Harvard Psychiatrist Didn’t Report Pharma Income
162 CommentsBy Ed Silverman // June 7th, 2008 // 9:31 pm
A Harvard child psychiatrist whose work has helped fuel an explosion in the use of antipsychotics in children earned at least $1.6 million in consulting fees from drugmakers from 2000 to 2007 but for years did not report much of the income to university officials, according to information given Congressional investigators, The New York Times reports.
By failing to report income, the psychiatrist, Joseph Biederman, and a colleague in the psychiatry department at Harvard Medical School, Timothy Wilens, may have violated federal and university research rules governing conflicts of interest, US Senator Chuck Grassley, an Iowa Republican tells the Times, since some of their research is financed by government grants.
Grassley has been investigating the interplay between academics who receive grant money from both pharma and the NIH. Another recent example he uncovered involved a University of Cincinnati professor who received funds from AstraZeneca while studying one of their drugs, but allegedly failed to report the outside income to the university while also receiving NIH grants.
Like Biederman, Wilens belatedly reported earning at least $1.6 million from 2000 to 2007, and another Harvard colleague, Thomas Spencer, reported earning at least $1 million after being pressed by Senate investigators. But even these amended disclosures may understate their outside income because some entries contradict payment info from drugmakers, the investigators told the Times.
In one example, Biederman reported no income from Johnson & Johnson for 2001 in a disclosure report filed with the university. When asked to check again, he said he received $3,500. But J&J told Grassley that Biederman was paid $58,169 in 2001. The Harvard group’s consulting arrangements were already controversial because of their advocacy of unapproved uses of psychiatric meds in children.
“The question you might ask is: Why weren’t Harvard and Mass General watching over these doctors? The answer is simple: They trusted these physicians to honestly report this money,” according to Grassley’s statement in the Congressional Record. Want to see Biederman’s lack of disclosure? How about Grassley’s letters to the NIH and Harvard? Look at the Congressional Record (just search for ‘Biederman‘ once you open the link).
In an e-mail to the paper, Biederman wrote: “My interests are solely in the advancement of medical treatment through rigorous and objective study,” and he said he took conflict-of-interest policies “very seriously.” Wilens and Spencer wrote e-mails saying they thought they had complied with conflict-of-interest rules.
John Burklow, a spokesman for the National Institutes of Health, told the Times: “If there have been violations of NIH policy — and if research integrity has been compromised — we will take all the appropriate action within our power to hold those responsible accountable. This would be completely unacceptable behavior, and NIH will not tolerate it.”
The federal grants received by Biederman and Wilens were administered by Massachusetts General Hospital, which in 2005 won $287 million in such grants, the Times writes, adding that the health institutes could place restrictions on the hospital’s grants or even suspend them altogether.
Alyssa Kneller, a Harvard spokeswoman, e-mailed the Times this statement: “The information released by Senator Grassley suggests that, in certain instances, each doctor may have failed to disclose outside income from pharmaceutical companies and other entities that should have been disclosed.” She added that the docs had been referred to a university conflict committee for review.
The NIH last year awarded more than $23 billion in grants to more than 325,000 researchers at over 3,000 universities, and auditing the potential conflicts of each grantee would be impossible, officials have insisted, the Times notes, so the government relies on universities. Universities ask professors to report their conflicts but do almost nothing to verify the accuracy of these voluntary disclosures.
“It’s really been an honor system thing,” Robert Alpern, dean of Yale School of Medicine, tells the Times. “If somebody tells us that a pharmaceutical company pays them $80,000 a year, I don’t even know how to check on that.”
Biederman is one of the most influential researchers in child psychiatry and is widely admired for focusing the field’s attention on its most troubled young patients, the Times writes. Although many of his studies are small and often financed by pharma, his work helped fuel a controversial 40-fold increase from 1994 to 2003 in the diagnosis of pediatric bipolar disorder, which is characterized by severe mood swings, and a rapid rise in the use of antipsychotics in children, the Times writes, adding that the Senate investigation did not address research quality.
In the past decade, Biederman and his colleagues have promoted the aggressive diagnosis and drug treatment of childhood bipolar disorder, a mood problem once thought confined to adults, the Times writes. They have maintained that the disorder was underdiagnosed in children and could be treated with antipsychotics, which were invented to treat schizophrenia.
Other researchers have made similar assertions. As a result, pediatric bipolar diagnoses and antipsychotic use in children have soared, the Times notes and then cites data from Medco, the pharmacy benefits manager, showing about 500,000 children and teenagers were given at least one prescription for an antipsychotic in 2007, including 20,500 younger than 6 years old.
Henry
I like Senator Grassley.
Laurie
So do I Henry! Biederman and his “team” are responsible for the most aggregious use of antipsychotics in children. Even their colleagues question their methods.
http://www.boston.com/news/globe/editorial_opinion/oped/articles/2007/06/19/misguided_standards_of_care/
If left to their own devices this “team” would being drugging every aspect of childhood. It was Biederman who polydrugged Rebecca Riley until her death.
It’s time that Harvard took away this mans “distingished” Harvard title, for the sake of his patients.
Laurie
Correction it was Biedermans research and recommendations, that Rebecca’s psychiatrist followed.
Matthew Holford
Biederman’s a very confused guy, I think. I came to the conclusion, long ago, that the people who work in the field of mental health are actually trying to repair themselves (but do so in secret, whilst pretending to be experts in repairing others). As I understand Biederman’s conduct, he’s been trying to crush certain kinds of apparently normal childhood behaviour.
I imagine that that is how he was treated, when he was a child, and that’s how he’s been programmed to behave. Which would be fine, except that, given his position, if his methods are incorrect (and I think they are), he will likely do a great deal of damage to his patients, when he is not treating them, but merely imposing his own reality.
Matt
ol cranky
I wonder if these folks who didn’t accurately report this income to university officials accurately reported it on their taxes. . .
Melody
You gotta love the concept of ’self-regulation’ and medical ‘ethics.’ Where are his outspoken ‘brethren’? Do they not recognize that they get smeared with the same broad paintbrush of contempt when misdeeds come to light? Do doctors endorse an unacknowledged code of silence when they enter the medical brotherhood? That code has served another organization quite well, hasn’t it?
Thom
Here’s some good footage of Biederman on 60 Minutes. The title of the program is “What killed Rebecca Riley?”
http://www.cbsnews.com/stories/2007/09/28/60minutes/main3308525_page2.shtml
HorusCat
ol cranky,
I think the pharma companies send in tax forms on what they pay docs, so the individuals concerned better have reported accurately to the IRS!
JC
Just another whore for Big Pharma. Harvard should be ashamed. I, as a physician, am ashamed.
Atlex
HC is correct. All consultants, speakers, researcher, etc. receiving payment from pharma companies receive a Form 1099 with income information. This information is also sent to the IRS.
Not wanting to make excuses for not reporting income to the University or in other places, it is important to put this in context to the era. For much of the era, there was not much emphasis on reporting this and reporting was very lax. It has only become a hot topic in the past 2 or 3 years. This is still not an excuse for not reporting, but does put it into context.
One final note…whether this was reported or not, anyone involved in this issue was very aware of Biederman’s support from pharma in terms of research grants and consulting fees. It doesn’t excuse his lack of transparency, but let’s not act as though this is “new” news.
Atlex
Laurie
While this may not be “news” to those who are well aware of funding, this is huge news when put together with the controversial nature of Biedermans “research” and influence.
If Biederman claims that the money had no influence over his research, then comes the question….why not be completely honest and open about those sources of funding?
This line in the article is especially disturbing:
” Dr. Biederman reported to Harvard that he received less than $10,000 from Lilly that year, but the company told Mr. Grassley that it paid Dr. Biederman more than $14,000 in 2000, Mr. Grassley’s letter stated.”
This statement highlights how it wasn’t about the financial gain(4000 dollars isn’t going to make someone rich), yet he purposely lowered that amount to conceal the violation of the disclosure rules. If he was willing to do that over $4000, what else was he willing to cover up? It comes down to integrity, which IMO he has none.
Rodney Wilson
This happens all the time, I’m afraid. Check out Side Effects: A Prosecutor, A Whistleblower, and a Bestselling Antidepressant on Trial, a new book by Alison Bass:
http://www.amazon.com/Side-Effects-Whistleblower-Bestselling-Antidepressant/dp/1565125533/ref=pd_bbs_5?ie=UTF8&s=books&qid=1212946585&sr=8-5
johnd
I have never voted Republican, but this guy Grassley is getting a big “thank you” email from me today. Not only is he uncovering Harvard’s and others criminal behavior, but he also found out UCLA has been doing liver transplants for Japanese gangsters while poor folk are dying. From this mornings NY Times:
http://www.nytimes.com/2008/06/08/washington/08transplant.html?th&emc=th
I have been going crazy, and now have taken my ex to court because my 7 year old doctors have been feeding here amphetamines, antidepressants, anti-anxiety meds and things to help her sleep. They have just started her on Respirdal, an atypical anti-psychotic!! They started these constantly-changing drug cocktails when she was 6 years old! This medication of masses of our children can clearly be blamed on big pharma and the unscrupulous doctors that take their money. They should all be put in jail.
Hooray for Sen. Grassley!!!
johnd
Doc
Sen. Grassley rocks!
Anne
Senator Grassley DOES rock. I am especially proud that he exposed the unscrupulous Biederman, busy disease-mongering and harming thousands upon thousands of children with a made-up illness and giving them lethal drugs. Grassley is Mr. Drug Safety in the Senate - not many more like him there.
Marilyn Mann
Ed’s link for the Congressional Record isn’t working. Try this:
http://frwebgate3.access.gpo.gov/cgi-bin/PDFgate.cgi?WAISdocID=96306823720+0+1+0&WAISaction=retrieve
or
http://frwebgate3.access.gpo.gov/cgi-bin/waisgate.cgi?WAISdocID=96319827735+0+0+0&WAISaction=retrieve
or go to http://www.gpoaccess.gov/crecord/index.html
and search for “Biederman”
Brian
Biederman has been one of the worst Big Pharma Hos ever… but what makes him and his ilk particulalry evil is that they take money and destroy innocent, helpless children. Sen. Grassley should have these guys tax returns audited; hopefully they can be prosecuted for tax evasion. At the very least NIH should strip Biederman and Harvard of its grants.
Anonymous
Dr. Biederman obviously didn’t want to disclose the degree to which he is enriched by pharma, even though such disclosure is required. It is more than an oversight, it is a deliberate effort to conceal material facts related to his work. If Dr. Biederman is so ethically challenged that he can’t or won’t disclose his compensation from pharmaceutical manufacturers, how honest is his work?
If Dr. Biederman won’t tell the truth to NIH and Harvard, how can he be trusted to conduct ANY research or to practice medicine? He should have his license revoked.
Lili
Henry,
You may like Chuck Grassley, but why do have so much corruption in our government? Maybe it is time Chuck Grassley and Congress, Federal and state elected should be honest and truthful, especially when it it is our health. I speak erience and when it happens to you and member of your dies because of our corruptive health system you
will feel differently.
Lisa Van S
Atlex,
I agree,.. Bierderman isnt news. His ties to Industry are well known to those who follow this issue. In other words this guy is a bum,.. no doubt about it!!!!!!
HorusCat
johnd,
Sounds like you have more of a problem than “pharma drugging your child.” No pharma company has ever taken a child to a doctor or written a prescription–your ex has something weird going on, if you think your child is perfectly fine and she thinks she needs medication. Child docs rely a lot on what parents report about behavior, so strange stuff is going on with your ex for her to be telling the doctor anything to get your daughter medicated.
Sounds like you and your ex need to hash some things out–no way should she be taking your child to a psychiatrist without your knowledge and input. Obviously, you already know that, because you are taking her to court. I am sorry it has to come to that–that is so damaging to you and to your child. I hope you already have joint legal custody and can put a stop to this–do you have visitation? I guess you can’t steal her while you get it hashed out in court, that would damage your standing. I hope you get it taken care of; in the meantime, don’t stop the meds suddenly. Get that court order and take your daughter to another psych with the explicit intention of tapering her off the drugs. Good luck!
johnd
HorusCat - thanks for the support. I’m looking for a psych in the SF Bay Area I can have my daughter see, and as well maybe provide expert testimony in support of therapy and parent training instead of this insanity of using antipsychotics on children who are not mentally ill. The whole thing seems pretty unreal.
Matthew Holford
Laurie wrote:
“…It comes down to integrity, which IMO he has none.”
I agree with that, wholeheartedly: it points to a bigger issue than a few grand.
It’s a different field, but in the UK, when one is licensed as an “competent person” within the financial services regulatory environment, one is required to disclose any criminal convictions. A traffic offence means absolutely nothing, and won’t impact on one’s application for Approval, but not reporting a traffic offence most certainly will…
Matt
Laurie
That $4000 difference not reported was a blatant attempt to circumvent the mandatory $10,000 limit for reporting. That’s what’s so disturbing about this whole situation. While some will argue that full disclosure of funding sources isn’t a true indicator of corruption of research….I think this situation highlights the fact that if an individual is willing to go to these lengths to decieve, then their ethical practices are in question.
HorusCat
johnd,
This will sound crazy, but if you know any reps in the area, ask them. Reps know who the good, thoughtful docs are–even though they often aren’t the ones prescribing our drugs! My middle son is autistic, and I recently wanted to change doctors. Sadly, the list was very short of psychiatrists who would also spend the time I wanted them to just talking to my son. Fortunately, I found one–she spends at least 45 minutes with him every time we see her. Additionally, we found a psychologist who specializes in kids on the spectrum, and she spends weekly time with us helping to problem-solve social situations and anger/impulsivity issues (like why you can only ask a person to explain a decision once, and after that they get annoyed!).
Another resource might be a local autism society–not that your daughter is autistic, but because those folks are really plugged in to the counseling community. They may have a list of psychologists who do behavioral/family counseling, much like I do with my son. They may also have insight into the legal situation. Hang in there!
AV
For an SF Area child psych, I would recommend you do some research on Kiki Chang, MD. A very progressive and highly respected doc.
Jane
I believe Kiki Chang is also part of the Biederman gang that believes in medicating children as young as possible.
Sam
In some legal circles there is a belief that if someone entices someone
to do something not legal or not ethical, the enticer is just as guilty as
the person who did something wrong.
All consultants, speakers, researcher, etc. receiving payment from pharma companies receive a Form 1099 with income information. This information is also sent to the IRS, but this latest news report clearly
shows that PHARMA is the enticer.
The money given to these so-called respected, highly regarded physicians is not as important as the motive for giving these physicians the money. It has been reported that these new psychotropic drugs accounted for $10 Billion in 2006.
Even more important is the fact that parents of young children and other adults were prescribed these drugs unnecessarily in many cases for FDA approved use and off label uses. How many patients suffered
from side effects of these drugs - in some cases age restricted was ignored. A couple of years ago, it was reported tha Zyprexa reps
did not tell physicians that the use of the drug caused patient to
gain from 20 to 100 pounds, in many cases causing patients to
become diabetic.
