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 5, 2008

More Trouble for Zyprexa

In what is becoming more and more common, Eli Lilly’s Schizophrenia drug Zyprexa has run into a little more trouble.  From the Reuters, via the Indianapolis Star:

Excessive sedation is a “serious safety concern” with an experimental, long-acting form of Eli Lilly and Co.’s blockbuster Zyprexa schizophrenia medicine, U.S. drug reviewers said in an analysis released Monday.

Food and Drug Administration staff said the injectable formulation, called Zyprexa Adhera, was shown to be effective for acute and long-term treatment of schizophrenia, Reuters and Bloomberg both reported.

But risks include excessive sleepiness.

The analysis was released ahead of a meeting by a panel of outside advisers who will evaluate the drug Wednesday.”Excessive sedation events are a serious safety concern because of the severity of excessive sedation, the unpredictable characteristics, and relatively high incidence – 0.07% of injections and 1.3% of patients,” FDA staff said.

Lilly officials, in a separate summary, said they thought the benefits of the long-acting formulation outweighed the risks.

“Although there are important additional safety considerations associated with the injection, they are manageable with appropriate labeling and risk-minimization activities,” the company said, Reuters reported.

January 23, 2008

FW Schools: Why Would We Need RN’s?

The Fort Wayne News Sentinel this morning is reporting a medication mix up in a Fort Wayne area school.  Read the excerpt below for more of the story, but isn’t this what happens when you cut school nurses out of schools?  Isn’t there some law, somewhere, that forbids the passing of meds by unregistered or uncertified professionals, other than family members?  If not, there should be.  By the way, neither if these medications are something you want to take if your not supposed to as they have are for serious disorders and have very serious side effects.

A 6-year-old child at Price Elementary School was given the wrong medication by a staff member last week, resulting in a trip to the hospital.

The child was supposed to be taking Adderall, a medication used to treat narcolepsy or attention deficit hyperactivity disorder (ADHD), but was given two doses of Seroquel, or Saraquill as it was written in the police report, which is a medication to treat schizophrenia or bipolar disorder. The incident occurred on Jan. 15, and the child was taken to St. Joseph Hospital by his mother for being “sick and sleepy,” according to a Fort Wayne Police Department report.

The Seroquel was another child’s medication. The child was said to be fine after treatment at the hospital, according to the report.

According to drugs.com, side effects of Seroquel are drowsiness, dizziness or decreased vision. Also, children who take this medication may “be at increased risk for suicidal thoughts or actions.” The Web site reports there is a possible fatal reaction to the drug.

The Price staff member, who was not identified, may have been a secretary at the school, although a police report says the person was the school nurse. Fort Wayne Community Schools spokeswoman Krista Stockman said full-time nurses are not available in all schools, and secretaries are sometimes required to give a child a medication.

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.”

December 6, 2007

Cymbalta to overtake Zyprexa as top seller

In a story published by the Indianapolis Star, drug maker and Indiana based Eli Lilly will continue to downsize in an effort to boost profits. 

“In a sweeping overview, the Indianapolis-based company also said it expects 2008 to deliver earnings of $3.85 to $4 per share and that next year should see the emergence of antidepressant Cymbalta to overtake Zyprexa as top seller in the U.S.”

In the Blogmeister’s view, this is not a comment on the state of depression in Indiana and the U.S., but all the “off-label” uses for Cymbalta (such as pain management).

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