Sunday, September 30, 2007

AntiDepressant Side Effects During Pregnancy

A case where some mid-wives were not as aware of the side-effects of anti-depressants during pregnancy as they should have been. As seen in this report

The Health and Disability Commissioner has criticised the West Coast District Health Board after lack of care by three midwives left a newborn boy with permanent neurological problems.

Commissioner Ron Paterson also criticised the DHB over the subsequent delays and handling of the complaint into the case.

When the boy, known as Baby A, was born in 2004, he developed hypoglycaemia, or low blood sugar, after he stopped feeding normally in the two days after his birth.

Mr Paterson said the baby, at the lower end of the normal weight range, was vulnerable to hypoglycaemia as his mother, Ms A, was a heavy smoker and taking antidepressants during her pregnancy.

An independent adviser to Mr Paterson, midwife Nimisha Waller, said that as Baby A's weight was still inside the normal range he was not considered to be at risk of hypoglycaemia and did not get regular blood glucose monitoring.

She said all the midwives failed in developing a plan of care on a daily basis and did not recognise a change in Baby A's feeding pattern which resulted in the condition.

Mr Paterson said the combination of risk factors meant the midwives should have immediately monitored blood sugar levels and monitored feeding.

The three midwives have since reviewed their practice and written apologies to Ms A for the lack of care. The DHB has also written an apology to Ms A and is to audit its neonatal policies in regard to low-weight or at-risk babies.

Saturday, September 29, 2007

Locked up and forgotten

A sad tale of why reform was needed, and likely still is. As seen in The Sun

A woman was locked up and “lost” for 70 years after being wrongly accused of stealing 13p.

Jean Gambell, 85, was “certified” indefinitely in 1937 over claims she had taken the cash while cleaning at a doctor’s surgery.

The money was found — but Jean still spent 70 years in a maze of care institutions.

She was “found” when brothers Alan, 66, and David, 63 — who thought she was dead — read a letter sent by a care home to their mother, who died 25 years ago.

David said: “I was about to throw it in the bin when I saw a name in the corner — Jean Gambell. I rang and they said our sister was there.”

The two brothers travelled from their homes in Liverpool to see Jean at the home in Macclesfield, Cheshire. Staff warned them she was deaf and may not remember them.

David said: “We were very nervous. We wrote on a piece of card ‘Hello Jean, we’re your brothers’. But she took one look at us and said, ‘Hello Alan, hello David’ — and flung her arms around us.”

He added: “Nowadays there are appeals — but back then a doctor could sign away a life with the stroke of a pen.

“They basically locked her up and threw away the key and she was stuck in the system.

“She just got moved from one institution to another.

“What a waste of a poor, innocent girl’s life.”

Jean had a stroke after meeting her brothers, believed to have been sparked by the shock of the reunion. She is said to be recovering.

The Failure of Quebec Governmental Mental Health Services for Children

Let's see, we have children in government controlled youth centers, where 80% are under the control of of a psychiatrist. About 67% are on prescription drugs, and 40% are on psychiatric drugs. Are we really surprised at these figures?

Granted, many are from broken homes, etc. and maybe the only practical method they have is to sort of warehouse them and drug them up. (Never mind the cycle of side effects that can drive people crazy)

But these kind of figures sound like the figures of a failed system to me. It's a surprise that the figures aren't worse. And of course, they don't make the connection between the psychiatrists and the high rate of psychiatric prescriptions. If you are hammer, everything looks like a nail.

Taken from this report in the Montreal Gazette.

Quebec children in youth protection services are extremely damaged, warned an author of a report showing nearly 40 per cent are prescribed drugs for psychiatric problems.

Children as young as six years old are medicated to control hyperactivity, aggression, depression and suicidal tendencies, said Pierre Charest, head professional services at Centre jeunesse de Montreal.


Made public earlier this week, Charest's report, however, strongly recommends finding alternatives to drug therapy, especially for young children.

Commissioned by the provincial health department, the working committee's study on the mental health of children under government care shows a disturbing trend of mental disorders.

The study tracking 3,600 youths in Quebec's youth protection network last year reveals that one in four suffers from multiple mental disorders. The majority are being treated for minor issues while 17 per cent are seriously ill.

Children ages six to 11 years old seem to have the most mental health issues, the report found. About 67 per cent are on prescription drugs.

"The rate of mental illness in group homes is very, very high. It's definitely higher than in the general population," Charest said.

Health professionals welcomed the report, a first of its kind for Quebec.

"For the first time we have a portrait of the Quebec reality," Douglas Hospital child psychiatrist Philippe Lageix said.

"But it's not something new that's popped up suddenly in Quebec."

Children in youth protection represent the most at-risk population for mental illness because of several factors, Lageix explained.

It's a predictable pattern:

"We meet one patient after another and realize that their parents have problems. They are exposed during pregnancy to (drugs, alcohol, cigarettes, malnutrition) and then neglected, then placed.

"They peak on all risks," he said. Those with severe mental health and behaviour problems cannot stay with their own families or be placed in foster care, he added.

But Quebec is not alone. Comparative studies show Ontario, Holland and the United States are dealing with similar issues, Lageix said.

"Very vulnerable youth are getting services from (youth protection) agencies and a lot of them are medicated," Lageix said. "But do we treat too much or not enough? That's a social debate."

Experts suggest health services to youths in centres has improved during the last decade.

In Quebec, nearly 80 per cent are under the supervision of a psychiatrist or other professional despite the shortage of physicians. But 20 per cent are fending for themselves, the report found.


Among the study's recommendations:

Better screening to evaluate and follow youth with multiple problems, special programs adapted to children with mental health issues, improved training for caregivers and professionals dealing with children at risk, multi-disciplinary teams in place in group homes and more studies to seek alternatives to medication therapy.

Quebec Health Minister Philippe Couillard has endorsed the study's recommendations saying funds are available in the 2007-2008 budget.

Friday, September 28, 2007

60 Minutes on Rebecca Riley and Bipolar Prescriptions

In a run up to their Sunday 60 Minutes show, Katie Couric had a news story to night on the tragic psychiatric drugging death of Rebecca Riley. As seen in this report/ press release We will have to see if this is an honest investigation, or free advertising for the drug companies. The online video seems to indicate that this is a damage control news item for the drug companies.

A mother charged with murder for what she claims was medicating a child diagnosed as bipolar, says her dead four-year-old daughter probably wasn't suffering from the disorder after all.

In her first interview, Carolyn Riley tells her story to Katie Couric for a report on the increase of bipolar diagnoses in children to be broadcast this Sunday, Sept. 29, at 7:30 p.m. ET, 7:00 p.m. PT, on 60 Minutes.


It's estimated today that one million youngsters in the U.S. have been diagnosed with bipolar disorder, which was once thought to affect only adults. Couric's story explores this phenomenon by talking to parents of diagnosed children and to doctors like Dr. Joseph Biederman, head of pediatric psychopharmacology at Boston’s Massachusetts General Hospital.

Bristol-Myers to pay $515,000,000,000 fine

Via the BBC and other news outlets

US drugmaker Bristol-Myers Squibb and a subsidiary have agreed to pay more than $515m (£251.7m) to settle allegations of marketing certain drugs illegally.

The fines issued by the US Department of Justice mark the end of a probe into the firm's drug pricing practices that began a number of years ago.


The US DoJ concluded on Friday that the company and a wholly-owned subsidiary called Apothecon had used incentive schemes to encourage doctors and wholesalers to stockpile their drugs and so help Bristol-Myers achieve its sales targets.

This included maintaining "fraudulent and inflated" prices for a wide range of cancer and generic drugs knowing that federal health care programmes established reimbursement rates based on those prices.

Bristol-Myers was also accused of knowingly misreporting its best price for the anti-depression drug Serzone to Medicaid, the government-backed health insurance scheme.

In addition, the DoJ claimed that the company had promoted the use of the treatment-specific anti-psychotic drug Abilify to a wider client base than recommended by the Food and Drug Administration.

"Patients are entitled to unbiased decision-making from their physicians and should not have to worry that financial inducements or lavish entertainment have influenced their physicians' prescribing choices," said Michael Sullivan, the US attorney in Boston.

As part of the settlement, Bristol-Myers said it had entered into a five-year "corporate integrity agreement" with the government healthcare regulator, the Office of the Inspector General of the Department of Health and Human Services.

The agreement is designed to ensure the company adheres to its compliance programs relating to its US pharmaceuticals business.

British Government Watchdog Patient Survey Rate North Lincolnshire the Worst in Country

From the Scunthorpe Telegraph

Psychiatrists in North Lincolnshire are some of the worst in the country, according to a Government watchdog patient survey.

Mental health service users ranked the region's psychiatrists at the very bottom of a national league table for trustworthiness, respect and listening.

The Healthcare Commission survey findings are in stark contrast with steadily improving national results.

North Lincolnshire Primary Care Trust (PCT) director of contracting Caroline Briggs, on behalf of the acting chief executive, said she was disappointed with the results.

She said: "It goes without saying that the psychiatrists feel badly our patients are generally dissatisfied with the service we offer and that we have done badly on a national scale."

They have promised a host of measures in an action plan to get the service back on track including keeping staff long term.

Half of North Lincolnshire PCT service users were unable to answer yes when asked if they had trust confidence in their psychiatrist.

Users also ranked psychiatrists at rock bottom when asked if they were treated with respect and dignity.
One third did not answer yes.

