As if there hasn't been enough bad news around anti-depressants and pregnancy of late--formerly assumed to be safe, now linked to preterm births!--there is news of a new study showing that SSRIs can cause delayed lactation. I think I'll just let that stand for itself without comment.
In a fascinating piece in the Boston Globe, which echoes one of my regular themes about weight gain problems with psych meds, Harvard psychologist Paula Caplan delivers some shocking news about the forthcoming DSM-5:
"Another disturbing link could be on the way. The fifth edition of the major psychiatric diagnostic manual, the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), is expected to be released in 2013. One proposal under consideration: listing obesity as a mental illness. That would be a mistake, since obesity can be caused by metabolic and other physical problems that are often undiagnosed. And because obesity can also result from psychiatric drugs, calling it a mental illness would create a vicious cycle: Someone is troubled, put them on drugs, they become obese, therefore diagnose them as mentally ill, give them more drugs."
Every so often I just have to say it: psychiatry has absolutely lost its mind.
Well, this ought to be fun for AstraZeneca to explain in court. The BBC is reporting that a former UK AZ executive was pressed by AZ marketing execs to lie about weight gain issues with Seroquel in the late-1990s.
"John Blenkinsop, the company's former UK medical manager, claimed he was pressurised by the company's marketing arm to approve claims about the drug which he felt did not reflect the medical evidence."'The clinical studies at the time of the launch of Seroquel showed patients developed significant weight gain, significant both statistically and clinically,' he told the BBC's File on 4.
"'They [the marketing team] came at me with a number of potential claims all of which were trying to intimate that Seroquel was not associated with weight gain - the data pointed in the opposite direction,' added Mr Blenkinsop who was speaking publicly for the first time since he left the company in 2000.
"He said: 'I understood where they were coming from. I had some robust discussions and exposed them to the data but that didn't seem to stop them because they were desperate for a differential advantage over one of the competitor products and they didn't have one.
"'In the end I was put under quite a significant amount of pressure by the marketeers to sign off claims with regards to the lack of weight gain and I was unwilling to sign that off. The marketeers made it clear it could be career limiting for me," Mr Blenkinsop added.'"
Of course, this weight gain would have absolutely nothing to do with diabetes associated with the use of the drug, so there's no need for the public to know.
Some interesting news from this morning's session of the murder trial of Rebecca Riley's mother back in Massachusetts. The testimony is from child psychiatrist Kayoko Kifiju and concerns Rebecca's older sibling, Kaitlynne.
"At the time, Kaitlynne Riley was 2 years old, and Carolyn Riley had turned to doctors because the girl was being aggressive toward her older brother, Kifuji testified."The psychiatrist said she met with the little girl for an hour, during which the girl talked about seeing 'monsters' and 'ghosts'--but did not display any sign of excessive aggressive behavior. Yet, Kifuji testified, she diagnosed Kaitlynne Riley as having bipolar disorder and prescribed Depakote for treatment.
"'I made a diagnosis of bipolar disorder on Kaitllynne Riley based on information I got and I put her on medication,' Kufiji testified.
"Asked by Middleton whether she saw any sign that the 2-year-old was unduly aggressive, the doctor replied, 'no.'"
Evidence-based medicine at work. Sarcasm aside, who diagnoses a kid so young who is not displaying outward signs of dysfunction based upon a one-hour appointment? If a 2-year-old seeing monsters and ghosts--meaning having an active imagination--is enough to get a kiddo diagnosed and medicated then we are in deep trouble as a society.
A new study out in the American Journal of Obstetrics & Gynecology adds more fuel to the controversy around pregnancy and anti-depressants. In it, researchers report that among 3,000 pregnant women in Washington State those who took an SSRI anti-depressants during the second or third trimester had an almost five times higher risk of delivering a preterm baby. The study also found a higher risk among women taking benzodiazepines.
The new study joins other recent studies casting doubt on doctors' longstanding claim that anti-depressants aren't linked to birth complications and it sure makes you wonder how post-partum depression can be properly addressed without putting babies at risk.
Thanks for all the kind queries about my situation. I'm fine. I've simply been overwhelmed with work--volunteer basis, mind you--ever since co-authoring the marijuana law reform initiative for Washington State on January 11. My days have been 12 to 14 hours. That's what it takes to begin the necessary organizational work on such a campaign. I cannot even begin to describe how much heavy lifting is involved.
I expect to be back to a more normal volume of posts fairly soon. I appreciate everyone's understanding.
