Text Messaging

Like many students this fall, I received an email from my school asking me to sign up for a campus text-messaging service so I can be notified if there is an emergency on campus. I signed up, knowing full well that this was most likely a reaction to the tragedy at Virginia Tech. The email went on to describe the various other measures the school would use to get in touch with the campus, including phone calls, emails, and sirens. But nowhere was there any info about what to do in an emergency--any emergency. Wouldn't it be good to know what to do if I see a fire on campus? Or who should I call if I witness a car accident? Or even where is the counseling center, in case I want to show one of my friends where to get help? Don't the thousands of people who received the same email about the text messaging need that info, too?

Ruined Lives

Yesterday I returned from Argentina, where we released the report we've been working on for three years, Ruined Lives: Segregation from Society in Argentina's Psychiatric Asylums. The report documents the conditions and treatment of the nearly 25,000 people detained in Argentina's psychiatric institutions. Abuses documented include people burning to death in isolation cells, physical and sexual violence, forced sterilization, arbitrary detention, long-term sensory deprivation in isolation cells, lack of appropriate medical care, among others.

The abuses are nothing new. In every institution I've monitored there are abuses. The striking thing about Argentina is the number of people detained in institutions for socio-economic reasons. According to authorities and mental health professionals interviewed, anywhere between 60 and 90% of those institutionalized are there because they have nowhere else to go. Indeed, authorities have coined the phrase, "the psychiatrization of poverty" to explain the phenomenon. Argentina has almost no community-based mental health services and supports, so people who are institutionalized tend to stay there: 80% of those committed to public institutions are detained for a year or longer; the average length of institutionalization is 9 years.

Despite this bleak outlook, there are mental health reform efforts under way. Two large institutions (more than 1,000 beds) are working to discharge people and provide them with community supports to aid in their social reintegration. The psychiatric forensic unit where we documented people detained naked in tiny, dark cells for months at a time have been dismantled. There are a number of movements lobbying the government to deinstitutionalize.

The transformation of mental health services in Argentina will doubtless take many years, but the reform movement is gaining momentum. Likely, the tide will not turn back. Ruined Lives is available in PDF at: www.mdri.org.

Sleezebags

This from a Department of Justice Press Release:

Bristol-myers Squibb to Pay More Than $515 Million to Resolve Allegations of Illegal Drug Marketing and Pricing

WASHINGTON – Bristol-Myers Squibb Company (BMS) and its wholly owned subsidiary, Apothecon, Inc., have agreed to pay over $515 million to resolve a broad array of civil allegations involving their drug marketing and pricing practices, United States Attorney Michael J. Sullivan announced today.

“The integrity of our health care system rests on physicians being able to make decisions based on the best interests of their patients,” said Keisler. “This settlement reflects the Justice Department’s strong commitment to holding drug companies accountable for devising and implementing fraudulent marketing and pricing schemes that undermine that decision-making process at the expense of federal health care programs for the poor and the elderly.”

Sullivan added: “Patients are entitled to unbiased decision-making from their physicians and should not have to worry that financial inducements or lavish entertainment have influenced their physicians’ prescribing choices. Kickbacks are especially nefarious when they are used as part of a marketing effort to convince physicians to prescribe drugs for uses that the Food and Drug Administration has not determined to be safe and effective.”

“The government alleges that Bristol-Myers Squibb, among other wrongdoing, fraudulently inflated the cost of a drug used primarily to reduce the side effects of cancer treatments and other generic drugs without regard to the increased costs borne by government health care programs or elderly and indigent patients,” said U.S. Attorney R. Alexander Acosta of the Southern District of Florida. “Corporations cannot continue to mislead the government into paying vastly exaggerated prices by exploiting a health care system based on trust and fair play.”

Today’s settlement covers a wide assortment of illegal marketing and pricing practices.

First, the Government alleged that, from approximately 2000 through mid-2003, BMS knowingly and willfully paid illegal remuneration to physicians and other health care providers to induce them to purchase BMS drugs. BMS paid the illegal remuneration in the form of consulting fees and expenses to physicians and other health care providers to participate in various consulting programs, advisory boards, and preceptorships. Some of these programs involved travel to luxurious resorts. The Government also alleged that, from 1994 through 2001, Apothecon knowingly and willfully paid illegal remuneration such as stocking allowances, price protection payments, prebates, market share payments, and free goods in order to induce its retail pharmacy and wholesaler customers to purchase its products. In both cases, the Government alleged that, by paying this illegal remuneration to physicians and others, BMS and Apothecon knowingly caused the submission of false and fraudulent claims to the federal health care programs.

