Wednesday, December 15, 2010

trigger: "you want the cops to come in and kill you"

Clay Duke, Clay A. Duke, THE Clay Duke, yes that one. Panama City. Rebecca Duke's man. The Gentle Giant. (Not that Gentle Giant, you hippie.) Schoolboard shooting.
http://www.foxnews.com/us/2010/12/14/official-gunman-killed-fla-school-meeting/

Bill Husvelt was saved by God. Good move, God, since Bill was handling things well at 99%, but slipped up. We are all flawed, and need God, as clever as we might be.

Bill Husvelt is not an expert on narcissism. Or on crisis management intervention with a homi/suicidal narcissist. IMHO, Bill Husvelt performed awesomely as an impromptu psychologist. Kudos. He deserves an honorary degree.

Husvelt's one flaw, in his plain-talk I-thou intervention, was to directly call the sad reality of it all straight to the injured narcissist. Causing more injury. How did he do this? What did he say? He said, ""I've got a feeling you want the cops to come in and kill you because you said you are going to die today,"

Oops.

William Husvelt blew the scheme. The heroic plan that was revealing Duke as Sir Duke. Everything was going so well. So well, that Sir Duke did not know what to say, in response to conversation. Well, that is to be expected because the only person Sir Duke was familiar with, by conversation, was himself. Circuitous conversations in his head painting the picture. Then, after enough laps around his head, he literally painted the picture: vengeance. V.

Bill pulled back the curtain. The careful, almost, no don't say it, I must, masterful -there, I said it- masterful Johnny Paycheck orchestration was exposed for what it was. A sadly pathetic program meant to be some spontaneous heroic stand.

But we cannot fault Bill Husvelt too much. Only the "V" for vengeance overgrown adolescent ended up dead. Bill literally ducked a bullet (that is where God stepped in).

Bill does not know what a narcissistic injury is, and it is quite unlikely, therefore, that he could, in the moment, calculate what man-to-man talk might de-fuse, and what mano-a-mano might blow up.

In crises, don't ever belittle your narcissistic client  - espeically when they are holding a loaded gun. Don't pull back the curtain to reveal the pathetic man furiously working machinations to maintain the Ozsome-ness. Don't reveal that you have calculated the end game.

Should Bill feel guilt that a death occurred? I don't think so. We may never know, but it sure seems that the story was scripted to end with Sir Duke's heroic death. Inevitable. I really kind of believe Bill was correct: Sir Duke fantasized an ending where he would go out in flames, suppressed by the Machine, or whomever was the oppressor. I have never watched V, and don't even know if it is a TV show or a movie, or both, or a comic book, or all three, so I don't know what kind of ending Sir Duke had in mind. But I believe Husvelt had it correct: Sir Duke would go out in glory by the tools of the oppressors.

I believe that because the sympathetic negotiations went nowhere. The pleas to ask about this guys' wife went nowhere. Nowhere. (store that detail - it may save your life.) Sir Duke was not trying to pay the mortgage or get his wife back into a job. He was out to be martyred.

PS: I saw the story, saw the video, and put my thoughts together, and have not, in these 24 hours, checked the blog of the Last Psychiatrist. I have just focused on this one aspect of the incident - Bill's mis-step - because I am pretty sure Alone will conduct a better psychological autopsy than I will. Alone will at least likely be familiar with "V."

Tuesday, December 14, 2010

the truth wears off; or was it never on?

This New Yorker article is getting a lot of blogsploitation...
http://www.newyorker.com/reporting/2010/12/13/101213fa_fact_lehrer
"Rethinking the scientific method." Oh, great. A NY journalist is going to fill us in on what we scientists have not been able to figure out.
"On September 18, 2007, a few dozen neuroscientists, psychiatrists, and drug-company executives gathered in a hotel conference room in Brussels to hear some startling news."
The Startling News? A bunch of cheating, unethical, greedy pharmaceutical people had a bunch of psychiatrists, who are not trained as scientists unless they deliberately go out of their way to do a science-based PhD in some spare 3 years, cooked up some data indicating that their new chemicals were superior to those whose patents had run out.

Now, just looking at this, you can begin to sniff the sweet smell of disaster. Clozaril was not really worth  a thousand dollars a month. Or worth the heavy monitoring for agranulocytosis. But hey, there's money to be made - I know  - I entertained the possibility of getting hired to go into doctors' offices and figure out who could be switched to Clozaril. Yes, the patent has run out - no one is doing this anymore - it was  a long time ago. But the opportunity was there for one brief, shining moment.

As time went by, and more studies were done under more circumstances, it became painfully obvious that Clozaril was not much better than the Haldol it had replaced. Same for the yellow one that was close on the heels - drawing a blank on the name. Give me a sec. Risperdal.

This has been the case with many new treatments: EMDR, etc. Initial optimism fades as the effect size shrinks like that perfect cotton t-shirt washed in hot water. A few times. The Thrill Is Gone. Same as the old one.

So, some person comes along, pretending to be the next philosopher of science, and declares that science is dead.

Science does not answer questions. It is a method for helping us discern what might be true. Withering efficacy does not change that. No need to change science.

If you can get behind the firewall, you will find this:
"Just because an idea is true doesn’t mean it can be proved. And just because an idea can be proved doesn’t mean it’s true. When the experiments are done, we still have to choose what to believe."

Does this disprove science? Is Lehrer the next Nietzsche? Is God alive again? If science is dead, can there still be a gay science?

Witheing results do not disprove the value of science.

This totally fits with the scietific paradigm, and, as a scientist, I have no problem with this.

Scientists, those people who have actually studied and practiced epistemology, scientific method, research design, likelihood/probability analysis, and such, have no problem with the quote above.

