… chronicled in this book, are entertaining places, and no doubt this new year we’ll continue following them at their most efficient, at the nation’s for-profit colleges.

But this country’s Centers for the Absorption of Corporate Funds deserve equal attention. Indeed these are arguably even more entertaining places, because while the federal government simply acts the well-meaning idiot as it dispenses hundreds of millions of dollars to hedgies pretending to run schools, corporations are often brilliant operators with bad motives — and it’s always more fascinating to watch the strategic villain than the bumbling good guy.

UD doesn’t claim that corporations looking for academic respectability in order, for instance, to hook America on opioids, always exhibit strategic brilliance. Crucially, they must identify research units within American universities able to balance compromised data (papers and presentations must uncover the urgent necessity plus the safety of massively increased pain pill intake) with the continued appearance of scientific integrity, a scheme fraught with difficulty. It’s not uncommon for reporters, and even politicians, to notice that a place like the University of Wisconsin’s Pain and Policy Studies Group is an almost wholly owned subsidiary of pharma, as it stashes away more and more OxyContin money while pumping out more and more Oxy Rocks! research.

Coca Cola, fast food, over-prescribed anti-depressants, over-prescribed anti-psychotics for toddlers, Dr. Shkreli’s Miracle Elixirs… All of these substances need whitewashing, and the university is where that happens. When things get too obvious, or when from the start they’re mishandled (remember what brought down Virginia’s last governor), the Centers suddenly shut down, or suddenly announce they’ve decided to stop taking corporate money…

UD’s friend Roy Poses at Health Care Renewal takes a look at Russell Portenoy, a professor at Yeshiva.

In the last few decades, Portenoy has been busy making the world safe for opioids, insisting that millions of Americans can take them with little to no risk of addiction. He has also been enriching himself through consulting and speaking for pain pill manufacturers.

Portenoy isn’t alone. Here’s another advocate:

[In 1998, one doctor] said he understood that a patient would simply ‘go to sleep’ before stopping breathing. While asleep, he said, the patient ‘can’t take a dangerous dose. It sounds scary, but as far as I know, nobody anywhere is getting burned by doing it this way.’

This is the functional equivalent of John Willke on rape.

****************************

Plenty of academic doctors continue to exploit the legitimacy their academic positions give them to shill for pain pill pharma, but what’s intriguing here is that Portenoy now expresses some regrets:

‘I gave innumerable lectures in the late 1980s and ’90s about addiction that weren’t true,’ Dr. Portenoy said in a 2010 videotaped interview with a fellow doctor.

Not just not true. They helped create the stupendous pain pill addiction epidemic in this country.

*****************************

It seems obvious that we should, as Roy says, be skeptical of “people paid by narcotics manufacturers advocating increased use of these drugs, no matter how distinguished, scholarly, or influential these people appear to be.” But in the equally destructive matter of anti-psychotics for children, Joseph Biederman, who continues on the Harvard faculty, seems to have met with no skepticism at all – at least none that could stop him as he almost singlehandedly caused a 40-fold increase in the use of these dangerous drugs.

… discover what we already know; but it’s important to get this confirmation. Makers of anti-psychotic drugs (scroll down for all posts) target Medicaid psychiatrists in DC.

Medicaid psychiatrists …received a disproportionate, share of industry largesse, receiving two-thirds (66%) of gifts and payments. In 2008 (the most recent data available), antipsychotic use by Medicaid recipients was especially high in the nation’s capitol, with approximately 1 in 10 recipients receiving a prescription — a rate five times higher than the total national population.

A large proportion of Medicaid recipients are children under the age of 18. Antipsychotics can cause sedation, weight gain, diabetes, and other adverse effects.

It’s an absolutely perfect storm from the manufacturer’s point of view. A large vulnerable population. Doctors who may not be among the most highly trained.

“Antipsychotics are clearly being used in patients who are not psychotic,” said Adriane Fugh-Berman, MD.

