Tags: I-Ward, Kelly Thomas, mental health, Michael Cornwall, police force, police shooting, violence
The Portland Press Herald [Maine] has exhibited exemplary journalistic skill and integrity (rare, these days) by publishing an extensive report on police shootings of individuals with mental health issues. The focus is, of course, on Maine:
In Maine, 42% of people shot by police since 2000 – and 58% of those who died from their injuries – had mental health problems. The Maine Attorney General’s Office, which investigates all police shootings, has never found one to be unjustified. The office doesn’t ask whether violence could have been avoided.
But the national statistic they published shocked me, too:
About half of the estimated 375-500 people shot and killed by police each year have mental health issues. In many cases, the officers knew from the start that the subjects were unstable.
Thinking back over the past few years, I can remember a few specific incidents nationally where police murdered – there’s really no other word for it – an individual who could NOT reasonably be believed to possess even the means (let alone the intention) to use deadly force against the officers in question.
The Press Herald report documents an astonishing number of stories from Maine as well (click here to peruse the database of incidents and Attorney General’s reports compiled by the reporters). Many of these stories are complicated; there’s a lot of pain and desolation here. A fair amount of misunderstanding, fear, and police aggression as well.
One of the main points of the series is that reform is needed…
1. a more rigorous system for official review of the use of deadly force (that actually includes consideration of administrative/disciplinary action and asks the question: “could the use of deadly force been avoided?”)
2. better training for officers in dealing with crisis situations, so that the use of deadly force can be avoided.
I find myself thinking of Michael Cornwall’s recommendations for using a heart-centered approach to individuals in extreme emotional distress.
Michael not only has his own personal experience of distress to draw on, but also years of working with individuals in these states (several of those years taking place in the medication and diagnosis-free sanctuary for the treatment of first-break psychosis, I-Ward) to inform this wise approach:
Aggression, rage, and other extreme out-pourings of energy — sometimes taking the form of physical force — were not uncommon on I-Ward, according to Michael. But the staff was dedicated to a.) using a heart-centered approach to address these challenges and b.) not involving the police. What happened most frequently was that the emotions were discharged (often, the staff would use what Michael calls a “loving embrace” to hold the person in the throes of such emotion) and then staff took the opportunity to process what happened with the individuals involved.
We used no restraints [on I-Ward] and every time after long periods of wild raging people would wind down and end up cuddling into the sometimes 2 or 3 staff needed to hold them. They would then softly start to cry and sometimes sob in a deep regrression of safely being held by strong and loving parental figures.
-Michael Cornwall, in a description of I-Ward
The contrast between the heart-centered approach and the gun-centered approach is clear. Can we, as a people, a community, a society, choose the path that leads towards a life preserved, healing begun?
I hope we can.
Experts attempt to persuade parents struggling with the decision to medicate their children that the “benefits outweigh the risks” 12/11/2012Posted by ALT in Bipolar, Children's Mental Health, Mental Health News, Pharmaceuticals.
Tags: antipsychotic, childhood bipolar disorder, Janet Wozniak, Joseph Biedermann, mental health, polypharmacy
When you see a USA TODAY headline like this – “Parents struggle with decision to medicate bipolar kids” – and a subheading like this…
Because treating a child with heavy medication has far-reaching implications, parents wonder whether using psychiatric drugs is the best way to help their children with bipolar disorder.
… you might be surprised to find that what you’re reading is far from a balanced consideration of the true risks and benefits of psychotropic medication and polypharmacy in children. Instead, what you get is an out-and-out endorsement for drugging children, fast and furious.
We begin with scare tactics:
“Without treatment [read: medication], I see my daughter as killing herself,” says a weeping McQuilkin, 60.
As quoted in USA TODAY’S article Parents struggle with decision to medicate bipolar kids [emphasis added]
Bipolar is a lifelong disease, and you don’t want to diagnose it too early and be wrong, or miss something and be too late.
Gabrielle Carlson, professor of psychiatry & pediatrics at Stony Brook University
As quoted in USA TODAY’S article [emphasis added]
We move quickly on to more expert opinions:
I understand the reason why a parent would be afraid to medicate their child. There are often serious and unknown side-effects to consider. But parents also need to consider that there may be a downside to not medicating and missing an opportunity to interrupt the course of a serious illness. … Not medicating may also carry with it risks.
Janet Wozniak, psychiatrist at Harvard Medical School
As quoted in USA TODAY’S article [emphasis added]
Finally, we are assured that the benefits outweigh the risks:
There’s no free lunch with medication. But if an eye tic is what a child gets vs. getting kicked out of school because his behavior is unmanageable, then it’s worth the risk.
Gabrielle Carlson [emphasis added]
No free lunch?
An odd choice of words for Gabrielle Carlson, who has this additional list of credentials (from a 2010 Conflict Of Interest [COI] disclosure):
- Honorarium and Travel Expenses: Ortho-McNeil-Janssen Pharmaceuticals, Inc., Shire Pharmaceuticals, Inc.
- Research Funding: Bristol-Myers Squibb Company, Eli Lilly and Company, GlaxoSmithKline, Otsuka America Pharmaceutical, Inc.
Janet Wozniak, too, is no stranger to the free lunch:
- Faculty: Johnson & Johnson Center for Pediatric Psychopathology at the Massachusetts General Hospital (more on that momentarily…)
- Consultant: to Pfizer, Shire Pharmaceuticals, and Eli Lilly
- Research Funding: Eli Lilly
- Speaker’s Bureau: Eli Lilly and Janssen
(from a COI statement issued 2009)
Don’t you think it’s more fair to say that there IS a free lunch for some (medical experts, or “key opinion leaders” as they’re referred to by pharmaceutical companies) but NOT for others (children subjected to the horrors of polypharmacy and the mortal risks included therein)?
What they forgot to mention
Wozniak, Carlson, and the other experts quoted by USA TODAY neglected to include a few key facts that parents struggling to decide whether or not they should medicate their children for so-called “pediatric bipolar disorder” DEFINITELY ought to consider:
1. The relatively recent (we’re talking mid-90s) rise of the idea that so-called “bipolar disorder” is not an almost exclusively adult phenomenon but a widespread pediatric disease which must be aggressively treated with hardcore psychotropic medications, possibly for life. Authors Joseph Biedermann and Janet Wozniak’s turn-of-the-millennium publications put forth this cash cow of an idea and jump started the 4000% increase of this diagnosis in children between 1994 and 2003.
2. Biedermann et al also established – at (coincidentally!) the very same time – a lucrative partnership with Johnson & Johnson, which generously provided grant funding for the “Johnson & Johnson Center for Pediatric Psychopathology at the Massachusetts General Hospital” in 2001. A report to the funders (that would be J&J) dated 2002 reads, in part:
An essential feature of the Center is its ability to conduct research satisfying… [certain] criteria…. [including that] it will move forward the commercial goals of J&J.
