|Blog Archive: Feb. 2004|
Note: Blog updates occur sporadically. I'm just too busy to maintain a schedule of daily entries. Thanks for understanding.
Saturday, February 28, 2004
Gee, and it only took how many decades for the psychiatric establishment to realize that the old man was a lunatic?
Psychoanalysis Is Dead ... So How Does That Make You Feel?
Arguably no other notable figure in history was as wrong as Freud was about every important thing he had to say.
What an utter disappointment the 1990s were for the fans of Freud. Time magazine asked aloud, and on its cover no less, “Is Freud Dead?” And the former analytic stronghold, the New York Review of Books, published lengthy feature articles debunking Freud's reputation as a man and as a thinker.
By the end of the decade, even the New Yorker was in on the action. Taken as a whole, these sensations of the 1990s, part of the so-called “Freud wars,” capture the gist of a cause well lost.
The year 2000 – the centenary of “The Interpretation of Dreams” – should have been a triumph for Freudians. Instead, amid the celebrations was a funereal whiff of defeat: The psychoanalytic century was over before the 21st century had begun. Everyone knew the answer to Time's rhetorical question. Psychoanalysis was indeed dead.
So what can we see today that we didn't see during the last century? We now know that Freud compulsively fudged the historical record. This tendency is evident in Freud's backsliding statements on his advocacy of cocaine, his opportunism concerning the case of Anna O., his flip-flops on the seduction theory, and in almost every instance where he mentions a patient.
Just ask the “Wolf Man,” Sergius Pankejeff, whom Freud supposedly cured but who was, in truth, consigned to psychoanalysis for an additional 60 years. Not surprising, Pankejeff considered Freud's effect on his life a “catastrophe.”
You realize, of course, that someday not too long from now a journalist is going to write a story analogous to the one above, but the subject won't be Freud – it will be antidepressants, antipsychotics, benzodiazepines, and the rest of the modern psychopharmacological armamentarium.
Hey folks, you just gotta love those pharmaceutical companies. What with warm and fuzzy slogans like, “We're part of the cure”, they must have our best interests at heart, right?
HRT risks 'were known years ago'
Women could have been told about the risks of taking hormone replacement therapy years ago.
Researchers say studies showing HRT may increase the risk of heart disease were published as early as 1997.
But most were done by drug companies and were not publicly available. The risk was only formally acknowledged in 2002 when a large US trial was halted.
Writing in the British Medical Journal, the researchers called for drug firms to be more open about their research.
I'm really glad that at least some physicians are catching on to the evils of Big Pharma. This is an excellent article from the New York Times:
When Your Doctor Goes to the Beach, You May Get Burned
By ABIGAIL ZUGER, M.D.
A doctor I know maintains a fairly typical relationship with the pharmaceutical industry.
He deplores its influence on medical practice and worries that his colleagues' prescribing habits are increasingly swayed by omnipresent drug advertisements and sales agents pumping new products.
Regarding his own independence and integrity, though, my friend has no doubts. He feels that, as a man of science, he is trained to recognize an advertisement when he sees one, and to file it away in that corner of his brain reserved for potentially biased information.
The facts stored there have no influence on his professional judgment, he believes.
In fact, he says, it amuses him to take advantage of everything the drug companies have to offer – the free pens and flashlights, the free lunches, the expensive dinners, the occasional all-expense-paid jaunt to a balmy resort to participate in a focus group and depart with a generous check.
“I need the money,” he says.
You have to read the rest of the article to see what happens when the other shoe drops.
Tuesday, February 24, 2004
Yes, there's hope:
Mentally ill people can recover, expert says
Diagnosis no longer a life sentence, Boston psychiatrist reports
HAYWARD -- Despite the stigma and public neglect, a diagnosis of mental illness is not a life sentence of doom and decay, a prominent mental health researcher said Saturday.
