In the editorial he writes:

I never dreamed that my discovery four decades ago would lead to such a profit-driven public health disaster. The medical community must confront reality and stop the inappropriate use of P.S.A. screening. Doing so would save billions of dollars and rescue millions of men from unnecessary, debilitating treatments.

In the heat of the moment around healthcare reform maybe we should pay attention to this instead of Billy Tauzin’s whining? Anyone listening?

Consider what this healthy middle aged under 50 male went through. Electron Beam Computed Tomography (EBCT) for measurement of the calcium in his coronary arteries, a super hyped procedure whose costs go into the hundreds if not thousands of dollars, and that has not been shown to have any beneficial effect on health outcomes. Next, a virtual colonoscopy, in a man who is recommended to get a one dollar stool guac test for early detection of colon cancer.
It’ not that these useless and expensive medical tests are so benign. The EBCT increased his risk of cancer by 9 out of 100,000 possible cases. The chairman of radiology here at Emory famously had a “routine” CT screening and ended up in the ICU because of all the tests that followed (in the end he had no disease).

So if Obama can’t give us a rational example of how to approach healthcare, who can?
Discuss!

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.

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!

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.

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.

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

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.”