… gets some high-profile attention.

David Brooks, New York Times:

Anybody who is on antidepressants, or knows somebody who is, should read Marcia Angell’s series “The Epidemic of Mental Illness: Why?” from The New York Review of Books. Many of us have been taught that depression arises, in part, from chemical imbalances in the brain. Apparently, there is no evidence to support that.

Many of us thought that antidepressants work. Apparently, there is meager evidence to support that, too. They may work slightly better than placebos, Angell argues, but only under certain circumstances. They may also be permanently altering people’s brains and unintentionally fueling the plague of mental illness by causing episodes of mania, for example. I wouldn’t consider Angell the last word on this, but it’s certainly a viewpoint worth learning about.

The latest study suggests antidepressants work no better than placebos.

UD‘s posts about Angell’s essays are here (scroll down).

Misdeeds — from hiding study results to paying off doctors — have made Big Pharma an inviting and, frankly, an appropriate target… Antidepressants have something like celebrity status; exposing them makes headlines.

It’s not that anti-depressants have celebrity status; it’s that more Americans take them than almost any other drug. Americans of all ages, including very little children. They make headlines because they are – I and many other observers believe – massively over-prescribed.

Peter Kramer’s missing the point here, in other words. As a result, his effort, in tomorrow’s New York Times, to defend anti-depressants against Marcia Angell, Irving Kirsch, and a range of other scientists who’ve argued that they achieve only a slightly better outcome than placebos, has a vague, irrelevant feel. He complains about the limitations of the studies Angell and Kirsch cite, but these limitations aren’t particularly significant, and the studies he cites have their own limitations.

Kramer insists, for instance, that anti-depressants seem to work for “social unease.” He does not ask whether social unease is something we should think of as needing treatment. Treatment with powerful brain-altering chemicals, chemicals that have significant side effects. He does not ask what we should do about a culture in which wall-to-wall happy pill television commercials make socially uneasy people demand anti-depressant medication.

Instead, Kramer points out that “data bearing on the question is messy.” Yes, it is. But increasingly the data points toward remarkably little effect, for many of the people taking them, from anti-depressants. To say this is not to be a headline-grabber. On the contrary, it is to express a concern about the well-being of one’s fellow Americans.

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Lacking an empirical basis for his claim that anti-depressants deserve to be given to masses of people, Kramer turns to scare tactics.

[I]t is dangerous for the press to hammer away at the theme that antidepressants are placebos. They’re not. To give the impression that they are is to cause needless suffering.

No one says anti-depressants are placebos. Would that they were. People getting bad side effects from anti-depressants would be far safer taking placebos. What people are increasingly saying — and shame on the press for reporting it! — is that when it comes to lifting depression, these pills are pretty much the same as placebos. For most people, they don’t seem to do squat.

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Felix Salmon also notices the remarkably vague, not-really-there feel of Kramer’s article.

Marcia Angell has follow-up thoughts on the latest medical research corruption case.

The cost of [the corruption] is high, and not just in drug prices. It means both doctors and patients believe prescription drugs are better and safer than they really are.

America’s struggling pharmaceutical industry finally gets the spokesman it needs! Bravo, John LaMattina, for having the guts to go up against the power of Marcia Angell and tell it like it is!

… an “explosive” segment on anti-depressants as no better than placebos for the vast majority of people taking them? Will it be, as promised, explosive? Harvard’s Irving Kirsch will talk about his research, featured in The Emperor’s New Clothes: Exploding the Antidepressant Myth – another promised explosion. Marcia Angell’s review of his and other books on the subject in the New York Review of Books was also, I guess, explosive… But so far that essay prompted only a flaccid little response from Peter Kramer in the New York Times.

We’ve heard nothing from the companies that make billions of dollars off the sale of do-nothing, stuffed-with-side-effects drugs except for what they told Stahl: They work. Kramer said the same thing: “[I]t is dangerous for the press to hammer away at the theme that antidepressants are placebos. They’re not.”

Dangerous!

But why are Kramer and company doing little other than repeating, while speaking darkly of risk, that antidepressants work?

Et alors. I’m not sure major attention even of the sort 60 Minutes represents will constitute a bombshell. Positions here are and have long been entrenched, and you don’t exactly kiss goodbye a ten billion dollar enterprise without a struggle.

And millions of Americans – despite witnessing an extremely loud and incredibly close prescription pill epidemic – seem wedded to a sense of themselves as chemically dependent. Indeed to a sense of life itself as the sort of thing you need Prozac to pursue.

