Hmmm… Interesting title, you say. Yes indeed! Not everyday you read about bastards in the Science Section of the New York Times. That, of course, is why readers have to come to alternative news sources like the Drug Safety and Health News Blog to find information on more uncomfortable topics in the realm of medicine and mental health.

Anyhoo, the topic comes up because my beloved mother, who died when I was almost five years old, was adopted at birth, and a couple of years ago I had the adoption records opened and found out that she had been born out of wedlock. I was able to track down some of her family, but others I wasn’t sure if they wanted to know that their father had had a child (her) out of wedlock, but when the time came for us to have a belated memorial for her last fall, I decided that they should know about her. So I called someone who was her half sister, who didn’t know about her, and the conversation went something like this:

ME: I am calling to let you know that you had a half sister. She died in 1966. She was my mother.

HALF AUNT: How I am I supposed to believe you? [after receiving various pieces of information that I might be correct]. I am proud of you for your research. [awkward pause]

ME: Well I don’t want to butt into your life or anything, I just thought you should know.

HALF AUNT: I am proud of you for that as well. [awkward pause #2]

Click. I sent her a bunch of pictures and things about our wonderful families and all, with my phone number, but never heard back from her. Recently, I had another lost cousin contact me (yeah, the one from Eastern Washington with the guns and the stogies). I had tried to contact him earlier and thought maybe he didn’t want to be found, but in fact he did. So I thought I would contact the children of this woman, since maybe they wanted to know and she shouldn’t be the only keeper of family secrets. When I said that to another of my newly found cousins, she said I was being a bully and had “ambushed” the half-aunt. That was then that I realized that half-aunt was actually ashamed of the fact that her half-sister was born out of wedlock. I had thought that such stigma against kids born out of wedlock was long gone, but maybe not. That got me to thinking, was Mommy a bastard? or was there another word for girls? That was why I was glad that one of my favorite things on the web, Yahoo! answers [a program that lets you ask a question and let a bunch of people answer, and then vote on the best answer], had asked “Can a female be a bastard?” had come back with the answer that she is a “bastard child”. Not a bitch, that would be a female dog.

Phew!

Anyhoo I couldn’t believe that people would still be prejudiced against people born out of wedlock. I mean we have an African American president now for Christ’s sake! Saying that half-aunt was born in the 30s and we should understand her views is like saying that we should go along with people who are racist against blacks cuz they were born in an earlier time!

BTW my genetic analysis showed that I am 4% black, and that is not “Black Norwegian” as the Bremners used to say about my Mom! That is Sub-saharan African!

Anyhoo all this reflection on bastards made me start reading about it. Turns out the term “illegitimite” refers to the fact that children born out of wedlock were literally not “legitimate”, i.e. had no legal status as human beings, up until the laws were changed (in Britain at least) in the 1940s. Seems like the government was trying to punish people who had kids outside of marriage by depriving their kids of any legal right to exist. It was common practice to lie and say that the kid was actually the child of the grand parents (with the mother being the sibling) or the child of a second man, or any number of things. These kids were often put up for adoption (as was my Mom). They were also extremely vulnerable to abuse and neglect, and were very insecure about themselves. Someone made the comment that it is morally dubious, at best, to blame the children for the actions of their parents.

The corporate staff at the Drug News and Health Safety Blog couldn’t agree more.

That is why we have declared the week of Feb. 2 2009:

Be kind to a bastard week. .

This week I had to fill out some online modules so that I could retain admitting priviledges at Emory University Hospital in Atlanta, GA. Part of that involved filling out a questionnaire about vaccines where it asked if I had been immunized with the various vaccines for hepatitis, the flu, and chickenpox. Well my daughter and I spent some quality time together with the chickenpox when she was three, so I don’t need that vaccine, and the fact is that I never got vaccines for hepatitis, and I don’t feel like getting one now. And readers of Drug Safety and Health News Blog know my opinion about flu shots. The form included the lovely lie from the CDC about how 36,000 people die from the flu each year (half of those are actually flu-like illness, not the flu, get your facts straight, Julie). Anyhoo they had a helpful multiple choice where they asked you why you weren’t getting vaccinated, and for the flu I stated that they didn’t work. After refusing the hepatitis vaccines the program froze me out, so when I went in to get my TB test I asked the nurse about it, and she had me sign this declaration form about why I didn’t want the vaccine. So I decided to do some research. I found a Dr. Di Bisceglie touting Hepatitis C vaccines in development, and what struck me was how LONG his list of disclosures were! Looky here:

Adrian M. Di Bisceglie, MD, FACP, has disclosed that he has served on the advisory boards of Roche, Idenix, Novartis, Vertex, Bristol-Myers Squibb, Metabasis Therapeutics, Anadys, and Globe Immune. Dr. Di Bisceglie has also disclosed that he has received research support from Roche, Gilead Sciences, Idenix, Vertex, Bristol-Myers Squibb, and Sci-Clone. Dr. Di Bisceglie has also disclosed that he serves on the speaker’s bureaus of Roche, Gilead Sciences, and Bristol-Myers Squibb. Dr. Di Bisceglie has also disclosed that he has served as a consultant to Bristol-Myers Squibb, Abbott, Schering Plough, Pharmasset, and Sci-Clone.

I mean geez, how can you do all that, plus do his research and be chairman of his department? Note that Roche is the maker of drugs for bird flu, which as I have written about in “Bird Flu Drugs are for Bird Brains” won’t work once the virus mutates to spread to humans, but which has made a ton of money for them and their pitchman ex Vice President Cheney.

Anyhoo anyone who serves on 8 advisory boards, get research money from 6 companies, is on three speakers bureaus, and serves as a consultant to 5 companies, is spending an awful lot of time hob knobbing and dining and getting payments and therefore is unlikely to be un-biased. For the hepatitis B vaccine there was some evidence that it might be associated with an increase in multiple sclerosis although it looks like the jury is still out on that one. As for Hepatitis C that is new and we don’t know the long term risks. I don’t get hepatitis vaccinations because even if you get it (which is unlikely) it probably won’t kill you. Gardasil? As I have written before I would rather have you guard your girls than give them Gardasil.

