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SHELLEY JENSEN
Port Coquitlam, B.C. Shelley Jensen is the founder of Shelley's Angels Society and "S" Team Counselling Services. She is a Professional Counsellor and Nutritional Consultant.
Over the past 18 years Shelley has dedicated her life to researching, learning and loving the compulsive eater. Childhood obesity sparked the beginning of a struggle with episodes of bulimia, and binge eating disorder that went well into her 20's.
After seeking therapy, she has experienced the joy of recovery for over 20 years and founded Shelley's Angels Society a non-profit organization providing bursaries for those unable to afford private counselling and treatment.
After working in the weight loss industry for many years, she watched as it added fuel to the fire of Eating Disorders and dreamed of a time when she could share her passion to empower women to reconnect with their bodies and their innate wisdom.
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The Following Section is from the blog of:
Christopher Lane, Ph.D.
Christopher Lane is the Pearce Miller Research Professor at Northwestern University. He teaches and writes about Victorian and modern literature and intellectual history, including psychology and psychiatry. His books include The Burdens of Intimacy, Hatred and Civility, and Shyness: How Normal Behavior Became a Sickness. He's written for the New York Times, Washington Post, Los Angeles Times, Boston Globe, New York Sun, Herald Tribune, and New Statesman and Society.
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Amanda Knox and the Power of Projection
- Sun, 06 Dec 2009 00:02:53 +0000
Like most of you, I'm sure, I've been stunned by the verdict against Amanda Knox in Perugia, Italy, and trying to gauge its accuracy. I've also been coming up with many questions about the trial and the Knox family's repeated statements of their daughter's innocence. As several commentators have pointed out, we seem to have watched not only two Amanda Knoxes on trial, but two different portraits of an American college student. Her closest friends insisted last night, on CNN, that Amanda is the least violent person they've ever met. The Italian media and prosecution insist, by contrast, that she's nothing short of a "she-devil," nymphomaniac, and a participant in satanic rites.
The guileless purity that Knox's family is insisting upon, somewhat frantically, in their daughter squares poorly with the Knox who's been cast by the Italian media as craven and vilely evil, partly because she had several affairs while abroad and partied a bit as an exchange student. (As if many of them don't.) Yet we do know that Knox was quite prepared to defame her boss, Patrick Lumumba, and falsely accuse him of murdering Kercher. Knox's family understandably prefers not to discuss that and other factors strongly counting against her.
Extreme cultural prejudices are also getting tossed around, either supporting our judgment or creating havoc with our sense of justice. Knox's family has come close to smearing not only the entire judicial system in Italy, but also much of the nation's culture. As some have pointed out, they likely would be praising the very same system now if it had found their daughter innocent. Meanwhile, many Italians, though critical of weaknesses in their judicial system, nonetheless resent the speed with which Americans and much of the American media have cast aspersions on the lengthy deliberations of the Italian jury, partly because we select ours more systematically in the States. Yet we make wrongful convictions all the time, some of them resulting in the death penalty; and we sometimes do so on the basis of open-ended, and thus inconclusive, forensic evidence. As a culture, moreover, it seems we hardly think about the repercussions of doing so, much less discuss how such travesties could be brought to an end.
But this was a trial over the brutal murder of an English student, Meredith Kercher (21). Passions are obviously running high over the verdict, not least because Knox (22) ended up retracting her statement that she was actually very close to the scene of the crime, apparently trying to block out Meredith's screams in order to sleep while her roommate was horrifically stabbed and assaulted next door. My own sense is that the jury had enough evidence to go on to convict Knox, and that Knox would indeed have been convicted in this country on the basis of the same evidence. People often are.
What we are also witnessing, as we weigh the verdict and debate its merits (including its almost-certain appeal) is a form of projection that insists only one country could get it right, that only one nation has the judicial system capable of reaching the right verdict. That's patently false. As Americans we risk displaying the very polarities that some accuse the Italian media of exhibiting. Statements that Knox could never hurt a fly are about as convincing as pronouncements on her behavior based largely on her appearance. That said, we can't ignore her behavior, or her statements, or indeed her reaction to police questioning. All of that matters, especially when it's markedly out-of-character, as in her turning cartwheels in a police station when her boyfriend was being questioned about the murder.
www.christopherlane.org | The High Cost of Trashing Healthcare Reform
- Sat, 03 Oct 2009 02:49:14 +0000
Over the summer, much was made of the agreement the White House reached with drug makers that it wouldn't seek more than $80 billion in price cuts from them over new healthcare legislation. "We were assured," declared Billy Tauzin, head of The Pharmaceutical Research and Manufacturers of America (PhRMA), that "if you come in first," in support of healthcare reform, "you will have a rock-solid deal."
The White House reluctantly confirmed that arrangement in the first days of August, then spent weeks dealing with concerned Democrats and progressives who accused it of making a Faustian pact with the pharmaceutical industry, reaching too quick a concession--and too shallow a cut on prices--to get at least the appearance of support from the industry.