If PHARMa funded these research physicians in a honest and ethical manner and not as a marketing tool, every one would gain. But one
has wonder, how many more unethical situations is still not known?
observer
kiki chang is indeed part of the biederman mafia and has spoken for them on pbs when biederman refused to answer questions.
docf
Just sent the following letter to Harvard Medical School. Made me feel a bit better. Maybe if they get swamped with mail and calls they won’t languish in their decisions.
“I am a psychiatrist who trained at NYU. There I was taught that honesty was integral to the practice of good medicine. I’m sure that’s what you teach at your institution as well.
Please do not just discipline but fire Biederman et al. as quickly and publicly as possible. Their moronic greed is going to have hideous ramifications in medicine for some time but the quicker that we all publicly denounce what they did and begin to take steps to correct our imperfect system, the sooner we will begin to earn our patient’s trust back.
That is of course, unless we just want to go back to a laying of the hands and stop prescribing drugs altogether.”
P.S. I also think that their licenses should come under review for revocation for unethical conduct.
Jane
Bravo docf! Every Psychiatrist and the APA should be sending letters just like the one you wrote instead of trying to justify these doctors behavior by stating they may not have known it was drug money such as Danny Carlat.
docf
Thanks Jane. I’m rather shocked there’s not more discussion going on about it in the medical community. It really puts a lot of off label research we depend on for prescribing (especially in psychiatry) at risk. I know if I have to wait for the the FDA to approve a use a drug for a particular indication, usually I’m doing my patients a tremendous disservice. I do hope more docs get upset by this.
Nathan
Sam,
As far as I can tell from the NY Times article, it appears that the pharma industry acted entirely within ethical and legal guidelines. This appears to be a failure on the part of the medical establishment at Harvard. Disagree?
CV MD
If the academic docs reported all of the income from pharma, the sheer amounts would shock the country. Research amounts are relatively small compared with consultant and speaking fees. I’ve worked in the cardiovascular area for years and can tell you that millions have gone to Harvard and Duke physicians who carry the label “Key Opinion Leader.” Yes, millions! Did all of this get reported? Highly doubtful. These large university centers all have their own research groups whose physicians are very well rewarded. Not only that, the amounts thrown around in cardiovascualr dwarf what is spent in psychiatry.
Former Big Pharma
CV MD is right on target. Grassley is just seeing the very tip of an extremely large iceberg. If he started to look at cardiologists who work for drug companies at the major academic institutions, he would find much, much more. I also agree that harvard and Duke have been extrtemely active for years.
More power to Sen. Grassley. he’s one of the few that is trying to do something about the corruptness that is Big Pharma.
Sam Kerr
I think that the research should be closely scrutinized. There will be an inquiry, but I’m not sure it will involve reviewing all the studies in detail. That would take a long time.
Nathan
CV MD,
Do you mean that pharma pays these KOLs money for *personal* use or are you talking about research sponsorships & unrestricted grants? Unrestricted grants are a great way that pharma is funneling money into research institutions. It provides very necessary money at a time when federal funding is drying up. At my level, I’m completely unaware that pharma is personally funding the bank accounts of these KOLs. I always thought we were primarily funding their research groups.
alan milner
I find it interesting - and disturbing - that I cannot find any references in the reporting on this story to the specific drugs which may have benefited from Biederman’s suborned endorsements. It would seem to me that the public should be informed about which drugs, or drug regimens, that Biederman endorsed are manufactured by companies that subsidized Biederman’s research activities.
The failure to “name names” with respect to the specific medications involved raises questions about the mendacity of the news media itself. My guess is that the management of the New York Times saw a potential law suit emerging if they were to identify the medications in question, and simply steered clear of the question.
Imagine how much more potent this story would be if it were connected to the specific drugs that Biederman has recommended. It would also have been a better service to the community to let the public know which drugs fall into this category so that they can reconsider any treatment regimen that includes these medications.
alan milner
Ah ha! There was a reference to a specific drug, all the way down on page two of the Times article, but there was a reference to only one drug out of the unknown number of drugs in question. I reiterate my concern about the inadequate reporting, and the absence - still - of a full disclosure about which drugs may have been recommended by doctors receiving compensation from the companies that manufacture those drugs.
truthman30
This kind of thing is rampant in the industry…
It’s corrupt to the core..
truthman30
“At my level, I’m completely unaware that pharma is personally funding the bank accounts of these KOLs. I always thought we were primarily funding their research groups”
You should read up on “Martin Keller” of Brown university Nathan and “Study 329″ …
If corruption, abortion of ethics and pharma whoring is the accepted status quo at the top of the psychiatric profession, you can only imagine what happens further down..
harpy
Not wanting to make excuses for not reporting income to the University or in other places, it is important to put this in context to the era. For much of the era, there was not much emphasis on reporting this and reporting was very lax. It has only become a hot topic in the past 2 or 3 years. This is still not an excuse for not reporting, but does put it into context.
You raise a good point, Atlex, but don’t you wonder if the lax reporting is what has led to it becoming a hot topic?
CV MD
Nathan,
You’re kidding, right? Advising, Consulting and Speaking fees have gone through the roof over the past few years, with some “KOLs” commanding up to $5000/day! Many speak several times a month and consult for multiple companies. Not only that, they sit on a number of advisory boards at the same time. And then there’s the research, where they charge outrageous amounts for their own personal time! How do you think these guys live in the most extravagant houses and drive the most incredible wheels? It’s not from their day job at an academic institution. They don’t get paid that much! If the government starts to look at who pays who what and who didn’t report side income, then the lid will be blown off of Pandora’s Box.
Nathan
CV MD,
Sure - speaking fees. We generally pay $1000-$2000 for academic speakers to come in for a day. That is “pay for work” — not just “pay for hell of it”. These guys won’t speak for free!
You said in your prior message that “millions have gone to Harvard and Duke physicians who carry the label Key Opinion Leader.” If it is all in <$5000 increments, for speaking, consulting, etc, so what? We need academic speakers and consultants in order to keep up with advances in technology. These guys don’t offer thier services (speaking and consulting) for free!
M Helm, MD
Nathan, your “academic” speakers charge you for speaking services because they understand that in those situations (where they are using the corporate written presentations) they are promoting a product.
I know a fellow (more senior) academic who was always delighted to give talks around the state. For one product, he expected $1,500 per talk, and would only do local area events not more than an hour away. He also liked to be picked up at the office, driven there and back. Lots of times he was “speaking” to two or three other physicians. I think he did around a dozen of these, but it might have been more. The really odd thing was although he is a pediatric subspecialist, the product he was speaking for products had no approved use (or studies) in children. About a year later, the product was pulled due to safety issues (which were signalled in the original studies).
I’m an academic, and I speak often locally on a variety of topics. I’ve given talks to family medicine meetings, pediatrics and psychiatry grand rounds, a state respiratory therapy meeting, as well numerous meetings for our Medicare/Medicaid quality improvement organization. I make my own presentations - which is a great deal more difficult and time consuming than attending a speaker training session (followed by golf). I don’t take honoraria. Academicians will speak for free. It is called teaching.
CV, MD is absolutely correct on this point. The KOL’s (who are usually deemed such by PhRMA)are simply leveraging their academic positions to get supplemental income.
The “advisory boards” are especially absurd. There is just no way that an “advisory board” member can provide any useful direction to a company on how to research or market any product. The research folks, and the marketing teams have a much more intimate understanding of the strengths, weaknesses, opportunities and threats for their product group than any outside “advisor.” These boards exist (I believe) to buy some goodwill from the attendees, and to plant some off-label use seeds. Having worked in PhRMA marketing, I know exactly why we had “advisory boards,” and the degree to which anyone internally paid any attention to them. Payments to “advisors” are little more than bribes and ego-stroking.
CV, MD - Can I get an AMEN?
Nathan
CV MD and M Helm,
I guess I’m in a different area of research. What you say may be true in clinical R&D. I’m in pre-clinical R&D. We bring in academic consultants (”advisors”) and speakers several times a year and pay them $1000/day for their services. They provide useful information to our project teams. They also bring an “outside the box” perspective. Sometimes we get “tunnel vission” from looking at the same project for so long. Often an academic might see something totally obvious, but because we’ve been so intimately involved in the day-to-day research, we’ve missed something obvious to someone with a fresh perspective.
My only point is that not ALL payments by pharma to academics are made with bad intentions. We fund basic research (with unrestricted grants) and we bring in speakers/consultants to educate our scientists about new work going on in academia. Just like physicians, we (in the lab) don’t always pay as much attention to primary literature as we should. Academic speakers and consultants are an important part of continuing education for pharmaceutical researchers.
HorusCat
M Helm and CV,
You are a little behind the times. No more golf, at least not with my company. Speaker training programs are a real pain in the patootey now; no free time whatsoever. We do most of the training over the internet, anyway. Ad boards are few and far between with the big companies; the smaller companies still get away with them. (Biogen comes to mind, as a matter of fact.)
Most speakers are not divas and don’t command fees of $5,000 per day. In fact, I am having one in a couple of days. He is driving himself–even using MapQuest! He did ask for two talks for the day, which will pay him about $2,500, but since he is driving four hours and giving up a day’s work in his office, I don’t think that’s unreasonable. His speaking cap for us is not very high–$20,000 or so total for all speaking for the year. He’s not a huge KOL, but he uses my drug and is passionate about the disease state. To me, that kind of speaker is more valuable than some big name from Duke–often those guys are out of the office so much they don’t have any real clinical experience to offer. My docs want someone who actually treats patients and uses different medications.
Another speaker I’ve used a bit is local; he speaks not just because he is passionate about the disease state and uses my drug, but because he can draw attention to current research, network with local doctors and talk about interventions that can occur if medications fail. I think that benefits all concerned.
The vast majority of speakers for pharma are local or regional level docs who do maybe ten or so talks a year. They don’t have the reputation or desire to do national tours. The Duke, Harvard, Cleveland Clinic types get lots of press, but they are a small minority of speakers. We don’t do a lot of dinner talks anymore, because no one wants to come out at night. That’s why we do talks with a few doctors–we can do lunch or breakfast. It’s a lot cheaper, food-wise, too. And reps have kids and lives, too. The worst thing in the world is to have one of those big names in and get no one at your program!
My point is that you get in high dudgeon over what is a small part of the speaker process. What goes on most of the time is pretty small potatoes.
HorusCat
Also–some academic centers require that physicians turn over speaking fees to the university.
Perks
Three (3) men make between them ‘at least’
$4.2 million dollars from drug companies in return for persuading physicians that children should be prescribed drugs with known toxic properties.
That should be considered criminal activity on both sides, bribers and takers.
CV MD
Amen to M. Helm! Nathan - you are sheltered in pre-clinical and have no idea what goes on in the commercial side of the Big Pharma companies. The business bozos are the ones throwing around the money, not the research groups! Trsut me - many are paid $5000 per day and bill door to door! many KOLs are on “retainers” to pharma for $50,000 - 100,00 per year!! Advisors and consultants are paid ridiculous sums for very little work. It happens all the time! Horuscat - perhaps your company follows the rules, but most don’t. just look at all the bad press lately. It’s at least once or twice a week that Big Pharma is in the news for another stupid move. Wait until the democrats get elected in November - then Pharma will not know what hit them. They will be royally toasted. Please wake up!
M Helm, MD
Nathan, You are correct that we are talking apples and oranges. The preclinical consultants are the reason the internal folks know all there really is to know before the late clinical and post launch phases. That’s really a different ball game.
HCat I think you do know the score for the majority of speaker bureau situations. The challenge is that while your company limits speaker bureau fees to a $20K cap, nothing stops the doc from being on multiple speakers programs. The problem I still is that the speakers are trained to present only the side of the story the Marketing department wants heard. The speakers, unlike the internal experts (such as Nathan will be if he is not already), don’t know where are all the warts and pitfalls.
You may be right that the “advisory boards” are a phenomenon relegated to the smaller players, but I certainly know a few MDs who are proud to say that they are on advisory boards for some pretty big products. I know one company that seems to specialize in a behavioral condition which affects children predominantly which still does it “old-style.” They aren’t that small.
The meds themselves aren’t the problem. Neither is the well-designed and well-executed research which is produced (sadly that doesn’t describe the majority of industry funded post-marketing research). The problem is the marketing tom-foolery and the greed and ego beyond all reason that seem always to go with the supposed KOLs. It is a problem and it makes PhRMA and physicians and everyone around them look bad.
I think PhRMA as a whole would do well to dump them, but there is a certain economic inter-relatedness that makes that hard to do. Biederman and Co generated billions in off-label sales of atypicals for many kids who may have done as well with behavioral interventions. (Watch a few “SuperNanny” episodes, you’ll see what I mean.)
Finally, to CV. MD - Preach it, brother!
Perks
When three (3) guys get to make ‘at least’ $4.2 million between them from drug companies in return for persuading physicians to prescribe drugs with known toxic properties to children, then the credibility of the meds and the quality of the studies surely comes into question.
Children would certainly have done better with behavioural interventions if that had excluded drugs, as without those drugs their health would not have been compromised by drug toxicity.
In any event, as in the usual business surrounding drug wars, it should be considered criminal activity on both sides, that of the bribers and of the takers.
Doug Bremner MD
Not as much profit in behavioral therapy as prescription medications.
CV MD– “I’ve worked in the cardiovascular area for years and can tell you that millions have gone to Harvard and Duke physicians who carry the label “Key Opinion Leader.”
Why is that if we followed the cholesterol guidelines written the expert consensus panel in cardiology that half of males over the age of 35 would be on a statin? Why is it that KOLs in cardiology say that statins should be put in the drinking water? Why is it that KOLs in cardiology say that we should develop a “polypill” that combines aspirin and a statin that the entire population should take? Why is it that the expert guidelines state that women without heart disease should take statins when the literature shows no reduction in heart attack, let alone mortality. Why is it that the US guidelines would have double the number of people on statins as any other country in the world? Could it be that 8/9 on the expert panel had major COIs?
Expert guidelines are a great tool because if you don’t follow them you feel like you aren’t practising the “standard of care”.
HorusCat
M Helm and CV,
We are talking at cross-purposes here. I don’t disagree with you about KOLs milking the system. Or that KOLs should be sanctioned for talking/promoting drugs off-label (i.e., for kids). I’m just pointing out that they are the ones who get all the press–the majority of speakers aren’t KOLs and don’t receive the attention and perks that KOLs do.
The company does strictly control what a speaker can say–or is supposed to do so. The speaker basically doesn’t have anything that I don’t have in my marketing pieces, at least when it comes to data about the drug. They have some epidemiological stuff and disease state material. As I pointed out, most of their value comes from their experience actually treating patients.
They also are required to present all the fair balance stuff: side effects, any warnings, etc.
After a speaker gives a talk for me, I have to sign a statement to be submitted to the company that affirms that he didn’t go off-label. And we have random compliance checks from a 3rd party company–they just show up at the program and report whether the speaker stayed on-label.
