Friday, September 20, 2013

Did Antidepressant Play a Role in Navy Yard Massacre?

Did Antidepressant Play a Role in Navy Yard Massacre? By John Horgan in Scientific American

Once again, antidepressants have been linked to an episode of horrific violence. The New York Times reports that Aaron Alexis, who allegedly shot 12 people to death at a Navy facility in Washington, D.C., earlier this week, received a prescription for the antidepressant trazodone in August.
 
When I first researched antidepressants almost 20 years ago, I encountered claims that they sometimes triggered violent episodes—for example, a 1989 incident in which a Kentucky man taking fluoxetine (brand name Prozac) shot to death eight co-workers and then himself. I dismissed the claims, reasoning that, because people prescribed psychiatric drugs are disturbed to begin with, it is not surprising that a tiny fraction hurt themselves and/or others.

By 2004, however, in part because of lawsuits that forced pharmaceutical companies to disclose data on adverse effects, the FDA ordered antidepressant manufacturers to include a warning that antidepressants “increased the risk compared to placebo of suicidal thinking and behavior (suicidality) in children, adolescents, and young adults in short-term studies of major depressive disorder (MDD) and other psychiatric disorders.”

Alexis, who was 34, was reportedly seeking treatment for insomnia when he received his prescription for trazodone. Originally marketed as an antidepressant after its approval by the FDA in 1981, trazodone is also prescribed for anxiety and insomnia. Trazodone was a precursor of the extremely popular selective serotonin reuptake inhibitors (SSRIs); like the SSRIs, trazodone boosts levels of the neurotransmitter serotonin.
website maintained by the National Institutes of Health states that trazodone and other antidepressants have been associated with “new or worsening depression; thinking about harming or killing yourself, or planning or trying to do so; extreme worry; agitation; panic attacks; difficulty falling asleep or staying asleep; aggressive behavior; irritability; acting without thinking; severe restlessness; and frenzied abnormal excitement.”

Could trazodone have played some role in the Navy Yard rampage? I put this question to David Healy, a professor of psychiatry at Cardiff University in England and an authority on side effects of psychiatric medications.* He has testified in numerous court cases involving suicides and homicides whose perpetrators were ingesting antidepressants. Healy is not opposed to psychiatric medications–he prescribes them to his own patients—but he has long been active in pointing out medications’ risks. *[Healy and other health-care experts have founded an organization called RxISK to gather data on side effects of drugs. See Postscript.]

Healy responded by email that he “would need to know much more details” to judge whether trazodone might have contributed to this week’s massacre. Indeed, as the Times reported, Alexis had displayed signs of mental illness and acted violently well before being prescribed trazodone. In 2004 he fired bullets into a car in Seattle, during what he described later as a “black out” episode. So far, moreover, there are no reports that he had trazodone in his system during his Navy Yard rampage.

But Healy said that, although data on antidepressants and violence are much more scarce than data on suicide, there is evidence that “you can put healthy volunteers on these drugs and some will become violent.” A study by the Drug Safety Research Unit in Southampton of paroxetine (Paxil) and fluoxetine (Prozac) involving more than 25,000 subjects showed that one out of every 250 subjects were involved in “a violent episode,” including 31 assaults and one homicide, Healy said.

Another study involving more than 9,000 subjects taking the antidepressant paroxetine (Paxil) for depression and other disorders showed that subjects experienced more than twice as many “hostility events” as subjects taking a placebo. Healy added: “I have had clinical experience of at least one older man, with no prior history of violence, who became homicidal after a week on citalopram where the problem cleared up once treatment had stopped.”

Healy suspects that the main causal factor behind suicide and violence toward others is increased mental and/or physical agitation, which leads about 5 percent of subjects taking antidepressants to drop out of clinical trials, compared to only 0.5 percent of people on placebos.
In their excellent overview “Antidepressants and Violence: Problems at the Interface of Medicine and Law,” published in PLoS Medicine in 2006, Healy and two co-authors note that “serious violence on antidepressants is likely to be very rare.” But they call for “more clinical trial and epidemiological data to be made available and for good clinical descriptions of the adverse outcomes of treatment.”
They add: “Legal systems are likely to continue to be faced with cases of violence associated with the use of psychotropic drugs, and it may fall to the courts to demand access to currently unavailable data. The problem is international and calls for an international response.”

Antidepressants and other psychiatric drugs clearly help alleviate mental illness in some patients. But as I have written previously, such medications may on balance harm patients more than they help. We need better data on the risks that these medications pose not only to patients but also to others.

*Postscript: David Healy and other health-care experts from around the world have formed an organization called RxISK to gather data on adverse effects of pharmaceutical drugs, including violence. The RxISK website calls it “the first free, independent website where patients, doctors, and pharmacists can research prescription drugs and easily report a drug side effect–identifying problems and possible solutions earlier than is currently happening.” I hope RxISK succeeds, because we badly need it.

Post-Postscript: For more on links between psychiatric medications and violence, see this 2010 paper in PLOS One, “Prescription Drugs Associated with Reports of Violence Towards Others,” and a followup blog post by journalist Robert Whitaker, author of Anatomy of an Epidemic.

Friday, June 28, 2013

Ex-psychiatrist in Cresco sex case has long history of lewd behavior

As reported in the Pocono Record

Charged in Monroe County with soliciting sex from what he believed to be a 13-year-old boy, a former psychiatrist has had his license revoked in three states including Pennsylvania, and served jail time in New Jersey for lewdness, according to the Pennsylvania Board of Medicine.

[...]

Monroe County District Attorney's Office detectives arrested Kessler at his home Friday.

This resulted from an investigation detectives began in May, after a woman told state police a suspicious adult had been contacting her 13-year-old son on Facebook.

Authorities said this adult, identified as Kessler and using a fake name online, contacted a detective posing as the boy and began a sexual conversation.

Authorities said Kessler, thinking he was still talking to a minor, sent links to pornographic videos, along with a photo of a nude male he identified as himself, and told the detective he wanted to perform oral and other sex. Kessler's license to practice psychiatry in Pennsylvania had been revoked in July 2012 by the Pennsylvania Board of Medicine, said Pennsylvania Department of State spokesman Ronald Ruman. Kessler's license revocation was the latest development in a troubled history that began in 2001. The Board of Medicine's license revocation ruling reveals the following details:
  • A graduate of the University of Connecticut School of Medicine and Central Connecticut State University, Kessler was first licensed in 1999 in New York, where in June 2001 he completed a four-year internship/residency at what was then Long Island Jewish Medical Center and Hillside Hospital.
  • Kessler later was licensed in Massachusetts.
  • On July 1, 2001, he began a residency in a child/adolescent psychiatry program at Cambridge Health Alliance in Massachusetts.
  • On July 8, Kessler was charged with "open and gross lewdness" and disorderly conduct, after two men told police he had exposed himself to them and masturbated in his car in a doughnut shop parking lot in Walpole, Mass.
  • This prompted Cambridge Health Alliance to fire him from its child/adolescent psychiatry program Aug. 1.
  • In November 2001, with the earlier criminal case still pending, Kessler again was charged with open and gross lewdness and indecent exposure.
  • Two boys, ages 10 and 12, told police they saw him nude and masturbating in the front window of his mother's Falmouth, Mass., home.
  • With two criminal cases now pending against him, and unable to find work since his termination from Cambridge Health Alliance, Kessler returned to New York.
  • Because he did not renew his Massachusetts license when it came due in December 2001, the license was labeled "revoked," though not due to any disciplinary action at that time.
  • Kessler applied at Brunswick Hospital Center in Amityville, N.Y., and Holliswood Hospital in Queens, N.Y.
  • He omitted his Massachusetts employment on both applications, and put "no" when asked on Brunswick Hospital Center's group malpractice insurance policy application if he'd ever been charged with a felony.
  • On Dec. 1, 2001, Kessler started working full time at Brunswick.
  • On June 2, 2002, Kessler was convicted of open and gross lewdness in the second criminal case in Massachusetts.
  • He began the long process of appealing the verdict, but there is no mention of whether he served any jail time, according to state papers.
  • On June 3, he pleaded not guilty to open and gross lewdness in the first criminal case, while the disorderly conduct charge in that case had been dismissed, but the matter would be continued for another year.
  • In October 2002, Kessler admitted on his New York license renewal application to having been charged with a crime and disciplined by a hospital.
Based on this, the New York Board for Professional Medical Conduct charged him in December 2002 with lying on his hospital job applications about never having faced any criminal charges.

