Is the use of coercion and force in psychiatry ethical?

via The New York Times:

LETTER

Forced Drug Treatment

an excerpt:

"In a society presumably under the rule of law, is it proper for physicians and other mental health professionals to coerce innocent individuals and force them to ingest dangerous drugs?"

DAVID COHEN
TOMI GOMORY
STUART A. KIRK
Los Angeles, July 31, 2013

read the letter here

The writers are professors of social welfare and co-authors of “Mad Science: Psychiatric Coercion, Diagnosis and Drugs.”

hat tip:

Forced Drug Treatment http://t.co/fRYbB78mlb #mentalhealth #coercion
— MARY HALL (@PsychVictim) August 5, 2013

Whenever a doctor cannot do good, he must be kept from doing harm.  Hippocrates 

via American Journal of Psychiatry:
The Cost of Assisted Outpatient Treatment:
Can It Save States Money?

Insel's assumptions are biased beliefs predicated on a hypothetical etiology that is reminiscent of eugenics

via NIMH The Director's Blog

Transforming Diagnosis

an excerpt: 

NIMH has launched the Research Domain Criteria (RDoC) project to transform diagnosis by incorporating genetics, imaging, cognitive science, and other levels of information to lay the foundation for a new classification system. Through a series of workshops over the past 18 months, we have tried to define several major categories for a new nosology (see below). This approach began with several assumptions:

A diagnostic approach based on the biology as well as the symptoms must not be constrained by the current DSM categories,

Mental disorders are biological disorders involving brain circuits that implicate specific domains of cognition, emotion, or behavior, (emphasis mine)

Each level of analysis needs to be understood across a dimension of function,

Mapping the cognitive, circuit, and genetic aspects of mental disorders will yield new and better targets for treatment.

Apparently, Thomas Insel is unaware that in order to ethically determine the direction and the focus of scientific research requires an open mind; not a pre-determined agenda. Insel's announcement that the NIMH will no longer use the DSM is a political decision. Insel acknowledges the NIMH adopted a biological research focus based on assumptions; instead of using ethical scientific principles, and allowing the existing empirical data to guide the direction of psychiatric research; he says, "because we lack the data"!? What a crock! Insel knows there is little to no scientific basis in his assertion that "Mental disorders are biological disorders."

It is an assumption that is and has been embedded in the language of psychiatric diagnosis and treatment, an assumption that was entrenched along with the eugenic theories that spawned it. Eugenic theories which are still used in an attempt to justify the inhumane "standards of care" that are without empirical support, standards without empirical support should not be considered "standards of care" since by definition, standards are theoretically to be derived from the evidence base; instead, psychiatry validated their standards of care by consensus,  a quasi-democratic political process, not using ethical medical judgement and empirical data from psychiatric research.  By consensus, psychiatry effectively determined that some people with certain  psychiatric diagnoses don't need their Human Rights protected; people of all ages are effectively stripped of their Human Rights by psychiatry, based on a belief that a diagnosis of mental illness is evidence the person has an incurable brain disease, that requires life-long treatment with teratogenic drugs. Without any definitive evidence to validate the brain disease hypothesis, it's simply a hope-filled belief in a hypothesis that is still seeking validation; it's not even a theory...let alone an actual disease.

Insel's assumptions are beliefs reminiscent of eugenics.  The eugenics movement in this country also proceeded without any empirical evidence to validate it's ignorant assumptions. 

