What's missing in the Psychiatric Times Article, "Prescribing Psychotropics for Women of Childbearing Potential"?

me and my grandson, Ragnar

I believe disclosures should be at the beginning of any professional journal article. ( particularly in journals and on websites that are basically marketing endeavors operating under the guise of providing continuing education to medical professionals by publishing professional journal articles)

via Psychiatric Times:

Prescribing Psychotropics for Women of Childbearing Potential

March 14, 2014 | Psychopharmacology, Mood Disorders
By Marlene P. Freeman, MD

DISCLOSURES
Dr Freeman is Associate Professor of Psychiatry at the Harvard Medical School; Medical Director, Clinical Trials Network and Institute; and Director of Clinical Services, Perinatal and Reproductive Psychiatry Program at the Massachusetts General Hospital in Boston. She has received research support from GSK and Lilly; is on the advisory boards of Lundbeck, Taleeda, Otsuka, and Genentech; and does medical editing for DSM Nutritional Products. (emphasis mine)

an excerpt:

"For some medications, such as SSRIs, lamotrigine, and benzodiazepines, there are a great number of published studies—some with conflicting results.7 For other medications that are known teratogens, such as lithium and valproic acid, the association with birth defects is clear, but the absolute risk of teratogenicity must be understood to make informed decisions.7 With lithium, which has a known association with a specific cardiovascular malformation—Ebstein anomaly—the absolute risk is low. Approximately 0.1% to 0.2% of pregnancies are affected when there is exposure in the first trimester. In contrast, valproate has a known and common association with neural tube defect, estimated to occur in 1% to 5% of exposed pregnancies.7 "  

Dr. Freeman's article does not even mention neuroleptic drugs, called antipsychotics, which are direct to consumer marketed in the United States as adjunct treatment for mood disorders; this may have been an oversight. It appears to reflect a head in the sand approach to the elephant in the room. Some of Dr. Freeman's statements that appear to undermine FDA warnings about the teratogenicity of FDA approved drugs is, in effect, basically a declaration that the elephant the good doctor is pretending no one sees can't possibly be dangerous; if it is, the elephant is not as dangerous some know it is. 

I don't tend to put much stock in doctors who fail to communicate in a forthright manner. Perhaps I am being harsh, but I don't believe so. A doctors stock in trade is a patient's perception of the doctor, and the real world effect on the patient (from the patient's perspective). It is important for a doctor to be HONEST. Psychiatrists cannot mislead through use of analogies and myths to explain psychiatric diagnoses are "real diseases"; label people who don't trust them with anosognosia, having no respect for authority, paranoid or delusional while simultaneously endorsing forced treatment under color of law on unwilling patients. Involuntary treatment is justified solely by professional opinion. In effect, by stating the person has a psychiatric diagnosis and that it is a "medical necessity" the person must have psychiatric treatment. The Rules of Evidence are not required or followed in the civil commitment process in Washington State. No evidence of the "medical necessity" of psychiatric treatment, no evidence that a patient has an identifiable neurobiological condition or a brain disease; and worse, no evidence that psychiatric treatment will benefit the patient forced under color of law is even required. 

Whether a patient believes a professional is communicating honestly with them, is perceived to have a genuine kind regard for them, and has the ability to treat a patient ethically, is not as important as the psychiatrist being humble and honest enough to practice medicine with ethical integrity. A doctor's primary duty ethical duty is to the patient; regardless of a psychiatrist's biases and beliefs about what causes "mental illnesses," and how to best help the people who are believed to have a psychiatric diagnosis. While it is unfortunate and "challenging to remain apprised of data pertaining to medication use in pregnancy, since the literature is constantly evolving;" it is more unfortunate that there has been so little evidence offered to validate or support psychiatric diagnoses and treatment. 

