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

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 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.”

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 9, 2008

A Lil Bit Country… Osmond to Speak in FW

The Fort Wayne Journal Gazette announces this morning that Marie Osmond will be speaking in the Fort in April.

[She will] be the keynote speaker at Indiana University-Purdue University Fort Wayne’s seventh annual Tapestry: A Day for Women, scheduled for April 25 at Memorial Coliseum. Tapestry is a daylong event that promotes renewal and self-growth for women.

Osmond was chosen for a variety of reasons, but the ones germane to this blog include…

…Osmond has also struggled in her life, most recently with the divorce from her husband of more than 20 years, the death of her father and her teenage son entering rehab – which all occurred last year.

Osmond, the mother of eight children, has also suffered from postpartum depression.

Here is the info on how to see her;

$60 for open seating. A reserved table for 10 close to the stage costs $650. Businesses can sponsor tables for $1,000. Registration begins Feb. 25, and women can either sign up on the Web site, www.ipfw.edu/tapestry, or through a mailed brochure.

January 6, 2008

APA Elections: Big Pharma’s Candidate

This should scare everyone whether you see a psychiatrist or not.  The practice of “paying” doctors with the unspoken agreement they will prescribe more of a company’s drug is prevalent in all areas of medicine.  Today, Dr. Daniel Carlot, a psychiatrist campaigning against such practices, brings to light ties one of the candidates for the American Psychiatric Association’s presidency has with Big Pharma.

In one corner, we have Donna Norris, M.D., a child and adolescent psychiatrist who has been active in APA governance for 25 years. She is currently the secretary-treasurer of the APA, chair of the Ethics Appeals Board, and a past speaker of the APA Assembly. More to the point, she is concerned about the pharmaceutical industry’s influence on our profession. She chairs a special task force in charge of screening all potential members of the DSM-5 committee for commercial conflicts of interest. On a more personal note, she receives no financial compensation from drug companies, depending on her private practice for all of her income.

By contrast, Alan Schatzberg, M.D., has no APA governance experience, although he once served as vice president of the Northern California Psychiatric Society. Even more troubling, he was involved in what many consider an ethical breach in 2002, when he wrote an article endorsing mifepristone for psychotic depression without disclosing the full extent of his financial involvement in Corcept, the company that has tried to develop the drug for this purpose. At that time he owned 3 million shares; the current value of these shares is about $12 million. Currently, Schatzberg is the editor-in-chief of a journal entitled the “International Journal of Sleep and Wakefulness” which is funded wholly by Cephalon, a pharmaceutical company that sells Provigil. The purpose of this pseudo-journal appears to be to convince readers that sleepiness is a huge public health problem and that Provigil is the mainstay of treatment.

[Blogmeister Note:  DSM-5, referred to above, stands for the Diagnostic and Statistical Manual of Mental Disorders, 5th edition.  Currently under development, it is the “Bible” of psychiatric diagnosis and treatment.]

Everyone should be aware of Pharma’s practices in medical treatment.  The Blogmeister would even go so far as to encourage you to ask your physician if they have received ANYTHING from the company who makes the drug you are prescribed (they ethically have to tell you).  If so, you could be prescribed medication that has less to do with your physical condition, than how much they are compensating your physician.

In the spirit of full disclosure, the Blogmeister barely gets paid by insurance companies and patients, let alone Big Pharma.

December 8, 2007

Lilly Hires Firm to Soothe Psychiatrists’ Concerns

According to the Indianapolis Star, Eli Lilly’s antipsychotic drug Zyprexia is the target of thousands of legal claims.   Lilly is attempting to reassure psychiatrists they do not face higher malpractice risk for prescribing the best selling drug.

“The company has hired a medical education company, Professional Risk Management Services of Virginia, to help spread the message that psychiatrists can manage risk.

The company recently mailed a 14-page brochure to psychiatrists across the U.S. with the message that the best way to avoid malpractice claims is to provide good care and document it carefully.

The program includes a 21-minute online slide show. The program does not mention Zyprexa or other drugs by name.

Lilly acknowledged Friday that some psychiatrists are concerned about being dragged into lawsuits.

“Psychiatrists have an increasing level of anxiety about malpractice and medication prescribing, and a lot of this is heightened by all the plaintiffs’ lawyers running everywhere,” said Lilly spokeswoman Marni Lemons.

The drug maker has paid more than $1 billion to settle tens of thousands of patient claims that it hid or downplayed the side effects of Zyprexa. Many patients said the drug gave them diabetes symptoms, including weight gain and higher blood sugar levels. Lilly has steadfastly denied that, despite agreeing to several rounds of settlements.

Lemons declined to say how much Lilly spent to hire the medical education company.

Lilly faces lawsuits from several states, including Alaska, Mississippi, Louisiana and West Virginia, that seek to recoup Medicaid money spent caring for Zyprexa patients.

The antipsychotic is Lilly’s top-selling drug, generating $4.2 billion in sales last year. But sales growth has been slowing, and Lilly executives told analysts this week that the company’s dependence on Zyprexa will diminish gradually as other products grow faster.

