From Becca: Which Rights Need Protection?
The Associated Press posted an update this week on the status of “mental patient” isolation in psychiatric hospitals.
STAUNTON, Va. - Mental patients sprinkled throughout the nation’s psychiatric hospitals are being locked up alone for years despite laws aimed at preventing the practice, because medical workers say they’re too dangerous to handle any other way.
Health officials call them outliers — rare, unpredictably violent people who don’t respond to medication or other treatment. Advocates call them victims of a system that has lost patience and creativity in caring for those who are most difficult to treat.
AP reports that roughly a dozen patients around the country have been isolated or restrained for years at a time, resulting in state lawsuits of up to
In Virginia, one man was locked in a three-room suite for 15 years and another patient was held in a similar setup for five years. Connecticut and Florida have paid millions over allegations that they tethered patients to furniture for years.
At first, this seems like an open-and-shut case of human rights violations. Clearly, no human being deserves to live in isolation: the very definition of humanity implies social living. On the other hand, what further injustice can be done to those mentally ill patients who must live in hospitals than to further destabilize their environments by introducing the constant possibility of physical harm?
The controversy parallels the question of whether or not repeatedly violent mental health patients among the general population should be confined. Which rights need to be protected at what cost? Ideally, our fundamental human rights values would answer these questions in a clear-cut manner that favors the freedom of the individual. However, among a national population of over 300 million people, it seems possible that a mere 0.00000004% (a dozen psychiatric patients across the US) might be at least temporarily unfit to live with others, especially among those who are themselves in need of serious help.
Look at the case of Cesar Chumil:
At Western State Hospital in Staunton, Va., the state stepped in after staff placed Cesar Chumil in a three-room “limited containment suite” in 1993, where he has remained since. Chumil averaged 300 assaults against staff and another 100 against patients over seven years before he was placed in the suite, according to records from a closed administrative hearing obtained by the AP.
Hospital officials claim the 58-year-old has more freedom than before, when records show he spent thousands of hours in a small seclusion cell or restrained to a bed or chair.
“It’s a big step to put somebody in a room like this and say, ‘You can’t come out,’ but we had so many people getting injured and so many staff were out of work,” said Stephen Johnson, the psychologist on Chumil’s ward. “It just got to the point where it was just untenable … so we had this one solution.”
One hundred patients were assaulted by one man over the course of seven years? I think that after the first five assaults, some actions should have been taken. Advocates assert that with intensive treatment, individuals like Chumil can reach the point where they are not a serious threat to those around them. But until that point is reached, the first goal of any mental hospital should be to ensure the basic safety of its patients.
Chumil is now being treated more humanely after a state oversight committee saw that he was given his own ward where he can interact with staff members who wear helmets and padded gear. We can only hope that the same sensitivities are being given to him at the mental/emotional level so that one day he can prove the advocates right.
Liz | 10:09 AM | Uncategorized
Redesign Still Pending
Hi guys. Sorry it’s been spotty the last couple days. That’s because I thought the blog was being given a new design, but various things have held up the process. So here we are, with our same template, ready to blog.
Yesterday Becca wrote a post about isolation and protecting rights. I’ll post it next.
Liz | 10:55 AM | Uncategorized
From Becca
Researchers at Indiana University were recently surprised to learn that contrary to popular belief, suicide rates do not increase during the holidays.
The holidays can bring out the worst in people, and the stresses of family get-togethers, loneliness, and the cold, dark winter months are commonly thought to increase the number of suicides at Yule time. But studies conducted around the globe show that, while the holidays may be a difficult time for some, there is no scientific evidence to suggest a holiday peak in suicides, according to Dr. Vreeman and Dr. Carroll. Furthermore, suicides are actually more common during warm and sunny times of the year.
You know what that means, readers – no excuse to be bleak. Certainly, social expectations to be cheerful when you don’t feel cheerful can be alienating. But as we Chanukah-inclined people say, “It could always be worse.” Although it might seem trite, I’ve managed to climb my way out of a few depressive holes by really sincerely counting my blessings. If you fall into the doomsday tunnel vision, keep searching for the better-feeling thought and watch it pay off.
But more importantly, the researchers also found that eating at night does not cause weight gain any more than eating during the day. So buck up, delve into those midnight leftover, and have a happy holidays.
