Family therapist charged with domestic battery

A report from TampaBay.com

Michael Anthony Holder is a family therapist who conducts at-home "Dynamic Parenting Courses" to correct negative patterns in children's behaviors.

But he's in jail now, after Hillsborough County Sheriff's Deputies charged him with two counts of domestic battery, including the battery by strangulation of his 15-year-old stepson.

An arrest report says that during a domestic argument, Holder, 39, grabbed the boy by his neck, restricting his airflow, and that he inflicted several lacerations to the boy's arms and face and left a contusion on his left arm.

The report states that Holder denied strangling the boy, but admitted to having touched him in an attempt to get his stepson out of his living quarters.

The report lists Holder's place of employment as ACTS, a non-profit agency that provides services from help with substance abuse to mental illness to child protection.

Holder is being held at Orient Road Jail with no bond.

Psychiatric Radio Host Had Undisclosed Drug Company Ties, Conflict of Interest Means His Show to Be Pulled From Air

From a Report in the NY Times

An influential psychiatrist who was the host of the popular NPR program “The Infinite Mind” earned at least $1.3 million from 2000 to 2007 giving marketing lectures for drugmakers, income not mentioned on the program.

The psychiatrist and radio host, Dr. Frederick K. Goodwin, is the latest in a series of doctors and researchers whose ties to drugmakers have been uncovered by Senator Charles E. Grassley, Republican of Iowa. Dr. Goodwin, a former director of the National Institute of Mental Health, is the first news media figure to be investigated.

Dr. Goodwin’s weekly radio programs have often touched on subjects important to the commercial interests of the companies for which he consults. In a program broadcast on Sept. 20, 2005, he warned that children with bipolar disorder who were left untreated could suffer brain damage, a controversial view.

“But as we’ll be hearing today,” Dr. Goodwin told his audience, “modern treatments — mood stabilizers in particular — have been proven both safe and effective in bipolar children.”

That same day, GlaxoSmithKline paid Dr. Goodwin $2,500 to give a promotional lecture for its mood stabilizer drug, Lamictal, at the Ritz Carlton Golf Resort in Naples, Fla. In all, GlaxoSmithKline paid him more than $329,000 that year for promoting Lamictal, records given to Congressional investigators show.

In an interview, Dr. Goodwin said that Bill Lichtenstein, the program’s producer, knew of his consulting but that neither thought “getting money from drug companies could be an issue.”

“In retrospect, that should have been disclosed,” he said.

But Mr. Lichtenstein said that he was unaware of Dr. Goodwin’s financial ties to drugmakers and that, after an article in the online magazine Slate this year pointed out that guests on his program had undisclosed affiliations with drugmakers, he called Dr. Goodwin “and asked him point-blank if he was receiving funding from pharmaceutical companies, directly or indirectly, and the answer was, ‘No.’ ”

Asked about the contradiction, Dr. Goodwin and Mr. Lichtenstein each stood by their versions of events.

“The fact that he was out on the stump for pharmaceutical companies was not something we were aware of,” Mr. Lichtenstein said in an interview. “It would have violated our agreements.”

Margaret Low Smith, vice president of National Public Radio, said NPR would remove “The Infinite Mind” from its satellite radio service next week, the earliest date possible. Ms. Smith said that had NPR been aware of Dr. Goodwin’s financial interests, it would not have broadcast the program.

Sarah Alspach, a spokeswoman for GlaxoSmithKline, said, “We continue to believe that healthcare professionals are responsible for making disclosures to their employers and other entities, in this case National Public Radio and its listeners.”

[...]

Mr. Grassley is systematically asking some of the nation’s leading researchers and doctors to provide their conflict-of-interest disclosures, and he is comparing those documents with records of actual payments from drug companies. The records often conflict, sometimes starkly.

In October, Mr. Grassley revealed that Dr. Charles B. Nemeroff of Emory University, an influential psychiatric researcher, earned more than $2.8 million in consulting arrangements with drugmakers from 2000 to 2007, failed to report at least $1.2 million of that income to his university and violated federal research rules. As a result, the National Institutes of Health suspended a $9.3 million research grant to Emory, and Dr. Nemeroff gave up his chairmanship of Emory’s psychiatry department.

In June, the senator revealed that Dr. Joseph Biederman of Harvard, whose work has fueled an explosion in the use of powerful antipsychotic medicines in children, had earned at least $1.6 million from drugmakers from 2000 to 2007, and failed to report most of this income to Harvard.

Mr. Grassley’s investigation demonstrates how deeply pharmaceutical commercial interests reach into academic medicine, and it has shown that universities are all but incapable of policing these arrangements. As a result, almost every major medical school and medical society is reassessing its relationships with makers of drugs and devices.

“We know the drug companies are throwing huge amounts of money at medical researchers, and there’s no clear-cut way to know how much and exactly where,” Mr. Grassley said. “Now it looks like the same thing is happening in journalism.”

Mr. Grassley has proposed legislation that would require drugmakers to disclose all payments of $500 or more to doctors. Eli Lilly and Merck have promised to begin doing so next year.

[...]

Former psychiatrist guilty of raping patients

From ABC News in Australia

An 80-year-old former Perth psychiatrist has been found guility of molesting and raping two of his patients more than 30 years ago.

