Why Auto Insurance And Health Insurance Aren't The Same, Mr. President

On Monday, President Barack Obama did an interview with ABC News' Jake Tapper wherein he was pressed on the penalties contained in the House health care reform bill, which passed the House 220 to 215 on Saturday night. The bill contains financial fines and even jail time for Americans without health insurance who refuse to get insurance. It's not clear to me if this business will be incorporated in the Senate's version of health care reform or if it will be in whatever eventual House-Senate bill is agreed to in conference.

It's a controversial measure of the House bill, but it's something President Obama defended to Tapper, arguing as he has before that forcing people to have health insurance is just like when the several states force car owners to have auto insurance. Specifically, the President said:

"What I think is appropriate is that in the same way that everybody has to get auto insurance and if you don't, you're subject to some penalty, that in this situation if you have the ability to buy insurance, it's affordable and you choose not to do so, forcing you and me and everyone else to subsidize you, you know, there's a thousand dollar hidden tax that families all across America are--are burdened by because of the fact that people don't have health insurance, you know, there's nothing wrong with a penalty."

I've never heard him make that $1,000 claim before and it strikes me as a stretch. But his larger claim that forcing people to have health insurance just like states force them to have auto insurance is a surprising one coming from a former Constitutional law professor. I was going to write about this back in September when he used the auto insurance analogy in an address to Congress, but things were so heated in the wake of that speech that I decided to wait.

Anyway, as I understand the law, driving a car on public roadways is not a Constitutional right but a privilege controlled by the states. Each state can determine its own conditions for extending that privilege to its citizens, and 49 states do require auto insurance for car owners.

But health insurance mandated by the Feds is not a power enumerated to either the Congress or the President under the Constitution. What's more, the Feds would be forcing you and I to buy a service that affects our bodies and minds and thus crashes right into our rights to personal liberty and privacy. I know there are Constitutional scholars out there who agree and disagree with me on this point (the LA Times has a round up of opinions here) and I know the insurance mandate will get tested in a court somewhere in 2013 or so, but I keep coming back to the language of Roe v. Wade, the landmark 1973 Supreme Court decision that legalized abortion in the US.

In it, the Supreme Court found the (I'm using the Wikipedia entry for Roe v. Wade):

"'[R]ight of privacy, whether it be founded in the Fourteenth Amendment's concept of personal liberty and restrictions upon state action, as we feel it is, or, as the District Court determined, in the Ninth Amendment's reservation of rights to the people, is broad enough to encompass a woman's decision whether or not to terminate her pregnancy.'"

If Constitutional guarantees of personal liberty and privacy are broad enough to protect citizens from governmental interference in terminating a pregnancy, then I think those same rights are broad enough to trump the government's ability to force you and I into buying health insurance. But that's just my opinion.

Either way, I wish the President would ditch the auto insurance analogy since it flat out doesn't work. It's interesting to me that the mainstream media--aside from Fox News--hasn't called the President out on this. I wonder why.

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I'll Just Do A Round Up

I'm in no mood to write today. My headache is gone, but I got yet another reject email from yet another media organization I'd applied to and I am simply not in the mood to put too many sentences together.

The NY Times has an op-ed today arguing against lumping together Asperger's syndrome and autism in the forthcoming DSM-5. It's interesting that the paper would choose to highlight that issue since it's been fairly quiet on developments around the new DSM. I wonder why.

The Chicago Tribune and ProPublica have a piece out on a Chicago psychiatrist who was prescribing tons of Clozaril to his patients (almost unheard of these days) as well as Seroquel. I was a source for the ProPublica reporter on this series (part two runs tomorrow and is allegedly "eye popping") and it's deeply ironic that the media organization that shot me down today is ProPublica. They don't see a "fit" for me with them. Please. Go fuck yourselves, ProPublica.

Forest Labs and the feds have reached a tentative settlement over allegations that the drugmaker illegally marketed Lexapro and Celexa to kids and that it paid kickbacks to doctors. Is there a single maker of psychotropics who has not entered into a legal settlement with the feds in the last few years or who isn't currently being investigated? Nope. That ought to tell you something.

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Bad Headache

I don't often get headaches but last evening I developed a doozie of one. I hope to catch up with posts later this morning.

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Fort Hood Shooting: Psychiatrist-Shooter A Domestic Terrorist

I'll just take a deep breath here because I wasn't far wrong when I opined yesterday that this story was bound to get uglier: the alleged shooter at Fort Hood, Maj. Nidal Malik Hasan, is a terrorist, domestic terrorist even. The AP reports:

"The officials also say Maj. Nidal Malik Hasan communicated 10 to 20 times with a radical imam overseas who in the past came under scrutiny for possible links to terror groups. They say the communications began last year and continued into this year between Hasan and the imam, Anwar al-Awlaki, and that U.S. officials had been aware of them since last year."

So much for the PTSD-victim line of thought.

How was this freak even in the military? If the feds knew of his activities, why the hell was this guy not just discharged from the Army?

For the larger meaning of it all, the New York Times has a decent round-up of opinionistas. I'm afraid I've got to line up with the more hardline voices out there who argue that there are some radical Muslims here in America who want to commit acts of terror against us (the Fort Dix plot, for example) and that Maj. Hasan is far from alone in his hatred for the US. Where you take that kind of thing I don't know, but I do know that as a citizen I have the right to be protected from these kinds of losers, all of us do.

I know some readers and Peter Breggin himself have speculated that Maj. Hasan was on anti-depressants. Right now, that's nothing but guesswork. We'll know more down the road.

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Fort Hood Shooting: Psychiatrist Calls Psychiatrist-Shooter "Terrorist"

And that psychiatrist is none other than Peter Breggin writing on the Huffington Post.

"Before I begin to look at his role as a psychiatrist, I want to confirm that Major Nidal Malik Hasan was driven by religious ideology. For years he openly claimed that the War on Terror is a war on Muslims. He announced on the Internet and to his fellow soldiers in a course on public health that a Muslim suicide bomber should be praised for killing a hundred soldiers. It's reported that fellow soldiers warned his superiors that he was a ticking time bomb.

"One wonders how and why the army failed to relieve him from active duty. One ridiculous explanation is that they had a lot invested him--his complete medical and psychiatric training. Much more likely, the army was hamstrung by the political correctness that's been imposed upon it.

"Let's also see through yet another media smoke screen--that Hasan was more a crazy person than a terrorist. During the American revolution Samuel Adams pointed out that he'd never seen a man commit treason without first losing his moral footing in his personal life. As for being a victim of prejudice, Hasan was instead a provocateur whom the army tried to ignore. Hasan is not only a terrorist, he's a traitor--a man who turned on his nation; on the army that nurtured, educated and paid him; and on his comrades in arms."

