Friday, November 30, 2007

The Psychologists and Gitmo

Recently a major 2003 Guantanamo Standard Operating Procedures [SOP] manual was posted on the wikileaks web site. Ignored by most major sources for a week, Reuters, has picked up on the leak Thursday (Nov 15) and the New York Times on Friday (Nov 16). This has lead to among other things an interesting article in Harper's Weekly attacking the APA:

Of all the major professional organizations addressing the torture and prisoner abuse issue, one has an unbroken record of clear ethical evasion. It has adopted a new professional mantra, it seems: hear no evil, see no evil, speak no evil.

Just a few days ago Major General Geoffrey Miller’s operations manual for Guantánamo was posted on the internet. It got a lot of attention because it contained provisions making clear that certain detainees were not to be identified to or permitted access to the Red Cross. That was, of course, a criminal act. And why was the Red Cross being kept away? The circumstances make the answer to that question readily apparent: they were being tortured, and the Bush Administration was extremely eager to conceal that fact as long as it could.

But this manual contains a number of less dramatic, but still extremely important disclosures. And among them is the use of isolation and sensory deprivation techniques as a means of “preparing” detainees. It’s been clear for some time that the CIA favors this over the truly “rough stuff.” And legal scholars and ethicists have also been clear that these practices may also constitute torture over sustained periods, and certainly constitute cruel, inhuman and degrading treatment.

Now psychologist Dr. Stephen Soldz has taken a close look at the manual, and applied it retroactively to the debate inside of the American Psychological Association. And it provides further information suggesting that the organization’s leadership, which is filled with individuals with unmistakable financial and business ties to the U.S. Government, has misled the membership in an effort to protect the Bush Administration and its torture practices.

[extensive quote from Dr. Steven Soldz, link to original article here]

And how did all of this play within the APA? As Soldz notes, it is now apparent that from the outset of the debate the APA leadership pursued a strategy of protecting the actual techniques of abuse which were being used in Guantánamo. And we have specific reason to believe that some in the APA leadership had actual knowledge of those techniques.

The leadership pursued its plan by involving a key military officer who was probably an author of these processes as its voice in presenting the matter.


This information has erased any doubt as to the role played by the APA throughout this process. The APA alone among all professional organizations dealing with the issue has provided cover to the Bush Administration’s program of torture and official cruelty. It is an abettor of the procedures adopted and used, not a professional organization exercising detached and objective ethical oversight of its members. It has brought the reputation of psychologists in America down several pegs. And it has a lot of explaining to do–both to its members, and to the public as a whole.
Also of interest in this extensive and detailed article regarding the impact this is having on the APA (Page 1, Page 2.) entitled "APA On the Road to Damascus?". It seems that the APA is struggling with the practical application of the concepts of ethics and Human Rights vs the short term profits in their political ties.

Swift firing of psychologist from teaching position restores School Board confidence

Apparently the Volusia County School Board has had a recent string of bad publicity due to their own screwups, misdeeds, and general incompetence. So the opportunity to do something to do their job, and also improve their reputation was a welcome relief. From the Daytona Beach News Journal.

Volusia County School Board members said Thursday they support the firing of an Atlantic High School teacher after a past fraught with lawsuits, allegations and a sex scandal was exposed to school officials.

They also believe it's a one-of-a-kind case.

Connie Reynolds, 52, of Ormond Beach was hired this summer to teach biology, anatomy and physiology at Atlantic after working as a substitute the previous year. On Tuesday, she lost her job, a job she loved, leaving her "reeling," she said by telephone Thursday.

"I did . . . exactly what I was supposed to do," she said.

On her job application she checked "yes" to a box asking whether she ever had a professional license revoked.

Three years ago, the Montana Board of Psychology effectively ended Reynolds' 20-year career as a clinical psychologist when it confirmed an administrative law judge's determination that she had an inappropriate relationship with a client, according to reports in the Billings (Mont.) Gazette.

But Volusia school district personnel assigned to scrutinize her application never asked her why she had lost her license. Had they known it involved an inappropriate relationship with a client, Reynolds would not have been hired, said Nancy Wait, a district spokeswoman.

Several board members contacted Superintendent Margaret Smith and other district officials with concern. They said they were pleased with the administration's response.

An additional set of eyes will review teacher applications before hiring is complete, board member Candace Lankford said. "This isn't a pattern," she said.

Board Chairman Al Williams also called Smith on Thursday.

"I feel confident we don't have any other situations like this," he added.

Of four board members interviewed, Williams -- a former school personnel director -- was the only one who raised questions about Reynolds' firing.

"This person did something wrong when she was in Montana. Do you continue to punish her when she comes here?" he said. "If it wasn't anything toward a child . . . she made a mistake. You give her two or three probationary periods to make sure."

But he later said he wasn't questioning the call to fire Reynolds, adding it's a "tough decision."

Other board members expressed empathy for Reynolds, but qualified it.

"By the same token, my first concern is the students. If she as a mature person had an inappropriate relationship, that's a red flag," board member Judy Conte said.

Reynolds said she does not believe she has any legal recourse over the firing. State law allows a school district to terminate a teacher without cause within the 97-day probation period.

Reynolds said she was still hopeful Thursday that a school district somewhere might be willing to take a chance on her, adding that she had an excellent evaluation.

"Every day, I woke up and said, 'I get to do something where I'm loving everything I did,' " Reynolds said. "I was a good teacher."

In addition to convincing another school district to hire her, Reynolds could face another hurdle. Cheryl Etters, a spokeswoman for the Department of Education, said she could not comment on the status of Reynolds' temporary teaching certificate, citing a statute that refers to an "investigation" that must be kept confidential.

Thursday, November 29, 2007

A tenth of therapists crossing sex lines

Research from Australia indicates that one tenth of all therapists will have sex problems with their clients. This contrasts with a know rate of 1 to 2 percent for other medical practitioners. Our own quick research indicates that the number is higher for the duration of their careers. Numbers may vary by region. As seen in the West Australian News

One in every ten male therapists will have sex or develop an intimate link with a female client, according to Australian research.

Leading psychiatrist Professor Carolyn Quadrio will present findings at a mental health conference on how those in her profession blur the line with their patients.

She said her research had found between seven and ten per cent of male therapists had some sort of sexual contact with a female client. Just one to three per cent of women therapists had done the same.

"It's clear that patients often idealise their therapists, that's kind of part of the process and that's what the therapist has to manage very carefully," said Prof Quadrio, from the school of psychiatry at the University of NSW.

"What I've done is identify the groups of therapists who take on, foster and enjoy this idealisation and let the whole thing go too far."

She said professionals most likely to let this happen fitted into three groups - depressed men who were going through difficult times and were more likely respond to an adoring client, the bad eggs who "prey" on vulnerable clients and the "ego maniacs".

"The bad eggs we can't do much about because they're psychopathic. Every profession has them, they just need to be expelled," said Prof Quadrio, who is well known for her research into sexual abuse in fiduciary relationships.

Those who are depressed are often easy to identify because they are troubled and not coping, the researcher said. The narcissistic types were the hardest to weed out because these therapists were often highly talented and admired by colleagues and patients alike.

"In this group they get on an ego trip," she said.

"They lose perspective and think that it is right that they should be adored.

"From there, a sexual relationship often develops - particularly if the client has been abused or has gone through trauma as a child."

Prof Quandrio, who has assessed hundreds of cases of people who were abused by teachers, clergy and in institutional care as children, will tell the World Psychiatric Association (WPA) conference that ethical practitioners to construct and maintain boundaries with their patients.

"It's a pretty uncomfortable thing for psychiatrists to hear, especially the men, but it's important to talk about it.

"We've come a long way in recent years, with public awareness and good investigation processes, but there's always further to go."

Update: Former psychologist loses teaching job over news of her sexual misconduct

A quick update from Montana TV station KTVQ

A former Billings psychologist who had her Montana license revoked after being accused of having inappropriate relationships with patients has lost her teaching job in Florida.

Constance Reynolds, 52, recently settled a lawsuit in Montana and agreed to pay an $800,000 settlement to the mother of one of her patients who is now deceased. The lawsuit had accused Reynolds of having an affair with the patient.

She had been teaching biology at a high school in Port Orange, Florida, but lost her job this week after officials there learned about her revoked license in Montana.
We also have this report from a local Florida newspaper reports. This one from the Orlando Sentinel
A rookie Volusia County teacher found herself unemployed Wednesday after officials discovered that she had once lost her psychologist's license in Montana following accusations of improper relationships with patients.

Constance Reynolds, 52, began teaching honors biology at Atlantic High in Port Orange this semester. Two weeks ago, she settled a lawsuit in Montana, agreeing to pay $800,000 to the mother of one of Reynolds' deceased patients. The lawsuit accused Reynolds of having an affair with the patient, according to published reports.


"Had we researched this and found out what we know now, we would not have hired her," Wait said. "It's a question of morality and ethics."

Reynolds passed a criminal background check and has on her record only a 10-year-old DUI from Montana, to which she pleaded no contest, according to her application.

Reynolds, who was earning $39,903 annually, was in a 97-day probationary period for new teachers. The School Board is expected to approve her termination at its Dec. 11 meeting. Reynolds was notified after school Tuesday after media inquiries called the district's attention to the situation.

Reynolds told the Orlando Sentinel that she had been honest on her application, which is why the firing took her by surprise.

"I didn't think it was going to be a problem," she said. "I thought I could make a difference in kids' lives."

Reynolds' moved to Central Florida, where she has family, about 2005 and worked briefly as a substitute teacher in Volusia last semester before being hired full time.

She was a psychologist in private practice for 12 years in Billings, Mont., but offered no references from that state, writing, "I do not have any contact with any of my former clients or colleagues in Montana."
This one from the Daytona Beach News Journal
When she was hired to teach science at Atlantic High School in August, Connie Reynolds escaped a nightmarish career disintegration far, far away.

