Noteworthy News Articles on Mental Health Topics, June 26-30, 2007



At the Bowery Mission, Songs of Faith and Redemption
Dalton Walker, New York Times- 6/26/2007

Inside an empty chapel in Lower Manhattan, Dwight Walker stood with his back facing the empty rows of pews. His voice began to rise with songs that included words like faith, found and lost. Five other men joined him. “The storm is passing over — have faith in the Lord,” Mr. Walker sang in the sanctuary at the Bowery Mission.
      The six men are known as Anointed Voices, an a cappella group that sings and preaches in churches, in hospitals, before youth groups and in prisons. Theirs is a small tale of redemption — of how hard work, willpower and faith can sometimes lead people away from lives of desolation. All were homeless at some point, struggling with drug and alcohol addiction. All forged a new path at the Bowery Mission, a faith-based organization that serves the homeless. “The message is, no matter where you come from, there is a place God has given you,” said James Macklin, 67, a member of Anointed Voices and director of outreach for the mission. “The only thing one has to do is mine for this goal and make a human being all he can be.”
     In 2004, Ien Williams, 46, lost everything to his cocaine addiction: his marriage, his truck-driving business and his home in Queens. He carried his possessions in two suitcases through the streets of Manhattan. Someone told him about the Bowery Mission, and though he was wary of its emphasis on Christianity, he decided he had nothing to lose by going there. Spending time there helped him beat his addiction, he said, and now Mr. Williams lives at the mission, on the Bowery near Rivington Street, where he is in charge of housekeeping duties. The other singers call him “the minister” because of his preaching. “For me, it’s a total worship experience,” Mr. Williams said. “I sense the presence of God. This is where I’m safe.”
     The life stories of the other singers — Eugene Chisholm, Dennis Ogarra and Carroll Baylor — are strikingly similar to Mr. Williams’s. Three of the six live at the mission, while the others have found their own places. Mr. Ogarra helped found Anointed Voices in 2006 and recruited Mr. Walker and Mr. Williams. The others joined soon after.
     Elvon R. Borst, manager of alumni programs at the mission, was impressed when she heard the group perform recently at a church in the Bronx. “It seems to me that the men really try to deliver a message of encouragement and hope,” she said. Mr. Macklin serves as the group’s coordinator, arranging four or five performances a month. Some churches have been particularly welcoming, impressed with their music and their message. “Everyone,” Mr. Macklin said, “deserves a second chance.”
     Two years ago, Mr. Walker, at 39 the youngest of the six members, was using large amounts of crack cocaine. His awakening came, he said, when he was shoved into a van in Manhattan with a bag over his head. The details, he said, are vague because he was high on crack. The next thing he remembers was a bright light shining through the bag into his eyes, he said. It was the police. Mr. Walker eventually found his way to the Bowery Mission. “This has helped me stay clean, helped me develop a relationship with God,” he said.
     Mr. Ogarra, 49, who was born and raised in Brooklyn, joined the Army to escape living on the streets. He was stationed in Kansas at Fort Riley, but before long he was back to his old ways — using crack and cocaine and abusing alcohol. After he was discharged from the Army he moved back to Brooklyn. “I took the habit with me,” Mr. Ogarra said. His addictions kept his life in chaos, preventing him from holding a steady job, and leading to the breakup of his marriage. In 2005, he said, he stood on a Long Island Rail Road platform on Atlantic Avenue and thought about killing himself. But something stopped him, he said, and someone who spotted him called the police. An officer suggested he seek help at the Bowery Mission. “I was just mixed up,” Mr. Ogarra said. “I drank many years away. I did many things. I had no direction, no drive and no hope.”
     The mission has kept him free of drugs. and the musical group has given him a more hopeful view of life. He now lives in Washington Heights and has a job with U.S. Security Associates, a nationwide security firm. “It’s a godsend I got here,” Mr. Ogarra said. “I’ve learned to trust in my faith. If I was to give up I would be lost.” A tear rolled down Mr. Ogarra’s right cheek as he spoke. But as the six men talked about their lives and prepared for another singing performance, there were plenty of jokes and laughter, too. “We’re kind of like a family,” Mr. Macklin said.