I know some feel that the term "terrorist" is a bit much for Maj. Hasan's murderous rampage, but given all that was tangled up in his motivations I can understand why some people are tossing the term around. Breggin also tosses several other bombs: stating that psychiatrists at Walter Reed are only interested in medication and that the military has been deluded by modern psychiatry and so on.

And this:

"The odds are that Dr. Hasan was self-medicating with antidepressants and tranquilizers that were causing his increasing disinhibition, at least in his pronouncements, until his final Allahu Akbar before he began shooting."

We shall see someday if Maj. Hasan was medicated in some fashion since the Senate will likely investigate the very tragic events of last Thursday.

The New York Times has photos of the 13 murder victims here.

The AP is now reporting a story first reported by the (London) Telegraph that:

"The alleged Fort Hood shooter apparently attended the same Virginia mosque as two Sept. 11 hijackers in 2001, at a time when a radical imam preached there."

Oh, boy. This story is going to continue to get uglier and uglier.

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Orlando Shooter Shouldn't Have Had A Gun

News is out that the alleged shooter in Friday's tragedy in Orlando, Florida has a diagnosis of schizophrenia. Jason Rodriguez allegedly killed one man and wounded five others when he shot up the offices of his former employer. The man who died was 26 years old and had a young child. Lovely. I feel for all the victims of this crime.

The big question to me in all of this is why did Rodriguez have a gun.

"Mr. Rodriguez periodically took medication for what his former mother-in-law, America Holloway, said was schizophrenia. When he was not taking the medication, Ms. Holloway said, he was unbearable to live with — angry, jealous, paranoid and controlling.

"Once, Ms. Holloway said, her daughter had appeared at the front door covered in bruises. She moved home, but a few weeks later Mr. Rodriguez apologized and said he was taking anger management classes. Her daughter took him back.

"The couple then lived with her for five years, Ms. Holloway said, before she finally threw him out and the couple divorced in 2006. They have an 8-year-old son.

"'I’d be standing in the kitchen, he would come from the back room and say, "I know you’re talking about me." I would say, "There’s nobody here,"' Ms. Holloway said. 'When he had his medicine, he was the most wonderful person'...."

"Ms. Holloway said she believed that Mr. Rodriguez, in a downward spiral, had not been able to afford treatment. About six months ago, she said, he left his car and keys behind and walked to a mental health facility, where he stayed for a few weeks before being discharged, she said."

You can argue about on-meds, off-meds all you want with schizophrenia and other psychotic disorders, but none of that really matters here. What matters is that Rodriguez had a gun or access to the same and there's no way he should've been able to lay hands on a firearm. Each state's laws differ a little bit on the details of who can legally own a firearm, but it's fairly consistent nationwide that people judged "mental defectives" (and that's the language of federal and most state laws. It covers mental illnesses and development disorders) cannot own a firearm unless a judge later restores that right. In Washington State, it boils down to anyone who's been involuntarily committed for 14 days loses their gun ownership rights. I suspect Florida's laws are somewhat similar.

So Rodriguez either brought a gun years ago, stole someone's gun, someone have him a gun years ago or he somehow managed to slip through the cracks and buy a gun (doesn't sound like he had the money). It'll be interesting to learn how he got his hands on a gun.

Over the years, I've run into enough tales similar to this one--someone diagnosed with schizophrenia running amok with a gun such as in Fairfax, Va in 2006--and I always wonder how the hell their families and friends could be stupid enough to let them own or access a firearm. There's got to be some way to prevent this kind of crap from happening again and again.

That said, I know and know of people diagnosed with schizophrenia who have to carry knives and other weapons to protect themselves on the streets of Seattle because they've been robbed and assaulted so many times that, as one told me, "I go nowhere without my knife." I suppose I can't blame him.

Obviously, there are some tradeoffs here. Thoughts?

BTW, I'm not blaming schizophrenia for what went on in Orlando. It's too early to know if he was a "sane" man who cracked under the press of life or whether he was "insane" at the time of the shooting. That we'll know some other day.

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In Which I Coin The Term "Nemeroffian"

I got to thinking over the weekend that the well-known conflicts of interest and dubious science of Charles Nemeroff--late of Emory University, soon of the University of Miami--deserve their own adjective, one that could be used to describe others in academic psychiatry who transgress similarly in the future. And so I have coined the term "Nemeroffian" to describe excesses and "science pimping" on a scale that Nemeroff himself can only achieve. (My Nemeroff back catalogue is here for those who wonder what I mean.)

Howard Brody at the Hooked blog had some thoughts on Nemeroff getting a job as chair of the psychiatry department at Miami.

"Miami's response? 'Pascal Goldschmidt, dean of UM medical school, called Nemeroff "an exceptional psychiatrist and an exceptional scientist who has one issue in which he recognizes he made a mistake," in not telling Emory how much he was getting from drug makers.'

"To anyone who has followed Dr. Nemeroff's career, this is sort of like saying that Jack the Ripper was a dedicated feminist, only he had one issue. The specific question of whether he honestly reported to Emory how much outside income he had made is just the tip of the iceberg. To reduce the question of his professionalism to that single matter indicates either denial or willful ignorance of the record."

Classic.

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The House Dems, Pres. Obama Have Lost Me On Health Care Reform

Watch what goes down with this House health care reform bill being voted on over the weekend (unless it stalls) because something very tricky is going on. President Barack Obama went up to Capitol Hill today to personally lobby for votes yet he's asking legislators to pass a bill that doesn't even meet his deficit-neutral goal of $900 billion or less over 10 years. I'm very suspicious of why President Obama would now support the bill because it's now costed out at $1.2 trillion over 10 years.

And how did the bill's cost jump from $872 billion last week to $1.2 trillion this week (the New York Times claims it's $1.1 trillion)? I cannot support this bill because of its cost (there are other reasons to oppose the bill)--and keep in mind that I've not had health insurance in two and a half years and would technically "benefit" under this bill.

What's more, there's word of various amendments being tacked onto this bill late in the game and, as we know from the Medicare Part D nonsense of a few years ago, that type of chicanery is not to be trusted, regardless of which party is pulling the strings.

Posted by Philip Dawdy at 11:34 AM | Comments (24) del.icio.us Digg it reddit

Nemeroff Accused Of "Science Pimping"

A big piece in the Miami Herald today on the University of Miami's hiring of controversial psychiatrist Charles Nemeroff to head its psychiatry department. Here's some of the fun stuff.

"The former head of psychiatry at Duke University told The Miami Herald Thursday that Nemeroff was 'economical with the truth' and his work can't be trusted, while the leader of the Columbia University psychiatry program said Nemeroff was a top-flight scientist and he had never seen any bias in his work...."

