And, then, there's this:

"What is specifically known from other reports is that on June 14, 2007, patient Mario Vidaurre died at West Oaks when the one-on-one tech assigned to him beat him to death [see "Death in a Box," by Margaret Downing, October 25, 2007]. An investigation by the state found West Oaks was at fault. On March 22, 2007, Alan Chambers, a man who was supposed to be under suicide watch, hung himself behind the closed door of his room on Unit 1. On May 12, 2006, a 17-year-old girl who tried to hang herself with one of her shoelaces was allowed to keep the other shoelace of the pair in her West Oaks room.

"Frederick Williams, the tech who fought with Vidaurre and caused his death, has left the psychiatric center and retained an attorney to represent him in a lawsuit against his former employer. He's arguing he had no business being assigned to Vidaurre; he never got trained for that kind of job."

A tech beating a patient to death? That's crazy. Keep in mind this is a private psych facility not a state hospital (not that this should go on anywhere, ever). Why is the Treatment Advocacy Center silent when this kind of stuff is going on? Cat still got your tongue Fuller Torrey?

There's plenty more on West Oaks in this fine article by the Houston Press. Why is this hospital even still open?

"'It appears that we need to enforce significant restrictions on DTC (direct-to-consumer) ads to protect American consumers from manipulative commercials designed to mislead and deceive for the profit of pharmaceutical companies,' said Stupak, head of the U.S. House of Representatives Energy and Commerce investigative panel.

"The Michigan Democrat said Congress should consider whether ads promoting medicines should be allowed to continue to target consumers in the United States, the only country that allows such marketing except for New Zealand.

'Pharmaceutical companies should consider it a privilege to be allowed to air DTC ads in this country,' he said. 'We should make sure that pharmaceuticals companies conduct themselves responsibly.'"

One pharma company defended the infamous Robert Jarvik Lipitor ads thus:

"James Sage, a Pfizer senior director, said ads are necessary because companies cannot sell prescription products directly to consumers. Such patient-targeted spots 'motivate them to seek additional information ... consult their physicians ... and follow treatment plans,' he said."

Yes, motivate them to seek additional information from their doctors who the pharma companies also go out of their way to misinform and deceive.

As much as I am against limiting anyone's free speech, the pharma companies have gone way too far in their advertising the last 10 years and I have a hard time understanding the benefit to the public when doctors can simply access the same information, twisted as it might be. Congress was not examining any ads for mental health meds today, but it is certainly the branch of pharma advertising that Congress should look at, especially magazine and online ads for anti-depressants and antipsychotics (I'm thinking of the Pfizer ad for Geodon featuring a serene looking woman practicing yoga).

I've written before that pharma ads for psych meds should be banned or greatly restricted. I stand by that statement.

For now, however, take a look at this piece on a child in Kansas--a kindergartner no less--with alleged child bipolar disorder. Despite my own disbelief in the disorder--no mania means no bipolar--it's clear that there is something very dramatic up with this child. And it's sad regardless of the cause.

Have a nice day and weekend.

"Phase II study results show that ABT-089 appears to significantly improve the core symptoms of ADHD, improve quality-of-life and work effectiveness, and reduce overall work impairment in adults with ADHD. Data also revealed that ABT-089 appears to be generally well tolerated with no significant negative effects on sleep, appetite or vital signs (heart rate and blood pressure).

"ADHD, an ailment historically associated with childhood, persists into adulthood in more than two-thirds of cases."

How much ADHD persists into adulthood is debatable (recent studies put it at closer to 50 percent), but you know how the ads for this drug will go: "Having trouble getting your reports done on time for the boss and still having spare moments to catch the kid's soccer practice and shag the wife? Abbo-Fix is the answer for you." Something like that at any rate.

