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OCTOBER 10, 2008

An Open Letter to Senator Charles Grassley (R-Iowa) From a Professor of Psychiatry at Emory University

This week the Chairman of my department at Emory, Charles Nemeroff, M.D., Ph.D., got caught up in a a broo-ha-ha about unreported earnings from outside activities related to giving lectures that were supported by the pharmaceutical industry. This led to his resignation pending the result of an inquiry into the allegations raised by Senator Charles Grassley. Mind you, I am not here to justify Dr. Nemeroff's bad behavior. To not disclose the payment of more than $10,000 a year from a drug company that makes a drug you are also studying with an NIH funded grant is clearly a violation of NIH policy (although not a violation of the law).

Nevertheless, I have some questions for the Senator.

First off, why are you only investigating psychiatrists? [Answer: psychiatrists have an approval rating in medicine that is only above chiropractors. Many people blame paxil for their problems. It is low hanging fruit]

Second, why don't you look at other specialties? Take a look at cafepharma.com, where the drug reps are gossiping in relation to the Nemeroff dispute that "key opinion leaders" for advair are at the front of the gravy train. [Answer: cardiologists make life saving drugs, while psychiatrists are pseudoscientists who are trying to invent a myth about serotonin imbalance so they can help sell drugs for their cronies, the drug companies.] [Answer to answer: Not true. You have to treat 100 heart disease patients with Lipitor to prevent one heart attack, while you treat only 8-17 depressed patients with an antidepressant to prevent a recurrence. And if you don't believe that depression is as bad as a heart attack, ask someone who has been there.]

Ask anyone who works in a university hospital. If their docs have any talent, they are never there. It is because they are always away giving talks for pharma. And pretty much all of it is undisclosed. And pharma is always after the ones who publish the most. They call them "Key Opinion Leaders" or KOL. They are students of anthropology who know that human behavior is such that the herd will follow the "innovators" rather than think for themselves. Even if proven by scientific studies, new treatments that go against the norm are not quickly implemented. This actually appears to be in the nature of general human behavior.

Delay in Adoption of Best Practices























Studies show that there is a small group of innovators that introduce new practices. These people do not communicate necessarily with their community. They are however highly mobile, and network with others.

Early Adopters























The early adaptors are connected with their communities, but they also talk to the innovators. They are the true conduits of knowledge of best practices making their way into practice (1,2).

In spite of the public perception of individual doctors poring over the primary literature and making individual decisions about best practice, this is far from the reality. Doctors follow the opinion of so-called opinion leaders.

Senator Grassley, if you really want to get to the bottom of the corruption that has permeated academic medicine, do a nation wide audit. Of ALL specialties. If you don't, you are a hypocrite.

1. Greenhalgh T, Robert G, MacFarlane G, Bate P, Kyriakidou O. Diffusion of innovations in service organizations: Systematic review and recommendations. The Milbank Quarterly 2004;82(4):581-629.

2. Berwick DM. Disseminating innovations in health care. JAMA 2003;289:1969-1975.

COMMENTS

Bob Fiddaman wrote, Thur 9 Oct 9:31 pm

Doug,

Firstly, thank you for leaving your comment. I would be grateful if you would allow this comment through on your blog as I have allowed yours through.

Quite why you would think Sen. Grassley would read this blog though is a mystery to me?

You are asking 'bloggers' to read Nemeroff's papers, do you think his papers are honest opinions or opinions based on money he has received and not declared from Pharma?

You know the guy personally and I see he stood by your side when you were getting a rough deal from Pharma regarding your work on accutane and depression. It's a pity he didn't give the same support to David Healy don't you think?

Way I see it is Grassley is merely making a start. Rome wasn't built in a day.

Finally, to label people who speak out against Nemeroff as 'children throwing rocks' is rather churlish. We are merely advocates fighting back because many of us were harmed by the very same drugs that Nemeroff has been paid to support. That would be our 'conflict of interest', if you will.