And 45 per cent said their psychiatrist listened only 'somewhat carefully' or 'not at all carefully' to them.

The survey was carried out among patients at 69 NHS trusts around the country.


The Potential Political Uses of Psychiatry

Someone else has discovered the political advantages of using psychiatry, and has become a little disturbed by this. Of course, old time Soviet style psychiatry would never become prevalent in the USA, comrade.

Or would it? These folks seem to think so.

Of course, we are not particularly aligned with any political party.

Thursday, September 27, 2007

Psychiatrist Loses Criminal Appeal

As seen in this report from the Capitol News Service

A Maryland court Wednesday upheld disciplinary action against the psychiatrist who leaked details about the sexual habits and mental health of convicted spy Robert Hanssen in 2001.

A three-judge panel of the Maryland Court of Special Appeals upheld lower court rulings against Alen J. Salerian, who had been hired by defense attorneys to evaluate Hanssen, a former FBI agent arrested for giving highly classified information to Russia.

The two met over the course of a week in April 2001, during which Hanssen admitted he had a "long history of sexual betrayal and exploitation" of his wife -- a fact that Salerian later shared with Hanssen's wife.

Court documents said Salerian was warned repeatedly by Hanssen's attorney, Plato Cacheris, not to disclose any details of his conversations with the former FBI agent. Salerian, along with most others involved in the case, had also signed a letter from the U.S. Attorney General promising not to disclose information about Hanssen due to "national security interests" involved.

In May 2001, within a week after telling Hanssen's wife about the sexual betrayals, Salerian was fired by Cacheris. Salerian also received a letter from Hanssen forbidding him from discussing their meetings with anyone other than defense attorneys, including family members and "certainly with anyone outside the family."

But in the following weeks, Salerian was quoted in numerous media outlets discussing Hanssen's mental state.

In a June 2001 CBS report, Salerian claimed that he had disclosed the information with Hanssen's permission. Salerian, who believed the FBI, the church and the medical system had failed Hanssen, said it was "a situation where there was life and death involved and I had to make a call as a physician to say what I think is right."

In a disciplinary hearing against Salerian, Hanssen testified via telephone that he had agreed to let Salerian tell his wife about the sexual exploits because Salerian convinced him that the media were about to publish it.

Hanssen pleaded guilty to espionage in July 2001 and is serving life in federal prison. The 2007 film "Breach" was based on his arrest.

Hanssen's attorneys and wife filed a complaint against Salerian in September 2001 with the Maryland State Board of Physicians, charging he disclosed confidential information. That same month, Salerian's license to practice medicine in Maryland expired.

He applied for reinstatement of his license in September 2002, only to be told the board was charging him with immoral and unprofessional conduct and violating attorney-client and physician-patient privilege. He attempted to withdraw his application in July 2003, but was told he could not do so while charges were pending.

An administrative law judge initially recommended that Salerian be fined $20,000, have his license revoked and be barred from applying for reinstatement for up to three years.

In January 2005, the board decided instead that Salerian be fined $5,000 and be placed on probation for two years, which would not end until he completed an ethics course.

Salerian challenged the action, but it was upheld by the Montgomery County Circuit Court. He raised 10 issues in his appeal to the Maryland Court of Special Appeals, which rejected all 10 Wednesday.

Messages left on his voicemail Wednesday at the Washington Center for Psychiatry were not returned. A woman who answered the phone at the address listed for Salerian in the state physicians board's records said he had not lived there for six years.

Cacheris called Wednesday's ruling accurate and said he agreed with the penalties against Salerian.

Redefining Depression as Everyday Common Headaches

An opinion piece we missed from earlier this year

Yesterday’s front-page splash in The Times (London) proclaimed that Britain is now ‘a Prozac nation’. ‘The number of Britons prescribed antidepressants is at a record high despite official warnings that many patients may not need them’, the paper reported.

Last year doctors wrote more than 31 million prescriptions for antidepressant drugs, and while ‘the exact number of people taking pills for depression is not known’, it is ‘thought to be several million, with many taking the medications over long periods on repeat prescriptions’. The cost to the National Health Service of antidepressants was £291.5 million. ‘Depression’, reported The Times, ‘is estimated to affect as many as one in five at some point during their lives. At any moment, 1.5 million people aged between 16 and 75 are suffering from depression, and 2.7 million from anxiety, although most cases are untreated’.

Yet is the problem here really antidepressants, some kind of ‘Prozac culture’? Shouldn’t we be more concerned about the question of why so many people seem to believe that regular doses of drugs provide solutions to their problems?

Commenting on these reports, Libby Purves, in a piece subtitled ‘Hurray for Prozac. But it’s prescribed too easily’, compared the news that ‘Britain is on antidepressants’ to ‘hearing that a crutch-and-splint factory has doubled its profits. You’re glad all those people are being helped to walk upright, but wonder why so many are getting hurt.’

She agrees with a Times blogger that ‘drastically reducing the hours that television is broadcast would be a good place to start’ in combating depression, hailing this sort of ‘turn off the TV and DO something’ ethic as ‘simplistic but bracing’: ‘You can’t help noticing that these worried news items about depression are generally surrounded, in all media, by a sea of gloom about house prices, terrorism and new diseases, and further decorated with ridiculous stuff about “must-have” handbags and how contemptible it is to be a bit fat and not yet famous.’

If sitting in front of 24-hour television news and watching endless bulletins on how the planet is dying of climate change, while eating a comfort donut that the government’s ‘war against obesity’ has made you feel guilty about, is enough to trigger depression, then the real question is why all of us aren’t scoffing down Prozac.

In 2005, the last time the nation flew into a panic about the overuse of antidepressant drugs in the UK, Dr Michael Fitzpatrick argued on spiked that the reason depression is now so prevalent is that the diagnostic term has been altered. The term depression was ‘formerly restricted to patients so severely afflicted by melancholy that they might require hospital admission’, but is now ‘adapted to cover a wide range of responses to existential distress, resulting from workplace dissatisfaction, marital disharmony, bereavement or other losses’.

The real motivating factor behind our ‘Prozac nation’ is not the existence of new drugs or the willingness of doctors to dish them out or 24-hour TV cycles – it is that people are continually educated these days to identify their human grief, feelings of loneliness, heartbreak or simply anxiety at their own personal foibles as ‘depression’.

Medicalising every problem and treating natural feelings as a form of mild psychosis has replaced the old framework of seeing problems as something to be overcome with the help of friends. In the past, individuals were encouraged to get through rough times in a pro-active way, through collectivity and community, whether by turning to their trade unions, churches, extended families or their mates in the local pub.
As such institutions decline, and claims that everything we experience can be a cause of depression or mental illness are on the rise, it seems inevitable that people will turn to drugs for answers.

As Dr Fitzpatrick concluded: ‘Rather than now telling GPs to stop prescribing anti-depressants, it might be more constructive for doctors and psychiatrists to ask whether it is beneficial either to individuals or to society to label a quarter of the population as being mentally ill.’

Today’s ‘Prozac Nation’ is the outcome of the relentless medicalisation of everyday problems – and if we switched off these messages about everyone being screwed up (rather than our TVs) that might be a first step to helping people get off the antidepressant bandwagon.

Wednesday, September 26, 2007

His lobotomy, his recovery, in his words

A review of an important book from the San Francisco Chronicle

Until he was 5, Howard Dully was a happy child. That was the year his mother, June, died of cancer. June was "loving and indulgent," Dully writes, so devoted that his father once said, "I could've dropped dead and it wouldn't have made a bit of difference. She had you."

After his mother's death, neighbors started sewing and cooking, doing laundry for the Dullys. One of them, Lucille "Lou" Cox, became his stepmother two years later. Rigid and punitive, Lou hated Howard. When he was 12, she arranged for the boy to have a transorbital lobotomy.

The surgeon, Dr. Walter Freeman, did the procedure at Doctors General Hospital in San Jose. After sedating Howard with four jolts of electroshock, Freeman inserted two skewer-like steel knives into his skull, entering through the inside of the right and left eye sockets.

"(He) swirled them around," Dully writes, "until he felt he had scrambled things up enough." The lobotomy took 10 minutes to perform. The charge was $200.

This is the story that Dully, a 58-year-old San Jose bus driver, tells in his memoir, "My Lobotomy" ($24.95, Crown Publishers). It's a gruesome but compulsively readable tale, ultimately redemptive. Unlike most lobotomy patients - some became vegetables, 15 percent died - Dully was relatively unscathed.

"The biggest impact it made on me was my self-esteem," Dully says during a conversation in Jimmy's, a San Jose coffee shop with early-'60s decor. "You know, they changed me. They rearranged me. 'Am I me any more? Am I really crazy and don't know it?' These things all go through your mind."

Dully is hardly the picture of victimhood. Six-foot-seven, 330 pounds, he's a bear of a man with enormous hands, a voice like a cello and the visage of a grizzled biker. Until last year, he wore his mustache super-long and droopy, like Yosemite Sam, and then decided "I was hiding behind it."

No one would want to mess with this guy, but when you sit down with Dully you find a gentle, vulnerable man who speaks easily of emotional hurt. Traces of sadness are embedded in his face. His mood is subdued - or at least leveled - by the Prozac he's taken for four years.

What's surprising is Dully's lack of bitterness. Despite the lobotomy, despite the subsequent years when he was bounced from foster home to juvenile hall to mental institution - he says "there's no point" in being angry.

