Prozac 'found in drinking water'

Via the BBC

Traces of the antidepressant Prozac can be found in the nation's drinking water, it has been revealed.

An Environment Agency report suggests so many people are taking the drug nowadays it is building up in rivers and groundwater.

A report in Sunday's Observer says the government's environment watchdog has discussed the impact for human health.

A spokesman for the Drinking Water Inspectorate (DWI) said the Prozac found was most likely highly diluted.

'Alarming'

The newspaper says environmentalists are calling for an urgent investigation into the evidence.

It quotes the Liberal Democrats' environment spokesman, Norman Baker MP, as saying the picture emerging looked like "a case of hidden mass medication upon the unsuspecting public".

He says: "It is alarming that there is no monitoring of levels of Prozac and other pharmacy residues in our drinking water."

Experts say the anti-depression drug gets into the rivers and water system via treated sewage water.

Prescriptions increase

The DWI said the Prozac (known technically as fluoxetine) was unlikely to pose a health risk as it was so "watered down".

The Observer says the revelations raise new fears over how many prescriptions for the drug are given out by doctors.

In the decade leading up to 2001, the number of prescriptions for antidepressants went up from nine million per year to 24 million per year, says the paper.

The Environment Agency report concluded that the Prozac in the water table could be potentially toxic and said the drug was a "potential concern".

The exact amount of Prozac in the nation's drinking water is not known.

Mental hospital under fire for neglect

Another mental hospital under investigation

Wisconsin's state-run Winnebago Mental Health Institute is under fire for poor patient supervision after several incidents in which patients were in jeopardy.

Poor supervision and bad judgment on the part of hospital staff are being blamed for three deaths and one rape at Winnebago, The Milwaukee Journal-Sentinel reported.

Almost three dozen acts of violence have been reported at Winnebago, which houses some of the state’s most severely mentally ill patients.

Among the cases recently cited is that of a 15-year-old girl with swallowing problems who, after being taken off her special diet of soft foods, choked to death on a sandwich, the newspaper said.

A 24-year-old patient collapsed and died after staff disregarded her complaints of dizziness. Another woman, who was supposed to be under constant supervision, committed suicide after she was left alone in a bathroom.

Rape is also reportedly an issue at Winnebago, which was cited for an incident in which a 13-year-old boy raped a 14-year-old girl while the two were unsupervised in a shower area.

Winnebago's director, Robert Kneepkens, told the newspaper there has been significant progress toward fixing problems of understaffing and patient neglect.

Introducing Anti-Government Phobia

Another Satirical Disease that might be coming to a shrink near you. (note the author's name Ivor E. Tower = Ivory Tower) As seen here:

This study conclusively demonstrates that unfounded fear of government is a recognizable mental illness, closely related to paranoid schizophrenia. Anti-Government Phobia (AGP) differs from most mental illnesses, however, in that it is highly infectious and has an acute onset. [...]

Having the patient committed to a qualified mental health institution is the best option for family and loved ones. For this reason, all psychiatrists and family physicians should be provided with educational materials which will help them recognize the various symptoms and warning signs accompanying onset. Since comparatively little is known about Anti-Government Phobia at the present time, a government-funded health commission should be set up to oversee, and help focus, future research.

Full satire at the link

Bipolar Diagnosis in Kids Jumps 40-Fold in 10 Years As Companies look for New Uses for Old Drugs

From this Report

The number of children in the U.S. diagnosed with bipolar disorder, a mental illness once seen mostly in adults, jumped 40-fold between 1994 and 2003, according to a study in the Archives of General Psychiatry.

By 2003, about 1 percent of children were diagnosed, or 1,003 for every 100,000 people age 19 and younger. The adult rate almost doubled to 1,069. Nine in 10 kids diagnosed with the disorder were on at least one drug, and two-thirds took two or more, said researchers led by Mark Olfson, a psychiatrist at Columbia University in New York.

Doctors said they don't know if the rise was caused by too little diagnosis in the past, or too much now as a one-size- fits-all response to aggressive behavior. The question is sparking debate as companies such as Indianapolis-based Eli Lilly & Co. and New York-based Bristol-Myers Squibb Co. seek to market drugs for children linked to weight gain and diabetes.

``There's no question that there is misdiagnosis going on,'' said Gary Sachs, director of the bipolar and mood disorders program at Massachusetts General Hospital in Boston, who was not involved with the study. [...]

The absolute number of children treated jumped to 800,000 from 20,000 during the 10-year study, according to data gathered from the National Center for Health Statistics survey of office visits by the researchers. The rate jumped from 25 for every 100,000 people age 19 and younger.

Manic Depression

Bipolar disorder was once known as manic depression. In classic, adult versions of the disease, people stay lodged for weeks or months in states of deep depression, then shift to a manic phase in which they sleep little, have intense energy, talk rapidly, and may engage in risky behavior.

Starting in the mid-1990s, some psychiatrists began to argue that the disorder looks different in children, who may alternate more rapidly between depression and mania. In their view, the key sign of a bipolar child is a high level of irritability and rage. The disorder has been linked to poor school performance and substance abuse.

Sachs said that one-third to one-half of patients who have been referred to his clinic with a diagnosis of bipolar turn out not to have a confirmable case. Patients treated for a diagnosis they don't have won't respond to the treatment and end up getting a lot of different medications, he said.

``They're likely to get more side effects than benefit,'' he said.

[...]

When children are misdiagnosed, the result can be dangerous, said Olfson, a psychiatrist at Columbia University. He said there are several factors that make him question the reliability of many bipolar diagnoses.

The disorder in adults is seen mostly in women, yet about two-thirds of diagnosed children are boys. Also, many children said to have bipolar were also diagnosed with attention deficit disorder, a condition that can look similar, Olfson said.

``If we're getting this wrong, if substantial numbers of kids are being misdiagnosed with bipolar disorder, it can have serious consequences,'' Olfson said in an Aug. 31 telephone interview.

Medication Types

Two groups of medications are widely used in children.

Anticonvulsants, developed to treat epileptic seizures, were taken by about half of the children. Drugs in this group include Depakote made by Abbott Laboratories; Johnson & Johnson's Topomax; GlaxoSmithKline Plc's Lamictal; Novartis AG's Tegretol and Pfizer Inc.'s Lyrica and Neurontin.

None are approved by U.S. regulators for treating children with bipolar disorder. Side effects include sedation, weight gain, tremor, and, more rarely, liver and blood problems.

The expanded use of bipolar as a pediatric diagnosis has made children the fastest-growing part of the $11.5 billion U.S. market for antipsychotic drugs.