Psychiatrist Frederick Berlin, founder of the Johns Hopkins Sexual Disorders Clinic in Baltimore, testified at the January 2003 board hearing on the charges.

Berlin said Kessler has "a sexual disorder characterized by exhibitionism and an urge to be seen masturbating by young males," but that Kessler at the time was being adequately treated for the disorder.

Psychiatrist Marc Reubins testified Kessler has "a systemic disorder characterized by anxiety and depression," while psychiatrist Seymour Block agreed with the anxiety assessment.

Deeming Berlin's testimony the most convincing, the board in February 2003 found Kessler's actions constituted "fraudulent practice" and "moral unfitness to practice medicine," and revoked his New York license.

Kessler then became a licensed life, accident and health insurance broker in New York, New Jersey, Connecticut and Pennsylvania. He went to work for a New Jersey firm specializing in minimizing health insurance cost increases related to disease management.

He also gave monthly free seminars in New York for high school students and parents on maximizing college financial aid, and prepared state and federal income tax returns for people and businesses.

Meanwhile, the first criminal case against him was finally dismissed in June 2003.

In September of that year, the Massachusetts Board of Registration in Medicine moved to take disciplinary action against Kessler's Massachusetts license based on the conviction in the remaining criminal case and his New York license revocation.

In November 2004, the Massachusetts Supreme Judicial Court overturned the criminal conviction.

Despite this, the Board of Registration in Medicine in July 2006 revoked Kessler's right to renew his Massachusetts license.

The board found he had "undermined public confidence in the integrity of the medical profession, lacked good moral character and had been disciplined by another state for the capacity to deceive and defraud."

After moving to Pennsylvania, Kessler in November 2006 applied to practice medicine in this state.

The Board of Medicine in January 2007 denied his application based on the New York and Massachusetts license revocations.

Kessler and Reubins, the psychiatrist who had testified on his behalf before the New York board, appeared at an October 2007 appeal hearing.

Reubins told the Board of Medicine that Kessler had been in no further trouble since 2001, was getting treatment for his anxiety and wanted to get back into medical practice.

Agreeing with Reubins that Kessler should have another chance to practice medicine, the board in December 2007 granted Kessler a five-year probationary license with terms and conditions, including the successful completion of a board-approved clinical skills evaluation/remediation program.

From October 2008 to June 2009, Kessler worked at ISL Psychiatric Services in Stroudsburg, and then as associate medical director for a school-based partial hospitalization program in Monroe and Northampton counties from July 2009 to May 2011.

He traveled among area schools, treating children with various mental illnesses.

From 2010 until March 2011, Kessler covered for the staff psychiatrist at Shawnee Academy in Shawnee-on-Delaware, a residential treatment facility for children with severe mental illnesses.

He was then at Pocono Psychiatric Associates in Smithfield Township.

But trouble again surfaced in November 2010, when Kessler for the third time was charged with lewdness.

Three juvenile males allegedly saw him masturbating in a vehicle at the Sutton Park Mall in Flanders, N.J.

Kessler in March 2011 pleaded guilty and was sentenced to 90 days in county jail and fined $1,000. This led to his Pennsylvania license eventually being revoked in July 2012.

It's unknown how or if Kessler was employed when charged Friday in the current criminal case.

He was placed in Monroe County Correctional Facility in lieu of $50,000 bail and will appear in district court at a future date.

Thursday, April 25, 2013

Disciplinary Hearing of Florida Psychiatrist Ronald Kurlander

As seen in the description on YouTube

On April 5, 2013 in Deerfield Beach, Florida psychiatrist Ronald Kurlander was disciplined by the Florida Department of Health. He was accused of prescribing drugs to people he had never examined or even met. The father of one of Kurlander's patients gave testimony as to the extensive damage caused by these drugs to his son. Kurlander is the one with the moustache and goatee with wire frame glasses seated to he left. He was fined over $30,000.00, given a reprimand, ordered to take a law and rules course, a drug course and a medical records course. Additionally, he has to undergo a risk management assessment.

Friday, March 29, 2013

Why the University of Minnesota psychiatric research scandal must be investigated

As writen by Carl Elliot, and Published on the MinnPost Website

Carl Elliott is a professor in the Center for Bioethics at the University of Minnesota.

Three former editors of the New England Journal of Medicine have called for an investigation. So has the scholar who uncovered the Guatemala syphilis studies. The former Health and Disability Commissioner of New Zealand has called the conduct of the researchers “unethical,” pointing out the need to “put in safeguards in place to prevent a similar tragedy from happening again.” A recent Medical Journal of Australia editorial compared it to the exploitation of poor black men with syphilis in Tuskegee, Ala. Yet the University of Minnesota, where the research scandal occurred, simply keeps repeating, “Nothing to see here, folks. Just move along.”

The research abuse in this case is so stunning that when I first learned about it I could scarcely imagine it happening anywhere, much less at the university where I work. In late 2003, psychiatric researchers at the University of Minnesota recruited a mentally ill young man named Dan Markingson into a profitable, industry-funded research study of antipsychotic drugs. The researchers signed him up over the objections of his mother, Mary Weiss, who did not want him in the study, and despite the fact that he could not give proper informed consent. Dan was acutely psychotic, plagued by delusions about demons, and he had repeatedly been judged incapable of making his own medical decisions. Even worse, he had been placed under an involuntary commitment order that legally compelled him to obey the recommendations of the psychiatrist who recruited him into the study.

For months, Mary tried desperately to get Dan out of the study, warning that he was getting worse and that he was in danger of committing suicide. But her warnings were ignored. On April 23, 2004, she left a voice message with the study coordinator, asking, “Do we have to wait for him to kill himself or someone else before anyone does anything?” Three weeks later, Dan committed suicide in the most violent way imaginable. His body was discovered in the shower of a halfway house, his throat slit so severely that he was nearly decapitated, along with a note that said, “I went through this experience smiling.”

Conflicts of interest, other issues

As outrageous as that sounds, there is more. The psychiatrists had financial conflicts of interest from their work with the pharmaceutical industry. The study sponsor also provided financial incentives for the researchers to keep subjects in the study as long as possible. Last fall, the state Board of Social Work found that the study coordinator had falsified the initials of doctors on study records, failed to warn Dan of new dangers of the study drugs, had been given medical responsibilities far beyond her training as a social worker, and had failed to respond to Mary’s warnings that Dan was in danger of killing himself.

After Dan’s suicide, it got even worse. When Mary’s lawsuit against the university was dismissed on technical grounds of “sovereign immunity,” the university lawyers filed a legal action against her called a “notice to assess costs,” demanding that she pay them $57,000 in legal fees. Yes, you read that correctly: The U tried to force the mother of a suicide victim to pay it $57,000.

None of this is a secret. The case has generated international outrage. Yet for three years the University of Minnesota has managed to bluster and stonewall its way through all the criticism, insisting that it has already been exonerated. Even when the state Legislature passed “Dan’s Law” in 2009, banning psychiatrists from recruiting mentally ill patients under an involuntary commitment order into drug studies, the university continued to insist it had done nothing wrong.

A petition to Gov. Dayton

Two weeks ago, as a last resort, Mary Weiss, the mother of Dan Markingson, and her friend Mike Howard started a petition to Gov. Mark Dayton. Their request is simple: Please appoint an external, impartial panel to investigate the scandal. More than 1,200 people have signed, including well over 150 academic experts. Many University of Minnesota alumni have joined as well. A typical but telling comment: “I am ashamed of my alma mater right now.”