…many clinicians question the wisdom of aggressively treating children with medications, especially those like neuroleptics, which expose children to potentially serious adverse events….
Through the funding provided by J&J, we [the J&J Center for Pediatric Psychopathology] are creating a team of investigators focusing on the following issues:
…We will generate and publish data on the efficacy and safety of medications for improving currently available treatment options for child psychopathology. This work is an essential precursor to the … widespread use of medications
[more on Biedermann and Wozniak’s collusion with J&J to carve out a market for Risperdal in the pediatric population here.]
3. The very serious side effects of antipsychotic medications in children, including extreme weight gain, type 2 diabetes, obesity, and heart conditions, and brain shrinkage. Antipsychotics have also been shown to significantly worsen symptoms of psychosis over time, making a potentially one-time occurrence into a chronic disease.
4. And finally, for children and adults alike, the Physician’s Desk Reference warns that use of antipsychotics can cause suicidal ideation, aggression, and violence. For example, the entry for Seroquel lists “thoughts of suicide or dying,” “feeling very agitated or restless,” “new or worse irritability,” “acting aggressive, being angry, or violent,” “acting on dangerous impulses,” and “mania” as symptoms that may occur in conjunction with use of Seroquel.
Bipolar disease is treatable, that’s the most important thing. I always tell young people who are at the beginning of treatment that bipolar is bad, but now is a great time to get it.
Kay Redfield Jamison, professor of psychiatry at John Hopkins School of Medicine
As quoted in USA TODAY’S article Parents struggle with decision to medicate bipolar kids [emphasis added]
Let’s be real: now is a great time for children to get themselves prescribed a whole bunch of pills under the guise of treating their ”lifelong, chronic, REAL bipolar disorders,” so that Wozniak and friends might partake in their free lunches.
But are those lunches really free if the children are the ones paying for them?
Tags: commercial free speech, FDA, off-label marketing, pharma, United States v. Caronia, Xyrem
On November 30, 2009, pharmaceutical sales representative Alfred Caronia was found guilty in a trial by jury of “conspiracy to introduce a misbranded drug into interstate commerce.” In plain English, he promoted the narcolepsy drug Xyrem for off-label uses to doctors, inciting them to prescribe it for issues – and to populations – NOT approved by the FDA.
There’s absolutely no doubt that he did this. Though Xyrem is only FDA-approved for narcolepsy and cataplexy in individuals aged 16-65, they’ve got Caronia on tape marketing it for a host of other purposes:
(transcript of Caronia speaking to Dr. Stephen Charno, a prospective Xyrem customer/prescriber who also happens to be a “government cooperator.”)
[Caronia]: And right now the indication is for narcolepsy with cataplexy . . . excessive daytime . . . and fragmented sleep, but because of the properties that . . . it has it’s going to insomnia, Fibromyalgia[,] periodic leg movement, restless leg, ahh also looking at ahh Parkinson’s and . . . other sleep disorders are underway such as MS.
[Charno]: Okay, so then so then it could be used for muscle disorders and chronic pain and . . .
[Charno]: . . . and daytime fatigue and excessive sleepiness and stuff like that?
[Caronia]: Absolutely. Absolutely. Ahh with the Fibromyalgia.
(transcript of Caronia speaking to Dr. Peter Gleason, a physician hired to promote Xyrem in a speaker program)
[Caronia]: Um, the youngest patients we have are sixteen in the studies as old as sixty-five. Ahh there have been reports of patients as young as fourteen using it and obviously greater than sixty-five.
It’s a very safe drug.
A very safe drug?
Well, the listed side effects include
- confusion, sleepwalking, and other neuropsychiatric events (eg, psychosis, paranoia, hallucinations, agitation, thought disorders and/or behavior abnormalities), depression
- CNS adverse events like seizures, sleep apnea, respiratory failure, coma, and DEATH
And there’s a black box warning, too, reading in part:
Sodium oxybate is GHB, a known drug of abuse…Even at recommended doses, use has been associated with confusion, depression and other neuropsychiatric events. Reports of respiratory depression occurred in clinical trials.
Free speech nightmare
So Caronia’s idea of a “safe drug” is a little twisted… so he promoted a drug off-label, as countless detail men have and will continue to do… so what? The courts found him guilty and imposed their penalty.
If only that were the end of the story.
Caronia decides to appeal. He claims that prosecuting him for off-label marketing is a violation of his right to commercial free speech, and is therefore unconstitutional. And yesterday, in spite of significant legal precedent condemning off-label marketing as a violation of the Food, Drug, and Cosmetic Act [FDCA], 2 out of 3 judges in a US federal appeals court agreed with him. According to the court’s decision:
A pharmaceutical representative’s promotion of an FDA-approved drug’s off-label use is speech. As the Supreme Court has held: “Speech in aid of pharmaceutical marketing . . . is a form of expression protected by the Free Speech Clause of the First Amendment.” (Sorrell v. IMS Health)… Caronia argues that he was convicted for his speech — for promoting an FDA-approved drug for off-label use — in violation of his right of free speech under the First Amendment. We agree.
- Judge Chin, in the court’s decision
Right now, this ruling only affects the circuit covered by this particular court – New York, Connecticut, and Vermont – but the FDA is likely to appeal the ruling to the Supreme Court. And if the Supreme Court upholds the decision, a drug, once approved for one purpose, can basically be marketed for any purpose at all.
The comments of Judge Livingston, the one dissenting vote, are sobering indeed:
If drug manufacturers were allowed to promote FDA-approved drugs for non-approved uses, they would have little incentive to seek FDA approval for those uses. Prohibiting such promotion is thus “one of the few mechanisms available” to encourage participation in the approval process. And premarket approval improves drug safety and effectiveness only to the extent that drugs are not sold without such approval.
The law generally permits a hardware store to sell turpentine, and though such conduct may not be advisable, the law generally permits a consumer to purchase that turpentine and use it as a pain reliever. Under the majority’s reasoning, then, any substance that may be legally sold for some purpose may be promoted by its manufacturer for any purpose—so long as the manufacturer’s statements are merely unsubstantiated, rather than demonstrably false or misleading. [emphasis added]
One can easily imagine the future that Livingston alludes to. Drug X is in development by a pharmaceutical company. They speed through the approval process by focusing on just one or two indications in a small population. Then, as soon as they get the now very hollow “OK” from the FDA, they start marketing Drug X as a cradle-to-grave miracle drug that will address everything from acne and ingrown toenails to colic and existential crises! A vast new market is created! Stock price charts will have beautiful black lines that go up! Doctors will be hired for speaking tours, shareholders will be counting their electronic dollars with glee, and patients will find themselves a part of the thrillingly inexorable march forward of the pharmaceutical technocracy!
