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CHILDREN

BOSTON GLOBE - Antidepressants appear to double the risk of suicidal thoughts and actions in children who take them, US regulators said in a study outlining the methodology used for a 2004 report that led to warnings on drugs including Eli Lilly & Co.'s Prozac and GlaxoSmithKline's Paxil. The Food and Drug Administration first presented the findings, detailed yesterday in the Archives of General Psychiatry, to an advisory panel in September 2004. The agency followed with a requirement that makers of antidepressants warn patients and doctors. The warning led to a 20 percent drop in antidepressant prescriptions for children between March 2004 and June 2005, according to Psychiatric News, the newspaper of the American Psychiatric Association.

JANUARY 2006

PRESSURE MOUNTS ON DOCTORS TO BREAK TIES TO DRUG FIRMS

CECI CONNOLLY, WASHINGTON POST - Declaring that the pervasive influence of drug industry money is distorting doctors' treatment decisions and scientific findings, a prestigious panel of medical experts called on their colleagues yesterday to adopt far-reaching new conflict-of-interest policies. In an article in the Journal of the American Medical Association, the group said that voluntary efforts to limit corporate inducements have failed, resulting in the over-prescribing of some medications and the withholding of negative discoveries about others. Highly publicized cases involving the anti-inflammatory drug Vioxx, antidepressants for children and spinal implants made by Medtronic -- all occurring while voluntary guidelines were in place -- highlight the need for stricter measures, they said.

http://www.washingtonpost.com/wp-dyn/content/article/2006/01/24/AR2006012401483.html

http://www.iht.com/articles/2006/01/25/news/doctors.php

HALF OF AMERICANS ON PRESCRIPTION DRUGS

REUTERS - About half of all U.S. women and 40 percent of U.S. men are currently using or have recently used a prescription drug, according to government statistics published on Thursday. This "snapshot" of information was based on a survey that found that 54 percent of white non-Hispanic women and 43 percent of white non-Hispanic men had used a prescription drug in the past month, the National Center for Health Statistics said in a statement. . . Nearly 44 percent of black women and 35 percent of black men reported using prescription drugs and nearly 38 percent of Mexican-American women and nearly 26 percent of Mexican-American men, the survey found.

DECEMBER 2005

DOCTORS TAKE $22 BILLION IN FREE GIFTS FROM CORPORATE DRUG PUSHERS

G. JEFFREY MACDONALD, CHRISTIAN SCIENCE MONITOR - Chen Kenyon and Dustin Petersen don't look like rebels. They look scrubbed and eager to learn from any doctor in a long white coat. But in the pockets of their shorter garments lurk symbols of a movement aiming to topple one of medicine's most entrenched traditions. Their pens read "Pharm Free," which means they don't take personal gifts of any size from the pharmaceutical industry. And that is touching off a quiet ethics war reverberating through the halls of academia and hospitals across the country. Messrs. Kenyon and Petersen are among a growing band of stethoscope-wearing students who believe the medical profession needs more detachment from big pharmaceutical firms.

Consequently, they're turning down everything from free catered meals to notepads, provoking debates among fellow students and quizzical looks from doctors. . . Behind the modest rebellion is the belief that taking gifts from drug companies creates a conflict of interest for doctors. The argument: To accept handouts is to feel indebted, and doctors indebted to drug firms may not be prescribing medicines based solely on what's best for their patients. The 60,000-member American Medical Student Association urges students and doctors alike to just say "no" to all personal gifts from drugmakers.

Doctors on the whole seem far less worried about the practice. The American Medical Association condones gift-taking from pharmaceutical representatives as long as no single gift is worth much more than $100. And drug companies seem to be finding plenty of takers: spending on marketing to physicians jumped from $12.1 billion in 1999 to $22 billion in 2003 ($16 billion of which was in free samples), according to data from Pharmaceutical Research and Manufacturers of America.

http://www.csmonitor.com/2005/1228/p20s01-lire.html?s=hns

38 SENATORS WITH DRUG STOCKS VOTE TO GIVE THEM A BOOST

FOUNDATION FOR TAXPAYER & CONSUMER RIGHTS - 38 U.S. Senators with up to $13.4 million in pharmaceutical holdings increased the value of their stock portfolios when they approved an amendment to the defense appropriations bill that immunizes drug makers from accountability to the public when they sell dangerous drugs and other products. . . FTCR released an analysis of Senate personal financial disclosures last week, revealing that 42 senators -- 27 Republicans and 15 Democrats -- held pharmaceutical stock worth between $8.1 and $16 million in 2004. Senators earned an additional $2.5 to $7.2 million in capital gains and dividends, and two senators' spouses also earned salaries from pharmaceuticals. . .

The provision grants immunity to drug companies for any vaccine or product, classified by the Bush Administration as necessary to respond to a public health threat, when patients are harmed by dangerous drugs. Its broad language will protect any product considered a "countermeasure," not just vaccines or drugs needed to respond to health emergencies. Sen. Bill Frist added the provision to the defense conference report, approved by the House of Representatives on Sunday, after conferees had signed what they were told was the final product. Nine members of the Senate conference committee hold pharmaceutical stock.

DETAILS
http://www.consumerwatchdog.org/resources/SenPharma.pdf

MEDICAL JOURNAL ARTICLES BEING USED FOR DRUG AGITPROP

PR SPIN - [Wall Street Journal reports that] "Many of the articles that appear in scientific journals under the byline of prominent academics are actually written by ghostwriters in the pay of drug companies." Used by doctors "to guide their care of patients," these "seemingly objective articles ... are often part of a marketing campaign." The New England Journal of Medicine recently revealed that a 2000 article on Vioxx "omitted information about heart attacks among patients taking the drug. . . The deletions were made by someone working from a Merck computer." A 1999 "publications strategy" prepared for Pfizer by a WPP Group agency listed 81 proposed articles, promoting Zoloft for everything from "panic disorder to pedophilia." One physiologist hired by Elsevier's Excerpta Medica says she was asked to "slant" a 2002 paper in favor of a Johnson & Johnson drug. Many journals ask for disclosure, but say their ability to weed out ghostwriters is limited. "I don't give lie-detector tests," said the Journal of the American Medical Association's chief editor.