The facts are that a large percentage of people with mental illness can recover, ignore the unjust, prejudiced stigma of mental illness and lead normal lives, said Dr. Courtenay Harding, a psychiatrist who is director of the Institute for the Study of Resilience at Boston University.
Dr. Harding is a pioneer in what is becoming known as the “recovery movement,” which creates support groups for the mentally ill and works on building self-esteem among former mental patients.
[...] Harding worked on two 30-year studies of the severely mentally ill, in Vermont and Maine. Researchers traced more than 500 people who had been diagnosed in the 1950s as severely mentally ill.
The follow up results were startling. They found that 62 to 65 percent of the former Vermont patients and 46 percent of the Maine participants had recovered.
Former schizophrenics, once thought to be incurable, had shed their symptoms, many were working and had normal social relations and cared for themselves, she said.
Heh, why didn't I think of this wonderful term?
Drugs Giant Accused of 'Voodoo Medicine'
Drugs giant GlaxoSmithKline was accused in the Commons tonight of pursuing “voodoo medicine” over sales of the anti-depressant Seroxat [called “Paxil” in the US].
Labour MP Paul Flynn (Newport W) said: “The Seroxat scandal is one of gigantic proportions that affects millions of people. There has been over-prescribing and mis-prescribing of this anti-depressant on a scale that is equalled only by the over-prescription of tranquillisers 40 years ago.”
[...] He said: “[GlaxoSmithKline] prize their profits above the health of their customers. Where there should have been scientific objectivity, there has been voodoo medicine. Patients who sought care had their trust abused.
Friday, February 20, 2004
Sorry about the lack of blog updates lately. Here's some good news out of Britain:
Cut down on tranquilliser prescriptions, GPs warned
Chief medical officer plans dosage crackdown to reduce dependence
The chief medical officer has warned doctors that far too many tranquillisers are being prescribed, exposing thousands of patients to potential addiction and damage to their health.
Professor Sir Liam Donaldson is concerned that many GPs are not following 15-year-old guidance that is meant to stop excessive prescription. Drugs such as Valium and Librium – once popularly known as “mother's little helper” – should only be used for a month at the most and only for people with distressing symptoms of anxiety.
It's good to see stories like this one, but I'm concerned about the misleading implication that antidepressants work in adults (they don't):
Antidepressants' use on kids raises issues
Data renew questions regarding effectiveness
WASHINGTON – As U.S. regulators debate whether a popular class of antidepressant drugs causes suicidal behavior in children, their review is also raising questions about whether the drugs are effective.
The use of antidepressants to treat depression or other conditions, such as attention-deficit disorder, in children is growing rapidly even though there are few credible studies showing they work.
[...] According to a January FDA memo, drugmakers have submitted 15 studies designed to test the effectiveness of these drugs in treating depression in children. Three came back positive, two were statistically inconclusive, and 10 were negative.
“These are sobering findings and certainly raise a question about the benefits of these drugs in pediatric depression,” the FDA's Dr. Thomas Laughren wrote in the memo. “The overall success rate for positive studies... is clearly a concern.”
This next article shows that the problem goes beyond just the dangers associated with psychotropic drugs:
Sharp increase in children hurt by prescription drugs
HALIFAX – The number of Canadian children harmed by suspected prescription drug reactions has tripled in the last five years, CBC News has learned.
CBC obtained the database Health Canada uses to track suspected adverse drug reactions. It shows about 500 reports of children who had what are suspected to be adverse drug reactions in the last year.
The percentage of reported reactions considered serious – causing hospitalization, disability or even death – has tripled since 1997.
Doctors are prescribing more SSRI (Selective Serotonin Reuptake Inhibitor) anti-depressants for children. But the CBC analysis suggests that only accounts for a small percentage of the increase in reported serious drug reactions.
