Sunday, October 17, 2021

Comments by Marie

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  • Being affected by a problem is different from linking that problem to mental health. There’s an unfortunate tendency for too many things to be framed as a mental health issue. It’s one of the ways psychiatry has insinuated itself into all aspects of society.

    I have a vision (or is it a nightmare) of the next issue of the DSM adding a disorder called youth climate change anxiety.

  • I had a very hard time relating to this article. I really think health professionals have more important things to do than address climate change. I’m sure young people are unhappy about global warming. But how about their distress at Covid lockdowns, gun violence, incompetent therapists, over medication for such things as depression and ADHD, social difficulties exacerbated by Facebook manipulations, and the excessive burden of student loans.

    I’m not convinced that global warming is a major factor in the mental health of most young people.

  • I read an excellent book a few years ago, Oligarchy by Jeffry Winters, that basically examined how the wealthy in various countries have controlled society from Ancient Greece to the present. Based on this book and my own observations, I doubt that we can overturn any political system enough to take away the power of the financial elites. Revolutions often just replace one group of oligarchs with their rivals.

    That drug companies can be so openly corrupt while aided not only by the medical profession, but by Democrats and Republicans is only one manifestation of the power of the super wealthy.

    I’m not completely pessimistic. Even within an imperfect system we can have better outcomes. We’ve all seen improvements in our country. Some examples are Medicare, the end of segregation, and more equality for women. I suspect, though, that if we did move beyond a capitalist profit system, the results would be different but not better than what we have today.

  • Pharmaceutical companies have to follow a protocol that they submit to the FDA. This protocol is reviewed by the agency and by an Institutional Review Board, which is supposed to protect study participants. The drug company and the FDA collaborate on many aspects of the study.

    Yet the drug companies still sometimes get approval for drugs that are poorly conducted. My question is will adding another layer of reviewers to what is already an extensive process really lead to better trials?

    I agree that making trial data accessible is a good idea, but that it probably won’t happen. Nonetheless, the information already available in published studies often gives us enough information to see whether the trials are well done. Often it’s obvious they’re not.

    I also think the public is generally unaware of the limited effectiveness of many of the drugs they take. I don’t think some people’s reluctance to get a COVID vaccine is because of a mistrust of medicine in general.

  • This is a very good article that points out more reasons to mistrust medical research.

    I sympathize with the author’s desire to try to improve the situation. But I question whether better and objective criteria that will lead to fair quality assessments are possible given the huge profits involved. These profits not only encourage deception, but give interested parties the resources to manipulate public policy.

    I hope I’m being too skeptical and that at least some beneficial changes can be made.

  • There’s no doubt that conservatorship can be abused. But some parts of this story don’t make sense. How did two tax preparers break into a home, steal records and kidnap someone. Why didn’t the police do something? Why wasn’t an attorney called to prevent this miscarriage of justice?

    How was the mother’s entire estate transferred to a step granddaughter in less than a week? In my experience the court system simply doesn’t work that fast. I don’t know what the situation is in California, but in Illinois even someone with dementia can retain an attorney to protect their interests. Why wasn’t this done?

    I could go on. But parts of this narrative really need more explanation.

  • Dr. Gøtzsche presents some good criticisms of the Cochrane review of antidepressants in children. And I think the review should have been far more critical than it was. Specifically, given the lack of credible evidence, they shouldn’t have suggested that antidepressants might sometimes be considered because their findings “reflect the average effects of the antidepressants, and given depression is a heterogeneous condition, some individuals may experience a greater response.”

    But I want to point out that the Cochrane abstract was hardly a resounding endorsement of the pills. It said:

    “Findings suggest that most newer antidepressants may reduce depression symptoms in a small and unimportant way compared with placebo. Furthermore, there are likely to be small and unimportant differences in the reduction of depression symptoms between the majority of antidepressants.”

  • This is an excellent article, but there’s one other thing that I’ve found adds to polypharmacy and that’s the belief that many patients have that every drug they take is beneficial.

    I used to point out to people the non benefit or low benefit of some of their drugs. No more. Many people are convinced their medications are extending their life span or helping them in some way.

    People want something to give them hope in the face of debilitating (or even not so debilitating) disease. No one wants to hear there’s nothing more to be done and US physicians, for many reasons, usually won’t say that. At one time religion or a shaman may have provided hope. Now it’s often drugs.

  • That 20% of health research is fraudulent is shocking. But the problem is even worse because much research, if not outright fraudulent, is misleading.