The NIMH will assume that the brain disease hypothesis is a brain disorder or disease in the absence of  empirical evidence that would validate the hypothesis. According to Thomas Insel, the NIMH is going to proceed as if an assumption, i.e."Mental disorders are biological disorders," is a sufficient substitute for using critical thinking skills, and for relying on the existing research data on "mental disorders" exercising sound judgment to determine what the focus and direction for psychiatric research should be. I wonder, if the best interests of those who experience cognitive, emotional and behavioral symptoms were even considered? Is there empirical data that supports Insel's use of biased assumptions that are without empirical support to justify this biased and myopic focus on brain biology for psychiatric research? Insel's announcement that the NIMH will focus on seeking evidence that "mental illness" is caused by a brain disease is not 'news;' the NIMH has been focused on seeking the evidence which would validate the brain disease hypothesis for decades...Insel's announcement that research funded by NIMH will no longer be guided by the DSM, due to it's lack of validity; is long overdue. The irony is, in the same blog post, Insel uses biased assumptions as if bigotry-based assumptions are a sufficient substitute for valid information when making mental health research policy decisions (theoretically) in the public interest. There is no ethical justification for the NIMH to continue to fund research looking for the still illusive genetic defects, brain diseases and bio-markers as it's  main agenda. The pre-occupation with proving schizophrenia and/or any other psychiatric diagnosis, is caused by a biological defect or disease seems to purposely exclude research on known and suspected social and environmental risk factors that cause cognitive and emotional difficulties; worse it neglects the cognitive/behavioral/psycho/social/ therapeutic treatments that can help people right now in real world practice, if the treatments were actually available...

In effect, Insel is announcing all cognitive and emotional symptoms of distress, including undesirable, or disapproved of behavior, is caused by a yet to be identified, biological disorder or disease process---while simultaneously ignoring the overwhelming evidence of environmental causal factors such as  sexual, physical, and emotional abuse and neglect, poverty, malnutrition, environmental violence, socio-economic-political status and intra- and inter-personal conflicts are highly correlated with, and known to exacerbate (if not cause) what Insel 'assumes' are biological disorders...

Allen Frances, had a OP-Ed published in New Scientist, which concludes with the statement, "Anything that goes into the manual should already have passed rigorous research testing; the manuals are far too important to include untested hypotheses. DSM-5 is not, and cannot be, an appropriate guide to future research." 

I agree. I would add that assumptions about the scientific validity of a hypothetical, neuro-biological cause for any psychiatric diagnoses (or anything else) is also inappropriate. An assumption is not an ethical scientific basis for psychiatric research; it is not an ethical foundation for a new nosology either.  

I wonder if Insel can explain why dangerous neuroleptic, or "antipsychotic" drugs that are minimally effective for a minority of people diagnosed with schizophrenia, are prescribed off label, to children? 

Human Experimentation is "effective psychiatric treatment." 

It's the standard of care used in psychiatric practice. 

via National Advisory Mental Health Council 219th Meeting September 18-19, 2008 

NIMH Director's Report: 

an excerpt:

"Results from the NIMH-funded 6-year multisite Treatment of Early Onset Schizophrenia Study (TEOSS) found no significant differences in outcomes with first- or second-generation antipsychotic medications. There was a striking difference in side effects, but there was no evidence that any of the medications was the best choice for the entire group of people being treated. Similar results were obtained in the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) trial, the Cost Utility of The Latest Antipsychotics in Severe Schizophrenia (CUtLASS) trial from the United Kingdom, and the large-scale Veterans Administration trial. Despite the lack of a clear superiority in overall effectiveness of the second-generation drugs, they account for more than 90 percent of the market and cost about 20 times more than the first-generation compounds." Thomas Insel 

via National Institutes of Health:

The NIH Public Access Policy ensures that the public has access to the published results of NIH funded research. It requires scientists to submit final peer-reviewed journal manuscripts that arise from NIH funds to the digital archive PubMed Central upon acceptance for publication. To help advance science and improve human health, the Policy requires that these papers are accessible to the public on PubMed Central no later than 12 months after publication.

photo credit:Psychiatry is junk science

Richard Bentall: Treating Psychosis: The limits of anti-psychotics

via IAI:
Clinical psychologist and author of Doctoring the Mind and Madness Explained, Richard Bentall is a leading critic of biological explanations of mental illness and the pharmaceutical industry. He teaches at the University of Liverpool.
The Talk

The clinical psychologist and author of Madness Explained presents new evidence for the limitations of anti-psychotic medication and of the psychiatric establishment.

Watch more videos on iai.tv

Antipsychotic Use by Medicaid-Insured Youths: evidence of criminal prescribing practices

Average rate of gray matter loss: evidence of neuroleptic drug-induced brain damage.

The more drugs you've been given, the more brain tissue you lose. What exactly do these drugs do? They block basal ganglia activity. The prefrontal cortex doesn't get the input it needs and is being shut down by drugs. That reduces the psychotic symptoms. It also causes the prefrontal cortex to slowly atrophy. 

