Psychiatrists, sales reps, and patients

[Ralph]

I wanted to respond to the following post however it's a different topic than the thread in which it was posted so thought a new thread in the proper forum would be best.

Sissa, I find your statements about medications, psychiatrists and such very insulting. I myself am a psychiatrist and I DO stay up to date with all the medications and you better believe I would never prescribe a patient something a pharmaceutical rep recommended to me BEFORE thoroughly educating myself about it. Some of us do care about our patients and their well beings. I have seen many patients benefit from ssri's when taken currently and the right dosage is found.

In defense of Sissa, it was I who said that psychiatrists tend to fall behind on research. I did not mean to insult you, but to reflect both my own experience and what I have learned in my business education. The Pfizer fraud judgment is the largest but not the only one of it's kind. Therefore, pharmaceutical sales reps have been able to manipulate prescribing physicians, including psychiatrists, on such a wide scale that the federal government had to step in. I don't see how that could happen if, as a whole, MDs were taking it upon themselves to understand the research.

This tells me that you are in the minority as a psychiatrist who would put patient needs before a golf trip paid for by Astra-Zeneca. I wish I could find a doctor with a similar level of commitment but to date I feel I have never been treated as anything more than an account number.

I don't hold each individual psychiatrist personally responsible but please understand that when these things are in the news, and patients basically feel that they are given short shrift by pdocs who appear to be prescribing drugs with no clear plan or strategy in mind, the two together create a powerful and less than inspiring impression on the patient as to the current state of integrity amongst practitioners.

I would welcome any suggestions you have for how to communicate with a psychiatrist to discover whether they actually care or not. If I had healthy self esteem I would be better at speaking up for myself in a dr's office, but funny thing about being depressed is self efficacy is not exactly at maximum you know.

[Sissagwaad]

Thank you for that Ralph, for having the courage to share an open mindedness to what is actually going on in this lucrative marketplace/hunting ground....

Something that was brought to my attention in line with this is Drug firms paid 'independent' experts

A whistleblower lawsuit joined by the Texas Attorney General's Office shows that pharmaceutical companies paid experts at state universities who were supposed to be objectively reviewing mental health medicines...

http://www.kxan.com/dpp/news/i​nvestigations/drug-firms-paid-​independent-experts

May that we all keep our minds open, and healthy.

[Leo1954]

I went to read the page that you posted but it wouldn't let me in. I'm very interested in reading because I must be very ignorant not knowing this I honestly never even thought that Drs. could be persuaded by sales reps. Isn't their some company or govt. whatever to monitor things like this. Sorry very ignorant knowing this since I have been on psych. meds since 1993

[Sissagwaad]

I went to read the page that you posted but it wouldn't let me in. I'm very interested in reading because I must be very ignorant not knowing this I honestly never even thought that Drs. could be persuaded by sales reps. Isn't their some company or govt. whatever to monitor things like this. Sorry very ignorant knowing this since I have been on psych. meds since 1993

try this http://www.kxan.com/dpp/news/investigations/drug-firms-paid-independent-experts

[Sissagwaad]

like the article states, contrary to what some would have you believe without question, Records maintained by the U.S. Food and Drug Administration show that such stories are not uncommon among patients.

All I'm saying is keep an open mind, and question statements of assurance dillegently, as to authenticity, and be careful...

[Ralph]

I honestly never even thought that Drs. could be persuaded by sales reps. Isn't their some company or govt. whatever to monitor things like this. Sorry very ignorant knowing this since I have been on psych. meds since 1993

Theoretically the FDA should govern approval of meds and what is available in the US market. However, they have for a long time been allied with pharma corps against the consumer: http://www.commondreams.org/headlines03/0724-10.htm

When I say against the consumer I mean from a business standpoint. Consumers want to spend as little money as possible on health care to have money available for purchases that they would chose. Pharma companies want to make as much money as possible because they have shareholders and Wall St to answer to. Therefore, the interests of the two groups are directly opposed. If the FDA acts to protect pharma corp profits, they are in effect tilting the playing field, when it is theoretically the FDA's job to protect the consumer because the average consumer hasn't got close to the business acumen needed to compete fairly in the healthcare market.

