A Hypocritical Oath: Psychologists and Torture

A column by Amy Goodman, who is the host of “Democracy Now!,” a daily international TV/radio news hour airing on 500 stations in North America. As seen here

First, do no harm. This tenet of medicine applies equally to psychologists, yet they are increasingly implicated in abusive interrogations, dare we say torture, at U.S. military detention facilities like Guantanamo. While the American Medical Association and the American Psychiatric Association both have passed resolutions prohibiting members from participating in interrogations, the American Psychological Association refuses to, despite the outrage of many of its members.

Now, with the declassification of a report by the Pentagon’s inspector general detailing psychologists’ role in military interrogations, the U.S. Senate Committee on Armed Services announced it will investigate.

Dr. Leonard Rubenstein, executive director of Physicians for Human Rights, says such an “investigation into the development of torture techniques by the United States” would be “very significant. ... It should get into ... the use of psychologists in the development of the techniques, what is happening now, and how this can be avoided in the future.”

Two years ago, after a leaked report from the International Committee of the Red Cross criticizing the role of health professionals in U.S. interrogations, the American Psychological Association formed its Presidential Task Force on Psychological Ethics and National Security (PENS). There were nine voting members. Six of them were connected to the military. At the time, the identities of the panelists were secret. The PENS panel endorsed the continued participation of psychologists in military interrogations.

Of the three nonmilitary voting members, one, Dr. Michael G. Wessells of Randolph-Macon College, resigned, and another, Dr. Jean Maria Arrigo, recently called for the PENS report to be annulled. “I’m an oral historian, maybe even before a psychologist, and I always take notes. And I was told very sharply by one of the military psychologists not to take notes.” She took notes anyway. She archived the group’s entire e-mail list-serve, including months of e-mails from before and after the sole two-day PENS meeting. She went on: “I came later to realize that the entire report had been orchestrated. I no longer felt bound by that confidentiality agreement.” She recently handed over all her materials to the Senate Armed Services Committee. The third, Dr. Nina Thomas, told me: “I don’t think I was, in fact, critically aware of what Morgan Banks’ role was at the time of the meetings themselves. I knew the outline of his background, but I didn’t know the meaning of his background. So it disturbs me.”

Col. Morgan Banks, as Mark Benjamin of Salon.com first reported, is “the senior Army Survival, Evasion, Resistance and Escape psychologist, responsible for the training and oversight of all Army SERE psychologists, who include those involved in SERE training. He provides technical support and consultation to all Army psychologists providing interrogation support.” Another task-force member, Capt. Bryce Lefever, served at the Navy SERE school from 1990 to ‘93, then became the “Special Forces Task Force psychologist to Afghanistan in 2002, where he lectured to interrogators and was consulted on various interrogation techniques.”

Also included was R. Scott Shumate, who was the chief operational psychologist for the CIA’s counterterrorism center until 2003. He then became head of the Pentagon Counterintelligence Field Activity’s Behavioral Sciences directorate, overseeing psychologist participation in the interrogation process at Guantanamo.

SERE (pronounced SEER-ee) includes sensory and sleep deprivation, isolation, cultural and sexual humiliation, “stress” positions (like forced standing), extended subjection to light, loud noise, extremes of heat and cold, and “waterboarding,” wherein subjects have their face covered with a cloth that then has water poured over it, giving the feeling of suffocation. The goal of SERE is to train U.S. military members to resist torture they might experience if captured. As first reported by Jane Mayer of The New Yorker, the SERE techniques were “reverse engineered.” In other words, they were used against the prisoners.

The upcoming APA Annual Convention, taking place Aug. 17- 20, promises to be hotly contested. An unknown number of members are withholding dues. Some have quit. Physicians for Human Rights’ Rubenstein summed up:

“Even the army surgeon general’s report ... said it was the role of psychologists to tell interrogators when to increase the pressure, how to exploit vulnerabilities. So I think we really do have to end this as a nation, not just as professional associations. ... We’re talking about ... ending complicity in torture by a profession that has an enormous amount to contribute to the good of humanity and should not be involved in the destruction of people.”

