Friday, July 31. 2009
'The myth of the chemical cure'
Do psychiatric drugs work? Dr Joanna Moncrieff, of the department of mental health sciences at University College London, says they actually put people into "drug-induced states". She discusses whether drug treatments work in psychiatry with consultant psychiatrist Trevor Turner.
Monday, July 27. 2009
Government virus expert paid £116k by Tamiflu vaccine makers
By David Derbyshire
27th July 2009
A scientist who advises the Government on swine flu is a paid director of a drugs firm making hundreds of millions of pounds from the pandemic.
Professor Sir Roy Anderson sits on the Scientific Advisory Group for Emergencies (Sage), a 20-strong task force drawing up the action plan for the virus. Yet he also holds a £116,000-a-year post on the board of GlaxoSmithKline, the company selling swine flu vaccines and anti-virals to the NHS.
Sir Roy faced demands to step down yesterday amid claims that the jobs were incompatible. 'This is a clear conflict of interest and should be of great concern to taxpayers and government officials alike,' said Matthew Elliott of the TaxPayers' Alliance.
'You cannot have the man in charge of medical emergencies having any financial interest in the management of those emergencies. We need someone totally unbiased to tackle this crisis.'
The Department of Health and GSK denied there was a conflict and said Sir Roy did not attend Sage meetings where vaccines and drugs were discussed. Sir Roy was appointed to Sage to 'provide cross-government scientific advice regarding the outbreak of swine flu'. He was one of the first UK experts to call the outbreak a pandemic.
During an interview for Radio Four's Today programme on May 1, he praised the anti-flu drugs and called for their distribution. Listeners were not told he was paid by GSK.
The West London-based drugs giant has had to defend itself from allegations of profiteering from swine flu after posting profits of £2.1billion in the last three months.
Sales of the company's Relenza inhaler, an alternative to Tamiflu used by pregnant women among others, are expected to top £600million. This figure could be boosted by up to £2billion once deliveries of the firm's swine-flu vaccine begin in September.
Sir Roy, 61, who was unavailable for comment yesterday, earned £116,000 at GSK last year, at least a quarter of which he received in shares. GSK's share price has risen 10 per cent since May from about 1,060p to more than 1,160p.
A spokesman for GSK insisted there was no conflict of interest.
'Professor Anderson stepped down from the government's flu advisory group on appointment to GSK. In May, he was asked to rejoin as a temporary member as the scale of the influenza pandemic became evident. He is a world authority on the epidemiology of infectious diseases and his positions as an adviser to the government and as a member of GSK's board are entirely appropriate.These interests have been declared at all times and he has not attended any meetings related to purchase of drugs or vaccine for either the government or GSK.'
A spokesman for Imperial College said Sir Roy's temporarily appointment to Sage was made 'with the full knowledge of the government departments involved in handling the pandemic'.
He added: 'He is not a member of the drug or vaccine sub committees of the flu advisory group.'
During the 2001 foot and mouth outbreak, Sir Roy's advice to Tony Blair led to the culling of more than 6 million animals.
The previous year at Oxford University, Sir Roy was at the centre of controversy after claiming a female colleague had slept with her boss before getting a job. He was forced to apologise and pay compensation.
A university inquiry in the wake of the scandal found that he was in breach of rules by failing to disclose his business interests as director and shareholder of International Biomedical and Health Sciences Consortium - an Oxford-based biomedical consultancy, which had awarded grants to his research centre.
Sir Roy was forced to resign, although his career soon recovered. He moved to Imperial College within months, was made the Ministry of Defence's chief scientist and, last year, took over as Rector of Imperial College, London where he earns up to £400,000 a year.
The promotion of Key Opinion Leaders in medicine has been highlighted many times and in many places and works alongside the capture of regulators. Sociologists now talk of regulatory capture by the pharmaceutical industry.The revolving door is an important element in that capture. In a November 2004 debate on the UK drugs regulator, Melanie Johnson, the then Parliamentary Under-Secretary of State for Health said:
“I will make a point about the agency's relationship with industry that I believe hon. Members will be keen to hear. The working relationship that the agency needs to have with industry does not inhibit the scientific and regulatory independence of the MHRA...a significant proportion of the MHRA's senior scientific staff are, of course, recruited from, or have a history in, the industry. That is necessary, as they make up the largest single pool of specialist advice for effective drug regulation. They must be drawn from the industry; there is no other source. We need to accept that the pool of people who may have a background in the drugs industry and who understand how it works are likely to be from the industry. The question is where Members believe we would acquire experts who at no point in their past have some sort of background connected with the drugs industry. We will bring UK policy into line with the new EU legislation on these matters which requires that experts should have no financial or other interest in the pharmaceutical industry that could affect their impartiality.”
The assertion that only those people with previous pharmaceutical industry experience are capable of policing it, has to be a complete nonsense, and has much more to do with the cosy working relationship between the Department of Health as a whole, the drugs Regulator and the Pharmaceutical Companies. The belief put forward that only those with a drug company working history can understand the evidence presented by manufacturers is facile, particularly since it transpires that the Regulator does not routinely work on raw data but rather on summaries provided by the industry.
John Abraham, Professor of Sociology at the University of Sussex, made these comments in the Guardian in 2005:
“There is too much of a revolving door syndrome at the MHRA. Not only do CSM members take fees from industry, but many agency officials used to work for drug companies. I would suggest, to a lay person there is a big problem with the concept of independence from industry of a body that is fully funded by industry. The criticism of the old Department of Health medicines department in the 70s was that it didn’t have any teeth. Not only does it not now have any teeth, but it is not motivated to bite.”
Personal financial interests in the drugs industry are now prohibited, bringing the UK into line with Europe, but that element was never the only factor in the influence of the pharmaceutical industry on regulators. In March 2003, Sarah Bosely, in the Guardian, wrote an article entitled, ‘Drugs inquiry thrown into doubt over members' links with manufacturers’. The article examined the subject of a proposed inquiry into the affair of antidepressant SSRIs. As it said:
“The credibility of a government inquiry intended to settle the controversy surrounding widely prescribed antidepressant drugs was thrown into question yesterday by revelations that most of the members have shareholdings or other links to the manufacturers.”
Those with interests in SSRIs but not part of the charmed circle were rightly unhappy with both the membership of the inquiry and with the role of the expert witnesses. Two of the four proposed CSM members were holders of shares in GlaxoSmithKline, the manufacturers of Seroxat. They were Michael Donaghy, a reader in clinical neurology at the University of Oxford, and David Nutt, a professor of psychopharmacology at Bristol University. In some sort of mannered dance, to demonstrate impartiality, the usual convention was to be used and because of their financial stake they would leave the room when Seroxat was discussed. Then, having changed partners as it were, they would re-enter for the debate on SSRIs in general.
The Department of Health and the drugs regulators themselves have always maintained that it is sufficient for members to declare their interests in drug companies before meetings and to leave the room if they have personal interests such as shareholdings. They now maintain that it is perfectly possible and reasonable for us to believe that careers in drug companies and/or research funding from drug companies, exerts no influence on their decisions and views on drug safety. The view put forward whenever criticisms are made is always something along the lines of—‘the system for preventing conflicts of interest works well; committee members and members of working groups are professionals of the highest standing in their fields and there is no evidence that members have acted other than with propriety and integrity.’
One expert witness, Dr Baldwin did declare a personal interest in Lundbeck, the makers of Citalopram. But according to the minutes, he did not declare his connections with five other companies, including Seroxat manufacturers GlaxoSmithKline. His department had been funded by SmithKline Beecham, Bristol-Myers Squibb, Eli Lilly, Organon, and Pharmacia for studies by the same five companies and he had been paid by them for speaking at symposia to other doctors about the drugs.
Wednesday, July 22. 2009
‘The 20th Eve Saville memorial lecture will be taking place on Tuesday 14 July 2009, 6-7pm in the Great Hall, King's College London. It will be presented by Professor David Nutt, Imperial College London, a leading academic and policy thinker on drugs policy and Chair of the independent and expert body the Advisory Council on the Misuse of Drugs which advises government. Professor Nutt will be addressing the broad theme of: drugs and other social harms in society, and what we might do about them.’
