A WATCHDOG group says mental patients at Hillside Hospital in Queens are being abused - mentally.

Since January, about a dozen patients have been coerced into receiving electroshock treatment under the threat of being shipped off to inferior state-run facilities.

"It's not physical abuse - it's mental abuse," said Dennis Feld, the deputy chief for the Mental Hygiene Legal Service, a state-funded watchdog group that represents all mental patients.

"What they are doing is frightening them."

Patients' treatment teams - which are made up of psychiatrists, psychologists, therapists, social workers and even nurses - are ganging up on our sick and vulnerable, Feld charges.

"They go a little further than just saying, 'You don't want to take this [electroshock therapy]? It's OK,' and moving on," said Feld, who is considering filing a class-action lawsuit. "They're really pushing it."

Feld claims that at least five patients have already been transferred for refusing to receive electroshock treatment.

A Hillside spokesperson didn't respond to repeated telephone messages.

The watchdog group began eyeing alleged electroshock abuse at Hillside when the hospital tried to strong-arm spunky 65-year-old Wilfredo Hernandez, of Brooklyn.

Hillside, with Hernandez's consent, zapped his 38-year-old mentally retarded daughter, Nina, 21 times. When Hernandez refused to allow the doctors to continue, they allegedly threatened to legally take custody of his daughter and get a court order to zap her again.

But one day - that's one day - after The Post reported Hernandez's plight, Hillside doctors decided Nina didn't need electroshock treatment anymore. In fact, they said she didn't need the hospital's services at all anymore. She was discharged Friday.

Hernandez, a deacon at a Borough Park Catholic church, is thinking about forming a parents group to combat forced electroshock at Hillside.

"I'm worried about the patients who don't have family members to defend them," Hernandez said.

Vera Hassner-Sharav, the president of the city's Citizens for Responsible Care and Research, called the alleged coercion practice at Hillside "unconscionable."

She said the only recognized use of electroshock is for patients with severe clinical depression who haven't responded to any other form of treatment.

Zapping Nina Hernandez, who doesn't suffer from depression, is "contrary to accepted medical standards put forth by the American Psychiatric Association" and, therefore, "that makes it experimental," Hassner-Sharav said.

Feld charges the pressure to zap patients at Hillside began 1997, when Dr. Max Fink, the godfather of electroshock, moved his research and teaching activities to Long Island Jewish Medical Center, which is affiliated with Hillside.

Published studies show Hillside has participated in several federally funded electroshock experiments.

Fink said he had retired from the electroshock business to write books, and at first distanced himself from Hillside. He's listed as a "research faculty" member on the hospital Web site.

When pressed, a flustered Fink said, "If he [Feld] alleges we are doing something wrong, he should go to court and sue the pants off the place."

Maybe Feld should. A lawsuit might teach these doctors not to play with electricity and the lives of patients who trust them.

next: Fish Oil Found To Ease Manic Depression - US Study
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~ all articles on depression

New York State Assembly, May 18, 2001

My name is Linda Andre, and I am a survivor of ECT. I had a fairly typical experience. Five years of my life were permanently erased as if they had never happened, including most of my college education; I lost 40 points off my IQ; and I've been left with permanent disabling memory and cognitive deficits. I have brain damage from ECT, and it's very similar to what happens to persons who suffer traumatic brain injuries from other causes such as car crashes. Let me hasten to say that I received what's often falsely called the "new and improved" ECT and that every doctor who consulted on my case agreed and will tell you to this day that my treatment was state of the art and done according to the specifications of the APA. Since 1985, I have been the New York Representative of the national organization of persons who've received ECT, the Committee for Truth in Psychiatry; in 1992, I became the Director of our organization.

I'd like to add that although I'm not a doctor, I passed the CME test that supposedly qualifies doctors to give shock. I've got the certificate to prove it.

The reason why there was and is a need for a national organization of ECT survivors is that there are big problems with this treatment, as you're hearing today. In a nutshell, the problem is that patients aren't truthfully informed of the known permanent adverse consequences of ECT, including permanent extensive memory loss and permanent brain damage. The industry, much like the tobacco industry, won't acknowledge these effects and ex-mental patients haven't got the political clout to make them.

Throughout the history of ECT, there has been conflict between doctors and patients. This conflict is at the very heart of the Paul Henri Thomas case, and the other forced shock cases in New York. What survivors know to be true about ECT, and what doctors believe, are opposed and are irreconcilable. Survivors and shock doctors cannot both be right. I sat through the Thomas court hearings, and I heard the doctors say that they considered Paul incompetent because he did not agree with their assessment of the risks and benefits of shock. I heard what the doctors said, and I don't agree with them either, nor would any of the members or our organization. I guess that makes all of us incompetent as well. Paul came to his conclusions by experiencing ECT. His doctors said they formed their opinions on ECT by reading a book. (There isn't major book on ECT that isn't written by a doctor with financial ties to the shock machine industry, as an owner, shareholder, grantee or consultant to these companies.) Paul's doctors believed things that are not true, such as that the FDA has performed safety trials of ECT; but then what matters in these hearings is not so much what is true as who has the power to define the truth.

Our group organized because we all had ECT without informed consent, we all suffered permanent memory loss, and we want to protect future patients from suffering tragically preventable amnesia and disability. Our one and only mission is to advocate for truthful informed consent, and we've done that over the past sixteen years in a wide variety of forums. In fact, Marilyn Rice, the founder of our group, testified before the New York Assembly at your first hearings on ECT in 1977. We called ourselves the Committee for Truth in Psychiatry to emphasize that we are for informed consent, not against ECT. Marilyn liked to say, "I'm not against ECT, I'm against lying about ECT."

In my position as Director of CTIP I've been in contact with literally thousands of ECT survivors from around the world over the past decade. I keep up with the industry research on ECT; I attend and present at psychiatric conferences; I write and publish on ECT; I consult with agencies such as the Center for Mental Health Services. I've worked with states which have passed or tried to pass laws to protect patients. This last includes an unsuccessful reporting bill in New York State in the early 90s, and reporting bills that were successful in Texas and Vermont. But CTIP's biggest accomplishment has been getting the Food and Drug Administration to acknowledge the risks of ECT, including brain damage and memory loss.

The FDA regulates ECT because the machines used to give it are considered medical devices. It is somewhat limited in its authority because ECT machines were in use before the FDA gained jurisdiction over medical devices in 1976. FDA was mandated by law to place the shock machines in one of its three medical devices categories, Class I, Class II, or Class III. Briefly, Class I would be an over-the-counter device, Class II one which is safe if used according to certain standards or safeguards, and Class III one which presents an unreasonable risk of injury or harm and cannot be made safe. To classify a device, FDA weighs its risks against its benefits. At the end of my presentation, I will tell you what the FDA says about shock machines. But first I will do what the FDA did, and give you an overview of what we know about ECT's risks and benefits.

ECT patients have been reporting permanent adverse memory and nonmemory cognitive effects ever since shock began in 1938. The nature and frequency of these reports has not changed in over 60 years. Let me explain that the so-called modifications of ECT have had no effect on these permanent adverse effects. You may have heard claims that oxygenation, muscle paralyzers, so-called brief pulse ECT, or unilateral ECT have solved the problems with memory loss and brain damage. But all of these modifications were in use by the 1950s, and none of them eliminated or minimized ECT's effects on memory and on the brain. You may also have heard that today's ECT uses "less electricity" than in the 50s, 60s, 70's, and 80s. The opposite is true. Today's ECT devices are the most powerful in history. Each new generation of machine is designed to put out more electricity than the one before it. This means, for example, that a person getting shocked today is probably getting more electricity through her brain than I did in 1984.

In the early decades of ECT, doctors were frank about sacrificing the brains, intellects, and careers of their patients in the hope of a temporary respite from depression. Since about 1975, the beginning of what I call the public relations era of ECT----that is, the period when organized psychiatry decided to deny there was any problem with ECT itself in favor of claiming there was simply an image problem with ECT---they have attempted to deny or cover up memory loss and brain damage, just as they have stopped writing up ECT deaths.

Even so, it is accurate to say that when researchers looked for the type of memory and cognitive deficits survivors report, and used measures that were relevant to these deficits, they have found them. There are just a handful of studies that follow ECT patients up for the long term, asking about memory. But the studies that have done this--followed patients for six months, a year, three years, and in one very brief and limited study, seven years---have all found that the majority of these patients still have amnesia and memory disability. There is nothing to support the industry's claim that memory or memory ability returns to normal shortly after ECT. In fact, patients tested as long as twenty years after ECT had brain damage verified by sensitive neuropsychological tests.

Outside of these of studies, which were done before 1990, no one has been interested in following up ECT survivors to document the permanent effects of ECT---except ECT survivors. Let me explain that survivors and others have had to step in because of the lack of ethical and scientific research, and this is something you may want to look into in further hearings because New York State is where the biggest problem is. You may know that one institution, the Psychiatric Institute, gets a large percentage of the total NIMH money that is available for mental health research. When it comes to ECT research money, the percentage is much greater. Millions and millions of dollars have been granted to one investigator in this lab, Dr. Harold Sackeim, to study ECT, including the adverse effects of ECT. Because Sackeim's had a lock on this money for 20 years, because his money is renewed automatically for as long as he wants it without his proposals having to compete with other grants, and because he sits on the panel which decides who gets funded, other researchers aren't able to get grants to do research in this area. Dr. Sackeim is on the American Psychiatric Association's Task Force on ECT, and he's the spokesman for industry, the one whose name is always given out to the media. His entire career has been built on promoting ECT. That's an ethical and scientific problem. But there's an even bigger legal problem: his research has been done in violation of federal law which requires disclosure of conflict of interest. While he's been getting millions of NIMH dollars, he's also been a consultant for, and received grant money from, the companies that make most of the shock machines in America, and he has never disclosed this financial conflict. That is illegal.