All in all, I think the average speaker program is a far cry from what goes on with the KOLs.
Nathan
Doug,
It’s fine for you to write in and criticize the standard cardiology guidelines for statins. You correctly point out that “Key Opinion Leaders” in this field have conflicts of interest. However, you left out some key pieces of information about yourself that are important to people reading your post.
1) In spite of the “MD” after your name, you are not a cardiologist. You are a psychiatrist, correct?
2) You just wrote a book entitled “Before You Take That Pill: Why the Drug Industry May Be Bad For Your Health”.
3) You receive royalties on sales of that book.
Don’t you think it’s a little hypocritical to point out conflicts-of-interests in others while not mentioning your OWN conflicts-of-interest?
BDM
Nathan - What drug company do you work for that creates your own conflict of interest? Pfizer? Schering-Plough? Merck? Astra Zeneca? Other?
Nathan
BDM,
Doug was the one critisizing conflicts-of-interest. I was not. If you critisize someone else’s COI’s, I think you should also point out your own COI’s. Doug didn’t take this step, so I did it for him.
Anyway, for what it’s worth I’ve been very clear on this site about my own conflicts-of-interest: I work for a top-10 drug company - I’d rather not specify which one. I could list my other (personal) conflicts, but no one seems interested… The only interest on this site seems to be in financial ties to the pharma industry.
Perks
Biederman and co are key opinion leaders with conflicts of interest which strongly appear to be the main motives behind why they have used their influence to create health risks for children on a wide scale, where they should have used them to improve the health of children.
HorusCat
Nathan,
The only important conflict on this site is that which anyone who works for or with pharma might have. Fortunately, and something I lose sight of if I spend too much time here, most physicians understand the value of pharma, appreciate the work we do to educate patients and support advocacy groups, know that drugs don’t sell themselves and that profits from drugs drive further research, and are capable of listening to a drug detail without swallowing the spin hook, line and sinker.
I had a great example of this today: I took a speaker to an office. Before he started to share his experience with my med (and the whole class of these meds), I said–the goal here is for you to choose XXX for all your patients. We all started laughing–and my speaker said, “That’s the sell. Here’s the science.” And we went on from there. At the end, the physicians there thanked me and the speaker–they got a new perspective on the disease state, they got all sorts of prescribing tips that didn’t have anything to do with my drug, they learned about new research (not all of it medication-related), and they confirmed what my company already knows: most doctors don’t think of my drug for this particular indication, because it has not been marketed for the indication. So the assumption that physicians already know everything they need to about every drug out there–and that they will do all the necessary research on-line and through networking is clearly a mistaken assumption.
You are doing good work, Nathan. I desperately want you to solve the Alzheimer’s dilemma before I get any older. My husband is absolutely convinced he is getting AD (he is 47)–and he is more than 80% serious when he says he will kill himself if he develops the disease.
Perks
Biederman, Wilens and Spencer failed to disclose their consulting fees from the drug industry which were ‘at least’ $4.2 million between them.
Biederman, Wilens and Spencer and Harvard Mass General have been highly influential advocates of children being prescribed unapproved drugs with well known toxicity levels.
Furthermore, Biederman & colleagues have attempted to counteract future criticism and consequences to themselves of advocating off label unapproved use of these drugs in children, by aggressively promoting the idea that young children suffer from bipolar disorder. As a result there has been a rapid rise in diagnosis and prescriptions to children. Rebecca Riley was diagnosed at the age of 2 by a psychiatrist who stated she was following Harvard-recommended guidelines. Rebecca Riley died from drug toxicity age 4.
The drugs with serious risks attached advocated for use in children are made by the drug industry from whom Biederman, Wilens and Spencer received the $4.2 million.
The $4.2 million they dishonestly, and in violation of federal law, failed to disclose.
Doug Bremner MD
Nathan said “Doug, It’s fine for you to write in and criticize the standard cardiology guidelines for statins. You correctly point out that “Key Opinion Leaders” in this field have conflicts of interest. However, you left out some key pieces of information about yourself that are important to people reading your post…”
1. I post my conflicts of interest on my website which can be accessed simply by clicking on my name associated with this post or by going to the bio at dougbremner.com.
2. Yes I did write the book you mentioned (thanks for the plug) and yes I do receive royalties although probably not as much as you think
3. I made a lot more money in my days giving talks for pharma but that quit by mutual agreement because I didn’t feel comfortable/didn’t think it was ethical to give talks where I had no say over the slide content, something that was claimed to be due to the need to have slides ‘vetted by the FDA’ which I don’t really believe, but maybe someone could comment on that).
4. The book probably isn’t as radical or dangerous as you might think but my guess is that you haven’t read it and just go by the title, but we have argued about this before and so be it. Again, people who read it don’t think it is such a big deal.
5. Yes I am a psychiatrist but also board certified nuclear medicine physician and read nuclear cardiology scans and do research in cardiology and therefore have some expertise.
6. I don’t think you need to be in a specialty to comment on a drug. That is the problem, the KOLs are the only ones that the media runs to and they are conflicted not just by pharma money but because their careers are often tied up in advocating for, e.g. screening for heart disease. Sometimes it helps to have an ‘outside perspective’, you know?
7. Fact is that US guidelines have twice as many people on meds as any other country. Why is that?
BAC
Nathan
If you work for Big Pharma, you automatically have a conflict of interest. The company pays your salary and it is in your best interest for it to do well. your livlihood depends on them.
Nathan
Doug writes:
“Fact is that US guidelines have twice as many people on meds as any other country. Why is that?”
While, it could be because the drugs work! Heart attack death rates have dropped dramatically over the last decade. Why? Most doctors attribute the drop to the use of cholesterol controlling drugs. What do you attribute the drop to? I don’t think Americans are any more healthy, fit, and less stressed than they were 10 years ago. Do you?
Nathan
BAC - of course I have a conflict of interest! Does that make my opinions irrelevant? I’ve been entirely open about what conflicts of interest I have. Whenever I point out other people’s conflicts of interest (like Doug’s), I also point out my own.
Doug Bremner MD
A lot of the reduction in mortality from heart attack is due to improved emergency responses
http://www.emaxhealth.com/93/22672.html
also blood clot dissolving drugs that can be given in the ER.
And half as many people smoke now as they did 30 years ago, an important risk factor for heart disease.
http://www.washingtonpost.com/wp-dyn/content/article/2007/11/08/AR2007110801094.html
And there has been a change in the American diet over time with less consumption of foods high in cholesterol. Sure, obesity has increased, but blood pressure and cholesterol levels have fallen.
http://www.cdc.gov/mmwR/preview/mmwrhtml/mm4830a1.htm
Also the decline in heart disease mortality began in the 1950s, before statins came on the market.
If you give 100 men a statin for five years, only one of them will be saved by a heart attack. So it isn’t possible that a 56% decline in heart disease mortality is attributable soley to statins. Not saying that statins had no contribution to make, but other changes should be put in perspective.
Doug Bremner MD
The fact is that declines in mortality from heart disease are related to a halving of smoking rates, decreased blood pressure and lower cholesterol, and improved emergency responding to heart attack over the past 30 years, as noted by the CDC.
http://www.cdc.gov/mmwR/preview/mmwrhtml/mm4830a1.htm
Since only one out of 100 men will be saved from a heart attack with a statin over 5 years (while three will have one even though they on a med) statins can’t account for the 56% reduction in cardiac mortality. Also the reduction in cardiac mortality began in the 1950s before statins came on the market.
Nathan
The study you pointed to was looking at rates through only 1999. Here’s a study that looks specifically at 1995-2004.
http://www.nlm.nih.gov/medlineplus/news/fullstory_62555.html
They found that 3% year-by-year reduction in death rate was largely attributable to drug therapy.
Here’s a quote: “After adjusting for various factors that could cloud the results, the study authors found that the prescription of drugs such as beta blockers, cholesterol-lowering statins, ACE inhibitors and the like may have been the primary reason for the improvement.”
(BTW, the study was NOT supported by the pharma industry)
Justice in Michigan
Nathan and Doug - I think you guys are talking about apples and oranges, or at least quite different kinds of apples.
The study Nathan cites was of secondary prevention - mortality in those who already had heard attacks. “The long-term survival of older Americans who have heart attacks,” says the article.
I think there are very few who question the value of a range of meds in secondary prevention/post MI mortality.
Atlex
Doug,
A couple of responses to your email. First, those of us who read your comments on this site are aware of your self-reported COIs. I think Nathan is trying to make a point by his comment. We are regularly seeing KOLs and others lambasted by the media for making a public comment (eg, an Op-Ed) or publishing a paper and not listing every possible COI; of course in most instances their COIs are easily found on the web. There seems to be a double standard; if you say something pro-pharma or make a positive statement about a drug, you are expected to list every possible COI every single time even if they are publicly available. If you make an anti-pharma statement or a negative statement against a drug, there seems to be no expectation for a listing of COIs.
The second point concerns your point regarding speaker program decks. At my company, there are very strict requirements that forbid speakers from making changes to slides. Certainly there are concerns about the FDA, but of equal concern are the possibilities that the speak may discuss off-label uses for the drug. From an OIG perspective, the speaker is considered an extension of the company, thus an off-label discussion could lead to Neurontin-like situations where the company is fined hundred of millions of dollars. I can understand your ethical concerns, but it is important to note the company has legitimate reasons for its approach.
Atlex
Jon
Most of you are idiots. You have judged and executed Biederman et al without due process. The NY Times article was yellow journalism at best and also attempted to turn innuendo into fact.
There is consensus, across the research community, in psychiatry, genetics, neurology, etc. that Biederman and his teams’ work is of the most professional and unbiased quality. His team has published as many papers identifying meds that have not worked as those that do.
This kind of witch hunting will only distract Biederman, and peers across this research community, and take them away from the important work they are doing.
I don’t claim that the pharmaceutical companies are not pushing meds or that doctors are not over prescribing but this is certainly not Biederman’s fault.
Personally, the real conflict of interest is between the FDA and the pharmaceutical companies.
You people are being irrational. How would like to be burned at the stake based upon unfounded accusations?
Laurie
“This kind of witch hunting will only distract Biederman, and peers across this research community, and take them away from the important work they are doing. ”
We can only hope! Biederman research is questioned by MANY in the psychiatric community. Drugging a two year old for two year old behavior is not “important work”.
BPW
Altex,
Unfortunately, there’s very little to be said about Big Pharma these days. Hence, the shortage of pro-pharma comments. They have dug themselves an “image” hole and it will take them a long time to crawl out. About the only people saying anything good are the highly-paid prostitutes called KOLs or persistently naive pharma employees.
As for slide decks, most companies have decks that need to be approved, but the problem is they don’t stick to them. They let speakers slip in new slides on recent research, use slides to answer questions. if that won’t work, they’ll direct the ‘unrestricted” educational grants or stick their noses in CME where they don’t belong. Face it,the industry is hopelessly corrupt and will remain so until it gets rid of all the MBAs who are running or controlling the companies.
BTW, Jon is a complete idiot. Probably works for s drug company pushing atypical anti-psychotics for every CNS condition known to man, and creating a lot of metabolic problems in the meantime.
Atlex
BPW,
You obviously don’t work for a pharma company, so how can you possibly know how most companies handle slide decks?
Atlex
Doug Bremner
Yes I was talking about primary prevention (meaning preventing the first heart attack in people at risk). I have no problem with giving statins with aspirin and beta blockers to those with a heart attack, although I will remind people that it won’t necessarily prevent another heart attack (although granted there is a statistically significant reduction in mortality). Also note that in these patients adopting Mediterranean diet and exercise work twice as good as statins (Trichopolou et al) for preventing heart attack recurrance.
My point was that for “primary prevention” the evidence for statins benefit is… meager. And the studies were done on people with multiple risk factors while the standard of practice in the US is to give statins to people with elevated cholesterol, no history of familial hypercholesterolemia, and no risk factors (no study has been done on this group, for good reason).
As for KOLs (we used to call them shining lights) we should ask, who are they? There is a mutually beneficial relationship between pharma and KOLs. Walk into a major medical meeting and there are posterboards advertising pharma sponsored talks by KOLs. Pharma can promote your career by putting into the minds of regular practitioners that you are a KOL. It is called promotion, marketing, public relations, what you will. At the risk of seeming self righteous, sour grapes, inviting ad hominem attacks, or whatever, I will say what are the objective criteria for a KOL? Usually in academia they use how many times your papers have been cited by others as measured by services like ISI. Are all the academics who meet these criteria equally called upon to consult to pharma? If not, why not?
As for giving talks with slides approved by the company, if OGI considers academics to be extensions of the company, what does this mean? That they accept that academics are mere pitchmen for pharma? Can’t pharma fund lectures in the interest of education and let them talk about what they want? I am confused. In any case I am not going to give any more lectures where the content of the slides is dictated by a pharmaceutical company, period. I don’t care what the rationale or justification is.
Perks
‘Can’t pharma fund lectures in the interest of education and let them [academics] talk about what they want?’
Apparently not. That in itself should give a clue as to why academic freedom is under threat.
HorusCat
Hi Doug,
“Can’t pharma fund lectures in the interest of education and let them talk about what they want?”
The answer is simple: it depends. If the talk is promotional in any way, NO. If the talk is educational, YES.
You are not the only one frustrated by the rigidity of promotional talks–our speakers are strictly bound to use only company-approved slides for DATA. They can use their own slides about disease state stuff, epidemiology, etc., but if they make any product claims, they have to use company slides. This is indeed to avoid the Neurontin-type debacle–any product claim has to be approved by legal, with an eye to not irritating the FDA. Whatever the speaker says about my product, it has to be within labeling guidelines. If a speaker deviates from the PI, I have to speak up and say “that was off-label and we do not advocate using our product in that way.” Then I have to report the speaker to legal. Two violations and he’s out. As I mentioned in an earlier post, we have random audits by 3rd parties. It does make the talks kind of boring; I think the pendulum has swung too far in the anti-Neurontin direction.
It used to be that we could sponsor particular speakers for educational talks–CME, Grand Rounds (which are usually CME), etc. We could pay a speaker’s honorarium or provide a grant. Now there is a strong Chinese firewall between sales and grant-funding, no matter what no-nothings like BPW say. A university can request a grant for grand rounds from a company, and the speaker can talk about the weather, if he wants. Of course, they usually ask for funding for a speaker in the area of interest of the company (i.e., asking UCB for funding for an epilepsy GR). We have absolutely no say in the content of the talk. And actually, most med centers go out of their way to keep the talks as non-medication oriented as possible. Another avenue some med centers take is to allow displays outside the GR auditorium. The display fees cover the cost of all the speakers throughout the year.
HorusCat
BPW,
Atlex is right. You don’t know what you’re talking about. Speakers can’t use any slides with data about the drug being promoted that aren’t provided by the company–and therefore approved by legal and on-label. This is part of PhRMA guidelines.