[Editorial Note:Bob Fiddaman has a letter for Dr. Nemeroff on his web site which interested readers can find there]

Bob Fiddaman
Seroxat Sufferers
http://fiddaman.blogspot.com

Bob Fiddaman: I also don't know why Senator Grassley would read my blog, or anyone else for that matter. Sometimes just writing things down makes me feel better.

I apologize if I seem patronizing by saying things like 'children throwing rocks'. I try to educate by entertaining, but sometimes it comes across wrong.

As for the dispute with David Healy I have read about it but I don't know him personally and have no knowledge about the dispute other than what Dr. Healy has written.

As for posting comments on blogs that are 'speaking out' against Nemeroff, I am not aware of any blogs that are doing otherwise, unless it would be drugwonks or something like that, and I don't like reading that blog anyway. I comment all the time on pharmalot.com using my real name, and have seen your comments there if I remember. And I have written articles with Dr. Nemeroff, that information and all of my financial disclosures are on my website at www.dougbremner.com.

[Update: Bob asked if I had any "ghostwritten" articles. Two out of 215 of my publications involved paid editorial support, both came out of conferences. Both papers involved editing of drafts that came from the authors.]

Evans DL, Charney DS, Lewis L, Golden RN, Gorman JM, Krishnan KRR, Nemeroff CB, Bremner JD, et al: Mood disorders in the medically ill: Scientific review and recommendations. Biol Psychiatry 2005; 58 (3):175-189.

Editorial support was provided by Scientific Therapeutics Information, Springfield, New Jersey.

Sponsor: Depression and Bipolar Support Alliance, Chicago, Illinois (Lydia Lewis, President)

Conference Underwriters: Abbott Laboratories; Bristol-Myers Squibb Company; Cyberonics; Eli Lilly and Company; Forest Laboratories; Glaxo- SmithKline; Janssen Pharmaceutica Products; Organon Inc.; Pfizer Inc.; Wyeth Pharmaceuticals

Nemeroff CB, Bremner JD, Foa EB, Mayberg HS, North CS, Stein MB: Posttraumatic stress disorder: A state-of-the-science review. J Psychiatr Res 2006; 40(1):1-21.

Editorial support from CTC Communications, funded by educational grant from GlaxoSmithKline.

Here is a previous blog I wrote on the topic of ghostwriting.

Other than those two exceptions, which I personally feel comfortable with, I have always written papers by myself in collaboration with authors. At this point that is all that I do. I don't think it is even worth the appearance of conflict.

Doug Bremner
Matthew Holford wrote, Thur Oct 9, 18:11 pm

From your original post, as far as I can establish, your major concern with Sen Grassley's investigations is that he is being unfairly partial towards psychiatry. However, neither of us is privy, I imagine, to where he may be going next. He is responsible to the public purse, after all, and therefore anything is "fair game" to the Senate Finance Committee. Who knows, we may hear that he is pursuing chiropractors, cardiologists and experts on respiratory disorders, such as asthma, if there is such a thing?

However, while you may feel that the blame should be shared more equally, it is Nemeroff, Biederman and Keller, amongst others, that are exciting the Senator's interest, just now. With justification. Incidentally, while it may not be a criminal offence to fail to disclose earnings from pharma in excess of $10k, it is an offence to fail to disclose such earnings to the IRS, although I don't doubt that Nemeroff and co. have made all the appropriate filings, in that respect. In any event, given that Grassley's attention is where it is, we should concentrate on that, because the role of KOLs in the marketing of psychotherapeutic drugs is a very important one. Indeed, the UK regulator, the MHRA, tells me that it places significant importance on academic articles, presumably because it doesn't bother to assess drugs, itself.

Nemeroff is apparently determined that mental illness is chemical/genetic/something/whatever in origin. I believe that he is mistaken, but because he is apparently convinced that chemistry is involved, he has blinded himself to all other possibilities by the look of things. Moreover, if it's not chemical, then psychopharmacology has no role to play, and given his reported attack on Healy, this possibility appears to make Nemeroff nervous. Anyway, because he is mistaken, he has never fixed anybody, but he has become rich, because he says things that people are keen to pay him for. Who knows? He may be saying them because he is being paid. I wouldn't know.