http://www.prwatch.org/spin/

PR SPIN - The only licensed U.S. anthrax vaccine maker, Bio Port, turned government contracts into "a gold mine," with help from the "right lobbyists and public relations professionals," writes Bob Evans. In 2002, following questions about vaccine safety and its financial practices, Bio Port nearly quadrupled spending on lobbyists (from $30,000 to $110,000) and hired Ruder Finn and Fleishman-Hillard, "high-powered public relations firms staffed by many former government officials." The company began "sponsoring 'public education seminars' and studies." In September 2002, a report released by "bioterrorism experts" encouraged the government "to purchase millions of doses of Bio Port's product." Evans says the report was actually "written by either BioPort or its public relations agent." Bio Port also pays $40,000 a year to upkeep a website that "says it's sponsored by the Partnership for Anthrax Vaccination Education" and touts Bio Port's product. This year, BioPort won "a $122.7 million contract" with the Department of Health and Human Services, with more funding under negotiation.

http://www.kansascity.com/mld/kansascity/news/nation/13368277.htm

NOVEMBER 2005

MEET THE CHEERLEADER WHO HELPS YOUR DOCTOR PRESCRIBE YOUR DRUGS

STEPHANIE SAUL, NY TIMES - At game time, Onya cheers on the Washington Redskins. But she saves some of her energy for her job in pharmaceutical sales. Drug companies have found that former cheerleaders like Penny Otwell are good at persuading doctors. Ms. Napier, 26, was a star cheerleader on the national-champion University of Kentucky squad, which has been a springboard for many careers in pharmaceutical sales. She now plies doctors' offices selling the antacid Prevacid for TAP Pharmaceutical Products. Ms. Napier says the skills she honed performing for thousands of fans helped land her job. "I would think, essentially, that cheerleaders make good sales people," she said.

Anyone who has seen the parade of sales representatives through a doctor's waiting room has probably noticed that they are frequently female and invariably good looking. Less recognized is the fact that a good many are recruited from the cheerleading ranks. . . Some industry critics view wholesomely sexy drug representatives as a variation on the seductive inducements like dinners, golf outings and speaking fees that pharmaceutical companies have dangled to sway doctors to their brands.

But now that federal crackdowns and the industry's self-policing have curtailed those gifts, simple one-on-one human rapport, with all its potentially uncomfortable consequences, has become more important. And in a crowded field of 90,000 drug representatives, where individual clients wield vast prescription-writing influence over patients' medication, who better than cheerleaders to sway the hearts of the nation's doctors, still mostly men.

BRITS TAKE AN AVERAGE OF 373 PAINKILLERS A YEAR

INDEPENDENT, UK - One in 20 adults takes at least six painkillers every time they are feeling ill, according to a new survey. The British Medical Association said patients were "misusing" pills and urged doctors and pharmacists to be on the look-out for patients who take too many. Pharmacologists warned that people would become addicted if they took such levels of paracetamol, ibuprofen or aspirin. Britons are taking an average of 373 painkillers every year, the study revealed. The figure alarmed doctors, who said it was "staggering".

A study published in the British Medical Journal earlier this year suggested that men and women over 50 should consider taking an aspirin a day to reduce the risk of heart attacks and strokes. A daily dose of aspirin is already routinely prescribed to patients who have suffered heart attacks. But doctors said such advice alone does not account for the large average number of painkillers consumed. Many people under the age of 50 take such drugs far less often

http://news.independent.co.uk/uk/health_medical/article328164.ece

JULY 2005. . .

CHARGE: NIH SCIENTISTS WERE CLOSE TO DRUG FIRMS

BLOOMBERG - Almost four dozen scientists at the National Institutes of Health violated rules governing outside contracts with the pharmaceutical industry and nine may be investigated for criminal violations, U.S. lawmakers said. Forty-four scientists failed to report income from drug makers or take personal leave for outside work or seek approval before starting such work, an internal NIH review found. The probe cleared 37 scientists, said Representatives Joe Barton, a Texas Republican who is chairman of the House Energy and Commerce Committee, and John Dingell, a Michigan Democrat.

The NIH review suggested the agency's ethics issues are widespread, the lawmakers said in a statement. A Congressional inquiry last year uncovered potential conflicts of interest among senior NIH scientists, as many supplemented their incomes with thousands of dollars from consulting contracts with companies including Pfizer Inc., the world's largest drugmaker.

DRUG INDUSTRY SPENDING HUGE BUCKS TO BUY POLITICIANS

PR WATCH - The Center for Public Integrity has released the results of its year-long investigation into lobbying by the pharmaceutical industry, which found that the industry has spent more than $800 million since 1998 on lobbyists and political campaigns. In the past year alone, the industry hired nearly 1,300 lobbyists, including hundred of former public officials. "It is astonishing to learn that no other interest has spent more money to sway public policy in this time period," said CPI executive director Roberta Baskin. In addition to lobbying for industry-favorable policies domestically, the drug industry's trade lobby has enlisted the Office of the U.S. Trade Representative to pressure pressure foreign governments into removing price controls on pharmaceuticals and restricting sales of lower-priced generic drugs.

MAY 2005. . .

FDA FINALLY ADMITTING DANGERS IN CALMING DRUGS

LIZ SZABO USA TODAY - The Food and Drug Administration plans to add new warnings about psychiatric side effects to the label of Concerta and other drugs for attention deficits and hyperactivity, according to documents posted on the FDA website and confirmed by the agency.

At a meeting today of the FDA's Pediatric Advisory Committee, officials will discuss safety concerns about Concerta, a form of methylphenidate, the active ingredient in Ritalin and similar medications.

A briefing document about the meeting says the review was prompted by reports of hallucinations, suicidal thoughts, psychotic behavior and aggression among methylphenidate users. Officials note that Concerta's label already lists possible psychiatric side effects but suggests the problems aren't serious or that the drug might only aggravate existing problems. . .

Attention-deficit hyperactivity disorder affects about 7.5% of school-age children, Concerta's maker says. The drug, approved in 2000, is intended to improve concentration and impulse control. Patients filled 7.8 million prescriptions last year, the FDA report says.

EX-EDITOR: MED JOURNALS TO CLOSE TO DRUG FIRMS
http://news.bbc.co.uk/go/rss/-/2/hi/health/4552509.stm

BBC - Medical journals are an extension of the marketing arms of drug firms, says an ex-British Medical Journal editor. Dr Richard Smith, who edited the BMJ for 13 years, criticised the journals' reliance on drug company advertising. Writing in Public Library of Science Medicine, he also said journals were undermined by relying on clinical trials funded by the drugs industry. The BMJ said a debate was needed, but drug industry representatives rejected the criticisms.

Dr Smith, who is now chief executive of healthcare firm United Health Europe, said the most conspicuous example of the dependence was reliance on advertising, but he added it was "the least corrupting form of dependence" since it was there for all to see. Dr Smith said the publication of industry-funded trials was a much bigger problem.

