British Psychiatrist Slams TeenScreen

Excerpted from Interview of Joanna Moncrieff, MD
Interviewer: Claudia Hammond
January 3, 2007
Audio can be found here: http://www.youtube.com/watch?v=vBfA2OBirBI

“All in the Mind” reports from the U.S.A. on the increasing controversial mental health screening programs for school children. Now, here’s Claudia Hammond with “All in the Mind”

Claudia Hammond: The biggest screening program is TeenScreen; it’s a quick questionnaire designed for 9-18 year olds. And the idea is to highlight anyone who might have symptoms of a psychiatric problem.

But not everyone is happy with the idea. Everyday teenage behaviour might be pathologized as illness and that the more children who are screened the more children will end up on psychiatric medication. And some parents are unhappy that their children were given the test at all.

Claudia Hammond: Joanna, in Chelsea’s case, the issue of consent did seem to be a big problem. But if in principal, if parental consent is obtained and it’s all voluntary, I mean it sounds like a kind of laudable aim to try and screen individuals.

Joanna Moncrieff: Well firstly on the issue of consent, in order for it to be informed consent, parents really ought to be told that there is no evidence that screening is actually going to prevent suicide, which is one of the main reasons it was introduced and also that the evidence about standard psychiatric treatment; such as drug treatments in children is questionable.

For example the trials on the use of antidepressants in children are inconsistent and many of them show that antidepressants do not have good effects in children. So parental consent needs to be properly informed consent. And I’m not at all convinced that the parents are getting the full facts when they’re being asked about whether to submit their children to this screening program.

I think problem with screening is it, it’s already suggesting way before you get into a clinical interview that it’s already starting to reframe peoples’ problems in medical terms and so even if the people who do this screening test don’t actually say explicitly to the children that they’ve got a psychiatric disorder called “this”. The children will take away from the experience of screening that they have a psychiatric problem and that they’re psychiatrically ill and in today’s’ climate many people will assume that that means that they need drug treatment. One test of the screening instrument that happened in Colorado diagnosed 50% of children as having evidence of possibly having some psychiatric disorder.

Claudia Hammond: 50%? That really is quite high isn’t it?

Joanna Moncrieff: It is indeed. And although not all of those people would probably have a confirmed diagnoses after a clinical interview, you’ve already started to suggest to them and their families that there’s something’s wrong and that what is wrong is a medical or psychiatric problem.

Claudia Hammond: So Joanna, if it’s all voluntary like that and it’s framed in such a way that the children themselves and their parents know exactly what it is they’re filling in and what this test can do and can’t do; isn’t that sort of reasonable to sort of highlight things if you can do it in a very sensitive way?

Joanna Moncrieff: Well first of all, as you know it hasn’t always been done in a voluntary way; often the screening has been implemented when parents haven’t objected to it rather then actually parents actively agreeing to their children to be screened. But secondly I think although many children will attend a clinical interview and won’t necessarily go on to be diagnosed and put on drug treatment. Actually even the experience of going to see a psychiatrist may be very frightening and very stigmatizing for some people, especially some young people. I think as psychiatrists we get immune to that and loose sight of how perturbing it is to be told that even might have a psychiatric problem. And of course some children will end up on drug treatment and we know that more and more children are being put on drug treatment. And I think that there is not enough concern about that at the moment.

Claudia Hammond: Joanna , what do you think will happen here? Will we see this coming across the Atlantic and being introduced in schools in the U.K. do you think?

Joanna Moncrieff: I don’t know whether we’ll actually get the full screening, with use of screening instruments. But we already see evidence in the U.K. of the sort of attitudes that inspired screening in the U.S.

For example, many more childhood behavioural problems are being labelled as psychiatric disorders, are being given diagnostic labels and the use of a range of psychiatric drugs such as Ritalin and stimulants, antidepressants and antipsychotics; their uses all increasing in line with trends in the United States albeit not as dramatically.