I also need to add that Dr. Sackeim, along with other New York ECT promoters such as Dr. Fink, and the other doctors of the APA's Task Force on ECT, are on record at the Food and Drug Administration as opposing an impartial safety study of the effects of ECT on the brain. They have successfully lobbied over a period of nearly two decades to prevent such a study by the FDA. So it is not only that these men monopolize the research funding and decide the research agenda; they also work to actively prevent anyone but themselves from researching ECT.

I hope you will look into this, and into other problems in this research as well, such as fraudulent informed consent, the "disappearing" of study participants with adverse outcomes, the fudging or falsification of data. All of this is documented. I bring it to your attention because there is no way to understand the dearth of valid and scientific research on longterm effects of ECT without placing it in this larger context.

So if the research money is monopolized by Sackeim and a handful of others with a personal financial and career stake in promoting ECT, how do we know what we know about the nature and prevalence of its adverse effects?

We know because of the research that was done prior to the public relations era, and in fact even up until the early 80s. There are dozens of brain anatomic studies of both humans and animals, autopsy studies where cells have been counted, solid scientific studies which have been replicated by other studies, showing brain damage from ECT. The industry tries, dishonestly, to discredit this research but there are too many studies. In fact, though they're either ignored or miscited by ECT proponents, there human MRI studies showing brain atrophy from ECT. There are also well-designed memory studies which have never been either discredited or replicated by the ECT industry, documenting the nature, extent, and permanence of ECT amnesia.

I refer you to the excellent presentation given by neuroanatomist Dr. Peter Sterling in 1977, in which he describes the mechanism by which ECT inevitably produces brain damage. The brain hasn't changed since 1977, and ECT hasn't changed except for the fact that today's ECT machines put out many times more electricity than those in use is 1977.

The permanent effects of ECT on the brains, memories, and lives of survivors are documented in the files of the FDA. The FDA has been collecting data from ECT survivors for nearly 20 years. Its docket on ECT, Docket #82P-0316, consists of about 40 volumes, each several inches thick, and I have read all of them. This is a public record and anyone making policy on ECT should look at it. There are several hundred reports from persons who have had ECT. They come from persons who had ECT at different institutions, at different times and in different places, but the similarity of the reports from these hundreds of survivors who don't know each other is unmistakable. They describe permanent amnesia and memory disability---the daily experience of living with a poorly functioning memory. Some have sent in laboratory tests documenting brain damage. They talk of losing jobs, forgetting the existence of children, becoming a permanently diminished human being. There are hundreds of reports of educations and careers ended, families destroyed. Many reports go into great detail about the nature of ECT disability, such as the fact that new learning after ECT doesn't stick. These people want something done about what happened to them. They beg the FDA to conduct an impartial safety investigation of ECT's effects on the brain.

There are exactly fourteen letters from patients who have anything good to say about ECT. Five were sent in by these patients' shock doctors, some of these written on hospital stationery, probably with the shock doctor literally looking over the patient's shoulder, telling them what to say. Four of the letters report memory loss.

That's fourteen letters in nineteen years from ECT patients who had positive experiences, versus several hundred who report negative, harmful, or devastating results.

This is and was not meant to be a scientific study but it is what we have to go on, and it has some advantages over a conventional study which would, after all, include patients all treated by the same doctor in the same institution, and would only include one or two dozen people. The ECT reporters had ECT in every decade, by every imaginable technique and type of machine, by every type of doctor, in every state and even some foreign countries. It's not possible to dismiss them by claiming they "just" had a bad doctor, or the wrong type of ECT.

Because of the absence of valid and scientific studies by impartial doctors, and the seeming political unlikelihood that such studies will ever happen, survivors of ECT have had to take the lead in designing and implementing our own research. In the past several years there have been four large studies which focused on amnesia and memory disability. All of these went to a heterogeneous group of survivors, from people who'd had ECT in the past year to those who'd had it twenty years ago. One was done in the US by Juli Lawrence, an ECT survivor and member of the Center for Mental Health Services Advisory Board; three were done in England. The findings of all of these independent studies have been strikingly similar.

In my own study which I designed, I sent an questionnaire commonly used to assess brain injury, slightly modified to include the most common ECT symptoms, to our members, and every one of the 51 people who responded reported having at least some of the symptoms. Two-thirds had become unemployed due to ECT. 90% said they wanted and needed help with their cognitive and memory deficits, and had been unable to get it.

The United Kingdom Advocacy Network, a patients rights group in England, surveyed 308 survivors of ECT, one-third of whom had received forced shock. 60% of women and 46% of men found ECT damaging or not helpful. 73% reported permanent memory loss. 78% said they would never agree to ECT again.

Juli Lawrence's study of 41 survivors found that 70% had not been helped by ECT. 83% reported permanent memory loss, in some cases up to 20 years of amnesia. 64% reported permanent problems with memory functioning. 43% said ECT had caused permanent changes in cognitive abilities.

ECT Anonymous is the sister group to the Committee for Truth in Psychiatry in the UK. It is entirely made up of ECT survivors. They designed an extensive survey which as of 1999 has been completed by about 225 people. 82% reported permanent memory loss; 81% reported permanent memory disability; 50 to 80% reported permanent impairment in various cognitive abilities; 73% reported that ECT was not helpful in any longterm way. 76% were never able to return to their previous occupations.

MIND is a British charity which might be compared to our Mental Health Associations. In 2001, they published their survey of 418 ECT survivors. One-third had ECT against their will. 84% reported permanent adverse effects, including amnesia and cognitive deficits. 43% of the total found ECT unhelpful, damaging or severely damaging, and 65% said they would not have it again.

There is another adverse effect even more chilling than losing years of your life, and that is death. We don't have accurate national figures on deaths from ECT, because we don't collect any national statistics on ECT. Those that you may have heard are either an industry projection based on very old numbers (like the claimed "100,000 people get ECT a year) or a complete fabrication (like the death rate claimed by the APA). Only six states are required to report deaths from ECT, and not all of them have up-to-date figures. Texas is one state that has kept statistics in recent years, and they show a death rate of 1 in 200. In 1998, Illinois reported a death rate of 1 in 550. Yet patients are never told of these statistics.

A large retrospective study of 3,228 ECT patients in Monroe County, New York found that ECT recipients had an increased death rate from all causes. Another large study corroborated the fact that ECT survivors die sooner than mental patients who haven't had ECT. There is research to show that ECT survivors relapse more quickly than patients who were treated with drugs, and are much more likely to commit suicide. There is research that suggests that ECT survivors are more likely to develop Alzheimer's disease. There is no research on other longterm adverse effects of ECT, such as its longterm effects on the heart. If someone such as myself develops a heart condition at an early age, a condition for which there is no risk factor or family history, is this a result of ECT? No one's even looking into this.

To summarize what we know about adverse effects: 100% of persons who have ECT experience permanent memory loss, and a majority experience significant, extensive loss. Memory lost to ECT doesn't "return". NIMH looked at what the industry says and estimated that the average period permanently lost to ECT is eight months. That's an underestimate, as you'd expect. It is frequent, not rare, for persons to lose many years of their life to ECT, and for this loss to be permanently disabling. ECT commonly causes many of the other permanent effects typical of brain injuries, including loss of intelligence, permanently impaired memory functioning, and other cognitive problems which is sum amount to preventable disability.

What about efficacy? Are there benefits to ECT that can justify these risks?

Let's look at what the industry itself says. You may have heard a claim that ECT prevents suicide or saves lives. It doesn't. There is not one study to prove this. In fact, the industry-designed research shows the opposite: ECT has no effect on suicide, at least as far as preventing it. There are many, many studies that document suicide after ECT, often when researchers attempt to find their patients a month or three afterwards and can't find a certain percentage of their patients because they've killed themselves. Ernest Hemingway is just the most famous example of a suicide caused by ECT.

In 1985, NIMH looked at the published research---again, this is research largely done by the industry itself---and concluded that there was no evidence that ECT has any beneficial effects that last longer than four weeks. In 1992, two British psychiatrists presented a paper at an international conference, evaluating all the studies that had been done up to then---there have been none since---which compared real ECT to what's called sham ECT (anesthesia alone without electricity). They concluded that there is no evidence that real ECT is superior to fake ECT. Remember, in both cases all that was being evaluated was ECT's efficacy in depression, the condition for which is it supposedly most effective; ECT is commonly used for other conditions for which it is considered less effective, as in the case of Paul Henry Thomas.

ECT's lack of efficacy is a big public relations problem for the industry. In 2001, the industry's leading spokeman Harold Sackeim published a paper looking at what happens to patients who've had ECT. This study was based on research done from 1992 to 1998, and I remind you that this research was done in violation of federal law. I have also examined the grant file for this study, and I can tell you that the actual results reported to NIMH do not match the results revealed to the public in the published study. I can't tell you why, or what happened to the patients who were disappeared, except to ask you to look into it.

The point here is not that this study is good science, or that you should believe what it says, but that it was the best that the most prominent and best-funded spokesman of the ECT industry, using millions of our tax dollars, could come up with.

Of the roughly 290 people who were shocked for this study, half did not respond to ECT at all. That's a 50 percent response rate for the very definition of state-of-the-art, 21st century ECT. But in fact Dr. Sackeim cheated a bit, because he uses the special shock machines that he designs to put out twice as much electricity as patients normally get. This, as Sackeim would tell you, boosted the response rate higher than it would have been in clinical use----but it was still only 50%. (Correspondingly, when a study focuses on cognitive effects and not efficacy, researchers are able to turn down the electricity to less than is given in normal practice.)