Given the company's emphasis on lifestyle improvement, you know Abbott will market the hell out of the drug once it hits the market, possibly in 2010. And why wouldn't they? Abbott hasn't had a homerun mental health drug since it turned Depakote into a "mood stabilizer" for bipolar disorder in the early-1990s (David Healy is deeply critical of Abbott for creating that terminology). But one does have to wonder about just what we are doing when we are introducing a lifestyle drug into the marketplace as opposed to something that addresses a truly debilitating problem. I guess that would make ABT-089 the Viagra of psych meds.

Aaron Rowe over at Wired Science put it thus:

"In my opinion, selling chemicals which affect the brain, but do not treat a major human malady, is a legitimized form of recreational drug dealing. But from a capitalistic point of view, it is a brilliant idea: A drug which strikes α4β2 nicotinic acetylcholine receptors is sure to have more off-label uses than duct tape, which means it could be a really big seller for the pharmaceutical giant."

That's a bit more harsh than I'd be, but since he opened the door, let me budge on in: So many ADHD scrips wind up being diverted into the underground market and so many teens and college students (and, hell, probably adults) are laying hands on ADHD drugs without a scrip, grinding the pills and snorting them like speed that I think Rowe's terminology is apt. This is especially true of Adderall, which goes for about $5 a pill on da' street and is quite popular among the college crowd as a, ahem, study aid.

I recently had a chat with an admitted Adderall snorter, who told me she didn't have an ADHD diagnosis, but that she and her friends in college often use the drug to help them stay up for days on end and cram for mid-terms and finals and term papers and such. She liked how easily available it was and how focused she was while on the drug. It also gets her high as a kite. I asked about side effects, fluttery heart beat and the like. She said she'd had no problems and that the only downside of using the drug in this fashion was when she had finals later than her fellow whiffers. They'd come off the drug first and be all zonked out and she'd have no one to stay up late and study with.

Oh, yes: there is apparently a very big crash coming off Adderall and the once-snorter becomes the many-hours-sleeper. This has become much larger phenomenon than I'd thought a few years ago (witness all the busts of teens for dealing Adderall) and whenever I speak at a college, I get asked about it.

I once took speed ("greenies") to keep me up all night for a Econ final when I was a freshman in college, in the days before ADHD meds were commonplace. So did a few pals of mine. The speed made me shiver internally and I felt chilled. It was such an icky feeling that I promised myself after the final that I'd never touch speed again (I haven't) and that I'd make sure to organize my life better so that I never had to pull an all-nighter ever again. And I never have.

What's interesting and spooky is that ABT-089 is not a stimulant, it's a neuronal nicotinic receptor agonist, making it somewhat akin to Chantix (Champix outside the US), the very messy stop-smoking drug that keeps acting like an SSRI and causes erratic behavior, suicidality, suicide and, in some reported cases, depression. It'll be very, very interesting to see how ABT-089 performs in the real world.

BTW, Rowe implies that ADHD is not a major human malady. I have no idea whether it is a major one or not since I don't have it myself and the adults I know with the disorder don't seem particularly disabled to me. What do you think? ADHD: major or minor malady? Is Abbott trotting out a mere lifestyle drug or are they addressing a major health issue?

Full disclosure: In the late-1980s, I was a sales rep (and a very good one) for Abbott Labs for its then-tiny Abbott Critical Care Systems which sold critical care monitoring devices commonly used in operating rooms and ICUs. I never repped drugs for Abbott.

What strikes me as strange is how the media has largely given the drug's many well-known problems a free pass and has instead largely parroted AZ's press spin in announcing the depression and anxiety data the company presented at the APA on Monday. Here's an example from WebMD.com wherein the "reporter" (or would that be copywriter?) details the new data on the drug and ignores its propensity to induce rapid weight gain in patients and cause diabetes and all sorts of fun extra pyramidal symptoms as well as daytime somnolence. Instead, she sticks to the AZ script.

