Photo: Garry Mcleod; Origami: Robert Lang

Medical ‘bible’ squabble

The Australian – May 18, 2012

by Sue Dunlevy

EFFORTS to update the psychiatrists’ bible – the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders – have led to bickering, contention, organised revolt and, finally, a backdown.

The association announced it has abandoned plans to class so-called attenuated psychosis syndrome and internet addiction as psychiatric disorders.

And four disputed additional criteria for diagnosing attention deficit hyperactivity disorder (ADHD) have been dumped: “impatience”, “acting without thinking”, “uncomfortable doing things slowly and systematically” and “finds it difficult to resist temptations or opportunities”.

The battle over the book used worldwide to define mental illness matters as it’s the arbiter of who is normal and who is mentally ill and, therefore, qualifies for special help with their education, subsidies for their medicines and access to treatment programs.

After more than 13,000 international psychiatrists signed a petition objecting to the way the manual was being revised, the US psychiatrist heading the review committee, in an opinion piece in The New York Times this week, called for a new independent process of defining mental illness.

“We need some equivalent of the Food and Drug Administration to mind the store and control diagnostic exuberance,” Allen Frances writes. “Experts always overvalue their pet area and want to expand its purview, until the point that everyday problems come to be mislabelled as mental disorders.”

The biggest concern among psychiatrists is that many of the proposed changes to diagnostic criteria and new mental health conditions run the danger of medicalising normal behaviour. They fear it could result in patients taking unnecessary, even harmful, prescription drugs.

Despite the squabbling, Australian anxiety expert Gavin Andrews – who heads one of the committees writing the fifth edition of the manual, or DSM-5 – argues the APA’s backdown this month shows the revision process is working. “Science says, here’s a good idea, let’s test it. Then science says, no, its unreliable, and you drop it,” he explains.

The committees updating the diagnostic criteria collected new research, carried out field trials of proposed new diagnostic criteria to see how they would be used by doctors on patients, and took criticism on board, Andrews says.

He adds that sometimes – as in the case of “early psychosis”, promoted but now abandoned by Australian psychiatrist Patrick McGorry – a proposed disorder is dropped because it would have led to large numbers of young people being medicated unnecessarily. For instance, Australian author, ADHD campaigner and Labor state MP Martin Whitely remains alarmed about the inclusion in the manual of a condition called “attention deficit hyperactivity disorder not elsewhere classified”. He says it would allow doctors to diagnose people who didn’t meet the ADHD criteria with the disorder.

Other new diagnoses that have survived the DSM-5 process include premenstrual dysphoric disorder, disruptive mood dysregulation disorder in children and autism spectrum disorder – a single condition combining the previous diagnoses of autism, Asperger’s disorder, childhood disintegrative disorder, and pervasive developmental disorder not otherwise specified.

Andrews says he’s fascinated by the interest in the debate in Australia. After all, technically DSM-5 is written by Americans for the US and has no legal standing here.

The World Health Organization’s International Classification of Diseases version 10 is the legal classification used in Australia.

However, Andrews admits that doctors here use DSM because it’s “more informative”.

It contains about 2000 words on each disorder and is more helpful to doctors.

According to Andrews, the WHO would be the ideal body to take on the job of developing a definitive diagnostic manual, but it needs the resources to do so.

The APA has so far spent more than $US35 million on developing DSM-5, but it will get its investment back as it can sell the manual all over the world.

In contrast, the WHO has limited funding and cannot charge for its more limited manual.

Flinders University child psychiatrist Jon Jureidini tells Weekend Health the to-ing and fro-ing over the DSM-5 diagnostic criteria for ADHD “highlighted the invalidity of the whole construct”.

The degree of debate indicates “we are not dealing with a valid disorder”, he claims.

And Frances says the body setting diagnostic criteria should include not just psychiatrists. Doctors, psychologists, counsellors, social workers and nurses should also be permitted to have some input.

“The broader consequences of changes should be vetted by epidemiologists, health economists and public-policy and forensic experts,” he says.

Andrews counters that psychologists, counsellors, social workers and nurses are already involved in the field trials of DSM-5 diagnoses.

Meanwhile, Whitely asks the fundamental question: why does Australia continue to follow the American lead?

“Are mental health outcomes in the US good enough to justify our continued devotion to the DSM model?” he says. “Or is it time to go it alone?”

Those interested have until June 15 to comment on the latest draft of DSM-5.

http://www.theaustralian.com.au/news/health-science/medical-bible-squabble/story-e6frg8y6-1226359242372

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For complete information on psychiatry’s labeling, click here

New Scientist – May 17, 2012

by James Davies

“LABEL jars, not people” and “stop medicalising the normal symptoms of life” read placards, as hundreds of protesters – including former patients, academics and doctors – gathered to lobby the American Psychiatric Association’s (APA) annual meeting.

The demonstration aimed to highlight the harm the protesters believe psychiatry is perpetrating in the name of healing. One concern is that while psychiatric medications are more widely prescribed than almost any drugs in history, they often don’t work well and have debilitating side effects. Psychiatry also professes to respect human rights, while regularly treating people against their will. Finally, psychiatry keeps expanding its list of disorders without solid scientific justification.

At the heart of the issue is the Diagnostic and Statistical Manual of Mental Disorders (DSM) – psychiatry’s diagnostic “bible” (see main story). Allen Frances, who headed the last major rewrite of the manual – DSM-IV – fears that the revised version will undermine the profession’s credibility. “What concerns me most,” he says, “is that its publication will dramatically expand the realm of psychiatry and narrow the realm of normality.”

Among the revisions he believes will be most damaging are those to generalised anxiety disorder, which threatens to turn the pains and disappointments of everyday life into mental illness, while “disruptive mood dysregulation disorder” will see children’s temper tantrums become symptoms of a disorder.

