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furious seasons

Blogging for Mental Health and Psychology 2010

by John M. Grohol, Psy.D. 5/28/2023

Blogging for Mental Health and Psychology 2010

The [American Psychological Association’s] Your Mind, Your Body “Mental Health Month” Blog Party represents the aim of APA’s bloggers to bring mental health writing to the web.

We love that the American Psychological Association (APA) has decided to designate today as some sort of “blog party” to increase mental health awareness, but their press release and related marketing materials on this “blog party” make it pretty clear they don’t have a clue. I’ve never seen bloggers “organized” through a press release before.

First of all, it kind of sounds like the APA doesn’t believe there’s any mental health writing on the web. Of course, nothing could be further from the truth… Mental health writing has been on the web for years! Some of the best writing has been in independent blogs, like Furious Seasons (which has sadly gone AWOL), The Last Psychiatrist, The Carlat Psychiatry Blog, Dr. Deb, and The Trouble with Spikol. You can’t “bring” something “to the web” which has already been around for years and years.

And of course, Psych Central has been writing nonstop about psychology and mental health issues for the past 15 years (and blogging about them for 10). We are the relentless, independent (and sometimes cranky) voice in mental health.

5/28/2023 14 comments

Online Mental Health Journalism Awards: 2009

by John M. Grohol, Psy.D. 11/21/2022

By John M. Grohol, Psy.D.

As we noted here, Mental Health America recently announced the winners of the “2009 Media Awards” that recognize excellence in mental health journalism. Sadly, despite the Internet’s popularity for the past 15 years, the Internet as a category is still missing from the awards. Apparently you can do good journalism online, you just won’t be acknowledged for it. (In Mental Health America’s defense, Pulitzer only began recognizing online journalism this year, too, so go figure.)

We thought we’d acknowledge some examples of outstanding online mental health and psychiatry journalism in 2008. You might argue with our broad interpretation of “journalism,” but we believe that writers or producers who can bring new insight, analysis or understanding about mental health concerns or significant issues in the fields of psychology and psychiatry are worthy of inclusion.

So without further ado, here are some of our top picks for online mental health journalism from the past year (largely based upon writing or publishing online in 2008).

Psych Central Outstanding Mental Health Journalism

Outstanding Online Mental Health Journalism: 2009

Shannon Brownlee and Jeanne Lenzer published an article in May 2008 in Slate, Stealth Marketers, that described the lack of transparency and disclosure on a particular radio show hosted by Dr. Fred Goodwin in an episode entitled, “Prozac Nation: Revisited.” Slate’s article led to additional mainstream reporting on the issue, which left a black mark on Dr. Goodwin’s otherwise stellar career. (Coincidentally, a month earlier, Philip Dawdy over at Furious Seasons focused on the same show, but zeroed in on the incorrect information and marketing slant the commentators had on the show.)

On a more positive note, one old media company published a new feature on their website that must be mentioned: The New York Times’ Patient Voices. Well-produced audio stories, Patient Voices provides a first-person and personal experience of what it’s like to live with various health and mental health concerns. I’ll just highlight their Bipolar Disorder and ADHD segments (note: self-playing audio upon clicking).

Dr. Daniel Carlat, blogging over at The Carlat Psychiatry Blog, did more than his fair share of citizen journalism exposing the corrupt continuing medical education (CME) system, too often bought and paid for by pharmaceutical companies pushing their specific medications. His entries in 2008 brought light to many such biased practices (and the resulting changes made in the industry as a result of efforts like his). Perhaps it’s not “mental health” enough, but CME is what provides education to psychiatrists and other professionals. This education is part of the basis they then use to make clinical judgments in the office treating patients for their mental health concern.

The mysterious CL Psych blogging at Clinical Psychology and Psychiatry: A Closer Look often breaks down complex research findings and puts them into more clear and understandable terms. He explains how researchers skew the data and their results to get to their intended goals (regardless of what the data actually show). Since research informs practice and practice trends, biased or poor research can influence how clinicians end up treating people.

One year ago, Jeremy Dean blogging at PsyBlog described the limited research behind “brain training programs” that have become all the rage on devices such as the Nintendo DS and iPhone. He described in the article how many different types of strategies promoting cognitive enhancement are often no more than marketing hype.

We often enjoy the insightful writings of The Last Psychiatrist, as he provides a witty and interesting outlook on news, cultural trends, human behavior and research that would be difficult to find anywhere else. One of his most popular entries of 2008 was an analysis of the modern manufacturing of pop musical hits like Katy Perry’s “I Kissed a Girl”, not for teenagers, but for middle-aged men. Or this entry that looked at why you probably wouldn’t want the widespread use of neuroimaging scans (like fMRI or MRI scans) in court. Or the three-part series about the apparent rise of narcissism in college students. Thought-provoking and always interesting.

