From: owner-fegmaniax-digest@smoe.org (fegmaniax-digest) To: fegmaniax-digest@smoe.org Subject: fegmaniax-digest V16 #200 Reply-To: fegmaniax@smoe.org Sender: owner-fegmaniax-digest@smoe.org Errors-To: owner-fegmaniax-digest@smoe.org Precedence: bulk fegmaniax-digest Saturday, May 12 2007 Volume 16 : Number 200 Today's Subjects: ----------------- Re: more bad ideas... [Benjamin Lukoff ] Re: more bad ideas... [2fs ] Re: more bad ideas... ["Lauren Elizabeth" ] Re: more bad ideas... ["Lauren Elizabeth" ] Re: smarter the average bear... [grutness@slingshot.co.nz] Re: more bad ideas... [Rex ] Re: more bad ideas... [Rex ] another, from my friend Mike ["Marc Holden" ] Re: more bad ideas... [Barbara Soutar ] Re: more bad ideas... [Eleanore Adams ] other people's books ["Lauren Elizabeth" ] Re: more bad ideas... [Jeff Dwarf ] Re: more bad ideas... [michaeljbachman@comcast.net] ---------------------------------------------------------------------- Date: Fri, 11 May 2007 15:56:16 -0700 (PDT) From: Benjamin Lukoff Subject: Re: more bad ideas... On Fri, 11 May 2007, 2fs wrote: > On 5/11/07, Benjamin Lukoff wrote: > > > > you've never been clinically depressed, I take it.. > > > > On Fri, 11 May 2007, Lauren Elizabeth wrote: > > > > > hi fegs, > > > > > > http://blog.wired.com/wiredscience/2007/05/chemists_try_to.html > > > > > > i never have much faith in fighting screwed-up brain chemistry by > > > screwing around with brain chemistry. > > (to Benjamin's reply) I can't speak for Lauren - and I haven't been - but > several close friends have, and while in some cases medication helped, in > others it did not - and even in those it helped, it was a long hard road > figuring out which medications did the trick, without severe side effects. Of course. I just don't like the implication (and perhaps it was inadvertent) that psychopharmaceuticals are bunk. I *have* been and while they're no panacea, they've certainly helped--in my personal case. ------------------------------ Date: Fri, 11 May 2007 18:16:12 -0500 From: 2fs Subject: Re: more bad ideas... On 5/11/07, Lauren Elizabeth wrote: > > > > http://www.nytimes.com/2007/05/10/health/10psyche.html?ei=5087%0A&em=&en=74e1f4ad10feb8b8&ex=1179028800&pagewanted=print > > The money is nice, too, he said. Dr. Realmuto's university salary is > $196,310. > > "Academics don't get paid very much," he said. If one definition of "mental illness" is being unable to discern reality from fantasy, Realmuto should be committed. Nearly $200,000 is not being paid much? "We don't have time to wait for them to prove us right," said Dr. Kent > G. Brockmann That's probably a better job than being a news anchor in Springfield... (Someone should do an article on people who share names with fictitious characters - particularly comical, stupid, or annoying ones - and see whether the sharing of names affects them to any extent. I wonder how long it took Dr. Brockmann to figure out why a significant number of his patients, hearing his name, stifled a bit of laughter at first.) - -- ...Jeff Norman The Architectural Dance Society http://spanghew.blogspot.com ------------------------------ Date: Fri, 11 May 2007 19:35:14 -0400 From: "Lauren Elizabeth" Subject: Re: more bad ideas... Benjamin Lukoff says: > Of course. I just don't like the implication (and perhaps it was > inadvertent) that psychopharmaceuticals are bunk. I *have* been and while > they're no panacea, they've certainly helped--in my personal case. i apologize if i made it sound as though i was implying that "psychopharmaceuticals are bunk." that's not how i feel at all. the article i was making a comment about was about the treatment of *addiction* with medication. and while i am all for anything that can help someone overcome an addiction, and know that medication may be a step in the initial treatment of addiction, i personally don't feel that the ultimate solution to a e.g. cocaine addiction will be found in a drug. i should have been specific in what i was saying because i am sensitive to the issue of treating depression with medication and i do know many people who have been helped with such medication. but again, i was commenting on the issue of addiction, not depression. xo - -- - -------------------------------------------------------------------------------------------------------------- "People with opinions just go around bothering one another." - The Buddha ------------------------------ Date: Fri, 11 May 2007 19:40:05 -0400 From: "Lauren Elizabeth" Subject: Re: more bad ideas... 