy into Katie, not those jerks (who don't even live in my building, but had arrived for some late night partying). Besides, when I managed to get back up the stairs the second time, I punched one of them in the face and knocked him to the ground. Not that I felt good about it (I haven't been in a fight in over 13 years), but he did get what he deserved.
Anyway, November has been truly rough and I appreciate everyone's kindness.
Have a Happy Thanksgiving wherever you are.
I'm experiencing real grief over the death of my cat Katie. Out of 10 cats I've owned or lived with in my life, Katie was the best. We had a connection from the first moment I saw her at a pet shelter seven years ago. I couldn't explain it in words. My other cat KC is doing what she can to help me, but she doesn't have the same voodoo Katie had. Maybe that will develop as she gets older.
I do have some posts I want to do for today, but I'm simply too ripped apart to focus. I hope I will be in better shape by late morning. I'll post then and update the fundraiser. I think $100 or so came in yesterday, which is much appreciated.
At 3.47 p.m. today I put my dear sweet cat Katie to sleep. She'd continued to lose weight the last few days, even with me feeding her, and she was in pain this morning and growling at me when I tried to feed her, so I went and did the right thing. I spent a peaceful afternoon with her and just as I was about to pick her up and put her in the cat carrier a huge crow landed on my window sill and Katie ran to the window. She and the crow had a minute-long stare down and then it flew off. I know what that was about. Katie had a great spirit and the forces of the Universe were saying good-bye to her. As I did holding her paws.
I did everything I could for her the last week and fought her leaving very intensely, but her vet thinks she had developed cancer and would likely only have had another month or so, even if she had bounced back.
I'll try to resume normal posting in the morning.
Another $5 from one person came in over the weekend bringing the total raised so far to $445 from eight people. That leaves $3,555 from 92 people to go to reach the overall of $4,000 from 100 people by sometime around Dec. 18th. Thanks to all of you who've contributed so far.
I know Thanksgiving is fast approaching, but if you'd like to make a contribution, the PayPal button is on the right. If you prefer snail mail, send me an email and I'll send you my mailing address.
Thanks in advance for your support.
I'm not quite sure how to describe Katie's condition right now. She's better than she was on Friday and Saturday afternoon, but she's not as good as I'd like. I'll be talking with her vet later today and figure things out then. She and I are both tired of the feeding-by-syringe process, but until her URI clears that's how it'll be. She's not suffering or in pain. If she were, I'd put her to sleep promptly.
Proving that there is some sanity on Earth, the Australian federal government has pulled ADHD guidelines, which were in draft form, because some of the underlying studies were authored by controversial Harvard child psychiatrist Joseph Biederman. Biederman has come into disrepute in the US because there is evidence that he promised one drug maker positive study outcomes before conducting the actual studies and because of approximately $1.6 million he got in payment from pharma companies, much of which he did not disclose, while taking federal research money. (His breathtaking arrogance has not helped his credibility much either.) What's more, Biederman and another Harvard psychiatrist are named in a federal subpoena.
Nice to see someone in authority in Australia taking the pharma-academy connection seriously and questioning how it influences research before charging ahead with Ritalin-for-kids guidelines.
"Australian authorities have been forced to admit the embarrassing discovery that has now put the guidelines--which recommend medication such as Ritalin as the best form of treatment for ADHD and are designed to help parents and doctors--in jeopardy."Child welfare and ADHD experts want the guidelines rewritten entirely.
"'This is an excellent opportunity for the Government to go back to the drawing board,' University of South Australia education faculty lecturer Dr Brenton Prosser said.
"'I advise parents to use medication as a last resort. Pills don't acquire skills. Medicines don't address social skills.'
"The Royal Australasian College of Physicians is in charge of devising the guidelines, following a Government review in 2007."
Of course, why this sort of reconsideration isn't going on in the US (it is to a degree in the UK with regards to ADHD) is beyond me. I'm not certain how Biederman and others hijacked child psychiatry, but they did. And despite tons of reporting by myself, the New York Times, the Boston Globe (and others) and a Senate investigation, not much has changed over here. That's a situation that needs to be rectified.
Another $125 came in on Friday from two readers bring the amount raised so far to $440 from seven people. That leaves $3,560 to go from 93 people to reach the overall goal of $4,000 from 100 people somewhere around December 18th.
Thanks to all of you who've contributed so far. If you'd like to join them, the PayPal button is on the right. If you prefer using snail mail, send me an email and I'll send you my mailing address.
For those of you following Katie's situation, I'm afraid the news isn't good. Unless she improves much over the next two days, I fear I will have to put her to sleep on Monday. I'm pretty shaken up. But who knows? Perhaps she will turn the corner here soon.
An eye popping article in the New York Times today on how some doctors in California are advising some teenagers with ADHD to use medical marijuana.
"Counterintuitive as it may seem, however, patients and doctors have been reporting that marijuana helps alleviate some of the symptoms, particularly the anxiety and anger that so often accompany A.D.H.D. The disorder has been diagnosed in more than 4.5 million children in the United States, according to the Centers for Disease Control and Prevention."
I cannot even begin to attempt to sort this one out.
The FDA today approved the atypical antipsychotic Abilify for the treatment of irritability associated with autism in pediatric patients aged 6 to 17 years old. I'll leave it at that.
As an adjunct treatment for bipolar disorder combined with either Depakote or Lithium. No comment.
Yesterday, $40 came in from one person came in bringing the total raised so far to $315 from five people. That leaves $3,685 from 95 people to go to reach the overall goal of $4,000 from 100 people somewhere around December 18th. Thanks to all of you for your contributions and support. If you'd like to make a contribution, the PayPal button is on the right or, if you prefer snail mail, send me an email and I'll send you my mailing address.
I appreciate the contributions that have come in so far, especially since it's boosted my mood a bit during a very tough couple of days with my cat, Katie. I managed to get an entire, huge (6 ounces) can of prescription cat food down her via syringe, 20 mls. at a time. I lost track of how times I fed her and how many times she scratched me. She's better than she was on Wednesday, so we'll see how things go over the next few days. I'm utterly exhausted. So is Katie.
Thanks to all of you for your support.
A few of you likely know of Dr. Bonkers, the Bonkers Institute and its website. Bonkers--aka Ben Hansen--has tirelessly catalogued pharma ads for psych meds for four years and recently posted some National Health Service brochures he obtained that are alarming. In them, children, teens and young adults are basically told to shut up and take their meds--Zyprexa, Risperdal and Strattera (links are to the brochures). In making them publicly available, Hansen has apparently angered the NHS which contact him and asked him to edit out much of the brochure from his website. Hansen refused (see the exchange below).
Some of the language in the brochures is interesting. I'll focus on the Zyprexa brochure.
"Your Medicine is called Olanzapine. Pronounced 'o-lan-za-peen.'"Many children, teenagers and young people need to take medicines prescribed by doctors to help them stay well and healthy."
Here's a question for NHS: On what basis do you argue that Zyprexa--oops, Olanzapine--keeps children healthy? What randomized clinical trial proves this in children? Is it even approved for use in children and teens in the UK? If so, for what? Even Lilly's UK website doesn't say. Or are you in essence helping off-label market to kids and teens?
Then:
"When you first start taking olanzapine it may make you feel a bit sleepy, but this should wear off after a few days. It may make you feel like eating more food. If this happens, try not to eat more than usual, and talk to an adult or your doctor about this."How long do I need to take olanzapine for? You will need to keep taking olanzapine until your doctor tells you to stop. It helps to keep you well, so you should keep taking it even if you feel better."
That kind of rot speaks for itself. The other brochures strike a similar tone. Now check out what the NHS's deputy chief pharmacist told Hansen:
"Could I please request that you amend the site so that it is no longer possible to access the whole leaflet -- the front page and our contact details would be appropriate. I'm sure you appreciate that the only way that we will be able to produce more materials for patient benefit is by recouping the cost from other organisations which want to use them -- our objective is provide written materials to support the verbal counselling given by healthcare professionals -- they are not meant to stand alone as sources of information. We charge a reasonable fee for full access to all the children's leaflets and so it not in our interest, or necessarily, patients and parents to have access to them on your website without the professional support intended."
Wow, the British government charges for these brochures? I wonder what groups use them and under what circumstances. And don't you just love the irony of the British government trying to censor an American website? Good luck with that!
Hansen replied:
"We posted the NHS leaflets to stimulate public scrutiny of your agency. We call upon the NHS to stop promoting harmful psychotropic drugs for children. In a spirit of full disclosure and transparency, we have now posted your letter as well."
You can read the emails at the bottom of each link above. (Via opednews.com.)
I call upon Hansen to continue to make such advertisements and brochures available. If any of you have "interesting" brochures and whatnot from the US, UK, Canada, Australia or wherever, feel free to pass them along to me or Dr. Bonkers.
Let me start by saying that it's well-known that withdrawal from anti-depressants (and other psych meds) can make some people act anywhere from oddly to violently, even in cases where people have carefully withdrawn from said meds. Fortunately, the instances of true violence are rare, but they do go on and should be a constant reminder to all of us--irrespective of where we stand on the on-meds/off-meds divide--that withdrawal can be dangerous and must be approached with respect.
Now, here's news of a tragic and ugly case in the UK where a husband allegedly strangled his wife after coming off a Parkinson's med (given to him to control vivid nightmares) and two unnamed anti-depressants.
"Dr Paul Skett, an expert in prescription drugs, said Mr Thomas would have experienced nightmares after coming off the drugs, two antidepressants, and one to control both Parkinson's Disease related hand tremors and nightmares."One of the effects of the hand tremor drug was to inhibit rapid eye movement sleep, he explained.
"'With withdrawal you get a rebound effect where the individual suffers more rapid eye movement and more dreaming,' he said.
"'These can be very vivid and take the form of nightmares.'
"Mr Thomas denies murder, but prosecutors are not seeking a guilty verdict.
"Paul Thomas, QC, said he was seeking a 'special verdict' of not guilty to murder due to "insane automatism" caused by an internal condition.
