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David Bransford MD More on Psychiatry Updates

Companion Pets - Such an important part of the Family

After yet another week of “Cognitive Dissonace” (H.T. to www.1boringoldman.com for refreshing my memory of the classic work by Leon Festinger and his research on Social Psychology), I return to the theme of Companion Dogs and their unique role as formal or informal Therapy Pets.

That incredible bond between a person and a pet

I have witnessed the highly trained Therapy Dogs working with people with special needs, particularly the Large Breeds with small autistic children. But the most common bonds I view are not dogs with years of special training, but a child with his/her special pet…one that accepts them unconditionally, is loyal, protective, and so devoted. A relationship far too many of these children have not consistently received from humans in their lives.

From a scientific backdrop, the research and lifelong hard work of Dr Joan Esnayrah, Ph.D has been most inspiring and warrants a complete documentary on her contribution to this field.Psychiatric Service Dogs website Jane Miller and many other therapists have written tirelessly, given TV and radio interviews about the great value of Therapy Pets for people, but Jane is my “Go To” reference. And, of course, Temple Grandin, PhD is our Gold Standard -with so many informative books, DVDs, and free YouTube videos.

Dr Joan Esnayra PhD gave personal family interview recently about her own life Joan on YouTube – without any mention of her dogs – discloses her personal history with Bipolar Disorder.

Mark Everett – inspiration of the Eels Rock Group and author of Things Grandchildren Should Know “E” and his Dog are so closely bonded.

Olive - a very special dog that is so natural, friendly, and protective of young children

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David Bransford MD – I would rather be Salmon Fishing !

I'd Rather Be Fishing for Salmon!

Very early this morning, after midnight, I checked the website of 1boringoldman….not expecting his Sunday Post yet at that early hour. But it had been a very active day, interacting with bloggers via Twitter over the all too common concerns about the reliability of various studies, specifically in the field of Psychopharmacology. The LA Times has printed an article regarding antidepressants and the potential risk of suicidal thinking/actions in adolescents..with numerous concerns about the researchers and the reporter. Same general themes regarding credibility, conflicts of interest, etc. Much of the recent discussions have intensified with the Blog of www.DavidHealy.org and the release of his Pharmageddon new book. I was growing tired, but still motivated. One quick switch to 1boringoldman’s Sunday post and it was all right there. See here:

The definitive work regarding Janssen, Risperdal, TMAP, and so much more!

With years of concern, months of expecting the Landmark Trial in Austin, Texas of Janssen (JNJ) versus the State of Texas, and weeks of daily updates from professionals at the Court House blogging, it seemed like it was finally over, once Janssen settled for about 150 million dollars. Then the questions of why did they cave, why did they settle for a relatively small sum, instead of going to trial over possible over a billion dollars in the State of Texas alone? Questions continued to fill the twitterverse and then-very early this morning – Dr Poses’s post seemed to bring some closure for me personally. Not that the “overweight” opera star has sung…but at least some temporary time out.
So after reading the reports, I was thinking of Chicago the Musical..having seen in on Broadway and, of course, the Movie. But this was not entertainment the way Broadway can be. This was (and is) about young children being harmed by well intended, but misinformed clinicians, Social Workers, Foster Care Provider, and Parents….and so much more .
Opening Fishing in Minnesota is usually about Mid May of each year….using in conflict with the Annual American Psychiatric Association meeting – This year in Philly.
I plan to be fishing, in spite if the weather in true Minnesota Tradition. Thanks to the many bloggers that have made this big step a reality.

Opening Fishing in Minnesota - typically Mid May

Health Care Renewal Blogspot on the Texan TMAP, Risperdal, Janssen, and more

davidhealy.org

Chicago the Musical – Razzle Dazzel Em – (sorry. could not resist – too similar to BigPharm)

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David Bransford MD Blog On “Full Disclosure”

