Psychiatry’s bible, the DSM, is doing more harm than good

Published on April 27, 2012, by Paula J. Caplan in the Washington Post

About a year ago, a young mother called me, extremely distressed. She had become seriously sleep-deprived while working full-time and caring for her dying grandmother every night. When a crisis at her son’s day-care center forced her to scramble to find a new child-care arrangement, her heart started racing, prompting her to go to the emergency room.

After a quick assessment, the intake doctor declared that she had bipolar disorder, committed her to a psychiatric ward and started her on dangerous psychiatric medication. From my conversations with this woman, I’d say she was responding to severe exhaustion and alarm, not suffering from mental illness.

Since the 1980s, when I first made public my concerns about psychiatric diagnosis, I have heard from hundreds of people who have been arbitrarily slapped with a psychiatric label and are struggling because of it. About half of all Americans get a psychiatric diagnosis in their lifetimes. Receiving any of the 374 psychiatric labels — from nicotine dependence disorder to schizophrenia — can cost anyone their health insurance, job, custody of their children, or right to make their own medical and legal decisions. And if patients take psychiatric drugs, they risk developing physical disorders such as diabetes, heart problems, weight gain and other serious conditions. In light of the subjectivity of these diagnoses and the harm they can cause, we should be extremely skeptical of them.

Psychiatric diagnosis is unregulated, so the doctor who met briefly with the aforementioned patient wasn’t required to spend much time understanding what caused her heart to race or to seek another doctor’s opinion. If he had, the patient would have realized that her bipolar diagnosis wasn’t necessary or appropriate. Neither on her ER trip nor in later visits to therapists did anyone explain how sleep deprivation impairs the body’s ability to handle pressure.

In our increasingly psychiatrized world, the first course is often to classify anything but routine happiness as a mental disorder, assume it is based on a broken brain or a chemical imbalance, and prescribe drugs or hospitalization; even electroshock is still performed.

According to the psychiatrists’ bible, the Diagnostic and Statistical Manual of Mental Disorders (DSM), which defines the criteria for doling out psychiatric labels, a patient can fall into a bipolar category after having just one “manic” episode lasting a week or less. Given what this patient was dealing with, it is not surprising that she was talking quickly, had racing thoughts, was easily distracted and was intensely focused on certain goals (i.e. caring for her family) — thus meeting the requisite four of the eight criteria for a bipolar diagnosis.

Continued here

The Illegality of Forced Drugging and Electroshock

 

POSTED ON MAD IN AMERICA, on MARCH 21, 2012

BY JIM GOTTSTEIN 

Court ordered psychiatric drugging and electroshock is illegal when measured against the constitutional requirements for forcing someone to ingest drugs, or be subjected to electroshock, against their will.

Under the United States Constitution, if a right is considered “fundamental,” in order to infringe on that right, the government is (a) required to have a compelling interest (reason),  (b) the method chosen to further that interest must be reasonably assured to achieve its objective, and (c) the method must be narrowly tailored, meaning there cannot be a less restrictive or intrusive means of achieving the objective.  This was most recently articulated in 2003 by the United States Supreme Court in Lawrence v. Texas, as follows:

Our opinions applying the doctrine known as “substantive due process” hold that the Due Process Clause prohibits States from infringing fundamental liberty interests, unless the infringement is narrowly tailored to serve a compelling state interest.

Let’s apply these principles to forced drugging and electroshock.  In 2003 the United States Supreme Court  also decided Sell v. United States, in which the government wanted to force Dr. Sell, a dentist, to take neuroleptics, to ”restore” him to competence so he could stand trial for health care fraud.  The U.S. Supreme Court held such forced drugging permissible under the constitution only when the following conditions are met:

1. The court must find that important governmental interests are at stake.
2. The court must conclude that involuntary medication will significantly further those concomitant state interests.
3. The court must conclude that involuntary medication is necessary to further those interests. The court must find that any alternative, less intrusive treatments are unlikely to achieve substantially the same results.
4. The court must conclude that administration of the drugs is medically appropriate, i.e., in the patient’s best medical interest in light of his medical condition.  (emphasis in original).

This is classic analysis of a fundamental right under the due process clause.  I will address each of these requirements in turn.

Governmental Interests

What is the government’s important interest in forcing someone to be psychiatrically drugged or electroshocked against their will?   It depends.  (The answer to all legal questions)   More specifically, there are various situations in which the issue comes up and the government’s interests are different in each one.

Standing Trial On Criminal Charges

In Sell, the government’s interest was to restore Dr. Sell to competency so that he could be put on trial for healthcare fraud.   To be competent to stand trial for a crime, a defendant must be able to understand the nature of the charges and be able to assist his or her lawyer.   Clearly, being able to put someone on trial for murder is an important enough governmental interest.   However, is putting someone on trial for “illegal use of telephone,” such as calling 911repeatedly, an important enough interest to force someone to take psychotropic drugs against their will?   I don’t think so.

