OK, folks, there's $99.74 to go to hit the fundraiser's goal of $4,000 before midnight tonight. Midnight approaches. Let's do it. The PayPal button is on the right.
Happy New Year.
OK, folks, there's $114.74 to go to hit the fundraiser's goal of $4,000 before midnight tonight. Let's do it. The PayPal button is on the right.
Happy New Year.
Just a quick note to let readers know that a couple of contributions have come in today so far and that there is now a mere $134.74 to go to hit the overall goal of $4,000, a goal that would be great to hit. Today is the last day of the fundraiser. The PayPal button is on the right. Thanks to all of you who've contributed so far and thanks in advance to whomever else contributes today.
Happy New Year.
Ruth Lilly, 94, died on Wednesday. She was the last surviving great-grandchild of Col. Eli Lilly, the founder of the pharmaceutical giant, and in 2002 her fortune was valued at $800 million to $1 billion, although she didn't have direct control of her estate. She gave away much of that before she died, including $200 million to the foundation that publishes Poetry magazine, which had long rejected Lilly's verse.
Lilly reportedly suffered from depression much of her life and, ironically, took Prozac, which apparently helped her greatly.
"Prozac, the Lilly company’s most successful drug in decades, came on the market in 1988. Ms. Lilly began taking the green-and-white pills, and her outlook brightened. 'That thing made a world of difference,' her physician Jack Hall told the Star in 2002. 'Prozac really helped her--it changed her life.'"
No cause of death was given.
Another $45 from two people came in yesterday bringing the total raised to date to $3,815.26 from 87 people. Thanks to all of you who've contributed so far. There's still another $184.74 to go from 13 people to reach the overall goal of $4,000 from 100 people. Today is the last day of the fundraiser, so it'd be truly awesome if that goal were hit today.
There hasn't been a single quarterly fundraiser in the history of doing them on this site that has failed to meet goal. It'd be nice to keep that streak going.
If you'd like to help, 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.
Thanks in advance for your support. Happy New Year.
I'd really rather not be writing about the forthcoming DSM-5 (come on everyone, let's drop the Roman numeral already. Cicero and Seneca ain't writing the dang thing), but Shirah Vollmer, a psychiatry and family medicine professor at UCLA, has written critically of the DSM on her Psychology Today blog. In other words, yet another academic within psychiatry is criticizing her colleagues who are putting together DSM-5. Who knows? Maybe they'll listen.
Vollmer's primary point:
"The biases of psychiatric diagnoses are powerful. The more people who are included in a mental disorder, the more research money there will be to fund the science, and the more drug companies have incentive to produce treatments. On the other hand, the more people who are included in a diagnosis, the more suspicious the public becomes about the quality of the diagnostic criteria. No matter how DSM V will be written, it will be flawed. There is no psychiatric diagnosis which has an objective measure. At the moment, all diagnoses are clinical diagnoses, meaning they are subjective. This is a field of humility. There is a lot that we do not know."I think there should be an introduction to DSM V which clearly states that this book is a product of work groups, and as such, the diagnostic criteria are subject to further revision. Perhaps this is obvious, but I think that this point needs to be stated clearly. The public needs to know that psychiatry is a field in its infancy, and as such, skepticism is warranted."
Skepticism, yes. But ignoring the whole DSM altogether might not be such a bad idea.
It's been a tough last year or so for DSM-5. The New Scientist called for an end to the DSM or at least its current clunky revision process. The APA delayed the release of DSM-5 by one year to 2013. In late 2008, DSM-3 creator Robert Spitzer slammed the DSM-5 process for its secrecy. And Christopher Lane busted the DSM-5 creators for a lack of transparency.
I'd say DSM-5 is in a lot of trouble. And it deserves to be. The DSMs have become so expansive that researchers could actually assert with straight faces, as they did last year, that almost 50 percent of college-age Americans have a psychiatric disorder. With assertions like that, the so-called Bible of psychiatry looks crazier than the Farmer's Almanac.
Good for Vollmer for pulling up a chair at what's becoming a hog killing, if I can put it that way.
Another $65 from three people came in yesterday and that brings the total for the fundraiser to date to $3,770.26 from 85 people. Thanks to all of you who've contributed so far. There's still another $229.74 from 15 people to go to reach the overall goal of $4,000 from 100 people. I'd really like to hit that goal by the end of tomorrow and I will not extend things beyond the 31st. So it's in your hands.
As usual, the PayPal button is on the right. Thanks in advance for your support.
I'm far too exhausted from traveling yesterday and from writing the much-ignored post on Sen. Debbie Stabenow--which one reporter friend predicts will be ripped off by a major paper any day now--to write anything original for this morning. I'll save that for later in the day.
For now, I thought I'd share 2009's 10 most popular posts based on hits of posts authored in 2009. (There are some older posts that remain quite popular too.)
1. Perhaps not surprisingly, this post from April on an experimental homeless housing program in Seattle addressing chronic street drunks took top spot.
2. My January rant on being used by a Rolling stone author got more attention than it deserved.
3. Not sure why my limited thoughts on a New York Times article on psychosis interested so many, but they did.
4. A May post on boys taking Risperdal growing breasts....Well, of course, that would be popular.
5. Adverse events and Pristiq. Say no more.
6. One of my posts on admissions by Jani's dad got hits all over the place after Oprah dida show on her.
7. Everyone wanted to know about a Harvard doc falsifying a sleep apnea study.
8. And placebo outperforming Seroquel in a teen bipolar depression study is always good for hits.
9. Placebo scores again with psychiatrists trying to explain away the huge placebo effect in child depression studies.
10. Although it got few comments, this post on a study of anti-depressants causing mania in bipolar disorder had many readers.
And that's the year that was.
Another $10 came in from one person yesterday and that brings the total for the fundraiser to date to $3,705.26 from 82 people. Thanks to all of you who've contributed so far. There's still another $294.74 to go from 18 people to reach the overall goal of $4,000 from 100 people and I would dearly love to hit that target by the close of Thursday, the last day of the year. But I'll leave that up to you all.
As I hinted yesterday, there's a major post up on the site today, revealing $1.25 billion in federal funds for depression centers (un-needed in my opinion) that suddenly wound up in amendments to the Senate health care reform bill on December 19, apparently to help snare the support of a single Democratic Senator. Amidst all the squawking in the mainstream media and in the lefty and conservative blogosphere over sweetheart deals for other Dem Senators, everyone missed what I've written about, even though the other giveaways pale in comparison on a dollar basis. I'll leave it to you to speculate as to why. But as I have mentioned before, this site does work that you won't find elsewhere in the media. And, in all modesty, I think it merits your support. Heck, it's a 2,000 word post. I won't even tell you what I used to get paid for such work back in the days before the Great Recession.
If you'd like to support my work here, the PayPal button is on the right. Or if you prefer using snail mail, send me an email and I'll send you my mailing address.
Thanks in advance for your support.
There's been a lot of coverage of amendments to the recently-passed Senate health care reform bill over the last 10 days, especially the Medicare giveaways for the State of Nebraska reportedly employed to capture the support of Sen. Ben Nelson (D-Nebraska) as well as giveaways to other Democratic senators. But one provision of the amendments, which were introduced on December 19, has escaped notice of the mainstream media and the political blogosphere alike. That would be $1.25 billion included in the amendments, apparently to secure the vote of Michigan Senator Debbie Stabenow. Sen. Stabenow, a Democrat, was a passionate advocate for the so-called public option who voted to support a bill without a public option in exchange for inclusion of $1.25 billion in new federal spending to support "centers of excellence" in depression treatment. (A list of so-called cash for cloture is here.)
In October, Stabenow introduced the so-called ENHANCED Act of 2009 on the Senate floor. But the Act was not included in the original Senate health care reform bill. Instead, it showed up virtually unnoticed in the manager's amendment (as the Senate amendments are known) on December 19. Was this inclusion in exchange for Sen. Stabenow's vote? What would these depression centers do (the relevant text begins on page 277)? Are they really needed? Depression is, after all, a well-researched and understood phenomenon and has been for decades and billions of dollars federal, state and pharma have been focused upon it. Why does the Senator believe that depression and bipolar disorder exist at twice the rate as does NIH? Is she engaging in scare tactics? How would these centers improve access to health insurance coverage for uninsured Americans, which is what I thought health care reform was supposed to be about?
Why is Sen. Stabenow proposing to spend $1.25 billion and saying, as she did in a floor speech, "My bill is based on work done informally" by the University of Michigan and 16 other academic centers? Shouldn't taxpayers, much less other senators, have a reasonable expectation that whatever program Sen. Stabenow proposes would be based on formal studies that a network of depression centers of excellence can make a marked improvement of some kind in depression treatment. Perhaps the Senator is resting on informal work because the formal, peer-reviewed, published evidence for current depression treatments shows that they don't work especially well, as I'll outline later in this post.
I made repeated requests for comment to Sen. Stabenow's office to clarify all of this. To date, I have received no reply.
THE ENHANCHED ACT OF 2009, A SENATOR'S EXCESSIVE CLAIMS
The ENHANCED Act is of course an acronym, in this case for "Establishing a Network of Health-Advancing National Centers of Excellence for Depression Act of 2009." The Act (here it is as introduced in the Senate on October 22, 2009) encompasses both depression and bipolar disorder, which has depressive episodes as one of its hallmarks. The Act's goals, as expressed in the amendment, are for the centers to:
"Each Center shall— ‘‘(A) integrate basic, clinical, or health services interdisciplinary research and practice in the development, implementation, and dissemination of evidence-based interventions; ‘‘(B) involve a broad cross-section of stakeholders, such as researchers, clinicians, consumers, families of consumers, and voluntary health organizations, to develop a research agenda and disseminate findings, and to provide support in the implementation of evidence-based practices; ‘‘(C) provide training and technical assistance to mental health professionals, and engage in and disseminate translational research with a focus on meeting the needs of individuals with depressive disorders; and ‘‘(D) educate policy makers, employers, community leaders, and the public about depressive disorders to reduce stigma and raise awareness of treatments. ‘‘(2) IMPROVED TREATMENT STANDARDS, CLINICAL GUIDELINES, DIAGNOSTIC PROTOCOLS, AND CARE COORDINATION PRACTICE.—Each Center shall collaborate with other Centers in the network to— ‘‘(A) develop and implement treatment standards, clinical guidelines, and protocols that emphasize primary prevention, early intervention, treatment for, and recovery from, depressive disorders; ‘‘(B) foster communication with other providers attending to co-occurring physical health conditions such as cardiovascular, diabetes, cancer, and substance abuse disorders;"
The Act as it appears in the amendment is a bit more watered down than its October version. Then it had language that would in essence seek to increase the number of Americans diagnosed with depression, as well as the number of Americans treated for depression and bipolar disorder. Sen. Stabenow also claimed in her floor speech that too many Americans went undiagnosed and untreated. Really? With 30 million Americans taking an anti-depressant every day? I don't buy that for a minute. I'll come to all the evidence-based interventions and practices in a moment.
Anyway, the Act would reach its ends by granting, in its first five years, $500 million to 20 universities or non-profits to work in the community to spread the word about depression and get folks into "evidence-based" treatment. More on the evidence in a minute. These centers, modeled on the University of Michigan's Depression Center, would get $5 million a year apiece for five years. In its second five years, the Act would fund 30 depression centers for five years at $5 million apiece per year for a total of $750 million. That brings the total for the 10-year life of the Act to $1.25 billion.
What university psychiatry department wouldn't want a piece of that action?
In her October 22 floor speech introducing the Act (officially S. 1857), Sen. Stabenow stated:
"Depression and bipolar disorders affect one of every five people in the United States...."
