Blog Archive: January, 2004

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.

Saturday, January 31, 2004

Nothing really new in this article, but it's still good to see the popular press running stories that are critical of antidepressants.  How different from the situation in the late 1980s to early 1990s, when Prozac used to appear on magazine covers.

ANTIDEPRESSANTS & SUICIDE: Lawsuits target drug makers

BY ED SILVERMAN  ||  Star-Ledger Staff

Four years ago, Michelle Van Syckel was losing weight and having trouble adjusting to her new school.

Doctors diagnosed the then-14-year-old with depression and prescribed different drugs over the next few months, her mother said. One was Paxil, a widely used antidepressant.

Later that year, though, she said her daughter became violent and attempted suicide.  She blames the drug and its manufacturer, GlaxoSmithkline, arguing that such serious side effects can be caused by a group of medicines used by millions of American each year.  [...]

“Glaxo had clinical studies that indicated people can become suicidal on the drugs, but didn't give them to anyone.  They should have placed warnings on the label.  Instead, they placed my child at risk for financial gain.  And I feel betrayed,” she said, adding that her daughter is now in college and doing better.

Numerous other lawsuits making similar allegations have been filed against several drug makers that sell antidepressants.  Also known as SSRIs -- selective serotonin reuptake inhibitors -- these pills include Pfizer's Zoloft, Eli Lilly's Prozac and Wyeth's Effexor.  Last year, the retail market for the drugs was $11.3 billion, according to Verispan, a market research firm.

Concerns have lingered ever since a 1990 study in the American Journal of Psychiatry reported that some patients became suicidal after taking Prozac.


Good to see the feds cracking down on Big Pharma -- better late than never, eh?

U.S. personnel agency subpoenas Wyeth over depression drug

TRENTON, N.J. -- Wyeth's pharmaceutical division has been subpoenaed by a federal agency looking into how it promoted its top-selling drug, the anti-depressant Effexor, to doctors and pharmacists.

Wyeth is at least the third pharmaceutical company to receive a subpoena from the U.S. Office of Personnel Management of the Inspector General regarding psychopharmacologic, or mind-altering, medications.  [...]

On Thursday, New York-based Forest Laboratories Inc. disclosed that it had received a subpoena from the Office of Personnel Management requesting documents related to Celexa.  That drug is a prescription anti-depressant also in the SSRI class.  The company did not give any details about the type of documents sought, and company officials did not immediately return telephone messages from The Associated Press Friday afternoon.

Last Friday, New Brunswick-based Johnson & Johnson said Janssen Pharmaceutica Products, one of the J&J companies that makes prescription medications, had received a subpoena from the same agency requesting documents related to its blockbuster anti-psychotic drug Risperdal, which had 2003 sales of $2.5 billion.


Friday, January 30, 2004

I don't often say this, but the following Washington Post article is a must-read for anyone who wants to understand how Big Pharma corrupts science and medicine:

Antidepressant Makers Withhold Data on Children

By Shankar Vedantam, Washington Post Staff Writer

Thursday, January 29, 2004;  Page A01

Makers of popular antidepressants such as Paxil, Zoloft and Effexor have refused to disclose the details of most clinical trials involving depressed children, denying doctors and parents crucial evidence as they weigh fresh fears that such medicines may cause some children to become suicidal.

The companies say the studies are trade secrets.  Researchers familiar with the unpublished data said the majority of secret trials show that children taking the medicines did not get any better than children taking dummy pills.

Although the drug industry's practice of suppressing data unfavorable to its products is legal, doctors and advocates say such secrecy distorts the scientific record.

“Conflicts of interest and the company control of the data have thrown out the scientific method,” said Vera Hassner Sharav, a critic of the drugs and a patients' rights advocate.  “If hundreds of trials don't work out, they don't publish them, they don't talk about them.”  [...]

Concerns over the safety of antidepressants among children have been heightened after a December warning by British regulators that the drugs may trigger suicidal thoughts and increase the rate of self-injury.  An expert advisory panel of the Food and Drug Administration is scheduled to meet Monday to examine the issue, but the agency's full U.S. analysis of the data is not likely to be completed until summer.  [...]

The U.S. psychiatric establishment largely supports the use of antidepressant medicines in children, with many arguing that abandoning the drugs would lead to more suicides in children with depression.  But its critics, including consumer advocates and some psychiatrists, question whether mainstream psychiatry is biased by widespread financial ties to the pharmaceutical industry.

The answer lies hidden in a maze of secret data, conflicting scientific interpretations and a corporate-funded clinical trial system that is not primarily designed to answer questions of public health.

“If the companies wanted to publish negative studies they could, but companies don't like to publish negative studies,” said Russell Katz, director of the neuropharmacology division at the FDA, which has access to all the data.  “It's amusing so many people are making pronouncements about the data -- scientists and physicians -- ... without seeing the data.”

