Monday, June 9, 2008
One more link on big pharma transparency
A helpful overview of the bill Sen. Chuck Grassely sponsored mandating transparency of drug company payments to physicians...
Old Links, New Links
If you are interested in the relationship between drug companies, flawed research, gigantic profits, and emotional health hit the following links:
for an up to date account of the attempts to reform the relationship between big pharma and doctors see the Carlat Psychiatry Blog. Read the article that made him famous!
Peter Breggin is likely more responsible for our awareness of how dangerous many of the these drugs are. You can link to his Center for the Study of Psychiatry and Psychology here.
You might want to read an appreciative overview of E. Foster Torrey's work. I think he is a mixed bag, but you should know about him.
If, say, Pfizer runs 20 studies on a new drug called "whoknowhowitworxiprine", one of them is bound to be positive, right? Especially if you keep tweaking the group you are using in the study by, say, not counting those people who dropped out due to "side-effects" such as chronic constipation or nervous twitches. But what happens to the other 19 studies that show the drug as being possibly dangerous or ineffective? Down the memory hole with that one! Here's another article on the same subject.
Then there is the rather disconcerting evidence that anti-depressants don't work much better than placebo. Here is one more link regarding the fact that serotonin is not the primary driver of depression.
Finally, speaking of the memory hole- which is an Orwell reference- here's a little big brother for you: that long standing attempt to find a diagnosis for every child, so they might have "access" to the mental health system. Or rather, so the big pharma companies have access to every child.
This is just a run down. Plenty more where that comes from.
for an up to date account of the attempts to reform the relationship between big pharma and doctors see the Carlat Psychiatry Blog. Read the article that made him famous!
Peter Breggin is likely more responsible for our awareness of how dangerous many of the these drugs are. You can link to his Center for the Study of Psychiatry and Psychology here.
You might want to read an appreciative overview of E. Foster Torrey's work. I think he is a mixed bag, but you should know about him.
If, say, Pfizer runs 20 studies on a new drug called "whoknowhowitworxiprine", one of them is bound to be positive, right? Especially if you keep tweaking the group you are using in the study by, say, not counting those people who dropped out due to "side-effects" such as chronic constipation or nervous twitches. But what happens to the other 19 studies that show the drug as being possibly dangerous or ineffective? Down the memory hole with that one! Here's another article on the same subject.
Then there is the rather disconcerting evidence that anti-depressants don't work much better than placebo. Here is one more link regarding the fact that serotonin is not the primary driver of depression.
Finally, speaking of the memory hole- which is an Orwell reference- here's a little big brother for you: that long standing attempt to find a diagnosis for every child, so they might have "access" to the mental health system. Or rather, so the big pharma companies have access to every child.
This is just a run down. Plenty more where that comes from.
Huxely, Part 3
Is it possible that a drug could wipe out guilt and shame? Is it possible that a person could take such a drug prophalactly, that is, ahead of time, so as to not remember or become preoccupied with an act of moral uncertainty? The article I linked to below brushes by that possibility.
Instead, it raised other crucial questions of the use of these drugs to patch up an terribly understaffed military mission, and of having entire units functioning less than optimally due to the drugs' many side-effects at certain dosages (I hesitate to even call them that- the deadening effect is the intent, isn't it?).
Now consider this (from Talking Points Memo):
By Andrew Tilghman - June 9, 2008, 10:09AM
Instead, it raised other crucial questions of the use of these drugs to patch up an terribly understaffed military mission, and of having entire units functioning less than optimally due to the drugs' many side-effects at certain dosages (I hesitate to even call them that- the deadening effect is the intent, isn't it?).
Now consider this (from Talking Points Memo):
By Andrew Tilghman - June 9, 2008, 10:09AM
The system designed to keep corporate cash from secretly slipping into the hands of doctors who do highly influential medical research isn't working very well.
Even at the nation's top institutions - such as Harvard - and affecting the most vulnerable populations - children with psychiatric problems.
A front-page story in Sunday's New York Times reports that a Congressional probe found some top child psychiatrists earning more than $1 million in often undisclosed consulting fees from drug firms.
What's most troubling about the investigation is that the these individual doctors and their public advocacy for certain drugs for mentally ill children "has helped fuel an explosion in the use of powerful antipsychotic medicines in children."
Dr. [Joseph] 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. Although many of his studies are small and often financed by drug makers, his work helped to 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 antipsychotic medicines in children. The Grassley investigation did not address research quality.
Biederman, who works at Harvard Medical School's department of psychiatry, received $1.6 million in consulting fees from drug makers from 2000 to 2007 but for years did not report much of this income to university officials, according to information given congressional investigators.
