Troops at Odds With Ethics Standards

Army Also Finds More Deployment Means More Mental Illness

More than one-third of U.S. soldiers in Iraq surveyed by the Army said they believe torture should be allowed if it helps gather important information about insurgents, the Pentagon disclosed yesterday. Four in 10 said they approve of such illegal abuse if it would save the life of a fellow soldier.

In addition, about two-thirds of Marines and half the Army troops surveyed said they would not report a team member for mistreating a civilian or for destroying civilian property unnecessarily. "Less than half of Soldiers and Marines believed that non-combatants should be treated with dignity and respect," the Army report stated.

READ MORE @ Washington Post

STAR*D Depression Study Finds Cognitive Therapy Equivalent To Medication But Selected By Fewer Patients

In the federally funded Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study, outcomes for cognitive therapy as a second-step treatment were not different from outcomes of medication therapy. However, random assignment in this STAR*D level was based on each patient's treatment preferences, and only 26 percent of the patients accepted cognitive therapy as an option. These findings are reported in two articles in the May issue of The American Journal of Psychiatry (AJP), the official journal of the American Psychiatric Association (APA).

The treatment results are presented in "Cognitive Therapy as a Second-Step Treatment: A STAR*D Report," by Michael E. Thase, M.D., of the University of Pittsburgh, and other STAR*D investigators. The patients in the second treatment step had discontinued citalopram in the first treatment phase, either because it was not effective for them or because the side effects were too burdensome.

READ MORE @ Medical News Today

READ MORE @ NIMH

Following the Script: How Drug Reps Make Friends and Influence Doctors

It's my job to figure out what a physician's price is. For some it's dinner at the finest restaurants, for others it's enough convincing data to let them prescribe confidently and for others it's my attention and friendship...but at the most basic level, everything is for sale and everything is an exchange. —Shahram Ahari

You are absolutely buying love. —James Reidy

In 2000, pharmaceutical companies spent more than 15.7 billion dollars on promoting prescription drugs in the United States. More than 4.8 billion dollars was spent on detailing, the one-on-one promotion of drugs to doctors by pharmaceutical sales representatives, commonly called drug reps. The average sales force expenditure for pharmaceutical companies is $875 million annually.

Unlike the door-to-door vendors of cosmetics and vacuum cleaners, drug reps do not sell their product directly to buyers. Consumers pay for prescription drugs, but physicians control access. Drug reps increase drug sales by influencing physicians, and they do so with finely titrated doses of friendship. This article, which grew out of conversations between a former drug rep (SA) and a physician who researches pharmaceutical marketing (AFB), reveals the strategies used by reps to manipulate physician prescribing.

READ MORE @ PLoS Medicine

READ MORE @ Pharmalot

Mental health worsens as deployments lengthen

The Mental Health Advisory Team (MHAT) IV Operation Iraqi Freedom Final Report, (2.3 MB pdf) dated November 17, 2006(!) surfaced today.

READ MORE @ CNN

Several findings, including one-third of troops report mental conditions, including acute stress, but clearly the report evaded stating clearly the effect of war and suffering on soldiers.

Who is the biggest purchaser of psychiatric medication in the world? That's right - the US Government. (General Motors is the largest buyer of Viagra and Lipitor.)

READ MORE @ transcript of the DoD press conference

READ MORE @ Army Times

The Doctor-Patient Relationship in Pharmacotherapy

The Doctor-Patient Relationship in Pharmacotherapy
Improving Treatment Effectiveness
By Allan Tasman, Michelle B. Riba, and Kenneth R. Silk
182 Pages - May 2000

"It's the relationship that matters! That message encapsulates this volume's critically important lesson for psychiatrists. Even when medications are the primary modality of treatment and sessions are brief, the psychiatrist patient relationship is the hinge on which the efficacy of treatment depends. Attention paid to our patients as unique individuals rewards them as well as ourselves."

-Paul S. Appelbaum, MD, University of Massachusetts Medical School

Buy it cheap @ $7.50 from Guilford Press

Behind The Curtain: Lilly Discloses Grants

In a long overdue move, Lilly today will release a report detailing the grant money given to non-profit groups and educational institutions. In this year's first quarter, for instance, the drugmaker gave $11.8 million to universities, foundations devoted to disease research and awareness, and companies that are in the continuing education business.

