In August of 2009 ABC News did a story on antidepressant use in pregnant women, with one of the sections entitled “Fresh Guidance on Antidepressant Use in Women”. Fresh guidance, indeed. The only thing fresh about it was that a number of the academic psychiatrists who had been receiving large sums of money to serve on various “Women’s Health” consulting boards related to mental health paid for by the pharmaceutical industry, who were also being paid to fan out across the country and give lectures designed to convince psychiatrists to give SSRIs to pregnant and lactating women, were being quoted in the article as stating that antidepressants were safe to give in pregnant and lactating women. That was, in fact, far from the truth. It has been known for quite some time that SSRIs can induce cardiac defects, increase the risk of miscarriage, and cause other problems like Primary Pulmonary Hypertension (PPH). The drugs cross the placental barrier, for Christ’s sake. Would you take a drug that messes with the brain’s serotonin receptors in your unborn baby, willingly? Hopefully not! Why not just use crack cocaine?

Amy Philo, a mom who developed severe psychiatric symptoms as a result of being given Zoloft in the post-partum period, was contacted by ABC News about their story, but she was never put on the air. Instead, ABC went with a mom who took antidepressants during pregnancy.

Amy Philo and son

See Amy Amy Philo Speaks Out on the Mother\’s Act.

Since 80% of the efficacy of antidepressants is purely placebo effect, the much vaunted effects of the mainstream academic psychiatry establisment to get all pregnant women with depressive symptoms on an SSRI, which held the risk of injury or death to their in utero babies, something they would have to live with for the rest of their lives, in exchange for a 4% or so bump over placebo on a depression rating, all of the ranting and raving of mainstream psychiatry over the tragedy of the depressed mom, and this bullshit about how she won’t connect with her baby when it is born, seems a bit overblown, no? The true risks of SSRIs to pregnant and lactating mothers and their babies are now becoming known, thanks to excellent journalist reporting by people like Evelyn Pringle. Hopefully it can save some lives. And babies.

Yesterday I did an interview on twitter using #writechat with novelist Peter Fogtdal, author of the novel THE TSAR’S DWARF. which I transpose here.

THE TSAR’S DWARF – Sorine a Danish dwarf tormented by her past is given as a present to Peter Tsar of Russia.

You can follow Peter @danish_novelist and his book @thetsarsdwarf on twitter.

I first became aware of Peter’s book through #litchat which is every MWF 4-5 pm EST, where writers chat about their books, gr8 idea. I bought his book and read it and Peter agree to a Q&A.

Peter Fogtdal

DOUG BREMNER: When and how did you first get the idea to write a novel about a dwarf in 18th cent Denmark and Russia?

PETER FOGTDAL: Initially I wanted to write a novel about Peter the Great, but then I read he collected dwarfs & the novel took off

DOUG BREMNER: What interests you about the character of a dwarf in a novel? #writechat

PETER FOGTDAL: I want to say something about how we treat people who are “weird”. Novel is about human dignity, not dwarfs as such

DOUG BREMNER: What kind of research did you do for the book? Were dwarves really called nonhuman in 18th century?

PETER FOGTDAL: Dwarfs were called “it”, not he/she in the 18th century. They were considered toys and at best treated like lap dogs

DOUG BREMNER: Your MC Sorine leads a tragic life but somehow “even she” emerges as human. Did you spend a year in the head of a dwarf?

PETER FOGTDAL: I spent a year in the head of a funny, dark FEMALE dwarf who despises the world but end up accepting it. Another important theme: If you’ve been harassed by everyone, how is that gonna effect your view of God?

DOUG BREMNER: What is your view of Peter the Great Tsar of Russia? Did your view change after the book? Was he flawed? Typical King?

PETER FOGTDAL:Russia’s Peter the Great was a brilliant genius & psychopath, ruthless, energetic, intuitive, eclectic, I love him!

DOUG BREMNER: OK thanks for taking questions.

My bottom line? I found THE TSAR’S DWARF to be a fascinating tale of the capacity for human redemption. Good job Peter and good luck with the book!

I think most people would agree with the fact that corporations are sucking the life out of individual expression and freedoms, whether is it oil companies, tobacco, drug companies, or Toyota. With their teams of corporate lawyers and lobbyists and powerful financial resources they control the stream of information and effectively block or even ruin and destroy anyone who gets in their way.

And how do we counteract that? Well, reading is one way. But the fact is that the corporations have gobbled up all of the publishers, so now there are only four publishing companies that can get their books into book stores, and one of them is owned by Rupert Murdoch, so, well, you know what I mean.