The defence is arguing the defendant strangled his wife of 39 years due to 'non-insane automatism' - acting invoulntarily while sleeping - brought on by external stress."
While I'm not arguing that the meds made him do it, I am arguing that they are deeply entangled in the tragic outcome, which argues that patients and doctors have got to take the withdrawal process much more cautiously.
Take a swing through ssristories.com and do a find in your browser under "withdrawal."
An article today in the New York Times simply blows my mind. I'll just quote from it:
"Few universities make required reports to the government about the financial conflicts of their researchers, and even when such conflicts are reported, university administrators rarely require those researchers to eliminate or reduce these conflicts, government investigators found."In a report expected to be made public on Thursday, Daniel R. Levinson, the inspector general of the Department of Health and Human Services, said 90 percent of universities relied solely on the researchers themselves to decide whether the money they made in consulting and other relationships with drug and device makers was relevant to their government-financed research.
"And half of universities do not ask their faculty members to disclose the amount of money or stock they make from drug and device makers, so the potential for extensive conflicts with their government-financed research is often known only to the researchers themselves, the report concluded."
That should shake everyone up because these universities, collectively, take in billions a year in federal research funding yet apparently refuse or are too lazy to monitor whether the researchers getting federal funds are also getting unreported pharma monies. The whole thing is downright Nemeroffian. I'm not sure what needs to happen to clean this system up but I think it's outrageous that these same researchers are the types of "experts" the media quotes in health stories that instruct the public in how to behave and these are the same folks who would likely claim to be "highly ethical" (and probably teach medical students in medical ethics) yet they're violating research ethics all over the place.
It's stories and reports such as the above that make me deeply distrustful of our health care system and the pronouncements of experts. It's simply not that hard to do the right thing and play by the rules and it's very telling that loads of researchers in various disciplines don't seem to care.
Yesterday, $275 from four people came in and that leaves $3,725 from 96 people to go to reach the overall goal of $4,000 from 100 people somewhere around December 18th. Thanks to all of you for your contributions and support. If you'd like to make a contribution, the PayPal button is on the right or, if you prefer snail mail, send me an email and I'll send you my mailing address.
And if you want take a look at yesterday's post where I outline some of what I've covered on this site since September 1st. Let's just say there's a good amount of news there that the mainstream media either doesn't know about or won't touch.
As for my dear 14-year-old cat Katie, she took ill again late last week with an upper respiratory infection, which made it difficult for her to eat, so the problem with her liver re-appeared. I spent much of yesterday at the vet and then feeding her prescription food via syringe. And giving her anti-biotics and closing her in the bathroom with me while I showered so the steam would help clear her nose. I've got to get as much food down her as I can and get weight back on her promptly or things won't work out too well. Getting a can of cat food down a cat by syringe takes multiple feedings and results in multiple scratches. Katie is tolerating the process as best she can, but there's not a cat alive who enjoys being fed that way. Hopefully, she'll be back to eating on her own in a few days when her nose clears up. She bounced back well enough after the problems in early October for me to trust that she's a fighter and that we can make this work.
I sure hope so.
Many of you are aware that there is a complex, class action lawsuit against AstraZeneca in federal district court in Florida. Yesterday, the judge in the case said she'd urge a panel of judges to send 6,000 lawsuits against AZ over various accusations involving Seroquel back to their original state courts. While this will slow down the litigation for plaintiffs, the reality is that this might be good news for injured parties, as the federal court judge was engaging in some wacky rulings and throwing out cases and evidence, according to a participant in the proceedings I've spoken with. We shall see.
Overall, AZ faces 14,000 Seroquel-related lawsuits.
Well, not exactly since no one has seen the bill beyond the CBO, which has costed it at $849 billion over 10 years. That's an initial estimate and may change, but for now it does meet President Barack Obama's goal of a bill coming in at under $900 billion over 10 years.
I won't have much more to say until I see the bill itself or at least see some thorough reporting on it.
One of the most consistently discouraging and gut-wrenching topics I write about on this site is suicide among active duty personnel in the US Army and today the news is awful. That's because yesterday the Army announced that active-duty suicides had hit 140 deaths for 2009, matching last year's total with six weeks left in the year. What's more, another 71 soldiers committed suicide after being taken off active duty.
Like I said, discouraging. That this is likely mostly going on amongst non-commissioned personnel who are probably fairly young is doubly upsetting.
I think we all know that the active duty military--especially the Army and Marines--are under epic amounts of stress and that many of our fighting men and women have been through multiple deployments in Afghanistan and Iraq. The Army did claim, however, that one-third of the suicides were among personnel who'd not seen action overseas. If we have so many suicides among Army personnel who've not been exposed to the stresses of war, then that does make me wonder what the hell is going on here. Because something is and it'd be good to know what that something is.
John Grohol at PsychCentral.com had some sharp things to say:
"When you’re threatening court martial to moms who can’t find child care for their 10-month old before deployment and have psychiatrists shooting up your training bases because you don’t acknowledge the inherent conflicts in service amongst your ranks (or your officers don’t have the stomach to discharge someone they clearly saw as problematic), then yes, you have some serious problems. And yes, they are related to the two wars you are currently fighting."As the article notes, the military’s suicide rate among active-duty soldiers was about 20 per 100,000, nearly double the national U.S. rate of 11.1 suicides per 100,000 people.
"There is something significantly wrong there if twice as many people in your service are taking their own lives. This hasn’t always been the case. And rather than trying to whitewash the issue, you should be pulling out all the stops — and all significantly increasing the funding — to figure out how to stop the blood letting."
I agree that this issue merits a lot of attention. The answers are bound to be ugly because we have very high rates of medication with psychotropics among our troops now and that clearly does not seem to be helping things. We have a military that pays more attention to mental health problems that it probably ever has in its history and yet things keep getting worse. We also have the problem caused by the military not keeping official suicide statistics before 1980 and, as a result, we've got no way to compare what's going on now with experiences in the Vietnam War and World War II.
I don't pretend to know what any of the answers are here. I just know that I am tired of writing about this topic.
I'm beginning this site's winter fundraiser a bit earlier than I'd originally planned for a couple of reasons. One, the last few fundraisers have taken longer than the two weeks or so of the glory day of 2007 and 2008, so this one will run longer but needs to be over by December 18th when I know folks will be well into their holiday travel and plans. Two, it absolutely feels like winter in Seattle the last few days what with cold winds and lots of rain and the dark coming on at 4.15 p.m.
Anyway, the overall goal for this fundraiser is $4,000 from 100 contributors over the next month, although the earlier contributions come in then the earlier I can end the fundraiser. As usual, the PayPal button is on the right. If you prefer using snail mail, shoot me an email and I'll send you my mailing address.
Of course, I know intimately just how rotten the economy is right now. So what have I been doing around here since September 1?
Here's a rundown of what I think was some pretty good work, much of it stuff that you won't find elsewhere in the mainstream media or elsewhere in the blogosphere.
In September, I reported on a child psych researcher who claimed 3-year-olds can have chronic depression had apparent unreported conflicts of interest in recent journal articles; I challenged the relevant journals to address the situation; the Archives of General Psychiatry later decided to investigate the matter while the American Journal of Psychiatry didn't respond; I wrote of an ignored study linking ADHD stimulants to risk of sudden death in kids and another study of the emotional blunting caused by SSRIs; that 60 percent of antipsychotic use in the VA system is off-label; that 2006's suicide rate remained unchanged from 2005's; that anti-depressants were again linked to some birth defects. In October, it was onto a study showing that the Mediterranean diet looked to be somewhat protective against depression (another study the media ignored); that a large percentage of cases of bipolar disorder "resolve spontaneously" by the mid-30s (another one the media went nowhere near); that Lilly is trialing its anti-depressant Cymbalta is kids as young as 7; AstraZeneca itself wrote me to defend its handling of Seroquel weight gain warnings; that Shire was trialing an ADHD stimulant as a depression treatment; I tackled NPR's recent biased reporting on mental health; revealed that Lexapro sales were boosted by the company selling anti-depressants to teens; wrote of an animal study showing that psych med use among young animals created psychiatric disorders in later life; wrote of a study (one the media picked up on) showing that atypicals are causing explosive weight gain in youths; revealed that the House health care reform bill had slipped the controversial MOTHERS Act into its language; called out NAMI National for lying in a letter to the New York Times. So far this month I've detailed yet another ignored study laying out depresson's link to processed food; wrote of a study where researchers shot down the existence of pre-adolescent mania; noted that Technorati ranked this blog way up in its Top 100 Health blogs; wrote of child psychiatrists allegedly behaving badly with children; wrote of a scary Yale study attempting to link ADHD in childhood to criminal behavior as an adult; wrote about absurd claims by the Juvenile Bipolar Research Foundation that bedwetting and nightmares among young children constitute pediatric bipolar disorder symptoms; and there's more to come.
I don't think you'll find much of the above anywhere in the mainstream media, print or broadcast. If you'd like to support such work, I'd appreciate your support. Thanks.
So yesterday results of a study of a drug called Flibanserin (its generic name) were rolled out at a conference in France. Flibanserin was designed as an anti-depressant, but failed its trials except in one key sense: female patients were reluctant to return the study drug at trial's end because they'd had a low libido pre-trial and experienced heightened libido while on the drug, which is made by a Germany pharma company called Boehringer Ingelheim. Since the company has run several phase 2 and phase 3 trials of the drug to treated so-called hypoactive sexual desire disorder or HSDD.
Anyhow one study of the drug got a ton of press attention yesterday. It involved 1,378 women in stable relationship who were diagnosed with HSDD. The drug was trialed against placebo over 24 weeks and study subjects reported more "satisfying sexual events"--a careful term if there ever was one--on the drug than on placebo.
Before I get to the skepticism of my headline, let me address the two or three of you who might wonder why I'm writing about a purported treatment for HSDD on a mental health website. First, sex and relationships are obviously entwined with mood and, in many respects, overall mental health. Second, I'm endlessly fascinated by how anti-depressants have been repurposed over the years and this story is a big repurposing.