It's still early in the new year but I'm betting none of the headlines in the many press releases I get around here will be able to top this one from GlobalData, a British company: "The Brain Tumor Market is Forecast to Show Positive Growth to 2016."
There's just something about tumor and positive growth that just doesn't quite work, if you know what I mean.
That's the big question out there today after the stunning victory of GOP Senate candidate Scott Brown in Massachusetts yesterday, which cost Senate Democrats their 60 vote edge in the upper house. Brown has indicated he'd vote against the health care bill currently being hammered out by House and Senate leaders.
Personally, I have no idea where I stand on any of this: both the House and Senate bills have huge problems, but if something doesn't get passed soon, we'll never have health care reform, which is badly needed
I'm curious what the rest of you think.
It's my sad duty to inform you all that psychiatry survivor and grandmother of the Mad Pride movement Judi Chamberlin died on Saturday after a long illness. Chamberlin was 65. I gather that NPR's "Morning Edition" will be doing a piece on her today.
I don't like talking about death too much and others are far more qualified to write about Chamberlin's life and work, but I can say with complete confidence that she was a hero.
Please show your respect by leaving a comment at Chamberlin's blog (first link above), which will remain active.
For readers who've been following the saga of Lindsay Newman, her mother reports on her blog that staff at Western State Hospital near Tacoma, Wash. have still not allowed Lindsay to go outside. That means Lindsay has not tasted fresh air in three weeks. This is an untenable situation especially since Lindsay responds well to being outside on occasion and because the hospital does have fenced outdoor areas where they can ensure she won't run off. I really hope WSH corrects this situation soon.
Despite the rotten weather we've had out here lately--a much wetter than normal January so far this year--it would be good for Lindsay.
On Jan. 4, I let you all know about a study just out in the Journal of the American Academy of Child & Adolescent Psychiatry (and it's still not online) concerning the doubling of antipsychotic use in toddlers aged 2 to 5. Well almost two weeks later the Reuters wire service reports on the study and notes that much of the uptick in toddlers is connected so-called child bipolar disorder.
"'The psychiatric diagnosis of very young children is anything but an exact science,' said Harry Tracy, a psychologist and publisher of NeuroInvestment, a monthly publication specializing in central nervous system disorders."'Such disparate causes as ADHD, depression, bipolar disorder, sexual abuse, and family dysfunction can produce very similar symptoms in a toddler.'"
You don't say. After banging on these sorts of issues in children for over three years, it's nice to see Reuters casting a skeptical eye on this whole business. In their report, no one is actively defending these diagnoses and medications in toddlers. That tells you something.
The murder case against the parents of Rebecca Riley--the 4-year-old with alleged child bipolar disorder who died from an overdose of psych meds in December 2006--has become two murder cases because a Massachusetts court has decided to try the parents separately. Carolyn Riley's case--she's hte mother of course--will begin on Tuesday. There's no date set right now for the trial of Rebecca's father Michael Riley.
I still have a hard time buying murder charges against either parent, but for them to have been jailed pre-trial does tell me a judge thought the evidence against them was compelling. That said, I still don't see a jury conviction for murder and given the dicey nature of medication use in small children and how imprecise and unresearched such psych med use is, if the jury has any sophistication they won't get to a murder conviction. Perhaps a lesser-included charge such an involuntary manslaughter.
Stay tuned. My Rebecca Riley back catalog is here.
There's been a small wave of studies published in recent months concerning diet and depression. There was one asserting that the Mediterranean diet is protective against depression and another one asserting a link between processed food and depression. Now comes a new study in the American Journal of Psychiatry by Australian researchers asserting that processed foods--or what researchers deemed a "Western" diet--was linked with greater odds of depression (38 percent) and anxiety (9 percent) than was a "traditional" diet (odds ratio .78 and .81) or a "modern" diet (1.08 and .97 odds ratios).
The study looked at the dietary patterns of 1,046 women and, of them, 60 had dysthymia or major depression and 80 had anxiety disorders. So while the statistical power of this study may not be large, it certainly follows the pattern of other recent studies.
The FDA has issued a warning to Eli Lilly concerning print ads for its anti-depressant Cymbalta. I've not been able to find the letter but have seen multiple press accounts. Here's what the FDA apparently said.
"'The print ad is false or misleading in that it presents efficacy claims for Cymbalta, but fails to adequately communicate the risks associated with its use,' the FDA said. 'The Blue Book Message is false or misleading because it overstates the efficacy of Cymbalta and minimizes the risks associated with the drug.'"
