Thursday, August 26, 2010

Disease Mongering Alert - Can the New York Times write an unbiased mental health article? NO - Can Preschoolers be defined as clinically depressed? NO


Disease Mongering Alert - Can the New York Times ever write an unbiased mental health article? NO - Can Preschoolers be defined as clinically depressed/bipolar? NO

I came across this article in the NY Times that I find extremely disturbing. It's another article in a major American Newspaper promoting new psychiatric diagnosis in preschool aged children.

We know from recent experiences that new psychiatric childhood diagnosis has a direct correlation to the catastrophic rise of dangerous psychiatric medications being used in toddlers with devastating consequences that will be with us and our society for many many generations to come. We are in essence abandoning our children as sacrificial lambs to greedy pharmaceutical corporate interest, and to horribly conflicted sold out charlatans that benefit financially and in academic stature from prostituting their profession to this legalized drug cartel.

I have taken excerpts from the NY Times article here for you to read. But, I also invite you to follow the link and read the whole 6 page article.

Now let me give you a little background on the main doctor they are quoting and using in this article to promote another early childhood psychiatric condition. Don't let Joan L. Luby, MD Puppet Master's facade fool you into thinking this not a deeply conflicted pharmaceutical minion that strongly believes in the drugging of children "along with the brain chemical imbalance theory" that is being now generally debunked as Hocus Pocus lunitic insanity along the same lines of Harvard's J. Biederman "second to God" and "this ain't no tushy massage" infamy .

Below Philip Dawdy at Furious Seasons Blog questioned Luby about her not disclosing her obvious conflicts of interest in Sept 2009:

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American Journal Of Psychiatry Ignores Unreported Conflicts In Its Journal:

Earlier this month, I noted that Washington University psychiatry professor Joan Luby appeared to have possible unreported conflicts of interest on three separate papers, including one on "early childhood depression" that appeared in this month's issue of the American Journal of Psychiatry. I queried the AJP's editor and the American Psychiatric Association about the situation, asking if they look into the matter and make whatever correction was appropriate. I got no reply from either the editor or the APA's press office.

Luby had reportedly received monies from AstraZeneca in 2003 and 2004. AZ makes Seroquel, an atypical antipsychotic that is being widely used off-label in children (and adults) as a treatment for depression and agitation.

Joan L. Luby, MD replies here http://archpsyc.ama-assn.org/cgi/content/extract/67/3/311-a in the General Psychiatry Journal - March 2010:

A reader questioned a discrepancy between the financial interests disclosed in an article that I published in 20061 and my recent Archives article2 in which I revealed no financial interests. In the prior article, I disclosed grant support from Janssen for a clinical trial of risperidol in autism completed in 2003, some academic lectures sponsored by AstraZeneca, and a consultation with Shire Pharmaceuticals, all in 2004. I did not disclose these financial interests in the Archives article because they were not relevant to the subject of the article. The article reported on the longitudinal course of preschool depression and made no recommendations about treatment. Furthermore, my program of research has not supported the use of antidepressants in preschool depression and none of these pharmaceutical companies market antidepressant drugs. However, as some feel that any financial relationships with a pharmaceutical company imply a potential conflict of interest, . .

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This was also followed by a bnet-pharma article By Jim Edwards | August 28, 2009

http://www.bnet.com/blog/drug-business/updated-doc-who-urged-antipsychotics-for-3-year-olds-funded-by-j-j-az-and-shire/2712

Doc Who Urged Anti-psychotics for 3-Year-Olds Funded by J&J, AZ and Shire. A doctor who wrote in an academic journal that preschoolers may suffer from depression and could be good candidates for atypical antipsychotics received funding from three drug companies that make mental health medicines. Dr. Joan Luby, a professor of child psychiatry at the Washington University School of Medicine in St. Louis, wrote that children as young as three years old may suffer from bipolar disorder, and that there are “promising findings for the use of atypical antipsychotic agents and mood stabilizers, both singly and in combination” in the very young. Atypical antipsychotics are not FDA-approved for such use. Her article, in a 2009 journal titled Child and Adolescent Psychiatric Clinics of North America, does not disclose that in the past Luby’s work has been funded by Janssen (the unit of Johnson & Johnson that markets Risperdal), or that she has given talks sponsored by AstraZeneca (maker of Seroquel), and has been a consultant for Shire (maker of Adderall XR and Vyvanse. Luby disclosed her relationships with drug companies in a 2006 article in the Journal of the American Academy of Child & Adolescent Psychiatry, which was also about depression in preschoolers. Her disclosure said: Disclosure: Dr. Luby has received grant/research support from Janssen, has given occasional talks sponsored by AstraZeneca, and has served as a consultant for Shire Pharmaceuticals.