"I've worked through all that. The only person it's gonna hurt is me. My biggest question is 'Why?' Why would an adult play the game to the extent it was played? ... I'm not going to say I was walking on water and here came the evil stepmother who just had things poked into the back of my head. But I don't feel I did anything to deserve a lobotomy."

At 12, Dully was already 6 feet tall - a "hellious" kid, in his words. He lied and shoplifted on occasion. He smoked cigarettes. Hated homework. Because his dad worked three jobs and was never home, his stepmom meted out the discipline. "Lou was a fairly small woman and it finally got to the point where she'd spank me and I'd laugh. I think that scared her."

In "My Lobotomy," Dully and co-writer Charles Fleming describe how Lou consulted six psychiatrists in her search for a solution, and was told by four of them that she was the problem and not Howard. Finally, she found Freeman and convinced him that her stepson was a candidate for lobotomy.

Freeman, subject of a recent book, "The Lobotomist" by Jack El-Hai, didn't need to be lobbied or prodded. A psychiatrist and neurologist, he didn't invent the lobotomy but popularized and promoted it. Full of hubris, he touted the procedure's benefits at medical conventions, behaving, his partner James Watt said, "like a barker at a carnival."

When patients suffered permanent brain damage, Freeman was unfazed. "Maybe it will be shown," he said, "that a mentally ill patient can think more clearly and constructively with less brain in actual operation."

Given the brutality and imprecision of the lobotomy procedure, Dully is luckier than most survivors. He believes his tear ducts were damaged by the lobotomy and attributes his sinus problems to the procedure. His thinking processes, he says, "seem to go off in different directions to reach conclusions, instead of focusing down one path."

More than anything, he feels a loss - a sense of having missed his youth. "I still go to Los Altos, to the old house where I lived (before the lobotomy). Go to the schools that I went to. I get out of the car and walk around. I'd do it daily if I had time. For some reason it fascinates me.

"I think it gives me an attachment to when I had a family," he says, clearing his throat. "A normal family life. Mom and dad and brothers. Because from 12 years on my life was not normal."

Throughout his 20s and 30s, Dully had problems with alcohol, drugs and homelessness. He went sober in 1985 and quit smoking in 1994 after a heart attack. In his 40s, he went back to school and got a degree in computer information systems but found he was too old to find work in that youth-centric market.

"I'll never get to where my brothers are, because I started at 40 and they started at 20. I lost 20 years. It happened too late in some respects. That's just the way it is."

Dully credits his wife, Barbara, with putting him on a positive track. They met 22 years ago and got married in 1995. Wedding pictures show them in gown and tux, astride matching motorcycles. Dully has two sons, 30 and 27, from an earlier relationship and has worked as a bus driver for 10 years. He's on a leave of absence from San Jose Charter Bus while he promotes his book.

"My Lobotomy" began as a radio documentary on NPR's "All Things Considered" in November 2005. Producers Dave Isay and Piya Kochhar intended a profile on Freeman but when they found Dully, who had recently started researching lobotomy on the Internet, they fell in love with his story. They decided to focus on him instead, and urged him to narrate the piece in his gentle, resonant baritone.

Isay and Kochhar took Dully to Freeman's medical archives at George Washington University in Washington, D.C. "My file has everything," he says in the narration. "A photo of me with the ice picks in my eyes, medical bills. But all I care about are the notes. I want to understand why this was done to me."

The NPR piece captures a conversation with Dully and his father, Rodney, a former schoolteacher who was later divorced from Lou. "I was manipulated, pure and simple," his dad says in regard to the lobotomy.

But when Howard breaks down and professes his love to his dad, his father answers, "Whatever made you think I didn't know that? You shaped up pretty good!" He doesn't say "I love you" back.

"Ever since my lobotomy I've felt like a freak," Dully says at the end of the broadcast. (But) I know my lobotomy didn't touch my soul. For the first time, I feel no shame. I am, at last, at peace."

The response to the broadcast was huge. So many e-mails flooded in that NPR's Internet server collapsed. Today, Dully says, there's interest from Hollywood producers to make a TV movie or feature film from his book. "I'd love it, provided it's done with truth. I don't want any fictional account making someone out worse than they were or better than they were."

There's also a playwright in New York who, inspired by the NPR documentary, has written a play about Dully called "The Memory of Damage."

Dully, who looks like a Buddha as he sits in his favorite coffee shop, seems to regard the celebrity as a cosmic joke. For someone who spent his life plagued by self-doubts, who says he's still intimidated by his father, it's difficult to accept this attention.

"I tease my wife and other people, and say I have a swollen ego," he chuckles. "But I don't have any news people camping outside my door. I don't live in any mansion.

"My idea for writing the book was first to get a little closure - which I find a little selfish, but that's OK. The other reason was to help people to think about how we treat each other daily. Not just loved ones but everybody.

"Something you start here or say here may affect somebody's whole day, maybe their whole life. Ten minutes of what Freeman did to me has affected me for 47 years."

Tuesday, September 25, 2007

Richard Feynman gets a psychiatric exam

As seen here, and which illustrates another reason why psychiatrists are not taken very seriously

I sit down at the desk, and the psychiatrist starts looking through my papers. “Hello, Dick!” he says in a cheerful voice. “Where do you work?”

I’m thinking, “Who does he think he is, calling me by my first name?” and I say coldly, “Schenectady.”

“Who do you work for, Dick?” says the psychiatrist, smiling again.

“General Electric.”

“Do you like your work, Dick?” he says, with that same big smile on his face.

“So‑so.” I just wasn’t going to have anything to do with him.

Three nice questions, and then the fourth one is completely different. “Do you think people talk about you?” he asks, in a low, serious tone.

I light up and say, “Sure! When I go home, my mother often tells me how she was telling her friends about me.” He isn’t listening to the explanation; instead, he’s writing something down on my paper.

Then again, in a low, serious tone, he says, “Do you think people stare at you?”

I’m all ready to say no, when he says, “For instance, do you think any of the boys waiting on the benches are staring at you now?”

While I had been waiting to talk to the psychiatrist, I had noticed there were about twelve guys on the benches waiting for the three psychiatrists, and they’ve got nothing else to look at, so I divide twelve by three–that makes four each–but I’m conservative, so I say, “Yeah, maybe two of them are looking at us.”

He says, “Well just turn around and look”–and he’s not even bothering to look himself!

So I turn around, and sure enough, two guys are looking. So I point to them and I say, “Yeah–there’s that guy, and that guy over there looking at us.” Of course, when I’m turned around and pointing like that, other guys start to look at us, so I say, “Now him, and those two over there‑and now the whole bunch.” He still doesn’t look up to check. He’s busy writing more things on my paper.

Then he says, “Do you ever hear voices in your head?”

“Very rarely,” and I’m about to describe the two occasions on which it happened when he says, “Do you talk to yourself?”

“Yeah, sometimes when I’m shaving, or thinking; once in a while.” He’s writing down more stuff.

“I see you have a deceased wife–do you talk to her ?”

This question really annoyed me, but I contained myself and said, “Sometimes, when I go up on a mountain and I’m thinking about her.”

More writing. Then he asks, “Is anyone in your family in a mental institution?”

“Yeah, I have an aunt in an insane asylum.”

“Why do you call it an insane asylum?” he says, resentfully. “Why don’t you call it a mental institution?”

“I thought it was the same thing.”

“Just what do you think insanity is?” he says, angrily.

“It’s a strange and peculiar disease in human beings,” I say honestly.

“There’s nothing any more strange or peculiar about it than appendicitis!” he retorts.

“I don’t think so. In appendicitis we understand the causes better, and something about the mechanism of it, whereas with insanity it’s much more complicated and mysterious.” I won’t go through the whole debate; the point is that I meant insanity is physiologically peculiar, and he thought I meant it was socially peculiar.

Up until this time, although I had been unfriendly to the psychiatrist, I had nevertheless been honest in everything I said. But when he asked me to put out my hands, I couldn’t resist pulling a trick a guy in the “bloodsucking line” had told me about. I figured nobody was ever going to get a chance to do this, and as long as I was halfway under water, I would do it. So I put out my hands with one palm up and the other one down.

The psychiatrist doesn’t notice. He says, “Turn them over.”

I turn them over. The one that was up goes down, and the one that was down goes up, and he still doesn’t notice, because he’s always looking very closely at one hand to see if it is shaking. So the trick had no effect.

Finally, at the end of all these questions, he becomes friendly again. He lights up and says, “I see you have a Ph.D., Dick. Where did you study?”

“MIT and Princeton. And where did you study!”

“Yale and London. And what did you study, Dick?”

“Physics. And what did you study?”


“And this is medicine ?”

“Well, yes. What do you think it is? You go and sit down over there and wait a few minutes!”

So I sit on the bench again, and one of the other guys waiting sidles up to me and says, “Gee! You were in there twenty‑five minutes! The other guys were in there only five minutes!”


“Hey,” he says. “You wanna know how to fool the psychiatrist? All you have to do is pick your nails, like this.”

“Then why don’t you pick your nails like that?”

“Oh,” he says, “I wanna get in the army!”

“You wanna fool the psychiatrist?” I say. “You just tell him that!”

After a while I was called over to a different desk to see another psychiatrist. While the first psychiatrist had been rather young and innocent‑looking, this one was gray‑haired and distinguished‑looking–obviously the superior psychiatrist. I figure all of this is now going to get straightened out, but no matter what happens, I’m not going to become friendly.