Anyhoo here I am back filling out my infectious disease module.

As I was taking the online exam I couldn’t help but notice that is said that most Emory employees encountered potentially infectious materials in the workplace that could transmit HIV or Hepatitis through percutaneous transmission, i.e. needle sticks involving infected blood. However they also listed “Other Potentially Infectious Material” (OPIM) as follows.

Did you notice the first few? It seemed odd that Emory Healthcare would be listing those as possible sources of transmission of viruses for people in the workplace! Especially for a place that is so worried about their public image, and which recently started a public “trust line” where people can call to anonymously report anything which is not consistent with Emory’s morals and ethics, including conflicts of interest, apparently in response to recent negative publicity (but don’t get me started on that). Anyhoo I was puzzling over this when I noticed the Emory logo…

 

Advancing the possibilities, indeed!

See how long it takes me to get fired for this one…

I was concerned to learn that Philip Dawdy who writes on the Furious Seasons blog was about to get kicked out of his appartment in Seattle. I grew up in Olympia WA and interviewed for a position in the Department of Psychiatry at the University of Washington in 2000 where I noticed that outside the University Hospital there was a sign that not only could you not smoke in the hospital, you couldn’t smoke outside of the hospital, and in fact you had to move 200 yards AWAY from the hospital to smoke. I mean my wife is Italian born Italian and I am used to going to bars, restaurants, parties, etc, where everyone smokes. I think that this recent Seattle phenomenon is a sign of Eco-Fascism and as a psychiatrist I have to try and interpret what the root pathology might be. Hmmm… could it be an arrest at the oral stage of development ala Freud?

Anyhoo, rumours state that my sister Anne Bremner, local Seattle lawyer and noted legal analysis commentator on CNN and FOX as well as lawyer for Amanda Knox in the Perugia Italy case, also a smoker, is getting similar harassments from Seattle Eco-Fascists, even though she owns her own property! We are going to have to get the half-cousins from Eastern Washington to come over there with their guns!

Rumours are that Anne might take on Philip’s case pro bonno! Do the Eco-fascists have a good legal basis for their actions? Only time will tell!

I felt so UPSET about this situation that I had to write a letter as a psychiatrist and physician scientist outlining my concerns, and here it is.

To whom it may concern,

I am writing in regard to Philip Dawdy, a resident of your apartment complex. Mr. Dawdy has been diagnosed with bipolar disorder, a mental condition. Mr. Dawdy is currently addicted to nicotine in the form of smoking cigarettes. In my medical opinion, stopping the smoking of cigarettes may disrupt his mental condition in an unacceptable way, and it is therefore medically contraindicated for him to stop smoking cigarettes. Forcing him to either stop smoking cigarettes or to move out of his apartment is not in his best medical interest.

Sincerely

 

 

 

 

 

J. Douglas Bremner, M.D.

Professor of Psychiatry and Radiology

Atlanta, Georgia

 

 

 

 

 

 

Take this letter and use as you will, Philip.

Good Luck.

Dr. B.
[Note: the name of my university and the letter with my university's letterhead have been redacted at the request of the Dean of my university following a complaint from an outside source. It was pointed out to me by the Dean that use of my university's name and letterhead for personal use (which this was judged to be) was a violation of university policies. Also people have taken this post to indicate that I am an advocate for smoking. I do not advocate smoking as it can cause heart disease and lung cancer. This blog is for entertainment purposes and is to be taken as medical advice. ]

This week I am in Scottsdale, Arizona, for the Annual Meeting of the American College of Narcissistic Psychiatrists (Oops! I mean Neuro-Psychopharmacology… or maybe it was Negotiators for Prostitution, since the word is that the original annual meeting was held in the 1960s and 1970s in San Juan, Puerto Rico, since the whores in San Juan were more affordable on the limited salaries of the academic psychiatrists, at least before they themselves became, well…)We’ve had some memorable moments at the annual meetings of the ACNP (of which I am a proud member, at least as of the time of the writing of this post). The narcissistic psychiatrists print out their research results on “posters” and pin them up on boards and then everyone walks around getting drunk while they pretend to read the posters while catching up on gossip. And oh, we have some great gossip to catch up on. Usually we are supposed to print the posters out from computers, but one year one of the narcissistic psychiatrists drew the title of his poster with a crayon. Although the posters are supposed to represent research, another year one of the narcissistic psychiatrists had a poster dedicated to the alleged corruption of another one of our august members. And then there are the numerous inquiries, investigations, accusations, and assorted phlegm sent to the group email list that livelies up our days.

Such fun!

We used to say that the struggles in academia were so great because the rewards were so small, but thanks to payola from Merck, Lilly, Pfizer, and friends, I guess we can’t say that anymore! Cheerio!

Anyhoo, to the point of this post, my dissenting opinion from the official position statement of the ACNP on suicidality and antidepressants. For years the ACNP has been solemnly convening a committee every year to comment on a possible association between suicidality and antidepressants. Even five years ago when I viewed their report (before the more recent uproar over the topic) I saw their list of studies showing that in almost every case the rates of suicidality were doubled. I therefore concluded that the conclusions of my august fellow members were, frankly… bullshit.

Even now the ACNP continues to put its head in the sand and denies a relationship between antidepressants and suicidality. But take a look at the people on the committee ruling on suicidality and antidepressants and you see conflicts abound with members taking speaking and consulting fees from drug companies. And it takes an infinite reach of the imagination to believe that antidepressants making you suicidal are no big deal, as was recently argued by one of the committee members on his NPR show, since it hasn’t been shown that they will make you SUCCESSFULLY kill yourself since suicide is rare and noone has ever shown that something will make you more likely to successfully kill yourself.

Hey buddy, wanna buy some blue pills that are gonna make you think about killing yourself? Dont’ worry, in the end you won’t actually do it.