(Emphasis added by me.)


Thursday, January 29, 2004

Sorry about the lack of blog updates lately.  Things have been really hectic around here.

The New York Times debunks the grief industry:

Often, Time Beats Therapy for Treating Grief

It is commonly assumed in this therapy-oriented world that nearly every grieving person can benefit from bereavement counseling or therapy.  But both the experience of psychologists who provide bereavement services and a thorough review of the literature on the results of grief therapy suggest otherwise.

Rather, the findings suggest, a majority of people who suffer the loss of a loved one neither need nor benefit from participation in a bereavement group or from more formal grief therapy.  These people experience what might be called a normal grief reaction, and the symptoms of it gradually diminish over 6 to 18 months.

“Feeling grief is the burden we face because we're capable of becoming attached and loving people,” said Dr. Robert Hansson, a psychologist and student of grief at the University of Tulsa.  “It's a natural process.  It hurts, but most people can work through it and go on.”

A major new “Report on Bereavement and Grief Research” prepared by the Center for the Advancement of Health concluded, “A growing body of evidence indicates that interventions with adults who are not experiencing complicated grief cannot be regarded as beneficial in terms of diminishing grief-related symptoms.”

The report adds that there is very little evidence for the effectiveness of interventions like crisis teams that visit family members within hours of a loss, self-help groups that seek to foster friendships, efforts to show the bereaved ways to work through grief and a host of other therapeutic approaches believed to help the bereaved.

In fact, the studies indicate, grief counseling may sometimes make matters worse...

(Emphasis added by me.)


For another, longer treatment of the same subject, see this article from the New Yorker:

THE GRIEF INDUSTRY

by JEROME GROOPMAN

How much does crisis counselling help -- or hurt?

Soon after the collapse of the World Trade Center, experts predicted that one out of five New Yorkers -- some one and a half million people -- would be traumatized by the tragedy and require psychological care.  Within weeks, several thousand grief and crisis counsellors arrived in the city.  Some were dispatched by charitable and religious organizations;  many others worked for private companies that provide services to businesses following catastrophes.

In the United States, grief and crisis counsellors generally use a method called critical-incident stress debriefing, which was created, in 1974, by Jeffrey T. Mitchell, a Maryland paramedic who was studying for a master's degree in psychology.  Mitchell had seen a gruesome accident while on the job:  a young bride, still in her wedding dress, had been impaled when the car that her drunk husband was driving rear-ended a pickup truck loaded with pipes.


Think that drugs are the only way to treat schizophrenia?  The following is not a particularly recent article, but it's still worth reading:

Schizophrenia: talking may help when drugs don't

New research has strengthened the case for using 'talk therapy' in the treatment of schizophrenia, especially for those who don't respond well to drugs.

A large-scale analysis of the scientific literature has found strong evidence for the use of cognitive behavioural therapy (also known as talk therapy or CBT) in people who have not responded well to medication.

Led by Professor Philippa Garety, a clinical psychologist at the Institute of Psychiatry at King's College London, the research was presented to the annual meeting of the American Association for the Advancement of Science being held in Denver, USA.

“The magnitude of the effect of this therapy is similar to the effects of the newest anti-psychotic medication -- average reduction symptoms of 20 to 40% -- and without the side-effects that medications typically cause,” said the British researcher.


Friday, January 23, 2004

News from Down Under:  the Australian authorities have banned the antidepressant Serzone, because of the drug's link to potentially fatal liver disease.

Depression pill removal to affect thousands

Thousands of Australians with mood disorders will be forced to switch to another antidepressant or cease medication altogether after the manufacturer of Serzone decided to take it off the market from May.

[...]

Serzone continues to be available in the US, where it is widely used especially in geriatric patients, despite being linked to 55 cases of liver failure, including 20 deaths, since 1994.

The decision to withdraw Serzone comes amid mounting concern worldwide about the side effects of antidepressants.

One can only hope that this is the start of a trend.


A new report concludes that selective serotonin reuptake inhibitors (SSRIs) are not, in fact, linked to an increased risk of suicide in children.  Well, maybe.  But there's reason to be skeptical about the report's conclusions:

Panel Says Zoloft and Cousins Don't Increase Suicide Risk

Adding to the debate over using antidepressant drugs for depressed teenagers and children, a group of prominent researchers issued a report yesterday saying that Zoloft and similar medicines did not increase children's suicide risk.

[...]

Dr. Richard Harrington, professor of child and adolescent psychiatry at the University of Manchester in England, said he was not sure that drugs were effective for teenagers and children.

“Maybe they work,” Dr. Harrington said.  “But if so, they don't work very well.  And I'm still troubled by the suicidality.”

Critics pointed to weaknesses in the report.  The panel did not have access to some information that British regulators used to come up with opposite conclusions.

