Dr. RICO Child Psychiatrist

updated April 25, 2014 first published May 20, 2012

Dr. RICO

Racketeer Influenced and Corrupt Organizations Act

I am disappointed by the lack of integrity that permeates the psychiatric profession. I see no evidence of any effort to be responsible or accountable for the harm done to patients. Bio-medical psychiatry has a foundation reliant on dishonesty. Psychiatrists who falsely reported of research results, fraudulently obtained FDA approval for drugs, and participated in illegally marketing of psychiatric drugs, help formulate public policy. It is plain that these psychiatrists are continuing to participate in what is a widespread ongoing criminal enterprise that continues to pick America's pocket and continues to harm thousands of patients. These doctors see nothing wrong with failing to warn other professionals away from corrupt 'evidence.' Psychiatrists don't petition medical boards to take away the medical licenses of the criminals among the APA and AACAP membership who have lied about 'the medicine;' not even those who have disabled and killed patients in drug trials and clinical practice. Doctors who buried the evidence of their wrongdoing, along with the bodies of their patients are considered 'Key Opinion Leaders.' Some are teaching in Institutions of Higher Learning using texts filled with their corrupt work. Discredited and fraudulent research remains in psychiatry's so-called 'Evidence-Base.' Coercive and manipulative social control strategies are standard clinical practices; this is social/political control by use of torture under color of law; if psychiatry is in fact an ethical medical specialty, I'm Mary Poppins...

At a Senate hearing that took place on December 1, 2011 Senator Tom Carper said the hearing was the culmination of the third investigation into the prolific use of psychiatric drugs particularly those prescribed off label then fraudulently billed to the Federal Medicaid program. What I want to know is WHY has there been no effort to prosecute obvious criminal activity, or better yet, STOP unethical pseudo-medical, i.e. fraudulent, standard practices? Psychiatrists adopting the bio-medical model by a political process have effectively functioned as social architects who willingly partnered with pharma and sold out their patients for financial and academic reward. Don't fool yourselves, psychiatrists are acting as eugenicists; psychiatrists have abused medical privilege, forgot ethical medical principles, lied about what is and is not known about psychiatric diagnoses---it is not the first time psychiatrists have done this. Psychiatrists have blatantly lied about the efficacy and the safety of prescribed drugs and their direct teratogenic mechanisms of action...Apparently lacking insight into the horrific human toll of their professional conduct, blinded to the iatrogenic harm inflicted on their patients, seemingly, absent any ability to truly empathize with or understand the meaning and the nature of their own tortured patients; psychiatrists determined by consensus that what they BELIEVE to be true about their patient is a fact, regardless of what their patient states. No need to ask the patient if they feel "effectively treated;" unless of course the patient is treatment compliant, i.e. successfully treated...

Somehow shared opinion is magically transformed it into scientific evidence by psychiatry. This 'evidence' is used by psychiatrists to 'practice medicine,' abusing their medical privilege to have noncompliant patients adjudicated as mentally ill in Courts of Law; while using subterfuge and coercion as 'medical instruments.' Psychiatrists are doctors treating 'brain diseases' but are not honest with their patients or the general public. Psychiatrists do not conform to ethical medical standards and violate the Human Rights of their patients as a matter of course. As a result, Human Experimentation has become the Gold Standard in clinical psychiatric care standards. The vast majority of psychiatric drugs are prescribed to people on Medicaid. When prescriptions are not FDA-approved, they are "off-label prescriptions;" e.g. prescribed experimentally. If the prescription is not supported by DRUGDEX, or another compendium of approved drugs recognized by Medicaid, both the prescriber and the pharmacist who cause a claim to be submitted for payment to Medicaid, are filing a fraudulent claim, it's a crime. This criminal activity continues unabated, and continues to cost billions; the human toll is inestimable.

The APA and AACAP professional associations are not regulatory bodies, both appear to be unable to accurately assess any ethical deficits in the "science" or the "medical practice" of psychiatry.  Albert Einstein said, “You cannot solve a problem from the same consciousness that created it. You must learn to see the world anew.” Psychiatry's ethical failure is the antithesis to medicine in the Hippocratic tradition, made more pronounced by it's consistent failure to recognize or respect the human rights of psychiatric patients. It is indeed criminal medical negligence for an individual, let alone almost an entire profession to abdicate any and all responsibility for the iatrogenic harm done to psychiatric patients; patients who are disabled and killed, without regard for the fact disability and death are consistent, if not desired outcomes. Willful blindness to obvious iatrogenic harm done by psychiatric drugs, including homicide is evidence of psychiatry's non-medical nature. Thomas Insel crowing about the need for using psychiatry's "evidence base" and recommending psychiatry implement even more reckless prescribing "standards" through "Translational Science;" is indicitive that Insel doesn't seem to realize there has to be actual 'ethical, medical science' to translate.

In reality, any actual medical science is too often obscured with the APA's pseudo-democratic manner of gathering "evidence" to validate the APA consensus driven diagnostic and treatment standards. Consensus is no substitute for ethical medical research. The willful blindness to a wide variety of cognitive, neurological, and metabolic iatrogenic damage inflicted on psychiatric patients is compounded by the medical neglect of psychiatric patient's iatrogenic injuries. Society is paying for the mentally ill to be legally compelled to be "medically treated" with neuroleptic and other psychoactive drugs; sometimes in combinations known to be fatal. Psychiatrists recklessly abuse prescription privileges off label prescribing is NOT license to prescribe for no good reason, without any evidence.... Psychiatry's psychopharmacological pseudo-medical treatments with or without electro-shock are potentially fatal. The fact some people subjected to psychiatric treatment describe it as torture, should not be ignored. Far too many people "medically treated" in reality, have been tortured. One never hears of the APA or the AACAP validating survivors and victims of iatrogenic drug induced disabilities much less honoring the memory of victims of iatrogenic fatality.
 
