Psychiatrist is haunted by celebrity death

As reported here Anna Nicole Smith's psychiatrist "best friend" Khris Eroshevich is haunted by the memory of her last chat with the tragic model, because she begged her friend not to leave her alone. But over looked in the report is the laundry list of drugs we reported earlier, which she had no problem filling out, and which was refused by more than one pharmacy.

As noted here,

Only in Los Angeles do psychiatrists suddenly pop up as best friends of their patients. It's unclear whether or not Eroshevich actually saw Smith as a patient or if she was just a hanger-on who got close to her in her later years.

This much is certain: It's Eroshevich's mug in the "ET" videos of the funeral, and all its tacky preparations. The good doctor happily gave quotes to the TV show, which sources say paid millions to Howard K. Stern for the right to have a landmark ceiling camera hovering over Smith's casket as it was rolled into the Bahamian church.

But back home, Eroshevich isn't all that popular with the other less famous people with whom she used to work.

One has to be suspicious, and I suspect that this is just another case of folks hanging on for the ride, looking to make as much as they can while they are able to.

Another case of Hollywood leeches. Pardon me if I am cynical, and file this under - deaths associated with "paparazzi shrinks"

UPDATE: and the media circus continues, first with Eroshevich's republican campaign contributions (not that this matters much), and the increasing perception of Eroshevich as an enabler

Here is that report we mentioned at the top

Anna Nicole Smith's physician pal Khristine Eroshevich is haunted by the memory of her last chat with the tragic model, because she begged her friend not to leave her alone.

Eroshevich, who was in Florida with a vacationing Smith, admits she was with the star in the days leading up to her death and recalls her final conversation with her friend.

She says, "She was taking a bath and she was shampooing her hair and I had been with her in the morning. That was Wednesday. I was going back and forth, saying goodbye and she was crying, and she said, 'Please don't leave me,' and I left."

The Bahamas-based doctor tells US TV news show Entertainment Tonight she has felt terrible guilt ever since her friend's death a month ago.

She adds, "I often think, 'Should I have stayed? What would have happened?' Certainly, I could have saved her."

And Eroshevich is keen to play down reports Smith died after suffering a fever, revealing her late pal was recovering from an illness when she left her.

She explains, "She wasn't well... She did spike a fever on Monday night but she got better really quick... I never thought that anything would happen to her. I called that night and was able to find out what she had eaten... and she was doing well. I called in the morning too. I never dreamed (she'd die)."

Ottawa psychiatrist faces sex charges - Dr. Juan Rosario is accused of having sex with two male patients.

An update to an earlier report in that criminal charges have been filed

A psychiatrist facing a disciplinary hearing for allegedly tying a rope around a patient's genitals and leading him around the office, and other bizarre sexual behaviour, has been charged with six criminal counts of sexual assault.

Dr. Juan Tejeda Rosario, 63, appeared briefly in an Ottawa court Thursday after police allege he repeatedly sexually assaulted two male patients over the past 10 years.

The doctor is also scheduled to go before a College of Physicians and Surgeons of Ontario discipline committee in Toronto on Monday.

According to a notice of hearing, Tejeda is accused of engaging in sexual impropriety with a patient, sexually abusing a patient and engaging in conduct that would "reasonably be regarded by members as disgraceful, dishonourable or unprofessional."

Among the allegations contained in the notice of hearing are that Tejeda had sex with two male patients, had both patients perform oral sex on him and masturbate him.

None of the allegations against Tejeda has been proven.

Tejeda and his lawyer, Todd Burke, have declined comment on the charges.

Another psychiatrist's licence is revoked after sex with patient

A psychiatrist and a complainant both wept Thursday at an emotion-packed hearing in which Newfoundland and Labrador's medical regulatory authority revoked his licence.

The College of Physicians and Surgeons of Newfoundland and Labrador stripped Dr. James Hanley of his privileges to practise medicine in the province after he admitted having sex with a patient who was under his care.

Hanley, who is now practising at Canadian Forces Base Gagetown in New Brunswick, told a college tribunal Thursday his judgment was clouded while he was carrying on an affair with Kathleen Wiseman.

Wiseman, 44, who filed a complaint against Hanley in 2005, said it was difficult to face Hanley at Thursday's hearing in a downtown St. John's hotel conference room.

"It was almost like reliving the trauma, and going through all over it again," she said after the hearing.

Wiseman had been Hanley's patient for 17 years. She began treatment to deal with depression and the consequences of abuse that she had suffered.

Emotional as she read a victim impact statement, Wiseman told the college tribunal that Hanley took advantage of her during a vulnerable period beginning in the fall of 2003.

"You knew how tragic my life was and I begged of you to help me, but you took advantage of me in the worst possible way," she told Hanley.

Later, looking directly at him, Wiseman asked, "What did I ever do to you to take advantage of me like that?"

Hanley closed his practice in St. John's in 2005 and moved to New Brunswick.

A six-page agreed statement of facts, which was read into the record, said Hanley had agreed to not practise medicine in New Brunswick, but did so anyway.

Hanley told the panel he admitted to what he described as "a very serious boundary violation," and apologized to his family for the pain they have endured.

Lost 'jewel of my life'

He said his judgment was clouded during the period he was having sex with Wiseman because of extreme fatigue from overworking.

He said he lives daily with feelings of anxiety and guilt, and lamented losing his medical practice in St. John's, which he described as the "jewel of my life."

Hanley also addressed how he would like to rehabilitate himself. He asked the tribunal to consider "the good I've done and can do in years to come."

Hanley concluded by tearfully apologizing directly to Wiseman.

Outside the hearing room, Wiseman accepted the apology, but indicated that was as far as she would go.

"I can't forgive him. I have a lot of healing to do," she said.

Lawyer Paul Stokes, who represented Hanley at the hearing, said his client is looking to rebuild his life.

"He's shown remorse and has taken ownership for his actions, and he's done the right thing," Stokes said.

Hanley still holds a medical licence in New Brunswick. The College of Physicians and Surgeons of New Brunswick must now decide whether it will revoke Hanley's privileges in that province.

More on the Psychiatric Drugs Prescribed for Anna Nicole Smith by Her Psychiatrist 'Friend'

Fox 411 has more on the drugs prescribed for Anna Nicole Smith by her claimed 'best friend' psychiatrist Khristine Eroshevich:

How many and how much? That’s what people want to know about Anna Nicole Smith’s drug usage. That, and how it might affect her baby daughter, Dannielynn.

A fax obtained exclusively by this column may shed some light on the still mysterious death of the modern-day pin-up model who accomplished nothing so much as getting the most publicity possible for the fewest achievements.

The fax was written and sent by Khristine Eroshevich, Smith’s personal psychiatrist and, since her death, “best friend.”

It’s a request for a laundry list of drugs that Eroshevich wanted sent to the Bahamas by courier for “M. Chase,” the pseudonym Smith used to obtain drugs.

You can see the damning evidence of the Fax in Khristine Eroshevich's own hand here

All of them are classified as different types of painkillers. In addition to the information given below, all of the drugs carry warnings for pregnant women and those who are breastfeeding especially not to take them.

Update: TMZ reports that

Kapoor's attorney, Ellyn Garofalo, tells TMZ, "Dr. Kapoor declined the request for prescriptions. He would never prescribe that combination of drugs, in such large dosages, to any patient."

In any case, here is a quick transcription of that fax. Unreadable text is marked by question marks, omitted/whited out text is marked by Xs:

Confidential Fax 8187

9/15/06

Dr. Kapoor,

Here are the medications for M. chase

1) Dilavdid 2mg/ml - 20 ml Bottle - for injection

I need 4 bottles

2) Lorazepam Intensol oral conc 2mg/ml -

30 ml Bottles - 2 bottles - ship on/carry in suitcase on ice pack

3) Soma 350mg - IV tabs po tid - #180 -

Send two bottles

4) Dalmona 30 mg II po qid #240 - 1 bottle

5) Prexige 400 mg II po qid #240 - one bottle

6) Methadone 5mg IV po qid #300 - one bottle

My name is KHRISTINE EROSHEVICH M.D., Ph.D.

XXXXXXXXXXXXXXXXXXX
Encino, CA 91436
office 818 XXX-XXXX
Cell 818 XXX-XXXX

You have my location here. Please call.

If half of the amounts can be prepared,
I'll have someone take them to a courier
to bring them to me and he can ????????
fed ex the rest, except for the Intensol,
which has to be on ice. Khris

Note: The Google telephone directory has a telephone and address listing for a Khristine Eroshevitch in Encino, California. We caution that this might not be the same person as seen in the news story. If you want this information, you'll have to look it up on your own.

Notes on Medical Abbreviations

PO = by Mouth

QID = 4 times a Day

TID = 3 times a Day

Notes On the Drugs mentioned: Most of this information was found via the RX List website

• Dilavdid
  Brand Name: Dolobid
  Generic Name: Diflunisal
  Drug Class: NONSTEROIDAL ANTI-INFLAMMATORY AGENTS (NSAIDS)

  Side Effects - NSAIDS may cause an increased risk of serious cardiovascular thrombotic events, myocardial infarction, and stroke, which can be fatal. This risk may increase with duration of use. Patients with cardiovascular disease or risk factors for cardiovascular disease may be at greater risk (See WARNINGS).
  
  DOLOBID is contraindicated for the treatment of peri-operative pain in the setting of coronary artery bypass graft (CABG) surgery (see WARNINGS).