Alan John Stubley had been on trial for the past week accused of forcing the two women to have sex with him during psychotherapy sessions between 1975 and 1978.

After six hours of deliberations, a Supreme Court jury found him guility of ten charges, but acquitted him of four others.

Stubley, who has senile dementia, has been remanded in custody and will be sentenced in January.

Sacramento judge castigates psychiatrist who vouched for killer

A Report from the Sacramento Bee

Napa State Hospital's attempt to release a killer into community treatment in Sacramento was based on the "horrifying" testimony of a psychiatrist who "clearly committed perjury in this court," a judge said Monday.

Sacramento Superior Court Judge Kevin J. McCormick made his comments about the Napa psychiatrist, Dr. Nathan Thuma, when he ruled from the bench that Ronald Benjamin Toppila is not fit for outpatient treatment and must remain in the mental hospital for killing his mother four years ago.

In a decision that will keep Toppila confined indefinitely on a jury's verdict that he was not guilty by reason of insanity, McCormick lashed Thuma for recommending in March that the defendant be released into community treatment even though at that time the psychiatrist had examined the client for barely a half hour.

McCormick said Thuma "could not have had enough information" to make the recommendation and that it was "beyond belief" the doctor could have reviewed Toppila's medical records in the short time he'd been on staff at Napa.

Thuma demonstrated "a total lack of independence and judgment" by concluding that Toppila did not present a danger because, in quoting the psychiatrist, "we all trust Mr. Toppila," McCormick said. The judge said Thuma's "demeanor and manner" in court "could only be described as horrifying."

"He clearly committed perjury in this court," McCormick said of Thuma. "He testified inconsistently at varying times. He showed a complete lack of any insight whatsoever into Mr. Toppila's history."

Thuma did not return a telephone call for comment Monday. A spokeswoman for the state Department of Mental Health said agency director Stephen Mayberg plans to review the judge's comments about Thuma.

"He would take it very seriously and look into it," the spokesman, Nancy Kincaid, said.

"If the judge expressed concern over someone's testimony or professional performance, that would be looked into both by the director of the department and by the executive director at the hospital."

McCormick did not specifically identify areas of Thuma's testimony where he thinks the psychiatrist lied under oath. In Thuma's testimony on Oct. 27, however, he wound up on both sides of a question on whether he thought Toppila had "malingered" to sway the therapists who were evaluating him. There were also inconsistencies in Thuma's testimony over whether he was aware of evaluations done on Toppila before the Oct. 7, 2004, beating death of his 86-year-old mother, Hilma Tone.

Deputy District Attorney Dawn Bladet hailed the judge's ruling, saying in an e-mail: "Toppila's continued confinement in Napa State Hospital is necessary to protect the public safety interest."

Toppila's lawyer, Robert J. Saria, said Toppila and his client's family were disappointed by the ruling. Saria said Toppila "is committed to returning to Napa and pursuing his treatment plan and engaging in all the treatment he is required to."

Toppila, 68, a long-time licensed clinical social worker, stabbed his mother 52 times and also bludgeoned her in the fatal attack in her South Land Park apartment.

Judge McCormick said he was also disturbed by the testimony of Antonio Alocer, an official from the Central Valley Conditional Release Program, which would have coordinated Toppila's community placement if he was released from Napa. McCormick said no treatment plan had been determined for Toppila in the event of his release. The judge said Alocer "could not tell me" where Toppila would be placed.

Alocer could not be reached for comment Monday.

"I cannot state with any degree of certainty based on the evidence that I heard in this courtroom that Mr. Toppila no longer poses a danger to the health and safety of others," McCormick said.

Psychiatrist guilty of misconduct after freeing dangerous patient

From a Report out of Plymouth, England

A Plymouth psychiatrist who released a dangerous schizophrenic from a mental health ward hours before he tried to kill his mother was today found guilty of 'recklessly' putting the public at risk.

Dr Andrea Tocca described the 39-year-old as 'no danger to himself or others' and discharged him from Derriford Hospital in Plymouth, Devon, a day after he assaulted a female patient.

Soon after arriving home, the man, referred to as GA, told his mother: 'I know what I have to do to you' and battered her repeatedly over the head with a spade.

Dr Tocca was found guilty of misconduct after the GMC panel decided that he had 'recklessly put the public at risk' in releasing GA from the ward.

Panel chair Ralph Bergmann said: 'This panel is particularly concerned by your decision to discharge GA on April 25, 2006.

'You had been responsible for the care and treatment of GA for some three months prior to discharging him.'

Mr Bergmann said during this time he had been informed by the patient's previous doctor in Torquay that 'if GA became acutely psychotic, his mother may be at risk.

'He (the doctor) had also informed you that GA had made two very serious suicide attempts.

'The panel accepts the proposition put forward by your counsel that your conduct in discharging GA amounted to a single episode of significant error.

'However, you had access to GA's medical history, you had become very familiar with his condition and you ought to have been very alert to the risks and potential consequences of discharging him.

'Your decision to do so leaves the panel in no doubt that this was serious misconduct on your part.

'As the consultant psychiatrist responsible foe the care and treatment of a vulnerable patient, you behaved irresponsibly and recklessly in allowing GA to be returned to the community.

'You thereby put at risk not only the patient but also his mother and the public.

'Taking all these matters into account, the panel has determined that your fitness to practise is impaired because of your misconduct.'