Luby did not return an email or two phone calls requesting comment. It is not clear whether academic journal rules at the time required her disclosures. AZ said:Also in 2007, Luby signed as an author to a Special Communication in the same journal written by a group of child psychiatrists called The Preschool Psychopharmacology Working Group. The purpose of their group, Luby and her colleagues wrote, was:to promote responsible treatment of young children, recognizing that this will sometimes involve the use of medications. The other authors of that paper disclosed a wealth of company ties, including Eli Lilly, Organon, Forest Labs, GlaxoSmithKline, Wyeth-Ayerst, McNeil, Novartis, Pfizer, Bristol-Myers Squibb, Abbott, AstraZeneca, Sepracor, Cephalon, Sanofi-Aventis, Boehringer-Ingelheim, and Janssen. Regarding Luby, the paper said:

The other authors have no financial relationships to disclose.

In Luby’s 2009 editorial, she wrote:

The need for large-scale and focused studies of this issue is underscored by the high and increasing rates of prescriptions of atypical antipsychotics and other mood stabilizing agents for preschool children with presumptive clinical diagnosis of bipolar disorder.

She cited a paper by Harvard’s Dr. Joseph Biederman, who was subpoenaed by federal prosecutors investigating J&J’s promotion of Risperdal, much of which was allegedly off-label to children. Separately, hundreds of lawsuits have been filed alleging that Seroquel has dangerous side effects such as weight gain and diabetes.

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Now you can put this NY Times disease mongering propaganda article in it's proper context with full disclosure and all the facts. That was something real reporters and newspapers used to do before they became just paid shills for multi-billion dollar corporations.

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http://www.nytimes.com/2010/08/29/magazine/29preschool-t.html?pagewanted=1&_r=1

Can Preschoolers Be Depressed?

By PAMELA PAUL Published: August 25, 2010

Kiran’s parents took him to see a child psychiatrist. In the winter of 2009, when Kiran was 5, his parents were told that he had preschool depression, sometimes referred to as “early-onset depression.” He was entered into a research study at the Early Emotional Development Program at Washington University Medical School in St. Louis

Is it really possible to diagnose such a grown-up affliction in such a young child? And is diagnosing clinical depression in a preschooler a good idea, or are children that young too immature, too changeable, too temperamental to be laden with such a momentous label? Preschool depression may be a legitimate ailment, one that could gain traction with parents in the way that attention deficit hyperactivity disorder (A.D.H.D.) and oppositional defiant disorder (O.D.D.) — afflictions few people heard of 30 years ago —

The answer, according to recent research, seems to be earlier than expected. Today a number of child psychiatrists and developmental psychologists say depression can surface in children as young as 2 or 3. “The idea is very threatening,” says Joan Luby, a professor of child psychiatry at Washington University School of Medicine, who gave Kiran his diagnosis and whose research on preschool depression has often met with resistance.

“In my 20 years of research, it’s been slowly eroding,” Luby says of that resistance. “But some hard-core scientists still brush the idea off as mushy or psychobabble, and laypeople think the idea is ridiculous.”

For adults who have known depression, however, the prospect of early diagnosis makes sense. Kiran’s mother had what she now recognizes was childhood depression. “There were definite signs throughout my grade-school years,” she says. “My parents knew my behavior wasn’t right, but they really didn’t know what to do.”

Though research does not support the use of antidepressants in children this young, medication of preschoolers, often off label, is on the rise. One child psychologist told me about a conference he attended where he met frustrated drug-industry representatives. “They want to give these kids medicines, but we can’t figure out the diagnoses.” As Daniel Klein warns, “Right now the problem may be under diagnosis, but these things can flip completely.”

says Alicia Lieberman, a professor in the department of psychiatry at the University of California, San Francisco. This is problematic, as 10 to 20 percent of mothers go through depression at some point, and 1 in 11 infants experiences his mother’s depression in the first year.

Washington University in St. Louis’s School of Medicine, Joan Luby is trying to figure out exactly what constitutes preschool depression. For a new clinical diagnosis to gain sanction with psychologists, schools, doctors and insurance companies, it requires entry into the Diagnostic and Statistical Manual of Mental Disorders, the field guide to psychiatric illness.

To get a sense of what a young child is feeling, Luby’s team uses a technique called the Berkeley Puppet Interview, which was developed to help children articulate how they perceive themselves and process their emotions. I watched as a wiry, blond 5-year-old boy responded to a therapist’s dog-faced puppets.

“My parents care a lot about me,” the first puppet said in an upbeat tone.
“My parents don’t care a lot about me,” the second said in an equally cheerful voice. “How about you?”