This is a letter sent to Professor Nutt following the lecture. The reply at the bottom of the letter illustrates well the way he operates. Almost the same words were used in his response to a Submission on Tranquillisers. On the face of it open to persuasion if the evidence is there BUT he will be the judge of the evidence. He is out of step with many people's experience of drugs such as benzodiazepines, SSRIs, ecstasy and cannabis but has somehow achieved a key role as government adviser and learned pundit. Supporters claim his voice is the rational voice of science.
Dear Professor Nutt,
I attended your lecture on July 14th and was extremely concerned about some of the points that you raised, especially around the evidence on cannabis harms which was the main subject of your talk.
You repeated the conclusions from the ACMD report that there is a weak but probable causal link between cannabis and psychotic illnesses, the likely role of cannabis in the development of these conditions being only modest.
Professor Robin Murray has been conducting experiments at The Institute of Psychiatry for about 2 years now which involve the administration of THC to healthy volunteers. I have listened to him talk about this subject now on 2 occasions. He is in no doubt that THC causes psychosis. In his words, it's simply a matter of how much is given. His research is still to be published but has received widespread publicity in the press and on TV.
He has also found that the presence of CBD (cannabidiol) in skunk has virtually disappeared, having previously balanced the amount of THC in the old herbal cannabis. CBD, thought to have anti-psychotic properties, would counteract the psychotic effects of THC.
In 2005 a rogue gene was found which can be triggered by cannabis in adolescence, If one copy is carried, the risk of psychotic illness increases by 5 to 6 times, 2 copies carry a 10-fold increase of risk (Caspi et al 2005). Also in the same year, Ashtari found damage in the same brain regions of adolescent cannabis users and adolescent non-users who were schizophrenic.
In October 2006, Professor Murray said, "Five years ago, 95% of psychiatrists would have said that cannabis doesn’t cause psychosis. Now I would estimate that 95% say it does”. Have you ever spoken to Professor Murray about his research?
It is rare in my experience to find anyone now who does not know of someone who has become psychotic because of cannabis use. I work with parents, all of whom have children badly affected by this drug. Maybe this would help to explain to you the 'unexpected results', in your view, of the MORI poll of 1,000 people that you commissioned which found that 32% would like it to be in class A, 26% in B and 18% in C. Only 11% preferred legalisation and 13% were undecided.
Other effects of the drug were not even mentioned. All youngsters are affected by the persistence of the fat-soluble THC in the brain cell membranes. Fifty per cent of the compound will still be present a week after consumption and 10% after a month. This 'clogging up' of the brain interferes with the transmission of all the neurotransmitters in the brain and subsequently impairs all brain activity. Concentration, learning and memory are adversely affected and academic performance plummets. I've seen students lose their university places. A grade 'D' student is 4 times more likely to have used cannabis than one with 'A' grades. Few children using cannabis even occasionally will achieve their full potential. Exam grades at senior level would improve for many if we could stop children from using this drug.
Personalities change. Young people become fixed in their ideas, cannot find words to express themselves, cannot plan their days and can't take criticism - it's always someone else's fault. (Lundqvist). They can become violent (thought to be due to the psychosis) and I have lost count of the numerous tales I have heard of offspring 'trashing the house' or hitting their parents. Murders and suicides have been attributed to cannabis use. At the same time they feel lonely, miserable and misunderstood. Some researchers believe that permanent brain damage is a possibility and I have seen ex-users still struggling for words many years after giving up.
Addiction to cannabis, both physical and psychological is well documented. Withdrawal is not so dramatic as that from heroin as THC remains in the body for a long time, but users find it very difficult to quit (Budney 2006).
Driving is hazardous. Airline pilots in a double-blind experiment on flight simulators could not land their planes properly 24 hours and more after a joint and thought nothing was amiss (Leirer et al). An alcohol-cannabis combination is 16 times more dangerous while driving than use of either drug alone. Many road fatalities have been attributed to cannabis use. (Laumon 2005).
Cannabis can also affect the reproductive, immune and cardiac systems and can cause cancers, emphysema, bronchitis and bullous lung disease. Two teenagers binged on cannabis and died of strokes, another was left paralysed (Geller 2004).
You said that the evidence of causality is not there for the "gateway" theory, and that this is not now believed. Have you not read the current research taking place in Sweden's Karolinska University ( Hurd, Ellgren) where they are finding that the brains of animals are "primed" by cannabis for the use of other drugs? Or seen the latest paper (2008) on The Dunedin Project by Professor David Fegusson in New Zealand. This 25-year study from birth concludes:
‘The use of cannabis in late adolescence and early adulthood emerged as the strongest risk factor for later involvement in other illicit drug use’.
Cannabis is undoubtedly a dangerous drug, especially skunk which now claims 80 to 90% of the market, with a THC content averaging 14 to 16%. Old-fashioned herbal cannabis contained 1 to 3% THC and is hardly available now.
I sent you my report on cannabis that I wrote for The Social Justice Policy Group in 2006, a fully referenced scientific document endorsed by leading scientists in the field. I keep it updated. All the information I have mentioned can be found here. Did you read it? I published a letter in The Times, signed by 6 others to say that I had sent it to the ACMD.
With reference to ecstasy and politicians versus scientists, you said the scientists had won that argument. I don't think Professor Andrew Parrott, unaware of the fact that an investigation into ecstasy classification was underway until I alerted him, would agree with you. Having researched ecstasy for the last 14 or 15 years, he is the top ecstasy researcher in the country. He severely criticised your conclusions when he gave his presentation to the open meeting of the ACMD on 25th August 2008.
Surely comparing horse riding with the taking of ecstasy is fundamentally flawed. There is a world of difference between pursuing a sport/hobby, be it riding or bungee jumping, to release more of the pleasure neurotransmitter dopamine, with the brain still firmly in control, and some semblance of skill involved, than stuffing the brain cells with chemicals to get the same effect. That way the brain loses control and the results are entirely unpredictable and often tragic. Were you really disappointed the BBC failed to make a programme out of this?
You entreated us to follow harm reduction approaches in all aspects and at all levels. This present Government philosophy has ended up with Britain having the worst drug problem in Europe. There are 10 problem drug users per 100,000 in the UK compared with 4.5 in Sweden and we lead Europe in "recreational drug use" with the highest levels of consumption of amphetamines, cocaine and ecstasy. Cocaine use continues to rise and the age of initiation into drug-taking for children gets ever younger (EMCDDA 2008).
There is a place for harm reduction - as a temporary measure in the course of treatment to keep the person safer on the road to quitting. But most certainly not in drug education where harm reduction policies replaced prevention some years ago. The vast majority of children do not want to take drugs so giving them "informed choice" from the age of seven when their brains are so immature is indefensible. The risk-taking part of the brain develops before the inhibitory part so they are most likely to choose risk.
Adults are supposed to protect children not abandon them to make critical life decisions at such a vulnerable age. We don’t let them “choose” to steal, or do any other illegal activity. And good information on cannabis is woefully inadequate, often misleading and sometimes wrong (FRANK). Harm reduction drug education doesn't tackle drugs, it condones their use.
Prevention works - I know - I have practised it in drug education for many years. The "Just Say No" campaign in the USA (which was always much more than that) also worked - 23 million users became 14 million, cocaine and cannabis use halved and daily cannabis use fell by 75%. Surveys at the time showed that over 70% of youngsters were put off cannabis by being given true unexaggerated scientific facts (Report from North America, Rosenthal MS 1992). A survey here a few years ago echoed these findings (Barry Twigg, Brunel University Doctorate thesis).
Several times you said that alcohol and tobacco caused more damage than the illegal drugs. Of course they do. Around 90% of the population drink, increasingly at a younger age, so this is inevitably going to result in more problems. It's the same with tobacco, around 20 % still smoke. In contrast, regular drug-taking is about 10% in the UK. Prohibition has kept this figure in check and long may it continue to do so.
You said that you are “looking at” cognition-enhancing drugs. Is it acceptable to allow students to ‘artificially’ improve their performance in exams? How does this differ from drug-taking in sport? Having succeeded in getting a better grade in an exam, then surely afterwards they would feel compelled to maintain their performance, thus enslaving themselves to a lifetime of drug use. One of the ones mentioned in this context is Ritalin, normally used to treat ADHD in children, a Class’A’ drug and the subject of grave concern among some medical people.
