Category Archives: Mental Health

Meet Your Doctor’s Generous Friend

Pharmaceutical companies have paid billions of dollars in fines in the US for giving bribes and kickbacks to doctors. Are their drug sales representatives behaving any differently in Victoria?

“Dinner and Yankee game with family. Talked about Paxil studies in children.” That note, written by a drug sales representative about his evening with a doctor and his family, was one of many records that forced GlaxoSmithKline (GSK) to pay a $3 billion fine to the U.S. government in 2012.

According to Public Citizen, since 1991, there have been 239 legal settlements between U.S. regulators and pharmaceutical companies adding up to $30.2 billion in penalties—a third of those in the past two years. Over half related to the kinds of activities that drug sales reps were doing in the GSK case: Reps promoted drugs with misleading information or for unapproved uses (the antidepressant Paxil carries government warnings against use in children), and gave doctors “expensive meals, weekend boondoggles, and lavish entertainment,” “trips to Bermuda and Jamaica, spa treatments and hunting trips,” and “cash payments” disguised as administrative reimbursements or consulting fees, all “to induce physicians to prescribe GSK’s drugs.”

The sheer scale of these cases is overwhelming, collectively involving dozens of multinationals, thousands of drug reps, and seemingly tens of thousands of doctors (although doctors have rarely been charged). And it shows no signs of abating, when such fines seem to be just the cost of doing business in a sector where profits rank with those of the oil and financial industries.

Notably, these same multinational pharmaceutical companies spend billions of dollars promoting the same drugs to Canadian doctors. And surveys show many Canadian doctors meet with reps monthly, weekly, or more often, regularly attend their educational events, and regard them as a primary source for information about newer drugs. Yet there’s never been any similar lawsuits in Canada. Do drug companies play nicer here, or are we just bigger dupes?

There are over 200 drug reps registered to visit Vancouver Island Health Authority facilities, and more visiting private doctors’ offices, but there’s no central tracking of what they’re doing. However, two former sales representatives who worked in Victoria and Vancouver for four different pharmaceutical companies agreed to interviews with Focus, and they make the case that most Canadians are dangerously in the dark. (Both men requested anonymity, which required removing identifying details of companies, drugs, and doctors.)

Read the rest at Focus online.

 

Global Psychiatric War Hits Home

Originally published in Focus, June 2013.

The international war raging between the titans of psychiatry and psychology may not seem like “local” news. However, tens of thousands of local Victoria citizens have been seriously injured and now desperately need caring attention.

The stage was set 20 years ago, with the fourth edition of the American Psychiatric Association’s (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM), the “bible” of mental illnesses. In recent years, Dr Allen Frances, who chaired that DSM-IV’s task force, has been writing publicly about his mistakes and regrets, and warning about the upcoming DSM-5. Frances has apologized profusely about how the DSM-IV led to diagnoses of ADHD, depression and bipolar spreading through the general population like flu bugs. And Frances recently lamented that DSM-5, finally released this May, is similarly “a reckless and poorly written document that will worsen diagnostic inflation” and “increase inappropriate treatment” as it defines normal, common levels of concern about physical health problems, grieving over a loss, and mild forgetfulness as mental illnesses requiring psychiatric drugs.

Frances’ credibility has lent weight to a broad movement against DSM-5. For example, a petition launched by the American Psychological Association and so far signed by thousands of heavyweights of mental health from around the world warns that the DSM has not been subject to independent scientific reviews and is “dangerous” to the public. Everyone, they argue, “should avoid use of DSM-5.”

Subsequent media coverage has been largely critical or even mocking of psychiatry’s seeming desire to diagnose, drug, and profit from every aspect of the human condition. In late April, mounting public embarrassment finally led even the US National Institute of Mental Health, the US government’s psychiatric funding and research arm, to distance itself. NIMH Director Dr Thomas Insel criticized the DSM-5’s “lack of validity,” and its diagnostic criteria based in backroom negotiations and “not any objective laboratory measure.” The government, Insel wrote, would henceforth be “orienting” its funding more towards genuine neuroscientific research.

The British Psychological Society then issued a call to throw out the whole notion that any mental-emotional distresses should be labelled as “diseases” or “illnesses” at all. The BPS argued we should be looking at and responding to all the social, economic, biographical, psychological, and biological stresses that influence people’s mental states.

Dr David Kupfer, chair of the APA’s DSM-5 task force, struck back and eventually the NIMH and APA issued a joint press release declaring themselves collaborators and not enemies in the proud marching forth of psychiatric science. However, along the way Kupfer was forced to concede, “In the future, we hope to be able to identify disorders using biological and genetic markers that provide precise diagnoses…Yet this promise…remains disappointingly distant. We’ve been telling patients for several decades that we are waiting for biomarkers. We’re still waiting.”

Kupfer’s confession, of course, was still one-half lie. What most psychiatrists have actually been telling the media and public for years is that there’s abundant evidence that depression, schizophrenia, bipolar and ADHD are biologically-based diseases which require primarily chemical treatments.

How many people are consequently taking psychiatric drugs here at home? When reading UBC’s 2008 RxAtlas examining drug use in BC, I was struck by some high numbers. I submitted requests for more data to the BC Health Ministry and discovered that between 18-25 percent of BC citizens are taking one or more psychiatric drugs. I was stunned. I didn’t write about these findings because I needed more data to be certain—data I was blocked from accessing. But recently, studies elsewhere in North America have found similar levels of psychiatric drug use in the general population, suggesting BC’s numbers are likely not far off.