~ Dr. Nancy C. Andreasen, New York Times, Sept. 16, 2008

Both the older and the atypical neuroleptics shrink brain tissue during routine clinical exposure.

~ Dr. Peter R. Breggin, Brain Disabling Treatments in Psychiatry (2008) 

ARTICLES   |   March 01, 2013 

Antipsychotic Use by Medicaid-Insured Youths: Impact of Eligibility and Psychiatric Diagnosis Across a Decade

Julie Magno Zito, Ph.D.; Mehmet Burcu, M.S.; Aloysius Ibe, Dr.P.H.; Daniel J. Safer, M.D.; Laurence S. Magder, Ph.D.

Psychiatric Services 2013; doi: 10.1176/appi.ps.201200081

Author and Article Information

Dr. Zito and Mr. Burcu are affiliated with the Department of Pharmaceutical Health Services Research and Dr. Magder is with the Department of Epidemiology and Public Health, University of Maryland, 220 Arch St., Room 01-216, Baltimore, MD 21201 (e-mail: jzito@rx.umaryland.edu).Dr. Ibe is with the School of Community Health and Policy, Morgan State University, Baltimore.Dr. Safer is with the Department of Psychiatry, Johns Hopkins University, Baltimore.

Copyright © American Psychiatric Association

a couple of excerpts:

Conclusions

"The expansion of antipsychotic medication use from 1997 to 2006 among Medicaid-insured youths was most prominent among those qualifying with low (SCHIP) and very low (TANF) family incomes. This was the case even though the most impaired youths—those in foster care or those receiving SSI—had distinctly higher levels of antipsychotic drug use within each study year. Factors contributing to this antipsychotic use pattern included the expanding SCHIP and TANF populations, the increased use of antipsychotics among youths enrolled in SCHIP and TANF, and the increased use of antipsychotic medication for behavior disorders over the decade. Likewise, although youths with diagnoses of schizophrenia and other psychotic disorders and pervasive developmental disorders had the highest rates of antipsychotic medication use, youths with externalizing behavior disorders far outnumbered those with these less common conditions and constituted the largest group of utilizers of antipsychotic medications."

"Methods: The authors analyzed computerized administrative claims data for 456,315 youths aged two to 17 years who were continuously enrolled in Medicaid in a mid-Atlantic state in 1997 (N=159,171) and 2006 (N=297,144)."

In 1997 a total of 615 kids with no diagnosis were prescribed neuroleptic drugs in this sample. More than twice as many kids, a total of 1,481 were prescribed a neuroletic drug in 2006, despite the fact they had no psychiatric diagnosis which would indicate a need for such a prescription!

What the above represents is only a small percentage of the number of fraudulent claims which were submitted to Medicaid for payment, i.e. fraud. Obviously, the civil and criminal penalties paid by the pharmaceutical industry for illegally marketing these drugs is not going to stop the fraud. The unethical medical practitioners are defending their "professional privilege" to use these drugs absent evidence the drugs "treat" the conditions the drugs are prescribed off label for. It is the prescribers whose unethical prescribing of these teratogenic drugs to children are guided by the APA and AACAP practice parameters and treatment algorithms who must be stopped.  Standard practices originally protected patients, now they serve to protect the unethical behavior of the professionals who use them as an affirmative defense for what is not only medical malpractice, but Human Experimentation; the current standard in mental health care for kids on Medicaid.  



hat tip: Allen Frances, M.D.

@allenfrancesmd It doesn't explain the lack of #medicalethics it takes to Rx drugs that cause a myriad of neurological cognitive impairments
— Becky (@yobluemama2) March 8, 2013

@narcotic_repose Pharma fined heavily for illegal off-label marketing,but continues because antipsychotic sales an outrageous $18 bil/yr
— Allen Frances (@AllenFrancesMD) March 8, 2013

@allenfrancesmd @narcotic_repose Pharma wouldn't be successful w/o unethical doctors Rxing neuroleptics for behaviors others find annoying!
— Becky (@yobluemama2) March 8, 2013

PRESCRIPTION PSYCHOTROPIC DRUG USE AMONG CHILDREN IN FOSTER CARE 

House Hearing,  2009

Special thanks to Methodius Isaac Bonkers of Bonkers Institute of Nearly Genuine Research for the graphic and the quotes at the beginning of this post.