Second, the Government alleged that, from 2002 through the end of 2005, BMS knowingly promoted the sale and use of Abilify, an atypical antipsychotic drug, for pediatric use and to treat dementia-related psychosis, both “off-label” uses. The Food and Drug Administration has approved Abilify to treat adult schizophrenia and bi-polar disorder, but has not approved the use of Abilify for children and adolescents or for geriatric patients suffering from dementia-related psychosis. Indeed, the FDA has mandated that the package for Abilify carry a “black box” warning concerning its use in the treatment of dementia-related psychosis. Nonetheless, BMS directed its sales force to call on child psychiatrists and other pediatric specialists, and the sales force then urged physicians and others providers to prescribe Abilify for pediatric patients. BMS also created a specialized long term care sales force that called almost exclusively on nursing homes, where dementia-related psychosis is far more prevalent than schizophrenia or bipolar disorder.

Third, the Government alleged that both BMS and Apothecon set and maintained fraudulent and inflated prices for a wide assortment of oncology and generic drug products with the knowledge that federal health care programs established reimbursement rates based on those prices. By reporting false and fraudulent prices that were substantially higher than commonly and widely available prices in the marketplace, BMS and Apothecon created a “spread” between the reimbursement rates for federal health care providers and the actual prices for the drugs charged to its customers. The larger the spread on a drug, the larger the profit or return on investment for the provider. Because reimbursement from federal programs was based on the fraudulent, inflated prices, the United States alleged that BMS and Apothecon caused false and fraudulent claims to be submitted to federal health care programs.

Finally, the Government alleged that BMS knowingly misreported its best price for the anti-depression drug, Serzone. Under the provisions of the Medicaid Drug Rebate Statute, BMS was required to report to Medicaid the lowest, or "best" price, for Serzone that it charged its commercial customers. In making its mandatory best price reports, BMS knowingly failed to include the low prices at which it sold "private-label" Serzone to Kaiser, a large commercial purchaser. As a result, BMS denied the Medicaid program and certain Public Health Service entities the benefit of the lowest price in the marketplace.

Out of the settlement amount, the federal recovery is over $328 million, of which over $25 million constitutes disgorgement of profits under the Food, Drug and Cosmetic Act resulting from BMS’s illegal promotion of Abilify. BMS also will pay over $187 million to the Medicaid participating states, and $124,000 to certain Public Health Service entities.

As part of today’s settlement, Bristol-Myers Squibb entered into a Corporate Integrity Agreement with the Office of Inspector General of the Department of Health and Human Services that, among other things, requires the company to report accurate average sales prices and average manufacturer prices for its drugs covered by Medicare and other federal health care programs.

“Illegal drug marketing schemes and deceitful pricing by manufacturers will be vigorously pursued by OIG," said Daniel R. Levinson, HHS Inspector General. "We are committed to ensuring that beneficiaries participating in federal health care programs are not taken advantage of by those engaging in unscrupulous practices.”

http://www.usdoj.gov/opa/pr/2007/September/07_civ_782.html

Rock Therapy

It was the summer before second grade and we were living at the Jersey Shore. My mother painted seascapes in a men’s dress shirts and rolled up jeans. My father worked at the Silica Sand Company; where giant mounds of sand turned into wall-sized sheets of clear glass. My sister played jacks with Trudy Golday and Susan Pettibone. I spent most of my time alone, controlling the weather.

I kept small rocks in my mother's old prescription bottles and lined them up in the narrow wedge between my bottom bunk and the wall. There were seven bottles of varying sizes, and forty-nine stones. These could summon the sun, stop the rain, and generally keep the beach from blowing away. I would, as magic law required, touch the top of each bottle before I went to sleep, and do the same thing right when I woke up every morning. I never forgot.

Every few days I would take the stones out to our gravel driveway for cleaning, rearranging and evaluation. Often the odd few had lost their power, and would be thrown into the bay and replaced.