Of the roughly 150 people who responded to ECT, only about 25 (we don't know the exact number because Sackeim says different things in different places) were free of depression six months after shock. An equal number, about 21, had become so depressed again that they had more shock within six months. That's a total of only about 10% of the total who had any benefit from shock that lasted as long as six months.

The study notes that most patients who relapsed did so very quickly. This is consistent with earlier studies. NIMH reviewed these studies and concluded that there is no scientific evidence that any benefit of ECT lasts longer than four weeks.

It has been noted by numerous scientists that this extremely brief period of well being is entirely consistent what is seen in other types of brain injuries, and with the theory that ECT "works" by causing an acute organic brain syndrome.

In contrast to benefits, the adverse effects of ECT are permanent. At any length of time at which survivors have been followed up post-ECT, the vast majority report a stable retrograde amnesia for months or years. When survivors have been tested with instruments sensitive to brain injury at any length of time post-ECT, they have exhibited stable and permanent deficits in intelligence, memory ability, abstract thinking and other cognitive functions, and the pattern of impairment is consistent among survivors no matter when or where they had ECT. All of the adverse effect reports collected by the FDA are of permanent, enduring deficits. The effects of electricity on the human brain have not been mitigated by any claimed improvements or refinements by the industry. There is a great deal of variance among individual ECT patients, because the amount of electricity received varies greatly and cannot be controlled by even the most modern devices, due to human physiology and the nature of electricity. There is no way to predict who will be most devastated by ECT.

ECT's morbidity rate is 100%. It commonly results in permanent disability, and lifetime Social Security payments, in adults who previously were able to work. Its mortality rate, based on very spotty statistics, may be as high as 1 in 200. ECT has not been shown to be more effective than no treatment at all, and even the most biased estimate of its longterm efficacy rate is only 10 to 40%.

You would be right if you guessed that the FDA has placed the ECT device in its Class III, High Risk category. FDA warns that the benefits of ECT do not outweigh its risks and that its risks include brain damage and memory loss.

If ECT were a drug just coming on to the market, it would not be allowed to be used.

If safety trials of a drug showed that the drug caused permanent amnesia, disability, and brain damage in even a small fraction of those who have experienced these effects due to ECT, that drug would be pulled off the market.

Would it surprise you at this point to learn that there have never been any safety trials of the ECT device? There have not. None of the manufacturers of the devices have ever conducted a single safety test. (When manufacturers, in their ads, say their devices are safe, they mean safe for the treating psychiatrists and nurses!) Even in 1997, when the FDA belatedly called for them to submit safety information, they did not submit one shred of evidence, because there is none. They knew there would be no consequences for not submitting the required information, and there have been none. If the ECT device didn't have the powerful lobby of the American Psychiatric Association behind it, it would be pulled off the market.

You may rightly ask why ECT continues to be used given its terrible track record. There are many reasons. One is the historical quirk that ECT was invented in fascist Italy, at a time and place where there were no protections for patients and no regulation of industry, that it continued to be used free of the restrictions and protections we take for granted in this country, and that today it is still largely immune from such restrictions and protections. We can't even get the most basic information about the use of ECT in New York State today, such as how much it's done!

In 1976 the APA formed its Task Force on ECT, and since then ECT has been kept alive largely by vigorous sustained effort on the part of a dozen men who design the machines, conduct the research, consult for the companies, and otherwise owe their highly paid lifestyles to ECT. New York State is home to two men in particular who have staked everything on ECT and have everything to lose if it is discredited. It's the shame of our state and part of the reason all attempts at patient protection here have failed so far. Both men are or were state employees. No wonder OMH is so invested in the forced shock of Paul Thomas, Adam Szyszko, and so many others.

Fink and Sackeim and a few others around the country are so busy promoting ECT, lying to the media, conducting big ticket how-to-do-shock seminars, etc., because if they let up on their public relations campaign for a minute ECT would collapse under the weight of all the scientific evidence against it.

Did I mention how enormously profitable it is? Medical journals recommend setting up "ECT suites" to bolster incomes threatened by managed care. Insurance companies pay for ECT without asking questions, and that's not an accident; the proponents of ECT, such as Dr. Fink, are consultants to the insurance companies. Psychiatrists who do ECT make an average of twice the income of those who don't use it, and they can achieve this increase in income by working only the few hours a week it takes to give a bunch of treatments. It's easy to set up an ECT practice; all you have to do is pay about a thousand dollars to Drs. Fink, Sackeim, Weiner, etc.; go to the seminar for a few hours, pass the test and you're considered qualified to do ECT. This practice bears further scrutiny by the Assembly.

As a society, we allow things to be done to mental patients that would be unconscionable if done to persons without psychiatric labels. Hatred and fear of mental patients is so ingrained among the general population, and so unquestioned, it's never recognized for what it is, except by those of us who are on the receiving end of it every day. Getting a psychiatric label is like having a curse placed on you: from this day on, as long as you live, you will not be believed. You may dismiss my testimony and that of my peers, if you wish, as the ravings of an irrational crazy person, without compunction, because it's socially acceptable for you to do so. You may place less value on the brain and life of Paul Henri Thomas than you would on your own, and that again is socially acceptable. You may even do these things without conscious awareness that you are doing them. This is how shock and forced shock came to be, and how they continue.

Along these lines, I warn you not to derail these hearings into a general discussion of mental patient competency---as happened to some extent in 1977. Too often, the discussion on informed consent to shock ends when someone assumes that the real issue is that mental patients lack capacity to consent to anything. First of all, that's not true in the vast majority of cases. Second, it implies that the problem with shock resides in the patient, and not the industry. In 2001, the sharpest, most alert, most intelligent and competent patient cannot give informed consent to ECT, because there is nowhere in New York State or in the country where that patient will be informed of the true risks and benefits of shock. The patient is deceived by the assurances provided by the shock industry that shock is effective, that memory loss is trivial and rare, that memory comes back...the lies propagated by the APA's small Task Force of career ECT promoters. Until the day when the most competent patient can give informed consent to shock, no one can.

There is one more reason why ECT continues to exist. Psychiatrists need it. There are always going to be people whom they cannot help, and the more the field comes to rely exclusively on biological theories of mental illness and biological treatments, the more true this will be. There must be something psychiatry can hold out to those it has failed (and it is they who have failed, despite their practice of referring to their patients as "treatment failures")---something drastic and dramatic, something absolutely certain to have a dramatic effect in the short term, some last resort that can get the patient out of the hospital in the time allotted by the insurance companies and make the psychiatrist look like a hero. If a patient's brain is damaged in the process, that is a small price to pay (for the psychiatrist). Psychiatry offers brain damage as treatment because it has nothing else to offer. It is bankrupt. I am sure that if psychiatry could come up with something else besides ECT that fit the need for the last-resort treatment, it would get rid of shock. It's been trying for decades and hasn't come up with anything. Dr. Sackeim and others who have tried to develop (and profit from) drugs to eliminate the adverse effects of ECT have been unsuccessful. He's currently experimenting with giant magnets. But psychiatry's not going to admit ECT is brain damage until it has something else to offer. It puts saving face ahead of saving patients' brains.

Contact information:
Linda Andre
Committee for Truth in Psychiatry
P.O. Box 1214
New York, NY 10003

212 665-6587
ctip@erols.com

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Some time back The Westend Weekly published a story about Wayne Lax. He is anti electro shock and has joined a growing world wide group who are trying to get the practice banned. There are conflicting attitudes toward these treatments. Most of the doctors (but not all) still insist it is effective and not barbaric.

The patients who have received these treatments, again with exceptions, say they have lost years of their lives, have long lasting or permanent memory loss and want it stopped. Wayne, along with many others take every chance to speak with anyone who will listen and give their accounts of horrible ordeals some encounter.

Wayne has had his story published in many periodicals and newsletters. He was interviewed extensively by the BBC both for booklets and for an upcoming documentary which will be shown at a future date. The London, England based BBC has interviewed people from all over the world in regards to shock treatments and the lasting effect they have. Wayne was so angry when he recovered that he used his anger to try and help others. He has lawsuits against doctors in Kenora and Thunder Bay which are still pending.

Despite the fact that these doctors said he would never be able to live on his own he now sits on the Board of Directors for Changes Recovery Homes, Kenora; a regional representative for the Northwest Ontario Patient Council and is a member of Sunset Country Psychiatric Survivors, The Association for Community Living, People Advocation for Change and Empowerment and many other associations that deal with good mental health. He was in Fort Frances last week for Mental Health Week.

Wayne maintains there are reasons for people taking medication and he does recognize there are some very good psychiatrists, but the use of shock treatment in combination with powerful drugs is not the answer for some of the problems. He has a real concern for the fact that many facilities for patients with mental disorders are being closed or amalgamated. He is afraid the inexpensive use of shock treatments will increase to maintain compliance enabling institutions and hospitals to discharge these patients sooner.

He asked if the big new super jails the Province is building might end up warehousing former mental patients. He cited a statistic where women and the elderly, particularly elderly women, have been the prime targets of electroshock. In Canada and the USA, approximately 70% of shock survivors are women. 45% -50% are over 60 years old and several are 80 years and older. Although psychiatrists claim that depression or "clinical depression" is the main indication to administer electro-shock, people with other conditions such as anxiety, mania, post-partum depression, alcoholism, schizophrenia and dementia have also undergone electroshock.

