Payments to Doctors by Pharmaceutical Companies Raise Issues of Conflicts

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Thousands of Texas doctors, researchers and medical experts — including more than 100 who are employed by the state and are paid with taxpayer dollars — routinely supplement their salaries with income from pharmaceutical companies.

Drug companies pay medical professionals for a wide range of activities, from speaking engagements to consulting. While legal, the practice raises questions about potential conflicts, and whether the interests of patients may be compromised.

From 2009 to early 2011, at least 25,000 Texas physicians and researchers received a combined $57 million — and probably far more — in cash payments, research money, free meals, travel and other perks, according to data culled from 12 drug companies and provided by the nonprofit investigative news organization ProPublica.

Dozens of these medical professionals were paid more than $100,000 each during that period. And 114 were professors, physicians, psychiatrists or researchers who were already paid a salary by the state — in some cases more than a half-million dollars a year. These state employees brought in nearly $3 million combined from pharmaceutical companies from 2009 to early 2011, according to a Texas Tribune analysis of the ProPublica data.

Nationwide, pharmaceutical manufacturers routinely pay medical professionals to assess a new product or to help contribute to the drug company’s sales. The companies fly medical professionals to seminars and conferences and may also pay speaking fees. State-employed doctors and researchers are generally no exception, though they are supposed to comply with their individual institutions’ conflict-of-interest policies….

By EMILY RAMSHAW and RYAN MURPHY

The New York Times

http://www.nytimes.com/2011/11/25/us/payments-to-doctors-by-pharmaceutical-companies-raise-issues-of-conflicts.html

Drugs Used for Psychotics Go to Youths in Foster Care

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Foster children are being prescribed cocktails of powerful antipsychosis drugs just as frequently as some of the most mentally disabled youngsters on Medicaid, a new study suggests.

The report, published Monday in the journal Pediatrics, is the first to investigate how often youngsters in foster care are given two antipsychotic drugs at once, the authors said. The drugs include Risperdal, Seroquel and Zyprexa — among other so-called major tranquilizers — which were developed for schizophrenia but are now used as all-purpose drugs for almost any psychiatric symptoms.

“The kids in foster care may come from bad homes, but they do not have the sort of complex medical issues that those in the disabled population do,” said Susan dosReis, an associate professor in the University of Maryland School of Pharmacy and the lead author.

The implication, Dr. dosReis and other experts said: Doctors are treating foster children’s behavioral problems with the same powerful drugs given to people with schizophrenia and severe bipolar disorder. “We simply don’t have evidence to support this kind of use, especially in young children,” Dr. dosReis said….

By

The New York Times

http://www.nytimes.com/2011/11/21/health/research/study-finds-foster-children-often-given-antipsychosis-drugs.html?scp=1&sq=Drugs%20Used%20for%20Psychotics%20Go%20to%20Youths%20in%20Foster%20Care&st=cse

Integrated Care Improves Mental Health Outcomes, Cuts Costs

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Integrating primary and mental healthcare in “health homes” can save lives, according to a leading mental health expert.

“It turns out, it’s actually a really great way to save money, too,” said Joseph Parks, MD, director of the Missouri Institute of Mental Health in St. Louis.

Dr. Parks, who is also chief medical officer of the Missouri Department of Mental Health, spoke to mental health advocates who gathered at the Mental Health Hope Symposium in Washington, DC, to learn about successful mental healthcare models and to raise awareness of mental health needs.

The meeting was sponsored by several behavioral health advocacy organizations. Its goal was to highlight the importance of patient access to quality care and treatment for people with mental illnesses before the US Congress Joint Select Committee on Deficit Reduction begins to slash $1.2 trillion from the federal deficit on November 23.

Through a health home initiative in Missouri that predates the Affordable Care Act’s patient-centered medical home concept, community mental health centers (CMHCs) function as healthcare homes, or medical homes.

A primary care provider is responsible for overall coordination of care. Case management is coordinated, people with serious mental illnesses have their medical diseases managed, and mental healthcare providers offer preventive healthcare screening and monitoring. Primary care nurses play an active role as agents of change at the CMHCs….

By Sandra Yin

Medscape

http://www.medscape.com/viewarticle/754122

Mouse Study: Missing Gene and Abnormal Behavior Linked

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Although many mental illnesses are uniquely human, animals sometimes exhibit abnormal behaviors similar to those seen in humans with psychological disorders. Such behaviors are called endophenotypes.

Now, researchers at the California Institute of Technology have found that mice lacking a gene that encodes a particular protein found in the synapses of the brain display a number of endophenotypes associated with schizophrenia and autism spectrum disorders.