Nearly half the children took atypical antipsychotics, such as Lilly's Zyprexa, J&J's Risperdal, AstraZeneca Plc's Seroquel, Bristol-Myers' Abilify and Pfizer's Geodon. Side effects caused by this group of medications include weight gain, diabetes and hormonal irregularities.

Lilly is developing an experimental antipsychotic drug that didn't show the same side effects in the second stage of testing regularly required for regulatory clearance, the company said yesterday. That drug targets a different brain chemical than drugs now on the market.

Risperdal in Children

Risperdal was cleared for use in children ages 10 and older on Aug. 22, beating Lilly and Bristol-Myers in a push to expand use of such medicines by younger patients. Risperdal, J&J's top- seller, generated $4.2 billion last year while Lilly's Zyprexa had $4.4 billion in sales. The FDA is reviewing Zyprexa and Bristol's Abilify for teens.

Vivek Kusumakar, global head of Risperdal development for J&J, said when it was approved that the side effects must be weighed against the potentially fatal conditions it treats.

David Healy, a professor of psychological medicine at Cardiff University in Wales, said the rise in the diagnosis was unprecedented. Healy, who has served as an expert witness for lawyers suing drug companies, said he was particularly concerned that so many children were prescribed more than one drug.

``The mismatch between possible benefits and likely harms is great,'' he said.

Political threat to take new-born over fear of imaginary disease

This is an example of the the arbitrary removal of a child by government services for reasons that have nothing to do with reality. As seen in the article, the mother is well educated and well qualified. The pediatrician making the recommendation is a fruit cake misdiagnosing without having even met the mother. From this report

A pregnant woman has been told that her baby will be taken from her at birth because she is deemed capable of "emotional abuse", even though psychiatrists treating her say there is no evidence to suggest that she will harm her child in any way.

Social services' recommendation that the baby should be taken from Fran Lyon, a 22-year-old charity worker who has five A-levels and a degree in neuroscience, was based in part on a letter from a paediatrician she has never met.

Hexham children's services, part of Northumberland County Council, said the decision had been made because Miss Lyon was likely to suffer from Munchausen's Syndrome by proxy, a condition unproven by science in which a mother will make up an illness in her child, or harm it, to draw attention to herself.

Under the plan, a doctor will hand the newborn to a social worker, provided there are no medical complications. Social services' request for an emergency protection order - these are usually granted - will be heard in secret in the family court at Hexham magistrates on the same day.

From then on, anyone discussing the case, including Miss Lyon, will be deemed to be in contempt of the court.

Miss Lyon, from Hexham, who is five months pregnant, is seeking a judicial review of the decision about Molly, as she calls her baby. She described it as "barbaric and draconian", and said it was "scandalous" that social services had not accepted submissions supporting her case.

"The paediatrician has never met me," she said. "He is not a psychiatrist and cannot possibly make assertions about my current or future mental health. Yet his letter was the only one considered in the case conference on August 16 which lasted just 10 minutes."

Northumberland County Council insists that two highly experienced doctors - another consultant paediatrician and a medical consultant - attended the case conference.

The case adds to growing concern, highlighted in a series of articles in The Sunday Telegraph, over a huge rise in the number of babies under a year old being taken from parents. The figure was 2,000 last year, three times the number 10 years ago.

Critics say councils are taking more babies from parents to help them meet adoption "targets".

John Hemming, the Liberal Democrat MP and chairman of the Justice for Families campaign group, said the case showed "exactly what is wrong with public family law".

He added: "There is absolutely no evidence that Fran would harm her child. However, a vague letter from a paediatrician who has never met her has been used in a decision to remove her baby at birth, while evidence from professionals treating her, that she would have no problems has been ignored."

Mr Hemming was concerned that "vague assertions" of Munchausen's Syndrome by proxy - now known as "fabricated and invented illness" - had been used to remove a number of children from parents in the North-East.

Miss Lyon came under scrutiny because she had a mental health problem when she was 16 after being physically and emotionally abused by her father and raped by a stranger.

She suffered eating disorders and self-harm but, after therapy, graduated from Edinburgh University and now works for two mental health charities, Borderline and Personality Plus.

Dr Stella Newrith, a consultant psychiatrist, who treated Miss Lyon for her childhood trauma for a year, wrote to Northumberland social services stating: "There has never been any clinical evidence to suggest that Fran would put herself or others at risk, and there is certainly no evidence to suggest that she would put a child at risk of emotional, physical or sexual harm."

Despite this support, endorsed by other psychiatrists and Miss Lyon's GP, social services based their recommendation partly on a letter from Dr Martin Ward Platt, a consultant paediatrician, who was unable to attend the meeting.

He wrote: "Even in the absence of a psychological assessment, if the professionals were concerned on the evidence available that Miss Holton (as Miss Lyon was briefly known), probably does fabricate or induce illness, there would be no option but the precautionary principle of taking the baby into foster care at birth, pending a post-natal forensic psychological assessment."

Miss Lyon said she was determined to fight the decision. "I know I can be a good mother to Molly. I just want the chance to prove it," she said.

The council said the recommendation would be subject to further assessment and review. "When making such difficult decisions, safeguarding children is our foremost priority," a spokesman said.

• A recording of social workers threatening to take a newborn into care has been removed from the YouTube website after Calderdale Council in West Yorkshire started legal action, claiming the Data Protection Act was breached.

Vanessa Brookes, 34, taped social workers telling her and her husband that they would seek to place the baby, due next month, in care, while admitting there was "no immediate risk to the child."

ADHD drugs: oversold and overused

A Report on the unashamed over-advertising of ADHD medications, via the Baltimore Sun

Back-to-school season is in full swing. Time to pick out a backpack, sneakers and a stimulant medication for attention-deficit hyperactivity disorder.

Nearly 2 million children in the United States are diagnosed with ADHD, which is marked by poor concentration, lack of self-control and/or hyperactivity. Besides time off from school, many kids with ADHD get a summer "vacation" from the prescription medications that help them focus in class.

So August has become a prime time to market the idea that a change in drug for the new school year (Concerta to Adderall?) might help the kids focus better, keep them going longer or have fewer side effects. Direct-to-parent marketing of ADHD drugs - most of which are stimulants - has grown pervasive over the last few years, despite a United Nations treaty banning most of it. Use of such medications increased by more than 60 percent from 2001 to 2005, according to the International Narcotics Control Board.

This month's homemaker-targeted magazines, such as Family Circle, Woman's Day and Redbook, feature advertising spreads for Vyvanse, Shire US Inc.'s new entry in the growing stable of ADHD medications. The ads show "Consistent Kevin through the day, even through homework," picturing a well-groomed boy smiling as he wields his pencil through a worksheet, and "Consistent Sarah," who even at 6 p.m. contentedly pecks away at the piano keys.