Risks associated with an anti-depressant? A pharma company downplaying risks? I've never heard of such a thing!
It seems like hardly a week passes when I don't see news of someone getting popped for dealing Seroquel or illegal Seroquel possession. This time out a ninth grader in upstate New York was the alleged dealer:
"The boy was caught with the pills after another student was brought to the nurse’s office Thursday morning for a reported drug overdose, sheriff’s officials said Monday. The student, who left his classroom unable to walk straight or speak clearly, told school staff and the school resource officer that he had bought the pill from the ninth-grader, who was selling pills for $1 each. The boy was taken to Mount St. Mary’s Hospital in Lewiston for treatment."
The article actually describes Seroquel as an anti-depressant. Sure it is.
Over the weekend, I co-authored a proposed initiative repealing the State of Washington's criminal penalties relating to the adult use, possession and cultivation. Then on Monday I drove to Olympia with co-author Douglas Hiatt and delivered the proposed text to the Secretary of State's office and paid the $5 filing fee. So that's why there were no posts on Monday. I can assure you that nothing sucks up all your time like helping to organize such an effort and then hammering out the language and figuring out what sections of state law apply. Needless to say, I am exhausted.
I think the findings and intent of the proposed initiative are covered fairly nicely in language I am about 50 percent responsible for and it should give you all a decent idea of why I am doing what I am doing:
"1. Whereas the State of Washington wastes tens of millions of dollars a year in taxpayer funds senselessly prosecuting responsible citizens of Washington State for use, possession and cultivation of marijuana, a benign therapeutic substance, and whereas citizens of the state face arrest, prosecution and loss of rights including property, employment and education for use of marijuana; and,"2. Whereas the State of Washington's medical marijuana law, enacted by the People in 1998, has proven ineffective at protecting the rights of citizens of Washington State; and,
"3. Whereas Washington State farmers and landowners are prohibited from growing industrial hemp on their land, denying them the ability to grow a valuable, environmentally friendly crop; and,
"4. Whereas the State Legislature has proven ineffective at offering appropriate legal remedies to the citizens of the State of Washington:
"The People of the State of Washington hereby repeal any and all criminal penalties for the adult use, possession, possession with intent to deliver, delivery and manufacture/cultivation of marijuana."
We await language and code changes from the Secretary of State's office and then proposed ballot title and ballot question language from the Washington State Attorney General, all of which should take a month or so. Then we'll be approved to circulate petitions for voter signature and need 241,000 valid ones to get on the statewide ballot for this November.
The Associated Press has a good article on our effort. In it, I was encouraged to see some support from one county's Prosecuting Attorney for getting the laws around marijuana in this state clarified. But I was deeply disappointed to read the comments of the ACLU of Washington's Alison Holcomb, who hadn't read our initiative yet felt compelled to trash it...probably because her group is pushing the Legislature to adopt one of its bills in its current session. She sure doesn't come off looking either classy or accurate in her assessment of our proposed initiative and what it would do since it is clearly designed to let the State Legislature come back next year--if our initiative passes--and draft appropriate time, place and manner kinds of restrictions on adult marijuana use, possession and cultivation...something the Leg seems incapable of achieving on its own.
So anyway that's what I've been up to the past few days.
Yes, those Seroquel for bipolar depression ads--bipolar depression can "consume" you, didn't ya know?--keep airing on TV and are in several major magazines. What's interesting is that the print ads contain five accompanying pages of warnings and precautions attached to use of the drug. Because apparently there's a chance Seroquel can consume you. See BNET for a visual of the print ads.
It's raining like crazy in Seattle and I know it's snowing like crazy on the East Coast. So bundle up and stay dry everyone and pour through this roundup of interesting items.
The FDA has failed to make publicly available, as required by law, the approval packages for at least nine of the 25 most popular drugs in this country. I had hoped this kind of thing would improve with Obama appointees running the FDA, but no.
AstraZeneca succeeds in getting two more Seroquel lawsuits tossed out of court. The company is eight for eight on that front now.
Talk about conflicts of interest: an MIT economist was under an almost $300,000 contract with HHS to evaluate health care reform proposals while publicly attacking critics of health care reform, but he never disclosed that conflict. Embarrassing at a minimum.
