Bad logic, bad science, and sensationalism

This is the kind of news release that angers me.

Brian Quinn, LCSW, PhD., Author Of A New Book On Bipolar Disorder, Discusses The Risks Of Antidepressants In Angry, Agitated Teens

It’s ill-conceived, illogical, and dangerous. It starts with the statement that “Dr. Quinn’s new book reviews the most up-to-date research on the use of antidepressants in bipolar disorder” and then proceeds to demonstrate that the author has little grasp of the most basic principles of logic, let alone the principles of research.  His statements are based neither in research nor in logic. They are self-serving and misleading. I get that he wants to sell his new book. I also get that using sensationalism and duplicity as a means to increase sales is perfectly acceptable to him. And that, in my view, is reprehensible.

“Eric Harris, one of the shooters at Columbine, was on an antidepressant when he and Dylan Klebold killed 12 students and then themselves. Jeff Weise, who killed nine people and then himself in Red Lake, Minnesota, was also on an antidepressant, and Kip Kinkel was on an antidepressant when he fatally shot his parents, two students and wounded dozens at a high school in Springfield, Oregon.”

Okay. And so? This tells us what? This is selective bigotry and stigmatization of mental illness at its very worst. “One of the shooters” at Columbine was on an antidepressant? And the implication is that caused him to kill people? What about the other shooter? What caused him to kill people? What about all the other historical and emotional characteristics of Eric Harris? Were those factors unrelated to the shootings? What about all of the other people who commit crimes, including mass or serial murder, every year who are not on any medication at all? What about the millions of people world-wide who are on antidepressants and other medications who will live their whole lives without ever killing anyone?

“Antidepressants have been linked to worsening hostility, suicidal behavior and psychosis in depressed children and teens and some people with bipolar disorder. While no one can say that antidepressants caused Harris, Weise, and Kinkel to commit mass murder, all these cases raise the question of who should be given antidepressants and who should not.”

No. This is false. Antidepressants have not been linked to hostility, suicidal behavior, or psychosis in children, teens, or anyone else, except by anecdotal evidence which is increasingly being exposed as hysteria. However, it is the case that hostility, suicidal behavior, and sometimes psychosis are among the symptoms of the illnesses and conditions that various classes of psychotropic medications, including antidepressants, are used to treat.

“‘These drugs tend to be handed out routinely to anyone with symptoms of depression and without a great deal of thought given to accurate diagnosis or the risks involved in using them, especially in young people with agitated depression,’ said Brian Quinn, LCSW, PhD., author of a new book, Wiley Concise Guides to Mental Health: Bipolar Disorder (John Wiley & Sons, 2007). ‘We don’t know what the diagnoses of these kids were, but we do know that they all had angry, agitated depressions — an indication they may have had bipolar disorder or could respond to antidepressants with a worsening of their symptoms. Caution should have dictated that they not be given antidepressants initially.'”

What absolute balderdash. These drugs are certainly NOT “handed out routinely to anyone with symptoms of depression and without a great deal of thought given to accurate diagnosis or the risks involved in using them”. The author is a social worker. He does not and cannot prescribe medications. What evidence is presented to back up the claim that physicians are ignoring diagnostic considerations in prescribing these medications?

“‘Psychiatrists, psychologists and social workers frequently misdiagnose those in the depressed phase of bipolar illness as having simple depression. This often results in them mistakenly being given antidepressants alone,” Quinn said.”

Okay. So people with bipolar disorder are often initially misdiagnosed with depression. Why is that, Mr. Quinn? I can tell you that it’s not a result of incompetence and it’s not a result of antidepressant medication. It’s a result of the nature of bipolar disorder – a fact you should understand as a self-styled expert on the subject. The majority of bipolar patients first present with depression, not hypomania, and the only way currently to accurately diagnose bipolar disorder is on the basis of longitudinal evidence showing recurrent cycles of depression coupled with evidence of at least one hypomanic or manic episode, evidence which is frequently not available when a patient is first being seen by a mental health professional. Given that, physicians do what they should be doing, viz., treating the symptoms of depression. That doesn’t mean that the possibility of bipolar disorder is ruled out. It simply means that physicians, like other men of science, follow the principle of Occam’s Razor: The simplest explanation is often the correct one and one does not proceed to a more complex explanation (diagnosis) of medical-psychiatric symptoms without first eliminating the simpler explanations (diagnoses).