That is why it is good that there is one individual typing away in rural County Kerry in Ireland who will “take the piss out of” the corporate masses as they say there and reaffirm the dignity of the individual through her writings. Marcella O’Connor, is part of a small collective of writers based called the YearZeroWriters collective who have decided to bypass corporate publishing and take their wares directly to the people. I have read their books which are consistently excellent. These include Daisy Anne Gree with Babylon, as well as others. Marcella recently wrote a wonderful story (“Prick Uniforms”) on the YearZero website. It described the anger of an Irish person who encounters an outsider using the Irish tongue to impress his girlfriend. The scene evoked the rage associated with the rape of cultures (and women) by foreign oppressors as well as the personal meanings of native tongues. Marcella is working on a book called The Emptying about a scientist who has donated eggs for IVF and then the children later come back to find her. She tells me that that character was based in part on a friend of hers who is the lead in a rock band.

Keep an eye on this up and coming group of writers.

21 Feb 2010. This blog was corrected from the original version which mentioned checkpoints and the bloody English.

I have been reading books on a website called authonomy.com where readers and writers get together to vote on which books they like best. At the end of each month the publisher HarperCollins takes the top five and gives them and editorial review, and if they like it, a contract. Unfortunately there are no “rules” and that causes some of the sociopaths who run amok on the site to say “Hey there are no rules” as if that gives them an opportunity to play out their bizarre fantasies like they are characters in Lord of the Flies as has been observed by a writer who recently left the site and to lie and cheat in their effort to climb over bodies on their way to the top. Once they get there, their books are appropriately judged as shite (as the Brits who dominate the site say) and promptly dropped in the garbage can. It just goes to show you that most people will act like rats unless they have someone to publicly shame them. JD on the other hand has consistently given great feedback to others, has been honest, and he has a great book that I want to promote. You see, I think writers who are not honest are shite, cuz they don’t describe real emotions, and if you don’t talk about real emotion, who the hell would you want to read your book?

Revene’s book Appetites is described thus:

Days that are going to change your life should come with a warning attached. James Harford misses the signs when he feeds his wife’s desires.

James is a modern man, defined by material successes. Approaching forty he has everything, and it’s not enough. Sal, his younger ex-model wife, is a stay-at-home mum. With the kids at school, her days are beginning to drag.

The day that changes their lives starts normally. They take time without the kids, enjoying a sultry Sydney day. Time for each other.

Then they pick up a charming stranger in a strip club, and one thing leads to the other.

Sal and James both crave something more, but that night changes everything. Yearnings become all consuming. While Sal seeks fulfillment from more and more men, James gets closer and closer to another woman, and gnawing jealousy eats away at what they share.

Can their appetites be sated or will they remain empty?

[WARNING Contains sexually explicit adults only material: readers who would prefer no sex are advised to consider chapters 2, 11,22, 37 or 46.]

i.e. don’t forget to get extra batteries for your vibrator.

I read appetites and I thought it was great. The use of the situation of introducing outside sexual partners into a monogamous relationship and the effect that has on the relationship and the motivations and self deceptions involved were compelling in my opinion as a psychiatrist.

Read more of Appetites here. Join the facebook cause “Get JD to the Editor’s Desk” here.

Back in 1999 I was asked to write an editorial for the American Journal of Psychiatry about a group of articles in the journal on Acute Stress Disorder (ASD). Prior versions of the Diagnostic and Statistical Manual (DSM) had a PTSD, acute (less than one month) and chronic types. The DSM-IV dropped the acute type and added AS, which was like actue PTSD but with some dissociative symptoms (feeling out of your body, feeling like you are in a dream, and so on). The editorial introduced the concept of trauma-related disorders, and proposed taking posttraumatic stress disorder (PTSD) our of the category of the anxiety disorders and creating a new category of disorders related to trauma, that would include acute and chronic PTSD, with and without a dissociative subtype.

I further elaborated this idea in my book Does Stress Damage the Brain : Understanding Trauma-related Disorders from a Mind-Body Perspective (WW Norton, 2002) where on page 36 I introduce the term “Trauma Spectrum Disorders (TSD),” based on the concept that there are a group of disorders linked to trauma that have a great deal of overalp in terms of symptomatology, as well as in brain findings from imaging studies. These disorders include acute and chronic PTSD, Dissociative Identity Disorders (DID), borderline personality disorder (BPD), conversion disorder, traumatic grief (currently a “research” diagnosis in DSM-IV), and the adjustment disorders. I further pointed out that there is a subtype of depression that is linked to early childhood abuse, and that other disorders had a strong connection with trauma, including somatization disorders, alcohol and substance abuse, and eating disorders. Since then I have given a number of lectures on the imaging findings from our group and others (smaller hippocampal volume, depressed frontal lobe function) that characterize these disorders and suggest a common link, and we published a book chapter and an article with Trauma Spectrum Disorders as the title in 2006.