Originally posted Dec 7 2008

Response to David Braff, MD PhD, President of the ACNP

I got a call yesterday from David Braff MD PhD, President of the American College of Neuropsychopharmacology (ACNP) and Professor of Psychiatry at UCSD. It seems that some of my fellow ACNP members were miffed about my post “A Dissenting Opinion from the ACNP on Suicidality and Antidepressants”. To set the record straight, the post was meant in jest, although a number of sites picked it up as evidence of “sleazy” behavior of ACNP members. ACNP members don’t routinely get drunk at poster sessions, as I implied. Although beer and wine is served there (as it is at the American Heart Association meeting, per Mrs. Bremner, and a number of other meetings) I hope they don’t stop that practice because of my post! And the comment about the prostitutes being cheaper in Puerto Rico wasn’t meant to imply that ACNP members currently frequent prostitutes. After all, they moved the meeting to Scottsdale, AZ. This was based on a rumour I heard years ago about scurilous activity that occurred back when the meeting started there in the 1960s. But I think it might have been a joke so I take it back. And if I have offended any ACNP members, I apologize.

As for the comments about the person who drew his poster title with a crayon and the other one who sat in a lawn chair next to his poster criticizing another ACNP member, well, what can I say?

On a more positive note, in response to concerns about the influence of the pharmaceutical industry on academic psychiatry through pharma funded educational activities and drug promotional talks and concerns that this compromises the patient-physician relationship, one of the ACNP members, Robert Golden, MD, Dean of the University of Wisconsin Medical School (Madison), has instituted a policy to place signs in clinics alerting patients that their doctors may be receiving payments from drug companies and providing a form so that they can get more information.

The Drug Safety and Health News blog applauds the efforts of Dr. Golden which truly represents a move in a new direction.

Originally posted Jan 13 2009

COMMENTS

If anyone should have the right to question Dr Bremner’s comparative expertise on the going rates asked by prostitutes at past ACNP congress venues, it’s Mrs Bremner, MD. But then Mrs Bremner obviously got the joke.

Why do high-raking members of the ACNP, as the English say, get their knickers in a twist about this? Don’t they have anything more pressing to worry about and comment on, like, uuh, shills being KOLs?

Pease keep up the good work!

Susie (M-1, in Europe)

An article from the Jan. 3 2009 issue of The Lancet used a meta analysis to show that so-called first generation antipsychotics (FGAs) and second generation antipsychotics (SGAs) are not that much different in terms of efficacy, safety, and side effect profiles. The purported superiority of SGAs for negative symptoms and fewer side effects for SGAs were primarily the results of comparator studies that put them up against high dose haloperidol.

I have been reading a book called Hooked: the Medical Profession and the Pharmaceutical Industry by Howard Brody, MD PhD, of the University of Texas, Galveston, which I highly recommend as an interesting book that adds a lot even for those of you who feel you are “read out” on this topic, and this episode of comparing new drugs to old drugs given at doses that cause more side effects without providing more efficacy (which is stacking the deck in favor of the new drugs) is a pharmaceutical industry tactic that he identifies, although this is the first time we have heard of it as applied to antipsychotic “life saving drugs”.

Psychiatrists moved en masse from the FGAs to the SGAs largely because of concerns about tardive dyskinesia, extra pyramidal side effects, and what may have been a misguided belief that these drugs worked better, fueled by pharmaceutical marketing. As the paper shows, most studies in the literature were found to be using high dose haloperidol (>7.5 mg/day) (Haldol) as the comparison drug, which biased the trials in favor of showing a better side effect profile for the newer drugs. When studies using lower potency first generation drugs were focused on, the differences in safety and efficacy were considerably diminished. Specifically, the SGA drugs as a whole were not seen to be specifically better for negative symptoms of schizophrenia, which does not support marketing claims to the contrary. The drugs that were better for negative symptoms were also equally better for positive symptoms and depression. Although clozapine, olanzapine, and risperidone were marginally better for extra pyramidal side effects, which is largely why psychiatrists moved so heavily into SGAs in the first place, the effects were not large, and there were no significant differences for the other SGAs. The only SGAs that were shown to be better for psychotic symptoms than low dose FGAs were amisulpride (Solian, Sultopride), clozapine (Clozaril), olanzapine (Zyprexa) and risperidone (Risperdal). These drugs, however, caused more weight gain than haloperidol (but not low potency FGAs). Only Amisulpride and sertindole (Serlect) were better for quality of life. Aripiprazole (Abilify) was only better for depression and quetiapine (Seroquel) was better for positive symptoms and depression. Sertindole (Serlect), ziprasidone (Geodon), and zotepine (Zoleptil) were not better for any symptom area.

The recent CATIE study compared SGAs to the FGA perphenazine (Trilafon), and found that most of them were not better for efficacy or side effects, only olanzapine had a longer time to discontinuation (the primary outcome) and clozapine was better for symptoms. However, clozapine has bothersome blood monitoring requirements because of the risk of aplastic anemia, and olanzapine has some worrisome diabetes risks. What was most amazing about the CATIE study, however, was the fact that half of people stopped taking their meds after a couple of months, which indicates that people feel really lousy on these drugs.

The article was accompanied by an editorial by Turner and Horton entitled “The Spurious Advance of Antipsychotic Therapy” in which the authors said that psychiatrists had been “beguiled” (presumably by the pharmaceutical industry) into believing that the SGAs were superior (a point highlighted by others like Vera Sharav of the Alliance for Human Research Protection (AHRP). Although I wouldn’t agree with the emphasis that there is no difference between these drugs, it is true that the safety and efficacy of these drugs have been greatly distorted, that we should stop using the distinction of SGA-FGA or talking about unique profiles of “atypicals”. In addition, It is unclear if the extra cost of these drugs justifies their use when there is an increased risk of obesity and diabetes with not that great of an advantage for extra pyramidal side effects. Certainly for the drugs not better than low potency FGAs there is not.

Guess we got duped by pharma. Yet again.

Sigh.

originally posted jan 12 2009

This has been quite a year for disturbing revelations about the corruption of the medical literature by pharmaceutical company interests. I wrote previously about ghost writing by Merck and others, and how papers were produced by drug companies that said “insert author here” and then they went out and shopped around for an author at an academic institution. Academics are always worried about damage to their reputations, but in these cases, what can your say…?