It is our duty to warn our offspring of the true dangers of drugs. Future generations will judge us harshly for not ensuring that they have had the best available up-to-date and accurate scientific information.
Article 33 The Convention on the Rights of the Child states:
States Parties shall take all appropriate measures, including legislative, administrative, social and educational measures, to protect children from the illicit use of narcotic drugs and psychotropic substances as defined in the relevant international treaties, and to prevent the use of children in the illicit production and trafficking of such substances.
Mary Brett, Biologist, Vice-President of Eurad (Europe Against Drugs). Member of PandA (Prisons and Addictions Forum, CPS) and Trustee of ‘Talk About Cannabis and Skunk’.
Thanks for your email.
I thought it was important to clarify in a public talk the way the ACMD reviewed cannabis to remind people of our processes and the conclusions in our last report. There we clearly state it can lead to psychosis but we do not consider the scale of this harm sufficient to warrant class B status. If your scientific advisers have a different view then they are more than welcome to submit their analysis of the data to the ACMD and we will consider it alongside any other new facts that emerge.
Please send any further correspondence to Will Reynolds whos is the secretary to the ACMD
Thursday, July 16. 2009
Yesterday, a debate in Parliament illustrated once again that most Labour party politicians wouldn’t know an ethic if they were joined at the head with one. Eighty-two Labour MPs signed three Parliamentary motions, going back to 2005, opposing the unbalanced Extradition Act which allows the US to try British citizens in the US and/or had opposed sending Asperger’s sufferer and Pentagon hacker Gary McKinnon to the U.S. for trial. Come the vote on the Conservative call for an 'immediate review' of the one-sided treaty, 59 of them decided that justice was a less important concept than supporting their government masters and 15 more thought they would avoid thinking about justice and did not vote at all. Only 8 stuck to their previous position and conviction.
Alan Johnson a former postman (a very nice chap according to newspapers) is the recently appointed Home Secretary and the responsible minister. He expressed a belief (based on advice) that he was unable to interfere, said he was not a lawyer and described himself as merely a hack politician. Liberal Democrat and Conservative MPs who were lawyers assured him that he did have the legal right to prevent McKinnon being sent to the US but Johnson preferred to remain helpless. Chris Grayling the conservative Shadow Home Secretary said: 'It's exactly this kind of behaviour that brings Parliament into disrepute.'
The hypocrite politicians displayed the same rubber backbone and false concern that former Home Secretary David Blunkett displayed (see letter below) when in Opposition (and when it cost him nothing) regarding the tranquilliser scandal. When he assumed office how quickly he forgot what he had said and put his own career first. Ironically, Blunkett was the former Home Secretary responsible for the unbalanced extradition-treaty and did not attend the debate.
The Daily Mail today provided a list of the MPs who abandoned their former position:
Diane Abbott (Hackney North and Stoke Newington), David Anderson (Blaydon), John Austin (Erith and Thamesmead), Joe Benton (Bootle), Clive Betts (Sheffield Attercliffe), Lyn Brown (West Ham), Russell Brown (Dumfries and Galloway), Richard Burden (Birmingham Northfield), Dawn Butler (Brent South), Martin Caton (Gower), Ann Cryer (Keighley), Jim Cunningham (Coventry South)
Quentin Davies (Grantham and Stamford), Janet Dean (Burton), Jim Dowd (Lewisham West), Jeff Ennis (Barnsley East and Mexborough), Hywel Francis (Aberavon), Neil Gerrard (Walthamstow), Roger Godsiff (Birmingham Sparkbrook and Small Heath), Helen Goodman (Bishop Auckland), John Grogan (Selby), Patrick Hall (Bedford), David Heyes (Ashton under Lyne), Kelvin Hopkins (Luton North), Joan Humble (Blackpool North and Fleetwood), Brian Iddon (Bolton South East), Eric Illsley (Barnsley East) Glenda Jackson (Hampstead and Highgate), Brian Jenkins (Tamworth), Martyn Jones (Clwyd South), Sadiq Khan ( Tooting), Mark Lazarowicz (Edinburgh North and Leith), Tony Lloyd ( Manchester Central), Kerry McCarthy (Bristol East), Jim McGovern (Dundee West), Anne McGuire ( Stirling), Shahid Malik (Dewsbury), Gordon Marsden (Blackpool South), Anne Moffat (East Lothian), Madeleine Moon (Bridgend), Julie Morgan (Cardiff North), George Mudie (Leeds East) Nick Palmer (Broxtowe), Gordon Prentice (Pendle), Joan Ruddock (Lewisham Deptford), Joan Ryan (Enfield North), Martin Salter (Reading West), Andy Slaughter (Ealing, Acton and Shepherd's Bush), John Smith (Glamorgan), Sir Peter Soulsby (Leicester South), Gavin Strang (Edinburgh East) David Taylor (North West Leicestershire), Desmond Turner (Brighton Kemptown), Rudi Vis (Finchley and Golders Green), Lynda Waltho (Stourbridge), Bob Wareing (Liverpool West Derby), Betty Williams (Conway), Anthony Wright (Great Yarmouth), Iain Wright (Hartlepool).
Roger Berry (Kingswood), Roberta Blackman-Woods (City of Durham), Harry Cohen (Leyton and Wanstead), Andrew Dismore (Hendon), Bill Etherington (Sunderland North), Frank Field (Birkenhead), Fabian Hamilton (Leeds North East), John Heppell (Nottingham East), Peter Kilfoyle (Liverpool Walton), Christine McCafferty (Calder Valley), Bob Marshall-Andrews ( Medway), Chris Mullin (Sunderland South), Edward O'Hara (Knowsley South), Marsha Singh (Bradford West), Mike Wood (Batley and Spen).
H O U S E OF C O M M O N S
LONDON SW1A 0AA
DAVID BLUNKETT MP
Shadow Secretary of State for Health
and Member of Parliament for Sheffield Brightside
24 February 1994
Dear Mr Haslam
Thank you for your recent letter regarding Benzodiazepine Tranquillisers.
Dawn Primarolo and myself have been taking up cases and have advised on how best the groups involved might organise a parliamentary lobby and keep attention on these issues.
We have also tried to assist through both Parliamentary Questions and raising the matter on the floor of the House, in pushing the Government to accept its own responsibilities and to take action now to ensure that it does not happen again.
This is something we will be returning to both in the House and in terms of our own future policy development.
I am passing your letter to Paul Boateng who, as the legal affairs spokesman, has specific responsibility for the litigation side of what is a national scandal.
With all good wishes
David Blunkett MP
Shadow Secretary of State for Health
Friday, July 10. 2009
After three long years Christopher Gillberg's Strattera study on adults is finally published.I revealed catastrophic results from this study already before it was completed. See Eli Lilly's and Christopher Gillberg's failed experiment with Strattera
http://www.24-7pressrelease.com/view_press_release.php?rID=10122 4 January, 2006.
And now after some good pressure the article Open-Label Trial of Atomoxetine Hydrochloride in Adults with ADHD is published on-line in the Journal of Attention Disorders, 20 May 2009, http://jad.sagepub.com/pap.dtl
What about this result, from the article: "Open-label trial of atomoxetine in 20 individuals with ADHD ... Six patients discontinued before 10 weeks and thirteen at 10 weeks or later, mainly because of side-effects (aggression, depressed mood, raised liver enzymes, thyroid hormones, diastolic blood pressure), decreasing efficacy or non-compliance."
And: "...benefits from the medication seemed, at least subjectively by the patients, to fade away over time, and in the long term, effects could not justify prolongation of the treatment, especially, when feelings of depression, aggressiveness and/or hostility, or just a feeling of numbness occurred."
Thursday, July 2. 2009
The drugs don't work
The number of people on antidepressants is soaring – we may be more miserable, but let's swap the pills for support and care
guardian.co.uk, Monday 29 June 2009
It may have been the happiest day of the year on 19 June, but we are already into the hangover. Figures obtained by the Liberal Democrats reveal that antidepressant prescription numbers are going through the roof – 36m scripts were handed out to patients in England last year, a rise of 2.1m on 2007. That's almost one for every adult. Lib Dem health spokesman Norman Lamb is right to describe the figures as "deeply disturbing".
