Friday, November 20, 2009

SSRIs in pregnancy associated with 5 days earlier delivery, 2X PICU likelihood

SSRIs in pregnancy associated with 5 days earlier delivery, 2X PICU likelihood.

More evidence emerging raising alarm regarding bad effects on the baby from mom taking antidepressants during pregnancy.

The new study is: Lund N, Pedersen LH, Henriksen TB.Selective serotonin reuptake inhibitorexposure in utero and pregnancy outcomes. Archives of Pediatrics & AdolescentMedicine. 2009 Oct;163(10):949-54.

For moms taking SSRIs, kids were born five days earlier. Kids who ended up inthe NICU were twice as likely to have moms on antidepressant versus not onantidepressants. Etc.
There are plenty of reasons to blog about this.

Discussing the issue repeatedly, from many angles, can possibly, hopefully,lead to some avoidance of these suspected harmful outcomes. As I have blogged before...

There is an awesome alternative to antidepressant medications in pregnancy.Talk therapy. This intervention has decades of empirical support, including ahost of recent-generation (most recent decades) evidence for efficacy. Itwould take an embarrasingly over-extended stretch of the imagination tohypothesize a risk of harm from talk therapy that is equal to the harm thatseems increaasingly evident.

Another great reason to discuss this issue is because of the vested interestspushing FOR the use of antidepressant medications in pregnancy. This is thetwo leading organizations that should be advocating for SAFE care for moms andthe unborn children: the American Psychiatric Association, and the AmericanCollege of Obstetricians and Gynecologists.

At the time when either, or both, ought ot be on the vanguard, comprehendingthe risks and alternatives, these two organizations have jointly combined,WITH FUNDING FRON BIG PHARMA, to advocate for exactly the opposite:medications for depression in pregnancy.
Here is the OFFICIAL, joint APA ACOG statement:

Here is THEIR language where they soft-pedal and downplay talk therapy:

"Pregnant and not currently on medication for depression:Psychotherapy may be beneficial in women who prefer to avoid antidepressantmedication. For women who prefer taking medication, risks and benefits of treatmentchoices should be evaluated and discussed, including factors such as stage ofgestation, symptoms, history of depression, and other conditions andcircumstances (eg, a smoker, difficulty gaining weight)."

---talk therapy, infinitely safer for the baby, is relegated to a condescending "preference," if the little lady insists.

I predict: within two years, this heavily credentialed guideline will be totally up-ended. Totally thrown out.

How can the APA and ACOG make such a glaring mistake?
Follow the money.

"Dr. Yonkers has received a research grant from Eli Lilly this past year. Shehas received study drug from Pfizer for a National Institute of Mental Healthtrial. Dr. Stewart serves on the Advisory Boards of Wyeth and Eli Lilly andBoehringer Ingelheim. Dr. Dell has received research grants from Pfizer hasconsulted to Bayer Schering Pharma AG and Berlex and is on the Speaker'sBureau for Berlex, GlaxoSmithKline, Pfizer and Wyeth. Dr. Wisner serves on theSpeaker's Board of Glaxo Smith Klein. Dr. Oberlander; Dr. Ramin; and Drs.Stotland, Chaudron, and Lockwood have no conflicts to disclose."

That is a brief review of the extensive degree of financial relationshipsbetween some of the authors and the drugs that the authors are advocating. Ibelieve I noted in an earlier post: Dr. Wisner has relationships going back at least a couple decades with Big Pharma.

So, take your pick. Meds vs. Therapy. According to paid shills from APA andACOG, meds wins. Until you account for the efficacy of talk therapy, and the horrible side effects, on developing babies in utero, of these antidepressants.

Friday, November 6, 2009

Tragic Fort Hood Shooting: This fits the pattern where I assume SSRI until proven otherwise.

This sounds like yet another story straight out of SSRI Stories.

If the problem is a rogue, loose-cannon religious fanatic, then we need to be aware of this type of problem, and respond accordingly. Regardless of denomination.

If the problem is that there is a great, growing Muslim conspiracy to overthrow the United States, then we neeed to be aware of this type of problem, and respond accordingly.

If the problem is that this man is one of the approx five percent of the population who get his nitric oxide neurotransmitter affected by SSRI drugs or SNRI drugs, and he has been on an SSRI / SNRI antidepressant, and he loses some second-thought and impulse control capability that is the function of the frontal lobe, then we need to be aware of this type of problem and respond accordingly. There are many psychiatrists who are on psychiatric drugs.

If the problem is any one of these, and we respond in a manner for one of the other ways, then we fail to make any progress, and we entrench the real problem.

In that sense, I don't so much care what the real problem is, but that we have truth as our goal. Not re-election, not PC correctness, not recruitment goals, not Jihad, but truth.

Another problem to figure out:
the military just came out and said most kids are not fit to be soldiers.

A year ago, there was a tragic incident at Fort Lewis, another army base, up near Olympia, Wash. A teen girl was escorted onto the base by one of the enlisted guys, and she died from at least too much alcohol, but possibly alc and other drugs. How did she get in? Security let her in. This revealed a pattern of some - not all - but some -- Ft. Lewis personnel traveling off base and down the road a bit, being approached by teen girls asking to be helped to get on base, then getting on base, and going wherever - not necessarily staying with the guy that brung 'em. Local teens were interviewed, and said, yes, this is what you do to go have fun and drink on the weekends. duPont is not a big town, and so secrets travel.

To get into Fort Lewis, you show ID to a hired / contracted security guy, not an Army guy. That is how it worked when I was hosted at Fort Lewis, and I commented to colleagues at that time: it seems odd that a major military base is protected by hired private security.

The person at Fort Hood who shot Hasan apparently was a hired security guy. In the middle of a crowded army base. At a time when most of our kids are unfit for duty. Sad. It just doesn't sound right. Our army base is protected by a hired security guy, not an army guy.

mediTation or mediCation: Well-Established Mindfulness Meditation Training Helps Kids in Psych Treatment Get Off Meds, Build Esteem

RCT study in JCCP: Well-established Mindfulness Meditation Treatment Helps Kids in Psych Treatment Get Off Meds.

THe study is: Biegel, Brown, Warren, Schubert, authors: Mindfulness-Based Stress Reduction for the treatment of adolescent psychiatric outpatients: A randomized clinical trial. Journal of Consulting and Clinical Psychology, 77, 5, October 2009, pages 855-866.

In short, the researchers took a group of adolescents who were refered to psychiatry specialty care in a large health care provider organization - Kaiser Permanente. The diagnostic problems were, bascailly, whatever came through the door - predominantly cases of depression, some cases of anxiety, some various other complaints.

The kids were randomized to the well-recognized Jon Kabat-Zinn developed MBSR (mindfulness-based stress reduction) or to usual care. This would typically end up being a mix of talk therapy, maybe family talk therapy, and some medication therapy. A hundred kids altogether, about fifity in each group. MBSR is explained and referenced well in the article. I have read the book and done MBSR-based treatment - their intervention is great from what I can tell.

So, the test ends up being: for a group of adolescents that is typical of cases seen in a mental health / psychiatric practice in a large health care organization, can mindfulness-based stress reduction lead to better outcomes than the usual?

The results? In brief, MBSR wins compared to care as usual. In other words, MBSR is a suitable treatment strategy for a general case load in a psychiatric practice. Depression scores improved more for MBSR than the usual care group. Also, MBSR was superior for anxiety, anger, and somatic symptoms. Across the board.

Is this a big deal? Maybe, maybe not. It does serve to expand the robustness of yet another psychosocial intervention. so, it helps me and other proclaim more strongly: you have plenty of options! You don't need to take psych drugs just because a DSM diagnosis fits!!

Here is the biggest deal, in my opinion:

**The MBSR got kids OFF of psych drugs.**

Without even trying. That was not a specific outcome of the study.

Not only did MBSR result in superior benfit across a whole set of outcomes, metioned above, but the kids in that group migrated away from psych drugs AND got even better than the other group. Double Play!

At baseline, about half in each group were taking psych drugs. At the beginning, 25 of those randomized to MBSR were on psych meds, while 20 in the usual-care group were on psych meds.

At completion, eight weeks later, the number of MBSR kids on psych drugs had gone down to 18. A 20% reduction. By the later follow-up assessment, the number of MBSR kids on psych drugs had gone lower, to 15. A 40% drop. From 25 to 15.

In the usual care group? No change. 20 to 22, reflecting increased psych drug use typically happens when you get referred, then to 19 at the follow-up assessment. I guess if you get out your calculator, you will see that there was, technically, a 5% reduction in meds, since one person fewer, out of 20, was on psych meds at the follow-up point.

Five percent or forty percent: you be the judge. Meds vs. therapy. Therapy wins this one.

**Also, another cool outcome**

While symptom change, what changes IN the kids? Sure we measure change, but what is going on?

Well, you think about it: you go for help for depression or anxiety, or whatever. You get given meds, or someone trains you in stress management. Either way, your symptoms get better.

What is your view of your problem and solution? If you get cured with meds, you figure: I have a biologically based brain disorder; without meds I am at risk of not being able to cope with whatever life brings me. For the rest of my life. I used to believe I was half-way OK, but now I know I am diseased, and need meds to be normal.


You learn skills, and you figure: I was lacking some skills to cope with life, and now I have been trained; I am better able to cope with whatever life brings me. For the rest of my life. I did it, and I can do it. There was not something wrong with me, I just lacked a skill set I needed, just like going through Driver's Ed.