Like him or hate him (he tends to be polarizing), Philip Dawdy also often provides the first public look into court documents, court trials and other information surrounding drug research (perhaps best known for making the Zyprexa court documents available for download on his site). You may never know quite what to expect from his blog, but he is a prime example of mental health journalism online.

Dr. Vaughan Bell at Mind Hacks found a pre-print of the “Voodoo” neuroimaging fMRI study which leveled significant criticisms at much of the fMRI research published in the field in the past 20 years. The final paper and responses to it were just recently published in the May 13, 2009 issue of Perspectives on Psychological Science. Bell’s finding of the pre-print set off a controversy online about the limits of fMRI brain imaging studies — which eventually affects our understanding of mental disorders.

And you can’t really leave 2008 without an honorable mention to U.S. Senator Charles E. Grassley. He has single-handedly led to the exposure of dozens of discrepancies between the monies researchers claimed they made from drug companies, and the monies they reported as a conflict of interest to their universities. Such disclosures have led to a fundamental change in how such disclosures are made, including at organizations such as the National Alliance on Mental Illness.

Did we overlook someone who provided independent reporting or journalism online in the past year on a mental health, psychology or psychiatry topic? Please leave us feedback and we’ll add them to our list to review for next year’s entry.

11/21/2022 10 comments

Can Consumers Also Have Conflicts of Interest?

by John M. Grohol, Psy.D. 10/12/2022

By John M. Grohol, Psy.D.

Is bias about a pharmaceutical company’s products limited only to direct financial benefits (as U.S. Senator Charles Grassley has so adeptly shown)? Or can a conflict of interest exist where no money changes hands, but a person has other reasons to either promote or speak out against a company and its products?

This is a loaded question, obviously, because the answer is, of course conflicts of interest can go above and beyond any direct monetary reinforcement. What if your own child was harmed, in your opinion, by one of the drugs you are then asked to judge?

If this were a court trial, such a juror would never be seated on the jury. Lawyers are keenly aware of these kinds of human influence biases, and ask questions to try and feel out whether such biases exist in potential jurors. Both sides disqualify obviously biased jurors, such as in a product liability case where a juror’s family member has been ill affected by the product in question.

So it came as some surprise to see that while the U.S. Food and Drug Administration has been cleaning its house of researchers and professionals with potential conflicts of interests on its advisory panels, it seems to have failed to do so when it comes to its consumer members and other kinds of conflicts of interest, as Merrill Goozner recounts:

I was rather shocked as the patient representative — Margy Lawrence of Potomac, Md. — on the panel announced her vote against approving the drug. ‘My son died of sudden cardiac arrest,’ she said. ‘Seroquel was part of his cocktail.’

Margy Lawrence sat on the advisory committee panel that recommended against granting Seroquel approval for additional uses (except one, as a second-line treatment for major depression when other treatments have failed). How can a process be thought to be fair and unbiased with such a representative? If this were a jury trial, Ms. Lawrence would’ve never sat on the jury to begin with. Shouldn’t all government processes seek to uphold the same sense of fairness and balance, no matter whether they’re a jury trial or a government advisory panel making influential recommendations?

Philip over at Furious Seasons suggests, “It would be virtually impossible to have patient and consumer reps on FDA advisory panels who do not have some kind of experience or exposure (through themselves, family members or friends) to the very meds they are being asked to review.” I suppose that’s true. But couldn’t we ask that anyone who attributes a direct family member’s death to the drug under review to recuse themselves from such a panel? I mean, we’re kidding ourselves if we believe such a member could be objective in their criticism (just as we were kidding ourselves about those researchers).

I’m glad the FDA has scrubbed its panels of direct pharmaceutical influence. But let’s not swing the scale in the other direction and put people on these panels who have an equally direct negative bias against a company’s product for very good personal reasons. As Goozner notes, if that happens, the process itself could be at risk of being discredited, hopelessly unable to assemble an unbiased, objective and independent panel.

Hat tip: Furious Seasons

10/12/2022 2 comments

Shaking Down a Pharmaceutical Company

by John M. Grohol, Psy.D. 9/18/2022

By John M. Grohol, Psy.D.

There’s been plenty of coverage in the past week on the latest drug company to hit an ethical bump in the road of marketing their atypical antipsychotic, coverage we didn’t feel like we could add much to. Instead, I encourage you to read Furious Seasons’ take on it, the first blogger to break the story online (Philip is also in the middle of a fund-raiser, so consider putting a few bucks in). He’ll have continuing updates on the story. CL Psych also has his typical initial witty analysis, and Dr. Carlat has weighed in on the secret documents and sexual relationships involved. CL Psych has since published a more thorough analysis of what the documents show, research-wise.