• Lorazepam Intensol
  Brand Name: Ativan
  Generic Name: Lorazepam
  Drug Class: BENZODIAZEPINES

  Side Effects - Drowsiness, dizziness, loss of coordination, headache, nausea, blurred vision, change in sexual interest/ability, hair loss, constipation, heartburn, or change in appetite may occur. If any of these effects persist or worsen, notify your doctor or pharmacist promptly.
  
  Tell your doctor immediately if any of these unlikely but serious side effects occur: memory loss, shaking, difficult/slurred speech, vision changes, mental/mood changes (e.g., depression, including rare thoughts of suicide), trouble breathing (especially during sleep), stomach/abdominal pain, yellowing of skin/eyes, dark urine, seizures, easy bruising/bleeding, signs of infection (e.g., fever, persistent sore throat), unusual weakness, low body temperature.

• Soma
  Brand Name: Soma
  Generic Name: Carisoprodol
  Drug Class: SKELETAL MUSCLE RELAXANTS

  Side effects - Dizziness, drowsiness, headache, unusually fast heartbeat, low blood pressure, or face flushing may occur. If any of these effects persist or worsen, notify your doctor or pharmacist promptly.
  
  Sometimes carisoprodol may cause a very rare but serious reaction (idiosyncratic) that occurs within minutes or hours of the first dose of this medication. Seek immediate medical attention and do not take more of the medication if you experience: extreme weakness, inability to move your legs/arms, shaky/unsteady movement, pain in your joints, vision changes (double vision, inability to see), widened pupils, mental/mood changes (e.g., agitation, restlessness, unexplained mood swings, confusion).

  
  
• Dalmona
  Brand Name: Dalmane
  Generic Name: Flurazepam
  Drug Class: BENZODIAZEPINES

  Side Effects - Dizziness, loss of coordination, or blurred vision may occur. To minimize falls, remember to get up slowly when rising from a seated or lying position. If any of these effects persist or worsen, notify your doctor or pharmacist promptly.
  
  Tell your doctor immediately if any of these unlikely but serious side effects occur: confusion, unusual feelings of well-being (euphoria), uncontrolled movements (tremor), restlessness, memory loss, sweating, mental/mood changes (e.g., hallucinations, agitation, anxiety, unusual/disturbing thoughts, depression, rare thoughts of suicide), increased or vivid dreams, vision changes, fainting.

  
  
• Prexige
  Brand Name: Prexige (a British medication)
  Generic Name: Lumiracoxib
  Drug Class: NONSTEROIDAL ANTI-INFLAMMATORY AGENTS (NSAIDS)

  Side effects - NSAIDS may cause an increased risk of serious cardiovascular thrombotic events, myocardial infarction, and stroke, which can be fatal. This risk may increase with duration of use. Patients with cardiovascular disease or risk factors for cardiovascular disease may be at greater risk (See WARNINGS).
  
  Tell your doctor if you notice any of these side effects and they worry you: • nausea (feeling sick), vomiting • diarrhoea, flatulence (wind) • stomach pains or indigestion • constipation • headache • dizziness, light headedness • depression or feelings of sadness, anxiety • trouble sleeping • chest or throat infections • swelling of hands, ankles or feet • drowsiness • tingling or numbness of the hands or feet • blurry vision and/or difficulty in seeing • bloating • flu-like symptoms, including fever, aches and pains • nosebleeds • inflammation of the gums, toothache • swollen joints, muscle pain • sinus congestion • thrush (a yeast infection).

Psychiatrist loses license - linked to 11 drug deaths

From the Milwaukee Journal Sentinel

A psychiatrist linked to 11 drug overdose deaths in Milwaukee and Waukesha counties has agreed to give up his medical license and repay the federal government $509,000 in overbilled charges to Medicare and Medicaid, according to the U.S. attorney's office.

Although there was a criminal investigation into Richard I.H. Wang's prescriptions for dangerous levels of addictive painkillers such as OxyContin, Percocet and Valium, he will not be criminally charged, according to Assistant U.S. Attorney Matt Jacobs.

"His principal problem was a failure to perform as a competent, current physician. It was a sin of omission rather than a sin of commission," Jacobs said. "He should have done more."

The civil resolution, finalized Friday after a three-year investigation, accomplishes the government's main goals: removing Wang from the practice of medicine and recovering the money he overbilled, Jacobs said.

Reached Friday, Wang, 82, said he wanted to retire anyway, and did so Wednesday. He had been banned by the state from prescribing drugs since 2004.

Wang, who practiced medicine in Wisconsin for 40 years and who once held key posts at the Medical College of Wisconsin and a local veterans hospital, has a history of complaints dating to 1993, records show. Burleigh Serv-U Pharmacy, which filled many of Wang's prescriptions, ordered more than 1,000% more of certain drugs from its supplier than others its size, court records show.

The pharmacist there said he had contacted state licensing officials 10 times since 1998 about whether he should continue to fill Wang's prescriptions and was told it was fine, according to the records.

Affidavits in support of search warrants for Wang's home and office, served in 2004, describe 11 drug overdose deaths, including six of Wang's patients. Authorities believe some of those patients and others were selling or sharing their medications with relatives and friends, five of whom also died. The deaths occurred between June 2000 and March 2004.

Wang said Friday that his patients were required to sign agreements not to sell or abuse their medications.

"Out of several hundred patients, there were a couple who didn't follow the rules and regulations. They should be the ones (prosecuted)," Wang said. "Instead, they say, 'Who did you get the medication from?' That's not right."

Jacobs, though, said having the patients sign forms wasn't enough. Wang should have been more diligent about recognizing drug-seeking behavior, perhaps doing urine screenings of his patients, Jacobs said.

"There was a failure for him to recognize some of the red flags," Jacobs said.

However, Wang did not sell prescriptions to non-patients and did not charge exorbitant fees to patients who were prescribed painkillers, Jacobs said. Also, some of his patients died from combining prescription drugs with illegal ones such as heroin. All those factors would have made a criminal prosecution difficult, Jacobs said.

Sandy Folaron, whose son J.R. committed suicide in 2004 after being treated by Wang for pain associated with a knee injury, said she would have liked to see Wang go to prison but was satisfied that he didn't get off scot-free.

"I still felt that what he had done and lives he had destroyed, he had to have his license revoked," she said.

At one point, Wang was prescribing between 300 and 400 pills to J.R. each month, Folaron said. By the time Wang lost his ability to prescribe drugs, J.R. was addicted, and the doctor did nothing to help him, she said. With the painkillers cut off, J.R. started using heroin. Within a month, he had killed himself.

"He was a young wonderful man, our son, who had such a future, who fell, and fell hard," she said. "He's just one of many."

As for the overbilling, authorities say Wang submitted $509,000 worth of improper bills to Medicare and Medicaid. Wang generally spent very small amounts of time with each patient, yet submitted bills indicating complex visits that lasted 40 minutes or more, according to court documents.

Wang said he had hired someone to calculate his invoices for the federal programs and he merely signed them. As part of the settlement agreement, he agreed to repay the money anyway.

Wang served as chief of clinical pharmacology at the Zablocki Veterans Affairs Medical Center from 1964 to 1992. He simultaneously was on the faculty of the Medical College of Wisconsin in Wauwatosa full time from 1963 to 1987 and part time after that until 1996, when he retired from the college.

Update: Psychiatrist License revoked due to Sexual Misconduct

As seen in this report

The state medical board revoked the medical license of local psychiatrist Dr. Arthur R. Schramm Wednesday on charges of professional misconduct and neglect.

The revocation is permanent and goes into effect when the order is mailed to Schramm this week, said Joan Wehrle, spokeswoman for the State Medical Board of Ohio.

Among several charges involving three patients, two of them dancers from local strip clubs, the board found Schramm, 68, took sexually suggestive photos of two patients; he prescribed painkillers and other drugs to patients that were addicted to heroin, marijuana and alcohol; he didn't keep records of the prescriptions, and he failed to properly treat the women for various mental and physical ailments.

Schramm, a specialist in child and adolescent psychiatry with no previous troubles with the medical board, could not be reached for comment.

His attorney, Todd Morman, also could not be reached for comment. But he said on Monday that Schramm had "made some mistakes" and the board was overreacting in seeking to revoke his license.

Schramm, semi-retired, has practiced in Dayton for nearly 40 years, many of those at St. Elizabeth Hospital leading its psychiatry department and detoxification program, according to his testimony in a board report. He later worked for Kettering Medical Center in various roles that included directing the juvenile sexual offenders program.

Acting on a complaint, a board investigation found Schramm entered into doctor-patient relationships with two strippers in 2004 after establishing personal relationships that included lap dances, taking sexually suggestive photos and hiring one for help at his Brookville home and for clerical duties in his office at 130 W. Second St. in Dayton.

Psychiatrist accused of role in death of patient

As seen in the Courier Mail

A hearing has begun against a Rockhampton psychiatrist accused of involvement in a patient's death from a drug overdose.

Christopher John Alroe is accused of prescribing an excessive quantity of methadone for a patient with a history of drug abuse and mental illness without proper supervision.

A 2004 coronial inquest attributed the young man's 2003 death to an overdose four days after Alroe prescribed medication.

The Medical Board of Queensland referred the matter to the Health Practitioners Tribunal, where Alroe faces a charge of unsatisfactory professional conduct. The hearing will continue in May before Judge Debbie Richards.

The tribunal cancelled Alroe's medical licence for four years in May 2005 after he was found guilty of unsatisfactory professional conduct for a sexual relationship with a nurse he had treated for a bipolar disorder.