“Sometimes they care about me,” the boy replied, and then paused. “They don’t care a lot about me,” he added with emphasis.

“When I do something wrong, I feel bad,” the first puppet said.

“When I do something wrong, I don’t feel bad,” the second said. “How about you?”

“When I do something wrong, I do feel bad,” the boy responded.

Later he told the puppets that he didn’t like to be alone. He worried that other kids didn’t like him, and he wished he had more friends. His insecurity, low self-image and, in particular, his sense of guilt and shame mark him as a possible depressive: it’s not only that I did this thing wrong, it’s I’m a bad boy.

But generally speaking, preschool depression, unlike autism, O.D.D. and A.D.H.D., which have clear symptoms, is not a disorder that is readily apparent to the casual observer or even to the concerned parent. Depressed preschoolers are usually not morbidly, vegetatively depressed. Though they are frequently viewed as not doing particularly well socially or emotionally, teachers rarely grasp the depth of the problem. Sometimes the kids zone out in circle time,

Further complicating the picture is the extent to which depressed children have other ailments. In Egger’s epidemiological sample, three-fourths of depressed children had some additional disorder. In Luby’s study, about 40 percent also had A.D.H.D. or O.D.D.,

to avoid stigmatizing young children, two catch-all diagnosesadjustment disorder with depressed mood, as well as depressive disorder not otherwise specified (N.O.S.) — are frequently applied. benefits to such diffuse diagnoses: they spare parents the crushing word “depression”

“We don’t like to diagnose depression in a preschooler,” says Mary O’Connor, from U.C.L.A. “These kids are still forming, so we’re more likely to call it a mood disorder N.O.S. That’s just the way we think of it here.”

But this way of thinking frustrates Luby and Egger, who say they fear that if a depressed child isn’t given the proper diagnosis, he can’t get appropriate treatment. You wouldn’t use the vague term “heart condition,” they argue. Egger asks. Is it right that rather than treat children for depression, clinicians wait and see what might happen three or four years down the road?

THEIR TENDERNESS OF age may render preschoolers especially vulnerable to depression’s consequences. Young children are acutely sensitive but lack the skill, experience and self-sufficiency to deal with strong feelings.

For a diagnosis of preschool depression to have any meaningful impact, an appropriate treatment must be found. Talk therapy isn’t practical for children who don’t have the verbal or intellectual sophistication to express and untangle their emotions. Play therapy, a favorite of preschool counselors, has yet to be proved effective.

she and other researchers say, 84,000 of America’s 6 million preschoolers may be clinically depressed. Intervention could potentially forestall, minimize or even prevent depression from becoming a lifelong condition. At a minimum, it could teach them ways to better manage future bouts. If we wait, their only options may be medication and ongoing talk therapy, forever.

“The promise of early-childhood mental health is that if you intervene early enough to change negative conditions, rather than perpetuate negative behaviors, you really are preventing the development of a full-fledged diagnosis,” says Alicia Lieberman at U.C.S.F. “Of course, you would never then know if the child would have become a depressed adult.”

Parent-Child Interaction Therapy, or P.C.I.T. Originally developed in the 1970s to treat disruptive disorders — which typically include violent or aggressive behavior in preschoolers — P.C.I.T. is generally a short-term program, usually 10 to 16 weeks under the supervision of a trained therapist, with ongoing follow-up in the home. Luby adapted the program for depression and began using it in 2007 in an ongoing study on a potential treatment.

SUCCESS WITH P.C.I.T. rests heavily on parents, who are essentially tasked with reprogramming their child’s brain to form new, more adaptive habits. Not all parents are equipped to handle the vigilance, the consistency, the sensitivity.

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BUT THEN WE HAVE LOTS AND LOTS OF PSYCHOTROPIC DRUGS WE CAN USE ON PRESCHOOLERS CORRECT DR. LUBY?

Oh By the way, AstraZeneca who you were getting those nice lucrative payments from do make an anti-depressant
(maybe you forgot on your way to a sponsored speaking engagement?) it's called "SEROQUEL", the anti-psychotic, turned anti-depressant, turned anti-blushing, or whatever else they can get doctors like you to pimp it for.....

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Update: August 30, 2010 - Jim Edwards @
bnet-pharma has written a great follow up article concerning this matter you should also read and truly weep over (for the children of course).

Link - http://bit.ly/9mVzFs

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Update Sept 1, 2010

I found this interesting article & honesty from David L Bransford M.D. @www.davidbransford.com blog that I believe adds some credence to the crisis fire of childhood mental health diagnosis and drugging we are now experiencing.

