Blog archive: August, 2003

Blog subjects:

  • Pseudoscience in the mental-health industry

  • Unethical behavior among pharmaceutical companies

  • Whatever else strikes my fancy

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Note:  Blog updates occur sporadically.  I'm just too busy to maintain a schedule of daily entries.  Thanks for understanding.

Sunday, August 31, 2003

Another article about Ritalin (generic: methylphenidate):

Girls get extra school help while boys get Ritalin

[...]  In classrooms nationwide, girls are pulling ahead of boys academically.  Recent federal testing data show that what starts out as a modest gap in elementary-level reading scores turns into a yawning divide by high school.  In 12th grade, 44% of girls rate as proficient readers on federal tests, compared with 28% of boys.  And while boys still score slightly higher on federal math and science exams, their advantage is slipping.

Most startling is that little is being done to correct the imbalances.  All of the major players – schools, education colleges and researchers – largely ignore the gender gap.  Instead of pursuing sound solutions, many educators merely advocate prescribing more attention-focusing Ritalin for the boys, who receive the drug at four to eight times the rate of girls, according to different estimates.  “Too often the first reaction to an attention problem is 'Let's medicate,' ” says Rockville, Md., child psychologist Neil Hoffman.  “Some schools are quick to recommend solutions before they've fully evaluated the problem.”

Saturday, August 30, 2003

Blog-reader Fred sends along this interesting article about Ritalin (thanks, Fred!):

Scientists Find Little, If Any, Proof Ritalin Is Effective

By Brad Evenson

National Post – Canada

OTTAWA – After a painstaking analysis of 62 studies of Ritalin treatment for attention deficit disorder, a team of Canadian researchers says it has found little scientific evidence the drug lives up to its reputation.

More than 200,000 Canadian schoolchildren take methyl-phenidate, the generic name for Ritalin, a stimulant drug prescribed to help them concentrate and control their impulsive behaviour.  Many parents, teachers and doctors praise the drug for turning around the tumultuous lives of millions of young children.

Yet a meta-analysis published today in the Canadian Medical Association Journal says the clinical trials of the drug have often been biased and poorly constructed.  For example, although patients may take Ritalin for years, most trials comparing the drug with a placebo lasted three weeks, with none lasting longer than seven months.  In some cases, scientists studying Ritalin ignored or downplayed the impressions of schoolteachers, who thought children taking the drug were no better off than those taking a placebo.  Finally, such adverse side effects as insomnia and loss of appetite have not been carefully measured.

“Collectively, these observations likely reflect a less than an ideal state of affairs given the long history of extensive, and ever increasing, use of methylphenidate for ADD particularly in North America for groups that now include pre-schoolers and adults,” conclude the researchers, from the Children's Hospital of Eastern Ontario and the University of Ottawa.

For a disease that didn't officially exist before 1987, attention deficit disorder has been remarkably catching.  An estimated 5% of children are affected.  Several years ago, the definition was expanded to the new name, attention deficit/hyperactivity disorder [AD/HD].

Friday, August 29, 2003

OK, today's entry has nothing directly to do with the mental-health industry, but it's relevant nonetheless.  Much of what passes for knowledge in medicine is actually a glorified urban legend (of course, this principle holds in spades for the medical subfield of psychiatry).  We have two cases of medical folklore to debunk today.

Case number one:

Doubt Is Cast on a Remedy for Asthma

Two studies have found that mite-proof bed coverings, at least by themselves, fail to relieve asthma and allergies, a perplexing discovery that challenges the frequent advice of doctors.

Doctors and medical groups widely recommend mite-proof bed coverings to treat allergies and the asthma mites can cause.

Up to 50 million people in the United States have allergies. Studies suggest that 40 percent to 60 percent of allergy sufferers in some areas are sensitive to dust mites, near-microscopic creatures that live in house dust and lay eggs in bedding. The tightly woven coverings, typically priced about $120 for a set, hold in their irritating allergens and keep new mites from bedding.

The findings of the two European studies, being reported on Thursday in the journal, were so surprising that some doctors vowed to keep recommending bed coverings.

Case number two:

Most heart attacks caused by an unhealthy lifestyle

Two sweeping studies out today appear to explode the long-held myth that half of heart attacks result from bad genes or bad luck.

The studies, focusing on different populations totaling about half a million people, indicate that roughly 90% of people with severe heart disease have one or more of four classic risk factors: smoking, diabetes, high cholesterol and high blood pressure.  [...]