Shock treatment sought for autistic man

As seen in the Ledger Enquirer and on CBS News

Bradley Bernstein's parents say an electric cattle prod is the only thing that stops him from banging his head and violently punching his eyes, nearly blinding himself.

The Illinois couple's fight to continue shock treatment on their severely autistic 48-year-old son and the uproar over a Massachusetts school that uses similar treatment, have pulled back the curtain on this extreme form of behavior modification. Critics call it outmoded, barbaric and unethical.

Even a leading supporter of the technique, Harvard-educated psychologist Matthew Israel, acknowledges, "The natural reaction is to be horrified."

"It always has been very controversial and is not politically correct, and if you want to advance your career, you try to stay away from it," said Israel, founder and director of the Judge Rotenberg Center, a residential school in Canton, Mass. The institution houses children and adults with autism, mental retardation and other behavioral and psychiatric disorders.

The school is under legislative and regulatory scrutiny for routinely using skin shocks on about half its 230 students to stop serious behavior problems, including self-injury.

Electric shocks and other painful or unpleasant treatments known as "aversive conditioning" were accepted more a generation ago. But mainstream psychiatry relies on new drugs and other methods that have proven effective.

Using this form of shock therapy is "cruel and unusual punishment," said Dr. Louis Kraus, an associate professor of psychiatry at Chicago's Rush University Medical Center. "The concept of doing that is frightening."

Some states, including Illinois last year, have banned or severely restricted use of electric shocks in mental health treatment.

But Israel favors the technique over psychiatric drugs that he says make students too drowsy to learn and says most critics "have never seen children who have blinded themselves, or banged their head to the point of brain injury, or bit a hole in their cheek."

Israel developed a device he calls a graduated electronic decelerator. It's carried in backpacks students at his school wear, and elicits shocks through electrodes strapped on their arms and legs.

"The beauty of it is there's no side effects," Israel said. "It's a temporary painful experience for two seconds."

His school's techniques are the subject of a bill pending in the Massachusetts Legislature and complaints including a lawsuit by a New York mother who says the shocks traumatized her now 18-year-old son.

The device used on Bradley Bernstein is a cattle prod. It used to be a long electrified rod, but the newer model is a handheld shocker about the size of a portable phone, with two short metal prongs.

Fran Bernstein, his mother, says it delivers a shock about as painful as a bee sting. Critics say it's considerably stronger, akin to sticking a finger in an electric socket.

Often just seeing the device was enough to make Bradley stop hurting himself, Mrs. Bernstein said.

Bradley Bernstein only says a few words and sometimes hurts himself in frustration or opposition to his caretakers' demands, his mother said. He is allergic to several drugs that could calm his behavior, she said.

The Bernsteins are fighting a Cook County judge's March 2 ruling that said Bradley's shock treatment violates an amendment to state law passed last May.

"Now we're not going to be able to control him and we don't know what's going to happen," said Mrs. Bernstein, of suburban Lincolnshire, Ill.

A therapist recommended the shocks when Bradley was a boy and he got the treatment routinely in group homes where he lived until the state law was enacted last year, his mother said.

Specialists at Trinity Services Inc., which took over the agency that used to care for Bradley, oppose shock treatment and helped change the law so it and other painful techniques are banned from group homes.

"This is something that our professional staff doesn't believe is ethical," said Trinity's president, Art Dykstra.

Bradley Bernstein is the only group home patient in Illinois known to have received shock treatment in recent years. His parents agreed to a compromise to gradually stop the treatment, but sued when Trinity officials abruptly stopped it after the law changed, according to the their attorney, Robert O'Donnell.

The judge's recent ruling said the change in Illinois law makes the Bernsteins' complaint moot. O'Donnell is appealing and has enlisted Matthew Israel to help evaluate Bradley and determine whether his shock treatment should resume.[...]

Trinity officials dispute the Bernsteins' claim that their son's behavior has grown worse without the shocks. [...]

Investigators Zero In on Pill Pushing Doctors

Another Excellent Article by Evelyn Pringle

The number one goal of drug makers in dispatching sales representatives to meet with doctors face-to-face is to increase sales by convincing doctors to prescribe drugs off-label for unapproved uses, by saying whatever it takes to achieve that goal.

A May 2006, study titled, "Turning Medicine Into Snake Oil," analyzed FDA warning letters sent to drug companies between 2001 and 2005, and found inaccurate statements made by sales reps in meetings with doctors to be the 4th most common source of false or misleading information used in pharmaceutical marketing.

Almost all of the statements were discovered by FDA representatives asking questions of sales reps at conferences, an activity the FDA says, it lacks the resources to do comprehensively. Most troubling, the study found, was that nearly all of the promotional activity between sales reps and doctors occurs without scrutiny by any regulators.

Critics say, these face-to-face meetings lead to bizarre prescribing habits. Knight-Ridder did an investigation into the off-label prescribing habits of doctors in 2003, and found high blood-pressure drugs prescribed for anxiety and headaches and epilepsy drugs prescribed for depression, weight loss, and hot flashes. The investigation also found doctors prescribing antidepressants to treat premature ejaculation and pain, and antipsychotics doled out for insomnia and attention deficit disorder.

It's gotten to the point where Big Pharma has manipulated doctors into prescribing drugs to everybody. According to Dr Marcia Angell, former editor of the New England Journal of Medicine, and author of, "The Truth About the Drug Companies", "What the drug companies are doing now is promoting drugs for long-term use to essentially healthy people.

"Why?" she says. "Because it is the biggest market."

According to attorney, Mark Labaton, of Kreindler & Kreindler, with offices in New York and LA, who handles consumer fraud cases, "off-label promotion of drugs is a form of quackery that victimizes vulnerable individuals who take these drugs with serious and dangerous side effects for purposes never intended."

The situation has gotten so bad in Pennsylvania, that the state's Department of Aging hired an "unsales" force to counter the effects of the false information provided to doctors by drug company sales reps, according to the March 13, 2006, Wall Street Journal.

The "unsales" representatives visit doctors much like drug company reps do to educate doctors about the evidence relating to all treatments, in an effort to shift prescribing patterns to older and cheaper drugs that are just as effective as the new ones.

One of the more recent busts was announced on December 19, 2006, when "The Statesman," reported that Dr E Wayne Sanders, the number one prescriber in California of the antipsychotic, Seroquel, marketed by AstraZeneca, is facing accusations by the state Medical Board of more than a dozen offenses as a result of an FDA sting operation.

According to the Medical Board, in 2003, an undercover agent posing as a mentally ill, patient sought medication from Dr Sanders and he diagnosed the agent, called JZ, with paranoid schizophrenia and asthma, without examining him.

"The suspected offenses," the Statesman reports, "include treating patients without examining them; improperly dispensing prescription drugs; allowing unlicensed staff to perform physician duties; falsely billing Medi-Cal; and mixing patient funds with his own," according to the 51-page accusation, filed on September 29, 2006.

The Board found pharmaceutical sales reps had improper access to Dr Sanders' patients and their records. One sales rep driving a car registered to Zyprexa maker, Eli Lilly, spent several hours looking though boxes of patient records, in violation of patient privacy rules.

Dr Sanders reportedly gave JZ free samples and billed Medi-Cal for the drugs, and during follow-up visits, he gave JZ fewer pills or switched his medication completely. When JZ asked to pick up his prescription at a pharmacy, Dr Sanders' assistant refused the request.

During his undercover investigation, JZ observed Dr Sanders and his assistants, handing out drugs to patients with little interaction, and in one case giving drugs to a patient without checking her chart or asking her name. Another time, he observed one assistant tell a patient to go in a cabinet and get the drugs himself.

In 2006, almost half of Seroquel sales were off-label, according to Datamonitor Plc, a marketing research firm, and Bloomberg.com reports that sales of the drug increased 24% in 2006 to $3.4 billion last year.

Sales to elderly patients even increased after the FDA warned against using the drug with seniors based on an analysis of 17 studies that found that elderly people who took the drug had a death rate almost two times higher than those who did not, and required the drug maker to add a black box warning to the label about the increased risk of death.

In another blatant case of off-label drug pushing, on April 5, 2006, the FDA indicted Maryland psychiatrist, Dr Peter Gleason, who traveled all over the country for Jazz Pharmaceuticals promoting the narcolepsy drug, Xyrem, for off-label uses.

According to the FBI, Dr Gleason was prescribing the drug to about 100 of his own patients for off-label conditions like depression and insomnia, so Jazz asked him to give speeches to other doctors.

The government actually began the investigation a year earlier in 2005, acting on a tip from a whistleblower, according to an affidavit by Darren Petri, a criminal investigator for the FDA, in the case titled, US v Gleason, Cr No 06-229 (EDNY April 5, 2006).

The affidavit claims that a witness taped Dr Gleason saying the drug was even safe for children. In one speech quoted in the indictment, he told doctors that "table salt is more dangerous," than Xyrem, and the FBI likened him to a "carnival snake-oil salesman."

Dr Gleason reportedly was making as much as $3,000 a day off Jazz, and was paid $450 for a face-to-face meeting in a doctor's office, $750 to speak at a luncheon, and $1,500 for a dinner speech. According to the New York Times, he even gave up his medical practice, in order to devote all his time to "hawking" the $600-a-month drug.