There are smaller companies playing the Neurontin game, but that’s because they can get away with it. The FDA doesn’t care about the Biogens pushing Tysabri first-line; they want Pfizer and Merck and Lilly. Better headlines and deeper pockets.
Perks
‘Can’t pharma fund lectures in the interest of education and let them [academics] talk about what they want?’
Not if the academic wishes to bring up relevant issues pharma do not want on the agenda.
HorusCat
Perks,
You don’t know what you are talking about. If my company provides grant funding for a grand rounds speaker, we have no control whatsoever over who is chosen or what he/she says. It’s not like anyone other than a rep is going to be there to watch over them. No one from the company is playing Big Brother, making sure the speaker doesn’t dis a drug.
Perks
‘Can’t pharma fund lectures in the interest of education and let them [academics] talk about what they want?’
Free speech or academic freedom is limited. For instance, pharma companies promoting lipitor would not welcome an academic speaker who wished to point out that ‘the evidence for statins benefit is… meager.’
Or that ‘patients adopting Mediterranean diet and exercise work twice as good as statins (Trichopolou et al) for preventing heart attack recurrance’.
Science must adhere to the aims and objectives of pharma regardless of its credibility.
HorusCat
Perks,
You’re just wrong. If Duke asks Pfizer for a grant to fund a GR on heart disease and cholesterol, they don’t have any restrictions on who the speaker is or what he can say. Like I said, he could get up and talk about NASCAR or global warming. He could say that he thinks Crestor is the cat’s meow and Lipitor is crap. He could say that cholesterol is a myth and prayer is the answer. No one at Pfizer gets to hear his talk or see his slides in advance. No one from Pfizer attends the talk and reports back to anyone on what he says. Hell, the reps probably don’t even go.
It’s ludicrous to think that a noted scientist would even talk about basic stuff like statins’ effects on cholesterol and heart disease. These ARE already trained physicians attending GR. They want to hear about new research and odd disease states. I funded many a GR before the firewall went up, and the speaker usually went off on tangents totally unrelated to my drug.
I know from my time with Pfizer selling Zoloft that we and other companies funded all the GR at my med center–and 75% of the talks weren’t about meds. They were given by psychologists, social workers, therapists and basic scientists, covering things like genetics, cognitive behavioral therapy, dialectic therapy, you name it. The doctors already know how the drugs work–they don’t need a primer in the action of SSRIs or cholinesterase inhibitors. I funded a GR speaker who touted CBT for OCD–and Zoloft was/is indicated for OCD. The speaker presented data showing that well-administered and slightly modified CBT is the most effective way to treat OCD in kids. No one from Pfizer asked me what the guy said.
If you are going to make assertions of fact, make sure you have the facts. Otherwise, you’re just engaging in polemics.
HorusCat
Perks,
BTW, what exactly are your credentials for expounding so knowledgeably on the industry? You work for the industry? Have worked for the industry recently, since PhRMA guidelines were put in place? Do CME for a university? Organize grand rounds? Apply for grants from companies? Are an academic who has been told he isn’t welcome to talk about the Mediterranean diet if Pfizer is paying his freight? Or just a pharma-basher eager to join in to a politically-correct orgy?
Odd how the pharma folks and those interested in actual conversation (such as Justice, Just A Thought, Jaynesday, CMC guy, M Helm MD) on the site are so up-front about their interests and motivations, while all the bloviating (how about that Justice?) anti-pharma wankers almost never reveal themselves–and never actually engage in dialogue, just sarcastic remarks and unsupported assertions.
BPW
Altex and HorusCat,
I actually do know what I’m talking about. I’ve worked as an MD in pharma for over 15 years. You are talking about what pharma should do and I’m speaking about what pharma does. They are supposed to follow rules, but many think that they’re meant to be broken. I’ve worked in medical Affairs and it is the biggest nightmare. The commercial crooks always want the MDs to sign off on illegal and unethical activities. It;s a constant battle. I don’t think that you know what really goes on inside.
The business people are impossible to deal with. That’s why i’ve switched back to R & D - it’s much more pleasant.
HorusCat
BPW,
Perhaps you need to change companies. I am good friends with a medical liaison (an MD) and she adheres rigorously to guidelines–as does every other liaison with whom I’ve worked.
I’ve seen funding for GR and CME speakers in action–and watched speakers talk about whatever they want. I have also seen that med centers refuse to use speakers who seem in any way to be promotional.
I just attended an all-day CME event funded by 5 companies with a dog in the fight, so to speak. The talks had nothing to do with the medications, except for one about pregnancy and medication use. So where was the big pay-off for the companies?
I’m not arguing that there are those on the commercial side who want to break the rules. You’re always going to have that, in every industry (look at good Sen Dodd and Countrywide). But as we shine a bright light on the instances where rule-breaking occurs, let’s not tar the entire industry with the same brush. The vast majority of us go about our jobs with integrity and sincerity. And let’s not assume that every person connected with the industry, whether as an employee or an outside researcher or KOL, is automatically corrupt when they advocate the use of medications. That’s what gets me about this: all the COI hoopla seems to suggest that anyone who advocates the use of a medicine is corrupt and can’t be believed–and yet we rely on these medications to treat disease. The logical conclusion of all this assumption of conspiracy and corruption is that we shouldn’t have medications and we certainly shouldn’t talk about how to use them.
I locate the root of the problem in the assumption that health care is a right that should be paid for by someone else–the obscurance of what health care costs and who is actually paying for it allows the waste and over-utilization to occur rampantly. Pharma, insurers, physicians, hospitals and patients take advantage of this shell game, because very few actually take the money out of their wallets to pay for their care. Make a patient pay for his Lipitor directly, and he may decide he’ll take the risk of an MI instead. Make him responsible for most of the cost when he does have an MI (probably due to overeating, not exercising and smoking), and maybe he’ll pay for the statin, eat a Mediterranean diet and stop smoking.
And let’s not lose sight of the fact that the vast majority of our health care dollars aren’t spent on drugs, anyway. They are spent on end-of-life care and over-utilization of testing and provider services. Pharma is an easy target–much easier than telling a family that grandpa is a vegetable and isn’t going to get heroic measures to keep him alive for another week so that family members can fly in from all over the country to see him lie there like a rutabaga before he finally is allowed to pass on. Or telling a young girl’s family that she isn’t going to get an organ transplant to keep her alive for 2 more months (Sen Edwards!).
Atlex
BPW,
I agree with HC, change companies or do something about what your company does. Frankly, outlier companies like yours hurt all of us. I know that in my company, noncompliance to these rules means automatic dismissal. Moreover, I’ve seen such dismissals happen.
Atlex
Justice in MI
For Atlex and HC - Is it conceivable that compliance (and consequences for noncompliance) varies within different teams within the same company, depending on a range of factors (importance of product in portfolio, who happens to be in charge at that level, etc.)?
Genuine question, tied into other thread about company structure.
Atlex
Justice,
Anything is possible; however, at my company the processes have been standardized, making it very difficult to abuse the system for very long. The grants system for CME and other similar activities has been completely divorced from the speaker’s programs. Each speaker’s programs is standardized with approved slides that cannot vary. Speakers are allowed to answer questions that arise from the audience, but are required to note that the answer comes from their own experience. They then must return to the approved slides. If the speaker does not follow “the script”, a company representative is expected to file a report. Moreover, 3rd parties regularly audit these programs to ensure compliance.
Do abuses happen? On occasion I guess. But they are likely rare because of the consequences. I’m pretty confident that most of the majors have similarly rigorous programs that will become more rigorous following the release of the forthcoming revision of the industry’s Code of Conduct.
Atlex
Perks
On the topic of conflicts of interest, there is an interesting audio interview with Melody Petersen that was aired on June 12 that can be listened to at onpointradio http://www.onpointradio.org/shows/2008/06/20080612_a_main.asp
Its called ‘This hour, On Point: Our daily meds, and a nation hooked on prescription drugs.’
Melody found ’shocking conflicts of interest. Medical professionals co-opted by drug companies for shady research and non-stop marketing. It looks like a scandal of pushers.’
Atlex
Perks,
Did Melody mention her COI? She has one you know–she wants to sell books! That is as much a COI as a KOL working with a pharma company. It doesn’t make her right or wrong, but it would be hypocritical for her not to admit it and self-serving if she doesn’t mention it as a precursor to her statements. I’d also be interested to know if she has other nonfinancial COIs.
Atlex
Perks
Atlex, as you most likely saw from my comment, it is made perfectly clear that she is the author of Our Daily Meds on the webpage the audio link is on.
Dr Carlat is also a guest and discusses talks, a drug rep brings up issues they do here including the topic of golf trips not taking place and much more. There is a mention of how one person every 5 minutes dies due to taking a prescribed drug.
You may like the interview, it is fairly long and there is a lot to it.
Perks
Melody Petersen’s book is also mentioned at length at the beginning of the audio, there is no non-disclosure here. http://www.onpointradio.org/shows/2008/06/20080612_a_main.asp
Jon
First of all. Biederman has never drugged a 2 year old for 2 year old behavior. This an outright lie.
Secondly, I have nothing to do with pharmaceutical companies, or medicine, or government, etc. I am much more qualified than that. I have a bipolar daughter who was initially diagnosed at age 6 and we received 2nd and 3rd opinions at Stanford (Steiner) and USF. We then read all of the available research (which 12 years ago was maybe 2 inches thick) and learned about all the meds that existed and as new ones as they became available.
At age 8, after all other less drastic options had been exhausted, and our daughter was still suffering terribly (at age 6 she would write notes to us begging us to kill her so she wouldn’t be in pain anymore) we began trying medications. After about 4 years, and 2 hospitalizations, we found a combination of meds that nearly eliminated her manic and aggressive behaviors. She was not subdued or a zombie. She was relieved.
If we had not opted to take the risks associated with these meds we are sure our daughter would be dead today. Suicide rates for untreated BP are the highest of all severe mental illness (around 18%).
Dr Biederman and the other dozens of researchers across the country, who also get funding and consulting fees from pharmaceutical firms, enabled my daughter to have this medical option.
I have read his and all the other BP pediatric researcher’s work and his team is clearly one of the most significant contributors to the field.
Most of the subjects in his longitudinal studies are not his patients. Many of the subjects are taking no medications at all. The research is just starting to include genetic correlations in conjunction with the Broad Institute. This will certainly lead to much better diagnostics and treatment that is clearly very subjective at this point.
I have never disagreed about the conflict of interest that exists because the pharmaceutical companies providing so much research funding. Given the NIH’s reluctance or inability to provide the necessary funding there no better option.
Finally, why is Biederman responsible for the explosion of BP diagnoses and treatment? He didn’t train these doctors? He didn’t treat these children?
If some researcher publishes findings about a new diabetes treatment and some doctor reads it and prescribes these new meds why is the original researcher responsible for the outcome? The researcher doesn’t approve medications. This is the job of the FDA.
If someone wants to prescribe something off label they better know more than just reading an article or talking to a drug rep. Also, the patient should be asking questions like, “What is your experience level with this medication? How many people have you diagnosed and treated with this medication?” etc.
Unfortunately, in today’s world of medicine, the patient needs to be a strong advocate for their children and themselves. Just because someone has a MD stuck at the end of their doesn’t make them necessarily the best resource for every kind of disease or treatment.
truthman30
Hi Jon..
While I do sympathise with your situation..
you should be aware that it was not too long ago that psychiatrists were adamant in their view that “depression” could not exist in children… I am sure it was the same with Bipolar disorder…
This was before the psychiatric drug cartels though…
Why the xplosion in diagnosis of “bipolar in kids”.. Follow the money trail and find out..
These “labels” are used now as a convenient “catch all” diagnosis for a range of different behaviors in children..
What ever happned to children just being sensitive or over sensitive or shy or just different?…
You should research psychiatry a bit more..
You would be horrified if you did…
Maybe you should start with reading this letter of resignation from Loren Mosher, a well known psychiatrist who resigned in disgust…
http://www.critpsynet.freeuk.com/Mosher.htm
Loren R. Mosher M. D.
2616 Angell Ave
San Diego, CA 92122
December 4 1998
Rodrigo Munoz, M.D., President
American Psychiatric Association
1400 94 Street N. W.
Washington, D.C. 20005
Dear Rod;
After nearly three decades as a member it is with a mixture of pleasure and disappointment that I submit this letter of resignation from the American Psychiatric Association. The major reason for this action is my belief that I am actually resigning from the American Psychopharmacological Association. Luckily, the organization’s true identity requires no change in the acronym.
Unfortunately, APA reflects, and reinforces, in word and deed, our drug dependent society. Yet, it helps wage war on drugs. Dual Diagnosis clients are a major problem for the field but not because of the good drugs we prescribe. Bad ones are those that are obtained mostly without a prescription. A Marxist would observe that being a good capitalist organization, APA likes only those drugs from which it can derive a profit - directly or indirectly.
This is not a group for me. At this point in history, in my view, psychiatry has been almost completely bought out by the drug companies. The APA could not continue without the pharmaceutical company support of meetings, symposia, workshops, journal advertising, grand rounds luncheons, unrestricted educational grants etc. etc. Psychiatrists have become the minions of drug company promotions. APA, of course, maintains that its independence and autonomy are not compromised in this enmeshed situation.
Anyone with the least bit of common sense attending the annual meeting would observe how the drug company exhibits and industry sponsored symposia draw crowds with their various enticements while the serious scientific sessions are barely attended. Psychiatric training reflects their influence as well; i.e., the most important part of a resident curriculum is the art and quasi-science of dealing drugs, i.e., prescription writing.
These psychopharmacological limitations on our abilities to be complete physicians also limit our intellectual horizons. No longer do we seek to understand whole persons in their social contexts rather we are there to realign our patients’ neurotransmitters. The problem is that it is very difficult to have a relationship with a neurotransmitter whatever its configuration.
So, our guild organization provides a rationale, by its neurobiological tunnel vision, for keeping our distance from the molecule conglomerates we have come to define as patients. We condone and promote the widespread overuse and misuse of toxic chemicals that we know have serious long term effects: tardive dyskinesia, tardive dementia and serious withdrawal syndromes. So, do I want to be a drug company patsy who treats molecules with their formulary? No, thank you very much. It saddens me that after 35 years as a psychiatrist I look forward to being dissociated from such an organization. In no way does it represent my interests. It is not within my capacities to buy into the current biomedical-reductionistic model heralded by the psychiatric leadership as once again marrying us to somatic medicine. This is a matter of fashion, politics and, like the pharmaceutical house connection, money.
In addition, APA has entered into an unholy alliance with NAMI (I don’t remember the members being asked if they supported such an organization) such that the two organizations have adopted similar public belief systems about the nature of madness. While professing itself the champion of their clients the APA is supporting non-clients, the parents, in their wishes to be in control, via legally enforced dependency, of their mad/bad offspring. NAMI, with tacit APA approval, has set out a pro-neuroleptic drug and easy commitment-institutionalization agenda that violates the civil rights of their offspring. For the most part we stand by and allow this fascistic agenda to move forward. Their psychiatric god, Dr. E. Fuller Torrey, is allowed to diagnose and recommend treatment to those in the NAMI organization with whom he disagrees. Clearly, a violation of medical ethics. Does APA protest? Of course not, because he is speaking what APA agrees with but can’t explicitly espouse. He is allowed to be a foil; after all he is no longer a member of APA. (Slick work APA!)