ADDitude magazine, published for people with ADHD, has ads for four medications. One ad touts a flavored, chewable form of methylphenidate with the slogan, "Give me the grape." (Methylphenidate is best known under the trade name Ritalin, which is not among those drugs advertised.)

Ads for candy-flavored methylphenidate are a far cry from the vision set forth in 1971 by the Convention on Psychotropic Substances. So far, 159 countries, including the United States, have agreed to ban consumer-targeted marketing of psychotropic medications - which all these ADHD drugs are - that carry the potential for addiction or dependency. For decades, pharmaceutical companies abided by its provisions.

But in 2001, one company began buying ads in the September issue of women's magazines in the United States to draw attention to Metadate CD, a long-acting form of methylphenidate. Other companies quickly followed suit.

Called on the carpet by the U.S. Drug Enforcement Administration, lawyers for the drug companies vowed to defend themselves under the umbrella of First Amendment speech rights. According to former DEA officials, the Department of Justice was unwilling to test this one in court.

Six years later, the results are drastic. Doctors and therapists increasingly see parents seeking to change their child's medication or coming in with their own diagnosis of ADHD and suggestions for medications they have seen advertised. Many of the companies offer coupons for a free-trial supply.

Children in the United States are 10 times more likely to take a stimulant medication for ADHD than are kids in Europe. In fairness, children in Europe are also somewhat less likely to be diagnosed with ADHD because of a stricter set of criteria. But that doesn't nearly account for the difference in prescription rates. The United States, the only nation to violate the U.N. treaty, consumes about 85 percent of the stimulants manufactured for ADHD.

Though the drugs do not appear to be habit-forming in children with ADHD, there's a rising black market for methylphenidate and similar drugs. A report last year by the National Institute on Drug Abuse found that teenage abuse of prescription stimulants was rising.

Drug companies would argue that increased production and use of ADHD drugs are the result of better diagnosis and treatment. But the International Narcotics Control Board holds advertising responsible. In a report earlier this year, the board noted that from 2001 - when the ads first appeared - to 2005, medical consumption of methylphenidate increased by 64 percent.

The Food and Drug Administration should move forward with rules to bring the United States into compliance - in conjunction with the Justice Department. There's legitimate debate about Americans' rush to diagnose and medicate children who fall problematically outside the norm. In some cases, the drugs are the only thing that keeps a child from being expelled for aggressive behavior, or falling into the foster-care system, or believing that he is an impossibly bad or stupid kid. Yet other countries are making do with far less of the medications.

Powerful psychotropic medications should be an option of last resort and uninfluenced deliberation, not another brand-name product to add to the back-to-school shopping list.

Karin Klein, an editorial writer for the Los Angeles Times, where this article originally appeared, is writing a book tracking the ADD generation as it reaches adulthood.

Psychotropic Drug Makers Bankroll Prescribing Shrinks Part II

Continuation of a report by Evelyn Pringle

Influence peddling in the field of psychiatry is out of control. An analysis of Minnesota disclosure records by the Pioneer Press and the consumer watchdog group Public Citizen shows that, between 2002 and 2006, 187 Minnesota doctors received payments from drug companies worth a grand total of $7.38 million.

No other field of medicine even comes close to that amount. The next highest specialty was neurology, with 99 doctors receiving $2.89 million, according to the analysis.

In psychiatry, drug makers underwrite decision makers at every level of care, according to a May 10, 2007, report by Gardiner Harris in the New York Times. "They pay doctors who prescribe and recommend drugs, teach about the underlying diseases, perform studies and write guidelines that other doctors often feel bound to follow," Mr Harris states.

He determined that, between 2000 and 2005, payments to Minnesota psychiatrists increased more than six-fold. The Times also analyzed Minnesota Medicaid records, and the report provides details on how the financial relationships between doctors and drug makers have played a major role in the growing use of atypical antipsychotics with children.

The drugs include Zyprexa, marketed by Eli Lilly; Seroquel, by AstraZeneca; Risperdal, marketed by Johnson & Johnson subsidiary Janssen; Geodon, sold by Pfizer, and Abilify, from Bristol-Myers Squibb.

The drugs are the most powerful psychiatric drugs on the market and were FDA-approved only to treat adults with schizophrenia or adults in the manic phase of bipolar disorder.

Over the past three years, every atypical maker has come under fire for influencing doctors to prescribe the drugs off-label to children for uses never approved by the FDA, and they are all currently involved in litigation related to the illegal promotion and sales of the drugs.

A study at Columbia University on the use of antipsychotics with children found that only a small percentage of the kids on the drugs had psychotic disorders and that, most of the time, the drugs were prescribed to treat mood disorders, depression, anxiety and ADHD.

Mr Harris reports that the Minnesota psychiatrists who received the most money from the drug's makers tended to prescribe them to kids the most often. On average, psychiatrists who received at least $5,000 between 2000 to 2005 appeared to have written 3 times as many prescriptions for kids as psychiatrists who received less or no money, the Times notes.

The rising Medicaid costs for atypicals also coincides with the rising payments to doctors. For instance, Minnesota Medicaid spent roughly $521,000 in 2000 on antipsychotics for children; but in 2005, the cost was more than $7 million, or a 14-fold increase.

In June 2007, Vermont officials revealed that disclosure records in that state showed payments to psychiatrists had more than doubled in one year, from an average of $20,835 in 2005, to an average $45,692 in 2005. There, too, antipsychotics were among the highest Medicaid drug expense.

The drug makers have shrinks in their pockets all over the country. However, only 3 states, Minnesota, Vermont and Maine, have laws that require companies to disclose their payments.

The media's recent reporting that members of a Minnesota advisory panel who decide which drugs will be covered by the state's Medicaid program are on the take, adds a new chapter to an old book. This same scam has been used in states all over the country since the late 1990's, and if not for two relentless fraud investigators from Pennsylvania, the fact that the formulary committees are bought and paid for by the pharmaceutical industry might have remained a secret for all time.

The fact that drug makers were bribing state policy makers and members of advisory panels with the ultimate goal of capturing the lucrative Medicaid customer base to increase the sale of psychiatric drugs was first discovered several years ago by Allen Jones, while he was a federal fraud investigator in the Pennsylvania Office of Inspector General Bureau of Special Investigations, and Dr Stefan Kruszewski, a pediatric psychiatrist by trade, who was hired by the Pennsylvania Department of Public Welfare to review the quality of care provided to persons covered by state programs.