In the study, which was published in The Journal of Neuroscience, the researchers created mutations in mice so that they were missing the gene for a protein called densin-180, which is abundant in the synapses of the brain.

These electro-chemical connections enable the formation of networks between the brain’s neurons. This protein sticks to and binds together several other proteins in a part of the neuron that is at the receiving end of a synapse, called the postsynapse.

“Our work indicates that densin-180 helps to hold together a key piece of regulatory machinery in the postsynaptic part of excitatory brain synapses,” says Mary Kennedy, the Allen and Lenabelle Davis Professor of Biology at Caltech, who was the senior author on the study.

In mice lacking densin-180, the researchers found decreased amounts of some of the other regulatory proteins normally located in the postsynapse. Kennedy and her colleagues were especially intrigued by a marked decrease in the amount of a protein called DISC1.

“A mutation that leads to loss of DISC1 function has been shown to predispose humans to development of schizophrenia and bipolar disorder,” Kennedy says.

In the study, the researchers compared the behavior of typical mice with that of mice lacking densin. Those without densin displayed impaired short-term memory, hyperactivity in response to novel or stressful situations, a deficit of normal nest-building activity, and higher levels of anxiety.

“Studies of mice with schizophrenia and autism-like features have reported similar behaviors,” Kennedy notes. “We do not know precisely how the molecular defect leads to the behavioral endophenotypes. That will be our work going forward. The molecular mechanistic links between a gene defect and defective behavior are complicated and, as yet, mostly unknown. Understanding them goes to the very heart of understanding brain function.”

The findings point to the need for a better understanding of the interactions that occur between proteins at synapses, she adds. Studies of these interactions could provide information needed to screen for new and better pharmaceuticals for the treatment of mental illnesses.

“This study really reinforces the idea that small changes in the molecular structures at synapses are linked to major problems with behavior,” Kennedy says.

By Janice Wood

Psych Central

Meditation May Help Brain Tune Out Distractions

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Study Helps Explain Why Meditation Improves Concentration

People who meditate may be able to use their brain in ways others can’t to tune out distractions and focus on the task at hand.

A new study shows that experienced meditators may have less activity in parts of the brain associated with daydreaming and distraction while meditating and in their day-to-day lives.

Researchers say this brain network, known as the “default mode network,” has also been linked to anxiety, attention deficit hyperactivity disorder (ADHD), and Alzheimer’s disease.

“The default mode is when you ruminate, think about yourself, or daydream,” says study researcher Judson Brewer, MD, PhD, medical director of the Yale Therapeutic Neuroscience Clinic. “Everybody has it, but experienced meditators have a different type.”

Brewer found that people who meditate are able to link up other parts of their brains to monitor activity in the default mode network that tell them to get back on task when distractions arise and be present in the moment.

The study is published in the Proceedings of the National Academy of Sciences.

Experts say the results help explain the benefits of meditation on concentration and open the door to future research using meditation to treat and potentially prevent a variety of psychiatric and neurological disorders….

By

WebMD  Health News

http://www.webmd.com/balance/news/20111120/meditation-may-help-brain-tune-out-distractions

New study shows smokers underutilize proven treatment and services for quitting

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70 percent of smokers want to quit as nation approaches the Great American Smokeout

Most American adults who smoke wish they could quit, and more than half have tried within the past year, according to a report by the Centers for Disease Control and Prevention.

The report says 68.8 percent of current American adult smokers say they want to quit and 52.4 percent of adult smokers tried to quit within the past year.  The report says 48.3 percent of smokers who saw a health professional in the past year recalled getting advice to quit and 31.7 percent used counseling and/or medications in the past year. The use of these effective treatments can almost double to triple rates of successfully quitting.

“More than two thirds of smokers want to quit smoking and more than half tried to quit last year,” said CDC Director Thomas R. Frieden, M.D., M.P.H.  “Smokers who try to quit can double or triple their chances by getting counseling, medicine, or both.  Other measures of increasing the likelihood that smokers will quit as they want to include hard–hitting media campaigns, 100 percent smoke–free policies, and higher tobacco prices.”

The analysis is in CDC’s Morbidity and Mortality Weekly Report. The report is being published in conjunction with the annual Great American Smokeout, observed this year on Nov. 17. Sponsored by the American Cancer Society, the Smokeout encourages smokers to use the date to make a plan to quit, or to plan in advance and quit smoking that day.

According to the report, making health care settings as well as all workplaces and public places smoke-free offers smokers additional encouragement to help them quit.  The report also notes the health care industry can increase successful quit attempts by providing comprehensive insurance coverage with no deductibles or co-payments for cessation treatments and services.