The new psychiatrist looks at my papers, puts a big smile on his face, and says, “Hello, Dick. I see you worked at Los Alamos during the war.”


“There used to be a boys’ school there, didn’t there?”

“That’s right.”

“Were there a lot of buildings in the school?”

“Only a few.”

Three questions–same technique‑and the next question is completely different. “You said you hear voices in your head. Describe that, please.”

“It happens very rarely, when I’ve been paying attention to a person with a foreign accent. As I’m falling asleep I can hear his voice very clearly. The first time it happened was while I was a student at MIT. I could hear old Professor Vallarta say, ‘Dee‑a dee‑a electric field‑a.’ And the other time was in Chicago during the war, when Professor Teller was explaining to me how the bomb worked. Since I’m interested in all kinds of phenomena, I wondered how I could hear these voices with accents so precisely, when I couldn’t imitate them that well … Doesn’t everybody have something like that happen once in a while?”

The psychiatrist put his hand over his face, and I could see through his fingers a little smile (he wouldn’t answer the question).

Then the psychiatrist checked into something else. “You said that you talk to your deceased wife. What do you say to her?”

I got angry. I figure it’s none of his damn business, and I say, “I tell her I love her, if it’s all right with you!”

After some more bitter exchanges he says, “Do you believe in the supernormal?”

I say, “I don’t know what the ‘supernormal’ is.”

“What? You, a Ph.D. in physics, don’t know what the supernormal is?”

“That’s right.”

“It’s what Sir Oliver Lodge and his school believe in.”

That’s not much of a clue, but I knew it. “You mean the supernatural .”

“You can call it that if you want.”

“All right, I will.”

“Do you believe in mental telepathy?”

“No. Do you?”

“Well, I’m keeping an open mind.”

“What? You, a psychiatrist, keeping an open mind ? Ha!” It went on like this for quite a while.

Then at some point near the end he says, “How much do you value life?”


“Why did you say ‘sixty‑four’?”

“How are you supposed to measure the value of life?”

“No! I mean, why did you say ‘sixty‑four,’ and not ‘seventy‑three,’ for instance?”

“If I had said ‘seventy‑three,’ you would have asked me the same question!”

The psychiatrist finished with three friendly questions, just as the other psychiatrist had done, handed me my papers, and I went off to the next booth.

While I’m waiting in the line, I look at the paper which has the summary of all the tests I’ve taken so far. And just for the hell of it I show my paper to the guy next to me, and I ask him in a rather stupid‑sounding voice, “Hey! What did you get in ‘Psychiatric’? Oh! You got an ‘N.’ I got an ‘N’ in everything else, but I got a ‘D’ in ‘Psychiatric.’ What does that mean?” I knew what it meant: “N” is normal, “D” is deficient.

The guy pats me on the shoulder and says, “Buddy, it’s perfectly all right. It doesn’t mean anything. Don’t worry about it!” Then he walks way over to the other corner of the room, frightened: It’s a lunatic!

I started looking at the papers the psychiatrists had written, and it looked pretty serious! The first guy wrote:

Thinks people talk about him.

Thinks people stare at him.

Auditory hypnogogic hallucinations.

Talks to self.

Talks to deceased wife.

Maternal aunt in mental institution.

Very peculiar stare.

(I knew what that was–that was when I said, “And this is medicine ?”)

Monday, September 24, 2007

Mental Hospital to Get Overhaul After Federal Funds Cut Off

Finally, an action that almost makes sense. Federal funds have been removed from a hospital that has a horrific track record in patient care. After all why should we reward the place with extra money if they have a track record of screwing it up? As seen in this report.

Broughton Hospital will be reorganized to increase staff supervision and patient safety after the federal government cut off funding for the mental health hospital, state health officials announced on Monday.

Health officials hope the reorganization will turn convince the federal Centers for Medicare and Medicaid Services to begin paying coverage for Broughton patients again. CMS cut off the funds on Aug. 25 after a probe into patient treatment at the Morganton facility.

"We cannot emphasize enough how seriously we take this matter, as well as our expectations that the prescribed actions are immediately undertaken to resolve the identified deficiencies," state health secretary Dempsey Benton and Mike Moseley, director of the state's mental health division, wrote in a memo to Broughton director Seth Hunt.

Federal funds were denied after two incidents involving patients.

In February, Anthony Lowery, 27, died while staff members, including one who laid across his chest, restrained him. On August 19, a patient who was supposed to be under close supervision fell. That patient has recovered.

Broughton will now give staffers more training on how to use physical restraints and how to prevent falls, said Dr. Michael Lassiter, psychiatrist who lead the review.

Supervision of clinical staff by clinical professionals will also be increased. Prior to the review, the lack of oversight meant nursing staff members did not report to the director of nursing, Lassiter said.

"The organization needs to be realigned, so that it is clear that the clinical team is supervised by professional staff that understands the role of clinical staff," Lassiter said. "We need to set up an organizational structure that empowers and enhances physicians' and nurses' oversight and accountability functions for clinical services."

Lassiter will lead the three-member reorganization team of nursing and administrative experts, which will report weekly to state health officials.

The team will conduct a mock CMS survey after the review, which is expected to last a month, and then request CMS look over the hospital's plan of correction.
I wonder what odds we should put on them getting their act together?

Sunday, September 23, 2007

Psychologists Shot Down Nine Times in 2007

Seen in this report

The National Psychologist reported in its Sept/Oct 2007 issue that prescription privileges bills to give psychologists prescription privileges in nine different U.S. states failed in each and every case. Most never left committee, reflecting the leadership’s unease of granting prescription rights to non-medical professionals.

The bills failed in Hawaii, California, Georgia, Illinois, Mississippi, Missouri, Montana, Tennessee and Oregon. It came closest to passing in Hawaii, but was vetoed by the governor when it reached her desk.

What’s at stake here?

Two powerful professional organizations — the American Psychological Association and the American Medical Association — butting heads over whether it is safe to allow psychologists, with additional medical training, to prescribe psychiatric medications.

Psychologists receive little or no formal training in medicine in their graduate studies today (as most physicians who are not psychiatrists receive little or no formal training in psychological theory and practices). If psychologists gained greater prescribing authority, they could rely less on medical doctors, such as psychiatrists, to prescribe common psychiatric medications.

Psychologists argue that there is a demand for such services in rural and areas throughout the country that currently do not have coverage by psychiatrists.

Doctors argue such privileges are already available to professionals who want them by undergoing medical school or similar training.

Psychologists believe they don’t need such intensive training because psychiatric medications are largely limited to affecting the mood, and don’t interact as much with other body systems.
As anyone who has looked into the side effects of psycho-active drugs knows, this last point is a woefully naive take on the situation. I can only imagine what additional horror stories await us if this were to go through.

The Suicide of a Former Psychologist Facing Child Pornography Charges

From this Press-Register News Report

A former north Alabama psychologist facing child pornography charges and his wife were identified Saturday as the couple who killed themselves Friday underneath a Gulf-front home in Baldwin County.

Michael Stephen Cometa, 59, and Keri Cometa, 45, of Trenton, Ga., died of self-inflicted gunshot wounds under the stilted duplex along Fort Morgan Road, according to Baldwin County Sheriff's Office spokesman Anthony Lowery.

Earlier that day, Michael Cometa failed to appear for an arraignment hearing in Huntsville's Madison County Circuit Court, said his attorney, Larry Morgan.

Cometa was accused of videotaping a nude 16-year-old girl in his office, Morgan said.

A report in The Huntsville Times, citing the indictment, stated that the girl was under 16, and police said she was a client.

Cometa was indicted in 2004 on six counts of producing child pornography and one count of possessing child pornography, according to online court records. The charges did not allege that Cometa had touched the girl in a sexual nature, Morgan said.

Cometa was free on bail pending his Oct. 29 trial, in which he faced life in prison, according to the attorney.

In March, after a bank foreclosed on Cometa's Huntsville home and he filed for bankruptcy, he and his wife moved to Georgia, and he did not renew his license to practice psychology, Morgan said.

"His life was absolutely turned upside down as a result of the whole incident," Morgan said. "He couldn't practice. His home was foreclosed. His wife was seriously ill."

Michael Cometa was the sole provider for his wife, and "if he had gone to prison, there would be nobody there for her," Morgan said.

Morgan said his client "was very remorseful and very contrite" over the charges he faced.

Cometa's previous wife committed suicide in 2003, Morgan said.

On the Web site, where people can anonymously review therapists, three comments were about Cometa. One was positive.

Another, posted by a 21-year-old named Courtney from Huntsville, said she started seeing Cometa when she was 16.

"He kept telling me I should be a model," Courtney wrote. "To make a long story short, one year later I am being called ... (by) an investigator to look at pictures of girls to see if I recognize them."

On Friday, a witness reported hearing two loud blasts, and the bodies were discovered at about 5 p.m. Inside a Jeep Grand Cherokee parked near the bodies, the couple left separate notes that indicated their suicide intentions, according to Lowery.

Investigators found two shotguns at the scene.

There was nothing to suggest the couple had ties to south Alabama, Lowery said. The two were not renting the vacation home.
Of course, following a old tasteless joke can also be read as This follows in the path of other unfortunate web site names

Symposium: Freud's legacy – does medication = healing?