This is the Dr. Phil phenomenon – the confusion of entertainment and marketing with science and professional practice. It is blatantly anti-science and anti-logic. And it worries me because of the potential damage it does to vulnerable people who need help and may be denied it if sensationalist propaganda such as this is believed.

We’re already seeing evidence of rising suicide rates among adolescents and children as a result of the fundamentally unfounded restrictions on the use of antidepressant medications among these age groups. We don’t need more biased sensationalism to make the situation worse.

antidepressants, bad logic, bad research, bad science, bipolar disorder, depression, sensationalism

UK psychiatrists oppose streamlined services

File under “Whose Interests Are You Really Trying To Protect?” 

The Mental Health Bill Will Not Help Vulnerable Patients, Say Doctors, UK
25 Apr 2007

With the Mental Health Bill for England and Wales going through Committee stage in the House of Commons, the BMA is concerned that the proposed legislation will harm patients with mental health disorders.

Currently two doctors [at least one must be a consultant psychiatrist] have to agree before anyone is detained under the Mental Health Act but the Government is proposing to change this and widen professional roles within this field.

Under the new Bill, it is proposed that doctors, psychologists, nurses, occupational therapists and social workers could receive training that would enable them to have overall charge and be the responsible clinician for a patient who is sectioned. This could mean that for some patients there could be the possibility of no medical input at all.

The Chairman of the BMA psychiatry committee, Dr JS Bamrah, said today:

“Psychiatrists have undergone in-depth and intensive medical training so that they can provide the best, up-to-date health care to patients suffering from mental health disorders. As the delivery of mental health services is multi-disciplinary, there should be recognition of the professional roles involved but the Government’s proposals go too far.”

He added:

“A decision to detain a patient is a very serious one and it would be irresponsible to by-pass clinicians when detention decisions are being made. We strongly urge the Government to think again and ensure that psychiatrists are fully engaged in caring for these very vulnerable patients. It is well documented that psychiatric patients often suffer from a range of medical problems so it is vital that the clinician responsible for their overall care is also able to deal effectively with a range of health issues.”

The reality is that this is scaremongering and professional protectionism of the worst kind. First, as a psychologist I don’t have a medical degree. I don’t have the legal right to prescribe medication or to recommend or perform medical procedures, and I don’t believe psychologists should be given that authority, despite what some of my colleagues in Canada and the US may say to the contrary. But I don’t need a medical degree to provide an accurate mental health diagnosis (indeed, many of the members of the committees who have worked on various versions of the Diagnostic and Statistical Manuals [DSMs] which define the criteria for those diagnoses have been psychologists or other professionals without medical degrees). And I don’t need a medical degree to be competent to determine imminent danger to self or others at least as well as a psychiatrist.

Second, the statement that someone could be hospitalized as an involuntary patient without involving and physician or psychiatrist at all is ludicrous, not the least because a physician of some type would need to be involved to prescribe any psychotropic medications, and it’s difficult to believe that someone meeting the criteria for involuntary detention under the mental health act would not require some sort of medication as part of that hospitalization.

And third, involuntary detention is always limited in scope and always requires review by mental health practitioners beyond the admitting practitioner, physician or otherwise. In Canada, that means the case must be reviewed after 72 hours to ensure that the patient still meets all of the criteria for involuntary detention.

I find it hard to believe that the protest of the BMA has anything really to do with the welfare of the patients who may be affected by the proposed new legislation. Frankly, I think it has far more to do with fears on the part of the BMA that the traditional sanctified hierarchical position of their member psychiatrists might be eroded should the legislation pass – and that, of course, might translate into some loss of income for the profession at the same time as it improves service to mental health consumers and their families.