    Medical research often cites relative risk statistics, for example, which greatly exaggerate the efficacy of a drug. And there are many other ways researchers massage their findings as MIA has often pointed out.

    Just one example, a study on statins claimed they are effective in preventing heart disease in the elderly, but the study combined those with heart disease and those without to come to that conclusion. The researchers also did not adequately address the lack of a mortality benefit, claiming lack of statistical power to do so, something I don’t believe.

  • Government has been coopted by these industries, so it’s not much help.

    It’s not easy to get accurate medical information. Big Pharma has its tentacles into so much. In addition to what’s been mentioned, it influences medical journals, journalists, physicians, and governmental agencies. I don’t want to be too pessimistic though. There are good sites and accurate information out there. Unfortunately many people don’t have the technical or general knowledge to be able to separate facts from propaganda.

  • A very sad story, but the problem is far worse than indicated here because so many medical associations and organizations that supposedly are patient advocates accept pharmaceutical money. Take the National Alliance on Mental Illness (NAMI), for example, which lists pharmaceutical companies as sponsors. NAMI is typical.

    Beware of online medical advice because so much of it could have been written by the PR department of any pharmaceutical company. One (admittedly minor) example is WebMD’s assertion that brain chemicals in people with ADHD may be out of balance.

    It’s not a pretty picture.

  • Racial equity in all research is important, but this article does not confront the major issue: Are drug companies, who will be aided and abetted by the FDA, promoting psychedelics as a way of coopting currently illegal substances in a blatant attempt to increase their obscenely high profits? I’ve already observed a lack of concern about the substantial bad effects of psychedelics on the part of advocates of this new treatment.

    I also feel legalization is coming because there’s so much money involved. But this concern about including people of color in the research seems to me to be just an additional way of attempting to legitimize a questionable endeavor. Making sure these “treatments” are available to marginalized communities is only fair, but let’s face it, it also increases the number of people the pharmaceutical industry will be able to profit from.

  • Fast track approval has been abused by the FDA and, as this article points out is often based on surrogate markers, like amyloid plaque. Unfortunately many drugs are based on these surrogate markers, not just those that are fast tracked. Examples include cholesterol medications for people without heart disease, which do reduce cholesterol but do little or nothing to increase longevity; and blood pressure medications for mild hypertension, which reduce blood pressure but may have no other benefits.

    I don’t expect the FDA to change its fast track or other approval protocols as long as both Democrats and Republicans are corrupted by pharmaceutical company money and permit such regulatory malfeasance to continue.

  • Incredible, but not surprising.

    I once worked for a pharmaceutical company that submitted a new drug application to the FDA. My boss kept warning that the data was inaccurate, sloppy and unreliable (not all people who work for drug companies are dishonest). She was ignored. The FDA rejected the application and basically accused the company of fraud.

    I observed some other questionable practices, but that was the most egregious.

  • I would just like to add one other major way drug companies fool patients into believing a drug is far more beneficial than it is: reporting the relative risk reduction of a drug instead of the absolute risk reduction. Depending on the study it could appear that a drug is effective 90% of the time, using relative risk reduction, while the more meaningful absolute risk reduction might show as little as 1% efficacy.

    Newspaper articles often present the misleading relative risk reduction when writing about a new drug I think partly because the new drug would seem so worthless they’d have nothing meaningful to write about if they reported the absolute risk reduction.

  • This is the state of too much medical research today: Conducted by people who ignore good science in order to gain financially. Unfortunately the United States government is going along with this sad state of affairs as is most recently evidenced by the FDA’s approval of a worthless, expensive and dangerous Alzheimer’s drug.

  • I read this book a few months ago and basically enjoyed it ( I’ll get to the basically shortly). The novel describes the ways pharmaceutical companies have (among other things) lied, distorted clinical trial results, hidden side effects of their drugs, and attempted to sell medications for all sorts of conditions whether these medicines can help or not. As a former medical writer, I was engrossed by how accurately Scott describes some of the really evil things that are going on. Scott describes the trials and tribulations of a journalist who gets burned when he publicizes some of the wrong doings of a pharmaceutical company. He also follows that company’s guilt-ridden ghost writer as she has increasing doubts about her role in the company’s deceptions. The depiction of those two main characters is decent. But Scott goes overboard in what pharmaceutical companies can do as for example when he lets the chief villain erase all proof of the existence of a main character. No way. My other objection is the jazzy writing style Scott uses. It may not bother everyone, but I didn’t like it. For example, “Yeah, conno-f….ing-rations. Lobster bake-on the beach is going to get us some sunsetty fantasy shots.” Or “Mad honeys, the full Abercrombie.” But for me the pleasure of reading a nicely plotted novel that so satisfyingly exposed the wrongdoings of the pharmaceutical industry outweighed the book’s faults.

