Saturday, July 21, 2018

Comments by Marie

Showing 61 of 61 comments.

  • 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
    Patent: Repligen

    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.

  • 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.

    https://www.theguardian.com/science/2017/mar/16/three-women-with-eye-disease-blinded-by-unproven-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.
    https://pharmawatchcanada.wordpress.com/2012/06/27/industry-influence/
    And here’s one on pre-hypertension.
    http://well.blogs.nytimes.com/2011/03/09/rethinking-normal-blood-pressure/

  • 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.

  • I think these comments show why MIA should not get involved in this election. At least one person who commented believes the US took a step toward fascism and another argued that Trump won because he played to the lowest political denominator and they showed up to vote for him. I consider this a vicious slur since I know people who voted for Trump who are decent, educated, not racist, and not hysterical. They had good reasons for voting for a flawed candidate because they couldn’t tolerate the other flawed candidate. Remember almost half of voters supported Trump. Does MIA really want to alienate these millions of people. This divisive argument does not belong here. There’s no reason to lose support over an issue like this.

  • I agree with you. In addition, since almost 50% of voters voted for Trump I don’t see any reason for MIA to unnecessarily alienate readers who may not share the point of view that Trump is Satan. He certainly was a flawed candidate but then so was Hillary. I think MIA should stay focused and not get mired in presidential politics.

  • A professional who commented on Dr. Pies’ article stated that he could attest to the fact that quality of life declines precipitously during the time patients come off their medications. He contended that if those in a placebo group are suffering from withdrawal during the course of a study, that could skew results considerably and asked if any studies compared outcomes with medication naive groups or subgroups.

    Dr. Pies answered that there are no such QOL studies that he is aware of. He said such issues could be dealt with by very slow tapering (usually 3-6 months). But he also claimed that “supersensitivity psychosis” because of withdrawal is speculative, and he dismissed the commentator’s observations by saying the concept of a withdrawal effect is only theoretical. Of course, in his article he claimed a superior ability to judge the effects of psychiatric medication because of his work with patients. So apparently anecdotal evidence is important, but only if it doesn’t contradict Dr. Pies.

  • I wondered if Dr. Frances ever apologized for taking pharmaceutical money to do the schizophrenia practice guidelines. Apparently he did in a 2015 blog where he stated:

    “…it was very unwise to do guidelines with drug industry funding. Even though they were fairly done, accurately reported, and contained built in methodological protections against industry-favorable bias, the industry sponsorship by itself created an understandable appearance of possible bias that might reduce faith in the sound advice and useful method contained in them. It was an error in judgment on my part that I apologize for. I have learned from my mistake and hope others do as well.”

    He still does not publicly admit that there’s no way to protect against industry bias when a special interest funds your research. And, of course, he does not acknowledge that the guideline was not fair, sound, or useful, even with the information available at the time.

  • I can possibly see telling a patient that taking an innocuous sugar pill will help them in order to make use of the placebo effect. Possibly. I’m really not sure. But antidepressants are not benign. So it is malpractice (or should be malpractice) to deceive a patient by telling them that an antidepressant will be effective when its side effects include sexual dysfunction, insomnia, weight gain, suicidal ideation, and who knows what else. Does the good doctor inform his patients that trying to get off the drug if they do have adverse effects could be problematic? The arrogance of Dr. Carlat’s position is stunning.

  • One of the (many) things that is upsetting is that Dr. Carlat justifies telling patients that antidepressants are effective in order to enhance the placebo effect. Frankly, I can possibly see making that argument if antidepressants were benign drugs. So to tell a patient that taking a pill composed of sugar will help them may have some justication. I’m really not sure. But it is malpractice to tell a patient that a drug is effective when its side effects include sexual dysfunction, insomnia, weight gain, possible increase in suicidal ideation, and who knows what else. Does the good doctor inform his patients that trying to get off the drug if they do have these adverse effects could be problematic? The arrogance of Dr. Carlat’s position is stunning.