The report did not undertake a sophisticated and difficult meta-analysis, in which figures from many studies are pooled for examination.  Other researchers are conducting that analysis.

Critics of the medicines noted that 9 of the 10 task force members had significant financial ties to the pharmaceutical industry, although such ties are common among prominent researchers.  The panel said no industry money financed the report.

“Of course they concluded that these drugs are safe,” said Tom Woodward, who said he believed the drugs led his daughter, 17, to commit suicide.  “All these guys are tied to the pharmaceutical industry.”

Of course, we have to be careful here not to fall into the trap where we find any excuse to reject research results that conflict with out biases, while giving a free ride to studies that support our favored position.  Yes, it's all very complicated.  Also, the whole suicide question is pretty much a non-issue, as far as I'm concerned.  Since antidepressants are glorified placebos, anyway, there's no reason why anybody should take these drugs in the first place (suicide risk or no suicide risk).


Tuesday, January 20, 2004

Excellent article in the New York Times:

Drug Companies Get Too Close for Med School's Comfort

One of our psychiatry residents smiles and leans against the wall.  A woman, a few years younger, stops filling the mailboxes with pens and sheets of paper advertising a new antidepressant and faces him squarely.  Her voice is melodic and bouncing.  Her eyes open wide and she laughs at something.  He smiles.  He moves to scratch his cheek and she makes the same movement, they are scratching in unison now.  They remind me of a flirting couple on a first date.

[...]

Studies indicate that most physicians meet with pharmaceutical representatives four times a month.

Studies also reveal that most physicians erroneously believe the representatives do not influence prescribing habits.

When doctors and trainees meet with reps, they change their prescribing habits and are far more likely to prescribe the drugs described, even when they are more expensive or have no benefit over alternatives.  They are also more willing to request illogical changes to hospital guidelines that govern which drugs can be prescribed.

Estimates suggest that roughly $1 billion was spent advertising antidepressants to health professionals in 2000.

More than 400 psychiatrists were asked by Dr. Timothy Peterson and his colleagues at Harvard to describe their beliefs about antidepressants.  More than half said they believed that newer agents were more effective than older antidepressants known as tricyclic antidepressants and that newer antidepressants, called selective serotonin reuptake inhibitors, or S.S.R.I.'s, had fewer side effects than generic S.S.R.I.'s.

But studies conducted at Oxford, Duke, the University of Manchester and the Canadian Coordinating Office for Health Technology that used a statistical strategy called meta-analysis to combine the results of hundreds of independent studies found that S.S.R.I.'s were as effective as tricyclic antidepressants or slightly less effective.  They also revealed that S.S.R.I.'s were tolerated by slightly more patients but had as many side effects.

In an 2002 article, Dr. Peterson wrote: “Despite the lack of evidence of a significant difference in efficacy between older and newer agents, clinicians perceive the newer agents to be more efficacious – these findings are significant as they highlight the discrepancy between empirical evidence and clinical practices and suggest that other factors influence clinicians' medication choices in the treatment of depression.”

The major problem with the article, though, is that it doesn't go nearly far enough in debunking antidepressants.  Still, the article's main point is valid and well argued.


Saturday, January 17, 2004

Richard Smith is the editor of the British Medical Journal.  He wrote this scathing essay about the evils of the pharmaceutical industry:

Foregone conclusions

The public is being regularly deceived by the drug trials funded by pharmaceutical companies, loaded to generate the results they need

Drug companies spend hundreds of millions of pounds to bring a new drug to market, and tens of millions of pounds to do the clinical trials that are necessary for both registration and marketing.  Understandably, they would prefer not to get results from these trials that are unfavourable to their drug.  And, despite the ubiquitous uncertainties of science and medicine, they rarely do.  How do they manage it?


This is an interesting article about a non-pharmacological way to alleviate paranoia:

Voices of reason

Chris Molloy believed his wife was poisoning him with heroin and cocaine.  He was convinced she and his friends were spiking his cigarettes, drink and food with the drugs.  His fears became all-pervasive, to the extent that Molloy became locked in a world in which he feared church leaders were secret drug barons, and cameras in his room monitored his every move.

[...]

That was four years ago, when Molloy was 32.  His confidence shattered, he has been in and out of work ever since.  Eight months ago, he fell back on his past experience as a social worker and established a community-based self-help group for people experiencing extreme paranoia.

The creation of the Sheffield paranoia self-help and support group, the first service of its kind in Britain, was audacious -- not least because it is run not by clinicians, but by Molloy and former psychiatric patient Peter Bullimore, the unpaid chairman of voluntary mental health group, Sheffield Hearing Voices.

The pair have been helping 16 people to meet every week in a former school building.  The group members, most of whom have psychiatric diagnoses such as schizophrenia, share the paranoias, conspiracy theories and bizarre beliefs that take such a stranglehold on their lives.

So how well does this method actually work?  Who knows, but it's worth investigating, I think.