An excellent satire and commentary in the World Net Daily about the state of modern psychiatry Here are some snippets:

Socrates (470-399 B.C.) was a famous Greek philosopher from Athens who taught Plato, and Plato taught Aristotle. Socrates used a method of teaching by asking questions. The Greeks called this form "dialectic" – starting from a thesis or question, then discussing ideas and moving back and forth between points of view to determine how well ideas stand up to critical review with the ultimate principle of the dialogue being veritas – Truth.

Socrates: We are gathered here today at my academy to discuss and hopefully resolve an exceedingly vexing societal problem: Are America's psychiatrists, psychologist and clinicians responsible doctors that promote healing, or licensed drug pushers that habitually over medicate their patients for craven expediency and crass monetary gain?

Psychiatric community: (collective gasp!) We didn't come here to be lectured to by you, Socrates! We are respected doctors of the community and will not have our integrity impugned by a mere philosopher.

Indeed. Before we begin this symposium, I would like to direct your attention to the recent case of Rebecca Riley, a 4-year-old little girl who tragically died Dec. 13, 2006, from a fatal overdose of medicines her parents administered to their child to treat her so-called bipolar disorder and attention deficit hyperactivity disorder, or ADHD, including clonidine, valproic acid, depakote, dextromethorphan and chlorpheniramine.

As if the death of their only child wasn't enough to endure, now the little girl's parents and their psychiatrist have been brought up on charges of murder. My question to the members of this symposium is this – does medication = healing?
After a delicious parade of psychiatric heroes who explain their therapies, admitting that each of their therapies give "no regard to morality, religion or the metaphysical realm" we reach the conclusion:
We have heard from the five psychological schools of thought and the primary progenitors of each school, which all advocate in one form or another what Freud proposed: 1) all talk; 2) all drugs; 3) more talk/less drugs; 4) less talk/more drugs; 5) no talk/all drugs; 6) shock therapy; and 7) hypnotherapy.


Dr. Freud, since you and your progeny prefer to treat the symptoms rather than the cause of your patients' mental illness, this catastrophic state of affairs has only led an entire generation of people who in my day would be considered "normal" children in need of a parent's loving care, attention and protection, to instead be manipulated for craven medical expediency and crass financial gain by these legalized drug pushers, and condemned to an early grave.
Worth Reading in full.

While they may protest that they avoid "discussions of morality, religion or the metaphysical realm" in order to be scientific, they can hardly claim any success when much if not most of their practice has had the success rate of doing nothing at all, or in fact has been harmful. And is it any wonder that when you avoid dealing with morality, you wind up trapped by the consequences of immoral actions?

Saturday, September 22, 2007

Study reveals 6,225 deaths due the effects of Paxil, Zyprexa, Risperdal, and Clozaril.

Recently a study was published in the Archives of Internal Medicine regarding "Serious Adverse Drug Events Reported to the Food and Drug Administration, 1998-2005".

The abstract reports that

From 1998 through 2005, reported serious adverse drug events increased 2.6-fold from 34 966 to 89 842, and fatal adverse drug events increased 2.7-fold from 5,519 to 15,107. Reported serious events increased 4 times faster than the total number of outpatient prescriptions during the period. [...]

For 13 new biotechnology products, reported serious events grew 15.8-fold, from 580 reported in 1998 to 9181 in 2005. The increase was influenced by relatively few drugs: 298 of the 1489 drugs identified (20%) accounted for 407,394 of the 467,809 events (87%)
This is alarming in itself. But then, if you get to read the actual report, there's more. As noted by the Furious Seasons weblog (who managed to get a copy of the study and put it online) there is more damaging information in the report:
What the media failed to report is that Zyprexa, Risperdal, and Clozaril, three atypical antipsychotics, and Paxil, an SSRI anti-depressant, were tied to the deaths of 6,225 Americans from 1998 to 2005. These numbers are shocking and far outpace estimates I've run into previously. That this data was not reported by the media is inexcusable, given the millions of Americans--and others around the world--who take these four drugs.


Since news broke around Zyprexa last year and accusations that its maker, Eli Lilly, had downplayed and covered up known injuries caused by the drug, the media has not provided an accounting of how many people died as a result of taking the drug. For my part, I downplayed the numbers I ran across in press accounts and in the Zyprexa documents. I didn't want to cast false aspersions.

But, now, I can say this:
  • Eli Lilly, your drug killed 1,005 Americans.
  • And, Janssen/J&J: your drug killed 1,093 Americans.
  • GSK and makers of generic Paxil: you guys make a drug that killed 850 Americans.
  • As for Novartis, makers of Clozaril, and whomever makes its generic form: you asshats killed 3,277 Americans.
The doctors who prescribed these drugs are just as responsible, ethically if not legally.

And I have a question for you guys: How's it feel?

Excepting Paxil, each of these drugs killed more people than Vioxx, which claimed 932 lives, according to the study. Vioxx was pulled from the market in 2004, following intense publicity around its association with heart attacks. Some estimates of deaths related to Vioxx go as high as 55,000 deaths, but I don't know how solid those numbers are.

So why is it that the New York Times was virtually alone in reporting on Lilly's attempts to downplay problems with Zyprexa and accusations that it marketed the drug off-label? The documents were in the hands of NPR, the Wall Street Journal, and the Washington Post--and yet these media giants remained largely silent. Wimps.
We can only agree with the sentiment

Protesting Conflicts of Interest in Psychiatry

An interesting letter to the editor in Psychiatric News regarding Conflicts of Interest, by Alan Stone, M.D. - Cambridge, Mass.

At our APA annual meeting in San Diego in May, I attended a symposium that continues to trouble me. It was unlike any other APA symposium I have attended over the past 40 years.

Various speakers presented different kinds of evidence about the ways large pharmaceutical houses distort the results of clinical trials and mislead psychiatrists about the relative merits of their products. One shocked clinician finally asked the question that I imagined was on everyone's mind—I paraphrase her words, "How am I to sort my way through all this misinformation so I can do what is best for my patients?" One of the speakers suggested that she subscribe to his independent newsletter. But the reality is that most ordinary practitioners continue to be awash in misinformation.

Perhaps the most troubling moment for me came when the discussant for the symposium, one of the most distinguished psychiatrists in the world, put the various presentations in perspective. What it boiled down to was that huge sums of money are at stake, it is a high-risk industry, and the pharmaceutical companies are not entirely evil. Most experts who know anything and whose opinions are worth having will be retained by drug companies, so the legalistic approach of focusing on conflicts of interest will eliminate only the knowledgeable experts from decision-making panels.

All this I had heard before, but then he confirmed a shocking and fraudulent practice of misinformation that one of the presenters had described.

Drug companies control their own clinical research, have it written up by science-writing firms created for that purpose, and then shop it around to find an academic with the right credentials to be the first author. The academic's resume grows, the career prospers, more captive experts are created, and the drug company plants more misinformation in our journals.

Other psychiatrists at the symposium seemed well aware of this fraudulent collaboration; I was not. But when the symposium discussant acknowledged that he had himself been asked to participate in this kind of obvious deception, I was compelled to believe it exists. The discussant then said, "We all know who is doing it, and the solution is to shame them." I am not one of the "we" who knows who the academics are who have done this or who are doing it, but surely it is an offense equal to plagiarism.

Unfortunately the discussant did not identify any of the offenders who have done or are doing this, so to my knowledge the shaming did not begin at that May symposium in San Diego. I would therefore like to remind the "we who all know" that section 2 of APA's principles of ethics require us to "strive to report physicians. . .engaging in fraud or deception to appropriate entities."

Someone once said about the medical profession that medical etiquette is more important than medical ethics. Unless the shaming begins, that damning judgment will once again be proven correct.

Friday, September 21, 2007

Advertising Allies Turn Tide for Pharma

As seen in the WSJ Health Blog

A provision to empower FDA to yank consumer drug ads was stripped from the final version of an FDA bill, which was passed yesterday.

But it wasn’t Big Pharma that carried the day on the revision; it was the Gucci-loafered lobbyists for media and advertising firms.


Some in the advertising industry were concerned that giving FDA broad powers to block ads would lead to other government ad restrictions. “People just looked and they were incredulous,” says Harry Sweeney, chairman of Dorland Global Corp., a health marketing and communications firm that is a unit of Huntsworth PLC. “You’re getting into a very slippery-slope area.”
But of course, they were really just protecting their profits all along.

Exercise on par with drugs for aiding depression

It seems that the big drug companies have something to fear from the fitness craze. After all, all these people running around being healthy or getting healthy won't need the drugs to control the depression they won't have. As seen in this Reuters news report.

Regular exercise may work as well as medication in improving symptoms of major depression, researchers have found.

In a study of 202 depressed adults, investigators found that those who went through group-based exercise therapy did as well as those treated with an antidepressant drug. A third group that performed home-based exercise also improved, though to a lesser degree.

Importantly, the researchers found, all three groups did better than a fourth group given a placebo -- an inactive pill identical to the antidepressant.

While past studies have suggested that exercise can ease depression symptoms, a criticism has been that the research failed to compare exercise with a placebo. This leaves a question as to whether the therapy, per se, was responsible for the benefit.

The new findings bolster evidence that exercise does have a real effect on depression, according to the researchers.

Doctors may not start widely prescribing exercise as a depression treatment just yet. But for patients who are motivated to try exercise, it could be a reasonable option, the study authors say.