  • Of course you’re right. Many common treatments offer no benefits to most patients for whom they’re prescribed. But there’s another factor here. People have an insatiable desire for physicians to do something to help them. What physician would dare say, yes you have a greater risk of a heart attack because of your family history, blood pressure, age, and cholesterol level, but I have no drugs that can help you, or at best there’s only a slight chance the drugs will be beneficial? For many people the medical field and the physician have taken the place of religion and the medicine man. A doctor who refuses to fill this role will lose patients. It’s hard to believe revolutionary change is coming any time soon.

  • There’s no doubt in my mind that the use of psychedelics to treat problems ranging from anxiety to depression to schizophrenia is coming to psychiatry. I don’t think the reason is that these drugs will necessarily be beneficial but because there’s money to be made. The legalization of marijuana has shown that the public may be willing to accept expanded use of psychedelics, drug companies see a new way to cash in on a trend and therapists can try new approaches to mental illness. I can’t say no one will be helped. But some people get relief from antipsychotics and antidepressants even if the hype goes way beyond what the statistics support. Minimized in the discussion for now are all the deleterious effects from psychedelics, including death.

  • Part of the problem are the consumer advocates that attempt to pressure the FDA (of course the drug companies may play a big part in organizing these “advocates”). It has happened before. The FDA approved a Duchenne muscular dystrophy drug in 2016 despite limited data showing efficacy and a negative panel recommendation. There were many desperate parents who ignored the evidence and pushed for approval. And that’s only one example. It’s obvious that the FDA is not always objective.

  • I have lost respect for the Cochrane Review. I recently read their research on maintenance therapy with antipsychotics and was stunned by its poor quality. It’s conclusion: “For people with schizophrenia, the evidence suggests that maintenance on antipsychotic drugs prevents relapse to a much greater extent than placebo for approximately up to two years of follow-up.” It failed to mention the problems with the studies that allowed them to reach this finding. One example, it ignores the fact that patients in the placebo groups have often been abruptly withdrawn from treatment, which could lead to relapse. It claimed long term studies could be difficult to interpret because of such things as environmental factors. I wouldn’t trust anything the Cochrane Review comes up with.

  • Actually I’m not surprised at these findings. How many patients know how to research their doctor’s conflict of interest or understand its importance? Medical journals accept pharmaceutical money and universities have their own conflicts of interest. So their indifference is to be expected. And how many physicians, especially psychiatrists, have an incentive to support tougher laws when they’re benefitting from pharmaceutical grants and gifts?

  • My experience with physicians and SSRIs has not been positive. Years ago a psychiatrist prescribed an antidepressant for my son (for anxiety). He wound up in the ER with the feeling that his whole body was on fire. The ER doctor said it was the SSRI. When my son called the psychiatrist, he said no way it was the drug and wanted to increase the dose. I’ve had two internists over the past 10 years. Both wanted me to take an antidepressant (not for depression). The second doctor was so insistent I lied and told her I’d think about it. You can say change doctors, but I think most of them are that way. Concerning antidepressants, the medical profession abetted by the FDA, has been irresponsible.

  • There is no doubt that antipsychotics are extraordinarily toxic, are over prescribed, and don’t “cure” psychosis. In addition, I have no doubt that few psychiatrists explain the dangers of antipsychotics to their patients, which is nothing less than malpractice. Nonetheless, some people suffer so much from a psychotic condition that antipsychotics may be the only help currently available. Such a prominent psychiatric critic as Joanna Moncrieff, for example, has written, “I still think antipsychotics can be useful, and that the benefits of treatment can outweigh the disadvantages, even in the longterm for some people.”

    Other toxic drugs are prescribed at times because nothing else is available, for example, chemotherapy for cancer. That antipsychotics may have limited usefulness under some circumstances does not mean that they are not misused most of the time.

  • Of course trying to break the blinding of a study is unethical. But I question whether these researchers are also duping the pharmaceutical industry. As I said in a previous post people can improve even when they know they’re taking a placebo. In addition, this study was small and flawed and it’s not clear, to me that the FDA would permit this ploy, at least I hope not.