UD could feature some new happiness study every week on this blog.

Manically, university researchers pursue the condition, the question, the mystery, the much-sought-after Thing. It’s especially much talked about in these thanksgiving days.

Most recently, a Princeton economist and psychologist teamed up to analyze data that allowed them to announce the exact most-happiness-inducing yearly salary: $75,000.

As a lifelong ‘thesdan, UD assumed this referred to personal income, but in fact family income is meant. Lower than this, you’ll be less happy; higher, you won’t be any happier.

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There’s other stuff. Consider this article about the happiest woman in America (the happiest man in the world is apparently Matthieu Ricard, a Buddhist monk). She’s in her fifties, has a meaningful job, an intact marriage, just one kid, takes long walks along the beach, has friends, is spiritual, is active in her walkable, close-to-a-city community, lives in the same smallish house she’s lived in for decades, and locks away the tv.

(Oh, and on Ricard: Here’s a hilarious article in the Independent about him – or, rather about the journalist interviewing him.)

The article about the happiest woman cites a much-cited recent statistic: One in four American women is on antidepressants or antipsychotics or something along those lines. This remarkable number has generated the sorts of headlines you’d expect (‘ONE IN FOUR WOMEN CANNOT POSSIBLY NEED MENTAL HEALTH DRUGS’), as well as the equally easy to anticipate defensive reactions from depressed people (‘MENTAL ILLNESS IS ILLNESS.’)

No one denies mental illness is illness; people are skeptical about that many American women really being mentally ill. Marcia Angell and others are skeptical about the utility and safety of all those potent, side-effect-rich drugs.

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Surely there’s too much vagueness in the matter of happy and sad for us to conclude anything with much firmness. OTOH, UD takes from years of thinking about this (she’s the daughter of a suicide, and suicide marvelously concentrates the mind) at least the following suggestion: To be happy, you have to be a human being with longings, as Ravelstein / Allan Bloom puts it in Saul Bellow’s novel: ‘A human soul devoid of longing was a soul deformed, deprived of its highest good, sick unto death.’

But the longing needs to be in the direction of love – for one other person, for humanity, for the earth, for ideas, for aesthetic experience, for God – rather than, say, money or status. Recall that $75,000 family income figure. If you’re a hedgie for whom anything less than twenty million a year is a disgrace, this model anticipates that you’re not a terribly happy person because of your, well, money worries.

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UD will venture another little point about sadness and happiness. In a review of Blue Nights, by Joan Didion – an iconically anxious and unhappy – and extremely wealthy – person – Meghan O’Rourke takes note of Didion’s regrets about how she and her husband raised their daughter.

The couple assiduously [built] a vision of Quintana as “the perfect child,” with John urging Didion to come watch their daughter — “a towhead in that Malibu sun” — descend the hill toward the glowingly blue Pacific on her way to school. “How could I not have had misconceptions?” Didion writes now…. “I had been raising her as a doll.“

Outsized fantasies – of the perfect life, the perfect child, the perfect portfolio – are real downers.

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And yet, having said all that — let’s be scrupulously fair, and remind ourselves of what shits happy people can be. Let’s do it prettily. Poetically.

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The Happy Ones are Almost Always Also Vulgar

Those stilled by pain don’t mix
with the cheerful, self-assured runners
but with those who walk at the same slow pace.
If one wheel locks and the other’s turning
the turning one doesn’t stop turning
but goes as far as it can, dragging the other
in a poor, skewed race until the cart
either comes to a halt or falls apart.

Harvard University’s Joseph Biederman, world’s biggest bi-polar diagnosis booster, is making life a little difficult for his psychiatry colleagues at Mass General. Short version: You don’t want to be too closely associated with his antidepressants-for-tots drive, his undisclosed financial conflicts of interest, and his influential insistence that zillions of American children, teens, and adults are bi-polar.

So let’s say you’re Harvard’s Andrew Nierenberg, and you want to light into Marcia Angell because you’re pissed that she’s down on antidepressants. Of course, you concede in a letter attacking her arguments, it’s “heart-breaking” that there have been some cases in which nightmarish damage was done to children who were over- or mis-prescribed these very powerful drugs… But a case here or there should in no way lead us to suppose that the harmful dispensing of such drugs is a serious trend.