He said: "For a drug company a favourable trial is worth thousands of pages of advertising, which is why a company will sometimes spend upwards of a million dollars on reprints of the trial for worldwide distribution." And Dr Smith argued, unlike ads, these trials were seen as the highest form of evidence. "Fortunately from the point of view of the companies which fund these trials - but unfortunately for the credibility of the journals who publish them - they rarely produce results that are unfavourable to the companies' products." . . . BMJ editor Dr Fiona Godlee said she agreed with much of what Mr Smith said

NPR SHILLS FOR CORPORATE DRUG PUSHERS
http://newstandardnews.net/alivewires/business/content/? show_item=1791#more

BRIAN DOMINICK, NEW STANDARD - Today on All Things Considered I caught one of he worst reports I have ever heard or read in the mainstream media. . . ATC host Melissa Block introduced the piece:

"It's been a tough year for the pharmaceutical industry."

What the hell is she talking about? If this was a "tough year," easy years must be phenomenal. True, a number of pharma co's saw their profits shrink in the first quarter of 2005. For instance, Pfizer reported a meager $301 million in profits. And just yesterday, Bristol-Meyers moved $110 million of profits into a reserve fund, leaving it a pathetic $533 million in net "earnings." Meanwhile, others are just plain blowing minds. And let's not forget this gargantuan new tax break for drug companies. . .

"There have been complaints about the high cost of medicine, as well as safety questions about popular drugs to treat depression and pain. Both have eroded the industry's reputation. In response, the industry's high-powered Washington trade group, known as PhRMA, has hired a high-profile new leader. NPR's Julie Rovner reports. . . "

"Billy Tauzin says his top mission as president and CEO of the Pharmaceutical Research and Manufacturers of America is to recapture the trust of the American public. . . [Tauzin] said he agreed to take the job at PhRMA because of his recent bout with intestinal cancer.

"But while Tauzin says regaining public trust is at the top of his agenda, he also made it clear that the industry isn't backing down on its opposition to some highly popular issues now before Congress. The biggest is whether or not to allow lower cost drugs to be imported from Canada and other countries. Tauzin says its simply too dangerous.

"Anybody who makes it the law of the land that counterfeiters and cheats and people working in dirty labs in Indonesia can ship drugs into this country that might not even be the drugs you need -- anybody who votes for that, and people start dying as a result, or terrorists get ahold of that situation and start importing products into this country to harm us on purpose -- is gonna live with that on their conscience."

Rovner's narrative continues:

"The group also remains unalterably opposed to efforts to negotiate prices for the new drug benefit that starts next year -- part of the law Tauzin helped write."

We hear from Tauzin again. . .

"It's price control. That's how it starts, that's how it ends. If you accept it in little chunks and bigger and bigger chunks, like wholesale blocks, you're walking right into the direction that Europe and some of the other places have gone. And if you really want rationing of medicine... good place to start."

Rovner:

"Tauzin says what the industry wants to do most is help those who can't afford their medicines [to] get them, both by improving insurance coverage for drugs and more immediately by spending what he described as tens of millions of dollars on an effort to link uninsured Americans with drug company-sponsored assistance programs."

APRIL 2005

ELDERLY PATIENTS HURT MOST BY DRUGS
http://tinyurl.com/59a7x

CBC, CANADA - A CBC News investigation reveals that Canadian seniors account for 44 per cent of adverse drug reactions causing death that are reported to Health Canada, even though they make up just 13 per cent of the population. CBC's analysis of Canada's adverse drug reaction database, obtained from Health Canada under Access to Information laws, suggests up to 16,500 elderly patients have died due to suspected drug reactions in the last five years. . .

Older people are more vulnerable to drug reactions partly because they use more drugs than the general population. Seniors are also more vulnerable because they metabolize and excrete drugs more slowly.

But when drugs are being developed, they're rarely tested in seniors, so their effects can be a surprise, says Dr. Robyn Tamblyn, an epidemiologist and researcher at McGill University.

"When a drug is approved to come into the market, you're almost in an experimental situation when you're trying it out on people for which it was never tested," said Tamblyn. Tamblyn says that in a given year, nearly one in 10 seniors who take drugs will have a reaction serious enough to put them in hospital.

In most cases she says it's a result of inappropriate prescribing: the wrong drug, the wrong dose, the wrong combination of drugs, or even unreadable handwriting on prescriptions that leads to mistakes. . .

CBC found that in 2004, 1.5 million Canadian seniors ­ more than one-third ­ were given drugs that are either ineffective in the elderly or put seniors at an unnecessarily high risk when safer alternatives are available.

DRUG MAKERS HAVE HUGE INFLUENCE IN WASHINGTON
http://www.ahrp.org/infomail/05/04/26a.php

ALLIANCE FOR HUMAN RESEARCH PROTECTIONS - USA Today provides a glimpse into the way the pharmaceutical industry controls health care policy by buying influence at the highest level of government, and underwriting professional and lay healthcare organizations whose spokespersons parrot industry's agenda. Of the 1,274 people registered to lobby in Washington for drugmakers in 2003, according to the Center for Public Integrity, 476 are former federal officials - including 40 former members of Congress.

- $158 million: Spending in 2004 to lobby the federal government.

- $17 million Campaign contributions in 2004 to federal candidates (67% to Republicans).

- $7.3 million Support for the 2004 political party conventions (64% to Republicans).

"They are one of the strongest, most well-connected and most effective lobbies in Washington," says Amy Allina of the National Women's Health Network. "Going up against them is more often than not a losing battle."

SELLING SICKNESS

IN A FLYER for their forthcoming book, Selling Sickness, Ray Moynihan and Alan Cassels quote the head of Merck thirty years ago saying something we have always suspected of the pharmaceutical corporados but never thought we'd find in print: "Wishing his company was more like the chewing gum maker Wrigley's, the chief executive of Merck said it had long been his dream to make drugs for healthy people, and 'sell to everyone.' "

WHAT STATINS CAN DO TO THE ELDERLY
http://www.geriatrictimes.com/g040618.html

BEATRICE A. GOLOMB, M.D., GERIATRIC TIMES - Statins. . . are among the best-selling prescription drugs in the world and are widely viewed as very safe and effective. Their benefits to coronary artery disease have been copiously documented and are incontrovertible. In addition, statins have been shown to benefit survival in a large study of middle-aged men with, or at high risk for, heart disease. Nonetheless, all drugs have potential adverse reactions despite their potential benefits. . .

Evidence suggests the balance of benefits to risks may be less favorable in the elderly: Cholesterol becomes a less potent predictor of cardiovascular problems, and adverse reactions from drugs, including statins, may become more prominent. . . No trend toward survival benefit is seen in elderly patients at high risk for cardiovascular disease . . .

