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Opinion: February 19, 2012 By Steven Greer, MD 
The CBS news show “60 Minutes” made waves with a story asserting that the antidepressants Read more »
Op-Ed, Policy, Psychiatry | apples49 | 
November 7, 2014 2:35 am | 
Comments (0)
March 30, 2014- Interviewed by Steven E. Greer, MD
A recent JAMA paper connects the dots between violent video games and aggressive behavior. Author Craig Anderson, PhD, from Iowa State, reviews the findings.
Iowa State, JAMA, Policy, Preventive Medicine, Psychiatry, Trauma | apples49 | March 30, 2014 7:32 pm | Comments (0)
March 20, 2014- By Steven E. Greer, MD
Richard Saul, MD strived to be provocative with his new book ADHD Does Not Exist. He not only succeeded, but also backed up his bold assertion with ample sound logic and supporting data.
This is an important book because ADHD, as defined by the psychiatry guidelines in the DSM-V, can now be diagnosed in 5% of the United States population. Up to 11% of all children have been diagnosed. Up to 20% of high-school-age boys have been diagnosed with ADHD: a 40% rise in just ten years.
Dr. Saul estimates that the monetary cost of this epidemic of ADHD is as high as $50 Billion. $14 Billion, or 27% of that $52 Billion, was spent on families related to the ADHD “patient”. Another $12 Billion was spent on schools and other health related costs. Read more »
Book reviews, HHS, Op-Ed, Policy, Psychiatry | apples49 | March 19, 2014 8:37 pm | Comments (0)
Christoph Correll, MD: antipsychotics in children
Op-Ed: A disease called ‘childhood’
Is JNJ illegally promoting deadly drugs to the elderly?
Pediatrics, Psychiatry | apples49 | February 24, 2014 9:53 pm | Comments (0)
April 19, 2013- Below are the actual Tweets of the surviving Boston terrorist bomber, Dzhokhar A. Tsarnaev. He is a fan of HipHop culture, likely has no girlfriend but wants one, seems to be enrolled at a college, and follows Islamic sites.
His tweets are not too intelligent but typical of a 19-yo male in The U.S. He seems to be a student or unemployed young male, bitter with society, and easily brainwashed. He also seems to have traits of narcissism. Some of his twitter friends have posted Instagram photos of marijuana. He possibly likes crystal meth, or at least the thought of it, based on comments.
Interestingly, he seems to have at least one accomplice that he was tweeting in coded words, acknowledging the bombing and wishing them luck.
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Some selected tweets from months ago….
Jahar @J_tsar 5 Dec something light for lunch pic.twitter.com/CvAiNXi
Jahar @J_tsar 7 Dec Once my teacher said she accepts all late work without penalties, 1. I fell in love with her and 2. It was my cue not to do shit until now Read more »
Harvard affiliates, Psychiatry | apples49 | April 19, 2013 2:25 pm | Comments (0)
Produced and interviewed by Steven Greer, MD
Numerous studies show that stimulant drugs used to treat ADHD are also now the most commonly abused on college campuses. Authors of the book “Medicating Children: ADHD and Pediatric Mental Health” discuss the specific policy changes in Social Security, Medicare, and the FDA that caused the explosion in prevalence of diagnosed ADHD that makes these stimulants so available. They also discuss how the psychiatric community forms the diagnostic bible, the DSM, and changes made in policy to reduce the incentives to diagnose ADHD in children.
Pediatrics, Policy, Psychiatry, Univ Virginia | apples49 | April 1, 2013 9:43 am | Comments (0)
Do 1 in 5 NYC preteens really suffer a mental woe? A psychiatry expert argues we’re overdiagnosing —and overmedicating — our kids
By DR. ALLEN FRANCES March 31, 2013 In The New York Post
Last week, The Post reported that more than 145,000 city children struggle with mental illness or other emotional problems. That estimate, courtesy of New York’s Health Department, equals an amazing 1 in 5 kids. Could that possibly be true?
There is nothing tougher in psychiatry than accurately diagnosing a mental disorder in a pre-teenager. It is so easy to make mistakes both ways — to miss problems that desperately need attention and to attend to problems that are better left alone.
Getting the right diagnosis and predicting its future course is especially difficult in kids because their symptoms have such a short track record and are often heavily influenced by transient factors like developmental differences: family, school and peer stress; and the use of drugs.
It usually takes a while before an illness declares itself — and often, it turns out that no diagnosis is necessary because the symptoms go away without intervention.That said, there’s been a massive mislabeling of psychiatric diagnosis among children because of recent medical fads.