So that means a staggering 65,000 to 90,000 people in the capital region are apparently taking one or more psychiatric drugs that used to be reserved for a tiny percentage of the population. Most of these drugs are known to cause dangerous side effects and long term damages, from diabetes, suicidal-homicidal ideation, cognitive decline, memory loss, emotional numbing, and kidney failure to permanent motor dysfunction and comas. Yet how many of these tens of thousands of people—likely persuaded during intimate meetings with their physicians that their most inner personal challenges were “diseases” requiring life-long treatment with daily psychoactive chemicals—will now be told all of that was just a lie?

Talk to your doctor.

 

The Pharmacist of Film

Over 20 years, Bruce Saunders has built Movie Monday into one of Victoria’s most enduringly popular arts events.

 

The police looked uncomfortable the night they came to Movie Monday. We’d just watched Crisis Call, an absorbing, emotional documentary exploring often volatile, sometimes deadly encounters between Canadian police and people with severe mental health problems. After the film, host Bruce Saunders introduced us to two Greater Victoria police officers whom he’d invited to share their perspectives and answer audience questions.

One important point, though, in case you don’t know: The weekly film event Movie Monday takes place in a 100-seat theatre located at Royal Jubilee Hospital’s Eric Martin Pavilion, formerly the psychiatric hospital and today still home to various psychiatric services. Probably at least half the audience that night was comprised of people who had a mental health diagnosis or knew someone who had one, including Saunders himself, diagnosed as bipolar. The ensuing discussion revealed a lot about the challenges faced by all sides, but at times it understandably took provocative, tense turns.

Afterwards, one of the local police officers contacted the Vancouver Island Health Authority to complain that he’d felt “attacked” at the “poorly moderated” event. Rumblings circulated that VIHA might pull the plug on Movie Monday. Saunders anxiously contacted other audience members to write up their own observations of the evening; however, the most important letter came unsolicited: The other local police officer dropped Saunders an email saying he was recommending his department purchase the “excellent” documentary, and adding that he was impressed by Saunders’ “community-minded devotion” and felt “very good” about how “the police perspective was appreciated” by the Movie Monday audience.

“You don’t always have witnesses to your dealings with police,” says the 63-year-old Saunders to me with the kind of light-hearted smile that can only come years after things long since turned out okay. “Luckily for me, there were a lot of witnesses that night.”

Read the rest at Focus online.

Elderly Woman Still Hiding from VIHA

An update on Mia following her narrow escape from involuntary electroshock therapy

Eight months after an independent tribunal ordered her released from hospital, the Vancouver Island Health Authority is still pursuing a Saanich woman. Focus previously reported on 82-year-old Mia (“The Case for Electroshocking Mia,” November 2012), whom VIHA senior geriatric psychiatrist Dr Michael Cooper had slotted for electro-convulsive shock therapy against the wishes of her and her family. Last July, an official inquiry determined Mia needn’t be forcibly treated for depression nor even hospitalized; however, almost immediately VIHA representatives began calling, coming by the family home, and demanding that Mia check in with them. Mia, her granddaughter Michelle and grandson-in-law Russel and their children fled the city.

They’d hoped they could have quietly returned to their normal lives by now, but in March, VIHA sent a letter to Mia’s lawyer demanding “evidence” of Mia’s exact current location and that she’s undergoing “treatment of her medical conditions.” Otherwise, continues the letter, “VIHA will need access to [Mia].” Read the rest at Focus online.

Ombudsperson Pans Incapability Assessments

Even when you already know them, sometimes it’s shocking to hear facts confirmed. In February, BC Ombudsperson Kim Carter released her 186-page investigation into BC’s processes for determining people to be “incapable” of controlling their own legal or financial affairs, “No Longer Your Decision.” Focus has reported extensively on the arbitrary, draconian, often self-serving ways by which citizens are being stripped of these basic rights by long-term care providers, health authorities, and the public guardian. Carter concluded the process has indeed been “failing to meet the requirements of a fair and reasonable procedure.”

Indeed, on nearly every key issue, the Ombudsperson’s findings disturbingly reflected many people’s worst experiences and reinforced the worst fears of the rest of us. For starters, there’s no definition of “incapability,” even though authorities are using the concept daily to take away people’s rights to make their own decisions. BC law, Carter clarified, “does not define what it means for an adult to be incapable or establish any criteria or test for this determination. Neither the Public Guardian and Trustee nor the health authorities have defined what incapable means.”

As for the assessment process through which authorities can declare you to be incapable, that’s a free-for-all, too. BC law “does not set out a process to be followed…does not require that an assessment or opinion from a physician be obtained…does [not] establish any standards for such an assessment…does not require that the [assessor] knows the adult and has examined the adult recently…” And to top it off, most health authority staff admitted to Carter that they had no special training in conducting incapability assessments, and the health authorities admitted they provide no such training.

Carter further found that there are no requirements for health care providers or the public guardian to even notify you or your family that your incapability is being assessed, let alone to explain their reasons for concluding you’re incapable or give you any opportunity to respond.

Carter recommended that the Ministry of Justice at least create steps allowing you to legally challenge a health authority’s or public guardian’s conclusion that you are incapable. The BC Justice Ministry promised only to “review” this final recommendation; however, most of the Ombudsperson’s recommendations on the other issues were accepted by government and will supposedly be in force by July 1, 2014. Carter wrote that she was “cautiously optimistic.”