|Blog Archive: Sept. 2002|
Monday, September 30, 2002
A few weeks ago, Noelle Bush (the President's niece) was apparently caught with crack cocaine hidden in her shoe. Now, a court has ruled that counselors from Noelle's rehab don't have to answer questions about the incident. I suppose I agree with the ruling, but I can't help wondering how much good (if any) will come of Noelle's stint in rehab. Addiction-treatment centers are staffed by well-meaning simpletons who vainly think they can provide simple answers to complex problems. Just turn your will and your life over to the care of God (AA's third step), and everything will be OK. Uh, right. Doesn't seem to do much for Robert Downey or Darryl Strawberry. Giving bad advice can be worse than not giving any advice at all.
Sunday, September 29, 2002
A long article, and not new, but still well worth reading: “Commentary: Against Biologic Psychiatry”, by David Kaiser, M.D.
Saturday, September 28, 2002
More and more college students are taking antidepressants and other psychotropic drugs. At Bennington College in Vermont, a stunning 40% of students are on some kind of psychiatric medication. Sure, being a student can be stressful, but adding Prozac, Valium, or Ritalin to the mix is probably not the answer.
Seems that anesthesiologists are prone to dipping their pens into the company ink, so to speak.
This is the kind of story that strikes fear into the hearts of skeptics everywhere. For years, doctors and scientists had maintained that Lorenzo's oil didn't work – that it was based on pseudoscience and quackery. Now, it turns out that the oil might work, after all. Sigh. Why is nothing in life simple?
Canadians are becoming increasingly concerned about Big Pharma:
Multinational drug companies in the United States are insidiously promoting their products through “gifts” to doctors, manipulation of the news media, and a bombardment of TV ads to consumers, a conference was told yesterday.
What a surreal scene: the Scientologists square-off against the drug companies. One scarcely knows whom to root against.
Friday, September 27, 2002
Not a new article, but still worth reading: “Despite frequent admonitions to 'just say no,' some people – from their teens to well past middle age – will use drugs anyway. Acknowledging that reality, some experts on drug abuse are advocating an approach called harm reduction, which says, in essence, that while drug use should be discouraged, people who do take drugs should be taught to do so in the least dangerous way possible.”
Xigris – made by the Eli Lilly Company – is a drug used for treating sepsis (acute infection of the bloodstream). It costs a whopping $7,000 per dose. Xigris was FDA-approved based on a study that showed only a six-percentage-point superiority of the drug over placebo. Now, the New England Journal of Medicine is expressing skepticism about the usefulness of Xigris. In a similar story, the FDA is doubtful about AstraZeneca's anti-cancer drug Iressa (a drug that is similar in action to ImClone's infamous Erbitux).
Thursday, September 26, 2002
Sometimes it pays to be a whistle-blower. Doug Durand exposed pervasive, illegal practices at his pharmaceutical employer. Now Mr. Durand is $77 million richer, and TAP Pharmaceuticals was fined a record $875 million.
Wednesday, September 25, 2002
GlaxoSmithKline is the British pharmaceutical company that makes the antidepressant Paxil (known as “Seroxat” in some other countries). Glaxo used to advertise their drug as being “non-habit-forming”. Now they've stopped making that claim. To be fair, though, I don't think that antidepressants are terribly addictive. Rather, the biggest problem with these drugs is that they don't work very well, if at all.
Tuesday, September 24, 2002
More evidence that our therapeutic culture may be doing more harm than good: New research suggests that dwelling on traumatic events is more harmful than trying to ignore those stressful feelings. “Ignoring trauma may be healthier than pouring out your heart about it, Israeli researchers reported on Tuesday.”
In a somewhat similar finding, researchers from the University of California, Irvine report that ruminating about unpleasant topics can put stress on the cardiovascular system.
Complete this analogy: “Heroin is to methadone, as cocaine is to _______”. The answer, it turns out, might be a new drug called “nocaine”. Researchers at Georgetown University have developed a substance that is similar to cocaine but appears to be less addictive (based on animal studies). If this drug turns out to be useful in clinical trials, it might be a good way to help cocaine addicts who have been unable to achieve total abstinence. Such a treatment strategy would be consistent with the concept of “harm reduction”.
Monday, September 23, 2002
Nick Nolte is apparently joining Robert Downey, Darryl Strawberry, and Noelle Bush – all people who (foolishly) rely on treatment programs to help them stop using drugs and/or alcohol. I have no ill will toward Nick Nolte, and I wish him success. But, to paraphrase Mark Twain, I hope Nolte doesn't let rehab interfere with his recovery.