UPDATE: A Bogus Poll

Today, this report from the Royal College of Psychiatrists attempts to claim that the British public is opposed to the new legislation:

“The public do not support proposed laws that would make it easier to detain and treat people with mental health problems against their wishes, according to a YouGov poll published today.

The poll, commissioned by the Royal College of Psychiatrists, showed that 72% of those surveyed do not think that people with mental health problems should be forced to have ‘treatment’ from which they cannot benefit. And 68% do not believe that hospitals should be used to detain people with mental health problems if they cannot benefit from treatment and have committed no crime.”

What’s wrong with this survey?

The UK psychiatrists are asking questions in a way almost guaranteed to elicit a negative reaction. And they are doing so without providing respondents with the information needed to make an informed decision.

This is almost a replica of how civil rights activists have opposed the implementation of “Kendra’s Law” in the US. Those states that have approved such legislation to date have not seen the predicted mass involuntary detentions – again, this is scare-mongering at its most blatant.

The goal is not and never has been to hospitalize individuals who do not need to be hospitalized. The goal is to facilitate the involuntary treatment of individuals who are a clear and imminent danger to self or others and who lack the capacity to make informed decisions regarding their own welfare. And in the case of the UK legislation, the proposal is to allow mental health professionals other than psychiatrists the authority to make such decisions within existing legal and ethical restrictions on involuntary hospitalization.

And THAT is the real reason for their vigorous opposition to this bill. 

mental health legislation, mental health treatment, politics of health care

Tonsils, Sleep, and ADHD

Some years ago, when I was first learning about conditions such as hyperactivity and attention deficit disorder (now merged into attention deficit hyperactivity disorder or ADHD), the diagnostic instructions used to be that one should not diagnose ADHD until one had ruled out other potential causes of the behaviors and symptoms, which might include depression or anxiety, a stressful or chaotic home environment, or even a physical issues such as allergies. Somewhere along the way, this part of the diagnostic criteria became blurred and then almost forgotten. The current DSM-IV-TR criteria do include the caution

E. The symptoms do not occur exclusively during the course of a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder and are not better accounted for by another mental disorder (e.g., Mood Disorder, Anxiety Disorder, Dissociative Disorders, or a Personality Disorder). 

However, this esentially instructs the clinician to look for another “mental disorder” as the culprit. It does not warn the clinician to consider other life factors.

Today, I found this story:

Tonsillectomy may help some kids’ ADHD symptoms

Tue Apr 4, 2006

By Amy Norton

NEW YORK (Reuters Health) – Children’s behavioral problems, including symptoms of attention-deficit hyperactivity disorder (ADHD), sometimes improve after they have their tonsils removed, a new study has found. 

The findings, published in the journal Pediatrics, support the theory that nighttime breathing problems — and consequently poor sleep — contribute to some children’s behavioral difficulties during the day.

When the tonsils at the back of the throat become enlarged, they can obstruct the breathing passages. Chronic breathing problems are a chief reason tonsillectomy is performed in children.

The new study followed 78 children, ages 5 to 13, who were scheduled to undergo tonsillectomy, most often due to suspected nighttime breathing problems.

Overnight sleep tests performed before surgery confirmed that half had obstructive sleep apnea, a disorder in which breathing stops and starts repeatedly during the night – typically causing loud snoring and, often, daytime sleepiness.

The children also happened to have a high rate of behavioral problems, as measured from parents’ reports and clinical assessments. A full 28 percent were diagnosed with ADHD, compared with only 2 percent of 27 children who served as a comparison group.

One year after the surgery, however, the children’s behavioral and sleep problems were no greater than those of their peers. The rate of sleep apnea fell from 50 percent to 12 percent, and symptoms of sleepiness improved.

The particularly striking finding, according to the researchers, was that half of the children who had been diagnosed with ADHD before surgery no longer had the disorder one year later.

This doesn’t mean that tonsillectomy is a “magic pill” for ADHD, Dr. Ronald Chervin, the study’s lead author, told Reuters Health.

But parents and doctors may want to consider the possibility of a sleep disorder when a child is either hyperactive or excessively sleepy during the day, according to Chervin, who directs the sleep disorders center at the University of Michigan in Ann Arbor.