That's a wildly inflated claim regarding the prevalence of depression and bipolar disorder in America. The National Institute of Mental Health estimates major depression affects 6.7 percent of adults in America at any one time and that bipolar disorder (types 1 and 2) affect 2.6 percent of adults in America at any one time. That works out to 9.3 percent of adult Americans.
Why is Sen. Stabenow more than doubling the rate of depression and bipolar disorder in America? What is the source of her prevalence claim? Her office did not return repeated requests for comment.
Personally, I think the Senator either doesn't know what she's talking about or was fed a bum steer by someone in the world of mental health advocacy. After she concluded her floor speech, Sen. Stabenow had introduced into the Congressional Record letters of support from the following mental health advocacy groups: Mental Health America, the American Association for Geriatric Psychiatry, the American Academy of Child and Adolescent Psychiatry, and the American Foundation for Suicide Prevention. (Scroll to the bottom of her speech to read them.)
Mental Health America is one of almost three dozen medical advocacy groups currently under investigation by Sen. Charles Grassley (R-Iowa) for undisclosed contributions from pharmaceutical companies.
Sen. Stabenow also made other excessive claims in her speech.
"Clinicians lack universally accepted multi-disciplinary approaches and real-time clinical and care management guidelines."
The American Psychiatric Association has a set of easily-accessible guidelines for the treatment of depression. I'm sure psychiatrists, PCPs and family physicians know where to find them. While I don't necessarily endorse them, to claim that guidelines don't exist is flat wrong. What's more, in recent years NIMH has completed two separate long-term, real-world clinical trials of both depression treatments, including medications and psychotherapy, and treatments for bipolar disorder. The trials are called STAR*D and STEP-BD, respectively. Their results have been widely-disseminated in the medical literature.
It strikes me as re-inventing the wheel to fund 30 depression centers at $1.25 billion over 10 years when much of what the Senator argues for is already well-researched, understood by clinicians and mental health workers and is already abroad in the land. How well it all works is a different story.
The Senator also played the suicide card in her floor speech.
"And tragically, one of the preventable costs of undiagnosed, untreated and undertreated depression is suicide. The World Health Organization recently reported that suicide causes more deaths around the world every year than homicide or war. Across all age groups nationwide, more than 90 percent of those who commit suicide have a diagnosable psychiatric illness at the time of death: usually depression, alcohol abuse or both. Clearly, we need better diagnostic approaches to depression in primary care, other medical settings, and mental health programs."
No mention, of course, of the role that some depression treatments can play in suicide and suicidality (I refer to the black box warnings on all anti-depressants and growing body of research showing links between anti-depressants and suicidality, especially in teens and young adults). There's even some evidence that suicidality in the STAR*D trials may have been covered up. No mention either of the increasing evidence base showing that anti-depressants are linked to a range of ailments such as sudden cardiac death, especially in women. (need link here) No mention that the 1999 HHS initiative Healthy People 2010 has utterly failed to meet its goal of a 50 reduction in the suicide rate (it's about the same as in 1999, give or take), despite leaning very heavily on precisely the kinds of education and interventions that Sen. Stabenow seeks to enshrine in health care reform.
WHY SPEND $1.25 BILLION TO PROMOTE WEAK TECHNOLOGY, CORRUPT EVIDENCE BASE?
As I've noted on this site often over the last four-plus years, when it comes to depression treatment we are working with weak technology. For example, in the STAR*D depression trials--funded by NIMH--researchers found that the best anti-depressant treatment could muster was about a 30 percent effect size and things were even worse for anti-depressants in the NIMH-funded STEP-BD trials of treatments for bipolar disorder where placebo outperformed anti-depressants. Psychotherapy, in particular CBT, performs in the 30 percent-ish effectiveness range as well.
What's more, the evidence base for depression (and other treatments) is notoriously corrupt. For instance a recent study found that the authors of the APA's practice guidelines (for several disorders) were deeply-tied to pharma monies. And a 2008 study by OHSU psychiatrist Erick Turner found that the pharmaceutical industry had significantly overstated the efficacy of anti-depressants for decades by keeping negative trials of anti-depressants unpublished. Meanwhile, Sen. Stabenow's colleague Sen. Grassley has been exposing academic researchers who are making millions from pharma companies while doing federal research on depression (and other disorders) and not disclosing the same, bringing into question the quality of the evidence base. (The two senators should talk. Seriously. My extensive Sen. Grassley back catalogue is here.)
So what evidence base and what excellent methods Sen. Stabenow is exactly proposing to spread across the land with $1.25 billion escapes me.
If you go to the University of Michigan's Depression Center looking for something new and innovative, you're going to walk away disappointed. The center's web page for depression and treatments reads like pretty much anything else you've ever read on any other center or advocacy group's website. Causes of depression? Unknown. Treatments? Medications, CBT, interpersonal therapy and, ick, ECT. Not a single mention of diet or exercise that I could find. That's kind of interesting in light of the fact that the UK's National Health Service has backed away from meds as first line depression treatments in recent years and begun to emphasize watchful waiting, diet and exercise and, then, psychotherapy as treatments in advance of using medications in treating mild to moderate depression. Anyone seen a spike in depression or suicide in the UK as a result? Didn't think so.
So much of what Sen. Stabenow is proposing sounds like it's straight out of 1993, back when anti-depressants were assumed to always work and had no side effects whatsoever and taking them was really, really good for you. We know better now. Or at least you do.
Look, we've been chasing our tail in America for the last 20 years or so trying to address depression, but it's a race that appears to have been run. While I cannot question Sen. Stabenow's good intentions, I can question the cost of these depression centers and what they would actually accomplish much less their inclusion in a health coverage reform bill. It'll be interesting to see how this all gets sorted out, or not, in the House-Senate conference committee next month.
I'm flying today from Tucson to Seattle and, with the new TSA security measures in place, God only knows how that might play out. A friend of mine is going to handle comment approval a few times during the day, but after about 9.30 a.m. EST until about 7 p.m. EST comment approval is out of my hands. Don't let that deter you from leaving comments, but know that their approval may be slowed somewhat today.
Things ought to be back to normal later this evening. Have a nice day.
I didn't expect the fundraiser to generate much action after the 22nd and I was right since nothing has come in since. As things stand now, the total raised to date is $3,695.26 from 81 people. Thanks to all who've contributed so far. There's a mere $304.74 to go to hit the overall goal of $4,000 and it'd be swell if that remainder was wiped before year end. On Tuesday (or late Monday), I will have a major post up that I've been working on over the holiday weekend that will reinforce for those of you who contribute why you support this site and will hopefully establish for those of you who haven't why you should. You'll see what I mean on Tuesday.
As usual, 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.
Thanks in advance for your support.
Over the weekend I finally got time to roll through the recently-passed Senate health care reform bill and, like its House cousin, it contains much of the language of the controversial MOTHERS Act. You can download the Senate bill here and start reading at page 595.
As I noted in October when the House Democrats rolled out their version of health care reform, let me just carefully point out that it confuses me that legislation that is supposed to gain uninsured Americans access to health care (out of their own pockets in many cases) contains an Act that is little more than a postpartum depression screening program and public health awareness raising nation-wide education campaign. That helps uninsured Americans gain access to health insurance how? It makes me wonder what Senate (and House) members pushed for its inclusion and on what basis. I know the Act has been knocking around Congress for much of the past decade and could never gain passage, so I guess this was the most efficacious manner for its backers to get it through.
The MOTHERS Act itself has been the object of much criticism--by women even and a psychiatrist--as a disease mongering gift to pharma companies. Feel free to draw your own conclusions. I've learned from bitter experience that it's probably not very wise for me to have an opinion about the Act itself.
The Senate bill also contains language supporting basic research of the causes of PPD, epidemiological studies of its frequency, "the development of improved screening and diagnostic techniques" and "clinical research for the development
and evaluation of new treatments."
One wonders what new treatments those might be--isn't Paxil in pregnant women working out just fine so far for mother and child? Is there some new drug on the horizon specifically tailored to PPD? Is there some new psychotherapy on the horizon? Or are they just going to hand out money so that some researchers can pretend that there might be when, in fact, we're probably stuck with the pills and therapies we already have? And all of this affects Americans access to affordable health care how?
Inserted into the language on PPD research and education, the bill contains language similar to the House bill (which I wrote about here) on researching the mental health outcomes of women who have abortions or otherwise resolve a pregnancy. To whit:
"It is the sense of Congress that the Director of the National Institute of Mental Health may conduct a nationally representative longitudinal study (during the period of fiscal years 2010 through 2019) of the relative mental health consequences for women of resolving a pregnancy (intended and unintended) in various ways, including carrying the pregnancy to term and parenting the child, carrying the pregnancy to term and placing the child for adoption, miscarriage, and having an abortion. This study may assess the incidence, timing, magnitude, and duration of the immediate and long-term mental health consequences (positive or negative) of these pregnancy outcomes.
As I wondered aloud in October, it's not clear to me how such a study would affect Americans access to health insurance, but perhaps I am a blockhead. I also wonder who pressed to have this provision stuck into the bill since it's not clear to me whether such a study would serve the interests of pro-lifers or pro-choicers.
If anyone knows, feel free to enlighten me.
A study by Harvard's Joseph Biederman and others at Harvard/MGH in the November Journal of Clinical Psychiatry, which just went online, and reached one of the least controversial findings of the controversial psychiatrist's career: adults with ADHD (and that's the term researchers used instead of ADD) have more difficulty with sleep than do people without ADHD.
"Results: Adults with ADHD went to bed later than control subjects and had a wider range of bedtimes (mean ± SD = 18 ± 92 min vs 54 ± 69 min before midnight; P < .001), were more likely to take over an hour to fall asleep (OR = 5.22, P = .001), and were more likely (P < .003) to experience difficulty going to bed, going to sleep, sleeping restfully, or waking in the morning. Adults with ADHD experienced daytime sleepiness more often (OR = 2.23, P = .003) and reported more sleep problems (mean ± SD = 6.7 ± 2.5 vs 4.3 ± 2.2; P < .001) than controls. All sleep impairments were significantly associated with ADHD independent of contributions to sleep disruption from ADHD pharmacotherapy, comorbidities likely to contribute to sleep disturbance, and age at ADHD onset."Conclusion: Sleep disturbances that are not attributable to comorbid mental health conditions or ADHD pharmacotherapy are associated with ADHD in adulthood. Clinicians and researchers should consider the potential contribution of sleep disruption to the clinical presentation of adults with ADHD."
While I don't necessarily buy researchers' implied argument that going to sleep before midnight is the gold standard of sleep (especially if someone works swing or graveyard shifts. Do Biederman et al. really believe that everyone works 8 to 5 and that that's the appropriate standard for poking into sleep and ADHD? Ah, ivory towers and pharma dough!), I have no problem with the idea that sleep difficulties could be tangled up with adult ADHD (A dx I'm somewhat dubious of, but I'll leave that be for now). The fact is sleep problems are entwined with several mental disorders, depression and bipolar disorder most prominently.
I'm not quite comfortable with the researchers' assertion that the sleep problems can be determined to be independent of ADHD meds or a history of taking ADHD meds and other psychotropics. I mean, maybe they can get there statistically. But over the years of doing this site and hearing from readers and from just your basic workaday observations of people with depression, bipolar disorder and ADHD, I've come to the conclusion that psych meds are almost always at least partially implicated in sleep problems (both in sleeping too little and in sleeping too much and in general difficulties falling asleep). In the years since I became meds-free (and it's nice to be able to say "years" in that regard), sleep has come more easily and been of better quality. Of course, if the Biederman crew took a look at what time I go to sleep most nights (2 a.m.), they'd be screaming "ADHD" at me. But I've been a late-night type since my college days. I had little choice since I was taking a full load, working five hours a day and studying six hours a night along with getting up at 6 a.m. to run three miles and go lift weights before breakfast. ADHD had nothing to do with that pattern establishing itself.
