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Psychiatrist Engaged in Research Misconduct, Says Gov't Watchdog
"I acknowledge there were regulatory issues raised, which I don't deny, but they were all unintentional," he told Medscape Medical News. "I regret the decisions that were noted, but, again, I acted with my best intentions, meaning I wanted to advance science, and therefore it's particularly sad and devastating for me personally, because I never intended to do anything wrong or act against any regulations or anything."
Survey shows many primary care doctors are unprepared to help patients avoid diabetes -- ScienceDaily
The researchers received 298 completed surveys, or 34% of the 888 ultimately found eligible for inclusion in the study. "Our results revealed that there are substantial gaps in the knowledge that PCPs have in all three categories we tested," Tseng says.
For instance:
- On average, respondents selected just 10 out of 15 correct risk factors for prediabetes, most often missing that African Americans and Native Americans are two groups at high risk.
- Only 42% of respondents chose the correct values of the fasting glucose and Hb1Ac tests that would identify prediabetes.
- Only 8% knew that a 7% weight loss is the minimum recommended by the American Diabetes Association as part of a diabetes prevention lifestyle change program.
"Our results also suggests that 25% of PCPs may be identifying people as having prediabetes when they actually have diabetes, which could lead to delays in getting those patients proper diabetes care and management," Maruthur says.
Study finds psychiatric diagnosis to be 'scientifically meaningless' - Neuroscience News
“Although diagnostic labels create the illusion of an explanation they are scientifically meaningless and can create stigma and prejudice. I hope these findings will encourage mental health professionals to think beyond diagnoses and consider other explanations of mental distress, such as trauma and other adverse life experiences.”
Study suggests overdiagnosis of schizophrenia: Reported symptoms of anxiety and hearing voices most common reasons for misdiagnosis by non-specialty physicians -- ScienceDaily
In speculating about other reasons why there might be so many misdiagnoses, the researchers say that it could be due to overly simplified application of criteria listed in the Diagnostic Statistical Manual of Mental Disorders, a standard guide to the diagnosis of psychiatric disorders.
"Electronic medical record systems, which often use pull-down diagnostic menus, increase the likelihood of this type of error," says Margolis, who refers to the problem as "checklist psychiatry."
"The big take-home message from our study is that careful consultative services by experts are important and likely underutilized in psychiatry," says Margolis. "Just as a primary care clinician would refer a patient with possible cancer to an oncologist or a patient with possible heart disease to a cardiologist, it's important for general mental health practitioners to get a second opinion from a psychiatry specialty clinic like ours for patients with confusing, complicated or severe conditions. This may minimize the possibility that a symptom will be missed or overinterpreted."
Is Dentistry a Science? - The Atlantic
Among other problems, dentistry’s struggle to embrace scientific inquiry has left dentists with considerable latitude to advise unnecessary procedures—whether intentionally or not. The standard euphemism for this proclivity is overtreatment. Favored procedures, many of which are elaborate and steeply priced, include root canals, the application of crowns and veneers, teeth whitening and filing, deep cleaning, gum grafts, fillings for “microcavities”—incipient lesions that do not require immediate treatment—and superfluous restorations and replacements, such as swapping old metal fillings for modern resin ones. Whereas medicine has made progress in reckoning with at least some of its own tendencies toward excessive and misguided treatment, dentistry is lagging behind. It remains “largely focused upon surgical procedures to treat the symptoms of disease,” Mary Otto writes. “America’s dental care system continues to reward those surgical procedures far more than it does prevention.”
Is Dentistry a Science? - The Atlantic
“The body of evidence for dentistry is disappointing,” says Derek Richards, the director of the Centre for Evidence-Based Dentistry at the University of Dundee, in Scotland. “Dentists tend to want to treat or intervene. They are more akin to surgeons than they are to physicians. We suffer a little from that. Everybody keeps fiddling with stuff, trying out the newest thing, but they don’t test them properly in a good-quality trial.”
Note 'average' number of treatments?!