The indictment charges Dr Gleason with four counts related to off-label promotion and fraud on an insurance plan. Specifically, he is alleged to have advised physicians to conceal the non-reimbursable off-label uses of Xyrem. The insurance forms were required to list the diagnosis, but Dr Gleason told doctors to leave that part blank, claiming that no diagnosis was required and that most prescriptions would be paid without further scrutiny.

According to the indictment, if an insurance company challenged a prescription, he told doctors to give a secondary code that was off-label but close enough to the approved indication so the prescription would be paid for.

Attorney, Barry Turner, a professor on medical ethics in the UK, says there are hundreds more doctors like Dr Gleason in the US. "Sheer greed motivates this practice," he says, "the same greed that motivates all fraud and theft."

He points out that Big Pharma pays for thousands of speeches by doctors each year because companies can not legally promote off-label uses. So in other words, the law allows drug makers to hire doctors to do the dirty work that would be illegal for the company itself. In 2004, doctors spoke at 237,000 meetings sponsored by drug companies, up from 66,000 in 1999, according to the July 15, 2005, Wall Street Journal.

World-renowned psychotropic drug expert, psychiatrist, Dr Peter Breggin, the author of many books including, "Toxic Psychiatry," is furious with doctors who engage in off-label prescribing of psychiatric drugs cocktails, with no evidence of efficacy or safety, and especially when its done to children.

"Psychiatry," he says, "treats people as if they are broken mechanical devices that can be tinkered with by a person who knows much less about the brain than the average mechanic knows about your car."

"The greatest child abuse of our time," he states, "is the mass drugging of our children."

"And the worst child abusers," Dr Breggin says, "are my colleagues in psychiatry who have led the way."

Psychiatrist accused of misconduct - Arthur Schramm's license at risk due to alleged sex photos of patients, more.

As seen in the Dayton Daily News

A longtime local psychiatrist could lose his medical license Wednesday on allegations he took sexually suggestive photos of patients, prescribed painkillers to an admitted heroin addict and committed other acts of "professional misconduct and neglect."

The case before the State Medical Board of Ohio surrounding Dr. Arthur R. Schramm, 68, involves three patients, at least two of them exotic dancers he befriended at local strip clubs, according to medical board records.

Acting on a complaint, a board investigation found Schramm entered into doctor-patient relationships with the two dancers in 2004 after establishing personal relationships that included lap dances, taking sexually suggestive photos of the women and hiring one for help at his Brookville home and for clerical duties in his office at 130 W. Second St. in Dayton.

The board also says Schramm:

• Continued to hire at least one of the dancers for lap dances after he became her doctor.

• Prescribed painkillers and other drugs that could have triggered a relapse or worsened the addictions of drug-addicted patients.

• Failed to properly treat the patients for various mental and physical maladies.

• Failed to report one household to Children's Services despite an 8-month-old boy living there with parents who were addicted to heroin and cocaine.

"The hearing examiner has proposed permanent revocation of Dr. Schramm's license," medical board spokeswoman Joan Wehrle said.

Schramm, a specialist in child and adolescent psychiatry, could not be reached for comment. He has practiced in Dayton for nearly 40 years with no previous trouble with the medical board.

"Dr. Schramm has made some mistakes recently and the state is overreacting in seeking to permanently revoke his medical license," his attorney, Todd Morman, said.

According to the medical board's report, Schramm is semi-retired, holds no hospital staff privileges and sees about 1,400 patients a year. In 2003, prior to meeting the dancers, he experienced a stroke, hip replacement and the death of his wife.

"I felt that I was able to keep a close eye on what was happening between me and the patient, and a few things went further than they should, I think," he told board officials.

Electroconvulsive Therapy Causes Permanent Amnesia And Cognitive Deficits, Prominent Researcher Admits

As seen at the Virtual Psych Center Website (typically a pro psychiatry website)

Abstract

In a stunning reversal, an article in the journal Neuropsychopharmacology in January 2007 by prominent researcher Harold Sackeim of Columbia University reveals that electroconvulsive therapy (ECT) causes permanent amnesia and permanent deficits in cognitive abilities, which affect individuals' ability to function.

"This study provides the first evidence in a large, prospective sample that adverse cognitive effects can persist for an extended period, and that they characterize routine treatment with ECT in community settings," the study notes.

Complete Article

For the past 25 years, ECT patients were told by Sackeim, the nation's top ECT researcher, that the controversial treatment doesn't cause permanent amnesia and, in fact, improves memory and increases intelligence. Psychologist Sackeim also taught a generation of ECT practitioners that permanent amnesia from ECT is so rare that it could not be studied. He asserted that most people who said the treatment erased years of memory were mentally ill and thus not credible.

The National Institute of Mental Health (NIMH) estimates that more than 3 million people have received ECT over the past generation. "Those patients who reported permanent adverse effects on cognition have now had their experiences validated," said Linda Andre, head of the Committee for Truth in Psychiatry, a national organization of ECT recipients.

Since the mid-1980s, Sackeim worked as a consultant to the ECT device manufacturer Mecta Corp. He never revealed his financial interest in ECT to NIMH, as required by federal law, and, until 2002, did not reveal it to New York officials as required by state law. Neuropsychopharmacology has endured negative publicity over its failure to disclose financial conflicts of journal authors, resulting in the editor's resignation and a promise to disclose such conflicts in the future; yet there is no disclosure of Sackeim's long-term relationship with Mecta, nor did Sackeim disclose his financial conflict when his NIMH grant was renewed to 2009 at approximately $500,000 per year.

The six-month study followed about 250 patients in New York City hospitals, an unusually large number; most ECT studies are based on 20 to 30 patients. Sackeim's previously published studies were short term, making it impossible to assess long-term effects. "However, in other contexts over the years -- court depositions, communications with mental health officials, and grant protocols -- Sackeim has claimed to follow up patients for as long as five years. This raises serious questions as to how long he has actually known of the existence and prevalence of permanent amnesia and why it wasn't revealed until now," Andre said.

Besides finding that ECT routinely causes substantial and permanent amnesia, the study contradicts Sackeim's oft-published statements that ECT increases intelligence and that patients who report permanent adverse effects are mentally ill.

"The study is a stunning self-repudiation of a 25-year career," Andre said.

(Source: Neuropsychopharmacology : Columbia University : January 2007.)

Utah Anti-Ritalin Bill signed - Law bars schools from strong-arming parents to put kids on psychotropics

As reported in the Salt Lake Tribune

The fourth time was the charm for the so-called "Ritalin bill," signed into law Friday by Gov. Jon Huntsman Jr.

The new law bars schools from forcing parents to put their kids on psychotropic drugs such as Ritalin. The law is the first of its kind in the nation, said Madeline Kriescher, a health policy associate at the National Conference for State Legislatures.

"Utah is pretty much on the forefront of doing that sort of thing," she said. "But New York has a bill right now that's similar in language."

Huntsman had vetoed similar legislation in 2005 and the 2002 and 2006 versions never made it to the governor's desk. This year's measure was virtually identical to the 2006 version, which had added language to clarify topics teachers may discuss with parents, and eliminated phrases banning school personnel from recommending psychological evaluations.

The Utah Board of Education opposed the legislation and urged Huntsman to veto the bill. Members said the board already has a rule prohibiting teachers from pushing medications and worry that replicating it with a law singling out psychiatric drugs would chill communication between teachers and parents.

It was those concerns that drove Huntsman's 2005 veto.

"This is a great bill. There are way too many kids on psychotropic drugs," said the Senate sponsor, Sen. Chris Buttars, R-West Jordan.

The reason for the bill's success this year is simple, Buttars said. "The governor told us the problems he had with the bill and we corrected them and he signed it."

More than 100 lines of text in the new law outline what teachers may and may not say to parents regarding children's behavior and possible psychiatric solutions. It says school personnel can't keep kids out of school or report parents for child abuse simply because parents refuse psychotropic medications.

No teacher who reads the law, Buttars maintains, would fear repercussions from discussing a student's needs with parents. Buttars said the law allows teachers to recommend a professional evaluation for a child, but not medication. "They can't say, 'We think he should be on Ritalin.' ”

Though supporters of the law cite anecdotes of school personnel strong-arming parents to drug their kids, numerous state and national officials say they've not heard a single such case.

Mad as hell - Angry activists say treatment for mental illness is too often more about the pills than the person

The advance of the Psychiatric Rights Movement - Putting Psychiatry under the microscope, as seen in this report. A step in the right direction, but more progress needs to be made

Geoffrey Reaume was 21 when he headed for the Dominican Republic with a youth group and a secret.

It was the summer of 1983. For seven years, Reaume had been taking chlorpromazine, a drug prescribed to people diagnosed with schizophrenia. For seven years, he had also endured the drug's side effects.

"I was zonked out, tired all the time" he recalls. "People were always asking if I just got back from Florida because the skin on my face was all red."

Silenced by the stigma associated with any diagnosis of mental illness, Reaume, who now teaches at York University, couldn't bring himself to tell anyone what he was going through. "I was scared but I wanted to try to wean myself off the drug," he recalls.

Slowly but surely he succeeded. "When I came back and told my doctor, to his credit, he came round his desk and shook my hand."

Reaume's agonizingly solitary ordeal is typical of most of his generation facing a psychiatric diagnosis. But a new century has bred a group of young people openly supporting each other in a bid to consolidate their strengths.

They are determined to erase the stigma faced by those branded as mentally ill. And in much the same way as the gay movement gained empowerment by embracing the queer epithet, they are building a growing community and identity.

Psych rights. Nutters with attitude. Welcome to the madness, they say. Embrace it. Learn from it.