This, then, is the issue for the mental health patient: we have a widely-proclaimed expert, who has never fixed anybody, and who may not be questioned on his position. His academic papers are not theoretical analyses, backed up by empirical, scientific observation, of what may lead to mental illness, as far as I know, because that is always assumed: it's chemical, even though it's impossible to demonstrate that this is true. No, his academic papers concentrate on the latest drug to show negligible benefit above placebo (of those trials that get published, that is). Now, if one wishes to repair something that has broken, one has to understand what it looked like when it was fully operational, and thus one may establish what has gone wrong, and how to fix it. No doubt like Biederman and Keller, Nemeroff will not be scrutinized as to what he believes, and how it is that he believes that. And what is the patient to make of all that?

Tell me, Doug: what do you believe depression is?

Best regards

Matthew Holford

Matthew Holford: As I said in an earlier post, I think that depression can often arise from emotions and experiences, and that the appropriate way to deal with this is through psychotherapy. That said, I think that depression is mediated by the brain, just not in such a simple way as a deficiency of serotonin, and antidepressant medications are helpful in some situations.

Doug Bremner

Aubrey Blumsohn wrote, 9 Oct, 20:52 pm

Doug, I am a fellow physician-colleague of yours. I have been watching you out of the corner of my eye with some degree of agreement and respect.

However I must say that I find your recent forays in support of Nemeroff a little disappointing.

Yes he might have supported you.

Yes you may have written some "science" with him. I wish I could trust that science (as you apparently do) but I have no obvious reason to do so.

Yes, what you say about going for psychiatry as a special case is correct. However, the reasons for that, are in part, because psychiatry has more than its fair share of demonstrable instances of scientific fraud, deception and blatant cheating. The patients are also more vulnerable, and these instances of fraud and deception deserve more than an average amount of contemplation.

I'm no psychiatrist, but it is hard to accept at face value the idea that psychiatry is just fine. Demonstrable fraud took place in many SSRI trials (for example). You should comment a little about that and try to explain why Nemeroff has not commented. We simply don't know that the NNT for an SSRI is 10 (or whatever you say it is). Nor could any reasonable scientist comment without also expressing doubt that this so called science could be called science that at all. "Innovation" it is not. It is hardly surprising that patients want to throw parts of our scientific literature down the toilet (including the good parts). They have good reason to think that way, and we have done this to ourselves.

I certainly agree with you as far as your skeletal writings go (mostly anyway). My adventures in this domain are

http://www.slate.com/id/2133061/ or

http://www.thejabberwock.org/wiki/index.php?title=Actonel_Case_Media_Reports.

Sadly all but 5 or 6 of my colleagues behaved abominably, or were silent even when the key lie, and a small part of the falsity of the reported "findings" were admitted. I can understand that you feel some indebtedness towards Nemeroff as someone who did not "run you out of town".

Scientific fakers can avoid almost anything simply by being important and by bringing in the cash.

Might he have had a vested interest in supporting you over the accutane issue (or at least not running you out of town)?

Whatever the case, Nemeroff is a not exactly a shining light for our profession. He is part of the profession that makes me feel deeply ashamed. Someone who is not particularly truthful about one scientific thing is likely to lie about other things. And there have been more than one such instance of deception. Why would you want to be so vocal about tying yourself to this particular mast, unless you discuss (and successfully excuse) the various aspects in detail. I am sure that this might be possible. As far as I am concerned a scientist who tells even one serious lie about scientific method or the source of data (conflicts of interest are essentially about "method") has no right to be part of the legitimate scientific community. Neither has a scientist who attempts to bully others who want to discuss fakery.

We have built an entire economy on lies and deceit. So much applies to some areas of medicine as well. A few chickens have come home to roost, but it is only a matter of time before we encounter an almighty disaster. You can drive under the influence of alcohol for a while, but sooner or later there will be an almighty crash.