Her past caught up with her this week.

Volusia County school district officials fired Reynolds after learning from the news media why she was stripped of her license to practice psychology in Montana, said Nancy Wait, a district spokeswoman. They also acknowledged a mistake in hiring her.

In 2003, Reynolds -- then working as a clinical psychologist in Montana -- was accused of an inappropriate sexual relationship with a female patient who later died in her care.

Reynolds denied the allegations but later lost her license. The patient's mother filed suit, claiming Reynolds improperly gave medications that led to her daughter's death. Reynolds settled the case earlier this month for $800,000, the Billings Gazette reported.

A tipster, Ken Kramer of Tampa, contacted The Daytona Beach News-Journal and other media organizations recently. Kramer is a board member of the Citizens Commission on Human Rights, a Scientology-affiliated organization that investigates and exposes psychiatric missteps.

Atlantic High Principal Ron Pagano fired Reynolds on Tuesday without cause because she had not yet completed her 97-day probation period.

Reynolds, 52, of Ormond Beach was making $39,903 annually to teach biology, anatomy and physiology.

When she applied for her job, she checked a box indicating she has had a license revoked. The application asked for the type of license and what state issued it but not why it was revoked. Reynolds, who noted on the application she has had no contact with any of her former clients or colleagues in Montana, said no one asked her about it during the hiring process.

Wait said the school district would not have hired Reynolds had it known about the allegations in Montana. Wait added the box marked "Yes" should have raised red flags.

"We should have done some further inquiries," she said, adding Superintendent Margaret Smith has met with personnel and professional standards staff to make sure procedures are in place to avoid such hiring mistakes in the future.


Wednesday, November 28, 2007

Therapist Constance Reynolds agrees to pay $800,000 settlement in damages

A followup to an earlier report. From the Billings Gazette

A district judge on Thursday approved an $800,000 settlement agreement in a lawsuit filed by a Billings woman against her daughter's psychologist.

Judge Susan Watters said the settlement amount was reasonable considering the damages that Betty Bowman suffered from her family's association with Constance Reynolds, a therapist whose license was revoked in 2004.

Bowman's daughter, Dana Mobley, was a client of Reynolds when the two became lovers. Mobley later died while living with Reynolds.

After the hearing Thursday, Bowman said the settlement brings little relief to a difficult period in her life. Her daughter died in February 2004, and her husband died six months later. She filed the lawsuit against Reynolds in 2005.

"It's hard," Bowman said outside the courtroom. "Losing my whole family and being financially embarrassed. You believe in somebody and trust somebody and then have them turn you upside down and backwards."

In the lawsuit, Bowman claimed the psychologist was negligent and committed malpractice, fraud and identity theft when she began a sexual relationship with her daughter while treating her as a client. The lawsuit stated that Mobley died in part because of medications Reynolds improperly gave to her.

Reynolds, who now lives in Florida and represented herself in the lawsuit, could not be reached Thursday for comment. She did not attend the hearing Thursday.

Despite the settlement, the legal case is not over. Chicago Insurance Co., which provided Reynolds with malpractice insurance, has filed a federal lawsuit against both Reynolds and Bowman, stating that Reynolds' policy does not cover the claims made by Bowman against Reynolds.

Bowman's attorney, Brad Arndorfer, said a judge is expected to rule on the issue early next year.

Reynolds was sued by two other Billings residents, Kelli Van Laanen and Kay Easterling. The women accused Reynolds in separate lawsuits of professional malpractice.

Easterling was in a relationship with Mobley when Mobley and Reynolds began dating. Easterling's lawsuit was settled last year; terms of the settlement were not disclosed.

Van Laanen's case was recently resolved with an agreement by Reynolds to pay Van Laanen $100 a month for three years. If Reynolds fails to make the payments, the agreement states, Van Laanen can seek to collect $80,000 in damages.

Befoare the lawsuits were filed, a state administrative law judge found that Reynolds had an inappropriate relationship with Mobley and recommended the psychologist lose her state license. The Montana Board of Psychology unanimously followed the recommendation in June 2004.

At the hearing Thursday, Missoula psychologist Janet Allison testified by telephone that Reynolds violated her ethical duties to Bowman, who she said trusted Reynolds to care for her daughter.

In a report prepared last year, Allison described Reynolds' actions as "a tragic example" of the harm an unethical psychologist can cause.

"In my three decades of work in the field, I have never seen a more egregious case of professional violations of ethics or of damage inflicted on clients by a psychologist," Allison wrote.

Bowman testified Thursday that she deeded a house to Reynolds so Reynolds and her daughter would have a safe home to share. Reynolds then took out a mortgage on the home, Bowman said, and never paid her the full price of the house.

Bowman said she loaned Reynolds $10,000 on one occasion and was not repaid, and Reynolds used her credit cards without her permission or knowledge. One credit card debt grew to $13,000, Bowman said, and her credit rating was destroyed as a result.

Bowman told the judge that her husband died six months after her daughter. Although he suffered a terminal illness, Bowman said she believes her daughter's death hastened her husband's death because the two were very close.

After the hearing, Bowman said she still believes Reynolds played a role in her daughter's death, but no criminal investigation was ever conducted. An autopsy found that Mobley died of asphyxiation while heavily drugged.

Arndorfer represented all three women in their lawsuits against Reynolds. He said Reynolds is not practicing psychology in Florida, but may be working as a teacher.

How Often Are Patients Misdiagnosed?

While this article has to do with standard medicine, we must ask the question as it relates to the field of psychiatry, where there is no objective test for mental illness. While modern medicine has the option of at least being able to check their diagnosis, even if via the autopsy table, psychiatry does not. Psychiatrists do not order objective tests when diagnosing their diseases. From the New York Times:

The only sure way to study the extent of misdiagnosis is to compare autopsy results to a patient's final diagnosis. When researchers have done this, they have generally found a contradiction between the two in about 40 percent of cases. Roughly half of these misdiagnoses prevented the patient from getting treatment that could have made a difference.

A good summary of the research appeared in a 1998 article in The Journal of the American Medical Association, by George D. Lundberg, then the publication's editor. He said recently that it still reflected his views.
The paper can be seen here:

Low-Tech Autopsies in the Era of High-Tech Medicine by George D. Lundberg, JAMA, Oct. 14, 1998 (pdf)

It is our opinion that misdiagnoses in the field of psychiatry will be much higher than in standard medicine precisely because there are no standardized objective tests. Further, if the diseases diagnosed are based on other considerations besides objective tests, then the misdiagnosis rate will trend off the chart.

It may even approach 100% when the understanding of the condition is fundamentally wrong.

The Fundamental Misdiagnosis of Depression as a Disease.

As seen on the Huffington Post website,where a shrink seems to have what I call "an attack of common sense". Not that they have any thing like an effective means of treatment yet.

On the other hand, I expect to find out any day now that he has lost his license because he is seems to be trying to help folks instead of profiteering. Earlier posts here have dealt with a variety of reasons why it is so much easier for shrinks to just dope people up instead of helping them heal.

If forced to choose between labeling immobilizing depression as either a character weakness or a disease, it's understandable that disease would be the preference. But there is a third choice, one that normalizes depression and which -- for people such as myself -- feels more respectful and better reduces suffering.

I regularly do battle with right-wing talk show hosts who mock depression sufferers as crybabies. Fundamentalist pull-yourself-up-by-your-bootstrap yappers are often heartless and uninformed, and I tell them just that. However, fundamentalist depression diseasers also need to be confronted.

"I have written a polemic, an insistent argument for the proposition that depression is a disease," is how psychiatrist Peter Kramer describes his Against Depression (2005). Kramer argues that depression must be a disease because of how devastating it is. He is certainly correct that depression can result not only in suicide but can ruin careers, destroy families, and stress the body so as to jeopardize physical health.

However, such nondiseases as war and poverty also have a devastating impact; and there is a long list of noncontroversial illnesses, including the common cold, that do not have a devastating impact.

Kramer's other disease arguments are just as shaky. According to Kramer, biological markers -- the sine qua non of disease -- for depression have been discovered. He tells us that brain scanning techniques focusing on the size of the hippocampus and amygdala can differentiate the depressed from the nondepressed.

However, five months after Against Depression was published, The New York Times ("Can Brain Scans See Depression?" October 18, 2005) concluded: "After almost 30 years, researchers have not developed any standardized tool for diagnosing or treating psychiatric disorders based on imaging studies."

Kramer also proclaims, "Deplete serotonin, and depression is unmasked." But researchers have depleted serotonin, and it did not cause depression in nondepressed subjects nor did it worsen the depressive symptoms of those already depressed.

By 1998 The American Medical Association Essential Guide to Depression had reported that there is no clear link between levels of serotonin and depression, "as some depressed people have too much serotonin."

Finally, Kramer tells us about the defective genes of depressives, "By the mid-1990s, scientists had identified genes that might lead to both conditions, neuroticism and depression." Kramer leans heavily on behavioral geneticist Kenneth Kendler; however, two months after the publication of Against Depression, Kendler reviewed the evidence for "gene action in psychiatric disorders" in the American Journal of Psychiatry (July 2005), where he concluded: "Although we may wish it to be true, we do not have and are not likely to ever discover 'genes for' psychiatric illness."

While symptoms of depression can be caused by a variety of medical conditions (for example, anemia and hypothyroidism), such medical conditions, according to the American Psychiatric Association, actually rule out the psychiatric disease of "depression."

What psychiatrists call depression has not in fact been linked to any biochemical markers.

Depression is neither a character defect nor biochemical defect but rather a strategy to shut down overwhelming pain. Used in excess, it can lead to immobilization and greater pain.