It's no secret that depression is a serious, debilitating condition – and that it is becoming more and more common. Depression was fairly rare in the U.S. just a few generations ago. Now, it's reaching epidemic proportions. Author Robert Wright has written an interesting article (“The Evolution of Despair”) that provides a Darwinian perspective on rising rates of depression. Although the article was written in 1995, the central message remains relevant today:
A small but growing group of scholars – evolutionary psychologists – are trying to do better [than Freud]. With a method less fanciful than Freud's, they're beginning to sketch the contours of the human mind as designed by natural selection. Some of them even anticipate the coming of a field called “mismatch theory,” which would study maladies resulting from contrasts between the modern environment and the “ancestral environment,” the one we were designed for. There's no shortage of such maladies to study. Rates of depression have been doubling in some industrial countries roughly every 10 years. Suicide is the third most common cause of death among young adults in North America, after car wrecks and homicides. Fifteen percent of Americans have had a clinical anxiety disorder. And, pathological, even murderous alienation is a hallmark of our time.
Google has launched a search function for news feeds. Check it out:
Sunday, September 22, 2002
The U.S. Food and Drug Administration (FDA) is supposed to regulate the pharmaceutical industry and make sure that drugs are safe and effective. But, in practice, how well does the FDA actually do its job? And what happens when the drug companies themselves provide direct funding to the FDA? It's hard to imagine a more egregious case of conflict-of-interest. Although I don't always agree with the American Prospect, this time they really hit the nail on the head:
Thirteen dangerous prescription drugs have been withdrawn from the market in the last decade – but not before hundreds of patients died and thousands were injured. Yet no congressional committee has investigated why the U.S. Food and Drug Administration approved these dubious medicines or why they were not withdrawn right away.
In fact, just this past May, Congress opted instead to renew the arrangement that's a major source of the problem. For 10 years, drugmakers have provided much of the FDA's own funding by paying “user fees.” In exchange, the FDA speeds up its regulatory reviews. If this Faustian bargain was a factor in the recent drug calamities, Congress was not about to find out. Instead, the lawmakers allowed the drug companies and the FDA to decide, in closed-door negotiations, how much the industry would have to pony up this time around and just what concessions it would get from its regulators in return. Then Congress tacked the agreement onto an unstoppable bioterrorism bill and – without a hearing, debate or vote in any committee – passed it.
Saturday, September 21, 2002
A few days ago, I received some less-than-enthusiastic feedback about this site. Specifically, a reader told me that I was being unfair to pharmaceutical companies – that these companies wouldn't knowingly skew results from clinical trials. Hmmm, let's see – Enron built an entire corporation around a house of cards, WorldCom cooked the books to the tune of billions of dollars, but Pharmacia would never lie about its arthritis drug Celebrex?
When editors of the Journal of the American Medical Association sent medical expert M. Michael Wolfe an unpublished study on the blockbuster arthritis drug Celebrex last summer, he was impressed by what he read.
Tested for six months in a company-sponsored study involving more than 8,000 patients, the drug was associated with lower rates of stomach and intestinal ulcers and their complications than two older arthritis medicines – diclofenac and ibuprofen.
JAMA's editors wanted to rush the findings into print, and Wolfe and a colleague provided a cautiously favorable editorial to accompany it. But in February, when Wolfe was shown the complete data from the same study as a member of the Food and Drug Administration's arthritis advisory committee, he said he saw a different picture.
“We were flabbergasted,” he said.
The study – already completed at the time he wrote the editorial – had lasted a year, not six months as he had thought, Wolfe learned. Almost all of the ulcer complications that occurred during the second half of the study were in Celebrex users. When all of the data were considered, most of Celebrex's apparent safety advantage disappeared.
British researchers have “discovered” the obvious: autism-treatment programs work better when they're tailored to the individual, rather than forcing a “one size fits all” approach on everyone. Too bad substance-abuse programs in the United States aren't as enlightened – the vast majority of rehab centers still claim that 12-step groups are the only answer to alcoholism/drug addiction, ignoring all evidence to the contrary.
Friday, September 20, 2002
Eli Lilly's new antidepressant Cymbalta has received preliminary approval from the Food and Drug Administration (FDA). Cymbalta acts on serotonin and norepinephrine. When Prozac and other selective serotonin re-uptake inhibitors (SSRIs) were being developed, the pharmaceutical companies kept saying, “The new drugs (SSRIs) are better than the older antidepressants, because the SSRIs are 'clean' – they affect only one neurotransmitter. The older drugs affect many neurotransmitters and are thus prone to causing unnecessary side-effects.” Now, Lilly is undoubtedly going to claim that Cymbalta is better than SSRIs, because Cymbalta affects not one but two neurotransmitters. I'm also amused by this passage in the article:
“Despite the advances in antidepressant therapy that began with the introduction of Prozac in 1988, often patients fail to benefit from existing therapy,” said Dr. John Lechleiter, executive vice president of pharmaceutical products and corporate development at Lilly. “As many as two-thirds of treated patients fail to achieve complete resolution of their symptoms, or remission.”