Now for some skepticism:
1. The press coverage I've seen of Flibanserin so far mixes its metaphors when it dubs the drug a female Viagra. Viagra and its ilk are drugs to treat erectile dysfunction--meaning an inability to get it up or keep it up, to be blunt--whereas HSDD involves a lack of female sexual desire. While I recognize that the two phenomena are loosely-related, it's little more than cheap tricks for the press to headline Flibanserin a Viagra type of drug. In effect, Flibanserin is an aphrodisiac, Big Pharma's Spanish Fly, if you will. It's not approved by the FDA.
2. If the response rate is as high as claimed--60 percent to 75 percent--then that means the placebo response in this study was very high. In one press account of the study, the effect size is put at 22 percent. That means that the placebo response rate would be 38 percent to 53 percent. Very high.
3. It's an anti-depressant playing with serotonin receptors and that likely means that there were patients in the study who could have had some level of side effects associated with taking the drug. None of the press accounts I've seen so far get into that question. But you know there's bound to be reports of suicidality and withdrawal problems and the like once this drug gets to a large population, if it ever does.
4. With such a high placebo response, you know something else has to be going on to explain these women's lack of libido.
"Problems with sexual desire are 'a big deal,' for women, according to Dr. Marie Savard, a medical consultant to ABC News."'We know the role of sex is so important to relationships,' she said. 'But for women it's unrealistic to think a pill is going to fix the impact of so many issues that women face.'
"Savard said women have many reasons for a lack of libido, including stress, caregiving roles and lack of self-esteem, and added it's difficult to label women with a simple diagnosis like HSSD. But she said since the brain is a woman's 'biggest sex organ,' it might make sense that they would benefit from a drug like flibanserin."
5. Said one of the study researchers:
"'Viagra increases blood flow. This doesn't do that. It affects the brain. (Flibanserin) affects the neurotransmitters in the brain that affects sex,' Guay said."
Points 4 and 5 come from the same article and in the same article you have two doctors in fundamental disagreement about what causes lack of desire.
6. Reportedly 20 percent of adult women in America experience HSDD. With roughly 115 million adult American women that would work out to about 23 million American women with HSDD, a potentially gigantic market for drug treatments as far as Big Pharma is concerned. By comparison, about 10 million to about 12 million American women take anti-depressants to treat depression. With a potential market so large, any drug that gets approved to treat HSDD--the causes of which remain unclear--will be marketed very aggressively, perhaps as aggressively as ED treatments. My point is that any claims for these drugs should be greeted with extreme skepticism because when Big Pharma is chasing a big market drug companies--and doctors --will make outlandish claims.
7. The results of four different studies of Flibanserin were presented at the same conference that resulted in the press coverage of but one of the studies. I don't know what the results of the other three were, but it's likely that the press was being spoonfed the results of one study. It'll be interesting to see the results of the other studies, once they become public.
8. I sure hope the FDA takes a long, hard look at the results of the main study because the placebo response is so high that it makes me a bit suspicious. Was there something odd with the study design? Why were so many people getting such a response to placebo? Is it really a good idea for the US for millions of Americans to take Flibanserin when it's clear that HSDD drug trials had such a high placebo response? The FDA isn't the most skeptical organization on Earth, but on occasion it does surprise me. I hope this is one of those times.
9. If Flibanserin is approved by the FDA, I simple cannot wait to see the television commercials that will roll out for this drug and what imagery the ad agencies will use to capture women's imaginations. One of the classic Viagra commercials, for example, features a bunch of country pickers cranking out "Viva Viagra" before blazing down the road on loud motorcycles and in fast cars. What would the women's version of that be? Who would be the feminine equivalent of NASCAR god Mark Martin tearing 'round Talledega in the Viagra car a few years ago? Would there be female sports stars endorsing the drug a la Rafael Palmeiro? The mind boggles.
This is the third time in two years that I've encountered a case of parents giving their kids with autism medical marijuana--usually in an ingested form as opposed to smoked--instead of antipsychotics and others meds. Reportedly, this novel treatment works fairly well. But there's the tricky problem of medical marijuana's legal status.
"Respected LA-area pediatrician Chris Tolcher says we don't know enough about cannabis for kids."'I think for all the parents out there whose children may have autism,' Tolcher says, 'I think the message here is that this is intriguing information that needs more research before we can confidently say that marijuana is a safe and effective treatment for autism complications.'"
If the DEA wouldn't make such research impossible, then perhaps we might have some answers.
Yesterday, a letter to the editor appeared in the Chicago Tribune, penned by AZ's chief spokesman Tony Jewell and critical of a recent article in the paper concerning the company's antipsychotic Seroquel. The paper had written about AZ giving $490,000 to a Chicago psychiatrist who prescribed tons of Seroquel, plenty of it off-label, and also authored a study claiming patients lost weight on the drug. In part, it reads (via Soulful Sepulcher):
"Since first approved in 1997 for the treatment of schizophrenia, the U.S. Food and Drug Administration has approved Seroquel as safe and effective for three indications in bipolar disorder, as well as in a new formulation for additional treatments in schizophrenia and bipolar disorder. Today Seroquel and Seroquel XR are the only medicines approved as monotherapy by the FDA to treat both the acute depressive and manic episodes associated with bipolar disorder."The safety and efficacy of Seroquel has been evaluated in clinical trials with thousands of patients and AstraZeneca has shared all required data with the FDA, both before and after the agency approved it as safe and effective.
"AstraZeneca believes the totality of the science around Seroquel -- including company-sponsored studies, research sponsored by the federal government and physician experience -- confirms it is an effective and appropriate treatment choice for many patients who suffer from schizophrenia and bipolar disorder."
OK, fine. But since Jewell is relying so much upon the FDA's blessing of the drug to make his case to the public that Seroquel is safe and effective and that AZ plays by the rules, then I need to point out that last December the FDA busted AZ for off-label marketing of Seroquel for depression. To date, the agency has refused to answer any questions about its finding or to reveal what sanctions it might impose on the company. It's almost one year later and high time the FDA did something.
An excellent piece in today's New York Times lays out how Big Pharma has been promising to cut costs of its drugs (to the tune of $8 billion a year) to help make health care reform happen while at the same time it's going around raising the prices of its drugs to the tune of $9 billion a year. That's such typical behavior by the drug companies that I'm hardly surprised. They are a truly brazen bunch.
You just had to know that with Big Pharma openly supporting health care reform and alleged cost-cutting that something funny had to be going on. Now, we know what it was.
A new study out in General Hospital Psychiatry blames smoking and inactivity for heart disease related deaths among people with schizophrenia and other psychotic disorders. No mention is made of the role of antipsychotics and other medications in this dynamic. From Medicalnewstoday.com:
"A large new study confirms that people with severe mental disorders - such as schizophrenia or other psychotic disorders - are 25 percent to 40 percent more prone to die from heart disease than people without mental illness are."Moreover, smoking and physical inactivity - behaviors that individuals potentially can change - significantly contribute to this increased risk of death, found researchers led by Amy Kilbourne, Ph.D."
The study was among people in the VA system.
Interestingly, inactivity was a greater risk factor (66 percent higher risk) of a heart disease death than was smoking (32 percent higher risk). The study calls for smoking cessation programs and promotion of physical activity among veterans with psychotic disorders. How they plan on getting veterans zonked on Zyprexa to exercise is beyond me.
There is no mention in the study of the role antipsychotics may be playing in all of this even though antipsychotics are well-known to boost blood lipids and cholesterol as well as to cause diabetes and weight gain--all risk factors for heart disease. What's odder about the omission is that atypical antipsychotics carry warnings of diabetes and cardiac problems, so why would researchers ignore the hazards presented by these medications?
Oh, we know why. These are doctors in denial much as with this study from earlier this year which claimed that people diagnosed with bipolar disorder died early, but barely mentioned any connection to chronic use of medications. I'm not excusing smoking or inactivity, but for this current study to ignore meds altogether is inexcusable.
The folks at the Juvenile Bipolar Research Foundation--that's the Papaloses of "The Bipolar Child" book fame's organization--have really gone an done it now. They've fully crossed the Rubicon and now claim that kids having nightmares, wetting the bed and who are interruptive have so-called pediatric bipolar disorder. This is all from a JBRF "news flash," which I cannot locate on the group's website yet, but which I have in email form (if you want it, send me an email and I'll pass it along). The news flash, which is also a solicitation for contributions to JBRF, is entitled "Characteristics of Juvenile Bipolar Disorder: A New Phenotype."
"What do the following have in common?* suffers horrendous nightmares
* antagonizes siblings
* excessively craves sweets and carbohydrates
* wets the bed
* sleeps hot
* takes excessive risks
* hoards food
* has many ideas at once
* interrupts or intrudes on others
* experiences periods of self-doubt and poor self-esteem
* deflects blame"Independently, each of these traits is a symptom of a myriad of different psychiatric disorders. Considered together, they are all symptoms of Pediatric Bipolar Disorder (PBD)."