2fs says: > On 5/11/07, Lauren Elizabeth wrote: > > > > > http://www.nytimes.com/2007/05/10/health/10psyche.html?ei=5087%0A&em=&en=74e1f4ad10feb8b8&ex=1179028800&pagewanted=print > > > > The money is nice, too, he said. Dr. Realmuto's university salary is > $196,310. > > > > "Academics don't get paid very much," he said. > > If one definition of "mental illness" is being unable to discern reality > from fantasy, Realmuto should be committed. Nearly $200,000 is not being > paid much? yeah, i noticed that too. i was thinking maybe i'm out of touch with today's family life, but i was wondering just how many damn kids of his got into princeton in order for that salary to be problematic. xo - -- - -------------------------------------------------------------------------------------------------------------- "People with opinions just go around bothering one another." - The Buddha ------------------------------ Date: Sat, 12 May 2007 11:52:01 +1200 From: grutness@slingshot.co.nz Subject: Re: smarter the average bear... >> p.s. i'm suffering a bit from the post-final blues. i think a lot >>of >> people are happy when they finish their tests but i always >>felt a bit >> lost and aimless afterwards. Anyone who's ever organised a science fiction convention will know the phenomenon known as the "dead dog party". A winding up party for the convention, which is celebrated with just those feelings. A similar sort of thing happens with other major organisational projects - a friend of mine said to me recently "I've had post-natal depression five times: after three kids and two art exhibitions". James - -- James Dignan, Dunedin, New Zealand -.-=-.-=-.-=-.-=-.-=-.-=-.-=-.-=-.-=-.-=-.-=-.-=-.-=-.-=-.-=-.- =-.-=-.-=-.- You talk to me as if from a distance .-=-.-=-.-=-. -=-. And I reply with impressions chosen from another time .-=- .-=-.-=-.-=-.-=- (Brian Eno - "By this River") -.-=-.-=-.-=-.-= ------------------------------ Date: Fri, 11 May 2007 17:21:05 -0700 From: Rex Subject: Re: more bad ideas... On 5/11/07, Lauren Elizabeth wrote: > > hi fegs, > > http://blog.wired.com/wiredscience/2007/05/chemists_try_to.html > > i never have much faith in fighting screwed-up brain chemistry by > screwing around with brain chemistry. > > reminds me of elliott smith's portrait of an alcoholic in "baby britain": > "fights problems with bigger problems." What's the Homer Simpson line? "Here's to alcohol, the cause of and solution to many of life's greatest problems..." something like that. - -Rex ------------------------------ Date: Fri, 11 May 2007 17:19:42 -0700 From: Rex Subject: Re: more bad ideas... On 5/11/07, Benjamin Lukoff wrote: > > > > (to Benjamin's reply) I can't speak for Lauren - and I haven't been - > but > > several close friends have, and while in some cases medication helped, > in > > others it did not - and even in those it helped, it was a long hard road > > figuring out which medications did the trick, without severe side > effects. > > Of course. I just don't like the implication (and perhaps it was > inadvertent) that psychopharmaceuticals are bunk. I *have* been and while > they're no panacea, they've certainly helped--in my personal case. Tricky. Like Benjamin, I've been helped by them. That said, the phase of sorting 'em out to find out what works for you... does suck rather badly (note to scorekeepers, that'd be a process I went through when I wasn't active on this list, some years ago), and I have known people who've gotten lost in that wilderness as fully as the one they were trying to escape. My condition, straight-up depression, is pretty run-of-the-mill as fucked-up brain chemistry goes, so I'm lucky. I've put a lotta energy, thought and study into the whole thing, and could hold forth about it at length, but since nobody's really arguing about it after all, I'll shut up. Other than to say that I'm more scared of people who are obviously messed-up and not seeking treatment of any kind (most people) than those of us who are at least trying to figure out if anything's wrong with us, and, if so, what. PS, I have six guitars in my car right now (counting basses, banjos, etc.) Dunno if there's medication for that. - -Rex ------------------------------ Date: Fri, 11 May 2007 16:05:41 -0700 From: "Marc Holden" Subject: another, from my friend Mike Date: Fri, 11 May 2007 12:53:25 +0100 From: hssmrg@bath.ac.uk Subject: Stunning Madcap performances Kevin: > I would sell my blood to catch that lineup, if only I weren't on the > wrong continent... You'd better not read on then, Kevin! . . . . . . . . . . . . . . . . The highlights for me were Kate Mcgarrigle (Piano And Vocals), her daughter Martha Wainwright and Marthas cousin (vocals) Singing 'Golden Hair And See Emily Play, But otherwise it was a wonderful evening of musical saws and songs. The show opened with a recording of Blind Boy Fuller and a cutting mentioning Pink Anderson and Floyd Council. The a massed choir trooped on stage unannounced, sang Bike and trooped off again. Kevin Ayers sang Here I Go apologising for singing it an octave too low, and one of his own songs - O Wot A Dream -dedicated to Syd, which I last saw him perform at the QEH on the Whatevershebringswesing tour, I think.. or was it 'Bananamour'? Captain Sensible performed an excellent Flaming during the first half and a sturdy Astronomy Domine during the second, complete with smoke effects; apparently he named his son Syd after Syd. The Bees played a memorable version of Octopus with spot on vocals and the only guitar playing all evening that came anywhere near Syds angular style (Robyn Chose To Play Acoustic Accompaniments When He Came On Later).. Mike