Archive for September, 2009
Family Docs Write Most Rxs For Psych Meds
While I think it’s been acknowledged for years that family physicians and other PCPs write the majority of scrips for psych meds, the scale to which that’s going on, as reported in a new study, is pretty eye-opening and concerning:
“They found that general practitioners prescribed the bulk of prescriptions in two main categories — 62 percent of antidepressants and 52 percent of stimulants.
“The stimulants were mainly drugs for treating attention deficit hyperactivity disorder, or ADHD. About 25 percent of all stimulant prescriptions examined were written by pediatricians, they reported in the journal Psychiatric Services.
“Family doctors also wrote 37 percent of prescriptions for drugs used to treat psychosis and prescribed 22 percent of anti-mania medications, the study showed.”
Problems are common with these meds even when prescribed by a psychiatrist and a whole load of people I know personally who’ve had bad experiences with anti-depressants have had it happen at the hands of a PCP casually giving them whatever anti-depressant they felt like. You’ve also got to wonder if there’s anything approaching adequate follow-up or if your average PCP is well-informed about problems with these drugs. (The study itself is not online yet.)
That said, I know PCPs here in Seattle who flatly refuse to prescribe psych meds of any kind for any reason.
Posted in Study Shows High Rate Of Dementia In Retired NFL Players
The New York Times reported yesterday on an unpublished study of retired NFL players which shows a shockingly high rate of dementia in former players over 50 years of age. This comes on the heels of other research showing depression in former football players who’d suffered concussions during their playing days.
The prevalence of dementia in the 50 and above general population is a little over 1 percent. Among former NFLers over 50 researchers found it to be 6.1 percent, according to the paper. Players aged 30 to 49 had dementia at a 1.9 percent rate as opposed to the national average of .1 percent. The paper also notes that the study had some weakness in that it used a telephone survey method, but even if the numbers might be off a bit from what a harder scientific approach might show the results are very troubling.
I presume the dementia is related to concussions and that gives me a bit of concern for myself. I’ve experienced four full blown concussions in my life (one from skiing, one from hockey, one in a fight and one when I was attacked by a gang of 18-year-olds when I was 14) and I guess the time I saw stars at a high school football practice counts as a minor concussion. I guess I should start taking Aricept right now! Um, no.
I deeply love football (between college and the NFL, I watch seven games a week during the season), but it’s clear something needs to be done about the number of concussions suffered, especially at the youth level, and the number of deaths (usually a few and we had one in Washington State this week) and paralyzations each year. I wouldn’t begin to know what the solution is. Helmets are very, very good these days. The NCAA has banned head-to-head hits, but it’s kind of hard to prevent what happens naturally in the course of tackling someone. It’ll be interesting to see how the NFL addresses this matter or if it does at all.
I wrote about a spate of head injuries among high school football players in Oregon back in 2000.
Thanks To You All
The Fall fundraiser ended successfully after all, now that the USPS has caught up with me. Thanks to all of you who contributed. I appreciate your support.
Rethinking My Professional Life
It’s time for me to sign a new lease for my office, and I’m not happy with the terms the landlord wants. Add to that how poorly the building is maintained and that the first floor retail space is probably one-third empty, and I’m thinking of relocating.
I’ve found a found place to go, but it’s way too big….I’ll need to find some other folks to share with me. And this has me thinking: do I simply want to relocate my practice as is, or do I want to form some type of cohesive group with a shared mission.
So as I think about the office layout with the freedom to create what I want, let me ask for your help. What’s important in a psychiatrist’s office? What colors do you like? What makes you love a physical space and what makes you hate it?
And if you’re in a group or see someone in a group: what makes it works and what really doesn’t work.
Lilly Settles With Connecticut For $25 Million
Announced earlier today is a $25 million settlement between Eli Lilly and the State of Connecticut over allegations that the company illegally marketed Zyprexa for unapproved uses including dementia and ADHD. Lilly has already settled about $2.7 billion in other Zyprexa related claims.
60 Massachusetts Docs Get Money From Eli Lilly To Promote Its Drugs
News is out in the Boston Globe that Eli Lilly’s recently-released list of payouts to docs includes 60 Massachusetts doctors, including some at Boston Medical Center–the main hospital for the Boston University School of Medicine. The university has ordered the docs in question to stop doing talks for industry. It’s refreshing to see a university take these sorts of things so seriously and so promptly.
How much money were doctors getting? What products were they promoting?
“At Boston Medical Center, Dr. Brian McGeeney, a neurologist, received $30,000 during that period [first three months of 2009], and Dr. Elliot Sternthal, an endocrinologist, was paid $11,587.50, according to a faculty registry on Lilly’s website.”
McGeeney was promoting Cymbalta, Lilly’s anti-depressant, presumably for fibromyalgia.
Psychiatrist Turns Down $170,000 To Promote New Antipsychotic
I think readers of this site are fairly well aware of the respect I have for Tufts University psychiatrist Danny Carlat, who’s led the fight in psychiatry to clean up the APA and pharma-sponsored CMEs. My respect for him now goes up by $170,000, the amount Schering-Plough reportedly (scroll down to the bottom of the linked page) offered him to go shill for its recently-approved atypical antipsychotic Saphris and the amount which Carlat turned down.
