Blog Archive: Dec. 2003

Blog subjects:

  • Pseudoscience in the mental-health industry

  • Unethical behavior among pharmaceutical companies

  • Whatever else strikes my fancy

Note:  This site has absolutely no association with any outside group, and most especially not with the “Church” of Scientology.


Other sites:


Blog archives:


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

Monday, December 29, 2003

I'm out of town until Friday, January 2nd.  No time right now for serious blogging – just a bunch of links:


Thursday, December 25, 2003

A few weeks ago, I posted a link to an excellent article that had originally appeared in Mother Jones magazine.  The story was called, “Is it Prozac? Or Placebo?”.  The article presented evidence that antidepressants may be nothing more than glorified placebos.  Interestingly enough, a similar article appeared in Psychology Today way back in 1995.  So the hypothesis that antidepressants are placebos is not a particularly new one.

Although more than eight years have passed since the older article was first published, the arguments and the data have withstood the test of time pretty well.  In some ways, this earlier article is actually better than the Mother Jones piece, perhaps because Fisher and Greenberg (the authors of the Psychology Today story) were the researchers who actually performed much of the analysis of the antidepressant data.  Thus, we're hearing it straight from the horse's mouth.  Here's an excerpt:

Prescriptions for Happiness?

by Seymour Fisher, PhD; and Roger P. Greenberg, PhD.

Psychology Today, Sept-Oct 1995 v28 n5 p32(6)

[...]

We recently conducted an analysis that further demonstrates how drug effectiveness diminishes as the opportunity for bias in research design wanes.  This analysis seized on studies in which a newer antidepressant is compared (under double-blind conditions) with an older, standard antidepressant and a placebo.  In such a context the efficacy of the newer drug (which the drug company hopes to introduce) is of central interest to the researcher, and the effectiveness of the older drug of peripheral import.  Therefore, if the double-blind is breached (as is likely), there would presumably be less bias to enhance the efficacy of the older drug than occurred in the original trials of that drug.

We predicted that the old drug would appear significantly less powerful in the newer studies than it had in earlier designs, where it was of central interest of the researcher.  To test this hypothesis, we located 22 double-blind studies in which newer antidepressants were compared with an older antidepressant drug (usually imipramine) and a placebo.  Our meta-analysis revealed, as predicted, that the efficacy rates, based on clinicians's judgments of outcome, were quite modest for the older antidepressants.  In fact, they were approximately one-half to one-quarter the average size of the effects reported in earlier studies when the older drug was the only agent appraised.

Let us be very clear as to what this signifies:  When researchers were evaluating the antidepressant in a context where they were no longer interested in proving its therapeutic power, there was a dramatic decrease in that apparent power, as compared to an earlier context when they were enthusiastically interested in demonstrating the drug's potency.  A change in researcher motivation was enough to change outcome.  Obviously this means too that the present double-blind design for testing drug efficacy is exquisitely vulnerable to bias.

Another matter of pertinence to the presumed biological rationale for the efficacy of antidepressants is that no consistent links have been demonstrated between the concentration of drug in blood and its efficacy.  Studies have found significant correlations for some drugs, but of low magnitude.  Efforts to link plasma levels to therapeutic outcome have been disappointing.

Similarly, few data show a relationship between antidepressant dosage levels and their therapeutic efficacy.  That is, large doses of the drug do not necessarily have greater effects than low doses.  These inconsistencies are a bit jarring against the context of a biological explanatory framework.

We have led you through a detailed critique of the difficulties and problems that prevail in the body of research testing the power of the antidepressants.  We conclude that it would be wise to be relatively modest in claims about their efficacy.  Uncertainty and doubt are inescapable.


Psychiatrist Peter Breggin is a bit of a controversial figure (apparently, his wife experimented with Scientology in her youth), but he seems to have published a good review article about the dangers of antidepressants.  Thanks go out to blog-reader Fred for bringing this to my attention.  The article appeared in the academic journal, International Journal of Risk and Safety in Medicine.  The full text is available as a PDF file on Breggin's website.  Here's the abstract:

Suicidality, violence and mania caused by selective serotonin reuptake inhibitors (SSRIs): A review and analysis

Evidence from many sources confirms that selective serotonin reuptake inhibitors (SSRIs) commonly cause or exacerbate a wide range of abnormal mental and behavioral conditions.  These adverse drug reactions include the following overlapping clinical phenomena:  a stimulant profile that ranges from mild agitation to manic psychoses, agitated depression, obsessive preoccupations that are alien or uncharacteristic of the individual, and akathisia.  Each of these reactions can worsen the individual's mental condition and can result in suicidality, violence, and other forms of extreme abnormal behavior.  Evidence for these reactions is found in clinical reports, controlled clinical trials, and epidemiological studies in children and adults.  Recognition of these adverse drug reactions and withdrawal from the offending drugs can prevent misdiagnosis and the worsening of potentially severe iatrogenic disorders.  These findings also have forensic application in criminal, malpractice, and product liability cases.


