|Blog Archive: Nov. 2003|
Sunday, November 30, 2003
Two posts today about disease-mongering.
Journal decries disease-mongering
By Michael Woods, Toledo Blade
November 24, 2003
“There's a lot of money to be made from telling healthy people they're sick.”
Strange words, indeed, to lead an article in the esteemed British Medical Journal, which has been published by the British Medical Association since 1840.
“Disease mongering” is how BMJ has described the pill-for-every-ill mindset.
And the supposed mongers have had no shortage of topics:
“The ordinary processes or ailments in life are classified as medical problems,” the article stated. “Mild symptoms are portrayed as portents of a serious disease; personal or social problems seen as medical ones; risks conceptualized as diseases; and disease prevalence (the number of people affected) estimates framed to maximize the size of a medical problem.”
And speaking of disease-mongering:
Doctor identifies 'Hurried Woman Syndrome'
[...] In his book, The Hurried Woman Syndrome, Texas-based obstetrician and gynecologist Dr. Brent Bost says he has discovered a new illness affecting women in “epidemic proportions.” He claims 50 million women in the United States suffer from this condition, based on surveys he has done with doctors.
He treats more than 200 women a year with the syndrome, which he says is essentially minor depression. If not treated, one in three Hurried Women are headed for severe depression, he believes. He has put about 60% of his patients on a short-term cycle of anti-depressants.
The only encouraging part of the article comes toward the end, when the reporter quotes a skeptic:
Other experts are skeptical of Dr. Bost's theories and suggest he is trying to medicate life.
Janet Stoppard, a professor of psychiatry at the University of New Brunswick who has written a new book, Situating Sadness: Women and Depression in Social Context, said using a “vague term” like syndrome does a disservice to women.
“It sounds like he is accurately describing what women go through, but to turn this into an illness is quite appalling. We should not turn women's attempts to reasonably deal with things in their lives by pinning a medical label on them.”
Friday, November 28, 2003
This shouldn't come as a surprise to anyone, but the Rorschach test is a complete joke:
The Rorschach Inkblot Test, Fortune Tellers, and Cold Reading
Famous clinical psychologists used the Rorschach Inkblot Test to arrive at incredible insights. But were the astounding performances of these Rorschach Wizards merely a variation on astrology and palm reading?
The Rorschach – including Exner's version – tends to mislabel most normal people as “sick.” In addition, the test cannot detect most psychological disorders (with the exception of schizophrenia and related conditions marked by thinking disturbances), nor does it do an adequate job of detecting most personality traits (Lilienfeld 1999; Lilienfeld, Wood, and Garb 2000).
Despite such shortcomings, the Rorschach is still administered hundreds of thousands of times each year in clinics, courts, and schools. Psychologists often use the test to help courts determine which parent should be granted custody of a child. It's used in schools to identify children's emotional problems, and in prisons to evaluate felons for parole. Convicted murderers facing the death penalty, suspected victims of sexual abuse, airline pilots suspended from their jobs for alcohol abuse – all may be given the Rorschach by a psychologist who will use the test to make critical decisions about their lives.
I'm constantly amazed at the ability of psychotherapists to fool themselves. At the same time, I'm dismayed by the fact that the mental-health industry often clings tenaciously to discredited treatments and theories.
Friday, November 21, 2003
So, it turns out that so-called “memory-enhancing” drugs might be harmful (although, to be fair, the study was apparently done only in animals):
Memory-enhancing drugs for elderly may impair high-level brain function
A new study cautions that drugs being designed to enhance some forms of memory in the elderly may actually worsen working memory, such as the cognitive ability to hold a phone number in mind long enough to dial it.
The research, published online in Neuron on November 5, analyzes the effects of these drugs on multiple brain regions and suggests that the medications may actually have hazardous consequences on higher-order thought processes that are regulated by the prefrontal cortex.
Thursday, November 13, 2003
The most-recent issue of Mother Jones magazine features an outstanding article about the strong possibility that antidepressants are nothing more than glorified placebos. Here's an excerpt, but the whole article is worth reading:
Is it Prozac? Or Placebo?
New research suggests that the miracles promised by antidepressants may be largely due to the placebo effect. Too bad there's no money to be made in sugar pills.
...in more than half of the 47 trials used by the Food and Drug Administration to approve the six leading antidepressants on the market, the drugs failed to outperform sugar pills, and in the trials that were successful, the advantage of drugs over placebo was slight. As it would hardly help drug sales, pharmaceutical companies don't publish unsuccessful trials, so University of Connecticut psychology professor Irving Kirsch and his co-authors used the Freedom of Information Act to extract the data from the FDA. What they found has led them, and other researchers who've investigated antidepressants' relatively poor showing against placebos, to conclude that millions of people may be spending billions of dollars on medicines that owe their popularity as much to clever marketing as to chemistry, and suffering serious side effects – not to mention becoming dependent on drugs for healing they might be able to do without them – in the bargain.