Psychiatrists Top List in Drug Maker Gifts
Gardiner Harris, New York Times- 6/27/2007

WASHINGTON, June 26 — As states begin to require that drug companies disclose their payments to doctors for lectures and other services, a pattern has emerged: psychiatrists earn more money from drug makers than doctors in any other specialty.

How this money may be influencing psychiatrists and other doctors has become one of the most contentious issues in health care. For instance, the more psychiatrists have earned from drug makers, the more they have prescribed a new class of powerful medicines known as atypical antipsychotics to children, for whom the drugs are especially risky and mostly unapproved.

Vermont officials disclosed Tuesday that drug company payments to psychiatrists in the state more than doubled last year, to an average of $45,692 each from $20,835 in 2005. Antipsychotic medicines are among the largest expenses for the state’s Medicaid program.

Over all last year, drug makers spent $2.25 million on marketing payments, fees and travel expenses to Vermont doctors, hospitals and universities, a 2.3 percent increase over the prior year, the state said.

The number most likely represents a small fraction of drug makers’ total marketing expenditures to doctors since it does not include the costs of free drug samples or the salaries of sales representatives and their staff members. According to their income statements, drug makers generally spend twice as much to market drugs as they do to research them.

“For the fourth year in a row, our analysis shows that there is a great deal of money being spent in our small state on marketing pharmaceutical products,” said William H. Sorrell, the Vermont attorney general.

Endocrinologists received the second largest amount, according to the Vermont analysis, earning an average of $33,730. Since the state identified the specialties of only the top 100 earners, these averages represent the money earned by only some of the state’s specialists. There were 11 psychiatrists and 5 endocrinologists in that top group of 100.

Still, a similar pattern was evident in a Minnesota database that was the subject of a series of articles in The New York Times this year. As in Vermont, psychiatrists earned on aggregate the most in Minnesota, with payments ranging from $51 to $689,000. The Times found that psychiatrists who took the most money from makers of antipsychotic drugs tended to prescribe the drugs to children the most often.

These and other stories have helped to fuel a growing interest among state and federal officials to document and restrict payments to doctors from drug makers. At a gathering last month at Columbia Law School in New York, state attorneys general from across the country discussed ways to get similar data for their states.

And today, the Senate Special Committee on Aging, which is led by Senator Herb Kohl, Democrat of Wisconsin, will hold the first of a series of hearings on the issue, which could lead to legislative proposals to restrict and require disclosure of payments and gifts to doctors from drug companies nationwide.

Several lawmakers on Capitol Hill have expressed interest in such legislation, including Senator Charles E. Grassley, Republican of Iowa. “A federal law requiring public disclosure of payments to doctors could be very effective if it was carefully monitored and consistently applied,” Mr. Grassley said.

Efforts to require disclosure of payments to doctors began almost by happenstance in 1993, when The Minnesota Legislature passed a law that restricts drug companies from giving doctors gifts valued at more than $100 in any given year. The legislation also required companies to report and make public any consulting fees paid to doctors.

Lee Greenfield, a former state representative in Minnesota and one of the law’s authors, said it passed with little fanfare or debate after legislators heard stories about doctors accepting gifts of great value from drug makers.

“Why do we want them bribing doctors to use what may not be the best or most cost-effective drug for the patient purely to get some hand-held TV, we all asked,” Mr. Greenfield said.

Still, compliance with the law has been spotty. Some companies never responded to the board’s requests for disclosures. Others did so fitfully. A few sent letters saying they did not collect that information and thus could not provide it.

Minnesota officials never cracked down. Such reports were put in file drawers and largely forgotten until this past year, said Cody Wiberg, executive director of the Minnesota Board of Pharmacy. Mr. Wiberg said he planned this year to pursue companies that fail to report.