The other thing I've picked up on over the years from reader emails and the real world is that far too often people with depression, bipolar disorder and whatnot spend way, way too much time on their computers late into the evening. Computers and the 'Net have become such deeply distracting, "You must multi-task on me or leave society" devices that I wouldn't be shocked at all if they are as much at the heart of adult ADHD problems as are sleep problems and ADHD itself.
I know a psychologist in Seattle who's been working with kids and teens and ADHD and conduct disorders and such for 30 years. I ran into her at a party perhaps a year ago and amidst telling me that she thought the entire bipolar child paradigm was BS, she said that when a new teen client came in with his or her parents she told them that if they didn't agree to limit computer/call phone use at home to one hour a day, then she wouldn't work with them. She couldn't control how much a kid was forced to use a computer at school, but getting them to back off the many hours a day kids spent using computers (and MySpace and IMs and text messages) each day in almost every case went a long way to resolving the kids' problems. They were less distracted and slept better. Or so she told me.
I wonder if the Biederman crew made any attempt to account for computer/Internet use confounds in its study. As far as I can tell, they didn't.
t's with a lot of sadness that I pass along news that the great singer-songwriter Vic Chesnutt died yesterday, aged 45. He'd been in a coma and some reports indicate that was as the result of a suicide attempt. A paraplegic since a car accident in his teen years, Chesnutt was reportedly facing $70,000 in medical bills due to recent surgery and was unable to pay. I have no idea if that fed into his possible suicide attempt.
I once saw Chesnutt play a show in San Diego back in 1992 or so. I bought a cassette tape of his wonderful album "West of Rome" off him at the show and chatted with him for a bit. Nice guy. It sucks that he's gone. RIP.
I hope you all are having a nice, peaceful holiday regardless of what you celebrate. My flight down from Seattle to Tucson yesterday was a complete pain in the butt--what has happened to air travel?--and I'd just like to say that US Airways stinks. But I'm enjoying the nice weather in Tucson--low 50s, sunny and two more hours of daylight a day than in Seattle this time of year. I need it.
I'll be back to regular posting on Monday.
Oh, yes, the Senate Dems passed their health care reform bill earlier today. I don't have much to say about it right now since the real action will come after the New Year when it has to be reconciled with the House version of the bill. That said, I'm sure you are all aware that the Senate bill is drawing heaps of criticism from both the political left and right. One writer at Firedoglake.com, about as lefty a joint as you'll find on the 'Net, described the whole business as "Obama's Health Care Cult of Personality" and offered a fairly decent critique of the bill. In less than one year, the President's most ardent supporters have turned into some of his biggest foes. Not sure if I saw that coming. I'm sure you can imagine what conservatives are saying about the bill.
Anyway, I hope the year winds down peacefully for you all.
I'm leaving for Tucson early this morning so no new posts for today. I'll do some catching up on Thursday. Comment approval will be non-existent between about 11 a.m. EST and 8 p.m. EST. I hope this year my flight doesn't get scrubbed for maintenance issues because I couldn't get another flight out and lost my Christmas trip to see my parents. Fingers are crossed.
Meanwhile, another $65 from three people came in yesterday bring the total raised to date to $3,695.26 from 81 people. Thanks to all who've contributed so far. There's a mere $304.74 to go to hit the overall goal of $4,000 and it'd be swell if that remainder was wiped out very soon.
As usual, 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.
Thanks in advance for your support. And also thanks to all of you who've offered such kind thoughts about Stephany's situation. I know she appreciates it and so do I.
Another $120 came in yesterday from three people and that brings the total raised so far to $3,630.26 from 78 people. Thanks to all of you who've contributed so far. That leaves a mere $369.74 to go from 22 people to reach the overall goal of $4,000 from 100 people.
I'd really like to wind up this extended fundraiser over the next few days. It's very close to goal and that should be doable.
If you'd like to contribute, the PayPal button is on the right. Or if you prefer using snail mail, send me an email and I'll send you my mailing address.
Thanks in advance for your support.
It is with a very heavy heart that I tell you all that Stephany of Soulful Sepulcher yesterday lost her three-year fight to keep her daughter Lindsay out of Western State Hospital here in Washington State. Stephany has written about the loss here.
Linds, as she's known, was sent there because there's no other placement for her even though a King County Superior Court judge found her not to be a danger to her self or others. She is instead at danger from society...ie, being hit by cars because she has a habit of walking off from her housing. Linds is officially diagnosed with schizophrenia or psychosis NOS, depending on who's diagnosing, but her mom makes a compelling case for Linds having autism.
Linds is 21 with the capacity of about a 13 year old. She was at WSH for about two weeks a few years ago and got molested by one of the male patients. I'm hoping to God that doesn't happen this time, but the last time I checked there were 19 registered sex offenders at WSH. While I suppose most of those are guys in WSH's forensic unit (ie, jail), there are likely some on the general adult units. A young woman like Linds is--excuse the expression--fresh meat to them and if one of those creeps goes after her I will hit the roof.
The system is bad enough already, but women should not have to face the prospect of sexual abuse. Same for the men.
Stephany has fought heroically for three years in ways that I have never seen a parent fight for a child. She and Linds deserved a better outcome. I hope they get one soon.
OK, news is just coming out this afternoon that the Senate health care reform bill will include a 10 percent tax on artificial tanning. Apparently, this was done to replace the Botox tax on cosmetic surgery that was in the bill at some point. I'm not a fan of the whole artificial tanning thing, but if people are into it, then whatever. Some folks use tanning sessions to ward off seasonal affective disorder. But a federal tax on it? To help pay for health care reform? I think there needs to be a diagnosis in the DSM for this kind of political chicanery and nanny statism. Heck, I'm just waiting for someone to declare this tax discriminatory against white people.
Meanwhile, here's a post by a public health type at the Huffington Post who's predictably ecstatic at the prospect of the tanning tax.
The AP had a small item today on a new and interesting project called Pets2Vets, which seeks to match military veterans with post-combat stress/PTSD with a suitable dog or cat from an animal shelter. This is such a great idea not only because animals have been proven to be quite useful therapies for PTSD, but because this country's animal shelters are overrun with unwanted animals, far too many of whom end up being euthanized. Anything that works to address those twin problems is good with me.
I'd hoped that the fundraiser would meet its goal on Friday, but despite $160 coming from three people on Friday and $40 from two people on Saturday, the fundraiser is short of its goal by $489.74. That's simply too close to the goal to not extend things a bit and see what happens, especially since I know a couple of checks are still headed my way and because I don't want this thing to fall short.
So here's where things are at: $3,510.26 from 74 people has come in to date. That leaves $489.74 to go from 26 people to reach the overall goal of $4,000.
Thanks to all of you who've contributed so far.
If you'd like to join them, 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.
Thanks in advance for your support.
The Chicago Tribune had a short piece a couple of weeks ago detailing that hundreds of foster kids in the Illinois state system were winding up on psych meds without consent and without approval of the state program. That's apparently an improvement over a few years ago when many more kids were getting them without consent. Even more stunning is that 9 percent of foster kids in Illinois have been diagnosed with bipolar disorder and methinks those can't be all troubled teens (the paper doesn't get at how young some of the kids are).
"'This is a really concerning statistic,' said Dr. Michael Naylor, a University of Illinois at Chicago psychiatrist who reviews psychotropic medicine regimens for the state Department of Children and Family Services. Naylor said he worries that drug firms' marketing efforts are driving the diagnoses."
No kidding. In other news, the paper found than about 10 percent of the 3,564 wards getting psych meds were taking four or more medications.
This sounds like what has been cropping up in Florida, New York and other states. And it pretty much needs to stop.
Posting this week will be pretty light after Tuesday as Wednesday is a travel day for me and Thursday and Friday are holidays. So most posts will go up today and tomorrow.
I hope you all are easing into a peaceful holiday season.
Ah, the lovely New York Times website is still running that big old Seroquel for bipolar depression ad--because it can consume you! As a consequence, I will not be visiting said site or linking to it until said ad disappears. Seroquel is a drug that messed me up, so I think I'll take my national news reading over to the WashPo for the time being.
It's probably time to fold your tent and leave. Or something. Anyway, the Seattle Times today has a fairly sensible editorial calling on Congress to set aside health care reform. I note this because the Times is a fairly liberal paper, but a long way from lefty blogger land where everyone wants the senate bill killed.
"THE health-care dance in Washington, D.C., has gone on long enough. Congress needs to focus on the economy and set health care aside."This is a change of position for us. This page supported Barack Obama for president, enthusiastically. We have supported the health-care effort until now. We still support universal coverage as a social goal.
"But the longer the fight goes on, the more it feels that the timing is all wrong. The economy is wounded. Employers are hurting. The time to think about loading employers with new burdens is when they are strong. Not now."
Health care reform is in big trouble. Simple as that. And I hope Congress is mature enough to not pass a bad, garbled, compromise-laden bill just to pass something and claim political victory. I doubt the American people will buy that.
Keep in mind, I write the above as someone who's not had health insurance in two and one-half years.
"About 1 in every 110 8-year-olds in the U.S. had autism spectrum disorder in 2006, according to a report today released by the Centers for Disease Control and Prevention in Atlanta. While more cases are being identified as people become aware of the disorder, a rise in the number of kids affected 'cannot be ruled out,' the CDC said."
I'm not sure that I buy the whole autism epidemic argument, but something sad certainly is going on out there.
Another $285 came in yesterday from five people and that brings the total raised so far to $3,310.26 from 70 people. Thanks to all of you who've contributed so far. There's still another $689.74 from 30 people to go to reach the overall goal of $4,000 from 100 people on or about December 18th, which is today.
I would dearly love the fundraiser to hit goal today. But I'll put it in your hands.
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.
Thanks in advance for your support.
I haven't seen myself yet, since they are reportedly running regionally until the New Year, but I've heard from readers and have read one press account of a wave of TV, print and online ads touting Seroquel, the truly nasty atypical antipsychotic, for bipolar depression. I presume these ads will soon morph into a Seroquel as an add-on depression treatment soon enough. You can get a feel for the ads on the Seroquel website.
“Bipolar depression doesn't just affect you--it can consume you,” state the ads. Oh really? That's quite the statement. I'll have more to say about the TV ads when I see one. There was an ad for Seroquel as a bipolar depression treatment on the New York Times main web page last evening. Hopefully, we don't get Quell ads on MySpace and such this time out (yes, AZ was running ads on that site in late 2005).
I'm flat out exhausted after a long week in a tough year in a trying decade, one that will soon be at an end, and have run into several tidbits I wanted to pass along.
Apparently things are hopping for the parents of Jani. Not only am I told that her dad has a book deal but the rumor is that ABC's "20/20" is doing a piece on her. Meanwhile, check out the website, scroll to the bottom and you'll see that mom and dad have their own publicist now. No comment.
More on the Miami psychiatrist who's been writing 153 prescriptions a day. The feds have stopped paying his Medicare/Medicaid claims. I suspect there are many, many docs like him across the USA who merit investigation.
The Last Psychiatrist has fun, as only he can, with a patient account of severe depression.
Danny Carlat has some thoughts on ghostwriting.
The wonderful Mind Hacks has a bit on a study establishing that some pre-Homo sapiens cultures were able to do planning of tasks, something thought only to have belonged to H. sapiens.
Soulful Sepulcher has a recent update on her daughter, Linds, who may end up in Western State Hospital soon. It's all sadder than I can get into.
Lastly but not leastly, Liz Spikol did her first post in forever the other day. She's far too busy to blog often, but it's nice to see her poke her head above the surface and to learn that she's gotten off Seroquel after 11 years. That's a major victory for her.
Another $220 came in yesterday from three people and that brings the total raised so far to $3,025.26 from 65 people. Thanks to all of you who've contributed so far. There's still another $974.74 from 35 people to go to reach the overall goal of $4,000 from 100 people on or about December 18th, which is tomorrow.