Regards

Aubrey Blumsohn

==================
Dr Aubrey Blumsohn
MBBCh, PhD, MSc, BSc(hons), FRCPath
Blog: http://scientific-misconduct.blogspot.com/

Aubrey Blumsohn: Yes, I have seen your websites previously, and followed the story of the bisphosphonate trials. I think bisphosphonates are one of the most poorly represented classes of medications in medicine. Even my friends in the field agree that they stop working after 5 years (if they can be thought to work at all) after which they make your bones more brittle. I understand your skepticism about antidepressants. As I wrote in my book they only give a 2 point blip on the Ham D over placebo, although it should be noted that the effect size for those studies is much better than statins for preventing heart disease. As for the unfortunate affair with Dr. Nemeroff, I don't really feel like I am 'lashing myself to the mast', although maybe there is something else that is missing my attention. As I said before I am not trying to justify behavior. The point I was trying to make, and one that I am sure you would not disagree with, is that the practice of academic physicians being involved in pharma sponsored talks, consulting, and other activities is wide spread throughout all of the medical disciplines. Until we invent a corruptometer we will not know which is worse. And yes I am grateful I did not get run out on a rail. As for vested interest in the accutane story, I can tell you there was no financial incentive on the part of Dr. Nemeroff, and he certainly wasn't very enthusiastic about my activities. The fact that I have grant funding may have helped motivate him to preserve me, although said manufacturer did their best to take care of that too. You got to give them an A for effort, that's all I can say.

On that note I will sign off.

Doug ("Drug", ha-ha! I liked that one!) Bremner

Matthew Holford, wrote, Thu, 9 Oct 2008 22:05

Doug Bremner wrote: "As I said in an earlier post, I think that depression can often arise from emotions and experiences, and that the appropriate way to deal with this is through psychotherapy. That said, I think that depression is mediated by the brain, just not in such a simple way as a deficiency of serotonin, and antidepressant medications are helpful in some situations."

Depression (whether in isolation, or as a proxy for all mental illnesses), is caused "often" by our experiences, then? The brain, being the centre of the nervous system (for the sake of argument), acts as the central hub for the experiences and attendant emotions? But while that informs me as to your opinion of the cause, it doesn't tell me what depression is?

I point this out, because one may not change a person's experiences. As such, believing that their experiences cause their current malaise is not a help. By way of crude analogy: knowing that a nail caused one's flat will not fix the puncture, unless one understands the nature of the puncture, and thus to begin to develop a methodology to make the repair.

Allow me to put another question to you: why would a person's experiences cause them to be depressed?

Matthew Holford: I would offer one explanation, and this is not meant to be all encompassing or the final word, but I would say that an experience like losing a parent to death, or being physically or sexually abused, as a child, can be an extremely threatening experience, leading to strong feelings of fear, or grief. And that one way to look at depression is as a response to an extreme circumstance. Consider a group of cavemen. If some of their number start getting picked off by a tiger in the neighborhood, don't you think their grief, and hence "depression", would be adaptive, since it would make them less likely to venture out of the cave, and thus have survival value and be selected for in evolution? Because (unless you are from my home state of Georgia, and don't believe that the world was created 6,000 years ago, and dinosaurs ran with humans like in the Flintstones, you have to ask yourself-- what is the purpose of depression? It could also be a side effect of something else. Maybe intensely close human relationships like between mother and child are needed for survival of the child, but if that relationship is broken, it can lead to depression.

Doug Bremner
Matthew Holford wrote, Fri, 10 Oct 2008 00:25:30

 Depression is a response to experience, the precise purpose and nature of which is unexplained (and perhaps unexplainable), then?

In the example you gave, though, why would the cavemen become depressed, solely because there was a man-eating tiger about? Is it a natural consequence, a consequence of a threatening situation, then? What of physical and sexual abuse - is it inevitable for one to become depressed, as a result of these events? Put another way, do all victims of childhood abuse become despressed? If they don't, then it's not inevitable, and therefore not a natural, inevitable reaction. Depression must be more than an unexplained phenomenon, then.