Depression is by no means the only strategy people use to shut down overwhelming pain. People use alcohol, marijuana, television, food, gambling, and worse. A depressed Sigmund Freud, pained by failure, used cocaine, then turned his friends on to it, but ultimately discovered its adverse affects and rejected it.
Joseph Goebbels, even more pained by failure than Freud, shut down his pain by embracing fascism; but, unlike Freud, Goebbels couldn't have cared less about the adverse effects of his strategy.

Labeling depression as a disease gives some people relief, but such labeling creates grief for others. I have met many people who have been failed by antidepressants and electroshock. They talk about the adverse physiological effects of their treatments, but they also talk about something else. By becoming compliant patients to a medical authority, they describe losing control over their lives. Depression is an experience of helplessness and hopelessness, and for these people, accepting depression as a disease makes them feel even more helpless and hopeless.

Instead of labeling depression as weakness or illness, we might better decrease depression by understanding it as a normal, albeit painful, human reaction. When we label a part of ourselves as either "weak" or "sick," we alienate ourselves from a part of who we are, and this can create even more pain. In contrast, when we accept the whole of our humanity, we are more likely to be freed up to resolve and heal the source of our pains.

Probe on mental health management sought

Reports from the island of Guam, via the Marianas Variety newspaper, regarding what appears to be small time politics and corruption at hospital in the western Pacific. Hopefully this doesn't turn out like another case of Nurse Ratchet from One Flew Over The Cuckoo's Nest

Reports of violations, mismanagement and clients’ security risks at the Department of Mental Health and Substance Abuse, or DMHSA, have reached the District Court of Guam, which received another letter asking to investigate the agency.

Magistrate Judge Joaquin Manibusan Jr., who is the designated special master for the permanent injunction against DMHSA and the Department of Integrated Services for Individuals with Disabilities, or DISID, said this is the second time that the court received an anonymous letter reporting several irregularities in the department.

The first anonymous letter was faxed by DMHSA employees in June, urging a federal takeover of DMHSA and DISID to improve the services to persons with disabilities.

The second letter was sent by a client to the chamber of Judge Manibusan, asking about who runs the mental health department.

According to the anonymous client, despite the designation of Dr. Andrea Leitheiser as acting director of DMHSA, the department is being run by Dr. Judith Avery, the nurse administrator who reportedly approves all the actions taken by the agency.

The letter sender reported that Avery, who was allegedly fired from the Division of Mental Health in the CNMI for illegal practice, is also violating government of Guam rules and regulations for working with Guam Community College at the same time.

As far as the permanent injunction is concerned, the client alleged that Avery wants to keep the situation in the department under her control to protect her standing and her annual salary of $90,000.

The client also noted the lack of security at DMHSA and the new unit that provides housing to clients from the Department of Corrections, adding that “this has become more dangerous for the staffers who work in this building.”

The client also reported that for the past six months, no psychiatrist wants to service DMHSA because they refused to work with Leitheiser, who is earning $120,000 a year, and Dr. Laura Post, whose annual salary is $150,000.

“In the past, there were two psychiatrists (Dr. Renato Gahol and Dr. Ruby Manalastas) who were hired to provide service to DMHSA clients. They felt they were unable to work with these doctors,” the client said.

Recently, a family client filed a complaint against DMHSA for its failure to provide service to a client.

The letter sender told the court that Gahol informed Lt. Gov. Mike Cruz about the situation, but did not act on it because of the permanent injunction pending against DMHSA and DISID.

Last month, the court was forced to send off-island a defendant who terrorized the Andersen Air Force Base after no psychologists or psychiatrists could conduct an examination to determine if he is mentally fit to stand trial or face the charges.

Ricardo Unpingco Palomo Jr. was arrested for terrorizing the AAFB with a handmade explosive device on Sept. 22. After DMHSA did not conduct a forensic evaluation on him, the court ordered the U.S. Marshals to transport the defendant to an appropriate Bureau of Prisons facility so that an appropriate psychiatric or psychological examination can be conducted on him.

The court received a letter from Post stating that DMSHA has concerns about assisting the court on Palomo’s case.

The client added that problems stated in the permanent injunction still exist with no clear answers to address them.

“An investigation into this matter is needed for the welfare of the island clients that need the service,” the client said.


Two court monitors

Meanwhile, visiting Judge Consuelo Marshall has approved the appointment of two court monitors in connection with the local government’s compliance with court orders related to the permanent injunction imposed on GovGuam, DISID and DMHSA.

Judge Marshall ordered the appointment of James Casey and Dr. James Kiffer to serve jointly as court monitors for a monthly salary of $8,000 each.

The judge said she is persuaded that approving each party’s nominee will enable the parties to finally resolve the case to the benefit of the community, adding that appointing Guam-based monitors is more efficient and less costly than appointing off-island monitors.

The court monitors, who can be removed or replaced by the court if it deems necessary, were ordered to submit a monthly report on or before the first day of each month. The first deadline for their first report is on Jan. 2, 2008.

Because the plaintiffs find the defendants’ proposed list of measurable milestones “too vague and conclusory” to benefit both court monitors, Judge Marshall ordered the parties to meet and confer regarding appropriate measures or additions to the list of measurable milestones.

The court gave both parties until Dec. 14, 2007 to submit the amended list of milestones.

Judge Marshall also ordered the parties to appear for a status conference on March 14, 2008 at 10 a.m. to assess the effectiveness of the court monitor appointments and the defendants’ progress in implementing the amended permanent injunction.

Tuesday, November 27, 2007

Investigating a Death at Erie County Medical Center - Psychiatric Misconduct Goes on Trial

From an investigation by WIVB TV

Patience Lucas' life ended on the night of February 1, 2002. She was only 37 years old.

Michael Drumm, attorney, "We believe that she was trying to get to the bus stop on the other side of Grider Street and she collapsed in Grider Street and a few minutes later was run over by a car."

Patience had just been discharged from the Erie County Medical Center in Buffalo. Sharon Whyte tells me her sister was schizophrenic and bipolar.

Sharon Whyte, Patience Lucas' sister, "We loved her, very much. And it was a huge loss in our family."

Just before she was struck by a car that night, a witness said it looked like she was gasping for air and then collapsed in the street. Attorney Michael Drumm is representing the family in a civil lawsuit.

Michael Drumm, attorney, "Clearly the care at ECMC directly caused her death."

That night she was taken to ECMC for a self-induced head injury. She was then transferred to the hospital's psychiatric unit for a mental evaluation.

Sharon Whyte, Patience Lucas' sister, "They never took the time to really care about how to treat her."

In court papers, the family is alleging that ECMC and the attending psychiatrist failed to provide proper and adequate care. A state medical review board noted that patience was detained at the hospital's psychiatric unit for 35 minutes, an insufficient amount of time, the review board found, to do a thorough analysis of her mental status.

In response, the hospital's clinical director wrote, "We do not disagree with this finding."

Michael Drumm, attorney, "Not only was she not evaluated properly, but she was literally assaulted by one of the security guards and then physically removed from the hospital."

In a pretrial deposition, the attending psychiatrist says he observed one of the guards holding patience in a headlock, telling her, "I'm going to break your head wide open if you don't shut up." Statements by security personnel on duty that night indicate that she was loud, belligerent and physical. One guard stated that he heard the same psychiatrist say, "Get her out, get her the f--- out of here." Keep in mind it was cold and blustery that night and buses were no longer running.

Michael Drumm, attorney, "No provision was made to transport her home, no effort was made to contact her family, no effort was made to contact her treating psychiatrist or her case worker, none of those things were done in this case."

About ten days earlier, Patience was treated at Niagara Falls Memorial Medical Center. Attorney Michael Drumm claims that began a chain of events that led to her death the lawsuit alleges the hospital was negligent because it prematurely discharged patience when it was not safe and did so in an improperly medicated condition.

Michael Drumm, attorney, "She was so out of control the next morning that they had to tranquilize her in order to get her out of the hospital."

Niagara Falls Memorial released this statement, "We deny all allegations and intend to vigorously defend against them."

No court case will ever bring back Patience, however, family members are hoping it will shed some light and bring about change.

Sharon Whyte, Patience Lucas' sister, "If this can prevent another family from having to go through what we went through or another mentally ill person having to feel like nobody's listening to them, then this will have been all worth it."

Erie County is named in the lawsuit because it operated ECMC back in 2002, the county attorney's office declined comment on the case, so did the attorney representing two psychiatrists named in the lawsuit.

Jury selection in the civil trial is scheduled for later this week in State Supreme Court.

Monday, November 26, 2007

FDA Not Playing the Game Anymore Charges Miffed Wyeth CEO

As seen on OpEdNews, by Martha Rosenberg

The Food and Drug Administration is acting like a watchdog not a lapdog says outgoing chief executive of Wyeth Bob Essner and it's no fair.

Not only has it failed to approve three new Wyeth drugs designed to replace Effexor revenues when its patent expires in 2010--Viviant, for osteoporosis, Pristiq, for depression and menopause and bifeprunox for schizophrenia--it dared to compare their benefit/risk profile to drugs already on the market, challenging the Pharma received wisdom that newer equals better.

In the past the FDA compared new drugs to placebo and not existing drugs which is how lemons like Vioxx, Avandia and Ketek happen says former editor-in-chief of the New England Journal of Medicine Marcia Angell in The Truth About the Drug Companies.

Now, the FDA is asking not just if a drug is safe and effective but if it's necessary after a decade of pharma induced carnage courtesy of unforeseen side effects in fast tracked prescription drugs.

And it's anti competitive says Essner!

"If you're the first company to get approved in a certain area and competitors can't get on the market, the FDA is now establishing monopolies. And that's certainly not their mandate."

Of course Essner could just as easily see the glass as half full.

The FDA didn't stop Wyeth from selling Redux-the notorious fenfluramine/phentermine combo-until a 1997 study found 30% of users sustained heart damage.