I previously wrote about a study showing that the overwhelming majority of negative trials never get published while the positive ones always do, which leads to a false sense of the efficacy of the drug. The worst extreme of course is the sorry example of trials of SSRIs in kids where multiple studies of paxil were “shoved in the desk drawer” as we say here in the industry, and a bs campaign to get kids on paxil was launched.

In the study I previously wrote about on suppression of the literature on antidepressants if you only looked at the medical literature, you would think that 94% of the studies show that antidepressants work, when in fact only 51% were positive.

I remember a couple of years ago standing at a poster with a glass of wine in my hand at the American College of Neuropsychopharmacology (ACNP) which presented similar data (maybe it was the same study). Someone from pharma commented that you can’t get negative data published. Well that is a lot of hooey. You can get data published somewhere. For instance, Psychopharmacology Bulletin, where I am an Associate Editor (at least for now), and that publishes its stuff online, makes a policy of taking in negative clinical trials.

In this week’s NEJM there is an editorial about the promotion of Neurontin (gabapentin) for off label uses ranging from bipolar disorder to neuropathic pain. This editorial includes references to online documentation of how data was suppressed and manipulated, marketing tactics were used to illegally promote off label use, and academics, government, and the FDA either colluded or did nothing. Other news comes from an article by Ray Moynihan in bmj showing that the pharmaceutical industry has used a strategy of “grooming” the Key Opinion Leaders (KOLs) (their terms, not mine) to promote their “message”, and how they measure prescribing practices before and after a “KOL” gives a talk to check their impact on local prescribing practices, and then reward “good” KOLs with more talks with lucrative speaking fees and “drop” under performers. Of course this unconsciously drives speakers to push their product. I for one went through this mill back in 2001 and was probably dropped for not performing and arguing with them about using their slides. I gave a talk last year for grand rounds at a med school and a friend of mine told me I was not “approved” by the drug company sponsors and therefore they had to scramble to find funds to pay for talk. More news from the bmj article is that there are organizations that offer to “manage” your “KOLs”, like kolonline.com. You can read for yourself, but they basically offer their services to drug companies to manipulate or control KOLs to deliver the “right” message to the other docs who will follow their lead about how to prescribe. They offer to “validate and manage” the KOLs and “identify rising stars” (sounds like grooming young girls to participate in prostitution and/or incest to me). Disgusting. Can you say…?

To comment on this blog please write to jamesdouglasbremner@yahoo.com and indicate whether comments are public or private.

originally posted Jan 8, 2009

COMMENTS

Doug, You may want to look up the settled qui tam false case act: David Franklin v. Parke Davis (Pfizer). Franklin was with Parke Davis while selling Neurontin, and he filed this case in 1996. It settled in 2004. He was a Harvard PhD, and working as a medical laison for them for maybe 3 or 4 months, and was being coerced to do things you illustrated in your post, Dan

---

Yes, there was a whistle blower cited in the article I linked to, I think it was the same one. His boss told him to sell Neurontin for everything. Put today (look here there is an article in the NYT that the FDA approved companies to promote off label use. Dreadful. Why is the FDA even there? -Doug Bremner

---

I wrote a blog post about Neurontin being no better than a placebo for bipolar treatment. Sounds like this drug is a junker–and used for pain far too often and then it can cause psychosis and weird stuff in medical patients. Stephany

http://bipolarsoupkitchen-stephany.blogspot.com/2008/04/neurontin-vsplacebo-for-bipolar.html

Update: article by former Yale Psychiatry resident Jeff Barkin MD on lack of efficacy of Neurontin for bipolar disorder and Pfizer’s fraudulent campaign to promote it for thie use. Other litigation reports and documents at the same web site.

There has been some press that most of the members of the Diagnostic and Statistical Manual for Psychiatry (DSM-V) task force are on the pharma payroll, but although sites like Public Citizen quote that 16/28 members are on the payroll, if you actually look at the list on the APA web site there are only about six who don’t report pharma ties, and these include NIH employees. Now a series of investigative reports from David Wilmer from the LA Times in 2003-4 showed that many scientists from NIMH were receiving consulting fees from pharma that they were not disclosing, so maybe they aren’t reporting it or they were too lazy to flee once the truth got out. The few others are employees of the APA so it isn’t clear what they are actually doing on th committee. Others have received educational grants and other perks from pharma, making pretty much everyone compromised, so it isn’t surprising that a lot of people are worried about the potential corrupting influence that the pharmaceutical industry may be having on our beloved “bible” of psychiatry. Not to mention the fact the members of the task force were required to sign confidentiality agreements that they wouldn’t talk to anyone until the book was published. Oh, here is another one. They apparently decided that dissociative disorders don’t exist, since they didn’t even include that as one of their diagnostic groups. I guess there isn’t a pill for that, and that’s the whole purpose of this exercise, isn’t it anyway? To create diagnoses that increase the number of under identified Americans who need a psychotropic pill? Anyway, with all of these concerns, some of us psychiatrists when we were at the Annual Meeting of the American College of Neuropsychopharmacology in Scottsdale, AZ, recently decided to form…

DSM-V SHADOW TEAM!

 

(front) Doug Bremner MD (Emory), (back), from left to right, Christian Schmahl MD (U. Mannheim), Ruth Lanius MD (U. Western Ontario), and Eric Vermetten MD (U. Utrecht). Photo credit: Rickey Gillespie, MD PhD (Emory)

…to express some dissenting opinions in the field of psychiatry. The idea is that we can “shadow” the “real” DSM-V task force and provide our own version of the DSM that is free of influence of pharma! (since we have either pissed off pharma by being to unsocial or ugly or asking embarassing questions or maybe we farted at the wrong time or live in Canada so that none of us have significant financial conflicts of interest!)