Richard Friedman’s “call for caution” on the use of anti-psychotic drugs in the American population comes a bit late in the day. Professors like Joseph Biederman remain at places like Harvard.

… Biederman is a leading proponent of the off-label use of antipsychotic drugs to treat bipolar illness in children. His work is widely seen as contributing to an explosive growth in such prescriptions, and much of his support came from companies that benefited from his research.

Friedman doesn’t even talk about the grotesque over-prescription of these drugs for children.

The professors putting together the upcoming edition of the DSM are also doing their bit, pathologizing moods like “mild emotional discomfort” so that everyone will feel comfortable medicating them with powerful anti-psychotics.

And as we approach a new year, University Diaries will continue to pursue the links between corporate-sponsored psychiatry research at some of America’s most high-profile universities, and the destructive, expensive pathologizing of the American public. ““[T]he increase in diagnoses [of mental illness in America] is a boon to pharmaceutical manufacturers,” notes a Forbes writer. “The new generation of psychoactives has displaced cholesterol-reducing medications as the biggest-selling class of drugs in the U.S.” It wouldn’t be happening without Harvard’s Joseph Biederman and the rest of the COI university crew.

There’s hope. But only a little bit of hope. The battle has to be fought hard, and we’ll probably lose.

But anger over the money culture behind pharma investment, and at the damage being done to our children by anti-psychotics, will no doubt find greater focus and expression this coming year. UD will of course follow the story.

These things are pretty easy to write, and given the incredibly lucrative medicalization of normalcy at the heart of the newest edition of the Diagnostic and Statistical Manual of Mental Disorders, we’ll see more and more of this literary genre.

Or maybe less and less. It can be hard to write clearly when you’re on anti-psychotics.

Mental health clinicians should consider signing this petition. It explains why taking the fifth, if you will, would be a terrible error.

… Libra, is “the megaton novel James Joyce would have written if he’d moved to Iowa City and lived to be a hundred.”

But Joyce is more likely to have written the upcoming fifth edition of the Diagnostic and Statistical Manual of Mental Disorders. The DSM’s predecessor, four, has a thousand pages, and we may be sure that five will have many more than that. It’s a megaton psychotropic prescription machine. As Allen Frances, editor of earlier, more sane, DSMs, writes, “DSM-5 is suggesting many new and untested diagnoses and also markedly reduced thresholds for old ones.”

Frances offers an example:

‘Attenuated psychosis syndrome’ will have a ridiculously high false positive rate ( 80-90%), no effective treatment, would promote unnecessary exposure to harmful antipsychotics, and would cause needless worry and stigma. Since studies prove conclusively that the symptoms are so very rarely predictive of psychosis, why in the world would DSM-5 give someone the stigmatizing and absurdly misleading label ‘attenuated psychosis syndrome’ and open the door to inappropriate antipsychotic use? Recognizing all these risks, a large portion of schizophrenia and prodromal researchers are sensibly opposed to the inclusion of ‘attenuated psychosis syndrome’ in DSM-5. But unaccountably, the work group stubbornly clings to its proposal and, without the petition, there is a good chance it may sneak into DSM-5.

In great part, the DSM-5 is a work of the imagination. Like all ambitious novels, it exhibits enormous scope and imaginative energy. Told from the point of view of a detached omniscient narrator, it chronicles the plummeting of populations into pre-psychosis, and their ultimate rescue by “the number one revenue producer of all classes of drugs,” anti-psychotics. Its pages evoke a les misérables America, massively prodromal, holding out its butyrophenone-bowl on every street corner.

It is pretty remarkable: Vegetarians, health food faddists, digestive obsessives of all sorts, blithely toss powerful anti-psychotics and anti-depressants down their gullets (and their children’s gullets) without knowing shit about what’s in them.

UD could understand it if these people were heroin addicts past caring about the ingredients of the compound someone’s handing them. But these are intelligent, watchful Americans, and it’s Down the hatch, baby!