Myself, I believe it is preferrerd for a kid to have good outcomes AND believe they are prepared for the future, versus believing, FALSELY, that they are diseased and are dependent on meds for the rest of their life. Hey, call me crazy. I am sure some people are comforted to know they can take a pill and get relief. Me, not so much.

I don't know what the kids are thinking. But I believe this interpretation of the nature of the problem is one dimension that shows us we should generally favor talk therapy if it seems indicated whatsoever, before meds.

In this study, evidence supporting my belief: self-esteem IMPROVED for the MBSR group, where med use dropped 40%, but got slightly worse for the usual care group, where med use was the same.

---It would be interesting to see an after-the-fact analysis: noting the influence of med use upon self-esteem, across the two groups, along with the main finding of MBSR being superior to usual care, which holds status quo with meds.

Thanks for listening. This analysis of the results will probably be found nowhere else, but is probably the result that has the most potential to really suport a change in every day practice for these kids.

Thursday, November 5, 2009

75% unable for military svc: failed to graduate hs, engaged in criminal activity, or are physically or mentally unfit."

"Today (Thursday, Nov. 5) the generals and admirals of Mission: Readiness, along with US Secretary of Education, Arne Duncan, are releasing a new report that details the fact that 75% of young Americans are unable to serve their country because they have either failed to graduate high school, engaged in criminal activity, or are physically or mentally unfit."

How is that permissive, indulgent, negligent parenting working out for ya?

Add this with the Maria Shriver Report: what a pretty picture.

Obviously, we need more se x ed, more Obama songs, more self-esteem curricula, and more "bullying" curricula in our schools. In our homes, we need more food stamps:

On the other hand, if someone comes to invade us, it will be easy, but they will be so disappointed in the populace they have taken over, that they will probably just turn around and leave.

Wednesday, November 4, 2009

If docs will sell out to Coca Cola, do you think they have any problem selling out to Big Pharma? Docs discover "Coke Adds Life!"

If docs will sell out to Coca Cola, do you think they have any problem selling out to Big Pharma? American Academy of Family Physicians discovers miracle cure: “Coke adds life!!”

If docs will sell out to Coca Cola, do you think they have any problem selling out to Big Pharma? American Academy of Family Physicians discovers miracle cure: “Coke adds life!!”

You just can’t make this stuff up. October 6, 2009. This press release has apparently been out for a mnoth, but media are just now running with this story. I believe because Center for Science in the Public Interest has hammered AAFP:

AAFP: Why?

I kid you not: They declare: to diversify support beyond Big Pharma: “The Consumer Alliance program also will create a new source of funding for AAFP, which, in recent years, has broadened its search for funding outside the pharmaceutical industry.”

So, do we now believe that AAFP will no longer be beholden to Big Pharma, will no longer be shills for pills?

Do we think they will decrease their dependence upon Big Pharma?

Only time will tell.

Are they gonna say Coke is healthy? Is it as good, or better, than other family physician type stuff, such as immunizations? Will their new slogan be “Cokes, Not Pokes!” how about “Cola, Not Ebola!”

Ouch. This story is making my stomach hurt. I am getting a case of dys PEPSI a. Maybe a coke would settle my stomach.

Sadly, there is probably not a more deleterious health influence that the AAFP could have chosen. The relations between sodas consumed and poor health outcomes are robust (no pun intended). Coke is omnipresent, including in our public schools, as the child obesity epidemic swings into full force. There have been simple before / after trials of removing coke machines from schools, and corresponding U-turns in the health of the kids. There are many weight-loss success stories where a person’s first step was to cut out cokes.

Cheeto’s would have been better: at least there is nutritional content in a Cheeto.

Coke adds life! Enjoy!

Tuesday, November 3, 2009

Lilly Publishes Study on How to Measure Placebo Effect In An Antidepressant Trial.

Lilly Publishes Study on How to Measure Placebo Effect In An Antidepressant Trial.

Wow. What a cool idea! Measure the placebo effct in a depression study!

I was looking for the HamD, a very commonly used depression scale, to see what the items are. To help me evaluate a study. I did a google scholar search, and came across a study that looked like it might have the actual items.

There are many of these scales. Typically, someone gives one of the provide responses to each of the questions: for the past two weeks, have you felt sad or blue? No, not at all, a little, somewhat, a lot.

You add the score for each question and that is your total depression score. If you score lower, you are less depressed. If you score higher, you are more depressed.

so, total score depends upon the various questions. What are the questions?

So, I pull up the study. PDFs-plus-internet is awesome for these types of things!

The study I look at is:The responsiveness of the Hamilton Depression Rating Scale. Journal of Psychiatric Research, 2000, v 34, pages 3-10. Authored by: Faries, Herrera, Rayamajhi, DeBrota, Demitrack, Potter.

The study notes the HamD scores across several antidepressant studies, comparing the drug to placebo. As is well-established, there will be a placebo effect: people taking the non-active pill get less depressed across a few weeks. As do the people taking the pill.

To declare that the pill has some effect, you simply look to see if the pill group has some degree of improvement beyond the placebo response.

The study does not have the various questions. So, My desired reason for looking at this study is not fulfilled. Bummer.

What it does have is an analysis of recognized subsets of the HamD questons, and how much each subset goes along with the treatment outcome or goes along with placebo effect.

So, here is an obvious depression-study, placebo-effect detail that has never occurred to me:
As well as getting more better, it is possible that the people getting less depressed due to pills versus placebo will have a different pattern of responses across the various questions that add up to the total depression score.

So, by analyzing questions within this scale, you might be able to figure out more specifically whether improvement is due to the med, or due to some other factors.

This study does just that. They report overall result for med- versus placebo, AND subscale results for three recognized sub-groupings of HamD items: "Bech," and "Maier Phillip." [they overlap each other but difer on a couple Qs.]

BOTH subscales were superior at distinguishing between the med and the placebo group than the overall HamD scale.

The authors conclude that, for med versus placebo studies, We depression researchers may be wiser to use the scales that seem to exclude some of the placebo response.

**My mind additionally throws in another idea: We depression researchers should maybe identify and include a few MORE items that are more closely responsive to placebo than med effect.**

This would help answer the question: to what degree is depression improvement due to placebo, and what degree due to the medication?

Add a few items to the HamD, and it goes from 17 to 20 or 21. Not much additional TIME. But a world of increased knowledge.

If it exists, it can be measured. If a placebo response exists, we can use our knowledge on deperssion symptomatology, and psychometrics, and develop a emasure of placebo response. To some degree, this study does just that. It is sub-optimal because the data were not specifically developed to do just that; it is more like: proof-of-concept.

to what extent has our observed improvement been seen with the questions that have been shown to be LESS responsive to placebo effects, in contrast to the items that have been shown to be MORE responsive to placebo effects?

Now, keep in mind: ALL questions measure depression. None alone is perfect. That is why you use several.

If it exists, it can be measured. But it will be measured imperfectly, since no measure is perfect.
It seems intuitive that some meds will have MORE of an antidepressant effect than others. If a med has more antidepressant effect compared to a med with less, you would see a greater response on that subset of questions. you could calculate the ratio between the "core," or less-placebo-influenced items, and the more-placebo-influenced items. A better antidepressant would be one with a greater ratio.

And yet another great idea occurs to me: you could look at this placebo-influece-subscale, and measure the degree that your specific study evoked a placebo, versus a med-based antidepressant effect, if you knew what a typical, desireable, med-based effet was: for example, if typical strong-antidepressant effect on a subscale is a change of 6 points in six weeks, and you get a good outcome OVERALL on the full HamD, and you do get a change of 6 points in your current study, then you know that your study had a normal amount of placebo influence. But if you get a good outcome, but a low response on the "core" subscale, then you know that, somehow, your study has a good amount of placebo effect built into it.

How? Could be any of many ways: very supportive, friendly, optimistic research assistants, clinicians wearing lab coats and ties versus wearing birkestocks and Hawai'ian shirts, Professional appeal of the med packaging, a prestigious institution, who knows.
With all of the drug studies we see, is this ever reported? discussed? No.

Why not? This has not occurred to anyone else? No one else read this 2000 study?

I know who IS aware of this study: Eli Lilly. Cuz 4 of the authors were Lilly employees.

Friday, October 30, 2009

Corruption at Highest Levels: Rangel / Pfizer Under Investigation. He might want to ask his friends for a Xanax right about now.

Corruption at Highest Levels: Rangel / Pfizer Under Investigation. He might want to ask his friends for a Xanax right about now.

Dozens in Congress under ethics inquiry
Document was found on file-sharing network

**Rangel said he has not discussed other parts of the investigation of his finances with the committee. "I'm waiting for that, anxiously," he said.**
---Charlie, try a Xanax. Ask your friends at Pfizer.

A confidential report revealing that Chuck Rangel is under U.S. congress ethics investigation just got leaked. Other house of representative legislators are also under ethics investigation. For Rangel’s part, some of the problem looks like he crossed the line regarding cozying up to Big Business, including Big Pharma. It pretty much doesn’t get any bigger than Pfizer, purveyor of Zoloft and Xanax, which pretty much keep America running, if you believe the paid spokespsychiatrists and believe the prescription rates. Pfizer also sells Lipitor, another ungodly mess of a drug that is nevertheless pushed as ambrosia due to intensive marketing.

Rangel’s name is alarming in part because of the tremendous power he wields in Congress. He leads the house “ways and means” committee. What does this mean? Some of us understand a lot about these political things. Most of us don’t. “Means” is the same as if someone says to you: do you have the means to pay for this? Rangel hold the purse strings to one half of Congress. Each senator, since there are fewer senators, generally has more power than each representative. However, when either side wants to get some bill turned into law, it has to go to the other side and figure out how to get the other side to cooperate. A big part of getting legislation through either the senate or house, and then getting the other side to agree, is this: how will any proposed law be paid-for? So, you have to get the other side to agree to the price tag as well as the idea.