The 16 participants in the FORSEE-II study had suffered from severe depression for 8 to 22 years and had previously undergone an average of 18 drug therapies, 20 electroconvulsive therapies, and 70 hours of psychotherapy -- without success.
Prof. Dr. Volker A. Coenen, first author of the study and director of the Stereotactic and Functional Neurosurgery Unit at the Department of Neurosurgery of the Medical Center -- University of Freiburg, and his team implanted the deep brain stimulation systems in the patients medial forebrain bundle of the brain and used them to stimulate the medial forebrain bundle. This brain region is involved in the perception and regulation of pleasure and reward and is thus also significant for motivation and the perceived quality of life.
Clear Relief Often within Days
The doctors evaluated the success of the therapy monthly with the help of the established Montgomery-Asberg Depression Rating Scale (MADRS). The MADRS scores of ten study participants already decreased significantly within the first week and remained at a low level. All study participants reacted to the stimulation in the course of the study. Eight of the 16 patients had a MADRS score of under 10 points at the end of the study and thus were regarded as non-depressive. "Our patients had struggled with severe depression for years with no signs of improvement. Deep brain stimulation brought most of them significant relief within days, which lasted throughout the course of the therapy. Other forms of treatment like medication and psychotherapy often lose their effectiveness over the course of time. Absolutely sensational about the study data is that the effect seems to be long lasting, with the positive effects continuing for years," says Prof. Schläpfer.
"We know from a pilot study that the stimulation of this brain region is very promising and we are delighted about the replication of these significant effects," says Prof. Coenen.
Medical Device Makers Report Malfunctions And Patient Injuries In FDA Database Hidden From Public ViewKaiser Health News
Agency records provided to KHN show that more than 480,000 injuries or malfunctions were reported through the alternative summary reporting program in 2017 alone.
Alison Hunt, another FDA spokeswoman, said the majority of device makers’ “exemptions” were revoked that year as a program took shape that requires a summary report to be filed publicly.
More than a million reports of malfunctions or harm spanning about 15 years remain in a database accessible only to the FDA. But with the agency’s new transparency push, the public may find a public report and submit a Freedom of Information Act request to get information about incidents. A response can take up to two years.
The long-standing exemption program “has allowed the FDA to more efficiently review adverse events … and take action when warranted without sacrificing the quality of our review or the information we receive,” Hunt said in an email.
Madris Tomes(Courtesy of Madris Tomes)
To those outside the agency, though, the exceptions to the reporting rules are troubling. They strike Madris Tomes, a former FDA manager, as the agency surrendering some of the strongest oversight and transparency powers it wields.
“The FDA is basically giving away its authority over device manufacturers,” said Tomes, who now runs Device Events, a website that makes FDA device data user-friendly. “If they’ve given that up, they’ve handed over their ability to oversee the safety and effectiveness of these devices.”
Antidepressants don't work, or depression doesn't exist (as a meaningful category)
The real truth isn't found within the published paper but rather within a busy table on page 142 of the online appendix. It is here where the authors report what we want: the actual difference between drugs and placebo, before and after treatment, on the depression rating scales. Here we see that the Cohen's d standardized mean difference effect sizes range from a low of 0.19 to a high of 0.62 with amitriptyline. Thus, amitriptyline exceeds the clinically meaningful threshold of 0.50, with a traditional meta-analytic method. No other drug does so, with the closest second place being fluvoxamine, with a Cohen's d value of 0.44.
Looking at all of the agents, 10 drugs have Cohen's d values less than 0.30, which is very small and clinically meaningless, whereas four have effect sizes from 0.30 to 0.34. Thus, 74% (14/19) of antidepressants clearly have little or no clinically important benefit in this analysis (for some reason, no data are provided in this table with two of the drugs). Four drugs have effect sizes of 0.37-0.44, and as noted, one agent exceeds the 0.50 threshold (amitriptyline).
Perhaps a clearer conclusion than anything else is the well-proven fact that the tricyclic antidepressants are more effective than newer agents (there were no monoamine oxidase inhibitors in this meta-analysis).
Blame everything but the gift horse...