Early one afternoon, a real estate agent came to speak with my mother about renting out our house for the winter. I was in the driveway looking for new stones. I held them in the folded bottom half of my t-shirt, belly exposed, deeply concentrating. The agent was pale and pear-shaped -- covered in a thin layer of sweat. He looked as though he had recently been boiled. Within moments of getting out of his car he was less than half an inch from my face, shouting, "Oh! I see we have a little rock collector here!"

I was thunderstruck. Breathless. I couldn't think of what to say and finally whispered, "I do not collect rocks." Those were the last words I spoke for the next 24 hours. I gathered my prescription bottles and buried them behind our house. I locked the door to my room and refused move from my bed. That night my uncle and cousins came for dinner. Each in their turn: Aunt Emma, Uncle Jimmy, Cynthia, Georgia, Little Jimmy, my parents, my sister, came upstairs one at a time. Each like a horse whisperer with a feral mare; convinced they could pry me from my misery and my bed. All failed. No one, not even my famously intuitive mother, could figure out what had made me so upset. Even I didn't know.

I suspect it had something to do with the fact that I thought I was very special - an alchemist, a seer, marked by God to help out with the weather - but in fact the rest of the world just saw a kid collecting rocks. The shame was new, overwhelming, and unconquerable. I wanted to go downstairs for spaghetti and meatballs, but the longer I stayed in my room the more disconnected I felt from this world that had rejected me.

That is a solar plexus memory. The feeling, however, has grown familiar. I feel a spasm of that shame every time I hear the words Mood Disorder. I don't believe the fiction that we're all a bunch of geniuses with too much brainpower to hold in one skull, but I believe we're engaged in a struggle with more heft and rigor than the word "mood" can possibly describe. Disorder? Okay, I've learned to live with that one. When I'm walking through the West Village in my pajamas and talking to strangers about how atoms travel, we can safely say something's "out of order." But is it that I'm not in the mood to wear street clothes and shoes? This from dictonary.com:

mood
–noun
1. a state or quality of feeling at a particular time: What's the boss' mood today?
2. a distinctive emotional quality or character: The mood of the music was almost funereal.
3. a prevailing emotional tone or general attitude: the country's mood.
4. a frame of mind disposed or receptive, as to some activity or thing: I'm not in the mood to see a movie.
5. a state of sullenness, gloom, or bad temper.


It puts me in a bad mood, reading those definitions. I'll tell you a few things about mood: The boss is in the mood to talk to God. The mood of the music was almost funereal but she couldn't hear it because she couldn't get out of bed. The country's mood is uncertain, but the country is nodding and smiling and serving up meds. I'm not in the mood to see a movie, or to watch Oprah squint with pity at the bipolar travails of Sinead O'Connor. I am sullen, gloomy, and in a bad temper. But I do not collect rocks.

And tomorrow's going to be partly sunny.

The people who want to help

Last Sunday night I sat at a table with a bunch of middle aged college educators. My mother was running a conference to educate people about mental illness on campus and Alison Malmon and I came down for it. Alison spoke at the conference, I was just along for the ride. The dinner the night before the conerence was one of those striking moments, with Alison and I sitting in the middle of all these well meaning older people tring to comumincate what it was to feel isolated at college and what educators might do to ease the burden of it. They were looking for us to guide them and I felt useless.

I listened and I tried to answer their questions about what I had needed and hadnt gotten at Amherst, but I felt like a phoney. My experience of being unhappy in college had been so personal and shameful, I couldn't relate to the stories of finding sources of support among other students. I don't I would have known how to look or how to utilize what I found. I was too busy pretending things were fine.

So how do we reach the kids like I was who struggled along because they feared the shame? If I don't know that answer all these later, I am not convinced there is a good answer.

Shopping Anxiety

Some people fear death, some public speaking. I'm comfortable with both but I hate shopping. Recently I've become addicted to Tim Gunn's makeover show, which brilliantly mixes psychology into shopping, and it's motivating me to go and buy new clothes. Ones that fit and express who I am. I know I need help--I'm way out of touch with how my body works in clothing, in fact I routinely buy clothes too big for me, or buy things I already have, or wear things that are worn out, stained, missing buttons, etc. I need help. That's the first step, right? Admitting the problem. And the second step is asking for help. And so I've asked my warm and wise friend Dominique, who is stylish and getting her PHD in Buddhism from Columbia, to assist me in the endeavor. I truly feel that only a Buddhist scholar can get me in and out of the dressing rooms without triggering a depressive episode or panic attack. I'm not being dramatic. I really hate shopping. I will blog after our date, next wed.