Wayne's story is included in a new book by Scott Simmie, "The Last Taboo," a collection of stories by the famed journalist who was featured in a documentary for the CBC. This book may be available at the local Library soon. There are other books on the subject such its Remembrance of Patients Past by Geoffrey Reaume, who was diagnosed with paranoid schizophrenia in his teens and is himself a former psychiatric patient. Mr. Reaume is a Hannah post-doctoral fellow at the Institute for the History and Philosophy of Science and Technology, University of Toronto. Another book which I have read is Wendy Funk's What Difference Does it Make. This was the answer she got from her doctor when she told him the shock treatments were robbing her of her past.

Wayne had with him a plaque he received recently. It is the "Courage to Come Back Award," given by the Centre for Addictions and Mental Health Foundation. The Honorary Chair, Silken Laumann, is the Olympian who displayed courage to come back in the Olympics. She states, "your extraordinary courage is an inspiration to us all." He was nominated for this award by his sister, Joyce Roller of Thunder Bay. Joyce is one of the people who stood by Wayne and supported his fight to get well.

Wayne is very busy these days, traveling to speak and meet with anyone that needs and wants his help. It is what continues to make him well. He is also busy trying to piece together his past with the help of his records and recollections of his family and patients of the facility he formerly was admitted to. With over 100 admissions he has a lot of people to talk to.

next: Speak Out Against Shock (ECT)
~ all Shocked! ECT articles
~ depression library articles
~ all articles on depression

The fatty oil found in salmon, cod and other fish, already touted for its effectiveness in combating heart disease and arthritis, may also alleviate the symptoms of manic depressives, researchers said on Thursday. In what experts described as a limited but landmark study of how a naturally occurring dietary ingredient can affect the brain, researchers found that patients suffering from manic depression given capsules containing fish oil experienced a marked improvement over a four-month period.

"The magnitude of the effects were very strong. Fish oil blocked the abnormal signalling (in the brain) which we think is present in mania and depression,'' lead researcher Andrew Stoll, the director of the pharmacology research laboratory at Harvard University's McLean Hospital, said in a telephone interview.

The study, published in the American Medical Association's Archives of General Psychiatry, comprised 30 patients diagnosed with bipolar disorders, which are characterised by chronic bouts of mania and depression.

Roughly half the subjects received fish oil supplements and half got capsules containing olive oil, a placebo. They underwent psychological testing at two-week intervals during the four-month study.

The chemicals in the fish oil believed to be at work on the subjects' brains were omega-3 fatty acids, which are present in certain types of fatty fish such as salmon and cod. They are also found in canola and flaxseed oil.

Among the many health benefits sometimes attributed to omega-3 fatty acids are smoothing blood flow through constricted arteries of heart disease patients, lubricating painful joints in rheumatoid arthritis sufferers, cutting women's risk of breast cancer, preventing an intestinal inflammation known as Crohn's disease, and even ridding the body of cellulite.

But there has been little done on the effect of omega-3 fatty acids on the human brain.

Stoll said omega-3 fatty acids boost levels of the neurotransmitter serotonin in the brain -- similar to the effect of popular anti-depressants such as Prozac -- although the mechanism by which either works remain uncertain.

He said previous research on animals showed that omega-3 fatty acids replenished the "lipid bilayer'' surrounding the body's cells, including brain cells, where receptors reside that receive signals from chemical transmitters.

Stoll theorised that diets in Western industrialised countries are low in fish and other foods containing omega-3 fatty acids, a deficiency that can be compensated for by consuming fish oil or flaxseed oil supplements.

Patients in the study received up to seven capsules daily with concentrated fish oil from menhaden, a type of Atlantic herring, containing a total of nearly 10 grams of fatty acids.

"If you're treating depression and bipolar disorder, you have to think of it as a medicine and take an adequate amount,'' Stoll said. He suggested that omega-3 fatty acids might be taken as an adjunct to anti-depressant drugs or lithium, which is commonly prescribed to treat bipolar disorders.

In a commentary on the study that was published in the journal, three researchers from Case Western Reserve University said it had "substantial limitations'' partly because of its small size, but called it "a landmark attempt.''

"Methodology aside, the fact remains that this is, I think, a critical study looking at the role of agents which are naturally occurring substances that are well tolerated -- patients nowadays have a high affinity for taking the most effective, least toxic agent they can find,'' Dr. Francisco Fernandez, chairman of the department of psychiatry at Loyola University Medical Centre, told Reuters.

"It suggests that these agents may be effective in bipolar disorders, maybe equivalent to psychotropic agents," he said, describing the effect of the omega-3 fatty acids as setting off a "cascade of chemicals'" that aid cell functioning.

The drawback is that no drug company was likely to throw its resources behind studies of fish oil, because it cannot be patented and profited from. Fernandez and the other researchers suggested government-financed research.

next: How Shock Therapy Works
~ all Shocked! ECT articles
~ depression library articles
~ all articles on depression

Non-stimulant, Amoxetine, for treating ADHD appears to be safe and effective - providing alternative to stimulants for treatment of ADHD.

An experimental drug could offer an effective nonstimulant alternative for treating attention-deficit/hyperactivity disorder (ADHD), according to Dr. David Michelson, who spoke here at the 154th annual meeting of the American Psychiatric Association.

Atomoxetine is more effective than placebo for treating ADHD and may be more easily tolerated, said Michelson, medical director at Eli Lilly, the company responsible for the drug's development. In a presentation of several studies funded by Eli Lilly that involved adults and children, he and his colleagues concluded that atomoxetine was superior to placebo in controlling ADHD symptoms.

ADHD is characterized by impulsiveness, difficulty with academic and social functioning, and short attention span. It is most frequently treated with the stimulant drug Ritalin.

In one study in which some patients were given Ritalin, investigators found some evidence that atomoxetine is more easily tolerated. For example, atomoxetine does not appear to be associated with insomnia.

"Atomoxetine seems to work by blocking the norepinephrine transporter and doesn't involve the dopamine receptors directly,'' he told Reuters Health. "Therefore, it has a different mechanism of action than the stimulants commonly used to treat ADHD.''

"Clinicians and parents have been looking for alternatives to stimulants for the treatment of ADHD for years,'' Dr. Christopher Kratochvil, assistant professor of psychiatry at the University of Nebraska, told Reuters Health. "There are concerns about side effects, and about reports of children and adolescents using it recreationally. We're looking for an alternative class of medications that will be effective and have a different side effects profile than stimulants. Indications are that atomoxetine is not an abusable drug.''

In addition, stimulants are not effective for every patient with ADHD. For example, children with ADHD who have other conditions, such as anxiety disorder, may be more effectively treated with a nonstimulant alternative, said Kratochvil, who was an investigator in the study. He has also worked as a consultant for Eli Lilly and other companies.

In his experience, Kratochvil said, atomoxetine has been a safe and effective treatment for the management of this condition. Phase III studies of atomoxetine are ongoing, and Eli Lilly is preparing to submit an application to the Food and Drug Administration for approval of this drug for the treatment of ADHD later this year, Kratochvil told Reuters Health.

Large study shows Luvox is safe and effective in treating anxiety disorders in children and adolescents.

A multi-site study to evaluate treatments for anxiety disorders in children and adolescents, funded by the National Institute of Mental Health (NIMH), found that a medication was more than twice as effective as the placebo, or sugar pill. The research trial, which cost $1.7 million, involved 128 children and adolescents ages 6 to 17 over a period of eight weeks. Symptoms improved in 76 percent of those randomly assigned to take the medication, compared to only 29 percent of those in the placebo group. The study, "Fluvoxamine (Luvox) For The Treatment Of Anxiety Disorders In Children And Adolescents," is being published this week in the New England Journal of Medicine.

Although anxiety disorders affect an estimated 13 percent of children and adolescents during any given six-month period, making them the most common class of psychiatric disorders in that age group, the disorders are often not recognized, and most who have them do not receive treatment.

Common signs of anxiety disorders in children are excessive worrying about ordinary activities, such as going to school or summer camp, taking a test or performing in sports. At times, there are physical symptoms such as palpitations, sweating, trembling, stomachache, or headache. There may be avoidance of certain situations that are perceived by the child to be sources of anxiety. This avoidance can cause social withdrawal. When these symptoms cause extreme distress and interfere with the functioning of the child in usual activities, a child is diagnosed as having an "anxiety disorder."

These disorders are properly recognized through a careful evaluation that includes direct examination of the child, a parent interview and a collection of past history. Anxiety disorders cause significant suffering and functional impairment in the affected children. While not all of them will continue to suffer from these disorders into adulthood, some will, and early treatment may help prevent future mental health problems, including suicide attempts.

Researchers used four inclusion criteria to select participants for the study, including a clinician-rated scale that was developed for the study to assess symptoms of the targeted disorders. The participants also had to go through several weeks of extended evaluation, during which time supportive psychotherapy was initiated. Only children who had not adequately improved at the end of that period were entered into the medication study. This was done to avoid exposing to medications children who might have improved with simple support and encouragement.

NIMH director Steven E. Hyman said, "This ground-breaking study is a big step forward in our understanding of how to treat children and adolescents with anxiety disorders. More research is still needed, however, to compare the efficacy of existing therapies, including cognitive-behavior therapy, to, or in combination with, medication."

The medication used in this new study, fluvoxamine, is one of the class known as selective serotonin re-uptake inhibitors (SSRIs), which is used to treat depression and anxiety disorders in adults. This medication has also been approved for treatment of obsessive-compulsive disorder in adults and children age 8 and above. Children and adolescents with a current diagnosis of obsessive-compulsive disorder were among those excluded from the study, which focused on those with at least one of three other anxiety disorders that typically occur together: generalized anxiety disorder, separation anxiety disorder, and social phobia.