I would dearly love the fundraiser to hit goal and it's entirely possible that it'll get hit or come close. But that's up to you all.
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.
Thanks in advance for your support.
I was bothered by a study that appeared in the American Journal of Psychiatry back in September which argued that atypical antipsychotics used as add-on treatments to anti-depressants were much more effective than a placebo add-on. The study was by J. Craig Nelson of UCSF and George Papakostas of Harvard/MGH. I was suspicious of the study's findings, which I wrote about in September, since I'm fairly up to speed on the clinical literature and seen only weak effect sizes of atypicals used this way. The reason I am bringing this up is because the great CL Psych has posted something on his blog this week on this study and utterly guts it. (A link to the study is on my original post.)
My suspicions then:
"Now, here's why you should be very suspicious of the apparent epic victory over placebo:"'The odds ratio for remission was 2.00, with a number needed to treat of nine.'
"The NNT as it's known means the number of people who would have to try a treatment before one person would realize a treatment benefit. An NNT of nine people translates to an overall efficacy for atypical augmenters of about 11 percent. Staggeringly low. And hardly the victory researchers seemed to be claiming."
And now for CL Psych, who is a stats jock par excellence:
"But the 'evidence' is not all that convincing. Here's why... The authors pooled together the results of 16 randomized controlled trials. In these studies, patients had failed to respond adequately (using various definitions) to an antidepressant. Patients were then assigned to receive either an atypical antipsychotic or a placebo in addition to their antidepressant. Outcomes were then tabulated somewhere between 4 and 12 weeks later. The results seem clear cut -- if your brain is turned to "off" -- the response rates for atypicals was 44% compared to 30% for placebo. The remission rates were 31% for atypicals and 17% for placebo. The advantage for atypicals is statistically significant. Well, there you have it. Done deal. Ask your doctor about Abilify/Zyprexa/Seroquel today..."But the most important thing in a treatment outcome study is... the outcomes. The authors of the meta-analysis did not bother to actually measure change in scores on rating scales. Instead, they only used response and remission rates. There is absolutely no good reason for doing this. It's potentially quite misleading. Doctors like remission and response rates because they provide the illusion that we are measuring depression exactly. A "responder" got a lot better and is functioning reasonably well whereas a "non-responder" is in bed 12 hours a day while spending the rest of her time watching the E! Network, eating Bon-Bons, and sobbing constantly. But it's not nearly that scientific. A "responder" is usually defined as someone who got 50% better on his or her depression rating score during the study period. So Bob's depression rating score improved by 52% (he's a responder), but Amy's score only improved by 48%, so she's a nonresponder. Is this 4% difference really meaningful?"
And that's why the study itself, which wasn't pharma-funded, produced an NNT of nine. In other words, atypicals are not effective augmenters as a class of drugs.
I've long complained about how our nation's schools are handling behavioral issues with kids and out of Tauton, Mass. comes one of the weirdest examples I've encountered. An 8-year-old boy was asked to draw a Christmas image and instead drew a person attached to a crucifix. The person was either himself or Jesus (the kid had apparently been taken by his folks to a shrine that had lots of crucifixes the week before and the images may have been stuck in his head and Christ is kind of connected with Christmas) and so the kid got sent home from school and was ordered to undergo a psychiatric evaluation by the school. Seriously.
You can read the rest of this odd episode here (scroll down a bit for the actual news account).
I've worked with kids this same age in schools and I cannot think of why a teacher would be alarmed by the image, why a teacher would connect it with possible violence, and why the school would insist on a psych eval. It seems like epic overkill on the teacher and school's parts. I think it is they who need to be evaluated.
File this one under OMG: the Miami Herald today reports that Sen. Charles Grassley (R-Iowa) has sent a stern letter to federal health officials citing the case of a Miami, Fla. psychiatrist who has been writing an average of 153 prescriptions a day. Sen. Grassley's concern is possible abuse of federal dollars. My concern is that and patient care, especially when the paper contacted the doctor in question and he said:
"In a telephone interview Wednesday afternoon, Mendez-Villamil said he works long hours and sees patients only for 10 minutes every two or three months. Each patient may require four or five prescriptions, he said, accounting for the large numbers."'When you know the patient, and the patient is stable, 10 minutes is long enough,' Mendez-Villamil said. He said he often works 12-hour days during the week and Saturday mornings. He said he only prescribes what's medically necessary."
How the hell could any doc claim to know a patient based on 10-minute appointments? How could a doc have so many patients who require so many multiple scrips on a daily basis? How could he provide even a minimal level of care to his patients?
I smell a rat and I hope the state medical board looks into this doctor.
Good on the senator and his staff for continuing to push on these issues.
Another $125 came in yesterday from two people and that brings the total raised so far to $2,805.26 from 62 people. Thanks to all of you who've contributed so far. There's still another $1,194.74 from 38 people to go to reach the overall goal of $4,000 from 100 people on or about December 18th, which is this Friday.
I would dearly love the fundraiser to hit goal by the close of Friday and with three days to go, it's entirely possible. But that's in your hands.
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.
Thanks in advance for your support.
I'm sure most of you are aware of what a profound mess the DSM-5 process has become, such a mess that last week the American Psychiatric Association postponed the planned release of DSM-5 by one year to 2013. Now the influential, UK-based New Scientist magazine has editorialized that the DSM has "outlived its usefulness" and in an accompanying article details the so-called civil war supposedly erupting within psychiatry over the DSM-5 process. The article doesn't add much to what readers of this site already know--the secrecy, the pharma conflicts, the opposition of editors of DSM-3 and DSM-4--but the editorial is the first formal call I've seen in the science press for the DSM to be scrapped or its process to be substantially altered.
And I've got some thoughts.
1. I'm not sure how useful the DSM ever was or is currently. It's not nearly the scientific document its proponents claim. If it were, it's not likely to have required so many revisions and its definitions of different mental disorders would be highly accurate and someone diagnosed with major depression would have major depression instead of situational grief or massive stress. And social anxiety disorder wouldn't be the epic joke that it is. And so on.
But, yes, I do agree with the editorial's global sentiment that it's bye-bye time for the DSM. I'm not sure what you'd replace it with, but the forthcoming and past DSMs have been so riddled with conflicts and outright stupidity that it's obvious big changes are needed.
2. Not that New Scientist has it all correct, for instance in referring to the DSM as the "Bible of psychiatry." The media needs to stop referring to the DSM as the Bible of psychiatry. The term is likely offensive to some Christians and is otherwise just dumb. You may not like the Bible much, but is there anything in the DSM that rivals the Sermon on the Mount? Didn't think so. So it's pretty much block-that-metaphor time. Perhaps, the DSM should be renamed "Psychiatry's Farmer's Almanac."
3. The mag is right to be alarmed by two new aspects of DSM-5: the proposed shift to disorders with dimensions and the possible inclusion of some dubious disorders as new mental and personality disorders (taken up in point 4). The dimensions thing is a bit tough to explain--especially since I've seen no draft of how they'd read--but the mag takes a shot at explaining:
"The DSM-V task force is expected to propose a series of 'dimensions' to be considered with a patient's main diagnosis. So as well as deciding whether someone has, say, bipolar disorder, doctors would determine whether they are suffering from problems such as anxiety and sleeping disturbances, and assess them on a simple scale of severity."This is widely seen as a first step towards a future in which psychiatric diagnosis has a more scientific base, where sprawling checklists of symptoms are replaced by sliding-scale measurements of the underlying determinants of mental health. Yet critics worry that even a limited embrace of this 'dimensional' approach is running ahead of the science. Until we understand more about the biological basis of psychiatric disease, this approach will not be helpful, they say."
In essence, this would lead to an even great softening of current disorders--and every time the DSM gods soften disorders even more people wind up diagnosed for life and slapped on poorly-researched meds.
4. There has been some true crazy talk going 'round psychiatry in recent years with talk of creating a bipolar disorder type 3 (subthreshold bipolar disorder), re-categorizing bipolar disorder as a psychotic disorder, adding bitterness as a mental disorder (oh, please), adding a disorder for homophobes (which you'd treat with what? Free tickets to a musical?) and so on. Oddly enough, the editorial and article mention none of these but latch onto the possible inclusion of Hebephilia (attraction to kids during puberty) and I'll just let you read what they've got to say there.
5. The article notes DSM-4 editor Allen Frances' gripe that DSM-5 authors are mostly academics and out of touch with real-world clinical work. That may not be 100 percent true--a lot of academics do clinical work albeit at public hospitals where they see the sickest of the sick and assume that's what everyone is like--but it would be good to see the DSM process incorporate workaday psychiatrists and, gasp, patients. After all, the DSM is supposed to serve doctors and patients, so what would be the problem with having patients on some of the DSM committees? Well, it's an idea at any rate.
6. Separately, "Shyness" author Christopher Lane has a post on his Psychology Today blog on the New Scientist's coverage and once again rightly decries the lack of transparency around DSM-5. But surely Lane realizes that this super-secretive process was put into place so there wouldn't be a repeat of the embarrassment when his book came out and revealed--via archived DSM-3 notes--what a travesty social anxiety disorder was.
Alexza Pharmaceuticals announced today that it's submitted a new drug application for Staccato loxapine (AZ-004). It's an inhalant designed to be used to address cases of agitation in schizophrenia and bipolar disorder. Much of that agitation is often caused by other active treatments patients may be taking (anti-depressants, anti-seizure drugs, antipsychotics), so it does seem a bit wild that a company has developed a drug to deal with it, but that's the way it goes in the mental health world.
Loxapine itself is a typical antipsychotic that is so seldom used that I've never heard of it before now.
GlaxoSmithKline has become the latest pharma company to go transparent with its payments to doctors and others to shill for its products. The company has released a 121 page document detailing such payments to US health care professionals in the second quarter of 2009. I've skimmed the list for some of the usual suspects, but didn't see any. Someone will inevitably find something tasty in this list, however. (Via Pharmalot.)
Another $500 came in yesterday from one very, very kind person and that brings the total raised so far to $2,680.26 from 60 people. Thanks to all of you who've contributed so far. There's still another $1,319.74 from 40 people to go to reach the overall goal of $4,000 from 100 people on or about December 18th, which is this Friday.
I would dearly love the fundraiser to hit goal by the close of Friday and with four days to go, it's entirely possible. But I need to leave that up to you all.
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.
Thanks in advance for your support.
Some of you have likely seen a depression screening ad that WebMD is running on TV. Designed to push you to the website, it features a woman complaining of being left by her husband one year before and how she can't cope and a voiceover declares that WebMD's depression screening test is just the place. When you head on over to said test, you find that it's "brought to you by Lilly" and there's the Lilly logo in the top right corner. Lilly of course makes Prozac and Cymbalta (and Zyprexa and Strattera).
Well at least they are being honest, but at some point I think we all get more than a little tired of seeing these kinds of hand-in-glove relationships. Not that WebMD is a paragon of journalistic independence. Back in the early years of this decade, I was a reporter in Portland, Ore., where WebMD happened to have an editorial office at the time. I once had drinks with someone who worked there who admitted to me that the website had been started in the late-90s principally to take advantage of all the DTC ads that pharma would inevitably push onto websites with health information. Read into that whatever you want.
WebMD does claim on the screening page that it controls the content, which I'm sure they do. But not once in the history of the site have I seen it say a tough thing about a psych med or fail to spin negative news as insignificant, as it did yesterday with the anti-depressants linked to strokes in older women study. On a page stressing the physical symptoms of depression--gee, sound like Lilly much?--and pushing people to the screening test.
It's all a big happy circle of independence.
A new study just out in the Archives of Internal Medicine delivers more bad news for anti-depressants and their defenders. The study was part of the Women's Health Initiative and looked at 136,293 post-menopausal women.