Thursday, December 18, 2003

Economists have invented a very useful concept called, “opportunity cost”.  Briefly (and loosely), an opportunity cost is the cost of choosing one alternative over another.  When you go to business school to earn your MBA, you pay tuition, of course – but on top of that cost, you also forego any income that you would have earned had you not been attending school.  That unearned, hypothetical income is an opportunity cost.

So why am I discussing economics in a blog that's concerned with pseudoscience in the mental-health industry?  I'll get to that, but first consider this heartbreaking story:

Tragic mum dies after drink binge

A WOMAN was found dead with her three-year-daughter asleep in her lap...

An inquest heard 37-year-old Kay Eastwick died from alcohol poisoning at the home she shared with her husband at The Old Bakery, Cock Street, Barford.

She had very high levels of alcohol in her blood, nearly six times the legal drink drive limit.

Mrs Eastwick was found sitting on the sofa in the lounge daughter Bethany, now four, cradled in her arms.  [...]

Mrs Eastwick had been prescribed Prozac and had seen her doctor numerous times in the months before her death and had been feeling extremely low because of family problems and the split with her husband.

Even if Prozac doesn't directly cause people to kill themselves (and there is some evidence that it does), I would argue that the drug contributed to this woman's death.  Poor Mrs. Eastwick chose to treat her depression by taking a drug that is useless at best.  She could have used some better method (or combination of methods), such as cognitive therapy, marriage counseling, interpersonal therapy, aerobic exercise – or some specific problem-solving approach that was appropriate to her particular situation.  But by foregoing the use of a strategy that works better than a placebo, Mrs. Eastwick ended up paying a heavy opportunity cost, indeed.

And that, I think, illustrates the true problem with antidepressants.  They give sufferers false hope and thus prevent these people from taking effective measures that might actually address the problems at hand.


Next, a correction:  Last Sunday (Dec. 13), I made a mistake when I tried to post links to a couple of articles in the Canadian newspaper the Vancouver Sun.  I used the wrong link.  Let me try again:

Depressed Kids: The Drug Debate

Are the young used as guinea pigs for untested antidepressants?

First of two parts

Every year more and more kids – some still in preschool – are popping pills for anxiety, depression, even shyness.

What they're mostly taking are selective serotonin reuptake inhibitors, or SSRIs.  [...]

Yet with the exception of Prozac, or fluoxetine, Paxil and its SSRI cousins have never been fully tested on kids.  They've never been approved for pediatric use and because drug companies have never sought pediatric approval, they have never had to show regulators the results of clinical trials.

And, by the way, nobody has ever done a study to determine what effect SSRIs will have on their developing brains and bodies.  [...]

There have always been questions about them – their efficacy and their effects.  But again, it hasn't in any way dissuaded doctors from prescribing them by the millions.


Drugs for kids need scrutiny

Canada slow to warn about pediatric use of antidepressants

Second of two parts

For most of us, it's an article of faith that prescription drugs are safe and effective, especially drugs prescribed for children.

But the flurry of warnings this week against the pediatric use of antidepressants indicates that our faith may be misplaced.

After nearly a decade of prescribing selective serotonin reuptake inhibitors or SSRIs to depressed kids and teens, doctors in Canada, Britain and the United States have been warned that some of the pills are no more effective than sugar pills for most patients and for others, SSRIs could make them even more anxious and suicidal.


I realize that this is a very serious subject, but that “Trotskyite” comment is the funniest thing I've read all week:

Drug Makers Resist State Efforts to Cut Medicaid Expenses

Kentucky's Medicaid program was $230 million in the red last year, and drastic cuts were on the table.  A state panel proposed excluding Zyprexa, an antipsychotic medication that is the state's single biggest drug expense, from the Medicaid list of preferred medications.

That was when the National Alliance for the Mentally Ill and the Kentucky Consumer Advocate Network swung into action.

The two groups, which are nonprofit, bused scores of protesters to a hearing in Frankfort, the state capital;  placed full-page ads in Kentucky newspapers attacking the proposal;  and sent angry faxes to state officials.  What the advocacy groups did not say at the time was that the buses, ads and faxes were paid for by Eli Lilly & Company, Zyprexa's manufacturer.

Zyprexa produced $3.69 billion in revenue last year, making it Lilly's top seller and the sixth-largest-selling drug in the world.  In the United States, 70 percent of Zyprexa sales are to government agencies, mostly to Medicaid.  If just a handful of large states were to limit Zyprexa sales, Lilly's profit and share price would be likely to suffer significantly, analysts say.  [...]

“Antipsychotics are the third rail of Medicaid politics,” said David Parella, director of Connecticut's Medicaid program.  “If you try to confront this issue, you get hit with these strange bedfellows of the Trotskyite lawyers for patient advocacy groups being allied with the plutocratic lawyers for drug companies.”

Zyprexa and other antipsychotics are actually worse than antidepressants.  Investigative reporter Robert Whitaker wrote a whole book about the way that the medical establishment has historically mistreated people who suffer from schizophrenia.  A substantial portion of the book – called Mad in America – is devoted to debunking the safety and effectiveness of antipsychotic drugs.  For a shorter treatment, see Whitaker's commentary piece, “Mind drugs may hinder recovery”.