"Although physicians often prescribe fluvoxamine for children and adolescents with these three anxiety disorders, this is the first rigorous examination of this medication's safety and efficacy in treating them," said Daniel Pine, one of the researchers on the study. "Each child or adolescent whose functioning is impaired by anxiety disorders should be carefully evaluated by a professional who is familiar with childhood anxiety disorders to determine the best course of therapy for that particular child." Dr. Pine is now Chief of Development and Affective Neuroscience and Child and Adolescent Research in the NIMH's Intramural Mood and Anxiety Disorders Program.

No severe side effects from the medication occurred in the study, although 49 percent of the study participants who were taking it had stomachache compared to 28 percent of the children and adolescents on placebo. The medication was also associated with greater increases in children's levels of activity than was the placebo. The side effects, however, were usually mild, and only five of the 63 children in the medication group discontinued treatment as a result of these adverse events, as compared with one of the 65 children in the placebo group. Most of the participants were under age 13. Half were boys. About 65 percent were white and about 35 percent were from minority ethnic groups.

The study was conducted at five sites of the Research Units of Pediatric Psychopharmacology (RUPP) network, which is funded by NIMH. The RUPP network is composed of research units devoted to conducting studies to test the efficacy and safety of medications commonly used by practitioners to treat children and adolescents (off-label use) but not yet adequately tested.

Source:

• NIMH, April 25, 2001

next: Anxiety in the Elderly
~ anxiety-panic library articles
~ all anxiety disorders articles

Men who suffer from eating disorders have higher rates of depression, anxiety disorders and alcohol abuse than their peers do, study findings suggest.

These men with eating disorders, are also more likely to report problems in their marriage and feel dissatisfied with life in general, researchers report in the April issue of the American Journal of Psychiatry.Women and Depression

However, it is not clear whether these findings reflect factors that predispose a person to an eating disorder or are consequences of anorexia and bulimia.

In an interview with Reuters Health, lead author Dr. D. Blake Woodside, of the University of Toronto in Canada, called anorexia and bulimia "extremely soul-destroying" disorders. Individuals with eating disorders "are very unhappy" and are more likely to experience difficulty in their relationships, he explained.

The findings are based on information from 62 men and 212 women with eating disorders and more than 3,700 unaffected men. Nearly 15% of anorexic and bulimic men reported that they had been depressed at some point in their lives and 37% said they had been diagnosed with an anxiety disorder.

In contrast, only 5% of men without an eating disorder reported depression and about 17% said they had ever suffered from an anxiety disorder, the report indicates. More than 45% of men with eating disorders said they had been alcohol-dependent at some point in their lives, compared with about 20% of their peers.

Men with eating disorders also reported less satisfaction with their leisure activities, housing, income and family life, the authors point out.

Nearly 26% of anorexic and bulimic men said they had more than one marital conflict a week compared with roughly 10% of their peers, and about 63% of anorexic or bulimic men said they were currently living with their spouse, compared with 83% of men without eating disorders.

"Men with eating disorders showed striking differences from men without eating disorders," Woodside and colleagues conclude. "The extent to which these differences are effects of the illness or possible risk factors for the occurrence of these illnesses in men is not clear."

In other findings, eating disorders appeared to be clinically similar in both sexes, the researchers note.

next:Anorexic Women More Likely to Be Suicidal: Study
~ all articles on depression and eating disorders
~ eating disorders library
~ all articles on eating disorders

Discover the history of the ADHD diagnosis along with DSM-IV diagnostic criteria for Attention-Deficit/Hyperacivity Disorder (ADHD).

The Diagnostic and Statistical Manual of Mental Disorders includes standardized diagnostic criteria for many psychiatric disorders. First published by the American Psychiatric Association in 1952, the manual is used as a resource by the majority of mental health professionals. In its earlier editions, many clinicians considered the DSM merely a tool for researchers. Now, in an era of managed care, clinicians are often forced to rely on the standardized criteria in the DSM in order to remit insurance claims. And its impact goes even further. If a condition is acknowledged by the DSM, it can be credibly used in a legal defense, or in a disability claim. In the case of ADHD, a diagnosis can mean that a child is entitled to receive special educational services from his or her school district.

In its 50-year history, the DSM has been significantly updated four times--in 1968, in 1980, in 1987, and in 1994. It wasn't until the second edition was published in 1968 that a disorder resembling ADHD appeared in the DSM. The "hyperkinetic reaction of childhood" was defined as a type of hyperactivity. It was characterized by a short attention span, hyperactivity, and restlessness.

In the third edition of the manual (DSM-III) published in 1980, the name of this childhood disorder was changed to Attention Deficit Disorder (ADD), and its definition was expanded. The new definition was based on the assumption that attention difficulties are sometimes independent of impulse problems and hyperactivity. Therefore, the disorder was redefined as primarily a problem of inattention, rather than of hyperactivity. In keeping with this approach, two subtypes of ADD were presented in DSM-III--ADD/H, with hyperactivity, and ADD/WO, without hyperactivity.

The inclusion of ADD/WO has been the subject of debate ever since. When the third edition of the manual was revised in 1987 (DSM-IIIR), the name of the disorder and its diagnostic criteria had been overhauled, once again emphasizing hyperactivity. The authors now called it Attention Deficit Hyperactivity Disorder (ADHD), and consolidated the symptoms into a unidimensional disorder, without any subtypes at all. This definition did away with the possibility that an individual could have the disorder without being hyperactive.

After the publication of the DSM-IIIR, a variety of studies were published supporting the existence of ADD without hyperactivity, and the definition was changed again in the fourth, and most recent, edition of the manual published in 1994 (DSM-IV). The authors did not change the name ADHD, but the symptoms were divided into two categories--inattentive and hyperactive/impulsive--and three subtypes of the disorder were defined: ADHD, Primarily Inattentive; ADHD, Primarily Hyperactive/Impulsive; and ADHD, Combined Type.

The DSM-IV listing attempts to describe the typical manner in which ADHD manifests in affected children--when symptoms appear, when parents and caretakers can reasonably expect the symptoms to attenuate, and what factors may complicate the diagnosis of ADHD.

The DSM-IV urges clinicians to use caution when considering an ADHD diagnosis under certain circumstances. The manual notes, for example, that it is difficult to diagnose ADHD in children who are younger than 4 or 5 years of age because the variability in normal behavior for toddlers is much greater than that of older children. It also recommends that evaluators use caution in diagnosing adults with ADHD solely on the adults' recollection of symptoms they experienced as a child. This "retrospective data," according to the DSM-IV, is sometimes unreliable.

Below are the current diagnostic criteria for ADHD, taken from the text-revised edition of the DSM-IV, which was published in the summer of 2000. Note that this excerpt comprises only a fraction of the DSM-IV's entry on ADHD.

Diagnostic Criteria For Attention-Deficit/Hyperacivity Disorder (DSM IV)

(A) Either (1) or (2):

(1) six (or more) of the following symptoms of inattention have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level;

Inattention

• often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities
• often has difficulty sustaining attention in tasks or play activities
• often does not seem to listen when spoken to directly
• often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions)
• often has difficulty organizing tasks and activities
• often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework)
• often loses things necessary for tasks or activities (e.g., toys, school assignments, pencils, books, or tools)
• is often easily distracted by extraneous stimuli
• is often forgetful in daily activities

(2) six (or more) of the following symptoms of hyperactivity-impulsivity have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level:

Hyperactivity

• often fidgets with hands or feet or squirms in seat
• often leaves seat in classroom or in other situations in which remaining seated is expected
• often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness)
• often has difficulty playing or engaging in leisure activities quietly
• is often "on the go" or often acts as if "driven by a motor"
• often talks excessively

Impulsivity

• often blurts out answers before questions have been completed
• often has difficulty awaiting turn
• often interrupts or intrudes on others (e.g., butts into conversations or games)

(B) Some hyperactive-impulsive or inattentive symptoms that caused impairment were present before age 7 years.

(C) Some impairment from the symptoms is present in two or more settings (e.g., at school [or work] and at home).

(D) There must be clear evidence of clinically significant impairment in social, academic, or occupational functioning.

(E) The symptoms do not occur exclusively during the course of a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder and are not better accounted for by another mental disorder (e.g., Mood Disorder, Anxiety Disorder, Dissociative Disorder, or Personality Disorder).

Sources:

• DSM-IV-TR. The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC: American Psychiatric Association.
• Diagnostic and Statistical Manual of Mental Disorders, Wikipedia.

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Child neurologist, Dr. Fred Baughman says ADHD and other psychiatric diagnoses are fraudulent and over-diagnosed. Other experts counter that ADHD is a legitimate diagnosis.

Fred Baughman, MD

You take the position that ADHD and many of these other psychiatric diagnoses are fraudulent. Why?

An active opponent of the ADHD diagnosis, Baughman has been a child neurologist, in private practice, for 35 years. He is also a medical expert for the Citizens Commission on Human Rights (CCHR), an advocacy group founded by the Church of Scientology in 1969.

The American Psychiatric Association's diagnostic manual, the DSM, lists 18 behaviors, from which a teacher can check off behaviors she observes in the potential patient or student. Likewise, the parent or caregiver does the same thing. In the current DSM, if one checks six or more of the nine, the individual is deemed to have ADHD.

Let there be no mistake about it. Present-day psychiatry, led by the National Institute of Mental Health in league with the American Psychiatric Association and the American Academy of Child Adolescent Psychiatry, represents ADHD . . . to be a biologic abnormality of the brain, a so-called neurobiologic disorder. Their representation to the entire public and to all the teachers and all mental health professionals is that, having ticked off six or more of these nine behaviors, one has diagnosed an organic or a physical abnormality of the brain.