[spiritual_emergency]

I'm glad to see that someone initiated a topic on the matter. Yes -- the links between psychiatry in particular and the pharmaceutical industry are very well established and they should be a matter of concern.

For what it's worth, I don't believe this has anything to do with whether or not a specific individual self-identities a form of medication as helpful to them. However, I also don't believe that the pharmaceutical industry really cares one way or the other about "you". Their job is to make money. That's their priority and they have demonstrated consistently that they will put that need first, not "your" individual health.

In light of this reality, "your" job is to keep reaching for your best recovery. When it comes to medications, I would certainly urge others to fully educate themselves about them so they can make an informed decision. This can include understanding the role the pharmaceutical industry has in determining diagnoses and treatement, and the degree of corruption that is present in that industry.

I remain particularly concerned about the relationship between big pharma and psychiatry as related to the use of anti-psychotic medications for children and those deemed to be schizophrenic. I am not as familiar with anti-depressant medications.

[spiritual_emergency]

An example of what I am referring to...

Joseph Biederman is a world-renowned Harvard child psychiatrist whose work has helped fuel an explosion in the use of powerful antipsychotic medicines in children.

He is the world's most prominent advocate of diagnosing bipolar disorder in even the youngest children and of using antipsychotic medicines to treat the disease, but much of his work has been underwritten by drug makers for whom he privately consults. His work helped to fuel a controversial 40-fold increase from 1994 to 2003 in the diagnosis of pediatric bipolar disorder.

He is in the middle of two controversies: one involves the use of antipsychotic drugs in children, and the other relates to conflicts of interest in medicine.

An inquiry by Senator Charles E. Grassley, Republican of Iowa, revealed last year that Dr. Biederman earned at least $1.6 million in consulting fees from drug makers from 2000 to 2007 but failed to report all but about $200,000 of this income to university officials, according to information given Congressional investigators.

Source: New York Times - Joseph Biderman

[spiritual_emergency]

A report from the FDA...

... Last September, an FDA report found that the number of anti-psychotic prescriptions dispensed to children (0-17 years) had risen 22 percent over the previous five years.

The FDA examined six anti-psychotic drugs: Seroquel® (quetiapine); Zyprexa® (olanzapine); Risperdal® (risperidone); Abilify® (aripiprazole); Geodon® (ziprasidone); and Invega® (paliperidone).

In 2008, of the 32 million prescriptions dispensed for these drugs, 4.8 million were dispensed to children (15 percent of the total).

That same year, one million individual children were prescribed these anti-psychotics (19 percent of the total of 5.5 million individuals). Here are the numbers, by age group:

1,770 children aged 0-2

64,664 children aged 3-6

414,451 children aged 7-12

540,760 children aged 13-17

Diagnoses applied to the infants and toddlers (aged 0-2) included: Attention Deficit Disorder; Mental/Behavior Problems, Behavioral

Problems; Other Emotional Disturbances, and Residual Schizophrenia, a diagnosis that can be made on the basis of “odd beliefs and unusual perceptual experiences.”

Source: One Million Children on Anti-Psychotics

[spiritual_emergency]

Rebecca Riley was but one of the many children who were impacted by Joseph Biederman's actions...

The medical examiner ruled that Rebecca died of a drug overdose from a mix of medications. And that the amount of Clonidine alone would have been fatal...

On Dec. 13, 2006, police responded to a 911 call and found a little girl lying dead on the floor next to her parents' bed. The autopsy revealed that she had died from an overdose of psychiatric drugs. Rebecca Riley was being treated for bipolar disorder, or manic depression, even though she was just four years old...

Source: What Killed Rebecca Riley?

Rebecca Riley was initially diagnosed with attention deficit disorder at the age of two by her psychiatrist, Kayoko Kifuji, following one twenty-minute consultation. Her mother's primary complaint was that Rebecca seemed "impulsive" -- this is hardly unusual behavior in a two-year old child.