It's interesting to note that Gary Greenberg (the author of the above article) is also a practicing psychotherapist.
Do you think that Alcoholics Anonymous is a highly effective program that helps millions of people stay sober? If so, you probably haven't visited a site called, “THE ORANGE PAPERS: One Man's Analysis of Alcoholics Anonymous”. This is a well-documented exposé of perhaps the most over-rated self-help group in the world.
Recently, the anonymous author has wisely decided to move the site to its own paid domain, rather than hosting it at a free (but less reliable and perhaps less reputable) Tripod location.
I have not read every page on the site, but I learn something new every time I browse there. Overall, it's well worth checking out. Hopefully, the author will someday publish his work in conventional book form, so that a wider readership can find out about the problems with 12-step groups.
And as long as we're on the subject, let me point out that journalist/author Anne M. Fletcher has written a very good book on the myriad different paths that are availalbe to substance-abusers who want to achieve sobriety. The book is called, Sober for Good: New Solutions for Drinking Problems. The New York Times gave the book an excellent review.
Unfortunately, the U.S. Food and Drug Administration (FDA) has decided not to follow the lead of Canada and Europe:
Should Antidepressant Serzone Be Banned?
Serzone Side Effect: Rare but Unpredictable Liver Damage
The U.S. won't join Canada [and Europe] in banning Serzone, the FDA says. The antidepressant rarely – but unpredictably – causes liver damage and death.
Since its introduction in 1994, 55 patients in the U.S. have had Serzone-related liver failure. Twenty of them died – and there likely have been 10 times as many unreported cases, according to the consumer group Public Citizen. Serzone is the brand name for nefazodone, which is available as a generic drug.
“Canada thought the drug was too dangerous to be on their market – and we think the drug is too dangerous to be on the U.S. market,” Sidney Wolfe, MD, director of the Public Citizen Health Research Group, tells WebMD.
Granted, it might be a small risk in the big scheme of things, but it's still worth knowing:
Increased Risk of Blood Transfusion with Serotonergic Antidepressant Use in Older Patients Undergoing Orthopaedic Surgery
[...] The authors conclude that “patients using serotonergic agents lost significantly more blood during orthopaedic surgery than those not using any antidepressant.”
They also warn that this “could pose a potential health problem for elderly patients because of the widespread and increasing use of antidepressants.” However, they note that while clinically important, “it remains an uncommon adverse effect that should carefully be examined along with other information.”
Saturday, November 8, 2003
The subject of this article was completely new to me. I had no idea that this was going on in France:
Depressed, moi? Why the French are driven to drugs
Patients and doctors blamed as 25% take mood-altering substances
Nearly one in four French people are on tranquillisers, antidepressants, antipsychotics or other mood-altering prescription drugs, according to an alarming report published yesterday.
It revealed that an average of 40% of men and women aged over 70 in France were routinely prescribed at least one of this class of dependence-creating drug, as well as some 4% of all children under nine. [...]
The French are avid consumers of pills and potions of all kinds... Panoplies of medicines exist here for ailments that do not appear to exist anywhere else, such as la crise de foie (liver crisis).
The cost of an expensive course of “thalassotherapy” – a range of treatments involving seawater, algae and marine mud that is claimed by some French doctors to cure arthritis, asthma, acne and even infertility – could until very recently be reclaimed from the French health service.
A dangerous dependence on mood-altering drugs is an altogether more serious problem. [...]
“French doctors have become merchants of false happiness”, Prof Zarifian said recently. “They are unable to resist the pressures of either the patients or the big drugs companies. They are the ones who really need educating.”
Friday, November 7, 2003
HALIFAX, CANADA – November 5, 2003 – Anti-depressant use is associated with obesity, according to research presented... at the 53rd Annual Meeting of the Canadian Psychiatric Association.
Participants in the study were drawn from a population-based obesity research initiative currently underway, and all participants had to have been taking an anti-depressant at the time of the study. [...] A total of 875 participants were evaluated: ...Moderately obese and morbidly obese patients had the highest rate of anti-depressant use: 26.8% and 26.0%, respectively.
[Note added by Alex on Sun., Nov. 9, 2003: As someone has pointed out on the “Comments” page, the above article doesn't seem to have established that antidepressants cause obesity. I should have been more cautious in my characterization of the study. Still, let's not forget that weight gain is a well-established side-effect of many antidepressant drugs.]
You just gotta love pharmaceutical companies, eh folks?