The GMC panel will now consider whether to kick Dr Tocca out of the medical profession.

The hearing was told that Dr Tocca did not read GA's medical notes and decided to 'make up his own mind' about the patient.

On April 24, GA assaulted a female patient on the unit by holding her in a headlock and punching her.

His medical records show that he had also threatened other patients and believed that the staff on the unit were trying to kill him.

Marios Lambis, for the GMC, said: 'At 9.55am on April 25, Dr Tocca made an entry in GA's notes stating that in his view, that assault on the female patient was not a product of his mental state but rather a result of the high level of stress he was experiencing on the unit.

'He recorded that once the police had completed their investigation into the assault, he would discharge GA, and twenty minutes later he recorded: ''In my clinical opinion, GA is not detainable under the Mental Health Act and he is not really a danger to himself or to others.'''

In a statement read to the panel GA's mother, referred to as Mrs A, told the hearing that Dr Tocca telephoned on April 25 to say her son had assaulted a patient but he was sending him home.

[...]

The GMC heard that GA had developed brain damage after falling from a tree swing at the age of 12 and became 'passive and apathetic.'

In 1991, at the age of 22, he was admitted to hospital in Manchester with paranoid psychotic symptoms, the hearing was told.

Mr Lambis said: 'He would not let anyone into his flat, his furniture was broken and he was talking in an incomprehensible manner.

'He had become suspicious and withdrawn.'

In 1993, he was diagnosed with paranoid schizophrenia and was admitted to acute mental health units nine times over the following three years.

Two years later he made threats to kill his grandmother.

GA took an overdose in 2003 and was later sectioned.

On August 8 2005, he set fire to his mattress five times before lying on it and burning himself in a suicide attempt.

He spent 11 weeks in the burns unit at Frenchay Hospital in Bristol.

Dr Tocca admitted being told by GA's doctor that he became acutely psychotic his mother may be at risk.

He also admitted that he ought to have known that GA had made threats to kill his grandmother and had shown previous incidents of violence, and he discharged GH when he ought to have known he should not have been discharged.

Psychiatrist pays for misconduct

A report from the Hamilton Spectator, near Toronto, Canada

A Hamilton psychiatrist has been handed an expensive penalty after a disciplinary panel accepted his admission of professional misconduct.

Dr. Brian Kirsh, medical director of the chronic pain management unit for Hamilton Health Sciences at Chedoke Hospital, appeared before the College of Physicians and Surgeons of Ontario yesterday.

A friend of Kirsh's alleged in 2007 the doctor failed to indicate the friendly, rather than professional, nature of a meeting where the man and his wife sought marital advice.

The panellists said Kirsh had blurred professional boundaries and they expected he would not make the same mistake again.

He was told to pay the $3,650 hearing cost, to take a $1,200 professional boundaries course and to make results of the hearing public online.

Before coming to Hamilton in 2003, Kirsch ran a family medical practice in Thornhill. He was friends with the couple for 18 years. The wife asked if he would meet with her and her husband. All three were members of the same religious community, and Kirsh and the woman worked together in that community. They met at his Thornhill practice in March 2007.

Kirsh asked the woman for her OHIP card at the beginning of the meeting, during which he advised them to seek a professional marriage counsellor for the troubles in their relationship.

The woman later told the college she understood Kirsh met with them as a family friend. The man, however, thought it was as a professional.

The woman asked to meet with Kirsh again that year. The two met at his office, where Kirsh told her he had feelings for her. She told him she was ending her marriage for reasons unrelated to him. The couple separated soon after.

Before the husband filed his complaint, Kirsh e-mailed him to apologize for any confusion and said he had seen the couple in a "spirit of friendship."

An agreed statement of facts says Kirsh admits to professional misconduct by taking the woman's OHIP card before the first meeting, by seeing them in his former medical office and by failing to "communicate clearly (to the man) that he was not seeing the couple in his professional capacity."

Woman describes alleged abuse by psychiatrist

From a Report in the West Australian

A 62-year-old woman has described freezing with fear as her psychiatrist sexually abused her during a session for post-natal depression in the 1970s.

Former psychiatrist Alan John Stubley, 80, is on trial in Perth Supreme Court accused of forcing sex offences against two of his female patients in the mid-late 1970s.

One of the alleged victims today told the jury the doctor had abused her on her first face-to-face session after being discharged from a psychiatric hospital where Dr Stubley had treated her for post-natal depression.

She said she had been shocked when the doctor told her to sit on his knee.

“It was just a terrible silence and then he repeated it (in a tone that) was very authoritative, quite demanding,” she said.

“He put his hand on my leg and he rubbed his hand up my leg and between my legs.

“I just froze, I was just so afraid. I was afraid of him and what he might do to me.

“I said I didn’t want to do this.”

Prosecutor Alan Troy said Dr Stubley had abused his position by taking advantage of his patient’s vulnerability in the pursuit of his own sexual gratification.

He said the two women submitted to the sexual contact because they had felt intimidated.

Mr Troy said one of the victims, who continued seeing the doctor for decades, had feared that no-one would believe her if she spoke out at the time about the alleged abuse.

“She had recently been in a psychiatric hospital and she didn’t think anyone would believe her,” Mr Troy said.

Mr Troy said she also feared she would be put in an institution if she did not continue to see him.

