Science and the Psychiatric Publishing Industry

A paper in the journal Ethical Human Psychology and Psychiatry, Volume 11, Number 1, 2009 , pp. 29-36(8) Publisher: Springer Publishing Company, by McLaren and Niall

Abstract

Objective: An empirical examination of the scientific status of psychiatry.

Method and Results: Analysis of the publications policy of the major English-language psychiatric journals shows that no journal meets the minimum criteria for a scientific publishing policy.

Conclusion: Psychiatry lacks the fundamental elements of any field claiming to be a science. Furthermore, its present policies are likely to inhibit scientific development of models of mental disorder rather than facilitate them. The psychiatric publishing industry is in urgent need of radical reform.

We told you so.

Drug Czar Plays Politics With Mental Illness, Suicide And Marijuana

Via Furious Seasons, a report from the White House Office of National Drug Control Policy. This comment at Furious Seasons hits the nail on the head:

Yes, pot makes people kill themselves. That's such a bizarre assertion that it's embarrassing--and, indeed, claiming pot causes anxiety and suicide while perfectly legal drugs such as Paxil, Zoloft, Effexor and so on have been linked to suicidality and suicides and to cases of very extreme agitation is the very height of hypocrisy. A 2001 study published in the Journal of Clinical Psychiatry found that 8.1 percent of admissions to one hospital's psych unit in a 14-month period were due to "antidepressant-associated mania or psychosis." In fact, a Whether you like or hate pot, you ought to be against the feds making such hypocritical claims or you ought to be in favor of Walters warning parents of teens about the dangers of anti-depressant-caused psychosis. I simply don't know of any studies proving that pot causes suicide. I'm not saying it's impossible, but it's highly unlikely that such a link is very strong.

Anti-depressants are much more of a suicide threat.

BBC Talking Head Psychiastrist Tonmoy Sharma Is Banned From Practising In Britain - Did Studies for Eli Lilly

As Reported in the Telegraph

A psychiatrist who regularly appeared as an expert on the BBC has been struck off the medical register after he lied about his academic qualifications and performed unethical drugs tests on mentally ill patients.

Tonmoy Sharma, who was a senior lecturer at the Institute of Psychiatry in London, has been exposed as a fraud who repeatedly referred to himself as a "professor" when records show that he had never completed a PhD thesis.

Despite this, Sharma, who was registered at the Clinical Neuroscience Research Centre in Dartford, Kent, regularly used the letters PhD after his name and managed to deceive the NHS and some of the world's largest pharmaceutical companies.

He also appeared on the BBC2 series Mind of a Murderer in 2000 and was often used as an expert commentator on BBC News Online stories.

A General Medical Council panel yesterday found Sharma guilty of "serious failings of personal integrity" after hearing that he recruited mentally ill patients to test drugs without seeking proper approval.

Andrew Popat, chairman of the panel, told Sharma: "Your persistent and wide-ranging dishonesty and untruthfulness, spanning a number of years, together with your lack of insight, is so serious that it is fundamentally incompatible with your continuing to be a registered medical practitioner."

Mr Popat said Sharma, the author of several books on mental illness, had "contributed significantly towards the advancement of medical science" and was highly regarded by his colleagues.

However, after a 10-month hearing, the GMC Fitness to Practise panel found Sharma guilty of serious professional misconduct and struck him off the medical register.

The 42-year-old, who trained in India, was found to have acted unprofessionally in relation to five major studies between 1997 and 2003, involving four leading pharmaceutical companies including Eli Lilly and the Janssen Research Foundation.

He also misled the companies when he chose to use identical patients in different studies, subjecting them to MRI scans and tests that had not been approved by an ethics committee. In 2003, he recruited mental health patients in unsolicited telephone calls and without consent from their doctors. He then failed to give them proper information about the trials - one schizophrenic was simply handed a leaflet.

His misconduct was first uncovered by the drugs company Sanofi, and a complaint resulting in his temporary suspension was made to the Institute of Psychiatry in 2001, prompting an investigation.

Sharma, who represented himself at the hearing, denied the claims and insisted that he "believed in ethics in medicine".