More fallout from the Traci Johnson suicide:
Drug trial participant recruiting questioned
Suicide of woman, 19, during drug trial puts recruiting practices under scrutiny
[...] Although no one knows how many college students offer themselves as guinea pigs, they are exposed almost daily to notices for the thousands of ongoing research projects via e-mails, Web sites, fliers and word of mouth.
That word even echoes to smaller schools near a research campus, beckoning students looking for a quick way to pay for books and tuition. Such was the case with Traci Johnson, a former student at Indiana Bible College in Indianapolis who killed herself last weekend while participating in a clinical drug trial on the IUPUI campus.
The 19-year-old Pennsylvania native was one of 25 local healthy volunteers taking higher-than-normal doses of duloxetine, a compound developed by Indianapolis-based Eli Lilly and Co. to treat incontinence and depression. The volunteers had no signs of depression or other illnesses.
Johnson's suicide is focusing further scrutiny on how researchers – and particularly drug companies – recruit participants for trials and how universities regulate them. Her death also has some questioning whether college students, often short on cash, are mature enough to fully understand the risks.
“This is a profit-making business, and (pharmaceutical companies) are exploiting essentially poor teens,” said Vera Sharav, president of the Alliance for Human Research Protection, which argues vehemently against the dangers of anti-depressant pills. “Kids are risk-takers anyway. They don't care about tomorrow. They don't realize what they're doing. And we should allow that?”
Argues against the dangers? Um, I think an editor was asleep at the wheel.
All I can say is, thank God for trial lawyers:
Law firm to probe suicide in Lilly test
Investigator hired by Pennsylvania attorneys says filing of lawsuit is not certain.
The parents of a 19-year-old woman who hanged herself during an Eli Lilly drug study have retained a law firm to investigate her death and “protect the interests of the family,” their spokesman and pastor said Friday.
The Rev. Joel Barnaby of The Greater Church of Philadelphia declined to say whether the family of 19-year-old Traci Johnson, who killed herself last Saturday in an Indianapolis clinic, would file suit.
The law firm of Cordisco Bradway & Simmons confirmed that it is representing the family. The Bristol, Pa., firm's Web site says it specializes in personal injury, wrongful death and work-related accident cases.
[...] Lilly officials have said they do not think the company's drug, duloxetine, played any part in Johnson's suicide.
Saturday, February 14, 2004
Sorry if I'm beating this story to death, but I think the Traci Johnson case will become an important turning point in the battle against antidepressants (though I still think that the best reason to oppose these drugs is because they're glorified placebos, not because they might make you kill yourself):
A spirited farewell
Mourners recall teen's smile, optimism
By John Strauss || February 13, 2004
PHILADELPHIA -- A packed inner-city church said goodbye Thursday to one of its best-loved members, a 19-year-old woman known for unstoppable optimism while working with youths in one of Philadelphia's more troubled neighborhoods.
Tributes during the emotional, two-hour Pentecostal service described Traci Johnson's beautiful smile and commitment to her church and community. No one directly mentioned her suicide at an Indianapolis clinic during an Eli Lilly drug study.
“Traci Johnson died last Saturday night -- by no fault of her own,” the Rev. Joel Barnaby told the standing-room-only crowd at his Greater Philadelphia Church in the city's Kensington neighborhood.
Some called out “amen” as he said it, after ministers, relatives and friends described a young woman whose parents and grandparents attended the church, who grew up with close friends there, was a leading member of the choir and volunteered for everything from fund-raisers to teaching Sunday school.
Her pastor has questioned whether the drug study she was in might have been to blame. Lilly officials have said they do not think duloxetine played any part in her suicide and that the drug is a safe treatment for patients with depression.