And it's still marketing Premarin and Prempro with impunity even though hormone replacement therapy (HRT) causes a 26% increased risk of breast cancer, 29% increased risk of heart attack, 41% increased risk of stroke, and 100% increased risk of blood clots according to the federal Women's Heath Initiative. And increases the risk of ovarian and lung cancer, mental decline, hearing loss, urinary incontinence, lupus, non-Hodgkin's lymphoma, scleroderma and asthma according to other studies.

And even though the recent dramatic drops in U.S. breast cancer-up to 15% for estrogen positive cancer -coincide with the millions of women who dropped out of HRT in the early 2000's .

The FDA sent Wyeth no cease and desist letters when it claimed in The Pharmacist's Guide to Women and Menopause, The Good Housekeeping Guide to Women's Health and Take Charge! A Woman's Guide to Fighting Heart Disease that estrogen replacement prevented (sic) coronary heart disease risk.

Or when it told its sales reps to "promote Prempro for Alzheimer's" as came out at the first Premarin/Prempro trial brought by mastectomy survivor Linda Reeves in Little Rock, AR last year. (she lost)

And even though Essner himself was described as staging Enron style Prempro parties in which he called for "no boundaries, no limits to your selling effort" to keep women "on HRT from menopause to death" by Wyeth sales rep Charles Payne at the Arkansas trial he is not in Club Feb like some counterparts.

But Essner evidently sees the glass half empty.

As the 60-year-old leaves the Wyeth helm and prepares to go back to teaching, the company faces $21.1 billion in Redux liabilities and 5,300 more Prempro/Premarin lawsuits.

And this month a jury of five men and two women in Reno, NV awarded $99 million in punitive damages to three breast cancer survivors who had taken Wyeth hormones, after only two hours of deliberation.

The jury didn't seem to think the cancer causing Premarin and Prempro taken by Jeraldine Scofield, 74, of Fallon; Arlene Rowatt, 67, of Incline Village; and Pamela Forrester, 65, of Yerington were safe, effective or even necessary.

Sunday, November 25, 2007

Dr. Drug Rep - how a psychiatrist became easily corrupted by easy big money

From the Blue Ridge Now website. Originally from the NY Times Magazine, which also supplies this nifty illustration Also seen here

Key point, if the drug companies pay you money, you become their employee. It is not practical to be objective in the long run, and it becomes a question of the money vs your medical integrity.

Far too long to quote in full, here are some key snippets:

On a blustery fall New England day in 2001, a friendly representative from Wyeth Pharmaceuticals came into my office in Newburyport, Mass., and made me an offer I found hard to refuse. He asked me if I’d like to give talks to other doctors about using Effexor XR for treating depression. He told me that I would go around to doctors’ offices during lunchtime and talk about some of the features of Effexor. It would be pretty easy. Wyeth would provide a set of slides and even pay for me to attend a speaker’s training session, and he quickly floated some numbers. I would be paid $500 for one-hour “Lunch and Learn” talks at local doctors’ offices, or $750 if I had to drive an hour. I would be flown to New York for a “faculty-development program,” where I would be pampered in a Midtown hotel for two nights and would be paid an additional “honorarium.”


A few weeks later, my wife and I walked through the luxurious lobby of the Millennium Hotel in Midtown Manhattan. At the reception desk, when I gave my name, the attendant keyed it into the computer and said, with a dazzling smile: “Hello, Dr. Carlat, I see that you are with the Wyeth conference. Here are your materials.”

She handed me a folder containing the schedule of talks, an invitation to various dinners and receptions and two tickets to a Broadway musical. “Enjoy your stay, doctor.” I had no doubt that I would, though I felt a gnawing at the edge of my conscience. This seemed like a lot of money to lavish on me just so that I could provide some education to primary-care doctors in a small town north of Boston.

The next morning, the conference began. There were a hundred or so other psychiatrists from different parts of the U.S. I recognized a couple of the attendees, including an acquaintance I hadn’t seen in a while. I’d heard that he moved to another state and was making a bundle of money, but nobody seemed to know exactly how.

I joined him at his table and asked him what he had been up to. He said he had a busy private practice and had given a lot of talks for Warner-Lambert, a company that had since been acquired by Pfizer. His talks were on Neurontin, a drug that was approved for epilepsy but that my friend had found helpful for bipolar disorder in his practice. (In 2004, Warner-Lambert pleaded guilty to illegally marketing Neurontin for unapproved uses. It is illegal for companies to pay doctors to promote so-called off-label uses.)


When it came to side effects, Effexor’s greatest liability was that it could cause hypertension, a side effect not shared by S.S.R.I.’s. Sussman showed us some data from the clinical trials, indicating that at lower doses, about 3 percent of patients taking Effexor had hypertension as compared with about 2 percent of patients assigned to a placebo. There was only a 1 percent difference between Effexor and placebo, he commented, and pointed out that treating high blood pressure might be a small price to pay for relief from depression.

It was an accurate reading of the data, and I remember finding it a convincing defense of Effexor’s safety. As I look back at my notes now, however, I notice that another way of describing the same numbers would have been to say that Effexor leads to a 50 percent greater rate of hypertension than a placebo. Framed this way, Effexor looks more hazardous.

And so it went for the rest of the afternoon. $750 if I had to drive an hour. I would be flown to New York for a “faculty-development program,” where I would be pampered in a Midtown hotel for two nights and would be paid an additional “honorarium.”

If I gave talks to primary-care doctors about Effexor, I reasoned, I would be doing nothing unethical. It was a perfectly effective treatment option, with some data to suggest advantages over its competitors. The Wyeth rep was simply suggesting that I discuss some of the data with other doctors. Sure, Wyeth would benefit, but so would other doctors, who would become more educated about a good medication.

A few weeks later, my wife and I walked through the luxurious lobby of the Millennium Hotel in Midtown Manhattan. At the reception desk, when I gave my name, the attendant keyed it into the computer and said, with a dazzling smile: “Hello, Dr. Carlat, I see that you are with the Wyeth conference. Here are your materials.”


When it came to side effects, Effexor’s greatest liability was that it could cause hypertension, a side effect not shared by S.S.R.I.’s. Sussman showed us some data from the clinical trials, indicating that at lower doses, about 3 percent of patients taking Effexor had hypertension as compared with about 2 percent of patients assigned to a placebo. There was only a 1 percent difference between Effexor and placebo, he commented, and pointed out that treating high blood pressure might be a small price to pay for relief from depression.

It was an accurate reading of the data, and I remember finding it a convincing defense of Effexor’s safety. As I look back at my notes now, however, I notice that another way of describing the same numbers would have been to say that Effexor leads to a 50 percent greater rate of hypertension than a placebo. Framed this way, Effexor looks more hazardous.

And so it went for the rest of the afternoon.


As the reps became comfortable with me, they began to see me more as a sales colleague.
I received faxes before talks preparing me for particular doctors. One note informed me that the physician we’d be visiting that day was a “decile 6 doctor and is not prescribing any Effexor XR, so please tailor accordingly. There is also one more doc in the practice that we are not familiar with.” The term “decile 6” is drug-rep jargon for a doctor who prescribes a lot of medications. The higher the “decile” (in a range from 1 to 10), the higher the prescription volume, and the more potentially lucrative that doctor could be for the company.

A note from another rep reminded me of a scene from “Mission: Impossible.” “Dr. Carlat: Our main target, Dr. , is an internist. He spreads his usage among three antidepressants, Celexa, Zoloft and Paxil, at about 25-30 percent each. He is currently using about 6 percent Effexor XR. Our access is very challenging with lunches six months out.” This doctor’s schedule of lunches was filled with reps from other companies; it would be vital to make our sales visit count.


Driving home, I went back over the talk in my mind. I knew I had not lied — I had reported the data exactly as they were reported in the paper. But still, I had spun the results of the study in the most positive way possible, and I had not talked about the limitations of the data. [...] I realized that in my canned talks, I was blithely minimizing the hypertension risks, conveniently overlooking the fact that hypertension is a dangerous condition and not one to be trifled with. Why, I began to wonder, would anyone prescribe an antidepressant that could cause hypertension when there were many other alternatives? And why wasn’t I asking this obvious question out loud during my talks?


In 2002, the drug industry’s trade group adopted voluntary guidelines limiting some of the more lavish benefits to doctors. While the guidelines still allow all-expenses-paid trips for physicians to attend meetings at fancy hotels, they no longer pay for spouses to attend the dinners or hand out tickets to musicals. In an e-mail message, a Wyeth spokesman wrote that Wyeth employees must follow that code and “our own Wyeth policies, which, in some cases, exceed” the trade group’s code.

Looking back on the year I spent speaking for Wyeth, I’ve asked myself if my work as a company speaker led me to do bad things. Did I contribute to faulty medical decision making? Did my advice lead doctors to make inappropriate drug choices, and did their patients suffer needlessly?

Dr. Phil as the rich man’s Jerry Springer Show

Dr. Phil apparently has made it into into Canada, to the appropriate horror of some. This author has one take that has to be quoted in full:

You know what’s wrong with Dr. Phil? He’s on Canadian television every weekday. Student-friendly rabbit ears pick up a mere three channels around here and this guy bombards one of them for an entire hour before dinner each day.

Who is watching this show?

Those interested in watching an inarticulate psychologist who prefers being referred to by his first name, watch Maury — or so you’d think. Unfortunately the truth is that they may be watching both Maury and Dr. Phil. Worse, there may be a new strain of viewers out there: the upper-middle class in hiding.

It all starts with the name.

Apparently nobody let Phil know that doctors go by their title and last name. Dr. Quinn, medicine woman, lived in the 1860s and still knew this. And yet there is a chance that Phil knows more about marketability than Michaela Quinn.

By establishing himself as "Dr. Phil," Phil McGraw has become a multifaceted marketing icon. Symbolically, the title "Dr." demands respect and announces intellect. Contrastingly, the title "Phil" says, "Hey Amurica, I’m just like y’all." These two elements fused together conjure the illusion of an educated hillbilly.