Drug alternatives

One protester, Harvard graduate and writer Laura Delano, started taking psychiatric medication at age 14, after a bipolar diagnosis. She felt this worsened her state until, in 2004, she attempted suicide. It was only once she had rejected her treatment and her identity as a psychiatric patient that things began to get better.

Many of the protesters want reform in the shape of alternatives to drug treatment. As protest organiser Susan Rogers explained: “People here are for choice, for the right to decline as well as choose treatment. We want sufferers to know there are alternatives to hospitals and medication – they can go into peer support run by people like themselves.”

“The best success rate for a diagnosis of schizophrenia is in rural Finland, where there is a slogan that problems aren’t in our heads, but between our heads,” says fellow organiser David Oaks. “They emphasise the importance of peer support in recovery.”

Talking to psychiatrists as they filed past the protest, there was quite a lot of sympathy. “These voices have to be heard. We are seeing a manifestation of some legitimate concerns,” said one.

Another was nearly as militant as the protesters: “Psychiatrists usually take 15 minutes to give a diagnosis, so we shouldn’t be surprised if we are getting it wrong. These 15-minute sessions are a form of malpractice.”

The APA’s response was to say: “Many of the proposed changes help to better characterise people currently seeking treatment but who are not well defined by DSM-IV. It is unfortunate there are instances in which people do not feel they have benefited, but these circumstances cannot discredit the clinical practice of psychiatry, or those helped by mental healthcare.”

It is significant that the protests exposed once again the lines of division not just between protesters and the establishment, but within the establishment too. Meanwhile, patients are still caught in the middle, sometimes to their detriment.

http://www.newscientist.com/article/mg21428653.700-label-jars-not-people-lobbying-against-the-shrinks.html

For more information on psychiatry’s labels – click here

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Alternet – May 17, by Martha Rosenberg

Pediatric psychopharmacology is a billion-dollar business that sustains Pharma and Pharma investors on Wall Street.

The following is an excerpt from Born with a Junk Food Deficiency: How Flaks, Quacks, and Hacks Pimp the Public Health

Children are known to be compliant patients and that makes them a highly desirable market for drugs, says former Pharma rep Gwen Olsen

In his book Psychiatryland, psychiatrist Phillip Sinaikin recounts reading a scientific article in which it was debated whether a three-year-old girl who ran out into traffic had oppositional-defiant disorder or bipolar disorder, the latter marked by “grandiose delusions” that she was special and cars could not harm her.¹

How did the once modest medical specialty of child psychiatry become the aggressive “pediatric psychopharmacology” that finds ADHD, pediatric conduct disorder, depression, bipolar disorder, oppositional defiant disorder, mood disorders, obsessive-compulsive disorders, mixed manias, social phobia, anxiety, sleep disorders, borderline disorders, assorted “spectrum” disorders, irritability, aggression, pervasive development disorders, personality disorders, and even schizophrenia under every rock? And how did this branch of psychiatry come to find the answer to the “psychopathologies” in the name of the discipline itself: pediatric psychopharmacology?

Just good marketing.

Pharma is wooing the pediatric patient because that’s where the money is. Just like country and western songs about finding love where you can when there is no love to be found at home. Pharma has stopped finding “love” in the form of the new blockbuster drugs that catapulted it through the 1990s and 2000s. According to the Wall Street Journal, new drugs made Pharma only $4.3 billion in 2010 compared with $11.8 billion in 2005—a two-thirds drop.²

Kids who start out with psychiatric diagnoses are not only lifers—they are expensive lifers usually shuttled into government programs that will pay for psychiatric drug “cocktails” that can approach $2,000 a month

Doctors have a “growing fear of prescribing new drugs with unknown side effects,”³explains the Journal, and the government is cracking down on illegal marketing. But also, private and government insurers are less willing to “cough up money for an expensive new drug—particularly when a cheap and reliable generic is available.⁴

It’s gotten so bad, AstraZeneca, whose controversial Seroquel^® still makes $5.3 billion a year though it is no longer new, now conducts “payer excellence academies” to teach sales reps to sell insurers and state healthcare systems on its latest drugs.⁵No wonder Pharma is finding “love” by prescribing drugs to the nation’s youngest (and oldest) patients, who are often behavior problems to their caregivers, who make few of their own drug decisions, and who are often on government health plans.

“Children are known to be compliant patients and that makes them a highly desirable market for drugs,” says former Pharma rep Gwen Olsen, author of Confessions of an Rx Drug Pusher.⁶ “Children are forced by school personnel to take their drugs, they are forced by their parents to take their drugs, and they are forced by their doctors to take their drugs. So, children are the ideal patient-type because they represent refilled prescription compliance and ‘longevity.’ In other words, they will be lifelong patients and repeat customers for Pharma.”

Just as it used to be said in obstetric circles, “Once a cesarean, always a cesarean,” it’s also true that “once a pediatric psychiatric patient, always a pediatric psychiatric patient.” Few, indeed, are kids who start out diagnosed and treated for ADHD, bipolar disorder, and other “psychopathologies” who end up on no drugs, psychologically fine, and ready to run for class president. Even if they outgrow their original diagnoses—a big “if” with a mental health history that follows them—the side effects from years of psychoactive drugs and their physical health on mental, social, and emotional development take their toll. Even children on allergy and asthma drugs, which are promoted for kids as young as age one, are now known to develop psychiatric side effects according to emerging research.⁷

Drugging children is big business. The only losers are kids given a probable life sentence of expensive and dangerous drugs, the families of these children, and the taxpayers and insured persons who pay for the drugs.