Head's Been a Spinning These Past Weeks

I wish – Like Garrison Keillor – I could state “Its been a quiet week in Lake Wobegon” But this is not a Prairie Home Companion post. On the contrary, it has been a week of intense disclosures and upsetting findings related not only to the Pharmaceutical Industry, but to Psychiatrists, Research Studies, Academic Institutions, and the National Institute of Mental Health. I found myself feeling duped by my chosen Profession at essentially all levels…colleagues, Professional Societies, the American Psychiatric Association, and private, non profits such as NAMI. I could find no safe harbors, as waves of well documented information was posted, verifying the fraud, the hidden studies, the Conflicts of Interests that keep appearing – thanks primarily to the hard work of expert Bloggers, Brave Whistle Blowers, and so much information via Twitter and Facebook. By the end of the week, I felt so overwhelmed, I turned to my usual resource to settle down by listening to some of my favorite musical artists and taking a complete break from the Internet Information I was finding so disturbing. I suspected it…I had been told about it, but actually reading the transcripts from some of the most recent court testimony was emotionally draining. The Austin, Texas Court Hearing between the State of Texas and Johnson & Johnson (Janssen) over the off label promotion of the antipsychotic – Risperdal – coupled with an extremely gifted blogger who was at the trial, made it so powerful and upsetting. The trial and the subsequent information called into question the legitimacy of my Chosen Profession & whether I could even continue clinical practice, as I have done since 1977.
I am often asked the past several years, if I plan to retire when I turn 65 in April….some hoping I will and others concerned, since many I have had the privilege of working with them for several decades. By the end of last week, retirement from clinical work seemed like my best alternative. Too many patients, damaged by antipsychotics, Foster Kids on Atypicals with Obesity, Diabetes, and life long metabolic changes. Perhaps most disturbing, the Primary Care Docs and Nurse Practitioners prescribing SSRIs, SNRIs, 2GAPs for disruptive behaviors and situational depressions with clear family dysfunction that goes unaddressed. Local Community Mental Health Centers promoting aggressively Long Active Antipsychotics, just as the the Drug Detail Men/Women tell them…having no awareness of the flawed data nor ‘Dollars for Docs” influencing these trends. As so clearly pointed out by a psychiatrist blogger who began psychiatric training the same year I did in 1974, the “deinstitutionalization” of the State Hospitals, the dramatic increase in Emergency Visits to the large County Hospitals (Hennepin County Medical Center in my case ) Mega-doses of Thorazine, Haldol, and numerous other very potent antipsychotics. Patients were placed out of sight in remote group homes and adult foster homes with minimal supervision, but the State Hospitals were closed, torn down, or converted to Federal Prisons. Unfortunately, nothing has changed, aside from huge profits for the so called Atypical AntiPsychotic Market..Schizophrenics still hallucinate and are treated with polypharmacy + ECT, in many cases. Vagal Nerve Stimulators are added for some with no evidence I can find for improvement. The State Hospitals in my region are closed, but the patient is typically in a poorly supervised adult foster home, visited by a Home Health Care Psychiatric Nurse, a Case Manager, possibly a personal care attendant, an individual therapist, a Med Checker psychiatrist, etc, etc..Far more attention and far more cost than the State Hospital Days. If there was evidence they were doing better and Quality of Life was better, perhaps it would be well worth it. But the evidence it not there ! The so call “New Atypicals” are untested and carry an entirely new risk of Metabolic Syndrome in all cases..not just Zyprexa or Seroquel. And the newest “Me Too” 2GAs of Fanapt, Saphris, and Latuda are really not new at all, yet tested and approved usually on 6 week trials….trials that are flawed..
So at present, I am left with no Safe Harbor, aside from the song written and performed so well by Vienna Teng…a talented singer/songwriter – computer expert, Stanford trained, and currently pursuing post grad work at University of Michigan- Ann Arbor on specialized, sustainable environmental research -while producing her first musical for 2013…..Amazing what a single, gifted person can accomplish.

In Psychiatry, my support of great minds includes some, but by no means all of the following bloggers or journalists.
www.1boringoldman.com www.Pharmalot.com www.Pharmagossip.com Soulful Sepulcher, Alison Bass, the Carlat Psychiatry Blog, WriteWithStan, Amy Harmon of the NYTs, @maiasz on Twitter and so many others that have been so supportive, usually without even realizing it.

In Seach of a Safe Harbor

Mother and Daughter Great Pyrenees Mountain Dogs

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DavidBransfordMD Update On The Downfall 01-29-2012

A Heroine in the NEWS

A front page article in today’s London Telegraph displays a photo of a crew member before the Concordia struck the rocks. She was said to have given her lifejacket to an elderly man..He survived. Her body was recently retrieved.

