Baby Boomers Leaders in Prescription Overdoses

Baby boomer are accidentally killing themselves with overdoses of prescription painkillers, anti-anxiety and sleep medication at a faster rate than any other group. According to an article in the Wall Street Journal’s Health Blog.

This is the fate that befell Batman’s Joker Heath Ledger. The total accidental prescription overdoses were 22770 in 2004 rising 700 percent since 1983. The Associated Press reports that, “The increase deaths was highest among baby boomers, people in their 40s and 50s.”

Perhaps the young are now beginning a new trend with the use of antidepressants.

Read this People Magazine piece on Anna Nicole Smith’s son Pathologist: Meds Killed Daniel Smith.

Psychiatrist Says, “Depression not a Disease”

National Public Radio devoted its show Science Friday to a debate between a psychiatrist who maintains that depression is not a disease and one who thinks that depression is a medical illness.

The two principals were:

• Harvard trained Dr James Gordon who founded and directs The Center for Mind-Body Medicine in Washington. Dr Gordon is the author of a new book Unstuck which prescribes a holistic program to deal with depression
• and Dr Peter D. Kramer who teaches at psychiatry at Brown University and practices psychiatry in Rhode Island. Dr Kramer is the author of many books including Listening to Prozac and Against Depression. The latter argues that the term depression has many meanings in our culture but most important is the fact that depression is a medical illness.

What is Depression

To Gordon, depression is a signal that something in one’s life is out of balance and can be a beginning to transformational change where a person can become unstuck and move forward.

On the other hand, Kramer sees depression as a cluster of disease traits and symptoms:

• Level of pain;
• Runs in families;
• Disruptions in normal brain activity;
• Co-morbidity with other illnesses such as diabetes and heart disease;
• And tendency to be recurrent and progressive.

So depression looks, smells and acts like a disease to Kramer.

Causes of Depression

Dr Kramer pressed his point that a depressed person’s brain activity and anatomy is abnormal. The head of the Center for Mind-Body Medicine responded that everything in the human body has biological manifestations.

Dr. Gordon believes that the primary response to depression should be a integrated program which includes meditation, relaxation, nutrition and exercise and help for the patient see the world and himself differently. Dr Kramer doesn’t write off these techniques but stresses that depression interferes with the ability to function which impacts careers and relationships and is dangerously associated with strokes, suicide and heart disease.

Depression and Medication

Gordon pointed out that recent antidepressant studies have shown them to be less effective that previously reported. The reason for this, according to Kramer is that the standards of research study have been raised:

• Studies now are based on larger samples of people;
• People are screened more rigorously before they come into to a study;
• And a closer review is conducted on the people who seemed to improve on the drug.

Dr. Kramer also mentioned that the studies of the effectiveness of psychotherapy has shown lesser results recently because the test bar in research studies has been set higher.

Dr Gordon maintains that usually stress is the primary cause of depression and the patient should first be guided through a multidisciplinary program; and that medication is the treatment of last resort for the very small percentage of people don’t respond to holistic treatment.

Morality and Spirit

During one exchange as Dr Gordon was making the point that a person needed to be guided through his program so that the patient could learn to help himself. Dr Kramer reacted by saying that the use of the word “guide” had a moral and spiritual feel to it that made him uncomfortable. Gordon responded by saying that doctors do help to save souls and they have a moral duty to do so. Kramer acknowledged that religion or spirituality can be very important to the patient.

A lot of what Dr Gordon had to say makes sense. In an ideal world, I would agree with his approach. Medications should be the last resort and not the first.

The profession of psychiatry is in a crisis. Efficacy claims for both psychotherapy and medications have been dropping based on new research studies. To be in the position of saying the reason the two treatments looked good a few years ago is due to bad research practices is devastating.

But there are elements of both our culture and the human equation that neither doctor brought up that explains what’s going on:

• Insurance companies have reduced psychiatrists to pill dispensers because it’s cheaper for a patient to spend 15 minutes talking with a doctor who then writes a prescription and sends them out the door. Of course the psychiatrist will prescribe a med, he’s a human being and wants to help is patient.
• Most people don’t have the time, interest or energy to participate in a multidisciplinary holistic program. Dr Gordon has stories in his book about people who have stretched themselves and been successful but they are very much the exception and not the rule. So the idea of taking a pill is probably the most attractive option for people.

Based on what I heard on Science Friday, I understand why we are in the mess that we are in. A healthy life style falls by the wayside when people don’t have the energy or time because they are figuratively running to stay in place economically; it’s difficult to change old habits; and there is big money to be made and time to be saved with drugs,

Antidepressants: No Diagnosis, No Problem

“Forty-three percent of those who had been prescribed antidepressants, had no psychiatric diagnosis or mental health care beyond the prescription of the drug.”

This comes from The Medicated Americans: Antidepressants Prescriptions on the Rise in the February issue of Scientific American.

The statement is mind-boggling. Most of these prescriptions are written by the family doctor for a drug that can have serious, even fatal side effects.

Reasons

I can see four reasons for this.