"Results: Antidepressant use was not associated with coronary heart disease (CHD). Selective serotonin reuptake inhibitor (SSRI) use was associated with increased stroke risk (hazard ratio [HR],1.45, [95% CI, 1.08-1.97]) and all-cause mortality (HR,1.32 [95% CI, 1.10-1.59]). Annualized rates per 1000 person-years of stroke with no antidepressant use and SSRI use were 2.99 and 4.16, respectively, and death rates were 7.79 and 12.77. Tricyclic antidepressant (TCA) use was associated with increased risk of all-cause mortality (HR,1.67 [95% CI, 1.33-2.09]; annualized rate, 14.14 deaths per 1000 person-years). There were no significant differences between SSRI and TCA use in risk of any outcomes. In analyses by stroke type, SSRI use was associated with incident hemorrhagic stroke (HR, 2.12 [95% CI, 1.10-4.07]) and fatal stroke (HR, 2.10 [95% CI, 1.15-3.81])."Conclusions: In postmenopausal women, there were no significant differences between SSRI and TCA use in risk of CHD, stroke, or mortality. Antidepressants were not associated with risk of CHD. Tricyclic antidepressants and SSRIs may be associated with increased risk of mortality, and SSRIs with increased risk of hemorrhagic and fatal stroke, although absolute event risks are low. These findings must be weighed against quality of life and established risks of cardiovascular disease and mortality associated with untreated depression."
Researchers were quick to tell the press that the study meant next to nothing.
"'[S]tatistical significance can be different from clinical significance,' stressed Dr. Jordan W. Smoller, an associate professor of psychiatry at Harvard Medical School, and lead author of a report in the Dec. 14 issue of Archives of Internal Medicine. 'It is possible that a statistically detectable effect may not be a problem for most people.'"
Um, call me crazy, but a 45 percent increase in stroke risk associated with SSRI use strikes me as significant as does all the other negative findings around anti-depressants and women's health and fetal health in recent years.
A reader passed along to me a link to an online survey being conducted on behalf of NAMI National. It's testing public sentiment on the group's funding by pharma companies and gives respondents room to provide commentary as well. It took me about 10 minutes, so if you've got 10 minutes to spare, go give NAMI a piece of your mind. The survey is anonymous.
After many attempts and many years, Lilly has gotten the FDA to approve Relprevv, its long-acting Zyprexa injectable, for he treatment of schizophrenia. God help any patient who ends up on it.
Another $37 came in on Sunday from two people and that brings the total raised so far to $2,180.26 from 59 people. Thanks to all of you who've contributed so far. There's still another $1,819.74 from 41 people to go to reach the overall goal of $4,000 from 100 people on or about December 18th. That's this Friday and there's still a good distance to go, so if you haven't contributed yet, then right now would be a very good time. As I've said before, if the fundraiser fails to reach its goal, then I'll have little choice but to scale back my work here proportionately. I don't think anyone wants that.
As usual, 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.
Thanks in advance for your contributions.
Doing some good old-fashioned reporting and document sleuthing, reporters at Bloomberg have totaled up all the payouts and settlements made by GlaxoSmithKline over the years involving Paxil and they find the total to be $1 billion. That's a stunning amount--Lilly's total legal payouts for Prozac are rumored to be about $50 million--and one GSK has kept quiet for a long time. It should be a huge red flag to doctors who continue to prescribe this drug as if there are no risks attached to its use and to patients who willingly take the drug. It would also make Paxil the anti-depressant whose maker has been forced to make the largest legal payouts to settle claims, as far as I know.
The Paxil lawsuits have fallen into three areas: suicide, birth defects and withdrawal. Yes, there's something especially special about Paxil. You can read the article for details of the payouts and the cases involved. The numbers are staggering: 3,200 withdrawal/addiction settlements; 150 cases of suicide and 300 of suicide attempts settled; 12 birth defects cases settled or with a jury verdict against GSK; 600 birth defects cases to go; and, a slew of British users still suing GSK over withdrawal and other problems.
Noted one attorney:
"'Paxil’s been different from most drugs,' said Pogust, a lawyer from Conshohocken, Pennsylvania, who is handling suicide and withdrawal cases. 'You’ve had three major personal injury litigations over one drug -- the suicide, the birth defect and the withdrawal cases. To have three significant problems with one drug is really unusual.'"
I don't think a single anti-depressant has been implicated quite as strongly as Paxil has been. Implications for doctors?
"'It’s important to disclose such settlements because it raises the red flag for both doctors and patients that there might be a problem,' said Dan Carlat, a psychiatrist at Tufts University School of Medicine in Boston who writes and edits a blog and a monthly Psychiatry Report. 'It would motivate doctors to dig into the literature even more before prescribing these drugs.'"
I'm sure a psychiatrist such as Carlat would do some digging, but sadly I fear too many of his psych colleagues and even many more PCPs and internists are either too lazy, too incurious or too overwhelmed with work to do the same kind of digging. Maybe I'm being too cynical, but that's what I've seen in mainstream medicine when it comes to anti-depressants and their problems.
As for Paxil, I've had psychiatrists I know tell me they'd like to see the drug remove from market or banned. I tend to lean in their direction. One wonders where the FDA has been the whole time while GSK was settling lawsuits.
I'm thrilled and puzzled that all of a sudden this here blog is ranked number 8 among health blogs by Technorati. I'm thoroughly confused how Technorati's ranking system has me ahead of PsychCentral.com's blog, but I'll live I suppose.
The rankings do shift around over time, so we'll where things are early next year.
I am thoroughly discouraged to report that I was just on the the New York Times' website and right there on the main splash page was a flash ad for Seroquel. I've not seen an ad for any psych med on that site before, so I found it startling.
The ad read: "My relationships, my family, my work, my life" and then flashed to "Support and resources for living with bipolar depression. Sign up for a patient support program."
That program is called "Thinking Forward," "A Program Designed to Help You Keep Moving in the Right Direction." I assume that direction would be taking lots of Seroquel. If you want to sign up for the program and see what kind of garbage AstraZeneca sends your way, go here.
An article in yesterday's New York Times reports on a forthcoming study in Health Affairs wherein researchers from Columbia and Rutgers universities identify that kids in various states' Medicaid programs are prescribed antipsychotics at four times the rate that kids whose parents have private insurance. The study found that 4 percent of Medicaid kids were getting antipsychotics versus 1 percent of privately-insured kids. The Medicaid kids were also mostly getting these nasty drugs for ADHD, conduct disorders and, gleaning from the article, pediatric bipolar disorder. Excepting the recent controversial approvals of Zyprexa and Seroquel for use in pediatric bipolar disorder and Risperdal and Abilify's approved use in autism, these drugs are not approved for use in non-psychotic disorders. Not surprisingly, much of the Medicaid prescribing (and diagnosing) has been done by PCPs.
I became aware of the article late last evening and was so disgusted by it that I couldn't post about it until today. I've been saying for a long time that American taxpayers have been underwriting much of the use of atypicals in our culture and that the government (both at state and federal levels) has been a handmaiden to Big Pharma's campaign to get these drugs used off-label. The new study essentially confirms a lot of my sick hunches over the last few years and what I've been picked up on in the clinical literature over the last year or so.
I think we're all aware that I have taken a fair amount of heat from other commentators on mental health issues as well as some parents for decrying the use of these drugs in kids and teens. It's nice to have a study come out that says I've essentially been on point (and so have many of you readers).
I cannot wait to see the study in its entirety. I also would love to debate this person:
"'Maybe Medicaid kids are getting better treatment,' said Dr. Gabrielle Carlson, a child psychiatrist and professor at the Stony Brook School of Medicine. 'If it helps keep them in school, maybe it’s not so bad.'"
First off, Carlson has zero data on which to base that claim. Second, I am so, so sick and tired of the school house and behavior therein being a justification for medicating children into the ground.
Another $410 came in yesterday and today from seven people bringing the total for the fundraiser to date to $2,143.26 from 57 people. Thanks to all of you who've contributed so far. There's still $1,856.74 from 43 people to to reach the overall goal of $4,000 from 100 people on or about December 18th. It'd be really great if that remainder was chipped away at over the weekend.
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.
Thanks in advance for your support.
Another $170 came in yesterday from five people bringing the total raised so far to $1,733.26 from 50 people. Thanks to all of you who've contributed so far. There's another $2,266.74 from 50 people to go to reach the overall goal of $4,000 from 100 people on or about December 18th, which is one week from now. It'd be great if that remainder got chipped away at significantly over the next couple of days. I simply don't want this fundraiser to fall short and then scale back the work I do on this site.
So if you'd like to help keep that from happening, 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.
Thanks in advance for your support.
The American Psychiatric Association yesterday announced that it has delayed the release of the forthcoming DSM-5 to May 2013, one year later than its previously scheduled release of 2012. In a press release the APA stated:
"'Extending the timeline will allow more time for public review, field trials and revisions,' said APA President Alan Schatzberg, M.D. 'The APA is committed to developing a manual that is based on the best science available and useful to clinicians and researchers.'"
The APA also said that the delay would allow the DSM-5 to dovetail better with ICD-10-CM codes, developed by the World Health Organization, which will be adopted by Medicare/Medicaid in late 2013.
While I don't want to read too much into this delay, it's clear that the DSM-5 process has become a real political hot potato within psychiatry itself with researchers such as DSM-3 creator Robert Spitzer criticizing the secrecy of the process and commentators such as Christopher Lane have similarly attacked the process. I've let rip over the possibility that bitterness may be included in DSM-5 and over the fact that more than half of the writers of DSM-5 have taken money from pharma companies. It'll be interesting to see if this delay allows DSM-5 authors to reconcile their product with reality.
Via Soulful Sepulcher.
Eli Lilly claims that its new product pipeline is robust.
A transgenic prairie vole will supposedly be a model animal for mental illnesses. Gee, wasn't that supposed to be rhesus monkeys?
How to address fear and possibly PTSD from a new basic psychology study. Oddly enough, no meds are required.
Postpartum depression apparently strikes 4 percent of new fathers. So where's the FATHERS Act in the health care reform bill? Joking aside, the author is mostly interested in the phenomenon from the psychiatrist-examines-depression angle instead of doing little more than poke at the fact that the case he describes appears to be mostly driven by epic stress.
For those of you interested in the stock markets, one of the big stories out there today was that Lilly's stock dropped about 3 percent today--a sizable move for a fairly stable stock. Reportedly, Lilly CEO John Lechleiter gave a speech before analysts in New York and offered little hope for how the company will fare financially in 2011 and beyond as Zyprexa and, then, Cymbalta come off-patent.
What no one has picked up on in the financial press so far is that Lechleiter also isn't saying a thing about Lilly's experimental compound, LY2140023, which failed a major clinical trial earlier this year. The company does have an ongoing safety study of the compound, so they are pushing ahead, but it's likely Lilly's revenues will take a huge hit in 2011. Unless the company has some trick up its sleeve. And it usually does.
Another $85 came in yesterday from four people and that brings the total for the fundraiser to date to $1,563.26 from 45 people. Thanks to all who've contributed so far. There's still $2,436.74 from 55 people to go to reach the overall goal of $4,000 from 100 people on or about December 18th.
There' a just a bit over one week to go in this fundraiser and I'm not feeling optimistic about meeting the main goal, especially since this fundraiser has been going for three weeks and hasn't even reached the halfway point in terms of monies raised. This site hasn't missed a fundraising goal since I began putting out the tin cup in June 2007 and I don't relish the prospect of it falling short this time out. I don't want to scale back the work I do on this site. But I'll leave that up to you all.
If you'd like to contribute, the PayPal button is on the right. Or if you prefer snail mail, then shoot me an email and I'll send you my mailing address.
Thanks in advance for your support.
