Archive for September, 2009
Fall Fundraiser, Your Help Is Needed
Another $15 came in yesterday from two people bringing the total raised so far to $2,839.49 from 60 people. That leaves another $1,160.51 to go from 40 people to reach the overall goal of $4,000 from 100 people by the end of this Friday. Thanks to all of you who’ve contributed to date.
If you’d like to join them, there are only about 24 hours left. So the PayPal button is on the right. If you prefer snail mail, send me an email and I’ll pass along my mailing address.
Thanks in advance for your support.
Posted in Massachusetts Screening Preschoolers For Mental Health Problems
A reader passed along an article that ran last October in the MetroWest Daily News in Massachusetts, an article I’d not seen previously about the implementation of Yolanda’s Law, named for a 16-year-old who committed suicide.
“The legislation, signed by Gov. Deval Patrick in August and backed by a coalition called the Children’s Mental Health Campaign, encourages doctors to screen their young patients for disorders and seeks to have mental health assessments provided at day care and pre-K programs.”
At day care and pre-kindergarten programs? Oh wow. They are really going after them young nowadays.
As I noted when I wrote about a slightly different law in Massachusetts requiring mental health screening for kids in the commonwealth’s Medicaid program that was touted by the Boston Globe which included a handy checklist of kiddo mental disorder symptoms on its website:
“One of the symptom checklists on the paper’s website contains a stunning array of non-symptom symptoms: teases others, refuses to share, is fidgety, acts younger than others, daydreams too much, is afraid of new situations. And so on. Many of these symptoms are hardly indicative of abnormal behavior or psychology.
“Could someone please let me know what is the objective standard for daydreaming?”
I wonder how these programs are working out and how many more Rebecca Rileys they’ll create. Anyone from Massachusetts know?
Sometime last year, I was interviewed by a reporter from WFCR-FM, the public radio station in Amherst, about mental health screening for kids. I gave the reporter several reasons to be skeptical, much less against, screening for little kids. The reporter got quite frustrated with me–I could hear it in her voice–and told me how much doctors liked screening programs. I reminded her of the Riley case and she basically ended the conversation. I know that nothing I told her ended up on the air. That’s some nice objective journalism by a publicly-supported radio station.
Zoloft Defense Fails In NY Assault Case
Last month, I wrote about a Long Island man who was allowed to use the Zoloft defense–an unusual move by a judge–in an assault/domestic violence case. The man had beat up his girlfriend and he was arguing that going off Zoloft a few days before had made him do it. As I noted then, I wasn’t particularly sympathetic to his situation, because as real as withdrawal problems can be, I just can’t develop sympathy for anyone who beats up his girlfriend. Period.
Yesterday, he was found guilty of felony assault, attempted assault and second-degree harassment charges. So the Zoloft defense did not sway a jury.
Oddly, Newsday notes:
“The FDA has not blamed such drugs for violent behavior.”
That’s kind of a BS line of thought since the FDA has never examined, as far as I know, that issue outside of the context of suicidality. The paper also reports that Pfizer paid an unnamed Harvard professor $7,500 a day to be an expert witness for the prosecution. The man was being prosecuted by the State of New York, so what the hell is a pharma company doing paying for an outside expert? That’s just odd.
Day Tripping
This is a post for ClinkShrink, but she’s so busy lately that I thought I’d stick it up.
So in Maryland, to the best of my knowledge (and I could be wrong) we have this idea that if someone is criminally insane and needs hospitalization, they should probably stay in the hospital. I’m not aware that forensic facilities take people on field trips. Like I said, I could be wrong, I don’t treat inpatients and I don’t work with designated forensic patients. The piece below caught my attention, it’s from The Seattle Times:
On Thursday, Phillip Arnold Paul, who had been committed after being found not guilty by reason of insanity in the slaying of an elderly woman, disappeared during a field trip to the Spokane County Interstate Fair with 30 other Eastern State Hospital patients and 11 staff members. The escape prompted an extensive manhunt that ended Sunday when Paul, 47, surrendered to authorities near Goldendale, Klickitat County, about 180 miles from the fair.
It was the second time that Paul had escaped from state custody.
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The photo, by the way, is of a cow at the Maryland State Fair, and has nothing to do with the story of the escapee from the state hospital in Spokane. I just like cows.
Fall Fundraiser, The End Is Near But The Goal Isn’t
Another $150 came in yesterday from four people bringing the total raised so far to $2,824.49 from 58 people. That leaves another $1,175.51 to go from 42 people to reach the overall goal of $4,000 from 100 people by the end of this Friday. Thanks to all of you who’ve contributed to date.