Regrettably, but not surprisingly, the concern turns out to have been justified.
The headline of yesterday's Guardian newspaper in Britain made clear that PhRMA has not only reneged on its deal with the White House, but also has paid enormous sums of money behind the scenes to torpedo the planned reforms.
"Revealed: Millions Spent by Lobbyists Fighting Obama Health Reforms" was the headline. "The [drug and insurance] industry and interest groups have spent $380 million in recent months influencing healthcare legislation through lobbying, advertising and in direct political contributions to members of Congress. The largest contribution, totaling close to $1.5 million, has gone to the chairman of the senate committee drafting the new law."
That would be Senator Max Baucus of Montana, who just helped kill the widely discussed "public option" for healthcare coverage. That option also was designed to drive down runaway costs, a key reason we need reform in the first place. Senator Baucus, the Guardian reports, "holds dinners for health industry executives at which they pay thousands of dollars each to be at the table, and an annual fly-fishing and golfing weekend in his home state of Montana that lobbyists pay handsomely to attend. They have included John Jonas, who represents healthcare firms for Patton Boggs, widely regarded as the top lobbying firm in Washington. Jonas, who formerly worked on the congressional staff, acknowledges that political contributions are intended to buy influence and says it works."
Senator Baucus apparently "took $1.5 million from the health sector for his political fund in the past year. Other members of the committee have received hundreds of thousands of dollars. They include Senator Pat Roberts, who last week tried to stall the bill by arguing that lobbyists needed three days to read it."
"Reform groups," the article continues, "say vast spending, and the threat of a lot more being poured into advertisements against the administration, has helped drug companies ensure there will be no cap on the prices they charge for medicines--one of the ways the White House had hoped to keep down surging healthcare costs."
Before he jumped ship to head PhRMA, Billy Tauzin almost single-handedly locked the Bush administration into paying exorbitant prices on drugs for seniors' prescription plans. It was Representative Tauzin--supposedly working on behalf of the government--who oddly made it impossible for the government to bargain down drug prices by prescribing cheaper-priced generics.
All of which might prompt us to wonder why the Obama administration continues to stand by its deal with PhRMA, when the industry is working so hard to undercut healthcare reform.
With six lobbyists for every member of Congress, it's depressingly clear that unless Americans grasp the urgency of the country's need for healthcare reform--and make that need felt soon--we are soon likely to be worse off than before, with higher across-the-board costs and still unacceptable numbers of Americans left without any kind of insurance at all.
Meanwhile, the Max Baucuses of this world will still be holding their fly-fishing and golfing parties, and charging lobbyists hundreds of thousands of dollars for the privilege of attending.
www.christopherlane.org | American Psychiatry Is Facing "Civil War" over Its Diagnostic Manual
- Sun, 13 Dec 2009 00:23:32 +0000
Yesterday, the American Psychiatric Association announced that it is pushing back the publication of DSM-V until 2013. The APA tried to put a good face on this rather embarrassing admission—embarrassing, because several spokespeople for the organization had insisted, quite recently, that they were on-track for publication in 2012 and that nothing would deter them. They maintained that position even as an increasingly acrimonious quarrel between current and former editors of the manual spilled onto the pages of Psychiatric News.
"Extending the timeline will allow more time for public review, field trials and revisions," APA President Alan Schatzberg declared, conveniently omitting that most of the field trials have yet to begin because the working groups can't agree on their criteria. "The APA is committed to developing a manual that is based on the best science available and useful to clinicians and researchers." Owing to Dr. Schatzberg's statement, several news services played down the announcement, perhaps fearing to make too much of it.
They may not know that an explosive article and editorial is due to appear in the print edition of New Scientist two days from now (December 14th). It's been up on the journal's website since Wednesday, and it's already had a significant effect. The article is called "Psychiatry's Civil War," and it documents in fairly exhaustive detail the DSM editors' public feud, which sank so low at one point that the current editors accused Allen Frances, editor of DSM-IV, of raising questions about scientific and editorial procedure simply to continue earning royalties from DSM-IV (DSM sales since 2000 have exceeded $40 million). "Both Dr. Frances and Dr. Spitzer have more than a personal 'pride of authorship' interest in preserving the DSM-IV and its related case book and study products," the same Dr. Schatzberg insinuated darkly in Psychiatric News last July. "Both continue to receive royalties on DSM-IV associated products."
Yet Frances raised legitimate questions about the scandalous lack of transparency surrounding the DSM discussions and the damaging pledge to secrecy that DSM consultants have legally agreed to uphold—allegedly to protect intellectual property, though the manual is already copyrighted.
Given the embarrassing evidence in the New Scientist article, whose associated editorial is called "Time's Up for Psychiatry's Bible," the timing of the APA announcement raises significant flags. As the New Scientist put it in a rider that appeared on its website yesterday, "Since [the] article was first posted [last week], the American Psychiatric Association has announced that the publication of DSM-V will be delayed until May 2013."