Heron From The String Band Sang Matilda Mother very cheerfully. I was expecting him to sing one more song but that was it. Was I surprised that Roger Waters ended the first half? Many people in the audience certainly were. He performed a song of his own which to me sounded like a cross between 'Ebony Eyes' and 'Transcaucasian Airmachine Blues' with mentions of Arapaho Indians etc. Anyone recognise this from my inadequate description? Nick Clowes (?) a singularly unpersonable guitarist and vocalist, performed Baby Lemonade (with Damon Albarn on piano and backup vocals) in the first half and opened the second half with Chapter 24 (complete with massed choir and freaky cello solo), after the notorious 'und they are much too loud und boring' Hans Keller BBC clip (wrongly attributed to ITV in the handout). Vashti Bunyan attempted Scarecrow in a key that was too high for her and then sang Love Song; some other woman did a totally humourless The Gnome; Damon Albarn with another musical saw player (or was it the same one?) and a clarinettist performed a silly singalong version of Word Song and brought Syds nephew on stage to say something: Listen to the words, they are really important, Uncle Rogers words and songs. Robyn Hitchcock performed a fine version of Terrapin solo, wearing his trademark polka dot shirt, and Gigolo Aunt with John Paul Jones on mandolin and Ruby Wright on (you've guessed it) musical saw. Barring the Canadians, who sing as a family, his vocals were noticeably the most consistent all evening. Chrissie Hynde apologised for singing in an American accent and had a valiant stab at Wont You Miss Me? then performed a sensational Late Night - or do I mean Dark Globe (When I Woke Up Today And You Werent Here To Play Then I Wanted To Stay With You, that one).This song is a corker she said; I thought it was terrific - she should put it out as a single, if there are such things nowadays. Joe Boyd came on towards the end and thanked Nick Clowes for energy and organisation, The Boyle Family for their unmistakeable light show, the Floyds original sound man who was doing the sound, and so forth. Very interesting reminiscence on how in late 66 Syd played him about half a dozen songs and said I dont think these are right for the band - do you know any singers who would like them?. Joe was obviously so disaffected with Syd after his last poor show at The UFO Club in July 67 that he didnt really care for the 2 solo slbums at the time but he did notice that several of the songs were the same ones Syd had played him. Syd always brought a kind of bounce to everything - people walk a bit differently after hearing his songs - I hope you will walk a bit differently on the way home tonight. And how do we end a show like this? Lets bring on the Pink Floyd to play Arnold Layne! No, Roger didnt play with them, but there were Rick, Nick And Dave Gilmour on stage, looking a little older than the last time I saw them at The Crystal Palace Bowl (15th May, 1971, just looked it up). Perhaps predictably, the sound engineer missed the first line sung by Rick, but the rest of the song was all fine. The crowd went politely wild and they brought on the entire cast and the entire choir to watch Jug Band Blues accompanying Syd on vid, and to sing Bike again and then it was over. Right at the end there was a video of Syd walking away from the camera with that characteristic bounce, accompanied by the final Seconds Of Piper - Uh Uh Uh Uh Aah Uh-Uh, Uh Uh Uh Uh Aah Uh-Uh. - - - Mike Godwin PS Definitely an evening worth catching, where were you all? I only spoke to one bloke in a Soft Boys T-shirt and he hadnt heard about the Games For May show. Nobody Performed Lucifer Sam Or Rats Or Puddletown Tom Was The Underground Or Opel Or Silas Lang  or 'Vegetable Man' or 'Scream thy last scream' come to think of it - but whos counting? PPS Reservations to follow when I find the full set-list. ------------------------------ Date: Fri, 11 May 2007 23:10:04 -0400 From: Barbara Soutar Subject: Re: more bad ideas... First, thanks to those who expressed condolences to me on the death of my mother. Appreciate it very much. Second: I must comment on the psychiatric drug article posted by Lauren. While I am now on an antidepressant which has changed my life for the better (Celexa) I am opposed to children being prescribed medication. That little girl who had lost her appetite should have been prescribed marijuana! In fact, I am very familiar with Risperdal. After I had brain surgery in Sept. 2000 I became paranoid and imagined that there were cameras in the ceiling filming me, that there was an escaped convict hiding in my closet, that several of my relatives were working in the hospital in disguise, and so on. I was given Risperdal as an anti-psychotic and it worked quite well. When my husband researched it on the internet, he found that Risperdal could cause PERMANENT facial twitching. It was recommended that it only be used on a temporary basis, only for extreme cases of psychosis. (I was only on it for two months.) Tardive dyskinesia: from wikipedia: *Dyskinesia* refers to an impairment of voluntary movement. The resultant tics and other movements are often referred to as dyskinesias. Dyskinesia is sometimes caused by long-term use of anti-psychotic dopamine antagonists like the antiemetic metoclopramide . The effect of these drugs can be *tardive*, meaning the dyskinesia continues or appears even after the drugs are no longer taken. What a horrible side effect! To give this drug to people who don't need it is a crime. Barbara Soutar Victoria, BC ------------------------------ Date: Fri, 11 May 2007 23:52:19 -0700 From: Eleanore Adams Subject: Re: more bad ideas... Hi guys, been stealthing for the past year or so. Yo Bay Area fegs! Well I just started meds for depression. Good, bad or indifferent. The point being, when you are depressed you will try anything to change the situation. Meditation, food, exercise. If they all fail, you try meds or you end up dead, like our friend Elliot Smith. If meds keep you alive, then they are worth the sacrifice. Yeah, they ain't perfect, but wtf.... eleanore On May 11, 2007, at 8:10 PM, Barbara Soutar wrote: > First, thanks to those who expressed condolences to me on the death > of my mother. Appreciate it very much. > > Second: I must comment on the psychiatric drug article posted by > Lauren. While I am now on an antidepressant which has changed my > life for the better (Celexa) I am opposed to children being > prescribed medication. That little girl who had lost her appetite > should have been prescribed marijuana! > > In fact, I am very familiar with Risperdal. After I had brain > surgery in Sept. 2000 I became paranoid and imagined that there > were cameras in the ceiling filming me, that there was an escaped > convict hiding in my closet, that several of my relatives were > working in the hospital in disguise, and so on. I was given > Risperdal as an anti-psychotic and it worked quite well. When my > husband researched it on the internet, he found that Risperdal > could cause PERMANENT facial twitching. It was recommended that it > only be used on a temporary basis, only for extreme cases of > psychosis. (I was only on it for two months.) > > Tardive dyskinesia: from wikipedia: > > *Dyskinesia* refers to an impairment of voluntary movement. The > resultant tics and other > movements are often referred to as dyskinesias. Dyskinesia is > sometimes caused by long-term use of anti-psychotic > dopamine antagonists > like the > antiemetic metoclopramide > . The effect of these > drugs can be *tardive*, meaning the dyskinesia continues or appears > even after the drugs are no longer taken. > > What a horrible side effect! To give this drug to people who don't > need it is a crime. > > Barbara Soutar > Victoria, BC ------------------------------ Date: Sat, 12 May 2007 03:36:46 -0400 From: "Lauren Elizabeth" Subject: other people's books hi fegs, i have to admit a fondness for other people's books and if i'm being completely honest here, i don't mind borrowing a t-shirt or two (the sublime ultravox song (PRE-post john foxx) "someone else's clothes" comes to mind.) my father's books are of course the best ones to borrow. he's a true book lover and i think reading for him is perhaps the redemption that catholicism didn't offer (or at least didn't pay up on soon enough.) over the years, through graduations and birthdays and such, i've become the proud owner of e.g. his college-era copies of "ulysses", "absalom, absalom" and "the sound and the fury" (i always forget whether that gets the 2nd "the") and i do really treasure them. at any rate, i was cleaning house a bit to-day and found my father's copy of don delillo's "white noise." he started reading pynchon and delillo and the so-called "postmoderns" around the time that i started reading wallace (i.e. david foster) so some of the books went back and forth between us a bit. i actually have two copes of 'white noise' that are his - one has an expanded critical essay session. shit, i can you tell right now this is way too much of a build up. i'll continue nevertheless, but i warn you - don't expect much. at any rate, i liked 'white noise' - any death fixation is okay in my book. i think my father liked 'underworld' and perhaps some more recent delillo, but i never have trouble remembering that apparently he didn't much care for 'white noise' as scribbled in his slowly-decipherable script on the last page of the novel is written: 'In the words of K.A. Porter - "If this is the future of literature, I'm grateful I have consumption.' i think i've come across that note about five times and needless to say it still amuses me. oh btw, when i've forgotton i've told you guys that story and tell it to you again, i promise to tell it better. xo p.s. which reminds me, i still haven't given marty back that syracuse sweatshirt that i accidently wore home after housesitting last summer. but, then again, he hasn't asked for it back, so i think i can keep it awhile longer. - -- - -------------------------------------------------------------------------------------------------------------- "People