Editor’s Comment |
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| A common theme of this month’s issues is CHANGE. The mental health field is CHANGING.Can you imagine that we are seeing the day when major medical journal editors are claiming they won’t publish only favorable drug studies?Or that the American Psychiatric Association has a group within it dedicated to educating members about complementary and alternative treatments?
Or that England’s Royal College of General Practitioners would publicly denounce pharmaceutical firms for pushing drug sales for people who are not really in need of medication? These things and MORE are happening and the movement is snowballing. Safe Harbor would like to take some of the credit, but honestly, this is the result of the work of millions of groups and people across the planet who are insisting on greater health for themselves and their loved ones. The mental health field is traditionally the last to catch up with scientific and social advance, unfortunately, but despite that handicap, change is still happening rapidly within psychiatry. These are historic times and the staff and volunteers of Safe Harbor are happy to play whatever small role we have in them. |
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Three Announcements |
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Book Review: Teaching The Restless
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| The subtitle of Mercogliano’s book tells it all: “One School’s Remarkable No-Ritalin Approach to Helping Children Learn and Succeed.”The author challenges head-on the notion that some children need to be medicated to go to school. Instead, he demonstrates that the adults around such children can make a lot of progress using common-sense approaches that are not focused on making the child fit in.He walks us through a number of cases of children who have attended his school (the “Free School”). We see how simple but firm discipline combined with treating each kid as an individual brings results for these children so that drugs are not needed. Mercogliano clearly sees that “Ritalin kids,” as he calls special children, are not so much in need of drugs, but they are in need of sensible, caring adults who can give guidance, set examples, and use creative reasoning to bring out the best in them. | |||||||||||||
British Doctors Denounce Drug Firms’ “Disease Mongering” Tactics |
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| The Royal College of General Practitioners has accused pharmaceutical companies of “disease-mongering” as a marketing tactic.By overplaying the dangers of mild depression, slightly raised blood pressure, and the like, drug firms encourage unnecessary prescribing of costly drugs, bringing the National Health Service to the brink of collapse, the doctors’ group told a parliamentary inquiry.Dr. Maureen Baker, the college’s honorary secretary, wants the Commons health inquiry to investigate the companies’ practices.”It would be fruitful to look into the increase in disease-mongering by them,” she told The Sunday Telegraph. “It is very much in the interest of the pharmaceutical industry to draw a line that includes as large a population as possible within the ‘ill’ category. The bigger this group is, the more drugs they can sell. If current trends continue, publicly funded health-care systems will be at risk of financial collapse with huge cost to society as a whole.” The college lists hypertension, high cholesterol, osteoporosis, anxiety and depression as examples of common conditions that, in mild forms, are often inappropriately treated with drugs. Richard Ley, a spokesman for the Association of the British Pharmaceutical Industry, said: “It seems odd for this criticism to come from the Royal College of all organizations, because a decision on when and how to treat a patient is the doctor’s.” Such decisions, however, are based on treatment guidelines issued by bodies of specialist doctors. All too often such panels are heavily subsidized by pharmaceutical money, Dr. Baker pointed out. It was recently divulged that three senior members of the government’s Joint Committee on Vaccination and Immunization have received “industrial support” from Aventis Pasteur and Merck Sharp & Dome, manufacturers of a new 5-in-1 baby vaccine that the committee recommended. Some observers are also concerned about “hard-sell” tactics applied to general practice. Last year, a survey of 1,000 GPs published in the British Medical Journal found that those who saw drug company representatives at least once a week were more likely to prescribe drugs that were not needed. |
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APA Establishes Caucus On Alternative Mental Care |
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| An official satellite activity at the American Psychiatric Association’s annual meeting in May 2004 was an organizing meeting of the Caucus On Complementary, Alternative And Integrative Approaches In Mental Health Care.Twenty-eight psychiatrists convened, bringing expertise in such diverse specialties as massage therapy, yoga, prayer, dietary supplements, orthomolecular approaches, and traditional Chinese medicine. Most are Board-certified clinical psychiatrists, and some are full-time researchers at Columbia, Stanford, Harvard, Duke, et al.Following informal introductions, a draft charter was reviewed and initial goals were discussed. The central objective of the Caucus is to give physicians and mental health professionals access to accurate, clinically relevant information on safe and effective non-conventional treatments.