Kids who start out with psychiatric diagnoses are not only lifers—they are expensive lifers usually shuttled into government programs that will pay for psychiatric drug “cocktails” that can approach $2,000 a month. What private insurer would pay $323 for an atypical antipsychotic like Zyprexa^®, Geodon^®, or Risperdal^®, when a “typical” antipsychotic costs only about $40?⁸

Not all medical professionals agree with the slapdash cocktails. Panelists at the 2010 American Psychiatric Association (APA) meeting assailed Pharma for such “seat of the pants” drug combinations and called the industry nothing but a “marketing organization.”⁹In a symposium about comparative drug effectiveness, a Canadian doctor castigated the FDA’s Jing Zhang, who had served as a panelist at the symposium, for his agency’s approval of drugs for “competitive reasons” rather than for patient health or effectiveness.¹⁰Research presented at the 2010 APA meeting also questioned the psychiatric cocktails. When twenty-four patients on combinations of Seroquel, Zyprexa, and other antipsychotics were reduced to only one drug, there was no worsening of symptoms or increased hospitalizations (except in one case), and patients’ waist circumferences and triglycerides improved (a large waist circumference and high levels of triglycerides [fat] in the blood heighten one’s risk of developing diabetes and cardiovascular diseases).¹¹The drug cocktails were not working and were making patients worse by creating new medical problems.

But pediatric psychopharmacology is a billion-dollar business that sustains Pharma, Pharma investors on Wall Street, doctors, researchers, medical centers, clinical research organizations, medical journals, Pharma’s PR and ghostwriting firms, pharmacy benefits managers, and the FDA itself—which judges its value on how many drugs it approves. The only losers are kids given a probable life sentence of expensive and dangerous drugs, the families of these children, and the taxpayers and insured persons who pay for the drugs.

The father of pediatric psychopharmacology, Harvard child psychiatrist Joseph Biederman, is often called Joseph “Risperdal” Biederman, because he is credited with ballooning the diagnosis of bipolar disorder in children by as much as fortyfold.

The father of pediatric psychopharmacology, Harvard child psychiatrist Joseph Biederman, is often called Joseph “Risperdal” Biederman, because he is credited with ballooning the diagnosis of bipolar disorder in children by as much as fortyfold.¹²In 2008, Biederman, a prolific author who has written five hundred scientific articles and seventy book chapters, was investigated by Congress for allegedly accepting Pharma money he didn’t disclose, and he agreed to suspend his industry-related activities.¹³After a three-year investigation, Harvard “threw the book” at Biederman and two other professors: they were required to “refrain from all paid industry-sponsored outside activities for one year and comply with a two-year monitoring period afterward, during which they must obtain approval from the Medical School and Massachusetts General Hospital before engaging in any paid activities.” What a deterrent. They also face a “delay of consideration for promotion or advancement.”¹⁴

When it comes to grandiosity, Biederman seems a lot like the three-year- old who ran out in traffic. He not only served as the head of the Johnson & Johnson Center for the Study of Pediatric Psychopathology at Massachusetts General Hospital, whose stated goal was to “move forward the commercial goals of J. & J.”—the facility was his idea! 15 According to court-obtained documents, Biederman approached J. & J. with the money-making scheme.¹⁶Biederman also promised the drug maker that upcoming studies of its popular child antipsychotic Risperdal would “support the safety and effectiveness of risperidone [Risperdal] in this age group.”¹⁷

The Johnson & Johnson Center for the Study of Pediatric Psychopathology netted a cool $700,000 in one year of operation, according to published reports, but a spokesman for Harvard Medical School said Harvard isn’t involved with Johnson & Johnson Center, even though the hospital where it operates, Massachusetts General, is a Harvard teaching hospital. “Harvard Medical School does not ‘own’ any of its teaching hospitals,” he told Bloomberg News. “While we are affiliated with them through academic appointments, all teaching hospitals are individually governed.”¹⁸

Many people are aware of such Pharma/academia arrangements, since the 1980 Bayh-Dole law allowed universities to operate as patent and profit mills for industries “commercializing and transferring” technology. But fewer realize how much taxpayer money is part of the play-to-pay. The government gave Biederman and a colleague $287 million in 2005—on top of their Pharma sinecures—to be administered by Massachusetts General Hospital. (No wonder Harvard keeps Biederman on.) Biederman also received $14,000 from Eli Lilly the same year he got a grant from the National Institutes of Health (NIH) to study Lilly’s ADHD drug, Strattera^®. Why does the government fund researchers already funded by Pharma? Not only do these researchers not need our tax dollars; working for Pharma is an overt conflict of interest that contaminates scientific results.

Psychiatrist Charles Nemeroff

Another master at playing both the Pharma and government sides of the street is psychiatrist Charles Nemeroff, former head of psychiatry at Emory University and also investigated by Congress for unreported Pharma money.

Nemeroff’s NIH grant was terminated after the probe, something that is rarely done with a government grant.¹⁹

According to the Chronicle of Higher Education, when Nemeroff was later under consideration to be the head of psychiatry at the University of Miami, the director of the National Institute of Mental Health (part of the NIH), Thomas Insel, MD, assured the medical school dean that if Nemeroff were hired, NIH money would follow, his prior problems notwithstanding. What’s a little congressional investigation? The reason for the largesse, according to the Chronicle, was that Nemeroff had gotten Insel a job at Emory when Insel lost his NIH position in 1994. Nor does the cronyism and revolving door stop there. Nemeroff serves on two NIH peer-review advisory panels that decide who else receives grant money, says the Chronicle, and Insel is personally involved with revising the National Institute of Mental Health’s “conflict of interest” rules.²⁰

Insel is also known for advancing Pharma’s “SSRI deficiency/suicide hypothesis,” in which a decrease in antidepressant sales was—according to Pharma—resulting in suicides because people weren’t getting their drugs. “[The National Institute of Mental Health is] “looking at whether the decrease in SSRI [antidepressant] utilization might be associated with an increase in suicidality rather than a drop in suicide, and my expectation is that we may see an increase,” Insel told Psychiatric News, lamenting “the focus on risk and a neglect of benefit.”²¹

Antipsychotics for Everyone

When the atypical antipsychotics Zyprexa, Geodon, Risperdal, Abilify^®, and Seroquel, for use in stabilizing schizophrenia, came into being in the 1990s, they were like the credit default swaps and collateralized debt obligations of the pharmaceutical world. No one knew exactly how they worked, how long they would work, or what the final effects of their wide use would be (as with many withdrawn drugs, FDA gives approval on the basis of information from short-term trials). But they could make a lot of quick money easily compared with old-fashioned products; they had government’s backing, and everyone was doing it!