Psychiatrists who willingly participated in research that effectively served as a marketing tool for pharma and published 'peer-reviewed' articles in support of marketing agendas are considered 'KOLs;' BMOC basically. The APA and the ACAAP membership fail to value ethical medical standards. As a whole, the profession has functioned without ethical integrity. Lead researchers have actively and passively participated in an ongoing criminal enterprise that is subverting science and defrauding the American people while using medical fraud as a standard clinical practice. It is little surprise that these geniuses who are so called KOLs are recommending that nothing in the practice of psychiatry change.

via AACAP The Academy of Child and Adolescent Psychiatry

FAQs on Child and Adolescent Depression

"What causes depression in children?

"Depression has no single cause. Both genetics and the environment play a role, and some children may be more likely to become depressed. Depression in children can be triggered by a medical illness, a stressful situation, or the loss of an important person. Children with behavior problems or anxiety also are more likely to get depressed. Sometimes, it can be hard to identify any triggering event."

The claim that depression is caused by a 'chemical imbalance' is no longer being made; paltry evidence of what should be a concerted effort to start providing factual information to the public. It is apparent to me that these professionals do not appear to concerned about regaining the public trust that has steadily eroded due to a serious lack of integrity in academic research, fraudulent marketing and abdication of ethical duty to patients. and . However, after reading this: "Are medications safe? Do they increase risk of suicide? When prescribed and monitored carefully, medications are both safe and effective ways to treat of depressed youth. Fluoxetine or Prozac, a selective serotonin reuptake inhibitor, is the medicine that so far has proved most safe and effective. There are times, however, when other medications can and should be used. While medications have been associated with a small increase in thoughts of suicide, there is no evidence that antidepressants actually increase the risk of suicide. For moderate to severe depression, the potential benefits from medication treatment seem to outweigh the potential risks. Click here for a complete discussion of the use of medication in childhood depression." I realized that no real changes are planned (to actually become ethical or evidenced-based medicine) Psychiatric drugs will continue to be recommended as a "First-Line" treatment for depression; and apparently, other drugs as well. I also realized (once again) that psychiatrists in positions of leadership at the ACAAP, seem to have no problem at all flat out lying about the drugs they are using.

The use of SSRI antidepressants on children and adolescents is based on the TADS Drug Trial. In the trial there were a total of 18 suicide attempts all but one was a kid who was on Fluoxetine, or Prozac, and there was an obvious attempt made by the researchers to present the data in a way that would misrepresent the suicide data in journal articles. Robert Whitaker reported, "The TADS study has been used to justify the prescribing of Prozac—and really, by extension—other SSRIs to children and adolescents. The TADS researchers reported that the drug treatment was effective and didn’t increase the risk for suicidal events, as compared to placebo. Adding CBT to medication “enhances the safety of medication,” the TADS researchers wrote.

"All the while, the real suicide data was being hidden. The TADS investigators weren’t disclosing the number of suicide attempts, and they weren’t reporting that all but one of the suicide attempts were in fluoxetine-treated youth. Instead, they made it appear that a similar number of suicidal events had been seen in the placebo group, and, at one point, even wrote that 15 in this group had attempted suicide." read here

Dr. David Healy reports, "The FDA became party to a myth that somehow Prozac was ok where other antidepressants given to children weren’t.

"Because FDA had licensed Prozac for depression before the 2004 suicide controversy blew up, they became party to a myth that somehow Prozac was ok where other antidepressants given to children weren’t. Prozac in fact shows no more efficacy than other antidepressants for children and has just as bad a suicidality profile, along with a range of other harms such as sexual dysfunction, inhibited growth, and other problems, as other antidepressants. emphasis mine

"This is not an argument against Prozac. Suicidality can be anticipated and forestalled by warning patients. I once thought that an appeal to patient safety would get doctors on board." here

In a large NIMH trial of 4,041 “real-world” outpatients, only 108 patients remitted and stayed well and in the trial during the one-year followup. Efficacy and Effectiveness of Antidepressants. Pigott, H. Psychotherapy and Psychosomatics, 79 (2010), 267-279.

Retract Study 329 from 1Boring Old Man

photo credit sciencephoto.com

Is the primary ethical duty of a physician unknown to mainstream psychiatry?

"I am sure that we will recognize that there are some things in our society, 

some things in our world, to which we should never be adjusted." 

Martin Luther King Jr.

"I am sure that to be silent about psychiatric abuse and oppression is to be complicit."
MadMother

Although definitive evidence in support of the hypothesis that schizophrenia is a brain disease remains elusive, psychiatrists who firmly believe in the correctness of it, used their belief in this hypothetical explanation for the etiology of schizophrenia to justify the "Standard Practice" of prescribing neurotoxic teratogenic drugs as a necessary medical treatment. Calling it a "Standard Practice" is misleading; it is not an ethical medical standard, since it is a "standard" only because it was designated as such by consensus; i.e. a quasi-democratic political process, evidence only of an agreement of the meaning to be attached to behaviors. Psychiatry relies upon consensus, a quasi-democratic process in the absence of evidence gathered by using ethical scientific principles.  It is a standard that does not rely upon the use of sound ethical medical judgement; it is contradictory to the ethical standards of medical science. The standard clinical practices used by psychiatry to "medically treat" psychiatric diagnoses are validated by a political process; as a result, they are not ethical medical standards. In other medical specialties, the standards used in clinical practice are derived from and supported by the data collected in research, and includes documented "anecdotal" evidence from experienced clinicians;  i.e. the "evidence base." Theoretically, to be ethical medical care, care is offered with the primary purpose of serving the best interests of the patient; in the Hippocratic tradition to, "First, do no harm..."

