Showing posts with label conflicts of interest. Show all posts
Showing posts with label conflicts of interest. Show all posts

Thursday, September 20, 2012

Marcia Angell, M.D. "The Truth About the Drug Companies"


Albert Schwitzer: “Let me give you a definition of ethics: 
It is good to maintain and further life it is bad to damage and destroy life.

Dr. Marcia Angell's lecture is interesting, informative and deeply disturbing.  

via University of Montana
President's Lecture Series 2009-10: Dr. Marcia Angell


Uploaded by UniversityOfMontana on Dec 21, 2009
"Americans spend more than $200 billion a year on prescription drugs. What are they getting for their money? Dr. Marcia Angell, senior lecturer of Harvard Medical School's Department of Social Medicine and former editor-in-chief of the New England Journal of Medicine, answers that question and more in this installment of the President's Lecture Series at The University of Montana. This presentation, "The Truth About the Drug Companies," took place Oct. 19, 2009, in the University Theatre."

Read the The Illusions of Psychiatry  Marcia Angell in The NY Review of Books

photo credit oaklandlocal.com

Sunday, January 9, 2011

Conflicts of Interest are Real

The following is from the Alliance for Human Research Protection, whose mission statement on their website states:

"The Alliance for Human Research Protection (AHRP) is a national network of lay people and professionals dedicated to advancing responsible and ethical medical research practices, to minimizing the risks associated with such endeavors and to ensuring that the human rights, dignity and welfare of human subjects are protected" 

Conflicts of Interest in Clinical Trials
Presented by Vera Hassner Sharav
14th Tri-Service Clinical Investigation Symposium
Sponsored by
The U.S. Army Medical Department
and
The Henry M. Jackson Foundation for the Advancement of Military Medicine

May 5-7, 2002



Case 7: Children exposed to risks in psychotropic drug trials:
Psychotropic drugs are being tested in children despite the acknowledged risks of harm. Psychotropic drugs are advertised as normalizing a "chemical imbalance" in the brain. In fact, they do the opposite: they induce profound changes in the central nervous system with demonstrable physical and neurological impairments.[48] Dr. Steven Hyman, former director of NIMH, an expert on the mechanisms by which psychoactive drugs work, explained that, whether abused or prescribed, the mechanisms by which psychoactive drugs work are the same.[49] Hyman stated that antidepressants, psychostimulants, and anti-psychotics created "perturbations in neurotransmitter function."[50] The drugs' severe adverse side effects are symptoms of the drugs' disruptive effect on the neurotransmitter system and on brain function.

In 2001 Dr. Benedetto Vitiello, NIMH's director of Child and Adolescent Treatment and Preventive Interventions Branch acknowledged the impact of FDAMA: "pediatric psychopharmacology has recently seen an unprecedented expansionclinical trials in youths has more than doubled in the last few years."[51] Indeed, children as young as three are being recruited to test mind-altering drugs that may affect their developing brain. Parents are being offered financial inducements to volunteer their children for drug trials. The foremost problem with prescribing or testing psychotropic drugs for children is the absence of any objective criteria for diagnosing children with pathological behavioral problems to justify pharmacologic intervention. Vitiello acknowledged "diagnostic uncertainty surrounding most manifestations of psychopathology in early childhood."[52] Vitiello also acknowledged the possibility of long-term harm: "The impact of psychotropics on the developing brain is largely unknown, and possible long-term effects of early exposure to these drugs have not been investigated."

Eli Lilly's highly touted new anti-psychotic, Zyprexa,[53] reveals much about the collision between corporate interests and the health and safety of children. In clinical trials averaging 6 weeks, Zyprexa was tested in 2,500 adults. The drug was linked to serious, in some cases life-threatening side effects requiring hospitalization in 22% of those tested.[24]Acute weight gain of 50 to 70 lbs is usual, and with it the increased risk of diabetes. FDA data (under FOIA) reveals a 65% drop out rate, and only 26% favorable response. During those 6 week clinical trials there were 20 deaths, of which 12 were suicides.[54] David Healy, who found a suicidal link to antidepressants (Selective Serotonin Re-uptake Inhibitors) in his research says, as far as he can establish, the data from these trials "demonstrate a higher death rate on Zyprexa than on any other antipsychotic ever recorded." [55] In 2000, FDA approved Zyprexa for short- term use only, in bi-polar patients. [56]

Yet, children aged six to eleven were recruited for clinical trials to test the drug. According to their published report, UCLA investigators tested Zyprexa on children who were not even diagnosed as having schizophrenia. The children were diagnosed as having a variety of questionable psychiatric disorders, including ADHD.[57] According to the published report, all the children in the trial experienced adverse effects, including sedation, acute weight gain, and akathisia (restless agitation). The trial was terminated less than six weeks after it had begun.