This past week, I have continued to follow the tragic events of the Cruise Liner, as well as the Blog posts regarding the recent Austin, TX Court Hearing from www.1boringoldman.com Both events struck me as very painful, but I will attempt to address the Pharmaceutical Industry and Doctors behaving badly, since that strikes me much closer to home. The posts regarding the trial became so much more realisitic to me, as the court transcripts were disclosed and I could read the testimony of some of the drug reps and how they were encouraged to promote the anti-psychotic Risperdal. Target audience was clearly psychiatrists, child psychiatrists in particular. The promotions were in strict violation of the FDA. It has led me to refuse to see drug reps at my office for over the past 18 months, but I see their targets shifting. Over 80 per cent of antipsychotics in my rural area are prescribed by family doctors and nurse practitioners. Many a specific program or speaker will address the clinical staff at the local Community Mental Health Centers. It is not at all uncommon for me to be told by a parent that a counselor or school teacher told them their child should be on a specific psychotropic medication. “Just ask (their) child’s Family Doctor” I continue to be amazed at the power of Marketing !
Many of the Direct to Consumer ads are believed “hook, line, and sinker” Yet, if they view a commercial from years ago, find them entertaining and do not seem to believe them for a minute. Searching YouTube, here are some examples :

This commercial sold millions of this item around the world

Very Realistic with the Surprise Ending

How many of you purchased a Sham Wow after seeing this classic ?

Many times/week, people ask me for Abilify

But as powerful as Direct to Consumer Ads can be, the posts from www.1boringoldman.com display how Doctors are still being instructed to use these new medications by the very Key Opinion Leaders that are paid by BigPharma to promote their products (see here)
www.1boringoldman.com A must read blog for Mental Health providers and advocates

And with each post, the Comments are often as valuable – not to be overlooked (see here)
Comments of great value to a post from 1boringoldman.com

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DavidBransfordMD The Selling of Psychiatry

Off Course, Hard Aground, and Sinking Fast

This past week, 2 major events captured my attention from different parts of the world..But extremely
important to me as an avid sailor and a clinical psychiatrist in independent practice for many decades.
As for the practice of psychiatry, a landmark court hearing took place in Austin, Texas and I relied heavily on a brilliant psychiatrist who attended the court hearing and maintains a powerful psychiatric blog with daily posts. Directly from his post at www.1boringoldman.com is an article that I am in complete agreement related to the “Selling of Psychiatry”
The Selling of Psychiatry from 1boringoldman blog
I also rely on so many other profession journalists and blogger advocates, but specifically – Ed Silverman of the Pharmalot.com post explains the court case in Forbes Magazine. General area of concern for me for years has been use of psychotropic medications in children without FDA clearance.

Ed Silverman's post on the Risperdal Trial in Austin, Texas Jan 2012

Perhaps it is far too great of a stretch, but the sinking of the Concorde and the current state of Psychiatry seem to have much in common, in my opinion.
Both are off course, bother utilize supposedly “State of the Art” techniques that are believed to be safe to the public, both lack competent leadership (APA Presidents, Ship Captains, etc) In the field of Psychiatry, Huge Managed Care Companies essentially restrict the psychiatrist to quick, 15 minute medication checks and totally overlook the need for a therapeutic alliance and talk therapy between patient and doctor. Far too much emphasis on medication, rather than time tested common sense and meaningful communication. With the Ship Wreck, I will wonder if too much attention was given to high tech navigation and so called “Dead Reckoning” was not utilized at all. “Dead Reckoning” in Psychiatry is a lost art, I fear…but was once the primary method of talking with patients – face to face -listening thoroughly to the patient’s story, and not depending on “high tech” scales and Pharma-Industry Developed screening techniques to determine which medication should be given.