  • Hopefully the FDA will not accept this devious attempt to break the blinding of a study. But who knows. The FDA has not always acted in the public’s best interests. Also, since it’s been found that people can improve even when they know they’re taking a placebo, this ploy may not work as well as the pharmaceutical industry would like. The study also has serious limits. It was a single blind, very small trial and, according to the researchers, there was no independent monitor reviewing sites’ work. So there may have been “inaccuracies” to hype the results.

  • I know it’s false to claim that only drugs are effective for psychosis, having personally known two people who had psychotic breakdowns , never took drugs and are now doing fine (employed, married, children, friends). One for 20 years, the other for about 8 years. So why does the press ignore studies that show this can happen? Because the press generally reports mainstream points of view, not only in the field of psychiatry but in other health fields as well. Reporters are often not experts in the areas they cover. They’re frequently weak in statistics and interpretation of clinical. trials. They’re also afraid to counter mainstream thinking and established “experts,” fearing they might do harm. I don’t see this changing any time soon.

  • I wouldn’t be too concerned if people don’t want to take statins because they don’t work very well, despite all the hype from the pharmaceutical industry. A study in the BMJ showed that with a statin, death was postponed between 5 and 19 days in primary prevention trials (people without heart disease) and between 10 and 27 days in secondary prevention trials (people with heart disease), with a median postponement of 3.2 and 4.1 days, respectively. Also, the trial mentioned in this article was very small and I’d be curious to know whether the researchers had conflicts of interest. The overselling of drug treatments as being effective, including antidepressants and antipsychotics, is commonplace.

  • I’m not convinced. The most I can say is that there may be some, maybe just a few, adults who do recover memories of childhood abuse, but it’s also possible that many such “recovered memories” are really false. No study cited in this article proves anything one way or another. For one thing, I question the contention that a trusted therapist would not have the same influence as a family member. Therapists can have a tremendous impact. Maybe delayed memory is as reliable as continuous memories, but that’s not saying much because continuous memories are often not that dependable. I truly doubt there are convincing studies of “recovered” memories. In general, most social and psychological research that I’ve seen has not been of the highest quality. The McMartin preschool case should not even be mentioned in a discussion of memory. It was one of the most egregious miscarriages of justice ever perpetrated. And that is one of the major problems of this article. It combines too many disparate cases, McMartin, abusive priests, Sandusky, incestuous parents. The bottom line for me is that nothing in this article proves that the weight of evidence is on the side of a genuine recovered memory vs a false memory when someone makes such a claim. Maybe. Maybe not.

  • Interesting comments. But I have a question. Are some of you saying that almost ALL people who are suffering from what is called “mental illness” (such as severe depression, bipolar disorder, schizophrenia) are reacting to severe abuse or horrible situations in their environment? I’m not denying that is sometimes the case. But how often? What is the relationship between innate vulnerabilities and mental breakdowns? Some people can be unable to function because they lost a job. Other people confront illness, death of loved ones, divorce, etc. and still manage to go on. I don’t think we know what leads to “mental illness,” except that there are undoubtedly numerous causes. And wouldn’t that mean we should accept various treatments, as long as they’re reasonable of course.

  • A very sad story. When as many as 13% of US boys have been diagnosed with ADHD you know something is wrong, not with the kids, but with psychologists, psychiatrists and educators. Why do so many boys supposedly have ADHD? Because boys are more difficult to control in school and drugging them is an easy fix. Psychiatrists and the pharmaceutical industry make money off an ADHD diagnosis and support short sighted educators in promoting this dubious condition. This article points out the dangers of being so irresponsible.

  • Dr. Pies should do a Google search. Not only has psychiatry promoted the chemical imbalance theory in the past, but the theory is still being promoted on many prominent websites.

    The Mayo Clinic says problems with certain naturally occurring brain chemicals, including neurotransmitters called dopamine and glutamate, may contribute to schizophrenia. As for depression, the Mayo Clinic cites one cause as abnormal or impaired neurotransmitters.

    WebMD says studies show that certain brain chemicals that control thinking, behavior, and emotions are either too active or not active enough in people with schizophrenia.

    The American Psychiatric Association says brain chemistry may contribute to an individual’s depression and may factor into their treatment. For this reason, antidepressants might be prescribed to help modify one’s brain chemistry.

    The Merck Manual says there are numerous causes of depression. One theory focuses on changes in neurotransmitter levels, including abnormal regulation of cholinergic, catecholaminergic (noradrenergic or dopaminergic), glutamatergic, and serotonergic (5-hydroxytryptamine) neurotransmission.

