Well we knew it was the case all along but this week there are emails released as part of Vioxx litigation in Australia against the drug company Merck related to Vioxx induced heart attacks, that show that Merck drew up a “hit list” of doctors in academia whose opinions about Vioxx were negative in order to “neutralise” or “discredit” them (their words, not mine). One of the emails stated:

We may need to seek them out and destroy them where they live

In other words, use influence and intimidation to block their promotion, remove their research funding, or threaten their universities with such tactics. Some doctors get death threats and letters are sent to their deans, or their deans get phone calls. As I have written previously, Hoffmann La Roche Pharmaceuticals didn’t like my opinion about their acne drug Accutane and depression, and went to great lengths to discredit me. One attorney who came onto the scene late said it was a “cautionary tale” and another one said that they did that in order to make an example, so that noone in the future would say negative things about their drugs.

So what you have is a picture where drug companies shell out hundreds of thousands of dollars to key academic physician leaders to buy their good will, and those whom they can’t buy off they try to destroy.

Find out where they live and destroy them!

 Hat tip to Marilyn Mann.

[update: video of "V-squad" training video of super heroes used to train Vioxx sales team posted here.]

Well I thought my last post on PTSD (see “DSM V Team Strikes Back Against PTSD Establishment on PTSD“) might at least flush out who the mystery woman psychiatrist is from the Sex and Seroquel scandal (it didn’t) but it did provoke a reaction from David Dobbs, the author of the Time magazine article (The PTSD Trap”) that I took on as peddling pseudo-contrarian views. My beef was not with David, whose Neuron Culture blog makes for good reading, but with psychiatrists such as Paul McHugh MD who give lectures saying that childhood abuse memories are implanted by therapists based on nothing more than his opinion, or by others making sweeping statements implying that PTSD is somehow problematic.

I guess David got upset that I called him retarded (actually I said his comment implying that the VA wanted to increase the ranks of the PTSD disabled was retarded, not him) and he took issue with my saying I am not part of the establishment (hey I am not on DSM committee and never get awards and stuff like that, unlike some of my more druggy friends). He and other bloggers on scienceblogs took issue with my picking on their friend, with Neuroskeptic blogger criticizing me for calling professors pointy headed (hey I have an old car and Rush Limbaugh is the only channel I get) and Orac from the blog “Respectual Insolence” (cool! I didn’t know he read my blog!) said I was getting on his nerves and he was going to pick a fight with me about cancer screening tests being more or less useless (Gasp! I slap you with my glove Sir!). Well since he is a cancer guy I guess it is always hard to get a criticism of what is your bottom line.

Come on! I'll fightcha with one hand behind my back!

But hey this is a blog for Christ’s sake and that post set a new record for readers so I guess people at least didn’t think it was boring.

Now it looks like David is going to make me the subject of a journalism symposium (yeah! I love attention!) and with these successive volleys the Good Ship Pilleous is now sailing into battle in the PTSD Wars!

Tally ho and onward buckaroos!

This has been knocked around in the blogosphere after an article in the Washingon Post publicized this week’s study results, however I thought I would give the study my usual thorough going over. The ongoing NIH funded Multi-site Multimodality Treatment of Attention Deficit Hyperactivity Disorder (MTA) study (updated in an article this week in the Journal of the American Academy of Child & Adolescent Psychiatry) showed that treatment with the stimulant medication Ritalin (methylphenidate) wasn’t any better than behavioral treatment after three years. As the parent of a child diagnosed with ADD who struggled for two years trying to cope on our own, going through hell for another two years with medications and their nightmare side effects (described in my book using a pseudonym) I sure would have liked to have known about these results (he’s off meds now and doing well), or in fact that behavioral treatment has been shown to be effective (I honestly didn’t know until today– blame myself). Thanks, National Institute of Health (NIH), for issuing a press release when these study results first came out in 2007 and glossing over the results by describing a “remarkable improvement in all groups” while euphemistically describing the result that Ritalin knocked an inch off of kids growth by stating that kids treated with behavioral treatment were “somewhat larger”.