How? For starters: accept as a rule a few concepts:

"experiments" don't give us truth; they give us evidence that plays a role when attempting to discern truth.

no single studies proves anything. (ten lousy studies with consistent results don't prove it, either.)

all of our studies are based on models, and the map is not the landscape/ ceci n'est pas une pipe. with our measures and tests, the best we can do is confirm a model.

all measurement have some degree of error.

science never arrives at the truth; when working well, it approaches truth asymptotically.

science doesn't tell us what to study. we decide, then use scientific principles and methods to evaluate our pet theory. thus, we are always beginning with some agenda before the first trial is run.

physical reality is wildly more complicated than we can grasp. (not all scientists beleive this, but when you begin considering all of the machinations you would need to have a valid and generalizable medical outcomes study, it becomes incredibly daunting.)

finally: accept the reality that what we hold as our faith, science, is really only a method for approaching knowledge, and should not be regarded as a faith, or dogma; science only helps us be very systematic, in a certain way, in evaluating claims of knowledge. let's not be so dogmatic. you cannot swear allegiance to the idea that whatever findings might emerge from "science" will be your truth. it just doesn't work that way.

these concepts are in my mind whenever i read a journal article.

Especially if it is from Big Pharma.

Tuesday, December 7, 2010

Earth To Dr. Manny: No Evidence Curcumin Cures Cancer. Or Prevents.

Dr. Manny is the FoxNews Doc on the Block. Sure to share some conventional wisdom and house-call hominess regardless of the evidence.

I don't know who the "Medicine Hunter" is, but apparently Dr. Manny trusts this guy.

Fox health video:
http://video.foxnews.com/v/4450273/curing-with-curcumin

"Curing With Curcumin


The Medicine Hunter tells Dr. Manny how incorporating one popular Indian spice into your diet can lower your risk for cancer and improve your mood. Find out how much you should be taking a day."

Mood? Bonus.

I help teach people how to evaluate clinical evidence. My strength is in mental health/psychology/psychaitry, but I can dabble. My students include Indian students, along with students from many places. So, when we review people's pet theories of what heals and does not, curcumin / turmeric comes up. So, I keep challenging students to provide the evidence. When we apply our standards for evaluating studies, we never arrive at the conclusion that curcumin looks promising. I hate to tell someone Grandma is not correct. So, I give an alternate explanation: it is the social support and love that comes with the lovingly home-cooked meal.

Thursday, December 2, 2010

In The Moment, There Is No Music. Mindfulness thoughts

Hi, there.
Studies keep coming out trialing mindfulness meditation as a psychological intervention component for a range of disorders and problems. About time: counselors had already been using mindfulness before any actual emprical evidence was ever out there. But hey, does that ever stop anyone?

I have participated in some of this, in practice and in research. So, I have carried out a pretty good reading plan on this. And thought about it a pretty good amt. when I was practicing regularly, in the course of guiding patients through the practice, I noticed that I slept better, and had a lower desire for coffee in the morning. And, we had a holding-the-breath-while under-water contest, and I was able to really simply observe the panicky suffocation thoughts and remain underwater, and allowing my need for oxygen, rathe than the prompting of panic, to send me back above the water line, winning the contest. So, I am certainly willing to believe there is something there.

Mindfulness essentially is a matter of getting to become increasingly aware of what your mind does by paying steady attention to what it is doing. Sounds easy. Well, you try it. It is like walking an energetic pup with no leash.

Also, you want to get attention focused on some specific thing, and that only. Usually, it is the activity of breathing. This works. You become more aware of how thoughts flow into your mind, and have their effects on your viscera.

A goal is to have your attention simply in the present moment. with practice, you will discover that your mind is almost never in the present moment - our minds are so awesome, they have to devote minimal attention to keep us in line with social interactions, navigation, and routines. So, it is a new thing to put deliberate attention in the moment.

Not reflecting on some argument from yesterday, or some pleasant memory from eight years ago, or worrying about the weekend to come, or looking forward to 5 o'clock quittin' time. In the present.

Well, it occurred to me: if you do this well enough, music would lose its music-ness, wouldn't it?

Music depends on acoustic events occurring in some purposeful arrangement in time. Right?

So, if you ceased having your mind on the past, the music-ness of music would disappear. Right?

One way to practice focused meditation is to pay attention to ambient noises. This is striking: you discover a whole panoply of noises all around. You can hardly identify and catalog them all, can hardly be aware of all of the current, momentary noises occurring in a moment.

I sure have not been able to get the music to stop. I have never heard of any yogi describing this as an experience or a goal. Please post a note if you have.

Also, it is curious that a lot of the faux-riental meditation-based experiences (yoga, or shopping at a crystal boutique) have the typical Steve Halpern or Deuter music. If your mind is supposed to be "focused" in the moment, then why are these people providing sensory input that commands attention to follow along in time? Would it not be the same to ask someone to meditate, and expect that a car rushing toward them would be helpful to not think about the next 10 seconds, but to stay in the moment?

I just don't know.

[warning: you can either focus your mind on something, or focus your mind on nothing; i really believe, based on case reports and such, that focusing your mind on nothing can be mentally bad, such as inducing psychosis, and leaving you disorganized for months afterward; I see no reason to try this at all, and I would avoid any meditation effort that has a mind full of nothingness as a goal. Others will disagree. Go enter meditation and psychosis into Pubmed and start reading.]

Wednesday, December 1, 2010

NEJM sez 'overweight die early;' I say, Wrong.