Monday, December 15, 2003

How many lives were ruined and families ripped apart because well-meaning but idiotic psychotherapists unwittingly created false memories of childhood sex abuse?

'We can implant entirely false memories'

You were abducted by aliens, you saw Bugs Bunny at Disneyland, and then you went up in a balloon.  Didn't you?  Laura Spinney on our remembrance of things past

Thursday December 4, 2003

The Guardian

[...]

“We can easily distort memories for the details of an event that you did experience,” says [psychologist Elizabeth] Loftus.  “And we can also go so far as to plant entirely false memories – we call them rich false memories because they are so detailed and so big.”

She has persuaded people to adopt false but plausible memories – for instance, that at the age of five or six they had the distressing experience of being lost in a shopping mall – as well as implausible ones:  memories of witnessing demonic possession, or an encounter with Bugs Bunny at Disneyland.  Bugs Bunny is a Warner Brothers character, and as the Los Angeles Times put it earlier this year, “The wascally Warner Bros. Wabbit would be awwested on sight”, at Disney.

Elizabeth Loftus' research has obvious implications for the reliability of eyewitness testimony.  And it was as a result of her findings that in 1994 she co-wrote her book, The Myth of Repressed Memory, and took a strong stand in the recovered memory debate of the 90s, for which she was reviled by those who claimed to have uncovered repressed memories of abuse – alien, sexual or otherwise.

The American Psychological Association (APA) now takes the line that most people who were sexually abused as children remember all or part of what happened to them, and that it is rare (though not unheard of) that people forget such emotionally charged events and later recover them. But it states that, “Concerning the issue of a recovered versus a pseudomemory, like many questions in science, the final answer is yet to be known.”  And the debate simmers on.  Several new lines of evidence suggest that the interaction between memory and emotion is more complex than was thought.  Powerful emotions, it seems, can both reinforce and weaken real memories.  We may be able to actively degrade painful memories.  And false memories, once accepted, can themselves elicit strong emotions and thereby mimic real ones.


Case in point:

Father sues over bogus abuse case

A former top official in the Scottish National Party who was falsely accused of sexually abusing his daughter is suing an NHS trust for £250,000.

Jim Fairlie said his daughter Katrina underwent a discredited therapy which produced false memories of violence.

He has asked a judge at the Court of Session in Edinburgh to allow a full hearing against NHS Tayside.

It has taken Mr Fairlie, a former SNP deputy leader, eight years and almost £100,000 to get his case this far.

Katrina was undergoing recovered memory therapy in a psychiatric hospital in Perth when she made a series of devastating allegations of sexual abuse by her father.

She later said those claims were completely untrue and a police investigation found there was no evidence of abuse.

The family are now reunited but the former SNP deputy leader will tell the court how his reputation was destroyed and his family torn apart.

Mr Fairlie said:  “Anyone who has been accused of paedophilia or rape, or in my case murder and running a paedophile ring, it's an enormous thing to take on board knowing that there is absolutely no evidence that there could be any possibility that any of those things took place.”


Saturday, December 13, 2003

Loyal blog-reader Fred pointed me toward this excellent story:

Revealed: how drug firms ‘hoodwink’ medical journals

Pharmaceutical giants hire ghostwriters to produce articles – then put doctors' names on them

Hundreds of articles in medical journals claiming to be written by academics or doctors have been penned by ghostwriters in the pay of drug companies, an Observer inquiry reveals.

The journals, bibles of the profession, have huge influence on which drugs doctors prescribe and the treatment hospitals provide.  But The Observer has uncovered evidence that many articles written by so-called independent academics may have been penned by writers working for agencies which receive huge sums from drug companies to plug their products.

Estimates suggest that almost half of all articles published in journals are by ghostwriters.  While doctors who have put their names to the papers can be paid handsomely for “lending” their reputations, the ghostwriters remain hidden.  They, and the involvement of the pharmaceutical firms, are rarely revealed.

These papers endorsing certain drugs are paraded in front of GPs as independent research to persuade them to prescribe the drugs.  [...]

One field where ghostwriting is becoming an increasing problem is psychiatry.

Dr David Healy, of the University of Wales, was doing research on the possible dangers of anti-depressants, when a drug manufacturer's representative emailed him with an offer of help.

The email, seen by The Observer, said:  “In order to reduce your workload to a minimum, we have had our ghostwriter produce a first draft based on your published work.  I attach it here.”

The article was a 12-page review paper ready to be presented at an forthcoming conference.  Healy's name appeared as the sole author, even though he had never seen a single word of it before.  But he was unhappy with the glowing review of the drug in question, so he suggested some changes.

The company replied, saying he had missed some “commercially important” points.  In the end, the ghostwritten paper appeared at the conference and in a psychiatric journal in its original form – under another doctor's name.

In the United States a legal case brought against drug firm Pfizer turned up internal company documents showing that it employed a New York medical writing agency.  One document analyses articles about the anti-depressant Zoloft.  Some of the articles lacked only one thing:  a doctor's name.  In the margin the agency had put the initials TBD, which Healy assumes means “to be determined”.