  • Interesting article. Unfortunately, most of the complaints concerning psychological research has been made about many other fields. To give just one example. It is a common criticism of medical studies that journals and authors suppress or ignore negative results leading to over reporting of positive findings. Biased abstracts and the refusal to share raw data are also commonplace along with the undue influence of special interests.

  • I agree about the consent, but he wasn’t so demented that he didn’t basically understand. The man I’m talking about who underwent ECT was in a state of terror. He not only threatened violence, but actually attacked people a couple of times. He didn’t experience any pain. He wasn’t tortured. I was as skeptical as anyone about the supposed benefits of something that makes little sense. But it worked. And this man’s quality of life improved immensely.

  • I have no doubt that there are no RCTs proving the efficacy and safety of electroshock therapy. I’m certain it has harmed people. But. An elderly relative with dementia recently was in a psychiatric hospital agitated, depressed, suicidal, convinced the hospital and his son were conspiring to cut out his organs and sell them to the mafia for millions of dollars. He threatened violence. Nothing was helping and his psychiatrist suggested electroshock therapy. He consented to it and his desperate family agreed. It worked. His delusions disappeared, he calmed down, his depression lifted and he was able to be transferred to a memory care center. Several months later the family has observed no bad after effects. I’ve heard of other cases like this. Maybe the reason ECT has persisted is because it is sometimes effective.

  • I have no doubt marijuana can be harmful, having experienced a feeling of being split into two personalities after smoking pot when I was in my 20s. The feeling lasted for several days. It wasn’t the pot, because no one else had a similar experience and it wasn’t an underlying psychosis because it never happened again. Nonetheless, the study cited here is not convincing and seems to have been poorly done.

  • Sera, my main point is that women are STRONG. We do not have to obsess over a relatively unimportant article that would have received no attention if it had been written about a man. True misogyny is obnoxious. But to keep looking for it makes us victims and is disempowering. As for leftist vs. rightist, well Melania Trump was often disparaged and I saw very little liberal concern about that. I predict that the same kind of attacks on Jill Biden will not be overlooked.

  • Lots of people are saying the term doctor should not be used by Ph.Ds, including Sera Davidow. So yes this kind of argument is being made to tell men not to call themself doctor. As for the word kiddo, again, Joe Biden used it to refer to his wife and the author of the WSJ article was simply referencing that. By doing so, Epstein certainly wasn’t being deferential. But treating high ranking individuals this way has become commonplace. Now you (me too) wouldn’t write an article on this topic, but Epstein and the WSJ do seem to know how to get attention.

  • I have a very hard time getting really getting involved in this argument, which seems to be mostly about leftists and rightists finding yet another excuse to attack each other. Personally it makes me feel good to call a physician by the honorific doctor simply because that term means they have achieved a certain educational level that should make me, hopefully, respect their opinion. If someone with a ph.D gets a kick out of referring to themself as doctor, I really don’t care, and I don’t think it elevates them or demeans anyone else to do that. I do get a little more riled at calling someone misogynistic simply because he used the future First Lady as a way to criticize the term doctor and because he used the term kiddo (apparently because that’s a term president-elect Biden has used to refer to his wife). I think it wasn’t the smartest way for him to start his article, but do you know how many dumb things I read every day? Maybe we should all calm down and not be so sensitive about truly unimportant subjects.

  • This is a very good article. The only thing I strongly disagree with is this:
    “Depression has become big business for the pharmaceutical industry, psychiatrists, psychologists, therapists, and a whole host of other players. It has been promoted as a lucrative brand for several decades now (although I don’t doubt most who promote it do so out of a genuine desire to help people).”

    Except for some low level uninformed physicians and therapists, I think that most of the people who promote it are mainly looking out their own financial self interest.

  • I believe that the way autism is defined today is overly broad and is a subjective social construct. The term is so nebulous I don’t see how it could be used in meaningful research. However, I do think a narrow definition, such as the one used 50 years ago, which described very severely disturbed children, may have had merit.

  • Whether autism is overdiagnosed depends on how you define autism. Should an individual who has a very low iq, who can speak only a few words and who cannot interact with others at all be put in the same “autistic” category as someone who is intelligent, very verbal, and able to interact socially even with difficulty. To me that doesn’t make sense. I understand that accepting the label autism is a comfort to you. And a lot of educational, financial and social help for children having difficulties probably depends on applying this label. But I suspect there’s also a downside to putting children in a categorical box and encouraging them to see themselves as having a disorder instead of seeing themselves as being like everyone else with their own unique strengths and limitations.