In the last 20 years, rates of attention deficit disorder have tripled, while autistic disorder and childhood bipolar disorder have each increased by a remarkable 40-fold.Human nature just doesn’t change that quickly, but the labels follow fashion and can escalate dramatically without there being an actual increase in symptoms. Our kids haven’t suddenly become sicker, it’s just that diagnoses are applied to them more loosely. Read more »
Op-Ed, Policy, Psychiatry | apples49 | March 31, 2013 10:39 am | Comments (0)
Update March 20 , 2013
The annual CDC autism report is out again, misleading the public about a non-epidemic.
Update March 29, 2012
The high prevalence of “autism” was in the news again with a CDC report claiming that the rates were even higher than reports last year.
May 9, 2011 Steven Greer, MD
The national TV news and papers jumped on a press-release-promoted paper in The American Journal of Psychiatry that summarized a trial led by Yale researchers evaluating the prevalence of autism on South Korea. The press misinterpreted the goals and conclusions of the paper and led with sensational headlines indicating that American children might have a 100% higher prevalence of autism than previously estimated. Previous estimates suggested a 1/100 or lower prevalence, and the new paper suggested a 1/38 (2.64%) prevalence.
The authors of the paper, Kim et al, never intended the study to answer any hypothesis about autism in North America. Studies were heretofore lacking in Asia. They wrote, “Research suggests that ASD onset, core symptoms, and prevalence are similar across European and North American populations. Nevertheless, with the exception of Japan and Australia, the data are insufficient to characterize ASD prevalence in other cultures. This is the first population-based autism prevalence study in Korea.”
The authors of the paper made no conclusions about autism in North America. They wrote, ” Conclusions: Two-thirds of ASD cases in the overall sample were in the mainstream (Korean) school population, undiagnosed and untreated. These findings suggest that rigorous screening and comprehensive population coverage are necessary to produce more accurate ASD prevalence estimates and underscore the need for better detection, assessment, and services.”
It is becoming increasingly known that non-North American data, such as these from the Yale Korean study, are not adequately relevant to the North American population to allow for clinical changes or approval of new drugs. These Korean data were from a homogenous population that represent a small portion of the North American population.
One also needs to be aware of political factors that have caused the increase in “autism” being diagnosed. In the year 2000, President Clinton signed into law the Children’s Health Act of 2000. The law specifically addressed autism and created new research branches within the CDC, NIH, and several medical centers. Congress has allocated close to a billion dollars to these programs in total, with a significant portion going toward the autism efforts.
It is a rule of political science that all bureaucracies have a tendency to grow and claim more of the federal budget. Lowering the bar and expanding the diagnostic criteria for “autism” is consistent with increased funding. The authors of the paper acknowledge this and wrote, “The increased prevalence appears to be attributable to greater public awareness, broadening ASD diagnostic criteria, lower age at diagnosis, and diagnostic substitution. Additionally, study design and execution have affected prevalence estimates, limiting the comparability of more recent estimates.”
The national media coverage of the paper in question also failed to explain that the researchers counted all forms of mild “autism” in the study. These were not the profoundly autistic patients that one thinks of when they hear the word “autism”. Many people with mild forms of autism are highly functional professionals that seem just a bit “odd”. These broad inclusion criteria can be found here. The new DSM-V expands the criteria ever further.
Proponents of diagnosing more children with “autism” claim that early treatment improves lifelong outcomes. Critics are worried that labeling a child for life carries with it tremendous stigma and harm to self esteem. They assert that it also places the child at risk of receiving harmful unnecessary medications as seen in the inappropriate prescribing of powerful antipsychotics to toddlers with “bipolar disorder”.
Moreover, as the incidence and prevalence of “autism” rise, human nature will erroneously attribute other medical therapies as the cause. Currently, the world medical societies are actively trying to undue the myth that vaccinations cause autism.
Every news outlet with a large viewership must begin to make an attempt to hire qualified producers who can properly screen press release medical news and filter out the junk science. Unlike other news, bad reporting on healthcare affects lives.
Late Breaking Data, Neurology, Op-Ed, Policy, Psychiatry, Yale | apples49 | March 21, 2013 7:51 am | Comments (0)
DSM 5 Is Guide Not Bible- Ignore Its Ten Worst Changes. APA approval of DSM-5 is a sad day for psychiatry.
December 2, 2012 by Allen J. Frances, M.D. in DSM5 in Distress
This is the saddest moment in my 45 year career of studying, practicing, and teaching psychiatry. The Board of Trustees of the American Psychiatric Association has given its final approval to a deeply flawed DSM 5 containing many changes that seem clearly unsafe and scientifically unsound. My best advice to clinicians, to the press, and to the general public - be skeptical and don’t follow DSM 5 blindly down a road likely to lead to massive over-diagnosis and harmful over-medication. Just ignore the ten changes that make no sense.
