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I completely agree with you Steve.
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.
MIA doesn’t have a “like” option ( I wish they did), so I just want to say I learned from your comment and I agree with you.
The approval of ADU is only the latest in a series of unprincipled FDA decisions. The agency has been broken for a long time. It has a ridiculously low bar for approval and conflicts of interest are rampant. Its employees often leave the agency to work predominantly for drug companies.
Here’s an excellent article on how the FDA is failing the American people.
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.
I have nothing important to say except that I enjoyed reading the comments. Very funny. A nice start to the day.
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.
Your response made important points in my opinion. I wonder what their real reason was for not publishing it.
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.
As an aside, the New York Times had an article on ADHD last fall. I posted three critical comments, one of which was similar to what I said here. They removed the posts after a day or so. My best guess is I insulted too many people.
I think the research dollars go to the areas that will make the most money for the interested parties, pharmaceutical companies, psychiatrists, physicians in general. It’s easier and more lucrative to have people take a pill (and convince them it works) than to examine the more complex causes of psychiatric distress.
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.
Very interesting article. It seems clear that memory is shaped by culture. I have no doubt that there are many other factors that impact memories, for example self-image and what people want to believe.
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’m so sorry. Your experience sounds absolutely horrible. I have no doubt there are extensive problems with ECT. I was just describing my family’s experience, which wasn’t bad.
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 wrote a paper on autism (for a master’s degree) in the 1970s. What was considered autistic then is not the same as today.
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?
The problem with this study, and similar studies, is the very real possibility that people who were treated with antipsychotics were more impaired than those who were not.
This is an interesting article, but all the statistics you quote involve relative risk. In order to adequately judge whether the lead researcher’s claim that the risk for violent crime among those taking SSRIs is very, very rare, we need to know what the absolute risk is. Unfortunately you don’t provide that data.
@Auntie Psychiatry. I’m not surprised at what you found. My disappointment in MIA is profound. I hope they read these comments and learn from this huge mistake.
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.
More evidence that the FDA is increasingly a tool of the pharmaceutical industry. What’s discouraging is that both Democrats and Republicans have helped facilitate this deterioration.
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 with you.
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?
Thanks for the suggestion. I found the movie on Amazon Prime.
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.
Very funny Dr. Kelmenson. I enjoyed this.
I was also horrified at the conclusion that a lack of empathy might be advantageous.
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.
“Thought to be” also stunned me. Outrageous.
“The FDA said the Monarch eTNS has several side effects – drowsiness, an increase in appetite, trouble sleeping, teeth clenching, headache and fatigue – but no serious adverse events associated with its use.” To me, a child that suffers from these symptoms has serious adverse events.
Removed for moderation.
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.
All I get out of this is that adversity can have a negative impact on mental health. War, famine, earthquakes, political instability and all sorts of other disasters will stress people out. This is not very interesting news.
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.
I become very emotional when I think of children being given antipsychotics. In most instances it’s child abuse and the perpetrators should be prosecuted. Of course that won’t happen.
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.
Fascinating. Just one point. The cynic that I am questions that the researchers always use the most appropriate way to analyze the data. With so many statistical approaches available it seems they would have the opportunity to choose the statistics that give them the result they want. Would they always avoid that temptation?
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.
Your comments question didn’t present me with an option that I felt was quite suitable for me. I read and observe and only comment when I feel I have something to add to an article or when I believe I have a legitimate criticism.
In a recent Medscape article that Jeffrey Lieberman wrote on antidepressants he stated in the comments section “I have and do not receive any financial remuneration from Pharma or biotech. it’s a matter a public record”.
I wrote a comment pointing out that at the beginning of his article, under disclosures, it states: Jeffrey A. Lieberman, MD, has disclosed the following relevant financial relationships: Served as a director, officer, partner, employee, advisor, consultant, or trustee for: Clintara; Intracellular Therapies
Received research grant from: Alkermes; Biomarin; EnVivo/Forum; Genentech; Novartis/Novation; Sunovion
I questioned why there was this contradiction and he replied: “I consult to them as I believe it is important to guide Pharma’s development of drugs, but I received no payment.” He then quoted his “full disclosure,” in which it was obvious he does receive compensation, as stated in the disclosure statement put in by the Medscape editors. I won’t call Dr. Lieberman a liar. But then what is he? This exchange indicates to me that at least some psychiatrists are not fooling themselves; they’re actively trying to mislead.