Take the wildly popular, constantly advertised anti-psychotic Abilify, which you absolutely must try with your anti-depressant, darling. Two professors of medicine at Dartmouth write:

[Versus a placebo, Abilify scored] only three points lower on a 60-point scale, and it resolved depression for only 10 percent of patients — that is, 25 percent with Abilify versus 15 percent with just the placebo…

Abilify [caused] 21 percent of patients in the trials to develop akathisia, or severe restlessness, and 4 percent to gain a substantial amount of weight. And, as with all anti-depressants, there is a small increase in suicidal thoughts and behavior among many young adults.

The writers point out that we know far more about our sun screens than about these powerful manipulators of our brain chemistry.

More here. And here.

Well, let’s be fair. Blame also attaches to Stafford’s colleagues at Stanford, and to professors at other American universities, who get paid by drug companies to hawk therapeutically unsubstantiated, physically destructive, and enormously expensive atypical anti-psychotics to prescribers. Now these over-prescribed pills are a national blight.

Every now and then University Diaries looks in on Harvard professor Joseph Biederman. She’s doing it today because he’s featured in a Duff Wilson article about the over-prescription of anti-psychotic drugs in this country.

… Documents produced in recent litigation and in congressional investigations show that some leading academic doctors have worked closely with corporate benefactors to expand the use of anti-psychotics.

The most well-known is Joseph Biederman… His studies, examining the prevalence of bipolar psychological disorders in children, helped expand practice standards, leading to a 40-fold increase in such diagnoses from 1994 to 2003. [Yeah you read dat right. Forty-fold.]

… Between 2000 and 2007, he also got $1.6 million in speaking and consulting fees — some of them undisclosed to Harvard — from companies, including makers of anti-psychotic drugs prescribed for children who might have bipolar disorder, a Senate investigation found in 2008.

Johnson & Johnson gave more than $700,000 to a research center that was headed by Biederman from 2002 to 2005, records show, and some of its work supported the company’s anti-psychotic drug, Risperdal. Biederman said that the money did not influence him and that some of his work supported other drugs.

… A Harvard spokesman said [Biederman is] still under review…

Yes, take your time reviewing him. He’s only been at it for a decade or so. Take another decade. There’s so much more he can do with Harvard’s prestige backing him up.

Kajoko Kifuji, a professor at Tufts, prescribed homicidal amounts of anti-psychotics to a child.

I mean, of course, she handed the prescriptions to the child’s parents – the child was only four at the time.

Kifuji had been giving her powerful drugs since she was two.

Rebecca Riley’s parents killed her (the mother has been convicted of second degree murder; the father’s trial begins soon) via doses of the multiple non-FDA-approved (for use in children) drugs Kifuji gave them.

Kifuji – who prescribed the same drugs to the parents’ other two children – based these prescriptions on what the mother told her about her children.

Kifuji testified that her diagnosis was primarily based on Carolyn Riley’s description of her daughter as aggressive and disruptive. She in 2004 prescribed Clonidine to Rebecca for ADHD; the next year, she prescribed Depakote to treat bipolar disorder.

Kifuji went on to approve a double dosage of the medication after Carolyn Riley told her that she was giving Rebecca twice the daily recommended amount.

That’s from the Tufts newspaper. Here’s Lawrence Diller with more detail:

Dr. Kifuji determined that Rebecca at age two had hyperactivity and began prescribing drugs to her at that time. Kifuji changed her diagnosis to bipolar disorder at age three. She also made the same diagnosis for Rebecca’s brother and sister who were nine and seven. All three were receiving variations of these sedating psychiatric medications. Kifuji, who was granted immunity against prosecution to gain her cooperation, testified during the trial that she relied almost exclusively on reports from Rebecca’s mother on the children’s aggressive behavior, sleep problems and history of mental illness in the family to make the diagnosis for the three children.