Humph.

Anyhoo back to the study. Children received either Ritalin or behavioral treatment or a combination of both, or received “regular care” or community care, administered in a placebo controlled randomized study design. Behavioral treatment involved 27 group parent sessions, 8 individual parent sessions, an eight week summer treatment program, 12 weeks of classroom behavioral therapy, and 10 teacher consultation sessions. At one year Ritalin or combination worked better than behavioral treatment, a result that was much trumpeted by the study authors. After one year patients were followed for another two years without controlled treatment. Although some kids went off drugs and some originally treated with behavioral therapy went on drugs, at the two and three year followup there were still more kids on medication in the original medication treated group than in the behavioral therapy group.

The result? Children who were originally treated with medication did no better than those treated originally with behavioral treatment at three years after the original start of treatment.

_____ Community Care ..... Meds __ __ __ Combo __ .. __ .. Behavioral Rx ____ ____ Normal

What’s interesting about this study that was not noticed in the press coverage is that based on the study results it isn’t clear if any kind of treatment is better than just leaving the kids alone for a couple of years. It’s hard to know though because the “community care” group also got treated with various medications and psychotherapies, but we really don’t know which ones.

Another thing is that by doing a press release that put a positive spin on the results borderlines on fraud. Back in 2007 the authors wrote that there was a “remarkable improvement in all the treatment groups” which glossed over the fact that the study showed that medications were not better than behavioral treatment after three years. Even now when one of the study authors, William E. Pelhem MD, stated the obvious conclusion that medications are no different than behavioral treatment after three years, he was accused by co-author Peter S. Jensen MD of being “biased against medications”. Here is a quote of Dr. Jensen, read and make your own judgment:

Jensen said Pelham was the only member of the team of researchers who took away “the silly message” that the study raised questions about the long-term utility of drugs.

Back in 2007 in the NIH press release Jensen made the following absurd comment:

Our results suggest that medication can make a long-term difference for some children if it’s continued with optimal intensity, and not started or added too late in a child’s clinical course.

What’s with these guys, anyway?

I say why does the Washington Post feel the need to get expert opinions? Look at the graph and decide for yourself. There is NO DIFFERENCE.

That said this study was a really goofy study design, one year of randomized treatment followed by two years of letting people drift. The only explanation for how they came up with such a goofy study design is that they were going with Harvard’s Joseph Biederman’s pronouncements that ADHD is a chronic condition which never gets better (which obviously isn’t true. I had to bite my lip the other day when our pediatrician sat there and told us that ADHD was a permanent condition and if our son was doing well now off meds that he would probably need to take meds again next year if his class wasn’t as interesting. Grrr.) and that treatment gains at one year would hold up at three years (which they didn’t). They must have been surprised at the findings and came up with all kinds of goofy explanations and press releases and stuff and then were relieved when they got away with it. I know that if I had read the paper in 2007 (I didn’t) I wouldn’t have let them get away with that. I don’t know if this study tells us that much, other than that giving your kids Ritalin at age 9 for a year won’t make a difference when he’s 12 over doing behavioral treatment. Looking at this data I was starting to wonder if behavioral treatment was worth the effort or whether kids just got better on their own, however I found this study by Pelham et al 2005 that showed that intensive behavioral treatments were better than doing nothing. I just wish someone had told me that such treatments were useful. I guess that’s what I get for putting my faith in pediatricians and child psychiatrists. It’s all drugs, drugs, drugs.

Another thing is that letting authors say things like “all treatment groups showed a remarkable improvement” rather than “the medication treatment group was no better than the other groups” made me wonder who was responsible for allowing this rot to get published. The current study, the 2007 study, and the infamous Study 329 of SSRIs in kids, all share in common publication in, guess what, publication in the Journal of the American Academy of Child & Adolescent Psychiatry. I started to wonder, what is going on here? And so I looked up the editor, who comes from, surprise, the Yale Child Study Center, home of the fun with Doug crowd, and knowing those guys, the appointment as editor comes more as political payoff than a decision based on merits, which is all the more dissapointing since in this case kids are put at risk.