Rebecca was prescribed Clonidine at that first appointment. Clonidine is typically used to treat high blood pressure and narcotic/alcohol addiction. It's used off-label as a treatment for ADD. Rebecca's diagnosis was later upgraded to bipolar disorder and the medications of Seroquel (an anti-psychotic), Zyprexa (an anti-psychotic) and Depakote (an anti-seizure medication used as a mood stabilizer) was added to the Clonidine.

Kifuji advised Rebecca's mother that she could increase and decrease the dosages as she determined were necessary. Her psychiatrist, not only increased the Clonidine four times in the course of her treatment, she gave verbal approval to Rebecca's mother to experiment with the dosages. She appears to have passed other responsibilities to Rebecca's mother as well such as expecting her to monitor Rebecca's blood pressure. Her explanation was that she didn't realize her own examination room contained a blood pressure cuff that she could have used herself.

Rebecca's parents were charged with murder and both have been sentenced; Rebecca's siblings went into foster care (children in foster care are probably the group of children most at risk for being overmedicated with psychiatric drugs). As for the good doctor...?

Dr. Kifuji settled a lawsuit for 2.5 million with Rebecca's estate and has returned to her practice at Tufts Medical Center. The center previously defended Dr. Kifuji, noting that the psychiatrist was only practicing "mainstream psychiatry".

See also:

- Rebecca Riley's Doctor on the Defense

- Psychotropics and Children

- Psychotropic Medication Patterns Among Foster Children

- Texas Medication Algorithm Project: Ruse to Increase Sales

- Children and Electroshock Therapy

[spiritual_emergency]

From a recent report I read...

... On March 19, 2009, Gardiner Harris of the New York Times reported on Biederman’s assurances to Johnson & Johnson that his yet-to-be-conducted research on risperidone in preschool children “will support the safety and effectiveness of risperidone in this age group” (Harris, 2009), a piece of evidence that strongly suggests that Biederman tailored the Johnson & Johnson study to produce the desired results.

... If Biederman was able to predict the outcome of his drug trials before he actually collected any evidence, one is reasonably led to believe that the Harvard psychiatrist may have intentionally manipulated data to get the desired results in exchange for kickbacks from the drug company.

... Cosgrove et al. (2006) also investigated conflicts of interest among panel members of the fourth edition of the DSM (DSMIV, 1994). The investigators discovered that 95 of the 170 DSM-IV panel members (56%) had financial ties to the pharmaceutical industry. ... Of particular concern were the especially pervasive ties to industry among panel members of mental disorders associated with very profitable pharmacological treatments, including mood disorders (100%), schizophrenia and other psychotic disorders (100%), and anxiety disorders (81%).

Based on these findings, it is reasonable for consumers to question the credibility of the DSM-IV diagnostic criteria and to wonder about the extent to which the categorization of mental health diagnoses has been unduly influenced by explicit or implicit economic motives.

Source: Conflicts of Interest in Research on Antipsychotic Treatment of Pediatric Bipolar Disorder, Temper Dysregulation Disorder, and Attenuated Psychotic Symptoms Syndrome: Exploring the Unholy Alliance Between Big Pharma and Psychiatry

See also:

- Lawsuits - Atypical Antipsychotics

- Psychiatric Times: DSM-5 Approves New Fad Diagnosis For Child Psychiatry: Antipsychotic Use Likely to Rise

- The Epidemic of Mental Illness

[spiritual_emergency]

A public lecture that should be of interest to anyone who is concerned about children and psychiatric drug use. This video addresses more than anti-psychotic drug use. In it, Whitaker takes a critical look at the scientific studies that have been done regarding medication use on children. What is surprising (and alarming) is that children placed on drugs seem to improve at first but after around two years, something very interesting happens in terms of the medicated group vs. the non-medicated group of children. What happens is the children on medication begin to rapidly decline while the children not using medication begin to improve.

This is consistent with what seems to happen when medicated groups of schizophrenics were compared with unmedicated groups. Initially, the medicated group seemed to improve the most but the surprising finding was discovering a year out that those who had been medicated were more prone to relapse and the onset of a chronic pattern of schizophrenia.