While there are rules for disclosing such payments, there's virtually no enforcement of those guidelines.
"It's really been an honor system thing," said Dr. Robert Alpern, dean of Yale School of Medicine. "If somebody tells us that a pharmaceutical company pays them $80,000 a year, I don't even know how to check on that."
While the probe, led by Sen. Charles Grassley, (R-IA) is scrutinizing the system for disclosing such payments, there is no effort to examine whether these payments may have influenced the doctors' research.
As the Times notes: "The Grassley investigation did not address research quality."
Controlling for bias is especially important in such work, given that the scale is subjective, and raters often depend on reports from parents and children, several top psychiatrists said.More broadly, they said, revelations of undisclosed payments from drug makers to leading researchers are especially damaging for psychiatry.
"The price we pay for these kinds of revelations is credibility, and we just can't afford to lose any more of that in this field," said Dr. E. Fuller Torrey, executive director of the Stanley Medical Research Institute, which finances psychiatric studies. "In the area of child psychiatry in particular, we know much less than we should, and we desperately need research that is not influenced by industry money.
E. Fuller Torrey is a hugely influential voice in the efforts to destigmatize mental illness (a term I am very uneasy with) and to treat it as a medical disorder. He is considered the devil himself among some groups of "psychiatric surviviors". Others consider him a man who has done great good for millions of people. To read an admission from him that psychiatry is in the midst of a "credibility" problem indicates to me that things might be changing more deeply than I though they were.
In any case, this country has a big, big drug problem. It encompasses the use of drugs for recreation, managing trauma, optimized performance, exploiting and extracting human resources, addiction, dementia, learning disabilities and much more. It also means that how research is funded and who profits from both the research and the drug products has to be utterly transparent.
We have to have a comprehensive debate on these issues. I have a feeling that in five years all these issues are going to be seen converging on our cohort of Iraq and Afganistan vets. The old distinctions between illegal, legal, recreational, medical, and enhancement are going to collapse.
Huxley, Part 2
Over time, I become very disenchanted with the overall approach we took at that hospital. In the end, I think we did more slightly more good than harm. But when the insurance arrangements collapsed in the early nineties with the emergence of HMO's and funding decreased for the treatment of the most poor and vulnerable, I was pretty happy to move on to playing music full-time for a couple of years.
But it was in this program that one can see great possibility for abuse: namely, early and thorough control of a child's behavior through drugs. And with no informed consent. After all, the parents are hardly in a position to object, and no one in the system was going to either. None of these drugs were approved for these uses (of this I am pretty sure, but not completely so), and the many side effects would certainly set the child up for future ridicule: constipation, slurring of speech, awkward movements, glazed expression, etc.
Keep in mind that this was more than fifteen years ago. You would think that long term studies on the safety of anti-psychotics (haldol, risperdol, clozaril) or anti-depressants (imipramine, prozac, and so on) would have been published. You would be wrong.
Now we have another vast, underserved, and traumatized population- returning veterans- who will be desperate for treatment, who will not receive the services, training, and economic support that greatly lessens the strain of emotional distress, and who will instead be treated as damaged brains and be subject to a largely unsupervised drug regimen.
Sure, some drugs help. But unless there is a wide and comprehensive range of services, our vets, like the poor and abused children I worked with years ago, will be presented a false choice.
It will seem as if beta-blockers and anti-depressants are the only options. And that will be because we have, once again, failed to address our societal problems with societal solutions.
But it was in this program that one can see great possibility for abuse: namely, early and thorough control of a child's behavior through drugs. And with no informed consent. After all, the parents are hardly in a position to object, and no one in the system was going to either. None of these drugs were approved for these uses (of this I am pretty sure, but not completely so), and the many side effects would certainly set the child up for future ridicule: constipation, slurring of speech, awkward movements, glazed expression, etc.
Keep in mind that this was more than fifteen years ago. You would think that long term studies on the safety of anti-psychotics (haldol, risperdol, clozaril) or anti-depressants (imipramine, prozac, and so on) would have been published. You would be wrong.
Now we have another vast, underserved, and traumatized population- returning veterans- who will be desperate for treatment, who will not receive the services, training, and economic support that greatly lessens the strain of emotional distress, and who will instead be treated as damaged brains and be subject to a largely unsupervised drug regimen.
Sure, some drugs help. But unless there is a wide and comprehensive range of services, our vets, like the poor and abused children I worked with years ago, will be presented a false choice.
It will seem as if beta-blockers and anti-depressants are the only options. And that will be because we have, once again, failed to address our societal problems with societal solutions.
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