Queens psychiatrist denies lying to save his driver's license. He killed three people in an auto accident.

From the New York Daily News

The Queens psychiatrist who killed three members of a Bronx family after suffering an epileptic seizure behind the wheel of his minivan denied yesterday that he lied about his condition to keep his driver's license.

Alexander Juwah, 44, of St. Albans, pleaded not guilty in Queens Criminal Court to making false statements to the Department of Motor Vehicles on a license-renewal form he filed before the Nov. 4, 2006, crash.

Juwah kept his hands clasped behind his back during the brief hearing, dressed in a crisp, green-plaid button-down shirt and jeans. He remained silent throughout the proceedings.

"This is just a sad case," his lawyer, Richard Leff, said after the arraignment, adding that his client did not intend to mislead anyone. "The issue was whether or not there was intentionally a false misstatement on the license renewal."

In November 2003, Juwah checked the DMV form's "no" box to indicate he did not have any medical condition that would have caused him to lose consciousness while driving, prosecutors said.

Around 10 a.m. the day of the crash, Juwah blacked out at the wheel of his Ford Windstar, which rear-ended a Mitsubishi Eclipse and rammed three two other cars before going airborne.

The van landed atop a Dodge Neon, killing the three people inside — Jesse Rutledge, 80; his son Jesse Jr., 47, and Jesse Jr.'s girlfriend, Zetteleen Smith, 24. Juwah was not charged in the deaths. His two young sons were also hurt.

Juwah was aware of his condition — and its dangers — after being involved in a prior car accident as a result of his seizure condition, Assistant District Attorney Kristin Fraser told Queens Criminal Court Judge Steven Paynter.

"As a medical practitioner and as a person suffering a seizure disorder, the defendant should have known better than to try and hide his medical condition," District Attorney Richard A. Brown said in a statement yesterday. Juwah told police he had taken his medicine the day of the accident.

Brown added that truthfully reporting the seizures "may have prevented three innocent people from losing their lives."

Juwah was released on $1,500 bail yesterday. He is due back in court Aug. 22 and faces up to four years in prison if convicted.

Judge steps down from psychiatrist fraud case

From the New Straits Times

A High Court judicial commissioner yesterday discharged himself from hearing a civil suit involving well-known psychiatrist Tan Sri Dr M. Mahadevan.

John Louis O’Hara, who was presiding in High Court 1, disqualified himself on the grounds that he knew the plaintiff personally through their involvement in polo.

O’Hara told both the plaintiff and defendant’s counsel in his chambers yesterday that he could choose to be impartial and continue with the hearing of the suit, but he did not want to put himself in a difficult position.

Mahadevan’s lawyer, Raam Kumar, said O’Hara then transferred the case to High Court 3, where Datuk Ghazali Cha is the presiding judge.

Mahadevan had filed a suit in 1998 against his sister-in-law, three nephews and two nieces claiming that they were trespassers in one of two houses built on a 1.6ha plot of land in Jalan Scotland here.
Raam Kumar said Mahadevan was asking for vacant possession of the property and for damages to be assessed against the six defendants, who were represented by K. Govinderaju.

The defendants filed a counter claim, stating that Mahadevan had fraudulently transferred the plot of land without the defendants’ knowledge in 1981.

They also stated that they had been staying at the house, No 10 Taman Scotland, since 1972.

Govinderaju said his clients were asking for the property to be returned to them.

Ghazali fixed Nov 14 for hearing.

Methadone Clinics Can Be Liable for Corporate Negligence

As reported here

A press release announces a landmark ruling by a Pennsylvania Court on Monday. A Blair County Common Pleas Court judge has ruled that methadone clinics can be liable for corporate negligence, just like hospitals. This is believed to be the first ruling of its kind in Pennsylvania.

The ruling comes as a result of a lawsuit brought before the court in 2004 against a private for-profit methadone clinic in Pennsylvania, a hospital, and a psychiatrist. The estate of Crystal M. Ickes filed this suit with the court. Crystal M. Ickes was a single mother of three who died in a car crash shortly after leaving Alliance Medical Services, Inc., a methadone clinic in Johnstown, PA. Crystal was returning home after her visit to the clinic, a journey of 46 miles back to her home in neighboring Altoona, PA.

Less than an hour after receiving the methadone dose, the car Ickes was driving crossed a median strip and struck a car operated by Matthew Stever, who suffered head injuries resulting in permanent neurological damage.

The Ickes complaint states that the combination of methadone, anti-depressants, and sleeping pills had impaired her ability to drive safely. The complaint states that she must have either suffered a seizure or fallen asleep at the wheel. This conclusion is supported by the fact that her car left no skid marks during this incident.

Judge Hiram A. Carpenter stated in this opinion, "For purposes of corporate liability, Alliance clearly meets the criteria of a healthcare provider." Alliance attorneys cited a Superior Court decision in Shannon v. McNulty, a lawsuit against an HMO. This case concluded that corporate liability is inapplicable to facilities that deal with limited aspects of a patient's care. Hospitals, on the other hand, provide a total healthcare approach to their patients.

The judge disagreed, however, and argued that the defendants' reliance on Shannon was "misplaced." The judge cited another case, Thomson v. Nason, where the Pennsylvania Supreme Court revealed a two-prong corporate liability test that the judge felt was met in the Ickes case.

The judge wrote in the opinion, "First, Plaintiff alleges that Alliance knew that its policies were ineffective in protecting the safety of its patients, yet failed to correct them. Plaintiff additionally alleges that failure resulted in Ms. Ickes being allowed to leave the facility to operate a vehicle in an overly-sedated state, causing her injuries."

This case is a landmark case as far as corporate negligence for healthcare providers goes. Other cases involving injuries suffered and inflicted by patients undergoing treatment at methadone clinics have come forth recently. With this decision by the Pennsylvania court today, we will have to see if the methadone clinics take extra precautions when treating their patients.

Paris Hilton and ADD/ADHD

Something we missed during the whole Paris Hilton Fiasco. From the Splintered Minds Weblog very nicely done

Does ADD poster child Paris Hilton get a pass for bad behavior because of ADD? Judging from some of the articles I've read she does, but did you ever get a pass for ADD? Neither did I.

I have a life beyond the gossip rags, so I missed this little gem last week where TMZ got the "scoop" of the decade. According to unnamed sources, Paris Hilton suffers from extreme Attention Deficit Disorder (ADD) and claustrophobia. These sources also fingered Adderall as Paris' particular poison of choice, and claimed 'twas pity that spared the beast when the ole Sheriff learned of Paris' panic attacks from lack of medication. All across the tubes site after site regurgitated the above sentences without skepticism. Not a single site, not even Foxnews, could corroborate this information separately. Yet all sites seemed relieved to finally have a medical reason to blame Paris' behavior on.

"See? She's not really a pampered brat," we are led to believe. "She has ADD. Poor thing..."

What do we really know about Paris, though? Heck, all I know about her new home in Lynwood came from a Weird Al album. I'm not an expert on celebrities, especially Paris. However, I do know a thing or two about ADD and even ADHD. Let's consider some implications of this "news".

Ever arrive late to work because you took the wrong bus? I sure would have liked to blame ADHD on that day. It was at fault, after all. I was just an innocent victim panicking because I was late and leapt on the wrong bus without thinking. In fact, all that high risk behavior in my youth, all the feet I crammed in my mouth, and all the friendships I left burning like abandoned husks behind me can be squarely blamed on ADHD.

It's not my fault. I don't have to be responsible. Wow! This is exhilarating!

Far be it for me to avoid an opportunity to wag my finger at the media, but I see a deeper problem here besides scapegoating. If I blurt out how much you dislike the hostess' dress to the hostess in a moment of AD/HD brilliance, do your feelings stop hurting because I can blame AD/HD? If I forget to tell you about a meeting that costs you your job, will a "Whooopsies! I have AD/HD!" set things right? There seems to be a concerted effort in the press of late to justify aberrant behavior through mental disfunctions such as Depression and AD/HD, as if a medical label makes everything all better. The trouble is that only apologies and reparation makes things better, not labels.

Where is our society going when we happily divorce actions from responsibility? Why are celebrities and monsters not held accountable in the press for what they do and instead are given excuses to avoid responsibility? Who knows, but if we excused all our bad behavior on ADHD would we grow? Would we mature? I don't believe we would, and that would be a terrible waste of living.

I propose instead that we take responsibility for our actions, even stupid and embarrassing ones. ADHD may explain how our reason left us for a moment, but only we can repair the damage we have done. Sometimes we lose the job. Sometimes we lose a friend, but by and large we grow when we accept responsibility. In my experience, taking responsibility has saved more for me than lost, especially with friendships.

And what of forgiveness? Frankly, one can't demand that from people even if they are being unfair. We first need to make reparation as best we can and hope for the best. I realize this will be difficult. AD/HD actions like taking out a third mortgage on the house to lose on risky stocks isn't going to go over well with the spouse, but neither will blaming it on AD/HD. By taking responsibility, your spouse is more likely to forgive you if you are upfront about things. Or at least your spouse might let you sleep on the couch instead of the dog house.

As for Paris, I'd like to see her learn some coping skills instead of pining for medication, but fortunately, we only have a gossip site's word that she has AD/HD in the first place. Can we please choose a new AD/HD poster child now? I'm available.

Renowned child psychiatrist to stand trial on multiple molestation charges

From the San Jose Mercury News

Dr. William Ayres, the child psychiatrist accused of molesting dozens of preadolescent boys in San Mateo County over decades, must face trial on charges that he improperly touched seven male patients from the ages of 9 to 12, a San Mateo County Superior Court judge ruled Monday.