Smokers can get free resources and help quitting by calling 1-800-QUIT-NOW (784-8669) or visiting www.smokefree.govExternal Web Site Icon….

CDC Online Newsroom

Centers for Disease Control and Prevention

http://www.cdc.gov/media/releases/2011/p1110_smoking_treatment.html

Perinatal Antidepressant May Affect Brain Development

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Rats exposed to an antidepressant just before and after birth had altered behaviors and substantial brain abnormalities. The findings raise questions about how perinatal antidepressants might influence brain development in people.

Serotonin—a chemical messenger in the brain—plays an important role in brain development. Antidepressants called selective serotonin reuptake inhibitors (SSRIs) work by boosting serotonin activity in the brain. However, recent studies have found associations between women taking SSRIs during pregnancy and potential development problems in their offspring, including an increased risk for autism….

NIH Research Matters

National Institute of Health

http://www.nih.gov/researchmatters/october2011/10312011antidepressant.htm

Psychiatric Drug Use Spreads

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The medicating of Americans for mental illnesses continued to grow over the past decade, with one in five adults now taking at least one psychiatric drug such as antidepressants, antipsychotics and anti-anxiety medications, according to an analysis of pharmacy-claims data.

Among the most striking findings was a big increase in the use of powerful antipsychotic drugs across all ages, as well as growth in adult use of drugs for attention-deficit hyperactivity disorder—a condition typically diagnosed in childhood. Use of ADHD drugs such as Concerta and Vyvanse tripled among those aged 20 to 44 between 2001 and 2010, and it doubled over that time among women in the 45-to-65 group, according to the report.

Overall use of psychiatric medications among adults grew 22% from 2001 to 2010. The new figures, released Wednesday, are based on prescription-drug pharmacy claims of two million U.S. insured adults and children reported by Medco Health Solutions Inc., a pharmacy-benefit manager.

“People from all walks of life are taking medications for mental-health conditions,” said David Muzina, a psychiatrist and head of Medco’s Neuroscience Therapeutic Resource Center, whose team compiled the report….

By SHIRLEY S. WANG

THE WALL STREET JOURNAL

http://online.wsj.com/article/SB10001424052970203503204577040431792673066.html

No Myth: Creativity and Mental Disorders Are Linked

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Creative individuals have a disproportionately higher rate of mental illness, including schizophrenia and bipolar disorder, and they and their relatives are more likely to work in artistic and scientific occupations, according to new research published in the November 2011 issue of the British Journal of Psychiatry.

“Creativity has long been associated with mental disorder, epitomized by Aristotle’s claim that ‘no great genius has ever existed without a strain of madness,’ ” lead author Simon Kyaga, MD, from the Karolinska Institute, Stockholm, Sweden, told Medscape Medical News.

“Working as a psychiatrist, I have many times encountered patients who, despite severe psychiatric disorder, were able to create in artistic and scientific areas, as well as being successful entrepreneurs,” Dr. Kyaga said. “I was therefore intrigued by the idea of a connection between creativity and madness, and together with my supervisors, we initiated the study, trying to provide answers to this old question.”

Dr. Kyaga and colleagues performed a nested case-control study using a variety of sources to obtain information on the association between creativity and mental illness.

These data sources included the Hospital Discharge Register, which provided discharge diagnoses for all in-patient treatment episodes for schizophrenia, bipolar disorder, and unipolar depression in Sweden between 1973 and 2003; the Multi-Generation Register, which identified biological relatives of patients; and national censuses for 1960, 1970, 1980, and 1990, which provided information on professions in the entire Swedish population….

By Fran Lowry

Medscape

http://www.medscape.com/viewarticle/753286

 

Many Inoculated Against Science In Understanding Schizophrenia

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In earlier posts (“Too Much Pop Psytchology and “Alzheimer’s and Schizophrenia”), I talked about the medical and scientific evidence that exists demonstrating that schizophrenia (and other serious mental illnesses) are diseases of the brain. While these are diseases, many people commonly refer to them as mental health issues or mental health problems.

Issues and problems are terms that, frankly, I fail to understand. After all, we do not call insulin-dependent diabetes a pancreatic issue or a pancreatic problem. Even type II diabetes which has a considerable life style cause, is not referred to as a problem or an issue. Why, then, do we not recognize schizophrenia and other serious mental illnesses as diseases?…

By Marvin Ross

The Huffington Post Canada

http://www.huffingtonpost.ca/marvin-ross/schizophrenia_b_1023721.html