Forget about alleged kiddie mania and kiddie depression (both of them extremely dubious) and forget about Biederman/MGH crowd who push irritability in kids as a proxy for mania. Forget about how psychiatrists elsewhere in the world find this whole kiddie bipolar disorder business hard to swallow. Forget about the recent Canadian study that shot down the existence of pre-adolescent mania. It's now about that list of alleged symptoms above. And a lot of biological and genetic determinism:
"This more complete list of symptoms is reflective of the research progress JBRF has made by adopting the dimensional approach of defining psychiatric disorders: symptoms overlap between psychiatric conditions and one condition is differentiated from the other by how those clusters of overlapping symptoms come together. "Proceeding down this path, researchers have arrived at a novel perspective of the illness. While traits like mania and depression remain important, this analysis finds that they are not the central behavioral dimensions of PBD. Other dimensions such as aggression, anxiety, sensory sensitivity, sleep/wake disturbance, attention/executive function deficit, and oppositional behavior also figure prominently. Of paramount interest is a dimension that establishes a link between obsessive fears and aggressive behavior. JBRF investigators have termed this correlation 'Fear-of-Harm' (FOH). This new characterization of PBD has been labeled the 'Core phenotype.' "The Core phenotype is a more complete and accurate description of what these children experience than what is offered by the Diagnostic and Statistical Manual for Mental Disorders (DSM). Investigators suggest that in the DSM, bits and pieces of this single disorder have been parceled out into numerous other diagnoses. It is likely that this fragmented perspective of the disorder has obscured a clear view of its actual presentation in children and stalled efforts to get at the underlying biology."Concentrated exploration of the FOH trait has lead investigators to define a clinically homogeneous subgroup of children who are the most severely impacted by this disorder. This subgroup is called the 'FOH phenotype.' These children are characterized by extreme anxiety and the hyper-perception of threat which causes them to respond in a defensively retaliatory manner. They are often hospitalized and face great challenges socially and academically.
"Not only have JBRF investigators been able to describe the symptom profile of the FOH phenotype, but under this new paradigm, they have also pieced together the likely underlying biology involved in the disorder. Certain brain areas, activities and development that had not previously been considered became obvious foci for their attention. The specific neural pathway that ties these activities together in a manner consistent with the profile has been identified. Investigation of this complex system is ongoing. The more the details fall into place, the greater its explanatory value grows.
"The definition of the FOH phenotype moves us further in our quest to uncover the genetic variations associated with PBD. The high heritability of the FOH trait, refinement of the dimensionally derived symptoms that associate with it, and the fact that the CBQ can identify with 96% accuracy children whose profiles fit the phenotype make us optimistic that we are on the right path for a meaningful genetic analysis."
I searched through the medical literature and the only mention I can find anywhere of this alleged FOH phenotype is in a 2007 Journal of Affective Disorders article by none other than Dimitri Papolos of the JBRF. I cannot find another reference to it anywhere, so this is clearly novel thinking.
Bed wetting as a symptom of child bipolar disorder? We live in strange times.
Thanks to the reader who made me aware of the above JBRF news flash.
NPR did some excellent reporting on Wednesday, which I didn't have the stomach to write about yesterday (I needed a day away from the Fort Hood story), but some officials at Walter Reed Hospital and elsewhere in the area were concerned that Maj. Nidal Malik Hasan may have been "psychotic" or "schizoid." No one had any strong evidence of it aside from one official who is quoted as saying:
"'Put it this way,' says one official familiar with the conversations that took place. 'Everybody felt that if you were deployed to Iraq or Afghanistan, you would not want Nidal Hasan in your foxhole.'"
Nonetheless, it sounds as if Maj. Hasan may have had some issues, but no one proceeded to order a fitness for duty evaluation, reportedly out of concern for seeming insensitive to a Muslim.
While I can appreciate that there may have been mental health issues underlying Maj. Hasan's actions at Fort Hood, I'm sticking with the terrorist interpretation of things, partly due to what my gut tells me, partly because of Maj. Hasan's contacts with an Al Qaeda-connected imam, and because a copy of Maj. Hasan's business card (presumably for private practice) has turned up. On it, Maj. Hasan declares in abbreviations that he is a "soldier of God" and adds "glory to God." Kind of odd for a doctor's business card.
I know some readers have troubles with declaring Maj. Hasan a terrorist. Hell, yesterday, I had an argument over coffee with a friend in the neighborhood who told me that it was OK for Maj. Hasan to have contact with Al Qaeda, since the contents of the emails were allegedly benign. I argued back that Maj. Hasan was in the US Military and military personnel are expressly forbidden from having contact with the enemy (for obvious reasons) and "What part of al Qaeda is our enemy don't you understand."
Fun stuff!
That said, I kind of get peoples' reluctance to label Maj. Hasan a terrorist and it has nothing to do with his being a Muslim or trying to be gentle with Muslim-Americans as a whole. In all his pictures, he seems so kind and gentle somehow and I cringe when I see them on the Internet or TV. It doesn't change my mind about his motivations, but it does give me pause.
For those of you who think Maj. Hasan looks too nice to be a terrorist, please take a look at the pictures of his 13 murder victims. They look far too nice to be murder victims.
A little noticed study came out in the obscure Journal of Mental Health Policy and Economics in September from a researcher at Yale University and a researcher at the University of Wisconsin, Jason Fletcher and Barbara Wolfe respectively. It's not the first time researchers have pushed this line of fear, but I'll just quote from the abstract while I scrape my jaw off the floor:
"Results: The empirical estimates show that children who experience ADHD symptoms face a substantially increased likelihood of engaging in many types of criminal activities. An included calculation of the social costs associated with criminal activities by individuals with childhood ADHD finds the costs to be substantial."Discussion: Our study provides the first evidence using a nationally representative dataset of the long term consequences on criminal activities of childhood ADHD. Our results are quite robust to a number of specification checks. Limitations of our study include that our measures of ADHD are retrospective, we have no information on treatment for ADHD, and it remains possible that our results are confounded by unmeasured variables.
"Implications: Our results suggest that children showing ADHD symptoms should be viewed as a group at high risk of poor outcomes as young adults. As such, a good case can be made for targeting intervention programs on this group of children and conducting evaluations to learn if such interventions are effective in reducing the probability that these children commit a crime. Development of such intervention programs and evaluating them for efficiency could be dollars well spent in terms of crime and drug abuse averted."
Isn't it nice that they are seeing such implications when their study cannot even establish whether or not study subjects were on-meds, off-meds or in psychotherapy?
A Yale press release claimed that "crimes where ADHD is a factor cost society $2 to $4 billion annually." With a $14.2 trillion GDP for the US in 2008 that estimated "damage" to society doesn't strike me as particularly important, macroeconomically speaking. It strikes me as infinitesimal, even if the claim is correct. Certainly, it's not big enough to justify slamming every boy with ADHD with Ritalin.
So why do researchers keep pushing on the benefits of ADHD treatment (you'll see how they are in a second)? Because they are trying to save a crumbling paradigm. In the UK, there's been an utter backlash against ADHD and its treatments and in the US there's been loads of evidence coming out that argues ADHD treatments are of limited effectiveness and that, developmentally, they aren't much help. They only produce minor test score increases, too. And a study earlier this year linked ADHD meds to a risk of sudden cardiac death. And the FDA recently linked ADHD stimulants to a risk of sudden death in otherwise healthy children.
So the public health crowd and the fine folks at Harvard/MGH have been fighting like crazy and squirming real hard in their desk chairs and ruminating at their computers (all signs of ADHD!) about how to protect their hegemony over little boys' behaviors and lives. Last year, for example, Joseph Biederman and Timothy Wilens of Harvard/MGH and Congressional investigation fame, separately published studies claiming that ADHD meds don't lead to later drug abuse in young adulthood and that ADHD meds keep girls from smoking and drug abuse. In other words, they are grasping at straws.
More from the press release:
"Fletcher said the link between ADHD and criminal activity will be further investigated by examining whether pharmacological treatments may reduce the risk of illegal activities as an adult. He is also investigating the relationships between childhood ADHD symptoms and labor market outcomes, such as employment and earnings."
Well, what wonderful reductionist public health researchers this pair is. I'll be honest and say that studies like this creep me out because the real world implications in public school could easily be schools demanding that disruptive boys (and girls) be medicated lest they turn into criminals of some kind down the road otherwise schools are somehow shirking their responsibility. I hope we aren't there yet as a culture but I fear that we are close.
Unless we start pushing back in the US the way they have in the UK.
BTW, the write-up of the Yale study in the New Haven Register is so unquestioning and unbalanced with contrary information about ADHD treatments that it is biased by omission.
Thanks to the reader who made me aware of this study.
Maryland Senator Ben Cardin (D-Maryland) today sent a letter to the Department of Defense seeking information how many anti-depressants are being prescribed to troops in-theatre (ie, not at home) and effectively questioned whether the record-high rate of suicide in the military might not be tied to anti-depressant use. (Letter here.)
"On November 3, 2009, the Wall Street Journal reported that during the most recent month of October, 16 active‐duty American Soldiers killed themselves, bringing the total number of active‐duty suicides thus far in 2009 to 134. At this rate, it is expected that the total number of suicides in 2009 will eclipse last year’s total of 140 – the highest yearly number of suicides in Army history, and the first time that the rate of active‐duty suicides exceeded that of the U.S. population....""Unfortunately, Congress cannot as easily provide a remedy for the stress or mental trauma created by combat experience. To begin to do so, Congress must first examine how the Department of Defense (DoD) is addressing the dilemma of mental trauma suffered by members of our Armed Forces. To do so in a comprehensive manner, it must also examine the extent to which DoD is prescribing anti‐depressants to its service members, especially those deployed in‐theatre, and the methods it is employing to ensure that sufficient observation periods are conducted by properly trained mental
health providers. In short, my concern is how DoD is managing the sheer volume and manner by which antidepressant drugs are being administered to our service men and women overseas."
It'll be interesting to see what answers he gets.
Via Pharmalot.
Bloomberg today reports on the British government taking steps to drastically reduce the use of antipsychotics in treating elders with dementia. A recent report estimated that upwards of 1,800 Brits die each year after getting the drugs for dementia and another 1,620 suffer strokes. Keep in mind that all that dementia-Rxing would be off-label bother in the UK and USA.
"About 180,000 elderly people with dementia in the U.K. are given the antipsychotic drugs each year, and just 20 percent improve because of the treatment, Banerjee said at a press conference in London. As many as two-thirds of the patients don’t derive any benefit from the pills, which boost the risk of early death and carry a range of side effects including sedation, stiff muscles, and trouble thinking and speaking clearly, the report found."'We need to be sure that only the people who benefit from these drugs get them, and they get them at the lowest possible dose for the shortest period of time,' Banerjee said. 'It is clear that these medications are being prescribed to deal with behavior and psychological symptoms in dementia rather than just for psychosis,' he wrote in the report."