Defence lawyer Mark Trowell said the sex between his client and the women was consensual and there had been no intimidation.

“This is not a court of morals…he may well have acted unprofessionally as a doctor but that doesn’t make him guilty of criminal charges,” Mr Trowell said.

People with a bizarre disorder that makes them crave having a limb removed should be allowed amputations, according to Psychiatrist Christopher Ryan

Of course, curing them of the condition is something that the simply do not know how to do. As seen on News.Com Australia

To most people, the thought of amputating a perfectly healthy limb is unimaginable.

But for at least three Australians, possibly dozens more, cutting off their leg has felt perfectly normal.

These so-called "amputee wannabes" have a very rare condition in which they feel one of their limbs is not truly their own, and they become obsessed with cutting it off.

And people suffering from the bizarre body image disorder should be able to opt for amputation, a Sydney psychiatrist says.

Christopher Ryan, a psychiatrist at the University of Sydney, says there is a good argument for allowing patients with body integrity identity disorder (BIID) to have their unwanted limb removed.

"I am not saying we should unthinkingly cut off people's legs," Dr Ryan said.

"I realise that the idea strikes almost everyone as lunatic when they first hear it. However, there are a small number of people who see themselves, and have always seen themselves, as amputees," he said.

"They are often miserable their whole lives because of their 'extra limb', and we know that at least some of them feel much better if it is removed."

Dr Ryan has examined the ethics of the issue in the international philosophy journal Neuroethics and says doctors have a moral duty to amputate for the health and safety of the patient.

He said one 30-year-old patient of his lived his whole life feeling he was truly an amputee, but was so ashamed of how he felt he did not tell anyone.

"Eventually he took the only step he thought he had open to him and placed his leg in a bucket of dry ice until it died and had to be removed," Dr Ryan said.

"Now, a year later, he is living happily as an amputee and getting on with his life."

The paper said the operations should be likened to plastic surgery, with elective amputation offered to BIID sufferers only.

"Unless these patients know that doctors will take their concerns seriously, and at least consider their requests, more people will risk their lives trying to remove their own limbs," he said.

The disorder hit news headlines in 2000 when it was revealed that a surgeon in Scotland had amputated a healthy leg from two patients with the disorder.

At the time, appalled Scottish politicians called the procedure "obscene" and tried to ban such operations.

Boston Legal: TV Drama Or Reality Show?

The Website PharmaLot has an item noting the intrusion of recent scandals involving Harvard Psychiatrist Joseph Biederman into primetime TV in the form the TV show Boston Legal

There is little time to watch TV on the Pharmalot corporate campus, but we were directed to a recent episode of ‘Boston Legal,’ that compelling drama about - what else? - a bunch of emotionally challenged lawyers, because there was mention of a recent pharma issue being investigated by the US Senate Finance Committee.

To wit, the committee is looking at alleged instances of undisclosed conflicts of interests involving academics who receive National Institutes of Health grants to research certain drugs and payments from drugmakers for consulting, research or speaking (back story). This is prominently noted by actress Candace Bergen, along with other matters such as pharma ties to the FDA, Congress and doctors, in a speech to a jury about a woman who suffered a heart attack after taking a drug…

[...]

(To watch, please go to this link and click on season 5, episode 6, and skip to about 27 minutes into the program, although it can take awhile to load and you may need to install a plug-in).

Psychiatrist arrested

As reported in the Edison/Metuchen Sentinel

Apsychiatrist at a behavioral health center in Edison was arrested on Oct. 17 on the belief that he inappropriately touched one of his patients.

The suspect, Chowdhury M. Azam, a 54-year-old Monmouth Junction resident, was charged with criminal sexual contact, a fourth-degree crime. Criminal sexual contact is described in the state legal code as "intentional touching by the victim or actor, either directly or through clothing, of the victim's or actor's intimate parts for the purpose of degrading or humiliating the victim or sexually arousing or sexually gratifying the actor."

The arrest was made the same day the alleged victim filed a report with the Edison Police Department. Following the filing, the Middlesex County Prosecutor's Office Sex Crime/Child Abuse Unit and the Edison Police Department embarked on a joint investigation, eventually leading to Azam's arrest.

Azam has been a licensed psychiatrist with Compass Behavioral Health, located on Pierson Avenue. According to authorities, it is alleged that the psychiatrist inappropriately touched one of his patients on one occasion. The New Jersey State Board of Medical Examiners, the regulatory agency that licenses medical professionals, was informed of Azam's arrest.

According to police, Azam has been released on $50,000 bail set by Municipal Court Judge Craig Coughlin.

Authorities have not released details regarding the alleged victim's age or gender.

Authorities are currently seeking more information about the matter. Anyone with information regarding this investigation, or incidents similar in nature is encouraged to contact Investigator Raj Chopra of the Middlesex County Prosecutor's Office Sex Crimes/Child Abuse Unit at 732-745- 3600, or Detective Michael Michalski of the Edison Police Department at 732-248- 7525 anytime day or night.

Psychiatrist charged with touching patient inappropriately

As seen in this report from Middlesex County in New Jersey

An Edison psychiatrist has been charged with criminal sexual contact after he allegedly touched one of his patients inappropriately, authorities said Tuesday.
Advertisement

Chowdhury M. Azam, 54, is accused of touching the patient on one occasion and was arrested on Friday, Oct. 17, after the alleged victim reported the incident to Edison police, Middlesex County Prosecutor Bruce Kaplan said in a news release.