Why are psychiatrists emotionally defending psychiatric diagnoses and the psychotropic drug treatment regimens that purportedly medically treat them?  Ethical integrity demands psychiatric diagnoses and drug treatment algorithms be empirically validated and supported; not merely believed in and relied upon by consensus. In effect, psychiatry has developed standards of care that protect psychiatrists from being held legally liable for iatrogenic harm caused to patients. The purpose of treatment standards is to protect patients from unethical medical practitioners; why are treatment standards used to refute accusations of iatrogenic harm? Psychiatry's treatment standards serve as a protective legal shield for psychiatrists professionals who wield Police Powers to detain and involuntarily treat patients with drugs  and/or electroshock treatments with serious risks including permanent disability and death. Since psychiatrists are doctors we must believe they are honest, ethical and NO EVIDENCE IS REQUIRED.

via Canadian Pediatric Society:

Selective serotonin reuptake inhibitors in pregnancy and infant outcomes

Principal author(s)Ann L Jefferies; Canadian Paediatric Society, Fetus and Newborn Committee
Abridged version: Abridged version: Paediatr Child Health 2011;16(9):562

Abstract

Adequate treatment of depression during pregnancy is very important for maternal, fetal and neonatal health. Selective serotonin reuptake inhibitors (SSRIs) are commonly used antidepressants. According to one American study, approximately 7% of pregnant women were prescribed an SSRI in 2004-2005. First trimester use of SSRIs, as a group, is unlikely to increase the risk of congenital malformations. Paroxetine may be associated with a small increased risk of cardiac malformations, but evidence remains inconclusive. Fetal exposure to SSRIs closer to time of birth may result in respiratory, motor, central nervous system and gastrointestinal symptoms in about 10% to 30% of newborns (SSRI neonatal behavioural syndrome). These symptoms are usually mild and transient. Persistent pulmonary hypertension of the newborn is an extremely rare consequence of fetal exposure. This information should be used to make individual risk-benefit decisions when considering the treatment of depression during pregnancy. Newborns with late- pregnancy exposure to SSRIs should be observed in hospital for at least 48 h. read here

Teen Screen on Steroids: Typical or Troubled?™

TYPICAL OR TROUBLED?™ SCHOOL MENTAL HEALTH EDUCATION PROGRAM appears to be Teen Screen on steroids...The website for the American Psychiatric Foundation (APF) cites no collaborators on it's website, it simply states, "The American Psychiatric Foundation, recognizing the important role adults can have in a teen's life, has begun an initiative to encourage and equip adults (such as parents and teachers) who closely interact with teens to notice the warning signs of mental health problems and refer teens to help in addressing these issues." here 

New York public television station WLIW, which broadcasts "Healthy Minds" states on it's webpage for "Teens: Typical or Troubled? Part One – What You Need to Know (#115)" that Colleen Reilly is the founder of Typical or Troubled?™  here

I find it more than a little strange that the APF basically pretends that this program was developed by psychiatrists in response to school violence as a public service, when it is plainly a marketing strategy developed by a marketing and public relations company in collaboration with the pharmaceutical industry--so the APF not citing any collaborators  is not honest, or ethical; but it is sadly, typical for the American Psychiatric Association to be less than forthright...    

Typical or Troubled?™ is supported by Janssen and McNeil Pediatrics, divisions of Ortho-McNeil-Janssen Pharmaceuticals, Inc. here

via CNS News.com:

Is That Kid Normal? Teachers Trained to Notice When Students May Not Be; Training Sponsored by Drug Companies

January 29, 2013 by Susan Jones

a few excerpts:

"APF says its "Typical or Troubled" program is sponsored by drug-makers Bristol-Myers Squibb Company, Janssen Pharmaceutical Companies of Johnson & Johnson, and Shire, and it teaches that effective treatments for mental problems include therapy and medication or a combination of both." 

Colleen Reilly, director of "Typical or Troubled?“ told The Miami Herald that after what happened in Newtown, "This needs to be a national curriculum and a part of every school.”

The newspaper quoted Reilly as saying the goal of the program is not to have teachers diagnosing students: "We're asking them to learn about and notice the warning signs, and if they see a problem to refer them to someone who has a better grasp.”

And what about normal children who are flagged as "troubled?" Judge Leifman told The Miami Herald, "The worst that would happen is they’ll get evaluated.” read here

The Judge is apparently ignorant about the potential consequences for a kid being flagged as "troubled;"  being sent for an evaluation is not the worst thing that could happen.  The kid being told he/she has a brain disease, disorder, or defect when they are evaluated and being given a psychiatric diagnosis along with the standard prescription of one or more psychotropic drugs to treat the "disease" is much worse, and much more probable than, "they’ll get evaluated...” Colleen Reilly I will assume stands to earn some money since she is the "founder." Small wonder she believes this program, "needs to be a national curriculum and a part of every school.” 

via The Reilly Group: 

Products and Programs

The American Psychiatric Foundation

"We've been working with the Foundation for over a decade helping to create and build programs and products to educate Americans about mental health disorders and encourage help seeking behavior. One program, the Typical or Troubled?™ school mental health education program, is a nationally recognized, program that is helping parents and school communities learn about teen mental health and connect students to help." 