Drug reps especially swarmed state agencies with many mentally disabled patients, including children. For example, Texas’s Medicaid program spent $557,256 for two months of pediatric Geodon prescriptions in 2005, according to court documents, and Geodon was not even approved for children at the time.²²Eighty-five percent of the state’s Risperdal prescriptions were paid by the state government, court documents also show.²³And Florida’s Medicaid program spent $935,584 for one year of Geodon.²⁴One hundred and eighteen prescriptions for Geodon were written in one day, according to the Tacoma News Tribune, at Western State mental hospital in Washington State. Asked why Pfizer reps made almost two hundred visits to the facility in four years, Pfizer spokesman Bryant Haskins told the Tribune, “That’s where our customers are.”²⁵

Mental institution psychiatrists were not the only ones targeted. United States Department of Veterans Affairs psychiatrists said in a survey that they were contacted an average of fourteen times per year by Pharma reps and were invited to attend company-continuing medical education seminars.²⁶And court documents unsealed in South Carolina in 2009 show that Eli Lilly sales reps even used golf bets to push their atypical antipsychotic Zyprexa; one doctor agreed to start new patients on Zyprexa “for each time a sales representative parred.”²⁷

But as state outlays for atypical antipsychotics grew twelvefold between 2000 and 2007, some states and whistle-blowers began bringing Pharma to court. In 2007, Bristol-Myers Squibb settled a federal suit for $515 million, brought by whistle-blowers in Massachusetts and Florida, which charged that the company marketed the antipsychotic Abilify for unapproved uses in children and the elderly, bilking taxpayers in the process.²⁸ And the next year, Alaska won a precedent-setting $15 million settlement from Eli Lilly in a suit to recoup medical costs generated by Medicaid patients who developed diabetes while taking Zyprexa. Atypical antipsychotics are known to cause weight gain and glycemic changes that can lead to diabetes.²⁹Soon Idaho, Washington, Montana, Connecticut, California, Louisiana, Mississippi, New Mexico, New Hampshire, Pennsylvania, South Carolina, Utah, West Virginia, Arkansas, and Texas took Pharma to court for the “prescribathon,” which hit the poor, the mentally ill, children, and the elderly the hardest.³⁰

Of course, as with credit default swaps and collateralized debt obligations (or the cases of Bernie Madoff or BP’s Deepwater Horizon or Enron), there were voices of dissent about the atypical revolution if people chose to listen. A National Institute of Mental Health study of children ages eight to nineteen with psychotic symptoms found Risperdal and Zyprexa were no more effective than the older antipsychotic Moban, but it caused such obesity that a safety panel ordered the children off the drugs.³¹ In just eight weeks, children gained an average of thirteen pounds on Zyprexa, nine pounds on Risperdal, and less than one pound on Moban.

“Kids at school were making fun of me,” said study participant Brandon Constantineau, who put on thirty-five pounds on Risperdal.³²

Other studies, like one on Risperdal in the British medical journal Lancet and one on Zyprexa, Seroquel, and Risperdal in Alzheimer’s patients reported in the New England Journal of Medicine, also found that atypicals work no better than placebos.³³One study in the British Medical Journal found that Seroquel not only did not relieve agitation in Alzheimer’s patients, but that it “was [also] associated with significantly greater cognitive decline” than placebos.³⁴As with Risperdal, the drug made patients worse.

“The problem with these drugs [is] that we know that they are being used extensively off-label in nursing homes to sedate elderly patients with dementia and other types of disorders,” testified FDA drug reviewer David Graham, MD, during a congressional hearing.³⁵Graham is credited with exposing the dangers of Vioxx and other risky drugs approved by the FDA. “But the fact is, is that it increases mortality perhaps by 100 percent. It doubles mortality,” said Graham. “So I did a back-of-the-envelope calculation on this, and you have probably got 15,000 elderly people in nursing homes dying each year from the off-label use of antipsychotic medications. . . . With every pill that gets dispensed in a nursing home, the drug company is laughing all the way to the bank.”³⁶

Just like Wall Street and banking lobbyist and cronies “advised” the government on how to write the credit default and derivative rules under which they would be regulated, Pharma helps states regulate—and buy—its brand- name drugs. An Eli Lilly–backed company named Comprehensive Neuroscience has “helped” twenty-four states to use Zyprexa “properly,” reports the New York Times.³⁷“Doctors who veer from guidelines on dosage strengths and combinations of medications for Medicaid patients are sent ‘Dear Doctor’ letters pointing out that their prescribing patterns fall outside the norm,” it reports. Doctors are also notified if patients “are renewing prescriptions,” lest they have “setbacks in their condition.” One such program sends registered nurses to the homes of patients who are on expensive brand drugs to ensure “compliance”; that is, to make sure patients have not stopped taking the drugs.