I got the inspiration for this idea when I responded to an article on pharmalot.com about conflicts of interests in FDA Advisory Boards by volunteering to work (for free) on an FDA advisory board as I have no significant conflicts, and I pointed out that I have alot to contribute (top in my field of PTSD based on ISI citations, 200 publications, drug trial expertise based on the last book I wrote). Henry Greenspan (Justice in Michigan) commented on pharmalot that maybe we could form our own “shadow” committees to parallel the FDA Advisory Committees for drug approvals that are so hopelessly corrupted by the fact that all of the members are paid consultants to pharma. I said I thought that was a wonderful idea.

I am not pointing out my own accomplishments for self aggrandizement but to demonstrate without equivocation that when the pharma shills say that the best and brightest always consult to pharma that they are full of bullshit.

Pharma pick and groom their candidates and them highlight them at circuses like the Annual Meeting of the American Psychiatric Association which further increases the glitter of their “thought leaders”.

We are a serious looking bunch in the picture, but, well this is serious business, I mean determining who gets psychiatric diagnoses and all. You’ll notice I couldn’t get any American psychiatrists to join the team. There are a few readers of the Drug Safety and Health News Blog that are on the “real” DSM-V work groups and we tried to get them to come over from the dark side but they just rolled their eyes.

Still time to reconsider guys! Won’t have a chance like this for another ten years!

OK, let’s get down to business. I am going to propose that one of the new diagnoses should be Narcissistic Psychiatrist Syndrome (NPS). This syndrome is characterized by:

 

• Inability to look patients (or anyone else for that matter) directly in the eye
• Delusional belief in the ability of psychopharmacology (as opposed to therapy) to heal all woes
• Inability to discuss emotions or feelings, whether in self or others
• Inability to perform self reflection
• Difficulty answering direct questions without somehow turning it around to the questioner
• Feelings of entitlement
• Inability to take blame
• Gravy spots on the tie
• Tennis shoes and jacket with patches on the elbows; pipe

 

Here is another one, Deviant Drug Rep Syndrome (DDRS)

Commonly lies to people while looking them straight in the eye

Compulsion to engage in risky behaviors associated with driving up drug sales (e.g., risky sexual behavior (possibly in doctor’s offices))

Inability to reflect on the consequences of one’s actions

Cries out loud in joy when sites like pharmalot close down saying things like ‘that will certainly make my job easier!’

Incrongruent emotional responses; e.g. persistently perky and cheerful behavior even in situations were sadness or other emotions are appropriate Which brings me to my next diagnosis, Pharmalot Withdrawal Syndrome (PWS). I must say that my experience working with adult survivors of childhood abuse helped me in the recognition of this disabling disorder. You see, back in 1993 when I was working in the Mental Hygiene Clinic (as they used to call it) of the West Haven CT VA, I wanted to set up a program for research of childhood abuse survivors. None of the other psychiatrists were even willing to *ask* their patients if they had been abuse for fear of the fact that they might crumble into dust if asked. So I had to do the evaluations for them and offer to do a group to treat these patients once identified. One of the persons I screened said that he had been in treatment with the state community mental health for 30 years and noone had ever found his problem and on the first visit to the VA the doctor (me) doing the screening had found his problem just by asking if he was abused as a child! (he was) I ran the group with a nurse who grew up in an Amish family and had been sexually abused in childhood. We ran the group for two years and at the end of the time decided that the group should come to an end. Every week for the next year though the patients kept coming back to my office on the day and time we held the group. Well, that is how I feel now about pharmalot. Anyway, enough sentimentality, and on to the Shadow Team’s DSM-V criteria for PWS! 

• Feelings of sadness, anger, or tearfulness when contemplating the closure of pharmalot.com
• Obsessive internet activity involving reading comments about feelings of outrage related to a pharma HR exec who took a helicopter to work while rank and file employees were being laid off
• Having feelings of attachment to people you’ve never met who use false names like ‘Atlex’ and ‘Former Pharma Exec’
• Checking email inbox obsessively for pharmalot feeds
• Fantasizing about Ed Silverman’s laptop
  

  originally posted Jan 7 2009

• update: I solely take responsibility for the actions of the so-called shadow team as I have not received input from the other members

• COMMENTS

  The Shrink’s bible has been around for over 50 years, and now possibly contains nearly 300 mental disorders. Published by the APA, it is also used, I understand, for mental diagnostic criteria to assure reimbursement as well as to validate suspected assessments by the psychiatrist and is organized by the following:

  I- Mental disorders

  II- mental conditions

  III- Physical disorders/syndromes, medical conditions (comorbidity)

  IV- Mental disorder suspected etiology

  V- Pediatric assessments

  The next DSM, DSM-V, has had it’s task force members sign non-disclosure agreements, which is rather absurd. Lack of transparency equals lack of credibility because of these agreements of the content of the next DSM. It opposes any recovery model necessary regarding such disorders, I believe.

  The DSM should be evaluated by another unrelated task force to assure objectivity,

  Dan Abshear

Therapy Patient wrote

I loved your post on the DSM-V Shadow team, in particular the “new diagnoses”.  Hysterical!  I especially liked the Narcissistic Psychiatrist Syndrome (NPS) because I went to a psychiatrist for a while very close to that description. I found it amazing that he could open the door, let me in, get the door closed, his file out, conduct an assessment, handle payment, all without EVER looking at my face. I would bet he never looked ANYONE in the eye.  It would have been funny even at the time if I hadn’t been wanting his help.  I DO find it funny now!

Regarding cheerleaders recruited for pharma, that’s nothing new. A woman I know well (I hate to say friend!), was recruited from her dance department in a Louisiana college in the early 1970’s to sell drugs to doctors, so similar tactics have been in use for quite some time.  She made a striking impression, I am sure, with her natural red hair. She STILL has exaggerated smiles, exaggerated enthusiasm.  I don’t know if it was a prequalification for the job or if she learned it working for pharma, but she STILL has no qualms about lying, misrepresentation, and doing just about ANYTHING to make a sale, which is why I don’t call her a friend.

Perhaps your Shadow Team photo was purposely dark to represent the “shadow” part of Shadow Team, but if it was just a lousy exposure I have attached a corrected file.