Brief background. DSM 5 got off to a bad start and was never able to establish sure footing. Its leaders initially articulated a premature and unrealizable goal- to produce a paradigm shift in psychiatry. Excessive ambition combined with disorganized execution led inevitably to many ill conceived and risky proposals.
These were vigorously opposed. More than fifty mental health professional associations petitioned for an outside review of DSM 5 to provide an independent judgment of its supporting evidence and to evaluate the balance between its risks and benefits. Professional journals, the press, and the public also weighed in- expressing widespread astonishment about decisions that sometimes seemed not only to lack scientific support but also to defy common sense.
DSM 5 has neither been able to self correct nor willing to heed the advice of outsiders. It has instead created a mostly closed shop- circling the wagons and deaf to the repeated and widespread warnings that it would lead to massive misdiagnosis. Fortunately, some of its most egregiously risky and unsupportable proposals were eventually dropped under great external pressure (most notably ‘psychosis risk’, mixed anxiety/depression, internet and sex addiction, rape as a mental disorder, ‘hebephilia’, cumbersome personality ratings, and sharply lowered thresholds for many existing disorders). But APA stubbornly refused to sponsor any independent review and has given final approval to the ten reckless and untested ideas that are summarized below.
The history of psychiatry is littered with fad diagnoses that in retrospect did far more harm than good. Yesterday’s APA approval makes it likely that DSM 5 will start a half or dozen or more new fads which will be detrimental to the misdiagnosed individuals and costly to our society.
The motives of the people working on DSM 5 have often been questioned. They have been accused of having a financial conflict of interest because some have (minimal) drug company ties and also because so many of the DSM 5 changes will enhance Pharma profits by adding to our already existing societal overdose of carelessly prescribed psychiatric medicine. But I know the people working on DSM 5 and know this charge to be both unfair and untrue. Indeed, they have made some very bad decisions, but they did so with pure hearts and not because they wanted to help the drug companies. Their’s is an intellectual, not financial, conflict of interest that results from the natural tendency of highly specialized experts to over value their pet ideas, to want to expand their own areas of research interest, and to be oblivious to the distortions that occur in translating DSM 5 to real life clinical practice (particularly in primary care where 80% of psychiatric drugs are prescribed).
The APA’s deep dependence on the publishing profits generated by the DSM 5 business enterprise creates a far less pure motivation. There is an inherent and influential conflict of interest between the DSM 5 public trust and DSM 5 as a best seller. When its deadlines were consistently missed due to poor planning and disorganized implementation, APA chose quietly to cancel the DSM 5 field testing step that was meant to provide it with a badly needed opportunity for quality control. The current draft has been approved and is now being rushed prematurely to press with incomplete field testing for one reason only- so that DSM 5 publishing profits can fill the big hole in APA’s projected budget and return dividends on the exorbitant cost of 25 million dollars that has been charged to DSM 5 preparation.
This is no way to prepare or to approve a diagnostic system. Psychiatric diagnosis has become too important in selecting treatments, determining eligibility for benefits and services, allocating resources, guiding legal judgments, creating stigma, and influencing personal expectations to be left in the hands of an APA that has proven itself incapable of producing a safe, sound, and widely accepted manual.
New diagnoses in psychiatry are more dangerous than new drugs because they influence whether or not millions of people are placed on drugs- often by primary care doctors after brief visits. Before their introduction, new diagnoses deserve the same level of attention to safety that we devote to new drugs. APA is not competent to do this.
So, here is my list of DSM 5’s ten most potentially harmful changes. I would suggest that clinicians not follow these at all (or, at the very least, use them with extreme caution and attention to their risks); that potential patients be deeply skeptical, especially if the proposed diagnosis is being used as a rationale for prescribing medication for you or for your child; and that payers question whether some of these are suitable for reimbursement. My goal is to minimize the harm that may otherwise be done by unnecessary obedience to unwise and arbitrary DSM 5 decisions.
1) Disruptive Mood Dysregulation Disorder: DSM 5 will turn temper tantrums into a mental disorder- a puzzling decision based on the work of only one research group. We have no idea whatever how this untested new diagnosis will play out in real life practice settings, but my fear is that it will exacerbate, not relieve, the already excessive and inappropriate use of medication in young children. During the past two decades, child psychiatry has already provoked three fads- a tripling of Attention Deficit Disorder, a more than twenty-times increase in Autistic Disorder, and a forty-times increase in childhood Bipolar Disorder. The field should have felt chastened by this sorry track record and should engage itself now in the crucial task of educating practitioners and the public about the difficulty of accurately diagnosing children and the risks of over- medicating them. DSM 5 should not be adding a new disorder likely to result in a new fad and even more inappropriate medication use in vulnerable children.
