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.