 Civil Commitment

Most of the time we think of forced psychiatric drugging and electroshock in the context of civil commitment.   In this setting, there are two justifications (governmental interests).  The first is known as Parens Patriae, which is Latin for ”parent of the nation,” and means the government is stepping in to act as a parent for someone who cannot take care of him or herself.  In other words, “We are from the government and are here to help you.”    In order for the government to be able to assert this right, it has to prove the person is incompetent to decide for him or herself.  These determinations, in themselves, are illegitimate and could be the subject of an entire article, in itself.  However, I will limit this to a couple of comments.

First, one can look at the transcript of Faith Myers’ testimony (pp 0123-0148)) to decide for oneself whether she was incompetent to decline the medication and then look at the judge’s decision (pp  12-14).  To me, the judge’s decision that Faith was incompetent to decline the medication was a travesty.

Second, I will note that the reasoning to find someone incompetent to decline the medication or electroshock, is often circular in that when a person says they don’t want the psych drug(s) or electroshock because it doesn’t work and/or is harmful, that is cited as proof the person is delusional and incompetent.  In the Myers case, the psychiatrist testified in a deposition (pp 39 – 43) that if someone agrees to to take the medication, he decides the person is competent and if not, the person is incompetent.

In fact circular reasoning is enshrined in Alaska Statutes 47.30.837(d)(1)(B), where it provides, “denial of a significantly disabling disorder or impairment, when faced with substantial evidence of its existence, constitutes evidence that the patient lacks the capability to make mental health treatment decisions.”

The second justification for forced drugging and electroshock in the civil commitment context is safety, i.e., that the person must be drugged for their own safety or those of others.  This is known as the “Police Power” justification.  Forced drugging under this justification also tends to be an illegitimate process.  First, the safety risk must be extreme.  For example, under Alaska Statutes 47.30.838 (a)(1), emergency forced drugging is only allowed if, “there is a crisis situation, or an impending crisis situation, that requires immediate use of the medication to preserve the life of, or prevent significant physical harm, to the patient or another person.”

In one of the Bill Bigley cases, I took the deposition (PDf pages 34-37) of the hospital psychiatrist about her use of “emergency” medication, which makes clear that (a) she didn’t know what the legal requirements were and (b) Mr. Bigley was being drugged for non-existent emergencies.

Whether the government has a sufficiently important interest in most civil commitment cases is certainly subject to challenge in many cases.

Prison

Another common setting for forced psychiatric drugging is people convicted of crimes and in prison.  Being convicted of a crime and in prison as opposed to being charged with a crime and in jail is a huge difference, legally.  People in prison have the least legal protection.  Thus, with respect to forced psychiatric drugging in prison, the United States Supreme Court held in Washington v. Harper  that the government doesn’t have to show an important or compelling interest, just that it is ”reasonably related to legitimate penological interests,” holding :

[G]iven the requirements of the prison environment, the Due Process Clause permits the State to treat a prison inmate who has a serious mental illness with antipsychotic drugs against his will, if the inmate is dangerous to himself or others and the treatment is in the inmate’s medical interest.

Note, that even here, in order to be constitutional the court ordered drugging must be in the person’s medical interest.

OUTPATIENT COMMITMENT

Outpatient Commitment, where people are court ordered to take psychiatric drugs in the community has taken what I consider a bizarre turn.  In 2004, the high court of New York held in the K.L. case that a finding of incompetence was not required, nor was the fundamental right to be free of forced psychiatric drugging involved, because the outpatient commitment statute did not authorize forced drugging, saying “it  simply triggers heightened scrutiny on the part of the physician, who must then determine whether the patient may be in need of involuntary hospitalization.”  In other words, the New York high court held that an [outpatient commitment] order mandating a person take psychiatric drugs does not really compel the person to take psychiatric drugs.  This is a classic example of a court decision being divorced from reality.

There is, however, a 2008 New Mexico case, Protection and Advocacy System v. City of Albuquerque, that recognizes the delusional (my word) nature of the New York high court’s holding that New York’s outpatient commitment law does not involve court ordered medication:

‘R]egardless of whether there are sanctions in the Ordinance for failure to comply with court-ordered treatment, the coercive nature of a court order requiring treatment would clearly allow an act contrary to the statute’s mandate that an individual’s consent be obtained as long as the individual has capacity.”

However, since the City of Albuquerque  case involved whether the city’s ordinance conflicted with state statute and was therefore invalid, the issue was not front and center.

In any event, with respect to the governmental interests involved, in K.L. the New York high court held the police power justification applied as follows:

Inasmuch as an [outpatient commitment] order requires a specific finding by clear and convincing evidence that the patient is in need of assisted outpatient treatment in order to prevent a relapse or deterioration which would be likely to result in serious harm to self or others, the state’s police power justifies the minimal restriction on the right to refuse treatment inherent in an order that the patient comply as directed.