In effect, the AACAP and the APA have determined by a quasi-democratic process, that psychiatric diagnoses are biological, neurodevelopmental brain diseases, or chemical imbalances that require "medical treatment." It is a determination that is not based on research, but on a political process; it is based on a vote. This is also how diagnoses and diagnostic criteria is standardized as well. So psychiatry recommends "treating" behaviors as if they are symptoms of disease; and this recommendation is not based upon the scientific method, or the ethical principles of medicine; which begs the question, why is it called, "medical treatment?"

The devotees of psychiatry's disease model have been frantically searching for proof of an elusive  hypothetical disease that causes psychiatric symptoms; and have yet to find definitive evidence despite decades of diligent searching for it. The fact that they have standards of practice that are based on the belief in an unidentified disease is despicable really, when one considers the loss of liberty, and life that has resulted from ego-maniacal hubris masquerading as "professional medical judgement." Belief in a hypothetical explanation for symptoms is not an ethical basis for any medical decision; it is a juvenile justification for bullying. Psychiatry is, in effect bullying psychiatric patients by using coercion, biased information, Police Powers, and Court Orders; none of which can ever magically transform what is being done into a valid or ethical medical treatment. Stating authoritatively, that a disease exists which requires medical treatment in order to compel or coerce "treatment compliance," is nothing but a fraud.

Do NOT misunderstand what I am saying--distress, social difficulties, emotional, behavioral and cognitive symptoms are all very real; but none have been proven to be the result of a neuro-biological disease, chemical imbalance or a genetic defect. This fact is acknowledged; by the APA, and AACAP and the NIMH. Yet all three of these entities disseminate educational materials for the general public that imply and literally state the exact opposite. At the same time, through NAMI, and other so-called patient advocacy groups, and in "peer-reviewed" professional journals the American Psychiatric Association and the American Academy of Child and Adolescent Psychiatry, disseminate information that authoritatively states, in effect, that psychiatric diagnoses are medical illnesses (like diabetes!) that can be treated "safely and effectively." The claim is more of a hopeful exaggeration; and strictly speaking, is not a truthful claim. The new psychiatry, or "psychopharmacology," purports to be "treating diseases" whose etiology and/or pathology have never been defined, validated, much less understood well enough to ethically support the claim made that their symptoms can be effectively treated.

The diagnoses in the Diagnostic and Statistical Manual are based upon the most unreliable scientific data, subjective observation/opinion. The disease hypothesis is supposedly derived from the mechanism of action of the drugs, but the disease hypothesis predates the use of drugs. In the field of medicine, a phenomenon is studied, and a hypothesis is formulated and tested. In medicine, a disease or defect is studied, defined and validated through testing of the hypothesis, once understood, somatic treatments to reverse, prevent or inhibit the progression of the disease can be developed and tested... Psychotropic drugs can cause disease in major organs and alter the function of physiological processes; in effect, the drugs cause iatrogenic illnesses and impairments; and can cause sudden death. Psychopharmacology has a devotion to the bio-disease paradigm; but it is due to a hopeful belief, an illusion, not sucessful use of the drugs. Psychiatry; i.e. psychopharmacology, does not consistently use scientific standards; and worse yet, it is not grounded in, or even seem to value, ethical medical principles.

Psychiatry does not keep track of how many actually die, develop obesity, diabetes, akathisia, tardive dyskinesia, tachycardia, or any iatrogenic illness from the drugs which will shorten their patient's lives. This is indicative of how important the collection of relevant data necessary for an accurate risk vs. benefit assessment in real world practice is to psychiatry. Why would a belief in a particular etiology for psychiatric symptoms become a justification for adopting a clinical standard of practice unsupported by evidence, or for using force to compel the treatment Under Color of Law? How can it be ethically or morally justifiable to compel treatment with significant and fatal risks by Court Order?

Sudden fatality, the development of chronic conditions that are disabling, i..e. the rate of iatrogenesis, is  needed information for a meaningful risk vs. benefit analysis in real world clinical practice; yet this information is purposely not being collected. Those who are disabled, and the fatal outcomes are considered "anecdotal evidence." Ironically, unlike  the anecdotal evidence used to recommend prescribing the drugs to a patient, this outcome data, is "anecdotal evidence" that is ignored---it is not considered relevant when making treatment decisions.  This is in no small measure why children are being drugged in the manner that they are... Rarely, are iatrogenic, drug-induced deaths, recorded in the FDA AER database, as such. Based upon my own casual observation, child fatalities are commonly reported by a parent or an attorney; not a medical professional.

The twisted logic seems to be, if psychiatric diagnoses are "diseases" and psychiatrists are "doctors" who diagnose the diseases; that what they are do is provide necessary "medical treatment."  Whether a person gives consent or not, is not important. Psychiatry does not treat individuals so much as apply a label to the individual; then implement a treatment protocol.  Since Practice Parameters are based upon consensus, outcomes or overall improvement in the patients was not ever considered important enough to be quantified in any meaningful way, nor was the data considered important enough to collect. The patients' perspective,  physical health and general well being, doesn't appear to be given thoughtful consideration. The effect of treatment on the patient is certainly never as important as the patient never questioning the bio-disease model. A patient must always remain treatment compliant regardless of the actual effects of psychiatric treatment.