  • It’s not surprising that psychiatry wants to expand its power and profitability by calling criminal acts illnesses. But I suspect it can do this because it is a common belief that criminals are ill. I can’t tell you the number of times someone has told me an abusive individual, a murderer , a child molestor or even someone with nothing more than a very bad temper is “sick.” And, I believe, this attitude is more prevalent among better educated individuals who are in the higher socio-economic strata.

  • I loved your analysis of the GSK funded study. I suspect that physicians and the public believe the statements in abstracts at their own risk. Because bipolar disorder is widely accepted as real I think it’s always interesting to call out errors in studies of this supposed illness, errors that Dr. Pies should have caught. I believe that psychiatrists who accept money from drug companies and think they are still objective are often deluding themselves.

  • I know two people well who had psychotic epidodes after traumatic events. One is a man who had a breakdown in his 30s. He thought, among other things, that a tv talk show host was talking about him in code and some waiters were poisoning his food. He was working at the World Trade Center and was diagnosed as paranoid psychizophrenic several months after the destruction of the twin towers. He refused medication, eventually recovered, and has had no further breakdowns. The second is a man in his 40s who discovered his wife was having an affair, feared that she might divorce him and was terrified he’d lose his kids. He couldn’t sleep for five days. He started having crying fits, thought someone put poison gas in his car and that his house was bugged. The psychiatrist diagnosed him first as schizophrenic, then as bipolar and blamed his sleeplessness on his illness, not even considering that such severe sleep deprivation could cause psychosis. He took an antipsychotic briefly and stopped because he didn’t like the way he felt. His marriage crisis resolved and two years later he’s fine. I personally have no doubt that trauma can precipitate a psychotic event.

  • Actually the article makes some good points. Namely, that conflicts of interest can include departments, research institutes, universities, nonprofit funders, such as the National Institutes of Health and foundations, and journals. The authors also point out that the pursuit of fame can lead to conflicts of interest, and they discuss the dangers of public-private relationships, although they don’t put it quite that way. Unfortunately, the positive aspects of the authors’ article is overwhelmed by their proposal to replace the rightfully pejorative term conflict of interest with the benign phrase confluence of interest. This absurd wordsmithing exposes the authors’ real motive for their article. Obviously, conflicts of interest have strongly influenced them and, it seems, JAMA.

  • This kind of approach is why 11% of American children ages 4-17 are diagnosed with ADHD, with many of these children being drugged. My guess is most of us have at least some trouble concentrating on boring, mundane tasks. And if you’re immature (i.e. young), it may be even more of a problem. This doesn’t mean you have a disorder. And it doesn’t mean you need to be given potent medications.

  • You very effectively expose how hypocritcal Dr. Lieberman was and what a sham diagnosis ADHD is. When my grandson was about 10 he was diagnosed with ADHD because he supposedly wasn’t concentrating adequately in school (his parents refused medication). When it was pointed out that he would spend hours reading books in his room, the psychologist said that was only because he was interested in the books, so that didn’t count. Being able to concentrate on video games also didn’t count. If the ADHD diagnosis wasn’t being so widely used to harm children by drugging them, I would consider it humorous to imply that you have an illness if your mind wanders because you’re bored.

  • You have written an excellent article that expresses many of the negative feelings I have about psychiatry. The only thing I may disagree with is how gullible reporters are. I have read many articles in major newspapers on clinical studies (not just psychiatric studies). Unfortunately, the reporters frequently appear to have have little knowledge of statistics and simply parrot what the study authors misleadingly feed them. Too often these articles sound like PR for the study. Usually the articles don’t mention the study authors’ conflicts of interest.

  • I wrote this comment in the NYT on Lieberman’s article.

