Study shows atypical antipsychotics pose a higher risk for cardiac arrest

The New York Times has reported that a recent study found atypical antipsychotics, which include the friendly family of Clozaril, Abilify, Risperdal, Zyprexa, and Seroquel (maybe Saphris soon), can increase a patient’s risk of dying from cardiac arrest twofold.

The study published in The New England Journal of Medicine also concluded that the risk of death from the psychotropic medications isn’t high. However, an editorial also published in the same issue “urged doctors to limit their prescribing of antipsychotic drugs, especially to children and elderly patients, who can be highly susceptible to the drugs’ side effects.”

A U.S. News & World Report article linked to the FDA’s atypical antipsychotics page for further patient information. If you’re on an atypical, I’d recommend reading each word in the patient safety info that applies to you. Proofreaders like me shouldn’t be the only ones tortured with reading all the fine print. *winks*

US Airways jet falls into Hudson shortly after takeoff; all onboard survive

Praise the Lord! Seriously. God is so merciful. Tragedy averted. A lot of people were spared grief, heartache, and—of course—depression.

US Airways jet
From The New York Times:

A US Airways jetliner with 148 passengers and 5 crew members plunged into the icy Hudson River on Thursday afternoon five minutes after taking off from LaGuardia Airport, and a spokeswoman for the Federal Aviation Administration said everyone on board escaped safely.

Moments after the plane, a twin jet Airbus A320 bound for Charlotte, N.C., landed on the river near the mouth of the Lincoln Tunnel, at least a half-dozen small craft rushed to aircraft to rescue the freezing passengers and crew.

I’m sure more details will be released in the following hours, days, and weeks but I’m so happy to hear that everyone on board the plane was okay. Here’s my favorite quote from the Times article:

“The plane was totally intact,” Mr. Duckworth said. “Everybody thought it was a sea plane. I kept trying to tell them no.”

Actually it looked like everybody was really calm, like on the subway platform when it’s really, really crowded, and everyone’s standing shoulder to shoulder,” he said. “Everyone was standing right up against each other on the wings.”

FDA: Doctors don't disclose conflicts of interest? We don't really care

According to a NYTimes article, government investigators have reported that the FDA doesn’t seem to care much about the financial disclosure of doctors who participated in clinical trials of medication and diagnostic devices. Then get this:

Moreover, the investigators say, agency officials told them that trying to protect patients from such conflicts was not worth the effort. (Despite the fact that the FDA’s rules require it.)

Doctor making moneyThe article goes on to say that in 42 percent of clinical trials, the FDA did not receive financial disclosure forms that might report conflicts of interest and never followed up on them. In 31 percent of the trials in which the forms were received, “agency reviewers did not document that they looked at the information.” And then, in 20 percent of the cases in which doctors disclosed significant financial conflicts—”neither the FDA nor the sponsoring companies took any action to deal with the conflicts.”

Apparently, the NIH has been investigated for the same thing and government investigators came to the same conclusion as in the FDA case.

The Act and Follow-through of Suicide: Part IV

Compilation of Statistics Regarding Suicide

Scott Anderson in his NYT article weaves the grim statistics of suicide in and out of his story. Here’s the morbid list:

General

  • mental illnessThe nation’s suicide rate (11 victims per 100,000 inhabitants) is almost precisely what it was in 1965.
  • In 2005, approximately 32,000 Americans committed suicide, or nearly twice the number of those killed by homicide.
  • The National Institute of Mental Health says that 90 percent of all suicide “completers” display some form of diagnosable mental disorder.

Demographics

  • Both elderly men living in Western states and white male adolescents from divorced families are at elevated risk.

Premeditation vs. Passion

  • [T]he person who best fits the classic definition of “being suicidal” might actually be safer than one acting in the heat of the moment — at least 40 times safer in the case of someone opting for an overdose of pills over shooting himself.
  • In a 2001 University of Houston study of 153 survivors of nearly lethal attempts between the ages of 13 and 34, only 13 percent reported having contemplated their act for eight hours or longer. To the contrary, 70 percent set the interval between deciding to kill themselves and acting at less than an hour, including an astonishing 24 percent who pegged the interval at less than five minutes.
  • “Sticking one’s head in the oven” became so common in Britain that by the late 1950s it accounted for some 2,500 suicides a year, almost half the nation’s total. By the early 1970s, the amount of carbon monoxide
    running through domestic gas lines had been reduced to nearly zero. During those same years, Britain’s national suicide rate dropped by nearly a third, and it has remained close to that reduced level ever since.

Continue reading “The Act and Follow-through of Suicide: Part IV”

The Act and Follow-through of Suicide: Part II

The British Coal-Gas Story

According to Scott Anderson’s NYT article, the little-known British coal-gas story — even among mental health professionals — is a good example of how suicides can be prevented if one takes away the means:

Coal-gas ovenFor generations, the people of Britain heated their homes and fueled their stoves with coal gas. While plentiful and cheap, coal-derived gas could also be deadly; in its unburned form, it released very high levels of carbon monoxide, and an open valve or a leak in a closed space could induce asphyxiation in a matter of minutes. This extreme toxicity also made it a preferred method of suicide. “Sticking one’s head in the oven” became so common in Britain that by the late 1950s it accounted for some 2,500 suicides a year, almost half the nation’s total.