You'll find the article and editorial here and here. The article was written by Peter Aldhous, bureau chief of the New Scientist's San Francisco office. (Disclosure: I was interviewed for the article, based on my knowledge of the unpublished documents and memos that went into the creation of DSM-III, -IIIR, and -IV and the dozens of new disorders they added to those editions of the manual. I've also written about the editorial feuding for the Los Angeles Times and Slate.)
Perhaps the most significant implications for the APA, right now, concern the New Scientist's argument that the DSM should cease to be known as the discipline's "bible." Given the acrimony and scale of disagreement, that sounds quite reasonable. If even the manual's editors have profound disagreements over its content and criteria, then it ceases to be an authority that psychiatrists, doctors, social workers, lawyers, health insurers, and others using it can cite and consult "chapter and verse." As the editors at New Scientist put it, "This week we report on a volume that has outlived its usefulness."
They aren't saying that the manual's diagnostic importance has disappeared altogether. "The final wording of the new manual," they concede, "will [still] have worldwide significance." But the New Scientist urges the APA to update the manual online, with full transparency and somehow without the influence of drug companies who fund much of the research and supplement the salaries of way too many DSM consultants. As the New York Times noted in May 2008, "More than half" of the writers of DSM-V "have ties to the drug industry" as paid consultants.
David Kupfer, chair of the DSM-V Task Force, has also given very mixed signals about the direction he intends to take the manual, telling the Chicago Tribune last December, "If currently listed maladies fail th[e] test, they'll be dropped," before he signaled far more loosely to the Los Angeles Times, five months later, "There are no constraints on the degree of change."
"No constraints"? The phrasing may be more than unfortunate; it also points to an underlying truth about the task force and the serious risks of manipulation by drug companies who are eyeing every poorly conceived idea and proposal—bitterness disorder, apathy disorder, internet addiction disorder, and quite a few others—like hawks.
Although I've had serious disagreements with Drs. Spitzer and Frances over past DSM publications, I share their concern over the lack of transparency to the revisions and the serious implications for public health of including so-called "subthreshold" diagnoses. As Frances put it in Psychiatric News,
"Undoubtedly, the most reckless suggestion for DSM-V is that it include many new categories to capture the milder subthreshold versions of the existing more severe official disorders. The . . . DSM-V Task Force has failed to adequately consider the potentially disastrous unintended consequence that DSM-V may flood the world with new false positives. . . . The result would be a wholesale imperial medicalization of normality that will trivialize mental disorder and lead to a deluge of unneeded medication treatments—a bonanza for the pharmaceutical industry but at a huge cost to the new false positive 'patients' caught in the excessively wide DSM-V net."
For more information on earlier revisions to the DSM, visit www.christopherlane.org. | When Does Psychiatric Precision Become Diagnostic Madness?
- Fri, 24 Jul 2009 14:13:19 +0000
Serious questions have surfaced about the competence, procedure, and secrecy of the task force charged with the responsibility of updating the DSM, the world's diagnostic bible of mental disorders. Perhaps surprisingly, the two most vocal skeptics are former editors of the manual. In one open letter, they chide the leaders of the American Psychiatric Association for creating a "rigid fortress mentality." The critics, Robert Spitzer and Allen Frances, also insist, more damagingly, that the organization needs to "save DSM-V from itself.
I write about the dust-up in Slate today. The article, "The Diagnostic Madness of DSM-V" appears here. | Drug Makers Still Repeatedly Breaking the Law over "Off-Label" Promotion
- Mon, 09 Nov 2009 19:45:02 +0000
As the healthcare bill moves to the U.S. Senate and the country focuses on what is best and worst about the proposed legislation, now is the time to consider serious reform of both the price and safety of prescription drugs.
Concerning price, one of the best recommendations in the House bill is repeal of the bizarre restriction on Medicare to negotiate for lower prices from the drug companies. A bonanza for the drug companies, that restriction for years has forced the government to pay far higher prices for brand-name drugs than it needed to.
As other bloggers have pointed out, the Veteran Affairs System, which isn't bound by the same rules, is a model for pricing reform because it keeps a list of effective medicines and pays a fraction for them than Medicare does. With tens of millions more Americans finally expected to join the ranks of the medically insured, so greatly increasing the profits of the insurance and drug companies, the Senate has a small window of opportunity to press aggressively for the deepest price cuts from both. Let's hope they don't blow it. Pushing for such reform is, after all, one of the few ways the bill will have any hope of reining in soaring costs.
Concerning safety, Bloomberg News published a long piece today, "Pfizer Broke the Law by Promoting Drugs for Unapproved Uses," that lists only the most egregious crimes knowingly and repeatedly perpetrated by Pfizer and other major drug makers. Even so, and for good reason, the article is already lighting up the web and was a headline piece on this morning's Huffington Post. Among the more eye-popping facts: drug makers have in recent years shelled out $7 billion in penalties for committing felonies, with Pfizer alone paying the largest criminal fine in U.S. history, at $1.19 billion.