Irish Mental health tribunals have cost over €10 million to date

An interesting story, but what is utterly missed is the point that this is the cost in trying to establish at least some justice in the Irish system of involuntary commitment to mental hospitals. The tone is slightly weird, like this is some unwanted expense. From the Irish Medical News

Over €10 million has been spent on mental health tribunals since they were first established in 2006, it has emerged.

In response to a recent Parliamentary Question, Minister for State at the Department of Health and Children, Dr Jimmy Devins stated that €1,001,174 was spent in 2006 and €9,008,051 was spent in 2007 on tribunals.

The Mental Health Comm­ission did not give a further breakdown of the figures when requested by IMN.

A total of 2,423 tribunals were held during this period, meaning that the average cost of each tribunal is approximately €4,130.

The figures do not include a number of outstanding attendance fees, which have yet to be submitted by mental health tribunal panel members to the Mental Health Commission or the overheads associated with the administration of the mental health tribunals by the Commission, according to Minister Devins. The costs of the tribunals are met from the budget of the Mental Health Commission.

Consultant psychiatrist Prof Patricia Casey has branded the figures as “extraordinary”.

She told IMN that it was of the utmost importance that the Mental Health Commission provide a detailed breakdown of the figures given the costs involved. In particular, Prof Casey said in the interests of transparency and accountability it should be reported how much is being spent on solicitors fees.

Out of the 2,248 hearings held in 2007, 256 cases were revoked at hearing.

Hartford Hospital On Probation, - Problems include a variety of psychiatric abuses.

We highlight the deficiencies in the psychiatric departments, but it sounds like the whole place is a mess. From the Hartford Courant

Citing multiple lapses in patient care — including four cases in which patients died — the state health department placed Hartford Hospital on probation Friday, demanding sweeping changes in the way the 800-bed teaching hospital delivers care.

"Frankly, we thought we were doing a better job than is identified in the report," said John Meehan, president and chief executive officer of the hospital.

[...]

The disciplinary action — one of the most serious the state can impose — grew out of an investigation that started after the health department received at least 28 complaints from dissatisfied patients or families from 2005 to 2007.

[...]

The fourth death was that of Marcia Maglisco, a Newington grandmother who was taken to Hartford Hospital in October 2007 after her grandson was found dead in a bathtub while she was caring for him.

Although Maglisco was distraught and spoke about suicide, she was discharged from the emergency room several hours after police brought her in. A psychiatrist told her to return to the hospital if she had further problems,the state report says. There was no written documentation of further follow-up instructions.

Maglisco hanged herself in her home a short time later.

[...]

A nurse slapped a distraught psychiatric patient in the face after the patient spit at the nurse, the state says. A psychiatric technician who was punched by a patient retaliated by punching the patient back multiple times.

The report also details deficiencies in the buildings at Hartford Hospital's psychiatric facility, the Institute of Living, that made it possible for patients there to attempt suicide. One patient tried to kill himself by hanging himself from a bedsheet attached to a closet door hinge.

[...]

Complaints on the rise against psychiatrists and other doctors

We would like to see a breakdown of the complaint statistics by specialty. There is evidence supporting the notion that there are more sexual misconduct complaints against psychiatrists, for example. A report from Victoria, Australia

Formal complaints about Victorian doctors have jumped significantly, and the number deemed unfit to practice due to serious health issues has also risen, a report has revealed.

A psychiatrist who had sex with two vulnerable patients and a doctor who prescribed illegal levels of morphine were among those to be struck off for serious misconduct.

Figures tabled in State Parliament show there was a 9% jump in professional conduct complaints to the Medical Practitioners Board — from 582 in 2006 to 633 last year.

And 70 doctors were investigated over serious health concerns such as psychiatric illness or drug and alcohol abuse — up from 59 the previous year.

A doctor who made sexual advances to a teenage patient he was counselling for a serious eating disorder was allowed to keep his licence. And a GP who sexually harassed a staff member, putting his hand down her jumper to touch her breast, also escaped with a reprimand.

In a tragic case at the Royal Children's Hospital, a trainee doctor gave a four-week old baby 10 times the appropriate concentration of glucose in a drip, causing irreversible brain damage. The board allowed her to continue practising and ordered her to undergo counselling, feeling she was "genuinely remorseful."