Trauma Spectrum Disorders

Others have had similar ideas. In 2002 Moreau and Zisook also wrote about a Posttraumatic Stress Spectrum Disorder, which looked similar to mine, and Bessel van der Kolk has long talked about complex PTSD, which is an extension of the more restrictive PTSD. It looks like the TSD tag has stuck, but interestingly the DOD and VA are now putting mild traumatic brain injury (TBI) into the mix. I don’t know if I agree with that, since TBI and psychiatric disorders are related to different traumas (one physical, the other psychological). I also get the feeling that the term has been passed around as being useful from a treatment and policy point of view, but that people may not know the background, which is why I wrote this post.

Today I got a call from a reporter who attended a conference on Trauma Spectrum Disorders last year conducted by the DOD, VA and NIH, so I guess the term and the ideas behind it have taken off over the years. He said there didn’t seem to be a clear idea of what disorders were included, so he was looking for clarification

A local FOX Atlanta show, you can see me and read about it here.

Reported By: Beth Galvin | Edited By: Leigha Baugham

Nearly 20 percent of American doctors get paid by drug companies to be consultants or speakers, and in some cases, they’re making quite a lot of money. So does that influence the decisions your doctor makes about your care?

Doctors earn money by giving professional talks to their peers about the latest research and the practice is pretty common.

For years it’s been unclear how much money physicians were actually earning for these speeches. Now, three major drug companies are going public revealing who is on their payrolls and how much money they’re making.

On Eli Lilly’s website, the company lists faculty on the drug company’s payrolls, including educators, advisors and contractors.

Nearly 200 Georgia doctors are on the list and they pulled in over $2.2 million dollars last year.

Some of Georgia’s highest paid physicians on the list are Emory urologist Dr. Muta Issa, who earned $ 91,000 from GlaxoSmithKline. Atlanta endocrinologist Dr. David Robertson cashed in over $78,000 from Eli Lilly and Roswell psychiatrist Dr. Michael Banov banked over $68,000 from Eli Lilly.

Some healthcare providers are earning much more by working for several companies at the same time.

“It’s common, that people who are very active, can make several hundred thousand dollars or more,” said Emory psychiatrist, Dr. Doug Bremner.

“We don’t sell medications. We simply educate physicians about data, and they make their own mind up,” said Dr. Banov.

Dr. Banov, a private practice psychiatrist, was paid over $68,000 by Eli Lilly. The Roswell doctor said he gives speeches for about five companies with competing medications.

“I think my patients welcome the fact they have a doctor who is meeting other doctors, actively involved in research, actively communicating with other physicians, someone who’s on top of the game,” Dr. Banov said.

Dr. Banov said the drug company, not him, creates the materials used in his speeches, and he also said there’s a reason for that. “We are only able to present the data. We’re not able to present our personal opinions, our personal preferences, how we use the medication off label, any of that. So we’re held to a very tight standard by the FDA.”

Emory’s Dr. Bremner said he thought paying doctors to speak for drug makers was a bad idea. Bremner said he used to do it, until he got a wakeup call about six years ago.

“I was going out to give a talk and the sales, the marketing guy like, slapped me on the back and said, ‘Go on out there and sell some,’ I’m not going to say the name of the drug. ‘Sell some of that drug,’” said Dr. Bremner.

Dr. Bremner said he worried that even the most independent doctor can get hooked on all that extra cash coming in. “Doctors are human, and once you get into this routine of making outside income, you become dependent on it.”

When asked how receiving money from the drug companies could from influencing how a doctor treats a patient, Dr. Banov said, “When I close that door, and I’m with a patient, my 100 percent interest is in getting that patient better.”

Last fall, Emory University’s School of Medicine banned staffers from making promotional talks for drug companies after congressional investigators accused the school’s chief of psychiatry, Dr. Charles Nemeroff of failing to report to the university over a million dollars he got from pharmaceutical and medical device manufacturers.

Dr. Nemeroff resigned his chairmanship, and has since left the school.

Another Emory staffer, urologist Dr. Issa listed his earnings as $91,000 in the first three months of 2009 from GlaxoSmithKline. Dr. Issa declined to comment on this story. A school spokesperson said Dr. Issa left the speaker’s bureau when Emory changed its policies.