Red flag on pediatric psychopharmacology

More opinion columns are appearing around the USA about the dangers of psychiatric drugs. As seen in the Ithaca Journal

The New York Times and The Ithaca Journal published the story of 4-year-old Rebecca Riley who died because her parents overmedicated her and professionals who should have protected her did not. Both stories express very pertinent concerns about the diagnosing and medicating of children. As a children's psychotherapist, I can shed some light on these concerns.

Collusion between members of the medical profession and pharmaceutical companies contributes to the misuse of medication; some psychiatrists collaborate in unscientific “research” funded and rigged by drug companies. Their names on publications imply those companies' products are safe when often they are not. In exchange, the doctors enjoy the companies' exorbitant financial rewards and luxury perks. Prestigious medical journals publish these studies, journals that are largely funded by drug advertising, compromising their veracity as well.

Rebecca's death is a worst-case scenario in a nation where chemical abuse of children has reached epic proportions. If the Associated Press stories about Rebecca are accurate, Rebecca's psychiatrist shares culpability for her death. It is reported that she diagnosed Rebecca with ADHD and bipolar illness at age 2, which is outrageous. Then, according to the report, she generously prescribed psychiatric medication off label, which means the medications are not approved for children.

Only stimulants are approved for children to treat ADHD. However, the Food and Drug Administration has now advised makers of stimulants to inform patients in writing of serious side effects like psychiatric and heart problems, including sudden death. Advising carries no weight with drug companies. They suppress negative information about their products. Independent studies indicate stimulants are ineffective and can worsen symptoms of children under 5. Few parents know that stimulants affect the brain just like cocaine. Often important information is withheld from parents, preventing them from making sound decisions about medicating their children.

After 1991 ADHD diagnoses exploded because they were added to the list of disabilities warranting special educational services, a boon for pharmaceutical companies. Children, their most lucrative growth industry, have been shamelessly exploited since then as companies put obscene profits ahead of pediatric health concerns. In 1996 a psychiatric group at Harvard, funded largely by pharmaceutical companies, claimed that many ADHD children also have bipolar disorder. Bipolar, or manic depression, had always been considered an adult malady. This group invented a new description for pediatric bipolar, claiming that children have a “rapid cycling” form of the disorder. Hundreds of thousands of children have been labeled with this diagnosis du jour, another boon for pharmaceutical companies, especially since bipolar portends lifelong illness and drug consumption. Labels become self-fulfilling prophecies; children identify with the label, especially when influential people in their lives convey expectations of “bipolar” behavior.

What a slippery slope from ADHD to bipolar. If stimulants fail to “work” for ADHD the doctor typically ups the diagnosis to bipolar. Standard treatment usually introduces two or three powerful chemicals into the developing brains of children, upsetting the natural chemical balance of the brain. This often creates illness in children who had none to begin with. This process often begins with school staff pressuring parents to use a “medical” approach (drugs) for their rambunctious child. Managed care companies promote the drugging of children to maximize profits.

Generally “mental illness” is considered neurobiological disease, despite failed efforts to prove it. Children who need to move are called “diseased”; throwing a tantrum is “mania.” Yet no medical test exists for any mental illness, except bona fide organic disabilities like heavy metal absorption. Brain expert Allan Jones states, “We know only 5 percent of what there is to know about the brain.”

Mind-altering drugs replace altering the psychosocial environment where the cause of children's distress usually resides. Often even then clinicians are applying first aid to distress rooted in the very infrastructure of our society: working and low-income parents often are unable to adequately care for their children; pollutants, much more readily absorbed by children than adults, permeate our environment; food additives can affect children's behavior; and violent video games and television pollute their minds.

Psychologist Daniel Burston writes, “Indeed, future generations may look back on the early twenty-first century as an era when the chemical colonization of childhood really began in earnest ...” Imagine a society of people whose brains are infiltrated with foreign chemicals. Some would be robotic. All, like many children today, would be deprived of their right to individuality and expression of their true selves.

April 2007 Big Pharma Litigation Update - Drugs (Part II)

From the Lawyers and Settlements website

The anti-epileptic drug, Depakote (valproate), marketed by Abbott Laboratories, is one of the most heavily prescribed medications for off-label use. Experts say the evidence of harm caused by Depakote is just beginning to emerge.