Veterinary Practice News identifies anti-depressants, benzos and ADHD drugs as among the top 10 classes of drugs causing pets seriously problems when they accidentally ingest them. "Pets, especially cats, seem to enjoy the taste of Effexor and often eat the entire pill," notes the article. "One pill can cause serious poisoning." Yikes.
News of an autism cluster in Silicon Valley.
A federal judge will now oversee monitoring of conditions and the treatment of patients at the psych unit of the notorious Kings County Hospital in Brooklyn.
CL Psych has its usual irreverent take on this week's JAMA study on anti-depressants.
My personal life crashed right into my writing life last evening in a way I couldn't avoid. As a result, I had no time to write a couple of new posts for this morning. I'll rectify that later today.
Have a good day.
Hi readers. I'm reposting this--something I've never done before--because this post originally went up during the dead week between Christmas and New Year's and, given its assertions, it's worth posting again since few people saw it last week. Or at least that's the opinion of some journalist friends of mine who've read the piece. Oddly enough, Sen. Stabenow's office has still not answered question I put to them about this situation almost two weeks ago.
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.
So things have gone into the crapper for Lindsay at Western State Hospital. She's being denied the ability to go outside at all, a true prisoner of the system. Or so her mother, Stephany Newman, reports on her blog after attending a treatment team meeting for Lindsay yesterday at which Lindsay's doctor, Daniel Ruiz, yelled at Stephany and Stan Cavers, who'd gone along as a patient advocate, as Stephany told me in an email last night.
Some thoughts:
1. It is entirely unacceptable for a public employee (cops excepted in some circumstances) to yell at a citizen. Ruiz owes Stephany and Cavers a written apology.
2. It is a violation of medical ethics as well as professional standards in this state for a doctor to yell at a family member. Ruiz is lucky Stephany hasn't filed a complaint with the Medical Quality Assurance Commission, the name of our medical board out here.
3. Why isn't Lindsay permitted to go outside? Have you folks at WSH gotten that understaffed or that hard-hearted? For God's sake, I've toured your facility and you do have fenced-off outdoor areas attached to the units where Lindsay could be outdoors for a bit each day without being in danger of walking off.
4. I recall WSH personnel once telling me how sad it was that many patients at WSH had families who'd written them off and forgotten about them. Now you have a parent who has fought extremely hard for her daughter and the best you guys can muster is disrespect? That's some nice public service there WSH/DSHS. Really touching.
5. Why are male sex offenders housed in units with women? That sounds like a disaster in the making. What are you all doing to guarantee that women like Lindsay are not raped and molested (much less beaten) by some of the men on your wards? How are women supposed to achieve psychological stability in such an environment?
6. I know Lindsay's case is remarkably complex clinically, but the reality is she was sent to WSH not because she was a danger to self or others but because her condition puts her in danger from society. It strikes me as bizarre that in 2010 there isn't appropriate community housing available for someone like Lindsay, especially when it would likely cost the state about half of what one day in WSH would (about $450 a day at WSH per person). What are you all doing to create appropriate community housing for people like Lindsay, even in an extremely challenging budget environment?
7. A note for readers: on her blog, Stephany encourages people to write Washington's Gov. Christine Gregoire. I know Lindsay's case has stirred strong emotions in some readers and I simply ask that if you write the Governor, please be polite. If you cannot be, don't write her.
About 6 p.m. this evening, someone using the handle "Serious Scientist" left the following comment in relation to a November 2009 post on defrocked Emory University psychiatrist Charles Nemeroff heading for the University of Miami. In my post, I wrote that Nemeroff was infamous for "dubious research findings." That didn't sit well with old Serious:
"Dubious research findings? Such as? Losers who are blogging from their mother's basements while sucking on lollypops (or worse) are not in position to comment on anyone's research, even someone accused of conflict of interest."
Serious's IP address indicates that he's from Atlanta and, quite possibly, does his serious science at Emory. Anyway, as to Nemeroff's dubious findings, would it be sufficient to point out that the psychiatrist Bernard Carroll (Nemeroff's former boss at Duke) called Nemeroff's work "science pimping" producing talking points for GlaxoSmithKline? Or perhaps this fine roundup of Nemeroffian excess by CL Psych?
Oh, and "lollypops" is actually spelled "lollipops."
Yesterday I noted a new study in JAMA asserting that Paxil and imipramine only seem to work well--meaning they beat placebo--in treating severe depression as opposed to mild to moderate depression. That study has been flying all over the media the last 24 hours and it strikes me that among the most sensible things said was by OHSU psychiatrist Erick Turner.