Claudia Hammond: If screening programs do start to appear over here we’ll keep you up to date on “All in the Mind” But in the meantime do let us know what you think about the idea of screening teenagers in schools. You can email us at allinthemind@bbc.co.uk

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Joanna is a Senior Lecturer in Psychiatry at University College London, department of Psychiatry and Behavioural Science. She has published several critical reviews of psychiatric drug treatments, as well as papers on the history of psychiatry. She is the founding member and co chair person of the Critical Psychiatry Network (web site: www.critpsynet.freeuk.com). This is a network of psychiatrists in the UK who challenge some of the orthodox thinking in psychiatry, especially the emphasis on the medical model of psychiatric disorder, and the link between psychiatry and coercion.

NY Times: Lilly Settles For 500 Million

This article is from the New York Times. I understand that "Zyprexa" is Prozac repackaged. It is an end run around the expiration of the Prozac patent. By making minor changes, Lilly was able to start up a new patent, thus getting richer by selling a drug that couldn't be copied. But bad drugs are bad drugs. Already discredited for its effect as "Prozac", it is still causing trouble in its new incarnation.

Lilly to Pay Up to $500 Million to Settle Claims


By ALEX BERENSON
Published: January 4, 2007
Eli Lilly agreed today to pay up to $500 million to settle 18,000 lawsuits from people who claimed they developed diabetes or other diseases after taking Zyprexa, Lilly’s drug for schizophrenia and bipolar disorder

Including earlier settlements over Zyprexa, Lilly has now agreed to pay at least $1.2 billion to 28,500 people who claim they were injured by the drug. At least 1,200 suits are still pending, the company said. About 20 million people worldwide have taken Zyprexa since its introduction in 1996.

The settlement covers cases filed in state and federal courts by 14 plaintiffs’ law firms or groups of firms, Lilly said. The federal suits have been overseen by a judge in Brooklyn, Jack B. Weinstein of the Eastern District of New York.

The settlement will not affect civil or criminal investigations pending over Zyprexa from state attorneys general and federal prosecutors, which are continuing.

Both Lilly and lawyers for plaintiffs said they were pleased with the agreement. With sales of $4.2 billion last year, Zyprexa is Lilly’s largest-selling drug and a major contributor to the company’s profits. Lilly shares were little changed after the settlement announcement.

Zyprexa is the brand name for olanzapine, a potent chemical that binds to receptors in the brain to reduce psychotic hallucinations and delusions. Clinical trials show Zyprexa also causes severe weight gain and increases in cholesterol and blood sugar in many patients.

Documents provided to The New York Times last month by a lawyer who represents mentally ill patients show that Lilly played down the risks of Zyprexa to doctors as the drug’s sales soared after its introduction in 1996. The internal documents show that Lilly’s own clinical trials found that 16 percent of people taking Zyprexa gained more than 66 pounds after a year on the drug, a far higher figure than the company disclosed to doctors.

The documents also show that Lilly marketed the drug as appropriate for patients who do not meet accepted diagnoses of schizophrenia or bipolar disorder, Zyprexa’s only approved uses. By law, drugmakers may only promote their drugs for diseases in which the Food and Drug Administration has found the medicines to be safe and effective, although doctors may prescribe drugs in any way they see fit.

In response to questions about the information in the documents, Lilly has denied any wrongdoing and said it provided all relevant information to doctors and the F.D.A. Lilly has also said it did not promote Zyprexa for conditions other than schizophrenia or bipolar disorder.

In 2004, a panel of the American Diabetes Association found that Zyprexa caused diabetes more than other widely used antipsychotic drugs in part because it tends to cause much more weight gain. But the F.D.A. has never made a similar finding. Instead, the F.D.A. added a warning in 2003 to the label of Zyprexa and other new antipsychotic drugs about their tendency to cause high blood sugar.

The settlement follows an additional $700 million agreement in 2005 covering 8,000 patients, as well as 2,500 individual settlements whose total value has not been disclosed, Lilly said. The 2005 settlement valued each claim at nearly $90,000 per plaintiff, while today’s agreement values claims at more than $27,000 per plaintiff.