The evidence that Ayres molested many of his patients -- instructing boys to strip naked and then stroking their genitals during in-office physical examinations -- is "quite strong," providing sufficient cause to try the child psychiatrist on multiple molestation charges, said Judge Jonathan Karesh at the conclusion of Monday's preliminary hearing.

Ayres, 75, was present at the proceeding, taking notes and showing little emotion.

He will be tried on 20 counts of lewd and lascivious acts against seven children younger than 14.

The hearing, featuring two San Mateo police officers recounting interviews with 22 alleged victims, was laden with graphic testimony and marked the first time that many details of the alleged molestations have come to light.

Altogether, more than a dozen of Ayres' former patients told police that the doctor fondled their genitals during psychiatric visits, providing a litany of details.

Prosecutors say Ayres molested dozens of former patients, but they are bringing charges in connection with only seven alleged victims, whose cases fall within the legal statute of limitations for child molestation.

State law requires that molestation charges be brought before the accuser turns 29 or that the alleged crime occurred after Jan. 1, 1988.

Of the 22 accounts from alleged victims related by police during the hearing, only seven fall within the statute.

Defense attorney Doron Weinberg filed a motion to discount the preliminary hearing testimony involving the alleged victims whose cases lie outside the statute, but Karesh dismissed the motion at the conclusion of the hearing.

Weinberg said outside court that he plans to refile the motion before the jury trial and promised to "litigate several legal issues" in the coming months, including a dispute over the search warrant that police used to build the case against his client.

The warrant, which Weinberg called "highly illegal and improper," enabled police to obtain the child psychiatrist's medical records and contact about 600 former patients to investigate the alleged molestation.

Weinberg dismissed the charges against Ayres as "vague" and "creative," and he defended the physical examinations that Ayres conducted as "perfectly appropriate" for a child psychiatrist.

The medical recollections of the alleged victims have "now been recast by memory and suggestion as inappropriate," Weinberg said.

"Dr. Ayres has been at the forefront of being open and honest with kids about sexuality," he said. "He believes that he is a physician as well as being a psychiatrist, and when treating someone, you treat the whole person."

"He has been misunderstood as a result of that," Weinberg said. "This is not a child molester by any stretch of the imagination."

Weinberg attacked in court the viability of the charges stemming from the seven alleged victims, citing interpretations of the statute of limitations and questioning whether the doctor's former patients could remember events that happened 15 to 20 years ago.

Deputy District Attorney Melissa McKowan, who said outside court that she was "very pleased" with Karesh's ruling, defended the alleged victims' inability to recall exact details during such "significant events" of their lives.

At the conclusion of the hearing, Karesh ordered Ayres to avoid contact with the alleged victims during the next year.

The state Medical Board revoked Ayres' license to practice shortly after his April arrest.

Ayres, who has been out of custody on $750,000 cash bail since April, is expected to appear at the Hall of Justice for his Superior Court arraignment September 6th.

Aftere 40 years of research, Ritalin STILL increases delinquency.

Isn't it absolutely extraordinary that studies in 2007 show that Ritalin STILL increases delinquency just as it did in a study of 1971? How is it that a drug causes the same effects consistently for almost 4 decades?

In a study entitled “Hyperactive Children as Teenagers: A Follow-up Study” (1971), eighty-three children were followed from two to five years after being diagnosed as hyperactive or as having attention deficit disorder. Ninety-two percent of the children were treated with Ritalin. Results were as follows:

• 60% of the children were still overactive and had poor schoolwork (the original reasons for being put on Ritalin), but in addition were now viewed as rebellious;
  
• 59% had had some contact with the police;
  
• 23% had been taken to the police station one or more times;
  
• 58% had failed one or more grades;
  
• 57% had reading difficulties;
  
• 44% had arithmetic difficulties;
  
• 78% found it hard to sit still and study;
  
• 59% were viewed as a discipline problem at school;
  
• 83% had trouble with frequent lying;
  
• 52% were destructive;
  
• 34% had threatened to kill their parents;
  
• 15% had talked of or attempted suicide.

Another research study, the Satterfield study (1987), states,

We found juvenile delinquency rates to be 20-25 times greater in our hyperactive drug-treated only group than in the normal control group. In the “Delinquency outcome for the drug-treated group,” the results were: of 61 boys, 46% were arrested for one or more felony offenses before age 18; 30% were arrested for two or more felony offenses; 25% were institutionalized.… Studies of the long-term effectiveness of drugs have been consistently discouraging.

There is also scant evidence of improved academic performance with stimulant treatment.

According to Rooney, research has still not shown the use of medication to be significantly effective in the treatment of processing deficits or academic achievement.

In The Learning Mystique, Gerald Coles confirms the findings of a 1978 review of both short- and long-term studies on the use of stimulants with children who were hyperactive and learning disabled. Of a total of seventeen studies included in this review, short- or long-term, whether they met basic scientific criteria or not, all the conclusions agreed: “stimulant drugs have little, if any, impact on…long-term academic improvement.” Their major effect seemed to be an “improvement in classroom manageability.”

In the Journal of Behavioral Optometry (1991), a study evaluated twenty-two previous studies/articles since 1976 concerning Ritalin use for hyperactive children. It states:

The fact that the above studies do not show the efficacy of Ritalin for helping hyperactive children should be apparent to the skeptic and make a skeptic out of the believer. But the argument should not stop at this point. The weak evidence for the value of Ritalin must now be viewed in the light of its reported side effects

As someone noted with scathing sarcasm:

36 years later and still a deep scientific mystery worthy of continuous, expensive and arduous attention... valiant 'expert' researchers and concerned manufacturers work hard running regular clinical studies in the desperate hope that one day they will discover that Ritalin is filled with remorse, has learned to change the way it acts within the human body and has at last started working towards the well-being of children.

Delaware Psychiatric Center staffers indicted in abuse, rape cases

From the News Journal (Also see this report)

Two former attendants at the Delaware Psychiatric Center were indicted Monday for multiple felonies, including rape, assault and patient abuse, stemming from two separate incidents that occurred at the trouble-plagued state hospital during the past two years.

Former attendant Woods Etherington Jr., 45, of Hockessin, was indicted on three counts of rape and six counts of patient abuse. According to documents filed with Delaware's Justice of the Peace Court, Etherington raped a patient three times in April 2006, in a toilet and a staff break room.

This isn't the first time Etherington has been accused of abusing a patient. In August 2000, he was arrested on charges of offensive touching and patient abuse, and pleaded guilty in 2001 to the offensive touching charge. The charges of patient abuse were dropped.

After those charges were settled, Etherington was brought back to work at DPC with the help of his union, whose president is Gregory Boston, himself a convicted felon. DPC administrators would not say why Etherington was allowed to return to work.

"We have no comment on employment decisions others made during a previous administration, nor on the length of time between our reporting of the substantiation of the allegation and today's decision to prosecute the individual," Jay Lynch, spokesman for the Department of Health and Social Services, said in a statement to The News Journal.

Lynch said Etherington was removed from direct patient care and suspended without pay in April 2006 following an internal investigation. A month later, he resigned from DPC.

The second attendant indicted Monday, Anthony R. Liggians Jr., 32, of Wilmington, faces two felonies: second-degree assault and one count of patient abuse.

The indictment stems from a July 2 incident involving Preston Hudson, a 44-year-old patient at the state hospital. According to documents filed with the court, Liggians punched Hudson in the face, after which he fell onto a bed in the admissions unit. Hudson's jaw was broken in three places, on both sides of his face.

"Anthony Liggians no longer works at DPC," Lynch said. "Woods Etherington has not been at DPC for over 15 months."

The News Journal was unable to locate Etherington or Liggians for this story.

Felons on staff

Last month, when the state hospital's troubles were documented by The News Journal, state House Majority Leader Richard C. Cathcart, R-Middletown, organized an investigative committee that will meet for the first time later this month to examine patient safety and operations at the center.

Among the new developments are statements by Thomas Jefferson University Hospital and Johns Hopkins University School of Public Health administrators that no official "affiliation" exists between their institutions and the residency program at DPC, despite a letter from Health and Social Services Secretary Vincent P. Meconi touting the affiliations to Delaware lawmakers and the public.

Meconi's letter was sent three weeks before The News Journal exposed the felony drug conviction of Adam Scioli, a psychiatric resident hired by the state hospital in early July.

Boston's felony record stretches to the 1970s, when he was convicted of shooting two men in the face with a shotgun. Boston has not been convicted of a crime in Delaware since 1993, six years before DPC Director Susan Watson Robinson said he was "grandfathered" into employment despite his prior criminal history.

Gov. Ruth Ann Minner did not return calls or e-mails seeking comment for this story. In an interview last month, Minner said she did not believe DPC needed to be investigated.

Since that interview, a half-dozen federal and Delaware probes of the state hospital have been launched, focusing on patient abuse, staff intimidation and the hiring of felons to work with mentally ill patients. Reports of abuse, mistreatment and neglect increased at the hospital from 35 in 2001 to 119 last year.

"The vast majority of DPC employees do a good job providing patient care," Lynch said. "When one does not, it is deeply distressing and we take swift action to remove or correct that employee."

Rape charges

According to documents filed with the court, Delaware State Police Cpl. Michael Willey went to DPC on April 12, 2006, to investigate a complaint of a staff member having sex with a 23-year-old female patient. Willey interviewed the victim, who said she had "consensual sex" with Etherington on two days in April. Both incidents occurred between 9:30 and 10 p.m.

The next day, a state police investigator interviewed the victim's mother, who said her daughter was "not capable of making rational decisions" and unable to consent to sex.