Why does that piss me off? First, a lot of people read WebMD.com. It is the number 34 website in the world, according to quantcast.com, as it's read by an estimated 19 million unique readers a month. Regardless of what one thinks of websites like WebMD (I think it largely blows), it's clear that the public is paying attention to the site's prose. The public certainly deserves more complete information about any drug the site writes about. Second, the Seroquel article on WebMD was allegedly reviewed by a doctor. One has to wonder precisely what kind of doctor would let pass an article that doesn't even offer the most basic set of information about the drug, especially since Seroquel's problems are well documented. Third, you also have to wonder what kind of media ethics and editorial oversight are in use at the company if that's the kind of prose they feel compelled to offer the public.

In short, WebMD is not being fair to the experiences of the many millions of people who have taken this drug and run into problems on it. And, fairness much less objectivity is supposed to be the hallmark of the mainstream media and WebMD clearly flunks that test. You can read my own writing about this drug here. While I don't always acknowledge that some people do derive benefits from the drug, no one really expects me to since blogs are supposed to be the metaphorical equivalent of an old school newspaper column and they are not required to be as fair-seeming.

What blows my little mind is that WebMD makes no mention of the fact that AZ faces a large class action lawsuit in federal court in Florida over its handling of the drug and that the drug is sometimes converted into a drug of abuse by crushing it and snorting it or by melting it down with cocaine and shooting it (a Q-ball). The drug already has some catchy street names such as Susie Q and Quell and is a favorite of prisoners. For WebMD to pretend that such information wouldn't be important to the casual reader looking for information on the drug is galling. This is basic stuff that most any responsible journalist would find a way to slide into an article on the drug, pro or con.

And it's websites like WebMD that have helped drive thousands of journalists out of their jobs. Keep that in mind every time you read its prose. These are the clowns driving hardworking people out of their jobs and they are doing a bad job of replacing them. Personally, I trust WebMD about as much as I'd trust adders fanged, to steal from Shakespeare. The article doesn't even mention that the "studies" it cites are in fact unpublished (meaning the data has technically not passed peer review yet) and that the data it pimped at the APA is little more than averages of each arm of the placebo controlled studies, not a report of what percentage of patients in which arm saw how much benefit from the drug. That's just lame.

The sad fact is that I get dozens of hits to this site each week from readers searching for information on "shooting seroquel," "snorting seroquel," "Susie Q" and the like. Teens have been arrested around the country for dealing the drug.

And that's just really strange for a drug that is on the verge of being approved to treat depression and anxiety. And it's strange that the mainstream media--online and offline--hasn't noticed. Weirder still: I've recently begun to get stray hits from people searching for information about "snorting Abilify." I kid you not.

Or am I wrong to be bothered by any of this?

For those of you who don't know, her daughter is technically diagnosed as psychosis NOS and is one of the most profound cases of mental illness I've ever run across. Her mother, who has fought heroically for her daughter's rights in the system, is beginning to lean towards autism as the most sensible diagnosis. The docs haven't gone there yet, but then she's usually ahead of the docs.

"A double-blind, parallel-group, placebo-controlled phase III study to evaluate the safety and efficacy of Lexapro in the treatment of depressed adolescents, aged 12-17, was conducted in multiple centers across the U.S. A total of 316 patients entered the eight week study, receiving either Lexapro 10-20 mg (n=158) or placebo (n=158). The primary endpoint was change from baseline to Week 8 on the Children's Depression Rating Scale - Revised (CDRS-R) using last observation carried forward (LOCF) approach. The CDRS-R is a commonly used clinician-rated instrument that covers 17 symptom areas of depression relevant to adolescents, including impaired schoolwork, difficulty having fun, social withdrawal, physical complaints, and low self-esteem. The study showed statistically significant improvement in patients treated with Lexapro relative to placebo based on the change from baseline in the CDRS-R score (-22.1 for Lexapro vs. -18.8 for placebo treatment; p=0.022)."

The improvement in the CDRS-R scores is an average of all the patients in a particular arm of the study, so it's not clear what percentage of patients in the Lexapro arm of the study received whatever benefit might be ascribed to Lexapro. I'll have to wait for the published results to be able to dig up those bones.