Thursday, January 15, 2004

The San Francisco Chronicle has an excellent editorial on the slimy tactics used by Big Pharma (thanks go out to Dave Myers for bringing this to my attention):

Pharmaceutical companies find new ways to reach anxious parents – go direct

“WELCOME to Ordinary,” reads the full-page ad for Strattera, in September's Family Circle magazine.  Two smiling boys proudly hold up a model plane they've just built.

“4:30 p.m., Tuesday.  He started something you never thought he'd finish,” the ad explains.  “5:20 p.m. Thursday.  He's proved you wrong.”

The ad, with obvious appeal to any parent whose child is at all troublesome, is for Eli Lilly's Strattera, the newest, and phenomenally successful, prescription medication for attention deficit/hyperactivity disorder, now known as ADHD.  [...]

“These ads are intended to convey the impression that if you're not checking into a certain drug or obtaining it for your child, you are not doing everything that you can for your children, regardless of whether it is appropriate or not,” said Gene Lee, a financial adviser in Mountain View, whose 9-year-old daughter has been diagnosed with ADHD.


Thanks go out to an anonymous poster on the discussion board who provided a link to this fascinating document.  Datamonitor is apparently a company that provides marketing research reports to the pharmaceutical industry.  The following report talks about the business aspects of selling antidepressants.  Although the on-line document is just a summary (the full report costs $6,400), the summary is enough to provide an interesting look at the way the pharmaceutical industry approaches the subject of antidepressants:

Strategic Perspectives: Commercial Opportunities in Depression - Generating Revenue Growth In Symptoms And Comorbidities

CHAPTER 1 EXECUTIVE SUMMARY

1.1 Scope

1.2 Datamonitor insight into the commercial opportunities available in the depression market

Sleep disorders are the most important symptom influencing antidepressant drug choice.  The treatment of sleeping disorders offers opportunities for new manufacturers to enter the depression market and potential secondary indications for Organon and Bristol-Myers Squibb

Opinion leaders identified physical symptoms of depression as a key area for growth, as it is an underdeveloped market.  Datamonitor believes that both Wyeth and Lilly will specifically target these symptoms over the next few years and should consider moving into other pain areas to maximize revenues

Movement into anxiety disorders has traditionally been the main line extension strategy for antidepressant medications.  However, the competitiveness of this market means that players must seek out under developed areas, such as GAD or SAD, to ensure this strategy provides a solid return on investment

Antidepressant manufacturers must target non-anxiety disorders, such as eating disorders, to ensure that growth rates are sustained.  However, despite the clear opportunities that exist in these markets, Datamonitor believes that manufacturers will have to develop sophisticated entry strategies to ensure revenue success

My favorite part (not excerpted above) of the document reads, “Misdiagnosis can be beneficial for antidepressant manufacturers”.  These people are shameless.


Good to see that Britain is continuing to investigate the possible link between antidepressants and suicide:

Probe into antidepressant link to suicides

Tue 6 January, 2004 12:23

LONDON (Reuters) - The government's medicines agency says it will look into whether people taking new anti-depressant drugs are at increased risk of suicide.

The Medicines and Healthcare Products Regulatory Agency said the study would estimate the risk of suicide, suicidal thoughts, non-fatal overdose and self-laceration in patients taking selective serotonin re-uptake inhibitors (SSRI) and tricyclic anti-depressants (TCA).

Britain has taken the lead in reviewing the safety of the newer SSRI class of drugs following reports that some depressed patients turn violent or suicidal after starting medication.

A safety review in children last year resulted in the UK agency advising doctors not to prescribe the majority of SSRIs to under-18s as the risks of treatment were found to outweigh the benefits. A notable exception was Prozac.

The new study will follow patients of all ages up to 90 who were diagnosed with depression between 1995 and 2001, the agency said.


Wednesday, January 14, 2004

If antipsychotic medications actually worked well, then forced drugging would be a thorny ethical dilemma.  But since these drugs are not, in fact, very effective, then the issue is a non-dilemma.  The following story is a bit of good news, although it turns out to be a mixed bag when you look at the details:

Some Inmates Are Allowed to Refuse Drugs

State high court rules that anti-psychotic medication cannot be forced on certain mentally ill prisoners without a judge's OK.

SAN FRANCISCO – Mentally ill inmates cannot be forced to take anti-psychotic drugs, the California Supreme Court ruled Monday, allowing a certain class of prisoners to refuse treatment in limited circumstances.

The justices' 6-1 decision concerns California inmates who have done their time for criminal convictions but have been found to be mentally unfit for release to the community.  Those inmates, hundreds in all, are housed at state mental institutions until they are deemed fit for return to the community.

If they refuse anti-psychotics, the court ruled, the state cannot force them to take the medication unless a judge authorizes it.  A judge must find that the inmate is incompetent to refuse treatment and is an immediate danger to himself or others.