This is not an issue from the distant past. We do not know if other research subjects have died, or if they have been injured or mistreated. We do not even know if mistreatment is still continuing today. That may well be the most compelling reason for Minnesotans to sign the petition. If a case of research abuse this brazen can be sanctioned and defended by the university, there is no way to feel confident that other research subjects are being protected. In 2004 it was Dan Markingson. But it could have been any of us.

Friday, March 01, 2013

Saturday, February 02, 2013

California Psychiatrist Suspended for Missing his Own Mental Exam

As seen in this report from The Marin Independent Journal

The state medical board suspended the license of a Mill Valley psychiatrist Thursday for failing to show up for a mandatory psychiatric examination. The board ordered Dr. Brent Taylor Cox to get the test last year after a complaint that he "may be suffering from a substance addiction disorder and/or other mental impairment that may affect his ability to practice medicine safely," according to board documents. The board said Cox did not arrive for his scheduled exam, even though it sent him notices by certified and first-class mail to three addresses and emailed the notice to his Gmail account. The board also sent an investigator to his addresses to serve the letter, but "no one answered the door," board documents said. Regulators moved to discipline Cox, and he appeared for a hearing in November with his attorney, Mitchell Green of San Francisco. Cox agreed to a settlement in which the board suspends his license and gives him 30 days to get the psychiatric testing. Green said the whole dispute exists because Cox never received the initial order to get the psychiatric exam. Cox was in the middle of changing his office location at the time and was no longer using the same Gmail address, but he neglected to update his email address with the board, Green said.
Hat tip to PsychSearch.net for the story

Friday, November 16, 2012

High-Prescribing Chicago Psychiatrist Faces Federal Fraud Suit

As Reported by ProPublica

The U.S. Attorney for the Northern District of Illinois filed a federal fraud lawsuit today against a Chicago psychiatrist profiled by ProPublica and the Chicago Tribune in 2009 for his voluminous prescribing of antipsychotic drugs to nursing home patients.

In a news release, the government says that Dr. Michael Reinstein “received illegal kickbacks from pharmaceutical companies and submitted at least 140,000 false claims to Medicare and Medicaid for antipsychotic medications he prescribed for thousands of mentally ill patients in area nursing homes.”

ProPublica and the Tribune reported in 2009 that Reinstein prescribed more of the risky antipsychotic clozapine to patients in Illinois’ Medicaid program in 2007 than all of the doctors in the Medicaid programs of Texas, Florida and North Carolina.

The government accuses Reinstein of billing Medicare and Medicaid for managing his patients’ medications, “knowing that he did not engage in substantive evaluations of his patients’ medical and psychiatric conditions to properly manage their medications,” the U.S. attorney’s office said in its release. “Instead, he allegedly prescribed medications to his patients based on his receipt of kickbacks from pharmaceutical companies.

Prosecutors allege that Reinstein’s prescribing decisions were motivated by money and perks from pharmaceutical companies. He allegedly switched patients from one brand of clozapine to another based on money and other enticements he received from a pharmaceutical maker.

Before August 2003, thegovernment alleged, Reinstein prescribed Clozaril, brand name for clozapine made by Novartis, which paid him to promote the drug.

When the drug went off patent in 1998, the lawsuit says, Reinstein resisted attempts to switch his patients to cheaper, generic versions. But when Novartis stopped paying Reinstein in 2003, the lawsuit says, he switched his patients to a generic version made by IVAX Pharamceuticals.

That company had agreed to pay him a consulting fee, pay his nurse to speak on the drug’s behalf and fund a research study at an affiliated institute, according to the lawsuit.

“While generally only four percent of schizophrenia patients who were prescribed antipsychotics received clozapine, during the time Reinstein was allegedly accepting kickbacks from IVAX, more than 50 percent of his patients were prescribed IVAX’s clozapine,” the U.S. Attorney’s office said in its news release. “At one nursing home, Reinstein had 75 percent of the 400 residents on IVAX’s clozapine.”

Ivax paid other perks to Reinstein and his associates, including airfare, entertainment expenses, a fishing trip, a boat cruise and a golf outing, the lawsuit says.

In 2006, Reinstein began switching to clozapine made by a different company but moved some patients back when he received additional perks and funds, the lawsuit says.

In an interview, federal prosecutor Eric Pruitt would not comment on whether his office would pursue criminal charges against Reinstein or whether any legal action would be taken against the pharmaceutical companies that allegedly paid the physician kickbacks.

A call left at the office of Reinstein’s attorney was not immediately returned.

The 2009 investigation by ProPublica and the Tribune showed that Reinstein’s high prescribing had serious consequences for his patients. Autopsy and court records showed that by 2009 at least three patients under Reinstein’s care had died of clozapine intoxication. One of them, a 50-year-old man, had five times the toxic level of clozapine in his blood when he died, according to his medical records.

Reporters determined that, based on his Medicaid prescribing alone, Reinstein he would have to work 21 hours a day, seven days a week to see each of his patients for 10 minutes. Research has found that the typical U.S. psychiatrist sees about 35 patients per week; Reinstein was seeing 60 each day, he wrote in an audit report in 2007.

In the 2009 investigation, Reinstein strongly defended his reliance on clozapine, saying the medication is underprescribed and is the most effective in its class for schizophrenic patients.

Friday, September 28, 2012

Big Pharma's Newest Money-Making Scheme: Adult ADHD

Evelyn Pringle has brought us another expose of disease mongering by the psych drug industry. Here's a snippet. Please visit the original post for all of the details

By Evelyn Pringle and Martha Rosenberg

Who belongs to this “untapped” market? Just about anybody.

There is good news and bad news about attention deficit/hyperactivity disorder (ADHD) -- that is, if you’re a drug company. The bad news is the kid market has peaked out with 4.5 million U.S. children now carrying the label. The good news is adult ADHD is an emerging market. In fact, adult ADHD, with symptoms similar to pediatric ADHD such as impulsivity, distractibility and difficulty paying attention, following instructions and meeting deadlines, is the next big thing.

"Immature adult market continues to offer greatest commercial potential," read a 2008 press release to the pharmaceutical industry from the market research agency Datamonitor: "Estimated to be twice the size of the pediatric ADHD population, the highly prevalent, yet largely untapped, adult ADHD population continues to represent an attractive niche to target."
Also seen on Alternet here

Monday, September 10, 2012

10 Mind-Boggling Psychiatric Treatments

As posted on Mental Floss

Nobody ever claimed a visit to the doctor was a pleasant way to pass the time. But if you're timid about diving onto a psychiatrist's couch or paranoid about popping pills, remember: It could be worse. Like getting-a-hole-drilled-into-your-skull worse.
Gems include Insulin-Coma Therapy, Malaria Therapy, Chemically Induced Seizures, and of course, Lobotomy Check out the link for the full article

Tuesday, April 03, 2012

Dr. Khristine Eroshevich, Beverly Hills Psychiatrist Who Treated Anna Nicole Smith, Has License Suspended

As Reported in the Huffington Post

LOS ANGELES -- State medical board officials say a Beverly Hills psychiatrist who treated Anna Nicole Smith has had her license suspended for a criminal conviction involving the Playboy Playmate.

The March 30 decision by the Medical Board of California did not name any patients in the case against Dr. Khristine Eroshevich, but the filing listed the court number of the Smith case.

Eroshevich's license was revoked, but the revocation was stayed.

Instead, Eroshevich's license will be suspended for 90 days and she will be placed on five years of probation by the state licensing agency for wrongly prescribing opiates and other misconduct.

As terms of her probation, the board ordered Eroshevich to take classes on prescribing practices, ethics. She must also undergo psychiatric and medical evaluations. When she returns to practicing medicine, it will be under the supervision of a monitor approved by the state's licensing agency.

Eroshevich was with Smith when the former Playboy Playmate checked into the Florida hotel, where she later died of an accidental overdose.

According to the medical examiner's office in Florida, Eroshevich authorized all 11 prescription medications in the Florida hotel room where Smith was found unresponsive shortly before her death on Feb. 8, 2007.

More than 600 pills – including about 450 muscle relaxants – were missing from prescriptions that were no more than five weeks old.