Until then, I'd say teens and their parents ought to be damn careful when using any anti-depressant--that black box warning isn't on Lexapro and the other anti-depressants for nothing, regardless of what Fred Goodwin thinks. To be fair, Lexapro is a long way from Paxil and Effexor on the ugly meter, but it's still an SSRI and the Brits banned all SSRIs (except for Prozac) for use in under-18s.

Whomever you are who posted that, drop me a line and I'll buy you the metaphorical equivalent of a beer.

"The WHO Collaborating Center for International Drug Monitoring received 867 reports from 24 countries of people encountering amnesia, often coupled with confusion, agitation and other behavior disturbances, while taking the new sleeping pills, like Lunesta and Ambien, through March, 2007. That compares with 1,032 adverse reports with the older class of benzodiazepines, even though they have been on the market for decades longer.

"People under the influence of these drugs have gone on eating binges, driven their cars and engaged in other activities that they later cannot remember. The Wall Street Journal relates one story of a woman who painted her front door in her sleep, and in some cases, people have had serious car accidents and even set fire to their homes while in the seemingly-hypnotic state sometimes caused by the drugs."

Yep, that's a nice new class of sleeping pills the pharma companies have bestowed upon us.

"In my private practice as a psychologist, I frequently find people misdiagnosed with Bipolar disorder. If someone has an anger problem, they often end up diagnosed as Bipolar. This happens frequently by family doctors and also psychiatrists. In my opinion, it's really often a matter of justifying the meds they want to prescribe (most often an antipsychotic). I'd say, anecdotally, that the level of overdiagnosis I see is pretty consistent with the studies results (50-60%). I do evaluations for people seeking disability based on mental illness diagnoses, so I frequently see people labeled as Bipolar. More often than not, the diagnosis is more consistent with a cluster B personality disorder (erratic, unstable, and hyperemotional personality traits). But once you diagnose someone as being Bipolar, you can pretty well throw any class of psychotropic medication at them that you want to."

Yes, the mental health industry throws whatever they feel like at bipolars and schizophrenics. It's amazing that so many people are winding up diagnosed with bipolar in such a fashion.

I wonder when the backlash will begin because this kind of nonsense won't go unanswered for long.

"I took 200 mgs. of Seroquel daily for two years after a questionable diagnosis for Bipolar II (manic symptoms appeared only after treatment with antidepressants or with high doses of IV steroids). Now, a year after withdrawing from Seroquel, I still wake up every two hours, and I still have episodes of akithisia. I believe this drug has permanently damaged my nervous system. I struggled with deep depression the entire time I was taking Seroquel; since withdrawing (a painful process) my mood has improved."

This drug is being given to millions of Americans for everything from psychosis to sleep problems to "public speaking anxiety." I wonder how many other stories there are like this. I wonder how many more we'll encounter once this drug is approved for depression and anxiety.

Slate focuses in particular on three guests Goodwin had on his program in late March, a show entitled "Prozac Nation: Revisited," which laid out the view that the press had wildly overreacted to concerns around anti-depressants and violence as well as suicides and suicidality connected to the drugs. As it turns out, the guests and host all have financial ties to pharmaceutical companies.

"Which brings us back to The Infinite Mind and "Prozac Nation: Revisited," a show that may stand in a class by itself for concealing bias. In addition to the show's unrestricted grants from Lilly, the host, Goodwin, is on the board of directors of Center for Medicine in the Public Interest, an industry-funded front, or "Astroturf" group, which receives a majority of its funding from drug companies. CMPI President Peter Pitts was one of Goodwin's three guests for "Prozac Nation." We don't know which companies fund his group because when we asked him, Pitts said, "I don't want to go into that." But CMPI took in more than $1.4 million in 2006 and, according to its tax forms, spent $210,000 to influence the media through a large conference, a blog the group maintains, op-eds published in major newspapers, and multimedia programs and podcasts. Pitts has another title that might have been relevant to The Infinite Mind; he is the senior vice president for global health affairs at the PR firm Manning Selvage & Lee, which represents Eli Lilly Inc., GlaxoSmithKline, Pfizer, and more than a dozen other pharmaceutical companies. Yet on the show, Pitts was identified only by his title as "a former FDA official."