Justice Carlos Moreno, writing for the majority, said the 1985 law authorizing the retention of mentally disordered inmates past their release dates allows the state to administer anti-psychotic drugs against a patient's wishes when there is a medical emergency or when safety and lives are at risk.

Although the court acknowledged the drugs can work wonders for the mentally ill, the medicine also can produce intolerable side effects, including muscle spasms, blurred vision, dry mouth, sexual dysfunction, body rigidity and tremors, among others.


Tuesday, January 13, 2004

More disease-mongering from Big Pharma:

Putting a Price on a Good Night's Sleep

Americans are about to be reminded again how much they need sleep – and sleeping pills.

A new effort appears to be developing to expand the use of sleeping pills, which because of their potential for abuse have long had a reputation as being in some ways more dangerous than the insomnia they are meant to treat.

Some sleep experts say newer pills are safer than the ones that once caused deaths from overdose.  Moreover, some say, there is growing evidence that insomnia is a serious medical condition, not just a nuisance.

“Slowly, we are beginning to identify that insomnia does have some risks associated with it, and when that happens there will be more press to treat it aggressively,” said Dr. Michael H. Bonnet, director of the sleep laboratory at the Veterans Affairs Medical Center in Dayton, Ohio.

But part of the new push is driven by drug company marketing.  Two new sleeping pills are expected to be available by the end of next year and their manufacturers hope to have them approved for broader and longer-term use than recommended for previous pills.  And the companies are expected to advertise their products, and the problem of insomnia, heavily.

Sepracor, which makes one of the new drugs, recently financed a press seminar on insomnia.  The other drug will be marketed by Pfizer, whose vast sales force and ample advertising have helped make best sellers of drugs like Viagra, the cholesterol fighter Lipitor and the painkiller Celebrex.


Monday, January 12, 2004

British psychiatrist Joanna Moncrieff doesn't mince words:

IS PSYCHIATRY FOR SALE?

AN EXAMINATION OF THE INFLUENCE OF THE PHARMACEUTICAL INDUSTRY ON ACADEMIC AND PRACTICAL PSYCHIATRY.

SUMMARY

Western society is consuming ever larger quantities of prescription drugs and many of these are for psychiatric complaints.  Drugs are central to modern psychiatric practice and to much psychiatric thought about the nature and causation of mental disorders.  Psychiatry has therefore become an important target for the large and powerful pharmaceutical industry.  Drug companies direct lavish advertising and hospitality towards psychiatrists and provide funding for much medical education and some mental health service initiatives.  The industry is now heavily involved in the organisation of research into psychiatric drugs and the dissemination of research findings.  This raises questions about the scientific objectivity of this research and the extent to which the industry is able to shape the research agenda.  Drug companies also provide funds for pro drug patient and carer groups and address advertising or disease promotion campaigns to the general public.  They exert influence at a political level through lobbying and direct funding of political bodies including drug regulatory agencies.

This influence has helped to create and reinforce a narrow biological approach to the explanation and treatment of mental disorders and has led to the exclusion of alternative explanatory paradigms.  The coercive function of psychiatry has been strengthened by promoting the idea that psychiatric disorders are akin to medical conditions and that they are amenable to technical solutions in the form of drugs.  In addition, alternative treatment approaches are neglected and it is likely that drugs are currently used for overly long periods and in excessive doses.  The adverse effects of drugs are neglected.

Psychiatry provides fertile ground for pharmaceutical industry profits because it provides opportunities for expanding definitions of sickness to include more and more areas of social and personal difficulty.  This paper gives examples of how the industry has been involved in promoting and expanding concepts such as depression, social phobia, attention deficit hyperactivity disorder and psychosis.

The current extent of drug company influence threatens the integrity of psychiatry and some suggestions are made about steps that could be taken to address this.  The influence of the industry must be curbed for political reasons too.  We are rapidly becoming a society that seeks a “pill for every ill;”  one that looks for simplistic, technical solutions to complex social problems.  This helps to divert attention away from the profound social and political changes that have occurred during the last few decades.  Psychiatrists should not be colluding in this process.


In yet another new drug with a bizarre name, “Symbyax” combines Prozac and Zyprexa:

Another Lilly drug gets nod from FDA

Combo product used to treat patients with bipolar depression

An Eli Lilly and Co. drug to treat bipolar depression has been approved for sale by the Food and Drug Administration, the third product approval of the year for the drugmaker.

Lilly said Monday that Symbyax should show up in U.S. pharmacies in two to three weeks.

Symbyax becomes the first FDA-approved drug for the depression phase of bipolar disorder, a hard-to-treat mental illness with debilitating mood swings ranging from deep depression to abnormal elation.

Symbyax pairs two Lilly drugs, Prozac and Zyprexa, in one pill.