The Monmouth Junction resident is a licensed psychiatrist at Compass Behavioral Health on Pierson Avenue in Edison, the prosecutor said.

Edison police received the complaint on Friday and investigated with the Sex Crime and Child Abuse Unit in Kaplan's office before arresting Azam.

Probable cause for the complaint against him was the statement of the alleged victim, Kaplan said. The news release did not specify where and when the alleged incident occurred, nor did it indicate the age of the victim.

Azam was released on $50,000 bail. Kaplan's office said it has notified the New Jersey State Board of Medical Examiners of the arrest.

Reached by phone Tuesday evening, Azam said he had been advised by his attorney not to speak about the case.

"The only thing I can say about this is that I'm not guilty and that this is a false allegation,'' he said. "That's all.''

He referred all other questions to his attorney, Steven D. Altman, who is based in New Brunswick.

Kaplan said anyone with information about this investigation, or similar incidents is encouraged to contact Investigator Raj Chopra of the Middlesex County Prosecutor's Office Sex Crimes/Child Abuse Unit at 732 745-3600, or Detective Michael Michalski of the Edison Police Department at 732-248-7525.

Lawsuit blames scientist's suicide on psychiatrist

As seen in this report

The widow of a former Los Alamos physicist who took an overdose of sleeping pills blames the death on the Santa Fe psychiatrist who treated him, according to a recent lawsuit.

Stanford P. Lyon was pronounced dead on March 7, 2007, two days after he was found unconscious with an empty bottle of Ambien nearby, according to the complaint filed in state District Court Wednesday on behalf of Patricia C. Lyon.

According to the wrongful-death complaint, psychiatrist Will L. MacHendrie began treating Stanford Lyon for depression and bipolar disorder after he took an overdose of Elavil and Triavil and slashed his wrists in early 1986. Lyon was institutionalized twice in 1998, it says.

In early 2007, Stanford "Lyon began to suffer increased anxiety, insomnia, depression and pessimism," the complaint says. It says he saw MacHendrie four times that February to say he was "terrified," unable to sleep and his concentration was "fragmented."

MacHendrie prescribed Ambien, Zyprexa, Symbyax, Cymbalta, Willbutrin and Exelon, the complaint says, but Stanford Lyon told MacHendrie "he desperately wanted to be placed back on Elavil for treatment of his depression."

On Feb. 28, 2007, Stanford Lyon called MacHendrie to say he was having anxiety, insomnia and "burning hands," the complaint says. Over the next few days, it says, Lyon's panic attack continued, and on March 4, 2007, according to MacHendrie's notes, he spent 20 minutes explaining to Lyon how to use the sleeping medications.

The next day, Patricia Lyon found her husband unconscious and without a pulse. The cause of death was determined to be multiple drug toxicity, resulting from a lethal overdose of Ambien and excessive amounts of Elavil, the complaint says.

The complaint says MacHendrie failed to properly assess Stanford Lyon's condition, to recognize he was a suicide risk, to conduct a suicide assessment, to control his intake of medications, to recognize the dangers of the medications, to have him hospitalized and to warn Patricia Lyon about the medications her husband was taking. This means MacHendrie breached his duties and was negligent, "proximately causing Mr. Lyon's death," it says.

Stanford Lyon, who was in his late 60s, was a physicist who worked in weapons design and materials science for Los Alamos National Laboratory, according to online records.

MacHendrie did not respond to a message seeking comment Friday. Santa Fe lawyers Mark Ish and William Winter, who filed the complaint on behalf of Patricia Lyon, seeking unspecified compensatory damages, funeral and burial expenses, also were unavailable for comment.

Are Antidepressant Drugs Actually Worth Taking? A psychologist says secret corporate documents show how ineffective the drugs really are.

As Seen in Discover Magazine

THE STUDY
"Initial Severity and Antidepressant Benefits: A Meta-Analysis of Data Submitted to the Food and Drug Administration" by Irving Kirsch et al., published online on February 26 in PLoS Medicine.

THE QUESTION
Irving Kirsch no longer sends patients to seek out antidepressants. "As a clinical psychologist," he says, "I used to refer patients to colleagues who were psychiatrists to get these medications." But his research over the years has soured him on the drugs, suggesting they work only marginally better in the average patient than a placebo pill. Kirsch recently analyzed the numbers behind a multitude of studies to answer the question: Do
antidepressants work?

THE METHODS
For the analysis, Kirsch and his colleagues were reluctant to rely solely on published drug trials. Those that get published, other researchers have found, tend to show medications in a more positive light than trials that go unpublished. To circumvent that influence, known as "publication bias," Kirsch's team used the Freedom of Information Act (FOIA) to solicit records from the Food and Drug Administration. That gave them access to data from all manufacturer-sponsored trials of the six antidepressants approved between 1987 and 1999—including some trials the manufacturers had never published.

Even then, the data did not reflect everything the researchers would have liked to know. For two of the drugs, for example, there was no indication as to how much the average patient's symptoms improved during treatment. So the researchers ignored those drugs and focused on the other four—fluoxetine (Prozac), paroxetine (Paxil), enlafaxine (Effexor), and nefazodone (formerly sold in the United States as Serzone). In all, they analyzed 35 trials, each of which involved a group of patients who took a placebo and at least one group who took one of those four antidepressants. Kirsch's team considered how sick each group of patients had been before treatment, how much they improved during treatment, and whether they'd gotten a real drug or an inert pill.