"The second guest on "Prozac Nation," Andrew F. Leuchter, is a professor of psychiatry at UCLA who has received research money from drug companies including Eli Lilly Inc., Pfizer, and Novartis. The third guest, Nada Stotland, president-elect of the American Psychiatric Association, has served on the speakers' bureaus of GlaxoSmithKline and Pfizer. None of Leuchter and Stotland's ties to industry was revealed to listeners—instead, each was introduced as a prominent academic.

"The Infinite Mind's Web site states, "Our independence is perhaps our greatest asset." Perhaps, indeed. Neither Goodwin nor the show's producers responded to our repeated requests for interviews and queries about their funding. Pitts, who to his credit did give us an interview, said he didn't know why his ties to industry weren't revealed on the show. Curious, we tried to learn more about the funding for The Infinite Mind—and could discover only that the show's award-winning production company, Lichtenstein Creative Media, was dissolved by the state of Massachusetts on March 28 for failing to file a single annual report since its establishment in 2004."

I congratulate the reporters on this piece--Shannon Brownlee and Jeanne Lenzer--for kicking butt all over the place. They didn't get into Goodwin's industry ties--probably because they speak for themselves--but here's a statement he made on behalf of Eli Lilly when Zyprexa was approved as a maintenance med for bipolar disorder in 2004 (and, you can bet such a statement isn't made for free):

"'It is good news that the FDA has now approved Zyprexa as a new tool for physicians to use to delay relapse and prolong periods of stability and wellness.'"

Here's Goodwin's financial disclosure from a 2004 paper in the Journal of Clinical Psychiatry (.pdf here) touting Lamictal:

Dr. Goodwin has received research support from Abbott, GlaxoSmithKline, Solvay, Janssen, Pfizer, Eli Lilly, Forest, Sanofi and Bristol-Myers Squibb; has received honoraria and participated in speakers/advisory boards for Solvay, GlaxoSmithKline, Pfizer, Janssen, Eli Lilly, AstraZeneca, and Bristol-Myers Squibb; and has been a consultant for GlaxoSmithKline, Eli Lilly, Pfizer, Bristol-Myers Squibb, Solvay and Novartis."

If Goodwin is willing to release his financial conflicts to his own academic peers in a juried article, then why isn't he willing to tell the public the same thing when he holds forth on criticizing the media over its coverage of anti-depressants? It is discouraging to me to see someone of Goodwin's stature--I know from a patient of his that he is well-regarded by his clients--is such a shill for Big Pharma on the side and doesn't disclose that on his program. It's even weirder to me that the program didn't disclose Peter Pitts' deep ties to Big Pharma.

I have previously criticized the "Prozac Nation" program for misstating available evidence on the issues and for not making available to the public competing viewpoints. In other words, the show was wildly biased in a way scientists and allegedly "independent" media should avoid and, frankly, had damn near religious overtones in its praise of SSRIs. If that's how Goodwin and his producers want to do things, it's a free country, but they ought to disclose whatever financial conflicts they have. It also galls me that the program, as I noted last month, is so one-sided yet is carried on taxpayer-funded and listener-funded public radio. It's heard by 500,000 people each week and one would expect a certain level of media ethics from such a program, if not some level of oversight by NPR itself. In fact, I think the NPR stations that carry the program ought to reexamine their relationship with the program, especially given that the program's producers won't disclose their funding to even the IRS.

Maybe some readers would be interested in writing the station in their area that carries the program. Let me know.

Here, I'll disclose my financial conflicts for this site: reader-supported and Pharma-free. I thank my readers for my ability to say this each and every day. In addition to reader contributions, I subsidize my work here through outside freelance writing.