Lamb has demanded improved help for people whose problems are recession-related. It's true that financial woes create more distress, but we shouldn't use the economy as a smokescreen for what is a longer-term malaise. Antidepressant use has been going up for years – prescriptions have more than tripled since the early 1990s. We have not become a Prozac nation overnight.
So what is going on? Are we genuinely becoming more miserable? That's part of the story – according to official statistics, the percentage of people with a "common mental disorder" increased from 15.5% in 1993 to 17.6% in 2007 (that's a million extra unhappy people across the UK). Some of these inevitably wind up at the GP surgery, seeking relief.
But perhaps more instructive is what happens next. Most GPs respond to mental health problems by reaching for the prescription pad, even though guidelines from the National Institute For Clinical Excellence generally recommend psychological therapies. To some extent, doctors do this because they have little choice – more than three-quarters have prescribed medication despite thinking an alternative would be more appropriate. Most do so because there are no other options available – decent psychotherapy services are still few and far between, and often have long waiting lists.
However, medics also prescribe drugs because that's what they are trained to do – pills have long been their (and our) default response to depression. The dominant view of psychiatric illness is that chemical imbalances in the brain are mostly to blame, and that they can be controlled with pharmaceuticals. This line has been peddled hard by drug companies, and for a long time it was accepted almost without question — the reception which greeted the arrival of Prozac and the other SSRI antidepressants (which were supposed to counter the "imbalances") was nothing short of hysterical. Reality has been more prosaic: a recent review found the SSRIs barely more effective than a placebo pill. Still, the NHS bill for prescribing them runs into hundreds of millions of pounds a year.
It's a crazy situation, and the tide may be turning. The dubious tricks used by drug companies to make their products seem more effective are becoming widely known (thanks in part to vocal critics from inside medicine, such as this paper's Ben Goldacre), while the government is beginning to invest in proven non-drug alternatives, such as psychotherapy. Research into the biological bases of mental ill-health is floundering – a study just released casts serious doubt on the existence of a previously heralded "depression risk gene". Meanwhile, there is a growing evidence base for simple, socially based steps everyone can take to improve their wellbeing. These include building good relationships, lifelong learning, being kind to others and exercise – not rocket science, but somehow we seem to have forgotten them.
And this week, renowned clinical psychologist Richard Bentall publishes Doctoring The Mind: Why Psychiatric Treatments Fail. In meticulously referenced detail, Bentall documents the shocking failures of biological psychiatry and the drug-based mental health system it perpetuates, and calls for an evidence-based alternative that offers patients support, care and respect. The book effects a courageous, comprehensive demolition of the status quo, and offers a radical vision of a more humane future for services – it should be required reading for everyone with a hand in mental health policy.
It won't be easy to make such radical changes in the way we approach wellbeing. It means giving up hope of medical "quick fixes", at least until they are as good as their makers claim, and turning instead towards methods that are far less financially profitable, and which require hard work on the part of professionals, patients, government and the rest of us. As well as an overhaul of services, it means tackling social fragmentation, greed-based economics and the stress created by a speedy, sensationalist culture. And it means starting a mature debate based on understanding rather than fear of the mind, promoting the ways we can look after our psychological as well as our physical health. That may sound like a tall order, but until we make a start, the queue of glum-looking folk at the chemist will just keep on getting longer.
Thursday, July 2. 2009
See a psychiatrist? Are you mad?
Salley Vickers applauds a brave work that argues that mind-altering drugs do more harm than good to the mentally ill
The Observer, Sunday 21 June 2009
Richard Bentall, a clinical psychologist, is a controversial figure in the field of mental health. An example of the hostility that his conclusions provoke among those practising conventional (that is, drug-based) psychiatry is given in the preface to this book, which raises serious questions about the treatment of mental illness. Bentall describes an encounter with an amiable-seeming psychiatrist who responds to a talk he has given as follows: "Professor Bentall has told us he is a scientist. But he is not! Nothing that Professor Bentall has said - not one single word - is true."
The unlikelihood of a professor of psychology delivering, in the sober environment of an NHS conference, a talk in which every word is fictitious and every opinion fallacious gives a flavour of the threat that Bentall's theories pose. The response, as reported, sounds deranged and it is interesting to observe how debate among professionals over the causes of mental illness appears to induce its own version of madness, as if the topic itself were contagious. One sign of sanity, both in the individual and society, is the ability to deal with dissent.
In an earlier book, Madness Explained, Bentall was at pains to distinguish his approach from other anti-psychiatrists - for example, RD Laing, whose radical views were discredited because of his flamboyant lack of rigour and attendant inability to accept criticism. Bentall, as this book attests, is a different kettle of fish. With patient persistence and without recourse to rancorous diatribes, he has appraised the scientific evidence for the success of contemporary psychiatric treatments and come up with a dismal report. It is probably the very balance of his approach that drives his opponents crazy.
Doctoring the Mind is an attempt to clarify the dense array of evidence offered in Bentall's earlier work. The result is a much easier read. It is also, for that reason, more disturbing. Other recent books (Lisa Appignanesi's Mad, Bad and Sad, for example) have also traced the dark strains of misperception, mismanagement and downright cruelty in psychiatry's chequered history, but Bentall's achievement is to focus on contemporary psychiatric practices, especially those dedicated to treating serious psychoses (his own area of expertise).
Bentall's thesis is that, for all the apparent advances in understanding psychiatric disorders, psychiatric treatment has done little to improve human welfare, because the scientific research which has led to the favouring of mind-altering drugs is, as he puts it, "fatally flawed". He cites some startling evidence from the World Health Organisation that suggests patients suffering psychotic episodes in developing countries recover "better" than those from the industrialised world and the aim of the book is broadly to suggest why this might be so.
The first part describes the historical evolution of different kinds of treatment, moving on to dismantle some myths about the nature of severe mental illness. On the way, Bentall addresses the problem of diagnostic categories, suggesting that what are conventionally called psychiatric "symptoms" are more accurately termed "complaints". A particular focus of his critique is the notion of heritability, the theory that mental illness has a genetic basis. According to Bentall, there exist grave flaws in the research methods adopted and the stigma of an inescapable genetic stamp baselessly fuels discrimination against those suffering mental disarray. In addition, the dangers of long-term exposure to many psychotropic drugs appears to outweigh their usefulness.
Here it is important to explain something that is not always understood, which is that mental "illness" is not strictly comparable with physical illness. There are several reasons for this, one being that the aetiology (causation) of so-called mental disease is not yet identifiable in the way that, say, measles is. The precise causal relationship between or mind and body remains misty, but that strong emotional states have an impact on physical states is recognisable in everyday life. We do not feel fear because we have paled or experience anxiety because we sweat. We blush or, if we have penises, have erections because strong emotions trigger these normal physical responses.
The question then becomes this: are distressing mental states the result of impaired brain chemistry or is it the other way round? Does trauma, whether singular or chronic, as in the long misery of an abandoned child or the recurring anxiety of an assaulted one, alter the subtle chemistry of the brain to affect subsequent states of mind? This debate, as Bentall demonstrates, is not only still on, but is heated.
The second reason for distinguishing between physical and mental illness is that diagnostic concepts defining "mental disease" are, in Bentall's words, "invented, not discovered". They arise out of a collective decision, rather than scientific discovery (you can't test for schizophrenia in the way you can for diabetes). Schizophrenia and bipolar disease (once called "manic depression") are merely the names given to a loose collection of "symptoms" and the decision to plump for one diagnosis over another will be influenced by the doctor's interpretation of the current psychiatric scoreboard.
Perhaps significantly, psychiatrists in the US and Russia are more likely to diagnose schizophrenia than their warier European colleagues. I was amused to find that, according to one of the quoted tests, I would be labelled psychotic, while no test (at least in my current state of health) could show that I have, for example, TB. In this context, it is relevant that, in the old USSR, dissidents were commonly labelled "schizophrenic". It would have been simpler to be rid of them by calling them "lepers", but leprosy can be disproved through laboratory testing, while schizophrenia cannot. That physical and mental illness are incommensurate is significant, as it has a profound bearing on treatment. While advances in the realm of physical illness have been spectacular, in the shadowy province of mental health the news is at best disappointing.