According to court documents, Etherington admitted to investigators that he had been "making out" with the victim, and that the victim performed oral sex on him. Investigators interviewed the victim's psychiatrist, who told them the she was "severely mentally ill, suffering from schizophrenia and a personality disorder, and in his opinion was incapable of consenting to sexual conduct."

Investigators interviewed Etherington's co-workers in the Kent 2 unit of the New Castle-area state hospital. Court documents state that Etherington was warned that the victim was "sexually preoccupied, and staff should not be alone with her." Etherington, in another interview with police, said he knew the victim's history and that "she did not fully comprehend what she was doing at the time of the incident."

A broken jaw

When Preston Hudson told his sister he was attacked by two attendants, she called 911.

At first, DPC officials denied Hudson's claim, saying he tripped and hit his chin on a bed frame. "Mr. Hudson was having an episode, running around the room and tripped on the edge of the mat," Lynch said during initial interviews about the incident. "As he went down, his jaw or chin hit the bed."

After The News Journal reported the incident, Lynch said two employees "were removed from direct patient care."

DPC re-examined the case after the state police opened a criminal investigation. According to documents filed with the court, state police interviewed several staffers, including Liggians, to determine how Hudson, who is diagnosed with schizophrenia, was injured.

The troopers found an internal "Incident Report" regarding Hudson's injuries, signed by Liggians and another staffer. The DPC report classified the incident as a "Slip/Fall-Witnessed." The report stated that Hudson "tripped over the mat and hit his face on the iron bed post."

Liggians was interviewed several times and gave several versions of the night's events.

A female DPC employee told investigators she "witnessed Liggians punch Hudson in the face." She stated that at the time, Hudson was "drugged up, medicated, and not very stable on his feet," and that he was not acting in a "menacing fashion or in a manner which would require that level of force."

Hudson's sister, Doris Scott, welcomed news of the criminal indictment. "It means that justice has been served, and that you can't treat a human being like that," Scott said Monday. "No one wants to be treated like that. They want to feel safe in a hospital."

Two days after the assault, doctors wired Hudson's jaw together, and he was returned to the state mental hospital. He hasn't eaten solid food for more than a month.

Hudson's family will meet with his treatment team today. They hope he will be released from the state hospital.

"Delaware citizens living with severe and persistent mental illness must have protection from those who wish to do them harm," said Rita Marocco, executive director of the National Alliance on Mental Illness in Delaware. " 'To do no harm' represents the most basic of expectations NAMI-DE families demand of professional caretakers," Marocco said. "Not only does it appear that the DPC administration failed to achieve this basic need for Mr. Hudson, but it seems likely that the administration of DPC took steps to cover up the assault on Mr. Hudson."

Psychiatrist in court for molestation hearing

From the Palo Alto Daily News

A San Mateo child psychiatrist accused of molesting several of his young patients in the 1990s will face the evidence against him for the first time in open court this week.

William Hamilton Ayres, 75, once president of the American Academy of Child and Adolescent Psychiatry, has been charged with 21 counts of lewd or lascivious acts on a child under the age of 14, for allegedly fondling seven boys who had come to him for counseling between 1991 and 1996.

The boys were between the ages of 9 and 12 at the time the alleged molestations took place, according to the San Mateo County District Attorney's Office.

Prosecutors claim there are about 30 other victims whose alleged molestations fall outside the statute of limitations.

Ayres' preliminary hearing for a judge to determine if there is enough evidence for a trial is scheduled to begin today at 9 a.m. and is expected to last about half a day.

Defense attorney Doron Weinberg has claimed that the accusations against his client were likely the result of either a mistake, false memory or suggestion.

Weinberg has also indicated that, following the preliminary hearing, he may file a motion alleging the search of Ayres' office and seizure of files by law enforcement violated privacy issues. If upheld, such a motion would not allow evidence found during the search to be admissible during a trial, he said.

According to authorities, from the 1960s through 2006, Ayres had a thriving practice treating children, and was called upon to evaluate hundreds of cases, including those of sex offenders, in San Mateo County juvenile court.

Ayres remains out of custody after posting $750,000 cash bail. If convicted, he could face the rest of his life in prison, according to the district attorney's office.

Some Side Effects of Cymbalta

The following information is taken from the WikiPedia article on Duloxetine, the generic name for Cymbalta.

Since duloxetine is a newer drug (FDA approved in 2004), few peer-reviewed articles have been published on its adverse effects, and effects of long-term use are still unknown. More than 40 different types of adverse effects have been reported, including completed suicide attempts and severe hepatic disorders.

• Journalists Jeanne Lenzer and Nicholas Pyke, writing for The Independent newspaper, uncovered 41 deaths and 13 suicides for patients taking duloxetine as of June 19, 2005.
  
  
• The French journal Prescrire International published this opinion: "In practice, duloxetine currently has no place in the treatment of depression or diabetic neuropathy. Its efficacy has not yet been demonstrated to be even equivalent to that of other available drugs, and it has too many adverse effects, given this degree of uncertainty."
  
  
• The Los Angeles County Department of Coroner released a report of the first post mortem studies of duloxetine; they identified twelve cases in which duloxetine was the ultimate cause of death. Five cases were declared multiple drug intoxication, and two were declared suicide.
  
  
• A case of hyponatremia induced by duloxetine was reported by doctors at Weill Cornell Medical College in New York.
  
  
• A case of dyskinesia during treatment with duloxetine was reported in Germany.
  
  
• Two episodes of serotonin syndrome have been documented in the use of duloxetine in conjunction with other medications.
  
  
• A case of fulminant hepatic failure involving duloxetine which resulted in death was reported by the Department of Internal Medicine, Ohio State University, Columbus, Ohio.
  
  
• An acute attack of porphyria in a patient taking duloxetine.

SSRI Makers Use Media To Reel In Pregnant Women as Customers

Another story from the pen of Evelyn Pringle

Big Pharma’s regular use of the media as paid shills, masquerading as caring doctors while feeding the public misinformation about the risks of prescription drugs, is disturbing, to say the least. However, when the goal is to increase profits through the sale of drugs to pregnant women that are known to be harmful to the fetus, the media’s participation is downright despicable.

Since June 27, 2007, nearly every major news outlet in the US has broadcast the story that two new studies published in the New England Journal of Medicine found a low risk of birth defects in babies born to women who took selective serotonin reuptake inhibitor antidepressants (SSRIs) during pregnancy.

SSRIs include Paxil by GlaxoSmithKline; Zoloft marketed by Pfizer; Prozac by Eli Lilly; Celexa and Lexapro from Forest Laboratories; Luvox by Solvay, and generic SSRI makers Barr Pharmaceuticals, Ranbaxy Labs and Genpharm.

On June 27, 2007, the headline that appeared in countless news outlets that run articles from the Associated Press stated: “Antidepressants Not Risky for Defects.”

ABC News reported on June 29, 2007, “Antidepressants Safer Than Believed During Pregnancy,”

“Antidepressants not linked to birth defects,” stated the internet headline for News-Medical.net, on July 5, 2007.

These headlines outraged experts knowledgeable about the true risks of birth defects, but none drew more outrage than the headline in a press release put out by the US Centers for Disease Control the day before the story broke which stated: “New Study Finds Few Risks of Birth Defects from Antidepressant Use During Pregnancy.”

“The reassuring attitude promoted in the CDC’s press release flew in the face of evidence linking SSRI exposure during pregnancy to increased birth defects, and the additional evidence of SSRI toxicity in the developing brain,” says Dr. Peter Breggin, author of The Antidepressant Fact Book and an expert on SSRIs.

“Women and their doctors who only catch the headlines created by these studies are being grossly misled,” he advises. “SSRIs should never be used during pregnancy.”

Dr. Breggin notes that the CDC instructs pregnant women to speak to their doctors about the risks and benefits of taking SSRIs, but says, “doctors will have read the headlines inspired by the CDC and imagine there is little risk.”

The paper, “Exposure to SSRI Antidepressants In Utero Causes Birth Defects, Neonatal Withdrawal Symptoms and Brain Damage,” by Dr. Breggin and Ginger Breggin, will be published in the upcoming issue of the Ethical Human Psychology and Psychiatry journal to refute the findings of the NEJM studies.

CDC Report and Media Coverage Misleading

The CDC claims the use of SSRIs during pregnancy is justified on the basis that depression has its own hazards. “But these hazards,” Dr. Breggin states, “pale in comparison to the upheaval that will befall new mothers, fathers and the extended families of the children who are born with profound birth defects.”

In addition to disputing the claim that birth defects are rare, experts say the headlines are deceptive because: (1) the studies referred to were limited to women taking SSRIs in the first 3 months of pregnancy; (2) some birth defects develop later in pregnancy; (3) stopping the drugs at the end of 3 months, or at any time, can result in a serious withdrawal syndrome; (4) infants experience a withdrawal syndrome after birth, and (5) the headlines do not mention all the other adverse effects associated with SSRIs.

The headlines dilute the findings of the many studies that have shown serious withdrawal symptoms in newborns exposed to SSRIs, including high-pitched or weak crying, tremors, irritability, convulsions, poor muscle tone, abnormal sleep patterns, feeding difficulties, rapid breathing and respiratory distress, and increased admissions to intensive care units.

In discussing a 2004 study published in the Pediatrics journal, lead author Dr. Philip Zeskind was quoted in the February 22, 2004 Sunday Telegraph as stating: “What we’ve found is that SSRIs disrupt the neurological systems of children, and that this is more than just a possibility, and we’re talking about hundreds of thousands of babies being exposed to these drugs during pregnancy.”

“These babies are bathed in serotonin,” he said, “during a key period of their development and we really don’t know what it’s doing to them or what the long-term effects might be.”