A drug that was tested on only a few indications and populations is unleashed on the public. We discover the potential adverse events and safety issues, not in a small, clinical trial setting, but in the real world – and a certain percentage of people experience the ultimate adverse event: DEATH.
But hey, that’s a small price to pay to preserve the pharmaceutical industry’s commercial freedom of speech, right? To say whatever unsubstantiated thing they want as they peddle their wares? And given modern day scientists’ phenomenal ability to prove that things are inconclusive, given the vast amount of well-researched “may bes” (as in “may be linked to cancer” or “may be linked to brain shrinkage“)… I reckon the right researchers receiving the right amounts of pharmaceutical dollars could keep pharma’s off-label marketing slogans in scientifically unsubstantiated limbo almost indefinitely.
To read the court’s opinion in its entirety (and follow the snarled strands of this spider’s web), click here.
Just for fun – the Xyrem Success Program instructional video! Actual quote: “Be sure you are sitting in bed while you drink it, so you can then lay down immediately afterwards.” Otherwise you might pass out on the floor.
“Depression is really a chemical imbalance of the brain” – just one more branch on the eugenics tree 12/03/2012Posted by ALT in Activism, Depression, Mental Health News.
Tags: chemical imbalance, depression, eugenics, mental health, Prozac, serotonin, stigma, suicide
Two Northwestern professors (Cristina Traina and Laurie Zoloth) wrote an article in response to a college student’s suicide, entitled “Culture stigmatizing mental illness must change.” It reads, in part:
Learning to accept your limits is learning what it means to be human. Realize that although difficult events can trigger depression and suicide, depression is really a chemical imbalance in the brain. You can no more adjust this balance than a diabetic can will their body to make more insulin or a person with low thyroid production can think themselves out of fatigue. At the physical level, the brain, like any organ, can become unable to function properly — in this case, to imagine that there are other futures beyond the intensity, or the injustice, or the pain of this moment.
What can you do for yourself and your friends? First, get rid of the stigma around depression, suicidal thoughts and treatment for mental illness. We need to learn to talk about mental illness like we talk about cancer, a serious emotional and physical crisis that can be treated, whose sufferers need support and decency and understanding as they face a life-threatening illness. Depression and anxiety are more common than asthma. You wouldn’t stigmatize a friend for using her inhaler; she shouldn’t feel shame if she uses Prozac to function, too.
I had to respond.
TO: Cristina Traina and Laurie Zoloth
CC: Editors, Northwestern Daily and Huffington Post College
SUBJECT: Response to your article: “Culture stigmatizing mental illness must change”
In your recent Huffington Post article (Culture stigmatizing mental illness must change), you wrote that “depression is really a chemical imbalance in the brain.” I understand this was not an academic publication – but could you provide a citation to back this up?
You’ll find it impossible to do so; because this mantra, this advertising slogan is about as scientific as the statement that “the best part of waking up is Folgers in your cup!” The best? Really?
Meanwhile, let me provide with you with a few citations of my own:
[Antidepressant] advertising campaigns have revolved around the claim that SSRIs correct a chemical imbalance caused by a lack of serotonin… Contemporary neuroscience research has failed to confirm any serotonergic lesion in any mental disorder, and has in fact provided significant counterevidence to the explanation of a simple neurotransmitter deficiency… In fact, there is no scientifically established ideal “chemical balance” of serotonin, let alone an identifiable pathological imbalance.
- from Lacasse, J.R. & J. Leo (2005) Serotonin and Depression: A disconnect between the Advertisements and the Scientific Literature.
A serotonin deficiency for depression has not been found.
- Psychiatrist Joseph Glenmullen, clinical instructor of psychiatry at Harvard Medical School, in Prozac Backlash (2000)
Although it is often stated with great confidence that depressed people have a serotonin or norepinephrine deficiency, the evidence actually contradicts these claims.
- Professor Emeritus of Neuroscience Elliot Valenstein, in Blaming the Brain (1998), which reviews the evidence for the serotonin hypothesis.
But I am not writing merely to correct a factual error in your post – there’s more.
When an advertising gimmick is touted as scientific fact and even entered into the canon of “common sense,” there are bound to be some serious consequences. Consider:
- Rather than helping us “learn what it means to be human,” as you say, the chemical imbalance theory actually tells us that some people are born with brains that don’t function properly. That are, in some fundamental way, pathological. Put another way, there are the mentally fit and the mentally unfit. Sound familiar? To any student of late 19th/early 20th century eugenic thought in the West, it would sound mighty familiar.
- The theory also supports another common biopsychiatric fallacy: that an individual with a mental health diagnosis will need to take psychiatric medications for the rest of his/her life, to “correct the imbalance,” as the story goes. Long-term use of most classes of psychotropic drugs (including antidepressants, antipsychotics, and mood stabilizers) not only comes with serious, LIFE-THREATENING adverse effects, but can actually serve to make what could be rare occurrences of severe mental emotional/distress chronic and repeating. In some cases, this remains true even after withdrawal from the offending chemical agent. (see Robert Whitaker’s Anatomy of an Epidemic for chapters of information devoted to this astonishing truth).
- Finally, the chemical imbalance theory takes nearly all agency away from the individuals who are suffering from mental/emotional distress – they become the victims of whatever their faulty, off-balance brains inflict on them. You write that a person “can no more adjust this [depression-inducing chemical im]balance than a diabetic can will their body to make more insulin or a person with low thyroid production can think themselves out of fatigue.” How horrible if this were so! The kinder truth is there are many strategies a distressed individual can employ that are not purely chemical or pharmaceutical, but rather make use of the mind, will, spirit, and being. That empower, enliven, and entail a joyful discovery of strength, stamina, and RESILIENCY within the human being, who is indeed FIT TO LIVE in whatever way he/she chooses!
You express a desire to reduce stigma in mental health – I think this is admirable. Unfortunately, several scientific studies have demonstrated without a doubt that the “chemical imabalance” theory of mental health issues has the opposite effect: it increases stigma.
For example, in 1997 Sheila Mehta of Auburn University conducted a simple experiment on stigma in mental health, comparing the “chemical imbalance” model to the psychosocial model (which acknowledges a broad variety of factors – including family, past trauma, diet, environment, etc. – as potential contributors to emotional distress).
55 male college students were enrolled, and each one was told that he and a partner would have to do a simple learning task. The partner was actually a confederate, who would disclose a mental illness to the subject and then explain either that he had this illness because of “the kind of things that happened to me when I was a kid” [psychosocial] or that he had “a disease just like any other, which affected my biochemistry” [biochemical].