The shortsightedness of this marriage of convenience between APA, NAMI and the drug companies (who gleefully support both groups because of their shared pro-drug stance) is an abomination. I want no part of a psychiatry of oppression and social control.
Biologically based brain diseases are convenient for families and practitioners alike. It is no fault insurance against personal responsibility. We are just helplessly caught up in a swirl of brain pathology for which no one, except DNA, is responsible. Now, to begin with, anything that has an anatomically defined specific brain pathology becomes the province of neurology (syphilis is an excellent example). So, to be consistent with this “brain disease” view all the major psychiatric disorders would become the territory of our neurologic colleagues. Without having surveyed them
I believe they would eschew responsibility for these problematic individuals. However, consistency would demand our giving over “biologic brain diseases” to them. The fact that there is no evidence confirming the brain disease attribution is, at this point, irrelevant. What we are dealing with here is fashion, politics and money. This level of intellectual/scientific dishonesty is just too egregious for me to continue to support by my membership.
I view with no surprise that psychiatric training is being systemically disavowed by American medical school graduates. This must give us cause for concern about the state of today’s psychiatry. It must mean, at least in part, that they view psychiatry as being very limited and unchallenging. To me it seems clear that we are headed toward a situation in which, except for academics, most psychiatric practitioners will have no real relationships, so vital to the healing process, with the disturbed and disturbing persons they treat. Their sole role will be that of prescription writers, ciphers in the guise of being “helpers”.
Finally, why must the APA pretend to know more than it does? DSM IV is the fabrication upon which psychiatry seeks acceptance by medicine in general. Insiders know it is more a political than scientific document. To its credit it says so, although its brief apologia is rarely noted. DSM IV has become a bible and a money making best seller - its major failings notwithstanding. It confines and defines practice, some take it seriously, others more realistically. It is the way to get paid. Diagnostic reliability is easy to attain for research projects. The issue is what do the categories tell us? Do they in fact accurately represent the person with a problem? They don’t, and can’t, because there are no external validating criteria for psychiatric diagnoses. There is neither a blood test nor specific anatomic lesions for any major psychiatric disorder. So, where are we? APA as an organization has implicitly (sometimes explicitly as well) bought into a theoretical hoax. Is psychiatry a hoax, as practiced today?
What do I recommend to the organization upon leaving after experiencing three decades of its history?
1.. To begin with, let us be ourselves. Stop taking on unholy alliances without the members’ permission.
2.. Get real about science, politics and money. Label each for what it is - that is, be honest.
3.. Get out of bed with NAMI and the drug companies. APA should align itself, if one believes its rhetoric, with the true consumer groups, i. e., the ex-patients, psychiatric survivors etc.
4.. Talk to the membership; I can’t be alone in my views.
We seem to have forgotten a basic principle: the need to be patient/client/consumer satisfaction oriented. I always remember Manfred Bleuler’s wisdom: “Loren, you must never forget that you are your patient’s employee.” In the end they will determine whether or not psychiatry survives in the service marketplace.
Sincerely,
Loren R. Mosher M. D.
——————————————————————————–
Note: Dr Mosher has an article in the October issue of Psychology Today magazine, in which he explains why he resigned from the American Psychiatric Association
Laurie
Jon, the decision you made for your daughter, was your’s to make. And as long as you made it being fully informed of the risks and benefits, that is your decision. If you were informed that these drugs may not “work” forever, that they may have permanent neurological side effects, that they may cause diabetes/liver damage and that they did not show efficacy in clinical trial in children your childs age and that risk vs benefit was worth it for you and your daughter then that’s your decision.
Sadly, most parents don’t get all this information and make decisions based on speculation by the doctor, and most don’t realize that long term use of these drugs is not studied or documented.
Behavioral/cognitive therapy in children is extremely effective in most cases.
I’m sorry for what you have gone through with your child. You made the decision that you think is best for your child.
I still believe that Biederman and his philosophy is dangerous and that will only be born out on the futures of his current patients.
Jon
I appreciate your rational response. My initial reactions and post were to the unproven accusations and mob mentality that seemed to pervade most of this blog.
Like most very polarized debates, I find myself somewhere in the middle. There is certainly a conflict of interest between the pharmaceutical companies and those that depend upon them as a funding source for research and income. This is caused by the lack of sufficient funding from any other source.
On the flip side, there are many if not most research groups performing important and valid research collecting data on a large number of children and adults. This initial research (almost nothing was going on 10-12 years ago) is primarily focused on trying to determine better diagnostics. The medicines that are used by those subjects, taking medications, is just another variable and sometimes a clue as to the efficacy of a particular diagnosis.
In the last 2-3 years, thanks to the longitudinal studies like Biederman et al, there has been the earliest analysis of genomes from the DNA samples collected over the last 10 years. Collecting a sufficient number of samples is always the biggest challenge of any genetic investigation. This 10 year collection may in itself be the biggest contribution towards a more definitive diagnostic mechanism and root cause breakthrough.
Ultimately, when I look at my personal situation I didn’t really care what my daughter’s diagnostic label was. We received multiple diagnoses along the way but in the end we realized that our only, undesirable, option was to try medications. We were traumatized for months and years having to administer these powerful medications to our child. However, we knew the alternative was worse and we prayed that we would beat the odds.
I certainly don’t consider this a hard science at this primitive a stage in the discovery cycle. If the pharmaceutical companies are portraying it that way it is a major problem. Given the FDA’s conflict of interest with the pharmaceutical companies I don’t see further government intervention helping very much.
This still doesn’t mean parents should not have the option to consider medications for children with severe mental illness. I am not talking about kids being disruptive in school. I am talking about kids like my daughter, who at age 5 kicked the windshield out of our car when we were trying to get her to school. I am not talking about kids that disobey their parents. I am talking about kids like my daughter who at 6 destroyed most of the prized possessions in her bedroom and then sobbed for hours in our arms full of remorse and confusion.
So to use a very overused cliche I worry that many justifiably angry parents and misdiagnosed children want to throw out the baby and the bathwater. I think a more rational analysis of the situation (by god knows who) is needed to determine the good medicine from the bad.
Jon
Laurie,
Thank you for your considerate response as well. It is difficult, and nearly impossible, to generalize from my specific situation, to the community of children and parents at large that are concerned about or victims of misdiagnoses.
I think there is a complex set of issues at work here. It seems that many people are pointing fingers, specifically at the likes of Biederman. From all of the research I have read from his group I have never perceived a pharmaceutical bias. They have produced evidence for and against the effectiveness of a wide range of medications. As I stated in another post, a large minority of the subjects have never been on medications and others have stopped medication.
I would not be surprised the pharmas are using even slightly positive results to promote their wares. Why is this Biederman’s responsibility?
Should he stop all his research, which is slowly advancing the knowledge base, because the pharmas might be pushing these meds with the general medical community? My answer to this is ‘no’. There needs to be another remedy.
IMHO I think education is where the most opportunity lies. Education of the general public about mental illness of children and adults. This was so stigmatized up until our generation that there are more myths than facts floating around.
There need to be more child psychiatrists. This may be the most difficult problem to solve. The insurance companies, governed by state parity laws, are just starting to cover therapeutic treatment like any other illness. There is little monetary security in becoming a psychiatrist (they don’t need to be rich but certainly deserve salaries akin to other medical fields).
Also, no insurance company is willing to pay for long term therapeutic outpatient or inpatient programs. We (me, my wife, and daughter) are about to consider a 6-9 month intensive therapeutic program for our daughter (she turns 18 next month) that will cost between $200-400,000. We are fortunate in being able to afford this by eating up her college savings fund and downsizing our lifestyle to the bear necessities. We have no regrets about spending this money if we determine it is likely to make a significant difference in the quality of our daughter’s life.
There are maybe 2-3 programs like this in the world in a large part because nobody can afford them and the insurance companies pay for a small fraction of the cost. Is there any wonder why so many parents find themselves in a corner having to take the risk of trying a medicine that may not help and might even cause other problems?
As a parent of a very sick child, and now young adult, I am abhorred by the state of things. We are the richest and most advanced country in the world and too many children, and their parents, are suffering the consequences of this complex situation. I hope that a rational dissection of the situation, identification of all the problematic elements, and the first steps of correction are taken to move things forward.
truthman30
“So to use a very overused cliche I worry that many justifiably angry parents and misdiagnosed children want to throw out the baby and the bathwater. I think a more rational analysis of the situation (by god knows who) is needed to determine the good medicine from the bad.”
Hey John…
As I said , I do totally sympathise with your plight , but I am of the view that “behavioral problems” in kids are complex and drugs may subdue, calm or modify this in order to make it seem like they work , but that doesn’t mean that the underlying personality traits are being dealt with.
And I understand parents have little choice..
It is an awful predicament..
I hope you find a way..
Maybe a nutritionist or holistic practicioner could help?..
HorusCat
Jon,
Despite what you read from the polemicists on this site, pharma isn’t out there telling psychiatrists to drug 2 year olds. I know because I have skin in the game on both sides–I am a rep who has sold atypical antipsychotics and SSRIs and the mother of an autistic child. While my son’s behavior has not been as obviously destructive as your daughter’s apparently was, his behavior is explosive and aggressive enough that he himself is disturbed and confused by it. And while ongoing behavioral therapy and counseling help him tremendously (and learning different parenting strategies for us), a low dose of an atypical is the final piece of the puzzle for him. What breaks my heart for him is that he feels different from everyone else–because he knows that he is, as his psychiatrist puts it, “a cat living in a dog world.” As he enters adolescence and a time where kids want to be as much alike as possible, he is growing more and more cognizant of his differences. The medication helps him control the extremes of his behavior, and the therapy is helping him, I hope, learn to celebrate his differentness.
HorusCat
Jon,
Also, as your obviously intensive research has shown you, these “personality traits” and behaviors are to a large extent genetically determined. Nature presents the possibility of what we see as flawed neural functioning (because in a civil society, certain behaviors ARE ok, and certain ones aren’t), and other factors then interact with the genes to produce what we call mental illness. I had a terrible infection about week 20 of my pregnancy, and I often wonder if that injury to my system is part of why my son is autistic.
It makes perfect sense to me that judicious application of chemicals may help to reorganize neural connections. As we know, the chemicals we use aren’t very specific and have all sorts of other effects. That is why we must be prudent in our use of them. You obviously are a caring, informed and active parent–my best wishes for you and your family.
Matthew Holford
HC wrote:
“…The medication helps him control the extremes of his behavior, and the therapy is helping him, I hope, learn to celebrate his differentness.”
People tend to get angry when they’re afraid, I’ve noticed. People usually get afraid of stuff that they don’t understand. I’m not saying that’s your son, but it’s a possibility.
Matt
HorusCat
Hi Matt. Long time no see, so to speak. Often, yes, fear underlies anger. But I don’t always know how to interpret my son’s anger. I know why he gets mad when I ask him to do something he doesn’t want to do, but I am more bemused by the anger he shows toward inanimate objects that don’t perform as he wishes them to. He has difficulty, as do we all, accepting responsibility for things that happen (like falling off his bike on the way to DQ), but I am not sure fear underlies that so much as childishness. Anyroad, the medication doesn’t stop the anger–it just gives us breathing room to talk about it and strategize how to deal with it. And it tends not to last as long as when he is unmedicated. He knows that ultimately, he has to learn to control himself; no medication or person is going to do that for him. It’s hard though, for one so young who has to learn all the regular lessons of growing up, to have extra obstacles through no fault of his own.
HorusCat
Huh. Just what we need. More rain. My feet are getting webbed.
Lisa Van S
Happy Father’s Day,.. to all!!!
Lisa Van S
Dr. B,…
Your book has been a big hit in my circle of family and friends,.. Thank You
Lisa Van S
Jon,
Unlike Laurie, im not as sympathetic. Your defense of Dr. Biederman leaves me with much suspician. A true identity of yourself will allow for credibility,.. until then,.. I take what you have to say with a grain of salt!!!!
Lisa Van S
HCat,..
Same goes for you!.. I dont buy your reasons for anonyminity. Like I have said in the past,.. you appear to be a Jack of all trades. You are a great story teller,.. for a “Man” that is.
Lisa Van S
Nathan,
Take your child to Dr. Biederman for an evaluation!.. and please let me know what you think!!
Jon
There isn’t a ‘right’ answer to any of these questions and issues. All entities involved in the process (or lack there off) of diagnosing and treating children are interested in a positive outcome. Because the science is so new there is an even larger rift between the most and least conservative (and everything in between) positions.
I completely understand the concerns about aggressive diagnosis and treatment potentially being as or more dangerous as doing nothing or only providing cognitive therapies for children that are on the fringes of normal behavior.
However, I also believe that there are children well beyond the fringe where aggressive treatment is the better alternative. I think these are two different situations, requiring different strategies, even though they may exist on the same continuum.
We are probably atypical parents and have constantly questioned every experts’ opinion until we were satisfied that there was a sound basis for their advice. We also dedicated ourselves to reading about every kind of treatment available and all the medicinal and neurological research. We even got some access to research in progress.
We also researched and tried nutritional changes, holistic options, yoga, exercise programs, and relaxation therapy. Our family was one of the first, with a BP child, to go through a family training and therapy program for dialectic behavior therapy designed for adolescents. All of these have contributed in some way to help our daughter and help us as a family to cope and succeed to a much greater extent than we thought possible 10 years ago.
I would estimate that 90% of the progress made by our daughter was not the result of medicinal treatment. However, this progress would not have been possible without the first 10% that came from finding an optimal combination of medications to reduce the aggression and pain to a level where other therapies could begin to help.
Lisa Van S
Jon,.. Like I said,.. reveal who you are. For all we know,.. you could be Dr. Biederman, making an attempt to defend himself!! Until you disclose yourself,.. you hold no credibility!!
Jon
Give me a break. Who nominated you judge and jury? What have I said that is so controversial? I am not trying to defend Dr Biederman - I am defending being reasonable about the issue in general. Biederman is just the witch that is being burned in effigy today. Tomorrow it will be someone else.
I am concerned about how polarized an issue this has become. I worry that this level of controversy may have unintended consequences (or intended in some cases) of further diminishing funding and interest in the necessary scientific research required to better understand and treat mental illness in children.
I have a very parochial concern that this will further reduce the chances of ever finding something that might be more helpful than generalized medicines with serious side effect risks, years of therapy, and prayer. I think other parents, with very ill children, want the same thing. Dr Biederman doesn’t seem like the devil that you and others portray him. Have you read any of his groups’ research? What specifically, in his research, do you think is biased or prejudiced by the funding he receives from the pharmaceutical companies?