"I'm proud to identify myself as mad," says Jeremiah Bach, 25, a veteran member of the inter-university Mad Students Society and a community service worker with Sound Times, a Toronto-based group that helps people who use or have used the mental health system.

Like the movement itself, Sound Times embraces both those who count themselves as consumers of mental health services and psychiatric survivors, who believe the system does more harm than good.

"The queer identity is a good parallel," says Bach, who also is taking a post-graduate course in critical disabilities studies at York University.

"We're reclaiming an identity. It's empowering for a fragile community."

It's still not easy to be different. But more possibilities and opportunities are out there, starting with the most "Ivied" of the so-called Ivy Leagues. Consider:

• Reaume today teaches a post-graduate course in "Mad People's History" at York and is one of the organizers of the Psychiatric Survivor Archives of Toronto.
• Yale University researcher Charles Barber talks to medical schools across the U.S. about his own experiences with obsessive-compulsive disorder and the importance of peer support in his work in New York City homeless shelters.
• A proposed University of Toronto endowment will fund research into homelessness and anti-psychiatry, the belief that communities pulling together do far more good than drug companies and psychiatrists pushing electroshock and pills.
• In May, British Columbia will play host to a summit held by the International Network of Treatment Alternatives for Recovery, a group of world psychiatrists, people who have experienced psychiatric treatment and others.
• On campuses across the country, the Mad Students Society works to empower and mobilize, helping tear down barriers to education and offer a range of perspectives on life.

Bach was among the first to champion the proposed U of T scholarship for research into anti-psychiatry and solutions to homelessness.

It is the brainchild of Bonnie Burstow, a senior lecturer at U of T's Ontario Institute for Studies in Education. Burstow, who is still very much alive, has included the endowment in her will. It also stipulates that scholarship priority be given to students who identify as psychiatric survivors and/or those who have experienced repeated bouts of homelessness, too often a side effect of society's attitude to anyone who views the world from a dramatically different perspective from the mainstream.

"This is about empowerment," she says. "I've been involved all my life with disenfranchised communities. You get to your 60s and you start thinking: `How do I do something that will continue to have meaning?'"

In a culture where universities are heavily endowed by big business, including pharmaceutical giants, the idea definitely has meaning for Bach and his peers.

Seven years ago, U of T and its affiliate the Centre for Addiction and Mental Health (CAMH) rescinded a high-profile job offer to a British psychiatrist after he gave a speech in Toronto warning that Prozac could increase the risk of suicide for some people. Prozac is manufactured by Eli Lilly, which provided funds to build a multi-million-dollar learning centre at CAMH.

After some very public legal wrangling, the psychiatrist, Cardiff University professor David Healy, and U of T buried the hatchet.

Healy, author of Let Them Eat Prozac, continues to question the mainstream in his books. "There's certainly plenty to research there," he emailed this week on learning of Burstow's anti-psychiatry scholarship plan. "In principle, I'm all in favour."

And Harvard-educated psychiatrist Peter Breggin, who also has broken with the majority of his peers by speaking out against drugs, calls the endowment "a significant step. Until now, psychiatry has been the only major discipline not subjected to serious scrutiny. It has been unwilling to accept criticism from within or without."

Ironically, news of Burstow's proposal comes as Eli Lilly has been in court in the U.S. defending itself against charges that it has spent 10 years knowingly playing down the health risks of Zyprexa, its latest best-selling medication for schizophrenia.

A series by New York Times reporter Alex Berenson says hundreds of internal documents show Lilly executives held back information about Zyprexa's links to obesity and its tendency to raise blood sugar, risk factors for diabetes.

Lilly has already agreed to pay more than $1 billion (U.S.) to settle suits by thousands of people who claimed they developed diabetes or other medical problems after taking Zyprexa. But the company also says the Times documents show "selective and distorted information" and adds it "looks forward" to telling "the complete story."

The story for clients taking Zyprexa or any other drug is between them and their doctor, says David Goldbloom, chief medical adviser at CAMH.

The relationship between psychiatrists and their clients should be a "collaborative discourse, a leveraging of the experience of physician and patient," he says. "For individuals, generalized statements and studies and percentages are not what's important. What's important is how they themselves feel."

Goldbloom says he's concerned about the amount of "unfiltered information" the public is exposed to through the Internet.

He points out that psychiatry is by no means the only medical field in which the public sometimes disagrees with prescribed treatments. And he takes exception to anti-psychiatry's approach.

"I'm not saying bad treatment doesn't happen but to say all treatments are toxic and all psychiatry abusive is unfair," he says.

Jim Gottstein, the Anchorage-based co-founder of the Law Project for Psychiatric Rights and one of the lawyers facing Eli Lilly in the Zyprexa case, calls Burstow's endowment for more study into the subject "terrific, ground-breaking.

"I'm not a fan of the term `anti-psychatry,'" Gottstein says.

"I prefer the term `psych rights,' but I do think the public is realizing that the psychiatric establishment has not told the truth about drugs and mental illness.

"There's starting to be a lot of scientific evidence for what psychiatric survivors have been saying for years."

No one can deny the damage of the past, says Chris Summerville, interim chief of the Schizophrenia Society of Canada. "Today we know how harmful certain drugs and treatments were."

Summerville argues that newer medications "are helping people get better." But he also believes it is community and peer support that sustains recovery. "We've gone from the biomedical model to the bio-psychosocial-spiritual-recovery-empowerment model."

Meanwhile, Geoffrey Reaume takes heart from young people like Jeremiah Bach and the Mad Students Society.

"I wish they'd been there when I was going to school," he says. "It might have made things a lot easier."

Suit urges state to overhaul prisons - Group says mentally ill held in poor conditions

Hundreds of seriously mentally ill prisoners are held in cells 23 hours a day in inhumane conditions that have led to self-mutilation, the swallowing of razor blades, and at least seven suicides since November 2004, an advocacy group alleged yesterday in a federal lawsuit demanding that the inmates be housed in special treatment units.

The Disability Law Center, a nonprofit organization that provides legal help for the disabled, sued the state Department of Correction in US District Court in Boston after a yearlong investigation during which the advocates questioned more than 220 inmates in segregation units at two maximum-security prisons, Souza-Baranowski Correctional Center and MCI-Cedar Junction.

In in-depth follow-up interviews, the advocacy group found that at least two dozen of the 220 segregated inmates displayed signs of mental illness. Extrapolating those numbers, the advocates estimated that hundreds of prisoners in the state with mental health issues are confined in such units, the group said, which is demoralizing for any inmate but exceeds "the limit of human endurance" for those with psychological problems.

The suit, similar to legal challenges that have led to changes in other states, says Massachusetts has ignored repeated calls from its mental health providers and consultants to stop segregating mentally ill prisoners. The suit demands that the state build maximum-security residential treatment units.

"The system is broken," Stanley J. Eichner , executive director of the Disability Law Center, said at a press conference where he and advocates for prisoners displayed graphic photographs of a mentally ill inmate at Cedar Junction who had repeatedly slashed his neck, torso, and arms while in segregation.

"We are not saying these prisoners are folks without [criminal] records," said Eichner, who interviewed the inmates, some of whom were violent felons, over three days in November. "What we are saying is that prisoners should not be driven to the point of mutilation and self-destruction."

Putting such prisoners in segregation units, the advocates say, violates the constitutional prohibition against cruel and unusual punishment and should be banned. The Disability Law Center also said the segregation of mentally ill inmates violates federal statutes, including the Americans with Disabilities Act.

The Department of Correction said in a statement that it does not comment on pending litigation. However, the department said it was "well aware of the national trend of the increasing number of prisoners with mental illness" and that it had begun taking steps to reduce the risk of suicide for the state's nearly 11,000 inmates.

On Feb. 22, an independent study of Massachusetts prisons, requested by the Correction Department after a sharp increase in suicides in 2005 and 2006, concluded that prison policies and practices had contributed to the problem.

In addition to criticizing the condition of segregation, the report found that staff lacked adequate suicide-prevention training, did not check frequently enough on inmates at risk of suicide, and isolated inmates on suicide watches by denying visits, showers, phone calls, and time outside cells.

The study done for the state by Lindsay M. Hayes, a national specialist in prison suicide prevention, had 29 recommendations, including increasing monitoring of suicidal inmates, adding training for staff, and improving mental health treatment. The Department of Correction immediately said it would comply with the recommendations and was seeking bids for a private contractor to improve mental health treatment. But the department gave no indication it intended to stop segregating the mentally ill.

"It's a response, but we feel that it's an inadequate response," Leslie Walker, director of Massachusetts Correctional Legal Services, said yesterday at the news conference at the law firm of Bingham McCutchen , which is representing the advocates pro bono. Several of the advocates said they believe the state commissioned the study because it knew the Disability Law Center was gearing up for a suit.

The suit describes 18 mentally ill prisoners, identified only by letters, who engaged in self-destructive behavior while in segregation units. Nine medium- and maximum-security prisons in Massachusetts have such units. About 500 prisoners are held in such cells across the state, the suit said.

In Massachusetts, the suit says, cells in segregation units often have minimal furnishings, little if any natural light, and solid doors with a narrow slot used to deliver food. Inmates are allowed out only an hour a day to exercise, and some are so depressed that they decline to do so, the suit said. The units hold prisoners who have committed serious disciplinary infractions, threaten security, or are in protective custody. Lengths of stay vary from days to years.