This is exactly like our private lives. We have to decide what, among a zillion things, we want to but, then how to pay. For those of us who are married, the analogy is even closer: we have to decide what, among a zillion things, to buy, then we have to go get our spouse to agree on what to buy and how to pay for it.

I want a new set of golf clubs. Sure, I could rush out and buy the best. But the spouse wants a new couch. Who prevails? Or can we each find a less expensive choice and each get our item, but not quite the item we truly desired?

So, for any legislation the senate wants, it has to go to Charlie, like a husband getting approval from his wife for a new set of golf clubs.

Do you see? Any representative is less powerful than any senator. Unless you chair the ways and means committee. Then, you almost have the wife-power over the entire senate.


So, how do you influence Charlie? Apparently, a trip to St. Martin works.

Currently, all of this is simply an investigation. Charlie, I am sure, has done nothing wrong. How could he do something wrong? He is a Democrat, and Democrats fight to protect us from Big Business. Right? Right?

Aren’t the Dems for the Little Guy? The Downtrodden? The Powerless? Us Versus Them? The EPA versus the Polluters? The Trial Lawyers Versus The Corporate Lawyers? The Unions Versus The Big Bad Auto Makers? The SEC versus Citigroup? The FDA versus Big Pharma?

Sure. Rangel took a trip with other congresspersons, and had it supported by a non-profit group. But who supported the non-profit group? Pfizer.

Why is Pfizer donating money to congress? The FDA is in place. Etc. what might they want to influence? Aren’t they just out there to make our lives better through polypharmacy? Surely they aren’t driven to any funny business at our expense?

And surely, our watchdog, our guardian, our protector, Charles Rangel, is on our side to protect us, if Pfizer strays a bit from beneficence. Right?

We’ll see. Myself, I am skeptical. Why? Maybe it is just my personality. Maybe I should learn to trust Rangel and Congress, and trust the psychiatrists. These people are saints, and money cannot taint their judgment.

Whatever. Like Rangel claims, I am for the little guy. I want to share info about when and how these powerful companies and organizations, and various aspects of our culture, are misleading us by lies, by misleading us, etc. If you are cheating people, you deserve to be exposed. Rangel does a lot of good. That does not give him license to cheat us, to sell the power we give him through our votes. Pfizer does a lot of good. AIDS patients are basically at the mercy of Pfizer for literal years of life. But because they do good, does this give them license to do bad? To lead us to suicide with something like Chantix, then pin the blame on us and deny their knowledge and culpability?

You decide. Is OUR political system dependent upon ACCEPTING abuse of power, accepting bad behavior, because we get a little good, also? Is it up to us to simply PICK OUR POISON? Pick which legislative candidate we prefer to have rip us off? Is that the deal? Or is it actually defensible that we DESERVE decent, committed people? Who should suffer the penalty when they cheat us behind closed doors? With our votes and our money?

Power to the people. Our govt works on our behalf with our money at our behest. Our report was put out in public on some file-sharing network, and this is how we learn what our reps are doing on our behalf at our behest with our money. Power to the people!!!! Now you know why Obama wants to be able to control "key" (subjectively interpreted) parts of th einternet in times of "emergency "subjectively interpreted). So the PEOPLE cannot find out what the govt is doing.

"Bill would give president emergency control of Internet"

You decide. You “decide.” There is an election next Tuesday. Do you skip all of the elections? Do you skip all but Presidential? You may have your opinion, but if you have no ACTION, the least of which is voting, then you have not actually made a decision. You actually may put more true DECISION into which movie to rent this evening, then deciding which scoundrels will be allowed to rip us off, and compromise our safety (FDA is supposed to be there for our safety), with our own money. You decide.

Also, as with these studies I review and criticize, we need to be skeptical of any and all politicians, regardless of party affiliation and regardless of what they claim. Sorry to bring you the sad news. But you cannot believe what you read in a peer-reviewed study published in the leading journals, and you cannot believe what the leading politicians, of the most noble party, tell you.

Thursday, October 29, 2009

Pharmaceuticals or Harmaceuticals? Kids have weight gain 4+ times normal rate with antipsychotic meds. This involves 1 / 20 kids

Pharmaceuticals or Harmaceuticals?

Big Pharma continues to define a great market for antipsychotics: all kids. How?

Mainly two ways: One: Expand the criteria for various disorders, including bipolar disorder and autism. Two: the concept of preventive medication based upon risk factors: if it can be "established" that a smoking middle-schooler has any increased risk of being depressed in the next couple of years, then smoking can be construed as "prodromal" depression, and treatment can be started early.

I know - you don't believe that we are going in that direction. Just watch.

However, there seem to be a few roadbumps a long the way to this Pharmatopia. Things such as: for kids, family psychotherapy works GREAT. For a range of problems.

And the emerging evidence that some of these drugs are not just worthless for their intended symptoms, but that these drugs are going to kill these kids off.

Kill the kids off? Oh, that suicide thing.
Well, yes. PLUS:

Kill the kid's liver. If you harm someone's liver, you have really harmed them.

This week in JAMA, the results of a harmfulness study have emerged.
This is the study:
Correll, Manu, Olshanskiy, and colleagues. JAMA, October 27, 2009 (volume 302, number 16, pages 1765 to 1773): "Cardiometabolic risk of second-generation antipsychotic medications during first-time use in children and adolescents."

Bottom line: for kids taking "second-generation antipsychotics," they are, on average, gaining TEN POUNDS of weight WITHIN three months.

We will have to interpret some research study findings from technical terms to someting we can understand. From "kilograms" to pounds. I myself cannot tell if "8.5 kg" weight gain, one of the higher figures in the study, is a lot or a little. I have to convert this to pounds. Yes, the metric system is still new to me.

AVERAGE weight gain, not exception, not for those experiencing any weight gain, not for boys but not girls, but AVERAGE: Ten pounds of weight gain within 10.8 weeks. For some of the antipsychotics, it is greater.

How bad is this?

Here's a more alarming way to ask that question: Is this anywhere close to normal?

Well, let's see: I google "growth charts children," and I quickly get this:

Complicated. But on page 27, we see what average weight gain across the adolescent years for boys:

Average weight gain per year? 10 to 12 pounds. The average teen boy gains 10-12 pounds per year, from ages 13 to 14, 14 to 15, 15 to 16.

Girls: page 28: even less average weight gain per year. Ages 12-13 maybe 10 lbs, then muxch less: 4-5 lbs per year.

Unless they are taking an atypical antipsychotic.

About half of the kids in this new JAMA study were girls. So, this extraordinary weight gain is even more drastic for girls.

So, kids on these drugs are having weight gain at a rate at least FOUR TIMES what should be expected. Girls: six to eight times average! That's a real self-esteem builder!

Why the weight gain? The physiological makrers tested (cholesterol, triglycerides, low density lipoproteins) are crazy; the drugs are damaging the body's metabolic regulation. This is not weight gain due to increased appetite, or feelign a little sluggish.

So, how big is this problem? Surely, this is limted to a focused group of kids with extreme needs! Right?

Well, a study was done in 2006 - old data, as the use of antipsychotics in kids keeps skyrocketing - here is the quote from a news story in 2006:"Based on the survey results, the researchers estimate that the number of office visits by children 20 and younger that included prescriptions for antipsychotic drugs grew from 201,000 in 1993 to 1.2 million in 2002. About 18 percent of visits to psychiatrists resulted in prescriptions for antipsychotic drugs."

Per U.S. census data, in the US, There are about 22 million people ages 10 to 19.

Therefore, these drugs are being prescribed for 1 in 20 of our kids.

One out of every 20 kids needs antipsychotics?

What is the goal of Big Pharma? One in ten?

The collective "we" are killing our kids off by killing their body's metabolic regulation system. With these drugs.

Astounding. This goes beyond black box warning to blacklist warning.

Friday, October 23, 2009

Psych Drugs may kill brain cells in preschoolers’ developing brain: animal study evidence

Psych Drugs may kill brain cells in preschoolers’ developing brain: animal study evidence

“Psychiatric Meds for Infants Linked to Later Behavior Problems
Researchers found drugs used to treat mood disorders, pain and epilepsy raised risk”

Do no harm: Don’t give psych drugs to preschoolers until we know what we are doing!!

This finding is being presented at a current research conference…
(here is my blog about research conferences…

Apparently, these researchers took a range of psych drugs and gave them to very young rats. Or mice. Or guinea pigs. Or whatever non-human animal. They found that certain drugs seem to kill brain cells.

Sure, this SOUNDS like the kind of study that we believe should be done BEFORE we go and test these drugs with preschoolers.

But no: psychiatrists, and ANY other physicians, are perfectly able to GUESS whether any commercially available psychiatric drug might work for some preschooler’s problem, and go prescribe it and see what happens.

Professionally / clinically, there are systems in place for these practitioners to communicate their experiences – articles can be published, ranging from a case study with one patient, to studies with greater sample sizes; Studies might be presented at research conferences, or in “continuing medical education” courses.

What cannot be done is the pharmaceutical companies cannot market, advertise, or otherwise promote a drug for a problem or a population unless they have gotten FDA approval. Docs are not limited in that way. So, docs are basically free to go try antipsychotics on preschoolers. And they do.