Experts say the headlines are also misleading because they infer that no birth defects were found in the studies when, in fact, the CDC study further confirmed associations between SSRI use and the occurrence of craniosynostosis and omphalocele, as well as certain types of heart defects.

The study also found anencephaly, babies born without a forebrain, to be 2.4 times greater in women taking an SSRI in the first trimester. “This is a catastrophic fatal birth defect that is not correctable,” Dr. Breggin points out. In babies born with anencephaly, much of the brain does not develop, and the babies are either stillborn or die shortly after birth, according to the National Institute of Child Health and Human Development.

Babies born with omphalocele, an abnormality in which the infant’s intestine or other abdominal organs protrude from the navel, were 2.8 times higher in women taking SSRIs.

The severity of this condition varies, but can be life threatening and usually requires surgery as well as weeks to years of adapting.

Craniosynostosis, a condition in which connections among skull bones close prematurely, was 2.5 times more prevalent. “A 2.8 times greater occurrence of this condition,” Dr. Breggin explains, “will cause 2,305 more US babies to be born each year with this birth defect as a result of their mothers taking SSRIs in the first trimester of pregnancy.”

In September 2005, Glaxo sent out a “Dear Doctor” regarding a label change based on a recent study wherein women who took an SSRI were more likely to have an infant with omphalocele, in addition to craniosynostosis.

The CDC study also found that babies exposed to Zoloft had twice the risk of having a heart defect and three times the risk with Paxil. In October 2006, the journal Epidemiology reported that babies born to women who took SSRIs during the second or third month of pregnancy had nearly two times the risk of having congenital malformations, with the most common being cardiovascular in 29%, muscle and bone malformations in 31% and 14% had digestive malformations.

According to SSRI expert, Dr. Grace Jackson, “It was already known in the 1980’s and 1990’s that the administration of SSRIs to embryonic cultures of rats and mice leads to craniofacial and cardiac defects.”

The NEJM studies also showed an increased risk of neural tube defects, which are birth defects of the brain and spinal cord, with the two most common being spina bifida and anencephaly.

With spina bifida, the fetal spinal column does not close completely during the first month of pregnancy, and there is usually nerve damage that causes at least some paralysis of the legs.

A recent study conducted by the Institute of Reproductive Toxicology at the University of Ulm, Germany, and the new NEJM article noted that some women who took SSRIs throughout pregnancy had infants born with a club foot, where the foot is turned in, stiff and cannot be brought to a normal position. According to the NEJM, women who took Paxil during pregnancy were at a 5.8% increase of having a child born with this defect.

The NEJM articles also suggest that there is an association between SSRIs and anal atresia, a malformation in which the normal perforation or opening for the anus is absent where the end of the intestinal tract has not perforated the skin in the perineal area.

Industry Influenced Media

The industry’s control over the mainstream media, evidenced by the broadcast of the NEJM studies, did not happen overnight. It began in the late 1990’s when drug companies were granted permission to advertise their products to the public.

Over the last decade, the drug companies have intentionally poured so much money into advertising that the overall operating budgets of the major media outlets and television networks are now highly dependent on the pharmaceutical industry.

In addition to advertising dollars, Big Pharma has mastered the art of using the media to promote the sale of drugs and downplay their risks. Stories featured as health care news, based on rigged studies carefully planted in medical journals are promoted through reports written by PR firms and sent out to all the major media outlets in press releases.

A 2005 report by the UK Parliament found that 75% of clinical trials published in the major journals, including The Lancet, New England Journal of Medicine and the Journal of the American Medical Association, were funded by the drug industry.

Experts say medical professionals can no longer rely on what they read. “The sources of knowledge that doctors have been trained to trust have been taken over by the medical marketing community,” says Dr. John Abramson, author of the book Overdosed America.

Each year, the Prescription Access Litigation Project announces the “Bitter Pill Awards” to expose Big Pharma’s efforts to manipulate consumers through the media. For the year 2004, the group granted “The Cure for the Human Condition Award” to Paxil maker Glaxo, “For Hawking Pills to Treat the Trials of Everyday Life.”

In support of the award, PAL cited an FDA warning letter sent to Glaxo about false advertising in a Paxil TV ad, saying it wrongfully “suggests that anyone experiencing anxiety, fear, or self-consciousness in social or work situations is an appropriate candidate for Paxil CR,” when these are simply not approved uses of the drug, PAL noted.

For 2007, the Bitter Pill Award could to go to CNN for granting the most airtime to industry-paid front men to downplay the risk of birth defects, with special thanks to Dr. Sanjay Gupta.

After hearing Dr. Gupta say the use of SSRIs was ok for nursing mothers on CNN on June 12, 2007 without discussing any of the risks of drugs, Larry Bone, an avid advocate for protecting the unborn child from the birth defects linked to SSRIs, wrote this author to state that the use of the TV news segments in recent weeks to promote the sale of these drugs to pregnant women and nursing mothers was “horrifying” and must be stopped.

“The public has a right to be honestly informed about the dangers of SSRIs,” he wrote, “and the media has an ethical responsibility to see that pregnant women and nursing mothers are adequately informed about the dangers of these drugs.”

“At the very least,” he says, “media companies should carry disclaimers at the end of such news segment stating that SSRIs all carry warnings on their labels that the public should read.”

The Reported Risks

Experts say it’s a crapshoot prescribing these drugs to nursing mothers. “No one yet knows what effects SSRIs may have on nursing infants,” Dr. Jackson warns, “because no one has studied the long term consequences of administering SSRIs to infants via breast milk.”

Furthermore, she adds, no one understands how the in utero exposure to SSRIs changes the wiring of the newborn’s brain and, “it has never been proven that there is no effect of giving infants these drugs during the first months or years of post-uterine existence.”

Researchers from Columbia University published a study in the October 2004 journal Science, suggesting that exposure to Prozac in the womb and in early childhood may permanently alter the brain’s circuitry and disrupt neural development, leading to serious emotional disorders later in life.

The warnings that Mr. Bone says viewers should be instructed to read are many. On December 8, 2005, the FDA issued a Public Health Advisory and a press release to announce that the agency was asking Glaxo to change the pregnancy category from C to D, a stronger warning which means “studies in pregnant women (controlled or observational) have demonstrated a risk to the fetus.”

The Advisory said that the FDA “has determined that exposure to paroxetine in the first trimester of pregnancy may increase the risk for congenital malformations, particularly cardiac malformations.”

The FDA also said that physicians who are caring for women receiving Paxil should alert them to the potential risk to the fetus if they plan to become pregnant or are currently in their first trimester of pregnancy.

On July 19, 2006 the FDA issued another Advisory after a study led by Dr. Christina Chambers in the February 9, 2006 New England Journal of Medicine reported a six-fold increased risk of the life-threatening lung disorder, persistent pulmonary hypertension, in babies born to mothers taking SSRIs and said, “the FDA has asked the sponsors of all SSRIs to change prescribing information to describe the potential risk for PPHN.”

According to the FDA Advisory: “Babies born with PPHN have abnormal blood flow through the heart and lungs and do not get enough oxygen to their bodies. Babies with PPHN can be very sick and may die.”

The risk of PPHN was first found by Dr. Chambers in a 1996 study where the researchers found two cases of PPHN, an unexpected finding since there were relatively few women in the study and both women had taken Prozac late in their pregnancies.

Warnings about the adverse effects of SSRIs in the patient information sheet on the FDA’s web site as of July 13, 2007, states: “babies delivered to mothers taking Paxil late in pregnancy have developed problems, such as difficulty breathing and feeding.”

“Babies delivered to mothers taking Paxil early in pregnancy are sometimes born with heart problems,” it states.

The Web Site Also Warns:

“Persons taking Paxil may be more likely to think about killing themselves or actually try to do so, especially when Paxil is first started or the dose is changed.”

“Paxil may cause bleeding problems,” the FDA warns, “especially if taken with aspirin, NSAID’s (nonsteroidal anti-inflammatory drugs, such as ibuprofen or naproxen) or other drugs that affect bleeding.”

The information sheet also advises that Paxil patients, “may become hyperactive, excitable or elated,” and, “have problems with impotence (erectile dysfunction), abnormal ejaculation, difficulty reaching orgasm, or decreased libido (sexual desire).”

Other side effects currently listed include weakness, dry mouth, constipation, yawning, infection, diarrhea, sweating, dizziness, tremor, nervousness, nausea, difficulty sleeping, decreased appetite and sleepiness.

According to Mr. Bone, CNN is not the only guilty provider of misleading information about SSRIs. “Major broadcasting companies like CBS, FOX, ABC and NBC,” he says, “are no longer worthy of trust when they shamelessly promote a class psychotropic drugs that threaten the public safety.”

“Such promotion,” he states, “constitutes a flagrant breach of basic television broadcasting ethics and fairness standards each and every time.”

Mr. Bone also says that the media should acknowledge whether the doctors featured in these segments have received grants or gratuity payments from SSRIs makers.

Risks Versus Benefits

Finally, experts point out that the headlines fail to disclose that SSRIs are ineffective. Clinical psychologist Dr. Bruce Levine, author of a new book due out this fall entitled Surviving America’s Depression Epidemic: How to Find Morale, Energy, and Community in a World Gone Crazy, says “legitimate science shows that these antidepressants are no more helpful for depression than a placebo or no treatment at all.”

“Even the dice-loaded drug company studies show that antidepressants are, in a scientific sense, a failure,” he notes.

“For example,” Dr. Levine points out, “in 2002 the journal Prevention & Treatment analyzed 47 studies that had been sponsored by drug companies on Prozac, Paxil, Zoloft, Effexor, Celexa, and Serzone, and it reported that in the majority of the trials, the antidepressant failed to outperform a sugar pill placebo.”