The only inmate whose name was released yesterday was Andrew Armstrong , 22, an inmate at Souza-Baranowski in Shirley who hanged himself in October 2005 from the bars of his cell window. On a desk in his cell, he had written in soap, "Dust in the wind."

Armstrong had a history of bipolar disorder and had been placed in segregation because of a fight with another prisoner while in a paranoid state, the suit said. He complained about cameras and listening devices in his cell. As with other mentally ill inmates, his erratic behavior and agitation had prompted prison officials to shuttle him multiple times between the prison and Bridgewater State Hospital.

"Did no one realize what was going on?" his aunt, Frances Armstrong of Cheslea, wrote in a letter that Walker read aloud. "Did they not understand this 22-year-old was on a fast-moving ride to the depths of hell?"

The suit described other inmates who injured themselves swallowing razor blades, batteries, and parts of eyeglasses. Another bruised his head by banging it against the wall, and another smeared feces over his body. Several had a history of hallucinations, including one who complained of seeing demons.

The advocates said in the suit that they want the state to build residential treatment units for inmates with mental disorders and provide at least 15 hours a week of therapy out of their cells as well as 10 hours a week for recreation and showers. The advocates had no estimate for the cost of building such units. They also want independent mental health professionals to screen inmates to ensure that mentally ill prisoners are not placed in segregated units and to operate treatment units.

Dr. Stuart Grassian, a Newton psychiatrist who has studied the effect of solitary confinement on inmates for more than 25 years, said the US Supreme Court noted in an 1890 decision that even healthy prisoners often become confused, hallucinatory, psychotic, and agitated in such conditions.

"Now if you take someone who is already mentally ill and put them in an environment that is supposed to be painful psychologically, what do you expect?" he said.

Since 1995, federal courts have ruled in at least six states -- California, Connecticut, Indiana, Ohio, New Mexico, and Wisconsin -- that seriously mentally ill prisoners must be removed from segregation units, said David Fathi of the ACLU National Prison Project in Washington.

"So, this Massachusetts case is really building on a body of unanimous case law that says you simply cannot house mentally ill prisoners in conditions of extreme isolation," he said.

Rhode Island Suspends License of Psychiatrist

Reported by the Boston Globe

A Providence, Rhode Island psychiatrist has been suspended by the state for allegedly prescribing a narcotic to his wife and then trying to deceive state investigators.

Doctor Lorin Mimless will lose his license to practice medicine for at least a year.

Doctor Robert Crausman, chief administrative officer of the state Board of Medical Licensure and Discipline, says Mimless' prescription to his wife was ethically questionable but the main reason for the suspension is that Mimless lied to the board and fabricated medical records.

Mimless' lawyer says no patients were ever put in danger by his client's actions.

The American Medical Association's ethics guidelines prohibit a doctor from prescribing medication to relatives except in emergencies. The state ruled that the Mimless' care of his wife violated accepted practice in psychiatry.

Antidepressants linked to sleep disorder that causes dreamers to act out their dreams

As seen in the News Sentinel

Living out your dream is one thing.

But acting out your dreams when you're still asleep?

Ouch!

People who do that have REM behavior disorder, and it's potentially dangerous.

"I once had someone who choked his wife until she was almost blue. He was dreaming he was choking a burglar," said Ann Romaker, director of the Sleep Disorders Center at St. Luke's Hospital.

It's also a disorder that researchers suspect may be on the rise as one of the odder and rarer side effects of the broad use of antidepressant medications.

"It's actually not that surprising, knowing what these medications do chemically in the brain," said psychiatrist R. Robert Auger of the class of antidepressants that includes Effexor, Prozac, Zoloft, Paxil and other serotonin reuptake inhibitors.

Auger, a sleep researcher at the Mayo Clinic in Rochester, Minn., presented findings on the link between antidepressants and REM behavior disorder last summer at a meeting of sleep researchers. But his work is also part of a broadening interest in a sleep disorder once thought to be an irksome curiosity.

Scientists, for example, have long known that some people who have Parkinson's disease may also suffer REM behavior disorder, acting out their dreams in their sleep, sometimes falling out of bed.

More and more, researchers are coming to believe that, for a small percentage of people, the sleep disorder may also be one of the earlier signs of a Parkinson's disease that has yet to develop. Some studies show that more than 10 to 25 percent of people with REM behavior disorder later develop Parkinson's or some other neurodegenerative disease. Researchers caution that the connection is anything but certain.

"I don't think we need to frighten people," Romaker of St. Luke's said. "I have been dealing with this for 18 years, and most of my patients never go on to develop anything else."

Sleep experts have known about the REM behavior disorder for years.

Auger called it a relatively rare phenomenon. About 0.5 percent of people have it. More than 90 percent of cases occur in men older than 50. But, possibly because of the rise in antidepressant use, younger men, women and children have begun to complain of the disorder.

"We had a 10-year-old boy who had had terrible REM behavior disorder," said Mark Mahowald, a leading researcher on the disorder at the Minnesota Regional Sleep Disorder Center in Minneapolis. "He was being given Effexor for some nondescript learning disorder and was falling out of bed constantly. When you see a 10-year-old boy with REM behavior disorder, you can bet that the first 10 causes are antidepressants, anti depressants, anti depressants."

REM sleep, or rapid-eye movement sleep, is the time in the sleep cycle when people have their most robust dreams. During REM - unlike other periods in the sleep cycle - the brain normally paralyzes the skeletal muscles so that body doesn't run around while sleeping. But this doesn't happen in REM behavior disorder.

Scientists don't know the exact mechanism, but they suspect antidepressants are acting on neurochemicals in the brain stem that typically cause what's known as REM sleep paralysis or atonia. People who later go on to develop Parkinson's may be getting REM behavior disorder early because certain cells in the brain have begun to deteriorate.

REM behavior disorder usually comes to the attention of physicians only after someone has tossed himself out of bed during an active or violent dream or, more common, after inadvertently assaulting a sleeping spouse.

"One of my patients was hitting his wife in the night, and he didn't know it," Romaker said. "They came to me in their 80s. This had been going on for years. His poor wife had never told him until she had a black eye. She didn't want to hurt his feelings. She worried it was due to some repressed feelings he had never told her about."

The range of behaviors is as vast as dreams themselves.

"It can be as simple as someone who sits up at night and turns pages because they're dreaming they're reading a book," Romaker said. "I had one gentleman who thought he was fishing. He was gutting a fish, and he was trying to gut his wife. It was fortunate he didn't actually have anything sharp."

Other patients have hurled themselves from their beds while dreaming of swimming or diving. One of Romaker's patients punched his wife during a dream about fighting a schoolyard bully.

Bob Whitman, director of the Sleep Disorders Center at the University of Kansas Hospital, had one patient who was so tired of getting up and bumping into furniture during her dreams, "she would tie herself to the bed," he said. "She had done this for several years so she wouldn't get out."

"Their behavior is completely consistent with the dream," Romaker said. Unlike patients who sleep walk or have night terrors, which don't occur during REM sleep, patients with REM behavior disorder are much easier to wake.

It's unclear how many women have REM behavior disorder. Romaker suspects that it's vastly under diagnosed simply because women may not have dreams that are as violent or active as men's.

Fortunately, REM behavior disorder tends to be treated easily, typically with a prescription tranquilizer such as clonazepam. Those who suffer REM behavior disorder because of antidepressants can often be switched to another antidepressant such Wellbutrin, which does not appear to trigger the disorder.

"I don't think its any reason to fear taking antidepressants," Auger of the Mayo Clinic said. "I just think it's something people need to be aware of."

Activists take on Eli Lilly over off-label sale of Zyprexa

Another excellent column by Evelyn Pringle

On February 23, a new grassroots advocacy group issued a press release to rally support for attorney Jim Gottstein in his legal battle with Eli Lilly over his role in providing secret company documents, obtained in litigation, to the media to alert the public about the health risks associated with Zyprexa that were kept hidden since the mid-90s.

In turning the document over to the press, Mr. Gottstein’s goal was also to alert the public about Lilly’s illegal off-label marketing schemes aimed at getting doctors to prescribe Zyprexa, a drug the FDA approved only for adult patients with schizophrenia or bipolar disorder, to patients of all ages for uses that were not approved as safe and effective.

Although a doctor may prescribe a drug for an unapproved use, it is illegal for Lilly to promote Zyprexa for an off-label use. The illegal marketing in this case includes influencing doctors to prescribe the drug to millions of consumers for conditions not listed on the label, prescribing Zyprexa in combination with other drugs or for a longer duration than recommended, and prescribing a drug for children that was only approved for adults.

Activists say most consumers are not even aware that it is legal for a doctor to prescribe a drug for an off-label use and take for granted that a prescribed drug picked up at a pharmacy is approved to treat their condition and their children’s.

The recent overdose death of 4-year-old, Rebecca Riley, in Massachusetts, demonstrates the dire need to educate the public about the practice of prescribing drugs for unapproved uses and the dangers of prescribing drugs like Zyprexa to children.

At the age of 2½, Rebecca was diagnosed with attention deficit disorder and bipolar disorder and was prescribed Zyprexa’s atypical cousin, Seroquel, along with Clonidine, an adult high blood pressure drug, and Depakote, a drug approved to treat adults with epilepsy. None of these drugs were approved for children and they were prescribed in a combination that has never been tested even on adults.

From age 2 on, Rebecca remained on this daily drug off-label concoction until she was found dead on the floor in her parent’s home on December 13, 2006. The autopsy report stated that she died of the “combined effects” of the drugs and that her lungs and heart were damaged by “prolonged abuse of these prescription drugs, rather than one incident.”