"But Bernard Carroll, former head of psychiatry at Duke University and once Nemeroff's boss, said parts of Nemeroff's work involved Paxil, a GSK antidepressant. 'Basically, he was doing basic science pimping for Paxil to produce talking points,' Carroll told The Herald in an e-mail Thursday. 'All he ever produced was speculation but that was enough to satisfy Glaxo marketing. . . . I have been exposing his shenanigans for some years.'

"Jeffrey Lieberman, head of psychiatry at Columbia University, praised Nemeroff as a leading expert in 'basic neuroscience,' studying underlying pathologies and proteins in the brain that cause mental illness. He said he had never detected 'any undue influence or bias' in Nemeroff's research."

I think Lieberman needs to re-review some of Nemeroff's work and his CME pimping.

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Feds Investigating Abbott Over Depakote Marketing

News is out that the federal Department of Justice is investigating Abbott Labs over questions about its marketing of Depakote, its anti-seizure drug that's also approved for bipolar disorder. It's not clear what the scope of the investigation is, so stay tuned.

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Fort Hood Shooting: Army Psychiatrist Kills 12, Wounds 31, Fuller Torrey Silent

With all due respect to the profession of psychiatry, I need to ask why the "world's most famous psychiatrist," E. Fuller Torrey, and his group the Treatment Advocacy Center are so far completely silent on the tragedy at Fort Hood, Texas. That's where an Army psychiatrist, Maj. Nidal Malik Hasan, shot up an Army building, killing 12 and wounding 31 before being captured. Maj. Hasan was wounded and is reportedly in the custody of the Army at a hospital.

Often, when a person in the mental health system loses it (for whatever reason) and commits violence, Torrey and the fine folks at TAC are quick to post (anonymously, of course) on their blog the details of the crime and to use it as a springboard to argue for forced outpatient commitment and forced medication for people diagnosed with serious mental illnesses and play their vomit-inducing game of arguing that bad behavior by one person diagnosed with schizophrenia, say, proves that pretty much anyone with a "serious mental illness" needs to be medicated into the ground.

Now, that a psychiatrist has blown away a bunch of outstanding Americans what does TAC have to offer on its blog? Silence, the telling kind. The kind that says they are hypocrites because Hasan clearly had psych issues (whatever his political and religious issues with America may or may not have been) and yet he did what he alleged to have done. TAC should at least say something. Silence.

What does the American Psychiatric Association have to say? Nothing. It's silent, too.

It'll be interesting to read what psychiatrists have to write about this bizarre and unacceptable tragedy. For those of you who read this site who are psychiatrists, feel free to email me your thoughts or leave them in comments.

Maybe it's not fair to read Maj. Hasan's act in the context of his being a psychiatrist. After all, who's ever heard of a doctor much less a psychiatrist committing mass murder? Almost never, excepting cases of genocidal killers like Nazis Josef Mengele and Aribert Ferdinand Heim and Radovan Karadzic (a psychiatrist. Thanks for the reminder, Qwerty). So inevitably this story will be treated as the multi-layered, conflicted beast that it is and there won't be much moment made of his being a psych doc, except to the extent where one might ask, "Why couldn't someone who did psych evaluations realize he had lost it and seek help?"

But, then, Torrey and TAC are never so fair to the people they write about. They never have complete lives and souls, their motivations are never complex. They are just schizophrenics and bipolars, bad boys and girls who didn't take their medicine.

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Are You Reading A Top 100 Health Blog?

Oh, yes you are, according to Technorati, which I happened to check in with yesterday and was surprised to see a Top 100 Health Blog badge next to this here website's name. In fact, yesterday this site was #33 among health blogs tracked by Technorati, sandwiched between Herbal Water and That's Fit. Among the tracking services Top 100 health blogs are only a few mental health ones: PsychCentral.com's blog at #3, Postpartum Progress at # 16 and Psychiatric News at #36. Mind Hacks at #23 is more neuroscience-y than mental health-y although it often dips into the psych world (and quite well, too). Health Care Renewal at #43 also deals with mental health issues, amongst other things.

Psychiatric News is a "chronicle of human rights violations and crimes by the psychiatric industry." And people call me anti-psychiatry!?

Technorati's rankings are based on how many blogs and websites link to a particular blog, so if you want to see me get up there with Postpartum Progress, then link to this site. Or should I go out and get a glamor shot for my site like PPP's author has up? (What is it with some bloggers and photos of themselves?)

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Army PTSD Psychiatrist Suspected Shooter At Ft. Hood

UPDATE: 6.29 p.m. PST. Following an Amry press conference, I've update this a bit and correct some repprting that was out there in media land.

The AP is now reporting that Army Maj. Nidal Malik Hasan, an Army psychiatrist, was the suspected shooter at Ft. Hood, Texas earlier today. The tragedy left 12 soldiers dead and 31 wounded and there were reports of other shooters. Two soldiers were taken into custody but later released. Maj. Hasan was said to be upset about his pending deployment to Iraq.

The New York Times reports that Maj. Hasan was a "Fellow, Disaster and Preventive Psychiatry, Department of Psychiatry, F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences." In other words, it sounds like Maj. Hasan had a specialty in PTSD.

Said Lt. Gen. Robert Cone at a press conference this evening: "The shooter is not dead but in custody." Gen. Cone declined to answer other questions about Maj. Hasan.

I really don't have anything reflective to offer on this at the moment, but I'd ask commenters to not play "trash psychiatry." Maj. Hasan must've had something really ugly going on inside to pull this off. It's one of the first instances I can remember of an officer--a senior officer, no less--opening fire on soldiers.

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Pristiq Ad Among Most Recalled On TV

Or so says Nielsen Research. The most-recalled ad was the ubiquitous Flomax ad, followed by ads for Cialis and Gardasil in a tie for second. Remarkably, Pristiq was next with its creepy wind-up doll ad. I say remarkably because there are so many ads for so many drugs, medical devices and procedures on TV that it boggles the mind and it's got to be hard for some of them to creep into the collective consciousness much less long-term memory. Not that Pristiq is selling particularly well.

For those of you who are troubled by DTC pharma ads, especially on TV, I'm with you. But we're stuck with them. They bring in so many billions of dollars in ad revenue for various media companies each year that they will go unchallenged (with a few exceptions) for decades to come. Yes, the mainstream media has become pharma 'hos.

Back in 1997, one of the first radio interviews I did was of Tom Brokaw who was visiting UC-Berkeley for some kind of smarty pants sit-down with the dean of the J-School. I took Brokaw into a hallway at school and pointedly asked him about the NBC "Nightly News," of which he was the managing editor, and its sudden embrace of health care coverage, which it hadn't focused on much in the past. But this was 1997, DTC ads had just become legal, General Electric owned NBC and sure as heck wanted those pharma ads. Any connection there, Tom?