"'I think the study could dampen enthusiasm for antidepressant medications a bit, and that may be a good thing,' said Dr. Erick H. Turner, a psychiatrist at Oregon Health and Science University. 'People’s expectations for the drugs won’t be so high, and doctors won’t be surprised if they’re not curing every patient they see with medications.'"But Dr. Turner added, 'The findings shouldn’t dampen expectations so much that people refuse to even try medication.'"
Turner is the author of a 2008 study in the New England Journal of Medicine which revealed that pharma companies had been hiding negative anti-depressant trials for decades. I wrote about Turner in a Portland, Oregon newspaper that same year.
When a 12-year-old girl in Florida gets busted for possession and intent to distribute Seroquel, then the easy availability of psych meds has gotten way, way out of hand. She reportedly got the drug, along with a painkiller from a 16-year-old. That's out of hand too. The girl was apparently OD'ing at home, her mother figured it out and got her to a hospital. What the hell is happening to this country?
A new study is out in JAMA today and it is likely to be picked to pieces because it concludes, based upon a meta analysis of selected clinical trials just two anti-depressants, that anti-depressants are ineffective for mild to moderate depression but are quite robust for severe depression. That's the spin the media is putting out at any rate. The reality though is that this study looked at six clinical trials of Paxil and Imipramine. So to extrapolate to other drugs isn't exactly fair--not that other studies haven't already questioned the effectiveness of other anti-depressants.
Anywhere, it's interesting that the study was published in JAMA (it doesn't strike me as the most important study in the world) and that it offers further proof of how limited in effectiveness anti-depressants can be. Which begs the question of why so many people are taking them.
A very interesting bit from a very smart financial analyst who went and somehow figured out which drugs had the largest pre-tax profit margins. Topping the list was Effexor with an 87 percent pre-tax profit margin. Even more astonishing is that more than half of the drugs the analyst looked at had pre-tax margins of 70 percent or greater.
Here's the list via Pharmalot:
1 - Effexor (Pfizer) 87 percent
2 - Arimidex (AstraZeneca) 85 percent
3 - Femara (Novartis) 84 percent
4 - Detrol (Pfizer) 84 percent
5 - Gemzar (Lilly) 84 percent
6 - Xeloda (Roche) 82 percent
7 - Lipitor (Pfizer) 82 percent
8 - Zometa (Novartis) 81 percent
9 - Plavix (Bristol-Myers/Sanofi-Aventis) 81 percent*
10 - Taxotere (Sanofi-Aventis) 80 percent
* - for the total brand, ignoring profit splits
As most of you know, the FDA is poised to approve ECT devices as "safe" without forcing their manufacturers to prove that point with the usual clinical trials. That's right: the geniuses at the FDA have allowed these devices to marketed, under some crazy exemption, for decades without requiring clinical trials. Regardless of your personal feelings about ECT, I think we can all agree that not requiring safety trials is complete BS.
The FDA is taking comments from the public on ECT devices, but you only have until January 8 (this Friday) to tell the agency what you think. There's much more information on all of this, including contact information, at PsychRights.
A new study out in the Archives of General Psychiatry reveals just how much polypharmacy has exploded over the last 10 years to 15 years. I'll let it speak for itself.
"Results: There was an increase in the number of psychotropic medications prescribed across years; visits with 2 or more medications increased from 42.6% in 1996-1997 to 59.8% in 2005-2006; visits with 3 or more medications increased from 16.9% to 33.2% (both P < .001). The median number of medications prescribed in each visit increased from 1 in 1996-1997 to 2 in 2005-2006 (mean increase: 40.1%). The increasing trend of psychotropic polypharmacy was mostly similar across visits by different patient groups and persisted after controlling for background characteristics. Prescription for 2 or more antidepressants, antipsychotics, sedative-hypnotics, and antidepressant-antipsychotic combinations, but not other combinations, significantly increased across survey years. There was no increase in prescription of mood stabilizer combinations. In multivariate analyses, the odds of receiving 2 or more antidepressants were significantly associated with a diagnosis of major depression (odds ratio [OR], 3.44; 99% confidence interval [CI], 2.58-4.58); 2 or more antipsychotics, with schizophrenia (OR, 6.75; 99% CI, 3.52-12.92); 2 or more mood stabilizers, with bipolar disorder (OR, 15.46; 99% CI, 6.77-35.31); and 2 or more sedative-hypnotics, with anxiety disorders (OR, 2.13; 99% CI, 1.41-3.22)."Conclusions: There has been a recent significant increase in polypharmacy involving antidepressant and antipsychotic medications. While some of these combinations are supported by clinical trials, many are of unproven efficacy. These trends put patients at increased risk of drug-drug interactions with uncertain gains for quality of care and clinical outcomes."