Liz | 3:51 PM | Uncategorized
And We’re Back…
I will not even go into the bizarre-ness that was the Moo Shu Jew Show, which included an elderly man at my table making reference to “black pipe” (meaning African-American penises), the insistent use of the word “schvartze,” mocking of retarded people and people with Tourette’s, and enough ageism to turn Methusulah into Benjamin Button. I don’t think I’ll be going back.
Additionally, I had the misfortune of seeing Marley & Me, which completely confused me. It would be like if you made a movie of my life. Me talking about my column. Me worrying about my pets. Me fighting with my partner. Me thinking about moving. The most boring-ass life you could imagine. Why do I want to watch that? No drama. No conflict. No suspense. Plus, what up with the saddest ending in the world? The poor kids at Riverview were all Bambi-traumatized.
Liz | 11:01 AM | Uncategorized
Merry Christmas to All, and to All a Good Fight
I know the holidays can be rough. I made a lovely video describing that but it won’t upload. So I guess I’ll just say if you’re celebrating between now and Jan. 2, take care of yourselves. I’ll be on and off, depending on the redesign and my own celebratory proclivities. Tomorrow my Muslim friend and I are going to the movies. We are going to save the world.
Liz | 2:25 PM | Uncategorized
Are You Kidding Me?
Thanks to Joe for sending me this link. This is absolutely appalling. Anyone who’s ever taken Seroquel knows it shouldn’t be approved for depression. I’m ready to go to the FDA and knock down the doors until they listen to me. Can you imagine taking Thorazine or Risperdal or Zyprexa for depression? Think about it, my friends. If you’ve taken an antipsychotic, you know how ridiculous this is.
AstraZeneca says FDA asks for Seroquel detail
Liz | 11:51 AM | Uncategorized
The Infinite Mind’s Bill Lichtenstein Responds to Fred Goodwin
This is in response to the statement Fred Goodwin made that I posted several days ago. (The site is undergoing a redesign; please be patient if we go offline in the next couple days or hours.) Again, to remind everyone in the interest of full disclosure, I was on the radio show once and was asked to be on once more. I met Bill Lichtenstein, president of LCMedia, a couple times in person.
I am writing as executive producer of the national, weekly public radio series, The Infinite Mind, in response to the statement posted [on The Trouble With Spikol] from Dr. Fred Goodwin regarding the disclosures in the November 22, 2008 New York Times article that Goodwin, former host of The Infinite Mind, had accepted $1.2 million to speak on behalf of the pharmaceutical company GlaxoSmithKline. Most of Goodwin’s statement attacks the New York Times’ Gardiner Harris for his reporting. In doing so, Goodwin adds Harris, a seasoned New York Times reporter, to the growing list of people, including Sen. Grassley, whom Goodwin claims have not gotten the story straight.
The issue at the heart of The Infinite Mind matter is Goodwin’s admitted acceptance of $1.2 million in fees from GlaxoSmithKline from 2000 to 2008 to speak on behalf of the drug company. According to the November 22, 2008 New York Times article that first disclosed Dr. Goodwin’s activities (“Radio Host has Drug Company Ties”), this included giving talks to medical professionals on behalf of GlaxoSmithKline at such locations as steak houses and resorts.
The New York Times article reported Dr. Goodwin’s disclosure (or lack of disclosure) as a “he said/she said” situation, with Goodwin asserting that I, as executive producer, was aware of his activities, and my denial at no point was I aware of the work he was doing behalf of GlaxoSmithKline. However, to date, reporters have failed to press Goodwin for any proof of his claim that he disclosed his activities, nor has Goodwin produced any evidence or basis in fact to support his claim that he disclosed his activities. The fact is he didn’t, despite strict conflict of interest and disclosure language in his contract (See signed June 12, 2006 contract posted on-line at http://www.LCMedia.com/agreement.pdf )At the same time, Goodwin’s position with regard to his conflict of interest has changed almost daily.
On December 2, 2008, the “GW Hatchet” (the student newspaper at George Washington University where Dr. Goodwin teaches) reported that Goodwin denied that there had been a conflict of interest, and he essentially proposed a novel concept of conflict of interest: “I frankly do not see these things as a conflict of interest. It was my judgment,” said Goodwin. “Like most experts in my field, I have relationships as a consultant with a number of pharmaceutical companies. I’ve always thought that if you have multiple relationships they sort of cancel each other out.”