    “Sure, let’s force the mentally ill to take antipsychotic medication that can result in inner agitation, weight gain, brain shrinkage, tardive dyskinesia (involuntary movements), and reduced life spans. All on the off chance that we might, just might, prevent a few violent acts. Civil rights? Why should the mentally ill have any say whatsoever in their treatment? Do we really want to give psychiatrists, many of whom are notorious by the way for having extensive ties to the pharmaceutical industry, the power to dictate who must take drugs? Jeffrey Lieberman, for one, has accepted money from companies that include AstraZenica, Bristol-Myers Squib, and GlaxoSmith Kleine. Surprise! He supports forced medication of the mentally ill, not all of them, he assures us. Just the ones psychiatrists (like him?) determine to be a danger, using their crystal balls, I assume.”

  • John, the researchers state that the drug apparently “lost efficacy.” They make an assumption that the most severe cases with expected worse outcomes took more medication, thus explaining the poor results. But they say their statistical analysis may not have been correct. I don’t see this as meaning that the whole body of conclusions as to what happened after month 14 is suspect, just that what they were trying to prove (the worst cases took more medication) is suspect. Maybe I’m wrong, but that’s the way I read it.
    My understanding is that the composition of the groups did not vary in a completely unknown manner. If children taking the drug at year 3 were doing worse than they were at month 14 and worse than children no longer taking the medication, you might question if the medication stopped working. This may not be definitive, but it’s certainly something to be explored further. And it casts doubt on the efficacy of the medication. Also, RCTs are not the only things that can be used to question the efficacy of a drug.

  • Your quote from the original authors says they don’t know why the ADHD medication stopped working. But it did stop. Other studies have also cast doubt on the efficacy of ADHD drugs. If I were a parent I’d be very reluctant to have my child take an ADHD med given the side effects of the drugs, the tremendous push by the pharmaceutical industry to promote the drugs, and the continuing questions about how well they work. An RCT wouldn’t necessarily be definitive since those kind of studies can be (and have been) manipulated.

    As an aside, I’m also very suspicious of the concept of ADHD. A psychologist once diagnosed my 10 year old grandson with this supposed condition. When it was pointed out that the child could concentrate on reading books he liked for hours at a time, she said that was only because he was interested in the books. If lack of interest makes it hard to concentate, then maybe almost all of us have ADHD.

  • The primary endpoint may have been 14 months, but the study authors chose to follow up and what they found was disconcerting. Of course the results of the follow up should have been emphasized. Let’s say a follow up study of a drug found an increased number of heart attacks in those who took the study medication, certainly this should not only be reported but publicized. It is true that the children who stopped treatment may have differed from those who did not. But according to Whitaker and Cosgrove, at the end of 3 years the researchers found that if anything the off-med group had more severe symptoms early in the trial. My own personal feeling is these facts cast not some doubt but severe doubt on the benefit of ADHD meds for most children.

  • The really sad part is that if this drug is approved many women will take it not knowing how marginally effective and dangerous it is. They will do this because they trust their doctors to do what is best for them. When I was younger I also trusted physicians. No more. Every doctor I go to wants to prescribe drugs for even minor conditions. They never discuss side effects, efficacy or drug interactions. For one thing, to do this would take too long. For another, most physicians know very little about the medications they so freely foist on their patients.

  • I read Friedman’s NYT’s opinion piece when it was first published and, like you, was disturbed by it. It was thus a pleasure to read your excellent critique of the piece. I just want to emphasize one point. I do not feel that the NYT provides quality news and information, at least not in its reporting of health related studies (including psychiatric studies). The articles on these studies often read like press releases for the study authors. They exaggerate the benefits of treatments and drugs by reporting relative risk statistics instead of more meaningful measurements like number needed to treat to obtain the desired results. The reporters do not appear to have enough statistical knowledge to adequately question the study authors. And they often don’t report conflicts of interest. So Friedman’s op ed fits in very well with the unsatisfactory approach the NYT takes to its health reporting in general.

  • I’ve also observed that many, many physicians are poorly informed about drugs. I’ve seen them inappropriately prescribe antidepressants, statins, antibiotics, and sleep aids, not to mention Ritalin, and antipsychotics. I too wonder if they get most of their information on drugs from pharmaceutical company reps. But even if they don’t, there is a tremendous amount of misinformation on drugs to be found in medical journals that publish drug company influenced studies and on popular websites that I believe have been influenced directly or indirectly by pharmaceutical companies. These companies also pay physicians who they identify as opinion leaders to try to promote their drugs to other physicians.