Friday, February 13, 2004
Here's a photograph of Traci Johnson (yeah, I swiped the image and the accompanying text from Yahoo News):
This is a photo of Traci Johnson, a 19-year-old from Bensalem, Pa., who committed suicide Saturday, Feb. 7, 2004, in an Eli Lilly and Co. research lab at the Indiana University Medical School. Johnson was a volunteer testing a new anti-depressant for Lilly, and had recently been weaned from a higher-than-normal dose of the drug, the company said. Nearly a fifth of the volunteers testing the antidepressant for Lilly have dropped out since Johnson's suicide, the drug maker said. (AP Photo/Greater Church of Philadelphia)
I'm very glad that the New York Times – with its high profile and excellent reputation – has decided to cover the latest Lilly suicide:
Student, 19, in Trial of New Antidepressant Commits Suicide
A 19-year-old college student who had shown no outward signs of depression killed herself over the weekend at an Eli Lilly & Company laboratory in Indianapolis where she had been participating in a company drug trial for an experimental antidepressant.
The student, Traci Johnson, was one of 25 healthy patients at an Eli Lilly clinic who were being given larger than therapeutic doses of duloxetine, which will be known as Cymbalta if it is introduced as an antidepressant. Four days before her death, Ms. Johnson was taken off Cymbalta and given a placebo.
While Eli Lilly asserted that it had properly screened Ms. Johnson before the study started to ensure that she was healthy and had no mental problems, her death is being used by critics of a popular class of antidepressants to bolster their case that the widely used drugs carry the risk of suicidal tendencies for a small number of people, particularly young people.
Four other patients who were given the drug during earlier trials also committed suicide, the company said. The drug is being tested not only as an antidepressant but also as a possible treatment for stress urinary incontinence.
Ms. Johnson's death came less than a week after a federal advisory panel concluded that the Food and Drug Administration should issue stronger warnings to doctors that this class of antidepressants may be linked to suicide and violent behavior in children and teenagers.
Will this story have legs? Will “Remember Traci Johnson!” become the psychiatric watch-dog version of “Remember the Alamo!”?
Hey, would you want to continue taking an experimental drug that may have caused a seemingly well-adjusted student to hang herself? No? Apparently, neither would one-fifth of participants in Lilly's drug trial (actually, I'm surprised that more people didn't drop out):
Death fuels fallout in drug trial
20% of patients exit Lilly's study for duloxetine after girl's suicide
By J.K. Wall || February 12, 2004
Eli Lilly and Co. said Wednesday that nearly one-fifth of the participants in a clinical trial for its new anti-depression and anti-incontinence drug have dropped out of the study after one test subject committed suicide over the weekend.
At the same time, Lilly acknowledged that four other suicides have occurred during several years of clinical trials on the drug duloxetine.
However, the other suicides were among patients with depression, unlike Traci Johnson, who hanged herself Saturday while participating in a trial involving what Lilly described as “healthy” volunteers.
That difference has led antidepressant watchdogs from around the country to seize on Johnson's death, saying the facts point to the drug as a possible cause. But Lilly officials reiterated Wednesday that they do not believe duloxetine played a part in the suicide and that duloxetine has been proven safe to treat patients with depression.
This next story has nothing to do with the mental-health industry. However, the article reinforces the notion that we need to be very skeptical of medical concepts, even if these concepts have wide acceptance and a long tradition standing behind them:
Benefit of Bed Rest Is Largely a Wives' Tale
[...] At least one pregnant woman in five is assigned to a week of bed rest or more in an effort to avoid complications and preterm births. The cost – which may include lost wages, hospitalization, home health aides, child care and transportation – can be extraordinary. The emotional and social costs are inestimable.
Yet, for all the trauma it can cause, bed rest has never been shown in good clinical studies to achieve its desired goals.
“Some benefits may be there, but they haven't been documented,” said Dr. Judith A. Maloni of the Bolton School of Nursing at Case Western Reserve University, who just completed a $1.7 million study of bed rest supported by the National Institutes of Health. In fact, as Dr. Maloni's study showed, there is good evidence that bed rest in pregnancy can cause harm, resulting in more than a dozen consequences, including babies who are smaller than normal and mothers who are too weak and tired to care for them.