On a positive note, in keeping with the hope that there will continue to be independent clinicians, I was greatly relieved to learn of the successful circumnavigation of a very determined teenager’s solo journey yesterday via Abbey Sunderland’s Blog. Several Years ago, I had followed Abbey’s posts as she began to solo her sailboat ‘Wild Eyes” around the World, but was dismasted by a rogue wave in the Indian Ocean..as her family and followers often expected the worst – until so many days later she was safely rescued. Much criticism was placed on the parents of both these girls for allowing them to be in extreme harm’s way….and many a post claiming the parents were simply exploiting the children for book and movie profits in the future. I see the girls as brave and using extremely good judgement, as they set out to Sea.Unfortunately, I see so much more danger for adolescents right here in the States with drug abuse, being victimized, abducted, teenage prostitution trafficking, and anti-psychotic medications for behavioral control, rather than for acute psychosis

Abbey
Sunderland's Blog

Visit on www.Twitter.com/ThinkShrink

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DavidBransfordMD – following landmark case in TX

It started at the beginning of the week, after months – perhaps years – of wondering about the State of Texas and a law suite against the manufacturers of an antipsychotic – risperidone. Primary issue is the question of whether the company had been promoting the medication for children – off label- against the FDA guide lines. For the State of Texas, were millions of dollars paid for this medication, utilizing a now questionable tool – termed TMAP. What makes this court hearing so unique to me is the primary fact that a blogger I greatly respect traveled down to the Courthouse in Austin, Texas – reporting via his blog www.1boringoldman.com daily posts of the entire process with his gifts of incredible analysis and descriptions. Also making it so unique, follow bloggers whom I so greatly value and respect followed along online as well. It was if we were all right there in the Court Gallery viewing the proceedings. Independent of the outcome of the trial, the support and online comments and input seemed to me to be unlike any of many Court Cases I have witnessed or testified in my Professional Career. Unlike my prior forensic work, it was not a commitment hearing, not a competency hearing….but addressing the huge questions of ethics, fraud, and -most of all- risk to the far too many children that were being medicated excessively and probably for the wrong reasons (behavioral control-rather than psychosis) On YouTube, I will place a link of an interview with an adolescent girl so you can hear her perspective. Not directly part of the TX case- but a far too familiar theme

A teenager discloses her experience in a Regional Treatment Center !

I could continue with hundreds of videos, blogs, chat discussions, etc – but the issues have been discussed at length by so many well informed adults – but with no apparent public outcry over excessive medicating of Foster Kids. What strikes me on a poignant level is the courage and strength it has taken for professionals (Mr Jones) to be key “whistleblowers” I am by no means an expert in this field, but over a decade ago, I was tracking very closely the FDA and BigTobacco. I had read Dr David Kessler’s book, disclosing his work in investigating the issue of whether nicotine was addicting. I had viewed the special on 60″ – later made into a movie “The Insider” tracking the painful saga of Dr Jeffrey Wigand’s testimony to the Senate – at great risk to his life and his family. At the University of Minnesota, in the early 1970s, I was deeply committed to the field of physiologic psychology – working with my mentors at the U of MN, implanting electrodes into lab rat brains-and locating so called “Pleasure Centers” deep within the brain. Then testing different families of medications with the lab rats to see if there were different responses….(Thorazine was in the only family that “turned off the pleasure center”} While working with Dr Walter Mink PhD (nearby Macalester College) and Dr Warren Roberts, a new researcher arrived from the East Coast with the technology to work with nicotine addicted mice and later primates) It was both frightening and exciting to think of major break thrus in the field of addiction. But Phillip Morris recruited Victor, under the ruse of needing his expertise to develop a safer cigarette. He was given an incredible lab and numerous incentives, only to later learn Phillip Morris was only interested in maintaining the necessary addictive properties to keep sales moving forward (see here-I think it is worth it) If the youtube date is correct, the special begins tomorrow.

By the Way – helpful to learn how “natural” Cigarettes are to manufacture (view here –

If any doubt about the safety of cigarettes, simply view this “scientific” study More Doctors Smoke Camels than Any Other Cigarette ! lol
Why post about Big Tobacco and Whistleblowers?
I see not difference between BigTobacco and BigPharma in the techniques and fraudulent behaviors .. Both are in the business of attempting to deliver dangerous chemicals to humans, motivated souley by greed and profits. The Marketing of Tobacco may no longer be on TV, but the Magazines and other media still target our children… www.TobaccoFreeKids.org

Smoking really is still glamorous - yes?

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DavidBransfordMD – Christmas Eve 2011 – a time to reflect!

Christmas Eve 2011 - My, how things have changed !