That sounds familiar. Haven’t we recently observed a lengthy puppet show embodying a similar icon? Oh yes, the presidency of George W. Bush. But the makers of Dr. Phil wouldn’t be chasing that ol’ southern drawl demographic would they? Do all those:yeehaw, buy-me -a-truck, country-music-is-actually- music, Iraq-had-something-to-do with-9/11, denim-tuxedo-wearin’, shot-gun-ownin individuals" make up that large of a demographic? They wish.

The phenomenon that named Dr. Phil the "second highest-rated daytime talk show in the [U.S.]" — according to his website — and has him appearing every evening on your Canadian television set, has something to do with the people in suits — namely, the upper-middle class.

Consider Dr. Phil the rich man’s Jerry Springer Show.

For instance, on the Dr. Phil show for the week of November 19, 2007, audiences will see: a wife dealing with her husband, "who, she just found out, is a sex addict and compulsive liar;" a vicious battle between a physically abusive daughter-in-law and an intrusive, victim-playing mother-in-law; and a "new debate over whether women should go mild or wild," regarding dress.

The difference between these episodes of Dr. Phil and the upcoming Jerry Springer Show — a show which claims to mend relationships with a Thanksgiving food-fight — is the obvious physical crudeness.

The Springer audience will certainly observe a censored breast and an overweight fist-fight, whereas Dr. Phil’s will avoid any such physical indecency. However, that doesn’t mean the underlying sensationalized subjects of each show are not suggestive enough to feed the insatiable appetite of the Springer audience. Because that is precisely what the professional appearance of Dr. Phil hides: a disturbing, Springer-craving personality. The result is a pseudo-normal audience to meet this inarticulate psychology.

In turn, John Doe of the upper-middle class can — and will — sit down in his fancy suit, watch an episode of Dr. Phil, feed this insatiable appetite and still manage to look classy — because frankly, Phil’s a doctor.

The glaring problem is that this type of media now confronts the face of mainstream, day-time television watchers.

While it may be far-fetched to say that this "Dark Side" is pulling in unsuspecting viewers, it is fair to say that Darth-Phil is dumbing us down.

If Canada is a multi-cultural society that differs from the melting pot of the U.S. why are we watching this sensationalist bullshit? There is a tinge of excitement in discovering "whose kid it actually is’"— an attention grabber that both Jerry and Phil use — but do the right thing as educated students: resist the temptation and avoid Darth-Phil with the force of your remote control.

Saturday, November 24, 2007

Woman flees her own country to keep her first child out of the hands of social workers when it is born.

Reported here several months ago, a 22 year old Scottish woman has been told by social workers that her own first born child was to be removed from her when it was born, based on bogus psychiatric theories evaluating how her problems as a young teen. Fran Lyon was told by social services that she was in danger of suffering from Munchausen's by Proxy, a fake disease invented by a long discredited psychiatrist. This diagnosis was used to threaten the removal of the child.

Munchausen's syndrome by proxy was identified in the 1970s by the now discredited Sir Roy Meadow. It was alleged to take the form of fabricated illness where a parent claims a child is ill by making up symptoms.

The theory became increasingly influential and in 1993 the professor's evidence helped convict British nurse Beverley Allitt of the murders of four children.

But the Angela Cannings and Sally Clark miscarriages of justice wrecked Meadow's reputation because he had been an expert witness.

Many now question whether Munchausen's even exists.

The mother in this most recent case has since fled the country and is now in hiding. As with almost all cases involving county council children's services, it is extremely difficult to discover why or how a decision has been reached. As a result, it is impossible for people to challenge what they see as a dubious outcome.

Fran's story was told on Tonight With Trevor McDonald, broadcast 26 November on ITV1. Online video streaming available, might not be available outside the UK.

(The ITV Video Player requires Internet Explorer and Windows Media Player with DRM (Digital Rights Management) enabled to protect video files delivered to your computer.)

From the other side of the pond, it appears like a secret court conducted by secret terrorists.

As seen in this report in the Daily Mail.

She is, on first impressions, just like any other first-time mother. The cot and the pram are on order, she has bought more cuddly toys than she will ever need and she has even given her little girl a name – Molly.

With less than six weeks to go before the birth, the baby is kicking and it brings Fran Lyon an undeniable thrill of pleasure. At least, it does now she finally feels safe to enjoy it.

For all the innocent joys of impending motherhood have been denied Fran since social workers warned her four months ago that Molly would be taken away ten minutes after birth and placed with foster parents.

Fran, a third-year student doing a neuro-science degree at Edinburgh University, is, to everyone who knows her, a sociable, kind and intelligent woman. But to her local authority she is a danger to herself and her baby.

Seven years ago Fran had an eating and selfharming disorder and spent 13 months in a psychiatric hospital followed by nine successful months of counselling.

Now 22, and with her emotional troubles behind her, Fran is outraged that she should be judged a risk to herself and her child despite a fistful of medical reports that dispute this.

Last week, fearing the worst, Fran moved from her home in Hexham in Northumberland to Birmingham, where she hoped a different authority would treat her more sympathetically.

But with the birth so close, she felt she couldn't take any risks with bureaucracy and on Wednesday, Fran took an even more drastic step. She got on a flight bound for Europe – and went into hiding. Wary of revealing her whereabouts, Fran agreed to talk about her nightmare in a lengthy telephone call to The Mail on Sunday.

She will also be seen in an exclusive report tomorrow evening on Tonight With Trevor McDonald. She said: "I wouldn't have done it unless I absolutely had to. Every time there was a twinge, I was absolutely petrified. I just kept thinking, 'Please don't go into labour, please, not yet.' It was terrifying.

"It's a lot better now that I'm away. Lots of people suggested I should leave but I always thought it was too extreme. Then when I went to Birmingham things weren't going to happen quicklyenough. Northumberland's plan stood until Birmingham made their own and I didn't have vast amounts of time.

Now it's such a relief not to be constantly looking over my shoulder. It has been so fraught with other people's interventions. For the first time this will be just us: me and Molly. I just want to enjoy it. I could never do that before.

"For months I've been reading a book called Molly The Hungry Caterpillar and feeling her kicking about. It's lovely, but all the time the fear has been in the back of my mind that these might be the closest moments I will ever have with her."

Fran is in good health apart from suffering a rare condition, angiodoema. It is possible her throat might swell and she has been given tracheotomy equipment in case of an incident.

For such a young woman, Fran seems practical and level headed. In just a few days, she has organised a lease on an apartment, had an appointment with a midwife, booked a place at the local hospital and made contact with English speaking mother-and-baby groups.

It is a considerable testimony to her ability to cope – given what social services had thrown at her. So why did Hexham Children's Services feel it necessary to take such draconian – some might say menacing – steps against a young woman who has battled to put her life in order?

As with almost all cases involving county council children's services, it is extremely difficult to discover why or how a decision has been reached. As a result, it is nigh on impossible for people to challenge what they see as a dubious outcome.

Fran's story began last April when she became pregnant. Although the baby was unexpected, she was delighted. She says: "I was shocked because I'd had the contraceptive injection. But I remember waking up the first morning after I knew and feeling secretly thrilled.

"I didn't have a clue how I was going to make it work with university and my job [for two mental health charities] but I was determined that I was having her."

The first problem began when she and Molly's father fell out. She had become unhappy about something he was doing and reported him to the police. She ended the relationship immediately and he is now the subject of an investigation by police – who alerted social services.

She told them her story – that she was brought up in Northampton in a middleclass household where her parents were teachers, and how at 14 she was raped by an acquaintance.

Traumatised, she became clinically depressed and spent the next three years, on and off, in residential psychiatric hospitals after being diagnosed with a borderline personality disorder characterised by self-harming instability and suicidal tendencies.

For the final 13 months, Fran had individual psychotherapy sessions and group analysis before being discharged into outpatient care. By the age of 18 she had fully recovered and the diagnosis of borderline personality disorder was removed. Despite it all, Fran earned nine A-grade GCSEs, four A-grade A-levels and her place at university.

When she became pregnant, Fran accepted that social services might take an interest in her and went out of her way to cooperate. "I was very up-front with the mental health staff," she said.

"I told them my history and gave them the names of my doctors as I assumed they would want to pursue it further. I thought I might need to see the health visitor a bit more often."

Instead, Fran received a letter informing her that a "child protection case conference" would be held on August 16. Social services contacted a number of experts. One of them, Dr Stella Newith, the psychiatrist who treated Fran as a teenager, had no doubts when called on to give her opinion about her former patient.

In a letter to Northumberland County Council, Dr Newith said: "I consider the risk of harm to a child to be so unlikely as to be negligible.

"There has never been any clinical evidence to suggest that Fran would put herself or others at risk, and certainly no evidence to suggest that she would put a child at risk."

It was a view backed up by Dr Rex Haigh, a psychiatrist who worked with Fran in the charity sector and acted as a character witness. He advised: "I have no doubt that her diligence and capacity, particularly in dealing with complex emotional situations, will stand her in good stead for the rigours of parenthood. Your efforts to protect children would be better directed elsewhere."

Yet the social workers decided, instead, to give more weight to the views of consultant paediatrician Dr Martin Ward Platt – even though he made it clear he had never met Fran.

In a letter, Dr Ward Platt said: "If the professionals were concerned from the evidence available that [this woman] probably does fabricate or induce illness, there would be no option but to put the baby into foster care at birth pending a post-natal forensic psychological assessment."

Fran says she was told by social services that she was in danger of suffering from Munchausen's by Proxy, a controversial and unproven condition in which a parent – usually the mother – invents an illness in her child to draw attention to herself.

Apart from Dr Ward Platt's letter, there has been no other evidence presented to Fran suggesting that she was at such risk. The syndrome was first identified by Sir Roy Meadow, the now-discredited doctor responsible for evidence that led to the wrongful convictions of Angela Canning and Sally Clark for murdering their children.

