Sunday, January 21, 2007

Nothing for Nothing

According to statistics, the direct costs of support and medical treatment of mental illnesses total $55.4 billion a year, a good deal of it paid by state and federal governments. I would like to tell you why I personally cost as much as I do. First I am on the atypical neuroleptic Risperdal that costs the government several hundred a month, although I pay just $5. I never asked for this expensive drug, I had no say in the matter. Although they say I will have to be on antipsychotics all my life, I have to get my prescription renewed every three months so I have to see a "professional" that charges $150 an hour (half paid by medicare, half by me) for "medical management". They never contact me to ever see if I am doing ok in between visits. If I pass a mental health underling in the hall on my way to my appointment and say, "Hi, how are you" they will write about it in your file and charge the government $20 for a quarter hour as part of your "case management". Nothing is for nothing in mental health world. After I read about the recent studies that older generic antipsychotics were as effective as the new ones, I photocopied the information and sent it to the "professional" that writes my prescription and told her that I wanted to save the government money and go on the cheap one. I see from my bill that the time she took to read it cost me another $18. I won't know until next month if she will let me change my prescription.

Friday, January 19, 2007

Off label use of Atypicals

This article about off label uses of atypicals does not mention the wide use in prison populations.

Some newer antipsychotic medications approved to treat schizophrenia and bipolar disorder are being prescribed to millions of Americans for depression, dementia, and other psychiatric disorders without strong evidence that such off-label uses are effective, according to a new analysis by HHS’ Agency for Healthcare Research and Quality.

The federally funded comparative effectiveness review of these drugs – called atypical antipsychotics – identified the medications’ potential for serious side effects while pointing to an “urgent need” for more research into new treatments for the growing population of dementia patients who display severe agitation.

Overall, however, researchers found that much of the scientific evidence for off-label use of antipsychotics was of insufficient quality because studies were too small or lacked scientific rigor.

Review authors evaluating the potential benefits and risks of the medications also found strong evidence that atypical antipsychotics can increase chances of adverse events. Some of the drugs increase risks of stroke, tremors, significant weight gain, sedation, and gastrointestinal problems.

The new review was produced by AHRQ’s Effective Health Care program. It was authored by AHRQ’s Southern California/RAND Evidence-based Practice Center. The center examined 84 published studies on atypical antipsychotics and summarized evidence about several conditions:

Sunday, January 07, 2007

What's Making Us Sick is an Epidemic of Diagnosis

While diagnoses used to be reserved for serious illness, we now diagnose illness in people who have no symptoms at all, those with so-called predisease or those “at risk.”

Two developments accelerate this process. First, advanced technology allows doctors to look really hard for things to be wrong. We can detect trace molecules in the blood. We can direct fiber-optic devices into every orifice. And CT scans, ultrasounds, M.R.I. and PET scans let doctors define subtle structural defects deep inside the body. These technologies make it possible to give a diagnosis to just about everybody: arthritis in people without joint pain, stomach damage in people without heartburn and prostate cancer in over a million people who, but for testing, would have lived as long without being a cancer patient.

Second, the rules are changing. Expert panels constantly expand what constitutes disease: thresholds for diagnosing diabetes, hypertension, osteoporosis and obesity have all fallen in the last few years. The criterion for normal cholesterol has dropped multiple times. With these changes, disease can now be diagnosed in more than half the population.

Most of us assume that all this additional diagnosis can only be beneficial. And some of it is. But at the extreme, the logic of early detection is absurd. If more than half of us are sick, what does it mean to be normal? Many more of us harbor “pre-disease” than will ever get disease, and all of us are “at risk.” The medicalization of everyday life is no less problematic. Exactly what are we doing to our children when 40 percent of summer campers are on one or more chronic prescription medications?

Full New York Times essay here

Monday, January 01, 2007

Using all of your Brain

Tip #1: Be Alive
Actually, that’s pretty much all you have to do. Despite what the Uri Gellars of the world would have you believe, you’re already using all of your brain. Everybody (from otherwise respectable media mavens to shamefully misinformed teachers) has probably told you at some point that humans only use 10 percent of their grey matter, but that couldn’t be further from the truth. The myth most likely originated from the phrenology craze of the early 19th century, when pseudo-scientists were busily chopping up the brain into overly distinct control sectors. Later, some of the early and very rough experiments in neuroscience involved hooking electrodes up to the brains of test subjects. Stimulating some parts of the brain cause instant, and obvious, physical reactions. But, when the electrodes were applied to other spots, there seemed to be no effect at all. Scientists called these areas “the silent cortex.” By the 1930s, stories of these cranial dead zones had morphed into the oft-repeated “factoid” that quickly became a favorite of advertising writers, self-help salesmen, and paranormal power hucksters—all of whom claimed to have the secret to unlocking that ostensibly unused 90 percent. It didn’t help matters much that respected scientific figures such as Margaret Meade and Albert Einstein (Say it ain’t so!) thought nothing of stepping well outside their own realm of scientific knowledge to repeat the 10 percent claim as if it were truth. But, just because some of the 20th century’s greatest minds were suckers for an urban legend, doesn’t mean you have to be. The next time someone brings up the 10 percent figure, flatten’ ‘em out with this one-two logic punch.

Real Fact! The “silent cortex” zones that neuroscientists discovered in the 19th century later turned out to be running some very important functions—like language and abstract thought. Personally, we’d rather not live without those, thanks. Modern brain imaging systems clearly show that there aren’t any vast swaths of useless cerebral cortex lying around. Although we don’t use every part of our brain constantly, we do use just about all of it at some point throughout the course of a given day.

Real Fact! Ever hear a doctor on your favorite surgical drama tell a patient that their head wound isn’t a big deal because it hit the 90 percent of the brain they don’t use? Yeah, you won’t hear that from a real doctor, either. If we truly did only use 10 percent of our brains, we would be able to remove big chunks of the grey stuff and not have it matter much at all. But that isn’t the case. Take away 90 percent of human brain’s volume, and you’re left with something roughly akin to the size of a sheep’s brain. Cut out a chunk, and there will be consequences.

This came from Mental Floss.