Without insisting on the absolute utility of the "treatments" of psychotropic drugs, how would psychiatry "practice medicine?" It would have to return to the "treatment" used prior to the drugs: lobotomy and insulin shock. Choosing to stop the using coercion to control, having respect and showing compassion for patients, considering patients to be worthy of kindness, and treating patients as equals would be an indication that the psychiatric profession may be worthy of trust. Choosing to use methods of control to main authority while continuing to deny the the plight of patients who are harmed, is evidence that psychiatry is not a profession that can be  trusted.

Psychiatry continues to defend the use of coercion, while wielding Police Powers; continues to mislead and lie to patients and the general public, continues to lie about patients and lie about the nature of the diagnoses that are applied to people in distress, with impunity. All of psychiatry's standard practices are anathema to ethical medical principles and the scientific understanding of disease. The manner in which psychiatry is practiced makes it impossible to earn the trust and respect of patients who have critical thinking skills; without mutual respect it is impossible to develop a therapeutic relationship.

It becomes obvious why Informed Consent is not really an important part of psychiatry's "standard clinical practices;" whether it is accidental oversight, careless disregard, or lack of appropriate training, doesn't really matter.  In the end, it is the real world outcomes of the patients themselves that matter; doing what is in a patient's best interest is supposed to be the primary focus in providing medical care.

The refusal to collect accurate data and to base treatment decisions upon ethical scientific methods and sound ethical medical principles, in effect, encourages psychiatrists to be wilfully blind to the countless, uncounted and discounted psychiatric patients they treat who are not "effectively treated;" but are instead grievously harmed. Psychiatry is blind to the plight of patients who are experiencing profound iatrogenic impairments and effectively dismisses the patients, and doesn't collect the data quantifying the harm done to them.

Psychiatric survivors are denigrated by mainstream advocates 'for the mentally ill' and by psychiatrists in "professional" journals. Patients who are liberated from psychiatric incarceration who have reclaimed their voices; refuse to be silent. Psychiatric survivors are the ONLY advocates who speak of and remember the lives that are lost forever. The psychiatric patients who are (de)voiced, who can no longer speak about what happened to them, whether they are alive or dead, are people worthy of respect. They are people who matter, and their real world outcomes are not "anecdotal evidence."

It is a choice to abdicate the primary ethical duty of a physician to, "First, do no harm..."

photo credit bipolarbears11 photobucket

Psychiatry: focused on defending unethical research and clinical care standards instead of real world outcomes

"Currently, there are no pharmacological or psychosocial therapies with enough evidence in youth samples to meet the standards for empirically-supported treatments as defined by Chambless & Hollon (1998; Brown et al., 2008; McClellan & Werry, 2001)." here

via NYTimes:
Use of Antipsychotics in Children Is Criticized
By GARDINER HARRIS

Published: November 18, 2008

a few excerpts:

"From 1993 through the first three months of 2008, 1,207 children given Risperdal suffered serious problems, including 31 who died. Among the deaths was a 9-year-old with attention deficit problems who suffered a fatal stroke 12 days after starting therapy with Risperdal."

"At least 11 of the deaths were children whose treatment with Risperdal was unapproved by the F.D.A. Once the agency approves a medicine for a particular condition, doctors are free to prescribe it for other problems."

"Panel members said they had for years been concerned about the effects of Risperdal and similar medicines, but F.D.A. officials said no studies had been done to test the drugs’ long-term safety."

"Dr. Dure said he was concerned that doctors often failed to recognize the movement disorders, including tardive dyskinesia and dystonia, that can result from using these medicines."

“I have a bias that extra-pyramidal side effects are being under-recognized with these agents,” Dr. Dure said.

"Dr. Laughren of the F.D.A. said the agency could do little to fix the problem. Instead, he said, medical specialty societies must do a better job educating doctors about the drugs’ side effects." here

via Archives of General Psychiatry:

Original Article | June 2006

National Trends in the Outpatient Treatment of Children and Adolescents With Antipsychotic Drugs

Mark Olfson, MD, MPH; Carlos Blanco, MD, PhD; Linxu Liu, PhD; Carmen Moreno, MD; Gonzalo Laje, MD

an excerpt:

Child and adolescent mental health visits that include antipsychotic treatment occur disproportionately among publicly rather than privately insured patients. After adjusting for patient diagnosis and other background characteristics, mental health visits by publicly insured children and adolescents were significantly more likely to include prescription of an antipsychotic medication. This finding is in line with higher youth antipsychotic prescription utilization among populations covered by Medicaid^2 - 3 compared with commercially insured populations.⁴ The basis of this is unknown but may relate to differences in public and private payer reimbursement schedules for pharmacologic or psychological interventions, insurance-related variations in parent or child acceptance of antipsychotic treatment, or selection of patients in different insurance plans by physicians for treatment. Because Medicaid covers children and adolescents with Social Security Income and young people who are medically needy or in foster care, illness severity may account for differences in antipsychotic medication use across insurance groups.²⁹ Additional study is needed to understand the factors that contribute to insurance-related differences in child and adolescent antipsychotic treatment.

Approximately one third of the child and adolescent visits with prescription of antipsychotic medications were by young people with mood disorders. In addition, approximately one third of antipsychotic visits included coprescription of an antidepressant medication and one third included coprescription of a mood stabilizer. At present, there is a dearth of empirical evidence to support these prescribing patterns. 