I am just another parent who will do anything possible to help my child. I am defending science. I am defending rational analysis of the issues and stepwise improvements in what appears to be a very dysfunctional system. Let’s try and take some of the emotion out of the debate, stop throwing darts, and start suggesting concrete measures to improve the situation. Small, measurable steps that are achievable. How can you be threatened or offended by this suggestion?
And explicitly, you are probably the last person I would identify myself to. You scare me.
HorusCat
Jon,
I should have warned you. There are certain people who will not offer you reasoned conversation, only condemnation and judgment. If you want, you can email me at cathorus@yahoo.com.
Lisa,
I don’t worry about my credibility with you, because you are not the one with whom I am interested in having a conversation; I don’t care about your suspicions because they don’t rob me of an eyelash. You are scary–I can imagine letting you know who I am and having you call my company. No thanks.
AA
Jon,
I am curious, did your child exhibit an extreme sensitivity to noise at a very early age like around 1?
The reason I am asking is that Max Blake, the kid with BP, featured in Newsweek, had this issue. I am wondering if many kids diagnosed as BP instead have sensory integration issues, which aren’t as well understood?
My interest in this is even before I was placed on psych meds, I wondered if I had these issues. Unfortunately, one of the side effects of the meds is that it considerably worsened my problems along with a hearing loss so at this point, I don’t really know what is what.
But I can tell you that last week, I had lunch with someone in a public place where people were moving chairs that were screeching. It bothered me so much that let’s just say my thoughts weren’t very pleasant. Of course, I would never act on them but I could literally see kids sensitive to noise wanting to do some of the things that have been attributed to kids with BP.
I know that many experts believe that sensory problems are part of BP but I strongly disagree. Neurodevelopmental differences do not equate to mental illness.
This isn’t a rant against you by the the way, Jon.
Anyway, I would love to know if your kid had those problems. With my luck, you’ll probably debunk my theory.
AA
Matthew Holford
HC wrote:
“…but I am more bemused by the anger he shows toward inanimate objects that don’t perform as he wishes them to…”
Sorry, I forgot to say “hello”!
I can only speak for myself, but inanimate objects really piss me off! It’s not so much that I *wish* them to “perform” in a certain way, but that I *expect* a certain thing to happen. There’s probably a theory about this, but, say, if I stub my toe, because I’ve not judged where an obstacle was properly, or I’ve not even seen the obstacle, then I might immediately TRANSFER my anger (fear, whatever), onto the object. The object, of course, has no say in the matter, at all - it was my responsibility to avoid it, and I failed. But I cannot admit my failure, and learn from it, because during my life I have learnt that if I admit that I have failed, rather than blame something/body else, others will begin to build up a picture in their minds (for their own reasons), of me as a failure, in totale. I would then be perceived as somebody unreliable, who could not be trusted not to fuck up. For the same reason, I may not ask how I may do something that I’m crap at, because that would be an admission that I am deficient, in some way.
Behavioural traits are horrible things.
Matt
Nathan
HC wrote:
“…but I am more bemused by the anger he shows toward inanimate objects that don’t perform as he wishes them to…”
I really think this is a “male” trait. I have the same issue from time to time. I’ll get so mad at a tool that isn’t performing properly for my application that I’ll throw it away or beat it against the ground! I’ve met quite a few men over the years who do similar things. However, I’ve never met a female who reacts that way. I’m sure it’s an overgeneralization, but from my experience women get mad at “relationship” issues, while men tend to get more angry at “performance” issues.
truthman30
“It makes perfect sense to me that judicious application of chemicals may help to reorganize neural connections. As we know, the chemicals we use aren’t very specific and have all sorts of other effects. That is why we must be prudent in our use of them. You obviously are a caring, informed and active parent–my best wishes for you and your family”
It migth make perfect sense to you HC, but your sense and “common sense” really are quite different now aren’t they?..
“reorganize neural connections”?..
You a really are quite mad aren’t you?..
So after 14 years of SSRI use HC , how are your neural connections doing? Are they a nice corkscrew shape?, how mushy has your grey matter become?
“As we know, the chemicals we use aren’t very specific and have all sorts of other effects” ..
You can say that again HC! …
How about the cause “brain damage” , wouldn’t that be a more honest statement? ..
“I am a rep who has sold atypical antipsychotics and SSRIs and the mother of an autistic child” ..
I have to say, I fear for your child, with a mother who is willing to sell brain damaging drugs to make a living , you might as well be out there selling crack cocaine…
CMC guy
HC I concur with Nathan but take it a step further that it may be linked to male genes as is wide spread in my family with variations in intensity and triggers. MSWord infuriates me constantly and I have to close office door at times so people don’t think I have gone nuts. Could be environmental reinforcement since still harder for males to express emotions in dealing with interpersonal relationship (as you know magnified in autism) so often frustration builds and comes out against defenseless target.
CMC guy
truthman brain chemical imbalances is the prevailing scientific common sense so targeting drugs that repair or manage is a viable approach. Granted there are problems with insufficient knowledge, poor models and unattended consequences so is a difficult area. Your option it is seems would be to do nothing and let people suffer rather than attempt to provide treatments that can be of benefit with varied degrees of risks.
truthman30
“truthman brain chemical imbalances is the prevailing scientific common sense so targeting drugs that repair or manage is a viable approach. Granted there are problems with insufficient knowledge, poor models and unattended consequences so is a difficult area. Your option it is seems would be to do nothing and let people suffer rather than attempt to provide treatments that can be of benefit with varied degrees of risks”
No not at all CMC guy ..
Brain chemical imbalances WAS the prevailing common sense but it is not anymore..
And the chemical imbalance theory was hijacked and used as a marketing ploy in the early days of SSRI pharmaceutical marketing ..
It is a difficult area , but depression can be successfully treated with proper care, compassion and guidance…
The side effects of these drugs do not justify their over prescription ..
Many people become dependent on them and the withdrawals stop them from coming off them even after they feel the drugs provide no benefit..
I myself was prescribed Paxil for four years in my early twenties, I know how awful it is to experience torturous side effects and frightening withdrawal symptoms, I also know the pain of depression …
I should never have been prescribed Paxil..
It is dangerous and defective and I have met many people whose lives have been destroyed by these drugs, the long term affects are also another can of worms which nobody seems to want to address…
AA
“brain chemical imbalances is the prevailing scientific common sense so targeting drugs that repair or manage is a viable approach. Granted there are problems with insufficient knowledge, poor models and unattended consequences so is a difficult area. Your option it is seems would be to do nothing and let people suffer rather than attempt to provide treatments that can be of benefit with varied degrees of risk”
CMC, treating depression isn’t a meds or nothing type of solution. I am too lazy to find the links to the studies but fish oil capsules have shown to be effective for treating depression. They aren’t totally risk free but compared to the long term damage that ADS cause in my opinion, that would be an easy decision for me to make.
Even if someone was suicidal, depending on the situation, people might try fish oil capsules first. Of course, the provider would have to be very knowledgeable about alternative health. Just because I am in favor of it doesn’t mean I don’t realize that there are quacks in that area also. Also, the fish oil capsules that you buy at a store would have to be high quality and not what you would buy at your local CVS store.
Both fish oil capsules and antidepressants take about the same amount of time to fully work. So you’re not saving time by trying medicine first. That is why I feel the less risky remedy should be tried first.
And even though St. Johns Wort has not been proven to be effective for major depression, people still might want to give it a shot. When I foolishly cold turkeyed from Prozac, SJW immediately ended a severe depression I got as a withdrawal symptom.
Again, quality is important. When I research the herb, I found out that the percentage of this one ingredient, which I have forgotten, played a key role in quality.
St. Johns Wort is also not totally risk free and in my opinion, has more risks than Fish Oil Capsules. However, if someone held a gun to my head and made me pick between SJW and Prozac, it would be an easy decision for me to make regarding St. Johns Wort.
Don’t laugh but I feel people should spend a minimum of 10 minutes per day in direct sunlight. When I did that, it did wonders for my mood.
I realize there are concerns about skins cancer which I am not going to even get into or this post will be way too long. I guess if spending time in the sun concerns you, I would advise people to try a lamp that would give the same effect.
Some people have found that taking extra vitamin D helps. I never really found that to be true in my situation but many people have. There is a test you can ask your doctor for that will test your vitamin D level so you don’t end up taking too much.
I hope I have given people information that treating depression isn’t a meds or nothing situation. Obviously, I do feel there is some type of imbalance that causes these various states. But I don’t think it is chemical in nature and I feel that it is meds that cause the imbalance that people refer to.
By the way, I am speaking as one who feels the cure ended up worse than the disease as the result of being on a psych med cocktail. I started tapering off of 4 meds and am now down to 2. I expect I will be complete off everything in 2010 as I believe in a very slow taper.
AA
PS – This site, http://www.vitasearch.com is an excellent site. You plug in a term like, “depression” and it takes you to various studies showing the remedies that have worked. Even though it is sponsored by a vitamin company, the studies seem pretty mainstream. Of course, readers will have to be the judge of that.
AA
HorusCat
truthman,
Your personal attacks are uncalled for. You, Lisa Van S and pg remind me of the type of people who bomb abortion clinics or justify the slaughter of millions for the sake of a cause like Marxism. You really have no care for persons, only abstractions, as evidenced by your venomous expostulations toward anyone who disagrees with you. I think I shall start calling you Torquemada.
Nathan, CMC guy,
Perhaps you are right about the anger-at-objects being a sex-linked trait. I’ll have to give that some thought. Whatever the case, how would you suggest I help my son learn to channel the anger? It’s not the anger itself, perhaps, as much as it is the perseverating. I don’t know how to move him beyond the incident onto whatever the next step is.
harpy
I always thought “anger-at-objects” was caused by displaced aggression, more commonly known as “kicking-the-dog.” However, displaced agression is not a sex-linked trait although it does have a connection to emotional maturity. Go figure.
gobsmacked
HorusCat, your attacks on decent people are truly something to behold!
Horus Cat says ‘truthman. Your personal attacks are uncalled for. You, Lisa Van S and pg remind me of the type of people who bomb abortion clinics or justify the slaughter of millions for the sake of a cause like Marxism.’
truthman30
Horus Cat ..
I was just making you aware that cosidering you have been on SSRI’s for the past 14 years, maybe your judgement is not what it used to be… And also considering you sell these meds and see no problem with it, readers should be aware of that too…
You see the difference between me and you HC is I was on the meds at one time for four years, but I decided the side effects were not worth the “benefits”.. And when I say benefits I use that term in the loosest possible
sense…
The only benefits I found from my use of SSRI drugs was, I was too out of it , sleepy and drugged up to really care if I was depressed or not and also too numb to even care where the original problems came from.. I was too whacked out in a Paxil haze to give a damn about anything really… Is that a solution to the human condition? … Hardly..
SSRI’s are an illusion HC, they are trickery, and they are fraud..
Effectively what I was doing without realizing it was disabling my thoughts and emotions, disconnecting myself from the real me… I was solving nothing, expecting and depending on a pill to make all the bad stuff go away…
But the bad stuff never goes away, because the world is not disneyland, and no matter how many SSRI’s you shove down your neck, the world will always be unfair and cruel…
It has been 6 years since my paxil withdrawal and I can honestly say that although life is a bitch , at least I am living it without the use of chemical crutches…
And yes, I do attack those who promote these meds..
And yes, I do attack those who spread pharma propaganda such as the defunct “chemical imbalance theory”..
And yes I will continue to do this until the lies and deceit stops…
Because HC, I know what damage these meds do to people, and I am not whacked out on an SSRI , I have my faculties and my have reclaimed my own mind.. Can you say the same for yourself?…
Matthew Holford
HC wrote:
“…Nathan, CMC guy,
Perhaps you are right about the anger-at-objects being a sex-linked trait…. I don’t know how to move him beyond the incident onto whatever the next step is.”
I’m not quite sure if you deliberately excluded me from your reply, but I’ll respond, anyway. There is a logic behind what your son does; of that I’m as sure as I can be. He needs an alternative to that way of dealing with the thing (whatever it is), that’s all.
Focus on the thing he’s angry about - never react to the WAY he has communicated the “problem” that he has perceived (you could ask him not to shout, or scream (if he does that), because it’s not necessary, as you’re listening, anyway). Ask him what the problem is, and then try to fix it. If you’re unable to fix it, it doesn’t really matter, because if my guess is right, the very fact that you tried will be enough.
Matt
HorusCat
Matthew,
Of course I didn’t deliberately leave you off, goose! Your words are wise–we do try to help him articulate what is going on, without harping on the fact that he is angry. We do, of course, set limits on how he can express the anger–hitting and cursing is not ok. The journey he has to make is one we all have to make–things go wrong, people don’t always do what we want, sometimes people are mean, etc.–and while we can be angry about it, we can’t hurt people or destroy things because of it. Eventually, of course, we want to arrive at a place where we don’t even get angry so much. This learning process is not easy for most of us (Buddha had it down, apparently), but it is especially difficult for those of us who are not, as my sister says, “neurotypical.”
Thank you for your kind words and insight, Matthew. It’s so ironic, because this one of my children is the most kind-hearted and empathic of all my kids!
truthman,
Your experience is just that–YOUR experience. What I object to is your assumption that your experience must be mine, and if I disagree, it is because I am brain-damaged. That very cutely renders anything I say immaterial, since I am obviously in my right mind if I agree with you and crazy if I don’t. Whatever–your tribulations with Paxil are nothing like my experience with Zoloft.
Gobsmacked,
Perhaps you should read farther back than just my comments. Or I suppose, because you agree with the Inquisition on this site, their verbal assaults are within the boundaries of good behavior, but my musings on the nature of those attacks is uncivilized.
HorusCat
truthman,
(What does the 30 stand for, anyway?)
I also find it intriguing that you sound so miserable. I am not numbed to what goes on around me, just at peace with it, for the most part. Like I said in an earlier post, my life is full of things that bring me pleasure–mostly little things that everyone could enjoy. Terrible things happen, but so do wonderful, beautiful things. I guess ultimately, I have found peace in the knowledge that nothing that goes on in this life is of ultimate importance. The very worst things that could happen to me are totally within my control–and the rest, in the end, doesn’t matter.
truthman30
“truthman,
Your experience is just that–YOUR experience. What I object to is your assumption that your experience must be mine, and if I disagree, it is because I am brain-damaged. That very cutely renders anything I say immaterial, since I am obviously in my right mind if I agree with you and crazy if I don’t. Whatever–your tribulations with Paxil are nothing like my experience with Zoloft.”
My experience and the experience of hundreds of thousands of others HC, hundreds of thousands of others who were lied to about the efficacy and side effects of these medications by the pharmaceutical industry for over 15 years ..
You said yourself that you have sold these meds, well that makes you complicit in the suffering and deception of countless people, people who you will likely never even meet, people’s lives which you have influenced and possibly played a part in their suicide, their withdrawal and their suffering through the marketing and pushing of these poisonous meds..