The court also held the parens patriae justification applied as follows:

[T]he state’s parens patriae interest in providing care to its citizens who are unable to care for themselves because of mental illness is properly invoked since an AOT order requires findings that the patient is unlikely to survive safely in the community without supervision;  the patient has a history of lack of compliance with treatment that has either necessitated hospitalization or resulted in acts of serious violent behavior or threats of, or attempts at, serious physical harm;  the patient is unlikely to voluntarily participate in the recommended treatment  plan;  the patient is in need of assisted outpatient treatment in order to prevent a relapse or deterioration which would be likely to result in serious harm to the patient or others;  and it is likely that the patient will benefit from [outpatient commitment].

There are many aspects of this that could be discussed at length, but I will just make two short comments.  The first is that the court held the patient must benefit from the drugging, which is highly dubious, at best.   The second, more over-arching, is that many of the requirements for obtaining an outpatient commitment order in New York cannot, in fact, be properly proven in most cases, such as the person is unlikely to survive without the forced drugging.  Again, that so many of these orders get issued demonstrates where I think the legal system vis-à-vis involuntary commitment and forced drugging is most broken, which is the lawyers assigned to represent people don’t do their job.

Forced Drugging Furthering Governmental Interest

The second Sell requirement is that the involuntary medication will significantly further the state interests justifying the forced drugging.  In other words, the forced drugging must accomplish the goal that justifies it.   So, again, the setting matters because that determines what is the state interest(s).   In the restore-a-criminal-defendant-to-competency situation so the state can put the person on trial, the forced drugging must therefore have a good likelihood of making someone competent to stand trial.   However, while in some cases drugs do knock down psychosis, most of the time they merely sedate the person so they are not bothersome.   This was classically stated in the recent reporting in connection with forced drugging of Jared Loughner:

He was removed from a May 25 court hearing when he lowered his head to within inches of the courtroom table, then lifted his head and began a loud and angry rant. But his psychologist has said that since Loughner has been forcibly medicated, his condition has improved. He sat still and expressionless for seven hours at a hearing in September.

Query:  Is sitting still and expressionless for seven hours an indication someone understands the charges against him and can assist his lawyer?   Of course not, it merely shows that the drugs prevent him from being disruptive.  In other words, the assertion that the drugs cause someone to become competent to stand trial can be challenged.  As an aside, I am not in favor of people using mental illness as a way to avoid criminal responsibility for their actions.

In the civil commitment and outpatient commitment contexts, it is also very dubious that the forced drugging will actually achieve the stated goals.   First, we know from Anatomy of an Epidemic and other sources that psychiatric drugs (a) increase rather than decrease violence, (b) dramatically shorten lives, (c) dramatically increase disability; and (d) dramatically decrease recovery.  Thus, it is quite questionable in many cases whether especially the parens patriae justification, in fact, exists.   However, even though psychiatric drugs, especially the antidepressants and neuroleptics, increase violence, the neuroleptics can also render people incapable of causing much trouble.  Thus, neuroleptics very well may further the governmental police power interest in that.

However, it is most often not true that the drugs accomplish the asserted justification for the forced drugging.  Again, the reason why so many forced drugging orders are issued is because the lawyers assigned to represent people, don’t do so.

Less Intrusive Alternatives

The third Sell requirement is the court must conclude that involuntary medication is necessary to further those interests; that there are no less intrusive alternatives.  The Alaska Supreme Court, in the Bigley case, addressed what the requirement means under the Alaska Constitution,

Although the state cannot intrude on a fundamental right where there is a less intrusive alternative, the alternative must actually be available, meaning that it is feasible and would actually satisfy the compelling state interests that justify the proposed state action.

(p. 31)

As Anatomy of an Epidemic, and many studies and other sources demonstrate, as a factual matter, this is rarely the case, especially if the government has to prove there are no less intrusive alternatives by clear and convincing evidence.

Here too, the lawyers appointed to represent people facing forced drugging rarely fulfill their obligation to assert the right to a less intrusive alternative.  However, proving there is a less intrusive alternative can be difficult even if the attorney tries because the hospital has an automatic “expert,” the testifying psychiatrist, while the defendant often does not have the resources to employ an expert or otherwise prepare a case.

In Bigley,  starting at page 30, the Alaska Supreme Court’s discussion of this issue can give one an idea of the way a court looks at it and the difficulties in prevailing.   In addition to the lawyers assigned to represent people not doing their job properly, one of the biggest obstacles is appellate judges, just like trial court judges, believe the common wisdom that the drugs are helpful and nothing else works.  As I wrote in A Three Pronged Approach to Mental Health System Change, this is one of the reasons why educating the public about the truth is so important.