Maybe we should compare Ritalin to treatment with a wet noodle. Hiyah!

This is a video on local TV news in Atlanta about our research study on teaching Mindfulness Based Stress Reduction (MBSR) to returning Iraq vets with PTSD with our star Donny.

Last week Mrs. Bremner was communicating to us from the American Heart Association Meeting about the importance of salt on blood pressure and health which led to a post about the topic which led to a lively discussion. David Colquhoun started out by pointing out that the graph showing a correlation between salt load and hypertension from the paper by Professor MacGregor could be accounted for by four data points. Mrs. Bremner countered by pointing out that they had re-analyzed the results without the four lowest data points and it was still significant. She subsequently pointed to another paper which summarizes clinical trials on the effects of salt reduction in the diet on health.

In this paper the authors point out that many studies that are used to argue that salt reduction has no effect on hypertension or health are studies in which the salt reduction only occurred of the course of one week, or involved acute salt depletion. The authors point out that one week is not long enough to evaluate the effects of salt reduction, and that acute salt reduction leads to an activation of the sympathetic nervous system, which leads to an artificial increase in blood pressure. Sounds good to me so far, guys.

They listed 17 trials of people with hypertension and 11 trials of people with normal blood pressure that were conducted for four weeks or more and had adequate salt reduction (4.6 g per day) as measured by excretion in the urine. People with hypertension had a 5 mm Hg point drop in systolic and 3 point drop in diastolic. People with normal blood pressure also showed a drop to a lesser extent. The authors note that this amount of salt reduction would result in a 14% drop in strokes and a 9% drop in heart deaths.

Clinical trials of dietary salt reduction and high blood pressure

Unfortunately noone has done a randomized trial of low salt versus high salt diet and it is unlikely to happen now due to ethical issues. Mrs. Bremner points out that increases in salt in the diet lead to a craving for salty food that causes a vicious cycle, which is one way people may become addicted to salty junk foods and snack foods.

Dr B.’s comment: It looks like cutting down on salt does lower blood pressure although a 14% relative reduction in cardiac events may not be that big of a deal in terms of absolute reduction of risk for a single individual. Salt may be just part of the problem with junk food. There was a study showing that people who eat in fast food restaurants three times a week have a greater than 90% risk of getting diabetes or heart disease and I need to find that reference again.

People have told me that I should go on Oprah because of my book about medications. But I am glad I never did (not that I got the offer anyway) after learning about how Dr. Mehmet Oz, described as America’s Doctor, who makes frequent appearances on the Oprah Show and who authored several books in the popular series of You: The Owner’s Manual which he co-authors with Michael Roizen, MD, is a paid consultant for a website called RealAge that asks you a series of questions to find out your biological or “real” age. The web site has registered 27 million people.

I'm not really that old, am I?

Turns out this web site collects demographic information and sells its services to drug companies, who then use it to target specific groups to sell prescription medications to. For instance, if it turned out that you were at risk for pre-hypertension, they would send you emails with “information”, and then when you were “softened up” hit you up with a pitch about how you should take a medication for hypertension. Which all means, of course, that Dr. Oz gets automatic admission to the Drug News and Health Safety Blog team of MD Cheerleaders for Pharma!

Gimme a D! Go Dr. Oz!

I was actually on their radio show right after my book came out, interviewed by Dr. Michael Roizen, but that is as close as I ever got to the bright lights. It is actually kind of weird how much the media shies away from the issue of prescription medication safety, unless they have the feeling that “everyone else is going after the story.”

The newspaper article on the topic quoted a woman who appropriately stated that she didn’t appreciate having her personal information used for drug marketing. But then the article (I guess to have “balance”?) bizarrely quoted a former pharmaceutical saleswoman who stated that it is important to have all the information you can get so you can make informed decisions for yourself.