Another of the world’s leading authorities on SSRIs, Dr. David Healy, also says that the effectiveness of SSRIs has been exaggerated, and the actual data reveals that only one in 10 patients on SSRIs can be shown to respond specifically to the drug rather than a nonspecific factor or a placebo.

Dr. Healy is the author of numerous books on psychiatric drugs including The Antidepressant Era and The Creation of Psychopharmacology.

He says that in prescribing SSRIs to pregnant women, he is concerned about “the benefit-harm trade-off,” because “without any benefits, the child runs all the risks including the neonatal withdrawal syndrome and birth defects.”

Dr. Healy points out that the CDC study focuses on linking particular specific defects to particular drugs, and once you do this, “you end up with very small numbers in each group and not a lot of significant findings,” he says.

TV plugging prescription drugs

The mixed blessings of product placement for prescription drugs, as seen here

When he thinks his life is spinning out of control, TV mobster Tony Soprano reaches for Prozac, an antidepressant developed by Eli Lilly and Co.

The names of popular drugs Viagra and Botox frequently come up in TV shows.

There were 462 mentions of prescription drugs on TV last year, more than double the number from just two years earlier. But while consumer-product giants such as Coca-Cola, Toyota and BlackBerry shell out hundreds of millions of dollars to TV and movie studios to mention their products in story lines, it’s a mixed blessing for drug companies to have such exposure.

I don’t think the drug industry really likes this trend at all,” said Rob Frankel, a branding expert in Los Angeles. “Some of the jokes about Viagra and Botox are pretty sarcastic or disparaging. They get darker and deeper when they start mentioning Prozac and (anxiety medication) Xanax.”

In an episode of “Freestyle” on HGTV, a homeowner defined a comforting room in her house as her “Prozac room.” In an episode of “House,” a sign over the coffee machine in the doctors’ conference room says “Good coffee – cheaper than Prozac!”

Drug companies are relatively small players in product placement, with none breaking into the top 10. Bigger companies such as Nike and Hewlett-Packard dominate, according to Nielsen Product Placement.

Overall, companies paid $3.36 billion globally last year to place their products in TV, film and other media, up 37 percent from a year earlier, according to PQ Media.

Some pharmaceutical companies have acknowledged paying for TV plugs. Lilly says it doesn’t pay.

The FDA does not have an explicit position on product placement. In normal advertising, drug makers are prohibited from advertising the benefits of their drugs without mentioning possible risks.

The Pharmaceutical Research and Manufacturers of America, an association that represents many of the country’s biggest drug makers, declined to comment on the topic.

Some drug product mentions on TV seem outright promotional. In the Jan. 16 episode of ABC’s “Boston Legal,” a teacher got in trouble for failing to administer EpiPen, an injectible medication, to a child who ate peanut candy and died.

The boy’s father, testifying on the show, said: “Anaphylactic shock can come on suddenly, which is what happened here. The airways can become clogged in less than 30 seconds. If the EpiPen isn’t administered, it can be fatal.”

EpiPen’s maker, Dey of Napa, Calif., did not return a call seeking comment.

In one episode of the NBC situation comedy “Scrubs,” a logo for the contraceptive brand NuvaRing appeared 11 times, mostly on posters placed in the background.

The brand’s maker, Organon Pharmaceuticals USA of Roseland, N.J., told trade magazine Brandweek that it had done placement deals with several television shows, including CBS’ “King of Queens” and ABC’s “Grey’s Anatomy.”

“A lot of the feedback we get is from health-care professionals,” brand director Lisa Barkowski told the publication. “They mention it to (our) reps, ‘Wow, I saw that poster.’ It reinforces in their mind; it makes them think of the product.”

The company did not return a phone call seeking comment.

Despite the billions of dollars the pharmaceutical industry spends on direct-to-consumer advertising, drugs still don’t have the instant connection with consumers that everyday products such as soft drinks and sports cars have, some media experts say. Therefore, television shows can do only so much to plug a drug.

“On some shows, a character can drink a Coke or hop into a car,” said Fariba Zamaniyan, senior vice president for IAG Research in New York. “You can’t do that with a pharmaceutical product. ... It’s only a brand name. Unless you talk about what the benefits are, you can’t see the value of it.”

Online pharmacy charged with racketeering, fraud

Eighteen people who helped sell more than $126 million worth of prescription drugs over the Internet to people without doctor exams have been charged with federal racketeering.

The U.S. Immigration and Customs Enforcement says a 313-count indictment marks the first time organized-crime statutes designed to combat drug cartels and mafia rings have been used to charge anyone with selling prescription drugs over the Internet.

The indictment says Costa Rica-based AffPower took more than one million orders for legal pharmaceuticals including diet pills, birth control pills, Prozac and Viagra between August 2004 and June 2006. A network of affiliated Web sites are alleged to have received a cut of fees in return for each order forwarded to AffPower.

The indictment names doctors and pharmacies along with AffPower executives and recruiters.

The indictment further states that doctors, who were paid $3 for each order reviewed, approved hundreds or even thousands of orders a day.

The indictment, unsealed in federal court in San Diego today, names three doctors licensed in Georgia, Kentucky, Ohio and Massachusetts and pharmacists in Colorado and Florida.

Political Storm Over Giving Ritalin to Babies Under a Year Old

A political storm brewing in Britain. From the Daily Mail.

Thousands of children are needlessly being prescribed mind-altering powerful drugs for hyperactivity, according to opposition MPs.

Research suggests that some GPs are even handing out Ritalin pills to children under a year old.

Almost 400,000 youngsters aged between five and 19 are being treated with Ritalin and similar drugs for attention deficit hyperactivity disorder, or ADHD, despite fears about the drugs' side-effects.

The Conservative Party says the number of prescriptions for behavioural problems has risen by 156 per cent in the last six years.

Those diagnosed with ADHD often display disruptive behaviour and have difficulty paying attention to specific tasks.

In the last five years alone, NHS spending on stimulant drugs such as Ritalin has trebled - despite concerns over the potential health risks.

Official guidelines recommend drug treatment only for the most severely affected children. But the Tories claim that Ritalin and similar drugs are being prescribed to those with mild symptoms.

A formal diagnosis of ADHD should take many hours, but they say some GPs are prescribing powerful drugs after brief consultations.

This is despite reports of side effects such as cardiovascular disorders, hallucinations and even suicidal thoughts.

At least nine deaths have been reported to the UK's Medicines and Healthcare Products Regulatory Agency since Ritalin became available in the early 1990s. Shadow Commons leader Theresa May said: "They are powerful prescription drugs and we don't know what their long-term effects are. Despite this, they are being given to children before they are a year old.

"I have no doubt that there are children in the UK with ADHD who will benefit from Ritalin.

"But the increase of prescriptions raises questions in my mind as to whether it is being prescribed properly in each and every case.

"A six-year-old who was prescribed Ritalin experienced low moods and marked depression and tried to throw himself out of a window within two months of starting treatment. He recovered after drug withdrawal."

She is calling on NHS bosses to review their policy on prescribing such drugs. "With such widespread use of these prescription medicines we need a review of the current guidelines, with a view to tightening them," she said.

"More research should be done into the effectiveness of non-drug treatment and natural remedies to treat ADHD."

As there are no official records on the number of children prescribed Ritalin in Britain, the Tories used research compiled from global studies conducted over the past decade.

It comes after a report by the University of California showed the use of ADHD drugs has tripled worldwide since 1993.

Monthly prescriptions for Ritalin in England and Wales increased from 4,000 in 1994 to 359,000 in 2004, it claimed.

But Andrea Bilbow, chief executive of ADHD charity Addiss, dismissed the research as "misleading" and claimed that the disorder was still "under-diagnosed and underprescribed".

I would love to see an investigation into the affairs of Mister Bilbow, biased sort that I am.

See also this report from the Netherlands: Ritalin Prescriptions up 30%

Doctor Buys 33.4% of Lions Gate Shares 1 Week before the Release of Michael Moore’s SICKO

SICKO is important because it exposes corruption in the health and insurance industries. We are particularly interested in his expose of the psychiatric drug industry.

Thus we found this story interesting and enlightening.

Mark H. Rachesky, M.D. purchased 33.4% (over 40 Million) shares of Lions Gate stock one week prior to the scheduled opening of Michael Moore's controversial film "Sicko". (SEC filing can be found here.) The film is being distributed by Lions Gate Films. Interestingly, a pre-screening of the film was held on the same day in New Hampshire for over 600 people including doctors, health care lobbyists, nurses, political figures and pharmaceutical companies all from the health care industry.

Dr. Rachesky is the founder and President of MHR Fund Management LLC and affiliates who are investment managers of various private funds. Dr. Rachesky is currently on the Board of Directors of Keryx Biopharmaceuticals, Inc. which focuses on the acquisition, development and commercialization of medically important, novel pharmaceutical products for the treatment of life-threatening diseases, including diabetes and cancer. He is also an investment broker for NovaDel Pharma Inc. (AMEX: NVD) which is a specialty pharmaceutical company which targets candidates suffering from nausea, insomnia, migraine headaches and disorders of the central nervous system (CNS). In addition DR. Rachesky is the beneficial owner of Medical Nutrition USA, Inc. owning approximately 29% of the company with 3,786,799 shares. He is also the Director of Neose Technologies, Inc. (NASDAQ: NTEC) which is a clinical-stage biopharmaceutical company focused on the development of next-generation therapeutic proteins that are competitive with best in class protein drugs currently on the market. In 2003, the market for therapeutic proteins grew by almost 19% to $37 billion, and is predicted to achieve sales of over $90 billion by 2010. Recently the Doctor also has invested in Emisphere Technologies, Inc. another bio pharmaceutical company charting new frontiers in drug delivery. Emisphere has strategic alliances with world-leading pharmaceutical companies

Originally, Lion’s Gate had planned a wide release of SICKO in over 1,600 theaters nationwide June 29, 2007 but one week prior to the release the number was reduced to a mere 400. This decision was made the same week Dr. Rachesky purchased Lions Gate stock. Could this be pure coincidence? I think not.