Eroshevich was initially convicted of two felonies in the drug trial involving the treatment of Smith. One was later thrown out and the other was reduced to a misdemeanor. The misdemeanor is under appeal.

According to the medical board filing, Eroshevich admitted misconduct in signing off on two workers' compensation and disability claims without actually examining the patients.

The examinations were done by Eroshevich's colleague in 2004 and 2006.

Sunday, June 12, 2011

Thousand Oaks psychiatrist arrested twice for DUI; patient death probed

As seen in this report from Los Angels' ABC7 News

A Thousand Oaks doctor arrested twice for DUI is now under investigation in connection with the death of a patient.

Dr. Daryl Westerback, 55, was arrested on June 5 for driving under the influence of prescription drugs after he was spotted on the road by a narcotics detective.

Westerback is now being investigated for overprescribing drugs to his patients. Authorities are looking into at least one death related to his practice.

"We began looking into him and found that one of his patients last year died of a fatal overdose, so we're now opening the case and investigating that death," said Capt. Don Aguilar with the Ventura County Sheriff's Department.

Westerback, a psychiatrist, is also accused of treating patients while he was impaired by prescription drugs.

"We started watching him and found that he was also under the influence of opiates while seeing patients. We found that he was operating a psychiatry office and was treating pain-management patients without an exam room, without all the typical methods of good medicine," said Aguilar.

Officials say they are investigating at least 10 doctors for operating criminally in Ventura County. They say these doctors appear to be nothing more than drug dealers peddling prescription medications for profit.

Ventura County sheriff officials say federal law enforcement is helping with a special task force to crack down on the growing illegal use of prescription drugs like Oxycontin, Vicodin and more.

"This has been created out of a prescription drug problem we've been seeing in the county, specifically in East County," said Aguilar.

Detectives said Westerback's license to prescribe medication has been suspended and he remains free on bail.

Westerback was also arrested for driving under the influence of drugs and felony child endangerment after being involved in a car crash in Thousand Oaks on March 8, according to Ventura County Assistant Sheriff Gary Pentis.

Monday, October 25, 2010

Licensing and the Pharma Patent Cliff

As posted on the Licensing Law Blog October 22nd, 2010, by Richard R. Bergovoy

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 2.0 Generic License.

Peering over the edge of a “patent cliff” that threatens to cut deeply into its profits, Big Pharma is considering modifying its current business model of in-house development of all-or-nothing blockbuster drugs towards a business model of in-licensing from biotech startups and university researchers.

The time and cost of developing new drugs from scratch is enormous– typically $2 billion per successful drug and 10 to 15 years from initial research to final regulatory approval.

But during the next five years, many top-selling blockbuster drugs will come off patent, and face severe price competition from generic versions, including: Pfizer’s Lipitor; Astra-Zeneca’s Seroquel; and Sanofi-Aventis’ and Bristol-Myers Squib’s Plavix. Between 2011 and 2014, four of Eli Lilly’s top five sellers will fall off the patent cliff: Zyprexa, Symbalta, Gemzar, and Evista. Estimates peg the total revenue loss to Big Pharma as high as $140 billion through 2016.

In response, analysts at Morgan Stanley are advocating a move away from the go-for-broke nature of the blockbuster business model, towards a Pharma 2.0 model of in-licensing from biotechs and academic researchers, who do all early-stage research and testing, and assume most of the risk. According to their analysis, the return on investment of in-licensed drugs is three times higher than drugs developed in-house.

And it appears that some of Big Pharma is listening. According to thepharmaletter.com, in 2009 the top 10 pharmaceutical companies entered into 12% more health-care focused licensing deals than the year before. Andrew Baum of Morgan Stanley estimates that large European pharmas will cut research spending by 40% in the next two years, and focus on licensing and acquisitions of promising drugs in development.

But for other pharmaceutical companies, the “Not Invented Here” syndrome still rules the day. Eli Lilly, which faces probably the most severe patent cliff among the major pharmas (above), has announced that it will meet the challenge mainly through cost cuts, job cuts, and modifications of existing product lines, rather than major new licensing or acquisition initiatives. It argues that slashing in-house research and development to boost return on investment is a short-term fix that would undermine Lilly’s long-term mission.

As we have argued in other contexts, while licensing may not always be appropriate as a complete replacement for in-house research and development, it is almost always appropriate as a complementary business model. When you are looking over the side of a cliff, Not Invented Here goeth before the fall.

Wednesday, June 09, 2010

Two Top Liability Risks for Psychiatrists: Patients with Suicidal Behavior and Psychopharmacology

as seen in this PRMS (Professional Risk Management Services) press release

Snippet:

Patient suicides may trigger the most lawsuits, but according to PRMS data, cases with the largest verdicts or settlements don't involve the death of a patient, but significant and permanent physical and neurological damage requiring lifelong care. Such damage can occur from things like renal failure from lithium toxicity, severe Stevens-Johnson Syndrome or brain damage from a suicide attempt.

"Defensive medicine is not the answer," said Jacqueline Melonas, RN, MS, JD, Senior Vice President of Risk Management for PRMS. "Care that has a sound clinical basis that also is well-documented is the best way to avoid or, if necessary, defend lawsuits."
more at the link

Tuesday, March 23, 2010

Alabama Psychiatrist Arrested for Drug Trafficking

As seen in this report

FLORENCE, AL (WAFF) - A Shoals area psychiatrist and his wife were arrested in a Huntsville hotel on trafficking charges. Dr. William Roddy and his wife Wendy Sue Roddy were both arrested at the Embassy Suites in Huntsville on Sunday. The two were accused of trafficking a controlled substance, though Huntsville Police would not comment on what the substance was. Trafficking a controlled substance is a felony in the state of Alabama and if convicted a person can serve as much as 20 years in jail for the offense.
also via Psych Search
Huntsville Police Sgt. Mark Roberts says 50-year-old Dr. William Roddy and 43-year-old Wendy Sue Roddy were charged with trafficking in a controlled substance. He says they were arrested on Sunday and were released on $250,000 bail each. Roberts says officers responded to a call about a man with a gun in a hotel parking lot and arrested Roddy. He says a search of Roddy and his hotel room turned up prescription narcotics and thousands of dollars in cash. Police say they searched the couple’s home and found more drugs.

Thursday, September 10, 2009

Chinese Dissidents Committed to Mental Hospitals

As reported on the PBS NewsHour of September 11, 2009



(Video Link Updated)

From the Transcript

China's emphasis on social harmony provides an incentive for petitioners to press for justice, but it also sets the stage for their persecution. That's because petitioners know that Chinese officials in the central government take unrest in local communities seriously, but the local officials who are being complained about will often seek retribution or try to stop people from petitioning in the first place.

Teng Biao, a professor at the University of Politics and Law in Beijing, says the system itself creates these kinds of problems. He runs an NGO to provide legal aid to petitioners.

TENG BIAO, University of Politics and Law, Beijing: From the top down, the petitioning situation is an assessing index for the officials on their political achievements. If there are many petitioners coming to Beijing from a place, then it will affect the local officials on their promotions and bonuses.

SHANNON VAN SANT: For his work, Teng Biao had his lawyers license and passport taken away. After this interview, Chinese authorities shut down Teng Biao's NGO, and police detained two of his colleagues. Despite the risk, Teng said he will continue his work.

I traveled to Wuhan to talk with another Chinese activist, Liu Feiyue, but he was under house arrest. Liu heads an NGO that is currently following 100 cases of wrongful psychiatric detention. Over the last three years, he says he knows of 500 more whistleblowers and protesters who have been detained in mental hospitals.

Robin Munro, who has extensively researched psychiatric detention in China and written two books on the topic, thinks the practice is widespread.

ROBIN MUNRO, human rights activist: China's experience in this area is far more serious and extensive than any other country.

SHANNON VAN SANT: Munro, who is based in Hong Kong, believes that since there are no national mental health laws protecting the rights of people who have been compulsorily hospitalized, but there are rules limiting arbitrary arrest, hospitals are becoming a convenient means of silencing protesters.