Brokaw, who had a huge pimple on his chin that day, insisted that there was nothing to it, that it was all legitimate news and so on. Some of it was, no doubt. Twelve years later, I watch health care news stories on NBC and other networks with much interest and much consternation. Almost across the board, the major TV and cable news networks all have doctors on their airwaves plus a few stray health care reporters and so many of them are terrible and spew out distorted, deeply-biased reports on various aspects of health care that it just makes me laugh, especially when you consider that roughly 50 percent of the advertising on a program like "Nightly News" is from a pharma company.

One of my favorite examples of dubious health care reporting came from "Nightly News" earlier this year when a huge study came out and linked depression and cardiac deaths in women. The same study also linked anti-depressant use to cardiac deaths in women.

"Meanwhile, NBC's 'Nightly News' gave the depression and cardiac death link huge play on its program last evening, but Brian Williams, the show's anchor, completely failed to mention the anti-depressant link. I'm not sure who is writing Williams' copy, but either they or he are utterly blind to not mention that point. Or is the TV media too scared of being dinged for allegedly scaring people off their meds?"

Or scaring Big Pharma from buying ads?

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It's Official: Nemeroff To Miami

News is just out that, as expected, the controversial former Emory University psychiatry department chair Charles Nemeroff has been named chair of the psychiatry department at the University of Miami School of Medicine. Nemeroff is infamous for epic conflict of interest issues and dubious research findings. I'd say Miami U. and Nemeroff are made for each other as the university has the dirtiest, most thuggerific football team in NCAA football.

The Miami Herald reports:

"On Thursday, Pascal Goldschmidt, dean of UM medical school, called Nemeroff 'an extraordinary psychiatrist and scientist. . . . He got into serious trouble on disclosure on conflict of interest.'

"Goldschmidt said he had read investigative reports from Emory about Nemeroff's activities and found nothing to indicate that payments the psychiatrist received had in any way influenced his research results.

"In a telephone interview at mid-day Thursday, Nemeroff, 60, told The Miami Herald he was excited to be coming to Miami. 'I think it's going to be a top-10 school.'"

Extraordinary psychiatrist and scientist? Last month, Bernard Carroll, a California psychiatrist and co-author of Health Care Renewal, delivered an epic smackdown of Nemeroff over his involvement in pimping Seroquel for major depression:

"As for Dr. Nemeroff, he is yesterday’s news. The adverse findings by ACCME about his program serve as a reminder to corporate sponsors and CME companies that Dr. Nemeroff is so compromised by now that he has lost effectiveness as a front man for Pharma. Indeed, he is so toxic that he now glows in the dark."

So it looks as though it'll now be sunny 24/7 in Miami.

My Nemeroff back catalog is here.

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Two Studies: Mom's Anti-Depressant Tied To Newborns' Health Problems

Two recent studies report risks associated with anti-depressant and other psych med use during pregnancy and how that impacts offspring.

First, a Norwegian study appearing in the British journal BJOG looked at 38,602 kids born between 2000 and 2005 and found:

"Children of mothers who used antidepressants during pregnancy showed increased healthcare use during the first year of life, independent of the mother's healthcare use. The relative risk of more than two visits to general practitioners was 1.5 (95% confidence interval, CI: 1.3–1.8) in the continuous antidepressant users group and 1.3 (95% CI: 1.2–1.5) in the group of children whose mothers stopped taking medication. In both study groups there was a trend towards more drug use for infections and inflammation compared with the control group. Children continuously exposed to antidepressants had an increased risk of cardiac interventions such as cardiovascular surgery or heart catheterisation, relative risk of 5.6 (95% CI: 1.8–17.4). The risk of physiotherapy was twice as high in the antidepressant group compared with the control group (relative risk 2.0; 95% CI: 1.5–2.6).

"Conclusion: Antidepressant use during pregnancy is associated with increased child healthcare utilisation and increased risk of major cardiac interventions in early childhood."

Almost six times the risk of needing invasive cardiac procedures is an official "Wow." The researchers told Reuters, however, that the mothers' depression might play a role in all of this:

"It's possible that mothers' depression itself was a factor here, according to Ververs' team. Past studies have found that depressed mothers tend to take their children to the doctor more often than other mothers do.

"Compared with other mothers, Ververs and her colleagues note, depressed moms may find it more difficult to cope with problems like respiratory ills and digestive symptoms."

Depression might explain the office visits, but it sure wouldn't explain the need for cardiac procedures. They did tell the wire service that the evidence supports fetal heart screening for mothers who use anti-depressants throughout a pregnancy.

Separately, a study in the journal Women's Health Issues in September (and brought to my attention by a reader) examined possible links between maternal depression, psych med use during pregnancy and preterm deliveries. Researchers found:

"The odds of overall PTD [preterm delivery] was increased among women who used psychiatric medication during pregnancy and had either elevated levels of depressive symptoms at mid-pregnancy (adjusted odds ratio [AOR], 2.0; 95% confidence interval [CI], 1.1–3.6) or a history of depression before pregnancy (AOR, 1.6; 95% CI, 1.1–2.5). The combination of psychiatric medication use in pregnancy and depression, before pregnancy, or within pregnancy was most strongly linked to a medically indicated delivery before 35 weeks' gestation (AOR, 2.9 and 3.6, respectively). Conclusions

"There are at least two plausible explanations for these findings. First, psychiatric medication use in pregnancy may pose an excess risk of PTD. Second, medication use may be an indicator of depressive symptom severity, which is a direct or indirect (i.e., alters behavior) contributing factor to PTD."

The study examined 3,019 women in Michigan.

Plain and simple, the evidence continues to mount that anti-depressant and psych med use during pregnancy poses significant risks to a child. Clearly, depression--past or present--is no friend to fetuses either, so the tricky question about how to treat all of this remains unclear.

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Kids Non-Profit Head Slams Overmedicating Of Kids

An interesting column appeared today in the Schenectady Daily Gazette. It's a rant about medicating kids and is written by the executive director of QUEST, a non-profit for kids, in upstate New York. She walks through a few real world examples of doped-up kids and then lowers the boom.

"Since when have we become a nation of super-conformists, fitting all children into slots and molds, killing initiative, uniqueness and creativity? The Beatles wrote a song about taking a "little white pill" to get through the day, but that song was about a suburban housewife, not a child.

"We scream about kids smoking an 'L' or taking Ecstasy or methamphetamine, but yet parents and medical adults are pushing drugs on them from a very tender age. Untried drugs, and by that I mean not tested for use on children. The long-range effects of these pharmaceuticals on children are as yet unknown....

"Frankly, I think the relief of prescription drugging belongs mainly to the teachers, the school system and the parents/caretakers. It would be most interesting to have a symposium of adults and children, a sort of moderated pro and con debate. We frequently talk about quality of life but in a nation that frowns on the use of medical marijuana, it seems strange to allow children to take habit-forming and potentially dangerous prescription drugs. Any drugs given to children 18 and under should be heavily monitored including six-month blood work and weekly therapy sessions, either group or family. Children are more apt to speak their feelings in a situation including like peers and/or complete (including siblings) family members."