Three broad goals were discussed: 1. Educating mental health professionals about safe, evidence-based uses of complementary and 2. Surveying psychiatrists’ beliefs and practices with respect to alternative treatments. 3. Setting research priorities. The first goal would be addressed with courses and symposia at future APA regional and national meetings. Courses on Western herbal medicines and natural supplements have been well received in recent years. The importance of developing evidence-based clinical practice guidelines for the use of CAM or integrative approaches was discussed. The APA has established an email forum in which Caucus members can exchange perspectives on their fields of interest. A new website, http://www.apacam.org/, is now available to clinical and research psychiatrists to help them evaluate alternative treatments. Michael Cohen, JD, MBA, Associate Professor of Medicine, Center for Integrative Medicine, Harvard Medical School, has agreed to help the Caucus draw up legal guidelines for psychiatrists using or recommending alternative treatments. Psychiatrists, whether APA members or not, are invited to visit http://www.apacam.org/, complete a brief survey, and register to participate in the Caucus. |
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Fatty Acid Found In Cold-Water Fish May Arrest Alzheimer’s |
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| A diet rich in the omega-3 fatty acid DHA, found in salmon, halibut, and other cold-water fish, has been found to protect animal brains from the damage associated with Alzheimer’s disease, says a new study published in the September 2 issue of Neuron.The research was based on human studies of risk factors for Alzheimer’s disease, said study author Greg Cole, a professor of medicine and neurology at UCLA’s David Geffen School of Medicine.Many studies have linked Alzheimer’s to low intake of DHA (docosahexaenoic acid), Cole said. A constant supply of DHA is key to normal human brain function. Cole’s team focused on altering the diet of lab mice once they were 17 months old, after feeding them a normal diet high in omega-3 fatty acids during their infancy. They studied mice bred with genetic mutations that cause the lesions linked to advanced Alzheimer’s, assigning them to one of three groups. “Group one continued on the diet they had always gotten,” Cole said. “Group two was put on a special diet with no DHA. Group three’s diet had more DHA than the diet they grew up on.” Three other groups of mice without the genetic mutations, serving as controls, were given the same three diets as the genetically altered mice. After five months, the researchers compared the various groups’ brain structure. The mice with the genetic mutations fed a DHA-deficient diet had high amounts of Alzheimer’s-like brain damage in the synapses -the chemical connections between nerve cells. “The [DHA-deficient] diet and the Alzheimer’s gene interact to cause a deficit of DHA in the brains of the animals,” Cole said. The mice on the DHA-deficient diet with the genetic mutation had 90 percent more synaptic loss than those with the genetic mutation fed the DHA-rich diet. The animals with the genetic mutation whose diets had no DHA took twice as long to perform on a test of spatial memory, said study co-author Sally Frautschy, an associate professor of medicine at UCLA. The test would be roughly equivalent to a human trying to remember where he parked his car, she explained. The study breaks new ground because “it shows the disease itself depletes our brain of DHA through oxidation, and you can correct it by putting it back [via a DHA-rich diet],” Frautschy said. “The study shows that replenishing the DHA can arrest the development of Alzheimer’s, at least in animals.” Added Cole: “We have evidence that DHA works as a risk factor for Alzheimer’s disease from associated studies. We know DHA is getting oxidized in the brains of Alzheimer’s patients. And it’s practically harmless to add it back to your diet” by eating more fish, taking fish oil capsules, or eating omega-3 enriched eggs. |
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Drug Trials Found Deficient In Safety Emphasis |
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The APA’s American Journal of Psychiatry has published a study showing the pharmaceutical industry’s inattention to safety in the development of psychotropic drugs.The EU[European Union]-PSI Project devised the study to
The authors randomly selected 200 entries from the PsiTri registry of mental-health-related controlled trials (http://psitri.stakes.fi/.html). They narrowed the field to 142 randomized controlled trials, including 103 drug trials, and analyzed them for adequacy and relative emphasis on safety issues. Among drug trials, only 21.4% had adequate reporting of clinical adverse events, and only 16.5% had adequate reporting of laboratory-determined toxicity. On average, drug trials devoted 1/10 of a page in their results sections to safety, and 58.3% devoted more space to the names and affiliations of authors than to safety. |
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Journals Insist Drug Manufacturers Register All Trials |
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| A dozen editors of leading medical journals jointly announced in September that they will refuse to publish drug research sponsored by pharmaceutical companies unless the studies have been registered in a public database from the outset.”When a pharmaceutical company sponsors a clinical trial and the results turn out not to be in the best financial interests of the company, it has been our experience these results are never made public,” said Gregory D. Curfman, executive editor of the New England Journal of Medicine. “They are buried away.”So far, the Journal of the American Medical Association, the Annals of Internal Medicine, the Lancet, the New England Journal of Medicine, and several other international publications signed the initiative, intended to give physicians and the public a window on unfavorable studies they would otherwise never see.