with opinions just go around bothering one another." - The Buddha ------------------------------ Date: Sat, 12 May 2007 00:59:49 -0700 (PDT) From: Jeff Dwarf Subject: Re: more bad ideas... Rex wrote: > What's the Homer Simpson line? "Here's to alcohol, the cause of and > solution to many of life's greatest problems..." something like > that. Close. It's "Here's to alcohol: the cause of and solution to ALL of life's problems." "Children have always enjoyed my movies. They are just not allowed to watch many of them." -- John Waters . ____________________________________________________________________________________Luggage? GPS? Comic books? Check out fitting gifts for grads at Yahoo! Search http://search.yahoo.com/search?fr=oni_on_mail&p=graduation+gifts&cs=bz ------------------------------ Date: Sat, 12 May 2007 09:43:03 +0000 From: michaeljbachman@comcast.net Subject: Re: more bad ideas... - -------------- Original message -------------- From: "Lauren Elizabeth" > Benjamin Lukoff wrote: > > you've never been clinically depressed, I take it.. > > i'll just say imo one could be well acquainted with depression and > still be of the opinion that drugs are not necessarily the way to go > when looking to treat addiction. > > when i posted that i admit was feeling somewhat contrary**, but i > didn't say anything that way too far off from how i really i feel. > > ** in part from reading this: > http://www.nytimes.com/2007/05/10/health/10psyche.html?ei=5087%0A&em=&en=74e1f4a d10feb8b8&ex=1179028800&pagewanted=print > > the ny times article is about a few things really and not all > necessarily directly related, but it does start to get on my nerves > how many problems "more drugs" seems to be the "answer" to. > > the article's kind of long so it would be kind of impolite to post it, > but it's a register site so it would kind of impolite not to post it. > fuck it: > > << > May 10, 2007 > Psychiatrists, Children and Drug Industry's Role > By GARDINER HARRIS, BENEDICT CAREY and JANET ROBERTS > > When Anya Bailey developed an eating disorder after her 12th birthday, > her mother took her to a psychiatrist at the University of Minnesota > who prescribed a powerful antipsychotic drug called Risperdal. > > Created for schizophrenia, Risperdal is not approved to treat eating > disorders, but increased appetite is a common side effect and doctors > may prescribe drugs as they see fit. Anya gained weight but within two > years developed a crippling knot in her back. She now receives regular > injections of Botox to unclench her back muscles. She often awakens > crying in pain. > > Isabella Bailey, Anya's mother, said she had no idea that children > might be especially susceptible to Risperdal's side effects. Nor did > she know that Risperdal and similar medicines were not approved at the > time to treat children, or that medical trials often cited to justify > the use of such drugs had as few as eight children taking the drug by > the end. > > Just as surprising, Ms. Bailey said, was learning that the university > psychiatrist who supervised Anya's care received more than $7,000 from > 2003 to 2004 from Johnson & Johnson, Risperdal's maker, in return for > lectures about one of the company's drugs. > > Doctors, including Anya Bailey's, maintain that payments from drug > companies do not influence what they prescribe for patients. > > But the intersection of money and medicine, and its effect on the > well-being of patients, has become one of the most contentious issues > in health care. Nowhere is that more true than in psychiatry, where > increasing payments to doctors have coincided with the growing use in > children of a relatively new class of drugs known as atypical > antipsychotics. > > These best-selling drugs, including Risperdal, Seroquel, Zyprexa, > Abilify and Geodon, are now being prescribed to more than half a > million children in the United States to help parents deal with > behavior problems despite profound risks and almost no approved uses > for minors. > > A New York Times analysis of records in Minnesota, the only state that > requires public reports of all drug company marketing payments to > doctors, provides rare documentation of how financial relationships > between doctors and drug makers correspond to the growing use of > atypicals in children. > > From 2000 to 2005, drug maker payments to Minnesota psychiatrists rose > more than sixfold, to $1.6 million. During those same years, > prescriptions of antipsychotics for children in Minnesota's Medicaid > program rose more than ninefold. > > Those who took the most money from makers of atypicals tended to > prescribe the drugs to children the most often, the data suggest. On > average, Minnesota psychiatrists who received at least $5,000 from > atypical makers from 2000 to 2005 appear to have written three times > as many atypical prescriptions for children as psychiatrists who > received less or no money. > > The Times analysis focused on prescriptions written for about > one-third of Minnesota's Medicaid population, almost all of whom are > disabled. Some