As I noted then:

"But the hell with the non-disclosures for a moment. Don't the 30 million to 60 million psych patients in this country deserve a health care system in which the bases of diagnoses are made independent of any conflicts with pharmaceutical companies? You bet they do. These researchers should be ashamed of themselves and so should the American Psychiatric Association, which publishes the DSM, for allowing this situation to persist. The APA promises that for the DSM's next revision in 2011 conflicts will be revealed. I have another suggestion: No one who receives a plug nickel from pharma companies should be allowed to particpate in any way in designing the DSM."

Somethings simply never change. (Via the NYT's Well blog.)

What's astonishing is that state employees were using chokeholds on patients. Almost every police department in the US banned the use of chokeholds in the 1980s after a series of deaths from the use of the procedure.

"The psychiatric hospitals, which have about 2,500 patients daily, had 137 confirmed abuse cases in 2007. The state schools for people with disabilities, which have twice as many residents, have an average of 300 confirmed abuse cases per year.

"But some advocates fear the mentally ill patients may face greater risks. Patients of the psychiatric hospitals are largely indigent, transient and not connected to their families, so they have few allies as they bounce through the mental health system.

"'It's a population that's easy to abuse because they're not on the radar in any way,' said Richard Hansen, a Texas mental health advocate who was chemically restrained, shackled and beaten to the point of broken ribs years ago while suffering from bipolar disorder in a New York mental hospital."

The whole thing is disgusting. How come the Treatment Advocacy Center isn't talking about this on its website? Cat got your tongue Fuller Torrey?

Now comes a small contrarian study in the psych world by Mark Zimmerman, a psych prof at Brown University, to be presented tomorrow at the American Psychiatric Association's convention. In a survey of 700 people, 145 indicated they'd been diagnosed with bipolar disorder yet Zimmerman found that only 43.4 percent of those diagnosed with bipolar disorder had been diagnosed by a doctor using the Structured Clinical Interview for DSM-IV. Although the doc doesn't come right out and say it in a press release, it's clear that he thinks some docs are diagnosing people far too casually (it's not clear from the press release if the other 46.6 percent of "bipolars" later checked out as bipolar on the SCID). Check out what he ascribes the cause to:

"'Clinicians are inclined to diagnose disorders that they feel more comfortable treating. We hypothesize that the increased availability of medications that have been approved for the treatment of bipolar disorder might be influencing clinicians who are unsure whether or not a patient has bipolar disorder or borderline personality disorder to err on the side of diagnosing the disorder that is medication responsive.' He continues, 'This bias is reinforced by the marketing message of pharmaceutical companies to physicians, which has emphasized the literature on the delayed and underrecognition of bipolar disorder, and may be sensitizing clinicians to avoid missing the diagnosis of bipolar disorder.'

"Zimmerman concludes, 'The results of this study suggest that bipolar disorder is being overdiagnosed and we recommend that clinicians use a standardized, validated method in diagnosing bipolar disorder.'"

Classically, bipolar disorder was estimated to affect about 1 percent of the adult US population but that estimate was bumped up to 2.2 percent by NIMH a couple of years ago, mostly to account for the prevalence of bipolar disorder type 2. But there have been numerous other researchers who've pressed for a prevalence of 4 percent, 5 percent and even as high as 11 percent.

Either way, Zimmerman is flat out accusing his colleagues of using their gut hunches with patients and of diagnosing based upon a person's reaction to medication, a very dangerous bit of backwards logic often employed in children (the Harvard bipolar child mafia have argued that since the kids they diagnose with bipolar disorder respond to antipsychotics and other meds then that proves they have child bipolar disorder). And, let's be clear that he's saying that doctors--you know, those rational, god-like creatures who do things based on Science--are being softened up by all those pharma ads saying bipolar is wildly underdiagnosed.

It will be interesting to see what kind of response this study gets.

Thoughts?