But what I found amusing (and enlightening) was yesterday’s entry on Furious Seasons about one of the top 5 largest prescribers of Seroquel in the U.S., Community Mental Health Service in Chicago, IL, apparently run by Dr. Michael Reinstein. Exhibit 17 from the court documents provided by Furious Seasons shows how they were apparently threatening AZ with reducing their prescriptions of Seroquel if AZ didn’t push more research opportunities their way:

This group, in particular John Sonneberg, Ph.D., Director of Research has been extremely persistent in recent months with demanding research from AZ. Their comments to several AZ employees suggest since they use large volumes of Seroquel they should by default be doing research on our behalf. They have further implied that should they not get research funding that they would switch patients currently on Seroquel to competitive agent(s).

Our Clinical colleagues have significant and numerous issues in past with the quality of research that this group has produced in the past. Matters such as not getting informed consent from study participants, modification of protocols without permission […]. There is little confidence that Good Clinical Practices can be adhered to. Their research is often criticized by peers in Psychiatry.

Now take that analysis with a grain of salt as the opinion of one AZ employee explaining the background of the situation to a superior, and it was written 8 years ago. We do not know the truth or accuracy of these statements.

If true, however, apparently some researcher-practitioners seem to have had little ethical regard for promoting a product in a quid-pro-quo arrangement — send us lucrative research contracts, or we’ll stop prescribing as much of your drug. The sliminess of these alleged practices is truly astonishing.

You need look no further than something like this that was occurring 8 years ago (we have no idea if these kinds of practices are still going on; we hope not) to see how troubled the relationship between industry and researchers has become. But the exhibit also shows something we don’t see enough of in these kinds of disclosures — a pharmaceutical company standing up for its own internal quality standards and trying their best not to be shaken down.

You can also view another interesting discussion in Exhibit 42, where John Tumas at AZ argues for full disclosure of a study that apparently did not show great results for Seroquel, something called “COSTAR.” COSTAR, sadly, was never published as Tumas argued that it should have been. A decade ago, Tumas rightfully predicted the negative backlash all pharmaceutical companies have been enduring now for a few years for suppressing negative clinical trial data.

These are extremely interesting disclosures, and we suspect that as court cases proceed regarding this and other medications, we’ll see more of these kinds of things to come.

9/18/2022 1 comment

Zyprexa Redux

by John M. Grohol, Psy.D. 9/7/2022

By John M. Grohol, Psy.D.

If you haven’t been hiding under a rock in the past few years, you’ve probably heard about Zyprexa (olanzapine). It’s an atypical antipsychotic psychiatric medication used first to treat schizophrenia, then extended to include the treatment of different types of bipolar disorder. There’s nothing extraordinary about the drug, other than it’s a fairly typical example of this new class of medications that was supposed to have fewer — and less serious — side effects.

Time, of course, tells a different story, as it so often does with these kinds of medications. Research that was at first promising and sold the U.S. Food and Drug Administration on the drug’s approval doesn’t study a drug’s real-world use. The fact is, virtually nobody is prescribed any psychiatric medication for as little as 6 to 8 weeks (the typical time of 90%+ of FDA drug approval studies). This means that while drugs can gain approval with little display of side effects initially, researchers simply don’t spend much time looking at the side effects longer-term. At least not early on.

Later, as the drug “catches on” with docs, more studies are typically done, and some may even span into additional months of treatment. But since the FDA hasn’t required such studies in the past (companies are now required to do a little more followup early on), companies were content with letting the short-term data speak for itself. Meanwhile, people start taking the drug and staying on it not just for 6 to 8 weeks, but for 6 to 8 months (and then for 2 to 4 years, especially for serious, chronic conditions like schizophrenia and bipolar disorder).

And that’s when you start seeing the real side effects of a medication.

In this case, Zyprexa’s side effects (some of which were actually noted in the original clinical FDA studies) included weight gain and higher risk of diabetes. Properly managed, such side effects might be okay for some people. But early on, the drug company who made Zyprexa — Eli Lilly — downplayed the significance of these side effects and their association with Zyprexa.

They also marketed the drug for uses and populations that the company never sought formal approval for — a big no-no in the U.S.

Ultimately, the chickens came home to roost in the form of dozens of lawsuits filed against the company by U.S. states. They settled many of the lawsuits for $1.42 billion (yes, that’s with a “B”), but may be on the hook for another $4 billion in settlements related to the drug in years to come.

One of the people who “broke” the scandal over Zyprexa and what the company knew and when it knew it was Philip Dawdy over at Furious Seasons. He brings us his take on this Rolling Stone account of the Zyprexa story. Philip was interviewed extensively for the article, but never quoted or referred to, which is just unconscionable given his was the first site to make the leaked Zyprexa documents widely and easily available to the public. He also has provided an enormous amount of analysis into those documents, and has stuck with the story for years now.

We continue to acknowledge and applaud Philip’s work over at Furious Seasons, which provides a valuable public service. And while we don’t always agree with everything he writes, we feel his contributions remain worthy of your notice.

9/7/2022 2 comments