In office-based practice, almost all of the antipsychotic treatment among children and adolescents is provided by psychiatrists. Although the NAMCS data suggest that primary care physicians and other nonpsychiatrist physicians provide care in approximately half of the youth mental health visits, they seldom prescribe antipsychotic medications. (emphasis mine) here

via American Journal of Psychiatry:

November 01, 2008 

Double-Blind Comparison of First- and Second-Generation Antipsychotics in Early-Onset Schizophrenia and Schizo-affective Disorder: Findings From the Treatment of Early-Onset Schizophrenia Spectrum Disorders (TEOSS) Study

Linmarie Sikich; Jean A. Frazier; Jon McClellan; Robert L. Findling; Benedetto Vitiello; Louise Ritz; Denisse Ambler; Madeline Puglia; Ann E. Maloney; Emily Michael; Sandra De Jong; Karen Slifka; Nancy Noyes; Stefanie Hlastala; Leslie Pierson; Nora K. McNamara; Denise Delporto-Bedoya; Robert Anderson; Robert M. Hamer; Jeffrey A. Lieberman

Am J Psychiatry 2008;165:1420-1431. doi: 10.1176/appi.ajp.2008.08050756

a couple of excerpts:
Finally, different choices could have been made with regard to the specific medications studied. At the time the trial was initiated, olanzapine was widely used in the pediatric population, whereas quetiapine had a small market share. Ziprasidone and aripiprazole, both of which may have fewer metabolic side effects, were introduced subsequent to the initiation of the study. Efforts to introduce them partway through the study were not supported by the FDA or NIMH. We also considered utilizing a placebo for comparison, as opposed to a first-generation antipsychotic. We expected that this would increase the demonstrated efficacy of the second-generation antipsychotics, but it would not address the fundamental comparative questions. Distributing the sample among four treatment conditions rather than three would also have reduced statistical power. We also considered requiring a drug-free baseline to minimize the likelihood of finding no apparent benefit of substituting one partially effective treatment for another. However, concerns about the long-term consequences of delaying effective treatment and associated recruitment difficulties argued against including a placebo treatment group or a drug-free baseline. At the time the study was initiated, there were significant ethical concerns about utilizing any first-generation antipsychotic in comparison with second-generation antipsychotics, because second-generation antipsychotic treatment was the standard of care for early-onset schizophrenia and schizoaffective disorder. We felt any traditional medication selected as a comparator would have to provide a strong potential advantage to maintain therapeutic equipoise. Molindone was chosen as the best option among first-generation antipsychotics based on its low propensity for both weight gain and extrapyramidal side effects. Despite this advantage, molindone is not commonly used in clinical practice. A more frequently used medication, such as perphenazine or haloperidol, might have facilitated comparison with adult studies and acceptance in the community. Failure to require a drug-free baseline may have reduced response rates and led to earlier treatment discontinuation.

Another potential limitation of the study is the 8-week duration of treatment. Different patterns of response or risk of side effects might have emerged over a longer trial. Some young people may require more extended therapy to adequately respond, and it is likely that some aspects of the illness, such as negative symptoms, neurocognitive function, and associated anxiety, may require longer periods to recover (44, 45). However, published standards of care for early-onset schizophrenia and schizoaffective disorder recommend the use of 6- to 8-week trials (1). A longer acute phase trial would have increased the risk of exposing subjects to prolonged ineffective treatment. Furthermore, antipsychotic medication trials in adults with schizophrenia suggest that nonresponse as early as 2–4 weeks after initiating treatment predicts nonresponse up to 12 weeks later (46–49).

The results question the nearly exclusive use of second-generation antipsychotics to treat early-onset schizophrenia and schizoaffective disorder. The safety findings related to weight gain and metabolic problems raise important public health concerns, given the widespread use of second-generation antipsychotics in youth for nonpsychotic disorders. here

Let's be real, using neuroleptic drugs for any psychiatric diagnosis is not supported by any definitive evidence; calling the drugs "effective treatment" is more than stretching the truth---Indeed, the evidence clearly demonstrates neuroleptic drugs are minimally effective for a small minority of children and adults experiencing symptoms of psychosis; and have significant disabling and fatal risks particularly for  children and the elderly.  The standards used in clinical practice are not supported by or derived from empirical data from clinical trials, or data collected from the decades long use of neuroleptic drugs off label in clinical practice---begging the question, how did prescribing these drugs to children "off label" become a "standard practice?"  This experimental use is a standard of care only because it was discussed, and adopted as a "standard" by psychiatrists. It is not because the prescription of neuroleptics is supported by, or derived from any empirical data of the safety or efficacy for the symtoms the drugs are being prescribed to children and youth to treat. In psychiatry, there are standards of care that are without support from any ethical scientific psychiatric research.  Since they are not derived from or supported by the evidence base, these so-called "standard practices" are not ethical medical standards. The drugs are used off label as a "standard" treatment due to the hubris of psychiatric professionals who have determined that consensus will suffice in place of the objective evidence that theoretically is required for a particular practice to become a clinical care "standard." 

I have been reading 'peer-reviewed' psychiatric journal articles for over ten years and I am still amazed at the lack of critical thinking exhibited by the psychiatrists who do the research and write the articles.  The utter lack of of ethical integrity of "RESEARCH PSYCHIATRISTS" is truly stunning.  The commonality is that all of them continue to repetitively state more evidence is needed to support psychiatric standards of care that are the standards psychiatrists disseminate to other professionals for clinical use; and teach to students and other medical professionals! When reporting trial results that don't support the standards used, which are the recommended 'first line treatments' that comprise the Standard of Care---does it not occur to any of these geniuses that the standards are not ethical medical standards!?  Apparently, psychiatric research and clinical practice requires no critical thought...