Those numbers began dropping over the next decade as the British government embarked on a program to phase out coal gas in favor of the much cleaner natural gas. By the early 1970s, the amount of carbon monoxide running through domestic gas lines had been reduced to nearly zero. During those same years, Britain’s national suicide rate dropped by nearly a third, and it has remained close to that reduced level ever since.

Experts seems to insist that committing suicide is proof of an underlying mental illness. Suicide that stems from impulsivity, among these experts, is also considered part of a mental illness. Anderson subtly argues against this, and I find myself agreeing with him:

How can this be? After all, if the impulse to suicide is primarily rooted in mental illness and that illness goes untreated, how does merely closing off one means of self-destruction have any lasting effect? At least a partial answer is that many of those Britons who asphyxiated themselves did so impulsively. In a moment of deep despair or rage or sadness, they turned to what was easy and quick and deadly — “the execution chamber in everyone’s kitchen,” as one psychologist described it — and that instrument allowed little time for second thoughts. Remove it, and the process slowed down; it allowed time for the dark passion to pass.

Would this mean that if people had less access to suicidal means that promoted “ease, speed, and certainty of death” (ESCOD), a number of suicides could be averted? It appears so. Anderson continues to make a case using the Ellington Bridge in Northwest Washington as an example:

Continue reading “The Act and Follow-through of Suicide: Part II”

The Act and Follow-through of Suicide: Part I

“What was immediately apparent was that none of them had truly wanted to die. They had wanted their inner pain to stop; they wanted some measure of relief; and this was the only answer they could find. They were in spiritual agony, and they sought a physical solution.”Dr. David Rosen, psychiatrist and Jungian psychoanalyst

A recent article in New York Times magazine suggests that those who exhibit suicidal behavior or have had unsuccessful attempts are least likely to die by way of suicide.

The author, Scott Anderson, delves into the psyche of what drives a person to commit suicide. And he attempts to answer the "what" question by evaluating the "how."

Continue reading “The Act and Follow-through of Suicide: Part I”

Great editorial in NYTimes

The New York Times published a great editorial supporting a ban on much of the lavish treatment that doctors get from drug reps. If adopted by medical schools, restrictions would include:

  • Ban on personal gifts, industry-supplied foods and meals, free travel (not reimbursed for services), and payment for attending industry-sponsored meetings
  • Ban on ghostwriting, the practice of drug companies drafting an article and then getting a doc to slap his or her name on it making it look at though the doc actually wrote it
  • Drug samples would have to be submitted to a central pharmacy not individual doctors

The restrictions, however, end there. The editorial says the proposal goes far but not far enough.

Patients need to be assured that their doctors are prescribing what’s best for them, not what’s best for companies.

Can someone get a doctor to read this?

NYTimes

“The drugs save lives, and we often have no choice but to use them — even if we have questions about their long-term use. But the questions are big ones, and we owe it to our patients to try to answer them.”

Richard FriedmanDr. Richard Friedman, a frequent mental health columnist for the New York Times, has written a piece that questions the use of antidepressants and how dependent patients have become on them. I’ve read Friedman’s previous columns and appreciate his realistic take on the psychiatric and psychological field. His most recent piece is worth reading.

Are Big Pharma murderers?

An book review in the NYTimes today focuses on Melody Petersen, a former reporter of the Times, who has written a book against  Big Pharma's marketing tactics called Our Daily Meds: How the Pharmaceutical Companies Transformed Themselves Into Slick Marketing Machines and Hooked the Nation on Prescription Drugs. In the book, she asks:

“Could drugs be killing people but escaping all blame, leaving them to harm even more Americans until someone, finally, catches on?” Ms. Petersen asks.

Few of us have. Most of America hasn't. Petersen outlines in great detail – the point of repetition according to Janet Maslin's review – Big Pharma's propensity for skewing clinical trial results so that their drugs perform better than placebo, the increased and ubiquitous DTC marketing, and the "payola-dispensing drug company representatives."

(“Hotel too cold inside,” one said, in an evaluation of a June 1998
drug company program, adding, “Resort places preferred.” From a
different doctor, miffed at the lack of a chauffeur at another event:
“Hired car would have been much preferable.”

Petersen also covers Big Pharma's tactic of fixing side effects of medications by creating medications to fix the side effects leading to medication on medication.

And when the side effects of sleeping pills or antidepressants mean
more elderly people fall down, the solution is not likely to be the
scaling back of such prescriptions. “Instead,” she writes, “the
companies have used the statistics on falls to create a new blockbuster
pharmaceutical market for drugs they claim will reduce the chances of
breaking a bone.”

According to the Maslin's review, the book calls for non-government watchdog agencies and closer oversight on published studies, which Petersen says are ghostwritten by pharma spokespeople. Overall, Petersen's book sounds like a must-read for anyone who is skeptical of Big Pharma's activities. However, I doubt her book will get much press or coverage considering that you can't read any major publication without turning the page and seeing a drug ad then the required 2-page side effect warning that everyone skips over. If anyone reads the book, I'd like to know your thoughts about it.

Sorry if this post sounds hastily written. I'm off to an interview to freelance for a company.