Did Dr. Rachesky purchase the stock for controlling interests in Lions Gate? Controlling Interest is when the parent company owns a majority of the common stock that allows the shareholder major influence on the company. Normally for one to obtain controlling interests in a company one would purchase at least 51% of all shares however, in some cases a single entity can essentially maintain control with only 33.4% of the outstanding shares. Ironically, this is the exact percentage of shares purchased by Dr. Rachesky.

In the film SICKO Michael Moore turns his attentions toward the topic of health care in the United States in this documentary that weighs the plight of the uninsured against the record profits of the pharmaceutical industry. Moore interviews a number of people who have been left broke by medical bills even though they were fully insured, and explains how the corporate drive for profits has left numerous people in financial and medical disarray. After hearing that detainees in Guantanamo have access to free health care, Moore assembles a group of World Trade Center rescue workers to travel to Cuba in order to get the medical help they need for ailments they incurred in 2001. Moore's film debuted at the 2007 Cannes Film Festival. ~ Perry Seibert, All Movie Guide

If Dr. Rachesky purchased Lions Gate shares for controlling power is it safe to ask why? There are many debates and arguments as the the accuracy of Moore’s film. What interests me is if there were no truth and validity to the documentary why would someone go to so much trouble to make sure it is not a success and limit the amount theaters where the film can be seen? Sounds to me like this film has left the health care industry shaking in their boots and they don't want us to know the truth.

Court psychiatrists found dysfunctional, and plagued by their own disorders

It looks like the dysfunctional nature of psychiatrists as seen on TV is closer to the truth than many people would care to admit. Somehow this supposedly did not affect the quality of their work. Seen in this report

Name-calling, factions and conspiracies are common in the "dysfunctional" office of more than a dozen psychiatrists who analyze criminals for the courts, an Edmonton judge has found.

In a 55-page decision released Friday, Court of Queen's Bench Justice Erik Lefsrud ruled that allegations of defamation in the department were unfounded, but the department was plagued by infighting and lack of leadership.

"What emerged is a picture of a very dysfunctional working environment in which name-calling, finger-pointing, intransigence and conspiratorial workings have thwarted the best intentions of all the psychiatrists involved," he wrote.

How such a group of obviously intelligent professionals could work themselves into such a state is beyond comprehension.

"This litigation served largely as a forum for a litany of complaints ... including complaints of discrimination, intimidation, harassment, mismanagement and lack of effective leadership." The psychiatrists, who work at the Forensic Assessment and Community Services (FACS) outpatient clinic at Alberta Hospital, are highly trained medical doctors who have spent years studying psychiatry.

They regularly write psychological assessments of criminals that are instrumental to the justice system. Lawyers often rely on them in making their arguments before judges, and judges cite their reports in sentencing decisions.

Lefsrud said the "saga" at the department began in February 2003, when respected forensic psychologist Dr. Inderjit Singh Chohan learned that Dr. Otakar Cadsky had called him a "paranoid Sikh" behind his back.

Chohan launched a defamation lawsuit against Cadsky and the Capital Health Authority, as well as several other doctors involved in later events.

Cadsky, also a veteran forensic psychiatrist, was then the clinical co-ordinator of the department and Chohan's boss. He had previously been the subject of disciplinary action for calling a colleague a "greedy money-grubbing Jew." He admitted in court that he had called Chohan a "paranoid Sikh" but said he also referred to other physicians by various epithets during the conversation, including "narcissistic Spaniard" and "disorganized Mexican." Cadsky said he meant no harm, and his lawyer told the court that "many of the medical staff revelled in devising abusive epithets and bandying them about," Lefsrud wrote in his decision.

In the time following the comment, Lefsrud found, factions developed among the staff and meetings disintegrated into shouting matches.

In testimony and letters, doctors in the department told of "politics of intimidation," "gossip and innuendo," as well as "personal attacks" and power struggles.

In a letter of resignation on April 1, 2004, one doctor wrote that "there is an ambience of stealth, guile, subterfuge which has actually destroyed the organization ... the place is totally factionalized and I am perfectly sure that there is harassment and intimidation.

"There is a general distrust, apprehensiveness and uncertainty and no one on medical staff knows exactly what is going on, they are totally demoralized, the place is rudderless." Capital Health authorities intervened and investigated, and ultimately made a series of recommendations to rectify the problems. The court judgment does not indicate the current state of affairs in the department. Capital Health spokesman Steve Buick declined comment Friday.

Lefsrud ruled that while the legal test for defamation had not been met, Chohan "was justified in feeling insulted and humiliated" and that his frustration was understandable.

Alberta Justice spokesman David Dear said his department was reviewing the judgment.

"Our first and only concern in dealing with the psychiatrists who perform psychiatric assessments for the justice system is their professional competence," Dear said.

He said Lefsrud's judgment did not indicate that the dysfunctional environment had affected the psychiatrists' work.

Moving away from public support of psych drugs

from this report

Suffolk mental health bosses today backed a nationwide government investment in psychological therapies - and said it is heading in the same direction.

The government today announced a £2.2million investment for non-drug and talking therapies for people overcoming mental ill health.

It comes after the Suffolk Mental Health Partnership Trust announced in June that it was recruiting someone to head up its psychology and psychological therapies staff following the death of Ipswich woman Nicola Duncan, whose death is under review by the trust.

The 34-year-old's body was found at the Walberswick nature reserve days after being discharged from St Clement's Hospital, where she had been an in-patient treated for depression.

Robert Nesbitt, the trust's director of community engagement, said; “We've always had trained therapists, but we want to make sure we are working as effectively as we can, and develop this further.”

A recent survey of the trust's service users showed they wanted to have easier access to talking therapies to help them alleviate common mental health problems, such as depression and anxiety, and to elevate their self-esteem.

The government's investment pilot sites are a at Ealing, Stoke-on-Trent, Hertfordshire, East Riding of Yorkshire, Salford, Buckinghamshire, Brighton and Hove City, Dorset, North Tees and Hartlepool, Derby City, and Bury.

Mr Nesbitt said: “We will be watching these pilot schemes with interest, to see how we can bring their experiences to the benefit of the people we care for in Suffolk.

“Psychological therapies are becoming increasingly important, and indeed it is our experience that, in many cases, people prefer having the opportunity to talk to someone about how they are feeling rather than rely just on medication. It helps us get to the root of the problem and helps people move forward in their lives.

“Our new head of psychological therapies will be an experienced clinician who will provide a clinical leadership to doctors and therapists to help us make it happen. We're also starting to talk to GPs and to voluntary organisations to make sure our services are better coordinated locally.”

Despite evidence, only 1 FDA Committee Member argued for Withdrawal of Avandia

GlaxoSmithKline continues its streak of marketing drugs with deadly side effects. Now it is not just psych drugs. See also the testimony of Dr Sidney Wolfe before the FDA on Avandia. the following is via Bloomberg

GlaxoSmithKline Plc convinced a U.S. regulatory panel this week to keep its best-selling diabetes drug, Avandia, on the market. Now comes the hard part: persuading doctors to use a medicine linked to heart attacks.

The U.S. Food and Drug ['Trust us - we know whats good for you!'] Administration committee of advisers said this week that the diabetes pill should carry new warnings about cardiovascular risks. Glaxo shares had their biggest gain in two years yesterday after the advisory panel decided not to recommend the withdrawal of Avandia, which brought in $3.3 billion in 2006 for the London-based company, Europe's largest drugmaker.

To hold onto even a portion of that revenue, Glaxo will have to spend more on marketing a product that analysts had estimated would generate $6 billion by 2011. Glaxo shares may resume a two- month decline that began in May as the company struggles for enough Avandia sales to keep profit growing.

``Glaxo will probably receive a black-box warning and the sales will probably not recover to the previous level,'' Pascale Boyer Barresi, an analyst at Bordier & Cie in Geneva, said in an interview.

Avandia sales ``will probably recover 10 to 15 percent, but the decline was so far I think once doctors have changed their patients, they will not switch back,'' he said.

A black-box in the drug's prescribing information is the FDA's sternest. While some of the advisers called for the high alert, the committee didn't vote to recommend it. The agency usually follows advisory panel rulings.

The FDA committee voted 22-1 to keep Avandia on the market and 20-3 that evidence shows the drug adds to the risks of heart attacks. The panel was seeking to resolve questions raised by a May 21 report in the New England Journal of Medicine that linked the medicine to a 43 percent increased risk of heart attacks.

Glaxo shares were unchanged at 1,255 pence in London, after closing at a two-year low of 1,215 pence on July 30, the day of the hearing. The share decline since the May report has cut 12.3 billion pounds ($25.1 billion) from Glaxo's market value.

Advisory committee members said they weren't convinced evidence from studies supported pulling the drug off the market, even if the pill increases a patient's chances of heart attacks. They said heightened warnings should help doctors.

Two FDA safety officials argued for removing Avandia from the market. They said the treatment raised cardiovascular risks for diabetics, whose chances of developing heart complications are already elevated. The officials also said continuing studies would probably never remove doubts about the product.

[...]

Psychiatrist wants immunity for testimony regrading her treatment of a soldier charged in a brutal rape and murder.