For instance, the largest single grant was $825,000 to Massachusetts General Hospital's psychiatry department for a year-long educational program with more than 150,000 registrants. And the National Alliance for the Mentally Ill, an advocacy group for patients, received $544,500. Of that, $450,000 went to fund a project called "Campaign for the Mind of America."

READ MORE @ Pharmalot

Antidepressant Warnings, Health Benefits in Coffee

NPR's News & Notes kicks off a regular, Thursday conversation on health, medicine and the black community. This week, Dr. Ivan Walks, former Chief Health Officer of the District of Columbia, talks to Tony Cox about new warnings about antidepressants, as well as the possible benefits of a morning cup of coffee.

LISTEN @ NPR's News & Notes

Puzzle of antipsychotic drug weight gain solved

Researchers said on Monday they have pinpointed the reason some drugs used to treat mental illnesses like schizophrenia cause patients to gain a lot of weight, raising hope for developing drugs without this side effect.

Antipsychotic medications such as Zyprexa, made by Eli Lilly and Co., increase the activity of an enzyme called AMPK in cells in the part of the brain that regulates eating behavior, according to research in mice led by scientists at Johns Hopkins University in Baltimore.

READ MORE @ Reuters

FDA expands antidepressant warning to young adults

Young adults beginning treatment with antidepressants should be warned about an increased risk of suicidal thoughts and behavior, federal health officials said Wednesday.

The Food and Drug Administration proposed labeling changes that would expand a warning now on all antidepressants. The current language applies only to children and adolescents. The expanded warning would apply to adults 18-24 during the first month or two of treatment with the drugs, the FDA said.

The proposed labeling changes also would note that studies have not shown this increased risk in adults older than 24, and that adults 65 and older taking antidepressants have a decreased risk of suicidal thoughts and behavior, it said.

http://www.cnn.com/2007/HEALTH/05/02/antidepressants.suicide.ap/index.html

Older schizophrenia drug works, costs less: study

A new study finds that an older antipsychotic drug is cheaper and equally effective for some patients with schizophrenia, sending makers of newer drugs scrambling to defend their products on Friday.

The American Journal of Psychiatry study concluded that the older, first-generation antipsychotic drug perphenazine was less expensive and as effective as newer medications such as AstraZeneca Plc's Seroquel and Eli Lilly and Co.'s Zyprexa.

Funded by the U.S. National Institutes of Health, the $42.6 million study suggests doctors should consider the use of older antipsychotics as a first choice for patients with schizophrenia, a group of psychotic diseases marked by delusions and hallucinations.

"There could be a very useful role -- from a clinical and cost-effectiveness standpoint -- for greater utilization of some older-generation medications," said Dr. Jeffrey Lieberman, a psychiatrist at Columbia University Medical Center and the study's lead author.

READ MORE @ Reuters

Metformin slows antipsychotic drug weight gain

Metformin safely and effectively abrogates weight gain and adverse metabolic changes that occur with atypical antipsychotic drug therapy in children, a new study shows.

"Weight gain was shown recently to be the most important factor leading to noncompliance with these very effective medications," study leader Dr. David J. Klein, from Cincinnati Children's Hospital Medical Center, Ohio, told Reuters Health.

Atypical antipsychotics generally have fewer side effects than some of the older antipsychotic drugs. Some of the drugs in this newer class of antipsychotics commonly prescribed include risperidone, sold as Risperdal; quetiapine, sold as Seroquel; and olanzapine, sold as Zyprexa.

READ MORE @ Reuters

Primary text: American Journal of Psychiatry, December 2006

Fish oils, vitamins, herbs helpful for depression

Diet and nutrition may play a key role in helping people fight depression, Australian researchers report.

A number of nutrients, including polyunsaturated fatty acids, St. John's Wort and several B vitamins, have the potential to influence mood by increasing the absorption of chemical messengers in the brain, Dr. Dianne Volker of the University of Sydney in Chippendale and Jade Ng of Goodman Fielder Commercian in North Ryde, New South Wales note in the journal Nutrition and Dietetics.