Lilly and the National Council for Community Behavioral Healthcare announced in June the results of a survey of 400 psychiatrists. The survey showed that more than half had patients who stopped taking antipsychotic medication or reduced their dosages based on fears raised by law firm advertising.

Lemons said initial feedback from psychiatrists who have participated in the program has been “overwhelmingly positive.”

But not all psychiatrists are sold. Dr. Daniel Carlat, a Massachusetts psychiatrist, criticized the program on his blog this week as “one of the more devious drug marketing campaigns in recent memory.”

“No psychiatrist who sees this is foolish or naive enough not to realize that the reason Lilly is doing this is because they’re having serious trouble with Zyprexa,” he said in an interview. “It’s obvious Lilly is just trying to do some damage control.”

More Indiana Kids Poor (part deux)

The Fort Wayne Journal Gazette carries this story today.  The Blogmeister first posted on this on 11/26/07, but these statistics are even more clear.

More Indiana children faced hunger and poverty issues this year than last, according to data released by the Indiana Youth Institute this week.

While the percentage of children living in poverty in Allen County has risen slightly since 2004, from 16 percent to 16.8 percent, the institute said the rising number of public school students receiving free and reduced-price lunches indicates an increasing problem.

Students from families with annual incomes less than $26,845 qualify for free lunches, and since 2000, the number of children involved in the lunch program has increased 40 percent, according to the Indiana Youth Institute.

The number of children receiving reduced-price lunches has risen 30 percent during that time period. Students from families with incomes between $26,845 and $38,203 qualify for reduced-price lunches.

Hungry children are more likely to receive lower grades, be suspended or expelled, suffer from depression and have suicidal thoughts, said Bill Stanczykiewicz, president and chief executive officer of the Indiana Youth Institute.

The most recent numbers show that hunger is not limited to unemployed or homeless people. A quarter of working families in Indiana are considered low-income, and the majority of Indiana families who receive food stamps have one of more workers in them, Stanczykiewicz said.

As the numbers have risen, so too have the number of working poor seeking aid from Community Harvest Food Bank – many families that have never needed assistance before, Executive Director Jane Avery said.

“I have never seen it this tough,” said Avery, who has been with the food bank for more than 11 years.

About 77 percent of Indiana households receiving food stamps include at least one worker, and 25 percent of those households have two or more workers, according to the Indiana Youth Institute.

Nearly half the food stamp recipients in Indiana are children under 18, one of many statistics that trouble Avery.

“You look at hungry kids and the percentages, and you have to remember, every percent has a face with it,” she said.

Get Nichols, director of elementary administration for Fort Wayne Community Schools, said hunger is just one of many issues facing children in poverty.

More than half of FWCS students qualify for free lunches, and the district also sees that those children sometimes aren’t properly dressed for cold weather and may have to fend for themselves after school, Nichols said.

What’s more, low-income families tend to choose the cheapest foods, which are generally higher in calories and carbohydrates, she said.

Cleaning out the RSS Feed Barrel

 Most days, the Blogmeister doesn’t get to all the news stories he wants to.  Here are all the stories and posts the Blogmeister either didn’t get to, or were deemed interesting, but not worthy of the Blog, over the past week.

Foster mother of 45 gets help in time of need  
Read This Story: What The Guv’s Tax Plan May Mean For Marion County 
The Fallen Mighty: Allen County GOP Short On Cash After Election  
Kenley Has Devoted Years To Tax Reform, Proposals 
County executive concept develops  :Commissioners back idea; plan may go to legislature.  
Harper’s findings 

Report Ready on Trimming Government
Late filings cost Burton’s PAC $4,450 
Supreme Court will decide Indianapolis case 
Daniels appeals FEMA aid decision 
Suicidal molester sentenced 

Gloomy Hoosiers Opinion 
Senators urging welfare overhaul 
Children dying for lack of child-sized drugs   
Always aroused: A good thing gone awry
Indiana lawmakers consider bill to eliminate township assessors office               
Senate skeptical about appointed assessors IndyStar.com        
Republican lawmaker’s support for Daniels’ tax plan is wavering?       
Local Concern: Kenley Cautious In Light Of New Circuit Breaker Data       
Now What? Tully Asks Readers To Chime In With Ways To Fix Phoenix       
Property tax plan to get another look     
Teacher’s post on blog leads to arrest, debate    
Dobson criticizes tax plan:  Commissioner says St. Joseph wouldn’t be able to function under Daniels’ proposal
Working ’10 til 2′ aids at-home professionals 
Lawmaker calls for balance on taxes  
Coming to terms with conflict at the office
Losing virginity early or late tied to health risks 
How depressed is your state?    
Child abuse death isn’t the fault of system 
Brain glitch behind distortion of self-image 
Smaller babies grow up to be sadder adults 
Anorexia risk may start before birth 
Fever can unlock autism’s grip     

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