Jeff Trewhitt of the Pharmaceutical Research and Manufacturers Association of America said several companies are already registering clinical trials on a voluntary basis, but individual companies “may have reservations about divulging proprietary information in clinical tests that are in very early phases.” Virtually the same stock phrase was used to explain the actions of the pharmaceutical companies concealing evidence that antidepressants prescribed to children are no more effective than sugar pills, and that they increase the risk of suicide attempts and suicidal ideation. The federal Food and Drug Administration Modernization Act of 1997 established a database at http://www.clinicaltrials.gov/ and required companies to register trials, but there has been no enforcement. Last year, British authorities warned doctors not to prescribe a number of antidepressants to children, but Prozac was not on the list. The FDA declined to take a similar step, commissioning a further study instead. In September, the author of the new report, FDA scientist Tarek Hammad, told investigators: “I can no longer say that Prozac is okay for children.” “It makes no scientific sense that you would find any significant difference in the effects” of the various SSRI drugs, said Dr. Steven Hyman, a Harvard psychiatrist and former director of the National Institute of Mental Health. “All target and bind to the same molecule in the brain” – the one the body uses to dampen the activity of a mood-altering brain chemical called serotonin. In any drug trial for depression, both the diagnosis and the evidence of recovery are subjective. From 31% to 59% of a “depressed” sample will feel better the next time you test them, as placebo results in the suppressed trials have shown. Christine Laine, senior deputy editor of the Annals of Internal Medicine, said the registration requirement would apply to any trial begun after July 1, 2005. For trials already in progress, she said, companies would have to register them before seeking publication. The editors hope that preserving the opportunity to publish a positive study in a prominent journal, which can greatly boost the visibility of a new drug, will be enough incentive for most companies to register their studies. If not, they would forgo favorable publicity as well – a classic case of throwing the baby out with the bath water. |
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Rheumatic Fever and “OC Spectrum Disorder” Linked |
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| Researchers have found that rheumatic fever may increase the risk of “obsessive-compulsive disorder” (OCD), tic disorders, and “body dysmorphic disorder” (BDD – exaggerated concern about physical appearance), according to a study recently published in the Journal of Clinical Psychiatry.Ana Hounie (University of Sao Paolo, Brazil) and colleagues say that their findings “reinforce the idea that OC spectrum disorders may share common underlying pathophysiologic mechanisms and vulnerability factors with RF, or that RF could trigger central nervous system late manifestations such as OC spectrum disorders.”Rheumatic fever (RF) can damage multiple organ systems, including the central nervous system. This is characterized by the movement disorder known as Sydenham’s chorea.
Previous research has indicated higher frequencies of OCD and tic disorders in patients with RF. Hounie et al assessed for OC spectrum disorders in 59 outpatients with non-acute RF. The age-corrected rate of OC spectrum disorders combined was eight times higher in RF patients than in controls, 20.89% as compared to 2.56%. “If these findings are confirmed, clinicians should be careful to investigate and recognize psychiatric symptoms in RF patients, allowing early diagnosis and treatment when necessary,” the authors concluded. |
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