And some of it is dire. Bentall is not the first to call attention to a drugs industry whose success is based on the efficacy of its marketing techniques rather than of its medications. But it is useful to be reminded of the massive financial forces behind the enthusiasm for drugs. It has become standard practice among psychiatrists to medicate for life those diagnosed with serious psychoses when, demonstrably, more is not better, either in dosage or time scale. In the US, children are being prescribed anti-psychotic drugs for "disruptive" behaviour. Grief, disappointment and old age are nowadays routinely met with serotonin-reuptake inhibitors.
In the course of his inquiry, Bentall is at pains not to fling out the baby with the bath water. He makes an all-important distinction between being "anti-psychiatrist" and "anti-psychiatry", a common category error, and is careful to say that "most people drawn to work in psychiatry are kind and caring". He recognises that there are occasions where drugs are necessary and some when nothing else will do. He is not in favour of half-baked "alternative" remedies.
He believes that it is true that some behavioural disorders are the result of a complex malfunctioning of neural chemistry, and also - not at all the same thing - that states of emotional anguish will have a somatic counterpart that can be eased by medication. In other words, he is open-minded about drug therapy, provided it is not used as a panacea or a substitute for treatments that may produce happier outcomes.
What's to be done? Abandoning his distinctive note of moderation, Bentall finally becomes passionate. The first answer, he suggests, is a greater regard for the role of adverse circumstances in provoking mental illness. If bad things happen to people, this is registered in their bodies' chemistry ("a troubled brain cannot be considered in isolation from the social universe"). The second answer is a concomitant respect for the power of interpersonal relationships to ameliorate these effects. One of the concluding chapters, entitled "The Virtue of Kindness" (the subject of the psychoanalyst Adam Phillips' latest book), asks if psychotherapy can help. The short answer is yes, because a person, unlike a drug, can learn to listen to another's story.
Psychoanalysis was popularly called the talking cure, but a better name is the listening one, because to be listened to properly inspires, or can inspire, hope. As Bentall starkly says: "Without hope, the struggle for survival seems pointless." At a time when dialogue in the presence of other human beings is becoming less and less available, this brave book gives a sense of why this could be disastrous.
• Salley Vickers is a novelist and former psychotherapist. Her latest book, Dancing Backwards, will be published next week by Fourth Estate
Saturday, June 27. 2009
The Penny Still Hasn't Dropped
What do Marilyn Monroe, Judy Garland, Jimi Hendrix, Elvis Presley, Paula Yates, Heath Ledger and Michael Jackson have in common? All seven were taking prescribed mind-altering drugs (often tranquillisers) at the time of their deaths.
And yet, we must so love and respect the medical practitioners responsible for prescribing these drugs that we are prepared to forgive and exonerate them. Not once, as far as I can recall, has a prescribing doctor been brought to justice. It seems a licence to practise medicine is also a licence to kill with impunity.
And spare a thought for the not so rich and famous. Countless millions have been wiped out, incapacitated and crippled by doctors in the fifty years since benzodiazepines were first introduced. Their plight rarely even gets a mention.
Saturday, June 27. 2009
From The Times
Dr Lobley is a general practitioner in South LondonMichael Jackson Drugs
Jackson was allegedly taking painkillers Demerol, Vicodin, Dilaudid, anti-anxiety medications Xanax and Zoloft, muscle relaxant Soma, Prisolec for heartburn and the anti-depressant Paxil.
Friday, June 26. 2009
email 24 June 2009
The almost obscured elephant in the room of the iatrogenic induced benzodiazapine plague, and the ineffective system of medicines regulation and pharmacovigilance in the UK, which predicated it would happen,...is that had the legal action against Hoffman La Roche and Wyeth, been allowed to proceed, the whole scandal of PHARMA's corporate dominance of health politics would have been exposed for what it mostly is: A money making scam.
But then you know that better than me. ie. An alleged quote from a Roche executive illustrates the why of the matter: "We are not in the business of curing people, we are in the business of making money" I have no reason to doubt that was said, and what difference? After all it is the truth. So are the illicit drug cartels, but of course they don't have their bought medical journals, medical articles, key opinion leaders and political lobbyists, nor do they fund govt. regulators, and I imagine no MP, or minister would make a declaration of interest to parliament that they were also a non-executive member of such an illegal enterprise, which, they do of course where employment by pharmaceutical companies and other corporate entities is involved.
If anyone other than your good-self gets to read this missive, I can imagine the shouts of "foul", "madness", "must be a scientologist", etc., and in truth the pharmaceutical industry manufacture many good and effective treatments, but in the matter of the so-called psychotropic drugs and the way they have been marketed by the industry, there is often little difference twixt the illegal (recreational) psychoactive drug(s) and the licensed drug(s) or their adverse effects, certainly with regard to their addictive properties, although with the licensed version we have come to be dependant on the drug, not addicted to the drug. What difference?
A small matter: It is called informed consent. Had I chosen too take crack cocaine, cannabis, or any other illicit psychoactive drug, then it could be argued I had used informed consent, and I could be prosecuted under the law, but would contrarily also probably be able to access drug counselling, and even a placement in a drug detox programme at a cost of around seven thousand pounds plus per treatment.
The unwilling iatrogenic addict is a different can of worms:
a) There was, and often still is, no informed consent, unless you count the prescribing doctor's.
b) The addiction is not illegal, after all, the state provides the drugs.
c) There are no publicly funded withdrawal programmes, the state will not admit to the problem, but rather prefers to blame the patient for their lack of informed consent.
d) No public body will ever prosecute the suppliers. They are the pillars of society itself.
And although in the USA., state attorneys' general are busily engaged in the process of recovering monies from pharmaceutical companies for fraudulent market practises, I don't have much faith that will happen in the UK. A lack of faith reinforced by the debacle of the MHRA's four year investigation into GSK's marketing of the SSRI Seroxat, with the result that although the MHRA did find there was malfeasance, when it came time to prosecute, someone had discovered some arcane legal excuse not to do so. Odd that!.... After a four year investigation.... More odd, was the fact that the investigating officers didn't even question the suspected persons involved in the scam, but then of course GSK had already informed the MHRA that none of their operatives would answer any questions put to them. However, the fact is: When a person is questioned under caution in this country they are given the option of not answering any question asked, but also informed that failure to answer may be used against them in a court of law. As I mentioned, odd that, but little wonder then, that benzo iatrogenically afflicted patients have not been able to get redress through the UK system of law. It may also account for why the so-called yellow card system of adverse event reporting does not work.
Stuart Jones, Drug Safety Advocate
Wednesday, June 24. 2009
Study highlights co-prescribing links to drugs deaths
22 June 2009
A 12-year study of addicts in Tayside has highlighted links between drug-related deaths and co-prescribing of methadone with anti-anxiety drugs (writes Steven Bell). Researchers found that almost nine in 10 recovering addicts who eventually died were mixing heroin substitute methadone with benzodiazepines.
The study was led by experts from Ninewells Hospital and Medical School and involved 2378 patients — 8% of whom died during the research period.
Dr Brian Kidd, a member of the Dundee team, said the retrospective study backed the approach to prescribing adopted in Tayside, and identified further areas of study vital to cutting the number of drug-related deaths.
He said, “The findings support local policy such as avoiding benzodiazepine prescribing and add to the understanding of factors affecting premature death in this population.
“They identify key areas of concern, such as mental health, which must be addressed as part of a joined-up approach to combating drug-related death.”
The paper, published by the British Medical Journal, showed that 181 Tayside patients on a methadone prescription died during the 1993-2004 period.
The research was carried out using data from the Health Information Centre — a database which records all medication prescribed by GPs in Tayside.
Clinical data is rendered anonymous and linked to other databases that record hospital admission or deaths so it can be used for research purposes.
As a result, Tayside is the only area where such research of this depth can be cross-referenced and used to study such large numbers of patients.