But this is not the best style of treatment for detecting possible long-term effects. Data are not systematically gathered at long-term outcomes. FDA approval of a drug requires short-term efficacy, and similar pre-market safety info, PLUS Voluntary post-marketing surveillance. If any clinical setting happens to be gathering long-term data, it is a challenge unless a project is strongly devoted to quality data -- A patient may drop out of care for any of many reasons – parents switch providers, parents move, parents change phone number, etc – if ANYONE were making the most feeble attempt to detect long-term harm from the use of psychiatric meds in preschoolers, they would have a great challenge gathering data.

This is partly why a non-human animal study is valuable: we can't really depend on FDA post-marketing surveillance since it is totally voluntary; there is no identified long-term systematic effort to gather long-term outcomes / safety data for preschoolers, or anyone esle, on these psych drugs.

With non-human animals, we can see what MIGHT be happening to us. Non-human animals are more acceptable as sacrifices for the sake of knowledge, and their lifespans are quicker: a mouse reaches adolescence and adulthood a lot quicker. So, you can see if a drug given in infancy has a bad effect at adulthood – well within a year, versus the two decades it would take with a human.

The limit is that, obviously, a mouse is not a human. Mice do not answer psychiatric interview questions, and their facial expressions are more difficult to read. But hey we do what we can. [not me – I haven’t done any animal studies like this. just observing monkey social behavior.] what can we do? We can sacrifice the mouse and look at his brain cells.

So, the presenter, Forcelli, and colleagues apparently have detected harm from some psych drugs. We will have to wait until they publish the full study for us to get a full report.

But the news does not look good.

"That is of particular concern because some of the drugs may predispose to psychiatric disorders later in life," study author Patrick Forcelli, a graduate student at Georgetown University Medical Center, said in a school news release.

This next part really bothers me:

"At the same time, our studies identify specific drugs that cause little or no long-term behavioral impairment."

This sounds like they have conclusively learned that, for some psych drugs, there is NO long-term harm from preschool use.

----How do they know about long-term harm? Scientifically speaking, and honestly speaking, that cannot declare this. Sad that this was a WELL-CRAFTED PRESS RELEASE, not a spontaneous comment to a reporter, where maybe a statement comes out the wrong way.

Here is what they should have said: “…our studies failed to detect indicators of harm from a range of other psych drugs.”

OK – why the big deal about this? Because a range of psych meds are increasingly being prescribed for preschool-age children. For their “behavioral problems.”

My opinion? Nearly ALL of the cases of preschool kids being prescribed psych meds are cases where meds should not be used at all. Significant parenting interventions should be used. I look at these studies, and I know: they rarely include a family evaluation to adequately rule out family chaos, instability, poor parenting, inconsistent parenting, abuse, etc. as a cause of this behavior.

Yet I know, from a range of psych work experiences, this is almost always the case.

If you believe these problems are “brain disorders,” then you are gonna prescribe drugs. If you believe that kids have tantrums, act oddly, are extremely anxious, etc., because of their social circumstance, then you are gonna do a parenting intervention.

We are in a time of indulgent, and/ or lazy, neglectful parenting. This is the problem with kids these days. I believe it is terrible to lay the blame on the kids. Preschool kids.

Where were these “severely disturbed” preschoolers when WE were young? Before the 80s, the style of parenting was NOT like it is today, and families were not producing these problems. Sure, there were kids with problems, and poor-parenting families. But not as a sport.

To figure out whether a FAMILY is not doing its job, and the kid’s problems are resulting from improper parenting, you need to do a full assessment like this:

Parent Interview. Major Developmental Domains. Lots of history. Psychosocial Functioning. Child Rating Scales. Assessment of Marital Discord. “Parental Stress:” –And I would prefer to include a profile of the family’s FINANCIAL picture: do both parents work? How much debt (house pmt, car pmt, credit card pmt, how much in savings, etc.). Household money management: is there a written budget? Do mother and father have money arguments? Single Parent Issues. Blended Family Issues. Non-resident parent issues. Support from Extended Family.

All of that sets the context for loving, consistent parental involvement. No matter what the child’s problems, loving, attentive, consistent parenting is a must.

Rarely is this properly done. Because Big Pharma and NAMI are triyng to convince all of us that we have “brain disorders” and pills are the answer.

Even for preschoolers. Toddlers. Infants.

Here is an example of the issue of preschool prescription of psych meds: keep in mind that the pharmaceutical industry has absolutely NO systematic long-term study to assess long-term risks. None. No patient registry, etc.

Luby JL, Tandon M, Belden A. “Preschool bipolar disorder.” In: Child Adolesc Psychiatr Clin N Am. 2009 Apr;18(2):391-403, ix.

“Although some empirical work has now been added to the larger body of case material, preschool bipolar disorder (BPD) remains a highly ambiguous diagnostic area. This is notable in the context of the significant progress that has been made in many other areas of psychopathology in the preschool period. While there is a need for well controlled empirical investigations in this area, a small but
growing body of empirical literature suggests that some form of the disorder may arise as early as age 3. The need for large scale and focused studies of this issue is underscored by the high and increasing rates of prescriptions of atypical antipsychotics and other mood stabilizing agents for preschool children with presumptive clinical diagnosis of BPD or a related variant. Clarifying the nosology of preschool BPD may also be important to better understand of the developmental psychopathology of the disorder during childhood. Data elucidating this developmental trajectory could then inform the design of earlier potentially preventive interventions that may have implications for the disorder across the lifespan.

--See? These people totally believe the toddlers have bipolar disorder. They totally believe BOTH depression and MANIA are seen in their clients.

And what about my wild accusations that these people WANT to sell PATENTED (i.e., money-making, no-generic-available) drugs to an ever-younger set of customers?

Well, Dr. Luby has been on the payroll of a few pharmaceutical companies: Janssen, AstraZeneca, Shire, and who knows which other psych med companies.

Who knows. Because she has not been consistent regarding sharing information regarding whether her views on prescribing preschoolers meds might be influenced by her financial sponsors…

In a 2006 article

[Luby J, Mrakotsky C, Stalets MM, Belden A, Heffelfinger A, Williams M, Spitznagel E. J Child Adolesc Psychopharmacol. 2006 Oct;16(5):575-87. Risperidone in preschool children with autistic spectrum disorders: an investigation of safety and efficacy],

she declared: "Drs. Luby, [et al.] have no conflicts of interest or financial relationships to disclose."

At the same time, here article here:

Luby JL, Sullivan J, Belden A, Stalets M, Blankenship S, Spitznagel E. An observational analysis of behavior in depressed preschoolers: further
validation of early-onset depression. J Am Acad Child Adolesc Psychiatry. 2006 Feb;45(2):203-12.

…declares: “Disclosure: Dr. Luby has received grant/research support from Janssen, has given occasional talks sponsored by AstraZeneca, and has served as a consultant for Shire Pharmaceutical.”

So: bottom line: this recently presented non-human animal study reveals that adding some, but maybe not other, psych meds to young, developing brains, at least in these non-human animals, leads to brain cell death and later problems.

AND: We simply do not have a research knowledge base with humans to answer such questions.

AND: the scholarly promoters of Rx preschoolers are often funded by Big Pharma

AND: the scholarly promoters have not been forthcoming about their financial relationships with their sugar daddy pharmaceutical company sponsors.

AND: these drug studies rarely conduct an adequate social / parenting assessment to rule out child problems secondary to situational or parenting problems.


You do the math. Meds vs. therapy: looks like more evidence on the therapy side with this recent science news.

Thursday, October 15, 2009

Shriver Report answers why so many kids are on meds

This report is getting a lot of press coverage.

"When we look back over the 20th century and try to understand what has happened to workers and their families, the movement of women out of the home and into paid employment stands out as one of the most important transformations. Workplaces are no longer the domain of men: Women now make up half (49.8 percent) of employer's payrolls. Quite simply, women employed outside the home changes everything. We need to ensure that everyone—men and women, parents and non-parents alike—is able to meet the challenges of the workplace, while being able to provide care for their family. We need new ground rules that recognize this transformation."

Sure. That's all fine and good. Our society should not be organized to prevent anyone from exercising their full choice and opportunity in life. Somehow the government will raise our children.

Each of us has a limit. There is only so much we can do.

If a couple has a couple children, they have obligated themselves to role of parenting. That will, one way or another, require time and effort.

That means each parent will have to give up on some potential futures in order to decently follow the future to which they have committed: to raise their children.

If, and when, they don't parent in the right way, the children will inevitably end up suffering.
This may be in the form of some behaviors or moods. It may be in the form of children who are not able to have good connections with others, or who feel like they cannot ultimately trust others. Or who become over-responsible, and miss out on the fun and learning that is supposed to happen in childhood and adolescence: the adult role fast-forwards them too quickly into the adult role, versus the more normal, optimal pace.

Mom and Dad get home from their self-actualizing, fulfilling, rewarding, humanitarian jobs, and get the kids from daycare, or out to tsoccer practice or whatever, and wrestle with time to deal with meals, and homework, and household tasks, and the time to just enjoy the family is not there.

Unless we all buy into the idea that it is some strident political demand that all parents work, and that somehow the government, or somebody else- not us- is responsbile for what I am declaring is the inevitable.

So, when a child is "raised" without much order in the home, without much face-time, without much loving discipline, with the reality that they are a hassle to their parents' lives, and they later start acting out, or acting-in, we have our easy answer:

Enter the head shrinker.

Judging by the numbers, things are working out really well for the head-shrinkers. Society has asked them to provide an answer in lieu of decent parenting, and they have obliged.
They have given us answers that all sound very profesisonal, and have three-dot-two digit codes, and are paid by the health insurance we have at our awesome, self-actualizing career jobs, and come with a remedy: pills.