"If exercise were a drug, I'm not sure that it would receive FDA approval at this time," noted study author Dr. James A. Blumenthal, a professor of medical psychology at Duke University Medical Center in Durham, North Carolina.

"But," he told Reuters Health, "there is certainly growing evidence that exercise may be a viable alternative to medication, at least among those patients who are receptive to exercise as a potential treatment for their depression."

The study, published in the journal Psychosomatic Medicine, included 202 men and women age 40 and older who were diagnosed with major depression. They were randomly assigned to one of four groups: one that worked out in a supervised, group setting three times per week; one that exercised at home; one that took the antidepressant sertraline (Zoloft); and one that took placebo pills.

After 16 weeks, the patients completed standard measures of depression symptoms.

By the end of the study, Blumenthal's team found, 47 percent of patients on the antidepressant no longer met the criteria for major depression. The same was true of 45 percent of those in the supervised exercise group.

In the home-based exercise group, 40 percent had their symptoms go into remission. That compared with 31 percent of the placebo group.

There are several theories on why exercise might improve depression. For example, physical activity seems to affect some key nervous system chemicals -- norepinephrine and serotonin -- that are targets of antidepressant drugs, as well as brain neurotrophins, which help protect nerve cells from injury and transmit signals in brain regions related to mood.

Exercise may also boost people's feelings of self-efficacy and promote positive thinking. Some experts speculate that group exercise, with its social aspect, may have added benefits.

Though the home exercise group in this study did better than the placebo group, it's not clear whether it's as good as supervised classes, according to Blumenthal. "Home exercise may be more convenient," he noted, "but patients not push themselves as hard on their own."

He added that supervised exercise may also be safer for some people, such as those with heart disease.

SOURCE: Psychosomatic Medicine, September 2007.

The Hand Seen Behind Alarmist Suicide Statistics

A column by Martha Rosenberg

Long before the New York Times reported this month that youth suicides were up 8% from 2003 to 2004 and experts blamed an "antidepressant deficiency" big pharma was trying to plant the story.

There's too much money in diagnosing children with major psychiatric illnesses and keeping them on psychotropic drugs their whole lives to let a little thing like the black box warnings the FDA imposed on antidepressants for children in 2004 ruin sales.

After all this is a nation that believes that children are born with a Ritalin deficiency, insomnia is Ambien deficiency and old age is hormone deficiency. Why shouldn't pharmacology trump biology with suicide statistics as well?

Last year an article in the June issue of PLoS Medicine set the stage.

Lead author Dr. Julio Licinio, a consultant to Prozac-maker Eli Lilly, found the U.S. suicide rate "dropped steadily over 14 years as sales of the antidepressant [Prozac] rose."

It was followed by an article in April in the Archives of General Psychiatry by four representatives of a private "drug development services" company called Quintiles Transnational and four other authors expressing concerns that "the number of children and teenagers who were prescribed antidepressants has decreased significantly" underlining "the importance of presenting a fair balance within the media." ("Impact of Publicity Concerning Pediatric Suicidality Data on Physician Practice Patterns in the United States")

And in February a MedPage Today article actually scooped the New York Times with the headline, "Teen Suicide Spike Linked to SSRI Black Box."

Black box warnings create a barrier to treatment "by scaring young people and parents away from care," said David Shern, Ph.D., president of Mental Health America, reported to have accepted $3.8 million from pharmaceutical companies in 2005, in a statement when the article broke.

Charles Nemeroff, M.D., Ph.D., of Emory University School of Medicine took it a step further.

"The concerns about antidepressant use in children and adolescents have paradoxically resulted in a reduction in their use, and this has contributed to increased suicide rates," he told reporters. Dr. Nemeroff has links to Eli Lilly, Pfizer, Wyeth-Ayerst, Pharmacia-Upjohn and five other drug makers according to published reports.

Unfortunately for pharma, when the New York Times broke the story it had a short shelf life.

The rise in suicides among ages 10 to 24 in 2003 to 2004 stood. But the charge that the rise was due to a drop-off in antidepressant prescriptions, especially selective serotonin reuptake inhibitors (SSRIs) like Prozac, which came from an article in the September American Journal of Psychiatry, promptly fell on its head.

It turned out the drop in SSRI prescriptions that "caused" the suicide rise occurred the following year. In most of the year cited, SSRI prescriptions actually "rose an average of just over 10 percent" for those 18 and under according to Psychiatric News and "the number of prescriptions peaked in March 2004."

Meanwhile preliminary Centers for Disease Control and Prevention statistics from the year that would have been influenced by a drop in SSRI prescription that occurred--2005--do not show deaths up, though they have not been broken into category. See what others are saying and join the discussion at our Forum

Asked about the 180% turnaround in facts which meant the suicide rise was not caused by SSRI prescription drop-offs and possibly caused by SSRIs themselves, vindicating the FDA's black boxes, the article's lead author Robert D. Gibbons, Ph.D., a professor of biostatistics and psychiatry at the University of Illinois at Chicago, did not sound the statistician.

"This study was suggestive, that's what we're saying," Dr. Gibbons told the Times in a follow-up story--"Early Evidence on the Effects of Regulators’ Suicidality Warnings on SSRI Prescriptions and Suicide in Children and Adolescents" is suggestive? try conclusive--and should piggyback off previous studies that showed the links… better.

Then why publish it?

There were other question marks about the American Journal of Psychiatry article too--not counting Pfizer's financial contribution and Dr. Gibbons link to Wyeth Pharmaceuticals.

What if the suicides aren't about SSRIs at all but the growing popularity of treating children with antipsychotic drugs?

"I would be absolutely certain that the increase is not because kids are not being treated," says David Healy, M.D., a psychiatrist at the University of Cardiff and early critic of SSRIs. "They may not be getting SSRIs, but they are getting psychotropics," he says and, "the antipsychotic 'mood stabilizers' have just as great an increase in suicide risk as antidepressants--if not greater."

Pharma is probably working on a new round of articles on the topic right now.

Thursday, September 20, 2007

Penalties in patient's suicide questioned

From the Denver Post

Five state employees were disciplined after the death of a mentally handicapped man at the Wheat Ridge Regional Center, but an attorney for the family questions whether the right people were punished.

One employee resigned in lieu of termination, two received 5 percent pay decreases for six months, one was counseled on employee expectations and another received a performance memo, according to information provided after an open-records request.

Brian Mattingley, 27, hanged himself at the center in the early morning of Dec. 17, 2005, after a long history of suicide threats and attempts, according to a lawsuit filed in August.

The lawsuit names the center's director, Sharon Jacksi, and an on-call psychologist in training, Joycelyn Lee, but Colorado Department of Human Services spokeswoman Liz McDonough said neither was disciplined.

Lee, who is still working under a licensed psychologist because she doesn't have her license, was a contract employee in 2005 but has since been hired full time, McDonough said.

Attorney Peter Harris, who filed the lawsuit for Mattingley's mother, Terri Wolfe, said Lee and Jacksi should have been disciplined. "If you're in charge, it falls underneath you," he said. "There should have been some sort of discipline. I think it's an institutional problem there."

McDonough disagreed. "It was a horrible tragedy, but based on review we did, we felt we held the appropriate people accountable," she said.

The lawsuit claims that staff failed to properly supervise Mattingley despite his care plan, which required wellness checks every 30 minutes. Lee spoke to Mattingley that evening, but she said he did not threaten suicide, the lawsuit says.

Harris said Lee should have done more than just talk to Mattingley by phone, considering his history.

McDonough said Lee was not disciplined because she was not told that Mattingley threatened suicide the night he died.

The document released by DHS lists the punishments handed out.

Stacey Larrabee, a health care technician at the center, was placed on administrative leave and resigned in lieu of termination in January 2006. She failed to perform bed checks.

Mary Pearson, a licensed psychiatric technician, was docked 5 percent pay for six months for false documentation of medication and failure to do visual checks between shifts. She has since retired, McDonough said.

Carla Juarez, a residential coordinator, also was docked 5 percent pay for six months, removed from the position of residential coordinator in training and made ineligible for promotion for a year for failure to do visual checks.

Joe Martinez, a health care technician, was counseled on employee code of conduct and job expectations because he did a solo check at shift change instead of doing so with another tech. McDonough said he has since left the center.

Carin Hagman, a licensed psychiatric technician II, received a performance memorandum for failing to inform Lee of Mattingley's suicide threats.

Children aged just 12 being put on adult mental wards

From this report seen in the Scotsman

Children as young as 12 are being forced into adult psychiatric wards due to bed shortages, leaving them exposed to sexual predators and seriously disturbed patients, a medical watchdog has warned.

The adolescent patients, many at risk of suicide, are not receiving specialist treatment in Scotland due to a lack of in-patient facilities.


New figures seen by The Scotsman show there were 186 admissions for children with mental health problems across Scotland in 2006-7, and 171 of those were treated on an adult ward.

Doctors have raised the issue of public safety, claiming that there is increasing pressure to discharge adolescent patients who may be a risk to themselves and others.


"There is a risk of sexual predators in these units, but also a risk of general violence and drugs," said Mr Malcolm.

"There are 171 children being admitted every year in Scotland to an adult unit, which is unacceptable. Children as young as 12 are being admitted."


A shocking report by the charity, Childline, earlier this year revealed hundreds of girls had contacted the helpline after contemplating suicide.

According to the counselling service, four out of every five calls UK-wide involved discussions with girls about their suicidal feelings, with about 1,100 Scots children calling to discuss mental health issues such as depression.