There is a wealth of epidemiological, experimental and circumstantial evidence to suggest that fish and the oils they contain, in particular omega-3 polyunsaturated fatty acid, are protective against depression, Volker and Ng write. They point out that the balance between omega-3 and omega-6 may also be important, given that the latter can prevent the body from absorbing the former.

READ MORE @ Reuters

Antipsychotic drugs linked to sexual function

Sexual dysfunction and hypogonadism are common in patients taking antipsychotics for schizophrenia or schizoaffective disorder, according to findings published in the March issue of the Journal of Clinical Psychiatry.

In a cross-sectional analysis, Dr. Oliver D. Howes and colleagues from the Institute of Psychiatry, London, UK, examined rates of sexual dysfunction and hypogonadism in 103 patients with schizophrenia or schizoaffective disorder stabilized on antipsychotic medication for at least 6 months. They were compared with 62 normal controls recruited from primary care attendees and with 57 subjects recruited from a sexual dysfunction clinic.

READ MORE @ Reuters

Primary text: J Clin Psychiatry 2007;68:361-367.

Drug Trials For Painkiller Addicts

Pill-popping addicts could get dope through NYU Medical Center and Bellevue Hospital - just like heroin junkies receive methadone - to wean them off the prescription pain killers that have bedeviled celebrities such as Anna Nicole Smith and Rush Limbaugh, The Post has learned.

The National Institute on Drug Abuse is launching its first large scale Prescription Opiate Addiction Treatment Study at 12 sites across the country, including the NYU/Bellevue primary-care clinic. The drug trials will test the effectiveness of buprenorphone/naloxone tablets - marketed as Suboxone - to break patients' addictions to painkillers such as Vicodin and OxyContin. The tablets will be accompanied by different levels of drug-abuse counseling, a key aspect of the study.

READ MORE @ New York Post

JNJ's Janssen closer to new Invega OK

Diversified health-care products maker Johnson & Johnson on Friday said its Janssen-Cilag unit's schizophrenia drug candidate Invega received a positive recommendation from European regulators.

The Committee for Human Medicinal Products in the European Union gave the drug a positive recommendation for approval. The drug will likely be approved in the European Union based on the positive recommendation. Also Friday, the U.S. Food and Drug Administration approved the drug as a long-term treatment for schizophrenia. It had already been approved as a short-term treatment.

READ MORE @ Hemscott.com

Patients Diagnosed Schizophrenic and Bipolar to boost Seroquel Sales

For over a decade, drug makers have been influencing doctors to diagnose patients, especially those covered by public health care programs like Medicare and Medicaid, with mental illnesses to justify the over-prescribing of the new class of drugs known as "atypical" antipsychotics.

For instance, Seroquel, marketed by AstraZeneca, is only FDA approved to treat acute manic episodes associated with bipolar I disorder and schizophrenia, and yet it is one of the most widely prescribed drugs in the world.

Astra reports that over 16 million patients have taken Seroquel since it came on the market in 1997, and the drug had sales of close to three and a half billion dollars in 2006, according to SEC filings.

READ MORE @ Lawyers & Settlements

Vigilance Still Necessary for Atypical Antipsychotics

Atypical antipsychotic medications have improved adverse-event profiles compared with the older generation of antipsychotics, but careful attention to major side effects is still required.

The overall medication plan should address the major side effect concerns of each patient, said Daniel E. Casey, M.D., of the Oregon Health and Science University in Portland, in a presentation here at the U.S. Psychiatric and Mental Health Congress regional extension.

“Choose your medications with the principle ‘first do no harm’ in mind,” he said. “Chose the drug with the lowest side effect profile.”

READ MORE @ from Psychiatric Times

Primary source: U.S. Psychiatric and Mental Health Congress

Johnson n Johnson schizophrenia drug gets wider US approval

Johnson & Johnson said on Friday that U.S. health regulators have broadened the approval for its Invega antipsychotic drug as a long-term maintenance treatment for schizophrenia.

The drug, a longer-acting version of J&J’s Risperdal, was approved in December to treat acute, or short-term, schizophrenia.

READ MORE @ at Reuters