According to Mr Jones, "the pharmaceutical industry has systematically infiltrated the mental health service delivery system of this nation."

"The situation uncovered in Minnesota," he says, "will be exposed in every state that demonstrates the political will to force transparency through full disclosure of industry payments to decision makers."

"Thinly veiled bribery of public officials by the pharmaceutical industry is a pervasive and deeply rooted problem," he warns.

During his investigation in Pennsylvania, Mr Jones found a drug money trail to key policy officials who controlled the Medicaid preferred drug list in that state, which eventually led him to Texas and an elaborate scheme that involved influential psychiatrists, including many who served as professors at Texas universities, and state policy officials who developed the preferred drug list known as the "Texas Medication Algorithm Project (TMAP)".

Mr Jones calls the Texas panel the "most transparent example" of industry influence, because all of the project directors had financial ties to the drug makers. It was put into effect, he says, by buying off doctors who were considered "opinion leaders" in the psychiatric field, along with state policy makers in positions of authority with control over the preferred drug lists.

For instance, Dr John Rush, from the University of Texas Southwestern Medical Center, served as the TMAP Project Co-Director with Dr Steven Shon, the Medical Director of the Texas Department of State Health Services.

Mr Jones determined that Dr Rush had received grants, research funding and served as a consultant and speaker for atypical makers Bristol-Myers, Janssen, Eli Lilly and Pfizer.

The director for the schizophrenia module was Dr Alexander Miller, of the University of Texas Health Science Center at San Antonio, who also served as a consultant, advisory board member and speaker for AstraZeneca, Bristol-Myers, Lilly, Janssen and Pfizer.

The director of the bipolar disorder module was Dr Patricia Suppes, from the University of Texas Southwestern Medical Center in Dallas, who also received grants and research funding and served as a consultant for AstraZeneca, Bristol-Myers, Janssen, Lilly and Pfizer.

Other University of Texas professors who participated in the development of TMAP included psychiatrist Dr Graham Emslie, who has received grants and research support and served as a consultant and member of speakers' bureaus for atypical makers Bristol-Myers, Lilly and Pfizer.

Another professor, Dr Karen Dineen Wagner, was a member of the speakers' bureaus for Janssen, Lilly and Pfizer, and a member of a scientific advisory board for Lilly, Janssen and Pfizer and received research funding from the same 3 atypical makers and Bristol-Myers.
Once the formulary was in place in Texas, the drug makers paid Dr Shon to travel around the country to convince policy makers in other states to use the TMAP model for their Medicaid approved list. Pennsylvania adopted the program and called it PennMap.

Mr Jones found that Janssen paid for Dr Shon to fly to Pennsylvania two times, and a document he obtained shows that the grant covering Dr Shon's travel expenses was "to expand atypical usage."

The New York Times reported that some payments were made through patient advocacy groups instead of directly to state officials. In 2002, Janssen gave the Olympia, WA, chapter of the National Alliance for the Mentally Ill a grant of $15,000 to fly Dr Shon and other Texas officials to speak to state legislators about the formulary, the Times found.

While reviewing the medical care provided to patients under state care in the summer of 2002, Dr Kruszewski immediately recognized that a mass drugging-for-profit scheme involving Medicaid patients, especially children, was taking place in Pennsylvania, and that several patients had died.

In one case, where the child fortunately survived, Dr Kruszewski found that the girl had been placed on 11 psychiatric drugs at the same time, including 5 antipsychotics, without ever being diagnosed with a psychiatric disorder. She exhibited impulsive behaviors and was mentally disabled, but there was nothing in the records to justify the use of all these drugs, he says.

According Dr Kruszewski, the atypicals are associated with an increased the risk of obesity which can lead to diabetes type II, hypertension, heart attacks and stroke. The weight of the girl who was on 11 drugs had ballooned from 106 pounds to 194, Dr Kruszewski found.

In reviewing patient records, he found a state-wide pattern where patients who were not mentally ill were placed on cocktails of 3 or more expensive psychiatric drugs at the same time and kept on the cocktails indefinitely and if patients experienced side effects from the original medications, more drugs were added to the mix.

The sheer greed evidenced by the mass drugging of patients on Medicaid all over the US, similar to that discovered by Dr Kruszewski in Pennsylvania, has forced state Medicaid programs to either put a stop to the drug maker's encouragement of the rampant prescribing of atypicals or go broke.

For instance, Texas Medicaid was charged nearly $15 million for antipsychotics for foster children in 2004, according to the December 2006 Special Report, "Foster Children - Texas Health Care Claims Study." In fact, Texas spent more money on antipsychotics for foster kids than any other class of drugs, and the report said, Zyprexa, Seroquel and Risperdal typically cost an average of $229 per prescription.

The report also pointed out that the drugs were not approved for children, and listed the health risks associated with the atypicals and stated, in part:

"These very powerful and expensive medications were prescribed despite a lack of studies demonstrating their safety and efficacy in children. There are questions regarding the long-term safety of these medications; documented serious side-effects include menstrual irregularities, gynecomastia, galactorrhea, possible pituitary tumors, hyperglycemia, type 2 diabetes and liver function abnormalities."

In a May 10, 2006 Press Release, Comptroller Carole Keeton Strayhorn said she was "particularly concerned" about the use and side effects of the atypical antipsychotic drugs.

"A clear pattern of overmedication and potential misdiagnosis of foster children is evident," she said and the "potential for Medicaid fraud and the possibility of long-term health problems in these children is alarming."

A USA TODAY study of FDA data from 2000 to 2004 found 45 pediatric deaths in which atypicals were the primary suspect, with at least six related to diabetes and other causes ranged from heart and pulmonary problems to suicide, choking and liver failure.

A 15-year-old boy died of an overdose, an 8-year-old boy died of cardiac arrest, a 13-year-old girl experienced diabetic ketoacidosis, a deficiency of insulin, and the youngest death was a 4-year-old boy whose symptoms suggested diabetes complications, who was also taking 10 other drugs.

A July 29, 2007, report by Robert Farley in the St Petersburg Times revealed that in the last 7 years, the cost to Florida tax payers for atypicals prescribed to children jumped nearly 500%, from $4.7 million to $27.5 million, and on average in 2006, it cost the state nearly $1,800 for each child on atypicals.

Mr Farley reported that last year, more than 18,000 kids on Medicaid were prescribed antipsychotics including 1,100 under the age of 6 and some as young as 3, even though guidelines from the Florida Agency for Health Care Administration say children younger than 6 should generally not be given psychotropic drugs and they should "only be considered under the most extraordinary of circumstances."