Body-Mass Index and Mortality among 1.46 Million White Adults


Amy Berrington de Gonzalez, D.Phil., Patricia Hartge, Sc.D., James R. Cerhan, Ph.D., Alan J. Flint, Dr.P.H., Lindsay Hannan, M.S.P.H., Robert J. MacInnis, Ph.D., Steven C. Moore, Ph.D., Geoffrey S. Tobias, B.S., Hoda Anton-Culver, Ph.D., Laura Beane Freeman, Ph.D., W. Lawrence Beeson, Dr.P.H., Sandra L. Clipp, M.P.H., Dallas R. English, Ph.D., Aaron R. Folsom, M.D., D. Michal Freedman, Ph.D., Graham Giles, Ph.D., Niclas Hakansson, Ph.D., Katherine D. Henderson, Ph.D., Judith Hoffman-Bolton, Jane A. Hoppin, Sc.D., Karen L. Koenig, Ph.D., I-Min Lee, Sc.D., Martha S. Linet, M.D., Yikyung Park, Sc.D., Gaia Pocobelli, M.S., Arthur Schatzkin, M.D., Howard D. Sesso, Sc.D., Elisabete Weiderpass, Ph.D., Bradley J. Willcox, M.D., Alicja Wolk, Dr.Med.Sci., Anne Zeleniuch-Jacquotte, M.D., Walter C. Willett, M.D., Dr.P.H., and Michael J. Thun, M.D.

N Engl J Med 2010; 363:2211-2219December 2, 2010


Background

A high body-mass index (BMI, the weight in kilograms divided by the square of the height in meters) is associated with increased mortality from cardiovascular disease and certain cancers, but the precise relationship between BMI and all-cause mortality remains uncertain.

Methods

We used Cox regression to estimate hazard ratios and 95% confidence intervals for an association between BMI and all-cause mortality, adjusting for age, study, physical activity, alcohol consumption, education, and marital status in pooled data from 19 prospective studies encompassing 1.46 million white adults, 19 to 84 years of age (median, 58).

Results

The median baseline BMI was 26.2. During a median follow-up period of 10 years (range, 5 to 28), 160,087 deaths were identified. Among healthy participants who never smoked, there was a J-shaped relationship between BMI and all-cause mortality. With a BMI of 22.5 to 24.9 as the reference category, hazard ratios among women were 1.47 (95 percent confidence interval [CI], 1.33 to 1.62) for a BMI of 15.0 to 18.4; 1.14 (95% CI, 1.07 to 1.22) for a BMI of 18.5 to 19.9; 1.00 (95% CI, 0.96 to 1.04) for a BMI of 20.0 to 22.4; 1.13 (95% CI, 1.09 to 1.17) for a BMI of 25.0 to 29.9; 1.44 (95% CI, 1.38 to 1.50) for a BMI of 30.0 to 34.9; 1.88 (95% CI, 1.77 to 2.00) for a BMI of 35.0 to 39.9; and 2.51 (95% CI, 2.30 to 2.73) for a BMI of 40.0 to 49.9. In general, the hazard ratios for the men were similar. Hazard ratios for a BMI below 20.0 were attenuated with longer-term follow-up.

the media love this.

http://www.usatoday.com/yourlife/fitness/2010-12-01-overweight-death_N.htm

BMI 25 to 29.9 'overweight'
30+ obese
So, a man at average height, say 5 foot 10 inches, is 'overweight' at 174 pounds, and is 'obese' at 209.
A woman who is 'average height at 5 foot 4 inches is 'overweight' at 145 pounds, and 'obese' at 174 pounds.
You can google and find the BMI tables, but here is a website that is paying to have theirs high up on the search results:

http://www.thaipoly.com/ovw-areyou.html
Who is paying for this study? Remember: follow the money.
Iovate.
http://www.iovate.com/
They want to continue making physicians believe that being "overweight" means that you will die early, and so you should PANIC and ACT. Specifically, by taking some patented medication.
Generally, this is not true. And, no one has evidence indicating that if you take tehir patented medication, you will be an overweight person who lives longer, or will move from being oevrweight to being obese, and consequently live longer.
Please prove me wrong: post the study.
So, their lips are moving. Now, to figure out the lie.
First: we will ignore the obese people. Why? Because either you have been on steroids, or are immobilized, or you are flat out using your minutes unwisely. In any of these cases, you are an exception, or should be considered an exception. There are such great needs on this planet. If you have devoted time and money to consuming food instead of figuring out something socially redeeming to do with your time and money, that is up to you. Like we say in career counseling when attempting to help people who have the amazing fortune of being able to be undecided about work: "what if you only had one life to live?"
I do care about the plight of the obese. Just, when discussing epidemiology and pharmacology, it is a distraction. Pay me $100/hour and I will feel self-fulfilled to help you address the obesity lifestyle you have chosen.
And, anyway: who cares? The 'overweight' care. Not all. Some. But this 'some' is the bulk targeted by the profiteers. The overweight pester the docs, and crowd the gyms, and take the supplements. They hear things about body fat, or dietary fat, and flock. They perked up when the young woman in the Meridia ad said, "I'm Ready." [BTW: she is still 'overweight,' in case you were wondering.]

You who are overweight are a vast portion of the populace, and are the target - they want you to perceive yourself as 'obese,' so that you sign up for interventions that ought to be delivered to the obese. Look at the ads. A woman who looks perfect to us men is posted as a 'before,' and a well-defined body-builder with a six-pack is featured as 'after.' Will she live longer? Short answer: no. If we convince her that being 'overweight' is 'unhealthy,' or not 'fit,' then we can make money off of her. Lots of money. Because she is not 'overweight.' She is 'normal,' as God intended.

So, we will consider the 'overweight' and ignore the obese.

This study, as far as I can tell (electronic is not accessible to me yet - I will have to do something as primitive as walk over to the physical library to get details - but logic, and the space-time continuum have a stranglehold on rhetoric that is challenging to break), does not say that overweight people die earlier, but that EARLY DEATH is associated with being overweight.

Here is the key: THEY GIVE IT TO YOU IN THE ABSTRACT: TEN-YEAR FOLLOW-UP. AND MEDIAN AGE 58. People! Wake up and do the math!!!
Two questions are needed to sort this out:
1. When do people die, on average?
2. Who did they study?

That is it. Common sense defeats Goliath.