“These papers are just amazing.  They're basically blowing away the myth that only half of the people who have heart disease have traditional risk factors,” says John Canto of the University of Alabama-Birmingham who co-wrote an accompanying editorial in the journal.

None of the researchers could identify the source of the erroneous assertion, cited by experts for years.  “It's folklore,” Greenland says.

(In both cases, emphasis was added by me).  One wonders what other myths are still out there, deeply entrenched in the minds of the “experts”.


Thursday, August 28, 2003

Be sure to check out a new blog called “Psych Watch”.  He (she?) updates more frequently than I do, and the focus of the blog is similar to mine (though Psych Watch has more of an emphasis on some of the personal foibles of psychiatrists).  Overall, entertaining and informative.  I do hope, though, that at some point the author includes an e-mail address, as well as a message-board or comment system.


Somebody named “alysandrya” has put together an excellent Amazon list titled, “The Ineffectiveness of Psychotherapy”.  I should point out that I don't believe that all psychotherapy is always ineffective or harmful.  I think that cognitive therapy and interpersonal therapy have a lot of potential to help people, and I'm enthusiastic about the prospects for positive psychology.

Here's another good Amazon list:  “The Dark Side of Psychology”.


Sad and disturbing news out of Japan:

Aggressive marketing for antidepressants giving drug companies a lift

With more and more people in Japan complaining of depression, drug companies are enjoying a bonanza in pushing antidepressants.

Aggressive publicity campaigns by pharmaceutical companies have eroded a long-standing aversion to taking antidepressants or going to hospitals for outpatient treatment of depression for fear of being stigmatized as having mental problems.

GlaxoSmithKline (GSK) of Britain conducted a campaign in Japan last autumn aimed at enhancing public understanding of depression. It received more than 40,000 responses.

Many of the respondents said they have realized that depression is not a special disease, according to the company, which said it will keep offering counseling by phone and on its Web site and distributing booklets until December.

“We want to enlighten people that depression can be cured by proper treatment,” an official of the company said.

This situation reminds me of the way that the recovery industry exports Alcoholics Anonymous to countries outside the United States.  The group is presented as some kind of godsend (literally, according to some apostles), when in fact A.A. is largely ineffective, and may even be harmful to some people.  We (the US and some other western countries) have some nerve trying to convince the rest of the world to follow our lead, when our own mental-health industry shows such poor results.  What's surprising to me is why other societies listen to us.


Tuesday, August 26, 2003

Another reason to avoid antipsychotic drugs:

3 Schizophrenia Drugs May Raise Diabetes Risk, Study Says

Three drugs commonly prescribed for schizophrenia and other psychotic illnesses increased patients' risk of developing diabetes when compared with older antipsychotic medications, researchers said yesterday, presenting the results from a long-awaited study of patients treated at veterans hospitals and clinics across the country.

The drugs – Zyprexa, made by Eli Lilly, Risperdal, made by Jannsen Pharmaceutica, and Seroquel, made by AstraZeneca – were associated with higher rates of diabetes than older generation drugs for schizophrenia like Haldol, the study found.

 


Monday, August 25, 2003

I have a feeling that we're seeing the beginning of the end of the antidepressant era.  There is an increasing amount of skepticism with respect to the effectiveness of these drugs.  See, for example, this article from the Australian newspaper, the Sydney Morning Herald:

Depression drugs on trial

Anti-depressant medications may be a case of the “emperor's new clothes”, according to studies that show that, in banishing the blues, drugs are only marginally better than a sugar pill.

Debate about the value of anti-depressants has spilled into the latest issue of the British Journal of Psychiatry (BJP), which highlights a recent US survey of the results of 19 anti-depressant drug trials.

The analysis found that placebos duplicated 80 per cent of the effects of anti-depressants.

“In this analogy, psychiatry is the emperor, drug trials are the fraudsters,” according to the BJP.

“The deception is being revealed by a growing body of critical opinion proposing that... anti-depressants either don't work at all or have an effect that is so small as to be clinically unimportant.”

What the article doesn't mention is that there is reason to doubt even the small but statistically significant superiority of drug over placebo.  Unlike placebos, antidepressants often cause significant side-effects, such as sleepiness, dry mouth, weight gain, etc.  Thus, patients think to themselves, “Ever since I started taking this medication, I've felt tired.  I've also had headaches, and my sexual performance has suffered.  Wow, this must be a powerful drug, and I bet my mood is going to improve soon”.  In this way, antidepressants can have an enhanced placebo effect that can account for the apparent benefit of the drug over an inert pill.