Dr Richard Smith, editor of the British Journal of Medicine, admitted ghostwriting was a “very big problem”.

“We are being hoodwinked by the drug companies.  The articles come in with doctors' names on them and we often find some of them have little or no idea about what they have written,” he said.


Britain's Telegraph doesn't mince words:

Antidepressants do children 'more harm than good'

By David Derbyshire, Science Correspondent

Doctors were told yesterday not to give some of the most common antidepressants to children after a review found that their risks outweighed the benefits.


Friday, December 12, 2003

Looks like there might to be a spill-over effect from Britain's decision to ban the pediatric use of certain antidepressants (use the word “pseudosci” [minus the quotes] as both the username and password if the website makes you log in):

Antidepressant Ban Puts Pressure On U.S.

Some Drugs Barred For British Kids

A decision by British regulators to ban the use of some antidepressants in children is being hailed as “historic” by critics of the drugs while putting the pressure squarely on the U.S. Food and Drug Administration, which is considering whether to ban the drugs in America.

Among the drugs banned by British authorities are Paxil, which has been temporarily banned for use by the Connecticut Department of Children and Families;  and Zoloft, made by Pfizer Inc. of Groton.  [...]

David Healy, a psychiatrist at the North Wales Department of Psychological Medicine and a critic of SSRIs [selective serotonin reuptake inhibitors], called the agency's ban “historic.”

“This will have a major impact on the entire market because I'm sure doctors will be thinking, ‘If it's not good to give it to people under 18 years old, then why would it be good to give it to somebody older than that?’ ” Healy said.


Wednesday, December 10, 2003

Two pieces of (mostly) good news out of Britain today.


Here is an encouraging report from the BBC:

Child warning on anti-depressants

The majority of the most commonly prescribed type of anti-depressants should not be given to people under 18, says the Department of Health.

The advice follows a review by medical experts set up to look at the safety of SSRIs [selective serotonin reuptake inhibitors] after concerns that they made some patients suicidal.

It found the risks of certain SSRIs outweighed the benefits of treatment.

Professor Ian Weller, chairman of the working group, told the BBC:  “The evidence is that the drugs either don't work, or work only very little, and there are large number of side effects that children get, such as headache, shaky hands, agitation, loss of appetite, loss of weight.”

The one piece of bad news from the article cited above:

The experts recommended that just one SSRI – fluoxetine (Prozac) – should continue to be prescribed for people under 18.  It was the only drug that had clearly demonstrated that the benefits outweighed the risks.

What do they mean, “clearly demonstrated”?  Prozac (fluoxetine) acts via the same mechanism as all the other SSRIs.  Perhaps the Eli Lilly Company is simply better than competing pharmaceutical companies at skewing the results of research studies (see, in particular, the following blog entry).  Furthermore, why are all the other classes of antidepressants – such as tricyclics and MAO inhibitors – apparently off the hook?  Shouldn't those be mentioned in the guidelines, as well?


The British Journal of Psychiatry has published a paper that reveals quantitative evidence for underhanded practices in Big Pharma (of course, should this really be news to anyone?).  The study argues that antidepressant research is biased toward whoever paid for the research:

ANTIDEPRESSANTS — REPORTING BIAS, RESOURCES AND RECOVERY

Antidepressants rank in the top three drug classes worldwide in terms of sales.  Studying the association between sponsorship and outcome in pharmacoeconomic studies, Baker et al (pp. 498-506) reveal that among industry-sponsored compared with non-industry-sponsored studies, the former more frequently reported results favourable to the sponsor.  For example, studies sponsored by manufacturers of selective serotonin reuptake inhibitors (SSRIs) favoured these over tricyclic antidepressants more than non-industry-sponsored studies, and studies sponsored by manufacturers of newer antidepressants favoured newer antidepressants more than did non-industry-sponsored studies.  Baker and colleagues conclude that bias in relation to sponsorship does exist and until the mechanisms producing the bias are better understood, interpretation of results from pharmaco-economic studies should take sponsorship into account.

This disclaimer caught my eye:  “until the mechanisms producing the bias are better understood”.  Ahem.  Better understood?  What do they expect — Big Pharma to stand up and say, “Hey, listen guys, the truth of the matter is that we're primarily in the business of marketing, not science.  If the science doesn't support our marketing claims, so much the worse for science.”?  In any case, this latest study is just a special-case of this earlier study, published about a year ago:

Medical scientists too close to industry, study shows

One in four biomedical scientists are affiliated with corporations, and two-thirds of universities hold equity in start-up companies that sponsor their research, a new study has found.  [...]

The analysis of 37 scientific papers looked at the relationship between industry sponsorship and scientific research.  It found strong and consistent evidence that industry-sponsored research tends to draw conclusions that are supportive of industry.

Bekelman and colleagues argue that one reason for this is that industry tends to fund trials designed to favour positive results, such as those that compared a new drug to a placebo but avoid the comparison of the drug with existing options.

Commenting on the research, Professor David Henry of the University of Newcastle's School of Medical Practice said research questions of industry-funded research were “driven by marketing considerations rather than science or health”.