How's that working out for you, mom?

Even worse: the insistence on self-fulfillment, equality, etc., as a political dogma has led to the many single-parent homes - if two adults have a challenge raising two kids, how is one gonna do it even better?

Again, the head-shrinker steps in and picks up the burden.

We don't have to face the truth, never questions until [google "cultural hegemony"], that parent-child time matters. That we are pursuing our self-actualization, and whatever else it is we get from our job, at the price of our children's well-being.

So we medicate the child, and take some of that precious money received from our self-actualizing job, and buy the kid off. Give them toys, phones, computers, whatever. To show them we love them.

If love of money is the root of all evil, think of how bad it is to take your money and use that to show your love.

To some of us, the relation between decreases in quality parent-child time, and the rising rates of "child psychopathology," is a no-brainer.

This is really clear to those of us who remembe what society was like befoer every women had to work -- not just chose towork, or took a great opportunity to work -- but HAD to work in order to be a full human, not that 3/5 of a human designated for slave-census count.

Get out of th house or you are oppressed. Or you are supporting the oppression of women. Sure, you get a choice. Choose to get out of the house, or esociety will label you as the oppressed supporting the oppressor. Never mind the children's welfare - we have oppression to deal with here. You choose to stay at home? Sorry, wrong answer. You must be [fill-in-the-blank].

So, plot this victorious, self-actualizing, liberating trend of no one being at home, and our rising incomes, our rising average size of the family car, the average size of the family home, etc., and map it out with the level of children who have "child psychopathology."

Is it glaringly obvious to you now?

No. Because they keep telling us: "these are biologically based brain disorders."

And they tell us the pills work.

And when the pills eventually FAIL to work, to make things right, they have an answer: lets' up the dose; or augment; or change meds; or do combo therapy; or prescribe off-label; or jump on the next bandwagon for the next diagnosis with [fill-in-the-blank-with-diagnoses-du-jour: "child bipolar," child schizophrenia;" "sensory integration disorder," "ADHD," "hyperactivity," "ADD," "zinc definciency," "fatty acid deficiency," "food allergy," etc.].

What works? What really works? Sure, some kids get better on the meds. But MOST DON'T.

Go ask the front-line staff who really know. Go ask the "psych techs" that work at child treatment centers what will make your child improve.

They will tell you: attention, special time, and loving discipline. That's it.

Sorry, you can't do that and spend 60 hours per week self-actualizing through your career job.

Sorry. This is not some civil rights battle. You won't win it with Maria Shriver's calls for equal-pay laws, or paternity leave.

If you are a hammer, everything looks like a nail. If you are a civil rights activist, everything looks like a civil rights case. If you are a politician, everything looks like it needs a law to set it right. The govt will not come up with anything that will parent better than a parent.

Well, kids are neither a civil rights cause nor a policy recommendation. They are kids. Devote special time to them regularly. At least a couple times a week, if not daily.

Arrange your budget and your lifestyle. Get out of your car loans. Get out of the marble-counter-top house. Move to a less-expensive part of the country, where you can still find your self-actualizing career job, but have a modest portion of your income go to house payment. Quit eating out - cook WITH your kids. Turn off the TV. turn everything off.

How do I know? I have worked with a lot of kids and families. All the "diagnoses." All the pills. Until you see it, you will not believe it. The look of pleasant surprise when I have strongly recommended that parents follow Forehand, or Barkley, or any of the other evidence-based child interventions, and start spending quality time with their child.

In the therapy office, I bring this up, and the child's face lights up. In two weeks, thing are getting much better.

Unless the parent does not agree to follow. And the child looks crest-fallen. Betrayed. "Dad said he would [fill-in-the-blank], and he didn't. And the counselor has made him admit it. He can't hide, and ignore, like he does to me. And now the counselor is sending me out of the room - because the counselor is about to get Daddy in trouble."

And finally: how self-actualizing is that job? Do you really reap that much dignity, compared to making peanut-butter-and-jelly sandwiches, and an endless cycle of cleaning up messes? How much have you contributed to humanity with your 60-hour work weeks, at the sacrifice of your child's well-being? The truth is you are working partly to pay for a decent car, so you can ride to work, and away from your child, in style.

So, as they release this Maria Shriver report about how horrible it is that not all women are working at self-actualizing jobs, let's put in our minds these sky-rocketing rates of child "psychopathology," and the skyrocketing delivery of psych meds to our kids, and let's try to figure out what battle we really want to fight.

Wednesday, October 14, 2009

I suspect sleeping pills. "Sleep Eating Disorder? Paula Abdul Says Kara DioGuardi Raided Her Fridge"

Fox news story:

"Paula Abdul Says Kara DioGuardi Raided Her Fridge."

--sounds exactly like sleep-eating, one of the noted side effects of the sleeping pills - Ambien, Ambien-CR, etc.

Why? Therapy wins this one. Psychological interventions for sleep beat pills, AND avoid the side effects.

You be the judge.

Monday, October 12, 2009

Risk of Non-Professional "Mental Health" Help: Rebekah Lawrence Sad, and Bizarre, Story

Risk of Non-Professional “Mental Health” Help: Rebekah Lawrence Sad, and Bizarre, Story

“Self-help course may have led to her suicideSome say the seminar Rebekah Lawrence attended led to her death”

This problem might be related to the problems that were developed oy overzealous therapists who believed that everyone had undiagnosed multiple personality disorder. The False Memory Syndrome Foundation is a great source of background, and the book by Mark Pendergrast is also a great source. If you "google" "SRA" you will find a lot of this terrible type of brainwashing in the name of “therapy.”

There are a few notable, well-documented cases where it is clear that the bizarre reported events never happened.The other clinical area where similar things have been noted has been the case reports of intensive meditation leading to psychosis. These may happen in meditation where the focus is on nothing, rather than on something. There basically are two types of meditation: focus on something (breathing, imagined candle, imagined rainbow or some other color phenomenon, etc.) and a focus on nothing: being conscious, awake, aware, but with nothing in your awareness -- FYI - I myself strongly recommend against this because in my limited knowledge, I have heard about bad things coming from this, and I just don’t see it being worth the risk. Certainly, others will strongly disagree.

A couple citations for support:

Kuijpers HJ, van der Heijden FM, Tuinier S, Verhoeven WM.
Meditation-induced psychosis.
Psychopathology. 2007;40(6):461-4. Epub 2007 Sep 11.

Sethi S, Bhargava SC.
Relationship of meditation and psychosis: case studies.
Aust N Z J Psychiatry. 2003 Jun;37(3):382.

French AP, Schmid AC, Ingalls E.
Transcendental meditation, altered reality testing, and behavioral change: a case
J Nerv Ment Dis. 1975 Jul;161(1):55-8.

"Mindfulness meditation," the type that has largely been in the media, and a health psychology component, as at Jon Kabat-Zinn's Massachusetts Stress center, has a focus on something. They have worked with many people, in medical settings, with ongoing health care – they would know if their program led to psychosis in some portion of people – it just does not.

In the 1970s, we also had the phenomenon of the "isolation tank." This spawned its own popular media, and I guess a bunch of people trying it out. BTW: in my opinion, this should also be avoided. Sensory Deprivation can lead to bad outcomes. I can find only one citation in pubmed, but I am sure there is some info on the web.

A common ingredient in these various esoteric self-improvement efforts is a guided and prolonged focus on self-examination/self-confession. By prolonged, I mean hours in a row. Talk psychotherapy rarely does this. And generally, most "schools" of talk therapy do not have this type of activity as part of their mix.

An exception is "Gestalt therapy." Back in the heyday, people participated in day-long encounter groups, getting "real," and trying to shake their "hang-ups." Some people walked away OK, but some really got messed up.

“Arch Gen Psychiatry. 1977 Apr;34(4):399-415. The impact of a weekend group experience on individual therapy. Yalom ID, Bond G, Bloch S, Zimmerman E, Friedman L. Thirty-three patients in long-term individual therapy were referred to one of three weekend groups: two experimental (affect-arousing, gestalt therapy) groups and one control (meditation-Tai Chi) group. The impact of the weekend group experience (WGE) on individual therapy was examined six and 12 weeks later. At six weeks the patients in the experimental groups showed, on some measures, a significantly greater improvement in their individual therapy than did controls. By 12 weeks, there were no demonstrable differences. The WGE was not without risk: even though the group leaders were highly trained, responsible clinicians, two patients suffered considerable psychological damage. The control (meditation-Tai Chi) group offered a relatively innocuous experience; there was no risk, but few members found the specific procedures useful in their lives.Intense affect arousal in the WGE was not related to positive change insubsequent individual therapy. Those expressing the greatest affect in either experimental group were no more likely to have had a measurable positive impact on their subsequent individual therapy than patients expressing little or no measurable affect.”

Of course, anyone can always claim that a person probably was psychologically fragile to begin with. Maybe.But I note this seemingly bizarre news story to note that the experiences encouraged by these non-therapists may fit the pattern of these other problem areas.

Since these are rare events, we need to learn from them. We need to learn what types of self-improvement activities are actually harmful to some - and it is probably highly unlikely that we could ever figure out who can participate safely and who migth get bothered -- either traumatized, or have some kind of other psychological adverse event, such as psychoticism.

Hopefully, if there is some common problem in these diverse topics, I am not the only person noting the relation.

Wednesday, October 7, 2009

Counseling: Self Pay pays off again.

"Abused then denied care: 8 states allow practice
Some insurers say victims of domestic violence are too high risk to cover"
Counseling / Psychotherapy is the most efficacious treatment, and/or preferred treatment for a range of problems including depression, sleep problems, anxiety disordes, PTSD, childhood behavioral and defiant disorders, etc.