• Extensive advertising by pharmaceutical companies create such consumer demand that when many people visit their doctor they ask for an antidepressant and the doctor simply complies.
• The insurance companies steer people towards antidepressants because a pill is cheaper and simpler than paying for therapy or encouraging people to live a healthier life style.
• Many people are under tremendous stress.
• Old habits die hard; most people want a magic bullet. Take a pill, no fuss, no muss.

Results

People are taking antidepressants with no valid medical; others are not getting the thorough medical care they need. This results in some people:

• Becoming even more ill because they are receiving only partial treatment;
• Running to their family physician to take a pill for no medical reason instead of dealing with the root cause of a problem or making simple lifestyle changes.

It also results in a huge waste of money.

The pharmaceutical and insurance companies get richer, lots of money is wasted and people get sicker.

Should Your Child Take Prozac? Ask the Grocer

An article in the The Australian highlights the ambivalence of modern societies towards psychotropic drugs. Particularly the use of those drugs to treat children.

Consider the difference between label warnings in Australia and the US.

• United States – “On the packet of one leading brand, the following warning is displayed in bold type: ‘Anti-depressants increase the risk of suicidal thinking and behaviour (suicidality) in short-term studies in children and adolescents with Major Depressive Disorder (MDD) and other psychiatric disorders.’”
• Australia – “They all say SSRIs are not recommended for use in children and adolescents for depression, but few reveal the increased risk of thoughts of suicide or self-harm in this group.”

The piece exposes a policy contradiction within the governments of both countries.

Although some drug labels in the US warn of suicide in children while Australia uses a “dis-recommendation”, government funded health insurance programs help people buy these drugs.

A quote from the paper attempts to explain the Australian government’s contradiction.

• “The health department said the decision to pay rebates but withhold marketing approval for the use of SSRIs in children for treatment of depression was a “sensible balance” between the risk of inappropriate prescription and the risk of leaving the illness untreated.”

We are talking about children here. Both governments are passing the buck.

As Australia’s Pharmaceutical Benefits Advisory Committee puts it “These treating doctors will, of course, have to carefully consider the options, risks and benefits of prescribing these medicines.”

Here in the US, Food Drug Administration makes its non-decision about the safety of antidepressants based on information provided by the drug companies; and with a child’s life in the balance, lets the psychiatrist roll the dice.

This is like saying “There’s a tomato salmonella outbreak across the country but we’ll let your grocer decide whether or not the tomatoes you buy are safe.”

Mental Illness: The Courts, Doctor’s Office and Coffee Shop

A June ruling by the Supreme Court is the latest example of our institutions wrestling with the mentally ill’s place in society. Different perceptions about what is right are sometimes based along political and philosophical lines but on the street it’s a different story.

Both the Supreme Court and psychiatric community are struggling with the competence of the severely mentally ill to make their own choices.

The issues at the center of the conflict are the:

• individual rights of the severely mentally ill to make their own choices
• government’s right to protect its citizens
• obligations of health care to serve their patients.

In a split decision, the Supreme ruled that a severely mentally ill person may be competent enough to stand trial with the aid of a lawyer but not competent enough to defend himself.

Majority votes were cast by liberal and moderate judges while dissenting votes were cased by conservative jurists.

This issue is discussed by Dr Peter Kramer on his blog “In Practice”; the title of the post is Degrees of Competence: Do Liberals and Conservative Understand Mental Illness Differently?

The liberal majority indicated that they felt a judge could finely grade the competence of a severely mental ill person; and their ability to participate in their own defense. The underlying assumption is that participating in the trial with the aid of a lawyer is less demanding than defending one’s self.

On the other hand, the dissenting votes of conservative Court members seemed to give the absolute concepts of autonomy, liberty and individual rights greater standing. In the case before him, Judge Scalia also cited the coherence presented by the man who was on trial.

Some people who are psychotic can be artful about how they communicate but yet be suffering from severe delusion. Perhaps Judge Scalia was more worried about the protection of the public at large or the courts being co-opted to send people to the gulag than the nuances of justice for the mentally ill.

The psychiatric community also struggles with the patient’s ability to act in his own self interest.

Does it take less competence on the part of a psychotic patient to accept a doctor’s recommendation than to refuse it. Some ethicists says “yes”. Refusing a doctor’s recommendation is a more complex decision because it would require evaluating other options.

A more specific example of this dilemma is whether or not the government can force a person to take their medications

In some states if the People determine that the person is a danger to himself or others, they entitled to force them to take their meds. As a practical matter states don’t have the resources to monitor compliance.

IMO, judges should exercise the ability to understand the level of competence of a person with severe mental illness so they can participate in their own trial to the maximum extent possible; and states should be able to force a patient to take medication for the protection of the public and patient.

As for the competence of a severely ill person to make his own health decisions, the person has every right to make choices as long as he is not dangerous.

In these extreme circumstances, society’s burden to respect the rights of the mentally ill falls upon the psychiatrist and the judge. As for the every life, affirmation and respect for people with mental illness severe or not, can lift the rest of us whether at work, a sporting event, or the neighborhood coffee shop.

Media Discrimates Against Mentally Ill More Than Blacks

The prime time media uses negative stereotypes to depict mental illness almost 4 times more than it does blacks.