The article reports that in 2004 Pfizer used one of its units, Warner-Lambert, to influence physicians into prescribing an epilepsy drug called Neurontin for treatments the FDA had not authorized. Pfizer paid $430 million in criminal fines and civil penalties, assuring authorities that it wouldn't resort to the same illegal activity. On September 2 this year, however, another Pfizer unit pleaded guilty to the same felony, having in that case employed over 100 people to encourage off-label prescriptions for Bextra, a drug approved for the relief of arthritis. For that last felony, the Pfizer unit, Pharmacia & Upjohn, agreed to pay a record fine.
In January this year, to cite just one other example, Eli Lilly pleaded guilty to misrepresenting Zyprexa, a drug approved for the treatment of bipolar disorder. For committing the same felony, it paid $1.42 billion in fines and penalties. For four years, the drug maker had promoted Zyprexa as a treatment for dementia. Yet in one clinical trial, 31 people died after they were given the medication for that condition--"twice the rate for those taking a placebo."
Rather than expressing contrition for such illegal activity, including the flagrant breach of public trust, the drug companies invariably refuse to admit or deny wrongdoing; the enormous fines they are levied are but a fraction of the revenue they have made from pushing for off-label prescriptions (just one percent of their revenue from the same period, according to one study). Clearly, a day or so of bad press and a minor rap over the knuckles is, they wager, better for them than reforming their marketing strategies from the top down and refusing ever to put patient lives at risk. Nor, amazingly, are shareholders abandoning them for their felonious activity. On the contrary, in January this year, after Pfizer agreed to pay billions in penalties, the drug maker's share price actually went up by 9.3 percent.
All the signs suggest that this illegal activity is becoming the norm. One investigator from USC's Keck School of Medicine who in 2006 led a study for the National Institute of Mental Health of off-label use of drugs, including Zyprexa, observes that the drug makers' promotion of "off-label" treatments has become "an unwritten business plan." "They're [like] drivers that knowingly speed. If stopped, they pay the fine, and then they do it again."
With the healthcare bill still awaiting final approval, the U.S. Senate has a rare opportunity to examine and tighten oversight of the drug companies, including to debate whether "direct-to-consumer" advertising--a key reason for the drug makers' runaway costs--is really advancing the interests of public health. (Among industrialized countries, DTC advertising is legal only in the United States in New Zealand.) With the drug companies now in the national spotlight, it's time to make sure our senators are fully aware of the activity, criminal and not, that the drug makers for years have approved and encouraged.
www.christopherlane.org | How Concerned Are You about Climate Change?
- Fri, 11 Dec 2009 00:59:21 +0000
Three nights ago, CNN decided to hold one of its regular "quick votes," inviting readers to respond to water-cooler topics.
With global warming now finally getting front-page coverage as a world issue, due to the Climate Conference in Copenhagen, climate instability is water-cooler news in the States. CNN was interested in gauging its viewers' reactions to the issue.
Now I concede right away that one can't put too much stock in a CNN poll. The number of respondents is relatively small and the news organization likes to court "yes" or "no" answers to often-complex issues. Still, the results of this "quick vote" caught my eye because the question went to the heart of the matter. "How concerned are you about climate change?," the news organization asked. The results might surprise you.
Extremely: 39% (19,529)
A little: 27% (13,282)
Not really: 13% (6,272)
It's all a con: 22% (10,886)
Total votes: 49,969
That was at 9:39 pm Eastern on Monday night, when I first saw the poll (full disclosure: I voted "extremely" with almost twenty thousand others). Because I was intrigued by the question and the results (seemingly so contrary to the myth of the unconcerned American), I snuck back less than an hour later, to see if the percentages had changed. By then, rather oddly, the entire question had been altered, as if CNN was already bored by the topic. Someone at the news organization apparently had decided that the real issue was that "it's all a con" option, which 22 percent of respondents had credited as true. So instead of asking us how concerned we are about global warming, the news organization asked:
"Do you believe global warming is a proven fact caused by man?"
Amazingly, in the course of just 44 minutes, almost five thousand fresh votes had materialized, to offer the following "snapshot" of our collective wisdom and anxiety:
Yes: 59% (2,850)
No: 41% (1,988)
Total votes: 4,838
Updated 10:23 p.m. EST, Mon December 7, 2009
This, too, was not a scientific poll, CNN reminds us. I'd have to agree, of course; it's also a poorly written question. Yet if it's even ballpark as a loose approximation of our collective thinking, I'm frankly worried that 41% of even a small demographic doesn't think global warming is caused by man.