2) Normal grief will become Major Depressive Disorder, thus medicalizing and trivializing our expectable and necessary emotional reactions to the loss of a loved one and substituting pills and superficial medical rituals for the deep consolations of family, friends, religion, and the resiliency that comes with time and the acceptance of the limitations of life.
3) The everyday forgetting characteristic of old age will now be misdiagnosed as Minor Neurocognitive Disorder, creating a huge false positive population of people who are not at special risk for dementia. Since there is no effective treatment for this ‘condition’ (or for dementia), the label provides absolutely no benefit (while creating great anxiety) even for those at true risk for later developing dementia. It is a dead loss for the many who will be mislabeled.
4) DSM 5 will likely trigger a fad of Adult Attention Deficit Disorder leading to widespread misuse of stimulant drugs for performance enhancement and recreation and contributing to the already large illegal secondary market in diverted prescription drugs.
5) Excessive eating 12 times in 3 months is no longer just a manifestation of gluttony and the easy availability of really great tasting food. DSM 5 has instead turned it into a psychiatric illness called Binge Eating Disorder.
6) The changes in the DSM 5 definition of Autism will result in lowered rates- 10% according to estimates by the DSM 5 work group, perhaps 50% according to outside research groups. This reduction can be seen as beneficial in the sense that the diagnosis of Autism will be more accurate and specific- but advocates understandably fear a disruption in needed school services. Here the DSM 5 problem is not so much a bad decision, but the misleading promises that it will have no impact on rates of disorder or of service delivery. School services should be tied more to educational need, less to a controversial psychiatric diagnosis created for clinical (not educational) purposes and whose rate is so sensitive to small changes in definition and assessment.
Psychiatry | apples49 | December 2, 2012 11:25 am | Comments (0)
Are Zyprexa, Risperdal, and Abilify overprescribed in children?
Update: June 11, 2012
Since our extensive coverage of the marketing strategies that led to wide misuse of antipsychotics, JNJ agreed to pay nearly $2.2 Billion in penalties to settle the DOJ investigation.
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January 12, 2010 By Steven Greer, MD
The antipsychotic drug market is one of the largest in the drug business. Zyprexa is Eli Lilly’s largest drug with an estimated $4.6 B (USD) in revenue for 2009 (Barclays estimates). Bristol-Myers Squibb’s Abilify is an important drug to the company with estimated 2009 revenue of $2.4 B. The Risperdal franchise for JNJ, at $2.3 B, and AstraZeneca’s Seroquel, at more than $4 B, are also vital to the respective companies.
Accompanying this massive revenue stream is one of the most powerful marketing and lobbying strategies in the world resulting in several million Americans now taking antipsychotics. Is classic schizophrenia with delusions and hallucinations really that prevalent or are these drugs being overprescribed in unapproved indications?
Evidence is growing that off-label prescribing of antipsychotics is leading to inappropriate usage of these drugs in the elderly nursing home setting and in the pediatric setting. More troubling, in the pediatric population, disadvantaged minority children are far more likely to be prescribed these drugs, leading to a lifelong sequelae of disease.
Pediatric psychiatrist. Dr. Correll, discusses whether drugs like Abilify, Zyprexa, Risperdal, Fanapt, Seoul, etc are overprescribed.
Recent studies have added to the literature showing the severe adverse events caused by antipsychotics (weight gain, diabetes, elevated lipids, suicide, etc.). In our previous story (below), Dr. Correll detailed the metabolic syndrome that arises rapidly in children on antipsychotics.
Antipsychotics in children associated with significant weight gain and elevated lipids
The use of antipsychotics in children is controversial for many reasons. The data to support this practice is scant and biased by industry funding. The U.S. Senate has documented this at length. Data are now mounting that show antipsychotics create significant adverse events, including large weight gain and elevated cholesterol, or “metabolic syndrome” in many cases. Given the ages of the children, these adverse events are harmful to development and may shorten lifespan.
Christoph Correll, MD, pediatric psychiatrist and recent author of a white paper in JAMA on this topic, discusses the adverse events in children associated with antipsychotic usage.
Topics discussed:
JAMA, North Shore LIJ, Psychiatry | apples49 | July 18, 2012 11:37 am | Comments (0)