According to Mr Jones, these new "miracle" drugs have proven to be no better than generics, and, "it is a statistical certainty that many lives have been lost and many others irreparably damaged."

In September 2005, the New England Journal of Medicine, reported that although Zyprexa was the most expensive and most prescribed antipsychotic, it was the only atypical that worked slightly better than the 40-year-old generic drug, perphenazine, but the NEJM also noted that Zyprexa had more side effects. The cost for a 3 month supply of Zyprexa in September, 2005 at drugstore.com, was $1,500, while a 3 month supply of perphenazine was only $135.

And the atypical drugging for profit scheme is not limited to the Medicaid population. An analysis revealed in March 2006 by investment firm CIBC World Markets showed that in the previous 12 months, the top 20 drugs in managed care spending included Zyprexa with $2.6 billion, Seroquel at $2.5 billion, and Risperdal was $2.2 billion.

The corrupt psychiatrists in Minnesota and other states might want to think about what is happening to "professionals" who were involved in similar behavior in Pennsylvania and Texas.

In Pennsylvania, the state Ethics Commission determined that Pfizer operated its own "Advisory Boards," comprised exclusively of formulary committee chairmen from various states who received honorariums and all-expense-paid trips from Pfizer at the same time they were evaluating Pfizer drugs for use in state mental health systems.

The Commission determined that Steven Fiorello, Director of the Pharmacy Services in the Office of Mental Health and Substance Abuse Services in Pennsylvania, and Chairman of the Formulary Committee, had used his office to obtain private pecuniary benefits for his participation in Pfizer's advisory board meetings in New York when he received honoraria for his participation in the meetings, as well as for his presentations at conferences in Orlando, Florida and Dublin, Ireland.

Mr Jones found that Mr Fiorello traveled to Pfizer's world headquarters in Manhattan 3 times to participate in advisory board meetings, with all expenses paid for by Pfizer, including lodging at Manhattan's Millennium Hotel and he was paid an honorarium of $1,000 for attending each meeting.

The Commission also found a number of additional violations, including Mr Fiorello's receipt of honoraria from other companies for whom he made presentations in connection with his public employment, and ordered Mr Fiorello to make restitution of $27,268.50 and referred the case to the Pennsylvania Attorney General's Public Corruption Unit.

On November 21, 2006, Mr Fiorello was charged with two counts of conflicts of interest, one count of accepting honoraria and one count of failing to disclose income on annual Statements of Financial Interests. In a press release, Pennsylvania's Attorney General stated: "As part of his responsibilities, Fiorello served on a committee that decided which drugs would be used for mental health treatment in all state hospitals - decisions which guided more than $9 million in annual drug purchases by the Commonwealth."

He also noted that, "while Fiorello was helping to guide the purchase of various drugs by the Department of Public Welfare, he was also paid more than $12,000 by drug companies for appearances, speeches and presentations, as well as service on a drug company advisory board."

Down in Texas, Dr Shon was fired last fall after the state's attorney general found that Janssen had improperly influenced him to list Risperdal on the state formulary. An October 9, 2006, letter to Dr Shon from Dr Charles Bell, acting commissioner of the Texas Department of State Health Services, obtained by the Austin American-Statesman states: "It is my determination that your services are no longer required by the Department."

"I am, therefore, terminating you as the Medical Director for Behavioral Health effective immediately," Dr Bell wrote.

In addition, Texas is now closely monitoring the prescribing of psychiatric drugs to Medicaid patients, and several psychiatrists have been ordered to reimburse the state for the cost of the drugs they prescribed to foster children.

Texas and Pennsylvania have also recently filed Medicaid fraud lawsuits against the makers of Zyprexa, Risperdal and Seroquel, seeking to recoup the cost of the drugs prescribed to Medicaid patients, as well as the medical care for persons injured by the drugs.

Texas Medical Board suspends license of Psychiatrist Sergio Silva for cocaine use.

From this report in the American Statesman newspaper

An Austin psychiatrist whose license was suspended last fall after a boy he was treating was hospitalized has acknowledged using cocaine but wants to practice again, according to a new order from the Texas Medical Board.

The board last week acted again in the case of Dr. Sergio Silva, indefinitely suspending him from practice and stipulating that he not seek reinstatement before May 11. To regain his license, Silva would have to prove that he can safely practice.

Silva did not respond to a request seeking an interview Friday but said through his attorney, Penny Hobbs of Austin, that the "case was contested" and that the board's latest order represents a compromise.

"He's not admitting or denying" what is outlined in the order, which Silva signed, Hobbs said. "It's a mechanism for him, hopefully, to get his license back someday."

Silva has not practiced since September, when the board temporarily suspended him not only for his treatment of the 7-year-old boy but also for mishandling the care of a housemate. The housemate overdosed on drugs that Silva prescribed, the board determined. It also sanctioned Silva for interfering with that patient's care to the point of losing hospital privileges, for failing to return phone calls to patients and for missing appointments.

In the case of the 7-year-old, the boy's mother told Silva that the child was getting worse while on the Prozac and Strattera that Silva had prescribed. He accused the mother of not complying with his medication orders. Later, he boosted the dosage, which led to the child's hospitalization.

Silva later filed a complaint against the mother with Child Protective Services.

The new order says that from Jan. 8 to 12, Silva took part in the "psychiatric and addictive disease evaluations" at Talbott Recovery Campus in Atlanta. Silva indicated that he had been following a 12-step program since Jan. 22, the order said. Talbott did not recommend that Silva be allowed to resume his psychiatric practice, the order said. It said a Jan. 11 drug screen of his hair was positive for cocaine and two substances involved in cocaine metabolism.

Hobbs declined to comment on specifics in the order.

[...]

The report mentions nothing about possible criminal charges for the cocaine possession.

Woman in police standoff was on Anti-Depressants

We have this report from Washington County in Wisconsin

A Jackson woman who threatened to shoot herself last week and eventually surrendered to a Sheriff's Department SWAT team after an eight-hour siege has been charged with second degree reckless endangerment and failing to comply with an officer, both felonies.

According to a criminal complaint, the Washington County Sheriff's Department unit was called to the home of Edna F. Markowski, 57, at about 10:15 p.m. on Aug. 19 after she threatened to kill herself with a pistol.

Markowski told police she had taken some anti-depressant medication and that she had an abundance of ammunition for the gun, according to the complaint.

Officers, protected by shields, entered the house and saw Markowski lying on a bed. She pointed the pistol at members of the team and then closed the bedroom door, at which point the officers retreated, the complaint says.

Markowski eventually came out of the house on her own at about 6 a.m., according to the complaint.