If you’d like to join them, there are only about 48 hours left. So the PayPal button is on the right. If you prefer snail mail, send me an email and I’ll pass along my mailing address.
Thanks in advance for your support.
Lilly Settles Zyprexa Claims With Another 7 States
Bloomberg is reporting that Eli Lilly has settled claims brought against it by seven states concerning the company’s marketing of its antipsychotic Zyprexa. Right now, the settlements are confidential (details should come out later), so it’s not possible to tell what states are involved or how much money Lilly is paying out. Most of the claims involved illegal off-label marketing of the drug for use in the elderly and children and the bilking of states’ Medicaid programs.
Lilly told the wire service that it’s in “advanced discussions” with the other states. A trial involving claims brought by South Carolina is set to begin in October.
Lilly has previously settled various claims brought by individuals, states and the feds for a whopping $2.7 billion.
Glaxo Defunds CME’s While Funding Them Under The Table
On Monday, GlaxoSmithKline US announced that beginning next year it would no longer fund medical education companies to put on CME’s for doctors, a practice that has come under increasing scrutiny by Congress, the press and physicians because the pharma-sponsored CME’s are little more than advertisements for the company’s drugs and leave docs with little information about competing products. GSK makes Paxil, Wellbutrin and Lamictal, although they likely do no CME’s for any of the drugs since all three are now off-patent.
But Danny Carlat, a Tufts University psychiatrist who’s policed this issue harder than anyone else, has gotten GSK to admit that it’s carving a huge loophole into its new policy by claiming that 20 yet-to-be-named academic medical centers will run the GSK-funded CME’s but are then free to go out and hire a medical education company to do the work. Seriously, the company admitted to this old-wine-in-new-bottles practice.
Don’t GSK and others in Big Pharma get it? Academics (the serious ones), doctors (the ones who care) and the public (the ones who are paying attention) are sick and tired of your damn dog and pony show. You need to change your ways completely or people like Carlat and I will continue to work to expose your shoddy drug-touting science and biased information you spoon feed docs as the garbage it is. The choice is yours.
I cannot wait to see who the 20 medical centers are who are going to allow themselves to be used in such a fashion? How much does anyone want to bet that Harvard will be on the list?
AstraZeneca Denied Seroquel Diabetes Link After Warning Of It In Japan
Bloomberg is reporting today on documents recently unsealed in federal court in Florida in the ongoing case against AstraZeneca concerning claims that the company did not properly notify the public of risks (principally, diabetes and weight gain) associated with its antipsychotic Seroquel, now one of the top selling drugs in the world
“Nancy White, the saleswoman, and a colleague met in July 2006 with an unidentified doctor who reported ‘getting a lot of flak’ from patients about Seroquel’s diabetes links, according to a note unsealed as part of a lawsuit. AstraZeneca wrote in November 2002 to Japanese doctors that it received a dozen reports of diabetes-related cases tied to Seroquel ‘where causality with the drug could not be ruled out.’
“White said in the 2006 note that she told the physician that ‘there has been no causative effect’ found between Seroquel and diabetes. The doctor ‘said he would not quit writing’ prescriptions for Seroquel ‘due to this at this time,’ White reported.”
Issuing a warning in Japan while not issuing one in the US probably won’t play out really well for AZ at trial. The behavior is reminiscent of Lilly warning Japanese doctors of similar diabetes problems with Zyprexa in 2002 while months later in the US claiming the drug was perfectly safe as it rolled out a huge sales campaign aimed at PCPs.
Tufts psychiatrist Danny Carlat echoes what I wrote in 2007 about Zyprexa:
“‘It’s pretty clear that if a drug poses a diabetes risk in one country, it poses that risk in others,’ Dan Carlat, a psychiatrist at Tufts University in Boston who writes a blog about the health-care industry, said in an interview. ‘I don’t think it’s ethical to warn doctors in Japan about this drug and then downplay or ignore the risk in the U.S.’”
Unethical? I’d say it should be illegal and the FDA ought to look into how it can reconcile US labeling to conform to warnings on the same drugs in other countries.
In other documents, AZ sales reps are reportedly working to downplay docs concerns about weight gain in Seroquel users, in effect flat out lying about the issue when Seroquel was known to be producing rapid weight gain in some patients, a potential precursor to diabetes.