Sunday, January 11, 2004

I really like this approach – this is a great idea:

Out to get the skinny on thin folks

Colo. doctor gets $1 million to study why some seem destined to stay slim

After years of feeding and overfeeding fat rats, putting them on diets and on small exercise wheels, of studying why they gain weight, why they lose it and gain it back again and again, something piqued the interest of Dr. Dan Bessesen:

The skinny rats.

Sure, they were bred to be lean, the same way fat rats were bred to bulk up.

But there was something different about the thin rats' behavior, something that mere breeding couldn't explain.

They just didn't eat as much.

In fact, after being overfed for days, the stuffed skinny rats actually left food on their little rat dinner plates.

“The obesity-resistant rats, they overeat for a day and they seem to get it.  They reduce their food intake by the third day.  And they reduce their food intake not only to where it was before but down lower to compensate for overeating.  It's a natural phenomenon,” Bessesen said.

Since rats rarely fret that their jeans are too tight or compare their bodies unfavorably to those of Britney Spears or Ashton Kutcher, Bessesen figured something else must be at work.  Something biological.

So the Denver Health endocrinologist decided to study whether something similar is going on in humans, something innate that makes them prone to remain thin.

“If there is something different about their metabolism or their genetics, that would be interesting to know,” Bessesen said.

The National Institutes of Health apparently found the idea interesting as well. The NIH gave Bessesen $1 million to probe the psyches, and the biology, of skinny people over the next five years.

“We spend so much time studying obesity, maybe we ought to study thinness,” Bessesen said.

This idea is similar to the one pursued by journalist Anne M. Fletcher in her excellent book, Sober for Good.  Maybe we as a society should pay more attention to the real-life ways that people use to avoid becoming mentally ill, or successfully recover from mental illness.


Saturday, January 10, 2004

This is not a particularly recent article, but it's worth a look:

Throwaway Kids

As kids get psychiatric drugs, some experts ask why

By JORGE FITZ-GIBBON AND DWIGHT R. WORLEY

(Original publication:  October 27, 2002)

Children in residential treatment centers are routinely given powerful and dangerous psychiatric medications with inadequate oversight, little accountability and no consensus that they work, a three-month investigation by The Journal News has found.

Most of the medications are not approved for children, and others were approved without new clinical trials or sufficient proof that they are effective.  A growing community of medical experts even questions the legitimacy of the disorders for which the children are being medicated.

And it is all happening in the midst of a marketing and lobbying blitz by the powerful pharmaceutical industry.

In Westchester, Rockland and Putnam counties, more than two-thirds of the 2,000 children housed in 13 residential treatment centers, or RTCs, are treated with drugs.  Many are on multiple medications despite rising concerns that prescription drugs are replacing psychotherapy and damaging developing young brains.


Friday, January 9, 2004

At first glance, this story might not seem to have any relevance to antidepressants, but bear with me here:

Trials End Parents' Hopes for Autism Drug

For several years, an experimental drug, secretin, has offered an unlikely ray of hope for some desperate parents of children with autism.

Discovered accidentally by the mother of an autistic boy and licensed to a small biotechnology company led by the father of two autistic girls, secretin has advanced through clinical trials even as study after study showed it had little or no effect.

Now, the largest and most definitive clinical trial of secretin has been completed, and it, too, showed that the drug was no better than a placebo in improving the social interaction of young children with autism.  The failure, announced yesterday by the company, Repligen, of Waltham, Mass., casts doubt on whether secretin will ever get to market as a treatment, dealing a blow to scores of parents and some doctors who advocated its development.

“We're horrified at the thought of this being dropped,” said Jan Henry of Chattanooga, Tenn.

The drug, which Ms. Henry said she bought from overseas sources and others at up to $10,000 a year, had helped her son Andrew speak and sleep.

“It's life to us,” she said.

“My parents mortgaged their home for us,” she added.

So what's the relevance to psychotropic drugs?  When discussing antidepressant effectiveness (or lack thereof), I've encountered many people who say to me, in effect, “Don't tell me that antidepressants are placebos.  I know they're not!  I was very depressed – suicidal even.  I took an antidepressant, and it saved my life.  I'm much better now.  I know the drugs work!”.  Ahem.  Introspection is not a reliable method to separate placebo effects from main effects.  Otherwise, why have double-blind clinical trials?  We could just give experimental drugs to patients, and then ask them to determine whether the drug worked.  It's ridiculous, of course.  People just don't know their own limitations.  Introspection and intuition will only get you so far.


Thursday, January 8, 2004

OK, I know this Washington Post article was written way back in August of 2001, but it's really good:

We've Been Misled by the Drug Industry

By Daniel B. Fisher

Sunday, August 19, 2001;  Page B03

I have recovered from schizophrenia.  If that statement surprises you – if you think schizophrenia is a lifelong brain disease that cannot be escaped – you have been misled by a cultural misapprehension that needlessly imprisons millions under the label of mental illness.