“Information”? Give me a break. And my comment on Dr. Oz’s behavior is go back and read your Hippocratic Oath, which sez above all do no harm. And sending blanket emails with scary messages to induce people to take prescription medications which could hurt them and that they may not need is a violation of that oath.

Hat tip to therapy patient.

In this recent piece from Howard Brody MD of the Hooked blog about how the American Psychiatric Association (APA) recently voted to eliminate pharmaceutical industry funding of educational symposia as well as free meals etc. from their annual meeting, he asks what they will do to pay for their education. I am not involved in the politics of the APA (or any other organization, for that matter, not that I shouldn’t be based on my research accomplishments, but maby they just think I am a curmudgeon or something. And neither me nor Mrs. Bremner have ever gotten one of those lifetime achievement awards).

The last time I went to an APA meeting it was in New York several years ago and I took my daughter so we could have a bonding experience and see the sights. I typically have gone to the American College of Neuropsychopharmacology (ACNPee pee) which doesn’t have overt drug sales displays but which is perhaps a more covert form of drug company coercion after all, so I am going to have to look into doing something at APA given these new rules (and forgoing ACNP). Good job guys. And hat tip to Danny Carlat who has gotten involved in the internal politics of education within the APA and surely must have played a role in this decision.

The fact is that the APA is the first medical organization to make such a move and hats off to them. Let’s celebrate.

Yeah! The wicked drug company is dead!

Howard quoted someone from the APA saying that without drug companies they would have to hold their lectures at the YMCA. Well I think I have a pretty good analogy for you. For one of our NIH funded grants we added as a consultant Lori Davis MD of the Tuscaloosa VA and the University of Alabama Birmingham Department of Psychiatry. Lori came over to Atlanta and gave a lecture on “Diagnosis and Treatment of PTSD” and then met with our staff and fellows to review diagnostic assessments of PTSD. She will return in May. The lecture was delivered in the auditorium of the old Georgia Mental Hospital which is now owned by Emory and called Emory Briarcliff. Not the Ritz, but no overhead, free, easy, and free of commercial influence. Isn’t that the way it should be?

President Barack Obama’s administration is rolling back into universal healthcare land just like Hillary Clinton tried to way back when. We’ll see if he can survive the shark infested waters any better than she did.

Come on in, the water's fine.

In case you are Rip Van Winkle or someone dropped you on your head so you don’t remember, back in 1993 Hillary Clinton got torn to shreds by insurance lobbiests and other special interest groups. Remember the Harry and Louise ads funded by the Health Insurance Association of American (HIAA), where they sit around fretting about how to pay for their mandatory healthcare insurance?

Now the health insurance guys are whining again. They say they don’t want a “Medicare for all” plan cuz it will drive them all out of business. Or if there is an expanded healthcare they don’t want the government to have the chance to negotiate contracts with doctors and hospitals (unlike them). Oh, and if the government can negotiate with doctors and hospitals they will go out of business too. But isn’t that anti-capitalist to be against negotiating prices? What they might as well say is that they are bloated and inefficient and couldn’t compete with any alternative system. I call the organizations that represent hospitals, insurance, doctors and drug companies the evil Gang of Four.

Clockwise from upper left, AMA, HIAA, PhRMA, AHA

Did you know that Ronald Reagan made promotional videos for the American Medical Association (AMA) that they showed to their members way back in the day, about how they should fight against Medicare, because it was socialized medicine? The AMA really has a disgraceful history and I am glad that their flagship journal, JAMA, is running into rocky shores. The insurance guys and their pals the hospital lobby (American Hospital Association, AHA), the AMA, and pharma (Pharmaceutical Research and Manufacturer’s Association (PhRMA) are gonna do what they can to confuse and confound. But in the meantime, they have offered to not charge people more for insurance who have pre-existing medical conditions, if everyone is required to buy insurance. This looks like a crumb they are throwing out to try and avoid any new government insurance program or expansion of Medicare.