ROBIN MUNRO: Once diagnosed in this way, as dangerously mentally ill, citizens have no rights. They have no legal right to see a lawyer; they have no legal right to be brought before a judge so that a judicial determination can be made.

SHANNON VAN SANT: The Chinese press, including the Beijing News, has reported on the hospitalizations. The story was picked up by the state's official press agency, The People's Daily and Sina.com, where it drew 23,000 comments. Such coverage in Chinese newspapers could imply there is central government support for preventing wrongful psychiatric detention by local officials.

China's Ministry of Health denied requests for an interview, but sent a list of relevant regulations on treatment of the mentally ill, which said, in part, "The diagnosis of psychiatric disease is, according to the Chinese mental disorder category and diagnosis standard third edition, approved by Chinese medical association and referring to the related standards of international disease diagnosis category."

When asked at a press conference about the increasing numbers of protesters being put in mental hospitals, the spokesperson for the Ministry of Foreign Affairs said...

QIN GANG, Spokesperson, Ministry of Foreign Affairs (through translator): It's the first time for me to hear the situation you addressed. I don't know about the situation of psychiatric hospitals, but please believe the related Chinese governmental departments conduct administration according to law.

SHANNON VAN SANT: But in Wuhan, another petitioner, Hu Guohong, said he has been forcibly hospitalized in mental institutions four times and that he and his wife, Cheng Xue, have been warned repeatedly by local officials to stop petitioning.

HU GUOHONG, petitioner: They said, "We don't allow you to go petitioning to the upper levels. If you do that, we will beat you to death."

Wednesday, July 15, 2009

The myth of the chemical cure - It only gets you stoned

A commentary publish on the BBC website It looks like the drugs merely get you stoned or something, and cost way too much as well.



Taking a pill to treat depression is widely believed to work by reversing a chemical imbalance.

Medication is a mainstay of mental health therapy

But in this week's Scrubbing Up health column, Dr Joanna Moncrieff, of the department of mental health sciences at University College London, says they actually put people into "drug-induced states".


If you've seen a doctor about emotional problems some time over the past 20 years, you may have been told that you had a chemical imbalance, and that you needed tablets to correct it.

It's not just doctors that think this way, either.

Magazines, newspapers, patients' organisations and internet sites have all publicised the idea that conditions like depression, anxiety, schizophrenia and bipolar disorder can be treated by drugs that help to rectify an underlying brain problem.

People with schizophrenia and other conditions are frequently told that they need to take psychiatric medication for the rest of their lives to stabilise their brain chemicals, just like a diabetic needs to take insulin.

The trouble is there is little justification for this view of psychiatric drugs.


Altered states


First, although ideas like the serotonin theory of depression have been widely publicised, scientific research has not detected any reliable abnormalities of the serotonin system in people who are depressed.

Second, it is often said the fact that drug treatment "works" proves there's an underlying biological deficiency.

Psychoactive drugs make people feel different

But there is another explanation for how psychiatric drugs affect people with emotional problems.

It is frequently overlooked that drugs used in psychiatry are psychoactive drugs, like alcohol and cannabis.

Psychoactive drugs make people feel different; they put people into an altered mental and physical state.

They affect everyone, regardless of whether they have a mental disorder or not.

Therefore, an alternative way of understanding how psychiatric drugs affect people is to look at the psychoactive effects they produce.

Drugs referred to as antipsychotics, for example, dampen down thoughts and emotions, which may be helpful in someone with psychosis.

Drugs like Valium produce a state of relaxation and a pleasant drowsiness, which may reduce anxiety and agitation.

Drugs labelled as "anti-depressants" come from many different chemical classes and produce a variety of effects.

Prior to the 1950s, the drugs that were used for mental health problems were thought of as psychoactive drugs, which produced mainly sedative effects.

'Informed choice'

Views about psychiatric drugs changed over the course of the 1950s and 1960s.

They gradually came to be seen as being specific treatments for specific diseases, or "magic bullets", and their psychoactive effects were forgotten.

However, this transformation was not based on any compelling evidence.

In my view it remains more plausible that they "work" by producing drug-induced states which suppress or mask emotional problems.


If we gave people a clearer picture drug treatment might not always be so appealing

This doesn't mean psychiatric drugs can't be useful, sometimes.

But, people need to be aware of what they do and the sorts of effects they produce.

At the moment people are being encouraged to believe that taking a pill will make them feel better by reversing some defective brain process.

That sounds good. If your brain is not functioning properly, and a drug can make it work better, then it makes sense to take the pill.

If, on the other hand, we gave people a clearer picture, drug treatment might not always be so appealing.

If you told people that we have no idea what is going on in their brain, but that they could take a drug that would make them feel different and might help to suppress their thoughts and feelings, then many people might choose to avoid taking drugs if they could.

On the other hand, people who are severely disturbed or distressed might welcome these effects, at least for a time.

People need to make up their own minds about whether taking psychoactive drugs is a useful way to manage emotional problems.

To do this responsibly, however, doctors and patients need much more information about the nature of psychiatric drugs and the effects they produce.

How to Interpret Your Rorschach Ink Blots

I occasionally poke around the news site Reddit, and came across this discussion related to the Rorschach Ink Blots. It seems only fair to post some of the interpretation summaries so that Redditors can see how they did.

From a legal standpoint, the Rorschach test images have been in the public domain for many years in most countries, particularly those with a copyright term of up to 70 years post mortem auctoris. They have been in the public domain in Hermann Rorschach's native Switzerland since 1992 (70 years after the author's death, or 50 years after the cut-off date of 1942), according to Swiss copyright law. They are also in the public domain under United States copyright law where all works published before 1923 are considered to be in the public domain. This means that the Rorschach images may be used by anyone for any purpose. William Poundstone was, perhaps, first to make them public in his 1983 book Big Secrets, where he also described the method of administering the test

I imagine that these days a lot of people will see imagery from many of the games they have played, movies they have seen, local TV shows, popular songs, etc. The standard imagery seems to be based on psychoanalysis and original conjectures of the 1920s. It would probably be dangerous to try to derive universals, when so many variations exist between cultures and subcultures, etc in each region of planet earth.

For example, a Yankee team uniform has different meaning in New York City vs in Boston. (The two cities are known for a long standing sports rivalry)

Thus we come to this SPECIAL NOTE OF IMPORTANCE: There are different responses seen as normal depending on culture!!! Something interpreted as normal in one culture (Europe, etc) can be seen as a sign of schizophrenia in another culture (North America). Military people have different responses compared to nonmilitary. Different political parties have different responses.

For these and other reasons, I believe that the tests are NOT valid. What is given below is a combination from various sources. I regard inkblots to be no better than fortune-telling.

Origins of the Test


As a child, Hermann Rorschach was a big fan of a popular game called Klecksography, so much so that his nickname was "Kleck" (meaning "inkblot"). The idea of the game was to collect inkblot cards that could be bought from local shops and make associations and stories from the inkblots.

Rorschach went on to study psychiatry and while training, in 1918, he noticed that patients diagnosed with schizophrenia made radically different associations to the Klecksography inkblots than did normal people. He therefore developed the Rorschach test as a diagnostic tool for schizophrenia.

In 1896, a similar game was described in the United States by Ruth McEnery Stuart and Albert Bigelow Paine in a book titled Gobolinks, or Shadow-Pictures for Young and Old. The book explained how to make inkblot monsters ("gobolinks") and use them as prompts for writing imaginative verse.

The term Klecksography originates with the doctor and poet Justinus Kerner (1786-1862). Kerner also dealt with the interpretation of the images. After the color blobs were interpreted, he drew conclusions about the nature of the person. The interpretations were made using poetic rhymes.

As an artistic device and technique, the nature of the resulting images are affected to some degree by selective application and choice of the paint volume. Among the artists who experimented with Klecksography is J. Beuys.