 Best Interests

The final Sell requirement and the one that ultimately leads me inexorably to the conclusion that forced drugging  and electroshock cannot be properly ordered, is the “court must conclude that administration of the drugs is medically appropriate, i.e., in the patient’s best medical interest in light of his medical condition.”  The truth is that while a small percentage of people might rationally decide to take neuroleptics with full knowledge of their lack of effectiveness for most and harm to all, it is not possible for a court to legitimately find by clear and convincing evidence that forcing someone to take them is in their best interest.   Frankly, I don’t think it is possible under the preponderance of evidence standard.

Space doesn’t allow me go through the evidence on this, but Anatomy of an Epidemic  does.   Much of the evidence has also been compiled as part of PsychRights’ and MindFreedom’s Forced Drugging Defense Package.  It includes an affidavit from Robert Whitaker, the“clickable”  verson of which has hyperlinks to the cited studies.   Also, my 2008, law review article, Involuntary Commitment and Forced Psychiatric Drugging in the Trial Courts: Rights Violations as a Matter of Course has much of the same material woven with the legal standards and the perspective of people faced with such court proceedings.  The bottom line is the evidence does not support forcing someone to take psychiatric drugs against their will is in their best interests.

The same is true of electroshock in light of the harm and lack of benefit from electroshock.  In contrast to the neuroleptics, however, I think electroshock should be abolished altogether in light of its complete lack of benefit and extreme harm.

 Conclusion

Under the United States Constitution, as well as state constitutions, the government is not allowed to force someone to take psychiatric drugs or be electroshocked against their will unless it can prove such drugging or electroshocking is (1) necessary to achieve a compelling governmental interest, (2) the least intrusive alternative, and (3) in the person’s best interest.   In most cases, neither the 1st or 2nd requirement is met because  (1) the drugging or electroshock does not accomplish the government interest asserted, and (2) there are less intrusive alternatives.   The last element, that the forced drugging or electroshock is in the person’s best interest, however, cannot be legitimately proven, which is why I conclude forced drugging and electroshock in the United States is illegal.

The question that jumps out from these circumstances is why people’s rights are being so pervasively violated?  The short answer, as I indicated in A Three Pronged Approach to Mental Health System Change, is the lawyers and judges believe the conventional wisdom that if the defendant wasn’t crazy she would know it is good for her so we won’t let her pesky constitutional rights get in the way.  This is why educating the public is so important.

In addition to this, however,  a big reason why people’s rights are being violated as a matter of course is the lawyers appointed to represent people faced with forced drugging and electroshock proceedings are not fulfilling their professional obligations when they go along with this.  But that is the subject of a future blog.

 

Electroshock Therapy: Is Oprah Right? Electric Shock Mental Health Treatment, Breeding Psychetruth

Medical Beauty Center, March 21, 2012

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Nation of Pill Poppers, 19 Dangerous Drugs Pushed by Big Pharma

from AlterNet, December 5, 2010 , by Martha Rosenberg

Here are some of the dicey drugs many Americans are hooked on, thanks to greedy pharmaceutical companies.

Since direct-to-consumer drug advertising was legalized 13 years ago, Americans have become a nation of pill poppers — choosing the type of drug they desire like a new toothpaste, sometimes whether or not they need it.

But if patients want the drugs, doctors and pharma executives want them to have the drugs and media gets full page ads and huge TV flights (when many advertisers have dried up), is the national pillathon really a problem?

Yes, when you consider the cost of private and government insurance and the health of patients who take potentially dangerous drugs like these.

Seroquel, Zyprexa, Geodon, atypical antipsychotics

Even though the antipsychotic Seroquel surpasses 71 drugs on the FDA’s January quarterly report with 1766 adverse events, even though it’s linked to eight corruption scandals, even though military parents blame Seroquel for unexplained troop deaths, it is the fifth biggest-selling drug in the world and netted AstraZeneca almost $5 billion last year.

Atypicals were originally promoted to replace side-effect prone drugs like Thorazine but soon became pharmaceutical Swiss Army Knives for depression, anxiety, insomnia, bipolar and conduct disorders and other off label uses — and betrayed the same side effects as older antipsychotics. (Especially tardive dyskinesia-linked Abilify.)

Foisted disproportionately on the young, poor and disadvantaged, atypicals cause such weight gain and metabolic derangement — 16 percent of Zyprexa patients gain 66 pounds and some gain over 100 — manufacturer Lilly Eli Lilly agreed to pay the state of Alaska $15 million in 2008 for the Medicaid costs of Zyprexa patients who developed diabetes.

Atypicals carry warnings of death in demented patients but are widely used in nursing homes. And even though Risperdal maker Johnson & Johnson, Geodon maker Pfizer, Abilify maker Bristol-Myers Squibb, Lilly and AstraZeneca have all entered into government settlements that acknowledge fraudulent or wrongful atypical marketing, FDA rewarded atypical makers by approving Zyprexa and Seroquel for children last year. And approved a new atypical antipsychotic, Latuda, in October. Maybe the FDA is bipolar.