A couple of footnotes about the antidepressant study:  I learned about it via Pharma Watch.  Although the paper appeared in a British journal, the lead author is actually affiliated with Yale University.


Tuesday, December 9, 2003

Now, granted, these studies were done only in rats, but the results are still intriguing:

Long-term effects of ADHD drugs?

Treatment could affect children’s growing brains

WASHINGTON, Dec. 8 — Drugs given to children to treat attention deficit hyperactivity disorder could have long-term effects on their growing brains, studies on rats suggest.

SEVERAL STORIES published on Monday show that rats given a popular ADHD drug were less likely to want to use cocaine later in life, but also often acted clinically depressed and behaved differently from rats give dummy injections.

William Carlezon of McLean Hospital and Harvard Medical School in Boston and colleagues raised two groups of rats.  One was given Ritalin, known generically as methylphenidate, during the rat equivalent of pre-adolescence, while the other was given a salt water injection.

When they matured, the rats were tested for “learned helplessness” – how quickly they gave up on behavioral tasks under stress.

“Rats exposed to Ritalin as juveniles showed large increases in learned-helplessness behavior during adulthood, suggesting a tendency toward depression,” Carlezon said in a statement.


Better living through chemistry?  Dave Myers from the forum page pointed me toward this story (if the Los Angeles Times website makes you log in, use “pseudosci” [without the quotes] as both the username and password):

Harsh Reality of 'Osbournes' No Laughing Matter

The hit show's star says he was 'wiped out' on drugs ordered by a physician investigated for overprescribing for others.

Week after week, viewers tuning in to the hit reality series “The Osbournes” saw the star of the show in a perpetual stupor.

With cameras rolling, Ozzy Osbourne fell on his backside into the surf off Malibu.  He passed out during a party at the Beverly Hills Hotel.  He struggled to swat a fly in his dining room – only to slap himself in the face.

The sight of the aging rocker staggering around his Beverly Hills mansion, glassy-eyed and mumbling, became a staple of the MTV series last season.

The cause of Osbourne's disorientation was never explained.  It turns out he was on Valium – and Dexedrine, Mysoline, Adderall and a host of other powerful medications.  They were all prescribed by a Beverly Hills physician who, unknown to Osbourne, was under investigation for overprescribing drugs to other celebrity patients.

Prescription records show that Dr. David A. Kipper had Osbourne on an array of potent drugs – opiates, tranquilizers, amphetamines, antidepressants, even an antipsychotic.

The singer said he swallowed as many as 42 pills a day.

[...]

The doctor diagnosed Osbourne as suffering from anxiety and depression and began treating him for those conditions and for a tremor that had become more pronounced during the family crisis

In August 2002, Kipper put Osbourne on Ambien, a sedative often used for insomnia, and Adderall, an amphetamine mixture.  Kipper also provided nurses to watch over Osbourne at home.

The drug regimen quickly expanded to include anti-anxiety pills, antipsychotic tablets and antidepressants, as well as stimulants and tranquilizers.

In September, Kipper added Mysoline, a barbiturate typically used to prevent seizures.  Its side effects include dizziness and lack of muscle coordination.

Soon Osbourne was also swallowing Zyprexa, an antipsychotic drug developed to control schizophrenia and other severe mental disorders.  [...]

In all, Kipper prescribed more than 13,000 doses of 32 different pharmaceuticals between August 2002 and August 2003, records show.


Monday, December 8, 2003

Investigative reporter David Willman has done it again.  Back in 2001, he won the Pulitzer Prize for an outstanding series of articles about abuses in the pharmaceutical industry.  Now Willman has written another, long article (found via Vera Hassner Sharav) about the corrupt relationship between Big Pharma and biomedical researchers (if the Los Angeles Times website makes you log in, use “pseudosci” [without the quotes] as both the username and password):

Stealth Merger:  Drug Companies and Government Medical Research

Some of the National Institutes of Health's top scientists are also collecting paychecks and stock options from biomedical firms.  Increasingly, such deals are kept secret.

By David Willman, Los Angeles Times Staff Writer

BETHESDA, Md. — “Subject No. 4” died at 1:44 a.m. on June 14, 1999, in the immense federal research clinic of the National Institutes of Health.

The cause of death was clear:  a complication from an experimental treatment for kidney inflammation using a drug made by a German company, Schering AG.

Among the first to be notified was Dr. Stephen I. Katz, the senior NIH official whose institute conducted the study.

Unbeknown to the participants, Katz also was a paid consultant to Schering AG.

Katz and his institute staff could have responded to the death by stopping the study immediately.  They also could have moved swiftly to warn doctors outside the NIH who were prescribing the drug for similar disorders.  Either step might have threatened the market potential for Schering AG's drug.  They did neither.

Questioned later, Katz said that his consulting arrangement with Schering AG did not influence his institute's decisions.


Here's an excellent article (via Pharma Watch) about the egregious way that the pharmaceutical industry continues to pervert science:

Revealed: how drug firms 'hoodwink' medical journals

Pharmaceutical giants hire ghostwriters to produce articles – then put doctors' names on them

Antony Barnett, public affairs editor

Sunday December 7, 2003

The Observer

Hundreds of articles in medical journals claiming to be written by academics or doctors have been penned by ghostwriters in the pay of drug companies, an Observer inquiry reveals.