Here in the U.S., those who are sensitive to the marketing of Meridia and health club memberships have a life expectancy of 75 years, give or take.
So, the optimal way to figure out who dies early and who dies late, given a ten-year 'parameter' (self-imposed limit), would be to follow people from the age of 65 to 75, and see who dies.

for those who have made it that far, which should be a pretty representative group of the pop in general (despite inherent limits, such as the inordinate portion of Blacks who die in the womb or in early adulthood by their brothers).
That is not early death. That would be examining the differentialiation of normal death.
The odds ratios just don't fit this pattern.
If they are examining people, with a median age of 58, with a ten year follow-up ----
let me see...this will require a calculator...
http://www.metacalc.com/


OK: now we know: they examined death in a group of people from ages 58 to 68.
Life expectancy is 75.
An average.
So, the study is looking at people who...calculator needed again....
http://www.calculator.com/calcs/calc_sci.html
...are a whopping 7 years before expected death.
So, we are not looking at death, but at "early death."
THat is to say: MOST people die around the age of 75; but if you HAPPEN to be an exception, and die several years before that, we have figured out the characteristics associated with EARLY DEATH, not normal death.
Not: among those living a full life, who dies earlier.

For that, you need a group who reach some age beyond 58. Maybe 65, then follow through the age of 80. Let's get the inter-quartile range of life expectancy.

The minority (doubel-entendre intended -we epidemiologists need to be painfully aware of these disparities ) who die early are different from most of us. They have behavioral problems, or cancers, or are victims of violence or occupational hazard, or were hit by the tornado, or died from a hospital-acquired infection.

The heaving bulk of us die from heart disease, and between 70 and 80 years of age.

This study is not about the bulk of us.

That is good news: we can relax and enjoy our 'overweightness.'

All this to say: 'overweight' is a marketing tool. BMI has a loose relation with body fat. It is the body fat that will kill you; the rest of us simply believe it will kill us, but have big estimation errors in our thinking.

Look at this:

http://en.wikipedia.org/wiki/File:Correlation_between_BMI_and_Percent_Body_Fat_for_Men_in_NCHS%27_NHANES_1994_Data.PNG

It is the correlation between BMI and actual body fat. Points on or near that horizontal line are well-predicted from one to the other. The MAJORITY of dots are not wll-predicted.

Variability. What accounts for that? What accounts for data that say: my BMI may not be too bad, but my body fat is gravely indicative of my impending early death AND My BMI is bad, but I will live to be 90.

Open your Bible. Work hard, and enjoy the love of your family and community. Stay in financial control, rather than living in debt. Have kids. Have sex only in marriage. AND: eat and drink your wine, because none of us knows when we will shrug off the mortal coil.

Nothing about being 'overweight,' or supplements, or treadmills.

That is ALL from the Bible. I know, I know: "eat, drink and be merry, for tomorrow we may die" is what they made us memorize to typify the Epicurean philosophy. If your course was decent, they told, you, Epicurus NEVER actually said that, and neither did Lucretius. They did not tell you that Solomon said it.

And "mortal coil?" As with much he wrote, Shakespeare lifted that, as he lifted a gret deal, from a book he was helping translate.

The rest: heavily in Proverbs, a lot in Leviticus, and elsewhere.

You will not die early from being overweight. That contradicts established epidemiology that follows cohorts from middle-age for well beyond ten years, through the normative death expectancy range. THAT is the only way to answer the question regarding what factors will generally lead to earlier death.

Being overweight will mathematically predict your death if you are overweight because you are sedentary, or a drunkard, or have some other health condition such as something requiring steroids, or are paraplegic and inactive.

Otherwise, you are not notably at risk of early death if overweight, compared to BMI 20-25.

Relax. Don't buy their drugs or supplements. Grow old gracefully. Like Solomon says, enjoy the company of your wife, the pride your children bring, and a couple glasses of Shiraz. And stay prayed-up.
 
And what is up with all of those authors?

Monday, May 3, 2010

Mobanished. A passing prompts a favorable reflection upon psychiatry, and meds.

http://ajp.psychiatryonline.org/cgi/reprint/167/5/501

In the recent Am J Psychiatry, a Dr. Neimark laments the discontinuation of Moban. I feel ya.

This strikes a chord for me. I have known a fair handful of people who have found help from Moban, out of the damningly frustrating puzzle of psychoticism relief.

Positive, negative, side effects, EPS, NMS, TD, AIMS, weight gain, weight loss, insight, light sensitivity, agranulocytosis, and on an on and on. Itself, maddening.

The people stricken with schizophrenia are heroes, with the heroism thrust upon them by misfortune. However, the docs who sign up to treat these patients have a choice. You don't have to make your professional life a matter of shots-in-the-dark, pages, scripts, drool, disappointment, and compromise. But the docs who venture to treat such a population are heroes. And are wise to grab hold of, and get trained with, any weapon that might come in handy.

Something occurs to you: maybe we will trial Moban.

For a couple weeks, you have a feeling, or a belief, that is hard to describe. That is in between confidence, surety, hope, and long-shot luck.

In the face of all of this lottery-ticket, against-the-odds foolish optimism, you know the task you must fulfill.

Achilles must take his fated stand.

You run through the questions you know you must ask, against your intuition, your hopes, your desire, your hunch, your clinical judgment. And, these must be recorded. Possibly only for the pharmacist to count. But then again to suffice for the highest level of subpoena scrutiny that might arise.

Some times it works.

And you incorporate that limited victory into the matrix that is a mix of clinical lore, evidence, memory, parataxy, receptor profiles, and who-knows-how-the-mind-calculates.

Some times it works.

God help us. The families are commited out of love and family bonds. A face only a mother could love? There is something that works inside of us to commit in a similarly endless-devotional way. We might say "professionalism." I don't know if there is a term for it. But we charge in, declaring that we surely might be able to help, and are confident. But we know the challenge we are in for. Yet commit. And show up day after day.