Experts say, this case reinforces the assertion that judges have got to quit giving drug makers court orders allowing the sealing of documents that show the side effects of drugs and the illegal conduct of promoting the sale of drugs for unapproved uses.

With the Zyprexa documents, as soon as The New York Times began running articles about Lilly’s off-label marketing scheme and the side effects of Zyprexa, Lilly went to court and got the judge in the underlying litigation to issue a permanent injunction against Mr. Gottstein, and other persons who obtained the documents from him, ordering them to return the documents to the court.

However, after a couple months of legal wrangling, the court recognized that it could not restrain the world because the documents were all over the Internet and lifted the part of the injunction that enjoined certain websites from revealing the documents.

One of the documents that Lilly fought to keep secret is a November 12, 1999, letter from a psychiatrist at the Ventura County Behavioral Health Department, Dr. Albert Marrero, to Lilly’s medical director, which describes the blood sugar problems occurring specifically with Zyprexa patients stating, “We have had eight patients out of possibly thirty-five patients on Zyprexa show up with high blood sugars.”

Dr. Marrero further informed Lilly, “Two patients had to be hospitalized due to out of control diabetes . . . We have certainly never seen this with Haldol, Navane, Risperdal and others to this extent.”

And yet, despite this clearly stated notification of these serious adverse events in 1999, Lilly did not revise the labeling on Zyprexa to include a warning about high blood sugar and diabetes until the fall of 2003, and then it was only because the FDA mandated it.

With the health risks of Zyprexa concealed for all that time, doctors were led to believe Lilly sales representatives who said they could safely prescribe Zyprexa and Lilly gained millions of new customers.

With this in mind, the new advocacy group has launched the Just Say ‘Know’ to Prescription Drugs Campaign, with a goal of getting 1 million people to stop and reevaluate the medications they are taking. It is also supporting Mr. Gottstein in his battle with Eli Lilly over the release of the Zyprexa documents.

“If there is a case that dramatically highlights the need to stop blindly taking prescriptions drugs, this is it,” says Dr. Greg Tefft, co-founder of the Just Say “Know” campaign. “We’re talking 20 million people potentially at risk and more being added daily,” he says.

But instead of focusing on Lilly or the judge who suppressed the documents, the campaign says, it will educate the public about off-label prescribing and what consumers can do to protect themselves against unwittingly taking Zyprexa, or other drugs, without knowledge of the side effects or that the drugs are not approved for their condition.

“We are convinced that the way to solve this problem is to work the demand side of the market,” Dr. Tefft said. “We are going directly to consumers and encouraging them to know what they are taking.”

To that end, a Zyprexa radio series, hosted by Dr. Dominick Riccio, chairman of the campaign, and Dr. Laurence Simon provides information to consumers about the drug. The official web site for the campaign is justsayknow.kpncradio.com/

This group has a lofty goal because the off-label sale of Zyprexa has literally been unstoppable so far. Throughout years of litigation, while settling out of court with an estimated 26,000 Zyprexa victims, Lilly has been successful in keeping the company’s off-label marketing schemes sealed under the ruse that they contain trade secrets and confidential information.

Mr. Gottstein obtained the documents from Dr. David Egilman, who had discovered that Lilly had failed to disclose Zyprexa’s link to rapid weight gain, high blood sugar levels, and diabetes, while he was serving as an expert witness in the underlying litigation.

It’s likely that Dr. Egilman also knew that by settling the second batch of Zyprexa lawsuits out of court that Lilly planned to go right on concealing the information.

The men had every reason to believe that the off-label prescribing would continue because even after paying over $1 billion in settlements, Zyprexa was still Lilly’s top-selling product with sales of more than $4 billion in 2006.

The story behind Rebecca Riley’s death, gives a clear picture of how blatant the off-label marketing scams have become. After she died, investigators discovered that her two siblings, ages 6 and 11, were also fed the same three-drug cocktail every day and that the parents were on psychiatric medications as well.

Which means, if not for the disruption by Rebecca’s untimely death, this family represented five steady customers for the “mental health industry,” with 100 percent of the costs for doctor’s visits and prescriptions paid for by public health care programs.

Psychotropic drug expert Dr. Ann Blake Tracy, director of the International Coalition for Drug Awareness and author of “Prozac: Panacea or Pandora?” says, “This is what is referred to as the ‘Family Discount,’ when everyone in the family is drugged.”

And this is the type of tragedy she worries about, Dr. Tracy says. “The parents unable to function, the children acting up and unable to function -- all due to the effects of the drugs.”

She states that she would not be surprised to learn that the mother was on psychiatric drugs while she carried Rebecca, which also may have caused problems for the child.

One of the world’s leading pharmacology experts, former secretary of the British Association for Psychopharmacology, Dr. David Healy, also maintains that there is no justification for giving these drugs a 2-year old and “certainly not for the combinations mentioned here.”

Testing a 2-year old for these mental disorders, he says, cannot be done.

Rebecca’s parents have been charged with first-degree murder for the overdose death of a child, but many legal experts and advocacy groups say the main perpetrator is still on the loose. That being the psychiatrist with the prescription pad, Dr. Kayoko Kifuji of Tufts-New England Medical Center, who diagnosed these kids with bipolar disorder and ADHD, and prescribed the drugs for all three children.

Attorney, Ted Chabasinski, who works on cases involving psychiatric drugs, says he is shocked that the parents are charged with the death, “while the psychiatrist who prescribed the drugs that killed her will probably never be held accountable.”

“The prosecutor makes much of the fact that the parents gave drugs to their daughter that were not approved for use in children,” he points out, “but it is the doctor, not the parents, who is responsible for that.”

Mr. Chabasinski says the drug company executives, and the psychiatrists who collude with them, are criminally responsible for Rebecca’s death. “This is an example,” he states, “of how the drug industry and the psychiatric profession are out of control.”

Houston Attorney Andy Vickery has been representing persons harmed by psychiatric drugs for many years and he also finds this story “appalling.”

He states that the father seems to be a bad actor and he may have purposely overdosed the child, but says, “he isn’t the one that started her on the psychoactive medications and someone needs to do something to hold the prescribing physician accountable.”

David Oaks, director of MindFreedom, an international human rights organization, also believes the psychiatrist should be charged with criminal negligence. “It’s revealing,” he notes, “that the criminal justice system has so far targeted the parents and not the psychiatrist.”

MindFreedom is calling for criminal penalties against physicians for this level of abuse, Mr. Oaks says, because it may be the only way to change their behavior.

Vera Sharav, the director of the Alliance for Human Research Protections, also believes that the only way to stop the prescribing assault on children is to put the professionals who prescribe the toxic drug cocktails on trial in open court. “Let the public bear witness,” she states, “to the proceedings that will demonstrate the absence of scientific-medical evidence to support the widespread misprescribing of harmful drugs for children.”

Kelly Patricia O’Meara, author of, “Psyched Out: How Psychiatry Sells Mental Illness and Pushes Pills That Kill,” says the most important issue raised in the media is the response by the psychiatrist who prescribed the drugs. “Given the known adverse reactions to many of these drugs, and that they are not approved for children,” she also says, “the psychiatrist needs to be held responsible.”

As for the behaviors of family members described in the media, Ms O’Meara says, the prescription drugs they were taking could have caused many of them. “Hostile, violent behavior,” she says, “is a possible side effect of many of the mind-altering drugs.”

Dr. Healy also notes that it is at least possible that some of the alleged behaviors of the parents could be caused by the drugs they were on. As far as drugging the whole Riley family, he says, there is no mental illness that affects entire families.

The off-label drugging of the Riley children is not an isolated incident. None of the atypical drugs are approved for children, yet on May 11, 2006, the Associated Press reported that the number of prescriptions written for children had increased 73 percent over a four-year period, according to Medco Health Solutions, a pharmacy benefits manager.

In addition to Zyprexa, the other atypicals in the same class include Seroquel (AstraZeneca), the drug given to the Riley children, Abilify (Bristol-Myers Squibb), Risperdal (Johnson & Johnson), Geodon (Pfizer), and Clozril (Novartis).

Dr. Timothy Scott, author of, “America Fooled: The Truth about Antidepressants, Antipsychotics and How We’ve Been Deceived,” reports a 2005 study that found there are approximately 30,000 children under the age of 5 on these drugs.

Overall, child neurologist Dr. Fred Baughman, author of “The ADHD Fraud: How Psychiatry Makes ‘Patients’ of Normal Children,” reports that 10 million of the 50 million school children in the nation are on one or more psychiatric drugs and states: “This is death by psychiatry.”

Along with Lilly, many of the above drug makers are currently under investigation by federal and state law enforcement agencies for promoting the atypicals for off-label use. Lawsuits have also been filed to recover the money paid by public health care programs for the actual purchase of the drugs, as well as the cost of medical treatment for patients who developed diabetes and other health problems as a result of taking them.

While Mr. Gottstein and Dr. Egilman may have set themselves up for big trouble by releasing the Zyprexa documents to the press, in light of the harm to the public from off-label prescribing, evidenced well by the Riley case, drastic measures were called for and they obviously believed the risks were worth taking.

According to Dr. Lawrence Diller, a behavioral-developmental pediatrician and author of “The Last Normal Child,” and “A Prescription for Disaster,” “The extensive prescription of these medications for children, without adequate testing for safety and effectiveness in children constitutes a hidden time bomb that could explode with still more casualties.”