Some states say they have saved money under Pharma’s guidance, but Wisconsin found that once it “placed restrictions on Zyprexa and three other antipsychotic drugs” and scrapped the Lilly-funded program, it lowered its antipsychotic bill by $4 million. ³⁸

And then there’s the Texas Medication Algorithm Project, a “decision tree” developed by Pharma and Johnson & Johnson’s Robert Wood Johnson Foundation in 1995 to “help” the state buy its drugs. The algorithm rules required doctors to treat patients—surprise!—with the newest, most expensive drugs first, which ballooned Risperdal sales as well as other atypical antipsychotics.³⁹

But in 2008, the Texas attorney general’s office charged Risperdal maker Janssen Pharmaceuticals, Inc., Johnson & Johnson’s antipsychotic drug unit, with fraud.⁴⁰Janssen defrauded the state of millions, said a civil suit, “with [its] sophisticated and fraudulent marketing scheme,” to “secure a spot for the drug, Risperdal, on the state’s Medicaid preferred drug list and on controversial medical protocols that determine which drugs are given to adults and children in state custody.” In addition to lavishing trips, perks, and kickbacks on Texas’s mental health officials to win drug sales, and disguising marketing as scientific research, the attorney general’s office charged that Janssen “paid third-party contractors and nonprofit groups to promote Risperdal . . . to give state mental health officials and lawmakers the perception that the drug had widespread support.”⁴¹

Such faux grassroots support from phony front groups has been cited in other lawsuits against Pharma. Whistle-blowers charge that Pfizer funded the National Alliance on Mental Illness (NAMI) to serve as a “Trojan horse” to sell Geodon in a complaint that led to forty-three states receiving givebacks and the largest criminal fine ever imposed in US history—$2.3 billion in 2009. ⁴²

Click image for more information on psychiatric/pharmaceutical front groups

The National Alliance on Mental Illness calls itself a “nonprofit, grassroots, self-help, support and advocacy organization of consumers, families, and friends of people with severe mental illnesses,”⁴³but it has been investigated by Congress for undisclosed Pharma money and is considered by some to be a front organization. The Geodon complaint even cites jailed physician Richard Borison, who also worked with Seroquel and Neurontin, in the corruption.⁴⁴

Of course, to lock in taxpayer funding of psychoactive drugs, especially for children, it takes more than “helping” state officials at the point of purchase (and sending zealous drug reps to state facilities where the “patients are”). Pharma also finances continuing medical education (CME) courses that reward credits doctors need to retain their state licenses. A CME course called Individualizing ADHD Pharmacotherapy with Disruptive Behavioral Disorders taught by the Johnson & Johnson–funded Robert L. Findling, MD, refers to Risperdal thirteen times.⁴⁵Another CME course that promoted Seroquel was “taught” by AstraZeneca staff and Dr. Nemeroff but was scrapped after the Accreditation Council for Continuing Medical Education found it “lacked sufficient information about possible adverse effects of treatment with atypical antipsychotic drugs; and failed to emphasize sufficiently the efficacy of alternative treatments.”⁴⁶ The course was called Atypical Antipsychotics in Major Depressive Disorder: When Current Treatments Are Not Enough.

Pharma doctors also spread confidence about the drugs by publishing in medical journals like a Johnson & Johnson–subsidized article that upheld the “long-term safety and effectiveness of risperidone [Risperdal] for severe disruptive behaviors in children” in the Journal of the American Academy of Child & Adolescent Psychiatry. Despite thirty-one recorded child deaths, the drug was found to be safe, according to the article, on the basis of a one-year study.⁴⁷

Click here for a copy of Born with a Junk Food Deficiency: How Flaks, Quacks, and Hacks Pimp the Public Health.

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by Jacob Sullum

Several interesting articles about the upcoming revisions to psychiatry’s diagnostic manual, for the new DSM 5.

"Seems like such a win-win change to the DSM. The Drug Czar wins because with all these new people “needing treatment” it justifies his emphasis on treatment. The drug companies win because they get to drug people up on drugs for which they get paid. The treatment industry wins because they get a ton of new people “needing treatment” that aren’t difficult cases, and with health care covering much of it, they can just rake in the dough without really having to do anything. As far as I can tell, the only ones who lose are, well, the people."

The next edition of the Diagnostic and Statistical Manual of Mental Disorders, scheduled to be published a year from now, is expected to include a looser definition of addiction that will qualify millions more drinkers, illegal drug users, and participants in other pleasurable activities for psychiatric diagnoses. The upshot will be a lot more spending by taxpayers and private insurers on rarely effective “treatment” for these putative diseases, along with expanded excuses for depriving people of their freedom and relieving them of their responsibility.

DSM 5 Could Mean 40% of College Students Are Alcoholics by Maia Szalavitz

If the change is finalized, anyone whose drinking or drug use creates any problems will essentially be an addict or alcoholic with a “mild” case of the disease and presumably, therefore, not someone who can learn control over his habits.

While researchers have been encouraging the widespread adoption of “brief interventions” and other techniques that don’t require abstinence or a label— with great success— this change could swing the field in the opposite direction.

And that poses a huge problem, particularly for adolescents and young adults with mild problems who may be pushed to adopt an addict identity and to see themselves as having no way to control their drinking or drug use if they ever “relapse.” Rather than empowering those who do have control to use it, these programs essentially tell kids that if they ever have just one drink or puff on a joint, they’re lost.

The New York Times article points out the self-interest that may be involved…

Addiction Diagnoses May Rise Under Guideline Changes by ian Urbina

“The ties between the D.S.M. panel members and the pharmaceutical industry are so extensive that there is the real risk of corrupting the public health mission of the manual,” said Dr. Lisa Cosgrove, a fellow at the Edmond J. Safra Center for Ethics at Harvard, who published a study in March that said two-thirds of the manual’s advisory task force members reported ties to the pharmaceutical industry or other financial conflicts of interest. [...]

Dr. O’Brien, who led the addiction working group, has been a consultant for several pharmaceutical companies, including Pfizer, GlaxoSmithKline and Sanofi-Aventis, all of which make drugs marketed to combat addiction.

He has also worked extensively as a paid consultant for Alkermes, a pharmaceutical company, studying a drug, Vivitrol, that combats alcohol and heroin addiction by preventing craving. He was the driving force behind adding “craving” to the new manual’s list of recognized symptoms of addiction. [...]

Seems like such a win-win change to the DSM. The Drug Czar wins because with all these new people “needing treatment” it justifies his emphasis on treatment. The drug companies win because they get to drug people up on drugs for which they get paid. The treatment industry wins because they get a ton of new people “needing treatment” that aren’t difficult cases, and with health care covering much of it, they can just rake in the dough without really having to do anything.