If convicted, Markowski could be imprisoned 18 years and 6 months.

Attorney for the actor says Owen Wilson had been taking antidepressants

Anti-depressants are well known for destructive side effects. So when actor Owen Wilson as admitted to the hospital, I was expecting them to show up. Finally here is the news tidbit I was expecting, from MSNBC

Police were called to Owen Wilson’s house after the actor slit his wrists. However, contrary to other reports, there was no drug overdose, an attorney for Wilson told “Access Hollywood.”

The attorney also told “Access” that the actor did not have his stomach pumped. The attorney said Wilson had been taking antidepressants, but was not aware of any other drugs in his system at the time of the incident.

While rumors quickly swirled over what sent the actor to the hospital, police call logs confirmed on Tuesday it was an “attempted suicide.” However, the Santa Monica City Attorney’s office has announced it will not be releasing the 911 call made regarding Wilson.

Paxil implicated in another murder

From the Nevada County Local News section of the Union newspaper

The murder trial of Richard Williams, accused of killing his estranged wife with a nail gun, is postponed as the court addresses several motions - including the defense attorney's push to exclude testimony from Williams' jail mates, as well as a possible conflict of interest.

According to court records, defense attorney Stephen Munkelt wants to prevent prosecutors from calling former Grass Valley residents Frank Zupan and Larry Watson to the stand during the trial.

For the prosecutors, the testimony of Zupan and Watson is expected to cast doubt on Williams' "unconsciousness" defense: He allegedly killed his wife and attempted to kill himself as a result of withdrawal from the anti-depressant drug Paxil, according to court records.

[...]

Pulling the Plug on Federal Funding for Psychiatric Hospitals

The Federal Government has decided to stop funding a psychiatric hospital after the facility failed to make safety improvements following an incident in August where a patient fell and ended up in intensive care. The development is the latest glitch for North Carolina’s battered mental health system. It sounds like a case of not throwing good money after bad, but, as seen in this report, there is concern about the lack of funding, which they say is needed for proper care of patients. Even though this was not happening before.

North Carolina taxpayers will fork over an extra $1 million next month to treat mental health patients because the federal government cut funding for one of the state’s four psychiatric hospitals.

And the price tag could soar higher if the state can’t convince the Centers for Medicare and Medicaid services to reverse its decision.

The government cut funding for Broughton Hospital because the facility failed to make safety improvements after a patient fell in August and ended up in intensive care, according to a federal report made public Friday. Another patient died at the hospital in February while in restraints, kicking off the recent federal inspection, according to state officials.

The development is the latest glitch in North Carolina’s battered mental health system. A reform plan started in 2003 to get people out of state-run hospitals and back into the community has resulted in a series of rate cuts that have meant less money for local providers.

This is first time one of North Carolina’s public psychiatric hospitals has lost federal funding.

“There is no question we were surprised,” said Jim Osberg, chief of state operating services for mental health.

[...]

Debatable decision

About 22 percent of the hospital’s 295 monthly patients are covered by federal dollars. Broughton, located in Morganton, is the only public psychiatric hospital for Western North Carolina.

Osberg said Broughton reviewed its procedures after the February fatality and made changes that were accepted by federal inspectors.

But when inspectors went back in August to check out the plan, they found another patient had been injured, according to the Friday statement from the Department of Health and Human Services.

That led them to recommend the funding cut, Osberg said.

[...]

What’s next?

The federal funding cut comes at a bad time for North Carolina as it works to fix its failed reform system.

In April the state threatened to slash the hourly amount it pays local providers by 40 percent but later backed off. The rate was cut from $61 an hour to $51. In July, the state made its third rate cut with a drop between 5 and 9 percent.

The cuts have the potential for sending more people to the state’s hospitals as providers scale back their services or get out of the business all together. WNC has already lost one provider – ARC N.C.

A special team will arrive on Tuesday at Broughton, which is the only public facility serving Western North Carolina.

It will include experts from other state institutions, including a psychiatrist and a nurse specialist with Medicare and Medicaid inspection experience. They will work with Broughton staff to fix problems.

After the state’s review and changes, federal government inspectors will be asked to re-inspect the hospital. If that inspection clears Broughton, the state could get its funding back.

The process will take at least 30 days and maybe longer, Osberg said.

State mental health Director Mike Moseley, in a written statement Friday morning, said his staff will work to make sure Brought doesn’t permanently lose its federal dollars. In the meantime, he said the public needs to know care will continue.

[...]

Crazy psychiatrist sent to 'Loony Bin'

From the NY Post

There was good news and bad news yesterday for a West Side mom who'd been choked into unconsciousness last summer by a manic-depressive, alcoholic, off-his-meds psychiatrist.

Dr. William Johns - who jumped her and her 2-year-old son Thorin at the New York Waterway terminal - must be committed to a locked psychiatric facility, but only for now.

"He tried to kill me, and he tried to take my son," victim Jill Novenski, 39, said tearfully after yesterday's decision in Manhattan Supreme Court. "Will he never do it again? It's a big question."

In yesterday's decision, Justice Daniel FitzGerald ordered Johns locked up for now. But he also found that Johns, 35, can eventually be discharged with intensive monitoring.

It really should be Rotten-Berg Center

The Technology weblog BoingBoing has picked up on the Mothers Jone expose of the electric shock treatment featured at the RotenBerg center. (Link to our own story on this item)

Mother Jones has a long, chilling feature on The Judge Rotenberg Education Center, a private radical behavior-modification school based in Canton, Mass. The school is run by a rogue behaviorist who uses discredited "punishment" techniques -- electroshock -- on children as young as nine to change their personalities. Matthew Israel, the school's $400,000/year executive director, straps homemade, overpowered shock apparatus to children (including severely autistic and retarded kids) and has his staff administer strong shocks for even minor infractions. Some children have been shocked thousands of times a day, and several children have died at the school.

Eight states send troubled children to the school, where "high functioning" kids are "educated" by being sat in front of computers all day, running through automated tutorial programs. Talking, fidgeting, or acting out during this "school" time is punished with shocks. Some kids' shock apparatus misfires, shocking them without any provocation. The staff are instructed to activate the shock apparatus out of sight of the children, so that they can't mentally or physically prepare for it.

The Rotenberg process lacks any kind of scientific basis, and the school uses a 20-year-old film of its "successes" to convince parents to send their children to the program -- however, some of the success stories in the film are still institutionalized at Rotenberg 20 years after their "cure," wheelchair bound and in terrible shape.