For example, in the TEOSS drug trials, 12% of patients enrolled were "effectively treated."  97 out of the either 116 or 119 enrolled experienced a serious adverse event; the Olanzapine arm was stopped due to the number of adverse events---At the time, Olanzpine was the most widely prescribed neuroleptic drug in the pediatrics population!  BUT there were no warnings for professionals to stop prescribing the drug to children...Exactly how many more children need to be subjected to what are harmful teratogenic neurotoxic drugs which may in fact disable and kill them, before "external forces" put a stop to these dorktors conducting research in their attempt to validate unethical standards of care? 

As a society we need to recognize that Human Experimentation on people given a psychiatric diagnosis is not an ethical standard of care; nor is it a benificent act. 

The BEST INTERESTS of the patient must come first---even if the patient is unpleasant, and even if we have been taught that the some psychiatric diagnoses mean that a patient's Human Rights can be ignored or revoked--in the interests of society... It is immoral, and it is unconstitutional.  It is also the same ignorant reasoning used to implement Eugenics laws in this country that brutalized tens of thousands, and unlike the Germans in WWII, we didn't keep track of those we killed.  America's program wasn't as 'successful' as Germany's, but it has left a stain.  Worse than that, the fundamental social control strategies and bigotry that propelled eugenics as public policy remain embedded in our publicly funded social service and mental health programs.  Sadly, the lessons learned have not remained in the general public's collective conscience...  

I believe the fact that medical care is supposed to be in the best interests of the patient, has been lost in the debate about how to help 'the seriously mentally ill' altogether.  Patients are being used as research fodder and Human Experimentation is standard psychiatric clinical practice.  In Medicine, a "standard practice" is theoretically supposed be derived from and well-supported by empirical evidence that is ethically gathered and reported in an unbiased manner.  In psychiatry, standards are discussed in committees and "validated" by a vote; these are not scientific methods, so the "standards" are unethical.  Without empirical evidence to support a particular "standard practice" or treatment protocol it is not a "standard of care," it is nothing more than an affirmative defense for psychiatric fraud and medical malpractice.  

The academic elite, Key Opinion Leaders who are members of the American Psychiatric Association and the American Academy of Child and Adolescent Psychiatry are unethical psychiatrists who are desperately defending what are obviously gross departures from ethical scientific methods and ethical medical practice, inexcusable errors in judgement, and blatant abuse of power and authority.  Ironically, these medical professionals are doing this while claiming it is not their ethical medical duty to treat the iatrogenic neurological impairments brain damage and physical diseases psychiatrists inflict upon their patients.  It is medical neglect; it is criminal.  Psychiatrists are doctors, doctors should treat the illnesses they cause instead of spending so much time defending their so-called "professional integrity."  Perhaps treating the iatrogenic illnesses and injuries they are causing will remove the scales of prejudice from their eyes...

It is certain that continuing to deny the iatrogenic harm psychiatrists are causing patients while simultaneously medically neglecting the victims and frantically tryiing to validate unethical clinical care standards with federally funded seeding trials, are desperate, dishonest acts that serve only to further undermine the integrity of psychiatry as a profession.  It's sheer hubris to vehemently defend unethical "standards of care" and "professional integrity," (which is sorely lacking) while maligning psychiatric survivors; adding insult to iatrogenic injury.  It's not possible to regain trust  with the same dishonest, unethical behavior that destroyed it. 

via Vitals NBCNews.com:
Docs: Antipsychotics often prescribed for 'problems of living'
by Sandra G. Boodman Kaiser Health News  March 18, 2012

"Adriane Fugh-Berman was stunned by the question: Two graduate students who had no symptoms of mental illness wondered if she thought they should take a powerful schizophrenia drug each had been prescribed to treat insomnia."

"In 2010 antipsychotic drugs racked up more than $16 billion in sales, according to IMS Health, a firm that tracks drug trends for the health-care industry. For the past three years they have ranked near or at the top of the best-selling classes of drugs, outstripping antidepressants and sometimes cholesterol medicines. A study published last year found that off-label antipsychotic prescriptions doubled between 1995 and 2008, from 4.4 million to 9 million. And a recent report by pharmacy benefits manager Medco estimated that the prevalence of the drugs' use among adults ballooned more than 169 percent between 2001 and 2010."

"Wayne Blackmon, a psychiatrist and lawyer who teaches at George Washington University Law School, said he commonly sees patients taking more than one antipsychotic, which raises the risk of side effects. Blackmon regards them as the "drugs du jour," too often prescribed for "problems of living. Somehow doctors have gotten it into their heads that this is an acceptable use." Physicians, he said, have a financial incentive to prescribe drugs, widely regarded as a much quicker fix than a time-intensive evaluation and nondrug treatments such as behavior therapy, which might not be covered by insurance."

"Medco is asking doctors to document that they have performed diabetes tests in patients taking the drugs. "Our intention here is to get doctors to reexamine prescriptions," Muzina said."

"In the short term, I don't see a change in this trend unless external forces intervene." here

Primum non nocere

FIRST DO NO HARM

Hippocrates

via Mad in America:
The Taint of Eugenics in NIMH-Funded Research Today November 25, 2011 by Robert Whitaker
an excerpt:

"Today, as a society, we would never conclude that we hold “eugenic” ideas about the “mentally ill.” Eugenics became a discredited science at the end of World War II, when it became evident that Hitler had risen to power on a eugenics agenda, and that this grading of humans—into the fit and unfit—had led to the Holocaust. Yet, it is easy to see today that our modern research agenda encourages eugenic conceptions of the mentally ill and encourages the adoption of policies that rob people so diagnosed of their basic rights." read here

via FearLoathingBTX: January 24, 2011 Posted by Carl :

Whatever Happened to the Nuremberg Code?

"Harriet Washington explains how the United States is failing to protect research subjects."