FAIR USE NOTICE: This may contain copyrighted

(C) material the use of which has not always been specifically authorized by the copyright owner. Such material is made available for educational purposes, to advance understanding of human rights, democracy, scientific, moral, ethical, and social justice issues, etc. It is believed that this constitutes a 'fair use' of any such copyrighted material as provided for in Title 17 U.S.C. section 107 of the US Copyright Law. This material is distributed without profit.

Abilifried: 3 takes on Abilify®

via Drug Discovery News' Virtual Break Room

by Amy Swinderman, ddn Chief Editor

Pharma news of the weird: Cartoons, government and beer

Have you ever seen a new drug commercial and literally said, out loud, “WTF?” Pharmaceutical company commercials often raise the ire of critics, but one in particular really has me scratching my head, and tops my little collection of weird news developments in the pharma arena.

A recent commercial for Bristol-Meyers Squibb Co.’s (BMS) antidepressant Abilify depicts a patient-doctor interaction, done in cartoon form, in which a patient sheds her “blue robe” of depression and heads in to ask her doctor if Abilify is right for her.

You can see the commercial on YouTube here.

BMS’ choice to use cartoons instead of real people is puzzling—but wait, the commercial is about to get weirder. Inexplicably, instead of telling his patient about the drug and its possible side effects and drug interactions, the doctor pulls down a projection screen … and allows a different cartoon version of himself to do the talking. Meanwhile, the animated blue robe looks on, blinking.

Are you following that? Me neither. Aren’t these commercials controversial enough without rocking the boat this much?

Meanwhile, in government news (which is frequently weird) … while the U.S. Food and Drug Administration (FDA) is often criticized for the speed by which it approves new drugs—and lawmakers continue to put forth legislation that aims to ease bottlenecks in the process—a recent report claims that new drugs are actually approved faster here in the United States than in Europe or Canada.

According to Yale University School of Medicine researchers, their recent study of drug-approval decisions made in the first decade of the new millennium refutes the common belief that the FDA’s drug-approval process is especially slow.

After studying decisions made by the FDA, Health Canada (the Canadian drug regulatory authority) and the European Medicines Agency (EMA), the researchers found that the FDA’s reviews were more than three months faster than those of its Canadian and European counterparts.  here

The study mentioned above, "Regulatory Review of Novel Therapeutics — Comparison of Three Regulatory Agencies" Nicholas S. Downing, A.B., Jenerius A. Aminawung, M.D., M.P.H., Nilay D. Shah, Ph.D., Joel B. Braunstein, M.D., M.B.A., Harlan M. Krumholz, M.D., and Joseph S. Ross, M.D., M.H.S.
N Engl J Med 2012; 366:2284-2293

Why would anyone want to take this drug? at Beyond Meds

Psychiatric Drugs are Killing American Soldiers

 

Marine patroling a poppy field in Afghanistan. Photograph: Patrick Baz/AFP/Getty Images

via The Guardian:

Friday 1 February 2013 12.00 EST

Simon Rogers
US military suicides in charts: 

how they overtook combat deaths

US military suicides are increasing as deaths in action are going down. 

Find out what we know about the trend• Download the data
• More data journalism and data visualisations from the Guardian

US military suicides have never been so high since data was recorded:up to 349 for 2012.

It exceeded the Pentagon's own internal projection of 325. US government began closely tracking suicides in 2001 through the Department of Defense Suicide Event Report (DoDSER). It exceeds the 311 Americans who died in war zones last year. read the rest here

By the way...

Why in the hell are American soldiers guarding poppy fields?  Intentionally or not, it facilitates  "greater heroin availability, rising purity, and lower prices." 