If we extract man from the imperative that we act quickly and responsibly to curb quite dramatic signs of climate change around the world (including the lengthy drought that has many people in Georgia and parts of Florida understandably concerned), then the opportunities that we face in Copenhagen will vanish into a puff of air. The action that we can and must take, to address serious warning signs of climate instability, may then be too late. St. Mark's Square in Venice is now regularly under water, to invoke only one major icon of world significance. During the summer, Barcelona, Spain, took the notable step of importing (at great cost) drinkable water from Marseille, France, to supplement its needs, which the drying rivers nearby couldn't meet. Parts of my own country, England, having been battered by storms and gales for much of the "summer," suffered what commentators called "biblical" amounts of flooding. These are not encouraging signs; they are frankly very worrying. We have reason to be concerned.
To accompany its coverage of the talks in Copenhagen, the BBC decided not to poll its viewers over whether we "believe global warming is a proven fact caused by man," perhaps because there's more consensus in the UK about such matter-of-fact evidence. Instead, the BBC published a feature entitled "Global Warming Maps: A Glimpse into the Future," which detailed projected changes in "water stress," "rising waters," and "heat maps" all the way to 2095. You can find the full results here. They are sobering, to say the least, with one image reproduced here:
The same news organization also entitled one news piece: "Copenhagen Summit Welcomes US Emissions Curbs." At long last, it might have added, after the cynical posturing of President Bush over the Kyoto protocol. Fortunately, we now have a President who treats these issues with the seriousness they deserve.
The Guardian, meanwhile, published a smart piece on the "Climate Change Denial Industry." The article reported on the politically motivated disinformation that the denial industry is busy spreading, including its making a song and dance over emails that don't—and simply cannot—mask the underlying trends and evidence unfolding before us. As columnist George Monbiot put it, "The climate denial industry is out to dupe the public. And it's working." Over here, indeed, the Washington Post just gave Sarah Palin a platform for discussing climate issues. Sarah Palin, the vice-presidential candidate who insists that climate change is mostly just a myth but Russia is visible from her backyard. Yes, the Washington Post. No, I haven't the stomach to provide a link.
Instead, in updating this post, I'll point your attention to Myles Allen's superb op ed in the Guardian, "Science Forgotten in Climate Emails Fuss," which justly points out: "No one identifies any scientific flaws in the work of Phil Jones [the University of East Anglia scientist at the center of the email furor], yet the 'fallen idol' narrative is too alluring for the media to resist."
"The discovery of the HIV virus involved one of the murkiest incidents in the history of science," Allen rightly recalls, yet "reporters on the HIV affair always scrupulously stressed that although the integrity of some of the individuals involved was called into question, the evidence that HIV causes Aids was unaffected." Can you imagine what would have happened over the treatment of Aids, Allen invites us to speculate, if we had systematically confused one with the other? We run the serious risk of doing that now.
I know that Gordon Brown is on a political deathbed largely of his own making, but I have to applaud him for insisting, "EU cuts must go deeper to get Copenhagen climate deal." The British Prime minister told the Guardian that he hopes the European Union will agree to a cut in emissions of 30% by 2020. That is both necessary and possible, providing our priorities can change in time.
We have to be frank about the urgency here, while also completely focused on the work of shoring up the economy by putting meaningful resources toward green energy. That is "an affordable truth," economist Paul Krugman insists with evidence in the New York Times. With all the TARP money the banks are now returning to the Federal Government, a wise percentage of it invested in American jobs and our future environment is surely money very-well spent.
www.christopherlane.org | Let's Have a Public Healthcare Option Already!
- Thu, 25 Feb 2010 17:10:08 +0000
As President Obama signals the urgency of healthcare reform at today's summit, experts and commentators are weighing in on the continued need for a meaningful public option to rein in soaring healthcare costs and to end double-digit rate hikes. Among the most eloquent of the commentators is Roger Cohen in this superb op ed in yesterday's New York Times:
"Crunch time has come on a question central to the nation's future, where an acknowledgment is needed that, when it comes to health, we’re all in this together. Pooling the risk among everybody is the most efficient way to forge a healthier society. That's what other developed societies do. And they don't have 30 million plus uninsured."
It's clear to such commentators that a public option with teeth and broad coverage is the only way to lower costs and keep health care affordable. So why isn't Congress and the White House responding in kind?
Bill Budowsky at The Hill put it this way: "It is sad and ridiculous that with a Democratic president who supports the public option, and with a historically large Democratic majority in the Senate, and with a near-80-vote Democratic majority in the House, and with the public option supported by a strong majority of voters, and with the public option supported by more than 70 percent of independent voters, and with the public option significantly lowering the deficit, and with the public option supported by four out of five congressional committees that have voted, and with the public option having passed the House, and with the public option supported on the record by a majority of senators, the public option cannot be passed."
If the President and Congress are willing to heed the degree of public support for the public health insurance option, reconciliation could be used to restore the option to the healthcare reform package.
Meanwhile, while the debate inches forward, the news story unfolding in California, about health insurer Anthem seeking to raise rates by a whopping 39 percent, should make clear to all of us that the Republican "policy" of leaving the market to regulate itself (i.e., leaving health insurers to their own devices) is a recipe for disaster. We have been there and done that, thanks very much, and we're still paying heavily for the consequences. Millions of Americans are still uninsured. The coverage that many others have is borderline dismal. And if we're talking about rate hikes of 39 percent this year, what's to come next year and the year after that?