Drug Promotions Woo Doctors to Use Unapproved Drugs
By CHRIS ADAMS & ALISON YOUNG
MEMPHIS, Tenn. -- Dr. Gary Murray, a cardiologist, was faced with a common medical dilemma: He had no idea what was wrong with his patient.
Milton Cole, a 71-yearold man in generally good health, was complaining of chest pains. A battery of cardiac tests couldn't pinpoint the problem. To blunt the pain, Murray gave his patient a prescription and some free samples of the drug.
The drug Murray prescribed was Prozac, a popular antidepressant that isn't approved by the Food and Drug Administration for treating chest pain. Murray later said he had no idea that experts had debated for years whether Prozac caused suicide.
Thirteen days after that visit to the doctor, on June 28, 2001, Cole's wife, Amby, found him hanging from a beam in a back room of their shop.
“This was a patient of mine, and I was trying to help him,” Murray recalled. “I'm completely upset. I'll be that way forever.”
That a heart specialist even had free supplies of a drug that's usually the province of psychiatrists says a lot about how drug marketing today encourages physicians to prescribe medications for unapproved, or off-label, uses.
By offering specialty drugs to nonspecialists, sending salesmen to doctors' offices and medical conventions, and touting their drugs' benefits on the slimmest of evidence, pharmaceutical companies have sent off-label retail sales soaring.
(Emphasis added by me.)
More monkeyshines from the most profitable legal industry in the United States:
Drug Companies Settle 7 Suits for $1.6 Billion
Drug companies have paid a total of $1.6 billion since 2001 to settle seven suits brought by whistle-blowers that accused them of marketing fraud and overbilling Medicare and Medicaid, according to a report released yesterday by an advocacy group.
More fines are in the offing, the Washington-based group, Taxpayers Against Fraud, said in its report.
The cases were all brought under the False Claims Act, a Civil War-era statute that allows individuals to sue on behalf of the government when they believe a contractor is defrauding the government. The cases are under seal until they are resolved, so the extent of the cases is not known.
“There are undoubtedly more pharmaceutical industry cases in the pipeline, in addition to those publicly known, waiting to be resolved,” said Neil Getnick, a New York lawyer who specializes in these type of cases.
Each of the seven cases was initiated by whistle-blowers and eventually joined by government lawyers. The defendants were AstraZeneca, Bayer, Dey, GlaxoSmithKline, Pfizer and TAP Pharmaceuticals. The suits contended that the drug companies took part in two types of fraud. In the first, manufacturers were accused of inflating the gap between the reported price of a drug and the actual price, allowing doctors to bill the government much more than they paid for the drug. In the other cases, manufacturers were accused of offering deep discounts to select customers but failed to report the discounts to the government, which demands the lowest prices offered.
Monday, November 3, 2003
OK, I'm starting November off with a bang. Seven, count ’em, seven blog entries today. I have to get rid of a large backlog of articles.
Hah, this is great. I wouldn't read too much into this story, but it makes me laugh. Actually, I feel sorry for the innocent animals that have to put up with our waste products:
Drugs may harm frogs and fish in the wild
ATHENS, Ga. (APOnline) – University of Georgia researchers have discovered developmental problems in frogs and fish exposed to minute quantities of common antidepressants that can pass from humans through sewage treatment systems into rivers and streams.
The scientists have been studying the toxicity of a widely used group of antidepressants called selective serotonin reuptake inhibitors, which are commonly prescribed for depression, anxiety, panic disorder, obsessive compulsive disorder, eating disorders and social phobia.
Some of the drugs, including Prozac, Zoloft, Paxil and Celexa, have been found in low concentrations in surface water, particularly wastewater.
The researchers found that low concentrations of fluoxetine – Prozac – the most commonly prescribed of the drugs, significantly slowed development in Gambusia, or mosquitofish, which are often used to study toxicity on aquatic organisms.
“We found that male sexual development slowed by two to four weeks,” said Ted Henry, a researcher on the project.
Perhaps what's bad for the gander is bad for the goose, eh?
Yeah, it's only anecdotal evidence, and lawyers are involved, but for what it's worth:
Widow sues Prozac maker in suicide of SWAT leader
INDEPENDENCE TWP. – Michele Alli was devastated, she was shocked and she was angry. The man she loved and the father of their two children – her husband, Daren – had died from a self-inflicted gunshot wound. It couldn't be.
“Those damn drugs,” she said at the time.
But there was no cocaine, no heroin, no marijuana in Daren Alli's system. He wasn't an addict or drug abuser. He was a decorated sergeant in the Oakland County Sheriff's Department, a leader of the department's SWAT team.
His wife, a registered nurse, contends it was the prescription antidepressant Prozac that prompted Daren to shoot himself in the head May 23, 2001.
What made the suicide even more surprising was that Daren had taken the prescribed dosage for only three days to treat a mild case of depression. The drug made him feel jittery, so he flushed the rest down the toilet, Michele said.