In 16 cases finalised at formal hearings, 15 doctors were found to have engaged in serious professional misconduct. Four were struck off, one had their licence suspended and 10 were either cautioned, reprimanded or ordered to undergo counselling.

The board president, Dr Joanna Flynn, said the rise in complaints was consistent with national and international trends. "It is not unexpected and may reflect gradual awareness within the community of the board and its role in protecting the public," she said.

The problem of soaring psychiatric drug use.

A report from Aberdeen, Scotland. As is typical in many of these reports, in the original story there is a sop to the industry with the mention of a sentimental story of some mother praising the drugs, distracting from the obvious criminal increase in their usage. Here are some snippets with the relevant information

Use of a controversial drug on unruly children has rocketed in the North-east.

This year Ritalin has been prescribed 7,268 times, compared to 5,937 last year by NHS Grampian.

The figures are among the latest health statistics from NHS Scotland.

It marks an astonishing rise in use of the stimulant, which was prescribed just 167 times in Grampian back in 1996.

Ritalin is used to control people, mainly five to 14-year-olds, who have attention deficit hyperactivity disorder (ADHD).

[...]

Its side effects include difficulty sleeping, stomach aches, diarrhoea and headaches.

[...]

Yesterday's statistics also revealed a rapid rise in the use of anti-depressants.

In 2006/07 there were 297,157 prescriptions for anti-depressants in Grampian compared to 284,661 in 2005/06. Back in 1992/93 there were just 97,162 prescriptions.

Nobody from NHS Grampian was available for comment.

[...]

Nuerosurgury errors force resignation in Rhode Island Hospital.

Nuerosurgeons usually deal with real medicine, but every so often they get confused when they speak with psychiatrists. This is one of the more reasonable explanations for this reported series of mistakes at a hospital in Rhode Island. As reported in The Day

The head of the neurosurgery department at Rhode Island Hospital has stepped aside while officials investigate three incidents in which surgeons operated on the wrong side of a patient's head.

John Duncan will still see patients but will not run the department, Gail Carvelli, a spokeswoman for the hospital's parent company, Lifespan, said Thursday.

“He has voluntarily stepped aside during this investigative process,” she said.

Since February, three different brain surgeons at the hospital have operated on the wrong side of a patient's head, most recently on Friday. In two cases, the doctors did not realize the errors until after they opened the skull. On Friday, the doctor realized the problem after he made an incision in the scalp.

An elderly man died in August a few weeks after a surgeon mistakenly operated on the wrong side of his head. David Gifford, head of the state Department of Health, said an autopsy was pending, but the department believes his death was not connected to the surgery.

In the other two cases, the patients were OK, the department has said.

The hospital this week was fined $50,000, reprimanded and ordered to make a series of changes including better training and more safeguards.

Rhode Island Hospital is the largest hospital in the state and serves as the teaching hospital for Brown University's Alpert Medical School. It is a private, not-for-profit hospital and performs more than 25,000 surgeries every year, according to its Web site

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.

Help! My doctor's not listening to me

CNN has a series of continuing stories about patients taking control over their own medical care, and the care of people close to them. This snippet caught our attention.

When Shelly's son, Travis, started to misbehave in first grade, her pediatrician diagnosed attention deficit and hyperactivity disorder and prescribed stimulant drugs.

After months on the drugs and several dosage changes, the medications didn't help, says Shelly, who asked that her last name not be used.

Shelly took Travis to another pediatrician, then another and another.

In all, she says, eight doctors prescribed stimulants such as Ritalin -- often increasing the dosage -- even though she explained they hadn't worked before.

"They just kept saying, 'You need to give it time,' " Shelly says. "But he was so jacked up on drugs he couldn't sleep at night. We thought, 'These drugs aren't working, so why do they keep increasing the dosage?' "

Finally, after three years of trying stimulants to treat ADHD, a psychologist diagnosed in Travis a high-functioning form of autism. At 9, Travis stopped the ADHD drugs and started therapy for autistic children.

His behavior improved, his grades went up, and now at 14, his mother says, he's a "model student."

"I cringe and cry when I think back on the three years wasted knocking on doors," she says.

This is a hard won victory, even though we are not thrilled by some of the issues related to the treatment of autism. We are glad to have more people standing up for themselves.