Dr. Robert L. Goldenberg, an expert in maternal-fetal medicine at the University of Alabama at Birmingham, said in an interview: “Most obstetricians believe bed rest will reduce the risk of preterm births and other pregnancy complications like preeclampsia, incompetent cervix and intrauterine growth retardation. But the data are mostly nonexistent. Medicine has a lot of folk myths. This is just one of them.”
(Emphasis added by me.)
Prostate test 'of little value'
A screening test which can reveal prostate cancer is too unreliable to be recommended to patients, it is claimed.
PSA, or prostate specific antigen testing, is often offered to older men as part of private health assessments.
However, a UK expert writing in the British Medical Journal says it should not be widely used as it is not clear whether it actually benefits patients.
Men testing positive do not fare better than those whose cancer is only spotted when symptoms emerge, it is claimed.
Seems to me that doctors and other medical professionals need a big dose of humility and skepticism.
And still more debunking:
Optimistic attitude 'no help against cancer'
A positive attitude does not improve the chances of surviving cancer and doctors who encourage patients to keep up hope may be burdening them, Australian researchers say.
Optimism made no difference in the fate of most of the 179 cancer patients that Australian researchers followed over five years. Only eight people were still living by the time the study ended in 2001.
All the patients in the new study were suffering from a common form of lung cancer.
Although the study was small and dealt with a kind of cancer that offers little chance for survival [about 12 per cent of patients live beyond five years], health experts say it is the first scientifically valid look at optimism and cancer. The results surprised researchers, who expected optimistic patients to live longer than their counterparts.
Patients are burdened by trying to maintain a positive outlook during their difficult situations, said researchers from the Peter MacCallum Cancer Centre in Melbourne and five other health centres in an article published in the journal Cancer.
The study found that optimism dimmed when patients experienced the toxic effects of cancer treatment and when they learned more about the realities of the disease.
“We should question whether it is valuable to encourage optimism if it results in the patient concealing his or her distress in the misguided belief that this will afford survival benefits,” the study's lead author, Penelope Schofield, wrote. “If a patient feels generally pessimistic... it is important to acknowledge these feelings as valid and acceptable.”
Tuesday, February 10, 2004
An extraordinary story in the local newspaper for Indianapolis, Indiana. Note that the woman killed herself inside a facility operated by Eli Lilly (yikes!).
Woman in Lilly clinical trial hangs herself
Coroner will consider whether drugs played a possible part in 19-year-old's suicide.
By J.K. Wall and John Tuohy
February 10, 2004
A toxicology test will determine whether drugs played a role in the suicide of a 19-year-old woman who was participating in clinical trials for a new medication that Eli Lilly and Co. hopes to launch this year.
Traci Johnson, whose pastor and family in Bensalem, Pa., described her as upbeat and devout, hanged herself Saturday night in the Lilly Laboratory for Clinical Research, according to the Indianapolis Police Department. She reportedly used a scarf tied to a bathroom shower rod.
While the toxicology test is standard procedure in the investigation of suicides by the Marion County coroner, it could have huge implications for Lilly if it is determined that the trial drug -- or removal from it -- played a role in the woman's suicide. Toxicology test results are expected in about a month.
Lilly said Monday it does not believe the drug, duloxetine, was related to the death of Johnson, who attended Indiana Bible College through December. But Johnson's family and friends said it is inconceivable that the tender-hearted teenager would have killed herself.
Duloxetine is key to future business prospects of Lilly. It is the main ingredient in Cymbalta, an anti-depressant drug, and in a stress urinary incontinence treatment, both of which are moving toward final approval by the U.S. Food and Drug Administration.
Friday, February 6, 2004
I have a problem. I've been very, very busy lately with activities unrelated to my "hobby" (i.e., maintaining this web page), and I've also accumulated a bunch of stories I wanted to blog. I just don't have time right now to quote an excerpt and write a brief commentary for each entry. You don't need my commentary, anyway, since I pretty much write the same stuff over and over (have you noticed this? Hey, it's hard to be creative day in, and day out.)