I realized years ago the truth stated in the above sentence.  My son is disabled after having been repeatedly traumatized by an unethical psychiatric researcher using treatments that were not approved for children.  Ultimately, these events are what compelled me to write this blog. Psychiatric diagnosis and "medical treatment" were in reality, inhumane mistreatment of my son.  He grew up being victimized by professionals who violated his human dignity, his human rights and caused him grave harm.  I know my son's experiences are not unusual.  It is not an uncommon Real World Outcome for a person with a psychiatric diagnosis, to be left disabled by psychiatric treatments used in standard clinical practice.

via Health and Human Services   

The Belmont Report

Office of the Secretary

Ethical Principles and Guidelines for the Protection of Human
Subjects of Research

The National Commission for the Protection of Human Subjects
of Biomedical and Behavioral Research

April 18, 1979

A couple excerpts: 

Part B: Basic Ethical Principles

"In most cases of research involving human subjects, respect for persons demands that subjects enter into the research voluntarily and with adequate information. In some situations, however, application of the principle is not obvious."

Part C: Applications

C. Applications

Applications of the general principles to the conduct of research leads to consideration of the following requirements: informed consent, risk/benefit assessment, and the selection of subjects of research.

1. Informed Consent. -- Respect for persons requires that subjects, to the degree that they are capable, be given the opportunity to choose what shall or shall not happen to them. This opportunity is provided when adequate standards for informed consent are satisfied. 

While the importance of informed consent is unquestioned, controversy prevails over the nature and possibility of an informed consent. Nonetheless, there is widespread agreement that the consent process can be analyzed as containing three elements: information, comprehension and voluntariness.

(emphasis mine)

Summary

The Belmont Report explicitly states the requirements for researchers who perform studies involving human subjects to comply with  Federal Law, The Code of Federal Regulations (45 CFR 46).   It is plain that these protections are not, and have never been  in fact effectively preserved or protected for people with a psychiatric diagnosis.  There is no way anyone could provide "Informed Consent" without being informed that all Psychiatric diagnoses, pharmacological or other mental health "treatment" protocols, algorithms and recommendations, e.g."Practice Parameters;" and standards of care are codified in committee by consensus, a quasi-democratic process; not a scientific endeavor. 

Psychiatry claims it is a "medical specialty," yet many of it's standard practices, including the standards guiding treatment using teratogenic, psychotropic drugs, are not supported by empirical data. It is without an ethical scientific foundation.  As a result, psychiatry cannot adhere to the ethical principles of medicine.   Psychiatric research and clinical practice violates patients rights under Federal Law as a matter of course.  In effect, and in fact,  psychiatric practice denies Human Research Protection to psychiatric patients, since treatment without solid empirical support is in fact, experimental treatment.  Psychiatrists and advocates alike claim these protections are not needed, and are not in psychiatric patient's best interest; some even claim these Human Rights are not relevant or meaningful to psychiatric patients.   CFR 46 and the Nuremberg Code, protect all people; even, (perhaps especially) people who have a psychiatric diagnosis.  The Nuremberg Code was developed to prevent the types of Crimes Against Humanity that were committed by psychiatrists in Europe leading up to and during WWII; why have we not enforced these Human Rights protections AT ALL in the United States?

Robert Whitaker's article points out that the NIMH is funding psychiatric research as if it is a scientific fact that mental illnesses are genetic, biological manifestations of a disease process.  This is merely a hypothesis, it is not even a validated theory, let alone a medical certainty... The NIMH list of 10 research advances do not include even one psycho-social or cognitive behavioral advance. Could this be an intentional owversight? Whether it is or is not intentional, it is irresponsible and unethical. It is a bias that is very telling, at the very least.  

The American Psychiatric Association, the American Academy of Child and Adolescent Psychiatry, the National Institutes of Mental Health and the Food and Drug Administration work in concert with Big Pharma to stifle dissent, discourage open academic inquiry and debate, and deny the harm done to patients as a result of their medical malfeasance. 


NIMH funded research is often not conducted or reported ethically.  The "medical professionals" who are Key Opinion Leaders and Educators, and paid consultants obfuscate the truth about the validity and reliability of psychiatric diagnoses; the etiology of psychiatric symptoms and mental illnesses; and then deny the negative effects of their subterfuge, their diagnoses, and their treatments.  This not medicine, e.g. "first, do no harm..."  Deception is not ethical, moral, or scientific; dishonesty serves no therapeutic, or medical purpose.  The purpose of this prevarication is to deceive; a deception with the underlying intent to change or direct individual and societal behavior.  It is fraud.  Stigmatizing people, including children given a psychiatric diagnosis and enlisting their families assistance in coercing treatment compliance; the primary goal is to maintain psychiatric authority, but never actually earning trust or respect.  It is fraud, not the ethical practice of medicine.  Fraud is illegal for good damned reason.  Doctors should never perpetrate fraud to "practice medicine." Obviously,  doctors who rely on deception, coercion and other social control strategies are criminals. 


Eugenics Building picture credit


Nuremberg Code picture  credit


Human Experimentation credit

first posted 1-25-2012

The DSM 5 Controversy Update

Update April 2, 2013 apparently, Psychiatric Times disabled every link sometime recently. One wonders on their motivation to disable links that had been functional for so long...

Original 8-15-2011 Updated June 14, 2012
I recently read, "Inside the Battle to Define Mental Illness," an interview with Allen Francis, M.D., lead author of the DSM IV, and an outspoken critic of the current effort to update the Diagnostic and Statistical Manual, the DSM 5.  My hat's off to  Dr. Francis for having the professional integrity to assertively state his case.   


via The Psychiatric Times:

A Warning Sign on the Road to DSM-V: Beware of Its Unintended Consequences


 By Allen Frances, MD | June 26, 2009

Dr Frances was chair of the DSM-IV Task Force and of the department of psychiatry at Duke University School of Medicine, Durham, NC. He is currently professor emeritus at Duke.