“In a letter to doctors, Schering-Plough says ‘you must present the Schering-Plough approved materials provided to you.’ The company offered one psychiatrist, Dr. Daniel Carlat, a Tufts University Medical School professor, up to $170,000 over two years to give 125 45-minute talks in restaurants, in his office, and by telephone and the Internet. A well-known critic of the drug industry, Carlat declined.”
First, that’s a ton of money for anyone to promote anything, especially a drug with pretty much no track record. Second, didn’t S-P know who they were dealing with and that he’d very likely shoot them down and that their offer would become public? Lame.
For the uninitiated, Carlat’s blog is here.
UK Girl Dies After Getting HPV Vaccine
This is alarming: The UK press is reporting that a 14-year-old girl died soon after being given GlaxoSithKline’s HPV vaccine Cervarix. A few other girls at her school took ill after getting the vaccine. Cervarix is not yet approved in the US, but GSK has submitted it to the FDA for approval, which is expected later this year.
What a terrible tragedy, exactly the kind of thing opponents of mandatory vaccinations for HPV feared could happen with Merck’s Gardasil.
Via Sexorat Sufferers.
Stuck in a Rut
To get out of a rut it’s important to figure out how I got in a rut, what type of rut it is, how deep it is and what will be required to get out of it. The particular rut I am in is geographical. I moved to Austin, Texas in 1991 and fell in love with it. However, like many people who stay in Austin for any period of time I’ve developed a serious allergy problem that is threatening my health.
How did I get in this rut?
I love where I am, but it is threatening my health to the point that I can no longer it, yet I grieve the idea of losing it. So I waffle back and forth. I should go. I don’t want to. As I waffle, my health continues to deteriorate and I enjoy Austin less and less. I see this in a lot of ruts. Over time, the detriments outweigh the benefits. In relationships: I love him, but he isn’t faithful to me. In work: I’m no longer happy in this job, but it’s scary to think about applying for a new one. In marriages: This relationship no longer makes me happy, but it’s become comfortable. What usually has to happen is that one’s losses or discomfort become so great that they eventually outweigh one’s fears or comforts. I think I’m finally there.
What is keeping me here?
The next factor is obligations. I have a family situation which, hmmm…. (I was going to write that I have a family situation which keeps me here. But that is a very disempowering way of thinking about it. That makes me a victim of circumstances, which I am not. If something outside of myself is actually keeping me here, there is nothing I can do about it. That is not the case. I am not being kept here against my will. So let me rephrase this.)
I have a certain family situation which I choose to stay and see resolved. (Now I’m not a victim of circumstances. I am the captain of my own ship. Now I am owning that I am here because of my own choices. I could walk away right now. That is the fact. But I’m choosing not to leave. I’m responsible. And if I’m responsible for choosing to stay I can also choose to leave.) I’m choosing to stay and finish this familial duty before I go. I am making the choice. And I take responsibility for the consequences of that choice.
Excuses
As a therapist I’m probably more aware than others of pitfalls into which people tend to fall. I like to examine my “reasons” for not doing something and make sure they are not “excuses”. So I do some careful self examination and come to the conclusion that I really do want to stay and fulfill my family obligation at the temporary expense of staying in my rut. I know it’s not an excuse because it’s not what I want to do, it’s what I need to do.
I also like to look at things I think I want (i.e. moving in this case) to see if they are distractions from dealing with a real problem somewhere else. I like to think moving would get me out of the rut, but I’m wary of what I call “geography therapy”, moving every time you have a problem. Unfortunately, when you move you take the problem with you since the problem is you. I don’t want to make this mistake. I don’t think this move is geography therapy. Why? Because I don’t want to go. Leaving Austin is going to be very sad. I need to go because it’s getting harder and harder to breathe here. I also don’t think that everything will be better some place else, a major clue that you are trying to change other issues in your life by changing geography. Moving will not solve all my problems, only one, breathing. I will lose a lot of things by moving and I will have to overcome a lot of obstacles in moving. I believe I’m taking all of these into account and have a realistic view of what will be improved by a move and what will not.
Suffering with Purpose
If you choose to stay in an unhealthy situation for some reason, it helps to know why you are suffering this adversity. Americans, myself included, seem to think we should be happy all the time and that our goal in life should be to avoid all suffering. I don’t think this is true. I think suffering for a cause can be quite enlightening. It builds strength, and character. It makes the struggle worthwhile, even if it is a little struggle.
Viktor Frankl (Man’s Search for Meaning
So I’m using this knowledge to make my remaining time in Austin fruitful. In this way I do not feel so trapped or so helpless. Feeling trapped and helpless leads to hopelessness and depression. So I am going to use my time here to pay off debt and make improvements to my home so that when I am able to leave I can sell it for a higher price and put more money in my pocket. This infuses the wait with some purpose.
The Importance of Hope
Irving Yalom (Existential Psychotherapy
In the meantime I keep writing and learning and, hopefully, growing.
Fall Fundraiser Update
The fall fundraiser ended Friday with $215 from three people coming in that day. As things stand now, the fundraiser ended $554.25 short of its $4,000 goal. But I’ll know more over the next few days as I know a few checks are still headed my way. So I’ll update you all later.
Thanks to all of you who contributed.