THE RESULTS
Just as one would hope, taking an antidepressant typically improved a person's depressive symptoms, the trials showed. But so did taking a placebo. In fact, the overall difference between medication and placebo was so small that it was "clinically insignificant" for all but the most depressed patients, Kirsch says, a point that was consistent with his past findings. Moreover, antidepressant therapy improved symptoms by the same degree in both mildly and moderately ill patients. "There seems little evidence to support the prescription of
antidepressant medication to any but the most severely depressed patients," says Kirsch, "unless alternative treatments have failed to provide benefit."

THE MEANING
In the end, the researchers found that most patients who take antidepressants may glean little from them other than a placebo effect. However, the initial severity of a patient's depression did influence the placebo effect. Placebos seem to help very depressed patients less than they help those with moderate symptoms. As a result, says Kirsch, antidepressants proved substantially more effective than placebos in — and only in — trials involving the most down-and-out patients. Blair Johnson, a social psychologist at the University of Connecticut in Storrs and co-author, recommends that doctors look at all of the alternative therapies—including psychotherapy, exercise, light therapy, omega-3 fatty acid supplements, and various others — first for all but the most depressed patients.

SECOND OPINION
Even if the drugs are effective, you would expect these results because the majority of depressed patients do not get better on the first antidepressant they are prescribed, say numerous critics including members of the pharmaceutical industry and physicians. Darrel Regier, the American Psychiatric Association's director of research, says this is probably why so many patients did not improve significantly. If the unresponsive patients had been tested on two or three antidepressants back-to-back, say critics of this analysis, then more improvement would have been seen.

Moreover, critics say a study like Kirsch's should focus on how many individual patients improve with treatment, not whether the average improvement is clinically significant. By averaging outcomes, the study dilutes some patients' large improvements with others' unchanged symptoms. "That's true," says Kirsch, but if some people improve more than the average, he says, some must improve less—or even be harmed. "Medications have side effects," he says. "One of the side effects [of antidepressants] is increased risk of suicide."

[...]

• More prescriptions are dispensed for antidepressants—232.7 million nationwide in 2007—than for drugs of any other type, according to the data firm, IMS Health.

• U.S. sales of antidepressants totaled $11.9 billion in 2007, IMS Health reports.

[...]

Top Psychiatrist Didn’t Report Drug Makers’ Pay

From a much longer report in the NY Times

One of the nation’s most influential psychiatrists earned more than $2.8 million in consulting arrangements with drug makers from 2000 to 2007, failed to report at least $1.2 million of that income to his university and violated federal research rules, according to documents provided to Congressional investigators.

The psychiatrist, Dr. Charles B. Nemeroff of Emory University, is the most prominent figure to date in a series of disclosures that is shaking the world of academic medicine and seems likely to force broad changes in the relationships between doctors and drug makers.

In one telling example, Dr. Nemeroff signed a letter dated July 15, 2004, promising Emory administrators that he would earn less than $10,000 a year from GlaxoSmithKline to comply with federal rules. But on that day, he was at the Four Seasons Resort in Jackson Hole, Wyo., earning $3,000 of what would become $170,000 in income that year from that company — 17 times the figure he had agreed on.

The Congressional inquiry, led by Senator Charles E. Grassley, Republican of Iowa, is systematically asking some of the nation’s leading researchers to provide their conflict-of-interest disclosures, and Mr. Grassley is comparing those documents with records of actual payments from drug companies. The records often conflict, sometimes starkly.

“After questioning about 20 doctors and research institutions, it looks like problems with transparency are everywhere,” Mr. Grassley said. “The current system for tracking financial relationships isn’t working.”

The findings suggest that universities are all but incapable of policing their faculty’s conflicts of interest. Almost every major medical school and medical society is now reassessing its relationships with drug and device makers.

“Everyone is concerned,” said Dr. James H. Scully Jr., the president-elect of the Council of Medical Specialty Societies, whose 30 members represent more than 500,000 doctors.

[. . .]

For all his fame in the world of psychiatry, Dr. Nemeroff has faced ethics troubles before. In 2006, he blamed a clerical mix-up for his failing to disclose that he and his co-authors had financial ties to Cyberonics, the maker of a controversial device that they reviewed favorably in a journal he edited.

The Cyberonics paper led to a bitter e-mail exchange between Dr. Nemeroff and Claudia R. Adkison, an associate dean at Emory, according to Congressional records. Dr. Adkison noted that Cyberonics had not only paid Dr. Nemeroff and his co-authors but had also given an unrestricted educational grant to Dr. Nemeroff’s department.

“I can’t believe that anyone in the public or in academia would believe anything except that this paper was a piece of paid marketing,” Dr. Adkison wrote on July 20, 2006.

Two years earlier, unknown to the public, Emory’s conflict of interest committee discovered that Dr. Nemeroff had made more serious blunders, including failing to disclose conflicts of interest in trials of drugs from Merck, Eli Lilly and Johnson & Johnson.