Maybe someone should tell Dr. Lechleiter about the “rule of thirds”.
On another note: AstraZeneca and TAP Pharmaceuticals both used underhanded tactics to sell their respective anti-prostate-cancer drugs. Now the chickens are coming home to roost.
Thursday, September 19, 2002
Can selective serotonin re-uptake inhibitors (SSRIs) cause some people to commit suicide? I don't know. I really haven't studied the evidence enough to make up my mind on this issue. But David Healy – a respected psychiatrist and researcher at the University of Wales – has long claimed that Prozac (and related drugs) can cause potentially deadly suicidal thoughts. It's certainly worth examining further.
Wednesday, September 18, 2002
Did two pharmaceutical companies ignore signs that pharmacist Robert Courtney was illegally diluting cancer drugs at his Kansas City store? Lilly and BMS deny the charges, of course, and the evidence isn't completely clear-cut:
Hundreds of documents in lawsuits spawned by Robert R. Courtney's drug-dilution scheme were unsealed Thursday – and the two sides could not disagree more over their interpretation.
The plaintiffs say the documents prove two drugmakers knew Courtney was diluting their drugs and failed to take steps to stop him.
The drugmakers – Eli Lilly and Co. and Bristol-Myers Squibb Co. – say the documents reflect nothing more than routine inquiries concerning sales credits for their sales representatives.
Patients in the U.K. are becoming more than a little concerned about the side-effects of the antidepressant Paxil (known as “Seroxat” in Britain.)
Question: What do you call a person who graduated last in his class from medical school? Answer: “Doctor”.
Tuesday, September 17, 2002
New research at Georgetown University shows that suggested drug dosages are often set too high by pharmaceutical companies. This is the same conclusion previously reached by Jay S. Cohen, a physician and professor of internal medicine at the University of California, San Diego. Cohen has written a book called, Over Dose: The Case Against the Drug Companies. “Start low, go slow” should be the rule-of-thumb when prescribing drugs, but pharmaceutical companies don't like this practice.
More evidence that the mental-health industry is in disarray:
The fundamental problem [is] emphasizing medicating people over fostering ways to help them lead productive lives. [...] Many mental health systems are crisis-oriented and do not focus on the resiliency of people with serious illness, creating a self-fulfilling prophecy, said Johanna Ferman, medical director at the Center for Mental Health, a nonprofit agency regulated by the Washington, D.C., Department of Mental Health. “They are not really focused on recovery,” said Ferman, a psychiatrist who has consulted for mental health organizations and government agencies.
Monday, September 16, 2002
Dr. Paul Stolley – a former insider from the US Food and Drug Administration (FDA) – dishes up the dirt on the agency. Dr. Stolley presents evidence that drug companies wield undue influence on the FDA.
Sunday, September 15, 2002
So the New York Times is reporting that the government doesn't do a very good job of taking care of the mentally ill. Well, duh. Is this surprising to anyone? For fifty years or so, the strategy has been to drug 'em up and warehouse 'em briefly until you can push them back out on the street. If you want to see how to do it right, look at the Belgian town of Geel:
There is a small town in Belgium where an hallucinating psychotic person can get served in a café without a raised eyebrow and where a woman with bells and ribbons on her dress can walk down the street without gathering a crowd of mocking children. The children of Geel, you see, are used to unusual behavior. They, their parents, and grandparents for generations now have grown up with retarded or mentally ill foster patients in their homes.
Saturday, September 14, 2002
I'm not sure that pharmaceutical price controls are such a good idea. However, Big Pharma's underhanded tactics are making it harder for me to feel much sympathy for them. (I love that term – “Astroturf lobbying”.)
Friday, September 13, 2002
Seems that lots of people are unhappy (so to speak) about their depression treatments. The popular press doesn't often report these kinds of results, though.
Thursday, September 12, 2002
The Guardian exposes unethical business practices of pharmaceutical companies: “First, you market the disease... then you push the pills to treat it.”
Wednesday, September 11, 2002
So, apparently nicotine patches and nicotine gum don't work very well at helping people quit smoking. This result shouldn't be a surprise. Anti-smoking activists claim that cigarettes are a delivery system for nicotine. This view is simplistic at best: “ ‘People associate a lot of things with smoking. They can't relax without it,’ [study co-author John P. Pierce] says. ‘In those situations, you've got to replace smoking with something else and feel that you're getting the same benefit.’ For example, if a writer can't write without puffing away on a cigarette, ‘you've got to come up with some other way of handling that problem,’ he says.”
In a related story, British authorities chastised GlaxoSmithKline for running misleading advertisements about its nicotine patch. (Strange that the company's studies show a much higher success rate than independent studies show...)