The journals, bibles of the profession, have huge influence on which drugs doctors prescribe and the treatment hospitals provide.  But The Observer has uncovered evidence that many articles written by so-called independent academics may have been penned by writers working for agencies which receive huge sums from drug companies to plug their products.

Estimates suggest that almost half of all articles published in journals are by ghostwriters.  While doctors who have put their names to the papers can be paid handsomely for 'lending' their reputations, the ghostwriters remain hidden.  They, and the involvement of the pharmaceutical firms, are rarely revealed.


Here's another good one from Pharma Watch:

Demolished: the myth that allows drugs giants to sell more

By Steve Connor, Science Editor

08 December 2003

For years, the drugs industry has grown fat on a myth – the false belief that all drugs will work on just about everybody.

That has essentially been the rationale for a culture that has encouraged doctors to prescribe first and ask questions later...

Yet it has been an open secret within the drugs industry that most drugs do not work for most patients, a secret that has now been publicly aired for the first time by Allen Roses, the head of genetics at GlaxoSmithKline, Britain's biggest drugs company.

Dr Roses, an academic with a distinguished record in medical genetics, is used to speaking his mind...  [...]

For many drugs, however, the efficacy rates hover around 50 per cent or lower, meaning that, for most people, these drugs just don't work.  As Dr Roses puts it:  “The vast majority of drugs – more than 90 per cent – only work in 30 or 50 per cent of the people.”


Saturday, December 6, 2003

Interesting piece in the Taipei Times newspaper (of all places).  Far be it from me to defend antidepressants, but I think that Charles Medawar overstates the case a bit when he starts making comparisons with thalidomide:

An emerging antidepressant crisis

By Charles Medawar

The widespread prescription of drugs for troubled minds has always ended badly, right back to the days of opiates and cocaine, up through bromides, barbiturates, and tranquilizers: all proved to be highly addictive drugs, but only after years of denial did doctors admit that this was so.  Now antidepressants – global brands with household names – are the problem.  The past decade has seen a three-fold increase in prescriptions.  In England, prescriptions of antidepressants now match Valium at its peak in 1979.

It is now clear that today's antidepressants are not the wonder drugs they were touted as being.  The sometimes intolerable withdrawal symptoms that can make it difficult and hazardous to stop taking antidepressants also expose many users to severe and depressing side effects:  substantial weight gain, loss of libido and mood changes, to name just the most common complaints.  Suspicions about such problems – especially about drug-induced suicidal behavior and sensitization to depression – have been rumbling for years, but searching scientific investigations have only just begun.  [...]

On the Richter scale of drug disasters, the looming antidepressant crisis appears to range between seven and 11, where thalidomide rates a 10.


Monday, December 1, 2003

Wow, we're really starting off December with a bang here in the editorial offices of the Pseudoscience-in-Psych blog (“we” being me and my trusty tapeworm).  We've slaved over a hot keyboard to bring you nine, count 'em, nine blog entries today.  So, without further ado, let's get started:


The good news is that the psychiatric establishment now realizes that Sigmund Freud's theories were largely wrong.  (Of course, the bad news is that the psychiatric establishment discarded Freud but replaced his ideas with theories that aren't much better.)

It's gotten to the point where even Freud's descendents realize that the old man was a lunatic:

Freud goes up in smoke

Granddaughter dismisses theories as outdated;  Psychoanalysis done in by new drug therapies

Would the last Freudian please turn out the lights?

The dimming of Freud's influence and fading of what he preached and practised – from penis envy to psychoanalysis – are making him little more than a footnote of history despite his brand name.

[Sophie Freud] dismisses most of her grandfather's theories as “outdated”...

She also faults her grandfather for “being very angry about any critique and viewing people who criticized him, or thought otherwise, as villains.”

“Penis envy, the bad mother – nobody believes that stuff anymore,” says [historian and author Edward] Shorter.

“Completely absurd,” agrees historian of psychology Sonu Shamdasani...  Freudian beliefs and psychoanalysis, he says, “were never a science.  Freud was a fashion, and then he became unfashionable.”

All very well and good, but the mental-health industry continues to be seduced by fashions masquerading as science.  The following commentary sums it up well:

It would seem that institutional psychiatry – unlike other fields of medicine – is inherently, doggedly intolerant of any competing theories.  At any given moment, psychiatry tolerates but a single theoretic doctrine to explain (without empirical proof) the cause and criteria of mental illness.  On the basis of that one unproven theory – be it psychoanalysis or biochemical imbalance – children and adults are assigned a mental “disorder” from a checklist and prescribed (often radical) treatments whose results have often been disastrous.

Lacking a body of scientific evidence, lacking empirical evidence that patients are helped to recover by the prescribed treatments, psychiatry swerves from one extreme orthodoxy to another.  One dogma (psychoanalysis) has been traded for another (biochemical imbalance) with equal fervor and baseless certitude, unfortunately with equally poor results.