This article shows that fraud is present not only in psychiatry but throughout medicine. The writer is correct. It’s very difficult to accept much of medical research because it’s funded by the pharmaceutical industry. This industry also pays off “respected” medical journals, physicians, researchers, federal and state government officials, congressmen, and medical associations.
In spite of all this, there are people, even in industry, who do try to do the right thing. But some are blatant in their acceptance of the fraud. As one commentator to this article said: Integrity doesn’t pay the bills. “Sorry, kids, we lost the house. Mr. Integrity here isn’t getting any more research projects.” (got 3 likes). Too many others try to delude themselves into believing they really are unbiased when they obviously are not.
It will be very difficult to correct the wrongs being perpetrated in psychiatry when the corruption is so widespread, but we have to try.
What you say is extremely reasonable. Unfortunately in a society where physicians use drugs to solve all sorts of problems, change is unlikely. Too many people benefit financially by maintaining the status quo. The NNT is high for many drugs commonly promoted (by doctors and medical associations as well as by pharmaceutical companies). For example:
Statins for people who have no heart disease: at least 104
Anti-hypertensive medication in people with relatively non-severe high blood pressure: 118
Daily aspirin to prevent heart attack or stroke in people with no previous heart disease: 1167
Bisphosphonates to prevent fractures in those with low bone mineral density: 50 for primary prevention
I agree there’s plenty wrong with capitalism. But there’s also a lot wrong with socialism, communism and every other ism ever devised by man. I feel we’ve just got to get along the best we can in a very imperfect world. As for personality tests, I think they’re mainly designed to figure out if an applicant will fit into the company culture. Suitable applicants will know how to answer the questions because they understand the job for which they’re applying and they understand the company. Truth is irrelevant and the company knows it so no one’s being deceived. It’s just part of the game. If someone doesn’t want to play the game, well, that is a problem if they want the job.
I personally found application personality tests to be humerous. Really, asking a person who’s applying for, say, a sales job whether they’d rather curl up with a book or go to a party on a Friday night is pretty funny. It never occurred to me to be in the least bit honest on these tests. I just answered questions the way I thought the company would want the ideal employee to answer them.
The powerful deleterious effects of psychotropic drugs have been documented in pharmaceutical company supported clinical trials (though many of these trials have undoubtedly underestimated the harms). And adverse effects can linger long after an individual discontinues a drug. It’s simply not true that stopping a medicine will necessarily stop the harm it causes. People who have been harmed by drugs are indeed victims. Because a drug causes a chemical effect on the brain and body does not mean the chemical imbalance theory of mental illness is correct. That is a logical fallacy. A drug could have no biological benefits and still have biological adverse effects, as ALL drugs do. You minimize this problem by claiming people can overcome the harms caused by medication by changing their attitude. The institutional effects you mention may be real, but that is a separate issue.
If African-American children are not receiving the same “standard of care” for ADHD as their white peers it may be to their benefit. This is because that standard of care involves overdiagnosis, over medication and unfortunate labeling of a child as somehow deficient. The solution should be to label and medicate white children less, making them more equal to their black peers. This will make the white kids better off and the black and white kids more equal.
This is a very suspect study. There were only 10 subjects. The “study” was poorly done. The criteria to determine whether individuals actually had Alzheimers was, well, at times ridiculous. Example: individual forgot where he put his keys. More serious symptoms could have been caused by such things as depression, anxiety, or over obsessing about perceived deficits. Finally, it appears that the authors are selling something called the MEND protocol. They can’t be trusted to be objective. This article is really not something MIA readers should be directed to.