  • Many years ago, when I was a newspaper reporter, I did a story on autism. At that time (late 1970s, early 1980s) the condition was defined very differently than it is today. Among other things, autistic children didn’t make eye contact, didn’t respond appropriately when spoken to and were unable to function. The condition was obvious from infancy, when such children didn’t even smile at their parents. For my story, I visited a small group home for autistic adults. Meaningful communication with them was not possible. Today, I see articles asking why the number of children with autism has increased so drastically. To me the answer is simple: the definition of autism has expanded to include all sorts of behavior that would never have been considered autistic decades ago. In this way, a very rare condition has become a relatively common one.

  • An article on ADHD appeared in the NYT last week (is It Possible To Outgrow ADHD, https://www.nytimes.com/2020/11/13/well/family/is-it-possible-to-outgrow-adhd.html). The article, and most of the comments to the article, accept the conventional psychiatric propaganda concerning ADHD, with some commentators being insulted when anyone had a different point of view. I wrote 4 comments to the article (3 were in response to individuals I disagreed with). My comments were posted, then 2 days later were all removed. This experience confirms my belief that it’s going to be very difficult to change the way psychiatry is practiced. It seems to me there are increasing attempts to suppress non-mainstream opinions.

  • I just read a summary of this study in Medscape, a website providing medical information to health professionals. The headline stated that Psilocybin provided “remarkable” relief for severe depression, a claim I found inaccurate give the limitations of the study. Your article was far more informative and was a pleasure to read. However, I am suspicious of these preliminary results, given the pharmaceutical industry’s push to cash in on the ingredients in hallucinogens and given the shameful history of so many pharmaceutical-backed psychiatric studies. The overhyping of the results of this study to medical professionals makes me feel even more strongly that caution is warranted

  • The VA article does not concentrate on antipsychotics. Just one other point. Is it really clear that more “ill” patients can do better off antipsychotics than the less ill? The problem is how illness is determined. Maybe a person who has the inner strength to refuse medication is not as sick as their symptoms might suggest, for example. In other words negative and positive symptoms may not be the best indicators of an individual’s potential for recovery.

  • The evidence and research does not disprove my argument because there are no conclusive studies.

    The Harrow study: The Harrow study, along with other studies, definitely show the severe limitations of antipsychotics in the long term treatment of schizophrenia. Nonetheless, Harrow has said that better outcomes in non-medicated treatment of schizophrenia is associated with internal characteristics of the patients, including better premorbid developmental achievements, favorable personality and attitudinal approaches, less vulnerability, greater resilience, and favorable prognostic factors.

    Wunderink: Interesting, small study.

    VA study: Not sure what you’re referring to. What drugs were they taking?

  • Forgive my skepticism when someone claims a drug or treatment is good for a very wide variety of things. Ms. Dejong hopes psychedelic therapies can be used for the treatment of end-of-life depression and anxiety, alcohol and drug addiction, dementia, anorexia and other eating disorders, cluster headaches and chronic pain. Really? In decades past didn’t the promoters of snake oil make such claims?

    I’m also perplexed as to why MIA has featured what seems to be an advertisement for the author’s business interests (and yes charities are a business). It would be interesting to look at psychedelics, the good and the bad. This article doesn’t do that possible subject justice.

  • It sounds as if there were many possible reasons for the schizophrenia prevalent in the Galvin family without having to even suspect a genetic cause. I also am convinced there is no strong genetic component to mental illness (meaning no specific gene or genes). However, I do believe that some people are more fragile and more vulnerable to adverse life events than others. Of course, I could be wrong. I base this simply on my own observations, not on any scientific study. I observed, for example, one person become schizophrenic over a possible divorce, while most people don’t react that way. I know someone who was at the Twin Towers on 9/11 who had a schizophrenic breakdown. Most people, though extremely distressed, didn’t. So heredity, who we are, may play a role in the development of mental illness. It could be argued that there are environmental reasons for vulnerability and undoubtedly there are, but does experience trump heredity. We just don’t know. There are probably very complex interactions.

  • @Sylvain
    The story of the Polgar sisters is interesting. And I have no doubt that hard work, etc. is necessary to create a genius. But it’s not obvious that any child can be made into a genius based solely on environmental factors. It’s as certain to me that there are genetic factors as it is to you that there aren’t. It’s not true that if early genius were inherited it would be passed from parent to child. There is such a thing as regression to the mean. Anyway, I don’t think either of us can positively prove our point of view.