Strong predictors of death were identified as taking the methadone over a shorter period than the prescribed period, a history of being prescribed benzodiazepines, and a history of psychiatric admission.
Of those people who commit suicide, 40% have substance abuse problems and the study identifies a need to address issues of access to appropriate mental health care and treatment.
Patients who took their methadone in a shorter period than that stated within the prescription had increased risk while those addicts who were assessed and monitored by doctors through urine testing were less likely to die prematurely.
Subjects prescribed benzodiazepines were found to be at increased risk if prescribed, which is an important issue for GPs who may prescribe such drugs for a range of complaints.
Many of the factors identified in the study have already been addressed in a review of prescribing policy in Tayside, researchers said.
Thursday, June 11. 2009
“Once a person has been announced as an expert, they lose the impetus to use wisdom wisely... The problem with being an expert is that once it's been announced you know it all, it almost ceases to matter what you say - because you're an expert. Some perfectly sane, intelligent people fail to question the questionable, because if a statement is prefixed with "the expert's view is ..." they think it escapes analysis... These people don't let new knowledge in, they don't allow for variables, they don't listen. They don't need to, after all. I wonder at which point experts decide they no longer need to learn, because they already know it all?” Annalisa Barbieri, The Guardian, Saturday February 9, 2008
It is time that medicine and involved politicians valued the solid values of Philippians ;-"Whatsoever things are true, whatsoever things are honest, whatsoever things are just, whatsoever things are pure, whatsoever things are lovely, whatsoever things are of good report; if there be any virtue and if there be any praise, think on these things."
Yesterday (10th June 2009), I received an email which was both surprising and unusual. Although Professor Malcolm Lader said in a radio interview in 1991, "The Medical profession, I think, is fairly ashamed of what has happened...” and Professor CH Ashton said in 2005, “How the dependence potential of the benzodiazepines was overlooked by doctors... is a matter for amazement and casts shame on the medical profession...” in my estimation, there has been little sign of it until I received the email that is. A senior GP was reported as saying:
"Do you know I stopped prescribing benzos when you came to us and I saw the mess you were in? I only wish you could be sitting in the corner when I get patients from elsewhere begging me for repeat prescriptions. If they could see what benzos do to people, they perhaps wouldn't be so keen."
This is truth and this is reality but the doctors’ trade union the British Medical Association has never been so frank and maintains the line of it being difficult to change prescribing habits. This may be true and it says a lot about the skill level of prescribers and how seriously patient safety is taken in this country.
Not only has the medical profession as a group failed to display any public sense of shame for what it has done to patients through gross over-prescribing of tranquillisers, but neither have those supposedly in charge of medical provision, the Medicines and Healthcare products Regulatory Authority, The Department of Health and local health authorities. Patients whose lives have been ruined have been left to pick up what pieces they can. Instead, maintaining the image of the NHS as a caring and scientifically based organisation has been the priority for all groups of providers.
Instead of offering help to people who have seriously injured lives, the past has been modified in terms of the present. BMA spokesmen will now say they things like this:
Tranquillisers are very good in the short term. But the problem is people want to go on and on and there’s the problem. Tranquillisers are excellent but they’re not designed for long term use. A lot of people can get off them but I’m afraid there’s a significant minority who have problems. Government should come out so that the public at large know it’s not their right to receive tranquilliser prescriptions. It’s not in their interests. It’s like smoking, alcohol and other things which are bad for people and doctors speak out against. And there is a growing problem of the drugs being obtained from the internet.
The BMA, the Royal College of General Practitioners and the Department of Health not so long ago, used to say things like this:
"There's still a significant continuing problem with benzodiazepines in this country. We would have liked if it was solved 20 years ago, but it still exists. We continue to work as a College with prescribing groups around the country to try and continue to raise awareness of this issue and reduce the prescribing of these drugs to appropriate use, but it is a very long struggle. ...” Dr Jim Kennedy, Royal College of General Practitioners, The Tranquilliser Trap, BBC Panorama, May 13, 2001.
"It is difficult to defend that we have such a huge problem of benzodiazepine prescription and long-term use and therefore dependence. – Professor Louis Appleby, National Director for Mental Health, The Tranquilliser Trap, BBC Panorama, May 13, 2001.
Today all three bodies emphasise internet buying and the role of the patient in insisting on prescriptions. People do buy drugs on the internet and patients do misguidedly ask for inappropriate prescriptions but that does not represent the true history of benzodiazepines in this country. The real history is one of pharmaceutical company marketing influence, the unquestioning attitude of prescribers, the political calculations of government and the ruination of large numbers of patients who thought they were taking medicine through informed advice.
Although benzodiazepines have been over-prescribed in the hundreds of millions to patients for fifty years, no attention has been paid to the real consequences for what the BMA describes as a ‘significant minority’. The BMA has no idea of the size of this ‘minority’, since no provider of medicine has ever thought it worthwhile to find out. The Public Health Minister Dawn Primarolo, who in the 1990s knew that medicine was involved in a scandal, felt no compunction in standing up in Parliament as a government minister recently to declare that the Department of Health had no information on impairment caused by benzodiazepines or the number of addicted patients.
For years a succession of ministers has been using this response:
“First of all let me say that the Department of Health, the NHS and the various professional groups regard involuntary addiction upon benzodiazepine drugs as a very important issue... As you know, the main focus of the Department of Health's action in this area has been to try and prevent addiction/dependence occurring in the first place by warning GPs and other prescribers of the potential side-effects of prescribed medicines and the dangers of involuntary addiction.”
Rosie Winterton MP, Minister of State, Department of Health, January 11, 2004
How it is possible to claim that benzodiazepines are an important issue for government when the bones of the issue are denied and ignored in practice, is mystifying. The issue is that government and its regulatory agencies took far too long to believe in the addiction and when they finally did, they did nothing for the thousands already adversely affected and did nothing effective to safeguard those in the future.
Today, five years after Rosie Winterton’s response, a very telling change has taken place within the DoH, There is a stubborn refusal to continue to admit what was admitted in the past. In the past there was admission that medicine had caused a problem, even though the nature of that problem and its size were not explored. Today, if you write to the department, they will not move from a position where the patient is seen as the cause of his own injuries. There has been a change to viewing the patient in the same way as the drug abuser on the street. You have to wonder why this is and it should serve as a warning to those who may in the future take potentially addictive drugs on the advice of doctors. The fact that benzodiazepines on the street are the same as benzodiazepines in the surgery is a poor excuse for maintaining now that if only patients had only been sensible and controlled their drug-seeking behaviour, the consequences would have been avoided. As Shakespeare said, ‘Though this be madness, yet there is method in ‘t.’
Tuesday, June 9. 2009
Special report: Prescription medicines
Deaths from prescription drugs more than double in 10 years
Published: 21 October 2007
Thousands of patients are dying each year as a result of side effects from pills prescribed by GPs and hospital doctors.
And while the number of deaths from suspected adverse reactions to prescription drugs has more than doubled in the past 10 years to 973 last year, medical experts warn that as few as one in 10 deaths and other serious complications are being reported.
Doctors' poor prescribing skills and repeated failures to recognise accurately adverse drug reactions in patients have seen deaths multiply by about two and half times since 1996.
...today's revelations highlight a 155 per cent rise in reported deaths from adverse reactions to prescribed and over-the-counter drugs – a far steeper increase that will shock the both medical profession and patient groups.
An international conference on drug safety which convenes in Bournemouth tomorrow will hear that "too little progress" has been made in the past 15 years in training doctors to use medications more safely.
Professor Saad Shakir, director of the Drug Safety Research Unit at Southampton University, said: "Doctors need to know how to use medications – this is the most important ethical responsibility for us. Surgeons wouldn't conduct an operation they haven't studied and trained for, and these same standards should apply to medications.
"The competence of doctors in understanding medicines, knowing when and how to use them and how to recognise problems is as essential as training a surgeon in how to perform an operation. Using medicine should be a part of medical training and the ongoing monitoring and evaluation of doctors."
"In recent years, there has been less pharmacology taught in medical schools, but if you consider the growing number of drugs available and the trend towards combination therapies, then this does seem to go against the grain."