doctors were misidentified by pharmacists, but the > information provides a rough guide to prescribing patterns in the > state. > > Drug makers underwrite decision makers at every level of care. They > pay doctors who prescribe and recommend drugs, teach about the > underlying diseases, perform studies and write guidelines that other > doctors often feel bound to follow. > > But studies present strong evidence that financial interests can > affect decisions, often without people knowing it. > > In Minnesota, psychiatrists collected more money from drug makers from > 2000 to 2005 than doctors in any other specialty. Total payments to > individual psychiatrists ranged from $51 to more than $689,000, with a > median of $1,750. Since the records are incomplete, these figures > probably underestimate doctors' actual incomes. > > Such payments could encourage psychiatrists to use drugs in ways that > endanger patients' physical health, said Dr. Steven E. Hyman, the > provost of Harvard University and former director of the National > Institute of Mental Health. The growing use of atypicals in children > is the most troubling example of this, Dr. Hyman said. > > "There's an irony that psychiatrists ask patients to have insights > into themselves, but we don't connect the wires in our own lives about > how money is affecting our profession and putting our patients at > risk," he said. > > The Prescription > > Anya Bailey is a 15-year-old high school freshman from East Grand > Forks, Minn., with pictures of the actor Chad Michael Murray on her > bedroom wall. She has constant discomfort in her neck that leads her > to twist it in a birdlike fashion. Last year, a boy mimicked her in > the lunch room. > > "The first time, I laughed it off," Anya said. "I said: 'That's so > funny. I think I'll laugh with you.' Then it got annoying, and I > decided to hide it. I don't want to be made fun of." > > Now she slumps when seated at school to pressure her clenched muscles, she said. > > It all began in 2003 when Anya became dangerously thin. "Nothing > tasted good to her," Ms. Bailey said. > > Psychiatrists at the University of Minnesota, overseen by Dr. George > M. Realmuto, settled on Risperdal, not for its calming effects but for > its normally unwelcome side effect of increasing appetite and weight > gain, Ms. Bailey said. Anya had other issues that may have recommended > Risperdal to doctors, including occasional angry outbursts and having > twice heard voices over the previous five years, Ms. Bailey said. > > Dr. Realmuto said he did not remember Anya's case, but speaking > generally he defended his unapproved use of Risperdal to counter an > eating disorder despite the drug's risks. "When things are dangerous, > you use extraordinary measures," he said. > > Ten years ago, Dr. Realmuto helped conduct a study of Concerta, an > attention deficit hyperactivity disorder drug marketed by Johnson & > Johnson, which also makes Risperdal. When Concerta was approved, the > company hired him to lecture about it. > > He said he gives marketing lectures for several reasons. > > "To the extent that a drug is useful, I want to be seen as a leader in > my specialty and that I was involved in a scientific study," he said. > > The money is nice, too, he said. Dr. Realmuto's university salary is $196,310. > > "Academics don't get paid very much," he said. "If I was an > entertainer, I think I would certainly do a lot better." > > In 2003, the year Anya came to his clinic, Dr. Realmuto earned $5,000 > from Johnson & Johnson for giving three talks about Concerta. Dr. > Realmuto said he could understand someone's worrying that his Concerta > lecture fees would influence him to prescribe Concerta but not a > different drug from the same company, like Risperdal. > > In general, he conceded, his relationship with a drug company might > prompt him to try a drug. Whether he continued to use it, though, > would depend entirely on the results. > > As the interview continued, Dr. Realmuto said that upon reflection his > payments from drug companies had probably opened his door to useless > visits from a drug salesman, and he said he would stop giving > sponsored lectures in the future. > > Kara Russell, a Johnson & Johnson spokeswoman, said that the company > selects speakers who have used the drug in patients and have either > undertaken research or are aware of the studies. "Dr. Realmuto met > these criteria," Ms. Russell said. > > When asked whether these payments may influence doctors' prescribing > habits, Ms. Russell said that the talks "provide an educational > opportunity for physicians." > > No one has proved that psychiatrists prescribe atypicals to children > because of drug company payments. Indeed, some who frequently > prescribe the drugs to children earn no drug industry money. And > nearly all psychiatrists who accept payments say they remain > independent. Some say they prescribed and extolled the benefits of > such drugs before ever receiving payments to speak to other doctors > about them. > > "If someone takes the point of view that