Here is a handy little chart comparing the pros and cons produced by the New York Times.

Hmmm, do we want more government control, or less of it? More government control, or less? Hmmm.
Maybe we should set up an office pool to see how long “healthcare reform” lasts this time around.

Since the establishment of the DSM V Shadow Team to track the proceedings of the DSM committee in response to their paranoid decision to keep all of their meetings a secret and not allow anyone to keep notes or talk to the press, we have been quietly reviewing psychiatric nosology and contemplating the architecture of psychiatry. The ongoings of the “mainstream” DSM committee were chronicled in an article in this month’s Time magazine (remember when you used to read that? So do I) called “Redefining Crazy: Researcher Revise the DSM-V” where it made the point that psychiatrists were spending more time arguing than coming to consensus (Hey Dr Hyman, I thought you weren’t supposed to talk to the press? I am gonna have to tattle on you to David).

However several recent articles by journalists who seem to have granted themselves honorary degrees in psychiatry and who quote whatever ridiculous opinion from psychiatrists that happens to cross their desk as if it is, well, worth quoting, have prompted us to speak out.

First off, the New York Times wrote an exceedingly lame editorial regarding the decision of the Department of Defense to not award the Purple Heart (the medal received by soldiers who are wounded in combat) for combat-related posttraumatic stress disorder (PTSD). Here is their lame comment:

PTSD can be difficult to diagnose, with symptoms that can arise later in life, far from the battlefield and are not necessarily linked to any specific actions of an enemy. So the Pentagon contends that it has no choice but to exclude its sufferers from the Purple Heart, given to those whose injuries result from direct and intentional action by the enemy…

The military is, in fact, moving forward merely by mentioning PTSD and the Purple Heart in the same breath. Imagine Gen. George Patton, who so notoriously slapped a quivering enlisted man, learning that his beloved Army was even considering giving medals to those whose combat tours left them mentally shattered.

Frankly I found this letter to be patently offensive, ill informed and incorrect. First off, General Patton was an idiot, and should not be celebrated for physically abusing soldiers. Secondly, PTSD is very much related to combat exposure, is not difficult to diagnose, and is not delayed in onset. The NYT morons go on to opine that “Purple Heart may not be the answer — not until, perhaps, advances in brain science bring full objectivity to the diagnosis of mental injury.” And exactly what “brain science” is that? The same morons who publicized dubious science such as the search for the neural correlates of morality or trumpeted a drug that would preserve marital fidelity are now turning those brain scanners against the recognization that war is hell and can be associated with life long mental wounds?

Next on the journalist role call is an article in Scientific American (”Soldier’s Stress: What Doctors Get Wrong About PTSD“) by David Dobbs. An example of one of his (highlighted) retarded statements is “misdiagnosed soldiers receive the wrong treatments and risk becoming mired in a Veterans Administration system that encourages chronic disability.” Since when does the VA want chronic disability? If anything they are invested in reducing their costs. And who is he to say who is “misdiagnosed”? Not everyone develops PTSD, but for those who do, it is real, believe me, and it doesn’t matter what some pointy headed professors (or journalists) who are seeking attention with provocative statements say.

Dobbs taps into an underbelly of academic psychiatry that looks for approval from others by trying to look like they buck the trend about trauma and PTSD, with the basic message that PTSD is an overblown diagnosis created by a bunch of cry babies. Most of these “detractors” he quotes were authors of articles in a moronic special issue of the Journal of Anxiety Disorders in 2007 on PTSD. These authors purport to be offering important and controversial papers that will undermine the diagnosis of PTSD but instead they just send up a bunch of hot air balloons. Simon Wessely, a psychiatrist from the Institute of Psychiatry in London, writes a convoluted “historical” piece that seems to imply that we should pay attention to the role of secondary gain (e.g. getting disability benefits) in the development of PTSD. Big deal, some people want disability payments, does that mean PTSD is a bullshit diagnosis? I don’t think so. It would have been more interesting if Simon had written a piece telling us about who was the mystery woman at his institute involved in the Sex and Seroquel scandal who said that she needed to be punished by the head of the Seroquel Study Team for reading a paper about Risperdal.