Dr Ward Platt also recommended that Fran be assessed by professionals. Social services drew up their "birth plan" without doing any of these assessments. In October, Fran was told the plan would mean that Molly would be immediately removed into care, minutes after she was born. Fran was also told she could not be trusted to breast-feed her, for fear that she might try to take strychnine as a way of poisoning her own child.

Fran says: "I was just horrified. It was horrific to sit in this room with these people and realise that they could not only conceive of such a bizarre, terrible thing, but think that I was actually capable of it.

"In some ways I think the whole thing was compounded by a lack of understanding. There is no evidence that Munchausen's by Proxy exists. I was being asked to prove that I wouldn't do something. But how can I do that? They were asking me to do the impossible."

Fran engaged the help of Bill Bache, the lawyer who overturned Angela Canning's conviction, and John Hemming, the Liberal Democrat MP and chairman of the pressure group Justice For Families. And yet all the time, she tried to find a compromise with the social workers.

She says: "I asked to go to a mother and baby unit so we would be under 24-hour supervision. I thought it would show I was willing to cooperate and there could be no argument about Molly's safety, but there was a lot of resistance to the idea."

In one last attempt to find a middleway through the nightmare, Fran agreed to yet another assessment. The assessor was to be appointed by the social workers but would be officially independent. They chose Professor Douglas Turkington, a psychiatrist based at the Royal Victoria Infirmary in Newcastle.

In his report, he said that Fran should not be separated from Molly but should instead be "supervised during the immediate postnatal period in her bonding with Molly and be allowed to breast feed".

It is the breakthrough Fran has been hoping for – but she says she can't risk waiting to see if social services view it in the same light. On November 9, the birth plan from Northumberland Social Services arrived in the post. Fran was expecting it but nothing could have prepared her for its conclusions.

"I just fell apart," she says. "It's only when you see it in writing that it becomes real. It said I would get ten minutes with Molly until the umbilical cord had been cut."

Fran and her baby would then be parted and the baby would be taken to another room in the hospital. Fran feared that the conditions of the birth plan would mean that even her mother, who she said she was very close to, would not be able to see the child.

She added: "They said if I didn't consent they would get a police protection order as soon as she was born. This effectively meant that there would be a policeman stood outside the delivery suite.

"She would be only a few minutes old and by herself. That was the one thing that tore me up inside . . . the thought of Molly lying in some horrible hospital baby cot with no one that loves her.

"I'm not an impulsive or dramatic person. I want to sit down and work things out. But this was agonising. I knew I had to do something."

She didn't know, then, that something would mean fleeing abroad. Despite the drastic upset, Fran is not bitter. "I suppose I feel very disappointed. It didn't seem possible for anyone to backtrack just a little bit, to say there was another way. That's what I found so hard. That and the fact there was no compassion. They said it was about Molly but it certainly never felt like that."

But perhaps most worrying of all is the fact that Fran's case, while undoubtedly extreme, is also indicative of a disturbing trend. Two thousand babies less than a year old were taken from their parents last year by social services – three times the number of ten years ago.

Fran's story already has echoes of Nicky and Mark Webster, formerly known as the Hardinghams, whose case was highlighted in this newspaper. They, too, fled the country in order to stop social services taking away their newborn baby, a boy called Brandon, after their first three children were adopted over abuse allegations.

The Websters have since returned to England and have won a landmark case to keep their fourth child. And what does the future hold for Fran Lyon, a young mother who was dealt a rough hand as a teenager and fought to get a normal life and now just wants to do what's best for her daughter?

Perhaps social workers know something Fran is not revealing. Last night a spokeswoman for Northumberland County Council said: "We are unable to comment on individual cases, and we do not believe that it is in the best interests of any mother or child to discuss personal details through the media, but unfortunately it does mean only one side is being heard.

"Safeguarding arrangements in Northumberland were rated as good in a recent rigorous Government inspection. Ms Lyon and her legal adviser have attended all of her case conferences and have been fully informed of the concerns of the professionals involved in her case.

"Where a child or unborn baby is subject to a child-protection plan and they move to reside in another authority or country, responsibility would normally pass to the new authority or relevant authority in another country. Northumberland County Council would make sure the new authority has all the relevant information it needs to make informed decisions."

Mr Hemming said: "I think it's appalling and very disturbing and, sadly, Fran's case is not unique.

"Of course there are situations where you've got to intervene but the system all too often fails to intervene where it should and then intervenes where it shouldn't. It's a steamroller of a system and it steamrollers mothers and children."

Only one thing remains certain. If Fran proves herself to be a good and loving mother, Northumberland's carefully worked-out "birth plan" can only ever be seen as an act of almost unimaginable cruelty by the State.

Families talk about 'worst nightmare' - man sentenced after murders, was on psych drugs.

From the Iowa City Press Citizen. A long and sand and tragic story, here are some of the essential points.

In a tearful and emotional sentencing Wednesday morning, Kyle Marin was sentenced to two consecutive life sentences without the possibility of parole for killing 18-year-old cousins Molly Edmondson and Katrina Hill in Edmondson's Cedar Rapids apartment on April 23, 2006.

Marin, 21, formerly of North Liberty, was convicted of two counts of first-degree murder Nov. 1. The mandatory penalty for first-degree murder in Iowa is life imprisonment without parole. Judge Robert Sosalla, who presided over the two-week long trial, ordered that the life terms be served consecutively rather than concurrently "because of the brutality of the offenses."

The sentencing also saw the only time Marin spoke out loud in the courtroom as he asked for forgiveness for his crimes.

"I will not forgive myself," Marin said. "I will do my time for the pain and suffering I have caused. I want Molly and Katrina, my friends, to know how sorry I am. ... I would like to ask for forgiveness, but I have no right."

Sometime in the early hours of April 23, 2006, Marin entered Edmondson's apartment, woke her and Hill and directed them to the bathroom, according to trial testimony. He had them strip before he brutally attacked them with knives, a hammer, a screwdriver and a pizza cutter.

Before and after the murders, Marin went to the top of a parking structure and contemplated suicide. His defense attorneys, Thomas Diehl and Dave Cmelik, argued that Marin's use of Zoloft and other prescription drugs drove him to experience suicidal and homicidal thoughts.

Marin's friendship with Edmondson and Hill was discussed at length throughout the trial. In a videotaped interview with police, Marin said the women were his best friends, and he did not know why he killed them. Marin attended two house parties with Edmondson and was staying at her apartment the night he killed the women.


In addition to the consecutive life sentences, Marin was ordered to pay $150,000 to the estates of both Edmondson and Hill, as well as court costs and attorney fees. He may seek an appeal within 30 days of his sentencing.
A number of victim impact statements are included in the original report. While the man who committed the crime deserves to go to jail, the psychiatrist who prescribed these dangerous drugs should also be held accountable.

Friday, November 23, 2007

Lawsuit Over a Woman’s Suicide at an Elite Private Psychiatric Hospital

Via the New York Times. The hospital, of course, is investigating and blaming one of the heirs to the woman for contributing to the suicide, even tho she was under the hospital care and custody. A long story, so here are some snippets:

Depressed and addicted to painkillers, Ms. Farrell had checked herself into the acute-care ward at Silver Hill the previous week. Records show she told the staff she was feeling better the day she died and even asked the dietitian for less garlic in her orzo, showing that she was looking ahead.

But by nightfall, Ms. Farrell had made other plans. The orderly who had been checking on her every 15 minutes found her suspended from a bathroom door, eight feet from the nurses’ station. Black Spandex pants were tied around her neck. A suicide note was in the trash.

Now Silver Hill — a 76-year-old nonprofit hospital specializing in psychiatric disorders and substance abuse — is being sued by the executor of Ms. Farrell’s estate, himself a former patient with whom she maintained a close relationship despite warnings by her doctor that she should stay away from him. The suit accuses the hospital and a psychiatrist there, Dr. Ellyn Shander, of wrongful death by failing to protect a troubled woman from herself.

The complaint, and other episodes recounted in lawsuits and police reports over the last decade, are peeling back the veil on life inside one of the country’s more prominent psychiatric institutions and raising questions about how far a psychiatric hospital has to go to ensure its patients’ safety.


Victoria de Toledo, a Stamford lawyer who has twice sued the hospital, saw the situation differently. Speaking generally, she said, “It’s heartbreaking when someone goes in because they need help at a place like Silver Hill, and they come out worse than when they went in.”

In one case, Ms. de Toledo represented a patient who settled a civil case after accusing a hospital employee with a long criminal record of sexually assaulting her while she slept. And in a case settled for an undisclosed amount in August, she was the lawyer for a man who had his ear partly bitten off by another patient in 2003.


In the months before the trial, lawyers for the hospital and for Dr. Shander fought to obtain Mr. Kervick’s psychiatric records in an effort to shed light on his relationship with Ms. Farrell.

Judge Thomas L. Nadeau acknowledged that some records might be relevant, although he displayed concern that the information might be used to smear Mr. Kervick. “What jury would want to give money to the beneficiary of an estate who is then portrayed as a bad guy, even if his bad-guyness didn’t impact her conduct?” he asked.

Neal P. Rogan, a Westport lawyer who once defended a man charged with abetting his wife’s suicide, though not involved in this case, said the judge’s concern was legitimate. “If the jury actually followed the law,” he said, Mr. Kervick would win his case because “even if you might not like the fact that he’s the one in the will, they’re the ones charged with her care.”

Isreali Defense Force Psychiatrist suspected of attempting to spy for Iran

In a new twist of psychiatrists behaving badly, we have a case in international espionage. From the Jerusalem Post

A psychiatrist who serves in the IDF reserves is suspected of offering classified information to foreign intelligence officials, including those from Iran, police announced Friday morning.