Special Note: Empowered Patient, a regular feature from CNN Medical News correspondent Elizabeth Cohen, helps put you in the driver's seat when it comes to health care.

Psychiatrist censured over patient's death

Another frustrating report where privacy rights are used to protect someone who was criminally negligent, from NZPA New Zealand

A psychiatrist should apologise to the family of a patient who was killed after deliberately stepping into traffic, the health and disability commissioner has found.

After a two-year investigation, a report released today by commissioner Ron Paterson has found breaches to its code of consumers' rights by the psychiatrist, known as Dr F.

The 24-year-old victim, referred to as Mr A, had been admitted to a hospital psychiatric ward for observation with symptoms of anxiety which had developed while his grandparents, with whom he lived, were away on holiday.

The report said Dr F formed the view Mr A was not suffering from a psychiatric illness, but that his judgment was impaired as a result of a head injury he received at the age of nine.

Mr A was then placed under the care of community mental health services and transferred to a rest home for respite care as a voluntary patient until his grandparents returned.

Two days later, Mr A left the home, followed by the home manager – Ms D – who tried to persuade him to return.

However, he deliberately stepped into oncoming traffic and was killed after being hit by a vehicle.

In September 2006, Mr A's mother laid a complaint to the commissioner about the appropriateness and adequacy of her son's care and treatment provided by the District Health Board, Dr F, a registered psychiatric nurse, the rest home and Ms D.

In the report, Mr Paterson said the lack of an appropriately thorough assessment by Dr F may have contributed to Mr A's lack of reassessment after he was transferred to the home.

Mr Paterson recommended Dr F review his practice "with a particular focus on improving his clinical judgement skills".

"Dr F should also ensure that he fully documents the rationale for his clinical decisions, and a clear management plan is recorded," the report said.

Mr Paterson also recommended Dr F apologise to Mr A's family for his breach of the code.

Others involved in the care of Mr A and investigated as part of the report were found not to have breached codes.

Tenfold increase in Ritalin prescriptions for ADHD children sets off U.K. investigation

According to this report

After studies revealed a nearly tenfold increase in Ritalin prescriptions in the U.K., public backlash spurred an investigation of doctors' prescription procedures by the National Health Service. However, the results of the review may not be available until March of 2008.

The delay has left some parents and doctors unsure of whether ADHD drugs are the right move for their children.

While one mother in Scotland said Ritalin had been indispensable in calming her son, another said her child became incredibly aggressive and hard to manage while on Ritalin, injuring his brother by throwing him through a glass door.

"I think in 10 years time we will say that ADHD was too simple an explanation for many children," said Dr Gwynedd Lloyd, head of Educational Studies at the Edinburgh University, adding that many doctors label children as having ADHD and prescribe them the amphetamine Ritalin without investigating other possibilities. "We will ask ourselves what we were thinking giving these children amphetamines," she said.

Dr. Dave Coghill, senior lecturer in child and adolescent psychiatry at Dundee University, disagreed, saying Ritalin was an effective drug. "By inhibiting impulsive behavior in children with ADHD it allows them to socialize and develop normally," he said. "Despite the risks, the medication can work for some children."

Attention Deficit Hyperactivity Disorder is usually diagnosed when children show signs of inattention, hyperactivity and an inability to start and foster social relationships. For many children, the alternative isn't better, as the side effects of ADHD drugs such as Ritalin can include loss of appetite, sleeping problems and death.

The FDA assigned Ritalin its most serious safety warning -- the "black box" warning -- last month after 25 deaths were linked to cardiac problems caused by the drug. Seven U.K. children are also thought to have died due to Ritalin side effects.

"Why is it conventional medicine, and even some parents, are so willing to rely on drugs to control children's behavior?" Asked consumer advocate Mike Adams, who has written extensively on ADHD at NewsTarget.com, and interviewed experts in the field such as Dr. Fred Baughman. "If colorful cereals made from processed sugar and refined grains didn't pass for a 'complete breakfast,' and soft drinks and fruitless 'fruit drinks' weren't standard lunchtime fare, we'd notice a marked improvement in the behavior and learning ability of our school-aged children.

"Ritalin is handed out like candy simply because the drug companies know it is a huge revenue producer, and school administrators support the practice because medicating students makes them more sedate," he added.