His continuing oversight of a federally financed trial using GlaxoSmithKline medicines led Dr. Adkison to write Dr. Nemeroff on July 15, 2004, that “you must clearly certify on your annual disclosure form that you do not receive more than $10,000 from GSK.”

In a reply dated Aug. 4, Dr. Nemeroff wrote that he had already done so but promised again that “my consulting fees from GSK will be less than $10,000 per year throughout the period of this N.I.H. grant.”

When he sent that letter, Dr. Nemeroff had already earned more than $98,000 that year from GlaxoSmithKline. Three weeks later, he received another $3,844.56 for giving a marketing talk at the Passion Fish Restaurant in Woodbury, N.Y.

From 2000 through 2006, Dr. Nemeroff earned more than $960,000 from GlaxoSmithKline but listed earnings of less than $35,000 for the period on his university disclosure forms, according to Congressional documents.

Sarah Alspach, a GlaxoSmithKline spokeswoman, said via e-mail that “Dr. Nemeroff is a recognized world leader in the field of psychiatry,” and that the company requires its paid speakers to “proactively disclose their financial relationship with GSK, and we believe that healthcare professionals are responsible for making those disclosures.”

Psychiatrist faces review in wake of massacre - Hearing to decide competency of Toronto doctor who treated man who killed his wife and children

As seen in the Globe and Mail. Edited for Space

The competency of a Toronto psychiatrist who was treating Chau Huc Minh at the time he massacred his family in 2006 is under scrutiny by the College of Physicians and Surgeons of Ontario.

The College has scheduled a hearing to determine whether the psychiatrist - Dr. Hung-Tat Lo - is competent to continue practising in light of his actions in the Chau case and 15 other unspecified cases.

The main complaint behind the hearing appears to be one lodged last year by Mr. Chau's sister, Jenny Chu. Ms. Chu alleged that Dr. Lo refused her plea to have Mr. Chau sent to a hospital for an assessment and possible treatment on Jan. 6, 2006. Five weeks later - on Feb. 9, 2006 - Mr. Chau used a meat cleaver to inflict fatal injuries on his wife, Shao-Fang, his three-year-old daughter, Vivian, and his five-month-old baby, Ivan.

A CPSO document states that its disciplines committee will decide whether Dr. Lo "failed to maintain the standard of practice and is incompetent in his care and treatment - including, but not limited to - his assessments, diagnoses, treatment and record-keeping, of 15 patients whose identities have been made known to Dr. Lo, between about July, 1983, and July, 2007."

It said the probe will also consider whether Dr. Lo displayed "a lack of knowledge, skill or judgment or disregard for the welfare of his patients of a nature," to the point that his practice should be restricted or terminated.

In the meantime, Dr. Lo has been told to submit sample medical charts and other patient information at least once every two weeks to a doctor appointed by the College to monitor his work.

CPSO spokesman Jill Hefley said in an interview yesterday that a complaint is referred to a disciplines hearing only if there has been a determination that "reasonable and probable cause" exists to believe it may be well founded.

Ms. Chu complained that she told Dr. Lo that her brother's behaviour had grown alarmingly erratic. "I was concerned that he might hurt his two young kids and wife" she said in her complaint. "Therefore, I urged Dr. Lo to send him to hospital with detailed descriptions of his strange behaviour."

[...]

Upon leaving Dr. Lo's clinic that day - Jan. 6, 2006 - Ms. Chu claimed that she tried to coax her brother to go straight to the hospital. She said that Mr. Chau became furious, and said: "Even Dr. Lo said that I was okay. Why must you make me go to a hospital?"

Mr. Chau was found not criminally responsible in the killings earlier this week by a Toronto judge.

According to a transcript from Mr. Chau's 2007 preliminary hearing, Dr. Lo denied that Ms. Chu asked him to admit her brother to hospital at the Jan. 6, 2006, meeting. Dr. Lo acknowledged that he saw Mr. Chau for just 140 minutes during the 12 years that he treated him. However, Dr. Lo, who stated he sees 15-20 patients a day, said that he didn't see it as necessary to spend more time with Mr. Chau.

Dr. Lo's office was closed this week, and he did not return telephone messages.

Peter Lindsay, Mr. Chau's defence lawyer, expressed misgivings yesterday about the quality of care his client was given. "The compelling story here is that Dr. Lo sees him so little. If you do the math, he saw him for just over 11 minutes a year. I'm not a doctor, but I think that's far short of what he should be seeing this guy."

[...]

Other victim

Chau Huc Minh was not the first of psychiatrist Hung-Tat Lo's mentally ill patients to explode into violence.

In 2004, two years before Mr. Chau's killing rampage, a 36-year-old Chinese immigrant, Xuan Peng, drowned her four-year-old, autistic baby in a bathtub at her Scarborough home.

She had been under Dr. Lo's care at the time.

According to a 2005 bail ruling that freed Ms. Peng pending her first-degree murder trial, Dr. Lo was treating her for a bipolar disorder at the time that her daughter, Scarlett, drowned.

The presiding judge at the bail hearing was Ontario Superior Court Judge David McCombs.

He was persuaded to grant Ms. Peng bail partly based on testimony from Dr. Lo, who said that she was capable of being managed in the community and agreed to supervise her treatment.

[...]

Police arrested Ms. Peng seven months after Scarlett's death. Last March, she was found guilty of second-degree murder, notwithstanding her history of mental illness.