Notes on the scientific value of the test


Rorschach never intended the inkblots to be used as a general personality test, but developed them as a tool for the diagnosis of schizophrenia. It was not until 1939 that the test was used as a projective test of personality, a use of which Rorschach had always been skeptical. Controversy about the reliability and validity of the Rorschach has been present since its conception. Today, many - probably most - psychologists think the Rorschach is nonsense.

A survey conducted on the members of The American Psychological Association Division-12, and The Indian Association of Clinical Psychologists showed concern from respondents about the limitations of the test (Wade et al 1978; Sharma, Ojha and Vagrecha, 1975; Dubey, 1982). Zubin (1965) has charged seven major failures as follows:
  1. Failure to provide an objective system, free of arbitrary conventions, and showing high interscorer agreement.
  2. Lack of satisfactory internal consistency, or test-retest reliability.
  3. Failure to provide cogent evidence for clinical validity.
  4. Failure of the individual Rorschach scoring categories to relate to diagnosis.
  5. Lack of prognostic, or predictive validity with respect to the outcome of treatment, or later behavior.
  6. Individual differences between groups of normal subjects.
  7. Failure to find any significant relationships between Rorschach scores and intelligence, or creative ability.
Many professionals now feel that the Rorschach is outdated, inaccurate, and meaningless. For example:
"Nobody agrees how to score Rorschach responses objectively. There is nothing to show what any particular response means to the person who gives it. And, there is nothing to show what it means if a number of people give the same response. The ink blots are scientifically useless." (Bartol, 1983).

"The only thing the inkblots do reveal is the secret world of the examiner who interprets them. These doctors are probably saying more about themselves than about the subjects." (Anastasi, 1982).
What these comments seem to indicate is that the Rorschach is potentially unreliable, easily misinterpreted, and essentially not a valid means of determining what it claims to detect. For more information on the use and potential unreliability of the Rorschach test read "Misuse of Psychological Tests in Forensic Settings: Some Horrible Examples" by Ralph Underwager and Hollida Wakefield.

Notes for if you take the test


Every Rorschach image has at least one obvious representation of sexual anatomy. You're not expected to mention them all. In some interpretation schemes, mentioning more than four sex images in the ten plates is diagnostic of schizophrenia. Most Rorschach workers believe the sex images should play a part in the interpretation of responses even when not mentioned.

The trouble is, subjects who took Psychology 101 often assume they should detail every possible sex response, so allowances must be made. People have since also come up with various methods and systems to try to objectively score the tests, but a lot of it is still the basis of you think it should mean this, and they think it should mean something else. It is like dream interpretation or fortune telling.

Your best bet when taking the test is probably to stick to "seeing" healthy, friendly images. Avoid dark or violent answers ("I see a monster eating a baby's brain!"). Butterflies, people holding hands, leaves, mountains, etc are all generally considered to be "safe" responses (although nothing is guaranteed when taking the Rorschach). If you can show how a particular shape really does resemble something, go ahead and say so. If you come up with a novel or particularly interesting answer you may get "points" for your creativity. The fact is, however, that in the end it's mostly up to the examiner as to how your responses are interpreted.

Further notes and advice on taking the test from this source
Just as secret as the blots themselves are the ground rules for administering the test. There are a few things that you, as a subject, are supposed to know and a lot of things you aren't supposed to know. If you ask about something you're not supposed to know, the psychologist will give you a pat answer as prescribed in Rorschach literature. For example, if you ask if it is okay to turn the card upside down, the psychologist will respond that you may do as you like; it's up to you. The psychologist won't say that many of the cards are easier to interpret when turned; that most people do turn the cards; that he or she will make a notation with a little arrowhead every time you do turn a card; and that you lose points in the initiative department if you don't turn the cards.

You'll be handed the cards one by one in the fixed order devised by Rorschach (there are numbers on the backs of the cards for the psychologist's benefit). The first card, for instance, looks like a fox's head or a jack-o-lantern. The cards are thick, rectangular cardboard, 6 5/8 inches by 9 1/5 inches. Half of the blots are black ink on a white background. Two others are black and red ink on white, and the last three blots are multicolored. The psychologist will always put each card in your hands "right" side up.

You aren't supposed to know it, but the psychologist will write down everything you say. This includes any seemingly irrelevant questions you may have. To keep you from getting wise, the psychologist always arranges to sit to your side and a little behind you, so that you can't look at the card and the psychologist at the same time. Most subjects realize the psychologist is taking notes, of course, but they don't realize that the notes are a special shorthand record of everything said. Some psychologists use hidden tape recorders.

The psychologist will also time how long it takes you to respond, using a "tickless" watch. The psychologist will not ask you to hurry up or slow down and will not make any reference to time, but response times (in seconds) are one of the things he or she is writing in the notes.

Don't hold the card at an unusual angle. Watch how you phrase things. Say "This looks like ..." or "This could be ..." never "This is..." After all, you're supposed to realize that it is just a blot of ink on a card. By the same token, don't be too literal and say things as, "This is a blotch of black ink." Don't groan, get emotional, or make irrelevant comments. Don't put your hands on the cards to block out parts. The psychologist will watch for all of the foregoing as signs of brain damage.

If there are no right answers for the test, there are some general guidelines as to what is a normal response. You can probably see images in the inkblots proper and in the white spaces they enclose. Stick to the former. Don't be afraid of being obvious. There are several responses that almost everyone gives; mentioning these shows the psychologist you're a regular guy.

It is okay to be original if you can justify what you see in the shape, shading, or color of the blot. If you see an abalone and can point out why it looks like one, then say so. Justifiable original responses are usually judged to be indicative of creativity or intelligence.

You don't want non sequiturs, images that don't fit the blot in the judgment of the psychologist. These may be interpreted as signs of psychosis. *(Comment: Again the cultural variation is important. If your are a big fan of Star Wars or Batman or Anime, you might upset some shrinks if all of your interpretations are filled with references to these cultural icons!)*

You're expected to see more than one thing on all or most of the cards. Not being able to see anything on a card suggests neurosis. Usually the more things you can see, the better, as long as they fit the form and color of the blot. Of course, you can see things in the whole blot or in parts of it, and images may overlap. *(Comment: Note more intelligent people tend to score higher on many pathology scales, since many scales do not correct for high response rate! if a subject gives twice as many responses overall, it is more likely that some of these will seem "pathological")*

Since time is a factor, it is important to come up with good answers fast. (It looks particularly bad if you take a long time and give a dumb, inappropriate answer.)

Information on Interpretations


The information on Interpretations is compiled from data seen at
  1. www.your3dsource.com/are-you-crazy-inkblot-test.html
  2. deltabravo.net/custody/rorschach.php and
  3. www.mrcoward.com/slcusd/The Rorschach Test.htm
Pics are from Wikipedia, and are in the public domain in both Switzerland (their country of origin) and the USA.

Note that these pictures are pretty small, you can click on them to embiggen (i.e., see larger).

The Wikipedia article on the test now forwards the line that there is no specific correct answer to the test, and generally fudges any interpretation.

But see the general notes below, followed by the set of pictures.

I Repeat: SPECIAL NOTE OF IMPORTANCE: There are different responses seen as normal depending on culture!!! Something interpreted as normal in one culture (Europe, etc) can be seen as a sign of schizophrenia in another culture (North America)

French subjects often identify a chameleon in card VIII, which is normally classed as an "unusual" response, as opposed to other animals like cats and dogs; in Scandinavia, "Christmas elves" (nisser) is a popular response for card II, and "musical instrument" on card VI is popular for Japanese people, and different languages will exhibit semantic differences in naming the same object (the figure of card IV is often called a troll by Scandinavians and an ogre by French people).

Many "popular" responses (those given by at least one third of the North American sample used) seem to be universally popular, as shown by samples in Europe, Japan and South America, while specifically card IX's "human" response, the crab or spider in card X and one of either the butterfly or the bat in card I appear to be characteristic of North America.