Then, in June of 2006, a report produced by the New York State Education Department threatened to destroy the program's carefully cultivated image. A group of investigators, including three psychologists, spent five days at the Rotenberg Center and compiled a 26-page document packed with damning findings.

• Staff shock kids for "nagging, swearing, and failing to maintain a neat appearance" and once threatened to shock a girl who sneezed and then asked for a tissue.
  
• Some students must "earn" meals by not displaying certain behaviors. Otherwise they are "made to throw a predetermined caloric portion of their food into the garbage."
  
• When students enter and leave the school each day, "almost all" are wearing some type of restraints, such as handcuffs or leg shackles.
  
• "Students may be restrained"--on a four-point restraint board or chair--"for extensive periods of time (e.g. hours or intermittently for days)."
  
• Some students are shocked while strapped to the restraint board.
  
• A "majority" of employees "serving as classroom teachers" are "not certified teachers."
  
• Rotenberg's marketing reps bestow presents on prospective families--"e.g. a gift bag for the family, basketball for the student."
  
• Although the center has described its shock device as "approved" by the fda in its promotional materials, it "has not been approved."
  
• The facility collects "comprehensive data" on behaviors it seeks to eliminate, but "there was no evidence of the collection of data on replacement or positive behaviors."
  
• The facility makes no assessment of the "possible collateral effects of punishment such as depression, anxiety, and/or social withdrawal."

Several drug companies have now been caught deleting important information from Wikipedia, in order to downplay the risk of their drugs

Wikipedia has developed a reputation as a semi-reliable onlineencyclopedia, and in general, it is not too bad with non-controversial material. But since anyone can edit Wikipedia, some controversial subjects have been subject to continual re-edits. And some companies have been acting to remove items that would be bad PR for the company, even if true. From the Brand Week NRX weblog

The first drug company caught messing with the Wikipedia was AstraZeneca. References to claims that Seroquel allegedly made teenagers “more likely to think about harming or killing themselves” were deleted by a user of a computer registered to the drug company, according to Times.

According to Patients not Patents, now it is Abbott Laboratories who've been caught doing the same thing. The group alleges that "employees of Abbott Laboratories have been altering entries to Wikipedia, the popular online encyclopedia, to eliminate information questioning the safety of its top-selling drugs."

The tool used to catch these corporate erasers is the WikiScanner, which was developed by Virgil Griffith, a researcher at the California Institute of Technology, and it reveals changes to the online encyclopaedia by linking edits back to the computers from which they were done, using each computer’s unique IP address. The scanner has wreaked havoc in news media, politics and among corporations caught redhanded "improving" articles.

Patients not Patents found that in July of 2007, a computer at Abbott Laboratories’ Chicago office was used to delete a reference to a Mayo Clinic study that revealed that patients taking the arthritis drug Humira faced triple the risk of developing certain kinds of cancers and twice the risk of developing serious infections. The study was published in the Journal of the American Medical Association in 2006.

The same computer was used to remove articles describing public interest groups’ attempt to have Abbott’s weight-loss drug Meridia banned after the drug was found to increase the risk of heart attack and stroke in some patients.

The site’s editors restored the deleted information, but Patients not Patents claim that Abbott’s activities illustrate drug companies’ eagerness to suppress safety concerns.

Jeffrey Light, Executive Director of the Washington, D.C.-based advocacy group said, “The argument that drug companies can be trusted to provide adequate safety information on their own products has been used by the pharmaceutical industry to fight against government regulation of consumer advertising. Clearly such trust is misplaced. As Abbott’s actions have demonstrated, drug companies will attempt to hide unfavorable safety information when they think nobody is watching.”

State petitions court over acquittal of psychiatrist on molestation charges

From this report from Isreal

The State Prosecution on Thursday petitioned the Supreme Court seeking to overturn the decision to acquit psychiatrist Marcello Spitz of child molestation charges.

In response, the health ministry said it would reconsider its decision to allow Spitz to resume practicing pending the court's decision.

A panel of Haifa District Court judges had acquitted Spitz by a vote of two to one, saying the prosecution was not able to prove his guilt beyond a reasonable doubt.

Spitz had been charged with repeatedly touching one of his patients. In their ruling, the judges said the witnesses' testimony was valid and that contrary to Spitz's claims he was not in a psychotic state.

However, they wrote that they had decided to aquit Spitz because they believed the patient's unstable mental state and will to leave psychiatric interment led him to believe a version of events of his own fabrication.

Judges had further doubts over the witnesses' claim that the acts were carried out by Spitz in an unlocked room while his mother was waiting outside and that he came forward only after the most serious incident.

In the petition, the State Prosecution claims the judges ignored the fact that Spitz lied in court, claiming he had diagnosed the youth as suffering from psychosis and delusions while records show he had not.

Cho, Va. Tech and System Failure

Various comments on the Washington Post about the report regarding the investigating the shooting at Virginia Tech.

Vunderlutz wrote that, "The brunt of the criticism should be directed at the lack of follow-through by the courts and the mental health professionals. But, all in all, this was a system failure and the blame, guilt and remorse are shared among many."

And jamalnasir_2000 said, "...this article makes it seem like VA Tech should have had a anti crime force of its own... This school just ended up being a victim of a screwed up/insane person. That can happen anywhere....example Columbine."

UncleWillie concurred, saying that "...the actions of a 1-in-a-million nut like this one remains unpredictable. As a result thousands will be subjected to more stringent rules and procedures which erode our freedoms and will fail to circumvent anything."

terryeo said "It is psychiatry that should be criticized...Treating someone so they kill people is simply not good medical practice... This idea of a psychiatrist using our tax dollars, treating Cho, prescribing Cho psychotropic drugs, and then not being held accountable for Cho's behaviour is beyond good sense."

RustNeverSleeps said, "Va Tech did nothing wrong! College students believe they are invincible and would not have listened to any warnings to stay inside behind locked doors? This commission was another waste of taxpayer dollars."

Last word goes to DardenCavalcade1, who wrote, "In ALL of these tragedies, institutional failures abound and are a principle contributing cause... Commonwealth institutions failed serially and repeatedly to do their damn jobs. Virginia government constantly fails to exercise due diligence in governance: drivers licensing of the 9/11 terrorists, gun laws that provide a statistically significant number of firearms to professional criminals in the Atlantic states, failure to build and repair critical infrastructures, failure to educate, and now the slaughter at Virginia Tech."

The discontent out there is obvious

Psychiatrist and Child Molester - His Fate Depends on Judge

From this report

(NY) State parole officials Wednesday tried to persuade a judge to return one of the county's most notorious child molesters - who jumped parole and triggered an international manhunt - to prison for every last day remaining on his sentence.