Besides Vermont and Maine, more than a dozen other states have or are now considering similar legislation, said Sharon Anglin Treat, executive director of the National Legislative Association on Prescription Drug Prices.

Officials in Maine and Vermont said they would try to compare reports of payments to doctors with Medicaid records to explore how marketing practices might influence prescribing by doctors in ways that increased costs to taxpayers.

“What we want to be able to do is overlay the prescribing information that we have with the drug detailing information,” said Jude Walsh, special assistant to the governor of Maine, John E. Baldacci. “If we see that doctors in a certain southern county in the state are prescribing a lot of a drug and getting a lot of detailing for that drug, that could lead to some record reviews to see what’s happening.”

A report prepared for the AMA's annual policy meeting had sought to strongly encourage that video-game addiction be included in a widely used diagnostic manual of psychiatric illnesses.

AMA delegates instead adopted a watered-down measure declaring that while overuse of video games and online games can be a problem for children and adults, calling it a formal addiction would be premature.

''While more study is needed on the addictive potential of video games, the AMA remains concerned about the behavioral, health and societal effects of video game and Internet overuse,'' said Dr. Ronald Davis, AMA's president. ''We urge parents to closely monitor children's use of video games and the Internet.''

Despite a lack of scientific proof, Jacob Schulist, 14, of Hales Corners, Wis., says he's certain he was addicted to video games -- and that the AMA's vote was misguided.

Until about two months ago, when he discovered a support group called On-Line Gamers Anonymous, Jacob said he played online fantasy video games for 10 hours straight some days.

He said his habit got so severe that he quit spending time with family and friends.

''My grades were horrible, I failed the entire first semester'' this past school year because of excessive video-game playing, he said. ''It's like they're your life.''

Delegates voted to have the AMA encourage more research on the issue, including seeking studies on what amount of video-game playing and other ''screen time'' is appropriate for children.

Under the new policy, the AMA also will send the revised video-game measure to the American Psychiatric Association, asking it to consider the full report in its diagnostic manual; the next edition is to be completed in 2012.

Dr. Louis Kraus, a psychiatric association spokesman, said the report will be a helpful resource.

The AMA's report says up to 90 percent of American youngsters play video games and that up to 15 percent of them -- more than 5 million kids -- might be addicted.

The report, prepared by the AMA's Council on Science and Public Health, also says ''dependence-like behaviors are more likely in children who start playing video games at younger ages.''

Internet role-playing games involving multiple players, which can suck kids into an online fantasy world, are the most problematic, the report says. That's the kind of game Schulist says hooked him.

Kraus, chief of child and adolescent psychiatry at Chicago's Rush Medical Center, said behavior that looks like addiction in video-game players may be a symptom of social anxiety, depression or another psychiatric problem.

He praised the AMA report for recommending more research. ''They're trying very hard not to make a premature diagnosis,'' Kraus said.

In other action on the final day of the AMA's annual policy meeting, delegates:

-- Voted to have the AMA support government policies requiring fast-food restaurant chains to provide menus detailing nutritional information including calories, fat and sodium content. A key way to fighting the obesity epidemic ''is that people know what they're eating,'' Davis said.

-- Recommended more research on a potential link between high fructose corn syrup and obesity. A measure had sought to have the AMA seek government restrictions on the popular sweetener and food labels declaring that excessive consumption of it may lead to obesity.

-- Rejected a move to lobby for limits on the noise levels of in-ear headphones used with iPods and other music-playing devices. A resolution supporting limits said devices with in-ear headphones can generate sound well above 100 decibels -- more noise than a chain saw makes and levels that have been linked with permanent hearing loss. AMA delegates voted instead to seek more research on the issue.

On the Net:
AMA: http://www.ama-assn.org
On-Line Gamers Anonymous: http://www.olganon.org

Conflict Alleged in Drug Firms' Education Role
Elizabeth Williamson & Christopher Lee, Washington Post- 6/27/2007

Drug companies have become the biggest sponsors of continuing medical education courses in recent years, even at the nation's top medical schools, a development that critics say raises health-care costs, skews doctors' treatment decisions and allows the industry to skirt laws against advertising "off-label" uses for its products.