There are about 600 Paxil birth defects lawsuits are already outstanding against GlaxoSmithKline, and now another three women in Texas have sued the drugmaker. They allege that taking Paxil while pregnant led to heart abnormalities in their offspring and that GSK knew of such risks and didn't appropriately warn patients and doctors.
GSK was found liable in a similar case in Pennsylvania in October and was ordered to pay $2.5 million.
Not much to say about this, but New Mexico on Monday settled its claims that Eli Lilly had off-label marketed its antipsychotic Zyprexa for unapproved uses. New Mexico becomes the 39th state to reach some kind of financial settlement with the drugmaker over allegations concerning Zyprexa. Six more states have outstanding cases against Lilly. Lilly's total tab for Zyprexa settlements is now over $2.8 billion, by my estimate.
Another $60 came in yesterday from three people bringing the total raised so far to $1,478.26 from 41 people. Thanks to all of you who've contributed so far. There's still another $2,521.74 from 59 people to go to reach the overall goal of $4,000 from 100 people on or about December 18th.
If you'd like to contribute, the PayPal button is on the right. Or if you prefer snail mail, then shoot me an email and I'll send you my mailing address.
Peter Kramer, the well-known author of "Listening to Prozac," apparently did an interview in the wake of the recent study claiming that Paxil changes aspects of some peoples' personalities and Kramer says he feels "vindicated."
Unfortunately, the LA Times didn't link to the interview (sloppy) and I cannot find it online. Here's what the paper had online:
"'It's hard not to feel justified' in the view--offered long before it became fashionable--that antidepressants now taken by 7% of American adults do more than lift depression: They nudge underlying personalities--even those of healthy people--into brighter, more appealing territory, and in so doing, raise ethical concerns about 'cosmetic psychiatry....'"Kramer found one possible inference from the study particularly striking: that it might turn on its head the view that many clinicians have of the value of drugs and/or cognitive therapy for their patients. 'It looks like medicine is good for chronic personality traits and cognitive therapy is good for acute illness,' he said. Translation: Maybe any of us who are given to sad or worried rumination should be on SSRIs, and then, if we fall into depression anyway, we can get some time-consuming and expensive cognitive therapy."
In my opinion, Kramer's fame has far outlived his usefulness as a researcher and he's become little more than a desperate tout for anti-depressants. He was lame enough in 2008 when he went after both Erick Turner's paper revealing that pharma companies had hidden negative anti-depressant trial data for decades and when he went after Charles Lamb's "Comfortably Numb," as well as when he tried to justify anti-depressant use because they seem to have an effect in post-stroke patients, but his being down with using Paxil to tweak personalities is far beyond the pale. If he and others are OK with altering peoples' beings this way, then I'm sure they'll be the first to argue for legalizing Ecstasy, Ketamine and PCP.
Enough of Kramer. It's time for the media to stop quoting him and it's time for editors to stop forcing reporters into interviewing him because he's the one psychiatrist said editor has heard of.
Earlier this year, Sen. Charles Grassley (R-Iowa) demanded that the National Alliance on Mental Illness reveal details of its funding by pharma companies. Now, the senator has gone many steps further and has demanded similar disclosures from 32 medical advocacy groups and, drum roll, TeenScreen. Among the groups are DBSA, Mental Health America, Children and Adults with Attention Deficit/Hyperactivity Disorder and Screening for Mental Health Inc. I congratulate Sen. Grassley and his staffer Paul Thacker for continuing to go after this issue.
If I can note this without sounding too self-congratulatory, it was yours truly who suggested to Thacker, after the blast of news around NAMI, that the senator also put similar requests to DBSA, MHA and CHADD. Not that that Thacker couldn't have figured it for himself.
Another $15 from one person came in yesterday from one person bringing the total of the fundraiser to date to $1,418.26 from 38 people. Thanks to all who've contributed to date. There's still $2,581.74 from 62 people to go to reach the overall goal of $4,000 from 100 people on or about December 18th. That's in about 10 days, so it'd be great if the contributions picked up this week.
If you'd like to contribute, the PayPal button is on the right. Or if you prefer snail mail, shoot me an email and I'll send you my mailing address.
Thanks in advance for your support.
A new study came out this month in the Archives of General Psychiatry, asserting that Paxil reduces symptoms of neuroticism and improves extraversion in patients with major depression. In effect, it changes peoples' personalities. This is taken by the researchers to be a good thing because:
"High neuroticism is a personality risk factor that reflects much of the genetic vulnerability to major depressive disorder (MDD), and low extraversion may increase risk as well. Both have been linked to the serotonin system."
Um, OK. I'm not even going to get into how crazy it sounds to essentially promote a pill--known to damage sperm, lessen sex drives, induce suicidality, cause physical dependence, linked to some birth defects, known to blunt emotions--in order to alter someone's personality. Isn't that therapy's job? The whole study gives me the creeps.
A much more straightforward account of the study can be found at PsychCentral.com.
I caught an item on a stock market website yesterday that seemed worth passing along.
"Wyeth is also conducting a late-stage trial evaluating Pristiq for the non-hormonal treatment of vasomotor symptoms associated with menopause. The FDA, which issued an approvable letter for Pristiq in July 2007, has sought additional data regarding the potential for serious adverse cardiovascular and hepatic effects associated with the use of Pristiq for the treatment of menopausal symptoms. The requested clinical trial that is underway is expected to be completed in the first half of 2010."
Indeed, there are several trials for such purposes registered online. Pfizer's not finding much of a market for Pristiq as an anti-depressant I guess.
The American Law Journal TV program will this evening air a one hour show on the recent lawsuit against GlaxoSmithKline regarding birth defects caused by its drug Paxil. The company was found liable in one case and the plaintiff was awarded $2.5 million. The program only airs lives in the New Jersey, Pennsylvania and Delaware areas. Check cable listings here. Or a live stream will be here. I assume there will be an archived version online at some point in the near future.
The show airs from 7 p.m. to 8 p.m. EST.
Another $55 came in from four people over the weekend and that brings the total of the fundraiser to date to $1,406.26 from 37 people. That leaves $2,596.74 from 63 people to go to reach the overall goal of 4000 from 100 people on or about December 18th. That's only 11 days away, so it'd be great if some more contributions came in beginning oh right about now.
Thanks to all of you who've contributed so far. If you'd like to join them, 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.
Today is Pearl Harbor Day and I'd encourage all of you to take a moment to remember what went on that day. Certainly, I've got no way of avoiding it, but I hope it's not as gut-wrenching for me this year as it was last year.
One of the biggest risks of injury faced by the elderly comes from falls and their attendant broken bones and joints. Of course, researchers have linked anti-depressants to falls by the elderly before and last month the Archives of Internal Medicine had a fascinating meta-study analyzing what classes of drugs commonly given to the elderly created the greatest risks of falls. This is the first time I've seen antipsychotics linked to such falls, not that it surprises me.
I'll just list the drug class and odds ratio in order:
1. Anti-Depressants 1.68
2. Antipsychotics 1.59
3. Benzodiazapines 1.57
4. Sedatives 1.47
5. Anti-Hypertensives 1.24
6. NSAIDs 1.21
7. Beta Blockers 1.01
8. Narcotics (presumably painkillers) .96
I think those numbers speak for themselves.
Over the years, I've read many, many discouraging stories of people killing themselves soon after beginning anti-depressants or adjusting a dosage and they just still my heart. But the tale of Harvard student who killed himself at the Harvard Medical School in 2007 is one of the most discouraging I've ever encountered.
In June 2007, John Edwards went to the University's health services center complaining of not being able to study as many hours as other students. He was prescribed an ADHD stimulant by a nurse practitioner, although he'd never been diagnosed with ADHD. Later the nurse prescribed Prozac and Wellbutrin--both infamous for increased suicidal thoughts--when he complained of anxiety and depression. Edwards was also taking Accutane, an acne medication suspected of increasing suicidal thoughts in some people.
"'The Wellbutrin is having the effect that we were seeking . . . but unfortunately I feel like it has canceled out the anxiety-reducing effects of the fluoxetine [Prozac], as recently I’ve been pretty nervous,' Edwards wrote in a Nov. 27, 2007, e-mail to the nurse practitioner, Marianne Cannon. 'Let me know if I should schedule to come in and meet with you soon, or if I should change the med plan.'"
The nurse asked him to schedule an appointment. Two days later, Edwards killed himself, pharma-ed to death and the clear victim of incompetent medical care. Who gives anti-depressants to someone taking Accutane? Who gives a stimulant to someone without ADHD? People who think these drugs are absolutely safe. Even when they are clearly not.
Edwards' family has sued Harvard, the nurse and the nurse's supervisor.
Another $136.26 from four people came in yesterday bringing the total raised so far to $1,348.26 from 33 people. Thanks to all of you who've contributed so far. There's another $2,651.74 from 77 people to go to reach the overall goal of $4,000 from 100 people by some time around December 18th.
Yesterday, I suggested that a bunch of readers donating $10 to $20 per person could reduce that remainder quite quickly. A commenter had another way of putting it:
"$20.00 a quarter is less than $0.22 a day. The Washington Post is $0.75 a day now."Just a thought."
That's a pretty apt way of putting it. These days a hard copy of the New York Times runs $2 in Seattle ($6 on Sunday). Seen any comprehensive coverage of mental health issues in either paper lately? Probably not. Like a lot of newspapers in this country, both institutions have shed reporters at a remarkable rate and have fewer pages upon which to write (something I take zero pleasure in watching from afar) and both have scaled back writing about mental health issues. So have a lot of other major metro newspapers for much the same reasons. Certainly, you don't see much of anything about mental health on TV news and you hear very little on radio. Major magazines are largely asleep to these issues as well, although I hear a very pro-ECT piece has just run in a big women's magazine (I'll get on it as soon as it becomes available online).
What I'm telling you is that the media has essentially ceded the field to me--not completely of course, but did any of them even note the recent Depakote for kids on ADHD stimulants study? Nope. Would they have questioned it if they had? Not sure.
So if you'd like to see someone out here in Internet land continuing to cover these issues, then please support this site. 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.
Yes, the FDA--in addition to giving Seroquel approval for use as an add-on depression treatment in adults--has also approved this nasty drug for use in adolescents aged 13 to 17 and diagnosed with schizophrenia and in kids and teens aged 10 to 17 who are diagnosed with bipolar disorder, a controversial concept in pre-pubertal kids.
I simply cannot wait to see whatever promotion AZ does for so-called pediatric bipolar disorder. If you see any ad of any kind for this drug's use in kids and teens, please let me know about it.
The fact that the FDA would approve this drug with its many known problems for use in kids calls into question the FDA approval process and also the FDA's commitment to patient safety and scientific evidence. Yet again.
Yesterday and today have got to be red-letter days in stupidity at the FDA. Yesterday, the agency approved the antipsychotic Seroquel as an add-on treatment for depression. Today, the agency approved Zyprexa, the controversial diabetes-inducing antipsychotic, for use in adolescents aged 13 to 17 who are diagnosed with schizophrenia or who have manic or mixed episodes of bipolar disorder. Zyprexa has been widely used off-label for these two indications in people younger than 18 for years and with the drug going off-patent in less than 18 months, it's not clear to me what these new indications do for Lilly.
I have little else to say. I am so thoroughly disgusted by two days of dubious approvals by the FDA that I want to go sit in a corner and vomit.
The FDA has known this is a problem for years but it's only now that FDA reviewers are recommending that the agency formally review its data on antipsychotic-induced weight gain in kids. I assume they felt pushed to do so due to a JAMA study released in late October which outlined explosive weight gain in kids being put on antipsychotics. So now the FDA is going to get into the game.
Another $22 from two people came in yesterday and that brings the total raised so far to $1,212 from 28 people. Thanks to all of you who've contributed so far. There's still another $2,788 from 72 people to go to reach the overall goal of $4,000 from 100 people somewhere around December 18th.
