Sunday, July 31, 2005

MIT Psychs Sued for Damages in Suicide Case

As Seen in the Worchester Telegram in Massachusetts

A judge has ruled the parents of a Massachusetts Institute of Technology student who committed suicide can continue their $27 million suit against college administrators and staff, a decision higher education officials criticized as unusually broad.

Elizabeth Shin died in 2000 after setting herself on fire in her dorm room.

Non-clinicians aren't usually held responsible for suicides, but Middlesex Superior Court Judge Christine McEvoy said Shin's housemaster and student life dean had a "special relationship" with her. That required them to protect her, McEvoy ruled, because they "could reasonably foresee that Elizabeth would hurt herself without proper supervision."

Sheldon Steinbach, general counsel of the American Council on Education, called the June 27 decision "an extraordinary stretch."

"I'm surprised the judge didn't find the president responsible, too," he told The Boston Globe. "How far are you going to go? Are the board of trustees liable because they should have known?"

McEvoy dismissed the claims against the university itself and dismissed some claims against the MIT employees. The remaining claims against four psychiatrists and two administrators will go to a jury trial. A pretrial conference in scheduled for September.

The lawyer for Shin's parents, Cho Hyun Shin and Kisuk Shin, praised McEvoy's decision.

"We believe it could have and would have turned out much differently for Elizabeth, had they chosen to respond to a known emergency situation," attorney David DeLuca said.

In a statement, MIT said Shin's death was a terrible tragedy, but "it was not the fault of MIT or anyone who works at MIT."

Suicide threats by Elizabeth Shin, of Livingston, N.J., were known to MIT before she killed herself on April 10, 2000. On that day, a group of administrators and psychiatrists discussed her case, including her statements to two students that she intended to commit suicide. One psychiatrist made an appointment for Shin for the next day at a psychiatric facility outside MIT.

McEvoy ruled the Shin family's lawyers had presented enough evidence to show their charges of gross negligence by MIT administrators were a legitimate issue because the administrators didn't enact "an immediate plan to respond to Elizabeth's escalating threats to commit suicide."

McEvoy's ruling is "very new ground," said Gary Pavela, director of judicial programs at the University of Maryland at College Park and the author of a newsletter for college administrators on law in higher education.

Pavela said a federal district court in Virginia found Ferrum College officials had a "special relationship" that gave them a duty to a student who committed suicide. But that case was settled out of court. In contrast, the Iowa Supreme Court in 2000 found no such duty toward a suicidal student, Pavela said.

Pavela said the legal uncertainty is upsetting college officials, and some are forcing students to go on medical leave at the first sign of any suicidal thoughts to avoid legal liability.

But Pavela said that's ethically wrong and illegal. The Americans with Disabilities Act requires schools to carefully consider the facts in an individual case before sending a student home, he said.

"If administrators overreact to these cases by routinely removing students, then they are jumping out of the frying pan and into the fire," he said.

Thursday, July 28, 2005

Hypochondria as a Marketing Tactic. You do feel sick, don't you?

Mother Jones has an extended article on the marketing of new diseases.

From a pharmaceutical company's perspective, the big money can be made not only by selling drugs to the sick, but by selling drugs to the healthy, the people who don't even know that they need drugs yet. A recent Reuters Business Insight report, designed for drug company executives, suggested that the drug companies can reap billions by "creat[ing] new disease markets." That involves convincing people that "problems they may previously have accepted as, perhaps, an inconvenience"—such as, for instance, the distress that can accompany PMS—are in fact "worthy of medical intervention." In other words, nothing short of the medicalization of everyday troubles. Cheerfully, the report believes that drug companies are up to the task: "The coming years will bear greater witness to the corporate sponsored creation of disease."

From this we get the marketing of psych drugs for new uses.

Consider this story. In 1998, Lilly, one of the world's largest pharmaceutical companies, was on the verge of losing its patent on fluoxetine (more commonly known as Prozac) worth over $2 billion annually. However, if Lilly could find a new use for the drug, the patent could be extended. That year, Lilly helped fund a "roundtable" of researchers to gather in Washington D.C., along with staff from the Food and Drug Administration to discuss a scientifically controversial condition called "premenstrual dysphoric disorder" (PMDD), which had only recently, and after much controversy, been included in the appendix of the Diagnostic and Statistical Manual—the bible of psychiatric disorders—as a disorder "under evaluation." But the Lilly-funded researchers soon published an article in a small medical journal suggesting, falsely, that the debate was over and that PMDD could now be considered a "distinct clinical entity," distinct from the stress and tension that can accompany ordinary PMS.

Lilly has not said what role it played in turning the "roundtable" into a journal article, but by 1999, the article helped convince the FDA to approve the use of fluoxetine to treat PMDD—and extended the patent until 2007. Lilly simply repackaged the drug in lavender pill-form, renamed it Serafem, and began marketing it to women. Never mind that independent researchers questioned whether PMDD even existed as a condition. Never mind that Europe's drug regulators raised serious questions about PMDD and criticized Lilly's clinical trials that purported to show the benefits of Serafem. Never mind that even the industry-friendly FDA was appalled at Lilly's television ads, with their too-vague tagline: "Think it's PMS? It could be PMDD." Undaunted, Lilly continued its advertising barrage, trying to convince women who thought they were experiencing regular PMS-related distress that, actually, they might well have a serious disorder that required heavy medication. Soon thereafter, both Pfizer and GSK got their own anti-depressants approved for treating PMDD. For all intents and purposes, the "debate" over whether PMDD was a disorder—let alone requiring medication with serious side-effects—was over. Industry money had carried the day.

Sunday, July 17, 2005

Child psychiatrist settles molestation claim case

A prominent San Mateo child psychiatrist has reached a confidential lawsuit settlement with a former patient who accused Dr. William Ayres of repeatedly molesting him when he was a 13-year-old boy in the late 1970s.

The settlement was submitted to San Mateo County Presiding Judge George Miram on Tuesday, the day after a civil trial was scheduled to begin.

The settlement was confirmed by Robert Tobin, an attorney for the now-40- year-old former patient, and by Ayres' attorney, Donald Putterman. Neither side would reveal the terms.

Putterman said that Ayres "hotly disputed" the allegations against him. "Hotly disputed cases are often settled,'' Putterman said. In reaching the settlement, "nobody conceded anything,'' he added.

Filed in December, the lawsuit cast a cloud over the high-profile career of Ayres, a past president of the American Academy of Child and Adolescent Psychiatry.

The patient, who alleged the molestation incidents occurred in 1977-78, did not come forward to police until decades later. Meanwhile, the San Mateo County court system continued to refer young boys who were either victims of abuse or juvenile offenders to Ayres for treatment.

Thursday, July 07, 2005

The Ritalin Cancer Link

Almost 30 million prescriptions for Ritalin and similar drugs to treat attention deficit hyperactivity disorder (ADHD) were written last year in the United States; 23 million were for children. While these drugs are among the most widely prescribed medicines in the world, they also remain one of the most controversial.

The latest chapter in the debate over the safety of ADHD drugs: The Food and Drug Administration's (FDA) investigation regarding a link between Ritalin and cancer -- based on a small University of Texas study.

The findings showed damage to the chromosomes of 12 children who had taken Ritalin for three months. A grant proposal is in the works at the NIH to fund a much larger probe in 2006, involving many more patients and a variety of drugs.

See the story as reported in Forbes Magazine. There obviously some people in a major panic over this