… [A] three year old was prescribed three psychiatric drugs for bipolar disorder…

… Joseph Biederman, head of Harvard’s Pediatric Psychopharmacology Clinic, has long espoused the bipolar diagnosis in children. He and his group have claimed the diagnosis can be made in children as young as two and should be followed by aggressive psychiatric drug interventions…

Once Kifuji’s finished with her busy court appearance schedule, she will be hiring lawyers to defend her against a malpractice suit from the estate of Rebecca Riley.

Tufts thinks she’s great. Happy to have on her board.

… await the updated DSM-V, with new mental disorders just for us, a voice of caution arises among the psychiatrists:

The first draft [of the DSM-V] is crucial because only the Task Force working as a whole can discipline and reconcile the often inconsistent outputs produced by the different Workgroups. It is a very reliable rule of thumb that Workgroups are always more willing to make changes than is desirable. Experts in any given area tend to have their pet ideas and to worry more about missed cases than about creating potential false positives. By ruthlessly applying the necessary rule of empirical documentation, the Task Force must provide a useful check on Workgroup enthusiasm.

Allow UD to clarify.

The Workgroups include people riding lots of horses very hard: Mr Internet Addiction. Ms Intermittent Explosive Disorder. Their careers and fortunes are riding on these things… False positives, you say? I dare you to falsify any psychiatric diagnosis. Can’t be done, and certainly not by some confused patient sitting in a psychiatrist’s office. What’s the poor fool going to say? I really doubt there’s good research backing up your claim that I need anti-psychotics because I’m shy. No, once the designation’s in the manual, we’re out of the starting gate…

Problems can result even from improvements in the wording of criteria sets. For example, the better written and more easily remembered DSM-IV criteria set for ADHD may have resulted in its overuse—especially by primary care doctors and the general public.

However perilous it is to change existing criteria sets, the risks are much greater still whenever the system adds totally new diagnoses that are at best lightly tested. The potential for false positive epidemics and forensic conundrums are much harder to predict for anything novel. New disorders are best kept in the appendix until they have achieved wide acceptance in the field. The DSM system should always follow, not lead, research and practice. It can never be paradigm shifting on its own weight.

Same crap. So the new ADHD language has netted more clients than the old. Problem?

So we’re creating new epidemics. And?

Publishing profits are the only possible driver of a fixed and implacable 2012 publication deadline, and this is obviously not acceptable.

The man’s paranoid.

… Wall Street Journal article about the devastating consequences of doping tens of thousands of children with anti-psychotics, but it should.  This is his legacy.

Harvard University, which continues to employ Biederman, should also take a bow.

The growth in antipsychotic-drug prescriptions for children is slowing as state Medicaid agencies heighten their scrutiny of usage and doctors grow more wary of the powerful medications.

The softening in sales for children is the first sign that litigation, reaction to improper marketing tactics, and concern about side effects may be affecting what had been a fast-growing children’s drug segment.

… Antipsychotics have faced heightened scrutiny and investigation over the past year. In November, a Food and Drug Administration advisory committee asked the FDA to research children’s use of the drugs and expressed concern about possible side effects such as weight gain and increased diabetes risk. And 11 state attorneys general are investigating alleged marketing of Eli Lilly & Co.’s antipsychotic Zyprexa for uses the FDA hasn’t approved.

In January, Eli Lilly agreed to pay $1.4 billion to settle allegations it improperly marketed Zyprexa. The company also agreed to plead guilty to a criminal charge of promoting the drug for unapproved uses.

A Lilly spokesman declined to comment on ongoing litigation and said the company doesn’t track the drug’s use in children.

Bristol-Myers Squibb Co. agreed to pay $515 million in September 2007 to settle allegations it promoted Abilify for use in children. The FDA didn’t approve of the use of the drug in children older than 10 until 2008.

… Some states began moving to require special approval before they would cover a claim for an antipsychotic. A group of 16 states started studying the use of psychiatric medication in children in 2007 in an effort they dubbed “too many, too much, too young” …

******************************************

Via Alliance for Human Research Protection.