If you'd like to contribute, 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'll level with you all: this fundraiser is going far too slowly for comfort and I truly fear having to scale back my work on this site should the fundraiser not meet its goal. But it's something I may have to do. Obviously, I know how much the economy stinks right now--I'm living it every day--but this site has several thousand regular readers and it shouldn't be such a difficult thing for a large group of readers to step up and contribute $10 to $20.
But maybe I'm wrong about that.
Yesterday, AstraZeneca announced it had licensed TC-5214, a compound with alleged anti-depressant qualities, from Targacept. Turns out TC-5214 was developed by researchers at the University of South Florida and today there was an article in the Tampa Tribune on how much money USF might make if the drug pans out.
Then a USF official said:
"Holbrook compared TC-5214 to the drug Abilify, or aripiprazole, commonly used in treatment of major depression disorder."'We have a drug here that is two to three times more effective than Abilify without the side effects,' Holbrook said."
Abilify is not commonly-used in the treatment of major depression, so that's an error of fact by the reporter. What's more, claiming that the compound is two to three times as effective as Abilify in treating depression isn't an impressive claim since Abilify's trials for add-on depression treatment status showed the drug had an effect size of 9 percent. Is the public to be impressed by an effect size of 18 percent to 27 percent? Um, no.
And what study wold back up such an efficacy claim? To date, there's been only a single phase 2 trial of TC-5214 as an add-on depression treatment, that study is not published, and it only involved about 100 people taking TC-5214. In other words, there is only a very slim evidence base upon which the USF official could make such a claim and yet the reporter swallowed it. Nice to see skepticism reigning in journalism.
I'm sorry, but reporters who don't understand the nuances of scientific research shouldn't write about the subject.
Interestingly, TC-5214 was also trialed as a treatment for hypertension, but the study was terminated early, presumably because the drug didn't work well.
News broke late last night that AstraZeneca announced that hte FDA has approved Seroquel XR, an atypical antipsychotic, as an add-on treatment for depression. It's been eight months since an FDA panel very gingerly recommended this approval and the agency took an unusually long time to follow through. That should tell you something. The FDA made a bad choice here.
Good luck to patients with the weight gain, diabetes, heart problems, muscle tightening, dead in the head feeling and back pain.
Can't wait to see if AZ advertises Seroquel on TV.
AstraZeneca has inked a deal with Targacept for its anti-depressant compoud known as TC-5214. It's a neuronal nicotinic receptor modulator.
The wonderful Dr. Bonkers has gone and translated a disgusting Swedish pharma brochure telling kids who to swallow their ADHD meds the "coool" way.
Big Pharma spends $20.5 billion a year marketing its drugs. The Wall Street Journal breaks down the numbers.
Depakote, Abbott's widely-used anti-convulsant for epilepsy and bipolar disorder, today was the object of a major FDA warning.
"The FDA notified health care professionals and patients about the increased risk of neural tube defects and other major birth defects, such as craniofacial defects and cardiovascular malformations, in babies exposed to valproate sodium and related products (valproic acid and divalproex sodium) during pregnancy. Healthcare practitioners should inform women of childbearing potential about these risks, and consider alternative therapies, especially if using valproate to treat migraines or other conditions not usually considered life-threatening."Women of childbearing potential should only use valproate if it is essential to manage their medical condition. Those who are not actively planning a pregnancy should use effective contraception, as birth defect risks are particularly high during the first trimester, before many women know they are pregnant."
Wow is about all I can say. In branded or generic form, Depakote is a drug taken by millions of American women and yet I have not seen a single press mention yet of the FDA's new warning. Abbott is under investigation by the feds for its marketing of Depakote. The FDA earlier this year urged a review of the drug's possible connection to developmental delay and autism. It has an FDA mandated warning for suicidality. A New England Journal of Medicine study linked the drug to lower IQs in the offspring of women taking the drug. And the drug is linked to an increased risk of ovarian cysts.
What a lovely drug.
Yesterday $0 came in for the fundraiser, which fills me with concern. The total raised so far is $1,190 from 27 people. Thanks to all who've contributed so far. There's another $2,810 to go from 73 people to reach the overall goal of $4,000 from 100 people on or about December 18th.
I'd still really like to get this thing to about $2,000 raised by the end of Saturday, so there's $810 to go. If you'd like to contribute, the PayPal button is on the right. If you prefer snail mail, shoot me an email and I'll send you my mailing address.
Yesterday, the Seattle Times had a good article on the "mental tailspin" Maurice Clemmons, who shot and killed four Lakewood, Wash. police officers on Sunday, had descended into. It's mostly an interview with Clemmons' uncle in Arkansas, who is a corrections officer there, and it is disturbing reading.
While it does make me think that mental illness may have played a larger role in this tragedy than I thought initially, the murderer still reads to me as being a sociopath. And, as a reader chided me the other day, you're right: it's not an either or. The line between sociopathy (or anti-social personality disorder if you prefer) and mental illness is very thin.
I once had a mental health evaluator who did forensic exams tell me that she feared having to evaluate sociopaths because they always seemed so sane and, she knew, always got through the system and back out into the public, where they presented real dangers to the public.
I've read the probable cause statement in Clemmons' child rape case. It is one of the most disgusting and bizarre documents I've read in many years of reading PCs. It's too disturbing to make publicly available. Suffice to say, Clemmons had sex with one 12-year-old girl (more than once) while wandering around proclaiming himself Christ and muttering other religious oddities. Apparently this was out of character for him.
While clearly in meltdown mode, people with extreme mental illnesses don't ordinarily go around raping kids and shooting up police. Sociopaths do, however.
A new study is out in the American Journal of Psychiatry, a small pilot study, touting the use of Depakote in combination with various ADHD stimulants in children and adolescents aged 6 to 13 years of age with both ADHD and a so-called disruptive disorder. The study involved so few children--14 in the Depakote arm--that its findings aren't robust at all, statistically. And yet the study is accompanied by an editorial trumpeting the future of child psychopharmacology.
Let's deal with the editorial first. Its author Hans Steiner is a professor of psychiatry at Stanford and the author of a 2003 study in the Journal of Clinical Psychiatry reporting good results using Depakote to treat conduct disorder in adolescents. He and his Stanford colleague Niranjan Karnik write in the editorial accompanying the study:
"[M]ost experts in the field agree that aggression, especially emotionally hot, impulsive aggression, forms a legitimate target for intervention across a spectrum of psychopathology, including attention deficit hyperactivity disorder (ADHD), bipolar mood disorder, and posttraumatic stress disorder."
OK, then.
"The future of psychopharmacology in childhood aggression and its underlying disorders is an important area of great need for more work along the lines demonstrated in this study. It is unrealistic to assume, as we have been for some time, that complex behaviors, such as aggression, will respond robustly to single psychopharmacological agents in all patients and all types of comorbidity, and yet the bulk of clinical trials are done with single agents. A more realistic assumption is that a careful blend of activating (like stimulants) and inhibiting (arguably valproic acid) agents will ultimately result in controls of main and downstream effects of neurotransmitters that produce remission of symptoms. This is especially likely in children and adolescents in whom development generates rapid shifts in neurosystems underpinning instrumental behavior such as aggression."This study points the way to a more complicated, but ultimately more realistic, polypharmacology in developmental psychiatry that should produce better results for our patients, rather than some of the unfortunate 'polypsychopharmacology,' where a high number of agents is combined in suboptimal doses in hopes of producing desired results."
Look, I'm all in favor of getting away from the wild polpharmacy advocated by the Harvard child psychiatry crowd and others, which has resulted in tons of aggressive kids on antipsychotics for non-psychotic issues, but it is more than a little Pollyannaish to suggest that a little old pilot study is as suggestive for the future of child psychiatry as the editorial pretends.
What's more, I'm really concerned that aggression in children is becoming such a defining issue in how our culture views children that aggression has become a force of evil to be stamped out. Much of this is driven by the culture of American schools these days, where behavioral calmness is everything and boys are to be firmly affixed to their chairs in class. I think we all know where Huck Finn and Tom Sawyer would be these days--headed to the nurse's office for their noon-time meds. OK, I know I'm overstating things a bit there, but something has changed so dramatically in how we address childhood aggression these days that someone has got to push back a bit, even if it seems unreasonable.
The study itself comprises 14 youngsters on stimulants whose aggression didn't abate and who were then put on various dosages of Depakote or were given a placebo (13). After eight weeks researchers reported that 57 percent (8 of 14) of the Depakote kids had improved on aggression scores while only 15 percent (2 of 13) had on placebo. That's a sizable effect size of 42 percent, but with such a small sample size (and the researchers admit this) the statistical power is limited. This could be a result of chance or something else.
Joseph Blader, a professor psychiatry at Stony Brook University School
of Medicine in New York led the study. His and other study researchers' pharma-funding conflicts are listed at the end of the study and they are epic: J&J, Lilly, Schering-Plough, Abbott Labs and so on. I'm concerned that this study blends funding from NIH and Abbott Labs. I wasn't aware that it was common practice to mix funding that way.
So who are some of these kids? The study includes a case profile of one 6-year old boy:
"'Freddy' was a 6-year-old boy whose mother related a long history of attention deficit hyperactivity disorder (ADHD) symptoms and behavioral dyscontrol. She characterized his present difficulties as being 'verbally and physically abusive.' She stated that 'he destroys property, defies authority, has no friends, hurts animals, and constantly annoys others.' He was in frequent conflict with family members, peers, and school authorities. When not acutely upset, he was an affectionate, articulate, pleasant boy. His ingenuity and engaging character attracted other kids initially, but subsequent interactions discouraged them, owing to his inflexibility in accommodating other children’s desires over his own...."At a 54-mg dose [of a stimulant], attention and appropriate participation in school improved, but aggressive outbursts persisted, including
incidents of throwing his desk over in response to directions to
conclude an activity...."By his fourth week after randomization [meaning he was getting Depakote], his mother reported that he was 'great,' with 'no problems at all.' She stated, 'He shows a lot less anger and is a lot more relaxed.'"
Poor Freddy is all I can say. I certainly cannot remember when not having friends at school and turning over desks counted as a psychiatric disorder. My entire elementary school in California should've come under suspicion for all the fights, kids flipping out, kids getting stabbed with a pencil in the arm (poor Ted Looney) and getting their hands slammed in windows (that'd be me, thanks to a little girl named Beth). How did we manage to survive and evolve into adults?
Although Norpramin is not much used these days, the FDA and Sanofi-Adventis today announced a Dear Doctor letter would be sent out detailing very serious problems with the tricyclic's use in some people.
"The new safety information states that extreme caution should be used when this drug is given to patients who have a family history of sudden death, cardiac dysrhythmias, and cardiac conduction disturbances; and that seizures precede cardiac dysrhythmias and death in some patients."
That says it all.
In a fairly surprising setback, US District Court Judge Jack Weinstein yesterday granted summary judgement--or dismissed--a major portion of the State of Mississippi's lawsuit against Eli Lilly. That would be the part of the suit contending that the company was negligent in marketing Zyprexa. The ruling lets stand the portion of the state's case claiming the company bilked the state's Medicaid system.
I'd expect the state to appeal the judge's ruling, one of Lilly's first substantive victories in more than four years of settling various Zyprexa cases for about $2.8 billion.
Another $240 from four people came in yesterday and that brings the total raised so far to $1,190 from 27 people. Thanks to all who've contributed so far. There's another $2,810 to go from 73 people to reach the overall goal of $4,000 from 100 people on or about December 18th.
I'd still really like to get this thing to about $2,000 raised by the end of Saturday or meeting the overall goal on December 18th is going to be dodgy. There are about 5,000 regular readers of this site, so hitting that goal should be fairly easy if a bunch of people each give a little.
