INdiana Systemic Thinking

February 19, 2008

Mental Health: Meds, Therapy, or Both?

In a story by the UPI, the Agency for Healthcare Research and Quality, part of the U.S. Department of Health and Human Services in Washington, said consumers spent 17 billion dollars on Anti-depressants and anti-psychotic drugs.  Accounting for just over 13 percent of the 127 billion U.S. consumers spent on prescription drugs in 2005.

However, in another UPI story today;

In a speech at the annual meeting of the American Association for the Advancement of Science in Boston, Jason Robert of Arizona State University said that while understanding biology is crucial to the understanding of psychosis, “there is more to psychosis than mere biology.”

Robert said claims that genetics and neuroscience will revolutionize medicine and elaborate predictions about new diagnostic tools and new treatments are not being borne out “because they fail to grapple with the complexity of human beings — as brains, bodies, and, embedded in culture, steeped in history, and dynamically creating their own worlds. If we’re really going to have personalized medicine, we have to be focusing not just on the genome, but the person.”

Rather that having a caricature of culture in mind, “what’s really critically important is understanding cultures dynamically, as complex, historic, social and political structures that dramatically influence people’s lives.”

Ignoring all except biology may mean never having the capacity “to actually influence the well-being of the patient,” he said.

Mental health professionals have long known of their patients propensity to want an easy way out of their difficulties by just taking a pill to address their mental health needs.  However, while medication is a wonderful way to feel better and treat the biology of a disorder, almost no one recommends pharmacology alone in the treatment of mental health difficulties.

When I was in school, the prevailing thought about how one develops some of these biologically based disorders was some people are more than likely born with the predisposition to develop these disorders, BUT it was an individual’s life experiences that brought these predispositions out.  Of course, I’m not including things like adjustment disorders (where the environment, social and otherwise, are to blame) or Developmental Disabilities (which are entirely biologically based).

Medication does not address any of the underlying experiences leading to a disorder.  Nor does it help develop new coping mechanisms for situations affecting the disorder.  Americans need to see psychotherapy as they do physical, occupational, speech, and/or other therapies that work in conjunction with medicine.   For example, if one breaks their leg, they would see a physician to set the leg, then begin working with a physical therapist to teach them how to use the newly set leg now and in the future.  They would probably also address what may have happened in the past to cause the fracture.  If Americans used this same rationale with psychiatrists and mental health therapists, we would probably see dramatic “cure” rates for those afflicted with mental health issues.

However, because of stigma, time constraints, or whatever else, we see more people taking medications to feel better about what is going on in their life, which never really seems to change.  Conversely, we also see people who spend years in therapy never getting better either, because, for one reason or another, they don’t want to see a psychiatrist.  However, the people who, in my experience, seem to get better faster and go on to live well adjusted lives are those who employ the services of both professionals.

February 2, 2008

Lilly to Reach Deal with Feds?

Maybe, but no one is talking, according to the Fort Wayne Journal Gazette, citing the New York Times.  Here is the background:

Zyprexa was Lilly’s top selling drug last year. It rang up $4.8 billion and accounted for 25 percent of the company’s total sales, but it also has brought the company many legal headaches.

Beginning in late 2006, a series of articles in the Times said Lilly downplayed the drug’s risks and marketed it for uses unapproved by the Food and Drug Administration.

Attorneys general from 30 states have subpoenaed documents detailing Lilly’s sales, marketing and promotional practices for Zyprexa as part of a civil investigation under state consumer protection laws.

The drug also has faced thousands of product liability claims from patients, many alleging the company did not adequately warn patients taking the medication of a heightened diabetes risk.

And here is what is being said:

Lilly spokeswoman Tarra Ryker declined to elaborate on the possibility of a settlement when reached by phone.

“We are cooperating with the government in these investigations, and the discussions around those are confidential,” she said. “We’ve said pretty much all we’re going to be able to say on this.”

She also declined to comment on the payment amount.

“We don’t know where the information came from,” she said.

The Times reported that federal prosecutors in Philadelphia are leading the settlement talks for the government, in consultation with Justice Department headquarters in Washington.

The amount being bantered around is 1 Billion dollars.

Insurance Co. Refuses to Pay for Anorexia or Bulimia

This is about the dumbest thing I have heard.  From Law.com:

Litigation over an insurer’s refusal to pay health benefits for anorexia or bulimia may turn on what is revealed from the alleged sufferers’ e-mails and postings on the social networking sites MySpace and Facebook.

The plaintiffs are suing in federal court in Newark, N.J., on behalf of their minor children, who have been denied benefits by Horizon Blue Cross Blue Shield of New Jersey.

Horizon claims that the children’s online writings, as well as journal and diary entries, could shed light on the causes of the disorders, which determines the insurer’s responsibility for payment. New Jersey law requires coverage of mental illness only if it is biologically based.

Horizon claims the eating problems are not biologically based and that the writings could point to emotional causes. It contends that access to the writings is especially important because the court has barred taking the minors’ depositions.