Many Americans, young and old, are confronting the awful necessity of trying to reduce their healthcare coverage to rein in their own monthly costs. The knock-on effect is forcing insurers to raise rates, which in turn is increasing the shortfall and worsening the crisis, leaving fewer Americans with adequate coverage and more of them vulnerable to bankruptcy from emergency medical bills. In today's San Francisco Chronicle, WellPoint CEO Angela Braly explains that Anthem's rate increases in California "were needed to keep the company solvent as healthy, young people have dropped coverage to save money, leaving an older, sicker population that requires more care."
To offset this vicious cycle and increase the pool of insurers, we need a meaningful public option that regulates rate hikes. That system works effectively in Canada; why can't we "Canadianize" our own system, as Paul Krugman asked recently about our similarly deregulated and chaotic banking system, to emulate the smart thinking of our neighbors?
Cohen goes one step further: "Why not offer Medicare as a choice — a choice — to everyone? Aren't Republicans about choice?"
It's a terrific idea. What are Republicans and the White House afraid of? That we'll choose Medicare over more expensive private insurers and move incrementally toward national coverage?
And that would be a bad thing because . . .?
www.christopherlane.org
Exciting March 12 Update: "The Public Option's Last Stand: A Matter of Will, Not Votes." | Longer-Lashes Syndrome
- Wed, 22 Jul 2009 13:55:52 +0000
It's amazing what an hour of aimless channel surfing can turn up these days. After some freewheeling with the remote one night recently, I managed to catch not only a half-dozen low-budget makeover shows, but also three ads for FDA-approved pharmaceuticals: one for depression; another for premenstrual dysphoric disorder; and a third for inadequate eyelash syndrome - sorry, "eyelash hypotrichosis." Yes, that's prescription treatment for "longer, thicker, and darker lashes."
Click here for more of my op ed in today's Los Angeles Times. | The Antidepressant Dilemma
- Sun, 10 Jan 2010 00:27:23 +0000
It was surely only a matter of time before blowback began over the latest round of news about antidepressants. I was just surprised by the speed with which it came.
Last Wednesday, CNN and several dozen other news agencies reported that "milder depression may not respond to antidepressants." A study published in JAMA that day had asserted, "There is little evidence that [antidepressants] have a specific pharmacological effect relative to placebo for patients with less severe depression."
This was news, no matter how one spins it. True, the JAMA study involved a relatively small number of patients (718), and for six-week trials rather than six-month ones, but it also focused on randomized, placebo-controlled trials, which makes it legitimate, if not exactly earth-shaking, and a study to take seriously rather than to dismiss out of hand, as some now seem intent on doing.
"The findings don't mean that antidepressants don't work," CNN was careful to report, "only that most of the drugs' effectiveness in people with milder depression can be attributed to the placebo effect."
Certainly, some news outlets didn't report the full story. ABC News titled its report, "Study: Antidepressants, Placebos Nearly Effective," which is only half-true, and misleading in terms of the findings over chronic depression. But the study does raise serious questions about the well-established pattern of prescribing antidepressants for minor depression and other mild disorders. It also calls the effect of antidepressants on those with even moderate depression "negligible." That's quite a statement, coming from the journal of the American Medical Association.
If you read Judith Warner's op ed "The Wrong Story about Depression," in the New York Times today, however, you might come away with the impression that the issue concerning medication and minor depression isn't sufficiently serious to worry about. Apparently, it's just blather and hype about overmedication; and it concerns only general practitioners rather than psychiatrists (well, that's a relief to know!). It may take some moments to recall that the last big story about antidepressants was that the drugs are linked to major personality changes, not all of them predictable or entirely welcome. In the news cycle before that, the headlines were that "Antidepressants May Raise Women's Stroke Risk," and so on.
While acute, Warner's perspective turns out to be entirely one-sided. It focuses exclusively on chronic depression, where antidepressants have been shown to have some efficacy, but leaves aside questions that inevitably support what's long been known: that antidepressants have limited-to-zero efficacy for those with mild depression. Yet the drugs have been prescribed to that population in very high numbers (in June 2005, as I've reported before, the International Review of Psychiatry estimated that the total amount prescribed in the U.S. alone has been to upwards of 67.5 million people, almost one quarter of the general population).
After reading Warner's column, you might almost come away thinking that the black-box warnings added to Paxil, Prozac, and other SSRIs the previous year, which were meant to stop the drugs from being prescribed to children because of a disturbing pattern of increased suicide ideation, were just matters drummed up by pharma critics like me, rather than a concern brought by the Food and Drug Administration, which the agency had been monitoring years before it decided to act. You might also wonder why the issue about antidepressant efficacy in mild depression is considered news now, more than two decades after the SSRI revolution in the late-1980s, when the FDA began approving those drugs for the first time, on the grounds that they were safe and effective. Since then, Americans have received literally billions of media impressions urging them to "ask their doctor" about taking antidepressants for mild depression. Also not a concern, right?