I bet it's going to be really tough to turn that ship around. Here in the US about 25 percent to 30 percent of atypical sales are for off-label use in dementia even though the drugs carry black box warnings concerning their use in dementia.
I'm glad the UK has caught some sanity on this issue. I hope the US is next.
The Maryland Board of Physicians has suspended the license of Miguel Frontera, a Towson, Maryland psychiatrist, for alleged improper conduct with five boys in his care. The boys were being seen for ADHD.
"Allegations from each of the boys, ages 10 to 12 at the time they were patients, were similar and all involved improper conduct during physical exams in his office that the doctor himself called 'not, you know, necessary' and 'very out of the mainstream of psychiatry,' according to the suspension order issued by the Maryland Board of Physicians."The public order says the investigation began after Baltimore County police turned over two reports in April. One report was filed in 2006 by a county high school crisis interventionist who said a boy she counseled told her he was repeatedly 'molested' during treatment visits when he was 11 or 12. Earlier this year, the parents of another boy reported to police possible sexual abuse that they said occurred in 2003 when their son was 10."
Why this idiot isn't being charged criminally is beyond me, but one hopes the Board takes away his license permanently at a later hearing. This kind of behavior is so unacceptable that it's difficult to imagine a grown man, much less an MD, engaging in it. Besides, who's ever heard of a psychiatrist conducting a physical exam?
Meanwhile, up in Quebec, the well-knwon and controversial psychiatrist Pierre Mailloux has had his practice limited to adults only by the Quebec College of Physicians after being found guilty or partly guilty of 13 charges of either mis-diagnosing young patients or of over-prescribing drugs to them.
And in September the Quebec College of Physicians found that he had breached profession ethics by talking trash about black and aboriginals in the media. The doctor's Wikipedia entry has more fascinating details about his career and many controversies.
Thanks to the readers who made me aware of these cases.
The office of Utah's Attorney General Mark Shurtleff today announced that it had recently settled its illegal off-label marketing of Zyprexa claims with Eli Lilly for $24 million. Said Shurtleff's office in a press release:
"It is a crime for pharmaceutical manufacturers to market their drugs for uses that are not approved by the FDA. Zyprexa was only approved for the treatment of schizophrenia and certain types of bipolar disorder in adults, but in 1999, Lilly's long-term care sales force, its marketing branch that focuses on doctors who treat the elderly, began encouraging doctors to prescribe Zyprexa for dementia, Alzheimer's, agitation, aggression, hostility, depression and generalized sleep disorder without prior FDA approval. The Attorney General's investigation showed that there were 1,769 Medicaid patients over the age of 65 who took Zyprexa but never had a diagnosis of either schizophrenia or bipolar disorder."
If it's a crime why did Utah not pursue criminal penalties under state law? I wonder how many of those 1,769 elders died early as a result of Zyprexa use.
Back in March, I wrote about a Chicago psychiatrist, Michael Reinstein, who was bugging AstraZeneca for money because he was such a heavy prescriber of Seroquel and who also authored a very dubious study asserting that Seroquel caused patients to lose weight. That's absolutely counter to most studies of the drug and most patient experiences.
Anyway, today the Chicago Tribune and ProPublica are out with an article on Reinstein and his AZ connection. AZ gave the doctor $490,000 over 10 years to speak on behalf of the drug, even though the company was internally pooh-poohing his science. One researcher quoted in the article recommends that other studies of Reinstein's should be reviewed by journal editors, given his likely errors in the Seroquel-causes-weight-loss article. The reporters also found one woman who was given Seroquel and put on about 150 pounds and developed diabetes.
Beyond that, take a look at the transcript of Reinstein's deposition in a lawsuit (it's on ProPublica's site). On pages 199 to 200 of the depo (page 51 of the pdf), Reinstein is questioned about off-label prescribing of Seroquel and admits to engaging in a lot of it.
Reinstein specifically states that he prescribed Seroquel off-label for insomnia, bipolar depression, major depression and anxiety. Even more, Reinstein ran a study where he subjected patients to 2,000 mgs. a day of Seroquel, three to four times the highest FDA-approved dosage (600 mgs. a day). What human subjects committee would approve such high dosages? It's difficult to imagine.
On an ironic personal note, back in the summer I spoke at-length with the ProPublica reporter on this story, Christina Jewett. I broke my own don't help the media rule because I've known Jewett's work for years (she was at the Sacramento Bee) and because I have a good friend who's a reporter at ProPublica. Probably the most useful thing I told Jewett was that Reinstein's above-referenced study had to be deeply flawed (hell, even AZ was admitting as much) and that she ought to press on that and there sure is plenty about the study in the article. The irony is that yesterday I got a rejection email for a job at ProPublica, which told me I wasn't a good "fit" for them. How could I be a good fit when offering one of their reporters my expertise on atypicals but a bad fit when it comes to reporting? Lame.
Jewett left ProPublica this summer to return to California where she now works at the California Watch, which I guess is a ProPublica for the Golden State. I'm not good enough to be working anywhere of course. Certainly no one in the mainstream media links to my work although a reporter at a major newspaper I won't name spent about 10 minutes poking through a bunch of my posts on Monday. I have no idea what they were looking for but it will lead to neither credit or a job or anything that will benefit me.
Yesterday afternoon, I got my second job reject of the day, this one for a policy analyst position with the Washington State Senate Democratic Caucus. Hell, they aren't even going to interview me. It's like this website has made me toxic when it comes to employment.
Discouraged? Oh yes. Glad I have two graduate degrees? No. They are useless.
On Monday, President Barack Obama did an interview with ABC News' Jake Tapper wherein he was pressed on the penalties contained in the House health care reform bill, which passed the House 220 to 215 on Saturday night. The bill contains financial fines and even jail time for Americans without health insurance who refuse to get insurance. It's not clear to me if this business will be incorporated in the Senate's version of health care reform or if it will be in whatever eventual House-Senate bill is agreed to in conference.
It's a controversial measure of the House bill, but it's something President Obama defended to Tapper, arguing as he has before that forcing people to have health insurance is just like when the several states force car owners to have auto insurance. Specifically, the President said:
"What I think is appropriate is that in the same way that everybody has to get auto insurance and if you don't, you're subject to some penalty, that in this situation if you have the ability to buy insurance, it's affordable and you choose not to do so, forcing you and me and everyone else to subsidize you, you know, there's a thousand dollar hidden tax that families all across America are--are burdened by because of the fact that people don't have health insurance, you know, there's nothing wrong with a penalty."
I've never heard him make that $1,000 claim before and it strikes me as a stretch. But his larger claim that forcing people to have health insurance just like states force them to have auto insurance is a surprising one coming from a former Constitutional law professor. I was going to write about this back in September when he used the auto insurance analogy in an address to Congress, but things were so heated in the wake of that speech that I decided to wait.
Anyway, as I understand the law, driving a car on public roadways is not a Constitutional right but a privilege controlled by the states. Each state can determine its own conditions for extending that privilege to its citizens, and 49 states do require auto insurance for car owners.
But health insurance mandated by the Feds is not a power enumerated to either the Congress or the President under the Constitution. What's more, the Feds would be forcing you and I to buy a service that affects our bodies and minds and thus crashes right into our rights to personal liberty and privacy. I know there are Constitutional scholars out there who agree and disagree with me on this point (the LA Times has a round up of opinions here) and I know the insurance mandate will get tested in a court somewhere in 2013 or so, but I keep coming back to the language of Roe v. Wade, the landmark 1973 Supreme Court decision that legalized abortion in the US.
In it, the Supreme Court found the (I'm using the Wikipedia entry for Roe v. Wade):
"'[R]ight of privacy, whether it be founded in the Fourteenth Amendment's concept of personal liberty and restrictions upon state action, as we feel it is, or, as the District Court determined, in the Ninth Amendment's reservation of rights to the people, is broad enough to encompass a woman's decision whether or not to terminate her pregnancy.'"
If Constitutional guarantees of personal liberty and privacy are broad enough to protect citizens from governmental interference in terminating a pregnancy, then I think those same rights are broad enough to trump the government's ability to force you and I into buying health insurance. But that's just my opinion.
Either way, I wish the President would ditch the auto insurance analogy since it flat out doesn't work. It's interesting to me that the mainstream media--aside from Fox News--hasn't called the President out on this. I wonder why.
I'm in no mood to write today. My headache is gone, but I got yet another reject email from yet another media organization I'd applied to and I am simply not in the mood to put too many sentences together.
The NY Times has an op-ed today arguing against lumping together Asperger's syndrome and autism in the forthcoming DSM-5. It's interesting that the paper would choose to highlight that issue since it's been fairly quiet on developments around the new DSM. I wonder why.
The Chicago Tribune and ProPublica have a piece out on a Chicago psychiatrist who was prescribing tons of Clozaril to his patients (almost unheard of these days) as well as Seroquel. I was a source for the ProPublica reporter on this series (part two runs tomorrow and is allegedly "eye popping") and it's deeply ironic that the media organization that shot me down today is ProPublica. They don't see a "fit" for me with them. Please. Go fuck yourselves, ProPublica.
Forest Labs and the feds have reached a tentative settlement over allegations that the drugmaker illegally marketed Lexapro and Celexa to kids and that it paid kickbacks to doctors. Is there a single maker of psychotropics who has not entered into a legal settlement with the feds in the last few years or who isn't currently being investigated? Nope. That ought to tell you something.
I don't often get headaches but last evening I developed a doozie of one. I hope to catch up with posts later this morning.
I'll just take a deep breath here because I wasn't far wrong when I opined yesterday that this story was bound to get uglier: the alleged shooter at Fort Hood, Maj. Nidal Malik Hasan, is a terrorist, domestic terrorist even. The AP reports:
"The officials also say Maj. Nidal Malik Hasan communicated 10 to 20 times with a radical imam overseas who in the past came under scrutiny for possible links to terror groups. They say the communications began last year and continued into this year between Hasan and the imam, Anwar al-Awlaki, and that U.S. officials had been aware of them since last year."