Tuesday, September 10, 2002
So, Noelle Bush (the President's niece) was apparently caught with crack cocaine hidden in her shoe. Her relapse puts her in good company, with the likes of Robert Downey Jr., Darryl Strawberry, Liza Minelli, and millions of other, less-well-known people. What puzzles me to no end is why there aren't any level-headed, skeptical journalists who can put two and two together and write exposés about the pseudoscientific, sometimes-harmful programs that make up the addiction-treatment industry in this country. When was the last time you read an article in the popular press that questioned the effectiveness of rehab centers?
Monday, September 9, 2002
Do you think that Alcoholics Anonymous is a wonderful organization that is the only answer for people who drink too much? Someone named “A. Orange” has written an on-line book that debunks many of the myths that surround AA. Orange's style is a little over-the-top, but he makes some excellent points. See his chapter about “a searching and fearless moral inventory of Alcoholics Anonymous”.
You can't do science without being completely honest and objective – or as close to it as humanly possible. Thus, it's disheartening to learn of researchers to who accept money for publications ghost-written by drug companies.
Sunday, September 8, 2002
“Safety Concerns Downfall for New Drugs”, says today's Washington Post.
Old news, but still interesting: “Alcoholism drug has no effect on long-term drinkers”.
Saturday, September 7, 2002
“Anatoly Kuzmin lies sweating on a narrow bed as Svetlana Kollovina drags the alcoholic demons from his body using a powerful crystal sphere.” Those crazy Russians. <shakes his head> But are Americans any more rational? Psychologist Stanton Peele has his doubts.
Friday, September 6, 2002
The Washington Post has been running a lot of good stories lately. In today's edition, they debunk the effectiveness of grief counselors that descend like locusts every time there's some kind of disaster, most notably the World Trade Center collapse.
Thursday, September 5, 2002
Are antidepressants addictive? I wouldn't say so, though it depends on how you define addiction. In any case, lots of people do experience unpleasant withdrawal symptoms when they discontinue using Paxil (and other antidepressants, as well). See, “Quit Paxil, And Then: Zap!”
Wednesday, September 4, 2002
I'm pleased that the Washington Post has a long article about the increasing use of cognitive therapy to treat mental illnesses. The article even takes some swipes at antidepressants:
“Medications such as Prozac and Zoloft are still the frontline treatment for depression: 80 percent of the 14 million Americans treated every year for depression take antidepressants.
“But there are signs of a growing backlash. The plethora of ads for these drugs don't mention that 60 percent of people who take them don't find adequate relief and often move from drug to drug seeking better results. Or that some studies show patients receiving placebos do just as well as those taking antidepressants. Or that when you stop taking the drugs, you have a 60 to 70 percent chance of relapse. Or that side effects, especially loss of sexual interest, discourage many people from staying with the drugs.”
Tuesday, September 3, 2002
I added a bunch of information to my “Pharmaceutical industry” page last night. Check it out (see the link on the left). The Betty Dong case still makes me angry.
Direct Marketing News is the must-read news source for people who fill your mailbox with junk. But even they are reporting on the unsolicited-Prozac-samples scandal in South Florida.
Monday, September 2, 2002
The Washington Post reports that some psychiatrists are lobbying to create a new category of mental illness: relational disorders. The Post explains, “Unlike every psychiatric diagnosis so far, this new type of disorder would identify sickness in groups of individuals and in the relationships between them. This is a profound conceptual shift from the medical model of psychiatry, in which illnesses are diagnosed solely in individuals.” Are we making progress, here? I'm not sure. This development seems to be a further move toward medicalizing any and every human problem.
Sunday, September 1, 2002
A new British program will use cognitive therapy to treat cocaine addicts. I'm glad that someone, at least, is moving away from the treatment paradigm where addicts sit in a circle, complain about their lousy childhoods, and talk about turning their will and their lives over to the care of God (AA's third step). Still, I'd be (pleasantly) surprised if the cognitive-therapy approach turns out to be spectacularly successful. Cocaine addiction – or any addiction, for that matter – is a tough nut to crack (no pun intended).
I've received some positive feedback about this site. Unexpectedly, no-one has (yet) attacked me for my stance against pseudoscience in the mental health industry. From past experience, I know that people often get very upset if you question the usefulness of their Prozac prescription, or their 12-step group, etc.
I wish that someone in Rochester would create a high-quality virtual community, like Craig's List in San Francisco. Two things are needed: a “critical mass” of visitors, and easy-to-use message boards. The best message boards tend to be the simplest. See, for example, the “Joel on Software” forum – a simple, straightforward board where no registration is required. Sure, forcing people to register might cut down on trolls, but you could end-up throwing the baby out with the bathwater.
© 2004 Alex Chernavsky firstname.lastname@example.org