Actually, almost all psychotropic polypharmacy is not supported by clinical trials (there are exceptions when it comes to mood stabilizer plus atypical for bipolar disorder, where there are FDA approvals for such combos) and there aren't even many post-marketing meta studies on these kinds of combinations (your Prozac plus Depakote plus Abilify kind of nonsense). So the almost doubling of polypharmacy from the mid-90s to the mid-00s strikes me as little more than experimental overprescribing. And that ain't good.
Some of you know that last night PBS aired Part 1 of the documentary "This Emotional Life," which is in three parts and will continue tonight and tomorrow on your local PBS affiliate. The series was apparently conceived by Microsoft co-founder Paul Allen (and co-produced by one of his many companies), who's been long-fascinated by neuroscience and has rolled some of his own money into interesting research...in addition to a SciFi museum, a cool Rock 'N Roll museum and a badass vintage airplane museum and tons of real estate in Seattle, some businesses, my Seattle Seahawks (who just finished an awful season and that makes me unhappy) and the Portland Trailblazers.
"This emotional life is a roller coaster," begins the show's narrator and that's sort of the deal with Part 1--it's a roller coaster. It focuses on families, friends and lovers and their epic importance in our lives. There's plenty of narrative on attachment theory, kids screwed up because of bad attachments, children's brains molded by love, and so on. Followed by a section on friends and a poor fellow named Jason who's got Asperger's and then a lengthy bit on bullying and by that point it was an hour into the show with an hour to go and I decided to bail. I wasn't getting anything new or terrifically interesting. I'm a dork for psych stuff, so if it wasn't intriguing me, then Part 1 had some problems.
I know one of the other parts is going to get into post-combat PTSD, a subject that deeply interests me, so I still have my hopes for the series. Allen, after all, doesn't often bet wrong with his money. So we shall see if there's a gem in there somewhere.
Need more evidence that America has lost its soul and that psychiatry has lost its mind? A study published today in the Journal of the American Academy of Child & Adolescent Psychiatry (it's not online yet) asserts that twice as many young toddlers are getting antipsychotics as in the late-1990s. We're talking kids aged 2 to 5, getting drugs which have no approval for their age group.
"In 1999-2001, about one in 1,300 were being treated with antipsychotics. By 2007, that had risen to one in 630, according to Olfson."For 5-year-olds, about one in 650 were being treated in 1999-2001. That doubled, to one in 329, in 1997, he noted."
The most commonly-prescribed antipsychotic for toddlers is Risperdal.
"'It is a worrisome trend, partly because very little is known about the short-term, let alone the long-term, safety of these drugs in this age group,' said study author Dr. Mark Olfson, a professor of clinical psychiatry at Columbia University in New York City."
If thought leaders are calling this a problem, then why do doctors continue to prescribe these drugs to tots? How much is pharma making off little kids?
Coupled with research out last month from Olfson that kids on Medicaid get antipsychotics at four times the rate of privately-insured kids, it is clear to me that we have a looming disaster among America's kids. I don't even know what to do to avert it anymore.
Via Pharmalot, news is out that controversial, pharma-whoring psychiatrist Charles Nemeroff has purchased a $1.9 million house in Miami. It's over 5,000 square feet, which is to say it's of Nemeroffian proportions. Nemeroff recently quit his post at Emory University for one at the University of Miami after disclosures of all manner of conflicts of interest and tons of pharma consulting monies and after he became the object of a Senate investigation for not disclosing said monies while receiving federal research dollars. My Nemeroff back catalog is here.
When you consider how tight the housing credit market is and just how large a purchase Nemeroff made, then you know he must have a ton of other assets or he'd never get such a gigantic mortgage. Unless he paid cash.
Late on Friday, the winter fundraiser met its goal of $4,000 raised. I'm humbled by the many contributions and appreciate everyone's support.
In other news, the first week of January is typically one of the slowest of the year as people get back to post-holiday reality, so posting will be rather light the first few days of the week (I'll have some new posts later this morning). I will be paying close attention to what's going on in Congress with the health care reform bills, but I don't expect things to heat up until next week.
Again, thanks to all of you who contributed and Happy New Year.