A failure by doctors to make the difficult distinction between adverse reactions and disease symptoms can prove potentially fatal, as patients may be given drugs that are more harmful than helpful. According to patient groups, doctors and other health professionals do not always take the suspicions of patients and relatives sufficiently seriously.
Penny Bunn was prescribed anti-depressants by a psychiatrist in 1998 when she was a slim 30-year-old broadcast assistant at the BBC. Five years later, she was in hospital with kidney and liver damage, weighing 20 stone. Eventually she was diagnosed as suffering adverse reactions to her prescribed drugs.
As well as serious weight gain, she experienced blurred vision, vomiting, jaundice, irregular periods, agitation and difficulty passing urine. But because none of these symptoms was recognised as adverse drug reactions, Ms Bunn was prescribed more and more medication, eventually leaving her close to death.
She said: "We now know that I am allergic to all anti-depressants. However, rather than even consider this as an option at the time, the consultant psychiatrist continued to blunder blindly on, misdiagnosing all the reactions I was having as being evidence of further psychiatric disorders.
"No medical personnel ever mentioned anything about side effects or interactions, yet I now know some of the medications I was given are not meant to be used together. How the psychiatrist managed to sit there, as I changed before his eyes, and never cotton on to the fact that there was something horribly wrong with what he was doing, I do not know."
Sedatives and sleeping pills raise suicide risk in the elderly FOUR fold, researchers warn
By Cher Thornhill
Last updated at 2:00 PM on 04th June 2009
Vulnerable elderly people prescribed sedatives or sleeping pills may be more likely to take their own life, a study suggests.
The drugs, which are prescribed to ease depression, anxiety and problems with sleep, raise the risk of suicide among the elderly four fold , the Swedish researchers found.
‘Clinicians need to be aware of this as these drugs are widely prescribed to the elderly,’ the researchers warn.
The team reviewed figures for the Swedish city of Gothenburg along with two nearby counties and found that older people taking antidepressants, antipsychotics, sedatives or hypnotics were all more likely than others to commit suicide.
While research has linked use of these drugs to suicides among younger people, there had also been evidence the pills may reduce the risk in the elderly, Anders Carlsten and Margda Waern of Gothenburg University reported in the journal BMC Geriatrics.
To find out, they compared the records of 85 men and women older than 65 who had committed suicide with those of 135 elderly people from the general population who had not.
Psychiatrists interviewed people close to the patients about mental problems over the past month and the volunteers were also interviewed in person.
After taking account of the diagnosed psychiatric conditions, the team found that patients who took sedatives and hypnotics for sleeping problems were four times more likely to commit suicide.
According to the World Health Organisation, some 877,000 people worldwide kill themselves each year.
For every suicide death, anywhere from 10 to 40 attempts are made, the U.N. agency estimates
Scientists have linked sleep disturbances to an increased risk of suicide in people with psychiatric disorders and in adolescents but it is unclear whether the association also exists in the general population.
‘A careful evaluation of the suicide risk should be carried out when an elderly person presents with symptoms of anxiety and sleep disturbance,’ the researchers said.
While they do not know exactly why, Carlsten and Waern suggested that the drugs somehow trigger aggressive or impulsive behaviour or provide the means for people to take an overdose.
However, disabilities or sleep problems may make people more likely to commit suicide, they added.
‘[People] with these problems might be more likely to seek health care and perhaps more likely to receive prescriptions for psychotropic drugs,’ they said.
Sophie Corlett, External Relations Director at mental health charity Mind said: 'Any research that links a drug treatment with increased risk of suicide is alarming, and further research is needed to clarify the role that sedatives might play.
'We know that older people can be routinely over-prescribed or given inappropriate medication for the sake of convenience, and health professionals must act responsibly and be alert to the damage some medications can cause.'
Doctor accused over death of 12 elderly patients who were 'over-sedated and left in comas'
By Daily Mail Reporter
9th June 2009
Twelve elderly patients died after being over-prescribed painkillers and sedatives by the same doctor, a disciplinary hearing was told yesterday.
Dr Jane Barton prescribed strong opiates in 'excessive' doses, leaving the men and women in 'drug-induced comas', the hearing was told.
Many died within days of coming under her care on two wards at the Gosport War Memorial Hospital, Hampshire, between 1996 and 1999
Opening the General Medical Council hearing, Tom Kark, for the GMC, said the elderly patients expected to be rehabilitated and sent home. But the two wards concerned, Dryad and Daedalus, became known as 'the end of the line'.
Many of the patients had never been given opiates before, but Dr Barton wrote prescriptions for drugs, including diamorphine, which allowed nursing staff to increase dosage massively if they saw fit.
Police carried out three separate probes into 92 suspicious deaths at the hospital in the late 1990s, referring ten cases to the Crown Prosecution Service, but no charges were brought.
Dr Barton, who graduated in medicine from Oxford University and still works as a GP, took charge of the two wards in 1988.
She would do two hospital rounds during the morning and then attend to her other GP work, leaving nurses with much of her authority.
In many cases, as soon as a patient was admitted - even ones previously described as 'well and happy' - she wrote on their notes: 'I'm happy for nurses to confirm death.'
Mr Kark told the hearing: 'Many of the patients you're going to hear about... had not been given opiates as a form of pain relief nor apparently required them. None of the patients were appropriately prescribed opiates by Dr Barton.
'There was, we say, a series of failures which led to patients being overmedicated and unnecessarily anaesthetised.'
The 12 who died were: Leslie Pittock, 82, Elsie Lavender, 83, Eva Page, 87, Alice Wilkie, 81, Gladys Richards, 91, Ruby Lake, 84, Arthur Cunningham, 79, Robert Wilson, 74, Enid Spurgin, 92, Geoffrey Packman, 68, Elsie Devine, 88, and Jean Stevens, whose age was not given. Mrs Lake was admitted to the Dryad ward on August 18, 1998, after a hip operation and was described as mobile, lucid, well and happy.
However Dr Barton prescribed sedatives diamorphine and midazolam, to be administered by an automatic syringe. Three days later Mrs Lake was dead.
Mr Kark said: 'It is likely that this patient died not from illness but as a result of the combined effects of the drugs in her system.'
Barton admits that the dosage prescribed for 11 of the 12 patients was 'potentially hazardous', that for 11 a situation where excessive drugs could be administered had been created, while for ten the dose range was too wide.
She also admits she failed to keep clear, accurate and contemporaneous notes in relation to some or all of her patients.
She denies serious professional misconduct.
The hearing continues.
Friday, June 5. 2009
This study from last year illustrates an aspect of the great unknown areas in benzodiazepine research.
Alprazolam Intercalates into DNA
Chitta Ranjan Santra
Amar Nath Ghosh
Journal of Biomolecular Structure &
Dynamics, ISSN 0739-1102
Volume 26, Issue Number 4, (2009) July 30, 2008
...Thus,our observations suggest the strong interaction of Alp with DNA, which may raise serious questions about the random uses of Alprazolam.
...In this study in vitro interaction between DNA and BDZs group of drugs, Alprazolam is evaluated. Several lines of evidence suggest that, this group of drugs is toxic (8, 9) and considered as a non-DNA interactive carcinogen (7). However, no efforts have
been made to determine its DNA binding abilities in vitro. So, we undertook this project to evaluate the DNA binding ability of Alprazolam. Here, we have provided evidences to show that Alp binds strongly with DNA in vitro.
...The reports about the toxic effects of BDZs are controversial. No evidence of carcinogenic potential wasobserved for the BDZs during two years of bioassay studies in rats at doses up to 30mg/kg/day (210 times the maximum recommended daily human dose of 10 mg/70kg/day) and in mice at doses up to 10 mg/kg/day (70 times the maximum recommended daily human dose) (4). But on the contrary, it was also reported that some of this group of drugs were teratogenic and also carcinogenic in experimental animals. Oxazepam, a member of the BDZs group of drugs has been shown to be a hepatocarcinogen (5) and induces DNA damage in human myeloid leukemia cells (6) through the production of oxidative stresses. Thus, oxazepam was considered as a non-DNA intercalative mutagen (7). On the other hand, an experiment carried out with 32 BDZs drugs, showed absence of liver DNA damage after oral administration of extremely higher doses of BDZs in rats (8). But no efforts were made to find their interaction with the DNA in vitro.