Rather than admit that one of their silver bullets, Accutane (isotretinoin), which was a “goose laying the golden egg” for F. Hoffmann-La Roche Pharmaceuticals (and their various “Roche” associates world-wide) to the tune of a billion dollars a year, could make kids depressed or kill themselves or cause grotesque birth defects in the kids of over half of women exposed when pregnant, dermatologists have sung themselves a lullaby that their magic pills don’t make kids depressed, they actually make them better, by clearing up those ugly zits that drive them to despair. In what can only be described as a tragic collusion of conflicts of interest (COI) amongst their Key Opinion Leaders (KOLs) and willful denial amongst the lowly rank and file, they have decided to say “What? Me Worry?”

When the heat got turned up on Roche Pharmaceuticals after the son of Congressman Bart Stupak’s (D-Mich) son Bart Jr. died of suicide while on Accutane in 2000, they got busy and called a “Scientific Advisory Board” meeting at the Ritz Carlton in Alexandria, Virginia, to opine on the topic of the relationship between Accutane treatment and depression. This meeting included figures from psychiatry like Kathleen Merikangas, PhD, Stuart Montgomery, PhD, and David Nutt, MD, Chair of Dermatology David Bickers MD, and psychiatrist Douglas Jacobs, MD. Between the lot of them I think they have written about one paper total in the literature on the subject. But they did get paid a nice consulting fee for their efforts, of course.

Their conclusion? No relationship, of course.

I wasn’t aware you were an Accutane expert, Kathleen!

I challenge them all to a debate. I’ll fight them with one hand behind my back!

Fact is Accutane’s efficacy for acne was discovered a decade before Roche put a patent on it, in a paper in the New England Journal of Medicine.

I have communicated with two of the authors, both dermatologists, Frank Yoder MDand Gary Peck, MD.

Both of them agreed with my opinion that Accutane can cause depression in some individuals.

What is really sad about this whole sordid tale is how degenerated the so-called dermatology “literature” has become on the topic.

For example, the most commonly cited study to support the statement that acne is associated with depression, a study that has been cited several hundred times by dermatologists writing in the literature, involved only ten patients with acne and no comparison subjects (Gupta et al., 1990). No statistics were performed (obviously since there was no comparison group). Scores on the questionnaires for anxiety and depression were not related to severity of acne.

And the fact is that the rest of the literature isn’t any better. Objective measures of acne do not correlate with severity of anxiety or depression. Acne does not cause major depression. It is simple as that.

Sure, kids worry about their zits and feel better when they go away, but the studies do not support the conclusion that acne causes major depression, and that treatment of acne cures depression.

In spite of this the manufacturer of Accutane, Hoffmann-LaRoche, has consistently downplayed the risks of suicide and depression and has denied a causal association (McCoy, 2004). The dermatology community has joined with the manufacturer in praising the merits of this medication for the treatment of acne which they describe as the “penicillin of dermatology”. It took only 10 months for the FDA to approve Accutane for the treatment of cystic and nodular acne in May of 1982, however controversy has followed it from the time of its initial launch. In January of 1983 one of the authors of the first paper to describe the use of isotretinoin for the treatment of acne in 1977, Dr. Frank Yoder, wrote about the potential dangers of Accutane (Yoder, 1983). In 1990 Dr. David Graham of the FDA highlighted the inability of the Dermatological Medications Advisory Committee to the FDA to be impartial since it was made up entirely of dermatologists (Green & Hutt, 2002). At that time he stated that Accutane should be taken off of the market, mainly because of the risk of birth defects. Indeed its use has always been curtailed or highly restricted in European countries, unlike the US where it is often prescribed for minor blemishes. Strong feelings about the utility of isotretinoin for the treatment of acne in the dermatology community, and forceful marketing by the manufacturer in the US, have caused a delay in awareness of the potential risks in the US. In 1998, the year that the FDA first approached Hoffmann-LaRoche about adding a warning related to suicide with Accutane to its label, the manufacturer ran an ad that stated, “Effective treatment of severe recalcitrant nodular acne minimizes progressive physical scarring, as well as negative psychosocial effects such as depression and poor self image” (Green & Hutt, 2002). This was in spite of the fact that less than half of patients prescribed the medication actually had nodular acne. The FDA required that Hoffman-LaRoche pull the ad.

In 2000 Congressman Bart Stupak’s son, Bart Jr., committed suicide while on Accutane. Congressman Stupak called for congressional hearings on the safety of the drug and in September of that year the FDA called a Dermatologic Advisory Committee meeting on the topic. In November of 2001 an educational grant from Roche funded a supplement of the Journal of the American Academy of Dermatology on isotretinoin which followed the Scientific Advisory Board Meeting in Alexandria VA they held on the topic. The basic science-related articles focused on retinoids and the skin, essentially ignoring the large extant literature on retinoids and the central nervous system. Psychiatric side effects merited literally two sentences, and one article, written by one of Roche’s hired guns, stated that there was no evidence for any association (Jacobs et al., 2001), ignoring the reported challenge-rechallenge cases which have been cited in the pharmacoepidemiology literature as adequate in and of themselves to establish causality (Strom, 2005). This led members of the FDA to write a letter of response, “in the interest of public health,” admonishing the authors of these articles for the short shrift they paid to the issue of Accutane and psychiatric side effects (O’Connell, Wilkin, Pitts, 2002).

The degree to which dermatologists have thrown science and logic out of the window in order to protect their magic bullet is simply remarkable. For instance in a 2004 article entitled “Myths of Isotretinoin Therapy” (Alcalay, 2004) “isotretinoin causes depression and suicide attempts” was listed as a “myth”. The article went on to state that any risk needed to be “weighed against the increasing prevalence of depression among adolescents and young adults and the psychological impact of acne.” [In fact, depression is not increasing amongst teenagers and acne has not been associated with clinical depression, rather only changes in self esteem].

Here are some authentic mythic figures for you, Dr. Alcalay! And they don’t have any pharmaceutical industry COIs!