According to Harrisburg, Pennsylvania psychiatrist, Dr Stefan Kruszewski, a recognized expert on psychotropic drugs, "we can anticipate a continuing series of tragic outcomes from the massive overuse of Depakote, secondary not only to birth defects and death, but also due to anemias, hepatic disease, obesity, diabetes type II, pancreatitis and other serious systemic and neurological dysfunctions."

Bayer is under fire for hiding the adverse effects of the anti-clotting drug, Trasylol, used in heart surgery, and will no doubt be hit with plenty of lawsuits in the not to distant future, considering that Dr Dennis Mangano, the lead author of new study in the February 7, 2007, Journal of the American Medical Association, says that the Trasylol may be responsible for 10,000 deaths over five years.

On December 15, 2006, the FDA announced new labeling for Trasylol, and said a study suggests that, in addition to serious kidney damage, Trasylol may increase the chance for death, congestive heart failure (a weakening of the heart), and strokes.

Because Trasylol is administered during surgery, many victims may not even realize they have been injured by the drug. But plenty have, according to Dr Mangano, who says that in 2006, Trasylol, was administered to 246,000 patients.

Another drug on the legal chopping block is the Parkinson's drug, Permax. As far back as December 2002, doctors at the Mayo Clinic reported heart valve disease in 3 patients who had been taking Permax, similar to damage caused by the Fen-Phen combination.

In 2004, HealthDay News reported that a study had confirmed previous findings that the drug could damage heart valves and surgery would be needed to correct it. Two new studies in the January 4, 2007, New England Journal of Medicine, report that the number of Permax patients who have developed valve damage is higher than expected.

One study, which included 155 patients taking various Parkinson's drugs, and 90 healthy patients in a comparison group, and found moderate to severe valve problems in more than 23% of the patients on Permax, compared to less than 6% in the comparison group.

The second study found Permax users were 5 to 7 times more likely to have leaky heart valves than patients taking other types of Parkinson's drugs, and patients taking the highest doses of Permax had a 37 times greater risk.

"This is not a rare side effect," says Dr Bryan Roth, a professor at the University of North Carolina, who wrote an editorial accompanying the reports in the NEJM.

"That's an extraordinarily high incidence," he warns. "That makes this a serious problem."

Heart valve damage is a life-threatening condition and costly to treat. Replacement requires open heart surgery, where the breastbone is divided, the heart is stopped, and blood is sent through a heart-lung machine, according to the Texas Heart Institute. No drug can reverse valve damage, making replacement surgery the only option. Medical experts are advising all Permax patients to undergo testing for valve damage.

The drug was introduced to the US market by Eli Lilly, but Valeant Pharmaceuticals now sells Permax. On March 29, 2007, Permax was pulled off the market after the FDA reviewed new information that associates it with heart problems.

During the last 2 decades, the antidepressants, known as selective serotonin reuptake inhibitors, or SSRIs, have been prescribed for more unapproved uses than any other class of drugs in history. A June 2005, study in the Journal of Clinical Psychiatry, found that 75% of SSRI prescriptions written were for unapproved uses.

SSRIs have now been linked to suicidality, extreme violence and homicide, several life-threatening birth defects, abnormal uterine or gastrointestinal bleeding, a decrease in bone mineral density, fertility problems, sexual dysfunction, and a severe withdrawal syndrome.

On April 10, 2004, the British Medical Journal, criticized the authors of studies on SSRI's for exaggerating the benefits and downplaying the harm, including suicidality, and discussed a study of 93 children on Paxil that produced 11 serious adverse events, including 7 hospitalizations, compared to only 2 in children in the placebo group.

The Paxil suicide risk is not limited to children. An August 22, 2005, study by Norwegian researchers of over 1,500 adults, found 7 Paxil patients attempted suicide compared to only 1 attempt in the group on a placebo, and recommended that warnings not to prescribe Paxil to children should also apply to adults.

According to Forest Lab's Annual Report filed on June 14, 2006, the company is a named defendant in approximately 25 lawsuits, with the majority involving the company's top selling SSRI drugs, Celexa or Lexapro, for inducing suicidality.

A wrongful death lawsuit was filed in September 2005, by the Pogust & Braslow law firm in Conshohocken, Pennsylvania, on behalf of the family of 32-year-old man who unexpectedly committed suicide soon after being prescribed Lexapro.

A steady stream of lawsuits have been filed against GlaxoSmithKline over Paxil, stemming from the company's concealment of the drug's link to suicide, birth defects, violence and withdrawal syndrome.