So much for the PTSD-victim line of thought.
How was this freak even in the military? If the feds knew of his activities, why the hell was this guy not just discharged from the Army?
For the larger meaning of it all, the New York Times has a decent round-up of opinionistas. I'm afraid I've got to line up with the more hardline voices out there who argue that there are some radical Muslims here in America who want to commit acts of terror against us (the Fort Dix plot, for example) and that Maj. Hasan is far from alone in his hatred for the US. Where you take that kind of thing I don't know, but I do know that as a citizen I have the right to be protected from these kinds of losers, all of us do.
I know some readers and Peter Breggin himself have speculated that Maj. Hasan was on anti-depressants. Right now, that's nothing but guesswork. We'll know more down the road.
And that psychiatrist is none other than Peter Breggin writing on the Huffington Post.
"Before I begin to look at his role as a psychiatrist, I want to confirm that Major Nidal Malik Hasan was driven by religious ideology. For years he openly claimed that the War on Terror is a war on Muslims. He announced on the Internet and to his fellow soldiers in a course on public health that a Muslim suicide bomber should be praised for killing a hundred soldiers. It's reported that fellow soldiers warned his superiors that he was a ticking time bomb."One wonders how and why the army failed to relieve him from active duty. One ridiculous explanation is that they had a lot invested him--his complete medical and psychiatric training. Much more likely, the army was hamstrung by the political correctness that's been imposed upon it.
"Let's also see through yet another media smoke screen--that Hasan was more a crazy person than a terrorist. During the American revolution Samuel Adams pointed out that he'd never seen a man commit treason without first losing his moral footing in his personal life. As for being a victim of prejudice, Hasan was instead a provocateur whom the army tried to ignore. Hasan is not only a terrorist, he's a traitor--a man who turned on his nation; on the army that nurtured, educated and paid him; and on his comrades in arms."
I know some feel that the term "terrorist" is a bit much for Maj. Hasan's murderous rampage, but given all that was tangled up in his motivations I can understand why some people are tossing the term around. Breggin also tosses several other bombs: stating that psychiatrists at Walter Reed are only interested in medication and that the military has been deluded by modern psychiatry and so on.
And this:
"The odds are that Dr. Hasan was self-medicating with antidepressants and tranquilizers that were causing his increasing disinhibition, at least in his pronouncements, until his final Allahu Akbar before he began shooting."
We shall see someday if Maj. Hasan was medicated in some fashion since the Senate will likely investigate the very tragic events of last Thursday.
The New York Times has photos of the 13 murder victims here.
The AP is now reporting a story first reported by the (London) Telegraph that:
"The alleged Fort Hood shooter apparently attended the same Virginia mosque as two Sept. 11 hijackers in 2001, at a time when a radical imam preached there."
Oh, boy. This story is going to continue to get uglier and uglier.
News is out that the alleged shooter in Friday's tragedy in Orlando, Florida has a diagnosis of schizophrenia. Jason Rodriguez allegedly killed one man and wounded five others when he shot up the offices of his former employer. The man who died was 26 years old and had a young child. Lovely. I feel for all the victims of this crime.
The big question to me in all of this is why did Rodriguez have a gun.
"Mr. Rodriguez periodically took medication for what his former mother-in-law, America Holloway, said was schizophrenia. When he was not taking the medication, Ms. Holloway said, he was unbearable to live with — angry, jealous, paranoid and controlling."Once, Ms. Holloway said, her daughter had appeared at the front door covered in bruises. She moved home, but a few weeks later Mr. Rodriguez apologized and said he was taking anger management classes. Her daughter took him back.
"The couple then lived with her for five years, Ms. Holloway said, before she finally threw him out and the couple divorced in 2006. They have an 8-year-old son.
"'I’d be standing in the kitchen, he would come from the back room and say, "I know you’re talking about me." I would say, "There’s nobody here,"' Ms. Holloway said. 'When he had his medicine, he was the most wonderful person'...."
"Ms. Holloway said she believed that Mr. Rodriguez, in a downward spiral, had not been able to afford treatment. About six months ago, she said, he left his car and keys behind and walked to a mental health facility, where he stayed for a few weeks before being discharged, she said."
You can argue about on-meds, off-meds all you want with schizophrenia and other psychotic disorders, but none of that really matters here. What matters is that Rodriguez had a gun or access to the same and there's no way he should've been able to lay hands on a firearm. Each state's laws differ a little bit on the details of who can legally own a firearm, but it's fairly consistent nationwide that people judged "mental defectives" (and that's the language of federal and most state laws. It covers mental illnesses and development disorders) cannot own a firearm unless a judge later restores that right. In Washington State, it boils down to anyone who's been involuntarily committed for 14 days loses their gun ownership rights. I suspect Florida's laws are somewhat similar.
So Rodriguez either brought a gun years ago, stole someone's gun, someone have him a gun years ago or he somehow managed to slip through the cracks and buy a gun (doesn't sound like he had the money). It'll be interesting to learn how he got his hands on a gun.
Over the years, I've run into enough tales similar to this one--someone diagnosed with schizophrenia running amok with a gun such as in Fairfax, Va in 2006--and I always wonder how the hell their families and friends could be stupid enough to let them own or access a firearm. There's got to be some way to prevent this kind of crap from happening again and again.
That said, I know and know of people diagnosed with schizophrenia who have to carry knives and other weapons to protect themselves on the streets of Seattle because they've been robbed and assaulted so many times that, as one told me, "I go nowhere without my knife." I suppose I can't blame him.
Obviously, there are some tradeoffs here. Thoughts?
BTW, I'm not blaming schizophrenia for what went on in Orlando. It's too early to know if he was a "sane" man who cracked under the press of life or whether he was "insane" at the time of the shooting. That we'll know some other day.
I got to thinking over the weekend that the well-known conflicts of interest and dubious science of Charles Nemeroff--late of Emory University, soon of the University of Miami--deserve their own adjective, one that could be used to describe others in academic psychiatry who transgress similarly in the future. And so I have coined the term "Nemeroffian" to describe excesses and "science pimping" on a scale that Nemeroff himself can only achieve. (My Nemeroff back catalogue is here for those who wonder what I mean.)
Howard Brody at the Hooked blog had some thoughts on Nemeroff getting a job as chair of the psychiatry department at Miami.
"Miami's response? 'Pascal Goldschmidt, dean of UM medical school, called Nemeroff "an exceptional psychiatrist and an exceptional scientist who has one issue in which he recognizes he made a mistake," in not telling Emory how much he was getting from drug makers.'"To anyone who has followed Dr. Nemeroff's career, this is sort of like saying that Jack the Ripper was a dedicated feminist, only he had one issue. The specific question of whether he honestly reported to Emory how much outside income he had made is just the tip of the iceberg. To reduce the question of his professionalism to that single matter indicates either denial or willful ignorance of the record."
Classic.
Watch what goes down with this House health care reform bill being voted on over the weekend (unless it stalls) because something very tricky is going on. President Barack Obama went up to Capitol Hill today to personally lobby for votes yet he's asking legislators to pass a bill that doesn't even meet his deficit-neutral goal of $900 billion or less over 10 years. I'm very suspicious of why President Obama would now support the bill because it's now costed out at $1.2 trillion over 10 years.
And how did the bill's cost jump from $872 billion last week to $1.2 trillion this week (the New York Times claims it's $1.1 trillion)? I cannot support this bill because of its cost (there are other reasons to oppose the bill)--and keep in mind that I've not had health insurance in two and a half years and would technically "benefit" under this bill.
What's more, there's word of various amendments being tacked onto this bill late in the game and, as we know from the Medicare Part D nonsense of a few years ago, that type of chicanery is not to be trusted, regardless of which party is pulling the strings.
A big piece in the Miami Herald today on the University of Miami's hiring of controversial psychiatrist Charles Nemeroff to head its psychiatry department. Here's some of the fun stuff.
"The former head of psychiatry at Duke University told The Miami Herald Thursday that Nemeroff was 'economical with the truth' and his work can't be trusted, while the leader of the Columbia University psychiatry program said Nemeroff was a top-flight scientist and he had never seen any bias in his work....""But Bernard Carroll, former head of psychiatry at Duke University and once Nemeroff's boss, said parts of Nemeroff's work involved Paxil, a GSK antidepressant. 'Basically, he was doing basic science pimping for Paxil to produce talking points,' Carroll told The Herald in an e-mail Thursday. 'All he ever produced was speculation but that was enough to satisfy Glaxo marketing. . . . I have been exposing his shenanigans for some years.'
"Jeffrey Lieberman, head of psychiatry at Columbia University, praised Nemeroff as a leading expert in 'basic neuroscience,' studying underlying pathologies and proteins in the brain that cause mental illness. He said he had never detected 'any undue influence or bias' in Nemeroff's research."
I think Lieberman needs to re-review some of Nemeroff's work and his CME pimping.
News is out that the federal Department of Justice is investigating Abbott Labs over questions about its marketing of Depakote, its anti-seizure drug that's also approved for bipolar disorder. It's not clear what the scope of the investigation is, so stay tuned.
With all due respect to the profession of psychiatry, I need to ask why the "world's most famous psychiatrist," E. Fuller Torrey, and his group the Treatment Advocacy Center are so far completely silent on the tragedy at Fort Hood, Texas. That's where an Army psychiatrist, Maj. Nidal Malik Hasan, shot up an Army building, killing 12 and wounding 31 before being captured. Maj. Hasan was wounded and is reportedly in the custody of the Army at a hospital.
Often, when a person in the mental health system loses it (for whatever reason) and commits violence, Torrey and the fine folks at TAC are quick to post (anonymously, of course) on their blog the details of the crime and to use it as a springboard to argue for forced outpatient commitment and forced medication for people diagnosed with serious mental illnesses and play their vomit-inducing game of arguing that bad behavior by one person diagnosed with schizophrenia, say, proves that pretty much anyone with a "serious mental illness" needs to be medicated into the ground.