What does a child experience, when they are being beaten, say? Fear? Anger? Confusion? What were they being beaten for? And do they perceive it to be appropriate to the circumstances (ie, is the beating disproportionate to the perceived offence)? Is the violence unprovoked? What are the adult's (typically), motivations for doing the beating? Imagine that the child doesn't enjoy being beaten, and wishes to avoid it. But let us say that the adult is locked into a longstanding behavioural pattern? The child can spend as long as they like trying to work out how to avoid being beaten, but if the beatings have nothing whatever to do with the child and its conduct, then such speculation is pointless. The child may not ask the adult, because the adult doesn't know, or else will justify the beatings by telling the child that it deserved it, irrespective of the minor nature of any misdemeanour.

So much for the model. So the child, unable to ask for more detailed instructions as to how to avoid the beatings, instead begins to modify its behaviour, in order to accommodate the unpredictable nature of the adult's behaviour. This might be expressed as a whole series of "if>then" statements - eg, if (s)he's stomping around, slamming doors, then I'm OK, but if his/her step quickens across the room, that's an attack about to happen," and so on. Is there a pattern to any of this? A generic summing up, whereby we might reduce our understanding of the process to a single point? What effect would this "lifestyle" have on a child. It would become intimate with the signals indicating violence, one might imagine, but would the indicators always look the same as when exhibited by the adult in our scenario? So many questions unanswered. Perhaps that's what depression is. And if it is, does it help us to know that?

Matt

Matthew Holford: First of all I would like to thank you for a very honest and thoughtful response. I can see that you are on a personal journey, as many of us are. I can tell you from personal experience that the way we experience things psychologically and physically in childhood is very different than in adulthood, but that the memories from childhood stay in our brains and influence our thoughts and behaviors as adults. We spend much of our lives arguing with and bargaining with our parents, decades later, even if they are dead. You can follow the links on my websites where I have posted much of my own history; my mother died when I was 4 1/2. And yes, children use magical thinking to explain why they do or do not get struck, or why their mother doesn't come back, it is natural, and it persists into adulthood and can be very confusing and can cause all kinds of problems. And finally, I think it is helpful to know about it. It is more painful, it can cause more tears, but ultimately it is good to be alive. I am guessing that you might have tried therapy, or medication, and your were frustrated with the results, but I would suggest try again, interview four or five in advance, and pick the one that feels most comfortable to you, and then learn to trust them, and tell them how you feel about THEM and YOURSELF.

God speed, and good luck my friend.

Doug Bremner

Stephany wrote on Oct 10, 2008 on bipolarsoupkitchen

 "Dear Doug,

It is nice to see my friends Aubrey, Matt and Bob posting comments here.

I appreciate your comment on my blog. Though I am not responsible for commenters words, I try to allow comments be what they are, an not attackful in threatening ways.

I am not sure about your comment here you refer to as "manic depressive".

I write a well-read mental health blog and mostly about my 20 yr old disabled daughter.

My comments are moderated, which means they wait until I get home to a computer to publish them.

Your comment is there now. The blogs you are dealing with are a core group of blogs where we reveal the truth and seek it in this (your) industry.

I respect professionals and am friends with several, and hope you would look at my blog from a different perspective now. Thank you for your time,

Stephany, author of soulful sepulcher"

Stephany: Thanks for your response. It was truncated on my site so I have posted it in full on my site now. I have taken off my comment on my website since you have posted it on yours. I am glad that you are friends with professionals; for my part I can say that some of my best friends are (or were) diagnosed as bipolar, or manic depressive. Nevertheless I maintain my previous response that references to the fact that I should be put in front of a firing squad because of my profession are, in fact, threatening, and that having a psychiatric diagnosis is not an excuse for acting like a troll. I do not personally treat people diagnosed as bipolar, so I cannot be blamed for the misery of Stan, or anyone else with a similar diagnosis. As I have said elsewhere, if psychiatrists were to vanish from the face of the earth tomorrow, that would not eradicate depression or the other miseries of the world. As I said, I don't have patients with the diagnosis of bipolar, but I have often wondered whether it must be a real drag to be in a manic high, and then have a "doctor" come and tell you that you are abnormal and have to take a pill for that condition.

Somehow I feel like I have stumbled into a private party, so I will go back to my Ivory Tower now.