Controversy surrounds a Zyprexa trial at Yale University. In that experiment, 31 youngsters aged 12 to 25 who have not been diagnosed with any psychiatric illness are being exposed to the drug for one year. The stated rationale given by the researchers (who are under contract with the sponsor) is their speculation that these children may be "at risk" for schizophrenia. Since there are, as yet, no objective tests or biological markers for the illness - they hypothesize without evidence, merely on the basis of conjecture. The shaky basis for their conjecture is that assumption that the children may develop schizophrenia because one of their siblings has been diagnosed with the disorder.

The risk of schizophrenia for the general population is 1%. For siblings the risk increases from 2% to 15% - in other words there is 85% likelihood that these children will never develop schizophrenia.

Given the absence of scientifically accurate tools for interpreting psychiatric symptoms, psychiatrists cannot as yet accurately diagnose schizophrenia much less predict which children will get it. Is it ethical to expose healthy children to risks of drug- induced pathology on such speculation? The Wall Street Journal aptly noted that such a study "raises the question of whether the drug companies are mainly interested in "creating" a new illness that requires drug treatment." Read the entire report here

Here is another Report from Alliance for Human Research Protection:
State Medicaid agencies began to question "off label" use of antipsychotics after the December 2006 death of Rebecca Riley, a four-year-old Massachusetts girl whose family received Medicaid benefits. After being diagnosed with bipolar disorder at age two, she was prescribed a cocktail of drugs, including an antipsychotic, court records show.

Some states began moving to require special approval before they would cover a claim for an antipsychotic. A group of 16 states started studying the use of psychiatric medication in children in 2007 in an effort they dubbed "too many, too much, too young," says Jeffrey Thompson, the medical director of the Washington state Medicaid program.

In California, the number of children six and under using psychiatric medications has fallen to 4,200 from 5,686 since a 2006 prior-authorization plan was put in place, the state's top Medicaid official says.

Florida's state Medicaid agency says the number of prescriptions for atypical antipsychotics written for children under age six in the second half of last year dropped to 1,137 from 3,167 a year earlier.

The agency says the decline was the result of a state program started last year under which prescriptions for children under six are reviewed for appropriateness by state-hired psychiatric consultants before Medicaid will cover them. 

Washington has created a system to flag the use of psychiatric drugs that may contain too high a dose for young children or have side effects that it regards as particularly dangerous. From May 2006 to April 2008, the system flagged 1,032 cases for review by outside consultants.

Write to David Armstrong at david.armstrong@wsj.com
Printed in The Wall Street Journal, page B1                                                    Complete article here
Copyright 2009 Dow Jones & Company, Inc. All Rights Reserved

It is obvious to me the informed consent guidelines for foster kids in Washington State primarily protect the State of Washington; not the children in State care.  Let's be real, who in their right mind would believe that it is in the "best interests" of the children and teenagers in Washington State to lower the legal age of consent for psychiatric treatment to thirteen?  Human's brains are not fully fully mature,until we are in our early 20's. Couple this reality with the dishonesty, abuse of authority and of "Medical" privilege that psychiatry is known to rely upon in standard clinical practice; we have in effect, "legally" placed kids in harm's way. 


Wednesday, January 5, 2011

Can Psychiatry Provide Client-Centered Family Driven Care?

This story from Stephany's blog is tragic to say the least.  Why are none of the the parent and family advocacy groups known for advocating for children's mental health treatment and family-driven care talking about this?  Advocacy groups bring a message that mental illnesses are the result of a broken and/or diseased brain. In fact declare, the disease can be treated safely, with medication.  Like any other disease.

This  statement denies the real world outcomes of those who are dead and disabled as a result of taking psychiatric medications.  Failing to provide any information on the very real risks, inherent in the medications, while declaring them to be necessary and harmless; particularly for children, is suspect.  Spreading the news about the the safety of medications in the treatment of an ever-expanding catalog of "brain diseases" while failing to provide a balanced view, specifically, real world outcomes of their use; is not advocacy with any integrity, in my humble opinion.