Because medications are a new treatment approach with children we can still ethically compare medicated vs. non-medicated groups however we no longer see these kinds of studies with schizophrenic individuals. This is because it's become standard practice to medicate nearly all individuals who experience psychosis.

Public Lecture: Robert Whitaker - Psychotropic Drugs and Children

See also: Schizophrenia & Medication

[Ralph]

Hi SE, I stopped watching this thread for a while but was a little shocked to see this much information. I didn't know the problem had extended to children because all of the meds I've gotten say "this medicine is not approved for use with children" in big bold letters in the info packet.

About Anti-psychotics, both the first generation and "atypical" are dopamine antagonists. Do you know where the theory of schizophrenia as too much dopamine originated from? I've lately been wondering if the drugs are used based on any evidence that schizophrenic individuals have too much dopamine circulating, or if it is just that shutting down dopamine shuts down the person, so that if they are acting strangely a catatonic state will appear as an improvement to those around the afflicted individual.

[spiritual_emergency]

Ralph: Do you know where the theory of schizophrenia as too much dopamine originated from?

Hello Ralph,

Here's some info that addresses the chemical imbalance theory of mental illness...

... Second, none of the three authors subscribes to the popular theory that mental illness is caused by a chemical imbalance in the brain. As Whitaker tells the story, that theory had its genesis shortly after psychoactive drugs were introduced in the 1950s. The first was Thorazine (chlorpromazine), which was launched in 1954 as a “major tranquilizer” and quickly found widespread use in mental hospitals to calm psychotic patients, mainly those with schizophrenia. Thorazine was followed the next year by Miltown (meprobamate), sold as a “minor tranquilizer” to treat anxiety in outpatients. And in 1957, Marsilid (iproniazid) came on the market as a “psychic energizer” to treat depression.

In the space of three short years, then, drugs had become available to treat what at that time were regarded as the three major categories of mental illness—psychosis, anxiety, and depression—and the face of psychiatry was totally transformed. These drugs, however, had not initially been developed to treat mental illness. They had been derived from drugs meant to treat infections, and were found only serendipitously to alter the mental state. At first, no one had any idea how they worked. They simply blunted disturbing mental symptoms. But over the next decade, researchers found that these drugs, and the newer psychoactive drugs that quickly followed, affected the levels of certain chemicals in the brain...

When it was found that psychoactive drugs affect neurotransmitter levels in the brain, as evidenced mainly by the levels of their breakdown products in the spinal fluid, the theory arose that the cause of mental illness is an abnormality in the brain’s concentration of these chemicals that is specifically countered by the appropriate drug. For example, because Thorazine was found to lower dopamine levels in the brain, it was postulated that psychoses like schizophrenia are caused by too much dopamine. Or later, because certain antidepressants increase levels of the neurotransmitter serotonin in the brain, it was postulated that depression is caused by too little serotonin. (These antidepressants, like Prozac or Celexa, are called selective serotonin reuptake inhibitors (SSRIs) because they prevent the reabsorption of serotonin by the neurons that release it, so that more remains in the synapses to activate other neurons.) Thus, instead of developing a drug to treat an abnormality, an abnormality was postulated to fit a drug.

That was a great leap in logic, as all three authors point out. It was entirely possible that drugs that affected neurotransmitter levels could relieve symptoms even if neurotransmitters had nothing to do with the illness in the first place (and even possible that they relieved symptoms through some other mode of action entirely). As Carlat puts it, “By this same logic one could argue that the cause of all pain conditions is a deficiency of opiates, since narcotic pain medications activate opiate receptors in the brain.” Or similarly, one could argue that fevers are caused by too little aspirin.