In her response, Angell points out the enormous influence Harvard, and Nierenberg’s colleague there (Joe), had on all those MDs giving all those children drugs. Biederman was – is! – the bi-polar man; he is almost singularly responsible for the astonishing inflation of pediatric bi-polar diagnoses and treatments in the United States in the last few years. Nierenberg co-authored papers, etc., with Biederman. Hence it’s a little on the disgusting side for Nierenberg to lecture us on the heartbreak of mis- and over-diagnosis without at least alluding to his own profoundly influential hospital’s financially compromised advocacy of the diagnosis.

Angell:

Nierenberg refer[s] to the death of Rebecca Riley, who was diagnosed with bipolar disorder as well as ADHD when she was just two years old, as a “tragic anecdote.” While that is true, I believe it should also be seen in the context of the extraordinary epidemic of juvenile bipolar disease that was stimulated largely by the teachings of some of Dr. Nierenberg’s colleagues [Biederman and two others] at the Massachusetts General Hospital. Three of them were recently disciplined by the hospital for not having disclosed some of their hefty payments from drug companies.

UD‘s advice to Nierenberg: Be like Australia. Distance yourself.

If you’ve read Marcia Angell on antidepressants, you’re unlikely to be surprised by a recent study suggesting that “individuals who use antidepressants are much more likely to suffer relapses of major depression than those who use no medication at all… [P]eople who have not been taking any medication are at a 25 per cent risk of relapse, compared to 42 per cent or higher for those who have taken and gone off an antidepressant.” Paul Andrews, of McMaster University, argues that “antidepressants interfere with the brain’s natural self-regulation of serotonin and other neurotransmitters, and… the brain can overcorrect once medication is suspended, triggering new depression.”

In her much-discussed New York Review of Books essay, Angell reviews the similar arguments of Robert Whitaker:

If psychoactive drugs do cause harm, as Whitaker contends, what is the mechanism? The answer, he believes, lies in their effects on neurotransmitters. It is well understood that psychoactive drugs disturb neurotransmitter function, even if that was not the cause of the illness in the first place. Whitaker describes a chain of effects. When, for example, an SSRI antidepressant like Celexa increases serotonin levels in synapses, it stimulates compensatory changes through a process called negative feedback. In response to the high levels of serotonin, the neurons that secrete it (presynaptic neurons) release less of it, and the postsynaptic neurons become desensitized to it. In effect, the brain is trying to nullify the drug’s effects.

… With long-term use of psychoactive drugs, the result is, in the words of Steve Hyman, a former director of the NIMH and until recently provost of Harvard University, “substantial and long-lasting alterations in neural function.” As quoted by Whitaker, the brain, Hyman wrote, begins to function in a manner “qualitatively as well as quantitatively different from the normal state.” After several weeks on psychoactive drugs, the brain’s compensatory efforts begin to fail, and side effects emerge that reflect the mechanism of action of the drugs. For example, the SSRIs may cause episodes of mania, because of the excess of serotonin. Antipsychotics cause side effects that resemble Parkinson’s disease, because of the depletion of dopamine (which is also depleted in Parkinson’s disease). As side effects emerge, they are often treated by other drugs, and many patients end up on a cocktail of psychoactive drugs prescribed for a cocktail of diagnoses. The episodes of mania caused by antidepressants may lead to a new diagnosis of “bipolar disorder” and treatment with a “mood stabilizer,” such as Depokote (an anticonvulsant) plus one of the newer antipsychotic drugs. And so on.

Some patients take as many as six psychoactive drugs daily. One well- respected researcher, Nancy Andreasen, and her colleagues published evidence that the use of antipsychotic drugs is associated with shrinkage of the brain, and that the effect is directly related to the dose and duration of treatment. As Andreasen explained to The New York Times, “The prefrontal cortex doesn’t get the input it needs and is being shut down by drugs. That reduces the psychotic symptoms. It also causes the prefrontal cortex to slowly atrophy.”*

Getting off the drugs is exceedingly difficult, according to Whitaker, because when they are withdrawn the compensatory mechanisms are left unopposed. When Celexa is withdrawn, serotonin levels fall precipitously because the presynaptic neurons are not releasing normal amounts and the postsynaptic neurons no longer have enough receptors for it. Similarly, when an antipsychotic is withdrawn, dopamine levels may skyrocket. The symptoms produced by withdrawing psychoactive drugs are often confused with relapses of the original disorder, which can lead psychiatrists to resume drug treatment, perhaps at higher doses.