There is something about America as a culture that is so inherently messed up when it's OK to give kids antipsychotics for non-psychotic disorders but we utterly freak out at the idea of them putting other unhealthy items into their bodies. How do we get this out of our culture?

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Study: Researchers Shoot Down Pre-Adolescent Mania

A study out in this month's British Journal of Psychiatry examined the course of bipolar disorder for as long as 15 years in the offspring of bipolar parents and found no evidence of pre-adolescent mania:

"We studied the course of major mood disorders in the offspring of parents with well-characterised bipolar disorder prospectively for up to 15 years. All consenting offspring were assessed annually or anytime symptomatic. The participants began to develop major mood episodes in adolescence and not before. The index major mood episode was almost always depressive, as were the first few recurrences. Onsets and recurrences continued throughout the observation period into adulthood. We did not find evidence of pre-pubertal mania. In summary, adolescence marks the beginning of the high-risk period for major mood episodes related to bipolar disorder."

Someone alert Joe "Agitation is Mania!" Biederman and CABF! Seriously, that's a pretty stunning finding and certainly confirms what other researchers elsewhere in the world have written. Of course, this study was done by Canadians, not proper psych researchers at Harvard.

But the rest of the world simply hasn't glommed onto the bipolar child paradigm. As I told Psychology Today earlier this year:

"As for bipolar disorder in kids (meaning pre-teens and younger), it's simply not an issue in the rest of the world. The bipolar child is a purely American phenomenon, as big a metaphor of our times as credit swaps, subprime loans, and government bailouts."

I appreciate peer-reviewed research that backs up what I've been writing.

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Psychiatrist Explains His Lilly Consulting

Manoj Waikar, an adjunct psychiatry professor at Stanford who's also in private practice in Palo Alto, Calif., has made $74,850 for speaking on Lilly's behalf 51 times this year. So the New York Times smartly tried to find out what made him so sought after by Lilly and what services he provided. What fun that new Lilly database of its outside consultants has become.

"In response to queries from a reporter, Dr. Waikar wrote in an e-mail message that he received fees for speaking to other health care professionals about disorders like schizophrenia and depression, which can be treated with the Lilly drugs Zyprexa and Cymbalta respectively....

"In an e-mail message to a reporter, Dr. Waikar wrote that although drug company presentations were standardized to comply with drug marketing regulations, he and other speakers did provide suggestions on the content. And he said that there was room for spontaneity at such events, because he was allowed to answer questions from doctors in the audience, drawing from his own practice experience or opinions, as long as he explained the basis of his answers.

"In an another e-mail message, Dr. Waikar wrote that talks like his could be helpful to primary care providers having to treat complex psychiatric problems. He added that doctors had contacted him after the talks to consult about difficult cases."

Since Waikar is affiliated with an academic institution and teaches medical residents, there are questions about the ethics of these kinds of things. While the article doesn't break any new ground, I'm glad it's somethign the paper chose to spend some time on.

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Study: Depression's Link To Processed Food

This may strike some readers as "Duh," but British and French researchers report in this month's British Journal of Psychiatry that a long-term study of diets and depression in some 3,500 Brits found more depression in those who ate a diet high in processed foods. Those who ate a diet stronger in "whole" foods--fruits, veggies, fish--saw a 26 percent less chance of depression than did those who ate the most processed foods (meats, cheeses, desserts) and fried foods. Conversely, the high-processed foods group had a 58 percent higher risk of depression than did the whole foods group. (A BBC account of the study is here.)

Coming on the heels of last month's study showing depression-protecting effects of the Mediterranean diet, this study is further evidence of the well-known link between food and mood. Of course, it's not going to be real easy for people in the UK to follow a Mediterranean diet nor in most of the US, so this study is quite real world in that sense. It's also a big argument in favor of moderation: there's a great middle group in this study who had little depression yet did eat some of the whole foods and some of the processed foods. That said, I'm sure some would love to make an ideological argument about corporations and processed foods and a conspiracy of depression-for-profit, when really what you eat boils down to individuals eating what they already know is good for them. If they don't buy Cheez Whiz and the like (or buy much less of it), then companies won't bother making it.

The study also confirms what I've long said on this site: if you don't eat reasonably well and reasonably often, then you aren't even giving yourself a fighting chance with depression. I feel the same way about exercise and socialization. Neither are cures per se, but without them, you can go down a rat hole of mood.

One weakness of the study (I haven't seen the full version) and the reportage on it is that I cannot tell how depressed people were at baseline and at the study's conclusion. My hunch is that the findings are probably most applicable to mild-to-moderate depression and that diet would have less of an effect, especially short-term, in severe, chronic depression.

At least that's the opinion of this light-on-processed-foods, heavier-on-fruits-than-veggies eater.

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Newsweek Column Argues For Upside To Depression

A column in Newsweek, penned by science editor Sharon Begley, argues for an upside to depression, driven by evolutionary psychology considerations and what she considers evidence of the all-powerful 5HT1A receptor.

"Human brains are not the only ones with the 5HT1A receptor. Rats also have it.

"Here's the really interesting part: the rat version is 99 percent identical to the human one. This suggests that in the evolution from the shared ancestor of rats and people (hold those creationism letters!), natural selection did not mess with the receptor much. That leave-well-enough-alone history tends to happen when the function of some trait is so important that tinkering with it evolutionarily would produce more harm than good. What kind of harm? Rodents that have a mutation causing them to lose this receptor exhibit fewer symptoms of depression when they suffer some stress, a 1998 paper reported. In other words, losing the receptor that promotes depression in response to stress is something evolution thought would be a very bad move. Ergo: depression is not something to be thrown out lightly.

"Why not? Because, argue Andrews and Thomson, depression alters thinking and behavior in beneficial ways."

Depression's supposed advantages are deep rumination and focused thinking. As with today's other post on diet and depression, I suspect this is most applicable to mild-to-moderate depression.

Anyway, it's interesting stuff, although perhaps not much comfort to someone in the throes of depression itself and I think Begley's argument is a bit too bio-reductionist for me to be comfortable with (depression is vastly more complex than brain receptors). What's interesting to me as well is that this appeared in Newsweek in the first place as the mag has a long history of subscribing to all psych disorders being fit for medication and objects of fear.

That said, Begley does make the excellent, likely controversial point that we monkey with depression perhaps to our own detriment as a culture.

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Nemeroff Leaving Emory

It's official: controversial psychiatrist Charles Nemeroff is leaving Emory University, according to the Atlanta Journal Constitution. Rumors have been swirling for weeks that he's accepted a post at the University of Miami. Nemeroff is expected to announce his plans later today.