On March 23, 2006, the California-based Baum Hedlund law firm filed a national class-action lawsuit against Glaxo on behalf of the mother of an 11-year old Kansas boy who committed suicide, and a teenager in Texas who attempted suicide while taking Paxil.

She says, Baum Hedlund has documents obtained in litigation that show there was an awareness of the suicide risk as far back as the late 1970's, a decade before the first SSRI was approved for sale in the US.

A new round of Paxil lawsuits began on October 16, 2006, when Baum Hedlund filed a case alleging that Paxil use during pregnancy resulted in an infant being born with a life-threatening lung disorder, PPHN. Between 10% and 20% of infants born with PPHN end up dying, even when they receive treatment.

On July 28, 2006, Baum Hedlund also filed a lawsuit on behalf of the parents of an infant who was born with congenital heart birth defects as a result of his mother taking Paxil during pregnancy. Since birth, the child has undergone 3 open-heart surgeries and will likely have to undergo more and possibly a heart transplant at some point in the future.

Based on the company's legendary history of concealing adverse effects, the lead attorney on the case, Karen Barth Menzies, says believes Glaxo has known about these risks and should have warned prescribing doctors and consumers about these birth defects long ago.

The Houston law firm of Robert Kwok & Associates is handling a Celexa birth heart defects case in Kentucky. The mother was prescribed Celexa during pregnancy, and her baby was born with Shone's Complex, a form of congenital heart disease that consists of defects that lead to the obstruction of blood flow from the heart to the body.

Legal analysts are predicting that SSRI makers will offer early settlements in cases involving birth defects to avoid having these families appear before a jury.

Pfizer is still being sued left and right over adverse effects related to the epilepsy drug Neurontin. In 2004, the company pleaded guilty to charges involving a massive off-label marketing scheme and agreed to pay the second-largest settlement ever in a health care fraud prosecution of $403 million. By 2002, a full 94% of Neurontin sales were for off-label use, according to the August 16, 2004 USA Today.

Many private lawsuits involve Neurontin-induced suicidality. The Pogust & Braslow law firm is handling a case for Natalie Biedenbender, whose husband committed suicide at age 39, after being prescribed the drug off-label for back pain.

"Although Neurontin is prescribed for scores of off-label indications," Attorney Derek Braslow reports, "since 1999, the off-label use continues to be most common in the areas where the company focused its illegal marketing efforts, such as bipolar disorder, peripheral neuropathy, and migraine."

Two lawsuits were recently filed against Novartis and Astellas Pharma, the makers of the topical skin creams, Elidel and Protopic, used to treat eczema. Alan and Dayna Thomson filed a lawsuit in December 2006 after their daughter Haley died after using Elidel, and Ashley McDonald filed a lawsuit in January 2007 after being diagnosed with lymphoma following her use of Elidel.

In another case, Traci Reilly, of Naperville, Illinois, developed breast cancer after applying Protopic and Elidel for a condition that caused patches of discolored skin on her breast.

Protopic and Elidel belong to a class of drugs known as calcineurin inhibitors, so called because they reduce immune activity by inhibiting the activity of the enzyme calcineurin in organ transplant patients. Use of these drugs has long been known to increase the risk of cancer, and the drugs were labeled accordingly for use in transplant patients.

Protopic and Elidel have only been on the market for about 5 years and together have already been prescribed to more than 7 million people. In 2006, the FDA added a black box warning to the skin creams about the cancer risk.

On February 21, 2007, Tom Moore, the author of several books on the pharmaceutical industry, told CBS News that he had studied about 1,200 cases of suspected injuries pertaining to Protopic and Elidel reported to the FDA through 2005 and found more than 100 potential cancer cases in children and adults, with most involving lymphoma or skin cancer.

Moving From AntiDepressents to AntiPsychotics

As noted here:

A Brief History of Diagnostic Trends:

When benzos were the big drugs, everyone had anxiety.

When the SSRI era was born, depression was the disease of the day.

When depression was saturated, the move was on to raise awareness about social anxiety, generalized anxiety, PTSD, etc, as the SSRIs still had patent life to spare, and hence markets to conquer.