I was in an emotional free-fall, so I visited a psychiatrist. He said the antidepressant my general practitioner prescribed to help with my life-long struggle with anxiety wasn't what I needed, so he prescribed a new one. This seemed to only make things worse. Within a few days, I found myself thinking the unthinkable: I want to die.
I couldn’t imagine a life without my father and our hours-long conversations about, well, everything. The pain was debilitating, getting out of bed was an Olympian event, and life was utterly devoid of meaning. I stopped eating and shed 15 pounds in a month. I couldn’t see any reason to be alive.
Merciful Love Can Help Relieve the Emotional Suffering of Extreme States - Michael W. Cornwall, 2018
I do not believe such love can easily well up inside us while we are distracted by ponderous, analytical mentation. Doesn’t the “clinical gaze” that sometimes may emerge in the eyes of “mental health” caregivers reflect the detached or even defended inner emotional state of the caregiver? That impersonal clinical gaze strives to keenly identify and measure the severity of the “symptoms” of mental illness in order to ascertain definable patterns of “psychopathology.” The clinical gaze also searches for the degree of deviance from codified societal norms. But the inner clinical stance of the caregiver that fosters the caregiver’s own emotionally detached, impersonal objectifying gaze, tragically, can reinforce the inner self-judgments and the inner devaluing and self-shaming of the suffering person the caregiver would hope to help. One’s very self-identity is called into question as the inevitable psychiatric diagnosis process unfolds. We are then redefined as “disordered” beings who are fundamentally failing to pass as equals with those more “healthy” and successful persons than ourselves. A psychiatric diagnosis almost always brings a diminution of self-worth to those so often already in the grip of harsh self-judgments about their worth and inherent value (Cornwall, 2016b).
Psychiatric drugs killing more users than heroin, cocaine: experts | Vancouver Sun
Kerr noted that the rise in BZD-related deaths — “It’s been an epidemic brewing for many, many years” — very closely mirrors a rise in opioid-related deaths that has been widely documented. He cited a fourfold increase in BZD-related deaths in the United States between 1999 and 2014, and also noted that there are 50 per cent more deaths each year in the U.S. due to psychiatric medicine than heroin.
University Officials Defend Handling of Researcher's Misconduct
In all, 89 of the 103 subjects enrolled in the study — 86 percent — did not meet the eligibility criteria to participate, records show. They were too young, had previously used psychotropic medication, or did not meet other guidelines to participate.
Teaching skills
In 1959, she was offered an internship in the psychiatric unit at Manhattan State Hospital, where she tended to forty schizophrenic women. They were guinea pigs, she wrote in her memoir, enrolled in an experiment to test the efficacy of new medications and LSD. Her job was to administer these experiments and complete the research logs, but instead, she taught the women independent living skills. They learned to comb their hair, dress themselves, and arrive to appointments on time. She took them on field trips and helped them find jobs and their own apartments.
The Characteristics of Psychiatrists Disciplined by Professional Colleges in Canada
There were 82 (14%) psychiatrists of 606 physicians disciplined in Canada in the ten years from 2000 through 2009, double the national proportion of psychiatrists.
A Test That Finds the Perfect Drug? - The Atlantic
“Psychiatry remains the only discipline of medicine that has no test to predict treatment response,” said Evian Gordon, the founder of one such company, Brain Resource. “This is providing, for the first time, an objective step as to which drug might be responsive.”
For Depression, Prescribing Exercise Before Medication
But this powerful, non-drug treatment hasn’t yet become a mainstream remedy. In a 2009 study, only 40 percent of patients reported being counseled to try exercise at their last physician visit.
What patients say and what doctors document: Comparison of medical record to self-report of eye symptoms shows wide variation -- ScienceDaily
Symptom reporting drove the inconsistencies between surveys and medical records, the study found.
The top discordant issue: glare. Of patients reporting concern about glare on their surveys, 91 percent didn't have it on their medical record.
Eye redness was second-most common (80 percent had no medical record mention), followed by eye pain (74.4 percent). Blurry vision was only the symptom to tilt the scales -- with more instances of inclusion in medical records than in questionnaires.