Childline counsellors have called on the government to tackle the shortages of specialist therapists to help troubled children through exam stress, family troubles and eating disorders.

Research shows an alarming decline in the mental health of UK adolescents, with rates of depression and anxiety increasing by 70 per cent in the last 25 years.

The number of teenagers being treated for mental health problems in Edinburgh has soared by nearly a quarter in just three years.

Medical experts have blamed growing stress related to exam results and divorce for contributing to the huge rise.

Minnesota psychiatrist reprimanded by Medical Board

From the Star Tribune

Dr. Larry Berger, an Eden Prairie psychiatrist, has been reprimanded by the Minnesota Board of Medical Practice for having an improper sexual relationship with a former patient.

Berger, 56, was cited for inappropriate conduct in a settlement agreement he reached with the board.

According to the agreement released Wednesday, Berger and a former patient he had treated irregularly for six years started chatting anonymously on the Internet in January 2005. He had treated the patient for the last time about eight months earlier, according to the board document.

After the patient and Berger decided that their physician-patient relationship had ended, they commenced a sexual relationship.

In January 2006, the board received a complaint about Berger.

Board officials said there are no specific rules regarding personal relationships between doctors and patients. If a complaint is made, the disciplinary board determines whether such relationships are inappropriate on a case-by-case basis, officials said.

The board takes into consideration the vulnerability of the patient and the speciality of the physician. Some specialities, like psychiatry, may be held to a different standard than others, officials said.

As part of the settlement, Berger agreed to take an education course on personal boundaries, meet quarterly with a board member and pay a fine of $1,620.

Psychiatrist with drug conviction loses Delaware medical license

From The News Journal

Adam Scioli, a psychiatric resident hired by the Delaware Psychiatric Center in early July who had a previous felony drug conviction in Pennsylvania and a suspended Pennsylvania medical license, lost his Delaware medical license last week.

Scioli had been a resident at Temple University until Nov. 2, 2004, when he was arrested for selling a potential date-rape drug to an undercover police officer.

Scioli was sentenced to two months in jail and then placed on probation until 2010, according to court records. But on July 1, Scioli began a new residency program in psychiatry at DPC.

On Thursday, at a public hearing of a legislative committee investigating DPC, Dr. Gerard Gallucci, medical director for the Division of Substance Abuse and Mental Health, told lawmakers that he had been responsible for hiring Scioli.

After a story about Scioli was published, James Collins, director of the state Division of Professional Regulation, said Scioli’s medical license was “erroneously issued” and may be annulled.

This week the status of Scioli’s Delaware medical license changed from “active” to “null and void.”

“The Division’s proposed course of action to annul the license issued to Dr. Adam Scioli became moot based upon information that Dr. Scioli is no longer employed at the facility for which the license was issued,” Collins told The News Journal in an e-mail.

Scioli’s Delaware medical license, Collins said, was a training license, and therefore was “institution-specific.”

The News Journal has not been able to contact Scioli, despite messages left with his friends and attorney.

Last month, Sen. Robert I. Marshall, D-Wilmington West, sent a letter to the president and members of the Board of Medical Practice and the Division of Professional Regulation, who oversee how physicians and other medical professionals are licensed in the state.

Marshall, a longtime patients’ rights advocate, included draft legislation that could slightly alter the requirements of applicants for physician licenses.

Marshall’s bill would change the wording of the state code governing background checks for physician license applicants, requiring the board to actually possess the applicant’s criminal background checks before issuing a license.

The proposed legislation, Marshall said, would not alter or remove the discretionary power of the board.

“I’m looking forward to early action in January, to see the bill move forward in the Senate, hopefully move through the House, and onto the governor’s desk,” Marshall said last month.

Parents convicted of caging adopted kids sue social workers, sheriff's deputies

Original reports say that these parents had caged their children based on the advice of a psychiatrist. The private agencies that reviewed the couple’s home life before the adoptions gave them “glowing reports". While there were some interesting discussions, in the end they were found guilty, although the psychiatrist seems to have disappeared.

Now they are filing a lawsuit against the social workers who entered their home to remove the children. This is NOT for giving the parents bad advice or improper direction. Note also that they are not going after the shrink whom they said advised them in this course of action. Snippet from the Columbus Dispatch

A couple convicted of forcing some of their 11 adopted children to sleep in cages have sued county social workers and other officials in federal court, accusing them of illegally entering their home.

Michael and Sharen Gravelle claim in the lawsuit that Huron County social workers and sheriff's deputies violated their constitutional rights when their special-needs children were removed from the home in 2005. The officials had received a tip about children sleeping in cages.
Never mind little facts like the sheriff protecting the children or enforcing the law....

And never mind the destruction apparently wrought by a psychiatrist who handed out bad advice, and who seems to have slipped away into the night....

Wednesday, September 19, 2007

Texas cases of mothers accused of killing kids

While we have previously covered cases from Texas, amd most recenty the sad case of Alysha Green, we came across the following news story regarding a series of mothers who had turned on their children. It is our personal opinion and suspicion that closer inspection will reveal that these poor people were each plagued by the side effects of psychiatric drugs, or the horrors of the withdrawal symptoms of these drugs. As seen here.

In the latest Texas case of a mother who apparently turned on her children, Alysha Green is accused of dousing her three daughters with gasoline and setting them on fire last weekend. She faces a capital murder charge after her 3-year-old died, and she has been charged with two counts of serious injury to a child as her 5- and 7-year-old daughters remain hospitalized.

Here are some high-profile cases of Texas mothers who killed their children:

  • Andrea Yates drowned her five children, ages 6 months to 7 years, in the bathtub of their Houston-area home in 2001.

  • Dee Etta Perez shot her 10- and 9-year-old sons and 4-year-old daughter and wounded her estranged husband before killing herself in her Hudson Oaks home in 2002.

  • Deanna Laney beat her 8- and 6-year-old sons to death with rocks and injured her 14-month-old son in East Texas in 2003.

  • Lisa Ann Diaz drowned her 5- and 3-year-old daughters in a Plano bathtub in 2003.

  • Dena Schlosser severed her 10-month-old daughter's arms with a kitchen knife in 2004 at the family's Plano apartment near Dallas.

  • Gilberta Estrada hanged herself and her four children — ages 8 months to 5 years — in their Hudson Oaks mobile home in May. Only the youngest survived.

  • Andrea Roberts shot her husband and 11- and 7-year-old children to death before killing herself last month in the Dallas suburb of Flower Mound.
As noted by the SSRI Stories Website regarding Alysha Green, and which may very well be true of the others ...
If this tragic case follows the usual scenario, then Alysha Green was given an antidepressant, became manic and/or psychotic, was diagnosed with bipolar disorder and then given an antipsychotic, a mood stabilizer, an antidepressant and an anti-anxiety medication.

Withdrawal from any one of these toxic substances can be a nightmare, so withdrawal from this kind of drug cocktail is beyond description. Almost 3% of the population in the U.S. is now diagnosed with bipolar disorder [Pharmaceutical Business Review: Nov. 21, 2006]. Consequently, the dangers to the public of the toxic drug cocktail for bipolar disorder, both while on it and while withdrawing from it, are enormous

Psychologist to creative women: sorry, you're freaks

We came across this item, a long and convoluted presentation on the nature of men, which half reads as a reasoned attempt by someone missing an essential point trying to justify their own set of peccadilloes.

via this reaction to the speech: Psychologist to creative women: sorry, you're freaks, quoted here, and which starts off a discussion worthy of reading on it's own:

Only read Is There Anything Good About Men? if you want to be enraged.

Highlights for my purposes: pits black men against middle-class white women and judges the black men better -- oops, more creative -- because there is of course only one relevant dimension in creativity, and because we have such stunningly good records of what women created that didn't find a commercial marketplace. Black women -- they don't exist in this account, it turns out. Or at least there was just no opportunity to evaluate their (lack of) creativity. Women in general are just off having babies instead, for lack of interest in other things.

Maybe it's ordinary that a psychologist doesn't know history or feminist theory (and thus thinks that feminism is the ideology that promotes women and men as natural enemies, and that sexism and oppression cannot exist in structures but only in conscious mental decisions), but it's sure depressing.

This was a speech at the American Psychological Association.

A Commentary on the Dangerousness of a Certain Psychiatrist

An interesting commentary on the dangerousness of a certain psychiatrist, Dr. Eileen Bazelon, as seen in this blog entry - the comments are also a worthy read. This is interesting and certainly worth further investigation given Bazelon's membership in a number of patient's rights organizations.

I didn’t know her name when I was a student at Bryn Mawr College and was in a deep depression my senior year, but I knew the reputation of my college’s psychiatrist and I knew that for me to seek psychiatric help as a student was to risk expulsion, loss of all my hard work thus far and even deeper depression. So despite the fact that I was unable to get myself to go to classes or do any work or even eat except once a day in the evening, I never walked over to the health center because I was not willing to risk losing everything.

I decided it was better to risk losing my life than losing my diploma. In the end a wonderful professor, now gone, walked over to my dorm room and offered to call my parents for me and my dean and did so. The late Katrin Burlin saved me. But she knew better than to refer me to the Health Center (than known as the Infirmary if I recall correctly) too.

I never thought about why she didn’t refer me there until later, but I had been accepted to an Ivy League University for graduate school with a full scholarship and stipend and being expelled by the college’s psychiatrist would have put an end to that.