Let's not forget that Big Pharma financed "public-awareness campaigns" for drugs such as Paxil that were more expensive than even comparable ad campaigns for Viagra ($92.3 million v. $89 million in the year 2000 alone). Let's also not forget that corporations such as GlaxoSmithKline, maker of Paxil, knew about problems concerning the drug's limited efficacy quite a few years before it received FDA approval in March 1999 for the treatment of social anxiety disorder.
We know about these things because we have documents proving that the drug companies chose to "spin the problem" so that they could capitalize on reaching the largest possible audience. Yes, Judith, even when that meant hiring ghostwriters to plant positive but fabricated research in reputable medical and psychiatric journals. The markets for mild depression and mild anxiety are not small or trivial. For the drug companies, there are billions of dollars at stake in ensuring that that market remains as open to treatment as possible.
The moment even a JAMA review of randomized control trials points to well-documented concern about overuse of antidepressants for those with less severe depression, however, apparently we can now expect rapid blowback from Judith Warner and others, mischaracterizing critics as saying that antidepressants are just "happy pills that don't work" and that we should beware of being "primed to believe stories of psychiatric trickery." That's such a misleading analogy. The JAMA article isn't about psychiatric trickery; it's a forthright report on two slightly different, similarly important, and far from mutually-exclusive concerns.
Americans are understandably conflicted over these and other reports about antidepressants; there's a real and understandable dilemma over whether to prescribe or take antidepressants for what the DSM and other diagnostic guides represent as mild disorders. We need reporting that weighs both sides of this complex issue, rather than trying to play up only one angle and dismiss every other. The JAMA report concluded, "For patients with very severe depression, the benefit of medications over placebo is substantial." Point taken. But that doesn't rule out its other statement, that "there is little evidence that [antidepressants] have a specific pharmacological effect . . . for patients with less severe depression."
Before there's a stampede to try to keep patients on medication they may not need (and may never have needed in the first place), a lot more research and careful investigation is needed to weigh the implications of those two statements.
Meanwhile, it's striking that commentators like Warner can never bring themselves to mention the rather serious matter of side effects, especially from SSRI antidepressants and antipsychotics (now marketed for depression with bipolar disorder). The narrators of pharmaceutical ads hurry through such side effects just seconds before the end of each commercial. You know them: They start with sexual side effects, an understandable concern for roughly 70% of affected patients on SSRI medication, then move to talking about the risks for pregnant mothers, and end up warning you not to take the drug if there's a risk of heart attack, stroke, blood-clotting problems, and several other widespread medical conditions. Those, too, are based on serious studies. We can't overlook that inconvenient truth in the effort to steer the conversation exclusively to chronic depression. Americans deserve to hear and assess the full story, warts and all.
www.christopherlane.org | America the Miserable?
- Wed, 24 Feb 2010 16:10:15 +0000
Yesterday, after scanning CNN for a quick update on the day's news, I came across a photo of a dear former colleague of mine at Emory, Patrick Allitt, beaming his customary smile under the title, "‘America the miserable' prof: U.S. isn't the same." An incongruous heading, to be sure, given Patrick's well-known energy and optimism; and not helped, it must be said, by the easy grammatical slip from "‘America the miserable' prof," to "America, [by a] miserable prof."
The latter was also the way certain readers chose to interpret the article, a striking interview with a brilliant historian about the existential crisis afflicting a country that is battling job-loss, home foreclosure, and personal and state-driven debt on a scale few can remember. Just to the right of the interview was CNN's "most popular" news item, "Nearly 25% of all mortgages are underwater." Some readers wondered crankily why they should even bother to listen to the thoughts and perspective of a British expatriate, even if he is the Cahoon Family Professor of American History at Emory and the author of six highly acclaimed books, including Religion in America since 1945: A History. But in his thoughtful article for The Spectator, which prompted the interview with CNN, Allitt opens with a snapshot of the peppy and purposeful America to which he emigrated in the Carter era, a time not usually remembered for nationwide euphoria. He then asks, quite reasonably,
"Where has that America gone? The United States are a little sadder and feel somehow deflated today. The burst of utopianism that greeted Obama in 2008 has disappeared with the return of everyday politics and the slow grind of two unwinnable wars. Now everyone talks about decline, recession and ageing."
Allitt's conclusions are not exactly grim, but they are certainly chastening and surely meant to remind us where we've been, based also on legitimate fear of where we may be heading:
"Where will it all end? You can still find vestiges of the old buoyancy, and I dare say the return of good times will give it a bit more lift. Habits as deep as American optimism don't die out easily. On the other hand, America has experienced a prolonged dose of unpleasant reality since 2001; its influential and ageing baby boomers feel morose, not having lived up to their own promise, and much of the rest of the world has caught up with America, robbing it of the complacent sense of superiority that it could hardly help feeling 30 or 40 years ago. Ironically, some of America's cheeriest people these days, me very much included, are immigrants who are acutely aware of what a good thing they encountered on crossing the Atlantic."