your doctor can be bought, > why would you go to an E. R. with your injured child and say, 'Can you > help me?' " said Dr. Suzanne A. Albrecht, a psychiatrist from Edina, > Minn., who earned more than $188,000 from 2002 to 2005 giving drug > marketing talks. > > The Industry Campaign > > It is illegal for drug makers to pay doctors directly to prescribe > specific products. Federal rules also bar manufacturers from promoting > unapproved, or off-label, uses for drugs. > > But doctors are free to prescribe as they see fit, and drug companies > can sidestep marketing prohibitions by paying doctors to give lectures > in which, if asked, they may discuss unapproved uses. > > The drug industry and many doctors say that these promotional lectures > provide the field with invaluable education. Critics say the payments > and lectures, often at expensive restaurants, are disguised kickbacks > that encourage potentially dangerous drug uses. The issue is > particularly important in psychiatry, because mental problems are not > well understood, treatment often involves trial and error, and > off-label prescribing is common. > > The analysis of Minnesota records shows that from 1997 through 2005, > more than a third of Minnesota's licensed psychiatrists took money > from drug makers, including the last eight presidents of the Minnesota > Psychiatric Society. > > The psychiatrist receiving the most from drug companies was Dr. > Annette M. Smick, who lives outside Rochester, Minn., and was paid > more than $689,000 by drug makers from 1998 to 2004. At one point Dr. > Smick was doing so many sponsored talks that "it was hard for me to > find time to see patients in my clinical practice," she said. > > "I was providing an educational benefit, and I like teaching," Dr. Smick said. > > Dr. Steven S. Sharfstein, immediate past president of the American > Psychiatric Association, said psychiatrists have become too cozy with > drug makers. One example of this, he said, involves Lexapro, made by > Forest Laboratories, which is now the most widely used antidepressant > in the country even though there are cheaper alternatives, including > generic versions of Prozac. > > "Prozac is just as good if not better, and yet we are migrating to the > expensive drug instead of the generics," Dr. Sharfstein said. "I think > it's the marketing." > > Atypicals have become popular because they can settle almost any > extreme behavior, often in minutes, and doctors have few other answers > for desperate families. > > Their growing use in children is closely tied to the increasingly > common and controversial diagnosis of pediatric bipolar disorder, a > mood problem marked by aggravation, euphoria, depression and, in some > cases, violent outbursts. The drugs, sometimes called major > tranquilizers, act by numbing brain cells to surges of dopamine, a > chemical that has been linked to euphoria and psychotic delusions. > > Suzette Scheele of Burnsville, Minn., said her 17-year-old son, Matt, > was given a diagnosis of bipolar disorder four years ago because of > intense mood swings, and now takes Seroquel and Abilify, which have > caused substantial weight gain. > > "But I don't have to worry about his rages; he's appropriate; he's > pleasant to be around," Ms. Scheele said. > > The sudden popularity of pediatric bipolar diagnosis has coincided > with a shift from antidepressants like Prozac to far more expensive > atypicals. In 2000, Minnesota spent more than $521,000 buying > antipsychotic drugs, most of it on atypicals, for children on > Medicaid. In 2005, the cost was more than $7.1 million, a 14-fold > increase. > > The drugs, which can cost $1,000 to $8,000 for a year's supply, are > huge sellers worldwide. In 2006, Zyprexa, made by Eli Lilly, had $4.36 > billion in sales, Risperdal $4.18 billion and Seroquel, made by > AstraZeneca, $3.42 billion. > > Many Minnesota doctors, including the president of the Minnesota > Psychiatric Society, said drug makers and their intermediaries are now > paying them almost exclusively to talk about bipolar disorder. > > The Diagnoses > > Yet childhood bipolar disorder is an increasingly controversial > diagnosis. Even doctors who believe it is common disagree about its > telltale symptoms. Others suspect it is a fad. And the scientific > evidence that atypicals improve these children's lives is scarce. > > One of the first and perhaps most influential studies was financed by > AstraZeneca and performed by Dr. Melissa DelBello, a child and adult > psychiatrist at the University of Cincinnati. > > Dr. DelBello led a research team that tracked for six weeks the moods > of 30 adolescents who had received diagnoses of bipolar disorder. Half > of the teenagers took Depakote, an antiseizure drug used to treat > epilepsy and bipolar disorder in adults. The other half took Seroquel > and Depakote. > > The two groups did about equally well until the last few days of the > study, when those in the Seroquel group scored lower on a standard > measure of mania. By then, almost half of the teenagers getting > Seroquel had dropped