Talk therapy treatment for these problems can often be "billed" to health insurance. At first blush that sounds great: I pay my $20 co-pay, or whatever, and I receive a session worth $150!! Typically, what is required is 1. meet any health plan requirements such as seeing a licensed provider, seeing someoen in your plan's "panel" of providers, etc., PLUS: you MUST have a diagnosable condition.

There are reasons to choose to pay out-of-pocket, rather than have talk therapy payed for by your health insurance.

This current news story shows how well-intentioned HELP can later HARM you.
The story reports that the woman was denied health insurance coverage:"She says the insurer told her that her medical history made her a high risk, more likely to end up in the mergency room or require additional care."

How did the insurer know?

This domestic abuse victim received medical/counseling care for the abuse through a provider -- could be an emergency room at a hospital -- that filed some kind of reimbursement claim.
The same goes for you seeking counseling for sleep, or behavior problems in your kid, or marital counseling.

Often, in counseling, the provider is assigning a diagnosis, and not telling you. Or, kind-of telling you. They phrase something one way. But on the claim / reimbursment form, they put some fitting, arguable, defensible code that will qualify as a "mental disorder" that is in the range of those that get reimbursed.

"Adjustment Disorder," as you struggle with anxiety adjusting to a new job in a new town in a new home, will not get reimbursed; but if you kind-of fit "generalized anxiety disorder," you will fit into the reimbursement category.

Then, you are "on the grid" as a person with a "mental disorder."

The insurance companies are tricky. THe news story noted here indicates that there are laws against health insurers denying coverage for a domestic abuse victim for the "pre-existing condition" of domestic abuse.

But - folks - let's think about this -- all they need to do is fond a couple emergency room visits for certain types of injuries, plus maybe a valium prescription. They can read between the lines.
Another challenge: some kind of application -job, etc. -- asks if you have ever been diagnosed with a "mental disorder," or received treatment for such.

If you HAVE been diagnosed and treated, you need to answer "yes."

If you go see a talk therapist for some interference from anxiety in your work, or your marriage, or some conflict between you and your child, you do NOT readily qualify to be diagnosed with a mental disorder.

ASk, or tell, the provider to NOT assign a diagnosis - or determine WHICH might be assigned -- as part of the payment-for-services arrangement.

TEll them you NEVER want your PRIVATE business to be on record anywhere. Unless, of course, you become a danger to yourself (imminently suicidal, etc.) or others (imminently homicidal, etc.), in which case the provider may NEED to act: with cops, with 911, whatever.
But otherwise: go self-pay. And arrange to have no formal "mental disorder" diagnosis.

There are a good amount of providers who have given up on the hassle of insurance companies, and now run "self-pay" practices. There is a value in that. They will encourage self-pay, or tell you they only work under self-pay arrangements. For other providers: If you offer to pay something close to what they might hope to get from the increasingly tight-fisted insurance company, WITH NO DELAY, the provider should be excited to accept your cash.

Understand that the provider will, in most all cases, stil be legally and ethically bound to keep records. If you are concerned about what goes into the reocrds, you can negotiate HOW certain things can be entered.

Counselors and therapists almost totally do NOT understand what happens to your medical records once submitted to the insurance company for reimbursement. Or, what happens if they share these records to your next provider in the future, or to court in anty sort of proceedings. What becomes public record?

If it is NEVER written down, it can NEVER be xeroxed, faxed, shared, etc.
Your therapist does NOT NEED to record "sex ual abuse by uncle." Your therapist can record "We discussed the impact of childhood experiences upon current relationships." And can record the same thing week after week, if it is fitting / true.

Your life history of se xual experiences do NOT need to be in ink anywhere in any professional's office.

It is YOUR money. YOU negotiate the terms of therapy. OR you walk. Counselors and psychiatrists NEVER have the authority to tell you what to do. IF there is such a need, it would actually be a legal COURT madating some type of service.

If you cannot find a mental health provider, look for alternatives: a pastoral counselor is an awesome plan - just get informed about training, etc. Depending upon circumstances, they may accept you as a client even if you are not in their denomination - but don't be surprised if they invite you to attend Sunday morn. And would it hurt so much to hear a good sermon?

Other alternatives, at least until you can find a decent provider who will work with you, are self-help books, self-help groups, and things of that nature.

Work your budget, and negotiate. Good talk therapy can make amazing changes in your life. It can be WORTH giving up cable and caffe latte.

Especially if the therapy does not later lead to a DENIAL of a job or of health insurance.
I am sad to say, but most all counselors / therapists do NOT know what happens to your billing records on the other end. They end up in a data base and future insurers "might" look at that data base to figure out coverage. In this news story, this vulnerable woman, and the counselor, had no idea.

Unless Universal health care gets approved: then the govt WILL have all info.

Monday, October 5, 2009

BMJ 2009: heart septum defects twice as likely with SSRI in pregnancy: from half percent to one percent.

This issue is getting a lot of press: a pregnant woman taking antidepressants is doubling the risk of a heart septum defect in her baby.

Here is the actual article, including a snippet of the heart of the conclusion from the abstract:

Pedersen LH, Henriksen TB, Vestergaard M, Olsen J, Bech BH.Selective serotonin reuptake inhibitors in pregnancy and congenitalmalformations: population based cohort study.BMJ. 2009 Sep 23;339:b3569. doi: 10.1136/bmj.b3569.PMID: 19776103

"Redemptions for SSRIs were not associated with major malformationsoverall but were associated with septal heart defects (odds ratio 1.99, 95%confidence interval 1.13 to 3.53)."

"The absolute increase in the prevalence of malformations was low-for example, theprevalence of septal heart defects was 0.5% (2315/493 113) among unexposedchildren, 0.9% (12/1370) among children whose mothers were prescribed any SSRI,and 2.1% (4/193) among children whose mothers were prescribed more than one type of SSRI."

Is one in a hundred a lot? Or a little?
If the doctor told you, as you planned for pregnancy, that the likelihood of a heart defect was one-half percent, but would double to one percent if you were taking an antidepressant, would you opt for the antidepressant?

This study probably UNDERestimates the relation: the study is based on prescriptins that are turned in to the pharmacy, NOT on women who took the pills. For many who submit prescriptions for psych meds, many either NEVER take them, or take them very little, giving up. Thus, the "antidepressant" group includes a lot of women - who knows how many, but in all likelihood between 15 and 50% - who did not take the suspected danger-pills. That means the bad news emerged from an even smaller set of women - those actually taking the psych meds - and this effect shines through despite all of the woman who turned in prescriptions but either NEVER took the meds, or took VERY FEW.

Reasonably, the true effect should be suspected to be more profound.

So: Would you like your doctor to inform you of alternatives?

What if your doctor told you that there was a standardized, empirically valid intervention for depression that had only good side effects? Would your ears prick up?

Because there is: talk therapy.

Chances are, though, neither your obstetrician nor your psychiatrist will lead you in theis direction.

Why not?

1. Nearly all of professional medical practice has bouhgt into the idea that depression is a biologically based brain disorder, having nothing to do with life events, thinking patterns, or social circumstances.

2. The majority of "continuing medical education" for docs is developed and paid for by pharmaceutical companies.

3. The leading professional group for obstetricians joined up with the leading professional group for psychiatrists to push this pill-view, with a condescending nod to talk therapy added on to "treatment" if a mom insists, or for "minor" depression.

Press Release Aug 21, 2009:
"Depression During Pregnancy: Treatment RecommendationsA Joint Report from APA and ACOG"

"Psychotherapy may be beneficial in women who prefer to avoid antidepressant medication."

"There, there, little lady. If you would like to talk with someone about your biological brain disorder, sure, we will indulge you. If you prefer."

So, what would I suggest instead?

Educate the mom, and others involved.
Talk therapy.
Build social support.
Monitor the woman - if you have decent insurance, the obsetrician is peppering your calendar with visits, anyway.
Educate everyone around the woman regarding surveillance for behavioral problems: suicidality, poor self-care (mainly diet insufficient for a pregnant woman), and dangerous substance use (alcohol, illicit drugs, SSRIs, and smoking).

Develop a plan for self-neglect or suicidality: hospitalization, without meds, on a day-to-day basis until the crisis resolves.

This happens routinely for some with severe mental illness. And we lose very few people with serious mental illness (including, sadly, people who go through life regularly hearing voices urging the person to kill himself ro herself) who are well-monitored.

This proposed type of care would be expensive. But if it is appropriate, let's do it.

Consider the alternative: a newborn with a heart defect will eventually generate a great health care cost, and be very disruptive to the parents' life. In a pregnancy, their life will be disrupted anyway. Every pregnant woman's life is disrupted. So, put the hospitalization effort here, not later.

A child born with a congenital heart defect will have a pre-existing medical condition. So, at status quo (we are on the even of health care for all, or status quo), it will be difficult to insure the child.

It is also very challenging to get life insurance as a person with a heart defect. I have looked into this myself, and discovered that life insurnace companies have no good answer. American Heart Assocaition has no good answer. The Adult Congential Heart Association has no good answer.

Best to throw the effort at prevention, prenatally, and avoid all of this.

Fox Spokesdoctor: Doubling of heart defect rate "Doesn't mean anything." 1/250 Incidence "extremely low."

Fox Spokesdoctor: Doubling of heart defect rate "Doesn't mean anything." 1/250 Incidence "extremely low."