Aktan, S., Ozmen, E., Sanli, B. (2000). Anxiety, depression, and nature of acne vulgaris in adolescents. International Journal of Dermatology, 39, 354-357.

Alcalay, J. (2004). Myths of isotretinoin therapy in patients with acne: A personal opinion. Journal of Drugs in Dermatology, 3(2), 179-182.

Green, J., Hutt, P. (2002). Babies, blemishes, and FDA: A history of Accutane regulation in the United States., Leda. Cambridge, MA.

Gupta, M. A., Gupta, A. K., Schork, N. J., Ellis, C. N., Voorhees, J. J. (1990). Psychiatric aspects of the treatment of mild to moderate facial acne: Some preliminary observations. International Journal of Dermatology, 29(10), 719-721.

Jacobs, D. G., Deutsch, N., Brewer, M. (2001). Suicide, depression, and isotretinoin: Is there a causal link? Journal of the American Academy of Dermatology, 45, S168.

Kellett, S. C., Gawkrodger, D. J. (1999). The psychological and emotional impact of acne and the effect of treatment with isotretinoin. British Journal of Dermatology, 273-282.

McCoy, K. (2004, December 7, 2004). Drug Maker rebuffed call to monitor users. USA Today, pp. 1-2.

O’Connell, K. A., Wilkin, J. K., Pitts, M. (2002). Isotretinoin (Accutane) and serious psychiatric adverse events. Journal of the American Academy of Dermatology, 48(2), 306-307.

Shuster, S., Fisher, G. H., Harris, E., Binnel, D. (1978). The effect of skin disease on self-image. British Journal of Dermatology, 99(Suppl 16), 18-19.

Smithard, A., Glazebrook, C., Williams, H. C. (2001). Acne prevalence, knowledge about acne and psychological morbidity in mid-adolescence: a community-based study. British Journal of Dermatology, 145, 274-279.

Strom, B. L. (Ed.). (2005). Pharmacoepidemiology (4 ed.). New York: Wiley.

Van der Meeren, H. L. M., van der Schaar, W. W., van den Hurk, C. M. A. M. (1985). The psychological impact of severe acne. Cutis, 36(1), 84-86.

Wu, S. F., Kinder, B. N., Trunnell, T. N., Fulton, J. E. (1988). Role of anxiety and anger in acne patients: Relationship with the severity of the disorder. Journal of the American Academy of Dermatology, 18, 325-333.

Yoder, F. W. (1983). Isotretinoin: A word of caution. Journal of the American Medical Association, 249(3), 350-351.

 

Originally posted Jan 5 2008

Well it is flu season now and I was asked by a reader if there was anything new from last year’s post on “Flu shots are for idiots”.

Well I have had some delay because, well, I had the flu.

But that doesn’t mean I am going to get a flu shot!

Since last year the Centers for Disease Control (CDC) here in my home town of Atlanta, GA, have gone from thinking that everyone under the age of 6 should get a flu shot to stating that everyone under 18 should get one, in addition to everyone over the age of 50, as well as other groups of people with specific medical conditions, and healthcare workers. In fact, government agencies world-wide seem to be hyper-eager to get everyone to get those flu shots. But, personally, before I do anything like submit myself to having a needle jammed in my arm that I have to pay for, I always ask myself, is there any evidence that this is going to actually help ME? In the case of the flu shot the answer is… probably not. Sure it will help the manufacturer of the flu shot make their sales projections. And why the CDC has gotten itself into the sorry ass position of recommending vaccines for people in whom the evidence does not exist to support a real benefit is beyond me. In fact the data that flu vaccines save lives in these age groups is just not that great (translation: doesn’t exist). The problem is that there are many strains of flu and the vaccine targets only one, and you need the shots every year cuz the viruses keep changing.

And that oft quoted figure of 30,000 deaths per year? Half of those cases of the “flu” are actually flu-related illness that is not actually caused by an influenza virus (and not prevented by flu shots). And most of the rest are in the elderly who often have impaired immunity so the flu shot wouldn’t work for them anyway.

I have reviewed the literature and the ONLY group for which there is ANY evidence that flu shots might save lives is with people with chronic obstructive pulmonary disease (COPD) which is caused by smoking. So if you want to avoid dying from the flu, stop smoking. And no, they don’t reduce days lost from work overall.

As for the guilt trip that hospital workers should get the shot to prevent spread to patients, the flu is infectious for one day before the onset of symptoms and five days after the start of symptoms, so if you get sick, stay at home for five days

The experts in the literature are actually saying not to use flu vaccines, although noone seems to listen to them. Quoting epidemiologist Tom Jefferson below: from an article in BMJ.

The optimistic and confident tone of some predictions of viral circulation and of the impact of inactivated vaccines, which are at odds with the evidence, is striking. The reasons are probably complex and may involve a ‘messy blend of truth conflicts and conflicts of interest making it difficult to separate factual disputes from value disputes’ or a manifestation of optimism bias (an unwarranted belief in the efficacy of interventions).

Translation: Politicians that fell asleep in science class in high school are getting a lot of money from vaccine manufacturers. Through a combination of greasing the wheels and the fact that they are too stupid to know better, they actually think that they are helping us out by using government resources to try and ‘educate’ us that we need to get a flu shot that actually will do nothing for us.

Should you take Tamiflu or similar drugs to prevent the flu? As I have written about before it will only reduce your days of symptoms from 7 to 5, hardly a great deal for a drug that might make you want to off yourself.

originally posted December 17,2008

COMMENTS

Dan Abshear wrote on December 17, 2008

It is understood that the disease influenza is a disease caused by a RNA virus that can infect both mammals and birds. In fact, this particular virus can mutate to where it can be shared between the two life forms and multiply within each one of them.

Unlike coryza, influenza expresses symptoms more severely, and usually lasts two weeks until one recovers who has the flu. Influenza, however, poses a danger to some with compromised immune systems, such as the chronically ill. In cases such as this, influenza can in fact progress to deadly pneumonia. Symptoms of influenza usually start to express themselves 36 hours after being infected with the virus.