Atlanta diabetes specialist Dr. David Robertson, who earned $78,000 for giving 47 promotional talks for Eli Lilly, said he only speaks about medications he actually prescribes.

“I think a presentation a physician makes should represent their own practice,” said Dr. Robertson. The doctor did admit that some physicians spend too much time promoting too many products. “That’s bad for everyone. That’s bad for the pharmaceutical companies, that’s bad for physicians as a profession and that’s bad probably for physicians as recipients of information because they become mistrustful.”

So are public lists like this a good thing?

Doctors on both sides say yes.

“I think it’s gotten to the point where the public is looking at it for what it is and they’re saying, ‘What’s going on here?’” said Dr. Bremner.

“Why not let the public know? There is nothing to hide. There is no shame. We’re not doing anything illegal,” said Dr. Banov. “I think it’s terrific. [It] should be completely open.”

So far, GlaxoSmithKline, Eli Lilly and Merck have published online lists of who’s on their payroll. Pfizer will be doing the same this spring.

Related Links: statements and public registries for Eli Lilly, Merck (also see here) and

GlaxoSmithKline (also see here).

Complete statement from Emory University School of Medicine regarding its new Conflict of Interest policy.

“In June of 2009, Emory’s School of Medicine adopted a comprehensive new policy governing faculty relationships with industry. The policy meets the recommendations of the Association of American Medical Colleges, the Association of American Universities, and the Institute of Medicine. Professors Issa, Pacifici, and Schulman are respected faculty members who are in compliance with that policy. Dr. Nemeroff resigned his position at Emory in fall of 2009 to become chair of psychiatry at another medical school.”

I pledge to donate the majority of my future earnings as an expert witness in Accutane litigation to a non-profit institute for transparency in medicine as a counter-balance to the pharma marketing driven information that floods the US medical field and educational system at the current time.

On Thursday an appellate court in New Jersey reversed the decision to let me testify in the case of Palazzolo v Hoffman La Roche, although they upheld the decision to not permit the results of our brain imaging study showing that Accutane affected function of the orbitofrontal cortex. In doing so they correctly noted that the results of the imaging study were just one part of the body of evidence needed to conclude that Accutane can cause depression, not the linchpin of the argument, as the prior judge had noted.

This announcement caused an outpouring of vitriol (e.g. calling my study “faked” and “junk science”), first from lawyers working on behalf of pharma and device makers, writing in the Drug and Device Law blog, then from an MD who works as writer and marketer for pharma and pharma-sponsored CME. I felt I need to set the record straight on a number of points that were made.

First of all, it is not true that the study was “commissioned for the litigation”. Eighty percent of the study was paid for by money donated by Liam Grant of Ireland. Brain scans aren’t free. Roche refused to do a study. In fact, back in 1999, I met personally with John McLane, who unbenownst to me was a senior executive for Roche at the time, who refused to even provide medication for the study. I am not an expert in Liam Grant’s litigation (in Ireland you cannot get more than $50,000 in litigation, so he is hardly doing it for the money). I agreed to be an expert after the study was done, not before. Half of all research is supported by pharma. They “commission” research to serve their marketing goals all the time. The bias that introduces has been well documented. When a study is done that is not controlled by them, they go bananas.

Some of the missing data referred to as “bmax” was actually an erroneous term introduced in the course of the 15 depositions (8 hours each) I went through with Roche over this study. The inability to retrieve the numbers was temporary due to problems accessing old media (not an uncommon problem in imaging research). By the time the data was retrieved a court deadline had passed. But it is inaccurate to imply that they were never retrieved.

The reference to not following the study methodology refers to a questionnaire about satisfaction with skin condition (called the Skindex) that was not part of the original protocol, and that was added late, and was not the primary focus of the study.  The original article stated that it was given before and after treatment, but the after treatment results were not presented. As I wrote in a correction later the questionnaire was not given to all of the subjects after treatment.

Roche spent a lot of time and effort trying to debunk this study, in the course of which some data entry errors were found. A re-analysis of the study with corrected data continued to show a reduction in function of the orbitofrontal brain function, in fact the results were more statistically significant than before. Roche next accused me of fraud and asked the journal to retract the paper, which led to an inquiry at my university where the committee had access to all the data and legal documents, and cleared me of the charges of fraud, recommending a letter of correction based on the corrected data, which led to this single sentence correction published in the journal.

The conclusion that Accutane can cause depression shouldn’t rest on a single study, which it doesn’t, as the evidence that retinoids play a role in affective disorders continues to grow.