  • I want to first say that I never mentioned bipolar because I believe it is one of the most abused diagnoses in the psychiatric lexicon.

    I agree that there are problems with the reliability and validity of severe depression and schizophrenia. But it seems to me that there are validity and reliability questions surrounding medical conditions that are known to be diseases. I’m no expert, but Alzheimer’s disease and sinusitis come to mind.

  • I agree with your point about medicalizing human conditions. And saying that people who are struggling with problems in their lives have a disease is demeaning.

    It is also clear that the pharmaceutical industry wants to create diseases in order to increase the market for its drugs. Questionable “diseases” certainly include ADHD, mild or moderate depression, low sex drive, pre-anything (pre-diabetes, pre-hypertension), and obesity.

    But it seems to me that whether conditions such as severe depression or schizophrenia are considered diseases depends on the definition of disease. Certainly these psychological states are not diseases if disease is defined as a condition of the body or one of its parts that prevents normal functioning, that produces characteristic signs and symptoms, and that has known or unknown chemical or structural causes. But if disease is defined as a disorder of normal functioning, couldn’t these conditions be considered a disease? Certainly it is abnormal if you can’t get out of bed for a week because you’re too depressed, or if you’re in a constant state of panic because you think everyone is talking about you on TV.

    I hate to give any ground to psychiatry, which I have personally observed as too often corrupted. But I do question whether no psychiatric condition should be considered a disease.

  • I’m writing, again, to my senators and representative about this outrageous bill. I think everyone who opposes it should do the same. Of course, they won’t read my email, but I’m sure they’ll tally up how many are opposed and if there are enough maybe the congressmen will think twice about voting for it.

  • I think if you try to change everything you will change nothing. Maybe you’re thinking revolution? I hope not. From what I’ve observed throughout history most revolutions turn out badly, with one corrupt power group supplanted by another that is different but just as bad. I think we have to accept a lot of unpleasant realities and hope to make some changes within a very imperfect system.

  • Maybe some people are trying to change the world. I’m not, I don’t think it’s possible. It’s going to be hard enough to change psychiatric practices, drug company fraud, and government compliance with this misconduct. If you try to change other kinds of oppression, you dilute resources and muddy your message. I can only repeat what I have said before, if MIA wants to be effective it should stay more focused

  • Systemic oppression could include throwing journalists in jail in China, forbidding women to drive in Saudi Arabia, beating a man because he is gay, and so on. Systemic oppression is too broad a topic. True, I could have skipped the article. The next time something like this is posted, I will. But I still think there’s more of a chance for MIA to make a social, medical and political impact if it stays focused.

  • There’s a lot I disagree with in this blog. But my main problem is that I really don’t believe this topic belongs in Mad In America. I read this site because I’m interested in mental illness, research on mental illness, criticisms of psychiatry (of which I have plenty), drug misuse, drug company fraud, things like that. I’m not interested in reading about the problems in Baltimore, police misconduct, or riots, not on this site anyway. Some people may see a connection between a man who may have been so mistreated by police that he died and individuals diagnosed as schizophrenic who are trying to survive incompetent or even corrupt psychiatrists. I don’t. I think if Mad In America wants to make an impact it should narrow its focus. That focus is broad enough without branching out to include the supposed oppression of rioters who loot and burn their own community.

  • I am very doubtful that antidepressants are effective, despite the fact that I’ve talked to a number of people who swear they couldn’t live without them. Based on your excellent work, as well as analyses done by others, it seems clear that on the average there are almost certainly no meaningful differences between antidepressants and placebo, especially for those with mild to moderate depression. But is it possible that there are a subset of patients who benefit? Are there individuals who experience meaningful improvements over what would be expected with a placebo? If so, can these individual results be reasonably characterized as being due to chance?