The sun has set several hours ago and it is officially Christmas Eve for my family of origin…Historically the greatest, busiest Holiday of the Year in our household, growing up with my parents and three brothers. Christmas Time was both sacred and commercial in our household. Living my first 10 years of life in a small town outside of Springfield, Il – seemed like I imagine Mayberry USA was portrayed. My father as 1 or 2 MDs in town was always on call and my older brother and I seemed to assume it was the norm for a ‘GP’. My dad was always busy, but also extremely accessible. We could ask him anything, I would often want to go with him when he was called out to a highway car collision. He would always allow it. I was abt 5 or 6 on a Christmas Eve in the early 50s and he was called to the scene of tragic crash on an icy bridge – with the nearest hospital about 17 miles away in Springfield, Il. In the back seat of the passenger car was a young child with a Christmas toy in his hand, lifeless and several others severely injured with major injuries.
Perhaps because my father always seemed to be in control as a professional, I do not recall being upset nor shocked, having viewed death from car accidents with him before. But it was Christmas Eve in late afternoon and I felt a deep sense of sadness for the dead boy. I still recall the image, so it must have had some profound impact on me. Such a contrast to our Christmas Eve celebrations at the house…a time of rejoicing, celebrating the birth of Christ, etc. I had blogged a few years ago about the unique Christmas times I had experienced, along with my brothers. From 2009, I just reviewed an earlier post……….with the finally paragraphs as follows:
Post from 2009, reflecting on childhood Christmas—
We lived near the tracks….it was such a small town, I guess everybody did. The Inter-Urban connected workers from my town to Springfield. Freight trains would come thru day and night and with the Hobos politely knocking on our door, my mother would invite them in and prepare them food..no fear, no feelings of intrusion…just small ‘Mayberry-like’ country living. They would repay us thru their stories and their unique life styles…seemed like they had such freedom
Back to the Trains–Christmas Eve Santa never failed to bring my brother and I Lionel Train sets. The greatest gifts on Earth back then. We kept collecting them each year and in the summer of 1957 – after John and I took trains to Traverse City, Michigan to attend Interlochen Natl Music Camp and returned to Springfield, we were given the news that my father was giving up General Practice after 15 years and we were moving to someplace called Minnesota. He utilized his military WWII benefits to specialize in something called Psychiatry. Wow…at first we were both devastated. But within abt 6 months, living off of Lake Nokomis in South Minneapolis, very near the major Airport. We were overwhelmed with excitement. No longer did we hear the trains, but the planes were so loud. Private, Commercial, and the Navy Air Base. We soon accommodated to the sounds from the planes and loved to watch them take off and land. We would then travel by train or plane to Ohio and Indiana to spend our summers on Lake Erie with my Aunts, Uncles, Cousins, and Grandparent. My younger two brothers were now part of the family and the Lionel train tradition continued, only my older brother and I took over the Santa role to see to it that my younger brothers received train sets. I still collect and gift Lionel Trains. Most of all, I wish to again travel the Great Northern route by train from Minneapolis to Seattle. And some late Spring I hope to take the City of New Orleans from Chicago to New Orleans and thank Singer/Songwriter Steve Goodman for writing that classic and handing it off to Arlo Guthrie before Stevie died way too early from Leukemia in the very early 1980s, I think. He would often sneak up from Chicago to Minneapolis ; I attended many a concert in the 1970s. He knew he was living on borrowed time. Arlo’s success- and Willie Nelson’s made a huge impact on supporting Steve Goodman’s widow and children after “Cool Hand Leuk” – as he called himself in his final months – died at the U of Washington in Seattle-all the while fighting the Leukemia – he just kept generating folk song after folk song with City of New Orleans his Signature Work. He would ride that train, knowing the RRs were giving way to air travel. Something magic

The Santa Fe WarBonnett Passenger train - Lionel's FlagShip!

about the lyrics clearly resonated with the world and his short life.

Just as the celebration of Christmas has changed so significantly, so has the practice of Medicine. “GP” are now Family Practitioners . The days of the independent town doctor seems to all but disappeared. Managed Care Rules !

As for the practice of traditional Psychiatry as I was trained in the 1970s, it too has completely changes. Psychiatrists in the States are expected to be “Med Checkers” – not psychotherapists, who may or may not suggest medication. I have been so inspired by the Retired Psychiatrist who maintains an excellent blog at www.1boringoldman.com Since he trained when I did in the 1970s, before Managed Care and Med Checkers (pdocs)- as patients refer to them online. So many of his posts are so informative for me, reaffirming that the changes in the field of Psychiatry are felt all across the Nation and not just in my rural Northern Minnesota safety zone.
So like Santa Clause, GPs, and General Psychiatry, the times have changed so greatly. On evenings such as this one, I do miss “the good old days” Happy Holidays to you all (8-)

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DavidBransfordMD – Update-Bipolar Disorder – Substance Abuse

According to the December 2011 “Clinical Psychiatry News” article, smoking and alcohol use in teens has diminished. However, cannabis usage in that same population has increased.