out because they missed appointments or the drugs > did not work. Just eight of them completed the trial. > > In an interview, Dr. DelBello acknowledged that the study was not > conclusive. In the 2002 published paper, however, she and her > co-authors reported that Seroquel in combination with Depakote "is > more effective for the treatment of adolescent bipolar mania" than > Depakote alone. > > In 2005, a committee of prominent experts from across the country > examined all of the studies of treatment for pediatric bipolar > disorder and decided that Dr. DelBello's was the only study involving > atypicals in bipolar children that deserved its highest rating for > scientific rigor. The panel concluded that doctors should consider > atypicals as a first-line treatment for some children. The guidelines > were published in The Journal of the American Academy of Child and > Adolescent Psychiatry. > > Three of the four doctors on the panel served as speakers or > consultants to makers of atypicals, according to disclosures in the > guidelines. In an interview, Dr. Robert A. Kowatch, a psychiatrist at > Cincinnati Children's Hospital and the lead author of the guidelines, > said the drug makers' support had no influence on the conclusions. > > AstraZeneca hired Dr. DelBello and Dr. Kowatch to give sponsored > talks. They later undertook another study comparing Seroquel and > Depakote in bipolar children and found no difference. Dr. DelBello, > who earns $183,500 annually from the University of Cincinnati, would > not discuss how much she is paid by AstraZeneca. > > "Trust me, I don't make much," she said. Drug company payments did not > affect her study or her talks, she said. In a recent disclosure, Dr. > DelBello said that she received marketing or consulting income from > eight drug companies, including all five makers of atypicals. > > Dr. Realmuto has heard Dr. DelBello speak several times, and her talks > persuaded him to use combinations of Depakote and atypicals in bipolar > children, he said. "She's the leader in terms of doing studies on > bipolar," Dr. Realmuto said. > > Some psychiatrists who advocate use of atypicals in children > acknowledge that the evidence supporting this use is thin. But they > say children should not go untreated simply because scientists have > failed to confirm what clinicians already know. > > "We don't have time to wait for them to prove us right," said Dr. Kent > G. Brockmann, a psychiatrist from the Twin Cities who made more than > $16,000 from 2003 to 2005 doing drug talks and one-on-one sales > meetings, and last year was a leading prescriber of atypicals to > Medicaid children. > > The Reaction > > For Anya Bailey, treatment with an atypical helped her regain her > appetite and put on weight, but also heavily sedated her, her mother > said. She developed the disabling knot in her back, the result of a > nerve condition called dystonia, in 2005. > > The reaction was rare but not unknown. Atypicals have side effects > that are not easy to predict in any one patient. These include rapid > weight gain and blood sugar problems, both risk factors for diabetes; > disfiguring tics, dystonia and in rare cases heart attacks and sudden > death in the elderly. > > In 2006, the Food and Drug Administration received reports of at least > 29 children dying and at least 165 more suffering serious side effects > in which an antipsychotic was listed as the "primary suspect." That > was a substantial jump from 2000, when there were at least 10 deaths > and 85 serious side effects among children linked to the drugs. Since > reporting of bad drug effects is mostly voluntary, these numbers > likely represent a fraction of the toll. > > Jim Minnick, a spokesman for AstraZeneca, said that the company > carefully monitors reported problems with Seroquel. "AstraZeneca > believes that Seroquel is safe," Mr. Minnick said. > > Other psychiatrists renewed Anya's prescriptions for Risperdal until > Ms. Bailey took Anya last year to the Mayo Clinic, where a doctor > insisted that Ms. Bailey stop the drug. Unlike most universities and > hospitals, the Mayo Clinic restricts doctors from giving drug > marketing lectures. > > Ms. Bailey said she wished she had waited to see whether counseling > would help Anya before trying drugs. Anya's weight is now normal > without the help of drugs, and her counseling ended in March. An > experimental drug, her mother said, has recently helped the pain in > her back. > This article is by Gardiner Harris, Benedict Carey and Janet Roberts. > >> > Depression runs pretty thick among the female members of my dads family, as two of his four sisters are on meds for the rest of their lives as well as my older sister. My eldest aunt even went through shock treatment during the 1960's. It's been really hard dealing with my older sister as she is in a bad marriage with a spineless husband who thinks she only needs therapy once every three weeks and a son who is a total user. MJ Bachman ------------------------------ End of fegmaniax-digest V16 #200 ********************************