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Women And Post-Combat PTSD

Much as with men, the women seeing active duty in Iraq and Afghanistan are seeing loads of post-combat PTSD, according to the New York Times.

"Never before has this country seen so many women paralyzed by the psychological scars of combat. As of June 2008, 19,084 female veterans of Iraq or Afghanistan had received diagnoses of mental disorders from the Department of Veterans Affairs, including 8,454 women with a diagnosis of post-traumatic stress — and this number does not include troops still enlisted, or those who have never used the V.A. system."

I appreciate their service and wish them well. While I'm wishing, I wish someone would come up with a safe, effective treatment for post-combat PTSD because what we are using now certainly isn't working well.

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House Health Care Bill Contains Autism Training Initiative

The House health care reform bill rolled out last Thursday contains what it calls a "National Training Initiative on Autism Spectrum Disorders." The feds are setting aside $17 million in the first year of the bill, assuming it passes and merges with whatever the Senate drums up, and unspecified amounts in later years of the proposed 10-year package. (Text beginning at page 1402 of the bill, downloadable here.)

As near as I can tell from the bill, these are largely technical assistance grants, providing for:

"eligible entities to provide individuals (including parents and health, allied health, vocational, and educational professionals) with interdisciplinary training, continuing education, technical assistance, and information for the purpose of improving services rendered to children and adults with autism, and their families, to address unmet needs related to autism."

Most of these grants would be aimed at universities. The main thrust is to:

"provide training and technical assistance in evidence-based practices to evaluate, and provide effective interventions, services, treatments, and supports to, children and adults with autism and their families; (II) include individuals with autism and their families as part of the program to ensure that an individual and family-centered approach is used; (III) share and disseminate materials and practices that are developed for, and evaluated to be effective in, the provision of training and technical assistance."

It's not clear to me how all of this will improve health care delivery and access much less reduce the cost of health care, but perhaps I am missing something. None of the ASD blogs I've checked in with have picked up on this funding, so I guess they don't consider it such a big deal. Aside from postpartum depression advocates getting the MOTHERS Act carved into the bill, as I reported on Friday, ASD is the only mental disorder to get any sort of special treatment in the bill.

Combined with $60 million in NIH funding from the federal stimulus bill, this has been a big year for autism advocates with the Congress and Obama Administration. I hope they get some results with all of this money.

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NAMI Lies In NYT Letter To The Editor

Today, NAMI National's executive director Michael Fitzpatrick penned a letter to the editor of the New York Times and objected to how NAMI had been portrayed in a recent article which outlined how the group had gotten about $23 million in pharma funding in recent years. The paper had claimed that represented two-thirds of NAMI's budget and Fitzpatrick wrote to claim it only represented 50 percent.

Then he dropped this claim into the letter:

"NAMI maintains strict guidelines that govern all corporate relations and does not endorse or promote any specific medication, treatment, service or product."

That's a bald-faced lie. In December 2006, Fitzpatrick was quoted in a Janssen/J&J press release wherein he openly touted the company's new atypical antipsychotic Invega:

"'We are pleased that innovative delivery technologies are being applied to new treatments for schizophrenia,' said Michael J. Fitzpatrick, MSW, Executive Director, National Alliance on Mental Illness (NAMI). 'New and efficacious treatment options, like INVEGA, provide significant opportunities for more people with schizophrenia to manage their disease as they work with their treatment teams to live more fulfilling and productive lives.'"

Sadly, the press release itself is no longer online, but if Fitzpatrick wants to claim his group has been mischaracterized, then he needs to be more careful in what he states.

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House Health Care Bill Pushes Mental Health Promotion, Nanny State In Workplace

There are many references to mental health in the House health care reform bill, 110 to be exact. Most of them use the term generically in reference to facilities and health care providers, but not so when it comes to "wellness program grants." (The language begins on page 62 of the bill, downloadable here.) These wellness grants appear to be--as best as I can understand the bill--aimed at smaller businesses and would allow for a 50 percent grant of wellness plan expenses (presumably from a private plan) but only if said wellness program and said businesses institute a Nanny State program that goes far beyond the usual "smoking is bad" provisions and rushes right into the stomachs and moods of working Americans.

If you think I am joking, it's clear that the federal government will be directing provisions of these plans, as the bill orders (on page 66) the secretaries of HHS and Labor to:

"compile and disseminate to employer health plans information on model health literacy curricula, instructional programs, and effective intervention strategies."

Employees will pretty much be forced to play along (pages 66-67):

"EMPLOYEE ENGAGEMENT COMPONENT. An employee engagement component which provides for the active engagement of employees in worksite wellness programs through worksite assessments and program planning, onsite delivery, evaluation, and improvement efforts."

Then it's time for behavioral change (page 67) for one and all!

"(3) BEHAVIORALCHANGECOMPONENT. A behavioral change component which encourages healthy living through counseling, seminars, on-line programs, self-help materials, or other programs which provide technical assistance and problem solving skills. Such component may include programs relating to (A) tobacco use; (B) obesity; (C) stress management; (D) physical fitness; (E) nutrition; (F) substance abuse; (G) depression; and (H) mental health promotion."

That's right, mental health promotion. That's exactly what government should be doing.

"(4) SUPPORTIVE ENVIRONMENT COMPONENT. A supportive environment component which includes the following: (A) ON-SITE POLICIES. Policies and services at the worksite which promote a healthy lifestyle, including policies relating to (i) tobacco use at the worksite; (ii) the nutrition of food available at the worksite through cafeterias and vending options; (iii) minimizing stress and promoting positive mental health in the workplace; and (iv) the encouragement of physical activity before, during, and after work hours."

Wow, going after smoking on breaks, food at work, stress, mental health promotion and pushing exercise. This set of provisions in the bill is simply...breathtaking. There's a Libertarian in me that just screams when I read that the feds want to get involved in creating positive moods at work and creating healthy lifestyles. That kind of thing is so far out of the purview of the feds--read the Constitution if you think I am kidding--that it makes my skin crawl that House Speaker Nancy Pelosi (D-Calif.) is pushing this kind of thing. But then she's always struck me as someone who has spiked her office water coolers with Zoloft.

So the Nanny State has arrived. Enjoy. When I was still at Seattle Weekly in January 2006 and wrote this lengthy piece on Seattle's Nanny State, I thought I was excessive in predicting what the Nanny Statists would come after. Looks like I understated things.

There is a provision on page 68 stating that employers cannot make participation mandatory, but if you've ever worked for a small employer (and I have for several), then you know how voluntary can become mandatory in two seconds. You like that paycheck, right? Well, go jogging with the boss!

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House Health Care Bill Contains MOTHERS Act

The House health care reform bill rolled out yesterday contains most of the language and provisions of the long-stalled, much-controversial MOTHERS Act. Go to page 1418 of the bill, downloadable here, for the language. An earlier version of the MOTHERS act is here.