So, when you are right, when Moban works, you want to underline the victory in the record. And you cleverly store away any clue, like you might tuck away the knowledge of an awesome, but isolated, restaurant or coffee shop at some vacation destination.

Boston? Oh, you have to go here.

Sarasota? You have to go here - totally off the guide map.

Sedona? you have to stay here.

[Symptom and patient profile]? Moban.

What? They're no longer in business? What a shame. What a loss.

Monday, April 19, 2010

"Unadjusted model." Why? [methods rant]

performing yet another manuscript review provokes a methodology rant:


technical note: why report an unadjusted analysis? if your study requires adjustment for confounders / covariates, then it simply makes no sense to report the results of your study BEFORE you have gone and adjusted for the fact that you know it has biases?

why?

i guess in an elliptical way, you could argue that the difference between the unadjusted and the adjusted analyses tells you the degree of prediction due to the adjusters / the covariates.
but if this is important, then just include them in your results table. report their weight, odds ratio, etc.

and give a "p" level if you feel like you need to.
if covariates, as a block, are interesting, then step them in on their own step in a hierarchical model.
step in demographic measures in one step.
step in comorbid conditions in the next.
step in psychosocial in another.
there. done. you have your info. done the proper way.

but reporting "unadjusted," and "adjusted," as if we are seeing things in various ways to round out our view? i don't get it. is it like when you get your eyes examined? which is better. this? ....or this (flip). this...(flip) or this?
we know which is better: the adjusted model. you would not run an adjusted model, otherwise. right? is it just me?

Tuesday, April 6, 2010

Pfizer: Feds encourage shell game to hide blame

Pfizer: Shell game to hide the blame. Read this recent CNN story - good job, CNN! We will miss this type of story when you go under!  Now, ask yourself: how much do you trust these drug companies? Has the level of shannanigans risen to the point where you no longer trust them? And consider: this con game worked by taking actual resaerch info, spinning it in the marketing blender, adding in some MD spokesmodels to clue in our overworked physicians, with the open basket of money coming from our tax dollars. In other words, worthless oversight at all levels, except maybe the poor grunts having to actually carry out the basic research.


http://www.cnn.com/2010/HEALTH/04/02/pfizer.bextra/index.html?iref=allsearch
"...any company convicted of a major health care fraud is automatically excluded from Medicare and Medicaid. Convicting Pfizer on Bextra would prevent the company from billing federal health programs for any of its products. It would be a corporate death sentence.
"Prosecutors said that excluding Pfizer would most likely lead to Pfizer's collapse, with collateral consequences: disrupting the flow of Pfizer products to Medicare and Medicaid recipients, causing the loss of jobs including those of Pfizer employees who were not involved in the fraud, and causing significant losses for Pfizer shareholders.

"We have to ask whether by excluding the company [from Medicare and Medicaid], are we harming our patients," said Lewis Morris of the Department of Health and Human Services.

"So Pfizer and the feds cut a deal. Instead of charging Pfizer with a crime, prosecutors would charge a Pfizer subsidiary, Pharmacia & Upjohn Co. Inc."

Monday, March 29, 2010

Headline: "Most kids don't drink. "Oh, wait: not alarmist enuff...

"Most kids don't drink, and portion of drinkers drops every year;" See Figure

3.6. Oh, wait: not alarmist enuff: "28% of U.S. Kids Drank Alcohol in Past

Month." OK, that's better.





http://www.nlm.nih.gov/medlineplus/news/fullstory_96861.html











"Most kids don't drink, and portion of drinkers drops every year;" See Figure

3.6. Oh, wait: not alarmist enuff: "28% of U.S. Kids Drank Alcohol in Past

Month." OK, that's better.





http://oas.samhsa.gov/nsduh/2k8nsduh/2k8Results.cfm#Fig3-1

---figure 3.6...

..or any such report.









How will all of us health experts and researchers and psychologists get public

support if we cannot prove that some catastrophe is afoot?



Public Health Crisis I tell ya!!! Plus: look at that poor "kid:" pooring red

wine into a container that is obviously not a red wine glass! The Horror!





Without the Public Health Crisis alarmism, how can we air bold statements such

as this, " "Underage drinking is a national crisis putting the lives of

millions of Americans at risk as well as the futures of many of our youth,"

agency administrator Pamela S. Hyde said..."



Well, we thought about this: "Public health, education, and law enforcement

efforts aimed at reducing teen alcohol use are working."



But it just did not have the zing to it that "28% of U.S. Kids Drank Alcohol

in Past Month" has.



Who are these kids?





They are adults.





They are from the ages of 18 to 20. In most states, a person becomes a legal

adult at the age of 18.



I am not arguing here for or against a drinking age other than 21.



What I am noting is that the term "kids" does not apply to a legal adult.



Unless you want to create a sense of panic amongst the general public.



We don't say, "A thousand kids were just sent into a war zone last week,"

leaving the reader to note in the fine print that these were legal adults in

the armed forces, fighting as armed forces do.



well, some people do. Some don't like 18 yr old to 20 yr old kids being sent

into war zones, trained or not. However, that group of concerned citizens is

strongly the group who are opposed to persons of any age being sent into a war

zone as part of a normal, standing army.





As you might guess, now that you have moved beyond their headline to consider

mine, is that past-month use of alcohol increases for these demographic groups

as age rises. You got it. By time you get to the 18-20yo cohort, you see fair

amts of past-month alc use. By time you get to legal drinking age, you see a

big jump, too.





So, what we are left with is alarmism.





When do we get to pat ourselves on the back? Drinking rates are dropping. We

need encouragement so that we do not get burnout from the disaster-scenario

headliens we hear every day, and or get the idea that, despite efforts across

decades, nothing seems to work.





What does work?



Here is a clue: Lowest rates are in Utah.



What are we to do with that info?