Beginning of original post from 8-23-2011:

Antidepressants, neuroleptics and other psychiatric drugs can kill the person who takes them, or compel the person to commit acts of violent aggression including homicide.  Why are these events, and the psychiatric drugs which contribute to and/or cause them, not being reported more accurately in the news in the United States?  Does the income derived from direct-to-consumer advertising of drugs serve another purpose?  Is the mainstream news media not reporting the news due to a Conflict of Interest? Is deriving so much revenue from the pharmaceutical industry preventing journalists from accurately reporting stories which are unfavorable or critical of a source of income for their corporate employers?  The United States and New Zealand are the only countries in the world where it is legal to market prescription drugs direct to consumers through print, electronic, radio and television advertisements.  

Who does all of this benefit most?

VIA: 

Column: Martha Rosenberg

Are US Soldiers Suicides Caused by Prescription Drugs?

by Martha Rosenberg,

Chicago 

"The suicide rate among US troops is astonishing.

"In 2009 there were 160 active duty suicides, 239 suicides within the total Army including the Reserves, 146 active duty deaths from drug overdoses and high risk behavior and 1,713 suicide attempts, says the Army's suicide report, released in July.

"Not only are more troops dying from their own hand than combat says the Army report, titled Health Promotion, Risk Reduction, Suicide Prevention, 36 percent of the suicides were troops who were never deployed.

"Also astonishing is the psychoactive drug rate among active duty-aged troops, 18 to 34, which is up 85 percent since 2003 according to the military health plan, Tricare. Since 2001, 73,103 prescriptions for Zoloft have been dispensed, 38,199 for Prozac, 17,830 for Paxil and 12,047 for Cymbalta says Tricare 2009 data, which includes family prescriptions. All of the drugs carry a suicide warning label.

"In addition to the leap in SSRI antidepressants, prescriptions for the anticonvulsants Topamax and Neurontin rose 56 percent in the same group since 2005 says Navy Times, drugs which the FDA warned last year double suicidal thinking in patients.... "

"Over 4,000 published reports of violent and bizarre behavior of people affected by antidepressants on the web archive ssristories.com reveal the same out of character violence and self harm in civilians, currently seen in the military.

"Twenty people set themselves on fire. Ten bit their victims (including a biter who was sleepwalking and a woman, on Prozac, who bit her 87-year-old mother into critical condition.) Three men in the 70s and 80s attack their wives with hammers. Many stab their victims obsessively -- one even stabs furniture after killing his wife -- and 14 parents drown their children, a crime seldom heard of before the 2001 Andrea Yates case. Yates drowned her five children on the antidepressant Effexor which manufacturer Wyeth (now Pfizer) "issued no public warning" about says the Associated Press.

"Then there's the North Carolina pilot on Zoloft who sings, "I'm going down for the last time," into the cockpit voice recorder before he crashes his plane in June. And the Mayor of Coppell, Texas, Jayne Peters who kills herself and her daughter in July over the grief of losing her husband. Police find antidepressants at the home.

"Such murder-suicides committed by women used to be rare says Betty Henderson the web site's moderator and researcher. "Before the SSRI antidepressants, women committed five percent of the murder-suicides and now they account for almost 15 percent of this type of violence," she said in an interview.

"Antidepressants are also causing women to become neo sexual predators says Henderson. "There have been more than a dozen recent cases of women school teachers molesting their young students under the influence or withdrawal of antidepressants. Who heard of this type of sexual aberration before the antidepressant craze?"
"In fact, the high percentage of civilian suicides on psychoactive drugs is probably the clearest indication that military life is not the only cause of the shocking troop suicides: In September alone, there were 18 civilian suicides, 11 murders, 2 murder suicides and other violence linked to people who were using or had used antidepressants, according to published reports.

"Also in the thirty day period, a 60-year-old grandmother in Seattle killed three family members and herself; a disc jockey in Bristol, UK set himself on fire; and a man in Exeter, UK man was determined to have stabbed himself in the heart. All were on antidepress-ants. Finally, in the month of September, legal proceedings began against two mothers and a father charged with killing their own children. read here.

Via: 9News in Australia:

Suicide brings a decade of war home

12:30 AEST Tue Aug 23 2011

A soldier kills himself and his wife. Another war veteran hangs himself in despair. Yet a third puts a gun to his head and pulls the trigger outside a gas station in a confrontation with Texas lawmen.