"We should begin with full disclosure. As head of the DSM-IV Task Force, I established strict guidelines to ensure that changes from DSM-III-R to DSM-IV would be few and well supported by empirical data. Please keep this history in mind as you read my numerous criticisms of the current DSM-V process. It is reasonable for you to wonder whether I have an inherently conservative bias or am protecting my own DSM-IV baby. I feel sure that I am identifying grave problems in the DSM-V goals, methods, and products, but it is for the reader to judge my objectivity." 

"Much of our effort in developing DSM-IV centered on avoiding possible misuses of the system." here

via Wired Magazine:
Excerpts from The Battle to Define Mental Illness, an interview with Dr. Allen Francis:

"Then an odd, reflective look crosses his face, as if he’s taking in the strangeness of this scene: Allen Frances, lead editor of the fourth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (universally known as the DSM-IV), confessing that “these concepts are virtually impossible to define precisely with bright lines at the boundaries.” For the first time in two days, the conversation comes to an awkward halt." 

"But he recovers quickly, and back in the living room he finishes explaining why he came out of a seemingly contented retirement to launch a bitter and protracted battle with the people, some of them friends, who are creating the next edition of the DSM. And to criticize them not just once, and not in professional mumbo jumbo that would keep the fight inside the professional family, but repeatedly and in plain English, in newspapers and magazines and blogs. And to accuse his colleagues not just of bad science but of bad faith, hubris, and blindness, of making diseases out of everyday suffering and, as a result, padding the bottom lines of drug companies. These aren’t new accusations to level at psychiatry, but Frances used to be their target, not their source. He’s hurling grenades into the bunker where he spent his entire career." read it here.

When I read the APA's response to Allen Francis' criticism in the Psychiatric Times, I was unimpressed.  Francis begins his criticism with the statement, "We should begin with full disclosure."   The APA's rebuttal was signed by four psychiatrists and was a lame attempt to defend the indefensible.  An advertisement  for Abilify was alongside of it:

6-14-2012 When updating this article, I discovered the page with the APA's rebuttal had an even larger advertisement for Latuda, that takes you to another page:

Explore results from Study 3, including the primary and key secondary measures.^1,2

Before I was done updating this article, the advertisement was changed to one for Seroquel...I must say, it is more than a little disconcerting to have so much advertising of the neuroleptic drugs in professional journals.  It is just as disturbing, if not more so, than the amount of direct to consumer marketing of  psychiatric drugs.  It is particularly troubling to see so much reliance on pharmaceutical industry funding for psychiatric journals, and the functioning of the APA itself.  It doesn't seem ethical to have Direct to Professional marketing for psychiatric drugs in "professional literature."  There is no way in hell that these marketing messages do not feed any existent biases a professional may have.

It is no secret that Conflicts of Interest, fraud and corruption have permeated every aspect of psychiatry for some time.  In the real world, some psychiatrists have caused a great deal harm to human beings they meant to help.  The societal damage has wide-ranging effects, and a negative impact on ALL of US.  Why is the APA (and the AACAP) allowing become and it originates with the criminal enterprise that conflicted academic psychopharmacology researchers involved themselves in; intentionally or not.  This criminal enterprise continues to defraud all of us through publicly funded programs, and continues to harm patients.  In spite of this reality, many psychiatrists do not seem to understand that even if they themselves did not perpetrate any  fraud themselves, they have an ethical obligation to have psychiatrists who have, held accountable.  It is obviously in everyone's best interest for professional groups to hold their individual members to high ethical standards.  It seems to me that unethical conduct has not only been accepted; it has been richly rewarded and honored...

My final observation is this:  The APA will conceivably make a great deal of money from the DSM 5.  It is preposterous and disingenuous for it's members to suggest a loss of income is motivating Allen Francis; yet failing to mention the anticipated income expected by the American Psychiatric Association with publication of the DSM 5.  Psychiatrists who are critical of the APA, have been maligned; and have had their careers dramatically altered.  Psychiatrists are punished for being ethical, having integrity and defending their work, i.e. showing all of the data generated, the procedures and parameters used. Such overt ethical integrity is punished in the APA; a person may be forced to defend themselves against malicious attacks and/or ostracized.  APA thugs are not even censured.   

Psychiatrists that are critical of any aspect of this process, that speak out about the harm caused patients; and that question the secretive process and the lack of validity are castigated. The professionals with the integrity to publicly express disagreement or dissent are said to be impaired or lacking insight by "Key Opinion Leaders" of the APA.   The psychopharmachology faithful in the APA have let loose a contagion that has spawned an epidemic of Pharmachosis.  Psychiatrists with Pharmachosis have ansognosia; and don't even know it. When experiencing Pharmachosis, a psychiatrist doesn't know what they have, or what they don't have, and they don't even know if they have or have not... (◔‿◔)  Completely oblivious to a quantifiable reality recognized by anyone without Pharmachosis, i.e. having a modicum of critical thinking skills. 

Alert to the Research Community—Be Prepared to Weigh in on DSM-V

Setting the record straight Schaztberg Scully Kupfer Regier

APA and DSM: Empty Promises Spitzer

A Response to the Charge of Financial Motivation

Criticism vs. Fact William Carpenter

Dr Frances Responds to Dr Carpenter: A Sharp Difference of Opinion

Advice to DSM-V . . . Change Deadlines and Text, Keep Criteria Stable

Advice to DSM-V: Integrate with ICD-11