Having finally witnessed the end of summer and having my office filled with desperate parents and students, preparing to start the new school year;

I am overwhelmed with seeing what is happening to the many young children with disruptive behaviors and “hyperactivity” Over the summer months of just June, July, and August, far too many were prescribed potent antipsychotic medications by their child psychiatrists, their local family doctors, pediatricians, and nurse practitioners.

No informed consent from the parents or legal guardians, no interventions other than potent medications. Little or no screening for neuropsychological disorders, developmental LDs, nor base line lab work. Just medicating children with antipsychotic medications for disruptive behaviorsd out the script and if the med doesn’t seem to be effective, up the dosage and/or add yet another medication from the same family.

By summer’s end, these prepubescent children have typically experienced profound weight gain, are having hyperprolactinemia, with subsequent breast enlargement with often leakage……………the adverse effects are so alarming.

No family intervention and education…just following Big pharma’s push to prescribe the SGAs (second generation antipsychotics) and tremendous cost to the consumer, the State, the private insurance companies, etc.

But the greatest cost of all is to the children, as they develop type two diabetes and numerous other metabolic changes. These practices must somehow be more closely regulated.

Experienced Nurses and PCPs believe the handouts of the studies from the drug detail men and women, in spite of volumes of evidence most studies with kids are flawed, ghost written, and filled with informercial conclusions. Doctors must reclaim the role as protector of their patients and first do no harm. As of today – Sept 1st – 2010 – I have decided to no longer meet with drug reps, no “free samples” no labeled pens nor postit pads. We have followed the no free lunch or gift policy now for the past several years.

A video in the NYT (Not a leading medical journal) was posted today and I hope it will load onto this blog. It describes far better than I can express, the current crisis….aside for a plug for Vyvanse ( an amphetamine tweak by Shire….really no better than generic amphetamines from > 50 years ago) the video, I believe, tells an accurate story of the crisis at hand.

http://video.nytimes.com/video/2010/09/01/business/1248068952581/medicating-kids.html

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Though we may disagree in prospective and interpretation of what is shown on this video, I must stand up and applaud David L Bransford's M.D. integrity, openness, and honesty in his post.



3 comments:

Stephany said...

Joan Luby is also on the CABF (Child Adolescent Bipolar Foundation)advisory board.

CABF and NAMI co-wrote a letter to the FDA ASKING for approval of SEROQUEL (made by AstraZeneca one of Luby's $$)for use in kids age 10-17.

Luby, by being affiliated w CABF in that capacity, has in fact agreed that children and psychotropics are OK.

If she was anti-medicating kids she would stick with the puppets and talk therapy and not receive one dime from drug companies, she would not represent them in any way (as she does when being a paid speaker)and she would not be on a board of CABF agreeing for the calling of Seroquel for use in kids age 10 and up.

Until researchers and data stop going hand in hand with pharmaceutical companies, this data is tainted, and has an agenda.

Once again, I raise the red flag alert for the target market with the most to gain profit for drug companies: CHILDREN.

Once we place children age 3 and up on antipsychotics or antidepressants we lose the baseline for normal childhood development and growth.

The human being, has developmental stages that are natural for becoming an adult. What will normal child behavior be based on once we lose these kids to drugs that can decrease life span, increase risk of diabetes, black box warnings for suicidal thinking, metabolic syndrome, etc?

REBECCA RILEY.

Stan said...

I can't help but see this as sleazy "Back Door Marketing" to validate a suspect diagnosis without actually saying what the outcome will really be in practice.

Which in this case will include the massive expansion of preschool/toddler drugging.

Mere words cannot express how disturbing this trend has become....

Radagast said...

"Oppositional defiant disorder is described by the Diagnostic and Statistical Manual of Mental Disorders as an ongoing pattern of disobedient, hostile and defiant behavior toward authority figures which goes beyond the bounds of normal childhood behavior. People who have it may appear very stubborn."
Courtesy Wikipedia

I thought this was quite interesting, because it makes several assumptions that are never questioned:

a) That hierarchical systems are in any way natural or normal;
b) That authority figures behave fairly and in accordance with agreed rules;
c) That authority figures don't panic and overreact when their authority is questioned;
d) That authority figures actually think about what it is they're asking their "subordinates" to do (eg, are they applying double binds, or otherwise impacting on their subordinate's own belief system?).
e) That authority figures don't allow others' reports of a person's behaviour to flavour the way that they approach that person.
f) Probably some others that I haven't thought of.

In my experience, a child's subtlety of thought and general understanding is altogether more sophisticated than adults... Adults only understand that if they hold "rank," then they're to be obeyed. This is foolish, and makes no allowance for the possibility that they've got it wrong. Besides, I've never met an authority figure who could conduct themselves with propriety and equity, so I'm fucked if I'm subscribing to that system, which looks more like anarchy than anything else I've seen!

Matt

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