It turned out the group presented with the biochemical explanation were far more likely to treat their partners harshly than the group presented with the psychosocial one. Says Mehta, “The results of the current study suggest that we may actually treat people more harshly when their problem is described in disease terms. We say we are being kind, but our actions suggest otherwise… Viewing those with mental disorders as diseased sets them apart and may lead to our perceiving them as physically distinct. Biochemical aberrations make them almost a different species.” [See: Mehta, S. (1997). Is being “sick” really better? Effects of disease view of mental disorder on stigma]
Rather than learning “to talk about mental illness like we talk about cancer” by doing as you suggest and falsely promoting it as a merely physical problem of chemicals out of balance, I say we need to talk about mental and emotional distress in psychosocial context. AND in context of community, society. What is it about our culture, our rather toxic life on this planet, that makes people sick? And even more importantly, what can we as a society learn from these individual experiences of distress?
I take it you are sincere in your desire to help young people support each other in dealing with the distress that seems to hit so hard at the dawn of true adulthood. Surely, as scholars and seekers of knowledge, you recognize that truth, however complicated and elusive it may be, is vastly preferable to an oversimplified falsehood? Especially when that truth embraces the human potential to survive and thrive, while the falsehood embraces a technocratic romance with chemicals and a eugenical division of what were once human beings into groups of “fit” and “unfit” participants in this consumerist, sick culture.
If you want to help, tell the truth. If you’re not sure what the truth is, take the time to find out. Go slow, think critically, ask questions. Look for the roots of ideas, the beginnings of things, and then follow them from earth to sky – and all the branchings inbetween.
This will not be easy – psychiatry is a strange plant, indeed. But our community needs you to be more than just professors; we need you to be professors of TRUTH.
Can you? Will you?
Mental health writer and activist
I have received a response from one of the professors. She actually seems pretty open to considering what I said and has asked for time to research the information I shared. I’m not going to post her response yet because I’d like to win her trust — I think she really wants to dialogue! — but I hope to document our conversation here once it’s developed a bit more. I’m looking forward to a valuable exchange with her.
Tags: bipolar, forced treatment, involuntary commitment, Jeneen Interlandi, medication adherence, New York Times
There is a famous optical illusion called the young lady and the old hag.
The drawing illustrates how one’s perception of an object can suddenly flip, and in a sense, the dueling histories [of psychiatry]… have that same curious quality. There is the “young woman” picture of the psychopharmacology era that most of American society believes in, which tells of a revolutionary advance in the treatment of mental disorders, and then there is the “old hag” picture… which tells of a form of care that has lead to an epidemic of disabling mental illness.
… If you think of the [psychotropic] drugs as “anti-disease” agents and focus on short-term outcomes, the young lady springs into sight. If you think of the drugs as “chemical imbalancers” and focus on long-term outcomes, the old hag appears. You can see either image, depending on where you direct your gaze.
- Robert Whitaker, Anatomy of an Epidemic
It’s my new favorite metaphor for looking at psychiatry (replacing the tried-and-true “Emperor’s New Clothes”). The gulf between what mainstream psychiatry preaches about mental and emotional distress and what alternative and critical thinkers have to say is vast. On one side is an almost completely biological interpretation of mental distress as a chronic disease requiring lifelong chemical intervention, “management,” compliance, and across-the-board lowered expectations – for livelihood, and life. On the other is the idea that extreme emotional states, if not directly iatrogenic, are often the result of environmental, social, and historical factor, are better not pathologized, and in some cases (specifically, a first break into psychosis) may actually be part of a psychic healing process.
The space between being dotted with possibilities as well, though a position located exactly in the middle is about as sturdy as a house built directly over the San Andreas Fault Line.
When I look at the illusion, my strongest inclination is to see the young lady. Only by staring intently for several minutes, carefully searching for the hag, can I find her – it’s the nose that does it, finally.
And though my strongest inclination is to see psychiatry-as-usual as the old hag, I recently had a experience of the beautiful lady, and in this case, it was the appeal to my heart that did it.
A daughter’s story
“When My Crazy Father Actually Lost His Mind,” by Jeneen Interlandi, ran in the New York Times magazine this weekend, and it is moving, heart-wrenching.
It’s a daughter’s retelling of her father’s most recent protracted manic episode, and the devastating costs – financial and otherwise – to her entire nuclear family. During a manic period that lasted from August 2010 until late February 2011, her father endured 5 emergency room visits, 4 arrests and court appearances, numerous police confrontations, 25 days in a psychiatric hospital and 40 in a county jail. Total medical expenses were more than $250,000.
Ms. Interlandi’s story is one of a frightened family desperately seeking a way to stabilize her father – and they felt that forced medication compliance, a stay in a psychiatric facility, or both, were the way to accomplish this.
Here’s what I thought should have happened: My father should have been hospitalized against his protestations until his mania subsided. Once it did, he should have been released under supervision and under the condition that he abstain from drinking, which can exacerbate the symptoms of bipolar syndrome, and adhere to a treatment plan involving some combination of talk therapy and medication. I imagined something like probation, but run by a mental health office instead of a criminal court.
- Jeneen Interlandi, in the New York Times magazine piece “When My Crazy Father Actually Lost His Mind”
And though we do not hear directly from her father about his experience, it seems he had different ideas about what should happen:
We wanted him to go to a state hospital, where he could be cared for until he came around to taking his medication or until his mania subsided … He wanted to go home. But he was unwilling to take any of the steps that we were laying out for him to get there. He insisted that nothing was wrong with him and refused to take mood-stabilizing medication.
- Jeneen Interlandi
Ultimately, Ms. Interlandi’s family got the kind of medication compliance plan they were looking for (complete with probation officer), and the story ends with a scene of domesticity in the Interlandi home.
I asked him what he remembered about the whole ordeal… He [said he] felt like some other being had possessed him for a time. And he hoped that whatever it was, it was gone for good. My mother echoed those sentiments, shouting from the kitchen that it was the only part of their marriage that she wished to forget. Both of them seemed perfectly happy to ignore the fact that bipolar disorder is considered to be a lifelong condition. They would bury this alongside their other shared tragedies until, eventually, it became just another story they told.
- Jeneen Interlandi
Threats of violence from a man who has fiercely loved his wife all the years of their marriage, half-hearted suicide attempts from this gregarious lover of life – one can understand why the author felt as if “an evil alien had invaded his mind and taken over his body.” My heart goes out to a family that managed to stick together through this bipolar nightmare (the author’s mother was told she might want to “get a divorce” by her doctor in the midst of the crisis; she promptly got a new one), and I am happy that, at least for now, they have found the stability they so ardently sought.
The beautiful lady grants them a return to domestic bliss.