As it happens, I found Allitt's article and interview soon after finishing Barbara Ehrenreich's superb recent book, Bright-Sided: How the Relentless Promotion of Positive Thinking Has Undermined America. The connections and differences between her and Allitt's work are worth underlining. As he did, Ehrenreich begins with an anecdote, this time shared by Soviet émigré poet Joseph Brodsky, to the effect that the problem with Americans is that they have "never known suffering." Ehrenreich's sharp parenthetical retort: "(Apparently he didn't know who had invented the blues.)"
Insisting rightly that "there is a vast difference between positive thinking and existential courage," Ehrenreich skillfully applies the second to expose the vast and often-ignored shortcomings of the first. "Positive thinking may be a quintessentially American activity," she notes, "associated in our minds with both individual and national success, but it is driven by a terrible insecurity."
The insecurity, she argues, stems from the unacknowledged anxiety that things will not get better on their own and that relentlessly positive thinking "requires deliberate self-deception, including a constant effort to repress or block out unpleasant possibilities and 'negative' thoughts."
Differing somewhat from Allitt, Ehrenreich notes that the American narrative of upbeat cheer and can-do positivity masks a great deal of distress and cultural turbulence that ends up reflecting back at us bewilderingly different perspectives on the U.S.: "Surprisingly, when psychologists undertake to measure the relative happiness of nations," she observes, "they routinely find that Americans are not, even in prosperous times and despite our vaunted positivity, very happy at all. A recent meta-analysis of over a hundred studies of self-reported happiness worldwide found Americans ranking only twenty-third, surpassed by the Dutch, the Danes, the Malaysians, the Bahamians, the Austrians, and even the supposedly dour Finns. In another potential sign of relative distress," she adds, "Americans account for two-thirds of the global market for antidepressants, which happen also to be the most commonly prescribed drugs in the United States."
There's a lot more to say about both Ehrenreich's book and Allitt's article and interview, and I would love to hear your thoughts on both. By my reckoning, given their wisdom, integrity, and fierce commitment to an honest appraisal of the country's deep-seated problems, both scholars should be commended for reminding us how we've gotten off-track and might also be brought back to fully realizing the country's extraordinary potential.
www.christopherlane.org |
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ORGANIZATION GUIDE
INTRODUCTION
When people go to a church
and start talking in tongues, they don't have any idea what they are
saying and neither does anyone else. However, such behavior and other bizarre
acts as talking to and seeing Angels that no one else can see or hear is
both acceptable and desirable within a religious setting.
Should someone
have similar experiences outside of a religious setting, however, they could
easily be called schizophrenic and locked away indefinitely.
The key
difference is in the write up or the nomenclature used to describe the
experience. While humans have had access to alternative states of consciousness
for countless thousands of years, it is only in relatively recent times that
scientists have sought to limit the ability of humans to experience other states
of awareness by specifying what they feel is normal and what is not and
by setting up an enforcement system backed by the force of law to hunt down
people whose state of consciousness they disagree with and lock them
away.
Click Title for more...
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Newsweek: The Growing Push
Listening to Madness
Why some mentally ill patients are rejecting their medication and making the case for 'mad pride.'
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Schizogenesis
The Mobbing Encyclopaedia
The Definition of Mobbing at Workplaces
© Heinz Leymann - 12100e
Bullying; Whistleblowing
Mobbing - its Course Over Time
New Literature
© Heinz Leymann - file 12220e
Identification of Mobbing Activities
© Heinz Leymann - 12210e
MOBBING: Emotional Abuse in the American Workplace
"Read this book as a safety manual for avoiding the most terrifying kind of workplace injury. The advice given here is clear, practical, and sound. Its foundation in empirical research is firm. I recommend this book to every employee and manager in America."
-Dr. Kenneth Westhues, Professor of Sociology, University of Waterloo, Canada, author of Eliminating Professors, A Guide to the Dismissal Process
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Neither pro- nor anti- medication, the guide provides valuable information for making wiser decisions, and supports people coming off as well as staying on meds. It was developed with the editorial involvement of 14 health care professionals, including psychiatrists, registered nurses, and acupuncturists, and published by The Icarus Project and Freedom Center. You can find out more about the Guide by clicking on the link in the Title. PLease make sure you scroll down far enough.
Harm Reduction Guide PDF Download
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Special People and Places
In June 2006, Leonard’s Electroshock Quotationary, was published on the Internet. The book is an illustrated, 154-page collection of chronologically arranged quotations, excerpts, and short essays about the history and nature of electroshock (electroconvulsive treatment, ECT), psychiatry’s most controversial procedure. This is a PDF file.
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