All of which leads to some suspicion regarding the psychiatrist. From this report

A military psychiatrist who treated at least three U.S. soldiers charged in the brutal rape and murder of a 14-year-old Iraqi girl and the slayings of her family said Thursday she would not testify unless she had blanket immunity.

Elizabeth Bowler, an Army reservist, has been called to testify in the court-martial of Pfc. Jesse Spielman, who has been charged with rape and murder in the assault.

Spielman's court-martial resumed Thursday with prosecutors scrambling to overcome a soldier's recanting of his story that Spielman conspired to participate in the March 12, 2006, assault of a family in Mahmoudiya, a village about 20 miles (32 kilometers) south of Baghdad. Spc. James Barker, who has admitted his own role in the assault, testified Wednesday that he had allowed investigators to draft sworn statements for him that implicated Spielman in the crime. Barker testified that several portions of the document were untrue.

The court-martial proceedings began Monday with Spielman pleading guilty to lesser charges of conspiracy to obstructing justice, arson, wrongfully touching a corpse and drinking. Bowler was sworn in Thursday to testify after the jury had been excused so a military judge could decide if her testimony would merit immunity from prosecution.

Defense attorney Craig Carlson asked Bowler under oath what she would do if she was called to the stand. She said she would exercise her constitutional right against self-incrimination. Bowler was in charge of a combat stress team attached to the Spielman's unit during its deployment last year.

The Justice Department last month denied a request to grant Bowler immunity. Maj. William Fischbach, the military prosecutor, said he was planning to ask the military authorities overseeing Spielman's court-martial if immunity could be granted to Bowler by the end of the day.

Prosecutors have only a handful of witnesses to call before resting their case against the 101st Airborne Division soldier.

Something about the whole topic seems to send rationality out of the window.

And, in passing, we have this series of posts and comments on the fury that exists in the debates on ADHD.

Somehow, my name became mud to some fellow commenters on Pharyngula. The original post was some innocuous thing on ADHD therapy. Something about the whole topic seems to send rationality out of the window. I am not going to repeat it all here. It’s an insanely tedious thread with upwards of 60-odd comments at this moment.

No one seemed to understand what anyone else was actually saying. Very few seemed to have taken even introductory lessons in English comprehension. People were ganging up to savage one commenter -”caledonian” - paying less than no attention to what s/he actually said and charging down so many logical back alleys that I had to doublecheck the URL to establish that I wasn”t in some southern baptist college’s logic class.

[...]

Red rag to bull time….

ADHD as Naughty Child Syndrome

From the Daily Mail

Millions of pounds of taxpayers' money is being paid to families of children suffering from the condition dubbed 'naughty child syndrome' - even though many experts say it does not exist.

Parents who have a child diagnosed with attention-deficit hyperactivity disorder (ADHD) can claim disability benefits of up to £10,000 a year, a situation which some doctors believe is fueling an astonishing rise in the number said to have the syndrome.

The Government says 345,000 children aged between six and 16 suffer from the disorder - meaning a doctor has attributed their disruptiveness to a medical condition rather than just bad behaviour or poor parenting.

ADHD was almost unheard of 20 years ago but the number of prescriptions for Ritalin - the controversial drug which suppresses symptoms of hyperactivity - has rocketed from 2,000 in 1991 to 329,000 last year.

Ministers and the Department for Work and Pensions say they do not know what proportion of the annual £8.6 billion disability allowance budget is devoted to ADHD sufferers. But Professor Eric Taylor, one of the country's leading experts on the syndrome, told the Mail on Sunday he estimated around one in 20 of the families who attended his clinic were receiving benefits for the condition.

They can pick up a disability living allowance of up to £5,350 a year, a carer's allowance of up to £2,376 a year and a disabled child tax credit of £2,300 a year.

If replicated across England and Wales, the figures from Professor Taylor, head of the Child Psychiatry Department at King's College, London, would mean more than 17,000 families claiming up to £170 million.

There are no medical tests for ADHD. Instead, children are diagnosed on the basis of their behaviour and questionnaires asking parents if a child is displaying symptoms of restlessness and fidgeting.

Critics say ADHD should never have been acknowledged as a genuine medical condition and accuse doctors of complicity in the 'mass drugging' of a generation of children.

Ritalin is an amphetamine-based stimulant, nicknamed the 'chemical cosh'. Its side-effects include loss of appetite, insomnia and unresponsiveness. US research also suggests it may cause depression later in life.

Dr Sami Timimi, a consultant and adolescent psychiatrist at Lincolnshire NHS Trust, said: "There is no evidence to suggest there is a medical condition called ADHD.

"It is a cultural concept, which is creating a market in various labels. Families will go to a doctor and if he or she doesn't believe in ADHD they can find another one who will. There's money in it. I have a problem with disability allowance being given for this diagnosis.'

Priscilla Alderson, who is Professor of Childhood Studies at London University, said: "There has been a very rapid increase in the alleged incidence of ADHD, but instead of kneejerk diagnosis, people should look at the changes in society that have contributed to it, including longer school days, children spending less time at home with families and reduced opportunities for them to let off steam by playing outside.

"Some of these teenagers are being hit with Asbos, which restricts their movement even further and makes them even more badly behaved."

Tory health spokesman Tim Loughton called for an end the 'diagnosis and drug' approach to disruptive children.

He said: "My concern is with the enormous increase in the prescription of Ritalin, which is a powerful chemical to give young children. A lot more should be done to examine alternative therapies."

The Department for Work and Pensions confirmed that £861 million was spent on disability allowances for children last year - which is more than double the £411 million figure from a decade ago.

A spokeswoman said: "ADHD does not automatically entitle someone to disability benefits. Disability living allowance is based on individual need and the effect of a disability on someone's mobility and care needs, not on a particular diagnosis. A diagnosis of ADHD should not be made without detailed psychiatric evaluation or involvement of a mental health team.'

Dominican police investigate psychiatrist who claimed he cured patients of AIDS

Not that there couldn't be a miracle cure for AIDS, but the circumstances seem to make it less than likely. Plus the fact that pigs and donkeys would normally seem to be immune to human diseases like AIDS, so testing an AIDS cure on them might not be the best tactic. From the International Herald Tribune

Dominican police shut down the laboratory of a prominent psychiatrist and former Santo Domingo mayor who claims he cured more than 50 people of AIDS by injecting them with an unknown substance, prosecutors said Thursday.

Police raided the lab of Jose Ramon Baez Acosta on Wednesday after receiving complaints from former patients, said Luisa Matos, a spokeswoman for the Santo Domingo Province District Attorney.

Investigators seized samples of the formula dubbed "Uman TS," medical equipment and two pigs and a donkey that Baez Acosta was apparently using for tests, Matos said.

Baez Acosta, who served as mayor of the Dominican capital in the mid-1960s, did not return phone calls to his office seeking comment. Last week he told the newspaper El Caribe he had cured 52 people of AIDS, and that God revealed the treatment to him in a dream.

Dominican police shut down the laboratory of a prominent psychiatrist and former Santo Domingo mayor who claims he cured more than 50 people of AIDS by injecting them with an unknown substance, prosecutors said Thursday.

Police raided the lab of Jose Ramon Baez Acosta on Wednesday after receiving complaints from former patients, said Luisa Matos, a spokeswoman for the Santo Domingo Province District Attorney.

Investigators seized samples of the formula dubbed "Uman TS," medical equipment and two pigs and a donkey that Baez Acosta was apparently using for tests, Matos said.

Baez Acosta, who served as mayor of the Dominican capital in the mid-1960s, did not return phone calls to his office seeking comment. Last week he told the newspaper El Caribe he had cured 52 people of AIDS, and that God revealed the treatment to him in a dream.

"Every now and then these people appear saying there is a cure," she told The Associated Press. "It is difficult to control that when it goes out in a newspaper."

Baez was not arrested or charged, but prosecutors are investigating with the aim of bringing him to trial, Matos said. Health officials ordered an immediate stop to the treatment.

At least 70,000 of the Dominican Republic's 9.2 million people have HIV, the virus that causes AIDS. The Caribbean has the second-highest infection rate of the disease outside of sub-Saharan Africa.

'Naughty child syndrome' costs taxpayers

From the Yorkshire Post

Cynical teachers call it Naughty Child Syndrome. But ADHD – Attention Deficit Hyperactivity Disorder – has become a common diagnosis and a reason for prescribing powerful drugs.

It started in the United States and swept across the Western world. But in some countries, it is still unheard of.

So what is happening to our children? Dorothy Rowe, a respected psychologist, has attempted to provide the answer.

Dr Rowe has been updating her thoughts on ADHD and similar diagnoses for a new edition of her best-selling self-help book, Beyond Fear.

When the book was first published, in 1987, ADHD was unheard of. Now it is part of the language – and an excuse for dosing children with drugs similar to amphetamines and cocaine [...]

The theme of her book is that fear, in a variety of grades and guises, is the common explanation for a range of human problems. And she believes ADHD is just a new way of describing the condition of children who are running scared of violence, rage, uncertainty, ridicule or some other adult weapon, used intentionally or unintentionally.

In New Scientist a few weeks ago, she asked readers to imagine themselves in a situation of extreme anxiety.

"You are at home awaiting the arrival of the person on whom you feel your life depends. The person is very late. You try to watch TV but can't concentrate. You move from chair to window, from window to door. You make phone calls, check traffic news. A friend phones to chat, and you rudely tell them to hang up. The line must be kept clear.

"You are exhibiting hyperactivity, impulsiveness, distractability. A psychiatrist might say you have been stricken with attention deficit hyperactivity disorder. Fortunately, as an adult, you articulate the reasons for your fear, and if the psychiatrist has any sense, she or he pours you a stiff drink.