In the last 20 years, the pharmaceutical industry has become the major force behind the belief that mental illness is a brain disorder and that its victims need to take medications for the rest of their lives.  It's a clever sales strategy:  If people believe mental illness is purely biological, they will only treat it with a pill.

Drug companies have virtually bought the psychiatric profession.  Their profits fund the research, the journals and the departments of psychiatry.  Not surprisingly, many researchers have concluded that medication alone is best for the treatment for mental illness.  Despite recent convincing research showing the usefulness of psychotherapy in treating schizophrenia, psychiatric trainees are still told “you can't talk to a disease.”  This is why psychiatrists today spend more time prescribing drugs than getting to know the people taking them.

I, too, used to believe in the biological model of mental illness.  Thirty-one years ago, as a Ph.D biochemist with the National Institute of Mental Health, I researched and wrote papers on neurotransmitters such as serotonin and dopamine.  Then I was diagnosed with schizophrenia – and my experience taught me that our feelings and dreams cannot be analyzed under a microscope.

Despite what many people assume when they hear about my recovery, that original diagnosis was no mistake:  It was confirmed by a board of six Navy psychiatrists after my four-month inpatient stay at Bethesda Naval Hospital.  I was devastated by being branded a schizophrenic.  My life seemed over.  Six years later, however, I had defied everyone's expectations and recovered.  The most important elements in my recovery were a therapist who believed in me, the support of my family, steadfast friends and meaningful work.  And I had a new goal:  I wanted to become a psychiatrist.  [...]

In a brief statement (not quoted above), Fisher seems to imply that psychotropic drugs might be useful for short-term use during crises.  Actually, it's a little hard to tell exactly what he thinks about this issue.  Too bad he didn't elaborate more on this point.


Wednesday, January 7, 2004

Interesting article in the Boston Globe:

Brain mapping may guide treatment for depression

For the first time, researchers have mapped what happens in the brain when a patient recovers from depression using cognitive behavioral therapy, a common form of psychological treatment aimed at breaking the bad habits of thought that bring people low.

The changes in the pattern of brain activity are quite different from those observed when patients recover with antidepressant drugs, and in some areas, even opposite, according to findings reported yesterday.

[...]  Researchers also predict that the study could help raise the public standing of cognitive behavioral therapy, a series of lessons that trains patients to recognize their negative thoughts – “I'm worthless” or “it's hopeless” – and combat them with facts.

More highly directed and shorter-term than ordinary talk therapy, the psychological practice is already solidly established and is routinely paid for by insurance companies, but it tends to get much less attention than antidepressant drug therapy.

The scanning study's importance is “that you can see such a solid physical finding from a psychological treatment,” said Dr. Bruce M. Cohen, president of McLean Hospital in Belmont.  He was not involved in the research.

More broadly, Cohen added, the findings represent “one more step toward answering the question:  What is happening in the brain when it's depressed?  What happens when you change the way you think or take a drug and change the way you feel?”

Mayberg and colleagues used a brain-scanning technique called positron emission tomography to analyze for 15 to 20 sessions the brain metabolism of 14 subjects whose depression lifted considerably after cognitive behavioral therapy.

They found, among other things, that some areas in the cortex – the outer rind of the brain associated with higher functions, such as thinking – appeared to become less active, seemingly because patients learned to ruminate and worry less.  With antidepressants, those regions became more active.

If you read the whole article, you'll see that parts of it are quite positive with regard to the usefulness of antidepressants.  I have my doubts about the validity of those arguments.


Tuesday, January 6, 2004

Looks like Big Pharma is starting to pay for its sins:

U.S. drug industry's image is ailing

Companies move to defend themselves as public anger grows over increasing prices

[...] 

U.S. Rep. Dan Burton, R-Ind., whose district is home to 6,200 [Eli] Lilly employees, has accused the industry of “raping the American people.”

Minnesota's attorney general released a report this fall calling the industry “the other drug cartel.”

In addition, fewer than half of Americans surveyed in a Gallup poll had a positive view of the industry.  In fact, drug companies ranked below the federal government and airlines and just above the legal profession.

Really, though, the price issue is (or ought to be) secondary to the despicable way that drug companies pervert science in the name of profit.


Monday, January 5, 2004

The San Francisco Chronicle has a long article about antidepressants and suicide.  The article has too much emphasis on anecdotal reports and not enough on science, but it's still worth a read:

A Suicide Side Effect?  What parents aren't being told about their kids' antidepressants

[...]  The British and American warnings were a stunning turnaround that left thousands of parents whose children are using the drugs wondering whether their children were at risk.  But it was also long-sought vindication for a small group of researchers, family members and lawyers who have been arguing for years that antidepressants cause some people to become violently unhinged.  They say they've been frustrated in getting this word out to the public, in large part because of the FDA's unwillingness to confront and control the drugmakers.