Suicides by veterans like these once would have left people reeling in this military community. But troops and their families here these days call it the "new normal" for a US Army that's spent a decade at war.

Melissa Dixon sees the stress in the tattoos she draws on soldiers back from combat.

"Some of them have issues with their wives or their loved ones, where they're fighting, or one will have a friend commit suicide," she said.

There's no place like Fort Hood in the Army. A post that sent soldiers from two divisions to Iraq three times since the invasion, it's logged more suicides since 2003 than any other — 107.

Soldiers at big posts like Fort Hood that have played key roles in deployments are at the greatest risk of killing themselves.

The post here in Killeen, northwest of Texas' state capital, Austin, set an Army record last year with 22 suicides.

Elsewhere, Fort Bragg, North Carolina, home of the 82nd Airborne Division, has lost 77 soldiers to suicide since 2003.

At Fort Campbell, Kentucky, home to the 101st Airborne Division, 75 soldiers have died by their own hand over the last eight years.

But the problem is widespread. Last year, a record 300 soldiers in the active-duty, Reserve and National Guard killed themselves.

The numbers appear to be down slightly in 2011, but 32 active-duty staff killed themselves in July, the highest since the Army began tracking the phenomenon in January 2009.  read the rest here.

SSRI Stories Note: The Physicians Desk Reference states that antidepressants can cause a craving for alcohol and can cause alcohol abuse.   Also, the liver cannot metabolize the antidepressant and the alcohol simultaneously, thus leading to higher levels of both alcohol and the antidepressant in the human body.

via guestofaguest.com from 2007

We came across something very disturbing in today's Metro.  In an article titled"A Soldier's Suicide: Did He Have to Die?" we read about the story of soldier Jason Scheuerman.  Jason took his own life in Iraq after numerous displays of suicidal characteristics and behaviors.  What was more horrifying was this statistic, imbedded halfway down in the article:

"At least 152 U.S. troops have taken their own lives in Iraq and Afghanistan since the two wars started, contributing to the Army's highest suicide rate in 26 years of keeping track."

This is so, so sad.  Not only are we loosing thousands of troops to the enemy (whoever that may be at the time), we are loosing hundreds of sons and daughters to despair.  And it doesn't end when they return home.  America is suffering an epidemic of suicides among traumatized army veterans.

"More American military veterans have been committing suicide than US soldiers have been dying in Iraq. At least 6,256 US veterans took their lives in 2005, at an average of 17 a day." [TimesOnline]

 As a nation, we need to step things up.  Jason is an example of several military leaders failing to take action.  On a mental health questionnaire he had admitted thoughts about killing himself, also that he was uptight, anxious, depressed, and had feelings of hopelessness and despair.  He had also made calls home saying goodbye, and spoke several times about wanting to kill himself.  His leaders many of the times played these claims of his off as exaggerated jokes by the soldier, and even gave him back his gun after serving him with 14 days of extra duty as punishment (minutes later they found him dead in his room).  Imagine the angst of his parents, who were soldiers themselves, and feel this should have been prevented.  His dad Chris:

"We will not see a statistical decrease in Army suicides until the Army gets serious about holding people accountable when they do not do what they are trained to do."

It IS time for our leaders both in the military and back home to step up and start aiding in the mental health of our troops and our veterans. Read it here.

Check out the website SSRI Stories link to stories specific to members of the military and veterans

The Rise and Fall of Atypical Antipsychotics: The belief in pharmaceutical marketing messages

 

via BJPsych:

Editorial

The rise and fall of the atypical antipsychotics

TIM KENDALL

Declaration of interests:
T.K. receives about £1.4 million per year from the National Institute for Health and Clinical Excellence (NICE) to develop clinical practice guidelines for the National Health Service in England and Wales. He also receives funding/grants from other bodies including the Academy of Medical Royal Colleges, the Department of Health and NICE International to undertake systematic reviews or guideline development. T.K. is a co-opted member of the Council of the Royal College of Psychiatrists and contributed to the development of the College Report CR148 on psychiatrists’ relationship with the pharmaceutical industry

the final two paragraphs:

In the recently updated NICE schizophrenia guideline we also found that there were no consistent differences between atypicals and typicals, SGAs and FGAs; there were no important differences between any of the antipsychotics in terms of clinical or cost effectiveness (except for clozapine in treatment-resistant schizophrenia); the side-effects varied from drug to drug and were not determined by class; and all the antipsychotics were associated with potentially serious dose-related and other side-effects. 4 Although some of the newer drugs are associated with lower rates of EPS/tardive dyskinesia, they are also linked to different and equally severe side-effects such as diabetes, and some other newer drugs may have similar rates of EPS to the older drugs. From Girgis et al in this issue, it now seems unlikely that there are any longerterm benefits for using atypicals or SGAs in the first episode.

In creating successive new classes of antipsychotics over the years, the industry has helped develop a broader range of different drugs with different side-effect profiles and potencies, and possibly an increased chance of finding a drug to suit each of our patients. 4 But the price of doing this has been considerable – in 2003 the cost of antipsychotics in the USA equalled the cost of paying all their psychiatrists. The story of the atypicals and the SGAs is not the story of clinical discovery and progress; it is the story of fabricated classes, money and marketing. The study published today is a small but important piece of the jigsaw completing a picture that undermines any clinical or scientific confidence in these classes. With the industry reputation damaged by evidence of selective publishing and its deleterious effects, 15,16 and the recent claims that trials of at least one of the new atypicals have been knowingly ‘buried’, 2 it will take a great deal for psychiatrists to be persuaded that the next new discovery of a drug or a class will be anything more than a cynical tactic to generate profit. In the meantime, perhaps we can drop the atypical, second-generation, brand new and very expensive labels: they are all just plain antipsychotics. here

As interesting as the above article is, I found what the editor of the British Journal of Psychiatry, Peter Tyrer said about the SGAs interesting, and the response to Tim Kendall's editorial from The Last Psychiatrist, illuminating.

From the Editor's desk

1. Peter Tyrer

Spotlight on antipsychotics

The act of prescribing an antipsychotic drug in psychiatry is like sex; it is almost universal in practice yet indiscriminate use can lead to multiple pathologies. Where it differs from sex is that the act is almost completely devoid of pleasure for most parties involved. Patients tend to hate these drugs because of their panoply of adverse effects – not for nothing was chlorpromazine named Largactil – and practitioners, unless they are avid psychopharma- cologists, feel their prescription is a necessary evil that is likely to change the relationship with their patients from a cooperative to a coercive one, particularly in a hospital environment.^1,2 We would all feel a lot better if this range of drugs was replaced by one that was at least equally effective and did not have the potential to attack every organ system in the body when it wasn’t looking, or even looked for, in clinical and research practice.³ Six papers in this issue touch on this subject from different angles. After looking at the similarities between the long-term benefits of clozapine and chlorpromazine in schizophrenia (Girgis et al, pp. 281–288), Kendall (pp.266–268) goes for the full frontal assault on the way guidance has been distorted by the pharmaceutical industry, ‘a story of fabricated classes, money and marketing’, with most changes being no more ‘than a cynical tactic to generate profit’. I have to declare my own interest here; I cannot see any justification for separating first- and second-generation antipsychotics and think these terms should be dropped far, far away from rediscovery by gullible psychiatrists.⁴ But Leucht & Davis (pp. 269–271) rightly emphasise the variability of antipsychotic drugs and that prescription should follow a ‘shared decision-making process’ with the patient, provided, some would add, that this is an honest and genuine one.⁵ Frighi et al (pp. 289–295) show that in those with intellectual disability, adverse effects are not usually major. My own explanation of this somewhat surprising finding is that because shared decision-making is much more difficult with this group than with those of normal IQ and that a minority of patients is unduly sensitive to these drugs, much lower doses are prescribed than in others and so there are fewer adverse consequences. Suzuki et al (pp. 275–280) confirm my own impressions from clinical practice that if there is no clinical response to an antipsychotic drug fairly soon after prescription (within 6 weeks) then its further prescription should be questioned, and long-term usage regarded as rare. (emphasis mine) here

via The Last Psychiatrist:
The Rise And Fall Of Atypical Antipsychotics [sic]

His point is that the atypicals aren't really better than the typicals (duh.)  Of course he's right, but in being factually accurate he is being deliberately deceitful.  