Their neurobiologic propaganda has been so intense for so many years, that the country believes in this. ... We've got probably, conservatively . . . six million [children in the United States] on medications for ADHD and a total of nine million with neurobiologic psychiatric diagnoses of one sort or another, on one or more psychotropic drugs. Here we're talking about as many kids as you've got people in New York City, and to me, this is a catastrophe. These are all normal children. Psychiatry has never validated ADHD as a biologic entity, so their fraud and their misrepresentation is in saying to the parents of the patients in the office, saying to the public of the United States, that this and every other psychiatric diagnosis is, in fact, a brain disease.

Establishing whether it's actually a biological brain disease seems to be a less important issue. The question is whether there aren't certain conditions with symptoms that can't be aided and addressed with psychotropic medications. What's wrong with that?

Well, what they've done essentially is to propose that there are children who, up to the time they walk down the schoolhouse path, seem to everyone to be entirely normal. But what they have proposed is that there are children who are misbehaving at school and at home who are inherently unable to achieve self-control because they've got something wrong in their brain. This ignores whether or not their parenting is optimal, and whether or not their de facto parenting in school or disciplining at school in the hands of a teacher is optimal or not. ...

But in the real world, parenting will never be optimal. Schooling is rarely optimal. But we've got a class of people telling us, psychiatrists and family physicians, that there is a drug that can help children that have a certain set of symptoms. What's wrong with that?

I think that the deficiency is, in fact, in the adults . . . It's a terrible misstep not to require any correction of the adults who are responsible for the development of the child. . . . By denying that there is any problem at all in the adults, and just accepting that it's a chemical imbalance and you're going to take a pill for it, I think you're going to leave unaddressed and undone . . . things that must be done, and should be done, and are being done in proper homes, and are being done in parochial and private schools throughout the country. . . .

Peter Breggin

Psychiatrist and author of Talking Back to Ritalin: What Doctors Aren't Telling You About Stimulants and ADHD, Breggin founded the nonprofit Center for the Study of Psychiatry and Psychology. He has been a vocal opponent of the ADHD diagnosis and he strongly opposes prescribing psychiatric medications to children.

How do you respond to the parents who give glowing testimonies about how that drug has helped their child?

In America today, it's easy to go out and get glowing testimony from parents about how wonderfully their children have been doing on Ritalin. There was a caged animal, a polar bear, in the zoo in Toronto, who was pacing up and down and looking uncomfortable, and looking like he'd really like to go back to the Arctic or the Antarctic. And they put him on Prozac, and he stopped pacing. His name was Snowball. He sat quietly and looked happy. And animal rights people gathered to the zoo and protested the drugging of a polar bear to make him into a good caged animal, and he was taken off the drug.

We have lost track of what childhood is about, of what parenthood and teaching is about. We now think it's about having good quiet children who make it easy for us to go to work. It's about having submissive children who will sit in a boring classroom of 30, often with teachers who don't know how to use visual aids and all the other exciting technologies that kids are used to. Or there are teachers who are forced to pressure their children to get grades on standardized tests, and don't have the time to pay individual attention to them. We're in a situation in America in which the personal growth and development and happiness of our children is not the priority; it's rather the smooth functioning of overstressed families and schools. . . .

There are no miracle drugs. Speed--these drugs are forms of speed--don't improve human life. They reduce human life. And if you want less of a child, these drugs are very effective. These parents have also been lied to: flat-out lied to. They've been told that children have a neurobiological disorder. They've been told their children have biochemical imbalances and genetic defects. On what basis? That they fit into a checklist of attention deficit disorder, which is just a list of behaviors that teachers would like to see stopped in a classroom? That's all it is. . . .

One of the really obscene things that has happened is that psychiatry has sold the idea that if you criticize drugs, you're making parents feel guilty. What an obscenity that is. We are supposed to be responsible for our children. . . . If we're not responsible for raising our children, what are we responsible for? If children aren't entrusted to us for the specific purpose of our turning ourselves inside-out to be good parents, what is life about? It is a disgrace that my profession has pandered to the guilt of parents by saying, "We'll relieve you of guilt. We'll tell you your child has a brain disease, and that the problem can be treated by a drug."

That's pandering to the worst desires that we have as parents--all of us--which is to say, "I'm not guilty of this problem." . . . I'd rather be guilty as a parent, and say, "I did wrong," than say, "Son, you have a brain disease." Sure, we're all tempted. We're all tempted, when we're in conflict with our children, to hold them responsible. And how much easier it is if we don't even have to hold them responsible. . . .

Let's talk about the lawsuits that have been filed against the Novartis, the manufacturer of Ritalin.

On Tuesday, May 2, a class action suit was brought against the manufacturers of Ritalin and Novartis, against [CHADD], a parents' group that has been heavily funded by the drug companies, and the American Psychiatric Association--for the fraudulent overemphasis on the ADHD diagnosis and treatment with Ritalin. The American Psychiatric Association, CHADD, and the drug manufacturer are accused of conspiracy. The case has been brought in Texas by the law firm of Waters & Krause, and is now actually in the courts. . . . Probably there's going to be a series of related cases, or at least a number of attorneys coming together, around this issue of fraud and conspiracy in the promotion of the diagnosis and the promotion of the drug.

So that will hinge on showing what? Damage to the children?

No damage is required to be shown to the children in this case, because it's not that kind of product liability case. All that the parents have to show is that they spent money on Ritalin, when they were in fact fraudulently induced to think that it would be worth something. . . .

There's actually a great deal of evidence for a conspiratorial relationship. According to international law, you cannot directly promote a highly addictive Schedule II drug to the public. Ritalin is in Schedule II along with amphetamine, methamphetamine, cocaine and morphine. And you're not allowed to put ads in the newspaper for that. You're not allowed, according to international conventions, to directly promote to the public.

Professor of psychiatry and neurology at the University of Massachusetts Medical Center in Worcester. Author of numerous books on ADHD, including ADHD and the Nature of Self-Control and Taking Charge of ADHD: The Complete, Authoritative Guide for Parents.

There are 6,000 studies, hundreds of double-blind studies, and yet, there's still controversy. Why?

There is controversy about ADHD, I believe, partly because we are using a medication to treat the disorder, and people find that to be of concern. But there's also concern because ADHD is a disorder that appears to violate a very deeply held assumption that laypeople have about children's behavior. All of us were brought up believing, almost unconsciously, that children's misbehavior is largely due to the way they're raised by their parents and the way they're educated by their teachers. If you wind up with a child who is out of control and disruptive and not obeying, that that has to be a problem with child rearing. ... Well, along comes this disorder that produces tremendous disruption in children's behavior, but it has nothing to do with learning, and it isn't the result of bad parenting. And therefore it violates these very deeply held ideas about bad children and their misbehavior.

And as long as you have this conflict between science telling you that the disorder is largely genetic and biological, and the public believing that it arises from social causes, you're going to continue to have tremendous controversy in the mind of the public.

Now, there is no controversy among practicing scientists who have devoted their careers to this disorder. No scientific meetings mention any controversies about the disorder, about its validity as a disorder, about the usefulness of using stimulant medications like Ritalin for it. There simply is no controversy. The science speaks for itself. And the science is overwhelming that the answer to these questions is in the affirmative: it's a real disorder; it's valid; and it can be managed, in many cases, by using stimulant medication in combination with other treatments.

Many people in the public ask, "Where were these kids when I was growing up? I've never heard of this before." Well, these kids were there. They were the class clowns. They were the juvenile delinquents. They were the school dropouts. They were the kids who quit school at 14 or 15 because they weren't doing well. But they were able to go to work on their parents' farm, or they were able to go out and get in a trade or get into the military early. So they were out there.

. . . Back then, we didn't have a professional label for them. We preferred to think of them more in moral terms. They were the lazy kids, the no-good kids, the dropouts, the delinquents, the lay-about ne'er-do-wells who were doing nothing with their life. Now we know better. Now we know that it is a real disability, that it is a valid condition, and that we shouldn't be judging them so critically from a moral stance. . . .

Skeptics say that there's no biological marker--that it is the one condition out there where there is no blood test, and that no one knows what causes it.

That's tremendously naïve, and it shows a great deal of illiteracy about science and about the mental health professions. A disorder doesn't have to have a blood test to be valid. If that were the case, all mental disorders would be invalid--schizophrenia, manic depression, Tourette's Syndrome--all of these would be thrown out. ... There is no lab test for any mental disorder right now in our science. That doesn't make them invalid.

William Dodson

A psychiatrist in Denver, Colorado, Dodson ascribes ADHD mostly to biological causes. He is paid by Shire Richwood, the makers of Adderall, to educate other physicians about the drug's efficacy.

. . . In this country, there is a tenet of faith that says that any difficulty in life can be overcome if you have a good character, if you try hard enough and long enough. And so they don't like that tenet of faith challenge, that there are some children who come from the womb genetically predisposed to being inattentive, compulsive, somewhat reckless, and perhaps aggressive, no matter how hard they try. Trying harder is ineffective.

These people confuse an explanation for misbehavior and failure with an excuse. In point of fact, when people are diagnosed with ADHD, more is expected of them, not less. Now that you've got the diagnosis, now that you're on medication, our expectations for your performance in life are going to increase. But there are a lot of people who say, "I don't want to let the person off. I don't want this to be an excuse." But it's not an excuse. It's an explanation. . . .