So long for now.

Doug Bremner

Steve Rhodes wrote on Thursday Oct 16, 2008

I keep forgetting to send you a note about your “Open Letter to Senator Charles Grassley” and the follow-up dialogue you had with some correspondents. It was most enlightening and enjoyable.

I often don’t agree with *everything* said in such exchanges, but I feel like I learn much more from it.

Steve Rhodes

Update! It seems like Sen Grassley has read my letter, because he is opening an investigation of cardiologists just like I told him to do! Ha ha ha!

You should have a good time rummaging around in their booty chests, Senator!

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OCTOBER 10, 2008

Response to University Diaries

I was attending a memorial for my mother who died in 1966 this Saturday which was a little fraught with conflict since my father remarried and the "old mom" wasn't always the most popular topic of conversation, when...

...the chairman of my department imploded.

That's right, just when I was getting closer to mom, "Dad" went down.

What was the story about that guy, Eddy Puss, or something?

Anyway, since then there has been a steady stream of rock throwing on the internet from everyone who feels that Paxil ruined their life to snubbed psychiatrists. I decided to give a response to one blog at University Diaries entitled 'Lying Sleazebag' which I thought was a little bit below the belt.

OK, here is what I wrote before. Followed by the stillborn Emory Press Release for my book that Emory never released (more about why later). I never got to go to my mother's funeral, so I had my own this weekend. I never got a press release from Emory, so now I now I am releasing it myself.

Ha ha ha!

[To University Diaries]: OK, here is the comment from the Emory professor you were looking for, in, yes, the department of psychiatry. I am not writing to excuse bad behavior, but I did want to write a note before Emory, NIH, and Pharma package up their scapegoat and send him out of town.

NIH: "We don't have the staff to monitor outside payments" [how about a database, idiots. Doih!]

Pharma: "We are going to voluntarily disclose now". [thanks for the memories, docs]

Emory: "We are very ethical." [translate: we watch our backsides and brood about our image]

And yes I am a psychiatrist and a researcher and yes in the past I did get paid hefty fees for giving talks that were funded by the pharmaceutical industry, not as much as what Dr Nemeroff got but not that far off. $3500 for one talk sounds like a lot of money but as a rep for GSK pointed out, it is the going rate for well known speakers, and giving a talk basically takes two days out of your schedule to travel, etc, can be a lot of work.

The reporting, your blog and others are incorrect in terming his work as 'consulting to GSK' when it was in fact giving lectures for a CME company. My own lecturing trickled off when I made the pesky demand that I not use ONLY slides that came from the company (they claimed the talks needed to be approved in advance by the FDA) and then ceased altogether when I wrote 'Before You Take That Pill, Why the Drug Industry May be Bad for Your Health,' which I wrote in reponse to my experience as an expert on the connection between an acne drug called Accutane and depression. That experience was an inside look at the corruption of pharma and their manipulation of the truth. My reward for stating my opinions (which were detrimental to the bottom line of the manufacturer), was that the manufacturer: 1) sued my university; 2) subpoenaed all my data and deposed me 16 times; 3) accused me of fraud, for which I had to go through a nine month Emory inquiry; 4) subpoenaed emails and documents from colleagues, administrators, my cat, and anyone else who knew me, so that the end result was that noone wanted to know me, and the same administrators named in the current fiasco who are so obviously trying to cover their derriers basically told me to cease and desist, accused me in so many words as being a plaintiff's whore who did research for money (the affected victims of this drug certainly don't think so), and that this would affect their ability to get funding from said manufacturer (I had an odd moment where everyone looked around the room once and they said, 'well we don't get funding from them anyway cuz we had a contract dispute'). When my book came out Emory refused to issue a press release. They wrote one, and they just never released it. Fact is, I am going to put that press release on my web site now... Emory is obsessed about their image, so not doing a press release is unheard of. The second point is that... Emory is obsessed about their image. Rather than do the right thing, they worry about how they will look; you can see it in all the internal memos and emails that are floating around the internet.