Muscle problems are the most common reported adverse effects of statins. . . Perhaps the most feared adverse effect of statins is rhabdomyolysis--a condition in which there is severe breakdown of muscle tissue that may be toxic to the kidneys and result in kidney failure or death. . .

Cognitive problems also occur with statins and may also have more impact in elderly patients. . .

A large variety of other adverse effects have been reported with statins, including (but not limited to) gastrointestinal and neurological effects, psychiatric problems, immune effects (e.g., lupus-like syndrome), erectile dysfunction and gynecomastia (breast enlargement in men), rash and skin problems, and sleep problems.

Of particular note for the elderly population, the PROSPER trial found a significant 25% increase in incident cancer in participants over age 70 randomized to statin therapy versus placebo.

ACTORS EXPOSE EFFECT OF DRUG ADVERTISING ON DOCTORS

SHANKAR VEDANTAM AND MARC KAUFMAN WASHINGTON POST - Actors pretending to be patients with symptoms of stress and fatigue were five times as likely to walk out of doctors' offices with a prescription when they mentioned seeing an ad for the heavily promoted antidepressant Paxil, according an unusual study being published today. . . Most who did not report symptoms of depression were not given medications, but when they asked for Paxil, 55 percent were given prescriptions, and 50 percent received diagnoses of depression.

The study adds fuel to the growing controversy over the estimated $4 billion a year the drug industry spends on such advertising. Many public health advocates have long complained about ads showing happy people whose lives were changed by a drug, and now voices in Congress, the Food and Drug Administration and even the pharmaceutical industry are asking whether things have gone too far. Nearly every industrialized country bans such advertising, and physicians said the new study raises new questions.

FEBRUARY 2005

MINNESOTA KILLINGS RAISE MORE QUESTIONS
ABOUT ANTI-DEPRESSANTS AND VIOLENCE

PROGRESSIVE REVIEW - Following Columbine, the media ignored the possible connection between the killings and prescribed mood-altering drugs. Thanks perhaps to increased skepticism about the pharmaceutical industry and the FDA, there has been somewhat more interest following the Minnesota killings. As well it should be given that no matter how effective such drugs have been for millions of Americans, the possibility that they have also contributed to mass murders should at least be as prominent a public issue as the Schiavo case. The moral questions in a drug that works fine for most but has disastrous effects on others needs to be widely discussed. And there are other questions such as: are non-psychiatric medical doctors qualified to prescribe these drugs to patients when they may not have adequate training to notice changes in violent tendencies? And why does the media (such as the NYT in the story below) and the government make such a clear distinction between suicide and violence? Isn't suicide, as one expert noted, just self-directed violence? As Dr Peter Breggin has said, "Experts in the field agree that suicide and violence emanate from the same basic impulses. A drug that causes suicide will also cause violence, and vice versa."

MONICA DAVEY AND GARDINER HARRIS, NY TIMES - In their sleepless search for answers, the family of Jeff Weise, the teenager who killed nine people and then himself, says it is left wondering about the drugs he was prescribed for his waves of depression. On Friday, as Tammy Lussier prepared to bury Mr. Weise, who was her nephew, and her father, who was among those he killed, she found herself looking back over the last year, she said, when Mr. Weise began taking the antidepressant Prozac after a suicide attempt that Ms. Lussier described as a "cry for help."

"They kept upping the dose for him," she said, "and by the end, he was taking three of the 20 milligram pills a day. I can't help but think it was too much, that it must have set him off.". . .

The effects of antidepressants on young people remain a topic of fierce debate among scientists and doctors. Last year, a federal panel of drug experts said antidepressants could cause children and teenagers to become suicidal. The Food and Drug Administration has since required the makers of antidepressants to warn of that danger on their labels for the medications.

Although some studies link the drugs to an increased suicide risk, the research does not suggest such a connection to violence like Mr. Weise's rampage through Red Lake High School. . .

"What I can say is that his physician, I'm sure, made the appropriate recommendations based on whatever the dosages were," said Morry Smulevitz, a spokesman for Eli Lilly, which makes Prozac. The dosage range, Mr. Smulevitz said, runs from 20 milligrams to 80 milligrams a day, so Mr. Weise's 60 milligram dose fell in that bracket. Mr. Weise, though just 16, was taller than 6 feet and weighed 250 pounds.

Ms. Lussier, who lived with Mr. Weise in her mother's house on the Red Lake Indian reservation in far northern Minnesota, said she could not understand what else, aside from drugs, had changed to explain his sudden violence.

http://www.nytimes.com/2005/03/26/national/26shoot.html?

ABC NEWS - The teenager who went on a shooting rampage at his high school was put on the antidepressant Prozac after a suicide scare last summer, a longtime friend says. Jeff Weise, 16, also had watched a movie about a school shooting with friends earlier this month skipping ahead to some of the most violent scenes, according to Sky Grant, a friend of Weise's since sixth grade. . .

Grant and his mother, Gayle Downwind, said Weise was taken to a psychiatric ward in Thief River Falls last summer after Weise frightened another friend with suicidal computer messages. Grant said he didn't know how long Weise stayed at the hospital. Grant, who was taking Zoloft, said he and Weise talked in detail about antidepressants.

He said Weise told him he was taking 40 milligrams a day of Prozac: 20 in the morning, 20 at night. "He was a lot more quiet. I wouldn't say any better," Grant said.

http://abcnews.go.com/US/wireStory?id=615224

DR PETER R. BREGGIN, Sep 14, 2004 - The FDA is finally admitting that the newer antidepressants, especially the SSRIs and Effexor, cause suicide in children. I first drew these conclusions about the SSRIs and began publishing them in 1994 in Talking Back to Prozac. In addition, I reviewed and analyzed the entire literature shortly before the February hearings. Ten years is a long time to wait for official recognition of such important risks. . .

The FDA overlooked other related hazards that swell the numbers of children afflicted with serious and life-threatening adverse drug reactions. Antidepressant-induced mania is very common. The FDA-approved label for Luvox, for example, cites a rate of 4% for mania and manic-like symptoms. A controlled clinical trial disclosed a 6% rate of mania for children taking Prozac in a controlled clinical trial. Antidepressant-induced manic behavior can disrupt a child's life and result in injury to others. It commonly results in a false diagnosis of bipolar disorder leading to stigmatization and many years or a lifetime of unnecessary, harmful treatment with drugs.