Isadore Rosenfeld is a guest doctor for Fox News. Fox consulted him in a pleasant little chat about the emerging evidence of risks of antidepressants to developing not-yet-born babies.
hopefully, he is simlpy unaware of the scary numbers emerging. Cuz his statement is quite callous otherwise.

The alarming evidence, as it continues to become available, suggests problems at a scary degree.
But Dr. Rosenfeld says this info "doesn't mean anything."

Watch his video at Fox News Health videos. Oct 4 "Sunday Housecall."

If you "need" antidepresant to make it through pregnancy, take 'em. But maybe keep it to just one. One doesn't mean anything. But who knows - two might.

Oct 04, 2009
I have posted a little on this topic: mainly that, with perfectly valid alternatives to pills, why bother with the risk? Why doesn't Dr. Rosenfeld recommend switching to an empirically validated, safe alternative?

Don't call on my house, Dr. Rosenfeld.

Thursday, October 1, 2009

Maternal Smoking During Pregnancy Causes Schizophrenia?

Well, this sounds pretty far-fetched. Based on a longitudinal study in the UK, the children of women who smoked while pregnant ended up with greater likelihood of "psychotic symptoms" at the age of 12.

"Smoking in pregnancy risks psychotic children"

If this relation is true, it is great to discover this clue, and start evaluating the issue more thoroughly.

But this type of study is ripe for yielding misleading conclusions. Let's take a look to see if the study data and design are worthwhile, or if someone is just out there trying to spin data for a headline.

This is based on a survey across time. The data are simply based on observing people across time and seeing what mathematically is related to what. There is no scrap of method or evidence beyond that which ties smoking and later poor outcomes in children.

I am sure any of us reading this headline can think of ways that this smoking-psychoticism relation might pop up due to some third factor.

Maybe the tendency for psychotic symptoms is partly genetic, and those moms who tend to be more psychotic tend to smoke more, and so what you are really seeing is mom smoking as a substitute indicator of the genetic likelihood of psychotic symptoms. Like pants size could be a fair substitute for body weight. Sure, the two are related, but no one would ever say maternal pants size causes obesity in her children.

These types of findings pop up in longitudinal surveys in two ways: one, there really is a relation, and two, there is a mathematical relation, but it just happened by chance. Sure, every now and then you end up meeting someone who has your same birthday. How funny! What a cooncidence. Well, it is bound to happen by chance every now and then.

Add enough measures to a longitudinal survey, and you eventually will find a relation between maternal smoking and something. Favorite color, desert preference, whatever.
Also, the authors lost a chance to help the readers, like you and me, understand what this outcome measure was: "adolescent psychotic symptoms." If the measure includes at least one symptom that could be misinterpreted, then the whoel finding falls apart. So, I pulled up the study to look at this outcome measure.

A composite outcome can yield a finding in one of two ways: one: a certain symptom carried the laod for the whole category, and two: the various symptoms all add up to a finding when they are summed.

A diet analogy: if caffeine causes indigestion, but other beverages don't, and you sum caffeine and all other beverages into a "beverage" category, then you will find that "beverages" cause indigestion.

Similarly here: are we talking about hearing voices that aren't there? Or are we talkign about some less impressive "symptom," such as "does your child ever act in nonsensical ways?" Sure a psychotic person talks in nonsensical ways, but a lot of parents of teens would answer "yes" to the nonsensical-talk question.

Turns out that on this aspect, the study is weak. First, the study does not report the actual questions.

Therefore, we cannot decently judge the quality of this study based on what is printed. In 7 pages, they could not find it within themselves to tell us the 12 "psychoticism" questions.
Next: the study does not report a separate analysis of the relation between maternal smoking and individual questions. So, like the "beverage" analogy, we cannot tell if the whole suspected relation between mom smoking and kid being "psychotic" is being carried wholely by some debatable item, such as nonsensical talk, or by some "Schneiderian, first rank" symptom of schizophrenia - such as hearing voices that are not there.

Why not do the study this way? Here, for me, with spending just a few minutes, I have asked a couple questions of this study, and sketched out a way to where the results mean nothing, yet the paper itself does not contain the easily available two pieces of info needed to determine whether we have a new reason to worry about maternal smoking, or if we just have something to put in the headlines on a slow news day.

Would it be that much trouble to add a paragraph or two, and really clear up this fatal flaw?
What are the items?

The paper describes what the items are ABOUT, but doesn't give the actual items. Are they top secret? Patented? Does this paper say somewhere, "I could tell you the questions, but then I would have to kill you?"

The paper does describe the items: "12 core questions covering halluciniations (visual and auditory); delusions (delusions of being spied on, persecution, thoughts being read, reference, control, grandiose ability and other unspecified delusions); and experiences of thought interference (thought broadcasting, insertion and withdrawal)."

Buried deep in the end of the "results" section is some evidence that my suspicion may be correct: that the relation may have emerged because of "soft," more ambiguous "psychotic symptoms."--

The authors looked at two more refined subsets of psychotic symptom questions.One subset: "definite, frequent" symptoms: those occurring more than once per month: they failed to find a relation between mom smoking and this more frequently occurring set of symtptoms.The other subset: "bizarre" items -- yes, the things like hearing voices, but not the things that, let's face it, kind of define adolescence - delusions of grandeur, delusions that various things (advertisements, songs, new stories, etc.) refer specifically to the teen, impression of being spied on, etc. --When these "softer" symptoms were excluded, and only the frankly bizarre symptoms were included, there was no relation between mom smoking and subsequent psychotic symtoms.

--Please note: this is MY guess regarding what is "bizarre" and what is "soft," partly based on my personal life experience interviewing dozens of people who actually answer a clear "yes" to these various questions, and my life experience working with dozens of adolescents with "emotional disturbance."

So, in the end, the story is good to generate a few headline clicks.

If a few pregnant women quit smoking, then that is great, too.

But I don't believe it is right to scare moms based on lousy info. There are plenty of reasons not to smoke during pregnancy without having to rely on this sketcky study.

Another, less drastic observation: I don't know what disorder these symptoms might represent, but they are not really the "prodromal" symptoms of schizophrenia -- the more subtle symptoms you might notice before the schizophrenai really shows up - which tends to happen beginning in mid-high school, or can show up first in college-age, and typically as late as later 20s. So, the symptoms detected here could be some schizophrenia, but some are surely something else. What, I don't know. But something else.

That is my conclusion. You are free to go click another blog, now.

Stick around, though, if you want my PSA.

My Public service Message: For many risks to a developing baby in pregnancy, quitting smoking, quitting alcohol, taking folic acid, etc., are behaviors that are changed TOO LATE to MAXIMALLY protect the baby if changed at the moment of the home pregnancy test.
AND half of babies are conceived to "unexpecting" moms. You young ladies out there need to behave in a healthy way long before the EPT dot goes blue. Or whatever color it goes. By time you find out you are pregnant, you have already exposed your developing baby to the risks you will now address.

Women "of child-bearing age" need to behave in a baby-healthy way all the time. Cuz, like I said, the data say that half of pregnancies are unexpected, so you can't wait til you "decide" to go get pregnant, or the EPT goes positive -- you will have missed out on some opportunity to lower risks. Look - its not me being mean. That is what the data say.

Thursday, September 17, 2009

Now: I know 3 from personal life with suicidal side effects from SSRI

I don't like to probe in the lives of others. Partly because I have been ingrained with a systematic way of gathering information. When I learn details, I am filling in blanks in an framework in my mind, and noting the blank spaces that call to be filled.

So, I end up missing the real deal: just getting to know someone in my personal life, not a counseling client or client being seen for an assessment.

So, I had a discussion with someone -- not related to clinical work -- about problems with depression. A sad story. Then, I heard the part about suicidality after taking SSRI for a while.

That makes me so mad!

No one expects to have this as a side effect of a med that is supposed to make you feel better.

Fortunately, in this case, the person was able to use some support, and some natural wisdom, and get off the meds. The problems that pitched this person into the depths of despair were eventually addressed -- chalk it up as a learning experience that builds character. There is always hope -- this was true long before the first SSRI.

I discussed what I know of this hidden epidemedic. I hope this info was a relief. People are ashamed, when the yget depressed, at how inefective and lazy they are. They know they are falling short of their own standards, and it hurt. It is also tough to face the fact that you were considering killing yourself. Sitting there in a state of ambivalence with such a preposterous idea. Knowing that this experience was a side effect hopefully is comforting for people, instead of living the rest of live ashamed for this past experience of foolishly debating Hamlet's debate, and playing out methods and scenarios with whatever cleverness and problem-solving you are able to muster in the state.

This person is still alive, no thanks to the drug company who covered up the suicidality side effect solely for the purpose of making money.

This is an academic issue for scholars to investigate. But it is also a personal, life-and-death matter. Once you discover this phenomenon, as long as you are in our med-enthusiastic society, you will be reminded of this problem from your family and friends every now and then. Til we recognize that therapy is at least equally effective, is preferred by the patients, and the side effects can be wonderful.

Thursday, August 13, 2009

Good night. Game Over. Therapy versus Pills for Sleep.

New York Times story:
Online Treatment May Help Insomniacs

By AMANDA SCHAFFERPublished: August 10, 2009.

Good for you, Amanda.

A USA Today article notes the extensive, billion dollar per year appetite we have in theU.S. for sleeping pills:
"It is not uncommon for a physician to dole out a prescription for sleeping pills. About 42 million were filled in 2005, according to research company IMS Health, up 60% from 2000."

Your doc has several he can prescribe, and there is literally an army out there - a Pharmy - promoting docs to Rx sleeping pills for sleep.