The flu vaccination contains three viral strains of suspected viruses for flu outbreaks during a particular winter season, as determined by the World Health Organization. Yet the strains chosen are speculated influenza viruses, as this does not eliminate the chance of a new and dominant influenza viral strain that possibly could cause a pandemic. It takes manufacturers about 6 months to make and formulate the influenza vaccination. We hope.

David Diamond wrote on December 17, 2008

Doug –

Kudos once again to you, perhaps because we think so much alike. I’ve been saying for years that the flu shot is useless and a waste of money.

FYI, attached is a paper published by the CDC. It shows that in ’97-98 people vaccinated with the flu shot actually had MORE lost work days and physician visits than placebo-injected controls. This is probably an example of randomness in science, since the next year the effect reversed with more placebo-injected people losing work than vaccinated people.

This paper also shows how rare the flu actually is – only 9 of 275 (3.2%) people in ’97 and only 20 of the 275 (7.2%) in ’98 were diagnosed with the flu – and no one died from it. It’s hard to see how the govt comes up with the figure of 30,000 deaths/year from the flu.

David Diamond

After posting about the increase in psychotropic drug use in children and commenting that doctors should stop giving antipsychotics to children without schizophrenia I got some words of praise from Philip Dawdy at Furious Seasons and some interesting information from Lisa Van Syckel who gave me a list of ages and drugs given to kids in NJ which I found shocking, as well as data on antipsychotic drug sales to kids in NJ. Here are some examples of kids given antipsychotics in NJ:

• A months old infant on chloral hydrate (sleeping pill).
• A two year old on Strattera (ADHD psychotropic drug).
• A three year old on methylin (methylphenidate, or Ritalin, a stimulant ADHD drug)
• A four year old on Concerta (extended release methylphenidate for ADHD)
• A two year old and a three year old on Risperdal (risperadone)
• A three year old on Adderall (amphetamine salts)
• A two year old on Ativan (lorazepam) (sedative, sleeping pill)
• A three year old on Ritalin
• A three year old on Focalin (dexmethylphenidate, ADHD stimulant drug)
• A four year old on Zyprexa (olanzapine)
• A three year old on Paxil (paroxetine)
• A three year old on Seroquel (quetiapine)
• An infant on Valium (diazepam)
• A four year old on Ambien (sleeping pill)
• A four year old on Prozac (fluoxetine)

Meanwhile sales of antipsychotic drugs to children continues to climb (data from NJ)

Shocking!

Come on guys! Here is some more free continuous medical education (CME) that is not funded by pharma! Babies don’t sleep through the night but they don’t need a pill! Toddlers have tantrums but don’t have bipolar disorder in need of antipsychotic drugs! It doesn’t matter if three year olds don’t concentrate because they aren’t in school anyway and they don’t need ADHD drugs! Three year olds don’t develop “major depression!”

Stay tuned for more CME.

[originally posted November 20, 2008]

Dan Abshear wrote on November 20 2008

“Bad Baby, Take Your Risperdal!” That title is intriguing.

Parents may give their kids drugs to displace their own fallacies and shortcomings as a parent? Get their kids on meds as an excuse?

It’s possible, and while I’m not a shrink, I’ve thought of this possibility in the past.

Regardless, I’m opposed to medicating kids in such a way, so thanks for the post,

Dan

Lisa Van Syckel wrote on November 20 2008

Dr. Bremner has been quite gracious to the Physicians who prescribe. Dr. Ilena Bernal,NJ, who was a psychiatrist at UMDNJ Behavioral Health prescribed my daughter risperdal without my consent. Dr. Robert Hendren a clinical Trial Investigator for risperdal at UMDNJ Behavioural health. Was he aware that children were given the investigational drug risperdal w/out parental consent? It was my belief that he did, and his peer reviewed paper on psychotic children in a hosptal setting is flawed!! and he has refused my calls to discuss this issue…

It should be noted that there are apprx. 39,000 children in NJs Foster Care Program. In Oct of 2006, 39,517 psychotropic drugs were prescribed for NJs most vulnerable children. Senator Joseph Vitale NJ has blocked a Parental informed consent bill from his [legislative docket. The parental informed consent bill would require such for prescription of psychotropics to kids (that don't work for them anyway, editorial note)]

Barbara wrote on November 20 2008

Doug, you wrote Three year olds dont develop major depression! I would add that three year olds that have been abused look depressed but are suffering from Acute Stress Disorder or PTSD. Charlie Whitfield has a new book coming out where he writes about the topic…

Doug Bremner wrote on November 20 2008

Hi Barbara, thanks for writing in. I totally agree that abused three year olds can have behavioral disturbances that are related to brain disturbances. However I think the problem is that psychiatrists are seeing these kids and saying they have a ‘chemical imbalance’ related to ‘major depression’ and the treatment of choice is an SSRI. Although these kids certainly have problems with their brains I think that giving psychotropics to them is highly problematic as they are not the same as classic adult major depression (where there have been positive clinical trials, albeit the results are not as great as some might think) and on top of that there have been no clinical trials in three year olds of SSRIs, and the studies in teens with ‘depression’ are negative. So not discounting the disorders, just the approach to treatment.

Lisa Van Syckel provided the following post on November 20 2008

Thursday, May 4, 2006

By EILEEN STILWELL

Courier-Post Staff

Had Laurie Yorke known about the potential for harm to her son four years ago when a child psychiatrist prescribed Paxil, a popular antidepressant, to treat a single panic attack, she would have said, “No thanks.” “Instead, taking the drug as prescribed launched her adolescent son on a two-year emotional roller coaster that triggered two suicide attempts and outbursts of aggressive and psychotic behavior that forced the former “A” student out of school, she said. ” “The good news said Yorke, a registered nurse, is her son, Ryan, now 18, has survived, unlike many other adolescent Paxil users.” “Yorke spoke passionately Wednesday at a press conference called to release a study on a deceptive marketing practice commonly used by drug companies.” Read more about Laurie Yorke’s experiences here.

A post about Laurie’s son on antidepressants is posted here.