While mentioning violence as a potential subject for investigation, the FDA did not analyze data related to antidepressant-induced violence. Experts in the field agree that suicide and violence emanate from the same basic impulses. A drug that causes suicide will also cause violence, and vice versa. . .

The FDA conducted an epidemiological study comparing rates of violent behavior for Prozac and another antidepressant, trazodone. The reports were drawn from the FDA's spontaneous reporting system that includes all events reported to the drug company and the FDA. The FDA found greatly increased reporting rates for violence on Prozac even when taking into account the higher number of prescriptions for Prozac. Also, the increased rate of violence reports began even before there was publicity and controversy surrounding the problem. When I attempted to obtain this data from the FDA, the agency told me it had been lost. However, I was able to obtain the data in the form of charts from the drug company through discovery. I testified about this in 1994 and published it in my books, but again the FDA and the drug company have not responded. . .

Finally, the FDA has insisted on requiring confirmation from controlled clinical trials before admitting that antidepressants can cause suicide. This has been a massive subterfuge. In the past, when the FDA has increased the severity of warnings for psychiatric drugs or withdrawn them from the market, the agency has almost always relied upon increased numbers of clinical reports in combination with a general medical analysis of the potential problem. On this basis, the capacity of Prozac to cause violence and suicide has been known since the 1980s, and was clearly documented in my books as early as 1994.

The FDA has colluded with the drug companies in hiding the dangers of the antidepressant medication. The risk of suicide in children is but the tip of the iceberg that includes high rates of antidepressant-induced suicide, violence, over-stimulation, and mania.

http://www.ahrp.org/risks/SSRI0904/Breggin.php

CATHY REDFERN, SANTA CRUZ SENTINEL, APR 24, 2004 - Jurors on Thursday found a Southern California man innocent of attempted murder and assault after a prominent neuropsychiatrist testified that he struck his friend in the head four times with a pronged brass knuckles-type weapon because of an adverse reaction to Zoloft, a popular antidepressant. Andrew Meyers, 28, had been taking the drug for two weeks when he struck his longtime friend in the head with a "ninja key ring" on June 20, 2002. The two had had a disagreement about a bike Meyers had sold the man five years ago, said Kristin Carter, the public defender who successfully tried the case. "Everyone was shocked he did this; Meyers was shocked," she said.

The Food and Drug Administration last month warned makers of 10 antidepressants, including Zoloft, to add warnings about a possible heightened risk of suicide in some patients, saying the drugs may cause agitation, anxiety and hostility in rare cases.

SARA HOFFMAN, JURAND, MAR 1 2003 - Vicky Jo "Brynn" Hartman of California was given a sample pack of Zoloft by her child's doctor. She was not diagnosed with--or even evaluated for--clinical depression, anxiety attacks, or any other psychological disorder. She merely mentioned she needed a "pick-me-up" to help with stress. Soon after starting the medication, she shot her husband, comedian Phil Hartman, and then herself. . .

Once considered wonder drugs, these antidepressants have reportedly helped millions of people with depression and anxiety disorders. Yet the drugs have had disastrous consequences for others. The manufacturers insist the drugs have only mild side effects and are non-habit-forming. Plaintiff attorneys across the country disagree, and they are working to debunk the drug makers' claims and obtain compensation for people allegedly harmed by the drugs. . .

By 1997, Prozac was the fifth-most-prescribed drug in the United States; Zoloft was 11th; and Paxil, 17th.

In 1990, one of the first public reports of Prozac's propensity to induce suicide appeared in an American Journal of Psychiatry article by two Harvard psychiatrists and a registered nurse. One of the authors, Dr. Jonathan Cole, testified in a 2000 wrongful death case, "The SSRI drugs, as a class, clearly have the potential to cause, and in reasonable medical probability or certainty do cause, akathisia in some patients ... [which could] trigger or contribute to violent or suicidal behavior."

Akathisia is a neurological phenomenon characterized by intense internal restlessness, agitation, aggression, and suicide attempts. Some patients describe it as wanting to "jump out of their skin." They have reported it as a side effect of Prozac, Zoloft, and Paxil. The makers have defended the drugs for over a decade by saying that most patients taking SSRIs suffer from clinical depression--and that depressed people can be suicidal. . .

In 1986 clinical trials, researchers found suicide rates of 12.5 patients per 1,000 taking Prozac, compared with 3.8 patients taking a non-SSRI antidepressant and 2.5 patients taking a placebo.

A 1995 study of suicides among British patients whose general practitioners prescribed antidepressants compared the rates of suicide for 10 drugs: Far more people killed themselves while on Prozac than on the others. The study found an annual rate of 187 suicides per 100,000 depressed patients taking Prozac, compared with 30 suicides per 100,000 depressed patients in general.

http://www.baumhedlundlaw.com/SSRIs/Lawsuits%20over%20antidepressants.htm

JEFF SWIATEK, KNIGHT RIDDER, JUN 7, 2001 - The manufacturer of the nation's second-best-selling antidepressant must pay $6.5 million to the relatives of a Wyoming man who killed himself and three others after taking the drug Paxil, a jury in Cheyenne, Wyo., said Wednesday.
Jurors in the U.S. District Court wrongful-death civil suit returned the verdict against GlaxoSmithKline after an 11-day trial. The five-woman, three-man jury deliberated about five hours over two days. The decision is the first time a jury has held any of the leading antidepressant makers liable in a wrongful-death case.

Paxil is a chemical cousin to Prozac, a product of Indianapolis-based Eli Lilly and Co. that revolutionized the treatment of depression. Such antidepressants have raised controversy for their alleged ability to induce violent behavior in some users.

Relatives of Donald Schell, 60, claimed that the Gillette, Wyo., man took two Paxil tablets before shooting his wife, their daughter, his granddaughter and himself to death on Feb. 13, 1998. The plaintiffs' lead attorney, Andy Vickery, had asked the jury to award a total of $25 million in damages.

Vickery is a Houston lawyer who specializes in handling lawsuits against antidepressant makers. In 1999, he lost a similar case against Indianapolis-based Lilly over a murder committed by a Hawaii man who had taken Prozac. Lilly faces about 10 other wrongful-death lawsuits involving the drug.

http://www.baumhedlundlaw.com/SSRIs/Paxil-Schell.htm

AUSTRALIAN, May 25, 2001 - A Supreme Court Justice in an Australian courtroom ruled that Zoloft was the cause for David John Hawkins strangling his wife of nearly 50 years. . . Justice O'Keefe stated in his ruling: "It can be seen that the medical evidence strongly supports a conclusion that but for the effect of the 250mg of Zoloft he had taken, it is wholly unlikely that the prisoner would have committed the crime to which he had pleaded guilty."

http://www.baumhedlundlaw.com/media/zoloft/Australian%20Zoloft%20Ruling.htm

SYDNEY MORNING HERALD, 2001 - Hawkins first took Zoloft in 1996 after the death of his youngest daughter from breast cancer. He suffered an adverse effect after taking one tablet. His depression returned in 1999 and Hawkins saw a different doctor, who prescribed him Zoloft again.