Now, that a psychiatrist has blown away a bunch of outstanding Americans what does TAC have to offer on its blog? Silence, the telling kind. The kind that says they are hypocrites because Hasan clearly had psych issues (whatever his political and religious issues with America may or may not have been) and yet he did what he alleged to have done. TAC should at least say something. Silence.
What does the American Psychiatric Association have to say? Nothing. It's silent, too.
It'll be interesting to read what psychiatrists have to write about this bizarre and unacceptable tragedy. For those of you who read this site who are psychiatrists, feel free to email me your thoughts or leave them in comments.
Maybe it's not fair to read Maj. Hasan's act in the context of his being a psychiatrist. After all, who's ever heard of a doctor much less a psychiatrist committing mass murder? Almost never, excepting cases of genocidal killers like Nazis Josef Mengele and Aribert Ferdinand Heim and Radovan Karadzic (a psychiatrist. Thanks for the reminder, Qwerty). So inevitably this story will be treated as the multi-layered, conflicted beast that it is and there won't be much moment made of his being a psych doc, except to the extent where one might ask, "Why couldn't someone who did psych evaluations realize he had lost it and seek help?"
But, then, Torrey and TAC are never so fair to the people they write about. They never have complete lives and souls, their motivations are never complex. They are just schizophrenics and bipolars, bad boys and girls who didn't take their medicine.
Oh, yes you are, according to Technorati, which I happened to check in with yesterday and was surprised to see a Top 100 Health Blog badge next to this here website's name. In fact, yesterday this site was #33 among health blogs tracked by Technorati, sandwiched between Herbal Water and That's Fit. Among the tracking services Top 100 health blogs are only a few mental health ones: PsychCentral.com's blog at #3, Postpartum Progress at # 16 and Psychiatric News at #36. Mind Hacks at #23 is more neuroscience-y than mental health-y although it often dips into the psych world (and quite well, too). Health Care Renewal at #43 also deals with mental health issues, amongst other things.
Psychiatric News is a "chronicle of human rights violations and crimes by the psychiatric industry." And people call me anti-psychiatry!?
Technorati's rankings are based on how many blogs and websites link to a particular blog, so if you want to see me get up there with Postpartum Progress, then link to this site. Or should I go out and get a glamor shot for my site like PPP's author has up? (What is it with some bloggers and photos of themselves?)
UPDATE: 6.29 p.m. PST. Following an Amry press conference, I've update this a bit and correct some repprting that was out there in media land.
The AP is now reporting that Army Maj. Nidal Malik Hasan, an Army psychiatrist, was the suspected shooter at Ft. Hood, Texas earlier today. The tragedy left 12 soldiers dead and 31 wounded and there were reports of other shooters. Two soldiers were taken into custody but later released. Maj. Hasan was said to be upset about his pending deployment to Iraq.
The New York Times reports that Maj. Hasan was a "Fellow, Disaster and Preventive Psychiatry, Department of Psychiatry, F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences." In other words, it sounds like Maj. Hasan had a specialty in PTSD.
Said Lt. Gen. Robert Cone at a press conference this evening: "The shooter is not dead but in custody." Gen. Cone declined to answer other questions about Maj. Hasan.
I really don't have anything reflective to offer on this at the moment, but I'd ask commenters to not play "trash psychiatry." Maj. Hasan must've had something really ugly going on inside to pull this off. It's one of the first instances I can remember of an officer--a senior officer, no less--opening fire on soldiers.
Or so says Nielsen Research. The most-recalled ad was the ubiquitous Flomax ad, followed by ads for Cialis and Gardasil in a tie for second. Remarkably, Pristiq was next with its creepy wind-up doll ad. I say remarkably because there are so many ads for so many drugs, medical devices and procedures on TV that it boggles the mind and it's got to be hard for some of them to creep into the collective consciousness much less long-term memory. Not that Pristiq is selling particularly well.
For those of you who are troubled by DTC pharma ads, especially on TV, I'm with you. But we're stuck with them. They bring in so many billions of dollars in ad revenue for various media companies each year that they will go unchallenged (with a few exceptions) for decades to come. Yes, the mainstream media has become pharma 'hos.
Back in 1997, one of the first radio interviews I did was of Tom Brokaw who was visiting UC-Berkeley for some kind of smarty pants sit-down with the dean of the J-School. I took Brokaw into a hallway at school and pointedly asked him about the NBC "Nightly News," of which he was the managing editor, and its sudden embrace of health care coverage, which it hadn't focused on much in the past. But this was 1997, DTC ads had just become legal, General Electric owned NBC and sure as heck wanted those pharma ads. Any connection there, Tom?
Brokaw, who had a huge pimple on his chin that day, insisted that there was nothing to it, that it was all legitimate news and so on. Some of it was, no doubt. Twelve years later, I watch health care news stories on NBC and other networks with much interest and much consternation. Almost across the board, the major TV and cable news networks all have doctors on their airwaves plus a few stray health care reporters and so many of them are terrible and spew out distorted, deeply-biased reports on various aspects of health care that it just makes me laugh, especially when you consider that roughly 50 percent of the advertising on a program like "Nightly News" is from a pharma company.
One of my favorite examples of dubious health care reporting came from "Nightly News" earlier this year when a huge study came out and linked depression and cardiac deaths in women. The same study also linked anti-depressant use to cardiac deaths in women.
"Meanwhile, NBC's 'Nightly News' gave the depression and cardiac death link huge play on its program last evening, but Brian Williams, the show's anchor, completely failed to mention the anti-depressant link. I'm not sure who is writing Williams' copy, but either they or he are utterly blind to not mention that point. Or is the TV media too scared of being dinged for allegedly scaring people off their meds?"
Or scaring Big Pharma from buying ads?
News is just out that, as expected, the controversial former Emory University psychiatry department chair Charles Nemeroff has been named chair of the psychiatry department at the University of Miami School of Medicine. Nemeroff is infamous for epic conflict of interest issues and dubious research findings. I'd say Miami U. and Nemeroff are made for each other as the university has the dirtiest, most thuggerific football team in NCAA football.
The Miami Herald reports:
"On Thursday, Pascal Goldschmidt, dean of UM medical school, called Nemeroff 'an extraordinary psychiatrist and scientist. . . . He got into serious trouble on disclosure on conflict of interest.'"Goldschmidt said he had read investigative reports from Emory about Nemeroff's activities and found nothing to indicate that payments the psychiatrist received had in any way influenced his research results.
"In a telephone interview at mid-day Thursday, Nemeroff, 60, told The Miami Herald he was excited to be coming to Miami. 'I think it's going to be a top-10 school.'"
Extraordinary psychiatrist and scientist? Last month, Bernard Carroll, a California psychiatrist and co-author of Health Care Renewal, delivered an epic smackdown of Nemeroff over his involvement in pimping Seroquel for major depression:
"As for Dr. Nemeroff, he is yesterday’s news. The adverse findings by ACCME about his program serve as a reminder to corporate sponsors and CME companies that Dr. Nemeroff is so compromised by now that he has lost effectiveness as a front man for Pharma. Indeed, he is so toxic that he now glows in the dark."
So it looks as though it'll now be sunny 24/7 in Miami.
My Nemeroff back catalog is here.
Two recent studies report risks associated with anti-depressant and other psych med use during pregnancy and how that impacts offspring.
First, a Norwegian study appearing in the British journal BJOG looked at 38,602 kids born between 2000 and 2005 and found:
"Children of mothers who used antidepressants during pregnancy showed increased healthcare use during the first year of life, independent of the mother's healthcare use. The relative risk of more than two visits to general practitioners was 1.5 (95% confidence interval, CI: 1.3–1.8) in the continuous antidepressant users group and 1.3 (95% CI: 1.2–1.5) in the group of children whose mothers stopped taking medication. In both study groups there was a trend towards more drug use for infections and inflammation compared with the control group. Children continuously exposed to antidepressants had an increased risk of cardiac interventions such as cardiovascular surgery or heart catheterisation, relative risk of 5.6 (95% CI: 1.8–17.4). The risk of physiotherapy was twice as high in the antidepressant group compared with the control group (relative risk 2.0; 95% CI: 1.5–2.6)."Conclusion: Antidepressant use during pregnancy is associated with increased child healthcare utilisation and increased risk of major cardiac interventions in early childhood."
Almost six times the risk of needing invasive cardiac procedures is an official "Wow." The researchers told Reuters, however, that the mothers' depression might play a role in all of this:
"It's possible that mothers' depression itself was a factor here, according to Ververs' team. Past studies have found that depressed mothers tend to take their children to the doctor more often than other mothers do."Compared with other mothers, Ververs and her colleagues note, depressed moms may find it more difficult to cope with problems like respiratory ills and digestive symptoms."
Depression might explain the office visits, but it sure wouldn't explain the need for cardiac procedures. They did tell the wire service that the evidence supports fetal heart screening for mothers who use anti-depressants throughout a pregnancy.
Separately, a study in the journal Women's Health Issues in September (and brought to my attention by a reader) examined possible links between maternal depression, psych med use during pregnancy and preterm deliveries. Researchers found:
"The odds of overall PTD [preterm delivery] was increased among women who used psychiatric medication during pregnancy and had either elevated levels of depressive symptoms at mid-pregnancy (adjusted odds ratio [AOR], 2.0; 95% confidence interval [CI], 1.1–3.6) or a history of depression before pregnancy (AOR, 1.6; 95% CI, 1.1–2.5). The combination of psychiatric medication use in pregnancy and depression, before pregnancy, or within pregnancy was most strongly linked to a medically indicated delivery before 35 weeks' gestation (AOR, 2.9 and 3.6, respectively). Conclusions"There are at least two plausible explanations for these findings. First, psychiatric medication use in pregnancy may pose an excess risk of PTD. Second, medication use may be an indicator of depressive symptom severity, which is a direct or indirect (i.e., alters behavior) contributing factor to PTD."