I would ask those people to prepare themselves for that day 15 or 20 years from now when their child comes to them and says the following, "Now, let me get this straight. You saw that I was struggling. You saw that I was failing in school. You saw that I couldn't fall asleep at night. You saw that I was having trouble with my interpersonal relationships. You knew that it was ADHD. You knew that it had a good safe treatment. And you didn't even let me try? Explain that to me."

Those folks had better start working on their answer right now, because they're going to need 15 or 20 years to come up with a compelling answer for their child who asks them that question. "You saw me struggling and you did nothing?" That's a good question. And to me, it's a far more compelling one than saying, "We don't have perfect answers, therefore, let's do nothing."

Peter Jenson

Formerly the head of child psychiatry at the National Institute of Mental Health, Jensen was the principal author of the landmark NIMH study: NIMH, the Multimodal Treatment Study of Children with Attention Deficit Hyperactivity Disorder (MTA). He is now the director of Columbia University's Center for the Advancement of Children's Mental Health.

There doesn't seem to be a lot of consensus about ADHD, even among your own peers.

I think there's consensus among most medical professionals that ADHD is a neurobehavioral disorder, that it's severe, that it affects boys somewhat probably more than girls, and that it's treatable. Now, where consensus begins to break down is how workable the treatments are, and effective and safe over the long-term; and what the exact causes of it are. And it likely has many different causes.

There isn't good consensus about the best way to draw the boundaries between ADHD and other syndromes. But I think you will find that most experts do agree that it's a real disorder that we can characterize reliably, that it has bad outcomes if left on its own, that we can do something about it, and that there is a research agenda that does need further pressing forward and carrying out. . . .

The job of medical science is to decide when it's a real medical condition that has suffering and impairment and lowers the quality of life--and sometimes not only lowers the quality of life, but lessens productivity and even actual days of life. Depression is a good example; we know there that life is actually shortened by suicide.

But kids with ADHD are also at risk for dying somewhat earlier. They are at risk for accidents. It's true for most of the psychiatric disorders. We don't know all the reasons why that is. Sometimes it's accidents, sometimes it's something like suicide. Sometimes it's because people don't obtain adequate health care. There are a lot of mysteries here. But the diseases of the mind shouldn't be treated any differently than the diseases of the other parts of the body, and we've done that too much, I think, as a society. . . .

What about the idea that ADHD is not a disease--that it's simply behavior that's a result of ineffective parenting?

There's no question that a child's behavior affects adults, and adults' behavior affects children. We call that "the human condition." Can it be the case that some children's difficulties are because they're not being handled appropriately? Absolutely true, of course. But does that explain ADHD? Well, all of the studies suggest just the opposite, in fact. When we do these studies to teach parents the most elegant, best parenting strategies that we know how to do--including things you have to get a PhD in parenting to learn--when we give parents and teachers those skills, does it make these problems go away? No. It reduces them a little bit, but there's something different for many of these children. . . .

There is a real need to get the message out, to help parents understand ADHD. This is not something a child chooses just to do. "Oh, I think I'm going to have real difficulties attending," or, "I don't want to attend," or "I want to look out the window and not attend to the blackboard." If you study these kids as we have, these kids feel bad about themselves. They don't want to be this way. In many ways, it's like a learning disability. Whereas you can maybe sit and listen and attend to me for hours on end, these kids' minds are off after 10 or 15 or 20 seconds. . . . Most kids can track this kind of situation, or a classroom situation, for minutes, tens of minutes, twenties of minutes, or even an hour on task, with minor deviations. . . . These kids can't. It's not that they're willfully disobedient or that we have bad teachers. . . .

Harold Koplewicz

Vice chairman of psychiatry at New York University, Koplewicz believes that ADHD is a legitimate brain disorder. He wroteIt's Nobody's Fault: New Hope and Help for Difficult Children and Their Parents. He is director for the New York University Child Study Center.

A lot of people out there say that all of this is just a fraud, that you've invented this disorder, along with hundreds of other psychiatrists and along with the pharmaceutical industry, which just wants to make more money. They say that there is no litmus test diagnosing ADHD, and this is just a whole bunch of subjective symptoms. What do you say to those people?

I think that the most important part is that when you're able to systematically study what these kids look like long-term, you start to recognize that without treatment, these children lose out on a normal life. They can't get the joy of getting decent grades. They can't get the joy of being picked to be on a team. They get very demoralized. They don't necessarily get depressed, but life becomes a very demoralizing place. If you're yelled at on a continual basis at your job, you'll quit. If you go to school on a regular basis and you're constantly missing out on whatever is being taught and you start to feel that you're foolish and stupid, you learn to quit. And that's maybe one of the reasons why you drop out. . . .

To suggest that this is a fraud, that somehow children are being abused by these treatments, is really an outrage, because for these kids, to not get treated is really the greatest abuse and neglect.

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ADHD expert, Dr. Lawrence Diller, criticizes the role insurance and pharmaceutical companies play in over-diagnosis of ADHD.

Lawrence Diller, M.D.

Author of Running on Ritalin, Diller received his medical degree from Columbia University's College of Physicians and Surgeons. While he has diagnosed some children in his private practice with ADHD, Diller has criticized the proliferation of the ADHD diagnosis and the rise of "cosmetic psychopharmacology."

What role do the insurance companies and pharmaceutical companies play in the world of ADHD?

. . . There's a suit going on right now in three states. It alleges that the major pharmaceutical company that makes Ritalin, the Novartis Company, along with the American Psychiatric Association, the main representatives of organized medicine in the ADHD movement, and the self-help group CHADD have conspired to dupe the American public into believing that there's such a thing as ADHD, and then thrust upon innocent children a potentially dangerous drug.

The suit alleges that there's a conspiracy. Now, there may be some legal definition that meets the conspiracy angle. But I don't believe that there's any conspiracy at all. We have what I call the "invisible hand" of Adam Smith at work. Adam Smith, as you know, wrote the fundamental textbook on capitalism. And we have market forces at major play here, getting people to think a certain way about medications, and then operating on the doctors and the patients to get them to take them first--often at the expense of other interventions that work.

As a doctor, how do you experience those forces?

. . . I experience them, first of all, by this unbelievable advertising barrage that has hit me first, and now is hitting the consumer directly. . . . I think Novartis has acted quite responsibly, relatively speaking, because I think Ritalin represents a drop in the bucket to them in terms of the kind of money they make. They're much more worried about their bio-engineered foods these days than they are about Ritalin.

On the other hand, the makers of Adderall have presented what I consider to be . . . the most disingenuous, elaborate campaign I've ever experienced. . . . Adderall has passed Ritalin in terms of trade medication written for ADHD. I've been offered $100 if I will sit and listen to someone talk about ADHD, funded by Adderall, for 15 minutes on the telephone, and then fill out a five-minute questionnaire. . . .

And now, with the loosening of controls on the pharmaceutical industry by the FDA, there is this direct marketing to families. You see this picture. . . . Well, it doesn't say that it's for Concerta. It says, "Learn more about ADHD." And it's this picture of this smiling boy who has a pencil in his hand, and on either side of him, his parents are beaming. . . . And underneath, it says something like, "They're happy, because now they know his ADHD is being treated." What's the problem with that? The problem is it pushes people to only one way of thinking about the problem--that this is a biological problem, and that it needs a drug. . . .

Is there an imbalance in how much money goes to studying the efficacy of drugs versus the efficacy of other things?

Yes. That's the other way that the market forces are operating here, in that virtually every ADHD researcher, now, because of previous cutbacks and because there is money out there, takes money from the pharmaceutical industry to do their research. And whether or not you're a doctor in the local hospital . . . or you are one of the editors of the New England Journal of Medicine, we all know that research gets influenced by the funding source.

And this is not impugning these men. It's just how it works. They don't publish negative findings. The studies are tilted more toward counting symptoms and pills, rather than looking at the bigger picture. And if you look at a very narrow picture, if you just ask very narrow questions, you will get answers that miss the big picture.

Dr. Peter Jensen, a respected authority in this field, says that, in the case of children's psychiatric medications, that it's not true; that the research money comes from the government, because the pharmaceutical companies are afraid of litigation, and they don't want to go there.

That was the case. It was difficult to fund pharmaceutical research in children, particularly psychiatric pharmaceutical research in children, because there was seen to be no market until the 1990s. The government added this rider, where the pharmaceutical company will get an extra six months of patent protection if they study the drug in children. So what we're going to get, and what we're getting, is a flood of pharmaceutical research money directed toward children. And one could be very glad for that in some ways. But again, if we only ask questions about how many symptoms does the kid have, and how many pills should he take, we are going to get a very, very narrow group of answers of what ails the kid, and what should be done about it.

So we are entrusting the research on our children's mental health and the solutions for their problems to pharmaceutical companies with vested interests?

You got it. It's clear to all of us, even those of us who do receive medication pharmaceutical money, which I don't. And I would like to, because I have to pay for my own trips. But the moment I do, I'm potentially influenced by that money.

William Dodson

A psychiatrist in Denver, Colorado, Dodson ascribes ADHD mostly to biological causes. He is paid by Shire Richwood, the makers of Adderall, to educate other physicians about the drug's efficacy.

. . . Over the last ten years, there has been extraordinary pressure within the medical field to deliver all medical care much more quickly and, therefore, much more cheaply, than it ever has been delivered before. And so there is a lot of economic pressure to diagnose and treat all disorders, medical or psychiatric, more cheaply and more quickly. So surely, yes, that's going to trickle down to the diagnosis of ADHD.

Can ADHD be diagnosed in a 15-minute well-baby check-up at the pediatrician? No way. In order to do a good, adequate evaluation, you need several hours: to do the evaluation: to rule out all the things that might mimic ADHD; to thoroughly evaluate all the things that can co-exist within ADHD; to educate the parents about the use of medication, and about the ancillary treatments that are going to be necessary; to do a quick screening for learning disabilities. A good, thorough evaluation takes time.