Dawdy on Oprah and Kay

From Philip Dawdy's blog, FuriousSeasons.com:

"After mulling it over for a day, I've come around to the idea that Oprah, who featured bipolar disorder and several examples of the same on her program on Monday, is out to paint bipolars as inherently violent and dangerous. I've not seen a lot of data on this point. Most of the research on violence and mental illness has been done on schizophrenia and shows a risk that is not particularly elevated above the general population.

But this is Oprah and she gets to do what she wants, data or no data. Why Kay Redfield Jamison, who appeared on the program and should be acutely aware of this issue, didn't peep in protest is beyond me. She appeared to be on the program to lend some medical authenticity to the affair and get a major plug for one of her books, which have been strong sellers for years and have had major media plugs aplenty. Jamison is an odd case--she's a professor of psychiatry, works in private practice as a psychologist, has oodles of money and privilege, and yet I have never heard her speak up on behalf of her brothers and sisters when they are getting kicked around by the media. There literally hundreds of thousands, if not millions, of positive stories around people with bipolar disorder, and she stands aside and let's the talk show queen get away with painting the rest of us who work very hard on these matters with the problems and bad outcomes of three other people, two of them Hollywood actors and one a convicted murderer.

If Jamison cannot start standing up when she makes her many media appearances, then perhaps it is time for her to stand down.

And, yes, like many readers, I am sick and tired of Hollywood actors being the go-to bipolar examples on shows such as these. They are poor proxies for the reality the rest of us live with. But have no fear: I hear that Sinnead O'Connor is coming out as bipolar on Oprah next week. I'm so happy. The Irish singer and the rest of us have so much in common."

Agree? Disagree? Please comment!

Baz Alert

Calls on Children's Health Insurance Urgently Needed

House Vote on SCHIP Is Imminent

September 15, 2007--Today, the House of Representatives will vote on the House-Senate compromise that would extend and expand health care coverage to low-income children through the State's Health Insurance Program (SCHIP). The bill (H.R. 976, Children's Health Insurance Program Reauthorization Act) would provide $35 billion over five years. The Senate will vote on the compromise bill later this week.

Bill Adds Parity for Children's Coverage
This critical bill would for the first time establish parity for mental health benefits in SCHIP plans. It would also provide a six-month moratorium on the Administration's effort to restrict Medicaid rehabilitative services and school-based services, as outlined in the President's fiscal year 2008 budget proposal and proposed regulations released by the Centers for Medicaid and Medicare Services. These two provisions are important victories.

With President Bush threatening to veto SCHIP legislation, it is imperative to garner a veto-proof vote in both the House and Senate. Your call is needed now!

Please Call Today!
Urge your Representative to vote for the State Children's Health Insurance Program bill. A simple message to help extend health insurance to 4 million more uninsured children! Use the toll-free number 1-800-828-0498 to connect to the Capitol switchboard and ask for your Representative's office. To find out who your Representative is, access www.congress.org or www.house.gov and enter your zip code.

What School Doesn't Need $960,685?

Yesterday the U.S. Dept. of Education announced it will award Virginia Tech $960,685 in federal grant money to improve counseling services.

Can you imagine what university health care could be like if every school received that much money? If mental health was prioritized to the extent that its budget could rival a college sports team's?

I'm thrilled that Virginia Tech will get this money, but it would be even better if a tragedy like that which occurred there didn't have to happen before college mental health was on the national radar.

[The Dept. of Education press release on the grant can be found here: http://www.ed.gov/news/pressreleases/2007/09/09212007a.html]

Pop Culture

I was watching the Redskins/Eagles game on Monday night, and was pleasantly surprised to hear the commentators respectfully discuss the issues that Andy Reid's family has been dealing with, including alcoholism and trouble with the law with some of the family members. The commentators spent over five minutes discussing the issue, and how 'real' celebrities really are; that they have problems just like all of us. It was one of the most honest discussions on the matter I've heard in a while.
Then I got to thinking about a couple of years ago when Tony Dungy's son took his life. What a terrible tragedy for him and his family. But I don't remember hearing anything then like what I heard this week - is this a sign that our society is slowly but surely opening up, or is it that suicide is still behind other serious issues like alcoholism in the popular culture dialogue?