Ritalin, Concerta, Strattera, Adderall and ADHD drugs

When it comes to the epidemic of 5.3 million US children between 3 and 17 diagnosed with ADHD, suspicions of pharma pushing the disorder are exceeded only by pharma’s admissions thereof.

During an August conference call with financial analysts, Shire specialty pharmaceuticals president Mike Cola credited the “very dynamic ADHD market” to Shire’s globalization efforts and “investments we have made in new uses for our existing products.”

Those uses, a.k.a. diagnoses, for Shire products like stimulants Adderall, Vyvanse and Intuniv include adult ADHD, cognitive impairment, depression and excessive daytime sleepiness.

Still, Cola says despite the 10 percent ADHD “new starts” that are helping Shire “grow the market,” and the “co-administration market” of add-on prescription drug$, the ADHD franchise suffers from patients who drop out when they quit seeing their pediatrician. “We don’t see those patients show up again until their mid-to-late 20s,” laments Cola.

ADHD drugs, in addition to “robbing kids of their right to be kids, their right to grow, their right to experience their full range of emotions, and their right to experience the world in its full hue of colors,” as Anatomy of an Epidemic author Robert Whitaker puts it, can also be deadly.

A 2009 article in the American Journal of Psychiatry called Sudden Death and Use of Stimulant Medications in Youths found 1.8 percent of youthful stimulant users died sudden deaths from cardiac dysrhythmia or unexplained causes versus 0.4 percent who were not on stimulants. Though it helped fund the study, the FDA said the results proved no “real risk” and kids should keep taking their meds.

Meanwhile, says Robert Whitaker, kids on ADHD meds “are told they are going to be on these drugs for life. And next thing they know, they’re on two or three or four drugs,” a phenomenon also known as the co-administration market.

Prozac, Paxil, Zoloft, SSRIs

Selective serotonin reuptake inhibitor (SSRIs) antidepressants like Prozac, Paxil, Zoloft and Lexapro probably did more to inflate pharma profits in the last decade than direct-to-consumer advertising and Viagra put together, no pun intended: over 60 million prescriptions were filled in the US in 2007 with many patients reporting their depression lifted.

But some critics say for mild depression, SSRIs don’t work at all and are no better than placebo.

And others say they can add aggression, bizarre behavior, self-harm and suicidal thoughts to depression. In fact, there are 4,200 published reports of SSRI-related violence, aggression, bizarre behavior, self-harm and suicide since the drugs were introduced in 1988 including the well known gun massacres at Columbine (1999), Red Lake (2005), NIU and likely, Virginia Tech (2007).

SSRIs have non-behavioral perks both sides agree on: life-threatening serotonin syndrome when taken with migraine drugs, gastrointestinal bleeding when taken with aspirin, Aleve or Advil and the bone condition, osteoporosis.

Paxil can reduce or abolish the effect of tamoxifen in breast cancer patients and increase deaths says British Medical Journal. It’s linked to a two-fold increased risk of cardiac birth defects in infants according to its own manufacturer, GSK.

And sex? SSRIs are so linked to dysfunction even the pharma-identified web site WebMD admits many will experience impotence, delayed ejaculation or no orgasm. But there is a solution (besides going off SSRIs) says WebMD: Add another antidepressant that’s not an SSRI, like Wellbutrin!

Effexor, Cymbalta, Pristiq, SNRIs

Selective norepinephrine reuptake inhibitors (SNRIs) are like their SSRIs chemical cousins except their norepinephrine effects can modulate pain, which has ushered in your-depression-is-really-pain, your-pain-is-really-depression and other crossover marketing. But the problem with giving a psychoactive drug for pain is that you’re giving a psychoactive drug for pain. “After three months of taking Savella [another SNRI], I started self-destructing and cutting myself,” writes a 40 year old woman on askapatient.com. “I don’t know why or anything, but it does similar to Prozac where it makes you think and do weird things.”

And Cymbalta, approved this fall for chronic back pain and osteoarthritis?

Cymbalta was the drug healthy 19-year-old volunteer Traci Johnson was testing when she hung herself in an Eli Lilly dorm in 2005. It was the drug Carol Anne Gotbaum killed herself on at Phoenix’s Sky Harbor airport in 2007.

SNRI’s are also harder to quit than SSRIs, especially Effexor. 25-year-old Chicagoan David F. told AlterNet he stood at the top of an 8-story parking lot contemplating jumping every day for weeks after quitting. It’s also the drug Andrea Yates was on when she drowned her five children in 2001.