As far as I can tell, the only ones who lose are, well, the people.

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The New American —May 14, 2012

by Alex Newman

Unlike in conventional medicine where objective diagnoses and treatments are made based on observable biological evidence, psychiatrists get together every so often to decide what should or should not be considered a “mental illness.”

And they do not always agree, as evidenced by the more than 13,000 professionals from around the world who recently signed an open letter demanding that the upcoming edition of the psychiatry industry’s “diagnostic manual” be put on hold and reconsidered.

As the elite of the nation’s psychiatric establishment work in the shadows to fully revise the highly controversial handbook labeling various behaviors and emotional states as “illnesses,” experts across the board are crying foul. A handful of new potential mental disorders and the revised definitions for others have caused a particularly fierce uproar among some psychiatrists and mental health professionals. At least 25,000 comments have already been submitted about the proposals.

The debate and its resolutions, of course, will have serious repercussions. Depending on the outcome of the ongoing conflict, millions of people may suddenly find out that they are afflicted with newly created “diseases,” while others — especially certain individuals diagnosed with forms of autism — may no longer qualify under the new definitions. Tens of millions more may soon be officially considered “addicts” under the revised definition for addiction, too.

The proposed changes would have broad implications affecting everything from treatment regimens to welfare programs, criminal law, and even education. But around the world, psychiatrists and mental health professionals are fighting back hard, urging the American Psychiatric Association (APA) to hold off on the revisions until more discussion and research can take place.

Known as the “Diagnostic and Statistical Manual of Mental Disorders” (DSM), the controversial handbook is widely used around the globe by the mental health industry, governments, insurance companies, and more. If all goes as planned, the fifth edition of the so-called “Bible” of psychiatry is set to be distributed in May of next year after the first major revision in over a decade.

However, if some of the more controversial proposed changes are not reconsidered — and the controversies addressed in an adequate manner — the manual’s influence is expected to wane significantly. And even as it stands today, not all experts are convinced about its usefulness or reliability in the field.

“[The DSM] is wrong in principle, based as it is on redefining a whole range of understandable reactions to life circumstances as ‘illnesses,’ which then become a target for toxic medications heavily promoted by the pharmaceutical industry,” clinical psychologist Lucy Johnstone with a Health Board in Wales told Reuters. “The DSM project cannot be justified, in principle or in practice. It must be abandoned so that we can find more humane and effective ways of responding to mental distress.”

Countless other experts agree, according to recent news reports, with many questioning whether a private group of individuals who stand to benefit by creating more diseases should really be writing the manual in the first place. Among the most vocal critics of the new proposals is Duke University psychiatry Prof. Allen Frances, who told the New York Times that the overly broad and vague definitions would create more “false epidemics” and increase the “medicalization of everyday behavior.”

“The DSM is distinct from all other diagnostic manuals because it has an enormous, perhaps too large, impact on society and millions of people’s lives,” explained Dr. Frances, who oversaw the writing of the current version of the diagnostic handbook and also worked on previous editions. “Unlike many other fields, psychiatric illnesses have no clear biological gold standard for diagnosing them.”

Read the rest of the article here: http://www.thenewamerican.com/usnews/health-care/item/11370-critics-blast-big-psychiatry-for-invented-and-redefined-mental-illnesses

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DETROIT – (WXYZ) A local mom chose not to medicate her special needs daughter, so the state took the girl — and the mom landed in jail. Now she is suing.

Thursday afternoon, Maryanne Godboldo filed a civil rights lawsuit. In it, there are new allegations that her daughter’s prosthetic leg was taken while in state care, to stop the child from trying to get back to her mother.

“Just one betrayal after another.  It’s a lie – bring us your children and we will help you.  That’s not true.  That’s not true at all.  Bring me your children, and we’ll take them,” Maryanne Godboldo told 7 Action News Investigator Heather Catallo.

Godboldo says she just wanted help when she noticed serious changes in her daughter, Ariana, after a series of vaccinations in 2009.   So doctors prescribed the controversial anti-psychotic drug called Risperdal for Ariana.

“I tried the medication, and it made Ariana terribly ill,” said Godboldo.

Godboldo signed a form, which states in two different places that she could choose to have Ariana stop taking Risperdal at any time.

“Do you feel like that when you started questioning the system, that’s when it turned on you,” asked Catallo.

“Oh absolutely,” said Godboldo.

According to her lawsuit – Godboldo worked with her doctor to wean Ariana off the medication – and that’s when the very people she had gone to for help reported her to Child Protective Services, or CPS.

So CPS presented a petition – filled with mistakes – to court staff, who signed off it and issued a child removal order.  The law requires that a judge review these petitions – but that never happened.

CPS then used the flawed order to get Detroit Police to take Ariana.

Attorney David Robinson says when police first came to Godboldo’s door, they didn’t show her the order or a warrant.  According to the lawsuit, she refused to hand over her daughter, so police used a crowbar to break in the side door.  That’s when the officers said Godboldo fired a shot.

“They had no authority,” said Southfield attorney, David Robinson. “She did what any mother is supposed to do… and that is protect her child.  And that’s what she did – she did so legally, she did so responsibly.”

What happened next made international headlines — tanks and SWAT teams surrounded the home and a 10 hour standoff began.

“The helicopters, the sharp shooters, that did not bother me.  I was terrified they would get their hands on my child, and do exactly what they did,” said Godboldo.

Godboldo says she surrendered only after she was promised Ariana would be placed in her Aunt’s care.  But that didn’t happen.

“I thought my daughter was safe, and she was not!! That bothers me,” said Godboldo.

After the standoff – Ariana was checked out at Children’s Hospital.

“She was physically healthy, in fact, she was in a good frame of mind, and she was by all accounts perfectly fine,” said Southfield attorney Allison Folmar.

Folmar was at Children’s Hospital with Ariana and her aunt.   Hospital records show the aunt “was… escorted out of the [hospital] room by CPS.”  Folmar says that’s when the CPS worker took Ariana to the psychiatric hospital called Hawthorn Center.