This is demonstrated in a quote from another NYT story, regarding the premier of Lunesta:
"Record Sales of Sleeping Pills Are Causing Worries " by STEPHANIE SAUL
Published: February 7, 2006
"Sepracor announced the addition of 450 people to its current sales force of 1,500 to increase marketing of the drug to physicians."

Has that sunk in yet? This is just one drug company. Divide 450 drug reps by the 57 U.S. states and you get an average of 9 reps per state whose full time job is to visit physicians and train them to detect sleep problems, and consider Rx Lunesta when detected.

Apparently, we are plagued by sleep problems. So, this plethera of pill promotion could be a good thing. The USA Today story noted above stated:
"According to the National Institutes of Health, insomnia is common, affecting one-third of adults. About 10% complain of chronic insomnia, meaning their troubles last for more than one month and occur at least three nights a week."

So, there is a need for sleep treatment.

But the sleep problems issue is a perfect problem for looking at the choice between medication or psychotherapeutic methods to resolve a psychological, behavioral, or emotional problem.

What are the down-sides of pills? Google terms such as sleep-walking, sleep-driving, sleep-eating. Do some web-searching and figure out whether the pills can be addictive. Figure out if they can be used in an overdose attempt. Why do all of these sleep meds warn you not to use them for longer than a week or two, or only occasionally? That is a good question to ask your doc. If the doc can answer, then follow up with: what do I do for sleep problems if they last beyond ten days (because they will - let's be real about this).

Will the doc have an answer? Will the doc recommend you to puruse behavioral methods for addressing sleep? Maybe, maybe not. The docs get educated by pharma reps, and other sources of "continuing ed" that are authored and broadcast by the pharmaceutical companies. Pharma is not runnign around telling people to seek behavioral methods for addressing sleep.

What alternatives are there? Behavioral interventions for sleep work. I have blogged about that topic before. In fact, I am running over the same topic yet again.

But this recent study is cool. Striking. It is stunning to grasp the implications of this:

The behavioral interventions for sleep have become so standard, so successful, so reliable, so well-elucidated, that you don't even need to have these delivered by a therapist.

The various recognized, understood, acknowledged components of a behavioral sleep cure have been put on line. You just click away and follow the program.

Now, you have to follow through and do what it says. Merely reading web pages will not cure insomnia (although some of mine come close to that goal).

Ya gotta do the work.

But that revelation, as reported by Amanda Shaffer in this NYT story, is awesmoe: you can avoid all the risks of pills if you go the behavioral route, and you can even be guided through this online. That is how advanced the clinical, scientific knowledge is for behavioral treatment of insomnia.

Think about it. Each of the 57 states could take these well-recognized, well-broadcast cognitive and behavioral components, and develop web-based routines for serving the needs of the citizens. For quite a modest cost.

It is time to put this issue to sleep. The pills include a drastic, life-threatening range of side effects. We just need to start thinking outside the pillbox.

Wednesday, August 5, 2009

Ghost writers wrote the pro-hormone papers of the previous decade. Am I surprised? No.

Surprise, surprise. Ghost writers wrote the pro-hormone papers of the previous decade.
Natasha Singer for the NY Times:"Medical Papers by Ghostwriters Pushed Therapy"
NYT reports revelations emerging from court cases against Wyeth, marketer of hormone replacement therapy: many of the the pro-hormone articles published in the 1990s, and up to the end of the HRT fiasco in early 2000's, were ghost-written.

The pharmaceutical companies paid physician researchers to stick their name on articles written by unknown hired writers. It was not very difficult to find physicians to go along with this dishonesty.

The conflict-of-interest list for the HRT story is extensive. Most of the first-author physician/researchers who published peer-reviewed articles favoring HRT for its various purported health benefits, especially the now-debunked claims of cardiac health, were funded by Big Pharma, especially Wyeth.

While they were paying for articles promoting off-label prescription of HRT for cardiac health, they were not paying for the work to pinpoint the apparent bad health effects. I say apparent because it is very clear, if you review the prominent, easily-identifiable published research, that the cancer risk from these hormones was known from a long line of research back to the 1930s, and the trick that made HRT look good, the use of observational studies rather than controlled trials, had clear signals of the error in this strategy from AT LEAST four PUBLISHED studies.

If I get time, I may post this handful of literature. In the meantime, contact me if you seriously want to get hold of this handful of information. Medline and Google scholar are always available, too.

Now, in 2009, we finally get the kicker to this whole pharma scam: we know that, in some cases, these physicians did not even write the articles.

Now, we know: the whole HRT phenomenon was a scam. A marketing ploy. Never really based on decent science, and never really emerging from decent physician/researchers.

Has there been any change to make things better, since 2002, when a controlled trial of HRT for cardiac protection finally produced worthwhile, accurate results?

No. JAMA, and others including AMA, continue to argue that COI is not a big deal (see my posts with JAMA in the title). They continue to argue that we should trust physicians because they have those initials after their names.

This revelation will generate some discussion. The MD researchers will claim that there are a few bad eggs, or that the ghost-writing issue is not really all that bad, but provides a vauable service. Or whatever.

In the meantime, no one will calculate the number of women who have died from the damaging effects of HRT. Premarin, the trade name for Wyeth's HRT pill, was the most frequently prescribed medication in the U.S. for a matter of years. Millions of women took HRT regularly.
We know that HRT raises risk of heart disease, and of breast cancer. We know women were encouraged to take HRT not only for menopausal symptoms, but to protect their heart health, based on evidence from observational studies rather than controlled trials. It is obvious that some portion of women have suffered heart disease, breast cancer, and death from HRT.

The NYT quotes from the identified physician/researcher show the nonchalance. The disregard for these women. This physician, Dr. Bachmann, does not express regret over her role in these deaths.

Has she returned the money, on principle? Has she published a retraction of her authorship? Has she apologized to the women who have been mislead? Not yet, it seems.

Tuesday, August 4, 2009

Which docs overprescribe? Study reports "An Easy Method of Detection."

Which docs overprescribe? Study reports "An Easy Method of Detection."

Whoops, that was just wishful thinking.

I receive a few "alert" emails regarding psychology-related research as it gets published.

This headline, from "Journal Watch-Psychiatry," caught my eye:

"Who Overuses Headache Medications? "An Easy Method of Detection."

I thought the study might help me tell which docs over-prescribe. I thought there might be some brief questionnaire, with items such as:
"has the doc recently been visited by a drug rep?"
"Is the doc holding a pen advertising a new headache remedy?"
"Does the doc's staff look well-fed?"

No such luck.

The study actually reports a measure for determining whether a patient might be over-using headache meds. Well, I guess that is helpful.

If you are interested, the study is:
R B Grande, K Aaseth, J altyt Benth, P Gulbrandsen, M B Russell, C Lundqvist. The Severity of Dependence Scale detects people with medication overuse: the Akershus study of chronic headache. Journal of Neurology, Neurosurgery, and Psychiatry 2009;80:784-789.

But what we really need is a measure to tell us what docs are over-prescribing. Wouldn't it be good if you, or your family member, was visiting a doc for some problem, and you wondered whether the meds pushed on you were actually useful and warranted, or just pushed because the doc is in some pmarma-sponsored program to win a vacation, and to answer the question, you had a validated questionnaire?

Maybe that will be published soon. Who knows.

This story makes me sick. And mad. "Kids as young as 3 can have chronic depression"

Have we lost our minds?

"Kids as young as 3 can have chronic depression
40 percent of kids still have problems 2 years after diagnosis, study says"

I have not looked at the actual publication. I have only looked at the news story.

As will be the case for most of us.

Think about it: what comes to mind if you learned that a child has been chronically depressed from the age of 1 year old to the age of 3 years old?

Call me crazy, but I do not perceive a wildly promising business opportunity.

I suspect: abusive or neglectful parenting. An insufficient social setting for raising a child.

In the news story, parents, parenting, abuse, neglect, and the social environment for raising a child get mentioned exactly.....never. Not at all.

This is the bias that big Pharma wants in your mind. Psych disorders are "brain diseases," "biological disorders," to be cured by a pill.

Never mind the mountain of evidence, of all kinds, demonstrating the social/experiential basis for depression.

Not once is the spectre of neglect, of adverse events, of abuse, of stressed, unavailable parents, etc. mentioned. Parents are not mentioned at all. At all.

How could a "news" story fail to include such an abvious concept?

I suspect that, somehow, by press release, or however, that the story was "fed" to some reporter by someone with a vested interest.

It is sick to do this to children. The rest of us? The 10% of the U.S. population that is on psych meds? hey, buyer beware. But let's at least take care of our children.

What if this study was about dogs?

People would be up in arms. Would be noting that dogs can't be cooped up all day. Need attention. Need room to run. Need toys. The home-breeder issue would come up. Someone from the ASPCA would be interviewed. The Dog Whisperer would be interviewed.

Kids? forget about it.

We are sick.

Do you need more proof?

Are you happy to know that "Kate is at peace"? --Same day, same news outlet:

No. i don't care. Kate is a millionaire, and an adult. she can take care of herself. I don't care if she is at peace or not. Sure, I want the best for anyone under the sun. But am I worried about how Kate is doing? No, not really. Is she worried about me?

What about her children? I am worried about them.

Just wait.

They are caught in the crossfire of a custody/divorce battle, magnified and captured by tv cameras. The Truman Show, but 8 kids, not one adults.

The story focuses no attention on the kids, but on Jon and Kate. At least they include Kate's comment about her efforts to include the children's welfare as she negotiates this parenting challenge. but the story focuses on Kate, then on Jon, but not at all on the children. And no one notices. No one blinked.

We are sick.