But not all SNRI side effects are behavioral. The FDA would not approve Pristiq, a newer version of Effexor, when Wyeth/Pfizer tried to market it for vasomotor symptoms, because it caused heart attacks, coronary artery obstruction and hypertension in clinical trials. That’s similar to another SNRI, the diet pill Meridia, which was just withdrawn from the market for causing heart problems. Pristiq is still available.

Foradil Aerolizer, Serevent Diskus, Advair and Symbicort

How could asthma drugs that increase the chance of dying of asthma become pharma’s top sellers? The same way antidepressants that cause depression and antifracture drugs that cause fractures become top sellers: good consumer marketing.

Still, unlike drugs that look safe in trials and develop safety signals postmarketing, the long-acting beta agonists (LABA), salmeterol and formoterol, found in many asthma products, never looked safe. In fact it was their links to deaths and adverse events that led to studies in the 1990s and 2000s which showed more deaths and adverse events: LABAS increase death in users, say the studies, especiallyAfrican-Americans and children.

Original safety trials were also marred with major fraud.

Pharma doctors, when reviewing the study results at FDA hearings in 2005 and 2008, blamed LABA deaths on patients’ underlying disease and non-compliance and dismissed hospitalization as a side effect less serious than death. They danced around FDA testimony, including from Dr David Graham of Vioxx fame, that there is no scientific evidence that the inhaled corticosteriods found in Advair and Symbicort make the products safer and that LABA’s modest clinical benefit does not justify their 28-fold increase in mortality risks. (5,000 deaths in ten years estimated Graham.)

While many regard LABAs as a medical mishap, marketing for “step up” asthma treatment is no misttake. Though inhaled corticosteriods are still considered the best asthma treatment, millions have been convinced they need two drugs to control their asthma and that the combination is keeping them out of hospitals. Except when it isn’t.

Singulair and Accolate, leukotriene receptor antagonists

How did Merck convince Americans to use an allergy drug that works no better than over-the-counter antihistamines but costs eight times as much?

A drug in which “asthma control deteriorates when switched from low dose inhaled corticosteriods” according to original FDA reviewers in 1998 — but was approved anyway?

How did Merck convince pediatricians and mothers to give kids such a drug on a daily basis for seasonal allergies, runny noses and minor wheezing? Even though FDA reviewers cautioned that adult trials “may not be predictive of the response” in children in the New England Journal of Medicine? And infant monkeys given Singulair had to be euthanized because “infants may be more sensitive” FDA reviewers wrote?

Last month, the saga of Singulair mismarketing story continued when Fox TV reported that Merck’s top selling allergy drug is suspected of producing aggression, hostility, irritability, anxiety, hallucinations and night-terrors in kids, symptoms that are being diagnosed as ADHD.

And that Singulair is being huckstered to parents by the trusted educational service Scholastic, Inc. and the American Academy of Pediatrics.

Eight-nine parents on the drug site askapatient.com report hyperactivity, tantrums, depression, crying, school trouble, facial tics and strange eye movements after their children, some as young as one, were put on Singulair. Similar reports appear on medications.com and parentsforsafety.org. Most symptoms subside when Singulair is stopped.

“Do NOT recommend this drug to other parents,” writes one mother. “4 year olds that suddenly talk about killing themselves are influenced by a DRUG!!

“THE GOVERNMENT SHOULD BE ASHAMED OF THEMSELVES FOR APPROVING THIS!!!!” writes another mother, though the shame may well not stop there.

 

 

Depression Linked to Circadian Rhythm…

ScienceDaily (Nov. 11, 2010) – Depression appears to be associated with a molecular-level disturbance in the body’s 24-hour clock, new research suggests.

Scientists examined genes that regulate circadian rhythm in people with and without a history of depression. As a group, those with a history of depression had a higher level of activity of the so-called Clock gene, which has a role in regulating circadian rhythm, than did people with no mood disorders.

Higher expression levels of this gene suggest something is amiss in the body’s 24-hour biological and behavioral cycle, which could affect sleep patterns and other physiological functions governed by circadian rhythm. Sleep disturbance is a common symptom of depression.

But the researchers noted that the association between the gene activity and depression is just that — a link, with no demonstrated causal effect in either direction. At this point in what is known about the relationship, this genetic profile could lead to depression or depression could alter this particular gene function, or some other biological or environmental influences could combine to disrupt the circadian clock.

Though this study offers just a snapshot in time of circadian activity in people with and without depression, the finding could have important clinical implications if it is supported by additional research. People with depression who share this genetic profile might benefit most from sleep-related treatments, such as light therapy or a class of antidepressants that act on melatonin, a hormone that regulates sleep.

“We know that there are a lot of insomnia symptoms in depression, especially early morning awakening,” said Jean-Philippe Gouin, a graduate student in psychology at Ohio State University and lead author of the study. “We can’t say with this study that there is a direct relationship between this altered gene function and behavior, but the research suggests that over-expression of circadian genes might serve as a biomarker of vulnerability to depression.”