To be clear: I am obviously aware of the buried data and the obfuscatory shell games of Big Pharma, but the truth of these medications has been available even without resorting to studies no one would have read anyway.  But in order to hide the fact that no one really paid much attention to the actual data that was in front of them (they took the word of the local thought leader and figured that was that) they pretend that the problem is the buried data. (empasis mine) here

photo credit

TMAP is considered a "Best Practice"

Primum non nocere 

Declare the past, diagnose the present, foretell the future; practice these acts. 

As to diseases, make a habit of two things to help, or at least to do no harm. 

A doctor who thinks TMAP is a "Best Practice," isn't much of a doctor...

Jeffrey Thompson, M.D. Medical Director, Washington State Department of Social and Health Services, testifying in a HEARING before the SUBCOMMITTEE ON INCOME SECURITY AND FAMILY SUPPORT of the COMMITTEE ON WAYS AND MEANS U.S. HOUSE OF REPRESENTATIVES MAY 8, 2008 on PRESCRIPTION PSYCHOTROPIC DRUG USE AMONG CHILDREN IN FOSTER CARE

A few excerpts:

"We note that the data is presented in a non-judgmental manner. This brings the Committee together, and I might add, the drug companies are actually at the table when we discuss this. What we want to do is stop and take a short, deep breath and review the treatment plans to ensure that there's an integrated plan for the treatment. (emphasis mine)

 
"Recently, our safety standards for stimulants have steered as many as 56 percent of prescriptions for stimulants to lower dose, fewer medications, and sometimes to rethink prescriptions in the very young. Note that 44 percent of prescriptions that are at high dose are in the very young, when our community and us agree that this is actually the appropriate use. (emphasis mine)

"When we look across the country we see antipsychotic use that varies between states--as much as 4% to 13% in the Medicaid populations. Because there is so much variation, the Medicaid medical directors asked NASMD and AHRQ to sponsor an up-to-date pharmacy claims and program bench marking project. We hope this bench marking will highlight "best practices'' like the Texas algorithims..." (emphasis mine) here 

Those Texas algorithms, known as TMAP is a marketing strategy that is used to sell the newest most expensive psychotropic drugs; TMAP was never a "best practice" it was always simply a fraudulent marketing strategy with patently false claims that the  preferred drugs on what Jeffery Thompson called, "the Texas algorithms" were safer and more effective than the older ones; justifying their high cost. TMAP algorithms played a critical role in  the massive amount of Medicaid fraud.  Apparently, here in Washington State it still does.    

I am having difficulty wrapping my mind around the idea that 44% of psychotropic drugs being  prescribed in high doses are being given to the very young here in Washington State. This is, according to Jeffery Thompson's testimony, "the appropriate use" for the drugs. He's obviously working closely with (or is it for?) the drug companies.  So very unethical for Washington's Medicaid Director to have characterized TMAP as a "best practice;" Allen Jones had filed a Federal Whistle-blower Lawsuit in 2004, the State of Texas joined it in 2006. In 2008, when Jeffery Thompson called "the Texas algorithms" a "best practice," it was well known that TMAP was simply an unethical marketing scheme. 

This is the same Director who issued an "emergency warning" for Methadone AFTER 2,173 deaths had become public knowledge.

Washington State hired an architect of the TMAP fraud

An eye-opener: from a psychiatrist and a healthy volunteer in study of the effects of 2 psychotropic drugs

A note: the drug lorazepam is referred to as an antipsychotic in the article below; it is a benzodiazepine.

Open Mind 93 September-October 1998
An eye-opener

Psychiatrist Gwen Jones-Evans PARTICIPATED IN A HEALTHY VOLUNTEER STUDY  LOOKING  AT THE EFFECTS  OF THE ANTIPSYCHOTICS  DROPERIDOL  AND LORAZEPAM

Read also "Unravelling Madness" an interview with Richard Bentall, Ph.D. about his experience taking an antipsychotic as a healthy volunteer in a drug study by Chris Barton in the New Zealand Herald.

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