… to highly specialized writing — writing that has one, and only one, quite narrow, interest. This sort of writing is the very definition of monoculture. It is the essence of one dimensionality, the pure beating heart of the provincial.

This writing is But is it Good for the Jews? writing.

And you gotta love it. Who wouldn’t want the thick, murky world distilled to one obsession? Everything in the vast globe understood in terms of one mania?

Here’s a good example of the form. A Forbes writer takes on the epidemic of mental illness and psychotropic drug taking in the United States today. But exclusively from the point of view of people who invest their money in pharma stocks.

Let’s take a look.

He begins with the nightmare story of Rebecca Riley, a four-year-old killed with prescription drugs by her parents and the doctor who just kept throwing drugs at the family (her parents’ other two children were similarly medicated). The parents were both found guilty of murder. This murder, which riveted national attention to the depraved overprescription of powerful drugs in America, “may one day prove very important to investors in pharmaceutical stocks,” warns the Forbes columnist.

“[P]harmaceutical marketing executives are evidently undeterred by the law,” he goes on to note (they routinely market drugs for off-label use and routinely have to settle federal charges in the hundreds of millions of dollars — just the price of doing business for them). If they keep this up for much longer, and if nasty stories like the Riley thing keep making headlines, you might see a total ban on off-label use, and that would “cut into a major growth area for pharmaceutical companies.”

And what a growth area! “[T]he increase in diagnoses [of mental illness in America] is a boon to pharmaceutical manufacturers. The new generation of psychoactives has displaced cholesterol-reducing medications as the biggest-selling class of drugs in the U.S.” Think of the investment possibilities here! Figure you can convince say twenty percent of the population that they and their children need lifelong powerful psychoactive drugs to function! I mean, there’s no physical basis for the diagnosis, so you can go to town! It’s a can’t lose proposition.

Unless! Unless party poopers like Marcia Angell keep making noise:

Dr. Angell links the astonishing rise in diagnoses of certain mental disorders to the huge financial stakes of physicians, pharmaceutical companies and SSI recipients.

Keep talking about this, the writer warns, and there could be a “public opinion backlash” that might affect your profit margin.

But — probably not. The writer concludes on a reassuring note. We’ll probably see increases in dependency on psychotropic drugs throughout the population, thank goodness.

… Marcia Angell highlights the corruption of academic psychiatry:

Drug companies are particularly eager to win over faculty psychiatrists at prestigious academic medical centers. Called “key opinion leaders” (KOLs) by the industry, these are the people who through their writing and teaching influence how mental illness will be diagnosed and treated. They also publish much of the clinical research on drugs and, most importantly, largely determine the content of the DSM. In a sense, they are the best sales force the industry could have, and are worth every cent spent on them…

[T]here are no objective signs or tests for mental illness — no lab data or MRI findings -and the boundaries between normal and abnormal are often unclear. That makes it possible to expand diagnostic boundaries or even create new diagnoses, in ways that would be impossible, say, in a field like cardiology. And drug companies have every interest in inducing psychiatrists to do just that…

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Related.

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Also related. If you can read this article without wanting to vomit, you’re a better man than I am.

Once the medical establishment started buying into the idea of bipolar kids in the 1990s, the diagnosis gained unusual force. In 2000 the National Institute of Mental Health convened a roundtable of researchers in pediatric bipolar disorder and financially supported several controversial propositions, including the practice of asking bipolar adults to date the origins of their own disease. The creation of a new source of funding generated frenetic activity among university psychiatrists, and in a twinkling it created stakeholders in the diagnosis.

Marcia Angell, New York Review of Books.

With long-term use of psychoactive drugs, the result is, in the words of Steve Hyman, a former director of the NIMH and until recently provost of Harvard University, “substantial and long-lasting alterations in neural function.” As quoted by Whitaker, the brain, Hyman wrote, begins to function in a manner “qualitatively as well as quantitatively different from the normal state.” After several weeks on psychoactive drugs, the brain’s compensatory efforts begin to fail, and side effects emerge that reflect the mechanism of action of the drugs… The episodes of mania caused by antidepressants may lead to a new diagnosis of “bipolar disorder” and treatment with a “mood stabilizer,” such as Depokote (an anticonvulsant) plus one of the newer antipsychotic drugs. And so on.