Cannabis Use in Teens at all time "high" ?

But from that same monthly publication, there is new hope from a research article involving 75 patients – aged 12-21. Seems topiramate plus quetiapine greatly reduced cannabis usage. (That is Topamax at 150 mg 2xday and Seroquel at up to 800mg/24hrs.) Using Ben Goldacre’s Good Science-Bad Science criteria, I will attempt to post the url to the study.
b373c583ea.html

065491376a.html

If you can open the first study and choose to read it, there are some very important facts re: side effects..not from the cannabis, but from the treatment meds…Metabolic Syndrome high risk from Seroquel and Topamax adverse effects included “pallor” and “excitability” The author did state no cognitive studies were addressed (I have had patients refer to Topamax as “Dope-a-max due to cognitive dulling) The author does disclose multiple Big Pharma Companies. Unfortunately, this is the type of information sent out to psychiatrists across the Country month after month. I so wish Dr Ben Goldacre’s information would routinely be included with the Journal, instead of attached articles about “New Products’
Dr Ben Goldacre on "Bad Science"

The PsychoPharm Pipeline must be outright dry! I see very old medications tweaked and rebranded (Ambien->Intermezzo doxepin (Sinequan in the 70s – promoted as a sleeping pill. Nuedextra for involuntary outbursts of crying and/or laughing – containing dextomethorphan and quinidine sulfate- DM synthetic cough supressor such as Robitussin DM and quinidine-a potent cardiac drug) I have yet to find a new product where the medication benefits outweigh the risks)
But if the DSM 5 draft becomes a reality in 2013, there will be less bipolar diagnoses in children. Instead, a new category will take its place, dealing with kids with irritability and possible mood swings. reassuring???

Inappropiate Behavior - At the very least must be Opposional Defiant Disorder ??

Overdiagnosis of Bipolar Disorder in kids? DSM5 would use a new pigeon hole !

link

Over the past several weeks, more coverage from the Media (press and TV) has been emerging.


Apparently ABC with Diane Sawyer did a special last week on the excessive psychiatric medicating of foster children. Weeks before that broadcast, bloggers were busy posting and magazines were printing the same theme..but with not enough outrage from the various Human Services Departments of the States, in my opinion.

Today, the Huffington post ran an important article @

Last Week, www.Healthland.Time.com published – thanks to Maia ! (@maiasz on Twitter)
Foster Children and Psychiatric Medications !
I could post numerous other examples, but the facts remain that the information is public, but there seems to be no known course of action to make major changes in the practices of over-prescribing these often dangerous medications to non psychotic children – seemingly using the meds as “chemical straightjackets” for behavioral control.

TransOrbital Lobotomy - an accepted method of treating "psychiatric illness' until early 1960s


There have been suggestions at a State Level that antipsychotics can only be prescribed to minors after a 2d opinion from another psychiatrist. But I fear that is so cumbersome and no guarantee the practice will cease. For the Big Pharmaceutical Companies, it is so profitable. And for the Treatment Homes, too convenient for establishing “tranquility”

Suggestions/comments would be greatly appreciated !

Please Help !

Its a Hard Knock Life !

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DavidBransfordMD – On “Bad Science”

"Bad Science" can be most dangerous ! On the Eve of Halloween, take caution!!