“We were mystified as to where Ariana was.  Now if that’s not kidnapping, I don’t know what is,” said Folmar.

CPS case notes show Hawthorn tried several times to refuse Ariana as a patient – but CPS kept pushing, and eventually got her admitted.

Folmar says at Hawthorne Center – the CPS worker immediately authorized the 13 year old to go back on Risperdal and have the controversial HPV vaccine.

“Where was the order to hospitalize the child?  Where’s the order to medicate the child,” asked Folmar.

Ariana is an amputee who has a prosthetic leg. Godboldo’s attorneys say employees at Hawthorne Center removed it to stop her from trying to leave.

“You can’t compensate for that type of psychological harm to a child,” said Folmar.

After months of court hearings – the criminal charges against Godboldo were dropped — because the judge ruled that child removal order was “invalid.”  Godboldo eventually got her daughter back.  But she says not before the damage was done.

“I knew the system was broken, but I didn’t know it was this broken, where anyone, literally anyone could come and take your child,” said Godboldo.

Tonight on 7 Action News at 11, 7 Action News Investigator Heather Catallo will show you how Godboldo’s case exposed how the court wasn’t following the law, and you’ll see what happens when she tried to talk to the judge who allowed this to happen.

A spokesman for the state’s Department of Human Services, which oversees CPS, said they had not seen the lawsuit yet, so he could not comment on it.

Watch the Maryanne Godboldo story here:

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Note from CCHR:   As the mental health watchdog exposing the fraud of psychiatry’s diagnostic system long before the current controversy now plaguing psychiatry’s billing bible (the DSM),  the only viable solution worth noting is that offered by psychologist Lucy Johnstone, quoted at the end of this article who states,  “(The DSM) is wrong in principle, based as it is on redefining a whole range of understandable reactions to life circumstances as ‘illnesses,’ which then become a target for toxic medications heavily promoted by the pharmaceutical industry.  The DSM project cannot be justified, in principle or in practice. It must be abandoned so that we can find more humane and effective ways of responding to mental distress.”

Yep. We agree.

May 11, 2012

by Kate Kelland, Reuters

“The DSM project cannot be justified, in principle or in practice. It must be abandoned so that we can find more humane and effective ways of responding to mental distress.”

Many psychiatrists believe a new edition of a manual designed to help diagnose mental illness should be shelved for at least a year for further revisions, despite some modifications which eliminated two controversial diagnoses.

The new edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM 5), a draft of which is open for public consultation this month, will be the first full revision since 1994 of the renowned handbook, which determines how to interpret symptoms in order to diagnose mental illnesses.

But more than 13,000 health professionals from around the world have already signed an open letter petition (at dsm5-reform.com) calling for DSM 5 to be halted and re-thought.

“Fundamentally, it remains a bad system,” said Peter Kinderman, a professor of clinical psychology at Britain’s Liverpool University.

“The very minor revisions … do not constitute the wholesale revision that is called for,” he said in an emailed comment.

The American Psychiatric Association (APA), which produces the manual and plans to publish DSM 5 next May, said Wednesday it had decided to drop two proposed diagnoses, for “attenuated psychosis syndrome” and “mixed anxiety depressive disorder.”

The former, intended to help identify people at risk of full-blown psychosis, and the latter, which suggested a blend of anxiety and depression, had been criticized as too ill-defined.

With these and other new diagnoses, such as “oppositional defiant disorder” and “apathy syndrome,” experts said the draft DSM 5 could define as mentally ill millions of healthy people – ranging from shy or defiant children to grieving relatives, to people with harmless fetishes.

Robin Murray, a professor of psychiatric research at the Institute of Psychiatry at Kings College London, said it was a great relief to see the changes in the draft, particularly to the attenuated psychosis diagnosis.

“It would have done a lot of harm by diverting doctors into thinking about imagined risk of psychosis (and) it would have led to unnecessary fears among patients that they were about to go mad,” he said in a statement.

But Allen Frances, emeritus professor at Duke University in the United States, said it was “only a first small step toward desperately needed DSM 5 reform.”

“Numerous dangerous suggestions remain,” Frances, who chaired a committee overseeing the DSM 4, said, adding that DSM 5 “is simply not usable” and should be delayed for an extra year “to allow for independent review, to clean up its obscure writing, and for retesting.”

Diagnosis is always controversial in psychiatry, since it defines how patients will be treated based on a cluster of symptoms, many of which occur in several different types of mental illness.

Peter Jones, a professor of psychiatry at Cambridge University, said DSM 5 should be “underpinned by science” built on an understanding of the biology and functions of the brain and mind – something he said neuroscience was not yet able to do comprehensively enough.

Read more:

Watch:

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Opponents claim the practice at the Judge Rotenberg Center is tantamount to torture.

Click here to sign the petition

Boston Magazine – May 10, 2012
By Casey Lyons

Image by Urban Woodswaller on Flickr.

The Judge Rotenberg Center in Canton is the only place in the country where kids with severe behavioral problems are shocked when they misbehave. You read that right.

After the release of a video depicting such a shock session, the Internet is rising in opposition to the practice, which the school claims to use as a clear disincentive to bad behavior — especially for kids who have difficulty with regular comprehension. It’s sort of like blasting your dog with a spray bottle when he tries to eat something off the table. Except replace dog with human, spray bottle with battery powered electric shock device, and eat something off the table with anything contra to what staff members instruct. (Read the details in Boston magazine’s 2008 story “The Shocking Truth.”)

Opponents of the practice — and now, even the UN — claim it’s torture, and more than 225,000 people have signed a petition condemning the practice on Change.org. They say even one place using the technique is too many, and it’s hard to disagree with that when taken at face value.