Here's another, slightly less skeptical article (from the British newspaper, the Guardian):

Research challenges role of antidepressants

People with mild depression are being prescribed antidepressants despite a lack of proof that it is the best treatment for them, according to a report published today.

Antidepressant prescriptions issued by family doctors doubled between 1975 and 1998 to 23.4m per year, research by the Drug and Therapeutics Bulletin (DTB) found.

Yet few clinical trials have studied the effectiveness of the drugs with regards to GP patients, with the vast majority focusing on severely ill patients in hospital.  The DTB investigation questioned whether prescribing antidepressants was the best way to treat mild depression when other therapies were available and preferred by patients.

Professor Joe Collier, editor of DTB, said:  “Serious questions must be asked as to whether there is any real benefit from the routine early use of antidepressant drugs in patients with the sort of mild depression seen in UK general practice.”

Monday, August 18, 2003

It seems unlikely to me, but for what it's worth:

ANTIDEPRESSANTS MAY HAVE DRIVEN KILLER'S RAGE

By DOUGLAS MONTERO

One of the assassin's bullets ripped into the back of the councilman's head.

Two of the .40-caliber bullets hit Councilman James Davis in the chest.

The other three were fired through his shoulder, left thigh and right buttock by a madman who for some unexplained reason picked a very public place – City Hall – to kill someone.

Those who knew Othniel Askew, 31, admit he was a bit odd.

But now some folks are wondering if the antidepressant drug Paxil turned him into a coldblooded killing machine.

The Food and Drug Administration recently warned doctors not to give it to children because it made them suicidal.  England and France banned it outright for children.

“It all fits,” said Lisa Van Syckel, who isn't a doctor but three years ago became an expert on Paxil's side effects when her 15-year-old daughter mutilated herself with a razor and tried to commit suicide several times.

“The scary part is that they focus in on one individual and they begin to have a paranoid reaction towards them – a hatred,” she said, describing how her daughter's behavior mirrored Askew's.  “One moment they're calm and the next they hate you.”

Donald Schell, 60, of Wyoming was also the picture of calm in 1998 – until he was prescribed Paxil.  On Feb. 14 of that year, he used a .22-caliber gun and .357 magnum to shoot and kill his sleeping wife, their daughter and his 9-month-old granddaughter, before committing suicide.

The family filed a lawsuit in U.S. District Court in Wyoming which blamed the drug and ordered the maker, GlaxoSmithKline, to pay the family $8 million.  Van Syckel sued the drug maker two weeks ago.

Saturday, August 16, 2003

Sorry about the lack of blog updates recently.  I've been very busy.  Just a quicky for today:

Pfizer Launches 'Zoloft For Everything' Ad Campaign

NEW YORK  Seeking to broaden the customer base of the popular drug, Pfizer announced the launch of a $40 million “Zoloft For Everything” advertising campaign Monday.  “Zoloft is most commonly prescribed for the treatment of depression and anxiety disorders, but it would be ridiculous to limit such a multi-functional drug to these few uses,” Pfizer spokesman Jon Pugh said.  “We feel doctors need to stop asking their patients if anything is wrong and start asking if anything could be more right.“  [...]

Last week, the FDA okayed Zoloft for treatment of “the entire range of unpleasant or otherwise negative social, physical, and mental feelings that an individual may experience in the course of a human life.”

(Yes, it's a joke – originally published in the Onion [though, strangely, no longer available on their site.])

Thursday, August 7, 2003

The New York Times has an interesting article about the possible link between antidepressants and suicide (note, also, the skeptical statements with regard to the true effectiveness of these drugs):

Debate Resumes on the Safety of Depression's Wonder Drugs

Warnings by drug regulators about the safety of Paxil, one of the world's most prescribed antidepressants, are reopening seemingly settled questions about a whole class of drugs that also includes Prozac and Zoloft.

Doctors are just beginning to react to the finding – reported first by British drug authorities in June and then endorsed the next week by the Food and Drug Administration – that unpublished studies about Paxil show that it carries a substantial risk of prompting teenagers and children to consider suicide.