“truthman,
(What does the 30 stand for, anyway?)
I also find it intriguing that you sound so miserable. I am not numbed to what goes on around me, just at peace with it, for the most part. Like I said in an earlier post, my life is full of things that bring me pleasure–mostly little things that everyone could enjoy. Terrible things happen, but so do wonderful, beautiful things. I guess ultimately, I have found peace in the knowledge that nothing that goes on in this life is of ultimate importance. The very worst things that could happen to me are totally within my control–and the rest, in the end, doesn’t matter.”
So Zoloft brings you peace does it?..
Well.. that speaks volumes…
So you can’t just “be” without being smacked out on an SSRI?…
I find that really sad actually…
You say you have “found peace in the knowledge that nothing which goes on in this life is of ultimate importance”…
Well, I happen to believe that a lot which goes on in this life is of huge importance HC, life is a serious business, but i suppose if that belief helps you to sleep at night, along with the Zoloft then that makes it ok to push these meds on others does it?…
“The very worst things that could happen to me are totally within my control”
You couldn’t have made a statement more delusional than that if I had have asked you to..
You can’t function without SSRI’s HC and you call me miserable?.. You have taken these meds for 14 years, you have sold these meds, and you think that ultimately life is of little importance, well I would rather be miserable than wear a chemical straight jacket to give me an illusion of control over my life. I would rather face the good and bad without the need for a hit of Zoloft every day…
And by the way, I am not miserable but I am cynical , there is a slight difference…
And what I am cynical about most is people who push dangerous psychiatric medications on others for no justifiable reason other than to make money, from the pharmas to the psychs to the drug reps to the psychiatrists, you all advocate them to make money, to line your pockets, none of you give a damn about the people whose lives have been ruined.. Desperate, ill and vulnerable people who trusted their doctors.. doctors who were lied to also, doctors who prescribed these drugs in good faith.. doctors who were also decieved..
No heed is given by you folks to the fact that they SSRI’s work little better than placebos (but so much more dangerous)
You don’t tell your doctors or patients that do you? .. Oh no, you’re just quite happy that a pay check comes your way , it doesn’t matter if people suffered for it, it doesn’t matter how many lives are destroyed in the process does it? It’s all about the money …
If you want to enslave yourself to a lifetime of Zoloft that’s fine, just don’t advocate them to others, because as you said yourself, Your experience is just that-YOUR experience ..
What I find most intriguing about you HC, is that you are on SSRI’s for 14 years..
Your neuro-receptors must be fried by now, I don’t envy your future if you ever try to come off them, because believe me, it won’t be pretty…
But I suppose that’s just it isn’t it, you don’t want to come off Zoloft because you don’t want to face the world or face yourself without it do you?..
Well that is all very fine, and your choice, but please do us all a favour and stop pushing them on others…
HorusCat
Wow truthman, you are one pissed-off cat. Your personal attacks are really getting tiresome, so I will end our conversation now. I hope that you find some peace in your life, because your self-righteousness and judgmentalism (oops, in England, that would be judgementalism) seem to be making you very unhappy.
BTW, the Zoloft isn’t what makes me happy or brings me peace. Faith in the grace of a God who died to save us, and the certain knowledge that even death cannot stand against that grace, gives me the courage to find beauty and hope in life. And I am confident in the understanding that God is a physical God who works with physical things–including the chemicals in our brains.
Perhaps your profound unhappiness comes not from a few years of taking Seroxat but rather years of denying the existence of a love that encompasses everything that we experience. Because what I know is that if you experienced that love, even though you disagree with me, you would not assault me as you do. Only a deeply spiritually empty person could spew such venom about another individual.
Oh and BTW, nobody promotes the SSRIs anymore, so you might need to find another outlet for your malevolence.
HorusCat
Oh and truthman, what exactly is delusional in thinking that the most horrible things that could happen to me are within my control? Death is not the worst thing that can happen to us. Nor is any indignity that another human being can inflict on me. In the end, I will die and my body will decay, no matter what happens to me along the way. No one can strip my faith from me, nor can anyone separate me from the love of God. No person on this planet has control of my soul and my freedom to submit to the will of God–so there it is.
truthman30
Oh , now i get ya…
You’re a jesus freak too!
God help us.. (pardon the pun)
Well good luck with your Zoloft life with Jesus Christ…
Oh and by the way you should watch the movie “Zeitgeist” ..
It might “enlighten” you.. ;)
You see there is another difference between you and me HC, I’m not holding out for the pearly gates of an after life and a saviour to protect my conscience and deeds in this lifetime..
I deal with them now..
truthman30
“Oh and BTW, nobody promotes the SSRIs anymore, so you might need to find another outlet for your malevolence.”
Hmmm..
Interesting, “nobody promotes the SSRI’s anymore” huh? ..
Would that be because they are useless?…
laura
truthman,
Your comments to HorusCat aren’t necessary. When you’re comments pertain to the topic at hand, I’m truly interested in reading them, but you don’t need to get personal in order to make your point.
truthman30
I do apologize Laura..
But sometimes when dealing with Snakes we have to bite..
HorusCat
Or make a wanker of yourself, as the case may be.
truthman30
So the snake has venom after all?..
Thought as much..
Good night Horus Cat..
:)
laura
OK, HorusCat, now I have to bite…what’s a wanker?
truthman30
A “wanker” is a British Expression, basically it’s a “jerk” , but with a little more imagery…
We have an expression where I am from, it’s called “pog mo hon”.. So “pog mo hon” HC ..
Night all..
:)
gobsmacked
Laura, the definition. http://en.wikipedia.org/wiki/Wanker
HorusCat, the definition.
http://www.youtube.com/watch?v=bdwOHMMABi8
gobsmacked
Ha ha Truthman30 and Night to you :)
Matthew Holford
HC wrote:
“…We do, of course, set limits on how he can express the anger–hitting and cursing is not ok…
…Thank you for your kind words and insight, Matthew. It’s so ironic, because this one of my children is the most kind-hearted and empathic of all my kids!”
Hmmm - try to explain why, as well. This is the point in the discussion where adult logic usually collapses in the face of a child’s inquisition! We try not to use physical violence, because that will only lead to more violence, or, in attempting to avoid the possibility of violence, a victim will censor themselves and their conduct in wholesale fashion, never understanding what it was that gave rise to the violence, in the first place, and not being allowed to ask. That’s not a pattern of behaviour that anybody should be obliged to adopt.
Swearing is irrelevant, as far as I’m concerned (but, then, I do swear a great deal) - most people don’t like to hear children (or adults) swear, but this is based on nothing other than some ingrained notion of social etiquette. If a person gets to the point where they have to swear in order to bring home how they feel about something, then it’s as well to appreciate that they’re escalating their own language, because they perceive the seriousness of their (perceived) predicament is not understood.
Incidentally, it doesn’t surprise me that this guy’s the most gentle and considerate, to be honest - that’s probably his default position.
Matt
Matthew Holford
HC wrote:
“……Thank you for your kind words and insight, Matthew…”
You’re welcome, btw!
Matt
Matthew Holford
Truthman wrote:
“…We have an expression where I am from, it’s called “pog mo hon”.. So “pog mo hon” HC ..
Night all..
:)”
LOL. Isn’t that what The Pogues called themselves, before they got a record deal?
Matt
PS It means “kiss my arse,” for anybody who wasn’t aware.
Matthew Holford
MH wrote:
“LOL. Isn’t that what The Pogues called themselves, before they got a record deal?..”
I just watched “Dirty Old Town,” (from “Rum, Sodomy and the Lash,” 1985), on YouTube. Quality! I remember 1985, vaguely, it was a time when Shane MacGowan still had (some) teeth!
Matt
Lisa Van S
AA,.. Newsweek BP Child. The Mother’s possible use of antidepressants during pregnancy could have caused damage to this child’s mood and auditory disturbances.
Lisa Van S
Jon,
You sound more like a Phsychiatrist, than a parent.
Lisa Van S
HC,
“Bombing of abortion clinics and the slaughter of millions.” Pretty frightnin words, from an individual who touts educating Physician’s on prescription drugs!!.
May I suggest, that you take some time, and visit the Holocaust Musuem in Washington, DC. Maybe you would think twice before spewing such venom.
HorusCat
Lisa,
If the shoe fits…(shrug). How interesting that of all the maliciousness displayed on this site, you only react to the person who disagrees with you. Says quite a bit about you, actually. There is quite a distinction between the personal attacks made by truthman and others against me on this site and my saying that their attitudes remind me of those who have committed violent attitudes against their perceived enemies.
truthman and others give off the vibe that the “truth” and urgency of their cause is far more important than the humanity of those who disagree with them. To wit: in response to my reasoned explanation of why I believe as I do, he calls me variously a snake, brain damaged, a Jesus freak. Looking back through history, one sees clearly that those who hold such beliefs in the righteousness of their cause and the defectiveness of those who disagree with them have no problem using violence to advance their cause. That truthman’s perception that what is actually only his opinion is absolute truth is indisputable if you read his posts. He obviously believes that since he is Right, any response to me, no matter how nasty, is justified. His characterization of one who disagrees with him as mentally ill and/or brain damaged shows that he is incapable of conceptualizing a different point of view than his. Thus, he dehumanizes me and devalues me. The dehumanization of the individual in front of you is the first step toward harming the individual whom you have dehumanized. truthman’s obvious misery and bitterness, in conjunction with his characterization of those who disagree with him as defectives, are indeed hallmarks of those who beliefs lead them to perpetrate violence against others. That’s not spewing venom, it’s an accurate characterization. Venom would be calling another individual brain damaged or a Jesus freak because she disagrees with you. Of course, demeaning those who actually believe in a Christian God is still politically correct, and on this site, characterizing one who works for pharma as brain damaged, greed-driven, murderous, etc. is the modus operandi and encouraged by people like you. I’ll accept your reprimand when you equally chastise those who attack me; otherwise, your hypocrisy is so loud I can’t hear your words.
BTW, you lose by invoking the Nazis.
HorusCat
truthman,
Your worldview is internally inconsistent. Either you believe in a transcendant Reality beyond this one, connection to which is the source of true humanness and healing (in which case the fact that I believe in God should be no problem for you), or you are a materialist, a reductionist, an existentialist. In the case of the latter, your assertion that we must connect to something spiritual and Real rather than “mask” reality with medication is ridiculous. If this is all there is, and humans are merely animals with opposable thumbs and a big cortex, then who cares if someone chooses to make it through this vale of tears with the help of pharmaceuticals?
If your approach to life works so well, and my approach (and indeed my entire existence) is so defective, then why are you so bitter and miserable? If this life is all there is, I would rather spend it my way than yours. You’ll come to the end of your life and look back on years of hatefulness, anger and despair. I’ll come to the end of mine and remember quiet times playing hangman with my kids, the wonderful taste of coffee in the mornings, the peace of having Horus purring on my lap, the sweaty little-boy smell of my kids when they’ve been outside playing, the beauty and power of the volcano we saw erupt in Costa Rica, the fact that my autistic son affectionately calls me a Queen Yellow Jacket…
If I am brain damaged and deluded but there is only this reality right in front of us, then so be it. Four little words: better living through pharmaceuticals. (And in case your irony meter is off–that was sardonic humor, lest you go off on another rant about how sinful and brain-damaged I am.)
HorusCat
Lisa,
Perhaps Jon is exactly what he says he is: a father doing the best he can to raise his child.
Oh, but you, like truthman, are a True Believer. In your Crusade, there is only one side. Anyone who has a different opinion and a different experienc is, by definition, a liar, a fake, a greedy manipulator. Jon can’t possibly be exactly who he says he is, because then YOU might have to broaden your viewpoint. So you attack him personally–in essence calling him a liar. Tells us a lot about you, Lisa.
truthman30
“truthman,
Your worldview is internally inconsistent. Either you believe in a transcendant Reality beyond this one, connection to which is the source of true humanness and healing (in which case the fact that I believe in God should be no problem for you), or you are a materialist, a reductionist, an existentialist. In the case of the latter, your assertion that we must connect to something spiritual and Real rather than “mask” reality with medication is ridiculous. If this is all there is, and humans are merely animals with opposable thumbs and a big cortex, then who cares if someone chooses to make it through this vale of tears with the help of pharmaceuticals?”
Horus Cat..
My stance and responses to you are driven purely from my “fight fire with fire attitude”..
Not long after I first posted on this site, you began your crusade and onslaught of insults before I had even expressed an opinion..
I don’t make a habit of offending people, but your patronizing, condecending and donwright rude attitude has unfortunately set the tone from the very beginning and also for our current exchanges…
For someone who is obviously an intelligent individual (you see I am capable of compliment) .. I fail to understand how YOUR World view could be so Black and White…
I have never said I that people should choose spirituality over medication, I am not religious, but I am open minded and my belief that depression has its root causes in psycho-spiritual emotional crisis stems from my experience, literature I have read and talking and listening to others who have experienced depression…
I also have no problem with people choosing to medicate themselves because they cannot cope with their life , but what I do have a problem with is lies about these drugs and people who push them on others …
My beliefs are not as black and white as yours HC, I do not think people are either redundantly materialistic, existential or god fearingly religious .. I think there are many shades of grey and I believe in people empowering themselves and not expecting the church, the state , psychiatry or a bottle of Pills to do so…
“If your approach to life works so well, and my approach (and indeed my entire existence) is so defective, then why are you so bitter and miserable? If this life is all there is, I would rather spend it my way than yours. You’ll come to the end of your life and look back on years of hatefulness, anger and despair”
I didn’t ever say your existence was defective, but I do think you must have some serious problems if you have been on SSRI’s for 14 years, and I also think you must have some serious problems if you think it is ok to sell these meds without a second thought to the damage you could be causing…
I have had quite an eventful life HC, and believe me I have no intention of spending the rest of it in hatefulness, anger and despair, I am actually quite contented with my lot …
And I was like you at one time, reliant on an SSRI to help me face the world, but that was some years ago…
Yes, I am pissed off at GSK, and I am angry about the Paxil scandal, being lied to about side effects etc, but that is something which will work itself out in time…
“truthman and others give off the vibe that the “truth” and urgency of their cause is far more important than the humanity of those who disagree with them. To wit: in response to my reasoned explanation of why I believe as I do, he calls me variously a snake, brain damaged, a Jesus freak. Looking back through history, one sees clearly that those who hold such beliefs in the righteousness of their cause and the defectiveness of those who disagree with them have no problem using violence to advance their cause. That truthman’s perception that what is actually only his opinion is absolute truth is indisputable if you read his posts. He obviously believes that since he is Right, any response to me, no matter how nasty, is justified”
You have this totally wrong HC..
The reason why myself and others who are fighting for truth, transparency, justice and ethics in the pharmaceutical industry are so impassioned and vocal is because it has taken us years to get the truth aout there. It has taken a lot of energy for us to make even a small dent in the system. A system which is powerful and a system which is set up to squash the patient and their rights and a system which protects pharma and psychiatrists before the health of the public.