Some critics argue that the testing psychologist must also project onto the patterns. A possible example sometimes attributed to the psychologist's subjective judgement is that responses are coded (among many other things), for "Form Quality": in essence, whether the subject's response fits with how the blot actually looks. Superficially this might be considered a subjective judgment, depending on how the examiner has internalized the categories involved. One example is that the response "bra" was considered a "sex" response by male psychologists, but a "clothing" response by females psychologists. Scoring systems have be developed to get around this, but in my personal opinion they sound like reading astrology charts, elaborately complex constructions on a foundation of sand.

For these and other reasons, I believe that the tests are NOT valid. What is given below is a combination from various sources. I regard it no better than fortune-telling.


The Rorschach Ink Blots


The cards are numbered 1 through 10, and that is the order in which they're always given to you by the psychologist. The originals are thick, rectangular cardboard, 6 5/8 inches by 9 1/5 inches. This will make a difference on what you see, vs the smaller images on a computer screen.

Plate I


Possible Sexual Imagery: Breasts, primarily the rounded areas at the top of the image.

Good/Common Answers: "Bat, butterfly, female figure (in the centre), moth"

You may be a little paranoid if you see: "Mask, animal face, jack o lantern"

Bad Answer: "Anything insulting about the female figure (it is an indicator of your own body image)"

The first blot is easy. How fast you answer is taken as an indication of how well you cope with new situations. The best reaction is to give one of the most common responses immediately.

A bad response is any that says something untoward about the central female figure. "She" is often judged to be a projection of your own self-image. Avoid the obvious comment that the figure has two breasts but no head.

If you don't give more than one answer for Plate I, many psychologists will drop a hint -- tell you to look closer.

Plate II


Possible Sexual Imagery: Male sex organ at top center or, in some cases, a vagina (at the center near the bottom).

You should see this image as: "Two human-like forms (females or clowns) If you don't it is an indicator that you have trouble relating to people."

Other Good/Common Answers: "Butterfly, cave entrance"

It is important to see this blot as two human figures usually females or clowns.

If you don't, it's seen as a sign that you have trouble relating to people. You may give other responses as well, such as cave entrance (the triangular white space between the two figures) and butterfly (the red "vagina," bottom center).

Should you mention the penis and vagina? Not necessarily. You may not say that the lower red area looks like a vagina, but psychologists assume that what you do say will show how you feel about women. Nix on "crab"; stick with "butterfly."

Plate III


Possible Sexual Imagery: Male sex organs and female breasts, right about where you would expect to find them.

This is the blot that allegedly can determine sexual preference.

A heterosexual response would be: "Seeing two male figures"

A homosexual response would be: "Seeing two androgynous (remember "Pat" from SNL?) or female figures."

Most people see the two human figures. Both figures have prominent "breasts" and an equally prominent "penis." If you don't volunteer the gender of the figures, you'll be asked to specify it.

This blot has been the subject of much debate, so it's best to take your answer's meaning with a grain of salt. Does it work? Not really

The splotches of red ink are usually perceived separately. Common responses are "bow-tie" or "ribbon" (inner red area) and a stomach and esophagus (outer red areas).

Plate IV


Plate IV is the "father card." At first glance it is a difficult blot to see as a single image. The two lower corners are often described as shoes or boots. This card may also be seen as viewing a person from below or a male figure with an enormous sex organ.

The "boots" are fairly conspicuous; between them is the apparent head of a dog or Chinese dragon. Many subjects see the blot as an animal skin. After a few seconds, though, most can see it as a standing figure seen from below.

The boots become the feet, enlarged because of the unusual perspective. The arms and head, at the top, are smaller. Common descriptions are bear, gorilla, or man in a heavy coat. Rorschach theorists equate your description of the figure with your perception of your father or male authority figures.

Possible Sexual Imagery: A pair of male sex organs, typically seen at the top of the image. Some subjects may instead visualize a vagina in the upper center of the blot.

Good/Common Answers: "A standing figure (man, bear, gorilla)"

A Bad Answer Would Be: "To describe the figure as menacing in any way, i.e. a monster, or attacking gorilla, as this blot indentifies with your perception of your father, or authority figures."

Plate V



Possible Sexual Imagery: A pair of male sex organs at the very top of the inkblot.

Good/Common "Answers: Bat, Butterfly"

Bad Answers: "Seeing the butterfly antennae as scissors or any cutting device is an indicator of a castration complex. Schizophrenics occasionally see moving people in this image. Seeing crocodile heads on the ends of the bat's wings indicates hostility."

Rorschach himself thought this was the easiest blot to interpret. It is a bat or a butterfly, period. You don't want to mention anything else.

Many psychologists take particular note of the number of responses given to this plate. If you mention more images here than in either Plate IV or VI, it is suggestive of schizophrenia.

Plate VI


Possible Sexual Imagery: The head of the male sex organ (the portion at the top of the card) or alternately, a female sex organ (middle and bottom part of the card).

Common Answers: "animal hide, boat, submarine, mushroom cloud, men with long noses and goatees. Apparently this blot reveals subconscious attitudes about sexuality."

Occasionally described as a foreshortened view of a person with their arms outstretched.

Basically, the secret of this plate is to turn it. A good response is to say it looks like an animal hide (about the only reasonable response when held right side up), then turn it on its side and say it looks like a boat or surfaced submarine with reflection, and then turn it upside down and say it looks like a mushroom cloud, a pair of theater masks, or caricatures of men with long noses and goatees.

Plate VII




Possible Sexual Imagery: The female sex organs (seen at the bottom of the card where the figures join.

Good/Common Answers: "Two Girls, or Women"

Bad Answers: "Insulting descriptions of the two figures i.e. gossips, girls fighting, witches.

This card has a rough "V" shape sometimes described as faces pointing towards one another, "bunny ears", or similar visualizations.

This blot is supposed to reveal how you really feel about your mother. Virtually everyone sees two girls or women. Deprecating descriptions of the figures~ "witches," "gossips," "girls fighting," "spinsters" indicate poor maternal relations. Seeing the blot as thunderclouds instead of female figures suggests anxiety to some psychologists; seeing it as a walnut kernel may mean a vulvar fixation.

There is an entirely different side to this blot, but you're not supposed to see it. The white space between the girls or women can be interpreted as an oil lamp or similar object. It is claimed that only schizophrenics usually see the lamp.

Plate VIII



A very colorful card with blue, orange, pink, and gray ink. A roughly diamond-shaped image with lots of places to see things

Possible Sexual Imagery: Female sex organs, usually seen at the bottom of the card.

Good/Common Answers: "Four legged animals such as lions, pigs, bears, etc. on the sides. Other common responses are tree, butterfly, rib cage, christmas tree."

Bad/Answers: "Not seeing the four legged animals can indicate that you are mentally defective"

It is important that you see the four-legged animals- lions, pigs, bears, etc. -on the sides of the blot. They're one of the most common responses on the test, and you're assumed to be a mental defective if you don't see them. Other good responses are tree (gray triangle at top), butterfly (pink and orange area at bottom), and rib cage or anatomy chart (skeletal pattern in center between blue rectangles and gray triangles). The entire configuration can be seen as a heraldic design (good answer) or a Christmas tree with ornaments (reaching).

Children tend to like this blot and say a lot about it-the bright colors and animal shapes make it more interesting than your basic penis/vagina number (II, IV, or VI).

Plate IX


Another colorful card, this time with orange, pink, and green inks. This one is tough to visualize anything specific in; most test subjects struggle to find something to "see" in it.

Possible Sexual Imagery: Female sex organs, usually seen at the bottom of the card.

Good/Common Answers: "Fire, smoke, explosion, map, anatomy, flower."

Bad Answers: "Mushroom cloud on the centre line at top can indicate paranoia. Monsters or men fighting can indicate poor social development."

If you're going to throw up your hands (figuratively!!!) and plead a mental block, this is the place to do it. The colors clash, apparently by Rorschach's design.

If you turn the card ninety degrees, you can make out a man's head in the pink areas at bottom. (The man is identified as Mark Twain, Santa Claus, or Teddy Roosevelt.)

As with Plate V, the psychologist may be counting the number of responses you give to this blot for comparison with the preceding and succeeding blots. You want to give fewer responses to this blot.