Minus the original bill's prologue about depression in new moms, much of the Act's provisions are in the House bill, but with slightly softened language. Postpartum depression screening is no longer, in essence, mandatory but is now something that "may" be included in a national education campaign for health professionals and the public. The bill also calls for research on the causes and treatments for PPD, studies of differences in PPD between different ethnicities, "[t]he development of improved screening and diagnostic techniques, Clinical research for the development and evaluation of new treatments."

So that ought to make Big Pharma and the Act's proponents happy.

As for the education program, the bill specifies:

"Information and education programs for health professionals and the public, which may include a coordinated national campaign that "(i) is designed to increase the awareness and knowledge of postpartum conditions; (ii) may include public service announcements through television, radio, and other means; and (iii) may focus on (I) raising awareness about screening; (II) educating new mothers and their families about postpartum conditions to promote earlier diagnosis and treatment; and (III) ensuring that such edu-cation includes complete information concerning postpartum conditions, including its symptoms, methods of coping with the illness, and treatment resources."

That sounds similar to what critics of the Act have objected to in the past (see Evelyn Pringle and Martha Rosenberg), seeing the Act as disease mongering by pharma companies, so it'll be interesting to see the reaction this time out.

I've learned through bitter experience that it's best for me not to have an opinion of the MOTHERS Act or to even ask fairly innocent questions about why we seem to have so much PPD these days. But I will point out that I find it odd that the House is using a bill that's supposed to reform health care access and delivery to fund various research studies which ought to be broken out into NIH's regular budget funding. These studies aren't going to affect health care delivery and access and just add to the cost of an already-costly bill. Just my opinion.

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House Health Care Bill Contains End-Of-Life Counseling

The AP reported last night that the House health care reform bill indeed contains provisions for end-of-life counseling, which generated so much controversy over the summer when it was included in earlier version of the bill. Former Alaska Governor Sarah Palin dubbed this counseling "death panels"--a bit of an overstatement I think--and it was off to the races.

I figured the Democrats were smart enough to strip these provisions out of the House bill, but no. The reality is the counseling likely wouldn't make its way into an eventual combined House-Senate bill because over in the more adult chamber the Dems are struggling to land votes. You can read the language of the end-of-life counseling beginning on page 641 of the bill, downloadable here.

While the language does state that such counseling would be strictly voluntary, I can appreciate why some people object to the Congress legislating much of anything about end-of-life because it seems just as weird to me as the bill's many Nanny State provisions--yay, the government is going to tell me how many calories are in restaurant food because I'm too stupid to figure out that a Big Mac is fattening!--and its provision encouraging workplace wellness plans to create positive mental health in the workplace. Can't business owners work that kind of thing out for themselves? Or is the government to regulate our moods now, too? I feel roughly the same about the end-of-life counseling--it's something the government is best keeping its nose out of.

Interestingly, the prime backer of the counseling is Rep. Earl Blumenauer (D-Oregon) who I dealt with many times when I was a reporter in Portland. I found him to be very smart, very quirky (bow ties, biking everywhere, showing up for endorsement interviews in biking shorts) and very committed to whatever his particular position was, often to the point where you couldn't ask legitimate questions.

He told the AP:

"'There is nothing more basic than giving someone the option of speaking with their doctor about how they want to be treated in the case of an emergency,' said Rep. Earl Blumenauer, D-Ore. 'I think the outrageous and vindictive attacks may have backfired to help raise awareness about this problem, which is why it's been kept in the bill.'"

Blumenauer knows damn well that there's a lot more in this portion of the bill than emergency treatment. There's consulting on wills, living wills, and "[a]n explanation by the practitioner of physician orders regarding life sustaining treatment."

I bet you this blows up all over cable news and the blogosphere later today. Stay tuned.

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House Health Care Bill Mandates Study Of Mental Health Outcomes of Abortion, Adoption

Just putting this out there in as non-confrontational a way as one can: Beginning on page 1420, the House health care reform bill rolled out earlier today requires NIMH to study the mental health outcomes for women who have abortions or otherwise "resolve" a pregnancy. The bill is downloadable here.

"It is the sense of the Congress that the Director of the National Institute of Mental Health may conduct a nationally representative longitudinal study (during the period of fiscal years 2011 through 2020) on the relative mental health consequences for women of resolving a pregnancy (intended and unintended) in various ways, including carrying the pregnancy to term and parenting the child, carrying the pregnancy to term and placing the child for adoption, miscarriage, and having an abortion. This study may assess the incidence, timing, magnitude, and duration of the immediate and long-term mental health consequences (positive or negative) of these pregnancy outcomes."

I have no idea why this is included in a bill that's supposed to reform our health care system--for good or ill. Maybe I'm missing something. The bill requires NIMH to report back to Congress on study progress and findings within three years.

Of course, the relative psychological impacts of abortion are some of the most heated aspects of the abortion debate. Pro-lifers often claim that women who undergo abortions often end up depressed while pro-choicers often claim that there's no psychological detriment. I've seen competing evidence in the medical literature on this point over the years. I'll leave it at that.

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House Health Care Bill Mandates Calorie Counts At Restaurants Nationally

House Speaker Nancy Pelosi earlier today rolled out the House's version of health care reform. The bill is a 1,990 page whopper, downloadable here. I've been able to poke through it a bit and, beginning at page 1,510, I encountered something that will embiggen the hearts of public health advocates (and frankly the whole bill is a gigantic wet kiss to the public health crowd) and make haters of the Nanny State say, "Told you so."

The House bill mandates for calorie counts of almost any item served at a restaurant (or similar food establishment) owned by a company with 20 or more restaurants in the US as well as on drive-thru menu boards. Currently, only a few cities and counties require such information in the US, notably New York City and King County (Seattle), Washington. So America is about to go from Nanny State cities to the Nanny State nation.

And the trouble with calorie counts is that they seem to have a fairly limited impact on what people eat, according to this New York Times account of a recent study of the calorie count law in NYC. (I have no idea how this is playing out in Seattle so far.) It perplexes me beyond belief that we have a government that doesn't get that people already know a Big Mac is fattening and people are going to order one anyway, calorie count information be damned, because they like Big Macs. This calorie count thing nationally is going to be expensive to implement and will likely not change human behavior much. I cannot wait to see how the food industry responds.

Beginning on page 1515, the bill also mandates calories counts for items in a vending machine operated by anyone who operates 20 or more vending machines. And the nutritional information that's already on the majority of food (chips, cookies, etc.) you can buy from a vending machine isn't sufficient under the House bill. Instead, vending machine operators would be required to post a prominent sign next to each item, readable before a consumer makes a purchase. That is going to be a very expensive hassle for vending machine operators across the country, especially smaller operators.