So, here a bunch of links -- sans comments -- to stories that I think are very interesting. I've tried to put the more-important stories closer to the top.
I also need to move January's blog entries onto a separate, archived page. Aye, Carumba! When am I going to get everything done?
Tuesday, February 3, 2004
Wow, antidepressants are all over the news today! Are we witnessing the beginning of the end of the antidepressant era? Here's an article from the Washington Post:
FDA Links Antidepressants, Youth Suicide Risk
By Shankar Vedantam || Washington Post Staff Writer
Federal regulators said for the first time yesterday that clinical trials of popular antidepressants such as Prozac, Paxil and Zoloft show a greater risk of suicide among children taking the drugs compared with those taking dummy pills.
Although only one of these drugs has been approved for the treatment of children with depression, doctors are prescribing them to hundreds of thousands of American children every year. The new Food and Drug Administration analysis of the trials is starkly at odds with repeated assurances by the U.S. psychiatric establishment that the drugs are very safe.
Regulators said the result of their review was identical to a British analysis, which prompted that country in December to prohibit use of most antidepressants in children. Before taking any regulatory action, however, U.S. officials have requested a second analysis of the data by Columbia University researchers. The new review, which will reevaluate the descriptions of adverse effects suffered by children in the trials, will likely be completed by summer.
Patients and impassioned families pleaded for more urgent action at a day-long meeting of an expert advisory panel yesterday. Dozens of parents, siblings and doctors from all over the country gave lengthy and moving testimony describing family members and patients who had committed suicide or had turned violent after taking the drugs.
"We were told that Paxil and Prozac were wonder drugs," said Glenn McIntosh of Austin, whose 12-year-old daughter Caitlin hanged herself with shoelaces weeks after being started on Paxil and then switched to Zoloft. "We were lied to."
Thanks to Dave Myers for pointing out this excellent editorial from the San Jose Mercury News:
Who will take on pharmaceutical companies?
INDUSTRY LEAGALLY SUPPRESSING VITAL INFORMATION ON MEDICATIONS
Americans need a champion to stand up to the pharmaceutical industry.
Without a powerful advocate in Washington, the industry continues to steamroll Congress and the Food and Drug Administration.
The latest outrage is the industry's policy of suppressing the details of clinical studies involving medications to treat depressed children. The practice is legal. But it's unconscionable for the drug industry to knowingly withhold data from parents about medicines that may cause some children to become suicidal.
Monday, February 2, 2004
I have mixed feelings about David Healy:
Talking back to Prozac
David Healy was among the first psychiatrists to prescribe Prozac. Now he's one of the fiercest critics of Big Pharma's "marketing" of depression. Did his outspoken views cost him his job?
For the past several years, David has been taking on Goliath.
In a flood of academic publications and talks, the British psychiatrist David Healy has issued harsh criticisms of both the pharmaceutical industry in general and the nearly $20 billion-dollar-a-year antidepressant industry in particular. Healy's central charge: The manufacturers of Prozac, Paxil, Zoloft and the other drugs belonging to the family of antidepressants known as SSRIs (selective serotonin-reuptake inhibitors) have deliberately misled the public about both the safety and effectiveness of their popular products.
A decade ago, Healy hardly seemed like a likely candidate to emerge as psychopharmacology's Public Enemy No. 1. In many respects he was the very incarnation of contemporary biological psychiatry: secretary of the British Association for Psychopharmacology, a leading researcher on the effects of the iconic neurotransmitter, serotonin, and a skeptic who dismissed talk therapy as a romantic fantasy. Healy has no use for the antipsychiatry camp, which charges that mental illness is a social construct, not a real disease. "I am as biological as you can get. The idea that we should all be able to stand on our own without pills is nice, but not very realistic," he says.
© 2004 Alex Chernavsky email@example.com