After reading this excellent article I googled the Lancet Psychiatry study. Maybe I didn’t look hard enough, but there was universal acceptance of the study’s conclusion that individuals with ADHD have a brain disorder. This was the case on sites that are written for the general public as well as on sites written for health care professionals. Unfortunately, I’ve found that the problem of fake science is not limited to psychiatry. It is rampant.
I’m not really sure what this qualitative study shows. At one time you could probably have surveyed people who took snake oil and found that a substantial proportion would say it worked.
All drugs have adverse effects. In order to decide whether the side effects are worth it you have to know if the drug has a good chance of helping you. For example, chemotherapy can cause death. Why would anyone take that risk for a drug that might provide no benefit? Deregulating the FDA makes us all guinea pigs just like those three women who went blind after (unregulated) stem cell treatment.
I sympathize with thewritejerry. I have contributed to MIA and have read it for years. I don’t appreciate being denigrated.
I know plenty of educated, intelligent, nonbiased people, including women, who voted for Trump not because they liked everything about him but because they disliked Clinton more. If MIA wants to engage in attacking people whose politics they don’t agree with (and, based on this article, don’t understand) I may have to reconsider my support.
Another question I have concerning genotyping is the extent to which it would add to preventing adverse drug reactions over what is already available. Physicians can easily access information on drug-drug interactions (although, unfortunately many don’t do this). They should also take into consideration a patient’s age when determining drug dose (also not always done). If another test is going to be added to the numerous tests Americans undergo it should be cost effective. And the genotype test itself should be tested to see how well it works in practice, not just in theory.
Problems with P450 enzymes are only one source of adverse drug reactions. Genotyping might help prevent the accumulation of too much drug and therefore prevent some bad side effects. But can’t even desirable levels of a drug wreck havoc with the body? For example, a statin may lower cholesterol, but since cholesterol is used by every cell in the body can’t that cause severe disruptions? And might not the increased level of seritonin in the brain caused by taking an SSRI cause unforeseen problems even at drug levels that are deemed desirable.
I agree so much with your article. Concerning the schools, not only can they get extra money but they (psychologists, social workers, administrators) have been brainwashed by psychiatric orthodoxy. I know of at least three children who would have been put on medication by schools. In each case the parents refused and in each case the children turned out fine.
Thanks for your response, but I disagree with you about pre-diabetes and pre-hypertension. Because of big pharma, standards as to what constitutes diabetes and hypertension have been lowered. Lifestyle changes to treat these “conditions” probably won’t do much, so the next step is medication. Here’s one of many articles you could read concerning pre-diabetes.
And here’s one on pre-hypertension.
As always I thoroughly enjoyed your blog Philip. I’d just like to add that although psychiatry may be the worst offender, expansion of the list of “illnesses” is rampant throughout our health care system. I’m thinking of such diagnoses as low sex drive, pre-diabetes, pre-hypertension, and the push to put huge numbers of healthy adults on statins. All of this is driven by the pharmaceutical industry with the help of its medical collaborators. It is aided by journals that accept ads and by medical associations that depend on pharmaceutical funding.
In an age when medication is considered by many to be the only treatment for severe mental illness, it is good to see Dr. Steinman write about his success using psychotherapy to help very disturbed individuals. It brought to mind. A book I read many years ago, I Never Promised You A Rose Garden by Joanne Greenberg (published in 1964 under the pen name Hannah Green). This was an autobiographical novel in which the author described how she was cured of schizophrenia through psychotherapy with Frieda Fromm-Reichmann, a famous psychiatrist at the time. The author went on to be married and have children along with a sucesssful career. Since the book was published it has come under criticism from psychiatrists who claim Greenberg never really had schizophrenia, because, I suppose, they just can’t believe psychotherapy can cure a supposed brain disease.
I also think MIA should consider who actually did support Trump. The media would have you believe his support was overwhelmingly uneducated, racist, working class male bigots. This is not true. One example: A MedPage Today survey taken shortly before the election showed 50% of its readers intended to vote for Trump. This newsletter is written mainly for physicians and other healthcare professionals. In 2008 and 2012 The readers said they would vote for Obama.