Incidentally, the single best source for debunking simplistic “chemical imbalance” theories of mental illness is a book called, Blaming the Brain, by distinguished neuroscientist Elliot Valenstein.  The author is a professor at the University of Michigan.  This is truly an outstanding book, well-documented and well-reasoned.  I highly recommend it to anyone who wants an in-depth, skeptical look at psychopharmacology.


And speaking of Freud (well, sort of), would anyone like to join me in a bit of schadenfreude?

Merck's Downer Keeps Deepening

After earlier warning that it won't meet 2003 forecasts, it's canning plans to market Emend as a new class of antidepressant

Merck is suffering from a bad case of the bottom-line blues, and it's just getting worse.  On Nov. 12, the pharmaceutical giant announced that it had pulled the plug on a highly anticipated treatment for depression.  The drug, called Emend, failed to ease the illness' symptoms in a late-stage clinical trial, the company says.  Merck (MRK ) already sells Emend as a treatment for nausea caused by chemotherapy, but approval to market it as a depression remedy would have transformed it from a niche product to a potential $1 billion-a-year blockbuster.

What's more, Emend promised to offer a whole new treatment option for the 45 million Americans who suffer from depression.  The most commonly used antidepressants, including Prozac and Celexa, are in a class of drugs called SSRIs, which work by manipulating levels of the mood-lifting brain chemical serotonin.  Emend, by contrast, controls a protein [called “substance P”] believed to be linked to emotions and stress.

Merck executives didn't speculate on why Emend was ineffective as an antidepressant, saying only that they remain committed to their other neuroscience-research initiatives.

The Emend news was the latest in a string of disappointments for Merck, based in Whitehouse Station, N.J.

Just a few weeks ago, I was in the local branch of the public library, when I stumbled across a semi-interesting article in Science magazine.  The article was about new treatments for depression, and it contained the usual amount of hype that always seems to characterize popular writing about neuroscience.  Here's an excerpt that's relevant to the above-mentioned story about Merck's failed substance P antagonist:

Future Brightening for Depression Treatments

[...]  The betting... is that the first genuinely new antidepressant will be some compound that blocks the effects of a neuropeptide known as substance P.  [...]  Merck [is conducting] Phase III trials on the compound...  Other companies are pursuing substance P antagonists as well.  “This is probably the most around-the-corner novel antidepressant”, says Husseini Manji, chief of the Laboratory of Molecular Pathophysiology at NIMH.

Note: The Science article isn't available on-line, so I can't link to it.  The excerpt above is the result of manual transcription from a photocopy of the article.  “Future Brightening for Depression Treatments”, by Constance Holden.  Science 2003 302 (Oct. 31): pp. 810-813.


Bad news out of New Zealand:

Anxious young turning to pills

Health officials are alarmed by a big increase in the use of anti-depressants by young people.

Use of the medication has increased by almost two-thirds in the past five years.

National Health Information Service figures show the number of anti-depressants given to six-year-olds to 18-year-olds has soared from 14,963 “items dispensed” in 1998 to 24,597 in 2002.  Items is defined as the amount usually prescribed for a one-month supply of medication.

More young people were getting depressed and younger children now seemed to be experiencing psychological problems traditionally associated with 17 to 24-year-olds...

In children under six, anti-depressants were probably used to stop bed-wetting or treat obsessive-compulsive behaviour...


More disease-mongering from Big Pharma:

An illness that's not just for kids anymore

A well-dressed executive is sitting in a meeting listening to her boss talk.  Except she isn't really listening.  Over the course of 30 seconds, more than two dozen images and sounds flash through her mind.  When the boss asks for her thoughts, she looks at him blankly.  Her co-workers stare.

“Ann?”

Ann, the fictitious subject of a glitzy ad campaign by Eli Lilly & Co and WebMD Corp., is the new face of attention deficit/hyperactivity disorder, that infamous condition long associated with unruly kids.  For decades, doctors believed that children outgrew ADHD in adolescence.  But researchers are convinced that distracted and disorganized adults may suffer from the same affliction.  By one estimate, two-thirds of children with ADHD don't outgrow the disorder, leaving 5 percent of adults suffering from it.

Enter drug companies, who are starting to see a big opportunity to expand the market for ADHD drugs, which, according to IMS Health, which tracks prescriptions, is now over $2 billion.  Lilly's Strattera is the first medication approved by the U.S. Food and Drug Administration for treating adults with the condition;  it came on the market in January.  Shire Pharmaceuticals Group PLC, of England, expects approval early next year to market Adderall XR to adults.  GlaxoSmithKline is considering seeking approval to market Wellbutrin XL for adult ADHD.  Wellbutrin is a widely known antidepressant but some doctors are already prescribing it for ADHD.


Big Pharma is corrupting the youth of America:

Doping Kids

As pharmaceutical companies push their products, more and more kids are being treated with powerful – and untested – adult drugs.