You compare anyone who is vocal about the misdeeds of pharma as a violent, unhinged abortion clinic bomber..
That would be funny, if it wasn’t so ridiculous..
All I am HC is a man with a laptop expressing an opinion…
Matthew Holford
Oh, for God’s sake (if you believe in a single deity, that is, and if you don’t, then please invoke whichever primary driver you feel inclined to invoke in support of your argument), can we ditch the ad homs, please?
The thing is, crap as I believe the Worshipful Company to be, it is never called before us to justify itself - it can make unsubstantiated pronouncements of its excellence via Mary Anne Rhyne, or Pinbenbow, or whomever, and, however unsatisfactory to us, that is all the public may expect. As critics, we have to be utterly scrupulous, and play with a straight bat at all times, in order to avoid being dismissed. Not that we’ll achieve anything by that, but at least we’ll look good!
Honestly: the mudslinging does nobody any favours.
Matt
Jon
Now I am really insulted being called a psychiatrist! (LOL) I suspect this is because I have been too immersed in their world trying to gather any clues about what the heck is going on with my daughter. There are so many dogmatic opinions about cause and effect that upon further investigation are based on very thin information.
I have found, over many years, that culling a few nuggets from each expert or lay-expert (holistic types or just very smart people) we were able to start putting a behavior model together that was somewhat helpful in developing a fluid treatment strategy.
To answer a much earlier question, our daughter has always and continues to be bothered by various sounds. I imagine it is like how most people can’t stand the sound of someone scraping a blackboard but for many more objects and at least a factor greater.
She is also very tactile sensitive. When she was born, she cried for hours, until her Mom quite coincidentally put some socks on her feet. She stopped crying immediately. From that point forward, the second her feet were bare, she would start howling (that stopped by age 1 or 2 thank God).
She will never wear any clothing that has a tag touching her skin. She loves silk or satin or anything soft. She won’t wear wool. Her Mom made her a baby blanket when she was 2 with a satin border. She would never permit herself to be separated from it for years (she used to take it in the car to kindergarten and kiss it goodbye before going into class).
Along the same lines of sensory issues we noticed that a common source of frustration came from having to make any kind of decision. I am talking about the most minor decision possible such that we don’t even realize we are making one. She would get stuck trying to decide which sock to put on first. Which shoe should follow. And on and on. This is how each day would start and she would be mentally exhausted by the time she was ready for school. Until we noticed the pattern (of course we thought she was just being a difficult child) this would lead to conflict and would only make it more difficult to deal with all these decisions.
We tried a variety of things upon this discovery. Family therapy being the first time we went the professional route at age 4. Out of this we jointly came up with ‘tricks’ to reduce the stress - preparing all the clothing choices the night before - including the sequence in which everything was to be donned.
This only pushed the problem down stream to breakfast choices, the sequence in which she said goodbye to the dog and cat, who left the house first, who got into the car first, etc. etc. etc. Ultimately it became impossible and impractical to try and control the entire universe of micro-decisions that could ignite her tantrums.
This led to step two: individual therapy at age 5 and the litany of books suggested to us on how to be better parents (it was obviously our fault). We read them all, tried all the behavior program suggestions, all the better listening suggests, etc. They all added some value but there wasn’t a significant improvement in our daughter’s quality of life. She was still suffering terribly. This phase lasted about 2-3 years.
Meanwhile, we began reading every snippet about childhood mental illness but nothing seemed to match our daughter’s situation. Even the bipolar stuff we read didn’t seem to match because at this point (about 12 years ago) there were just a few case studies based upon children who had also suffered extreme abuse and other equivalent hardships.
I will stop at this point. I can go on and on and it mostly just makes me cry. I am not sure if this is helpful for this audience.
Thanks for listening.
Matthew Holford
Jon wrote:
“…Thanks for listening.”
If you’d like a wild guess, then I’d say it sounds as if she’s come to the conclusion that she is not permitted to make her own decisions (or else it’s unpredictable as to whether her choices will be met with approval, anger, or derision, which will be responses so confusing that she’s chosen the safe route, and decided to make no decisions, because that’s sure to displease nobody). Having her make her own choices on a piecemeal basis is all very well, but you won’t always be around to help her plan her life out - she needs to be confident that, even if one makes a “wrong” choice (ie, a choice that others disapprove of), then nothing really happens.
I have a suggestion for you, if you’re interested: present her with a bunch of options, in the style of “would you like A, B, C, something else, or would you like me to choose,” and that way, even if YOU choose, it will have been her choice - but allow her to disagree with your choice, down the line, when she realizes that it wasn’t exactly what she wanted. I can’t think of a safer way of doing it than that. If she’s old enough to understand, then explain what you’re doing, to save her having to waste mental energy working it out (and also to avoid her coming to the conclusion that she’s being tricked via forced choice into making decisions that she’s going to be held responsible for - she may not have the vocab to express those concepts, but her mind is perfectly capable to dreaming them up; I assure you of that).
Matt
AA
Jon,
Have you looked into asperger syndrome or non verbal learning disability to see if either one reasonates? I am not 100% convinced by your post that this is what your daughter has but sensory issues are so common with both conditions.
Also you said this,
“She would get stuck trying to decide which sock to put on first. Which shoe should follow.”
Again, I am not 100% sure but could that be due to the visual spatial confusion she is experiencing? Does anything like that resonate?
If you want more information on NLD, go to:
http://www.nldline.com or http://www.nldontheweb
Warning, the information can sound doom and gloomish but it might be relevant to your daughter. Visual spatial weaknesses are quite common as well as motoric difficulties. The weaknesses one with NLD has are generally the opposite of dyslexia, thus the term non verbal learning disability
Anyway, asperger syndrome and NLD are commonly misdiagnosed as bipolar disorder. I am not saying that is what happened to your daughter but you’re saying enough to make me wonder.
While obviously, they can have manifestations that seem psychiatrist, they are considered by most experts to be neurodevelopmental disorders and not mental illness.
AA
AA
Jon,
One more thing as I kind of typed fast without thinking things through.
Sensory issues can occur by themselves without having NLD or AS. So I would also google that. It sounds like from what you’re saying that your daughter definitely has that which is not bipolar disorder in my opinion.
The reason I am so adamant about it is as one with NLD, I have heard stories about parents taking kids to professionals who were clueless about NLD/AS/Sensory issues. I doubt that Biederman has heard of NLD (smile).
AA
HorusCat
Jon (and AA),
You don’t have to justify yourself to anyone here. My son shares many of the same sensory issues as your daughter–too much noise, tags, necklines, seams on clothing, smells (oh the years of vomiting!), tastes…You have been through Hell–and like you, when I think too much about my son and what his future might be, I start to cry.
AA has some interesting points…while my son carries a diagnosis of autism and has some Asperberger’s-like traits, it would probably be more accurate to say he is just not “neurotypical.” Even with days of neuropsychological/educational testing, we haven’t come to any firm conclusions. He does have problems with working memory and there is something with verbal retrieval going on…but no one is quite sure what. Then on top of that are the sensory/behavioral issues.
Ultimately, I think you deal with the manifestations of whatever is going on rather than depending on a diagnosis. Like you say, you rely on multiple “experts” and take a little here and a little there to find what works. I wish you the best.
truthman,
I just find it funny that you should be so offended by my likening your attitude to those that lead to aggressive behavior in other extremists (how about PETA folks throwing paint on fur coats or environmentalists burning down housing developments?), yet you find it acceptable to suggest that I am mentally damaged in some way. I have acknowledged on this site that I have at times been acerbic–and I think my posts have been moderate and reasonable. In response, I am told I am evil, brain-damaged, delusional, a snake, etc.
I don’t agree with you that SSRIs are bad. I don’t agree that the reason they are written is because manipulative, powerful drug companies are out there bending physicians and patients to their will. I have no conscience problems with my work.
I think you are the one seeing in black and white. The gray area is what I say: judicious use of medication along with other forms of therapy, etc. is warranted in some patients. Nowhere have I said these meds are magic and should be used in situational depression. Nowhere have I said these meds should be used in kids for depression. I have made the point that your experience is not only not mine, it is not normative. Millions of people have taken Zoloft and don’t share your experience or opinions. But I guess you would conveniently discount their opinions because the very fact that they have a positive experience with an SSRI renders them somehow delusional or damaged. Not “in touch” with reality.
Your characterization of me as somehow defective (and therefore what? not credible? not as insightful as you?) because I take an SSRI is a cute and convenient way to discount what I say. Your arguments are tautalogical: if someone has benefited from an SSRI, then BY DEFINITION (yours) they are delusional and have no credibility. Only a person who has rejected SSRIs is truly in touch with reality and non-delusional and therefore only that person can be believed. Therefore, you don’t have to consider what I (or any other person who has used/uses an SSRI) have to say, because ipso facto I and my arguments are defective.
Whatever. Fortunately for the rest of the world, prudence and reason reign, and the SSRIs are available to those who have need of them.
AA
HC,
You said:
“”Ultimately, I think you deal with the manifestations of whatever is going on rather than depending on a diagnosis. Like you say, you rely on multiple “experts” and take a little here and a little there to find what works. I wish you the best.”"
Your reasoning is more applicable in cases where you’re not sure for example if someone has dyslexia vs. a central auditory processing disorder. Since neither issue is usually medicated as a general rule, that makes sense.
But when the issue is someone getting heavy duty antipsychotics vs. not getting them for a disorder that responds to occupational therapy and other types of remediations, in my opinion, it would be gross negligence not to pursue an accurate diagnosis.
HC, not to be rude but if your son is on an antipsychotic, that is going to greatly worsen his problems if he has problems with working memory and verbal retrieval. In fact, I saw a study that antispsychotics interfere with learning.
When you’re not an NT, I can tell you from personal experience that when already have compromised cognitive ability, it is cruel to make that worse with meds. I am not condemning you but am explaining how that feels from my perspective.
I can’t tell you how many situations I have heard of where when people were finally diagnosed properly and their conditions were dealt with, the mental health problems disappeared.
HC, for the sake of your son, I hope you will seriously listen to what I am saying. This isn’t about you being a drug rep and my position vs. yours. This is about your son’s life and how he will function not being an NT.
AA
Something to think about HC.
AA
truthman30
“I have made the point that your experience is not only not mine, it is not normative. Millions of people have taken Zoloft and don’t share your experience or opinions. But I guess you would conveniently discount their opinions because the very fact that they have a positive experience with an SSRI renders them somehow delusional or damaged. Not “in touch” with reality. ”
My experience is not “normative” You say?..
Well, unfortunately my experience happens to well over a third of SSRI users HC, particularly from long term use…
Your problem is, you have been taking these drugs for 14 years, you cannot live life without them, that does not mean you should push them on others…
It is rather similar to a heroin addict claiming they are quite happy to be an addict and then telling everyone its fine to take Heroin..
You are dependent on these drugs HC, whether you admit that to yourself or not, that is the reality , 14 years of use quite clearly proves that…
What you consider to be Acerbic, I consider to be conceited …
You talk about millions of people having a great time on these meds ,you talk about them as if they are harmless, that is what I find so insulting… So where are all these “positive stories”… Provide me with one link where someone has set up a blog or a web site praising the virtues of SSRI’s! …
The Fact of the matter is these drugs do not help people deal with their problems…
They should only be used in the right circumstances on a short term basis…
Drug companies have lied and suppressed the side effects for years to protect profits..
That is unacceptable..
“truthman,
I just find it funny that you should be so offended by my likening your attitude to those that lead to aggressive behavior in other extremists (how about PETA folks throwing paint on fur coats or environmentalists burning down housing developments?), yet you find it acceptable to suggest that I am mentally damaged in some way. I have acknowledged on this site that I have at times been acerbic–and I think my posts have been moderate and reasonable. In response, I am told I am evil, brain-damaged, delusional, a snake, etc.”
I find nothing you say offensive actually HC, I think what you say is ridiculous…
I do think , yes after 14 years of SSRI use, you would definately be damaged in some way, possibly in every way, emotionally, mentally, your state of mind,most definately yes…
“Your characterization of me as somehow defective (and therefore what? not credible? not as insightful as you?) because I take an SSRI is a cute and convenient way to discount what I say” ..
No HC, you do a better job ast discrediting yourself than I could ever try to do…
HorusCat
AA,
I am not offended by what you have to say, but rather extremely interested. You are very empathic in how you express yourself–I can tell that you want only what is best and right for me and my son.
I feel stuck between a rock and a hard place. I know that the meds don’t help his learning disabilities–but they do help him control his behavior and they make him much more social.
What we need is a really skilled pediatric neurologist–and those are hard to come by. We have several ped neuros here in town, but none of them specialize in non-NT kids–it’s mostly epilepsy and ADHD.
I appreciate your insight and your sharing of your own experience. Despite your terrible experience, you remain civil, sympathetic and humane. If you wouldn’t mind, please email me at cathorus@yahoo.com with some of your nutrition and behavioral experiences.
Thanks.
HC
HorusCat
truthman,
It just occurred to me that any time I waste interacting with you is time out of my life I’ll never get back. Ciao, baby.
truthman30
Like Wise HC..
Take care (and I mean that sincerely)
Jon
Just got back visiting elderly parents. Isn’t it fun being the sandwich generation and having an ill child.
Thank you for the NLD perspective. I only touched the surface of our trip through the land of experts. My wife started a log about a year into the process, realizing we would never be able to keep track of the sequence of events over time - which inevitably was the most compelling evidence of BP. The trend was consistent with what we learned from the nuggets of reason we heard from experts from every field.
Our daughter was thoroughly tested for NLD at Mclean Hospital and also San Francisco Med Center by top NLD gurus. There was some evidence of NLD issues which we in turn attempted to validate/treat/meld with experts from other academic perspectives.
Ultimately we realized that the various treatment strategies were significantly overlapping and sometimes nearly identical. This is when we stopped trying to refine the label and focused on the optimal treatment strategy (i.e. lowest risk and highest possibility for significant improvement in quality of life).
I do think the meds are critical, in our daughter’s particular situation, because it enables her to get any value out of the different cognitive/behavior/yoga/et al therapies out there.
Your suggestion of giving her a choice of none-of-the-above is very pertinent. We are slowly pulling the plug on her nearly complete reliance on our guidance. Whereas we started this process with her older sister at age 12-13 we knew that her younger sister was on a different time line than most kids. We have been very sensitive about watching for signs and testing the waters for when she might be ready to take on more, but, without regressive consequences.
I can fully appreciate how a more typical family with both parents (or a single parent) working full time would never have the time we have committed to learning everything we could and pursuing every idea that held even an inkling of hope.
I think until there is better science for less subjective diagnoses, paired with more specific medical and other therapies there will be mis-diagnoses which has and will lead to detrimental treatments. Biederman and a few dozen others, all funded by pharmas, are the ones leading the way in trying to figure this all out. They should be held accountable for standard research procedures and policy but should not be lynched just because the science is in the earliest stages of being developed.