"ADHD is not a diagnosis most mature adults face. Children, on the other hand, are being diagnosed with it in their millions."

Dr Rowe, 76, worked as a teacher and educational psychologist in Australia before getting a PhD at Sheffield and working for the NHS in North Lincolnshire. She has since written more than a dozen books, praised for their insight and common-sensical wisdom.

She has seen a lot of "naughty boys" in her career and she believes that behaviour which was once considered normal is now being diagnosed as illness. Schools are penalised if children do not fit into their systems. If parents cannot make them fit, something must be wrong. And it is easier to dose the child than to change the parents.

Few of the psychiatrists who diagnose ADHD or bipolar problems have spent much time with the children, she comments. They are usually acting on descriptions of the children's behaviour from parent and teachers. In short, all the adults collude to blame the child ...

"Parents fail to mention their own economic, social or personal problems, or underplay them. Doctors don't ask, because they lack the skills and resources to help the parents.

"If a child behaves badly, the child is at fault. If she or he can't be regarded as naughty and be punished, she or he must be mad."

Dr Rowe told the Yorkshire Post: "No physical basis has ever been discovered for this disorder. And it only exists in Western society. It is just a way of describing children – particularly boys – who cannot fit in to ordered situations."

[...]

Her book quotes Sami Timimi, a psychiatrist in Lincoln, who made some of the same points two years ago, in a book called Naughty Boys.

He said ADHD had become a "dumping ground" for problems arising out of the failures of adults and their institutions. And he commented: "Western governments spend billions to fight a war on drugs with the right hand, while the left hands out millions of prescriptions for stimulants."

He said this week: "ADHD is a cultural invention. We define what normal child behaviour is and what we call problems might be valued in another context."
[...]

Tussle over tax deduction continues

You would think that in a field of real experts operating with integrity, that you would be able to achieve a reasonable scientific certainty as to what the heck was actually going on. But here, as in many other cases, instead of scientific certainty we have keystone psychiatrists. I am starting to think that we might as well employ astrologers in the court system instead. They otherwise do a tragic dis-service to people saddled with real problems and situation.

Seen Here

A psychiatrist testifying as an expert witness for the Internal Revenue Service (IRS) questioned the judgment of his colleagues who recommended sex-reassignment surgery for Rhiannon O’Donnabhain, who is suing the IRS for the right to deduct the cost of the surgery from her taxes. But one of O’Donnabhain’s lawyers, Bennett Klein of Gay and Lesbian Advocates and Defenders (GLAD), questioned the psychiatrist’s qualifications to determine O’Donnabhain’s treatment needs, as U.S. Tax Court Judge Joseph H. Gale heard a third day of testimony in the case on July 26.

Dr. Chester Schmidt, Jr., a psychiatry professor at John Hopkins University and co-founder of the university hospital’s Sexual Behaviors Consultation Unit (SBCU), stated that gender identity disorder (GID) specialists Diane Ellaborn, a licensed clinical social worker, and psychologist Dr. Alex Coleman recommended O’Donnabhain for sex-reassignment surgery without knowledge of her history of attention deficit-hyperactivity disorder (ADHD) and her history of depression, for which O’Donnabhain was treated with anti-depressants. Schmidt learned of the conditions after reviewing the notes of Dr. Judith Robinson, a psychiatrist who also treated O’Donnabhain, and those of Ellaborn and Coleman, who both previously testified at the trial (See "Experts at tax trial explain gender identity disorder," July 26).

Asked by IRS attorney John Mikalchus whether or not he agreed with Ellaborn’s and Coleman’s individual assessments that O’Donnabhain was in good shape from a psychological and psychiatric point of view prior to her sex-reassignment surgery, Schmidt replied that the fact that neither seemed to know of her history of other disorders posed a dilemma. "I don’t want to be critical," Schmidt replied. "... It’s difficult for me to not to take that into consideration when weighing the accuracy of [Ellaborn’s and Coleman’s] notes." Schmidt went on to say that the fact that O’Donnabhain was being treated with anti-depressants prior to her surgery should have been known to Ellaborn, who testified that she treated O’Donnabhain for about five years, and Coleman, who stated he did a two-hour consultation with O’Donnabhain to specifically evaluate her fitness for sex-reassignment surgery. It may not have impacted their decisions to recommend the surgery, said Schmidt. But he added, "We’ll never know that." Schmidt explained that knowledge of "co-morbidity" - the coexistence of two or more diagnosable conditions or diseases in an individual - is important because the treatment of one condition can worsen the symptoms of another condition. "The clinical challenge is to be able to parse out how they affect each other."

Schmidt took the stand in the IRS’s effort to bolster its contention that O’Donnabhain’s sex-reassignment surgery was a cosmetic rather than a medically necessary treatment, therefore is not tax deductible. O’Donnabhain, a 63-year-old South Shore resident, underwent sex-reassignment surgery in October 2001 and deducted the $26, 000 cost on her 2001 tax return, receiving a $ 5,679.00 deduction. Months later she received noticed that she would be audited by the IRS, which resulted in the deduction being denied. She was ordered to pay back the money. With GLAD’s help, she filed the lawsuit, known as O’Donnabhain v. Commissioner of Internal Revenue, instead. Klein and fellow GLAD attorneys Karen Loewy and Jennifer Levi assert that GID is a disorder recognized by the medical community and that it is included in the Diagnostic Statistical Manual of Mental Disorders (DSM), a standard handbooks of mental health practitioners. Witnesses have testified that O’Donnabhain’s treatment, including her surgery, was well within the norms of treatment for GID and that the surgery was medically necessary.

O’Donnabhain was diagnosed with GID in 1996, after struggling since childhood with feeling as though her physical body did not match her female gender identity. In testimony occasionally punctuated by tears on July 24, O’Donnabhain recounted her long struggle with GID, which included thoughts of suicide and self-castration.

Under questioning by Klein, Schmidt testified that he has not personally evaluated O’Donnabhain - as he did when offering expert testimony in the case of Michelle Kosilek, an imprisoned murderer who is seeking sex-reassignment surgery - nor has he ever encountered her beyond listening to her July 24 testimony in court. Though he co-founded the SBCU, which does consultation and evaluation on gender identity issues, Schmidt also said he has not personally treated a patient with GID since the 1980s. He also testified that since 1992, much of his work has focused on "current procedural terminology," a complex system of evaluation and management codes used by mental health professionals for billing and other purposes; in recent years he has published a handbook on the codes and chaired an American Psychiatric Association committee on the subject. Schmidt said that overall, 75 percent of his work is administrative, as opposed to being in a clinical environment. He said he keeps current on the literature regarding GID through his teaching duties and through "rubbing shoulders regularly" with some of the most prominent practioners in the field of human sexuality and GID, who are also on staff at Johns Hopkins, which Schmidt noted has topped U.S. News and World Report’s list of Best Hospitals for the past 17 years.

Klein also asked Schmidt a number of questions relating to the diagnosis and treatment of GID. Schmidt testified that people who appear to be ambiguously gendered could suffer psychological damage as a result of their appearance. He also stated his belief that the physical changes brought about by taking cross-gender hormones can provide a sense of psychological well-being to a patient with GID and that sex-reassignment surgery can provide important psychological benefits as well.

But under questioning by both Klein and Mikalchus, Schmidt several times emphasized his belief that the Harry Benjamin Standards of Care - a set of widely recognized and accepted standards for the treatment of GID set out by the World Professional Association for Transgender Health (WPATH) - are simply guidelines for physicians treating GID patients rather than mandatory treatment protocols. "These are what is considered at the moment the ’best practices’," said Schmidt of the standards. "But they do not say any practitioner has to follow them."

The Harry Benjamin Standards recommend sex-reassignment surgery after successful hormone treatments and at least one year of living in the gender with which the patient identifies. Ellaborn testified previously that she treated O’Donnabhain in accordance with standards.

Though Schmidt testified that he does not disagree with the substance of the standards as far as their use as guidelines, he stated he does not ever recommend sex-reassignment surgery as a treatment for GID, a position he described as a "significant point of departure" between himself and WPATH and Dr. George Brown, a WPATH board member who was called to testify as an expert witness by GLAD on July 25. "I firmly believe that the decision to take hormones and have surgery should be the patient’s decision," said Schmidt.

Asked by Mikalchus if he would recommend sex-reassignment surgery if he felt it was medically necessary, Schmidt replied that he could not think of such a situation. "It’s certainly medically helpful," he said. "It’s not necessary in terms I understand."

Earlier in the day, Gale queried Brown, who finished his testimony that morning, on how consensus on standards of care is reached by doctors for any type of medical condition. Brown replied that most often professional organizations with an interest in a given field would conduct research and/or review existing research on a particular condition and create standards of care based on their findings. They will then issue an opinion based on their knowledge and research, said Brown, even if the research is inconclusive at that point in time.

Dr. Toby Meltzer, the Oregon plastic surgeon who performed O’Donnobain’s sex-reassignment surgery, also testified in the case. Under questioning by Loewy, Meltzer who performed genital surgery, breast surgery and facial feminization procedures on O’Donnobhain, said that the purpose of the procedures was to treat O’Donnabhain’s GID. Meltzer said that for patients with GID, sex-reassignment surgery "is a validation of their being in many ways," because it allows their external appearance to align with their internal gender identity. "It allows them to move on with their life in the way they always wanted to but were not allowed to," said Meltzer.

Under questioning by Mikalchus, Meltzer said he was not aware that O’Donnabhain was being treated for "severe depression" at the time of her surgery. He also said it would not have impacted his decision to perform the surgery.

Testimony in the case is scheduled to continue on Aug. 23, when the IRS’s second and final expert witness will take the stand, followed by closing statements by lawyers for both parties in the case.