Big Bad Science - An Ever Present Danger in Our Daily Lives

Far too often, I see examples of claims by Pharmaceutical Companies, Medical Device Manufacturers, and perhaps most troublesome – Mental Health Policies on a Federal, State, and Local level that completely Fails to even approximate the Ben Goldacre Standards (more from Ben via video later).With best intentions, I should hope, governments need to know that the tax dollars they are spending, are spent on programs that are beneficial to the public. This is hardly a new concept for me, having been actively involved in Outcome Mental Health Research as far back in my training as college and Medical School at the University of Minnesota. The famed Psychologist Dr Starke Hathaway (developer of the MMPI, among so many other measurement instruments) was given an entire inpatient Psychiatric Unit at the U of MN hospital – called the PTU program (Psychological Treatment Unit) Highly unusual at the time, since Psychiatrists, not Psychologists typically “ruled” in the Hospitals. My mentor at Macalester learned that there was a need for a researcher to gather outcome data and later obtain objective discharge and 1 year follow up data. I jumped at the chance to work with Dr Hathaway and also have Dr David Cline MD as my primary mentor. I was trained by Starke to administer and score admission, discharge, and 1 year follow up MMPIs on each and every patient in the PTU program. The forerunner of today’s Treatment Plan was utilized, generated by the therapist and patient together – a very novel idea in the late 1960s. Multidisciplinary Therapists were so pleased to see how much improvement generally occurred from admission to discharge – and see it verified on Goal Attainment Scale, as well as the discharge MMPI. However, at 1 year follow up, when past patients from all over the Midwest were brought back for retesting and clinical re-assessment, the outcomes were dismal. More often than not, their 1 year follow up status was far more similar to the admission testing than their discharge results..I felt like a modern day pariah, as treatment staff would want to see how well their patients were doing after 1 year out of the hospital.
A Short Abstract of some of the research from the program which had us all so enthused.
Goal Attainment Scales to measure results from PTU inpatient program at U of MN
It was an incredible learning experience, but clearly verified that good ideas and good outcome often do not go hand in hand. Now take a time leap from the late 1960s to the 21st Century, if you will. Medical Devices are still heavily promoted…what was “Biofeedback” in the 60s is now Alph-Stim in the 21st Century…but still unable to receive FDA approval as therapeutic…safe, yes, but effective…over time-??? FDA not convinced. So following Ben Goldacre’s fundamentals, when 99.9% of people say Alpha-Stim works, that is a huge red flag..What procedure works for 99.9% of the population–BTW, in the early 1960s, outpatient “ice pick” lobotomies were all the rage, as thoroughly document in the book The Lobotomist. The author lives in Minneapolis-Jack El-Hai. His award winning book about Walter Freeman MD was made into a special on PBS..I have a Podcast of a Mr Howard Dulley who received a lobotomy as an outpatient at age 12 for being a bit “defiant”. He is now in his late 60s and met with Dr Freeman’s son and has reviewed his old records. Fortunately, he survived the lobotomy and drove a bus in California until retirement. The same Dr Freeman that performed a lobotomy on the Kennedy brothers only sister for “Bipolar” – but spent the rest of her life in a private institution in the State of Wisconsin until her death in recent years.

"Ice Pick" Lobotomies were commonly performed on outpatients in the 1960s

So Why Does Alpha-Stim treatment trouble me….I suppose it is not FDA cleared as effective, insurance will not generally cover it, and it costs people so much money with no long term scientific evidence to back it. FDA has claimed it is safe, but no more helpful than a massage or hot tub soak. At $800 dollars/unit, is it a scam? Are insurance companies being billed with a different code, which would be fraud?
Back to one final, but important point about scientific outcome research. Many States, including Minnesota, were sold of the Wellness and Recovery Model, patterned after the 12 Step Method of AA. Case Management services are reviewed after 6 months and the CM is to serve as a MH broker. Then all these other services may or may not be offered…with a “Too Many Cooks Spoil the Stew” outcome. After about 18 months of this new system, I have seen too often relapse, which could have been prevented if CM had been left in place. The idea of Wellness and Recovery if a Noble One, but often not possible. Because of the nature of the disorders these patient/consumers face, they have no external support or they will not utilize them in times of crisis. Much like the recovering alcoholic with a decade or more of sobriety. when they relapse they are too embarrassed and guilt ridden to seek out their support system, assuming they have one. As for the LOCUS, it may make the State or County feel better, but is not a sound scientific instrument. Before leaving this post, please listen to the intelligent, witty MD Doctor Ben Goldacre on ‘Bad Science’ With my psychiatric Twitter contacts now Global and IPS FB page, Ben has been a great source of inspiration and edification for which I owe him a great deal of gratitude.
Dr Ben Goldacre TED presentation on \"Bad Medicine\"

The Lobotomist Jack El-hai

More Clarification of the Status of Alpha-Stim and similar devices

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