Plate X



This is the last Rorschach card and certainly the most colorful, consisting of blue, gray, pink, green, orange and yellow inks. It's a very complex mish-mash of shapes with lots of "activity" and plenty of places to "see" things.

Possible Sexual Imagery: Male sex organs at the top center of the card.

Good/Common Answers: "Sea life, or a view through a microscope. Also common: spiders, crabs, caterpillars, rabbit's head"

Bad Answers: "Two faces at top centre blowing bubbles, or smoking pipes can indicate an oral fixation"

The unspoken purpose of this last blot is to test your organizational ability. Plate X is full of colorful odds and ends easy to identify---blue spiders, gray crabs, paired orange maple seeds, green caterpillars, a light-green rabbit's head, yellow and orange fried eggs--and you're expected to list them.

But the psychologist will also be looking for a comprehensive answer, something that shows you grok the whole Gestalt. There are two good holistic answers: sea life and a view through a microscope.

Some subjects see two reddish faces at top center, separated by the orange maple key. If you describe them as blowing bubbles or smoking pipes, it may be interpreted as evidence of an oral fixation. Seeing the gray "testes" and "penis" as two animals eating a stick or tree indicates castration anxiety.


Misuse of Psychological Tests in Forensic Settings: Some Horrible Examples

As seen on ParentingPlan.net We have not quoted the entire paper, but only the introductory section with a few of the smaller examples.

The original post has many fine examples, plenty of detailed references, and is oriented to situations where parents are separated. Unfortunately, given other news reports of recent years, this paper is still quite relevant


Misuse of Psychological Tests in Forensic Settings: Some Horrible Examples


Ralph Underwager and Hollida Wakefield

American Journal of Forensic Psychology, Volume 11, Issue 1

Psychological tests are often used inappropriately and are misinterpreted and overinterpreted in the forensic setting. This harms the person being evaluated and interferes with the cause of justice. It also does a disservice to the reputation of psychologists and the science of psychology. Actual examples of misuse of particular techniques and tests and misinterpretation illustrate what has been done in forensic settings.

A forensic evaluation is different from a clinical evaluation. When an evaluation is done in the clinical setting, the conclusions are used to develop a treatment plan. These conclusions form working hypotheses which can be confirmed or rejected during treatment. However, in the forensic setting, a one-time decision is made about the individual — a decision which can markedly affect the person's life.

If tests are misinterpreted in the clinical setting, the treatment plan developed from the evaluation may not be the most effective for the client. However, since treatment plans are generally modified and revised throughout the course of treatment, the mistaken conclusions can be corrected. But, an erroneous decision in the forensic setting can result in immediate and severe consequences, such as losing custody of a child or being jailed. If decisions and recommendations by the psychologist are not based on adequate data, the psychologist is acting both incompetently and unethically.

In addition, conclusions drawn by the psychologist are subject to cross-examination in the adversarial setting. If the conclusions are not based upon adequate data, the psychologist's testimony will be discredited or impeached by a skillful opposing attorney. Therefore, the psychologist should only present conclusions in reports and testimony which can be defended when challenged in cross-examination.

In the course of examining hundreds of reports, we have seen many examples of tests that are misadministered, misinterpreted, overinterpreted, or should never have been given in the particular setting. We are presenting a sample of these to illustrate what should be avoided by any psychologist who does forensic evaluations.

DRAWINGS

Tests such as the House-Tree-Person (HTP) and Kinetic Family Drawings are often overinterpreted and misinterpreted. There is a lack of validity and reliability in the use of drawings as projective assessment devices. In a review of the Draw-A-Person test in the Seventh Mental Measurements Yearbook, Harris (1) notes that there is very little evidence for the use of "signs" as valid indicators of personality characteristics. With children's drawings there is so much variability from drawing to drawing that particular features of any one drawing are too unreliable to say anything about them. The Tenth Mental Measurements Yearbook (2), in reviews by Cundick and Weinberg (p.422-425) continues the consistent finding since the first edition, 1938, that interpretations of drawings (as are often done in forensic evaluations) are unsupported by empirical evidence. Both reviewers note that there are no normative data establishing reliability and validity of the Kinetic Drawing System.


Here are some of the examples as given:

Example 2
A four-year-old girl was asked to draw a picture of herself and the family doing something. She instead, according to the school psychologist who was evaluating her, "seemed to be preoccupied with drawing circles within circles which she called 'caves.' Her second representation bore a significant resemblance to male genitalia (when asked what it represented, she reported that it was a ball rolling into a lion's cave)." This was interpreted as being suggestive of sexual abuse and the fact that the child has been subjected to some type of traumatic experience.

When we saw the child, now age five, we tested her and found borderline to low-average intelligence and no ability to draw anything other than scribbled circles. The child clearly had difficulties with visual motor perception and indeed, could not draw, a fact which was ignored by the other evaluator. This example, therefore, illustrates the importance of recognizing the child's developmental level.

Example 5
A four-year-old girl's drawing of a tree in the HTP was considered significant because the child, when asked to draw a tree, also drew a cactus. This was interpreted in terms of "unconscious expression of danger and fearfulness." However, the child was not asked if she had a cactus in her yard (this was in Texas).

The child also brought a drawing of a clown's face to the therapist which she had ostensibly drawn while in the waiting room with her parents. The clown was interpreted as being significant because "there is an element of sadness in the clown's eyes." This clown is of much greater sophistication and detail than the child's other drawings. When pressed about this in his deposition, the psychologist acknowledged that the parents probably drew it and she colored it. This example illustrates both problems in administration and in interpretation.

Example 20
A baby was returned to the foster mother following a visit with the parents and was described as having the "smell of sex." An emergency hearing was held in which social services attempted to cut off visits because this "smell of sex" triggered the suspicion that the parents were having sex with their baby. A psychologist agreed that the sex smell was significant and indicated probable abuse on the part of the parents. Fortunately, the parents had been at a church potluck dinner during the entire visit so they were able to disprove, the accusations.


We can just imagine the horror that happens when this gets involved with separation and divorce proceedings.

Tuesday, July 14, 2009

Attorneys begin closing arguments in William Ayres trial

As reported in the San Mateo County Times

Closing arguments are expected to conclude today in the trial of Dr. William Ayres, the once-prominent child psychiatrist accused of lewdly touching half a dozen boys under the guise of medical necessity.

Prosecutor Melissa McKowan and defense attorney Doron Weinberg began their closing statements Monday in San Mateo County Superior Court. Ayres, 77, faces nine counts of lewd and lascivious conduct with a minor younger than 14. The charges are based on the accusations of six former patients who argue that they were molested by Ayres between the ages 9 and 13.

McKowan said Monday that a 10th charge had been dropped during the course of the trial that stemmed from the accusations of a man referred to in court as Eric B., who testified that Ayres masturbated him during a physical exam when he was 13. He originally was going to testify that a second incident had occurred, McKowan said.

She told the jury Monday that Ayres performed physical and genital exams exclusively on male patients because he is a pedophile — a psychiatrist who desired to undress, touch and see the bodies of young boys. She referred to the exams he conducted as "sloppy, drop your pants and sit on the table" procedures.

"If genital exams are necessary in the diagnosis of adolescent children with psychological or mental health issues, why would you only conduct those exams on boys?" she asked the jury.

McKowan urged the jury to consider why Ayres kept poor notes of the exams and the unusual conditions under which he gave them. She also pointed out that no witness ever testified for the defense that Ayres taught the importance of physical exams at UC San Francisco, something he told the court last week that he had done.

Judge Beth Freeman issued jury instruction before closing arguments. She told the jury that four former patients who accused Ayres of molesting them but whose charges fall outside the state's statute of limitations can be considered in deciding if Ayres has a disposition to commit sexual offenses, or if their testimony can show that Ayres had a plan to lewdly touch the in-statute accusers.

Weinberg told the jury that there is simply no evidence Ayres committed a crime. He said the case rests entirely on memory, asking jurors to recall the testimony of memory expert Dr. Elizabeth Loftus.

"This case is about memory and memory alone," Weinberg argued. "There is no physical evidence."

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