But the main problem with the theory is that after decades of trying to prove it, researchers have still come up empty-handed. All three authors document the failure of scientists to find good evidence in its favor. Neurotransmitter function seems to be normal in people with mental illness before treatment. In Whitaker’s words:

Prior to treatment, patients diagnosed with schizophrenia, depression, and other psychiatric disorders do not suffer from any known “chemical imbalance.” However, once a person is put on a psychiatric medication, which, in one manner or another, throws a wrench into the usual mechanics of a neuronal pathway, his or her brain begins to function…abnormally.

Carlat refers to the chemical imbalance theory as a “myth” (which he calls “convenient” because it destigmatizes mental illness), and Kirsch, whose book focuses on depression, sums up this way: “It now seems beyond question that the traditional account of depression as a chemical imbalance in the brain is simply wrong.”

Source: The Epidemic of Mental Illness

See also: Doctor, is my mood imbalance due to a chemical imbalance?

[Ralph]

Thanks for that, SE. I read this last night and was doing some thinking about it. If it is true that the company doesn't have to publish anything but positive trials then there is no way the public should have any confidence in the medical industry. Even a broken clock is right twice a day. At the very least they should publish how many trials it took to get the magical two trials with positive results.

This system is ridiculous in how it exploits unknowing people for profit. So many people, including me before I learned this, just trust that doctors are the experts; they must know what they are doing. Then children die as a result. I don't know how those pharma sales reps can sleep at night, knowing how many lives are ruined so they can drive a bigger car or join a higher end country club.

[Luna-]

Maybe they think about all the lives that have been helped ...

[Ralph]

My concern is that if a drug can barely be shown to be better than a placebo and the only studies that need be published are the two positive ones, can a significant component of a given patient's improvement be attributed to the medication?

The information SE referenced points out that, despite a proliferation of new drugs to treat mood disorders, if anything the rate of mood disorders is increasing. At the very least, I feel highly misled by my doctors (both psychology and psychiatry) who literally told me that my depressive symptoms were due to my brain not producing enough serotonin and that is why I would need to be on meds for life just like a diabetic needs insulin.

Turns out it's not nearly so simple although it was never even aluded to that this was merely a guess and in fact it could be the case that depression causes serotonin to drop, not the other way around. If they had said this "chemical imbalance" story was a gross oversimplification I would have asked more questions, and at least if I was making an educated decision I could feel responsible for it. Yet since information was deliberately hidden from me I feel disrespected and manipulated, and suspect that such an experience is the rule rather than the exception.

[spiritual_emergency]

Luna_ Maybe they think about all the lives that have been helped ...

I try to respect that the relationship between the pharmaceutical industry and the field of psychiatry is separate from whether or not someone self-identifies a medication as helpful. For example, there are probably some people out there who have found Seroquel to be a beneficial drug for them. That doesn't change the fact that it's being prescribed off-label to hundreds of thousands of children; that the leap in pediatric bipolar diagnoses were related to Joseph Biederman's falsified records, that Biederman hid $1.4 million dollars in pharmaceutical industry payments from his Harvard employer, that the general public has ample reason to distrust the "scientific data" that is presented by the pharmaceutical industry and even, to distrust the diagnoses of "mental illness" when it is revealed that up to 100% of the physicians who decide what is or is not a mental illness and how it should be treated are also on the payrolls of the pharmaceutical industry.

Meantime, I'm fresh from a conversation with a woman whose schizophrenic brother just died of heart failure. There was a family history of heart disease but even with that knowledge, he was treated with a drug that came with heavy cautions because of its history of producing cardiac complications. The first autopsy has suggested his death was due to a drug overdose with an anti-psychotic medication. They have further been told they cannot sue because her brother had no wife or children. But she loved him. He was her last surviving family member.

See also:

- Sudden Cardiac Death and Antipsychotics - Part I

- Sudden Cardiac Death and Antipsychotics - Part II

- Information for Healthcare Professionals: Haloperidol (marketed as Haldol, Haldol Decanoate and Haldol Lactate)

[spiritual_emergency]

She's five...

[Ralph]

This may be off topic or not but thank you for the link to the Green Tara Mantra. I've never done much with mantra stuff before so not sure if there is a technique to "mantra-ing" but listening to this has headed off a panic attack for me twice now.