I'm a bit lost on what American over the age of 14, say, doesn't know that chips from a vending machine are high-calorie items, so why this provision exists in the bill is beyond me--except that I know it's there to serve the true believers in the Nanny State.

There's more in this bill that I'll post on in a bit.

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AstraZeneca To Pay Feds $520 Million To Settle Seroquel Claims

Just out this morning in AZ's third quarter financial results is this little whopper:

"Agreement in principle reached with the US Attorney`s Office in Philadelphia to resolve its investigations related to Seroquel sales and marketing practices. This accounts for $520 million of the $538 million provisions taken in the first nine months, $108 million of which taken in third quarter."

I don't have any more details on this yet, so stay tuned.

Excepting J&J/Janssen, all the makers of atypicals have agreed to settlements with the feds over illegal marketing.

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Pristiq Ad Runs During World Series As Adverse Events Reports Mount

Yes, that creepy ad for Pristiq with the woman staring at the wind-up doll has been running again during the ALCS and NLCS and now during game one of the World Series last night (won by the Phillies 6-1 over the Yanks with a big assist from former Mariner Raul Ibanez). It's bad enough having to sit through Cialis and Viagra ads during the Fall Classic, but anti-depressant ads, too? Hand me a beer instead. You see the ad here.

Meanwhile, adverse events for the Son of Effexor continue to mount and stand at 1,361 adverse events reports in the FDA's database. That's good going for a drug that's been on the market two-plus years and that still is used so little that Pfizer (Wyeth's new owner) doesn't list third quarter 2009 sales figures for the drug.

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Congress To Go After Medicaid Fraud, Why Not Fraud Against Patients Too?

The Wall Street Journal noted yesterday that Congress is planning to take steps to wipe out the estimated $60 billion a year in Medicaid fraud.

"'The scale of health care fraud in America today is staggering,' Senate Judiciary Committee Chairman Patrick Leahy (D., Vt.) said at a hearing. 'Now, as health care reform moves through the Senate, I want to make sure we do all we can to tackle the fraud that could undermine efforts to reduce the skyrocketing cost of health care.'"

That's all well and good and I wish Congress luck. A good amount of the fraudulent behavior comes from our friends at America's Pharmaceutical Research Companies (see Lilly, Pfizer, BMS, etc.). All of the billions in awards the feds have gotten out of these companies for ripping off taxpayers has also come at the expense of individual Americans who, in many cases, never get compensated and never get the satisfaction of watching a Lilly exec, say, do a perp walk. Meanwhile, their bodies are ravaged.

Congress ought to be interested in beefing up consumer protections regarding pharmaceuticals and also in creating penalties that really matter instead of the situation we have now where pharma basically pays off the feds through its liability insurance. The system of laws and regulations in place now is apparently not sufficient to protect Americans against another Zyprexa or Byetta.

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Yes, I Got Spoofed

JC, a reader from Back East somewhere, left a comment yesterday that I broke out as a post because he fooled me into thinking he really was one of the Biederman groupies, bipolar child defenders, etc. His comment was so perfect that it got by my BS detector, which may not have been fully on at 10.30 am. It's classic and you all should go read it here.

What I love is that JC says he took a lot of the language straight from the Child and Adolescent Bipolar Foundation website.

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Weirdest Comment Ever On This Site

And thus well worth highlighting since it comes in response to the JAMA study which found that antipsychotics are putting tons of fat on youngsters.

"I think this report smells fishy. Smells like the work of anti-psychiatry Scientologists. Psychiatric medications are a healthy part of a balanced lifestyle for the majority of children with childhood bipolar disease, a serious but treatable medical condition.

"My child has bipolar disorder and I've come to learn that her rages have nothing to do with me and that this is a highly genetic biological brain-based disorder.

"We have her on eight meds prescribed by the director of our local university clinic and we've received extensive psychoeducation about the nature of her disease. Additionally, my husband and I attend a support group three times a week for parents of bipolar children at the hospital.

"I trust very much in the power of medicine and am very thankful for the big glitzy university hospital where we live. Her neuropsychopharm says that when taken as prescribed, her medicines including the atypicals are safe and effective. They're all FDA approved drugs anyway.

"Studies like this are done by stupid Scientologists that don't understand brain-based disorders."

Speaks for itself.

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Harvard Psychiatrist Stabbed, Patient/Attacker Killed

Yesterday, a tragedy occurred at one of Massachusetts General's buildings. A patient attacked a psychiatrist named Astrid Desrosiers with a knife, reportedly inside the Massachusetts General Hospital Bipolar Clinic & Research Program. An off-duty security guard shot and killed her assailant, identified as Jay Carciero, after he refused to surrender and put down his knife. Desrosiers is reportedly is serious, but stable condition. I wish her a continued and speedy recovery.

I'm sure we'll learn more about this tragedy in the near future.

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JAMA Study Slaughters Antipsychotics For Kids, Teens Paradigm

Late yesterday I got a copy of the JAMA study detailing how kids and teens on atypical antipsychotics are putting on lots of weight very quickly and suffering detriments on just about every metabolic measure researchers looked at (my initial post is here). I'll come to the study itself in a moment as well as the accompanying editorial, but first I wanted to note that I have been banging on the kids-on-meds issue (especially atypicals) for three years and have taken a ton of heat in the process. I feel vindicated by this new study and other recent studies tossing cold water on various treatment paradigms involving kids and many of you should feel vindicated as well. I remember how gingerly I first took on the subject in November 2006 and how many of you kicked me in the pants and told me to trust my instincts. Thanks.

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JAMA Study Finds Explosive Weight Gain In Kids On Antipsychotics

A study to be published in JAMA tomorrow finds staggering weight gain in kids given antipsychotics. According to the AP:

"Children on widely used psychiatric drugs can quickly gain an alarming amount of weight; many pack on nearly 20 pounds and become obese within just 11 weeks, a study found.

"'Sometimes this stuff just happens like an explosion. You can actually see them grow between appointments,' said Dr. Christopher Varley, a psychiatrist with Seattle Children's Hospital who called the study 'sobering.'

"Weight gain is a known possible side effect of the anti-psychotic drugs which are prescribed for bipolar disorder and schizophrenia, but also increasingly for autism, attention deficit disorders and other behavior problems. The new study in mostly older children and teens suggests they may be more vulnerable to weight gain than adults."

That is very rapid and very significant weight gain. The drugs involved were Risperdal, Seroquel, Zyprexa and Abilify. Since I've not seen the study, which involved 205 New York-area kids aged 4 to 17, I don't know what range of diagnoses kids were getting these drugs for, but it'll likely be the usual muddle of schizophrenia, pediatric bipolar disorder, autism, ADHD and so on.

If this study does not give pause to those who wish to medicate kids, then nothing will.

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