The doctor told him not to take the medication until breakfast on Sunday, August 1. But he woke at 2 am and took five tablets. At 7.30 am, as his wife prepared to light the fire, Hawkins strangled her.

"I was looking at my wife but I wasn't seeing her face," he told a doctor. Hawkins then attempted to kill himself. A spokesman for Pfizer, which makes Zoloft, defended the drug, saying there was no evidence to suggest it had any side effects of aggression or aggravation. Dr Bill Ketelbey said: "It is pure speculation that aggression is a side effect. . .

Sertraline is the essential ingredient in Zoloft. . . It can cause sleeplessness, agitation, confusion, hallucination and psychosis. . . * The Australian Department of Health and Aged Care says sertraline has been officially recorded as the sole drug implicated in 20 cases of aggression, 319 cases of agitation, 43 cases of hallucination, 34 cases of manic reaction, 63 cases of confusion, 18 cases of psychosis, eight cases of delirium and five cases of delusion.

http://www.baumhedlundlaw.com/media/zoloft/SMH-Drug_Turned_Loving_Man_Killer.htm

CNN, APR 29, 1999 - Reports surfaced Wednesday that one of the gunmen in the Littleton, Colorado, school shooting, Eric Harris, was rejected by Marine Corps recruiters days before the Columbine High School massacre because he was under a doctor's care and had been prescribed an anti-depressant medication. Harris' prescription was for Luvox, an anti-depressant medication commonly used to treat patients with obsessive-compulsive disorder.

It is one of a class of drugs called selective serotonin reuptake inhibitors. Other SSRIs are Prozac, Paxil and Zoloft. Prozac is the most commonly prescribed anti-depressant in the United States. Serotonin is a chemical released in the brain that can affect mood and behavior. SSRIs work by enhancing the brain's ability to use serotonin. . .

It is not known if Harris actually took the medication, and investigators said Wednesday early toxicology tests performed by the medical examiner's office showed no evidence of drugs or alcohol in the body of either gunman, Harris or Dylan Klebold.

http://www.cnn.com/HEALTH/9904/29/luvox.explainer/

REPORT: PAINKILLERS DAMAGE INTESTINE

REUTERS - More than 70 percent of patients who took painkillers such as ibuprofen for more than three months suffered damage to their small intestines, U.S. researchers reported on Monday. The study is yet another blow to patients trying to find ways to treat arthritis pain, after reports that the most advanced drugs, called COX-2 inhibitors, can raise the risk of heart death.

Dr. David Y. Graham of the Baylor College of Medicine in Houston and colleagues studied 21 patients taking a range of drugs called non-steroidal anti-inflammatory drugs, or NSAIDS. They compared them to 20 patients taking either acetaminophen, an unrelated painkiller, or nothing. "Small-bowel injury was seen in 71 percent of NSAID users compared with 10 percent of controls," they wrote in Monday's issue of the journal Clinical Gastroenterology and Hepatology. . .

"Anybody who takes aspirin or (other) NSAIDS for a year has a 1 to 4 percent risk of serious gastrointestinal complications," Graham said in a telephone interview. "If the drugs didn't have such benefits, we'd have taken them off the market some time ago." Acetaminophen, sold generically and also under the brand name Tylenol, does not work for many patients, Graham said.

NEW CHOLESTEROL GUIDELINES A GIFT TO DRUG FIRMS
http://www.forbes.com/healthcare/2004/07/12/cx_mh_0712mrk.html

MATTHEW HERPER, FORBES - New guidelines issued by the United States government could increase the number of people who take cholesterol-lowering medicines; already the top-selling medication in the world with $26 billion in annual sales. . . Under previously existing guidelines, 36 million people should be taking cholesterol-lowering pills such as Lipitor, Zocor, or Pravachol to prevent heart attacks. In reality, only about 11 million do. Changes issued today by the National Cholesterol Education Program, advocate lowering cholesterol in even more patients. Moreover, patients at the highest risk should receive even more aggressive treatment--meaning higher, more expensive doses of these drugs. Now, that figure will increase by millions of people, as the new guidelines suggest treating diabetics and people who at one time would have been considered healthy.

PHARMACIDE GROWING IN U.S.
http://www.realcities.com/mld/krwashington/10443482.htm

TONY PUGH AND SETH BORENSTEIN, KNICHT-RIDDER - Thousands of Americans are getting sick and many are dying each year from prescription drugs that were pushed onto the U.S. market ahead of the rest of the world.
A Knight Ridder analysis shows that as the number of new drugs given first to Americans has increased, the reports of drug-induced ailments have soared. Yet, even as the deaths and damage have increased, the Food and Drug Administration has never instituted an aggressive system to track the safety of drugs once they're on the market. . .

Nearly 60 percent of all the genuinely new drugs sold in the world in 2003 - those with active ingredients never before marketed - were first dispensed in America. That's up from about 3 percent 20 years ago when most drugs were first introduced abroad, where the approval process in many countries is much more stringent than in the United States. "We're the guinea pigs in the sense of extensive population exposure," said Dr. Marcus Reidenberg, a professor of pharmacology, medicine and public health at Cornell University Medical School in New York City. . .

Knight Ridder found that in 1992, just before Congress directed the FDA to speed up drug approvals, there was an average of one adverse drug reaction for every 16,300 prescriptions filled. In 2003, adverse reactions hit one in 9,000.

While the FDA has no official estimate on the number of people killed by these drugs, the agency says 106,000 people a year die from all types of drug reactions. One new drug, the painkiller Vioxx, which was pulled from the market this fall, may have caused 55,000 deaths, a top FDA scientist said recently.

DRUGGING OF AMERICA BY PHARMACEUTICALS SOARING
HEALTH BENEFITS DON'T CORRELATE

WHILE SPENDING for drugs has gone 9% in the time period discussed mortality rates for the big diseases has declined only 1-3%. Even if all that decline is due to drugs - which of course it isn't - it would appear that Americans would have to spend about a $1.5 dollars a year just to reduce mortality from cancer and heart disease by ten percent. Note also how we are drugging boys for hyperactivity far more than girls

AND NOW THE REALLY DIRTY secret nobody talks about: while 84% of Americans over 65 are on highly expensive drugs the life expectancy of such people has increased only 3.6 years for men and 4.4 years for women since 1950.