The FDA's warning about a possible suicide risk from Paxil left Sara and Jim Reich feeling furious, betrayed, and ready to sue.  “Had I known there was a threefold increased risk of suicide among kids taking Paxil, I would not have allowed my daughter to go on that drug,” said Jim.  In fact, Jim has prescribed the drug himself and is outraged that the Physician's Desk Reference, or PDR – the drug bible for doctors, based on FDA-approved prescribing information – says nothing about Paxil's suicide risk.

The British and American warnings also raised some troubling questions:  How did drugs that have been widely promoted as nearly risk-free, and that are commonly prescribed by pediatricians and child psychiatrists, come to be seen as potentially dangerous?  What should parents whose children are taking them do about it?  And just how effective are these drugs that can sometimes cause such serious problems?


Saturday, January 3, 2004

Interesting article in the Boston Globe.  I don't know if I believe it.  I wouldn't classify this as pseudoscience – more like “highly speculative science”:

The ancestry of anorexia

Blame biology, not parenting, new theory suggests

Anorexia, the most lethal of psychiatric disorders, afflicts as many as 1 percent of young women and about a tenth as many men, and casts a Svengalian spell, leading its victims to willingly starve themselves in the midst of plenty.  Now, psychologist Shan Guisinger has developed a radical new view of anorexia that she says explains both the bizarre features of the illness – self starvation and hyperactivity – and its resistance to treatment by traditional psychotherapy.

Anorexia, she contends, is not primarily a psychological condition brought on by a troubled childhood – as is often thought – but a disorder based in biology, specifically in the appetite regulation mechanism in the brain.  Her theory postulates that anorexics have a biological adaptation to weight loss that causes their bodies to shut off hunger signals, and to ratchet up physical activity, even as their flesh melts away.

“Anorexics are often told to stop dieting, to listen to their body and to give it what it wants,” Guisinger said.  “But the reality is that they are listening to their bodies, and their bodies are telling them not to eat.  The truth is, they have to stop listening.”

So is this article on-topic for this blog?  I dunno, but it seemed pretty interesting – and it's a slow news day.


Friday, January 2, 2004

There is some evidence (the link opens a PDF file) that SSRI antidepressants lead to suicidal and/or homicidal behavior.  Sure, the following story is just anecdotal evidence, and I hesitate to even include these types of “horror stories” in my blog, but for what it's worth:

Pittman trial likely to start in February

CHESTER -- It's been more than two years since Christopher Pittman was charged as a pre-teen with killing his grandparents in rural Chester County.  His trial is tentatively scheduled to begin Feb. 23.  [...]

Now 14, Christopher will be tried as an adult.  If convicted, he could be sentenced to life in prison.  [...]

His family and supporters claim a five-week regimen of Paxil and Zoloft, anti-depressant medications, are to blame for his violent behavior.


And in another story:

Anti-depressants may have had role in plane crash at Port Tampa

TAMPA, Fla. - Investigators say a pilot's high dose of a prescription anti-depressant may have played a role in the fatal 2002 crash of his experimental airplane.

Scott Reviere's home-built RV-6A lost power and spiraled down shortly after taking off from Peter O. Knight Airport on Aug. 18, 2002.  The aircraft crashed into the Port of Tampa dry docks and caught fire, killing Reviere and passenger John Malecki.

A report from the National Transportation Safety Board released Wednesday blamed the crash on Reviere's inability to maintain air speed, which caused a stall and spinout.  The airport is on Davis Island, just off downtown Tampa.

But Paroxetine in Reviere's blood at 10 times the normal level also was a factor, the report said.  The anti-depressant is often known under the brand name Paxil.


And in yet another story:

Fighting to get kids off Ritalin, Prozac

A Feb. 2 FDA hearing will review studies that link children's prescribed antidepressant use to violence and suicide.

MESA - Eight years ago, Pepper Draper's son was put on Ritalin.  Now, she's crusading against the use of antidepressants in children.

“I put him on it because his teacher said he had some concentration problems and if I didn't put him on Ritalin he would eventually drop out of school, become a drug user and an alcoholic,” Draper said about her son, Broque Draper, now 17 and a junior at Higley High School.  “I was scared because there is alcoholism in my family.  I ran to the doctor and he put my son on the medicine.”

A few months after using the drug, a mix-up in the dosage given to her son caused an overdose.

For years afterward, she said, her son had problems from Tourette's syndrome, a neurological disorder characterized by repeated involuntary body movements, to extreme depression.

Since then Draper has been on a crusade to get children off Ritalin, and the class of antidepressants known as selective serotonin reuptake inhibitors, such as Prozac.

Draper, who for the past 18 months has been the Arizona director of the International Coalition for Drug Awareness (www.drugawareness.org), plans to present her views Feb. 2 at a Food and Drug Administration hearing concerning the use of such drugs in children.