The thrust of Ms. Interlandi’s article was that her family’s worst suffering was directly caused by the difficulty they had in getting her father committed and medicated – if only involuntary commitment were easier and there were more places for such people to be committed to, her father could have (her words) “been cared for until he came around to taking his medication.”
One can fairly say that stability via medication compliance was a top priority for this family; Mr. Interlandi’s return to his home was conditional and depended upon it.
Is this the only way to achieve stability?
It’s an important question, because the number of adults (and children, too!) experencing severe mania and being diagnosed with bipolar disorder is soaring. From 1996-2004, the number of adults given the bipolar diagnosis rose by 56%. And I’m sure most readers are familiar with the 4000% increase of childhood bipolar disorder diagnoses between 1998 and 2004.
How to explain this?
We turn again to the old hag, psychiatry-as-usual.
A person treated with an anti-depressant has a significant chance of experiencing mania and receiving a bipolar disorder diagnosis that is, in reality, describing an entirely iatrogenic (drug-induced) phenomenon.
A 2004 study of 87,290 people originally diagnosed with depression or anxiety found that those treated with anti-depressants “converted” to bipolar disorder at the rate of 7.7% per year – ultimately adding up to between 20% and 40% of all people treated with anti-depressants. And this survey found that 60% of people with a bipolar disorder diagnosis said they “had initially fallen ill with major depression and had turned bipolar after exposure to an antidepressant.”
As it turns out, for many with a bipolar diagnosis, medication adherence is the key to instability, to increased mania and ever-more-rapid cycling. This is especially true for people who withdraw abruptly from their medications (as mania is a well-known symptom of rapid withdrawal from both antidepressants and mood stabilizers). And folks who do comply with long-term medication adherence have significantly worse mental and physical health outcomes than those who don’t – the science shows this over and over again.
It becomes clear from reading the New York Times comments section that Ms. Interlandi’s experience is not unlike that of many other families, desperate for a loved one’s return to stability that they believe can only be achieved by lifelong medication compliance, enforced, when necessary.
But how many of these beloved family members would never have experienced mania without previous exposure to a psychotropic drug? How many of these families would’ve been spared the endless cycling through moods, courts, hospitals, and jails, the threats, the attempted suicides if a family doctor had put away the prescription pad?
How many of the new bipolar diagnoses are iatrogenic?
Psychotroipcs as first line treatment, long term medication adherence, psychiatry-as-usual: beautiful lady or old hag?
Tags: APA, conversion therapy, Dr. Robert Spitzer, DSM-5, mental health, psychiatry, stigma
Meet Dr. Robert Spitzer.
This man has recently done something no other psychiatrist [to the best of my knowledge] has done: when confronted with an insurmountable critique of a view he had previously defended vehemently as “scientific,” he admitted he was wrong. Publicly.
And then he said he was sorry.
Well done, sir.
On Monday, the New York Times ran a story about Spitzer’s public apology for the publication of a 2001 study claiming to prove that so-called “reparative” or “conversion therapy” is effective – some of the time, with highly motivated individuals — in enabling homosexual individuals to “change” their sexual orientation to heterosexual.
I believe I owe the gay community an apology for my study making unproven claims of the efficacy of reparative therapy. I also apologize to any gay person who wasted time and energy undergoing some form of reparative therapy because they believed that I had proven that reparative therapy works.
- Dr. Robert Spitzer; Professor Emeritus of Psychiatry, Columbia University [emphasis added]
This was big news nationally – for homosexuals, gay advocates, and also various religious and “family”-oriented groups who have been using that “Spitzer 2001” citation for years to promote conversion therapy.
But I think this news is bigger than big (huge, even!) for the mental health advocacy community. If we can understand Spitzer’s reasons for apologizing, and his path to doing it so publicly and with such grace, we will be one giant step closer to eliciting other much needed apologies in psychiatry, to bridging the gap between psychiatric professionals and patients. A “truth and reconciliation” between psychiatry and its survivors is a real possibility, if more apologies are forthcoming.
Why did he change his mind?
On Monday, Spitzer gave a brief interview on NPR’s Talk of the Nation. When bluntly asked, “Why did you change your mind?” he replied:
I changed my mind because I had been bothered for several years about it, and then when I was visited by Gabriel [gay journalist who had undergone conversion therapy]… and he described what it was like to be in therapy when he really didn’t get any benefit from it at all… and I just realized that I had to make – explain to people why I think I made a big mistake.
- Dr. Spitzer on NPR’s Talk of the Nation
Later guests on the show discussed some of the more “bothersome” aspects of the study. It was rushed to publication and wasn’t “peer reviewed,” its data was not – really could not be – validated, as it was based entirely on self-reporting over the short term.
But more important were the philosophical and societal consequences of the study’s publication. The legitimization of “conversion therapy” (which indirectly treated homosexuality as pathology)…
1. Was used by certain groups to perpetuate the stigmatization of homosexuals under the guise of “helping” them:
And what it [Spitzer’s study] allowed the Christian right to do is put a more benevolent face on anti-gay prejudice… Instead of angry denunciations from the pulpit, the Christian right could then say that they were actually caring for homosexuals, that they wanted to help gay people and that they wanted to help cure them.
- Gabriel Arana, gay journalist and activist
2. Caused various homosexuals to internalize fundamentally negative, pathologized views of themselves
It [conversion therapy] stopped me from accepting myself, it lowered my self-esteem. As I said earlier, it made me see myself as… as a leper without a cure. And encouraging – I mean, and the premise of therapy is that there is something wrong with – fundamentally and innately wrong with the person, and if you can’t change it, then you’re sort of left with this disease that has no cure. And I think that… affected [me] very much as a young adult.
- Gabriel Arana [emphasis added]
Regardless of your stance on homosexuality, I think the parallels to the broader debate about psychiatry are clear.
Psychiatrists publish studies and papers in academic journals (about mental illness as brain disease, for example, or childhood bipolar disorder as a widespread and “undertreated” phenomenon, or the existence of such things as “dysphoric mood disorder,” “psychosis risk syndrome”, et al.) that are highly flawed, but touted as science. This pseudoscience is used to legitimize various practices — like pharmacological intervention as first line treatment for mental distress, forced outpatient therapy, the DSM itself – that pathologize a variety of human experiences that simply ARE NOT pathologies in the strict sense of the word. They’re not physical maladies of the body diagnosed by blood tests or other physical symptoms, their causes are not empirically known, they’re not like diabetes. Countless people are taught to internalize the belief that a “biochemical imbalance” in the brain causes them to be fundamentally different from humanity – truly lepers without a cure – and only a semblance of normality is possible through pharmacology, symptom suppression, and denial of self.