The new frontiers are depression with pain, for which Cymbalta is allegedly the drug of choice (despite rather meager supportive evidence), and bipolar, for which Seroquel, Abilify, Zyprexa, and Risperdal/Invega have already made significant inroads.

Lilly cleverly tried to expand the bipolar market with the Viva Zyprexa and Zyprexa Limitless campaigns, but it was just the first step in a much larger campaign.

Of course, who are we to be surprised that mental diseases rise and fall with the fashion of new drugs on the market?

We have this comment from someone in the business, entitled FareWell Depression

Write this day down: 4/4/07, it is the first day of the new psychiatry. Everything changes, starting today.

Today, in the New England Journal Of Medicine, is an article ostensibly about the lack of additional benefit from adding an antidepressant to a mood stabilizer. This is both surprising and not surprising: surprising, because, well, you'd think two drugs would be better than one. Not surprising because, well, if the first drug worked, why would a second even be necessary? (See #8). And if the first didn't work, how do you know the improvement didn't come entirely from the second drug?

If this is all the article said, it would not be worthy of mention, let alone the herald of a new dynasty.

The study also found that the studied antidepressants did not induce mania. That this should have been prima facie obvious even to a 9 year old without the benefit of eyes (what's an antidepressant? They're not all chemically similar, so why should they all be blamed for the same side effects?) isn't the point here. [...]

Psychiatry is not about science, it is about language, politics. What's happened here is that "mood stabilizer" now includes atypical antipsychotics; and-- compare what the study was designed to show and what they spun it to show-- we've gone from "polypharmacy is not better" to "monotherapy with mood stabilizers [read: antipsychotics] is just as good as two drugs at once."

There's a subtlety there, and that subtlety is magnificent.[...]

What the article is saying is that academic psychiatrists are no longer behind antidepressants and antiepileptics. SSRI and SNRI use will decline from here, as will Depakote. They're behind antispychotics. And antipsychotic use is positioned to explode.

But without academics pushing SSRIs, their use will wane--and, importantly, so will their support of the diagnosis "Major Depression." This is going to sound controversial, inane, but it will happen.

Look for upcoming articles finding that "Depression" is overdiagnosed, that it is really just-- life. Look for articles that now find SSRIs aren't that effective after all, that the old "10% better than placebo" is a statistical trick with little clinical utility. That they are way overused in kids.

You might say, wait, isn't the decline of polypharmacy a good thing; that SSRIs are overused in kids; that they aren't that great; and that depression is overdiagnosed? All of this is true, but this isn't psychiatry finally coming to its senses; this is psychiatry entering the manic phase. Sure, it's less SSRIs for kids; but it's more antipsychotics.

Because simultaneously there will be articles pushing the idea that recurrent unipolar depression is really bipolar depression; that there are common genetic or heritability patterns; that the epidemiology and course is similar, etc.

The move will be to squeeze out MDD into "life" and bipolar. This done, antipsychotics become first line agents. Oh, and look for antipsychotics to get FDA approvals for kids. [...] There's no science here, only a tinkering with language and loyalties, with staggering results.[...]

This isn't psychiatry suddenly waking from a coma, aha! it turns out the existing data do show antipsychotics are mood stabilizers! Instead of using them to replace antiepileptics, they will use them to replace everything: SSRIs, benzos, antiepileptics, stimulants, etc.

And polypharmacy will only be reincarnated-- in the form of multiple simultaneous antipsychotics (Abiliquel, anyone?), with preposterous pharmacologic justifications ("this one acts on serotonin, so it's the antidepressant, and this one on dopamine, so it's the antimanic.") If anyone says that to you, stab them.

You don't get many changes like this, maybe once every ten years-- the last was the beginning of the Depakote era, and before that was the advent of SSRIs, each with it's own erroneous semantics ("kindling model;" "serotonin model of depression.")

I wish all the patients in the world good luck, you'll need it. Not because of the antipsychotics themselves, which will work or not, oblivious to doctor and diagnosis; but because of the doctors, who take little interest in examining the evidence behind their practice, and even less interest in reevaluating its core principles; and who lack the courage to even treat what they see, instead resorting to artificial, and wrong, paradigms and algorithms.

There's not even pseudoscience here. Psychiatry is being lead by the siren call of semiotics, and it is saying, follow me, I am made of words...

And right on time is this story in the NY Times