Thursday, March 18, 2010

Dumb Criminals! Stole the wrong drugs. Unless you think dry mouth, suicidality, and weight gain are cool ways to get high.

Dumb Criminals! Stole the wrong drugs. Unless you think dry mouth, suicidality, and weight gain are cool ways to get high. This news story cracks me up...
"Thieves grab up to $75 million in Eli Lilly drugs"

"The thieves disabled a burglar alarm in the building and carted away dozens of pallets loaded with Lilly antidepressants Prozac and Cymbalta, anti-psychotic Zyprexa and other company medicines, according to published reports."

http://www.reuters.com/article/idUSSGE62G07D20100317?loomia_ow=t0:s0:a49:g43:r2:c0.140110:b31982992:z0

Here is a post on the terrible weight gain issue with Zyprexa...
http://www.medsvstherapy.com/2009/10/pharmaceuticals-or-harmaceuticals-kids.html

The SSRIs have all kinds of troubles. I have blogged about the most alarming: birth defects from pregnant moms taking these drugs...

http://www.medsvstherapy.com/2009/11/ssris-in-pregnancy-associated-with-5.html
http://www.medsvstherapy.com/2009/10/bmj-2009-heart-septum-defects-twice-as.html
http://www.medsvstherapy.com/2009/10/fox-spokesdoctor-doubling-of-hear.html

...and other problems including suicidality, withdrawal problems, etc., are well-noted at a couple great sites...
http://www.ssristories.com/
http://seroxatsecrets.wordpress.com/

Those drugs are the last drugs I would want to steal!

Wednesday, March 17, 2010

Am Psychiatric Assoc recently publishes review of Guidelines for Panic. Somehow they favor meds over therapy. I will have to dig in.

Am Psychiatric recently publishes review of Guidelines for Panic. Somehow they favor meds over therapy. I will have to dig in. Has pro-meds focus, while declaring that "CBT" is also beneficial.

It is 65 pages. I will have to dig in and see how they tilt the world to have meds, mainly SSRI, be preferable for panic, over behavioral interventions.

In February 2010's Am J Psychiatry.

This will be fun.

Monday, March 8, 2010

Thankfully, a new placebo for knee pain. Electromagnetic pulses.

Thankfully, a new placebo for knee pain. Electromagnetic pulses.
http://www.healthday.com/Article.asp?AID=636730

"Electromagnetic Pulses May Stem Arthritic Knee Pain."
"New device could improve life quality without side effects, expert says"


After surgery got the ax (Mosely et al NEJM, 2002), knee pain sufferers have had to be satisfied with the chondrointin/glucosamine placebo effect (There are a lot of studies finding little to no benefit from this well-markted remedy; an example- Houpt JB, McMillan R, Wein C, Paget-Dellio SD. Effect of glucosamine hydrochloride in the treatment of pain of osteoarthritis of the knee. J Rheumatol. 1999 Nov;26(11):2423-30: "CONCLUSION: There was no significant difference in pain reduction between the glucosamine hydrochloride and placebo groups as measured by WOMAC. However, the secondary endpoints of cumulative pain reduction as measured by daily diary and knee examination were favorable, suggesting that glucosamine hydrochloride benefits some patients with knee OA.")
Seeming much less scientific-y, and not so mechanical, these pills just have not delivered the way some good ol blood and guts surgery would deliver. Not necessarily in measureable outcomes, but in patient satisfaction.
Thankfully, some one has come along to hitch some mechanical device up to your knee, and give you a placebo response that way.
Note how carefully the quote is crafted: the researchers are almost admitting the goal is patient satisfaction. The same as the neighborhood palm-reader. They (the researchers, not Marie Laveaux), say: ""We look at electromagnetic pulses as a potential way to improve quality of life and independence for those who suffer from osteoarthritis of the knee."
In the meantime, a continual parade of studies repeat the finding that you need to engage in regular physical activity to stave off knee arthritis itself, and to stave off knee pain. These medication and device studies rarely perform the study the proper way: use only exercisers, or get people up to some decent level of regular physical activity, THEN test their pet theory drug or gismo.
Here is an aexample of one of a parade of studies:

Gail D. Deyle, Nancy E. Henderson, PhD, Robert L. Matekel, Michael G. Ryder, Matthew B. Garber, Stephen C. Allison. Effectiveness of Manual Physical Therapy and Exercise in Osteoarthritis of the Knee. A Randomized, Controlled Trial. Annals of Internal Medicine 2000 v. 132, 173-181.
They conclude: "A combination of manual physical therapy and supervised exercise yields functional benefits for patients with osteoarthritis of the knee and may delay or prevent the need for surgical intervention."
Why am I commeting on this at a psych blog?
I see it as the same phenomenon: we want medical establishment-authorized cures for our maladies, even when the best answer is good old fashioned work: psychotherapy work, or physical rehab / physical activity work.


This preference for the easy way out, plus the placebo effect on a soft outcome such as "patient satisfaction" makes a big market for pill pushers. And device pushers.


Should you invest in this gizmo? I don't know. If it gets marekted the right way, millions will be sold.
Does it actually work? I doubt it. Also, I am kind of afraid of it: if it is moving around calcium in knee pain cells, where else is it affecting calcium in the vicinity? You stick it on your knee, which is close to the largest bones and muscles in your body. Bones make red blood cells. I am sure it is not a good idea to mess with calcium there in the bones as they make their red blood cells.

Hopefully the physiomechanical effect is just strong enough to evoke the placebo response, so we will all be satisfied and safe.

Friday, February 26, 2010

"Growing Pains" actor Andrew "Boner" Koenig: another SSRI-related suicide?

http://www.foxnews.com/entertainment/2010/02/25/growing-pains-star-andrew-koenig-reportedly-dead/?test=latestnews

Andrew Koenig, the  actor artist from "Growing Pains," was recently reporeted missing, with a tone that indicated that those who know him were not too surprised.