The study examined 3,019 women in Michigan.
Plain and simple, the evidence continues to mount that anti-depressant and psych med use during pregnancy poses significant risks to a child. Clearly, depression--past or present--is no friend to fetuses either, so the tricky question about how to treat all of this remains unclear.
An interesting column appeared today in the Schenectady Daily Gazette. It's a rant about medicating kids and is written by the executive director of QUEST, a non-profit for kids, in upstate New York. She walks through a few real world examples of doped-up kids and then lowers the boom.
"Since when have we become a nation of super-conformists, fitting all children into slots and molds, killing initiative, uniqueness and creativity? The Beatles wrote a song about taking a "little white pill" to get through the day, but that song was about a suburban housewife, not a child."We scream about kids smoking an 'L' or taking Ecstasy or methamphetamine, but yet parents and medical adults are pushing drugs on them from a very tender age. Untried drugs, and by that I mean not tested for use on children. The long-range effects of these pharmaceuticals on children are as yet unknown....
"Frankly, I think the relief of prescription drugging belongs mainly to the teachers, the school system and the parents/caretakers. It would be most interesting to have a symposium of adults and children, a sort of moderated pro and con debate. We frequently talk about quality of life but in a nation that frowns on the use of medical marijuana, it seems strange to allow children to take habit-forming and potentially dangerous prescription drugs. Any drugs given to children 18 and under should be heavily monitored including six-month blood work and weekly therapy sessions, either group or family. Children are more apt to speak their feelings in a situation including like peers and/or complete (including siblings) family members."
There is something about America as a culture that is so inherently messed up when it's OK to give kids antipsychotics for non-psychotic disorders but we utterly freak out at the idea of them putting other unhealthy items into their bodies. How do we get this out of our culture?
A study out in this month's British Journal of Psychiatry examined the course of bipolar disorder for as long as 15 years in the offspring of bipolar parents and found no evidence of pre-adolescent mania:
"We studied the course of major mood disorders in the offspring of parents with well-characterised bipolar disorder prospectively for up to 15 years. All consenting offspring were assessed annually or anytime symptomatic. The participants began to develop major mood episodes in adolescence and not before. The index major mood episode was almost always depressive, as were the first few recurrences. Onsets and recurrences continued throughout the observation period into adulthood. We did not find evidence of pre-pubertal mania. In summary, adolescence marks the beginning of the high-risk period for major mood episodes related to bipolar disorder."
Someone alert Joe "Agitation is Mania!" Biederman and CABF! Seriously, that's a pretty stunning finding and certainly confirms what other researchers elsewhere in the world have written. Of course, this study was done by Canadians, not proper psych researchers at Harvard.
But the rest of the world simply hasn't glommed onto the bipolar child paradigm. As I told Psychology Today earlier this year:
"As for bipolar disorder in kids (meaning pre-teens and younger), it's simply not an issue in the rest of the world. The bipolar child is a purely American phenomenon, as big a metaphor of our times as credit swaps, subprime loans, and government bailouts."
I appreciate peer-reviewed research that backs up what I've been writing.
Manoj Waikar, an adjunct psychiatry professor at Stanford who's also in private practice in Palo Alto, Calif., has made $74,850 for speaking on Lilly's behalf 51 times this year. So the New York Times smartly tried to find out what made him so sought after by Lilly and what services he provided. What fun that new Lilly database of its outside consultants has become.
"In response to queries from a reporter, Dr. Waikar wrote in an e-mail message that he received fees for speaking to other health care professionals about disorders like schizophrenia and depression, which can be treated with the Lilly drugs Zyprexa and Cymbalta respectively...."In an e-mail message to a reporter, Dr. Waikar wrote that although drug company presentations were standardized to comply with drug marketing regulations, he and other speakers did provide suggestions on the content. And he said that there was room for spontaneity at such events, because he was allowed to answer questions from doctors in the audience, drawing from his own practice experience or opinions, as long as he explained the basis of his answers.
"In an another e-mail message, Dr. Waikar wrote that talks like his could be helpful to primary care providers having to treat complex psychiatric problems. He added that doctors had contacted him after the talks to consult about difficult cases."
Since Waikar is affiliated with an academic institution and teaches medical residents, there are questions about the ethics of these kinds of things. While the article doesn't break any new ground, I'm glad it's somethign the paper chose to spend some time on.
This may strike some readers as "Duh," but British and French researchers report in this month's British Journal of Psychiatry that a long-term study of diets and depression in some 3,500 Brits found more depression in those who ate a diet high in processed foods. Those who ate a diet stronger in "whole" foods--fruits, veggies, fish--saw a 26 percent less chance of depression than did those who ate the most processed foods (meats, cheeses, desserts) and fried foods. Conversely, the high-processed foods group had a 58 percent higher risk of depression than did the whole foods group. (A BBC account of the study is here.)
Coming on the heels of last month's study showing depression-protecting effects of the Mediterranean diet, this study is further evidence of the well-known link between food and mood. Of course, it's not going to be real easy for people in the UK to follow a Mediterranean diet nor in most of the US, so this study is quite real world in that sense. It's also a big argument in favor of moderation: there's a great middle group in this study who had little depression yet did eat some of the whole foods and some of the processed foods. That said, I'm sure some would love to make an ideological argument about corporations and processed foods and a conspiracy of depression-for-profit, when really what you eat boils down to individuals eating what they already know is good for them. If they don't buy Cheez Whiz and the like (or buy much less of it), then companies won't bother making it.
The study also confirms what I've long said on this site: if you don't eat reasonably well and reasonably often, then you aren't even giving yourself a fighting chance with depression. I feel the same way about exercise and socialization. Neither are cures per se, but without them, you can go down a rat hole of mood.
One weakness of the study (I haven't seen the full version) and the reportage on it is that I cannot tell how depressed people were at baseline and at the study's conclusion. My hunch is that the findings are probably most applicable to mild-to-moderate depression and that diet would have less of an effect, especially short-term, in severe, chronic depression.
At least that's the opinion of this light-on-processed-foods, heavier-on-fruits-than-veggies eater.
A column in Newsweek, penned by science editor Sharon Begley, argues for an upside to depression, driven by evolutionary psychology considerations and what she considers evidence of the all-powerful 5HT1A receptor.
"Human brains are not the only ones with the 5HT1A receptor. Rats also have it."Here's the really interesting part: the rat version is 99 percent identical to the human one. This suggests that in the evolution from the shared ancestor of rats and people (hold those creationism letters!), natural selection did not mess with the receptor much. That leave-well-enough-alone history tends to happen when the function of some trait is so important that tinkering with it evolutionarily would produce more harm than good. What kind of harm? Rodents that have a mutation causing them to lose this receptor exhibit fewer symptoms of depression when they suffer some stress, a 1998 paper reported. In other words, losing the receptor that promotes depression in response to stress is something evolution thought would be a very bad move. Ergo: depression is not something to be thrown out lightly.
"Why not? Because, argue Andrews and Thomson, depression alters thinking and behavior in beneficial ways."
Depression's supposed advantages are deep rumination and focused thinking. As with today's other post on diet and depression, I suspect this is most applicable to mild-to-moderate depression.
Anyway, it's interesting stuff, although perhaps not much comfort to someone in the throes of depression itself and I think Begley's argument is a bit too bio-reductionist for me to be comfortable with (depression is vastly more complex than brain receptors). What's interesting to me as well is that this appeared in Newsweek in the first place as the mag has a long history of subscribing to all psych disorders being fit for medication and objects of fear.
That said, Begley does make the excellent, likely controversial point that we monkey with depression perhaps to our own detriment as a culture.
It's official: controversial psychiatrist Charles Nemeroff is leaving Emory University, according to the Atlanta Journal Constitution. Rumors have been swirling for weeks that he's accepted a post at the University of Miami. Nemeroff is expected to announce his plans later today.
Much as with men, the women seeing active duty in Iraq and Afghanistan are seeing loads of post-combat PTSD, according to the New York Times.
"Never before has this country seen so many women paralyzed by the psychological scars of combat. As of June 2008, 19,084 female veterans of Iraq or Afghanistan had received diagnoses of mental disorders from the Department of Veterans Affairs, including 8,454 women with a diagnosis of post-traumatic stress — and this number does not include troops still enlisted, or those who have never used the V.A. system."
I appreciate their service and wish them well. While I'm wishing, I wish someone would come up with a safe, effective treatment for post-combat PTSD because what we are using now certainly isn't working well.
The House health care reform bill rolled out last Thursday contains what it calls a "National Training Initiative on Autism Spectrum Disorders." The feds are setting aside $17 million in the first year of the bill, assuming it passes and merges with whatever the Senate drums up, and unspecified amounts in later years of the proposed 10-year package. (Text beginning at page 1402 of the bill, downloadable here.)
As near as I can tell from the bill, these are largely technical assistance grants, providing for:
"eligible entities to provide individuals (including parents and health, allied health, vocational, and educational professionals) with interdisciplinary training, continuing education, technical assistance, and information for the purpose of improving services rendered to children and adults with autism, and their families, to address unmet needs related to autism."
Most of these grants would be aimed at universities. The main thrust is to:
"provide training and technical assistance in evidence-based practices to evaluate, and provide effective interventions, services, treatments, and supports to, children and adults with autism and their families; (II) include individuals with autism and their families as part of the program to ensure that an individual and family-centered approach is used; (III) share and disseminate materials and practices that are developed for, and evaluated to be effective in, the provision of training and technical assistance."
It's not clear to me how all of this will improve health care delivery and access much less reduce the cost of health care, but perhaps I am missing something. None of the ASD blogs I've checked in with have picked up on this funding, so I guess they don't consider it such a big deal. Aside from postpartum depression advocates getting the MOTHERS Act carved into the bill, as I reported on Friday, ASD is the only mental disorder to get any sort of special treatment in the bill.
Combined with $60 million in NIH funding from the federal stimulus bill, this has been a big year for autism advocates with the Congress and Obama Administration. I hope they get some results with all of this money.