Next in the Journal we have Richard McNally, who gets a lot of mileage out of pointing to his study showing that people who think they were abducted by aliens have psychophysiological responses that look like PTSD as evidence that PTSD is a bs diagnosis (if those aliens did that to my rectum I think I would have PTSD too, wouldn’t you)? He makes the point that if you tightened the criteria for PTSD that there would be fewer veterans classified as having PTSD (based on an article that revised the estimate downward from 14% to 9%). So what? As we pointed out in a letter to Science in 2007 that still would mean 236,000 Vietnam veterans with PTSD 30 years later.

We come in peas to help Shadow Team solve mystey of psychiatric diagnosis.

Last time I saw Richard he broke his glasses down the middle during a lecture he was giving and had to hold up one half to read his slides, which he called his “monacle”, which together with his spirited presentation made him look like a mad professor, indeed.

Next we have Paul McHugh, MD, the evil troll who used to second as chairman of psychiatry at Johns Hopkins School of Medicine in Baltimore. Last time I saw him lecture was whining about one of his “case reports” of a woman claiming childhood sexual abuse ”how could that woman have been sexually abused by her father? That family was one of the most prominent families in Baltimore!” as if that made any frigging difference. They write:

PTSD, as presently diagnosed, described, and treated, has failed to improve on what had been standard teaching. It has redefined and overextended the reach of a long-recognized natural human reaction of fear, anxiety, and conditioned emotional reactions to shocks and traumas.

In other words, nothing like the old days, when guys killed Japs and enjoyed it, and gals got raped and if they didn’t stop sniveling you could just give them a good wack to help them get over it.

PTSD doesn't exist cuz I said so. So shut up and sit down.

Robert Spitzer wrote an editorial in this special issue which promised a radical revision, but instead merely recommended requiring that the person be personally exposed to the traumatic event, and dropped a few of the symptom criteria like irritability that were not specific to PTSD. Another editorial was written by the sociologist Allan Young and the epidemiologist Naomi Breslau. Last time I saw Allan he was reading a paper about the Yale Neurosciences PTSD program as an object for study by sociologists with the basic thesis that PTSD is a “social construct”. Frankly when I see a sociologist who studies mental health my instinct is to run in the opposite direction as quickly as I can. For what it’s worth here is the abstract of their paper. Let me know if you can understood it; I sure as hell couldn’t:

As represented in the DSMs, the PTSD syndrome coheres through cause and effect relations among diagnostic features. Research practices routinely ignore this essential characteristic, by atomizing the diagnostic features, especially the role of memory. The failure to confront this contradiction explains the failure of research to fully engage the pathological process that justifies the PTSD diagnostic classification. Several papers in this collection direct readers’ attention to this fundamental problem. We are pessimistic that their insight will lead to positive results.

They don’t sound very optimistic. Does that mean they are not resilient and are vulnerable to PTSD? Don’t worry guys if you get sick I’ll make sure that you do not go on disability and become chronic charges of the government.

What these guys are saying is that PTSD is “not reliable, not accepted” often made up to get victims’ compensation and compare that to “accepted” diagnoses like major depression and bipolar. What’s more their cronies on the mainstream DSM wants to drop Dissociative Disorders as diagnoses all together, for no better reason than because they, well, want to. Well I’ve got news for you guys just because drug companies made billions off of the pedalling of depression (and not PTSD) doesn’t make that disorder somehow more “real”. And the suffering of patients with PTSD and Dissociative Disorders for that matter is very real, thank you very much.

Bye now.

Yodelling video from reader and Lynden WA native Junior Dunham and Ray Charles bird video from Mrs. Bremner.