The trend accelerated after the government backed off a plan to limit commercial sponsorships in 2002 at the urging of the industry, Senate investigators said.

Now, nearly two-thirds of the cost of continuing education courses sponsored by medical schools, popular for their prestige, are paid for by drug and medical device companies and other commercial interests, figures show. Overall, commercial sponsors pick up about half of the $2.25 billion annual cost of the courses doctors must attend to keep their licenses.

"Most of what doctors know about drugs comes from the industry, and that's not healthy," said Jerry Avorn, a Harvard Medical School professor and critic of the sponsorships. "Academic organizations lend their names to courses that are nothing more than infomercials."

But Scott Lassman, senior assistant general counsel at Pharmaceutical Research and Manufacturers of America, said industry funding of continuing medical education is a great way to educate physicians about the latest medical and scientific research.

The courses "are viewed as running independently of the pharmaceutical company," Lassman said. "The company may be providing the funding for it, but they are not directing the content."

He also defended the practice of discussing off-label uses for drugs -- uses not approved by the Food and Drug Administration -- in the courses. "A lot of times, the regulatory process lags behind the science," he said. "I think it's a benefit for physicians, as long as it's independent and as long as the scientific information is solid."

For doctors, though, drug company funding "makes it very difficult to know what research to believe," said J. Gregory Rosenthal, an Ohio retinal surgeon and a founder of Physicians for Clinical Responsibility, a group pushing for tighter controls on conflicts of interest in medicine. "Even at the [specialty] academy level, you can't go onto a Web site without being confronted by sponsorship logos."

Rosenthal will testify today in a hearing before the Senate Special Committee on Aging, which is looking into physician links with the drug industry. Sen. Herb Kohl (D-Wis.), the chairman, said the commercial sponsorship of courses creates a conflict of interest.

"It appears that everyone profits from this pervasive system of gifts and payments, except the consumer," Kohl said.

The hearing marks the second time this year that the Senate has examined the independence of industry-sponsored continuing education. In April, a Senate Finance Committee study found that the Accreditation Council for Continuing Medical Education, the main accrediting body for education providers, does not scrutinize course materials for accuracy or evidence of bias toward sponsors' products. At times, sponsors have been able to select topics, and presenters have discussed off-label uses for drugs, the report found.

"There has to be a bright line between drug company spending on medical education and spending on marketing," Sen. Max Baucus (D-Mont.), the committee's chairman, said in remarks echoed by Charles E. Grassley of Iowa, the panel's top Republican.

Murray Kopelow, chief executive of the accrediting council, acknowledged that concerns over the drug industry's influence persist despite the advent of stricter oversight and ethical guidelines. "We've done a lot, but we believe we could do more in putting into place detection systems and monitoring systems in order to provide data to address those concerns," Kopelow said.

He said the drug industry does hold some sway over which topics are covered in the courses.

"Commercial interests fund educational activities that are consistent with their business," he said. "To that extent, the industry has some control over the topics that are taught. The title of the activity would not be in the hands of the commercial interest but would be in the hands of the accredited provider."

Last year's meeting of the American Psychiatric Association in Toronto, the field's biggest educational conference, reflects the extent of corporate sponsorships. In the meeting program, a voluntary listing of the financial ties to drug firms of the physicians who served as instructors covered 14 pages. Some instructors were sponsored by at least a dozen companies.

"Between a third and a half of medical providers have a relationship with industry," said Jerome P. Kassirer, a professor at Tufts University's School of Medicine and the author of a book about the financial links between doctors and drug companies. "These are promotional activities disguised as education."

In 2002, after identifying prescription drugs as the biggest factor in soaring federal health-care costs, the inspector general's office at the Department of Health and Human Services drafted tighter rules governing industry sponsorship of the courses, according to the Senate aging committee. Soon after, however, lawyers for the industry hand-delivered a 56-page memo objecting to the draft, and the guidelines the government eventually adopted closely matched the industry's voluntary code of ethics.