The research is published in a recent issue of the Journal of Affective Disorders.

Gouin is currently serving a predoctoral clinical psychology internship at Rush University Medical Center. As a graduate student at Ohio State, he has worked for years on studies led by the Institute for Behavioral Medicine Research that examine the health effects of chronic stress in people who take care of loved ones with dementia. Some of the people who participated in this study were from that population.

“There was some evidence that chronic stress led to changes in circadian gene expression in animals,” Gouin said. “We wanted to see if that would be the case in humans, and one of the models of chronic stress in humans is dementia caregiving stress. We found that caregiving was not related to circadian genes, but instead it was really the history of depression that distinguishes between regulation of these genes.”

The researchers collected blood samples from, and conducted interviews with, 60 people: 25 who were providing at least five hours of care per week for a family member with dementia and 35 non-caregiving controls with similar demographic characteristics. Thirty participants had a lifetime history of depression, while the other 30 had never been clinically depressed.

All blood samples were drawn between 9 a.m. and 11 a.m. to control for variations in circadian clock gene activity that occur throughout the day.

The researchers analyzed the blood to determine the messenger RNA levels for four circadian genes, including Clock. Messenger RNA (mRNA) contains the set of instructions for building proteins, so its level in genes dictates how much protein each gene is making.

As a group, the participants with a history of depression had a significantly higher level of Clock mRNA expression than did participants who had never been depressed. The researchers didn’t find statistically significant results for the other three genes.

The association between depression and elevated Clock mRNA levels held up even when figures were adjusted for differences in age, sex, body mass index, alcohol and tobacco use, exercise, other medical conditions and caregiving status, Gouin noted.

He said that to further define the relationship between this genetic profile and depression, researchers ideally would monitor research participants over time to measure the changes in mRNA expression in circadian genes through a 24-hour cycle.

“If we look at people who have depression, they can have very different groups of symptoms. So if some of them have a biological profile that shows circadian dysfunction, there is a chance that a circadian type of treatment might be more helpful for them than for others,” Gouin said.

He conducted the study with co-authors James Connors, Janice Kiecolt-Glaser, Ronald Glaser, William Malarkey, Cathie Atkinson and Ning Quan of Ohio State’s Institute for Behavioral Medicine Research, and David Beversdorf of the University of Missouri.

The research was funded by the National Institutes of Health, a General Clinical Research Center grant, a Comprehensive Cancer Center grant and a Fonds de la Recherche en Santé du Québec Doctoral Training Award.

Alternatives 2010 Conference

ALTERNATIVES 2010 is a conference held once a year in the U.S. In less than 12 hours, more than 2,000 mental health consumers and psychiatric survivors are expected to attend the national conference from all over the U.S.A. in Anaheim, California. The conference will take place at the Hyatt Regency, 11999 Harbor Blvd., Anaheim/Garden Grove, CA 92840. Registration begins at 2.00 p.m. It is a 5-day conference, including workshops, seminars, Caucus sessions, open mic, activities and entertainment. Since 1985 the federal government has funded this annual conference, mostly for people who run mental health ‘Peer Delivered Services (PDS)’. There are many PDS, including community centers, advocacy systems, supported housing, employment programs and more.

Among the workshops and keynote addresses, will be Robert Whitaker’s address on Friday, October 1, 2010 at 8:30 a.m. He is the author of the book ‘Anatomy of an Epidemic’ which is highly critical of hype by the psychiatric pharmaceutical industry the past two decades. In fact, because he was considered controversial, federal officials had Whitaker disinvited. However, MindFreedom International immediately launched an online campaign to contact President Obama, and, within days, Whitaker was re-invited to give his keynote address!

Also censored at the conference was Will Hall’s workshop titled ‘Coming Off Medications’. The conference has withdrawn its previous approval for a workshop on coming off psychiatric medications. The workshop, based in a pro-treatment choice, harm-reduction philosophy, was to share information about continuing, reducing, or coming off medications. After approving the workshop in June, the National Empowerment Center, which organizes the conference to be held in Anaheim California, made a last-minute decision to change the title and description to remove any reference to coming off medications.

Will Hall, an internationally-recognized schizophrenia survivor and radio host who was set to lead the workshop, decided that he could not go along with the decision and will not be attending the conference. “Coming off medications is a topic vital to wellness and recovery, and should not be censored,” he said.

The controversial move by the National Empowerment Center comes in the wake of a recent similar decision to bar Robert Whitaker, a Pulitzer finalist investigative journalist whose work spotlights medication dangers and growing evidence that non-drug alternatives work better for some patients. With workshops ranging from wellness, youth, housing, employment, advocacy and diversity issues, Alternatives is the country’s most prominent gathering for mental health consumers, who attend from all US states and as far away as Guam. Medication issues, however, have consistently been excluded from the program.