"The Real Behavior Crisis is Among Baby Boomers, Not Teenagers"

Mike Males has a great Op-Ed today in the NY Times that says brain researchers are overstating neuro research about young people and its implications while ignoring the research that shows that American adults ages 35-54 are in more trouble than the youngins, and in more trouble then ever. He cites these stats about the 35-54 set: 18, 249 deaths from illegal overdose, up 550% since 1975; 46, 925 fatal accidents and suicides, "leaving today's middle-agers 30 percent more at risk for such dealth than people aged 15-19"; more than 4 million arrests in 2005 for violent crimes, up 200% since 1975; 21 million binge drinkers, which is "double the number among teenagers and college students combined"; and more than half of all new HIV/AIDS diagnoses in 2005 went to middle aged Americans. I appreciated his last sentence: "Commentators slandering teenagers, scientists misrepresenting shaky claims about the brain as hard facts, 47 year olds displaying far riskier behavoirs than 17 year olds, politicans refusing to face middle-aged crises...if grown ups really have superior brains, why don't we act as if we do?"

I think this may shed light on the overdiagnosis of bipolar disorder----if the above people are in charge, what kid wouldn't show symptoms of mental unbalance? When we focus on the problems of teenagers, are we just avoiding shining a light on the problems of adults?

Mental Illness and Love

I feel like when I was a teenager, as many of my peers were developping a sense of their romantic and sexual identities, I was preoccupied with anxiey, depression, and mania; mental illness seriously disrupted the development of healthy intimate interpersonal skills. If you grew up with mental illness, do you agree? Disagree?

AFTER Tragedies Every Sports Team Has the Best Community

I am going to start this post by saying the issue I am covering can be really sensitive for people and I hope that no one will take offense to this, but will rather think about it before the emotional reaction. Yesterday it was reported that a man wearing a Texas football t-shirt was nearly castrated at a bar in Oklahoma by an Oklahoma Sooners football fan. Yes you heard that right it took 60 stitches to repair a man’s “area” after he was attacked in an Oklahoma bar. And this reminded me of something I have been thinking about a lot lately.

I am an avid college football fan and love watching games. On the first weekend of the games the largest ESPN college football show went to Virginia Tech and there were endless stories about how VA Tech was the nicest community in the world, and the head coach was saying they’re America’s team now. They weren’t going to let one person destroy their community. At the Clemson vs. Florida State game there was a story about a Clemson player who had to adopt his younger brother to get him out of a negative home environment and then the town of Clemson raised money to help him get the things he needs. That night it was Clemson that had the best community in the country. Obviously in these situations I think it’s great that football can bring people together etc. and I’m happy that people turn to this to heal, but I really wish people would stop saying communities are the best AFTER a tragedy. Shouldn’t we focus on being good before a tragedy?

Here’s another example. Virginia Tech won their first game and played at LSU last weekend. LSU honored Virginia Tech by playing their alma mater before the game instead of LSU’s and two of LSU’s top players asked their fans to show respect to the Hokie fans at the game. So when Virginia Tech was introduced the LSU fans didn’t chant their usual “Gator Bait,” instead they either cheered or said nothing. All nice things, but why would people be compelled to do this only after tragedy? Why would large football communities continue to treat people like this all year round, unless of course something terrible happens? Trust me I know that for a large majority of people at these games it’s just all in good fun to chant or cheer for your team and a little yelling or harassment rarely turns into castration, but I just find it fascinating that announcers are just endlessly commenting on how amazing of a community LSU has to treat the Hokie fans this way, when next week a team that didn’t happen to have the largest school shooting in the history of the country will come in and they’ll be “gator bait” and booed.

Is it too much to ask for people to treat people in a humane way all of the time and not just after something terrible happens? In the same train of thought would it be too much for Extreme Makeover to not just take a ton of money and build one house for one family, but take the same amount of money and build a neighborhood? Or do we just feel better when we have one instance to look at and smile and say what a great world we live in?

Now I know there are a lot of amazing people at all of the schools I mentioned in this piece and many more. There are a lot of fans who don’t fight, don’t treat people with disrespect and some of my views here may be coming from the few people that get focused on and seem to ruin a lot. So if you are one of the good fans, then maybe we need to start making our voices heard louder and larger than those who give schools and communities a bad name.