Colleen Reilly

President, The Reilly Group, Inc.

Colleen Reilly has more than twenty five years experience in communications, public affairs and health.  Having worked in senior positions in the government, non-profit organizations, media and the private sector, she uses this multi-dimensional experience to conceive and implement communications strategies to achieve clients’ goals.  She is a recognized communications and branding expert on women’s health, mental health and integrative medicine.  She brings creativity and innovation to her work in public education and advocacy campaigns, alliance building, public and private sector partnerships, global philanthropy, conferences and forums

She works directly with Executives from a diverse group of national and multinational public and private organizations to take ideas from creative inception to effective detailed execution.

Colleen is a notable expert in new media and health 2.0 tools, and advises clients on leveraging digital technologies to advance global health issues, patient education and advocacy.

Prior to starting The Reilly Group, Inc, Colleen  served as senior communications advisor to the US Public Health Service Office on Women’s Health in Washington, DC, where she was responsible for designing and implementing national partnership and public education campaigns on a range of women’s health issues with other government agencies, non-profit groups and corporations.  She also served as the Senior Vice President for Communications and Marketing for the National Mental Health Association where she oversaw national media, public education and advocacy campaigns on mental health issues for over 300 affiliated chapters.  Before founding The Reilly Group, she worked as a newspaper journalist and political consultant in Colorado and California.

Colleen received her Bachelor of Arts degree from the University of Colorado in Boulder, Colorado and a Master of Public Policy from the University of Southern California in Los Angeles, California.

Public Education Health Campaigns

National Public Education Campaign on Clinical Depression

We're known for helping direct, produce and manage the first ever mental health public education campaign in our nation’s history - The National Public Education Campaign on Depression, sponsored by the National Mental Health Association that forever changed the way Americans viewed this public health issue.

Results:

• Engaged the White House Office of the Vice President in launching the campaign and other media and other public education activities
• Built a coalition of over 20 national organizations
• Managed over 40 state campaign coalitions conducting educational and media events and training campaign leaders
• Helped launch National Depression Screening Day
• Launched the groundbreaking report Economic Burden of Clinical Depression
• Changed the way the public viewed depression and led to millions of people seeking help and treatment

The campaign’s success was replicated in the UK and Australia.

photo credit: msn

"The pharmaceutical industry is making money hand over fist while it systematically defrauds taxpayers"

via Bernie Sanders US Senator for Vermont:

Sanders: Crack Down on Pharmaceutical Fraud May 23, 2012

WASHINGTON, May 23 - Sen. Bernie Sanders (I-Vt.) today proposed tough new penalties to combat rampant pharmaceutical industry fraud.

Sanders' amendment to a Food and Drug Administration bill before the Senate would take away exclusive marketing rights - potentially worth hundreds of millions of dollars - if a company is found to be at fault for fraud involving a particular drug.

"Companies that are fined for overcharging Medicare or Medicaid, or for dangerous illegal marketing practices, should not enjoy government-granted monopolies on those same medications," Sanders said.

The pharmaceutical industry achieved a dubious distinction in 2010 when the dollar amount of fraud against the government surpassed the notoriously-corrupt defense contracting industry, according to a Public Citizen study. Drug makers accounted for nearly half - $1.8 billion out of $4.1 billion -- of the penalties collected in 2011 by the Health Care Fraud and Abuse Control Program, a joint task force of the Department of Justice and the Department Health and Human Services. This year, pharmaceutical companies are expected to pay up to $9 billion under pending fraud settlements, according to Taxpayers Against Fraud.

While the penalties are steep, the amount pales in comparison to the huge revenues generated by illegal and fraudulent practices such as off-label marketing and price inflation. The top-12 pharmaceutical companies made $49.1 billion in profits in 2011, with Pfizer making $10 billion and Johnson and Johnson making $9.7 billion. "The penalties these companies pay when they are caught and prosecuted simply aren't big enough to stop them from being repeat offenders," Sanders said.