The numbers are from a study, Liz Sayce cites in her book From Psychiatric Patient to Citizen: Overcoming Discrimination and Social Exclusion

The research found that films and tv shows run during prime time depicted the mentally ill characters as villians 73% of the time, blacks 20% of the time and the disabled 12% of the time.

This means the media discriminates against the mentally ill almost 4 times more than blacks and 6 times more than the disabled.

The book also noted a second study published in the The British Journal of Psychiatry found programming for children under 10, showed the mentally ill as “crazy” , out of control and without positive qualities.

No one is suggesting that changes in content be imposed on the media however the studies show that the popular media exploits and perpetuates the stigma of the mental ill.

Bristol Myers Squib Gets 5YR Probation For Illegal Drug Sales

Bristol Myers Squib Chairman & CEO James M. Cornelius

His company (BMS) just paid out one of the biggest settlements ever for drug dealing. It sold the antipsychotic drug Abilify without FDA approval to children and the elderly. There were the usual consulting fees and luxury resort trips paid to doctors and health care providers to grease the skids.

In order to push product to little ones, BMS had a sales force visit “child psychiatrists and pediatric specialists”. For the elderly who had dementia, this pharmaceutical multinational created a “special long-term care sales force”

The icing on the cake was when the company tried to spin the fact they got 5 years probation with Inspector General’s Office by calling it a “corporate integrity agreement.” Where are mandatory jail sentences when you really need them.

Street dealers are more authentic than these guys.

Facts Courtesy of the Boston Globe

See also Harvard Psychiatrists Flunk Appearance of Propriety about peddling antidepressants to children.

Well Care vs. Sick Care

A quote from an article by Senator Tom Harkin

“But it’s not just cancer, we must do everything we can to prevent all chronic diseases. Preventing heart disease, diabetes, stress and depression would significantly lower the costs of healthcare for every American. More than 75 percent of all medical expenditures are used to treat chronic conditions, many of which are preventable by changes in diet and lifestyle.

This focus on treating rather than preventing disease is indicative of our broken healthcare system. We spend untold billions of dollars on pills, surgery, hospitalization, and disability, but spend peanuts for prevention. In fact, right now in our country we don’t have a health care system, we have a sick care system. If you’re sick, you get care. “

Harvard Psychiatrists Flunk Appearance of Propriety

Three Psychiatrists who perform research at Harvard University have a lot of explaining to do. In fact there are practices throughout the entire profession that give one pause.

Senator Chuck Grassley, Republican from Iowa, has been a bulldog in examining how money from pharmaceutical companies influences the practice of psychiatry. As a result of the Senator’s tenacity, the following has come to light.

• Dr. Joseph Biederman of Harvard Medical School’s Psychiatric Department belatedly reported $1.6 million in consulting fees to his university. To protect the integrity of academic research, disclosure of anything more than $10, 000 in money from drug companies is required by the National Health Institute.
• His colleagues Dr. Timothy E. Wilens and Dr. Thomas Spencer belatedly disclosed $1.6 million and $1.0 respectively.
• Dr. Melissa P. Debello of the University of Cinncinnati reported $100,00 in consulting fees. While the drug company Astrazenca, maker of the antipsychotic Seroquel, paid her $238,000.

Dr. Bierderman has championed the controversial practice of prescribing unapproved psychiatric drugs to very young children for bipolar disorder. According to NYT article Researchers Fail to Reveal Full Drug Pay, the number of children diagnosed as bipolar has increased 40 times in a 9 year period. The benefits of prescribing these psychiatric drugs remains unclear.

In 2006 The American Psychiatric Association received 30% of its financing, $63.5 million from the pharmaceutical industry. As quoted in the article Psychiatric Group Faces Scrutiny Over Drug Industry Ties, Senator Grassley’s reaction, “I have come to understand that money from the pharmaceutical industry can shape the practices of nonprofit organizations that purport to be independent in their viewpoints and actions.”

In the states of Vermont and Minnesota, the pharmaceutical industry pays more to psychiatrists than does any other medical specialty. National studies of industry practice have shown that when psychiatrists are on the company payroll, they report more favorable drug findings to the manufacturer than psychiatrists who are not compensated by the company.

It will be important to watch what changes, if any, are made to prevent the appearance of impropriety. I think that the IRS might also be interested in the ability of these learned professors to properly disclose their consulting fees.

Depression in Men: Denial, Destruction & Death

Although more women than men are diagnosed with depression, the consequences for men and their families are more violent and destructive.

The Men’s Health Network has recently published a free e-book entitled “Depression, Anxiety and Stress“. It includes the following statistical.

• Men are 4 times more likely to commit suicide than women.
• Men with depression are twice as likely to die from any cause.
• Older men has the highest suicide rate of all.

The book also contains critical points about how depression is expressed in men.

• “Deny to himself and everyone else that he might have a problem
• Try to mask the problem by turning to drugs or alcohol or throwing himself into work in an attempt to avoid dealing with the issue
• Act out by behaving hostilely or aggressively or doing dangerous or self-destructive”

The wages of depression in men can be catastrophic.