Some patients take as many as six psychoactive drugs daily. One well- respected researcher, Nancy Andreasen, and her colleagues published evidence that the use of antipsychotic drugs is associated with shrinkage of the brain, and that the effect is directly related to the dose and duration of treatment. As Andreasen explained to The New York Times, “The prefrontal cortex doesn’t get the input it needs and is being shut down by drugs. That reduces the psychotic symptoms. It also causes the prefrontal cortex to slowly atrophy.”

Getting off the drugs is exceedingly difficult, according to Whitaker, because when they are withdrawn the compensatory mechanisms are left unopposed. When Celexa is withdrawn, serotonin levels fall precipitously because the presynaptic neurons are not releasing normal amounts and the postsynaptic neurons no longer have enough receptors for it. Similarly, when an antipsychotic is withdrawn, dopamine levels may skyrocket. The symptoms produced by withdrawing psychoactive drugs are often confused with relapses of the original disorder, which can lead psychiatrists to resume drug treatment, perhaps at higher doses.

Angell’s review of three books about psychoactive drugs and depression suggests that for the most part the pills don’t work, and are (see above) positively dangerous.

And what’s this got to do with universities? High-profile professors of psychiatry all over this country, some of them paid by drug companies, legitimize the use of these pills by millions and millions of Americans, including very small children.

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UD thanks MattF for the link.

In yet another sign of what Marcia Angell describes as “the widespread corruption of the medical profession by industry money,” a Columbia University study reveals that

Twenty-five out of 32 highly paid consultants to medical device companies in 2007, or their publishers, failed to reveal the financial connections in journal articles the following year…

Researchers followed the disclosure activities of a group of MDs and PhDs who were paid a million dollars or more by orthopedic device companies in 2007. Most of these people failed to disclose their financial conflicts of interest in the journals that published their articles.

And, as Angell points out, the journals get money from the companies too, in the form of advertisements, so they’re not about to actually enforce their disclosure policy…

Everybody’s getting paid, see. Professors at medical schools are getting paid. Journals are getting paid.

Some in this group might be getting paid twice, as it were. Ghostwriters, possibly hired by the same companies paying their consultancy fees, could be writing their articles for them…

Quelle postmodern! Simulacral research (ghost-written, guest-written), simulacral disclosure, simulacral journals…

… before we look at what the University of Michigan medical school has just done, let us remind ourselves of the basic truths about Continuing Medical Education. I quote from Marcia Angell:

… In most states doctors are required to take accredited education courses, called continuing medical education (CME), and drug companies contribute roughly half the support for this education, often indirectly through private investor-owned medical-education companies whose only clients are drug companies. CME is supposed to be free of drug-company influence, but incredibly these private educators have been accredited to provide CME by the American Medical Association’s Accreditation Committee for Continuing Medical Education—a case of the fox not only guarding the chicken coop, but living inside it.

… If drug companies and medical educators were really providing education, doctors and academic institutions would pay them for their services. When you take piano lessons, you pay the teacher, not the other way around. But in this case, industry pays the academic institutions and faculty, and even the doctors who take the courses. The companies are simply buying access to medical school faculty and to doctors in training and practice.

… [T]he pharmaceutical industry has no legitimate role in graduate or post-graduate medical education. That should be the responsibility of the profession. In fact, responsibility for its own education is an essential part of the definition of a learned profession.

Simple enough? Fox, chicken coop; lessons wrong way around…

Hokay. Let’s proceed with the announcement from the University of Michigan, reported by the New York Times.

In the latest effort to break up the often cozy relationship between doctors and the medical industry, the University of Michigan Medical School has become the first to decide that it will no longer take any money from drug and device makers to pay for coursework doctors need to renew their medical licenses.

University officials voted to eliminate commercial financing, beginning next January, for postgraduate medical education, a practice that has come under increasing scrutiny from academics, medical associations, ethicists and lawmakers because of the potential to promote products over patient interests.

… [One] leading medical ethicist asserted that the prohibition did not go far enough. Dr. Bernard Lo, lead author of a 2008 Institute of Medicine report on conflicts of interest, said private doctors and academic physicians who are paid to speak for drug companies should be barred from presenting educational material at accredited conferences. “Mouthpieces for their products,” he called them.

… “Industry wouldn’t be paying billions of dollars to do this stuff if it didn’t benefit them,” [another physician said]…

So Michigan boldly leads the way. As other schools attempt to join UM, expect to hear a lot of chickens squawking.