AP - The annual report on Americans' health found that just over 44 percent of all Americans take at least one prescription drug, and 16.5 percent take at least three. Those rates were up from 39 percent and 12 percent between 1988 and 1994, the Centers for Disease Control and Prevention reported.

The report, "Health, United States 2004," presents the latest data collected by CBC, the National Center for Health Statistics and dozens of other Federal health agencies, academic and professional health associations, and international health organizations.

Deaths from heart disease, cancer and stroke - the nation's three leading killers - are all down 1 percent to 3 percent, the analysis said. The study also found that spending on health climbed 9.3 percent in 2002 to $1.6 trillion.
Prescription drugs, which make up about one-tenth of the total medical bill, were the fastest growing expenditure. The price of drugs rose 5 percent, but wider use of medicines pushed total expenditures up 15.3 percent in 2002. Drug expenditures have risen at least 15 percent every year since 1998. . .

Usage peaked at 84 percent for people aged 65 and over, with the top rate at 89 percent for black women over 65. Even for people under age 18, however, nearly one-fourth - 24.1 percent - were taking at least one prescription medication. The rate rose to 34.7 percent between age 18 and 44; for those ages 45 to 64, it was 62.1 percent.

ROBERT PEAR, NY TIMES - Adults' use of antidepressants almost tripled from 1988 to 2000. Use was higher among women than among men. In 1999-2000, 10 percent of women 18 and older reported taking antidepressants in the previous month, compared with 4 percent of men. Use of cholesterol-lowering statin drugs among people 45 and older more than tripled from 1995 to 2002, the report said.

The report also confirms a sharp increase in the use of stimulants by children ages 5 to 17. Such drugs, like Ritalin, are often used to treat the impulsive, aggressive traits known as attention deficit hyperactivity disorder, the most commonly diagnosed psychiatric disorder in children. Boys are much more likely than girls to receive such drugs when they visit doctors' offices and clinics. In 2000-2002, the government counted an average of 13.5 such visits for every 100 boys ages 5 to 17, up from an average of 8.5 visits in 1997-1999. The comparable figures for girls were 5.3 and 3.3.

The report also shows a sharp increase in heart surgery among elderly patients in the last decade. Ms. Bernstein said this reflected an increase in procedures to clear clogged arteries and to insert the wire mesh tubes known as stents, which prop open the arteries.

In 2002, the infant mortality rate was 7 deaths for every 1,000 live births, up from 6.8 in 2001. Much of the increase was attributed to deaths in the first month of life, especially the first week.

Large racial and ethnic disparities persist. The infant mortality rate for 2002 was 5.8 deaths for every 1,000 births among whites, compared with 13.8 for blacks, 5.6 for Hispanics and 4.8 for Asian Americans.

Mortality from heart disease, the leading cause of death, declined almost 3 percent in 2002, continuing a long-term trend. Mortality from cancer, the second leading cause of death, decreased more than 1 percent in 2002, continuing a decline that began in 1990.

http://www.nytimes.com/2004/12/03/politics/03drug.html?oref=login

Deaths caused by terrorists on U.S soil since 1999: c. 3,000

Deaths caused by the drug Vioxx on U.S. soil since 1999: 25,000-55,000

Budget of Homeland Security Department: $30 billion

Budget of Food & Drug Administration: $1.8 billion

Punishment for terrorist killing people on U.S. soil: Execution

Punishment for drug companies killing people on U.S. soil: Not much, it seems

DRUG COMPANIES OUT OF CONTROL

TONY PUGH, KNIGHT RIDDER - The recently withdrawn painkiller Vioxx may have caused as many as 139,000 heart attacks, strokes and deaths, a government drug-safety scientist told lawmakers. He said the Food and Drug Administration and the public are "virtually defenseless" against a similar future catastrophe with another drug.

David Graham, the associate director for science and medicine at the FDA's Office of Drug Safety, made the charges in a scathing assessment of the FDA's reviews of drugs already approved and marketed.

Graham told the Senate Finance Committee that his agency's earlier projection that Vioxx may have caused roughly 28,000 heart attacks or sudden cardiac deaths was "an extremely conservative estimate." Graham said Thursday that the number of deaths alone may have been as many as 55,000.

Graham blamed the Vioxx deaths on the FDA's decision in 1999 to approve Merck & Co.' s sale of the drug, despite data that suggested the arthritis medication was linked to increased risks of heart attack and stroke. Unless the FDA establishes an independent division to monitor the safety of drugs once they're on the market, Graham said, more Vioxx-like disasters are likely.

"We are faced with what may be the single greatest drug-safety catastrophe in the history of this country or the history of the world... a catastrophe that I strongly believe could have (and) should have been avoided," Graham testified.

Additionally, Graham said the FDA was derelict in approving the sale of five other drugs that he felt pose serious safety risks. According to Graham, those drugs are Crestor, a cholesterol-lowering drug by AstraZeneca PLC; Meridia, a weight-loss drug produced by Abbott Laboratories; Accutane, an acne-fighting drug by Roche Holdings; Bextra, an arthritis pain-relieving drug by Pfizer; and Serevent, an asthma treatment by GlaxoSmithKline.

PR WATCH - After challenging Food and Drug Administration policies that he claims leave the public "virtually defenseless" against questionable drugs, FDA drug safety official Dr. David Graham contacted the Government Accountability Project, a non-profit organization that protects whistleblowers. Shortly afterwards, anonymous callers to GAP charged Dr. Graham with "scientific misconduct" and being a "bully." After further research, GAP concluded that "the callers were trying to smear [Graham]." In addition, GAP's legal director said he's "certain [the anonymous callers] were supervisors at the FDA because of the details of the arguments they made and the phone numbers from which they called."

NY TIMES EDITORIAL - Not many years ago, the F.D.A. was routinely criticized by the drug industry and conservative commentators for being too nitpicking in demanding proof of efficacy and safety before allowing new drugs on the market. A result, that line of argument went, was that valuable new drugs were first introduced abroad and long delayed here, depriving American consumers of their benefits. Now the balance has shifted. Approval times for new medicines have been cut sharply, and new drugs often go into use first in this country. Whereas disastrous consequences once showed up first in Europe (witness thalidomide babies), now they are more likely to show up here first.