OK, to anticipate the trolls that are going to come on and say that I am self promoting, Emory shithead, etc, I will disclose that I signed a letter of support for Dr. Nemeroff to WSJ after the issue about the non disclosure of financial conflicts related to the paper on Vagal Nerve Stimulation in 2004. He said it was a mistake, I took him at his word. Anyway the point I was trying to make is that when I got attacked by said drug company, he wasn't happy about it, but he did stand up for me in a way others did not. The other point is that pharma payola and the lack of reporting is wide spread. There is a whole system built around 'thought leaders' and 'talking points' for reps. Look at cafepharma.com. The reps themselves say things like 'they send us out the door with 50K in cash in a suitcase every month' or 'go look at the key opinion leaders for advair'.

As for reporting, at Emory if you submit requests for approval to do outside work, they come back six months later with a bunch of legal language changes, you make the changes and never see it again. Oh and we are not supposed to utter any opinions not approved by Emory PR, because after all we are not professors with academic freedoms, we are more like members of a corporation or something, where MBAs tell me (yes it is true) what I can or cannot do research on or write about). I say: Emory, stop worrying about your image and start doing your job: i.e. supporting the professors that make up your university.

Here is the press release that was never... released (sniff, sniff)

The Missing Press Release

DRAFT COPY

EMORY Health Sciences News

http://www.whsc.emory.edu

XXX, 2008

Medications Put to the Test in New Book by Emory Researcher and Author

Media contacts:

Kathi Baker, 404/727-9371, kobaker@emory.edu

Sarah Goodwin, 404/727-3366, sgoodwi@emory.edu

ATLANTA–J. Douglas Bremner, MD an Emory University and Atlanta Veterans Affairs Medical Center researcher, was concerned about the way information was communicated about medications and supplements, so he decided to take action. After two years of doing his own research on hundreds of the most popular medications, he has written a book called "Before You Take that Pill," which is scheduled to be released on February 28, 2008.

"You have the right to know the risks and benefits of the pills you take and to form an active partnership with your doctor to make decisions about what is right for you," says Dr. Bremner.

"We all want to live as long as possible," he continues. "If this book allows you to use medications safely and convinces you to change your diet and lifestyle to prevent disease, I will consider it a success."

The book covers over 300 of the most commonly prescribed prescription drugs, the fifty top-selling prescription drugs, vitamins, and the best selling herbs and supplements. Also included in the book are drugs that are not used much any more but that are particularly unsafe and haven't been taken off the market yet by the Food and Drug Administration (FDA).

Dr. Bremner says the U.S. is focused on developing newer drugs. But those drugs are more expensive and drive up health care costs and are not necessarily more effective than the older drugs. He says that pharmaceutical companies are not required to prove that new drugs are better and have fewer side effects than the older drugs they are claiming to replace.

In addition to that, vitamins and supplements and some medications can be avoided altogether if people are encouraged to stick with a healthy diet, exercise regularly and wash their hands to avoid infection.

"Despite the fact that Americans spend twice as much on health care as any other country in the world, we have some of the worst health care outcomes," says Dr. Bremner. "In a survey of 13 industrialized nations, the United States was found to be the last in many health related measures, and overall was second to the last!"

Dr. Bremner read and analyzed journal articles, editorials, and drug research related to all the medications he describes in this book. Additionally, he reviewed investigative reporting about the safety of the drugs in credible publications such as the New York Times, and he consulted colleagues with specialties related to the medication he was researching.

Says Dr. Bremner "My goal in writing this book is to give patients all the information they need to be aware of the effects of the medications they are taking so that they can have knowledgeable conversations with their physicians, and make informed decisions together."

Dr. Bremner is professor of Psychiatry and Radiology at Emory University School of Medicine, director of the Emory Clinical Neuroscience Research Unit and director of Mental Health Research, Atlanta Veterans Affairs Medical Center. Dr. Bremner performs research using brain imaging to look at the effects of medications on the brain and brain correlates of mental disorders. He is a board-certified psychiatrist and nuclear medicine physician and has authored or co-authored over 200 peer reviewed articles and book chapters and three books, including "Before You Take that Pill".

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