...Consequently, after entering into cells BDZs can interact with different molecules and modulate their functions of which PBR mediated apoptosis and cell cycle arrest have been already reported (15,16)
...By measuring cytochrome c oxidase, it was shown that Alp induces selective changes in brain oxidative metabolism (18). Alp reduced endothelin-1-stimulated thymidine incorporation into DNA, protein synthesis, and cell growth significantly(19).
...We showed that, Alp interacts with chromosomal and plasmid DNA with an affinity greater than that of ethidium bromide (EtBr). From circular dichroic (CD) spectroscopy and transmission electron microscopy (TEM), it was also shown that Alp induced conformational changes in DNA. Thus, our present study for the first time demonstrated the in vitro interaction of DNA with Alp, the drug that is generally considered so far as less harmful.
5. M. L. Cunningham, R. R. Maronpot, M. Thompson, and J. R. Bucher. Toxicol Appl Pharmacol 124, 31-38 (1994).
8. P. Carlo, R. Finollo, A. Ledda, and G. Brambilla. Fundam Appl Toxicol 12, 34-41 (1989).
9. G. K. Isbister, L. O’Regan, D. Sibbritt, and I. M. Whyte. Br J Clin Pharmacol 58, 88-95 (2004).
15. A. P. Sutter, K. Maaser, B. Barthel, and H. Scherübl. Br J Cancer 89, 564-572 (2003).
16. K. Maaser, A. P. Sutter, A. Krahn, M. Höpfner, and P. Grabowski. Biochem Biophys Res Comm 324, 878-886 (2004).
18. H. Gonzalez-Pardo, N. M. Conejo, and J. L. Arias. Prog Neuropsychopharmacol Biol Psychiatry 30, 1020-1026 (2006).
19. A. Montero, A. Rodriguez-barbero, and J. M. Lopez-novoa. Eur J Pharmacol 243, 235-
Monday, June 1. 2009
"When the whole rot started in the 1980s we had 700,000. I suspect that's much closer to the real figure than the one we've got now. If you want a recipe for getting people on to IB, we've got it: you get more money and you don't get hassled. You can sit there for the rest of your life. And it's ludicrous that the disability tests are done by people's own GPs - they've got a classic conflict of interest and they're frightened of legal action." David Freud, Investment Banker and Welfare Reform adviser
" Purnell is showing astonishing energy, there is going to be a much more single-minded ferocity." David Freud, Investment Banker and Welfare Reform adviser
"If you're disabled, work is good for you and not working is bad for you.” David Freud, Investment Banker and Welfare Reform adviser
"A life lived without work is not a life fulfilled," James Purnell, Work and Pensions Secretary, February 2008
“We know that sickness absence is economically and socially damaging and makes people more likely to drift into social exclusion and poverty. Getting people back into work quicker is good for their health as well as the country's finances.” Health minister Ben Bradshaw, 28 May 2009
“When people demand that the disabled - and I'm talking about the genuinely incapacitated here, not the malingerers - should work, they generally mean that they should do rubbish jobs for rubbish money. Fill the call centres with cripples. Dogsbody jobs for the deaf; boring ones for the blind, they can't see anyway. But where are the decent job offers?” Alice Miles, The Times 23 July 2008
“I know that the withdrawal symptoms can be agonising for some people and can be very difficult indeed." – John Patten, Health Minister, 1984.
“...a lot of these patients are just kept on their medication indefinitely. No real attempt is made to help them come off ... The Government should tackle this problem face on... I think the Government should now acknowledge the problem and set funds aside... Professor Malcolm H Lader, Royal Maudesley Hospital,1991.
"Withdrawal symptoms can last months or years in 15% of long-term users. In some people, chronic use has resulted in long-term, possibly permanent disability." Professor C Heather Ashton DM, FRCP, August 2003.
In the third age of Blair after the 2005 election, the Conservative opposition and to a lesser extent the Liberal Democrats found a new stick to beat the government with - the issue of a vast number of people receiving sickness benefits (Incapacity Benefit) many of whom it was said were scroungers and should be added to the total of unemployed people. The government it was declared had been keen to keep the jobless total down by allowing the inexorable rise of those declared sick and unable to work.
In 2001 James Purnell was elected MP for Stalybridge and Hyde. In 2002 he bought a house in the Manchester constituency and claimed it as his main home. In 2004 he sold his London flat which had been his second home for parliamentary expenses purposes. He avoided Capital Gains Tax though by telling HMRC it was his main home for tax purposes. Also in 2004 he rented a flat in Covent Garden and then switched his second home designation to that address, claiming around £20,000 a year in expenses. This was all within parliamentary rules which seem in his case and that of a number of others to be at variance with tax rules that apply to the rest of the population. Purnell is the Work and Pensions Secretary. Purnell is responsible for catching benefit cheats!
Purnell rehired an investment banker, David Freud (great grandson of Sigmund) to look at Incapacity Benefit, a man who had also influenced the Conservative welfare reform proposals. It was Blair who originally hired Freud to review the Welfare system in 2006 because of his success in the City it was said but political rows between Blair and Brown ensured nothing was done at the time.
Freud's great idea was to put out welfare provision to private tender, putting the private sector in charge of the long-term unemployed and paying them to do it. Companies taking part would receive large fees for getting somebody to stay in a job for more than three years and nothing if they were unsuccessful. His belief was that up to two thirds of people claiming Incapacity Benefit were not entitled to do so. Brown had been against the original proposals but in 2008 saw the light and backed the shake-up. In the present recession however, it is worth asking just who is going to provide the jobs for those forced off benefit.
The fifty years of prescription addiction to tranquillisers leading to thousands being unable to work and being forced onto benefits (many, including myself for decades), is a bigger picture than the one described by Freud, Purnell and others. It is by any definition a scandal but it has never been acknowledged by government. The present harrying of all claimants makes no recognition of the special nature of those living on benefits because of what medicine did to them. This scandal is not just about getting the benzo-affected with unrecognised and invisible symptoms back to work, it is about the fact that these victims were ignored, rejected and left to rot on benefits for decades. Now it suits politicians to look at welfare and so these people who were rejected, ignored and left to wither are to be resurrected and looked at in the same way as everyone else. The fact that they were rejected, ignored and left to rot is not an issue for the DWP which follows the Department of Health line in the few symptoms it recognises. It does not recognise permanent ill health and lost careers. Its doctors prod and poke, take urine samples, blood pressure readings and ask about irrelevancies. Twenty or thirty years of not working because of the effects of medicine is not relevant. Twenty or thirty years of living in poverty is not relevant. The psychological scars are not relevant - I have never heard of the symptoms you claim to have. What is relevant is that you have two working hands and two working legs – you are capable of work. What that work is or even whether it exists is not my concern.
The situation is this. You have an unquantified by government (but certainly large) number of people who are claiming benefits because of the effects of drugs over-prescribed and wrongly prescribed in their millions over a period of fifty years. These drugs reduced people to the level of supplicants because of the side-effects they caused. No attempt was ever made by government to effectively control this prescribing and no attempt was ever made to discover how many were affected and to offer help to those made dependent. Government went in the other direction, repeatedly saying it took the problem seriously without ever admitting what the problem was while seeking to minimise it. Now that for political reasons it is seen as desirable that the number of Incapacity Benefit claimants is reduced, tranquilliser victims are lumped in with the rest. The recession has intervened but the DWP bureaucrats still follow the intended line and are systematically and methodically calling on all claimants to justify their claims. Suddenly a life on benefits is a life not lived.
"Thousands of people could not possibly invent the bizarre symptoms caused by therapeutic use of benzodiazepines and reactions to their withdrawal. Many users have to cope, not only with a frightening range of symptoms, but also with the disbelief and hostility of their doctors and families. Trickett S, Withdrawal from Benzodiazepines. Journal of the Royal College of General Practitioners 1983; 33: 608.
That has been the situation for fifty years, and to doctors and families we should add the Department of Health and the Department of Work and Pensions.