The closed parole hearing at the Schenectady County Jail came as federal authorities continue to probe whether Alan J. Horowitz's 11-month flight throughout southern Asia should result in additional charges for his failure to register as a sex offender.

It could be several weeks before Administrative Law Judge Patricia O'Malley renders a decision in the state matter, Division of Parole spokesman Mark Johnson said.

But Johnson said parole officials are hopeful O'Malley will send Horowitz back to prison for the five-plus years remaining on his sentence for a 1992 sodomy conviction, including the 11 months he was on the run.

Horowitz, 60, a former adolescent psychiatrist who has claimed to be an ordained rabbi, was captured in Mahabalipuram, a coastal city in southeastern India in late May. In June 2006 he met with his parole officer for the last time, then hopped a plane to Japan and, authorities say, glibly penned a goodbye note of sorts to his parole officer.

At the same time, Horowitz at least nominally told officials who run the state sex offender registry he would be living in Tel Aviv, Israel, though authorities are still probing whether he ever went there. Either way, parole officials said he had no permission to leave the country.

The stunt earned him a spot on the state's list of 100 "most wanted" fugitives and landed him in the sights of federal marshals, who continue to investigate his travels overseas.

Gary Mattison, a criminal investigator with the U.S. Marshals, said Wednesday his office is working with federal prosecutors to determine whether Horowitz ran afoul of the Adam Walsh Child Protection act, signed by President Bush last year to toughen federal laws against sex offenders.

The law is named for the murdered son of John Walsh, the well-known host the popular FOX television show "America's Most Wanted," which featured Horowitz's case and helped generate the tips that led police to Horowitz in India.

Public Defender Mark Caruso, who represented Horowitz Wednesday, did not immediately return a call for comment.

More in Case of Murietta Psychiatrist Drug Ring

A followup to a recent story, as reported in the Press Enterprise, which also has mugshot photos of the accused.

A Temecula woman and her two adult sons arrested last week on narcotics charges are suspected associates of a Murrieta psychiatrist who was arrested on suspicion of selling prescriptions for addictive drugs, police said.

Murrieta police Lt. Dennis Vrooman said Tuesday that Janine Keating Hall, 45, Saege Michael Hall, 18, and James Dylan Hall, 21, arrested Friday after their Temecula home was searched by police, received unlawful prescriptions from the doctor. They might also have been selling the drugs they received to others and referring potential clients to him, Vrooman said.

Outside their home Monday, Saege Hall declined to talk about the arrests.

Joel Stanley Dreyer, 69, who previously worked with troubled children at group homes, was arrested in July at his home in the Bear Creek area of Murrieta and has been charged with writing unlawful prescriptions.

Police said he had been writing prescriptions for large amounts of drugs such as painkillers Vicodin and OxyContin for $100 apiece. Investigators said he would meet his clients in the parking lots of local businesses, as well as at his office. Undercover investigators were able to purchase several prescriptions from Dreyer in the months leading up to his arrest.

Vrooman said he was unsure how the Hall family became acquainted with Dreyer.

The arrested Hall brothers are known to police. Their father, Mark Hall, is a well-known former ultimate fighting champion.

Both Saege and Dylan Hall were convicted in connection with a 2003 racial attack on a black student at Murrieta Valley High School. A judge ordered Saege Hall, then 14, to serve several months in juvenile hall for felony assault and injuring someone because of race, a misdemeanor. The prosecution in the case had also tried unsuccessfully to remove Saege from his family.

Dylan Hall pleaded guilty to making racial threats in an argument that took place just before the attack and was given six months probation. Since then, he has been convicted of several other crimes including theft, drug possession, burglary and making terrorist threats, court records show. In their search of the family's Calle Pantano home Friday, police found 38 grams of marijuana and an undisclosed amount of Vicodin and Xanax tablets, a police news release said.

Janine Hall was released on bond Friday and Saege Hall on Saturday. As of Tuesday evening, Dylan Hall was still in jail with bail set at $75,000.

The brothers were charged Monday with possession of a controlled substance, possession of a controlled substance for sale and prescription drug fraud, court records show. Dylan Hall was also charged with three counts of burglary. He pleaded not guilty to all charges Tuesday.

Janine Hall was charged with possession of a controlled substance and prescription drug fraud.

Janine and Saege Hall's arraignments are scheduled for Sept. 21.

Dreyer, whose license to practice medicine has been suspended pending the outcome of the case, was released from jail Aug. 8 after a judge set his bail at $50,000. He had been held without bail since his arrest July 24. No trial date has been set.

Lilly products are among those mentioned frequently on popular television shows

From the Indianapolis Star. Seems like this is making the rounds.

Look fast. Here comes another Eli Lilly and Co. drug on your favorite television show.

When he feels his life is spinning out of control, TV mobster Tony Soprano reaches for Prozac, an antidepressant developed by Lilly.
When trauma doctors on "ER" need to treat a heart patient, they shout for ReoPro, a blood-clot buster co-marketed by Lilly.

When a character in the situation comedy "30 Rock" wants to get ready for Valentine's Day, he takes Cialis, an erectile-dysfunction pill made by Lilly.

In the first half of this year, Lilly products were mentioned 48 times on broadcast and cable TV shows, nearly triple the amount from the same period a year ago, according to Nielsen Product Placement.
But Lilly says it's not paying for those plugs, unlike consumer-product giants such as Coca-Cola, Toyota and BlackBerry, which shell out hundreds of millions of dollars to TV and movie studios to mention their products in story lines.

"We see these when we're at home, sitting on the couch, just like everyone else," said Lilly spokeswoman Judy Kay Moore. "We're not in cahoots with scriptwriters. We don't pay them. If it happens, it's by happenstance."

To be sure, Lilly is not the only drug company when it comes to TV mentions. In fact, Viagra, Vicodin and Botox, made by competitors, outnumber Lilly's products by a wide margin.

There were 462 mentions of prescription drugs on TV last year, more than double the number from just two years earlier.

But drug companies are relatively small players in product placement. None breaks into the top 10. Bigger companies such as Nike and Hewlett-Packard dominate, according to Nielsen. 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.

Still, Lilly products are popping up across the dial, from situation comedies ("King of Queens," "Everybody Hates Chris") to medical dramas ("House," "ER") to reality makeover shows ("Freestyle," "What Not to Wear").

Most of the Lilly mentions were for Prozac and Cialis -- two household names that need no explanation -- and are seen as cultural touchstones. But the context isn't always flattering.

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!"

"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 Xanax."

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 product mentions on TV, however, 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.

Some pharmaceutical companies have acknowledged paying for TV plugs. 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."