To stand here before you as a person who ingested the intoxicating language of psychiatry and began to speak it as her own, who incorporated the clinical gaze and began to see herself entirely through its lens, brings a flood of emotions … These emotions bring with them the pain that came with being labeled ‘abnormal’ and unacceptable by society for my most formative years; with carrying a diagnosis after my name that meant I would always be different, always fighting to appear like everyone else, struggling to manage life instead of living it. I was bipolar, from my teenage years until age twenty-seven, and I was convinced it was all I ever would be.
- psychiatric survivor and activist Laura Delano, in a speech at “Occupy the APA”
Psychiatric survivors are in a position very similar to that of the gay community after the publication of Spitzer’s 2001 study, except for the fact that many scholarly publications (including the DSM), faulty clinical trials, “treatment advocacy” organizations, and public institutions are replicating the same kind of errors and prejudices, day after day. An unrelenting campaign of stigmatization and “for your own good” interventionism.
An apology is long overdue.
If he’s in the mood for apologizing…
Maybe Dr. Robert Spitzer might like to reconsider some of his other scholarly publications. The most of famous of which is… the DSM-III.
Technically Spitzer is not the author of the first edition of the Diagnostic and Statistical Manual to include the “modern” mode of classifying mental illnesses by their symptoms – and leaving causation completely out of the question. But he is almost universally acknowledged as the main architect of that third and pivotal edition (I guess appointing yourself head of all 25 development committees will do that for you) and certainly was its defender for years.
When I say what I’m about to say, I’m not being sarcastic or vindictive – I’m being sincere.
Maybe Spitzer (and his colleagues) are nearly ready to apologize to psychiatric survivors at large. Maybe the time for truth and reconciliation has come.
Spitzer is reaching the end of his career and perhaps even his life (he suffers from late stage Parkinson’s Disease). Priorities are changing. Misgivings long buried are being brought to the surface and addressed. An interaction with a “survivor” of the policies born of his conversion therapy research was the catalyst for a change of heart, publicly declared.
Has the time for truth and reconciliation come? As psychiatric survivors continue to lift their voices and share their stories, to graciously and meticulously expose the flaws in the pseudoscience, psychiatry as a profession has a chance (just as Spitzer did) to explore buried conflicts, half-acknowledged truths that have been hidden from the light of day for years. Will they acknowledge the damage that has been done, will they apologize, will they move forward in partnership with psychiatric survivors?
Some may say it’s unlikely, but because of Spitzer’s actions, we know at least that it is possible.
Tags: Afghanistan, Iraq, Native American culture, PTSD, suicide, veteran, Veteran's Affairs, war
So says a report released a couple weeks ago.
It bears repeating:
In 2010, and again in 2011: More US soldiers died from committing suicide than died in combat.
And that’s according to official reports, numbers that the Army itself tracks and then [if prodded] releases to the public. Are they renowned for their excellent body-counting abilities, their unflinching and honest reporting of the true costs of war? No, not even a little bit. *
[Oh, and on that note – check out this clever vocabulary replacement policy the Army has employed to mask the number of people wounded in combat.]
Yes, as it turns out the Department of Veteran’s Affairs went to trial in 2010 for (among other things**) deliberately hiding rates of suicide amongst soldiers and veterans. Internal emails from Dr. Ira Katz, Deputy Chief of Patient Care Services for the VA’s Mental Health Division, contain some juicy tidbits not meant for public eyes:
From: Katz, Ira R.
To: Chasen, Ev [top media advisor for the VA]
Subject: FW: Not for the CBS News Interview Request
Our suicide prevention coordinators are identifying about 1000 suicide attempts per month among the veterans we see in our medical facilities. Is this something we should (carefully) address ourselves in some sort of release before someone stumbles on it?
(from a set of emails made public here)
Oooh. That doesn’t sound good, Dr. Katz. Especially since you told CBS reporters in November of 2009 that “there is no epidemic of suicide in VA,” and that their statistics, remarkably similar to the ones quoted in the email above, were “not, in fact, an accurate reflection of the [suicide] rate.”
The courts ruled in the veterans’ favor.
Suicide rates aren’t the only thing going up
Mental health diagnoses in the military population (especially that of Post-Traumatic Stress Disorder [PTSD]) and usage of psychotropic drugs are, too. The New York Times reported on the sometimes disastrous effects of overmedicating active duty and returned veterans thusly diagnosed. Part of the problem may be the current view of PTSD as a mental illness, when it is perhaps better understood as an injury to the autonomic nervous system. More information on that here.***
One article I was reading this morning suggested making acupuncture more widely available to active duty troops. They call it “battlefield acupuncture.”****
Yeah, sure, ok.
But how about NOT HAVING A WAR IN THE FIRST PLACE?
That’s apparently not an option. I guess the engine of our economy, the military-industrial complex (which now certainly includes pharma) cannot run on fumes alone; we need this war. Like an internal combustion engine needs fossil fuels to burn? Yes.
And let’s not hear any nonsense about alternatives.
More nonsense about alternatives
One commenter’s perspective on the military suicides issue really resonated with me:
Native American cultures used a ritual of honor, respect, and spiritual cleansing to help their warriors return to “normal” life. Our society could sorely use a similar process.
- commenter from news article “More US soldiers died from committing suicide than died in combat”
On the road trip I took last summer, I had the opportunity to witness at least part of this ritual — in North Dakota, on the Fort Berthold (3 Affiliated Tribes) Reservation, at their annual Pow Wow.
A young woman had returned from 2 tours of duty, one in Afghanistan and one in Iraq. On the first night of the Pow Wow (the giveaway night), a large part of the ceremony centered around her. She was asked to stand in the middle of the sacred ceremonial dance space, wearing her full military attire. She was given a strikingly beautiful, handmade bonnet of eagle feathers. It reached almost to the ground! She was honoured with specially composed songs and tributes from relatives and friends. Her body was wrapped in 8 or 10 homemade quilts of beautiful colors.
At the close of the ceremony, a box was placed in front of her, and all who watched were asked to step forward and place something of value (money, basically) in the box. To help her as she adjusted to being home. To support her and her family. They would then press her hand gently, kiss her cheek, or perhaps touch her feet. Signs of respect and love were heaped upon her.
Over and over the emcee emphasized the fact that “in our culture, we honor our warriors, we honor our veterans. We welcome them home with open arms.”*****
It was a powerful and moving ceremony. I truly felt the whole community’s support for this brave young woman; I hope that she felt it, too. Contrast this with most returning veterans’ feelings of utter isolation, and perhaps even shame and despair.
The contrast is somewhat apparent in the data on veteran suicide, too. National data for veteran suicide by ethnicity was not available, but this analysis of veteran suicide data from 2008-2010 in Nevada shows (in that state at least) suicide rates amongst returning White veterans were almost 5 times higher than those of Native American vets. Native Americans, as an ethnic group, had the second lowest suicide rate of those surveyed (the “Asian” ethnic group had the lowest).