Additionally, the “GW Hatchet” reported that “[Goodwin] maintains he did not violate any contracts with ‘The Infinite Mind’ because . . . it was never required for him to disclose information,” despite the fact that his signed contract included strict language with regard to his disclosure of any potential conflicts of interest.
The “GW Hatchet” also reported that Goodwin said Sen. Charles Grassley was mistaken when he asserted, based on GlaxoSmithKline records, that Goodwin had received $1,226,300 in speaking fees and $117,300 in travel reimbursement from the pharmaceutical company. Goodwin now maintains he received less than $1 million from GlaxoSmithKline. Goodwin also disputes the New York Times‘ inclusion of travel fees as part of his “compensation” from GlaxoSmithKline, to which New York Times reporter, Gardiner Harris, replied, “I think most people would see travel expenses to very nice places as a benefit worthy of citing.”
On December 9, 2008, the prestigious British Medical Journal published an article on this matter, in which Goodwin again asserted there had been no conflict of interest in his accepting pharmaceutical fees while hosting The Infinite Mind. The journal reported that “besides GlaxoSmithKline [Goodwin] has been paid by Pfizer, Solvay, Janssen, Eli Lilly, AstraZeneca, and Bristol-Myers Squibb. He said he believed that this cancelled out the possible influence of any one company.” (See British Medical Journal article at: http://www.LCMedia.com/BMJ.pdf )
Finally, Dr. Goodwin cites The Infinite Mind’s hiring of another primary host from 2004 to 2006 as an indication that we were aware he was working for pharmaceutical companies. In fact, we were aware of Goodwin’s prior research funded by the pharmaceutical industry, which according to Goodwin ended in 2001, and that Goodwin spoke at Continuing Medical Education programs sponsored by the pharmaceutical industry, which are highly regulated with regard to conflicts of interest. Goodwin continued to guest host programs during this period, and when Goodwin returned to the program as primary host in 2006, he negotiated and signed the contract that provided he disclose any possible conflicts of interest, including those going back to 1997, which he failed to do.
Liz | 11:11 AM | Uncategorized
What’s More Important: Brains or Looks?
Though I try to write about the brain fairly often, today I’ve received several Cute Fix requests/suggestions. So here you go.
For Becca:
My favorite variation on that theme:
From Susan:
And the new puppy cam link.
Liz | 2:52 PM | Uncategorized
Comment From Dr. Fred Goodwin
Someone saying he’s Fred Goodwin asked me to post the below. I’m assuming it’s the real Fred Goodwin, though I suppose it could be an imposter. Why anyone would want to pretend to be Goodwin is a mystery, but I want to issue that caveat. At any rate, I present it without comment or prejudice.
This is the response I sent to the NY Times 2 weeks ago and was not published. I’d appreciate if you could post it here.
Thanks,
Fred Goodwin MDStatement of Frederick K. Goodwin M. D. regarding the 11-21-08 New York Times article by Gardiner Harris and the follow up editorial of Nov 29:
Mr. Harris’ article is filled with misstatements of fact, and incorrect implications; which also characterize the brief mention of me in the Nov 29 editorial.
Let me first note that I spent nearly an hour on the phone with Mr. Harris, and followed this up with a detailed email providing easily verifiable factual information. While he did quote a few things I said, most of the important information I provided was left out of the story.
Some of the article’s misstatements have been covered in other media reports (e.g., NPR, 11-26-08). I’ll focus on the most egregious misstatements and omissions. First, his story implied that I am and always have been the host of The Infinite Mind. In fact, from April ‘05 through January ‘08 the producer replaced me with another psychiatrist with no ties to drug companies, while I served as guest host for shows unrelated to pharmacological treatment issues. Furthermore the show ended well before Sen. Grassley’s report or the Times story and had nothing to do with them. The show simply ran out of money.