Four days later, he was dead.
He flushed them down the toilet?! Good god, man – think of the fish!
Hey, they may be criminals, but they're not stupid. Go, criminals!
Inmates Discarding Medicine Pose Problem
Correction officers at the Arthur Kill Correctional Facility, a state prison on Staten Island with about 900 inmates, say they collect at least 200 prescription pills every day that inmates who are considered psychotic, depressed or disruptive pretend to swallow in the presence of nurses but then throw out.
Perhaps the inmates mistrust the people giving them the drugs, or are weary of the side effects or believe they are not sick. But the costly result, according to Arthur Kill correction officers and members of the nursing staff, is a constellation of expensive yellow, blue and white pills they pick up off the ground, collect in a bag and flush down the toilet each day.
The most common type of pills found, officers said, are Thorazine, a powerful antipsychotic; lithium, an antidepressant; Paxil, an antianxiety medicine; and Neurontin, an anti-seizure mood-stabilizing medicine often prescribed for nervous or unruly prisoners.
“On a comfortable day,” said John Schiavone, an Arthur Kill correction officer and a steward of the New York State Correction Officer and Police Benevolent Association, “you've got a solid 200 pills, without even blinking an eye.”
“They're all over the ground,” he added. [...]
Psychiatrists who have worked with prison inmates, however, said they were not surprised at the amount of drugs inmates threw away.
“When I interview inmates and ask them what medications they're on, they often don't know,” said Dr. Stuart Grassian, a psychiatrist who has evaluated mentally ill prisoners in Massachusetts. “They feel as if they're being forced to take medication,” he said, “and the only way they deal with that is that they fake it.”
Jennifer Wynn, a research director at the Correctional Association of New York, who has visited state prisons and interviewed mentally ill inmates, said. “Many inmates would tell us that they feared the effects of medication, being overmedicated, and that they discouraged other prisoners from taking their meds.”
Sigh. Once again, the drugs are flushed down the toilet.
This article is written in a slightly dry style, but the overall subject is very interesting and significant. How much stock are we to place in clinical studies of antidepressants, if the results from the studies don't hold up in real life?
Adolescents' Response to Antidepressants Lower in Community Clinic than in Clinical Trials
MIAMI BEACH, FL – Adolescents who are treated for depression in community clinics have lower response rates than those seen in clinical trials, according to findings presented here October 17th at the 50th Anniversary Meeting of the American Academy of Child and Adolescent Psychiatry.
“The research with which we are presented reflects rather cleaned-up samples,” said Leo Bastiaens, MD, a clinical associate professor of psychiatry, University of Pittsburgh, where he practices in community mental health centres. “In the real world, patients come to us with a variety of comorbid conditions and problems that may interfere with successful treatment. We need to collect data in the real world to address this gap.”
Gee, do you think that drug companies might have something to do with the gap?
Bad news out of Canada:
Doctors continue antidepressant prescriptions despite warning
HALIFAX – Last summer's warnings of the dangerous side effects of certain antidepressants on teenagers haven't stopped Canadian doctors from prescribing them.
Health Canada warned in July that Paxil and Effexor should not be prescribed to anyone under 18 years of age because they may increase the risk of suicidal thoughts.
But sales of the drugs have dropped only slightly since then, which suggests that doctors haven't changed how they prescribe the drugs.
Bad news out of Britain (yes, I realize that it's an old article, but I just “found” it in my huge backlog of bookmarked pages):
Drugs 'foisted on mentally ill'
Too many people who consult their GP over problems with their mental health are offered medication as the only option, say campaigners.
The mental health charity Mind says NHS mental health services must offer people more choice.
It says the over-reliance on medication is illustrated by the fact that the number of prescriptions for antidepressants has more than doubled over the last ten years.
Mind is to publish a full survey examining the issue in the summer. Interim results indicate:
The survey found that that the top five alternatives to medication rated by respondents were: counselling, group therapy, art/music/drama therapy, psychotherapy and aromatherapy.
And in a similar story (this one more recent and somewhat more encouraging than the one above):
Crackdown on antidepressants given out 'like sweets'
BRITAIN is becoming a nation kept artificially happy by pills, with doctors handing out eight million more prescriptions for depression, anxiety and stress than five years ago.
About two million people are estimated to be taking antidepressants every year, costing the NHS £380 million, according to government figures. Amid fears that doctors are prescribing drugs for the normal problems of life, The Times has learnt that the Government is to advise them that antidepressants should no longer be used as a first-line treatment in such cases.
Recent trials showed almost no clinical difference between antidepressants and placebos in the treatment of mild depression.
(Emphasis added by me.)
© 2004 Alex Chernavsky email@example.com