…more

Clinicians and students should take heed: Diagnosis is not a cookbook science and the essence of good diagnosis is differential diagnosis – and that should always include looking at the whole person, not just the collection of symptoms.

Related Story

attention deficit hyperactivity disorder, ADHD, sleep, medicine, child psychology, diagnosis, differential diagnosis

Video game blasts cancer

Video game helps young people blast cancer
Story by Lisa Baertlein 

In the midst of all the commercialism, nihilism, and sheer craziness in the news most days, I found this little article that deserves a greate share of the available bandwidth than it will probably get:

LOS ANGELES (Reuters) – Saif Azar, a 14-year-old video game fan, said a new title called “Re-Mission” helped arm him with the knowledge of how to fight cancer after he was diagnosed with Hodgkin’s lymphoma in 2003.

“It was perfect, actually. It helped me understand the things that were going on in my body,” said Azar, who started playing the game as part of a clinical study and continues playing today as he wraps up his treatments.

Roxxi, the main character in “Re-Mission,” is a gutsy, fully-armed “Nanobot” who seeks out and destroys cancer cells throughout the body.

HopeLab, the game’s maker, said the results from its scientific study involving 375 teen and young adults at 34 medical centers in the United States, Canada and Australia showed that young people who played “Re-Mission” were more likely to stick to their medication regimens than those who did not.

Palo Alto, California-base HopeLab is a nonprofit organization that helps young people deal with chronic illnesses. It was founded in 2001 by board chair Pamela Omidyar, wife of eBay Inc. founder and Chairman Pierre Omidyar.

The results showed that the game helped players feel empowered to confront the challenge posed by their illness, which made them more likely to take their medicine — and more likely to get better, said HopeLab President Pat Christen.

“We approached the study in the same way and with the same rigor that we would with a new drug,” she said.

HopeLab targeted teens and young adults because their health outcomes tend not to be as good as younger and older groups, she said.

“There is an assumption that they’re doing what they’re supposed to be doing and they’re not monitored as closely,” Christen said.

The PC game is immediately available, free of charge, to teens and young people diagnosed with cancer. It will be widely available on May 1 for a suggested donation of $20.

You can find more information about Hopelab here and copies of Re-Mission can be ordered here:

Re-Mission is a challenging, 3D “shooter” with 20 levels that takes the player on a journey through the bodies of young patients with different kinds of cancer. Players control a nanobot named Roxxi who destroys cancer cells, battles bacterial infections, and manages realistic, life- threatening side effects associated with the disease.

Hopelab also hosts re-mission.net, a forum for teens and young adults battling cancer:

A community for teens and young adults with cancer: Explore our site to learn more about the Re-Mission video game and join our online community of young people with cancer. 

cancer, teens with cancer, pediatric cancer, video game

Medicine on the Net

Writing in the The Boston Globe, reporter Wendy Lee discusses the internet and the changing face of medicine in North America.

When a 32-year-old patient with rapid heart palpitations showed up in the emergency room at Massachusetts General Hospital saying she suffered from Holt-Oram Syndrome, Dr. Jonathan Adler had no idea what this syndrome was. But he knew he had to work quickly. Using his computer, he looked up a comprehensive description on eMedicine.com, a Nebraska-based Web database of various diseases and conditions. He got his answer in minutes — an inherited disorder that causes abnormalities of the upper limbs and heart.While he still uses textbooks to review content, Adler said he tends to look at eMedicine when it comes to making clinical decisions for patients. “A textbook can’t take the space to go into it,” Adler said, but eMedicine can “because it’s a bigger hard drive somewhere.”In fact, 64 percent of all US practicing physicians use online technologies for pharmaceutical-related products and services, according to a study released last week from New York market information firm Manhattan Research. The majority of these physicians — 87 percent — believe the Internet is a critical resource on information for prescription drugs and treatment options, with three-fourths admitting their behavior is sometimes or often changed as a result of what they found online, according to the study. In addition, about 39 percent of all US adults rely on the Internet for health information, according to the 2003 study by Manhattan Research.