For Dr. Stephen Borowitz, the most frustrating office visits are with parents of kids suffering from stomachaches and infants prone to spitting up. Often, he says, the parents already know what they want – adult heartburn drugs such as the “purple pill,” Prilosec.  “I tell them about nondrug tactics that often help the symptoms,” says Borowitz, a professor of pediatric gastroenterology at the University of Virginia.  “But they want their kids to have the pills they've seen on TV.”

Borowitz and other experts worry about the safety of using potent adult drugs to ease common childhood ailments.  But their warnings are unlikely to be heeded by most doctors and parents – thanks, in large part, to an aggressive marketing campaign by pharmaceutical companies.

The purple pill is just one of hundreds of powerful adult drugs – many of them not tested for pediatric use – that are increasingly being given to children.  Children's use of prescription drugs has risen by one-third since 1997, according to a recent study by Medco Health Solutions, the nation's largest prescription-management company.  Last year, notes Medco public-relations director Ann Smith, prescription spending for children rose faster than spending for any other group, including seniors and baby boomers.  Among the fastest-growing categories were asthma and allergy drugs and psychotropic medications such as Prozac;  spending on gastrointestinal drugs, mostly PPIs, rose a full 660 percent.

“The survey was a real wake-up call,” says Smith.  “Children are on more drugs that we think of as adult drugs:  Prilosec, anti-depressants, even arthritis drugs like Celebrex and Vioxx...”


This is very bizarre, and I don't know what to make of it:

Dangerrrr: cats could alter your personality

They may look like lovable pets, but Britain’s estimated 9m domestic cats are being blamed by scientists for infecting up to half the population with a parasite that can alter people’s personalities.

The startling figures emerge from studies into toxoplasma gondii, a parasite carried by almost all the country’s feline population.  They show that half of Britain’s human population carry the parasite in their brains, and that infected people may undergo slow but crucial changes in their behaviour.

Infected men, suggests one new study, tend to become more aggressive, scruffy, antisocial and are less attractive.  Women, on the other hand, appear to exhibit the “sex kitten” effect, becoming less trustworthy, more desirable, fun- loving and possibly more promiscuous.


And yet another article about disease-mongering:

High anxiety

Nervousness, panic and shyness are now part of the most-diagnosed group of mental illnesses – and drug companies just happen to have an array of products to treat them.  Is marketing the tail wagging this dog?  ANNE McILROY investigates how anxiety became the new depression.

By ANNE McILROY

From Saturday's Globe and Mail

The questions on the Internet quiz were making me anxious.  Am I bothered by blushing in front of people?  Well, somewhat.  Do parties and social events scare me? Somewhat.  I tend to like small dinner parties and I get nervous walking into big bashes.  Does fear of embarrassment cause me to avoid doing things or speaking in front of people?  Somewhat.  I'm a bit shy, and don't like speaking in large meetings.

I click a button to send in my answers, most of them “somewhats,” and a few seconds later the results arrive from a drug company Web site:  34 out of a possible 68.

“Your score suggests that you may be experiencing the symptoms of a social-anxiety disorder.  We encourage you to make an appointment with a qualified health-care professional to discuss your symptoms,” says the response from the site for Paxil, a drug that has generated rocketing sales as a treatment for anxiety disorders.

Twenty years ago, social anxiety was a new and rare mental illness, characterized by debilitating shyness and fear of being humiliated in public.  Today, it is being billed as the third-largest mental-health problem in the world, and one of half-a-dozen anxiety disorders that are probably the most diagnosed mental illnesses on the planet.


Bad news out of Stanford University, where I spent some time back in the early 1990s:

Antidepressant use on the rise at Stanford

In the last 10 years, Stanford has seen a dramatic rise in the number of students seeking psychological counseling and using psychotropic drugs such as Zoloft, Prozac and Wellbutrin, reflecting an increasing trend among college students nationwide, experts say.

Counseling and Psychological Services (CAPS) counsels 10 percent of the student body each year.  In addition, the Bridge, a confidential peer counseling service with a 24-hour hotline and nighttime drop-in hours, receives an average of one or two calls a day.

“Through Vaden, there has been a pretty significant increase in the use of antidepressants at Stanford in the past 10 years,” said Alejandro Martinez, director of CAPS.  “There has also been an increase in the number of students that are seeking help.”


Spirituality takes a hit:

Power of prayer found wanting in hospital trial

The biggest scientific experiment on prayer has failed to find any evidence that it helps to heal the sick.

Doctors in the United States will today disclose that heart patients who were prayed for by groups of strangers recovered from surgery at the same rate as those who were not.  [...]

Over three years, 750 patients awaiting angioplasty, a procedure to clear obstructions from their arteries, were recruited for the experiment.

Names selected at random by a computer were sent to the 12 prayer groups, who began praying immediately for their recovery.  Neither the hospital staff nor the patients and their relatives knew who was being prayed for.

The prayer groups included American Christian mothers, nuns in a Carmelite convent in Baltimore, Sufi Muslims, Buddhist monks in Nepal and English doctors and medical students in Manchester.  Prayers were even e-mailed to Jerusalem and placed in the Wailing Wall.

An analysis of the results found that there were no significant differences in the recovery and health of the patients who were prayed for and those who were not.