Arnold Relman, in the New York Review of Books:

Nearly a half-century ago, Stanford economics professor Kenneth Arrow, later a Nobel laureate, convincingly argued that medical care cannot conform to market laws because patients are not ordinary consumers and doctors are not ordinary vendors. He said that sick or injured patients must rely on physicians in ways fundamentally different from the price-driven relation between buyers and sellers in an ordinary market. This argument implied that, contrary to the assumptions of antitrust law, market competition among physicians cannot be expected to lower medical prices. And since physicians influence decisions to use medical services far more than patients do, the volume and types of services provided to patients—and hence total health costs—need to be controlled by forces other than the market, such as professional standards and government regulation. But Arrow’s argument was largely ignored in the rush to exploit health care for commercial purposes that ensued after the passage of Medicare and Medicaid in 1965.

When the organizations that set professional standards — the whorish American Psychiatric Association, for instance — are themselves market law conformists, what hope for change? That organization, speaking of excess volume and types of services, is even now revising the profession’s diagnostic manual to medicalize more and more non-medical human behaviors. There’s money in it.

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Update: Recall Marcia Angell in the New York Review of Books:

Since there are no objective tests for mental illness and the boundaries between normal and abnormal are often uncertain, psychiatry is a particularly fertile field for creating new diagnoses or broadening old ones. Diagnostic criteria are pretty much the exclusive province of the current edition of the Diagnostic and Statistical Manual of Mental Disorders, which is the product of a panel of psychiatrists, most of whom, as I mentioned earlier, had financial ties to the pharmaceutical industry. [Christopher] Lane, a research professor of literature at Northwestern University, traces the evolution of the DSM from its modest beginnings in 1952 as a small, spiral-bound handbook (DSM-I) to its current 943-page incarnation (the revised version of DSM-IV) as the undisputed “bible” of psychiatry—the standard reference for courts, prisons, schools, insurance companies, emergency rooms, doctors’ offices, and medical facilities of all kinds.

Given its importance, you might think that the DSM represents the authoritative distillation of a large body of scientific evidence. But Lane, using unpublished records from the archives of the American Psychiatric Association and interviews with the principals, shows that it is instead the product of a complex of academic politics, personal ambition, ideology, and, perhaps most important, the influence of the pharmaceutical industry. What the DSM lacks is evidence. Lane quotes one contributor to the DSM-III task force:

There was very little systematic research, and much of the research that existed was really a hodgepodge—scattered, inconsistent, and ambiguous. I think the majority of us recognized that the amount of good, solid science upon which we were making our decisions was pretty modest.

Lane uses shyness as his case study of disease-mongering in psychiatry. Shyness as a psychiatric illness made its debut as “social phobia” in DSM-III in 1980, but was said to be rare. By 1994, when DSM-IV was published, it had become “social anxiety disorder,” now said to be extremely common. According to Lane, GlaxoSmithKline, hoping to boost sales for its antidepressant, Paxil, decided to promote social anxiety disorder as “a severe medical condition.” In 1999, the company received FDA approval to market the drug for social anxiety disorder. It launched an extensive media campaign to do it, including posters in bus shelters across the country showing forlorn individuals and the words “Imagine being allergic to people…,” and sales soared. Barry Brand, Paxil’s product director, was quoted as saying, “Every marketer’s dream is to find an unidentified or unknown market and develop it. That’s what we were able to do with social anxiety disorder.”

Some of the biggest blockbusters are psychoactive drugs. The theory that psychiatric conditions stem from a biochemical imbalance is used as a justification for their widespread use, even though the theory has yet to be proved. Children are particularly vulnerable targets. What parents dare say “No” when a physician says their difficult child is sick and recommends drug treatment? We are now in the midst of an apparent epidemic of bipolar disease in children (which seems to be replacing attention-deficit hyperactivity disorder as the most publicized condition in childhood), with a forty-fold increase in the diagnosis between 1994 and 2003.[18] These children are often treated with multiple drugs off-label, many of which, whatever their other properties, are sedating, and nearly all of which have potentially serious side effects.

See the post just below this one, where the militancy that matters derives from Harvard medical school students.

Similarly, a med student at the University of Minnesota shows you, in this all-business, supremely clear opinion piece, how to eviscerate deans who can’t imagine adjusting to life without industry money.

While the militancy has to come from the students, we shouldn’t forget those other sources of moral clarity and pressure: High-profile professors unencumbered by greed, like Harvard’s Marcia Angell; and bulldogs in Congress like Charles Grassley.