“Catastrophic side effects,” he says, “may be rare, but they become predictable when we treat so many children with so many drugs.”

As for Lilly, the company has billions of reasons to keep the documents buried because they prove beyond any doubt that the company knew about the health problems caused by Zyprexa and intentionally kept the information hidden while it influenced doctors to write off-label prescriptions for million of consumers in the name of the almighty dollar.

How Anna Nicole Smith's Shrink Got Her Pink Slip

Normally we don't do celebrity gossip, but you have to wonder about the professional ethics of the former psychiatrist for the now tragically dead Anna Nicole Smith. As seen on Fox 411

Here's a little more info on psychiatrist Khristine Eroshevich, friend of Anna Nicole Smith and a cameo player in the "Entertainment Tonight" video extravaganza of Smith's now-historic red carpet funeral.

Only in Los Angeles do psychiatrists suddenly pop up as best friends of their patients. It's unclear whether or not Eroshevich actually saw Smith as a patient or if she was just a hanger-on who got close to her in her later years.

This much is certain: It's Eroshevich's mug in the "ET" videos of the funeral, and all its tacky preparations. The good doctor happily gave quotes to the TV show, which sources say paid millions to Howard K. Stern for the right to have a landmark ceiling camera hovering over Smith's casket as it was rolled into the Bahamian church.

But back home, Eroshevich isn't all that popular with the other less famous people with whom she used to work.

At the Los Angeles County Employees Retirement Association (LACERA), Eroshevich's professional issues cropped up right away. On July 7, 2006, the doctor was stripped of her job for failing to perform her duties properly.

From the Board of Retirement minutes:

"Recommendation to terminate the services of Board Panel Psychiatrist Khristine Eroshevich, M.D., Ph.D. (Memo dated July 7, 2006):

"Mr. [James] Castranova [the board's legal counsel] gave a brief explanation of the recommendation to terminate Dr. Eroshevich's services. It was noted that on two occasions, Dr. Eroshevich arranged for psychologists to conduct fact-to-face examination of LACERA members, which is a violation of the agreement between LACERA and Dr. Eroshevich, when only Board Certified Physicians are allowed to conduct these examinations.

"A motion was made by Mr. Russin, seconded by Mr. Chery, to approve the recommendation. The Legal Office, at the request of Mr. Russin, will review Dr. Eroshevich's invoices to ensure that charges are proper. The Legal Office will report its findings and any recommendations to the Insurance, Benefits and Legislative Committee. The motion passed with Mr. Macias abstaining."

James Castranova, whom I spoke with yesterday, confirmed that Dr. Eroshevich farmed out her duties to other shrinks in violation of her agreement.

In other words, she was sending unqualified doctors to interview members of LACERA when she was supposed to be doing the work herself.

LACERA spokesman Gregg Rademacher told me it's the first time he can remember that his organization had a physician who farmed out their job to other professionals, only to be caught later.

Calls to Eroshevich at two California offices with answering machines were not returned.

What also remains unclear is whether or not Eroshevich — who seemed to be an expert on Anna Nicole Smith on television — knew of the dead model's drug habits and those of her son, Daniel, and whether she tried to do anything about it.

Psychiatrist case 'totally bizarre'

As seen in this report, which previously escaped our notice:

An eminent Melbourne psychiatrist arrested and charged last week with carrying a loaded handgun into Victoria's busiest court has been refused bail.

In a case he described as "totally bizarre", Magistrate Peter Reardon today found Jerry Gelb, 49, of Armadale, posed an unacceptable risk of committing further offences after police expressed fears for the safety of the public.

Mr Reardon said Dr Gelb's explanations for having the .22 handgun at Melbourne Magistrates Court were implausible.

Dr Gelb, who was arrested on Thursday with his wife Kerry Gelb and their bodyguard David Schmack, said the gun was to be an exhibit in a court application against his ex-wife, who he claimed had taken out a contract on his life.

Sharon Guy, Dr Gelb's former wife, has denied the allegation.

The court heard during his contested bail application this week that Dr Gelb also told police he carried the weapon for personal protection.

The court yesterday heard that Dr Gelb had fortified his Armadale home with security cameras and weapons after he and his wife had been subjected to harassment, extortion attempts and threats by underworld figures.

In refusing bail, Mr Reardon compared Dr Gelb's case to the daytime television soap operas The Bold and The Beautiful and Days of Our Lives.

He said in Melbourne Magistrates Court he had serious reservations that Dr Gelb would comply with bail conditions if released.

Dr Gelb, who shook his head and looked perplexed, was remanded to appear again in April.

His wife and Schmack were granted bail by Mr Reardon last
week.

Defense blames Rebecca’s Riley death on her Psychiatrist; Calls prosecution’s likely argument a ‘sick theory’

As reported in the Patriot Ledger this morning. The prosecutions likely argument is that the parents originally wanted the girl to qualify for dis-ability money from the state. The allegation seems to be that once it was obvious that this was not in the works, that the parents then killed the child through the overdose of ADHD drugs. The other theory, not cited in the story, is that the father, already in trouble for child abuse, etc, used the drugs to try to cover up the abuse in progress. of course, there could have been more than one scenario in play.

A medical malpractice case, and nothing more. That’s the explanation of the lawyer defending a mother accused of killing her 4-year-old daughter in Hull with a prescription drug overdose.

The lawyer said the district attorney will argue the woman and her husband, also accused of murder, killed their daughter because they were unhappy with how much they were getting from the state to help care for the girl, who suffered from bipolar and attention deficit hyperactivity disorders.

The lawyer called that a ‘‘sick theory,’’ and said he would seek release of the mother during a court hearing today.

Carolyn Riley, 32, and Michael Riley, 34, were arrested last month and charged with killing their daughter, Rebecca, at the home in Hull where the family was living.

Boston attorney Michael Bourbeau, who represents Carolyn Riley, yesterday advanced what he said would be a prosecution argument: the Rileys killed Rebecca because they wanted more state money because of her condition.

‘‘It’s a very sick theory,’’ Bourbeau said. ‘‘It’s completely not based on the evidence. If they indict her on this theory, there is something tragically wrong. It should be nothing more than a medical malpractice case.’’

Bourbeau said he feared his client wouldn’t get a fair trial because of publicity that has been generated.

‘‘It’s turned into a media circus and a prosecutorial nightmare,’’ he said. ‘‘What exactly caused her (Rebecca) to die? I don’t know. It wasn’t an intentional overdose.’’

Bourbeau said only two days before Rebecca’s death, her parents bought her dresses.

Bridget Norton-Middleton, a spokeswoman for the Plymouth County District Attorney’s Office, declined comment last night.

The Rileys, who have yet to be indicted, are scheduled for an appearance today in Hingham District Court.

Bourbeau said he planned to argue that Carolyn Riley should be released on bail because of inaccurate information from a police affidavit used to obtain the arrest warrant.

‘‘They drew conclusions that are flat-out wrong,’’ he said.

In an affidavit filed with the court, State Police Trooper Anna Brookes said there was evidence of a ‘‘slow and painful killing of Rebecca Riley over a period of days.’’

Carolyn’s mother, Valerie Berio of Weymouth, said she was stunned when a State Police investigator told her they believed Rebecca was murdered because she was only worth $2 a month in Social Security benefits to her parents.

‘‘I couldn’t believe it,’’ Berio said. ‘‘They said they killed her because she wasn’t worth enough money.’’

Berio said her daughter is a wonderful mother.

‘‘If they would listen to anyone who knows my daughter, there would be no one who could deny the amount of love and patience she has,’’ Berio said. ‘‘She adores her children.’’

The Rileys’ two older children, an 11-year-old son and six-year-old daughter, are now in foster care. Both youngsters had also been diagnosed with bipolar and attention deficit hyperactivity disorders and are receiving federal disability benefits from Supplemental Security Income.

The program provides money to people who are 65 or older, as well as blind or disabled individuals, including children.

Hull police were called to the Rileys’ home at 70 Lynn Ave. in the town’s Kenberma neighborhood at 6:30 a.m. on Dec. 13. Rebecca was already dead as she lay on the floor of her parents’ bedroom.

Prosecutors later called the girl’s death an ‘‘intentional overdose,’’ but have declined to reveal a motive since the couple’s Feb. 5 arrest.

Witnesses told police the Rileys gave their daughter large doses of powerful prescription drugs to keep her quiet and sleeping for long periods of time.

The state medical examiner’s office said Rebecca died from the combined effects of three drugs used to treat bipolar disorder, including clonidine, and two over-the-counter cold medicines.

Dr. Kayoko Kifuji, a Tufts New England Medical Center psychiatrist, had prescribed clonidine for the youngster to treat her for hyperactivity and bipolar disorder. The other two drugs were Depakote and Seroquel, which are also used to treat bipolar disorder.

Rebecca, who attended the Elden H. Johnson Early Childhood Center in North Weymouth, was 28 months old when she was diagnosed.

Attorneys for the Rileys have said they were only following the dosage Kifuji prescribed.

Although Kifuji has since agreed to stop practicing pending a Board of Registration in Medicine investigation, her attorney has said she was innocent of any wrongdoing.

The Rileys were also receiving Social Security benefits for mental disabilities, according to Berio.

Carolyn reportedly had been diagnosed with depression and anxiety while Michael had a bipolar disorder.

Michael Riley was awaiting trial in Norfolk Superior Court on charges of attempted rape of a child under the age of 14, giving pornography to child and four counts of indecent assault and battery on a child when he was arrested for his youngest daughter’s murder.