I am disappointed and angry that the same psychiatrist is hosting a conference on what to do about “dangerous” behavior on campus now.

From all I have heard from more recent graduates, students at Bryn Mawr still have to fear expulsion for being mentally ill and apparently Dr. Bazelon not only does not feel confidentiality is an issue in cases of need to warn but also when she feels like sharing patients/students’ confidential medical information with her daughter as soon after Virginia Tech’s tragedy, her daughter wrote an article for an online publication that gave confidential details of the cases of two expelled former students.

Here I am on the Commitment Taskforce of the Supreme Court Justice’s Commission on Mental Health Law Reform all these years later with kidney failure from forced and abusive psychiatric treatment and fear of forced treatment; and the psychiatrist in chief at my alma mater is still working to undermine the rights and the confidentiality of women with psychiatric illness.

How sad.

How scary.

How maddening.

Too bad I already pledged for this year’s alumnae fund.

Conference Asks: What Should Colleges Do About Dangerous Behavior on Campus?

Inspired by the shootings at Virginia Tech, Bryn Mawr resident psychiatrist Eileen Bazelon ‘65 has convened a group of nationally recognized experts to discuss the law and ethics of balancing students’ right to privacy against their own safety and that of their communities. The one-day conference, to take place in Thomas Great Hall on Monday, Sept. 24, is open to college and university administrators, counselors, deans, security officers, legal counsel and other interested parties.
Full story:

Tuesday, September 18, 2007

Youth Suicide Rates Up? Not So Fast

We have previously looked at the 2004 increase in youth suicides, falsely blamed on a decrease of antidepressant prescriptions. Now someone has looked at the numbers in detail:

The headlines read, "Highest increase in youth suicide" and "girls aged 10-14 increased 75%." And of course, the only explanation anyone seems to want to debate is antidepressants: was it too many prescriptions, or too few? And self-righteous indignation all around.

Well, I did something apparently no one else cares to do: I looked up the individual suicides. They are individuals, right? With different reasons for doing things? And guess what? I have another explanation: Ohio.

The year in question is 2004, the most recent year the data is available. I focused on girls aged 10-14, because that's what the majority of the news articles focused on. Most reports described an increase of 75%, from 56-94. I actually found 98 total suicides in this group.

If antidepressants had any effect-- in either direction-- then the increase should have been spread out throughout the country.

Most states had very few suicides in this demographic. Maine had zero. North Carolina had 1. Oregon, 1. Florida, 1. Etc. These small numbers are generally unchanged from 2003. California, which had the one of the highest absolute number of suicides, had 6 in 2003, and 7 in 2004.

If you look at Ohio, however, you see something interesting. In 2003, there were no suicides. In 2004, there were 11.

Indiana was next: 0 in 2003, 6 in 2004.

This, of course, speaks to the problem of medicine’s over-reliance on epidemiology. People are different, and even “matched controls” have such variability that association studies are often nearly useless. This is even more true in psychiatry. Suicide is not an involuntary pathogen, it is a complex, volitional behavior whose causes can only be meaningfully investigated at an individual level.

I have to go back and look closely at all the states' data, etc. But it seems to me that when two small states account for almost half of the entire increase in the suicides, we should stop talking about antidepressants and maybe go find out what the hell happened over there?
Those blessed with an evil wit will point out the preponderance of political advertising in Ohio during that elections year. The more cynical will point to the arrival of Teen Screen on the scene in Ohio at about this time, something that might or might not be relevant.

Burned Alive - The Tragic Side Effect of Another Psychiatric Drug Withdrawal

A tragic case of the side effects associated with psychiatric drug withdrawal, as seen in this report from CPS 11 in Dallas/Forth Worth

A court hearing was held Monday to find out the fate of three little girls who were allegedly set on fire by their mother.

Police say 29-year-old Alysha Green admits to setting her children on fire.

According to court documents filed in juvenile court, Green had been diagnosed with bipolar disorder.

According to the woman's husband, Green had stopped taking her medication and over the last three weeks her condition had diminished. Adam Green had little comment about the day's court proceedings, and simply asked for prayer for his children.

A family member told CBS 11 News that only one of the three injured girls is conscious. Seven-year-old Adamiria is said to be awake and talking with family members. As of Monday afternoon 3-year-old Arianna was on life support with burns over 90-percent of her body. Doctors put the girl's 5-year-old sister, Alexandria, in a medically induced coma. She has burns over 57-percent of her body.

After the three girls were pulled out of a burning house, the scorched 7-year-old screamed, "Why mommy? Why mommy? Why did you do this to me?" said a neighbor who helped the girls.

As rescuers tended to the girls their mother told a fire investigator that she doused them with gasoline and set them on fire, neighbor Kevin Lopez said Monday, two days after the fire.

"She was crying and saying, 'I'm sorry' and she didn't know why she did it," Lopez told The Associated Press.

In 911 calls released Monday terrified witnesses could be heard at the scene. During one emergency call a woman can be heard screaming in the background.

Police would not confirm neighbors' accounts of the events or fire officials' earlier statements that Green put her daughters in a closet, poured gasoline on them and herself and set them on fire.

On Monday, a row of balloons, teddy bears, flowers and candles lay in the front yard of the wood and tan brick house. Someone placed a sign that read, "Get well soon; we are praying for you" by a front window. A doll house, small purple plastic car, pink scooter and pink bicycle were by the front porch.

On a boarded side window, soot was visible on the window sill and a faint odor of smoke was in the air.

Also Monday, Child Protective Services filed a lawsuit to get temporary custody of the children. The courts granted the request, which among other things gives CPS power to make decisions about the girl's treatment at Parkland Hospital.

"As the temporary managing conservator CPS certainly has the legal authority to be making medical decisions, but at this point they have clearly indicated that they expect the father to play the key role," said James Teel, Tarrant County Assistant District Attorney.

Green, who is also being treated for burns at Parkland Hospital, has been arrested on three counts of suspicion of injury to a child. If convicted of the first-degree felony, Green could face up to life in prison.
As noted by the SSRI Stories Website
If this tragic case follows the usual scenario, then Alysha Green was given an antidepressant, became manic and/or psychotic, was diagnosed with bipolar disorder and then given an antipsychotic, a mood stabilizer, an antidepressant and an anti-anxiety medication. Withdrawal from any one of these toxic substances can be a nightmare, so withdrawal from this kind of drug cocktail is beyond description. Almost 3% of the population in the U.S. is now diagnosed with bipolar disorder [Pharmaceutical Business Review: Nov. 21, 2006]. Consequently, the dangers to the public of the toxic drug cocktail for bipolar disorder, both while on it and while withdrawing from it, are enormous

Monday, September 17, 2007

FDA announces study to find out if ADHD and ADD medications raise the risk of heart attack and stroke

From the WSJ Health Blog: The federal government will fund a $4 million analysis of a giant pool of data to tease out whether ADHD and ADD medications raise the risk of heart attack and stroke, the FDA said today.

Two U.S. Department of Health and Human Services agencies will collaborate in the most comprehensive study to date of prescription medications used to treat attention deficit hyperactivity disorder (ADHD) and the potential for increased risk of heart attack, stroke or other cardiovascular problems.

Researchers supported by the Agency for Healthcare Research and Quality and the U.S. Food and Drug Administration will examine the clinical data of about 500,000 children and adults who have taken medications used to treat ADHD, to determine whether those drugs increase cardiovascular risks.

Because medications used to treat ADHD can increase heart rate and blood pressure, there are concerns about the drugs' potential to increase cardiac risks. It is also thought these risks may be different for adults and children, but more evidence is needed about the long-term effects of using ADHD medications.

The planned analysis follows an FDA-sponsored preliminary study that compiled information from large health care databases on prescription drug use, inpatient care, outpatient treatment, and health outcomes, including death. Based on that effort, researchers identified people who took ADHD drugs during a seven-year period ending in 2005. AHRQ, which sponsors research on clinical effectiveness and safety, will team with FDA to complete the analysis of the data.


The study will be coordinated by Vanderbilt University researchers on contract through AHRQ's Effective Health Care program. Data analysis will be performed by researchers at Vanderbilt, Kaiser Permanente of California, the HMO Research Network and i3 Drug Safety, as well as from FDA and AHRQ. The analysis will include all drugs currently marketed for treating ADHD. The study will analyze the risks of all the drugs as a whole, and risks of the drugs grouped by class.

The analysis will take about two years to complete. Results are expected to be important not only to patients, their families and health care providers, but also to government insurance programs. Medicaid, Medicare, and the State Children's Health Insurance Program provide reimbursement for drugs prescribed for ADHD. This information could also be used to inform product labeling, which is used by health care providers when making treatment decisions.


Use of ADHD drugs has increased in recent years among children and adults. A recent AHRQ analysis of medication expenditures found three ADHD drugs—Concerta, Strattera, and Adderall—ranked among the top five drugs prescribed for children ages 17 years and younger. About $1.3 billion was spent on those drugs in 2004, the study estimated. Adult use is also believed to be increasing.

In May 2006, based on a review of anecdotal reports of heart attack, stroke and sudden death among patients taking usual doses of ADHD medications, the FDA asked drug manufacturers to revise product labeling to reflect concerns about possible adverse events. Drug manufacturers have created patient Medication Guides for individual products to help patients understand risks.


For more information:

FDA News—ADHD Medications and Cardiovascular, Psychiatric Adverse Events