Mr. Harris’ story also implied that I had been a speaker for Paxil, a GlaxoSmithKline product, since 2000. I never spoke for Paxil. Starting in 2001, I spoke about mood disorders and Wellbutrin (now generic) and in January ’04 began giving talks dealing with lithium. Incidentally, I used this as an opportunity to remind psychiatrists about lithium, a forgotten drug, forgotten because it’s been generic for decades and doesn’t make enough money to justify promotion by drug companies. I referred Mr. Harris to my 2007 book (with KR Jamison) Manic Depressive Illness 2nd edition, where my dismay at the fact that many young psychiatrists don’t use lithium is clearly expressed. Later, as Lamictal joined lithium as the only other FDA-approved mood stabilizer, my talks included the FDA indications for both.
More egregious is Harris’ Paxil narrative. The article implied that I asserted on the air that “there is no credible scientific evidence linking antidepressants to violence and suicide” because of my ties to drug companies. Note he did not question the accuracy of the statement because he could not. Both I and the show’s producer (who wrote the script) stand by the scientific accuracy of what the script said. A major focus of the show was the FDA’s “black box” warning about a relationship between antidepressants and “suicidality.” But suicidality as defined by FDA encompasses everything from suicide attempts to any “self harm,” much of the latter having no relationship whatsoever to actual suicide. The concern expressed by me and the guests that the producer had selected was that this “black box” warning might be scaring many doctors away from using these drugs when they were needed for fear of being sued (suicide being the number one reason why psychiatrists are sued). Doctors should be warned about the distressing symptoms that young patients can sometimes feel on these drugs, but many (not all) experts in the field believe that a less charged word would have been better. I made all this clear to Mr. Harris.
I also pointed Mr. Harris to my long-standing, easily accessible record of being quite critical about the overuse of SSRI antidepressants, especially in young people. I referred him to Manic Depressive Illness and gave him references to two recent journal articles I co-authored, all of which expressed major reservations about the overuse of SSRIs. I further pointed out that I had never spoken on behalf of Paxil. All of this information was ignored. Instead, the above quote from the show was paired with the fact that Glaxo has been accused of suppressing data. A careful reading of the article shows that these are unconnected facts, but a casual reader will be left with the impression that I was somehow involved in suppressing data on Paxil.
The article also implied that I was trying to promote Lamictal by pushing the diagnosis of bipolar disorder in kids. I pointed out to Mr. Harris that Lamictal hasn’t yet been properly studied in that age group. The show in question, as I recall, did discuss mood stabilizers that have been studied in kids, especially lithium and divalproex, both now generic drugs and no longer “promoted” by anyone. (For that matter, I also pointed out that Paxil had been generic for some time and is therefore no longer promoted.)
Finally, the article states that my involvement with pharmaceutical companies was “undisclosed.” Again, Mr. Harris simply ignored much of what I told him–that there is ample evidence in the public record disclosing my work with drug companies; it’s never been a secret. It’s extensively acknowledged in papers that I have published, in my book, and in all of my continuing medical education (CME) activities.
I also explained that The Infinite Mind producers were aware of my connections to pharmaceutical companies. While he did quote me in the article to this effect, he failed to cite an important, easily verifiable fact: Mr. Lichtenstein recruited another psychiatrist without any ties to industry to be the host starting in 2005, and serving through January 2008. This action was taken to deal with Mr. Lichtenstein’s concern that my industry ties could become a problem for the program. Given this fact, Mr. Harris’ report that Mr. Lichtenstein knew nothing of my activities on behalf of drug companies is clearly not accurate. It is true that Mr. Lichtenstein may not have known all the details, but he was generally aware of my activities.Sincerely,
Frederick K. Goodwin, MD
Liz | 12:13 PM | Uncategorized
Poor Paula Godspeed
The uber-fan who killed herself in front of Paula Abdul’s house is still causing controversy for the American Idol producers. But not in the way you might think.
Ken Warwick was asked about Paula Abdul’s criticism that the show put her in danger by allowing an alleged stalker, Paula Goodspeed, to audition in a previous season. Goodspeed was found dead near Abdul’s home from an apparent suicide.
Warwick says he would definitely not put a dangerous person in front of the judges. He says other than giving “everybody a psych test before they walk in,” the show does its best to screen candidates.
Well, thank god for that. No one wants a dangerous (read: mentally ill) person in front of the Randy Jackson or Simon Cowell. They might throw their shoes!
Liz | 3:11 PM | Uncategorized