Antidepressants may damage male fertility

As reported via Reuters

Common antidepressant drugs may reduce some men's fertility by damaging the DNA in their sperm, according to scientists.

A study of 35 healthy men given paroxetine - sold as Paxil or Seroxat by GlaxoSmithKline - found that, on average, the proportion of sperm cells with fragmented DNA rose from 13.8 percent before treatment to 30.3 percent after just four weeks.

Similar levels of sperm DNA damage have been linked to problems with embryo viability in couples trying to have children. The research by Peter Schlegel and Cigdem Tanrikut of the Cornell Medical Center in New York was reported in New Scientist magazine and is due to be presented in November at a meeting of the American Society for Reproductive Medicine.

A copy of the study abstract was made available to Reuters.

"The fertility potential of a substantial proportion of men on paroxetine may be adversely affected by these changes in sperm DNA integrity," the experts concluded.

The study adds to concerns voiced by the same doctors in 2006, after finding that two men had developed low counts of healthy sperm following treatment with two different selective serotonin-reuptake inhibitors (SSRIs).

SSRIs like Paxil/Seroxat and Eli Lilly's Prozac, both of which are now available generically, are the most commonly prescribed class of antidepressant.

Glaxo said it was reviewing the investigators' findings, since the study was not conducted by the company.

"These medicines remain an important option, in addition to counselling and lifestyle changes, for treatment of depression and this study should not be used to cause unnecessary concern for patients," a spokeswoman said.

"Patients should discuss their situation with their doctor before stopping use of their medicine."

Allan Pacey, Senior Lecturer in Andrology at the University of Sheffield, said the apparent increase in sperm DNA damage was "alarming", although he noted the level at which damage becomes clinically significant was open to debate.

"It is a shame that the authors appear not to have conducted a randomised controlled trial which would be the most scientific way to investigate the drugs effects, but I agree that the results are of concern and need to be investigated further," he said.

SSRIs have long been known to depress libido in some men and previous research has also found that women taking the medicines are more likely to have a low birth weight baby.

Welcome to Chemical Imbalance.org

As posted as an introduction on Chemical Imbalance.org

This website provides scholarly information on mental health topics of interest to helping professionals, as well as to the general public. We focus primarily on two controversial areas in the field of mental health. First, we examine the popular notion that depression and anxiety are caused by an imbalance of neurotransmitters which is corrected by antidepressant medication. Second, we discuss the influence of the pharmaceutical industry on psychiatric research. We also cover related topics, such as consumer advertising of psychiatric medications, clinical trial research, and media coverage of these issues.

The information on this site is for educational purposes and does not constitute medical advice. If you take psychiatric medications, please be aware that stopping them suddenly can be dangerous. Please consult with your prescribing physician regarding all treatment decisions.

We welcome them to the discussion.

William Hamilton Ayres Watchdog Site

We now have a blog devoted to tracking the declining career William Hamilton Ayres

William Hamilton Ayres is a "noted" former child psychiatrist who now stands accused of molesting many young boys over the course of his long career. For those not familiar with the case, click on career milestones below the mugshot.

William Hamilton Ayres

Career Milestones

Great Background Article!

Another Good Background Article

Ayres' California Medical License

2003: Ayres Sued - Confidential Settlement

04/06/2007: Arrested

04/12/2007: Prohibited from practicing.

04/13/2007: In Jail Again.

07/24/2008: Trial in January 09

William Ayres: Unmitigated Gall

Time keeps on slipping, slipping, slipping...

America, Your Kids Are Over-Medicated

As seen on Scientific Blogging

American children are approximately three times more likely to be prescribed psychotropic medication than children in Europe, according to a new study published Child and Adolescent Psychiatry and Mental Health. The study claims that the differences may be accounted for by regulatory practices and cultural beliefs about the role of medication in emotional and behavioral problems.

Julie Zito led a team of researchers from the USA, Germany and the Netherlands who investigated prescription levels in the three countries. She said, "Antidepressant and stimulant prevalence were three or more times greater in the US than in the Netherlands and Germany, while antipsychotic prevalence was 1.5 to 2.2 times greater".

The use of antidepressants, like Prozac, and stimulants, like Ritalin, in children has been the subject of a great deal of controversy and this study quantifies the differences in practice between the US and Western Europe. The authors claim that the differences may be partly due to different diagnostic classification systems, "The US trend of increasing bipolar diagnosis in children and adolescents does not reflect European practice".

The authors also mention government cost restrictions in Europe, the larger number of child psychiatrists per capita in the US and the use of two or more different psychotropic drugs in a single year in US children as possible explanations.

Zito concludes that, "Direct to consumer drug advertising, which is common in the US, is also likely to account for some of the differences. The increased use of medication in the US also reflects the individualist and activist therapeutic mentality of US medical culture".

The Health Ranger challenges drug companies to a $10,000 Health and Fitness challenge.

Think prescription drugs make you healthy? In this video, the Health Ranger challenges drug companies to a $10,000 Health and Fitness challenge.

His challenge of finding someone on 8 life quality enhancing drugs over the course of a year might be hard to do. There might not be anyone out there, realistically. (but give it ten years)

But his point of healthy living as a cure for many things is not off base.

Doctors would love to find an anti-depressant as effective as exercise, for example.