And insurance companies wonder why everyone hates them.  Look, this is just another way for an insurance company to get out of paying for something to line their already fat pockets.  So let me get this straight, Horizon Blue Cross Blue Shield are not going to pay for disorders that are not biologically based?  What about the kid who breaks his arm at a football game.  What about smokers who develop lung cancer.  Don’t even try if your depressed because your going through a divorce.  It was one thing when insurers wanted detailed medical histories, but now it appears they want to delve into every detail of a person’s life to justify not paying a claim.  At the same time, they charge higher and higher premiums.  Nice.  At some point the public (employers are already realizing this) are going to revolt and demand the service these companies promise at the time they sell the policies.  Already, employees, when given the choice ,overwhelmingly take cash over insurance benefits, because of things like this.  I guess everyone will have to make this choice before the insurance companies wise up and realize there are other options to their dictatorial policies and unjustifiable high rates.

January 30, 2008

Autism and Vaccines: Pediatricians Speak Out

Filed under: autism,Disorders,Uncategorized — kurtglmft @ 8:41 am
Tags: , , , ,

This from the Evansville Courier Press:

The nation’s largest pediatricians’ group on Monday said ABC should cancel the first episode of a new series because it perpetuates the myth that vaccines can cause autism.

ABC’s new drama, “Eli Stone,” debuts Thursday. It features British actor Jonny Lee Miller as a prophetlike lawyer who in the opening episode argues in court that a flu vaccine made a child autistic. When it is revealed in court that an executive at the fictional vaccine maker didn’t allow his own child to get the shot, jurors side with the family, giving them a huge award.

“If parents watch this program and choose to deny their children immunizations, ABC will share in the responsibility for the suffering and deaths that occur as a result. The consequences of a decline in immunization rates could be devastating to the health of our nation’s children,” Jenkins said in a statement.

Autism is a complex disorder featuring repetitive behaviors and poor social interaction and communication skills. Scientists generally believe that genetics plays a role in causing the disorder; a theory that a mercury-based preservative once widely used in childhood vaccines is to blame has been repeatedly discounted in scientific studies.

Remember folks, this is a fictional series. Sometimes the whole “bad things happen to good people” way of thinking is too much to handle. We look for reasons and people to blame because the real explanation is too difficult to accept. However, please don’t forgo vaccinating your child, as it is a proven way to make sure they will never develop a myriad of diseases, because of some theory that has little, if any basis in fact or research.

January 29, 2008

Zyprexa, Cymbalta Fuel Growth for Lilly

From the Indianapolis Star:

Driven by solid sales of its antidepressant Cymbalta, Indianapolis drugmaker Eli Lilly and Co. today said fourth-quarter profits grew to $854.4 million and 78 cents per share, beating many analysts’ estimates.

Earnings jumped six-fold from the same period in 2006, when Lilly recorded income of $132.3 million and 12 cents per share as it took a big charge to settle claims with patients who said they were harmed by Lilly’s Zyprexa schizophrenia drug.

But showing how little harmed it was by that publicity, Lilly said Zyprexa sales were again No. 1 in its sales lineup, accounting for $1.27 billion. Cymbalta was next up with $628.3 million. Overall, its sales increased 16 percent to $5.19 billion.

“Lilly completed a very successful year by continuing to deliver strong financial results to our shareholders in the fourth quarter,” said CEO and chairman Sidney Taurel. “Our additional investment in sales and marketing helped fuel accelerated double-digit sales growth.”

Britney Spears: Has “Mental Issues”

This from her manager.  Gee, ya think?  The whole article is on WTHR, but here is and excerpt:

Barbara Walters says she has been contacted by Britney Spears’ manager and “very good friend,” Sam Lutfi, who says the pop singer has seen a psychiatrist.

Lutfi told her the 26-year-old pop singer “is suffering from what he describes as mental issues which are treatable,” Walters said Monday on ABC’s “The View.”

“He said that she has been to a psychiatrist and that she, I assume, is starting some kind of treatment,” said Walters, a co-host on the ABC daytime talk show.

“She has been having mood swings. She’s been having trouble sleeping, and also she is in touch with her mother – ’cause we had heard she wasn’t – and her mother has been very supportive of whatever it is that Britney is going to do,” Walters said.

Lutfi has been staying with Spears constantly, “and he got in touch with us,” Walters said. “I can’t vouch for this, he seemed to be very knowledgeable and he certainly was very nice.”

Spears’ attorney, Sorrell Trope, didn’t immediately return a phone call seeking comment Monday. Spears’ spokeswoman at Jive Records, Gina Orr, didn’t immediately respond to an e-mail seeking comment.

Mental Health: Fourth Most Expensive Condition to Treat

Wow, I was really surprised when I read this today.  It’s a study estimating the top 10 most expensive health conditions.  It has the usual…heart conditions and cancer are numbers 1 and 3, respectively, but “Mental disorders, including depression”  came in at number 4 with an estimated cost of 56 billion.  I found that hard to believe because Therapists, Psychologists, and Psychiatrists don’t make anything near what a cardiologist or oncologist does.  Then I saw this:

The money paid for visits to doctor’s offices, clinics and emergency departments, hospital stays, home health care and prescription medicines [were included].