  • I agree that twin studies are very flawed (I was especially incensed by the MISTRA). But heredity obviously plays a role in making people what they are. For example, a photographic memory, and an extraordinary musical ability (Mozart was writing compositions at the age of 5) must be largely dependent on genetics. The problem with the twin studies is they overreach in what they claim is inherited. You point out the extensive flaws in their methodology and reasoning. Maybe someday we will be able to disentangle the interaction between heredity and environment. But at this point, I don’t believe that we have the tools to do that.

  • You make some excellent points. But I’m suspicious of your characterization of Cuba. Yes, it provides doctors to other countries. But these physicians have been described as slave laborers with the Cuban government keeping a huge percentage of their salary. The Cuban medical system gives far better care to the elites than the common citizen (see the NYT article https://www.nytimes.com/2020/05/23/opinion/sunday/how-cubans-lost-faith-in-revolution.html). Bribes to doctors are common. Some pharmaceutical successes do not make Cuba a giant in the field of medicine. I’m opposed to the U.S. embargo, but even without it an authoritarian system like that in Cuba is not going to succeed overall for the ordinary person.

  • I suspect there are two reasons why the websites are so consistently inaccurate concerning antidepressants. First, drug company donations to the sites along with pharmaceutical ads. Second, the possibility that these sites copy information from each other, accurate or not. It would have been helpful to know which websites were reviewed in the study.

  • Excellent article. I’ve often wondered if at least part of the reason Americans don’t live as long as people in other developed countries is because of the number of drugs they take. Physicians are a major cause of this travesty. They prescribe antidepressants for everything from transient depression to anxiety to trouble sleeping. Statins are another category of drug that are indiscriminately prescribed (do physicians tell their patents that the chance of a statin helping a person without heart disease is 2% at best). The assault on children who are unnecessarily prescribed ADHD drugs and then prescribed other drugs to counter the bad effects of the ADHD drugs is unconscionable. Even worse are the number of children who are prescribed antipsychotics for reasons that include behavior control. Among those complicit in this perversion are medical societies that accept pharmaceutical funding. So many people are making money from our drug obsessed culture that I don’t expect to see any major changes in the near future.

  • “There is nothing inherently wrong with using medical writers in the publication process, as long as they are given credit on the byline for their work.”
    I don’t completely agree with this. For many years I worked as a medical writer for a pharmaceutical company. I didn’t write journal articles, but the medical writers who did had minimal input in the final product. Their work was heavily edited and was scrutinized by researchers, statisticians and managers. The job of the medical writer was to make the research data readable and to put it in a form acceptable for publication. I don’t believe that deserves a byline. Maybe at some companies the medical writer had more control over content. I don’t know, but if that’s the case a byline would be warranted.

  • You make a very persuasive case that that suicide prevention efforts and treatment with antidepressants increase suicide rates. But you also state that antidepressants help some people and that VHA mental health services decrease rates of suicidal ideation and suicide attempts.

    So is there a way to target antidepressant use mainly to those who will benefit? And is there a way to give mental health treatment only to those who will benefit and not to those who will be harmed? Or do you feel that antidepressant use and VHA treatment are so deleterious that these approaches should be abandoned, even if some people are helped?

  • Your experience with the NAMI affiliate you worked for sounds horrendous. I am very suspicious of NAMI because it accepts pharmaceutical donations and has a drug-centered approach to treatment. But, I understand that some affiliates are better than others, and the one, very brief, encounter I had with a local affiliate was positive. Nonetheless, I would never support NAMI. It is too uncritical in its support of drug treatment for such things as ADHD, anxiety, depression, and psychosis. But this is what I would expect from an organization that is funded, even if only in part, by big pharma.

  • Anticholinergic drugs may indeed increase risk for dementia. However, a study such as this can only suggest not prove causality no matter how many sensitivity analyses are done and how many confounding factors are checked. The increased risks presented in the article refer to relative risk. This kind of statistic is often used by researchers to overstate their case for the efficacy of a drug or in this case possibly overstate the dangers of anticholinergics. The article should have provided the absolute risk of taking the drugs. I am very suspicious of many drugs (including very common ones) and firmly believe they are over prescribed especially for psychiatric conditions. But it doesn’t help the case against these drugs to present incomplete information.