Here I go again

I was disturbed that the VMA's were at the Palms casino in Las Vegas. How does MTV get away with such a cheery endorsement of partying at the Palms when the majority of its viewers are under 21? Bob Herbert wrote a great Op-Ed about prostitution in Las Vegas last week in the Times, and it really disturbed me that so many teenage girls are getting swept into prostitution there at such a young age. It already disturbed me that Las Vegas markets itself as a great place to get loaded, gamble, and fuck without anyone at home knowing. But for MTV to sell that place to children is inexcusable.

A provocative analysis of the suicide data

Provided by Philip Dawdy, over at the Furious Seasons blog---

http://furiousseasons.com/

His writing is so smart, and so persuasive. Please read, think, digest, comment---

Increased suicide rates linked to removal of warnings on anti depressants?

Ross brought this up with me earlier in the day and I just saw a piece on NBC news making the same link. It's so hard to tell if this is based on real information or on pharmaceutical propaganda. The stat was that suicide has gone up in teenage girls 76% since the warnings came on. This increase does not seem possible. And the idea that this rise in suicide is caused by all of the young people who didn't go on meds because there were warning labels sounds totally unbelievable too. What is really happening out there?

Drunk and Unbalanced Astronauts?

I've just glanced at a fascinating piece that reveals that NASA is trying to ignore the mental health issues of its astronauts; this an even bigger, broader problem than the "drunks in space" issue currenly in the spotlight, which already has officials scampering around denying that many of the astros blast off before takeofff. What I appreciate is that the article peels back the misuse of alcohol and discovers mental health issues, which I hope, as an informed culture, we can start doing more and more automatically, since most of the time these things are linked. Any way, here's the piece:
http://news.yahoo.com/s/ap/20070906/ap_on_sc/astronauts_drinking


NASA is pretty much an arm of the military, so that they are military like in their denial of problems seems totally consistent.
But I love the power logic at work, which underlies so many dysfunctional institutions, never mind colleges, and families, which is this: if you make a culture that discourages people from seeking help, then you won't have a problem. We're really going to have to make an economic argument that says encouraging people to disclose is much more cost effective, because the moral underpinnings don't tend to inspire as effectively.

Thoughts?

Owen Wilson and his Fans

I had the awesome opportunity of blogging about how Owen Wilson's suicide attempt and emotional difficulty may make him very similar to his young fans on the Huffington Post! You can read it here!

Healthy Skepticism

This from the LA times report in the surge of bipolar diagnoses in children:

Dr. Gabrielle A. Carlson, a psychiatrist at Stony Brook University, said only 1 of every 5 children referred to her with a diagnosis of bipolar disorder actually has it. The rest have autism, depression, anxiety or another psychological disorder. All these conditions involve different treatments, either with drugs or behavioral therapy, or both.

Carlson, who has studied the increase in bipolar diagnoses, said some parents seemed to prefer a diagnosis of the disorder because the illness, thought to be largely genetic, absolves them of blame. "They don't have to deal with their chaos, their psychiatric disorder, their marital troubles or abuse.'"

This Guy

Homophobia is toxic--to those who feel it and upon whom they spew it---and the mental health toll is real, and deep. I don't think you can be a mental health advocate without being a gay rights advocate. Speaking of which: Here's a brilliant and funny essay in the Nation about Larry Craig, written by my friend Tim McCarthy----
http://www.thenation.com/doc/20070910/tpmccarthy2
Enjoy!

Front Page of NY Times

Today the times reported that there was a forty percent increase in children being treated for bipolar disorder. That is astounding--and disturbing--I worry that many of those kids have emotional problems, not pyschiatric ones, problems for which the the solution lies in better parenting, schooling, communities, and family therapy, not medication. I was a kid with bipolar disorder, so of course I believe they exist. But not in these numbers. What also bothered me about the report is that 100 percent of these kids were treated with medication, and only forty percent of them with therapy. What I would really like to see is how many of those kids are still on those meds---because the only checks and balances in this situation is that those meds are so expensive and have so many side effects that I doubt a kid without bp with stay on them for very long. I hate blaming parents---especially since I'm not a parent---but many of them are colluding with myopic child psychiatrists and greedy pharmaceutical companies.