Okay, I get it now.  Most of the money in Mental Health care goes to hospitals, emergency departments and prescription medications.  This is due to the public perception they can handle any situation, or take a pill,  and do not seek help early.  When people figure out this strategy is usually ineffective, they usually end up in an emergency room or hospital, where the costs are astronomical.  This “solution” is vastly more expensive than outpatient therapy.  As an aside, most therapists, this one included, do not consider ER and hospital admissions treatment, but crisis management.  With those factors included, the numbers make sense.  If costs for “mental disorders including depression” are ever reduced, a correlating change in perception among the public would also have to occur.  In that regard, Mental Health is no different from any of the other conditions cited, where prevention and early detection is paramount to decreasing costs.

January 26, 2008

Lilly’s Cymbalta Sales Grow

From a Bloomberg report, via the Indianapolis Star
INDIANAPOLIS — Eli Lilly and Co.‘s antidepressant Cymbalta exceeded $2 billion in global saleslast year, Chief Executive Officer Sidney Taurel said. That would represent at least a 52 percent increase from the $1.32 billion reported in 2006, when Cymbalta was Lilly’s third-best-selling product globally. The drug is intended to replace revenue lost to generic competitors for the antipsychotic Zyprexa, Lilly’s top-selling drug, when it loses patent protection in 2011. “Cymbalta is growing very, very fast,” Taurel said Friday in Davos, Switzerland, where he is attending the World Economic Forum. “It will be bigger than Zyprexa before Zyprexa loses its patent.” (Bloomberg)

The Blogmeister agrees with Mr. Taurel.  They just keep finding new uses for this drug.  I recently heard some physicians have found it very useful in the treatment of pain managment.  New uses equal more prescriptions which equal more sales.

January 22, 2008

Mid-day Musings: Dems Debate, Lobotomies, Etc.

Last night I was flipping channels between the Democratic debate and a PBS documentary on lobotomies.  Seriously, I was, I’m not just making that up for some punch line.

First, the debate.  Because I was switching channels, I obviously didn’t get to see the whole thing.  BUT WOW!  Can Hillary and Barak be more hateful toward each other?  On one hand it was entertaining to watch…sort of like a schoolyard fight, but on the other hand, has the Democratic party really sunk so low that two out of the three top contenders have to interrupt each other so much that they can’t even carry on a civilized conversation?  Someone needs to remind these two it was a debate, not an argument.  There is a distinction there.  The first is an exchange of ideas with mutual respect where, at the end, two people can agree to disagree.  The second, well, looked a lot like what we had last night.  Oh, and John Edwards didn’t come put looking too good either.  He appeared to agree with whoever had the best “gotcha” or the most applause.  All the time though, never getting his hands dirty.  If I continue with the schoolyard fight analogy, he is the kid in the back, yelling the loudest, but never putting himself out there to either throw a punch or take one in the gut.  Some would say that is smart, but where I went to school we had a rather unflattering name for people who did that.

Next up, Lobotomies.  Wow, what an interesting, if not gut wrenching show from PBS’s American Experience.  Everything anyone wanted to know about the procedure was presented in detail.  I have to admit, at times, I was glad to flip over to the debate as descriptions, pictures, and video were presented about the procedure.  It’s one thing to academically study something from the psychiatric past, but another to have it so blatantly explained.  I’d recommend watching it if your in the field, although ever being confronted with someone who had one is rare nowadays (they aren’t performed anymore).  Luckily, if you follow this link, PBS is promising to allow the show to be viewed online in a few days.

January 21, 2008

10% Laid Off At Dunn MHC

Calling it a “temporary reduction in force”, Dunn Mental Health Center is saying goodbye to 29 employees, according to the Indianapolis Star.  This accounts for almost 10% of their workforce.  Not wanting to sound partisean, here is the whole story from the Star.  Remember, she said it, I didnt.

Twenty-nine employees of Dunn Center Mental Health in Richmond have been laid off, said CEO Kay Whittington on Sunday.Whittington called the “temporary reduction in force” a result of Gov. Mitch Daniels’ proposed cuts in Medicaid and a bill that could limit how much Medicaid communal health centers may offer.
Dunn Center is comprised of a staff of more than 300.”We have had a temporary reduction in staff across (the) seven counties that we provide services to,” Whittington said.The Dunn Center is a Medicaid provider, and the state government has “dramatically reduced what (the center) can do for Medicaid rehabilitation options,” Whittington said.Gov. Mitch Daniels said in early January a new budget forecast that shows state revenue falling below predictions could lead to some cuts “in some of the entitlement programs like Medicaid.””It all relates to that,” Whittington said.Five of the 29 positions laid off are part-time and the rest are full-time, and Whittington said many of the employees were offered a transfer into other positions.

Whittington said she knows of other communal health centers in the state that have laid off workers.

“We’re all faced with the same thing,” she said. “You can’t wait for the ship to sink.”

Whittington will be available for further details about the situation today, she said.

“We wanted to make sure our staff had the weekend to think about (transferring).”

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