The lower value for the new claims comes in part because of the F.D.A. label change, which has allowed Lilly to contend that it adequately warned doctors of Zyprexa’s risks after 2003. The label change may also help to protect Lilly from other lawsuits going forward, drug industry analysts and lawyers say.

In its statement, Lilly said the settlement did not change its views that Zyprexa is a safe and effective treatment for mental illness.

"We wanted to reduce significant uncertainties involved in litigating such complex cases," Sidney Taurel, Lilly’s chief executive, said in the statement.

Richard Meadow, one of the lead lawyers for plaintiffs, said the deal was fair to both sides. "Prolonging this litigation further is in no one’s best interest," he said.

Letter To The Editor In The San Francisco Chronicle

I want to thank you for your Dec. 27 article, "Illiteracy reinforces prisoners' captivity" which provides interesting statistics on the enormous number of prisoners who are poorly educated or illiterate.

The illiterate person is cut off from being able to communicate with or understand the rest of society that he depends on. Too many find crime as their only solution. If we could just get our schools to educate children, we will have fewer people turn to crime and then fewer people in prison, instead of more and more.

My plea is not for money. I am begging parents and school officials to reject the insidious idea that schools are supposed to be mental-health clinics and return to real teaching methods that produce real results: Children who can read, write, do math, and have knowledge of history to make informed political decisions, and sciences to have vocational choices.

A Brit Doubts The Existence Of ADHD

Here's an interesting rant by a Brit who doesn't buy the ADHD fraud. It's from the Sunday Mirror newspaper.

NAUGHTY KIDS NEED DISCIPLINE NOT DRUGS

Paul Routledge

I seem to have stirred up a hornet's nest by doubting the existence of so-called Attention-deficit hyperactivity disorder (ADHD).

One reader, who claims two children with ADHD, accuses me of "hurtful, unhelpful comments".

Another points out that children today sorely lack discipline.

And I hear from South Wales of a family whose "very modest" demand is for a three bedroom council house because one of their two sons might have the disorder. This is obviously a very divisive issue. It is also a hidden scandal.

Let's look at the facts. ADHD was first described by a Dr Friedrich Hoffman in 1845, in his book of poems about "Fidgety Philip". The symptoms were inattention, fidgeting, restlessness - and noisily tapping pencils.

This sounds like most children in my experience. They can't sit still, and their attention span is shorter than a politician's.

Over a century later, doctors in the US - who get paid in proportion to the treatment they say is necessary - realised this syndrome is a goldmine. ADHD was unknown in my childhood, but like so many Yankee ideas it soon crossed the Atlantic. And if we are to believe the medical profession, there are now 366,000 sufferers under the age of 18 in the UK.

Official figures from the Department of Health show that more than 1,000 prescriptions for powerful drugs are doled out every day to treat behavioural disorders in children. GPs prescribed drugs such as Ritalin, known as the "chemical cosh", on 384,000 occasions last year - a fourfold increase since 1997. An estimated 32,000 children are being drugged every day, at a cost to the NHS of £13.5million a year.

A whole generation is in danger of becoming drug-dependent because parents and doctors want to "medicalise" bad behaviour, rather than control it through diet, discipline and parental devotion. Consultant child psychiatrist Dr Sami Timimi argues that medicalisation of childhood problems is due to a search for "an easy cure that fits in with our fast lifestyles and gives us a quick answer".

Real-life TV programmes also glorify misbehaved children, and pander to the hand-wringing inadequacy of parents. Stroppy Johnny makes good telly, but it also encourages imitative behaviour.

So far, so bad. But I also learn that drug companies secretly fund support groups for parents of kids diagnosed with behavioural problems. In other words, they are fuelling this Ritalin bonanza - despite evidence linking their very profitable drugs to sudden deaths and heart problems.

Even Health minister Andy Burnham accepts that there is "limited information" about the long-term effects of these drugs.

I am not a doctor, and do not pretend to medical knowledge. But my sense of smell is unimpaired, and this business stinks.