We as a culture have so much to learn.
* Here’s an older reference on that, too, specific to US casualties… Doubtless the trend continues.
**Those “other things” included deliberate and unnecessary delays in the provision of mental health care and in the adjudication of service-connected death and disability compensation claims by the VA. The court ruled in favor of the veterans, stating that this was a violation of “veterans’ due process rights to receive the care and benefits they are guaranteed by statute for harms and injuries sustained while serving our country.” Full opinion available here; a very good read.
*** The PTSD label may be the new “hysteria” – a diagnostic catchall category in mental health that is really describing brain injury or pathology.
**** Which nobody seems to find ironic. Ho-hum.
*****More information on the Native American attitude towards veterans here.
Tags: Carmelo Valone, dehumanization, homeless, Kelly Thomas, police brutality, schizophrenia, Talk of the Nation
Have you heard the story of Kelly Thomas, a 37-year-old homeless man diagnosed with “schizophrenia” who was beaten to death by 4 policemen last July in Orange County, California?
It’s reemerged as a topic of discussion recently because of an Op-Ed piece published in the Los Angeles Time by a psychiatric survivor named Carmelo Valone. Entitled “My Kelly Thomas Moment,” the author makes no bones about it: this could have been him.
I had my Kelly Thomas moment on a hot summer night in Boston in 1995…The Boston police officers who responded that night weren’t exactly boy scouts when they restrained me, but I did live to see another day. Because of that, I’ve had the chance to improve, something Thomas didn’t get….
It would be easy to conclude that Thomas was homeless by choice because he refused to take medication to treat a range of symptoms that had been diagnosed as schizophrenia. But things are more complex than that. I myself have never been truly homeless, but I have refused mental healthcare on many occasions, often when I was at my most vulnerable… I am today a functional part of this dysfunctional world we call Los Angeles, and it has been quite a while since I needed any form of inpatient treatment. But there have been times — and this is not an easy thing to admit — when mental illness took over my life.
- Carmelo Valone, in “My Kelly Thomas Moment”
Fact of the matter is— when it comes to alternative experiences of reality, or “mental health challenges” (if you’d like to call them that), psychosis, mania, extreme emotional states; fact of the matter is, it could be any of us.
As a society we long to place the mentally ill in some kind of category separate from the rest of human existence, so that we can chant blindly to ourselves “this would never happen to me, this would never happen to me.” Folks, that’s dehumanization; and aside from being a terrible way to handle the blessing that is human difference! individuality!, it also leads to all sorts of behaviors that are absolutely unacceptable. Like forced electroshock.
Like beating a man to death in the street.
Back to the testimony of psychiatric survivor Carmelo Valone.
Valone was interviewed briefly by Neil Conan on NPR’s “Talk of the Nation” yesterday. I highly recommend you check it out. He expressed himself admirably, even in the face of some very negative opposition (check out the caller – a psychiatrist – at 11 minutes in… YIKES!). Through it all, he maintained a position that I applaud: namely, that the behavior of a person like Kelly Thomas or himself comes primarily from not being heard, from being stigmatized and isolated by his label, from being made hopeless by the lack of compassion from his fellow men, from being dehumanized.
Some stand-out moments:
VALONE: [...] I almost – I almost want to say that these police officers were the mentally ill ones, and Kelly Thomas was the sane one in the situation. I mean, they tasered him. They smashed him with the taser, buttons, the flashlights. They broke his throat. I mean, it’s horrifying. I mean, I had nightmares about it for months, and I feel very badly for his family.
CONAN: Of course, the police officers have something to say on their side, as well. They felt threatened by someone who is out of control.
VALONE: He had no weapons though, you know? He had no weapons. He wasn’t posing any sort of threat from what the witnesses say.
- From Valone’s interview on “Talk of the Nation”
VALONE: […] I didn’t become violent because I stopped taking my medication. I was violent because I was frustrated because no one was listening to me, OK? This is a problem I’d heard, time and time again, because I have friends that are in the psychiatry field – a number of them. And people seem to equate not taking the medication with violence.
- From “Talk of the Nation”
Who’s on Trial?
2 of the 4 officers involved in the death of Kelly Thomas will stand trial, one for second-degree murder and the other for involuntary manslaughter. But let’s not pass it all off on them. WE – as a society of humans – need to examine ourselves. Why are the homeless so maligned? Why are the mentally ill shunted off to the side, neither to be seen or heard as they struggle to speak about their experiences?
Let’s all take a close look at the myriad ways dehumanization darkens our coexistence. With warmth and a little loving kindness, perhaps we can shed some light on the reasons why, 15 years ago, Carmelo Valone wandered the streets of Boston, hopeless and without a voice; why Kelly Thomas walks the streets no more; and why so many of us can, heads held high, walk right past the suffering of our fellow human beings without a glance.
Tags: chemical imbalance, chemical imbalance in the brain, depression, ketamine, NPR, Prozac, selective serotonin reuptake inhibitors, SSRIs
FINALLY — the truth comes out on a major news network (NPR): a so-called “serotonin imbalance” in the brain has never been scientifically linked with depression, and this false theory was used for years to sell SSRIs (selective serotonin reuptake inhibitors – modern antidepressants) to a lot of people out there as a scientifically proven, biological cure to their biopsychiatric problems. Meanwhile, news of the appalling “side” effects of the drugs (suicidal and homicidal ideation in at the very least 5% of patients) was squelched, and literally thousands of people lost their lives in SSRI-related suicides and homicides.
After hearing all this, one would assume that we were done with that whole “chemical-imbalance-in-the-brain-causes-depression” thing. We have established that the theory is false. It’s a dead (and deathly) issue. Right?
Turns out that little NPR piece is part of a series. The second installment of which ran on “Morning Edition” today.
And the biopsychiatric idea that a chemical imbalance of some kind MUST cause depression – and that ameliorating this chemically/pharmaceutically must therefore CURE depression – is alive and well. In only a week’s time, NPR has managed to resurrect it. You see, it wanted to live. Or at the very least, pharma wants it to.
I Wanted To Live
“’I Wanted To Live’: New Depression Drugs Offer Hope For Toughest Cases” is the name of the piece, and it is a simple reiteration of the serotonin/Prozac storyline, only with a new neurotransmitter/miracle drug combo: glutamate/Ketamine.
Zarate [a “research scientist”] sees depression as a bit like a leaky faucet in the brain. There are different ways to stop the leak, he says. “You can go straight to the faucet and you can fix it,” he says. “Or you can go to the water plant and shut down the water plant. The end result will be the same.”