Despite the ridiculously cruel impression that such a practice leaves, it makes a fellow wonder: Why are we treating children with a mix of fear and pain? For it to work, the shock has to be painful, and it has to be painful and undesirable enough that the students would want to avoid it — hence fear. The place is also the child therapy version of a re-education camp, and I’ve heard stories that employees at other child-treatment centers use the place’s very existence as a way to control their charges. As in, “Keep it up and you’re going to the Judge.”

People seem to know that you come out different than you went in. That is, in fact, the idea of the therapy. And I’m sure that’s what Andre McCollins’ parents had in mind when they sent him there. It later came to light that McCollins had been strapped down and shocked literally for hours, and the procedure left him catatonic for days. That’s not the kind of change his mother was likely looking for. She signed the petition, too, and wrote:

As a parent, I was not prepared for the inhumane manner in which they treated people. I expected logic and some form of reason to be applied to the students in addressing behaviors that were considered inappropriate. Parents are not told “corrective measures” particularly a painful shock is appled without any warning or concern for what triggered the targeted behavior. What was dangerous about keeping his coat on. THIS INSANITY HAS TO STOP.

It’s unclear what will happen if the petition reaches its goal of 250,000 signatures, but one thing will be clear: Public opinion is very much turning against the Judge.

Click to sign the petition 

Read article here: http://blogs.bostonmagazine.com/boston_daily/2012/05/10/change-org-petition-shock-therapy-kids/

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Canton Patch – May 8, 2012

The Judge Rotenberg Center in Canton, Mass. Credit Maggie McClellan

More than 200,000 people have joined a campaign on Change.org calling for the Judge Rotenberg Center to stop its practice of giving electric shock treatments to students with special needs, for instance, Autism, as a form of therapy.

Greg Miller started the petition on Change.org after video of a student with Autism being shocked for hours was released.

Miller was a teacher’s assistant at the Judge Rothberg Center from 2003-2006, and during that time, he said he not only witnessed the shocking of students but also shocked many of them himself. Miller says the students would receive shocks for even the most minor of behavioral issues and that other students would watch in fear as their peers received the shocks.

“I want to help these students and put an end to this practice all together in Massachusetts,” said Greg Miller about his campaign on Change.org. “Not only should the JRC stop shocking students, Massachusetts legislators should ban the use of shocks altogether.”

Students at the center wear electrodes on their bodies that are attached to a small device carried around in a staff member’s backpack or fanny pack. When the student engages in forbidden behavior, a staff member administers a shock. Students may wear the electrodes as much as 24-hours a day, seven days a week.

The United Nation’s former Special Rapporteur on Torture investigated the shocks at the Judge Rotenberg Center and condemned them as torture. In 2002, 18-year-old Andre McCollins was strapped down and shocked for hours at the JRC. He begged for the shocks to stop and when they did, he was left in a catatonic state for days which resulted in permanent damage. That video footage wasn’t released until recently, and Andre’s mother has signed Greg Miller’s petition.

“Thousands of people are signing Greg’s petition on Change.org because they are concerned for the safety of young people at this center,” said Change.org senior campaigner Jonathan Perri. “Change.org is about empowering anyone, anywhere to demand action on the issues that matter to them, and it’s clear Greg Miller won’t stop until he’s made a difference.”

Live signature totals from Greg Miller’s campaign:
http://www.change.org/petitions/judge-rotenberg-educational-center-please-stop-painful-electric-shocks-on-your-students

Read article here:  http://canton.patch.com/articles/campaign-to-stop-electric-shock-therapy-at-the-judge-rotenberg-center-gaining-momentum#c

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May 7, 2012

by Ethan A. Huff

The ever-expanding list of so-called psychiatric conditions included in the American Psychiatric Association‘s (APA) Diagnostic and Statistical Manual (DSM) may soon include “relational disorders,” or mental illnesses supposedly attributed to two or more people involved in a relationship together.

According to the official definition, relational disorders are “persistent and painful patterns of feelings, behavior, and perceptions involving two or more partners in an important personal relationship.” A married couple, for instance, that continually fights would constitute a relational disorder, as would a troubled parent-child relationship.

If recognized and included in the manual, relational disorders will be the first psychiatric condition that involves more than one person. It will also be the first condition that exists only between two or more people, and not in a single individual.

“When couples go to counseling, trying to communicate, neither member is the ‘sick’ one,” said Michael Frist, associate professor of clinical psychiatry at Columbia University, to USA Today in reference to relational disorders. “It is the relationship that needs to be worked on.”

While many psychiatrists see the potential acceptance and recognition of relational disorders as a breakthrough in psychiatric medicine, others see it as a ploy to sell more drugs and thus keep the flailing psychiatric profession in business.

“DSM certification of RD could prove to be a cash cow for all the professionals treating people from heartbroken marriages and feuding families,” writes Ian Dowbiggin for the Huffington Post. “800,000 U.S. couples a year visit offices for marital and family help. Do the math. Some people stand to make a lot of money.”

Modern psychiatry driven by pushing drugs for made-up conditions

A recent ABC News report highlights other glaring financial conflicts in the DSM as well. Set for official publication in 2013, the fifth edition of DSM contains “updated” treatment protocols for a host of psychiatric illnesses that are pharmacologically based, which means the modus operandi treatment guidelines entail a purely pharmaceutical drug approach (http://www.naturalnews.com).

The new DSM is also slated to dub everyday emotions like sadness and grieving as mental disorders in need of psychiatric drug treatments (http://www.naturalnews.com). This is hardly surprising, as a study conducted by researchers from Tufts University revealed that more than half of the DSM’s fourth edition authors had direct ties to drug companies (http://www.naturalnews.com/019404.html).

“It is important to understand clearly that modern psychiatry — and the identification of new psychiatric diseases — began not by identifying such diseases by means of the established methods of pathology, but by creating a new criterion of what constitutes disease,” writes Kelly Patricia O’Meara in her book http://www.naturalpedia.com.

“[W]hereas in modern medicine new diseases were discovered, in modern psychiatry they were invented.”

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