Now he has been found, dead, possibly suicide, along the beautiful pathways of Vancouver's Stanley Park.

This news story tells that, ironically, he had been protesting aspests of the Chinese Olympics 2 years ago, and here he possibly decided to act on suicidal impulses at a spot where the slopes of Whistler can be seen, and where Olympic skiing is wrapping up.

His depression was recognized. For depressed people who commit suicide, especially the entertainment hollywood people, often there is substance abuse involved. This story doesn't say, and I don't know the guy myself. That Canadian beer is pretty strong, but I ahve n oidea abt substance use.

However, given that his depression as known, it is pretty darn likely that he was under prescription for an SSRI. We will have to wait and see.

The role of SSRIs contributing to suicide is a big problem, as is substance abuse, but the SSRI risk is not on the radar for the media and a lot of health care professionals. Hopefully, web sites such as
ssristories.com can make this problem more known. If no one knows about this problem, no one thinks to ask, autopsies do not test, etc.

Monday, February 15, 2010

Kids Doing Chores? Report These Parents To The Authorites!!!!

Oh, it is Framingham. Well, let's just never mind them, and turn back to our Charles coffee.

http://www.boston.com/news/local/articles/2010/02/14/more_parents_west_of_boston_are_asking_their_children_to_help_on_chores/

The Boston Globe says, "Bucking a modern trend, parents - and children - are finding value in chores"

What? Are you kidding me? Who would raise their child and have no chores? Seriously. Are there families with at least more than one child where you honestly look at your kids, and let them sit there like a bump on a log, while you drag around laundry, wash dishes, and bring groceries in from the car?

Every now and then, I have occasion to be involved in some event where some teens are helping out. It is sad and pathetic. These kids are about as useful as a screen door on a submarine. And these are good kids, not troubled youth. They have been told, and sold, that good will and enthusiasm are merits in and of themselves. Having the opinion that we should end world hunger, or clean up a littered park, is good enough. Stamps of approval.

And you know what comes next? Take them out to Mac Donald's because they did something great.

Why are all of our kids overweight and depressed?

I have a solution. It is called "being a working member of your family." It is called "we are raising an adult, not raising a child." It is called "You have two good arms, two good legs, and you are not blind. Get to work." If a kid is blind, they should be pitching in anyway. If a kid only has one arm, they should be pitching in anyway.

There is no other way. This is absolute. This is normal. Anything else is debilitating.

If a child is quadraplegic, get them to tell you when the water is boiling. Anything.

As kids grow, one of our obligations is to teach them mastery, and teach them discipline. And stuff like that. Mastery is recognizing a challenge and knowing that if you set yourself to it, you can do it. Nowadays, if you put a rake, or a carving knife, or a trash bag, or a boat oar, or a cake decorating dealio, in a teen's hands, the thing gets held in a wobbly fashion until you give up on how pathetic and worthless the child is, and do it yourself.

A few years ago, I went to carve a Halloween pumpkin with a middle-schooler. The kid was scared of the knife, and did not know how to hold it. I let hte kid START, then I pretended like the deal was to take turns. My "turn" involved finishing a Jack-O-Lantern after the kid knifed an outline.

"Helpful," sure. People, wake up. Where will we be as a society if a middle-school-age kid cannot operate a knife? A knife.

This Boston Globe article notes that in the 1970s, kid started having less chores, and we all started being obsessed with keeping these blobs safe. Safe from pcket knives, bicycle falls, whatever.

We have handicapped an entire generation.

A generation of kids have headed into the workforce with an attitude that they don't clean out the trash cans.

People - if your employer is having a tough time, it is time to sweep the parking lot and empty the trash cans either before the place opens or after it closes.

Thank God I am old enough to remember the old days. we all did chores. THere was nothing unusual about it.

NO ONE GOT HURT.

And - get this: WE ARE NOT ALL ON PSYCH MEDS.

Because we have "mastery." And follow-through. And perserverence. And, we have jobs because we go do our job and finish it, so we don't get fired for being a dead weight on our employer.

And when the money gets tight because of the economy, we know how to cook a meal. Chop vegetables. How much beans, how much water. How much rice, how much water. We can "preheat" an overn even if an over has no "preheat" setting.

In my era, not too many of us know how to iron clothes properly, if at all. To me, that is old school. You would have to go very far to find someone in my era who knew how to make their own "starch." The cleaners have gotten very inexpensive and convenient, plus we have just gotten so casual. But in the old days, everyone knew how to press a crease.

But at least in my era, we are not all overweight and depressed and entitled.

Entitled?

Yes. Like that little Dalai Lama. What do you think the kids are doing if they are not doing chores? They are playing video games. And who is doing the chores? The adults, or a maid.

So, kids grow up believing that life is about playing video games. They actually do not notice that someone does chores for them. They have no clue. They do not see the laundry getting into the waashing machine or dishes getting washed. That is background noise. That is simply interference in the way as the kids ask for another popsickle or Capri Sun or whatever kids drink now.

Some parents follow along believing they are showing their love for their child, or making their child's life so wonderful. They are handicapping their children to a life of worthlessness.

Kids must DO things, and complete them satisfactorily, which means without mommy or daddy tying up loose ends. Kids need to complete the job. Every speck.

They can master it in phases. Getting laundry together could be phase one. Gettintg it into washing machine, and learning the buttons, could be phase two. Sorting, putting away could be phase three. Ironing could be phase four.

I headed off to college from a home where we kids did chores. We did so much that we were driven to go get a teen-ager job to get out of the house, before we were driven to go live on campus. That was our reward for having motivation and gumption in life. Graduate yourself from chores and enjoy. If you quit your job, you are back in the chore rotation.