If you'd like to contribute, the PayPal button is on the right. If you prefer snail mail, shoot me an email and I'll send you my mailing address.
Thanks in advance for your support.
Perhaps I just wasn't in the mood to write about the latest ginned-up justification for medicating small children (a study I'll get to later today) or maybe I was just reflecting on something a friend and I were discussing the other day, but it strikes me as remarkable in a very good way that American society hasn't melted into social unrest this year. The economy is terrible, the unemployment/underemployment rate is at about 20 percent of the workforce and there are millions of more Americans who've had their pay cut to do the same work (in some cases to do more work, as some of my pay-cutee friends tell me) and the stimulus package has had negligible results so far. Those are usually the conditions that have people marching in the streets and so on. But that's not happening and I don't even see a hint that it will (aside from the intermittent political protest).
Is it because we are fairly resilient as a people and are sucking it up and pressing ahead, hoping for things to get better? Is it because folks are so beaten down they can't express their discontent? Are we all zonked on Zoloft? (I'm joking there.) I see loads of discontent on peoples' faces every day and yet it's not taking things anywhere bad in a broad cultural sense. I really cannot account for that.
I'm curious what you all think.
I don't write about politics here so much and I'm not really dipping into it now as much as playing media critic. That said, last night I was appalled when MSNBC's "Hardball" host Chris Matthews described West Point cadets as the "enemy camp." Matthews was commenting on the polite, but uncheering response President Barack Obama's Afghanistan speech received, which is exactly what you would expect from late-teen/20somethings who are supposed to be apolitical regardless of who the President is.
Here's Matthews:
He needs to apologize for this. Maybe I'm PO'd because my grandfather was a Naval Academy graduate and died for this country and I just consider Matthews to be hugely disrespectful to young people willing to do the same as he. Like so many of my colleagues in the media, Matthews doesn't get what "ultimate sacrifice" means. I do. It's not a pleasant thing to have to get.
Matthews also might want to consider that many of the young men and women whom the President was speaking to will wind up being Second Lieutenants leading troops into combat. Matthews expects them to smile about that?
For what my opinion is worth, I support the President's policy in Afghanistan.
I'm sure most readers are aware that we had an awful mass killing in Lakewood, Washington on Sunday when a man named Maurice Clemmons killed four Lakewood police officers execution style at a coffee shop. Clemmons had a confrontation with Seattle police early this morning and was shot and killed by a Seattle police officer. His family and friends had helped him evade an extensive manhunt for almost 48 hours (several of them have been jailed already and more will likely be charged in the coming days), a manhunt that at times came uncomfortably close to my neighborhood on a couple of occasions.
As usual with such bizarre incidents, the question of whether the killer was mentally ill or insane gets floated. It's a fair question to ask since normal people don't go around assassinating the police, but then neither do people with mental illnesses. Clemmons had an extensive criminal record, but had been granted clemency in 2000 (by Mike Huckabee no less) for crimes he committed as a teen in Arkansas. Then he moved out to Washington State and was pretty low key until going completely berserk back in May of this year: raping a child, forcing family members to get naked, throwing rocks at neighbors, punching a cop, etc.
Here's what the Seattle Times has turned up on Clemmons' mental health history:
"But in May, Clemmons told evaluators, he'd been hallucinating about 'people drinking blood and people eating babies,' the report said. This went on for about three weeks, during which time he wasn't sleeping or eating well. But, he told the psychologists, 'I went to a counselor and then things died down.' That counselor gave him a diagnosis of 'Brief Psychotic Disorder.'"Asked if he had thoughts of harming others, he said: 'Sometimes I think about it. ... Everybody thinks the police can't lie.' But when pressed, he had no specific targets in mind.
"In the end, evaluators couldn't come up with a diagnosis for Clemmons, other than stress. However, they did say his violence at an early age, including robbery convictions, suggested he had an 'increased risk for future dangerous behavior.'"
The Tacoma News-Tribune has a fuller take on his psych evaluation (Lakewood is next to Tacoma and Tacoma is 30 miles south of Seattle) for those of you not familiar with the area):
"The reported threat to kill jail workers appeared in the evaluation, along with notes describing hallucinations. Clemmons said he had them back in May before his arrest. He remembered seeing 'people drinking blood and people eating babies, and lawless on the streets, like people were cannibals.'"Those visions had passed, he said.
"Two psychologists from Western State Hospital, Melissa Dannelet and Carl Redick, concluded Clemmons was dangerous.
"'He presents with increased risk for future dangerous behavior and for committing future criminal acts jeopardizing public safety and security,' the evaluation states.
"The forensic mental health report was ordered by Pierce County Superior Court Judge Kitty-Ann van Doorninck to determine whether Clemmons was mentally competent to stand trial on the rape and assault charges.
"On Nov. 6, van Doorninck signed an order finding Clemmons competent. She later ordered Western State Hospital to evaluate Clemmons again to determine if he was insane or had a diminished mental capacity at the time of the alleged rape and assault. That opinion is pending.
"Clemmons’ attorney on those charges – Daniel J. Murphy Jr. – notified the court that he intended to pursue an insanity or diminished-capacity defense for his client."
I'm sure we'll learn more about Clemmons' mental health issues in the near future. But it does strike me that this rotten man was a sociopath, at least that's what my gut tells me right now. I've not heard of people who crack up going and raping kids and in my experience most rapists are flat-out sociopaths. I think the child rape is a big clue to this guy's make-up. (A run down of brief psychotic disorder is here.)
How Clemmons got clemency in Arkansas is beyond me. Why he was offered bail in Washington State when he was facing charges that could put him away from life will need to be looked into. How could the man's family not have alerted police when the day before his rampage Clemmons told them to watch the news because he was going to kill cops? Why were so many family and friends willing to help him escape the cops?
There are lots of ugly questions around this case. I hope we get some answers.
Another $40 from two people came in yesterday and that brings the total raised so far to $950 from 23 people. Thanks to all who've contributed so far. There's another $3,050 to go from 77 people to reach the overall goal of $4,000 from 100 people on or about December 18th.
I know there comes a point in each fundraiser when things take off and it'd be great if that point was today. I'd really like to get this thing to about $2,000 raised by the end of Saturday or meeting the overall goal on December 18th is going to be very tough. There are about 5,000 regular readers of this site, so hitting that goal should be fairly easy if a bunch of people each give a little.
If you'd like to contribute, the PayPal button is on the right. If you prefer snail mail, shoot me an email and I'll send you my mailing address.
Thanks in advance for your support.
I noted on November 23 that the Australian government had pulled draft ADHD treatment guidelines due to concerns that they leaned heavily upon the work of Harvard's Joseph Biederman who's embroiled in all kinds of controversy and investigations due to his taking millions from pharma companies while allegedly doing unbiased research. A couple of days later the Royal Australasian College of Physicians announced that no such pull back would happen.
"The body charged with setting new guidelines for the treatment of ADHD has refused to release details of payments by drug companies to its experts, but has said conflicts of interest are being properly 'managed.'"The comment by the Royal Australasian College of Physicians comes after health experts this week called on federal Health Minister Nicola Roxon to appoint a new panel to draft ADHD treatment guidelines that was free of conflicts of interest.
"Ms Roxon yesterday brushed aside criticism of the panel as well as concerns that its draft ADHD guidelines had been tainted by drug company payments to a US expert.
"Instead, she said she expected new ADHD treatment guidelines would be released in the 'very near future.'"
Yes, nothing to see here, move along. What's stunning is that Biederman's work is reportedly cited in the draft guideline 50 times. That doesn't sit well with every Aussie psychiatrist, however.
"Monash University child psychiatry expert George Halasz said more scrutiny was needed of this panel's links to the drugs industry, as well as the panel that drafted the original 1997 guidelines because there was a risk of 'systemic dysfunction.'"'Clearly there are question marks about bias and conflicts of interest,' he said.
"'There is no dominant theory about what ADHD is.'
"'When there's no dominant theory you have to ask why there are people who insist on declaring the case is closed, when it's just false.'"
At least in Australia they are willing to thrash out the tricky issues involved. I fear we don't do such a good job in the States. It'll be interesting to see where this whole process winds up.
Of interest as well is that a reported 60,000 kids were on ADHD drugs in Oz in 2007. The nation has 21 million people or so. In the US, we have about 300 million people with 2.5 million-plus kids on ADHD meds. If the US ADHD diagnosing and treating rate of kids were the same as Australia's, you'd expect about 850,000 American kids to have an ADHD diagnosis. Instead, we have three times-plus that many, so perhaps they are actually doing something right in Australia, regardless of where this current guidelines process ends up.
An estimated 27 million to 30 million Americans--mostly adults, but Big Pharma is working on that!--take an anti-depressant each day. I once saw an estimate, one I cannot find right now, that several million people had been on anti-depressants for a decade or more. Among all those people were me and a recently-made friend, a 30something woman who went on anti-depressants in her mid-20s for depression and anxiety and has been on Paxil and Effexor at fairly high doses for more than 10 years. She also sees a therapist, one who sends her to a nurse practitioner for her "mental meds."
So a few weeks ago my friend shot me an instant message and complained that she hadn't slept well in weeks and that she felt agitated and antsy. I pointed out to her that her problems could well be connected to her anti-depressants, both of them well-known for producing such side effects. What's more, she and her now-ex boyfriend bought a house together a few years ago and because they are underwater on their mortgage they are still living together. No possibility of stress and tension there! She told me that she knew she'd have to be off her anti-depressants someday--she's read the long term studies of their effects on women--but that she'd basically need a "benefactor" to pay her bills for six months as she expects to be non-fucntional while undergoing withdrawal. Not an unreasonable expectation.
I really didn't know what to tell her beyond pointing out that her anti-depressants and the stress she was under could well be causing most of her troubles with sleep and agitation. I would have never expected what came next.
Sometime in early November, she went to see her nurse and instead of the nurse suspecting a case of low-level akathisia and stress, the nurse diagnosed my friend with bipolar disorder type 2 and added Lithium to her regimen. Later that evening, she messaged me and I told her that I flat-out didn't buy the BP2 diagnosis (diagnosed quite late while having anti-depressant problems and never having a hypomanic episode) and that the BP2 diagnosis itself had its critics within psychiatry (David Healy chief among them). She told me that she trusted her nurse. I know this person well and she's pretty stable and the BP2 diagnosis simply makes no sense to me.
A few days later she messaged me again, complaining of leg cramps, twitching in her hands and a salty metal taste in her mouth. "That's Lithium toxicity," I told her and pressed her to contact her nurse immediately. She did and the nurse, to her credit, called my friend after-hours, denied that it was a toxic reaction to the Lithium and pressed her to continue taking the drug. Which she did. A couple of days later, toxic symptoms persisting, she finally listened to me and stopped the Lithium and went to see the nurse again a couple of days later. I knew she'd end up on another mood stabilizer of some kind and sure enough my friend is now taking Neurontin (well, at least it wasn't Depakote).
I've pointed out to my friend that her nurse likely doesn't have a ton of training in diagnosing and that what she has gotten likely came at a pharma-sponsored CNE (the nursing equivalent of a CME). I pressed her to get a second opinion from a psychiatrist and recommended a couple of decent ones here in town, all to no avail. I've done what I can for her for now and I'll leave it at that for a while.
I bring all this up because I think it illustrates another element of the anti-depressant trap in America. Instead of long-term anti-depressant use leading to health problems and physical dependence (or addiction, if you prefer), it's now leading to people being re-diagnosed with another disorder. I've been deeply suspicious of the whole "Your depression is bipolar disorder" line being bandied about much of this decade and I wonder how many people with long-term depression problems have wound up being diagnosed with bipolar disorder 2 principally as a result of a reaction to anti-depressants. I don't have an answer. But I do have a hunch. And I don't like it.