Some states have begun looking into the issue. In Pennsylvania, for example, Avorn, the Harvard professor, helped create RxFacts ( http://www.rxfacts.org), a two-year-old program that provides physicians with evidence-based, noncommercial prescription information.

"I don't think we ever can or should prevent companies from making honest statements about their approved products," Avorn said. "But we need to give doctors a chance to hear from people who don't have products to sell."



Antidepressants Not Big Risk for Defects
Associated Press, 6/28/2007

BOSTON -- Newborns face little risk of birth defects from antidepressants taken by many women early in pregnancy, say the reassuring findings of the two biggest studies of this controversial link.

The research focuses on the class of drugs chosen most often for depression and anxiety, including the brands Prozac, Paxil and Zoloft.

Paxil carries a warning of possible heart defects in newborns, and experts don't expect the new research to change that. However, they find the new studies comforting for women struggling with depression.

The possibility of birth defects from antidepressants has put doctors and patients in a tricky quandary. Birth defects obviously hurt newborns, but depressed mothers who can't give proper care also endanger their babies.

Confusing matters, researchers have wondered if the concern about birth defects should extend beyond Paxil to this entire class of drugs, known as selective serotonin-reuptake inhibitors, or SSRIs. The two latest studies, appearing Thursday in The New England Journal of Medicine, relieve some of that worry, say birth specialists.

''Yeah, there's a risk, but the risk overall is probably pretty small,'' said Dr. Susan Ramin, obstetrics chairman at the University of Texas Medical School in Houston, who was familiar with the findings.

The two studies -- one from the federal Centers for Disease Control and the other from Boston University -- use more cases of birth defects than previous research to consider links between the abnormalities and SSRIs. The Boston University study was funded partly by the National Institutes of Health and Paxil maker GlaxoSmithKline PLC.

Together, the two studies looked at 19,471 newborns with birth defects and 9,952 without them. Then they considered what SSRIs the mothers in both groups took during the first three months of pregnancy and mapped the patterns of birth defects.

Neither study was able to tie SSRIs as a group to either heart defects or most other defects. That reassurance is especially welcome because depressed women fret even more than other mothers about the health of their newborns, said Dr. Stephan Quentzel, a psychiatrist who treats pregnant women at Beth Israel Medical Center in New York City.

Also, a mother's untreated depression can lead to poor care or turmoil at home, a weaker maternal bond, and other problems for a newborn. ''The fetus and the newborn are almost always worse off if the mom is depressed than if ... exposed to the vast majority of antidepressants,'' Quentzel said.

However, doctors and mothers have been very wary about medications and birth defects since Europe's thalidomide scandal of deformed babies in the 1960s. Defects from all causes are expected in about 3 percent of births, enough to make many mothers nervous.

The concern about SSRIs grew out of GlaxoSmithKline's own alert in 2005 about possible heart defects in newborns whose mothers took Paxil early in pregnancy. The U.S. Food and Drug Administration added its own warning. Last year, a separate study linked SSRIs taken late in pregnancy to a lung disorder in newborns.

The latest studies do not consider that disorder, known as persistent pulmonary hypertension. But they suggest that the risk of other defects from an SSRI -- even if confirmed -- would add only a fraction of 1 percent to the overall danger, researchers said.

Paxil did appear to triple the risk of a defect in blood flow from the heart, both studies found. But that additional danger would still be modest, experts said.

The studies further hinted at possible ties between other SSRIs and a handful of other defects, but researchers said the numbers of newborns with specific defects were too small to draw strong conclusions.

''Based on these studies, it's correct to say: no major risk,'' said Carol Louik, a public health expert who led the Boston study. ''I wouldn't say, 'No risk.'''

Researchers said women should talk over the potential risks and benefits with their doctors, preferably before pregnancy.

The New England Journal of Medicine: http://nejm.org/

Birth defects facts from Centers for Disease Control: http://www.cdc.gov/ncbddd/bd/facts.htm