The senator described "a culture of fraud" that he said permeates the pharmaceutical industry. Over the past decade, virtually all of the major private pharmaceutical companies were involved in significant health care fraud. "The question arises, is fraud within the pharmaceutical industry the exception, or is it, simply put, their business model?"

The too-many-to-list examples include:
Abbott Labs, which agreed last month to pay $1.6 billion for illegally marketing the anti-seizure drug Depakote. The New York Times said the company also agreed to plead guilty to one misdemeanor charge for violating the Food, Drug and Cosmetic Act for misbranding.
Abbott Labs agreed to pay $421 million in 2010, along with two smaller companies, to settle charges that they deliberately spiked drug costs by up to 10 times the actual cost in order to boost reimbursements from Medicare and Medicaid.
Pfizer, which paid $49 million to settle charges that a subsidiary defrauded the Medicaid program by overcharging for the cholesterol-lowering drug Lipitor.
A division of Pfizer pleaded guilty to two felonies and agreed to pay $430 million to settle charges that it fraudulently promoted the drug Neurontin for a string of unapproved uses.
GlaxoSmithKline, which in 2011 reached an "agreement in principle" to pay $3 billion to conclude the company's most significant ongoing federal government investigations into illegal sales and marketing practices for a diabetes drug that was severely restricted last year after it was linked to heart risks.
Merck, which in 2009 reached a $670 million settlement for fraud on patients and Medicare/Medicaid involving a conspiracy with hospitals to give the elderly cheaper drugs but charging them for the more expensive product prescribed by the patients' doctors.
Merck last year pleaded guilty to a criminal misdemeanor charge and paid a $950 million settlement for illegally promoting Vioxx for rheumatoid arthritis before that use was approved. Vioxx was linked to thousands of heart attacks and sudden cardiac deaths before it was pulled from the market in 2004.
Johnson & Johnson last year illegally marketed Risperdal, an anti-psychotic medication, to nursing home patients, and paid over $2 billion in fines, a mere 6.3 percent of sales from the drug.

"And on and on it goes," Sanders said. "The bottom line is that the pharmaceutical industry is making money hand over fist while it systematically defrauds taxpayers, all the while individuals in the United States (let alone the developed world) are not getting the medicines they need because they cannot afford them."

Sanders' amendment would send a message to the drug industry that illegal behavior will not be rewarded with government-granted monopolies.

The proposal is backed by Public Citizen, U.S. Public Interest Research Group, the Consumer Federation of America, Consumers Union, the National Women's Health Network and the National Committee to Preserve Social Security and Medicare.  here
photo credit healthexecnews.com

"How to Recognize a Bad Psychiatrist"

Dr. David M. Allen's recent blog post entitled, "How to Recognize a Bad Psychiatrist," in Psychology today offers some advice, along with some astute and humorous observations about 'how psychiatry is done' by bad psychiatrists; this and a couple of blunt opinions, make it well worth the read.  I am going to share what he had to say about bp magazine, because in this case, Dr. Allen shared information about the publication, and allows his readers to draw any conclusions.

Via Psychology Today: 

A Matter of Personality

From borderline to narcissism.

by David M. Allen, M.D.

How to Recognize a Bad Psychiatrist

Don’t Count Symptoms That Don’t Count
Published on April 16, 2012 by David M. Allen, M.D. in A Matter of Personality
AN EXCERPT:

I was not able to find much online about the publishers of this magazine, and what I found may be faulty, but apparently the publisher, Green Apple Courage Inc., was founded by one Bill MacPhee, a patient with schizophrenia who was finally stabilized on medication and became productive again.

The primary advertisers for BP Magazine were listed on one web site as "Platinum sponsor Pfizer Inc. and Gold sponsors Bristol-Myers Squibb Company, Otsuka America Pharmaceutical, Inc. National mental health association advertisers include the Child and Adolescent Bipolar Foundation, Depression and Bipolar Support Alliance, Mental Health America and the National Alliance on Mental Illness."

I receive the magazine in the mail for free unsolicited, which usually means a pharmaceutical company is paying for producing a publication and distributing it to psychiatrists like me. Draw your own conclusion about whose interest the magazine might be best serving. (emphasis mine) read here