45-year-old David Shamir, ranked as major in the army, was indicted on severe charges of attempted espionage, contacts with a foreign agent and perverting the course of justice.

He was arrested by the Shin Bet (Israel Security Agency) in cooperation with the Israel Police's Serious and International Crimes Unit on November 14, police said.

According to the prosecution, during his IDF reserve duty, the psychiatrist was exposed to classified material including emergency plans of the IDF Medical Corps, detailed plans for the deployment of medical units and control centers, procedures for providing psychiatric services to the home front during a war and tactics for evacuating civilians in the event of rocket attacks, as well as IDF intelligence and operations assessments.

The November 22 indictment served in the Petah Tikva Magistrate's Court asserts that "in April 2007, Shamir decided to provide information to hostile entities in exchange for money and he contacted the Iranian Foreign Ministry by electronic mail."

He allegedly introduced himself in the mail as a civilian and an Israeli officer "well tuned in to what goes on in Israel." Police said that during his interrogation, Shamir confessed that he told the Iranians he had widespread contacts with Israeli public figures and Israeli companies including those with security clearances.

The IDF psychiatrist purportedly expressed his willingness to cooperate with Iran, saying that he would be prepared "to provide further details." A few days later, he received a response by the Iranian officials but he didn't finalize an agreement with them, police said.

In addition, it is alleged that in August 2007, Shamir sent faxes from his home to the Iranian consulates in London and Turkey and, about a month ago, after receiving no responses, he faxed them again. Police said that after sending the faxes he destroyed them and saved the fax numbers to his cellular phone memory in order lessen the chances of detection.

Shamir told his interrogators that he was motivated by "greed."

Furthermore, on November 3, he allegedly turned to the Hamas-controlled al-Azhar University in the Gaza Strip where he introduced himself as an Israeli citizen interested in "joining the struggle." Police assert that he did this in order to create an opening for future cooperation between him and Hamas.

Shamir also allegedly wrote an anonymous e-mail to the Russian intelligence service, seeking clarification on its recruitment process and expressing willingness to join the organization.

Police requested that Shamir be remanded in custody until the end of legal proceedings and until now, his remand has been extended several times for the purpose of the investigation.

Shamir, who ran a drug rehabilitation clinic, was also found to be in possession of marijuana, police said.

"This fact surprised the investigators, in light of the fact that he is a civil servant in a government institution who as part of his job is supposed to treat suspects sent by the court for drug rehabilitation treatment," read a police statement.

Thursday, November 22, 2007

Case against psychiatrist unfolds - Shrink accused of molesting patients at Gwinnett clinic

As seen in the report, more than one doctor has had disciplinary problems at this fine facility. From the Atlanta Journal Constitution

Dr. Mohammad Qureshi seemed typical of the psychiatrists at Georgia's state mental hospitals.

He was young, with just a few years' experience. He trained at a foreign medical college. And he was willing to work for the relatively low pay the state offers to those who treat the extremely difficult patients who occupy its psychiatric facilities.

But for five months this year while working at Northwest Georgia Regional Hospital in Rome, Qureshi was under suspicion for sexually molesting patients on his second job 90 miles away.

Still, he continued seeing patients at the state hospital until police arrested him in late September. At least 12 women have told authorities that Qureshi fondled them during psychiatric examinations at a Gwinnett County clinic.

The psychiatrist's arrest prompted an investigation at Northwest Georgia Regional. But no patients there made allegations against him.

"There is no evidence of any misconduct by Dr. Qureshi," said Kenya Bello, a spokeswoman for the Department of Human Resources, which runs the state hospitals.

Qureshi, 45, of Lawrenceville has pleaded not guilty. He is free on bond, awaiting trial on sexual assault charges, facing the possibility of years in prison. DHR fired Qureshi from Northwest Georgia Regional, and the state medical board could suspend or revoke his license.

The case is playing out as officials face questions about the quality of medical care in the seven state psychiatric hospitals.

The U.S. Justice Department is investigating whether poor care in the facilities violates the civil rights of patients. Meanwhile, a panel appointed by Gov. Sonny Perdue is examining the role of the hospitals' staff physicians in creating and sustaining dangerous conditions, among other issues surrounding mental health care in Georgia.

The inquiries followed articles in The Atlanta Journal-Constitution reporting that at least 115 patients died under suspicious circumstances from 2002 through 2006, many after questionable medical treatment.

Qureshi's lawyer, Andrew Margolis, did not respond to requests for an interview. He proclaimed his client's innocence at a hearing last month.

Qureshi, a native of Pakistan, is a U.S. citizen, according to his state personnel records. He graduated from Sindh Medical College at the University of Karachi in 1986 and trained at the University of Connecticut from 1999 to 2003. Files on his medical licenses in New York and Georgia do not show where he practiced during the 13-year interval.

Qureshi came to Georgia in 2006 after working for 19 months at a state mental hospital in Ogdensburg, N.Y., on the Canadian border.

At the St. Lawrence Psychiatric Center, hospital administrators received no complaints about Qureshi's behavior, said Dr. Hari Sanghi, the clinical director.

"Nothing," Sanghi said. "We don't have any adverse record on him. He was doing his job properly. We did not see any problems."

Qureshi left the New York hospital, Sanghi said, to be near his parents after they moved to Georgia.

He went to work at Northwest Georgia Regional in November 2006. His annual salary was $108,000 for a 32-hour work week — a significant cut from the $145,000 a year he earned in New York.

About the same time, Qureshi took a second job with the Gwinnett-Rockdale-Newton Community Service Board, which operates several mental health clinics in three counties outside Atlanta.

In April, according to recent court testimony, two female patients at the community service board's Lawrenceville clinic complained that Qureshi had touched them inappropriately. The board's director warned Qureshi but kept him on the staff, a police detective testified.

Qureshi's personnel file does not reflect whether anyone at the community service board notified state officials about the allegations. In fact, the file makes no mention of Qureshi's second job in Rome.

By September, complaints about Qureshi had escalated.

A 43-year-old woman alleged that during a psychiatric session, Qureshi had instructed her to disrobe and then fondled her. Over the next few weeks, 11 more women came forward to Gwinnett authorities with similar allegations.

Northwest Georgia Regional suspended Qureshi shortly after his arrest on Sept. 28. He remained on the state payroll until Oct. 22, three days after a Gwinnett County magistrate judge bound the case over to Superior Court for trial.

State personnel officers thoroughly checked Qureshi's background and credentials before hiring him, said Bello, the DHR spokeswoman. Sanghi, who was Qureshi's supervisor in New York, said he gave him a positive recommendation when Georgia officials called for a reference.

Past ethical lapses do not necessarily disqualify physicians from working in Georgia's state hospitals.

At least five doctors now employed in the facilities were hired despite having been disciplined for drug abuse. Another had temporarily lost his license because of alcohol use. Yet another had been punished for sexual misconduct with two of his patients at a private psychiatric hospital.

Big Pharma and the Big Sleep racket

Snippetts from a interesting and extended article in the NY times. Our interest is in another angle by which people around the world get fleeced by big bad pharma. Of course, the article examines other aspects of the Sleep Industry, including mattresses, marketing, and such.

Compared to how most people sleep, or have slept through history, we never had it so good. Is this another case of "the better off people are, the more they complain?"

A sleep boom, or as Forbes put it last year, “a sleep racket,” is under way. Business 2.0 estimates American “sleeponomics” to be worth $20 billion a year, which includes everything from the more than 1,000 accredited sleep clinics (some of them at spas) conducting overnight tests for disorders like apnea, to countless over-the-counter and herbal sleep aids, to how-to books and sleep-encouraging gadgets and talismans. Zia Sleep Sanctuary, a first of its kind luxury sleep store that I visited in Eden Prairie, Minn., carries “light-therapy” visors, the Zen Alarm Clock, the Mombasa Majesty mosquito net and a $600 pair of noise-canceling earplugs as well as 16 varieties of mattresses and 30 different pillows.

Prescription sleeping pills have been the most obvious beneficiary. Forty-nine million prescriptions were written last year, up 53 percent from five years ago, according to IMS Health, a health-care information company. It is now a $3.7 billion business, more than doubling since 2003. At $3 or $4 per pill, their success indicates not only that we have an increasingly urgent craving for sleep but also that many of us have apparently forgotten how to do it altogether — quite a feat for any mammal.


Even the most comfortable mattress can only create a place for sleep, not manufacture it directly. But a sleeping pill puts us down — and under circumstances when we’re unable to do it ourselves. Bils told me: “The sleeping pill is an easy path. It promotes sleep over all the rules you break.” In trying to deride his competition, he spelled out its greatest advantage.

Pharmaceutical companies realize they are selling a reassuring guarantee. “Does your restless mind keep you from sleeping?” asks one Lunesta commercial, while the green moth floats in front of a tossing man. Suddenly, like a hypnotist’s watch, it dispatches him into a deep slumber and flies on to lull even the stern, stone visages of Mount Rushmore to sleep. A couple in a commercial for Ambien CR, meanwhile, lie absolutely motionless all night until the darkness around them fades to daylight.

Last year the industry spent more than $600 million on advertising, helping the newest generation of pills, the so-called “Z drugs,” destigmatize sleeping-pill use
The nation’s most popular, Ambien and its extended-release counterpart Ambien CR, accounted for 60 percent of all sleep-aid prescriptions last year according to IMS Health, for $2.8 billion in sales. Surely great numbers of Americans are experiencing the kind of satisfying knockouts depicted in the commercials.

Yet, as a very infrequent but contented user of both Lunesta and Ambien myself, I was startled to read efficacy trials for those drugs submitted to the F.D.A. In one six-week trial, for example, people taking Ambien every night fell asleep, on average, only 23 minutes faster than those taking the placebo. They spent 88 percent of their time in bed asleep, as opposed to 82 percent. Given that their objectively measured improvements are frequently this meager, why do sleeping pills create incommensurate feelings of having slept so well?