The current antidepressants act in a way that is like shutting down the water plant, Zarate says. It takes a long time for the water to stop flowing through the miles of pipes that eventually lead to the leaky faucet.
He thinks the reason is that these drugs act primarily on the brain chemicals serotonin, norepinephrine and dopamine. Ketamine acts on a chemical called glutamate, which is much closer to the problem, Zarate says.
- from the NPR story “I Wanted to Live.”
So let me get this straight:
Last week we learned that a serotonin imbalance in the brain does not cause depression. Scientists were confused on this point for some unspecified length of time because Prozac, a miracle/blockbuster drug that somehow “cures” depression, raises serotonin levels in the brain. Scientists understandably put two and two together and assumed that higher serotonin levels = no depression because Prozac presumably also = no depression. (Never mind that Prozac and other SSRIs have since been proven to be no better than placebo).
At some point, scientists figured out their theory was incorrect, or at best oversimplified to the point of being false [a distinction they insist on making!], but they continued to present it to patients as fact “for the patients’ own good” so the patients would take their meds. Which scientists still insisted “worked” to “cure” depression. (Again, no better than placebo.)
One week later, in the next installment of the series, we learn two things:
1. NPR has changed the story about serotonin – now it does work to cure depression by addressing problems in brain chemistry. [Never mind what they said last week!]
Traditional antidepressants like Prozac work on a group of chemical messengers in the brain called the serotonin system. Researchers once thought that a lack of serotonin was the cause of depression, and that these drugs worked simply by boosting serotonin levels.
Recent research suggests a more complicated explanation. Serotonin drugs work by stimulating the birth of new neurons, which eventually form new connections in the brain. But creating new neurons takes time — a few weeks, at least — which is thought to explain the delay in responding to antidepressant medications.
- from “I Wanted to Live.”
It works, but it works real slow.
2. This new drug – ketamine – works, too, but it works BETTER and FASTER!
Ketamine, in contrast, activates a different chemical system in the brain — the glutamate system. Researcher Ron Duman at Yale thinks ketamine rapidly increases the communication among existing neurons by creating new connections. This is a quicker process than waiting for new neurons to form and accomplishes the same goal of enhancing brain circuit activity.
- from “I Wanted to Live.”
I need hardly add that the author of this story did not cite any of the research studies referred to above. He did, however, include these pretty pictures which successfully distracted my attention from the lack of documentation for his outrageous claims by looking so very “scientific” and “official.”
Just kidding. I’d like to see proof, not pictures.
The story’s headline promises to give us hope. Here is what the author has to offer, at the close:
The goal of the NIH [National Institutes of Health] experiments with ketamine, riluzole and scopolamine is to identify compounds that pharmaceutical companies can use as molecular models to develop an entirely new class of antidepressants… Drug companies have taken notice. Several are now working on glutamate drugs for depression.
- from “I Wanted to Live.”
I guess we’re supposed to hope that pharma can patent this new chemical and sell it using a recycling of the old SSRI pitch? (As NPR has already begun to do for them…)
Are we supposed to hope that drug companies will conduct fair research trials on this new class of antidepressants, that they will accurately report the results of these trials, that they will be ethical in addressing concerns about adverse drug events in or out of court?
Let me try that on for size….
Nope. I don’t feel hopeful. Not in the least bit.
I’d rather hope for something else.
I hope I never again have to hear another repetition of this ridiculous, thousand-fold lie about mere “chemical imbalances” being the cause of this thing we call “depression.” (Or any “mental illness,” for that matter.)
I hope that people dealing with depression will be allowed to make their own, fully informed choices about treatment.
I hope they will be told the truth – that antidepressant drugs have been proven to cement depression into a chronic state, when an unmedicated and honest interaction with the problem often allows it to pass and to then stay in the past. [more on all of that here.]
I hope that their family members and friends will be their cheerleaders and confidants, and they will find wholesome and healthy ways to address the root causes that their depression arises from.
Because depression is not merely “of the body,” a simple biological imbalance and nothing more. It is a mind-body phenomenon, it is subjectively real, it is connected to the world, and it is oftentimes a message about the world.
A message we should each process, understand, and integrate in our own way, in our own time.
Doing the math on Risperdal 01/23/2012Posted by ALT in Mental Health News, Pharmaceuticals.
Tags: antipsychotics, big pharma, Johnson & Johnson, off-label marketing, Risperdal
Johnson & Johnson has come under fire recently for sundry illegal marketing practices related to the antipsychotic drug Risperdal (as enumerated here and here in legal documents, and here by a former J&J salesperson). “Recently” isn’t entirely accurate… considering that they were warned in 1994, 1999, and 2004 by the FDA to stop making “false and misleading claims” about Risperdal’s efficacy and superiority to other atypical antipsychotics, this has been a long time coming.
So let’s do the math. How much money will J&J have to pay for the privilege of doing whatever they damn well please in marketing Risperdal, a brain-damaging, diabetes-, obesity-, akathisia-, homicidal/suicidal ideation-causing, so-called “safe” antipsychotic?
$1 billion to the US and some states who have joined in the federal (civil) case against Risperdal
$257.7 million to the state of Louisiana in 2010
$327 million to South Carolina in 2011
$158 million to Texas in a settlement agreed upon last Thursday
$400 million more as a penalty for violating the “Food, Drug, and Cosmetic Act”
TOTAL: $2.14 billion (more or less) in fines for illegal marketing practices
That would make Risperdal the most heavily fined of any single drug ever produced by pharma (incidentally, another atypical antipsychotic medication, Lilly’s Zyprexa, comes in a rather distant second at $1.4 billion).
Let’s do a little more math
What percentage of J&J’s total Risperdal profits does this fine represent? In other words, if J&J were to design a business model with fines for off-label marketing built right in, how much money would they have to set aside?
$2.14 billion in fines for illegal marketing practices
$34 billion in worldwide sales from 1994 to 2010*
TOTAL: fines are 6.3% of profits
Not too shabby. It becomes a mere line item in the marketing budget, simply a “cost of doing business.”
Never mind the human cost.
The human cost
Since they’re not going to, let’s you and I spend a moment considering the human cost.
Meet Ke’onte Cook, a 12-year-old survivor of the foster system who was wrongfully medicated with antipsychotics.
As you may recall, in November of 2011 an important study published in the journal Pediatrics found that youth in foster homes with behavioral problems were being wrongfully prescribed antipsychotics as a chemical means to ensure docility. On average they were being prescribed these drugs at twice the rate of children outside the foster system. More on that here.
The foster system population is one of the specific groups that J&J is accused of targeting with their off-label marketing practices.
Here is Ke’onte’s story about the human cost, for him, of J&J’s marketing strategies:
* According to this synopsis of the federal civil case.