Hall, who works as a therapist, says he educates individuals, families, and health care providers to make more informed choices, and is not anti-medication and does not give medical advice. “People are caught between pro-drug marketing by pharmaceutical companies and the anti-drug message of some activists. We need honest and unbiased information about psychiatric medications, including assessing drug risks and discussing how to come off drugs safely when they aren’t right for you. Many people find medications helpful, but there are huge dangers involved, and sometimes it’s better to reduce medication or slowly go off.” After several hospitalizations and a diagnosis of schizoaffective disorder schizophrenia, Hall has been medication-free for more than 17 years. He says a combination of holistic health, support groups, and spiritual practice nurtured his recovery from mental illness, but believes that “each person’s path to recovery is different. My work fills a great need for information, and it’s a shame this topic is censored at a national conference that claims to be dedicated to wellness and calls itself ‘Alternatives.’”

Hall is the author of the Harm Reduction Guide to Coming Off Psychiatric Medications, published by mental health peer groups The Icarus Project and Freedom Center. The guide, available freely on the internet, has been distributed to more than 15,000 people and is available in Spanish and German translations.

Recently, Dan Fisher from the NEC decided to approve Hall’s workshop, so Will Hall will present during the Alternatives 2010 Conference in Anaheim after all.

Eco-consciousness and our HOME…

Everything has a balance. Life itself is a balance. When we are balanced, we feel better, act nicer, and are content within ourselves. When we are off balance, we feel fear, hate, violence, guilt, and many other negative emotions. We seek joy in material wealth and cannot see the beauty around us.

One of the beauties we ignore is our own home… our planet. The movie ‘Home’ reflects how we are upsetting the delicate balance on Earth every day, each moment. One of the main aspects of the film shows us that our food habits may be at fault. Our food habits are contributing to the imbalance of our planet. The good part is that WE CAN DO SOMETHING ABOUT IT! If we change our food habits and make eco-conscious choices, we not only can improve our health but also the health of the planet.

This film is an objective look into where we are at on planet earth and offers subtle hints as to what we can do about improving our health and the health of the planet.

CLICK HERE TO WATCH THE FULL VERSION OF ‘HOME’ ON YOUTUBE

In 200,000 years on Earth, humanity has upset the balance of the planet, established by nearly four billion years of evolution. Scientists tell us that we have 10 years to change the way we live, avert the depletion of natural resources and the catastrophic evolution of the Earth’s climate. The stakes are high for us and our children. Everyone should take part in the effort, and HOME has been conceived to take a message of mobilization out to every human being.

For this purpose, HOME needs to be free. A patron, the PPR Group, made this possible. EuropaCorp, the distributor, also pledged not to make any profit because Home is a non-profit film. HOME has been made for you: SHARE IT AND ACT FOR THE PLANET!!

Medicalizing Human Conditions

A Growth Industry — But What Does It Cost?

ScienceDaily    May 19, 2010

Menopause. Normal pregnancy. Infertility. ADHD. Erectile dysfunction. Over the last several decades, these conditions have come to be defined and treated as medical problems. They’ve been “medicalized.” In the first study of its kind in the current issue of Social Science and Medicine, Brandeis researchers used national data to estimate the costs of these and a handful of other common conditions on escalating U.S. healthcare spending.

The researchers, led by Brandeis sociologist Peter Conrad, evaluated 12 conditions that had been defined as medicalized by physician organizations, and for which there were current medical spending data. The other conditions considered in the study were anxiety and behavioral disorders; body image; male pattern baldness; normal sadness; obesity; sleep disorders, and substance-related disorders.   

The robust trend toward ever-greater medicalization of human conditions is undeniable, with an increasing number of medical diagnoses and treatments for behavioral problems and normal life events. Conrad and his colleagues analyzed medical spending on these disorders — payments to hospitals, pharmacies, physicians and other health care providers — and discovered that they accounted for $77.1 billion in medical spending in 2005 — 3.9 percent of total domestic health care expenditures.

“We spend more on these medicalized conditions than on cancer, heart disease, or public health,” said Conrad. “While medicalization is unlikely to be a key driver of skyrocketing health care costs, $77 billion represents a substantial dollar sum.”

Although the study did not evaluate whether medicalization is good or bad for health and society, it demonstrates the need for understanding the societal and economic impact of growing medicalization. Conrad explained that some researchers attributed medicalization to the growth of medicine’s professional jurisdiction, increased consumer demands for medical solutions, and the pharmaceutical industry expanding markets for drugs.

“By estimating the amount spent on medicalized human problems, we’ve raised the obvious question as to whether this spending is ‘appropriate,’” said Conrad. “The next question is whether we can more directly evaluate the appropriateness of these medical interventions and consider policies that curb the growth or even shrink the amount of spending on some medicalized conditions.”