Because the studies also found that Paxil was no more effective than a placebo in treating young people's depression, the regulators recommended that doctors write no new Paxil prescriptions for patients under 18.  Experts say that the suicide risk is highest in the first few weeks young patients are on the drug.  [...]

Almost no one suggests that Prozac, Zoloft, Paxil and their cousins are not safe for the vast majority of adults, although studies have shown them to be only modestly effective.

(Emphasis added by me.)

My main criticism is that the article doesn't go far enough in pointing out the poor effectiveness of antidepressants.  In fact, the drugs are barely better than placebos, and even that small apparent superiority is suspect.

Monday, August 4, 2003

Another outstanding article written by Melody Petersen of the New York Times:

Undisclosed Financial Ties Prompt Reproval of Doctor

Two scientists are raising concerns about an article in a medical journal that described experimental treatments for depression because an author did not disclose his significant financial ties to three therapies that he mentioned favorably.

The executive editor of the journal said it had not required disclosure of the potential conflicts, but was considering changing its policy in light of the criticism.  The ties between pharmaceutical companies and researchers have come under increasing scrutiny in recent years.

The lead author of the article, Dr. Charles B. Nemeroff, chairman of the department of psychiatry and behavioral sciences at the Emory School of Medicine in Atlanta, said he would have reported the conflicts of interest, which include owning the patent on a treatment he mentioned, if the journal had asked him to.

[...]

In his article, Dr. Nemeroff mentions roughly two dozen potential new therapies, saying that some had shown disappointing results and that others were promising.  One treatment he describes favorably is a patch that delivers lithium through the skin, a method that he says would improve patients' ability to tolerate the medicine. He did not disclose that he held the patent on that patch.

Dr. Nemeroff also did not disclose that he was a significant shareholder in Corcept Therapeutics, a company in Menlo Park, Calif., that is trying to develop mifepristone, a drug now approved to induce abortions, into a treatment for psychotic depression.  In the article, he wrote that there had been "impressive studies" with mifepristone, indicating that it "is very effective in the treatment of psychotic depression."

According to papers that Corcept filed with the Securities and Exchange Commission, Dr. Nemeroff was given the option to buy 72,000 shares of its stock for less than $25 total.  Those shares would have been worth more than $1 million if Corcepts had sold its shares to the public at a price of $14 to $16, as it announced it would do in late 2001.  The company decided in the fall to delay that offering. Dr. Nemeroff said in an interview that he owned 60,000 shares of Corcept stock.

Dr. Nemeroff also did not disclose any of his ties to Cypress Bioscience of San Diego, whose sole product is milnacipran, a drug being developed to treat fibromyalgia, a chronic pain disorder.  Dr. Nemeroff noted in his article that drugs that work in a similar way to milnacipran have been shown to be more effective than some other antidepressants.

According to papers Cypress filed with the S.E.C., Dr. Nemeroff is on the Cypress board and the company has given him tens of thousands of options to buy its stock.

See also this earlier article about Nemeroff's possible role in the David Healy affair (briefly, Dr. David Healy was essentially fired from the University of Toronto, following a lecture in which he criticized Prozac.):

Healy said he had a warning that taking the Toronto post might be troublesome.

[The warning] was delivered last summer by Nemeroff, during a scientific conference in Britain.

Nemeroff, who chairs the department of psychiatry at Emory University School of Medicine in Atlanta, accosted Healy and warned him that his Prozac views “would be bad for my career,” Healy said.

A few months later, at a U.S. meeting on suicide prevention, Nemeroff reportedly boasted to colleagues that Healy wouldn't get the Toronto job, said Healy, who claims he has a letter detailing the statement from a participant at the meeting.  Those comments by Nemeroff came a week before the university told Healy in an e-mail that the job offer was rescinded, saying he “is not a good fit” with the center, Healy said.

Healy said the withdrawal of the job offer was all the odder because the university had been courting him for two years and already had told him to pick his office decor and start interviewing staff.

Healy called the personal encounter with Nemeroff “scary” and “unfriendly.”  Healy said Nemeroff warned him that drug companies “were so big that they would simply roll over people who got in the way.”

Nemeroff has been paid by Lilly and other drugmakers to do antidepressant research and is considered one of the nation's most influential psychiatrists.  A recent issue of the Economics of Neuroscience journal called Nemeroff the “boss of bosses” in the U.S. psychiatric community.

“Those who do not heed his advice,” the article noted, “are often recipients of his wrath.”