  • The idea that by being white you have more privilege than non-whites is a really simplistic concept. Your other categories of privilege are also suspect. Christian? I’ve known many happy and extremely successful Jews. Male? Some of the most successful people I’ve known are women. Heterosexual? There are plenty of very successful gay people, especially in the arts. Black? I’ve known very successful black men and women, and what about our last president. I could go on. The fact is that no matter what characteristics you have there will be positive and negative impacts from the social structure that you live in. Do some groups benefit more than others? Yes. Is society unfair? Yes, but in many ways that your concept of white privilege doesn’t even touch on. And whether you intend it or not, you are insulting white people.

  • I was enjoying your article Sera until you insulted me by saying “Not all white people. Because even the best of them are somehow benefiting from the systemic oppression”. Well, my white mother who came from Sicily was terrorized by a drunken abusive father. She worked for low wages in a sewing machine factory until she retired. How did she benefit from the systemic oppression? Or me, for that matter who had to struggle to make it through school and work without the benefit of knowing how to navigate through middle and upper middle class society because my working class parents didn’t have the knowledge to teach me. There is no reason, Sera, for an article on NAMI to veer off into a gratuitous attack on white people who are supposedly enjoying some unspecified privileges.

  • I believe that adult trauma can also lead to a psychotic experience. I personally know of two incidents. In one case a man in his forties had a breakdown after he found out his wife was having an affair. He became terrified they would get a divorce and he’d lose his family. His psychosis lasted several months. He briefly took medication. The second person I know had a breakdown that lasted a year. Her trauma was related to 9/11. She took no medication. In both cases there was a full recovery.

  • Years ago I read Born Together-Reared Apart, a book by Nancy Segal about the MISTRA study. I skimmed a lot because I found the book to be poorly written. I wasn’t convinced the study’s methodology was adequately vigorous. The study came up with all sorts of amazing similarities in the lives of the twins, but Segal dismissed critics who assumed the twins exchanged information. No way, said the author, because the twins understood the importance of not doing so and fully complied. She presented no proof of this assertion Also, the study compared dozens of the twins’ traits. When that many comparisons are made at least some of the positive heritability correlations are going to be due to chance. How was this problem handled? As far as I could tell it wasn’t. It also annoyed me that at one point homosexuality was discussed under the heading of psychopathology. Incredible. The fact that the researchers won’t allow the raw data to be examined is very suspicious. Based on my own criticisms and what you and others have said, I’m convinced this study is worthless.

  • I’m glad to see that in this instance the Cochrane review took into consideration whether a drug was sponsored by a pharmaceutical company. It didn’t do that when it supported the use of statins for primary prevention in 2013. The independence of Cochrane became even more questionable after it’s board expelled Peter Gøtzsche. I used to think Cochrane conducted unbiased rigorous research. Now I don’t believe that’s necessarily true.

  • Very informative commentary. I know MIA is a mental health website so I understand an article emphasizing how psychiatric drug dealing is killing Americans. And I can believe that psychiatry is the worst offender in our pill-pushing medical culture. Unfortunately, Americans are being harmed by pills given for many other diseases and non diseases. Doctors prescribe statins for people who have no heart disease under the unproven assertion that it will help them. Diseases are created (like pre-diabetes and pre-hypertension) and then pills are prescribed to treat these conditions. Thresholds for having a disease are lowered so more people can be prescribed drugs. And pharmaceutical-sponsored studies over-emphasize the benefits of the pills they sell. To stop abuse of psychiatric medications, we may need to pass laws and create regulations that address the abuse of all medications.

  • I started questioning Cochrane’s objectivity after it supported the use of statins for primary prevention in 2013. Among other things, the Cochran Center did not address the fact that all the studies it used in its review were either partially or completely funded by the pharmaceutical industry. The removal of Gøtzsche from Cochrane further supports my belief that the organization has moved away from being unbiased and scientifically based.

  • The STAT article obviously ignores the data Robert presents. But the authors seem to be making the argument that if the TREND toward increasing use of antidepressants had continued after 2004, adolescent suicide rates would not have gone up. In other words if there had been enough of an increase in antidepressant use, the adolescent suicide picture would be better and, by implication, the drop in suicides after the black box warning is insignificant. So while Robert is looking at the actual data, the STAT authors are looking at what they believe might have been if antidepressant use trends had continued. Their contention must be based on a belief that antidepressants are so beneficial that no other proof need be offered. I guess, because their thinking isn’t clear to me. The STAT article obviously errs by not looking at what has actually happened and addressing that issue.