When I got to college, I was shocked to discover that many of my peers could not do laundry. This is the generation that grew up in the 1970s as kids with no chores. you can't do laundry? And we college freshman thought we were so smart, begin college kids and all. We could not operate a washing machine if our wardrobe depended on it. when SHOULD a kid be able to launder, up to ironing? Ask the older geenrations. Any normal human should certainly be able to do these things early in high school. They can ALL be mastered - including handling a hot iron - BEFORe high school age, although that is pressing it (no pun intended) - you will hear a lot more stories of people burning themselves as they learn to iron from the older generations who did this at the cusp of teenager-hood than those who learned to iron in order to look good at high school functions.

When do chores START? I kid you not - there are tons of discussions on mommy sites and parenting sites on the internet about this: chores START BEFORE kindergarten. Little things. Just cleaning up a mess. A lot of it is "pretend," mimic play. That is the root of our normal capacity and need to do things. That is how civilization rtains the next geenration. With a four-year-old playing with a broom as mommy or daddy sweeps. That is the jump-start. It is not "cute," and a passing phase. That is the beginning, and you should never let up.

Kids need to be doing these things. It develops hardiness. You learn to rely on people coaching and training, you, oyu learn to pay attention, and you learn that, no matter what happens to you in life, you will have the ability to deal with it. But we raise our kids exactly as you might raise a quadraplegic. Lifting their feet to vacuum under them.

In a household, when WE all share the work, it is easiest on all of us. Life is not drudgery. you just do it, knock it out, and move on. Please don't think I am declaring that any kid should do chores 24/7. No. Just be normal.

Our BONES need physical strain to properly grow. When astronuats go into outer space, with no gravity, they MUST do special exercise, or they lose bone mass. Even within 2 weeks. Now, think about this. Only the mose awesome people get to go into outer space. They are not sending old ladies with osteoporosis. They are sending fit, robust adults. The normal way to maintain bone health is WORK. Same with mental health.

This is how it is with our mental health. We must be doing things, and accomplishing things, in order to be normal. This is not a "cure" for depression. It is "normal." Depression is abnormal. Or, it used to be. Now, depresson is normal, and so are the meds. And there is a generational trend to all of this.

Kids need to be doing chores. And completing the work. No wonder Biederman has such an easy time finding childhood bipolar disorder cases in Boston. And preschool bipolar. Here is a "treatment" for ya: a mop and a bucket. Get to work.

Wednesday, February 10, 2010

An update on Drug Sales Manual V (DSM-V). And: "Intellectual Disability" is the new MR.

http://www.msnbc.msn.com/id/35319386/ns/health-mental_health/

"Big changes proposed in psychiatric diagnoses"

OK, I am getting old. When I first began my involvement in mental health/mental illness/psychological/psychiatric treatment, the diagnostic code book was the DSM-III, yellow-and-green.

I had no idea what significance was involved as DSM-III was succeeded by DSM-III-R - blue-with-yellow. But that blue cover seemed so much more sophisticated.

Then came DSM-IV - maroon - wow - did that look like burnished leather! next to the blue.

Then DSM-IV-TR: the silver! Distinguished.

Now: DSM-V? Through my experiences, I understand what the DSM is and is not; what it does and does not do. I lyself am not looking for some great advancements in mental health treatment no matter what color this book will be.

I do agree with critics out there that we are likely to see more diagnoses, including more things that will make us wonder if these things really fall into the range of "mental disorders" (the DSM's term).

I certainly believe that there is heavy influence from Big Pharma to use any new diagnosis as an opportunity to give physicians an easy answer: pills. Pills that happen to be under patent. The conflicts of interest noted regarding the people developing DSM-V surely make it clear that big money is at stake.

I am getting older and more cynical.

Another sign I am getting older: how we label problems of lower-intellectual-functioning is again changing. The history books say the old terms were "imbecile, "moron," etc. At the time, did these sound as benign as I believe "mentally retarted," or "mental retardation," sounds to me now?

Does MR sound old? Is "intellectual disability" better?

In the future, will "intellectual disability" sound bad, like it sounds bad to describe a physically handicapped person as "crippled" sounds? As bad as "moron" sounds?

Are we getting better at naming these problems, or do we just need to periodically update our terms, as the current term collects a pejorative, innacurate connotation? Should we figure out what the lifetime of each term is? Should focus groups be done regularly to monitor the point when "intellectual disability" changes from sounding OK to sounding like an insult?

We will see.

Wednesday, February 3, 2010

Not in mood for a couple months to hassle with editor settings.

All of a sudden, back in November, I could not use the 'copy/paste' feature here.

I am always busy. I did not have time to goof around and figure out why this would not work anymore. I usually compose my posts in some other editor, then copy them into this blog. All of a sudden, that stopped working.

I took a few moments to get into this problem - I found no explanation, but opted for the choice of the 'new and improved' blog editor. that has solved the problem.

Good thing, because I have a backlog of ideas to post.

I really have to get these thoughts and observations posted here, or else people in my physical world will have to listen to me rant about these mental health topics, and they really don't care as much as I do, plus they have to listen to me make the same points over and over.

Here, I can post and feel like I have made my point, and that my point does not die away wit the fading echo of my noisy rants. Here, it stays and reverberates without my continued effort.

The allure of the "Genetic Disease." HIV, malaria genetic? I don't understand it.

http://www.nytimes.com/interactive/2008/05/05/science/20080506_DISEASE.html#

At this link, there is a super cool visual display of what is supposed to be the sahred genetic contribution of genes to a wide range of diseases.

Look closer with the magnifying glass. Near Asthma, to the W and to the SE.

HIV is a genetic disorder?

Malaria is a genetic disorder?

They share common genes, and thus common diease cause, with asthma?

OK, there ya have it. Remember this the next time NAMI or whomever tries to tell you somethingg completely opposite to what your common sense tells you: that all of these mental disorders are "biologically based brain disorders," with genetic explantions and pharmaceutical cures.

I have drunk the kool-aid, and believe that malaria and HIV are infectious disease.