An AZ spokesman told Bloomberg:
“‘The heart of these cases are unproven claims that Seroquel caused diabetes,’ Tony Jewell, an AstraZeneca spokesman in Wilmington, Delaware, said in an e-mailed statement. ‘The evidence does not back up the allegations that Seroquel was responsible for the plaintiffs’ alleged injuries.’”
That remains to be seen.
Jaycee Dupree, Sexual Abuse and Stranger Danger
The story of Jaycee Dupree is a sad and tragic one. Stories of children being abducted from their homes are often seen in the news and sometimes recounted in movies or mini-series. The alarm is raised and parents frequently worry themselves and warn their children about “stranger danger”. What is rarely, if ever, discussed is a much greater danger to our children - their own families.
I am reading The Assault on Truth: Freud’s Suppression of the Seduction Theory
Having worked with numerous clients struggling with sexual abuse I have found the majority of their perpetrators are not strangers but family, or friends of the family. Fathers, mothers, brothers, uncles, grandfathers and mothers’ boyfriends have been the predominant threats to clients with whom I have worked. Yet the issue of child sexual abuse is still a clouded one. When a claim of sexual abuse is made it provokes all kinds of reactions, many no better than those of Freud’s Victorian era. If a mother reports that her child is saying the father molested her (the daughter), the mother may be accused of being a vindictive ex-wife. The father’s rights may be invoked. People may tell the mother to keep quiet and not embarrass the father. People may deny that the father could do such a thing, since he is a prominent member of the community. (Freud discovered this was a common argument against claims of child sexual abuse.) They may call into question the mother’s sanity for making such a claim.
Freud discovered this in the 1900′s and tried to make the public aware of it but was shouted down by the psychiatric community. It seems we have made very little progress in the past 100 years.
Changing the old dating rules
Women are much choosier than men when it comes to romance. This is well known, but the reason for this gender difference is unclear. Evolutionary psychologists think it’s because, way back in prehistoric times, “dating” was much riskier for women. Men who made an ill-advised choice in the ancient version of a singles bar simply had one lousy night. Women who chose unwisely could end up facing years of motherhood.
That’s less true today, yet women remain much more selective. Is this difference a vestige of our early ancestry? Or might it be totally unrelated to reproductive risk, something more modern and mundane? A couple of Northwestern University psychologists, Eli Finkel and Paul Eastwick, decided to explore this question in an unusual laboratory: a real-life speed dating event.
For the uninitiated, speed dating is an increasingly popular way for men and women to meet and find potential partners. Participants attend a sponsored event and go on a series of very brief “dates,” about four minutes each. Typically, the women sit scattered around a room, and the men make the rounds. Afterward, both men and women indicate to the sponsor if they would be interested in seeing any of the others again. If two “yeses” match up, they get phone numbers and that’s it. They’re on their own.
Men say “yes” a lot more than women. That’s expected, but Finkel and Eastwick had a novel theory about why. Perhaps it could be explained by the simple convention of men standing and approaching—and women sitting passively. There has been a lot of recent work on the mutual influence of body and mind–how we embody our thoughts and emotions—and the psychologists speculated that physically approaching someone might be enough to make the potential date more appealing romantically—and thus to make the men less choosy overall.
They tested this in a series of 15 heterosexual speed dating events, involving 350 young men and women. Each participant went on about 12 dates, but the researchers changed the rules: In these events, the women and men approached each other about equally. Following each date, each participant rated the other for romantic desire and romantic chemistry. They also rated their own sense of self-confidence on the date. A bit later, they decided thumbs up or thumbs down.
The results were a score. As reported on-line in the journal Psychological Science, the well-known gender difference vanished when men and women assumed more egalitarian roles. The difference didn’t completely reverse when women were on the move. That is, their choosiness went away but they didn’t become more indiscriminate than men. This suggests that the ancient tendencies may still have some force, but they are also reinforced by arbitrary social norms. What’s more, it was increased self-confidence that appeared to make the difference: Simply standing and being on the move boosted confidence, which in turn boosted romantic attraction.
We don’t speed date through real life, of course, but there are all sorts of social conventions based on gender, and these presumably shape romantic feelings and actions. Having men behave more like women and women more like men appears at least to narrow this one gap between the sexes.
For more insights into the quirks of human behavior, visit the “Full Frontal Psychology” blog at True/Slant. Selections from “We’re Only Human” also appear regularly at Newsweek.com and in the magazine Scientific American Mind.