A popular theory is that one of the pill’s side-effects is actually contributing to their success. Most sleeping pills are known to block the formation of memories during their use, creating amnesia. This is why people who endure freaky side-effects — so-called “complex sleep-related behaviors” like getting into a car and driving or ravenously eating, all while asleep — don’t remember those events. Yet this amnesia could be quite beneficial, suggests Michael Bonnet, a professor of neurology at Wright State University Boonshoft School of Medicine in Dayton, Ohio. “How do you know you slept last night?” Bonnet asked me. A night of lousy, interrupted sleep, he points out, is easy to remember. “It’s full of memories, noise and pain, and heat and rolling around and obtrusive thoughts and worries — all of these various stimuli.” And we may continue to register such things even while asleep, making sleep vaguely unrefreshing. But a good night of sleep, Bonnet went on to say, “is always the antithesis to all those things, which is oblivion.” A sleeping pill, Bonnet speculates, in addition to encouraging sleep chemically in the brain, also “erases all of these thoughts that we use to define ourselves as being awake. The pill knocks them all out, and the patient says, ‘Hey, I must have been asleep because I don’t remember anything.’ ”

Drug-company representatives and consultants I spoke to confirm that their pills can create this mild form of amnesia but disagree that it contributes any significant benefit.
“That is not my understanding of how Ambien works,” Dario Mirski, a psychiatrist and spokesman for Ambien’s manufacturer, Sanofi-Aventis, told me. It is difficult to find a clinical trial in which Z-drug takers drastically overestimated how long they slept.

Andrew Krystal, a Duke University psychiatrist and consultant to pharmaceutical companies like Sepracor, Lunesta’s manufacturer, acknowledges an apparent discrepancy in studies between small, objectively recorded improvements and the large percentage of subjects who end up feeling that a pill alleviated their insomnia. But because insomnia is complaint-based, he explained to me, an insomniac is cured when he stops complaining. Who’s to say how many more minutes of sleep or fewer awakenings during the night it should take to relieve each individual’s highly subjective dissatisfaction? Many insomniacs don’t show impaired sleep by any objective measure to begin with — but presumably they benefit from sleeping pills, too. So, Krystal asked, what would you expect to see improve? (A 1990 study presents a jarring example: it focused on a group of insomniacs who, when woken up, swore they hadn’t been sleeping. But if given a sleeping pill first, then woken up, they knew they’d been asleep.) He added, “I’m not a person who shares the view that the reason the drugs work is because they’re amnestic.”

Another prevalent theory is that sleeping pills produce a beneficial physiological effect that clinicians don’t realize they should be measuring. The standard battery of brain-wave and other measurements used in sleep labs provide only a “limited picture,” Krystal said. Nevertheless, several researchers suggested why the amnesia factor isn’t likely to be explained to patients, even as a theory. We tend to see sleep problems as physiological. A treatment that works, even in part, by altering our perception of that problem would seem like “more of a fake,” says Charles Morin, director of the Sleep Research Center at Laval University in Quebec City. Imagine, Morin said, if doctors told their patients: “You keep waking up at night but you just don’t remember it.”

Sleep doctors have criticized sleeping-pill ads for setting up an unattainable expectation of how blissful and easy sleep should be. But the mattress industry operates under that expectation, too, trying vigorously to build a state-of-the-art, NASA-engineered arena on which that idealized, paralytic oblivion can occur. But how did we come to need so much help sleeping in the first place, and how did we come to want, much less expect, the sleep these people are selling?

Wednesday, November 21, 2007

Antidepressants Now No. 1 Drug Prescribed For Women 18-44 - High Number Of Prescriptions Worrying Some Experts

Snippets from a report on MSNBC

Studies are showing that for every 100 American women, 37 have been prescribed an antidepressant, which is now the No. 1 drug prescribed to women ages 18 to 44.

Some experts said they're worried.

"Some of the women are not really depressed," said Diana Zuckerman, president of the National Research Center for Women and Families.

She said these numbers are too high. A big issue for her is that too often a medical doctor like a gynecologist or general practitioner is prescribing the antidepressant rather than a psychiatrist trained to treat mental health issues. As a result, many patients on mood meds are not getting the follow-up care they need. One study suggests that just 20 percent of adults on these drugs are getting follow-ups.

"But realistically, you want somebody who's keeping an eye on that patient and a lot of doctors are just not going to do that," Zuckerman said.


In fact, about two-thirds of people on these drugs experience side effects, which can be severe and devastating.

Internet bloggers are even sharing their experiences with antidepressants online. They descibe these effects as a "nightmare" and like "torture." Common reactions include "weight gain, decreased sex drive and severe stomach cramping."

"Something is going on with these drugs," Zuckerman said. "Not everybody metabolizes them the same way. It doesn't have the same effect on every person and some people are harmed by them."
Of course, we remain skeptical about the psychiatrists.

Drug firms accused of biasing doctors' training

As reported in the scientific journal Nature

Can the pharmaceutical industry be trusted to fund doctors' compulsory education without introducing bias? The issue is dividing Congress, academics and drugs companies. Now, preliminary data have emerged suggesting that industry-sponsored courses skew training material in favour of commercial interests.

Pharmaceutical firms spend over US$1 billion a year to fund more than half of the continuing medical education (CME) courses that qualified physicians are required to take in the United States. Although drug firms say that they are scrupulous about separating their CME involvement from promotional activities, some may be influencing doctors, intentionally or not, and may even be putting patients' health at risk (see 'Smokescreens'). Drug companies deny this, insisting that the independent educational firms they pay to produce CME activities always operate outside industry influence. Government standards specify that commercial promotion must be kept separate from education.

Now, two small studies have attempted the first objective measurements of bias in doctors' education. Neither is large enough to settle the issue (and neither has yet been published), but their data suggest that industry sponsorship is distorting medical education.

Psychiatrist Jatinder Takhar, head of the CME office at the University of Western Ontario in London, Canada, first became interested in industry bias after attending a CME presentation on antipsychotic drugs that she had audited and approved previously. She was surprised to find that it did not match her recollection. "The data were slanted and the presentation was more promotional and less educational," she alleges.

Takhar and her colleagues went on to develop a standardized checklist of potential problems to be used for measuring bias in CME, which they published in June (J. Takhar et al . J. Cont. Educ. Health Prof. 27, 118-123; 2007). The team then applied its checklist to 17 company-sponsored CME events. Nine of these were found to be biased and should not have been approved, Takhar says. Some focused only on the sponsors' product and ignored rival treatments. In others, information on side effects associated with the sponsors' drugs was reduced to small print.

Another study, by Daniel Carlat, a psychiatrist at Tufts University School of Medicine in Somerville, Massachusetts, looked at printed CME material — typically, medical articles followed by a written test. Carlat asked his colleagues to remove information about the sponsor from exercises sent to his office during 2005 and 2006. He then calculated the ratio of positive to negative statements made about every drug mentioned in the exercises. In 14 of the 15 exercises he looked at, the drug that received the highest ratio turned out to have been made by the firm sponsoring that exercise. He is preparing his paper for submission to the American Journal of Psychiatry .

Carlat publishes a CME newsletter that operates independently of industry funding, presenting a conflict of interest to his study. Researchers shown the findings of the two studies by Nature add that the samples Carlat looked at might not be representative of all written CME exercises. They also note that, unlike Takhar, Carlat has not validated his method for estimating bias. Drug companies also point out that firms tend to sponsor material about disorders for which they sell the best treatment, so it is right that those exercises focus on the sponsors' drugs. Yet interviews with physicians involved in the exercises that Carlat evaluated reveal that, at least in some cases, the focus is not simply the result of sponsors' drugs outperforming those of their rivals.

One exercise Carlat looked at was based on talks on bipolar disorder given at the 2005 US Psychiatric and Mental Health Congress. Anton Porsteinsson of the University of Rochester Medical Center in New York gave one of the presentations. Porsteinsson alleges that he mentioned problems with a sponsor's drug — Depakote (divalproex), manufactured by Abbott Laboratories in Illinois — in his talk, but that these were missing from the exercise. Yet he claims that positive results about the drug that were not mentioned during the talk were included. In his opinion, "the big issue is that the article is selective". Abbott denies claims that the presentation was distorted. A spokeswoman says that the firm had reviewed the material and found it to be in line with current thinking on bipolar disorder.

When asked about Carlat and Takhar's findings, Jennifer Page, communications director at the Pharmaceutical Research and Manufacturers of America in Washington DC, said only that drug companies do adhere to her organization's CME guidelines. Those standards require a firewall between pharmaceutical firms and medical-education companies. Drug companies can recommend speakers for events, for example, but CME providers select the physicians best suited for the job and are not obliged to follow a sponsor's suggestions.

But the firewall is not working, some argue. As other forms of promotion are scaled back, marketing is increasingly disguised as education, says Jerome Kassirer, a former editor of the New England Journal of Medicine , now at Tufts University in Medford, Massachusetts. "It's a reallocation of marketing money," he says.

One physician who was employed by a drug company to check the accuracy of promotional material, and who asked to remain anonymous, claims that CME material is still viewed by drug companies as part of marketing campaigns. He adds that the provider-sponsor firewall is easy to subvert, because CME providers do not need to be explicitly told to produce biased programmes. "They know that if they don't provide what the company wants then they're never going to be hired again," he claims.

The Accreditation Council for Continuing Medical Education (ACCME), based in Chicago, Illinois, which approves CME providers, acknowledges that more could be done to protect against bias. Murray Kopelow, the council's chief executive, says that next year the ACCME will launch a trial in which reviewers will check CME material and report back on problems they encounter. The council will also consider whether drug companies could be asked to pool CME funds for distribution by an independent body in a bid to reduce the influence that any one firm has over an educational exercise.