But we're not set up to do that?

We're set up to do it. It's that ADHD and managed care just don't go together. Managed care wants it done quickly and cheaply, and ADHD can't be done quickly and cheaply.

Another controversy is the role of the pharmaceutical companies in marketing these drugs. . . . The pharmaceutical companies make profits off of the sale of Ritalin or Adderall or Concerta. They're companies. They can strategize and put out a marketing message. The alternative therapies--such as behavioral therapy or psychotherapy--don't have that kind of lobbying muscle or marketing muscle. Therefore, it tilts the balance in favor of medication over other therapies. ... Do we have a structural bias in favor of medication?

... Everything in the United States is driven by the profit motive. We get better cars because we have a private enterprise of car manufacturers, who continue to improve their product in hopes of making more sales and making more money for their investors. That's the set-up we have in the United States. If people could demonstrate clear effectiveness from the treatments that didn't involve medication, I think that there would be a lot of people beating a path to their door. The fact is that they haven't been able to demonstrate that. . . .

Peter Jensen

Formerly the head of child psychiatry at the National Institute of Mental Health, Jensen was the principal author of the landmark NIMH study: NIMH, the Multimodal Treatment Study of Children with Attention Deficit Hyperactivity Disorder (MTA). He is now the director of Columbia University's Center for the Advancement of Children's Mental Health.

Perhaps part of the problem is that most of the studies just study the medications, so the data is there for the medication. Perhaps there isn't that much other data because there's not a lot of money out there to study the impact of behavioral therapies?

In actual fact, the money to study the medications has not been any more plentiful than the money to study the behavior therapies. The drug companies have not wanted to study kids and medicines. They're scared of them, because they've been afraid of lawsuits. . . . So 80 percent to 90 percent of the research has all been supported by the federal government. And what the federal government would do is not say, "Oh, we want medication studies." No, they'd say, "We want studies." . . . Two or three years ago, we've gone through and we counted all of the studies in the ADHD area that met certain criteria.

Well, we had about 600 studies--good clinical trials of one form of meds or another. But there were another 1,500 studies of non-meds. The med studies are easy to describe, and they're easy to kind of get the word out on. But in actual fact, most studies are not medication studies. . . . We hear about medications in the news, because it's a bit of a tempest in a teapot. But we have a lot of studies of the other treatments. ...

The pharmaceutical industry spends a lot of money in an attempt to convince you that that little pill is the next little miracle. How do you feel about that?

The FDA regulates what the drug companies--or anyone, for that matter--can do and what they can advertise if it's a pharmaceutical. ... What the drug companies are doing is guided by science. It's not the only science, but it's guided by science, and it's regulated by the federal government. ... So do I think it's a good thing that industry is trying to teach doctors about what their science has shown? . . . Absolutely. I'm all for it. We need more of it for science. . . . We need more of it for the behavior therapies. . . .

Fred Baughman

An active opponent of the ADHD diagnosis, Baughman has been a child neurologist, in private practice, for 35 years. He is also a medical expert for the Citizens Commission on Human Rights (CCHR), an advocacy group founded by the Church of Scientology in 1969.

Psychiatry and the pharmaceutical industry have become financial economic partners. And frankly, part of their economic compensation has been to develop a strategy whereby they claimed, without science, that all mental illnesses, all things behavioral and emotional, are physical brain dysfunctions or abnormalities.

Representing such things as depression, anxiety, conduct disorder, ADHD, oppositional defiant disorder, and learning disabilities as diseases, absent any scientific proof, is to deceive the public. It preempts the public's right to informed consent in every single case.

. . . [As Running on Ritalin author Lawrence Diller] pointed out, they've led the public to believe that these are brain diseases, chemical imbalances--making it logical for the public to think that a pill is going to be the solution. . . .

But the charge that the psychiatrists and the pharmaceuticals have joined together in a joint common mercenary interest is quite a charge. How can you say that?

I'm not the only one saying this. In the October, 1995, in the DEA background paper on methylphenidate, which is Ritalin, the DEA says that they have been contacted by the United Nations International Narcotics Control Board (INCB), that had expressed concern about the financial ties of Ciba-Geigy, then the manufacturer of Ritalin, to CHADD. They noted that CHADD had received over $775,000 from Ciba-Geigy, I think up through 1994, and eventually the figure went over $1 million. The INCB charged CHADD with being a vehicle for marketing a controlled substance directly to the public in violation of the Controlled Substances Act of 1971, and international statute by which all countries, all signatories, agreed.

Ciba-Geigy confessed at that point that CHADD was their conduit to the public. CHADD personnel and NIMH personnel were regularly in-house at the Department of Education office of Special Education authoring ADHD materials. I think CHADD made a grant, I believe, of $700,000-some to the Office of Special Education to make a video about ADHD. Then when John Merrow, in his video production in about 1995 . . . pointed out the financial ties between the Ritalin manufacturer, Ciba-Geigy and CHADD, I think that money was then given back by the Department of Education, back to CHADD.

Peter Breggin

Psychiatrist and author of Talking Back to Ritalin: What Doctors Aren't Telling You About Stimulants and ADHD, Breggin founded the nonprofit Center for the Study of Psychiatry and Psychology. He has been a vocal opponent of the ADHD diagnosis and he strongly opposes prescribing psychiatric medications to children.

There are many, many reasons why we're giving more and more psychiatric drugs to children. Probably the most important reason is simple marketing. The drug companies, like the tobacco industry, like the alcohol industry, are highly competitive, and are always searching out new markets. The adult market has been saturated for anti-depressant drugs. How many millions and millions of people can take Prozac and and all the other drugs? We have more adults taking anti-depressants than the National Institute of Mental Health estimates there are depressed people in the United States. The market is saturated, so the pressures move automatically to other markets. And the biggest next market is children. So you have drug company representatives, you have drug company-sponsored conferences examining this issue, or encouraging this issue of marketing to children. ...

What Ciba-Geigy, now a division of Novartis, has done is to fund a parents' group, CHADD, and the group has then gone and promoted Ritalin to the public. So that's one potential aspect to the situation.

How is it different than another pharmaceutical company supporting the American Diabetes Foundation or the American Cancer Society with funding? How is it different that Ciba-Geigy is providing some funding to CHADD?

One of the big differences in what Ciba-Geigy is doing, say, compared to a drug company who might give money for a diabetes drug to the AMA, is that Ritalin is a Schedule II--a highly addictive drug. And there are special controls put upon it by the US government. CHADD, in fact, has lobbied the US government to try to get Ritalin taken out of Schedule II. They couldn't do anything more valuable for the drug company, and more dangerous to the public, than that. Fortunately, they failed, and they failed in part because of our disclosures . . . about CHADD having so much money from the drug companies. . . .

What role did the pharmaceutical industry play in promoting Ritalin and Prozac to the country?

Even before Prozac was approved by the FDA, the drug company was sponsoring seminars for doctors throughout the country on the biochemical basis of depression, mentioning over and over again serotonin, which is the neurotransmitter that's affected by Prozac. They didn't happen to mention that there may be 200 neurotransmitters in the brain, and that connecting any one to depression is absolutely foolish speculation. The brain is an integrated organ, with probably thousands of substances participating in its function.

To label one, serotonin--which is, in fact, a widespread neurotransmitter that goes to every single lobe of the brain and affects everything from memory to coordination to cardiovascular function--imagine that that one happens to be the one that's out of balance, because Eli Lilly is selling Prozac.

But people are so eager nowadays for biological explanations. So physicians and the public grabbed on to what is essentially a PR campaign--perhaps the most successful one in the last 30 years in the Western industrialized nations--that if you have a mental disturbance, it's biochemical.

Harold Koplewicz

Vice chairman of psychiatry at New York University, Koplewicz believes that ADHD is a legitimate brain disorder. He wrote It's Nobody's Fault: New Hope and Help for Difficult Children and Their Parents. He is director for the New York University Child Study Center.

I think that we should look very carefully at who's funding science. I think you'll find that, overwhelmingly, the studies looking at treatment have been funded by the federal government. The National Institute of Mental Health has spent millions and millions of dollars looking at treatments. . . . When you looked at the medicines--all different kinds of medicines that basically have the same mechanism of action--they did work, and they were effective. And when you looked at behavioral therapy, you found that behavioral therapy wasn't effective unless they were taking medications. The federal government doesn't have a bias. They're not looking to support one treatment versus another. . . .

But yet there are pharmaceutical companies that do lobby politicians, and are out there and are pushing certain things and trying to get more funding for certain other things. And sales reps come around doctors' offices and invite doctors on cruises.

I don't think the pharmaceutical companies are affecting what the National Institute of Health is funding. I think that the reason why that's considered the gold standard is, to get funding from the National Institute of Health, you have to have a scientific research project that is peer-reviewed. Your peers review it and decide whether or not they think it's scientifically sound to use federal funds to study it.

The other question, though, about sales reps, is worthwhile. I think that doctors who are in private practice are overwhelmed with new challenges, and they are working harder than ever. Managed care has turned out not to be managed care, but managed money. We are just trying to keep the costs down of the healthcare system. So you find that doctors are seeing more patients that they ever saw before, especially if you're a primary care physician. . . .

Quite clearly, if a rep comes to your office and quickly tells you about a medication that's effective and easy and safe, that may influence your prescription practice more than reading a peer-reviewed journal. . . . And I think that that's a real problem when you have doctors who don't have enough time to keep up to date.

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