Why is it that biased "Educational Literature" is all that is available to desperate parents looking for help?  Where does it come from?  Many parents and other family members believe the safety and efficacy message without question; they feel informed, empowered even, by being involved with these advocacy and support groups. Advocacy groups are not obligated to, and do not inform those seeking information and support about the Conflicts of Interest which exist in the educational materials used. So called, "Facts on Mental Illness" and "Medication Fact Sheets" distributed often use biased statements, which are opinions, written by marketing departments; NOT information based on science.

The source of the information is not cited or disclosed and is often the drug manufacturers themselves; who pay for the printing and distribution of the materials through donations to the nonprofit advocacy groups.  So, in effect, this literature is more in the nature of direct consumer marketing and advertising of the drugs.  To be educational, (not commercial) would require the information be based on relevant research, and it would require an unbiased presentation of information.  To provide education and advocacy for those who are in need of support in coping with a diagnosis that is ethical and person-centered with transparency; these issues need to be addressed.    Literature which is developed and funded by drug companies would also provide the added benefit of a charitable contribution Income Tax deduction for  the "donor."

A current example of a Conflict of Interest that in my opinion is alarming, CABF, now called The Balanced Mind Foundation, has 6 scientific advisory board members who are currently getting money for working with/for the manufacturers of the medications they are recommending.  One of them, Joseph Biederman, lost his job a Harvard due to research fraud in the research of the diagnosis and treatment of bipolar in children.  Apparently, lack of ethics and fraud now qualifies psychiatrists for an advisory position for a nonprofit advocacy group!

Information on Informed Consent according to the American Medical Association which Psychiatry uses:

Informed consent is more than simply getting a patient to sign a written consent form. It is a process of communication between a patient and physician that results in the patient's authorization or agreement to undergo a specific medical intervention.
In the communications process, you, as the physician providing or performing the treatment and/or procedure (not a delegated representative), should disclose and discuss with your patient:
  • The patient's diagnosis, if known;
  • The nature and purpose of a proposed treatment or procedure;
  • The risks and benefits of a proposed treatment or procedure;
  • Alternatives (regardless of their cost or the extent to which the treatment options are covered by health insurance);
  • The risks and benefits of the alternative treatment or procedure; and
  • The risks and benefits of not receiving or undergoing a treatment or procedure.
In turn, your patient should have an opportunity to ask questions to elicit a better understanding of the treatment or procedure, so that he or she can make an informed decision to proceed or to refuse a particular course of medical intervention.
This communications process, or a variation thereof, is both an ethical obligation and a legal requirement spelled out in statutes and case law in all 50 states.  

In my opinion, Informed Consent does not occur in mental health treatment.  This opinion is based on just under 20 years of accessing mental health care for myself and my two sons.  The first time I read the Ethics Guidelines for Informed Consent approximately 8 years ago, I became profoundly aware of a betrayal of trust that had in fact occurred;  particularly in my son Isaac's care.  I have yet to have one of the conversations described above with a psychiatrist, or any other prescriber of psychiatric medications.  I no longer believe my experience unusual, nor do I believe it is due to my son's mental health services being paid by Medicaid.  Psychiatry as a profession, does not value or comply with The Ethics Guidelines for Informed Consent; in the real world they do not have to.  In the words of one Psychiatrist and children's advocate, "Parents who objected to medical treatment would be seen as at best ill informed and at worst impaired themselves."  

Final Thoughts

How do advocacy groups advocating for medication without acknowledging adverse events and outcomes of long-term medication use affect the current effort to transform the current mental health system in which client-centered and family-driven services are the goal?  


How is the goal in which TRANSPARENCY in all aspects of policy and program development, recognized as a necessary value, being affected by advocacy groups?  This question is specific to groups who receive funding from the pharmaceutical industry directly or indirectly; or whose advisors and/or board members do.

Why is Informed Consent ignored for the practice of mental health care?


Is is possible that everyone who disagrees with a psychiatrist or other mental health prescriber, on a medication issue is "ill informed" or "impaired?"


Does the perception a person is "ill informed" or "impaired" exclude them from client-centered and/or family-driven care and Informed Consent is not required?   

photo credit 

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