Should we be worried about this trend? There is something seemingly reassuring about that big blue book sitting on the physician’s bookshelf — one can imagine hours of work going into compiling the information and even more hours of work proofreading it before publication. On the other hand, try to visualize putting a web page together, even one containing medical or pharmaceutical information, and what comes to mind? The familiar figure of Dr. Marcus Welby, the ever-present stethoscope draped around the shoulders of his white lab coat, hunched over a keyboard two-finger typing the information into a WYSIWYG web page program? Or some geeky kid with a grilled cheese sandwich holding open the pages of a book while, music blaring through his speakers and sipping on a jolt cola or Mountain Dew, he slams together page after page of medical or drug data?

Organizations like HONCode (Health-on-the-Net Code) certify that medical and health websites conform to certain standards in the presentation of medical-health information, and they do repeatedly visit certified sites to ensure that they remain in compliance with the code, but is that enough? And is there a difference in the medical-health information provided by commercial versus non-profit versus government websites?

I worry sometimes that the growth of the net has taken us all by surprise, that we didn’t have time to think ahead about what we were going to do with all this technology and information. The problem becomes particularly apparent in the case of medication side-effects. Pick a drug, any drug, and there exists a forum or website somewhere with one anecdote after another describing the horrors of the drug and disparaging the ethics of the drug companies who produce it and the physicians who prescribe it. And yet, armed with a little knowledge of the medication, normal symptoms of the conditions it is used to treat, and information about such factors as control groups, placebo effects, and statistical significance, it isn’t difficult to conclude that most of the alarmist information available on such sites isn’t valid or accurate.

There is a need not only for organizations like HONCode to expand their presence on the net but also to do a better job of publicizing what it is they do and don’t do. In essence, it needs to become a Better Business Bureau of medical-health information websites, and it needs to have the familiarity and to inspire the confidence in consumers that the BBB worked hard to establish.

health information, HONcode, Internet Behavior, internet health information, medical information

File under “ewwww! gross!!!”

I just came across this story on the medical use of maggots (!) — yes, not leeches (which is also a bit ewww!) but maggots (mega ewww!!).

Apparently, they are being used in certain cases both to clear dead tissue and to counterattack bacteria. Who knew? All I know is that if you’ve ever had them show up in your house, you never want to see them again.

Maggots make medical comeback for wound healing

WASHINGTON (AP) – Think of these wriggly little creatures not as, well, gross, but as miniature surgeons: Maggots are making a medical comeback, cleaning out wounds that just won’t heal. Wound-care clinics around the country are giving maggots a try on some of their sickest patients after high-tech treatments fail.

It’s a therapy quietly championed since the early 1990s by a California physician who’s earned the nickname Dr. Maggot. But Dr. Ronald Sherman’s maggots are getting more attention since, in January, they became the first live animals to win Food and Drug Administration approval – as a medical device to clean out wounds.

A medical device? They remove the dead tissue that impedes healing “mechanically,” FDA determined. It’s called chewing. But maggots do more than that, says Sherman, who raises the tiny, wormlike fly larvae in a laboratory at the University of California, Irvine. His research shows that in the mere two to three days they live in a wound, maggots also produce substances that kill bacteria and stimulate growth of healthy tissue.

According to a Dr. Robert Kirsner quoted in this article, “it takes work to convince people”. No kidding! He adds, “They’ll probably be easier to use now that they’re FDA-approved.” Ah… yes… sure… count me out, though, okay?

This has been quite a year for wormlike critters. In June, the FDA also gave its seal of approval to leeches, those bloodsuckers that help plastic surgeons save severed body parts by removing pooled blood and restoring circulation. And in the spring, University of Iowa researchers reported early evidence that drinking whipworm eggs, which causes a temporary, harmless infection, might soothe inflammatory bowel disease by diverting the overactive immune reaction that causes it. (But) there’s a little more yuck factor with maggots.

“Yuck factor” – that’s not a bad description.

Whatever happened to antibiotics and iodine?