That makes post-marketing surveillance of drugs increasingly important, but the F.D.A.'s authority in this area is shockingly weak. The system relies on doctors to make voluntary reports to drug companies about any adverse side effects they spot. Only a small fraction of the bad outcomes are actually reported. Even more problematic, the prime responsibility for collecting and evaluating data from post-marketing studies rests with the manufacturers. It defies belief that any company whose fortunes are riding on a blockbuster drug will be hard-nosed when assessing unexpected consequences.

The typical pattern - shown in cases like Vioxx and Baycol, both ultimately withdrawn from the market - is that manufacturers cling to any rationalization that might explain away hints of danger in their products until the evidence becomes too strong to ignore. The F.D.A., alas, has no power to order a manufacturer to test for possible dangers after a drug is being sold. Indeed, the agency is so impotent that manufacturers mostly fail to complete even the post-marketing trials they have pledged to conduct as a condition for their drug's approval

DECEMBER 2004

BRITISH OFFICIALS ADVISE LESS USE OF ANTI-DEPRESSANTS
http://www.washingtonpost.com/wp-dyn/articles/A41332-2004Dec6.html

SHANKAR VEDANTAM WASHINGTON POST - British health officials advised doctors yesterday not to prescribe antidepressants for about 70 percent of the patients who show up complaining of depression without first trying exercise, self-help, talk therapy or just waiting a couple of weeks to see if they got better. In issuing new treatment guidelines for doctors, the British regulators and a standards-setting panel said patients with mild depression who are able to go to work and function normally, even if they complain of symptoms such as a lack of interest in things, low energy, dark mood, difficulty sleeping or difficulty concentrating, should avoid widely used antidepressants at first because of the possibility of side effects and withdrawal symptoms. . .

Numerous studies have shown that antidepressants are among the fastest-growing sectors of the U.S. pharmaceutical industry. A government report last week said the latest figures indicated that one in 10 American women is taking an antidepressant.

SEPTEMBER 2004

DOCTOR WHO CAUSED INQUIRY INTO ANTI-DEPRESSANTS SAYS HOMICIDE RISK IS BEING IGNORED

[We have noticed that a number of young mass murderers in the news were on anti-depressants. It would make sense to demand an accounting of the drugs that young mass murderers were using at the time of their crime.]

SARAH BOSELEY, GUARDIAN - Evidence that antidepressant drugs like Seroxat and Prozac could make people homicidal is being ignored by the body responsible for regulating medicines in the UK, a leading expert said yesterday. The charge came from David Healy, an expert on psychiatric drugs from north Wales whose warnings that the drugs could cause suicide prompted a major inquiry. That investigation, by an expert working group of the Medicines and Healthcare Products Regulatory Authority, led to the entire class of drugs except Prozac being banned last year from use in children. . .

Dr Healy, director of the north Wales department of psychological medicine, says he has seen data from the clinical trials that show even some healthy volunteers - people with no illness at all volunteering to take part in the earliest safety trials of the drugs - became unaccountably aggressive. Their reaction is coded as "hostile" which can include homicidal behavior and serious aggression.

"I think there is very clear evidence for all of the SSRI group of drugs that in addition to making people suicidal, they can make people homicidal or seriously aggressive and the data have been sitting in the MHRA's files on this issue," he said.

The signal from the healthy volunteer trials is supported by data from trials in children on Seroxat for obsessive compulsive disorder, depression and social phobia. Children taking part amounted to 738 on Seroxat and 647 on placebo. Of those, there were 27 hostile events on Seroxat and only four on placebo. Taking the children with OCD alone, those on the drug were 17 times more likely to become aggressive than those on placebo. . .

GlaxoSmithKline last night denied that its drug caused adults to become hostile, although it acknowledged there had been a problem in the children's trials.

NEW DATA CONFIRMS RISKS IN ANTI-DEPRESSANTS FOR CHILDREN

SHANKAR VEDANTAM WASHINGTON POST - Six months after the Food and Drug Administration withheld an internal finding that antidepressant medications were associated with an increased risk of suicide among children, a second staff analysis has arrived at the same conclusion. The agency has not publicly disclosed either report, despite growing pressure from critics and Congress.

STUDY: PROZAC INCREASES CHANCE OF SUICIDE IN YOUNG BY 50%

USA TODAY - Prozac, the only antidepressant certified as safe for children, may make kids more suicidal, according to evidence out Monday. A large, new study added to previous research on Prozac shows that kids taking the drug have about a 50% higher risk of suicidal thoughts and suicide attempts than those getting placebos, says Robert Temple, director of the Office of Drug Evaluation at the Food and Drug Administration. . .

Other major antidepressants prescribed for kids already have been found to raise the risk of suicidal behavior. Prozac had been an exception. "What's interesting and persuasive is that these studies now all lean the same way," Temple says.

USE OF ANTI-DEPRESSANTS FOR CHILDREN SOARING

BLOOMBERG - Children throughout the world are increasingly prescribed antidepressants and other drugs designed to calm or stimulate their brains, according to two studies published in Archives of Disease in Childhood. . . In Germany the increase was 13 percent, the lowest recorded, while the U.K. had the highest with 68 percent, the researchers said.

"We believe the use of psychotropic medications in children is a global public health issue, which should be studied in partnership with pharmaceutical companies, governments and researchers," said Ian Wong of the Centre for Paediatric Pharmacy Research at the University of London.

EARLIER

STUDY WARNS AGAINST ANTI-DEPRESSANTS FOR CHILDREN

GARDINER HARRIS, NY TIMES - Pediatricians and family physicians should not prescribe antidepressants for depressed children and adolescents because the drugs barely work and their side effects are often significant, Australian researchers have concluded. The researchers analyzed data from five published trials of three antidepressants, Prozac, Zoloft and Paxil, in depressed patients under age 18. They found that the drugs offered only a "very modest" benefit over placebos. At the same time, the drugs carry significant risks, the researchers said in their report, published in today's issue of the British medical journal BMJ.

PRESCHOOLERS BIG USERS OF ANTI-DEPRESSANTS

JOYCE HOWARD PRICE, WASHINGTON TIMES - Preschoolers are leading the growth in use of antidepressants by U.S. children, even though many questions persist about the safety and effectiveness of using these drugs on minors. A study published in the journal Psychiatric Services found that children 5 years old and younger are the fastest-growing segment of the non-adult population using antidepressants today.

ANTIDEPRESSANTS FOUND INEFFECTIVE ON TEENAGERS

ROD MICKLEBURGH, GLOBE & MAIL, CANADA - Widely used antidepressant drugs prescribed to tens of thousands of Canadian teens and children are barely more effective than placebos in treating adolescent depression, according to a leading Canadian expert in the field. The assertion by psychiatrist Jane Garland follows a recent cascade of critical information questioning the risk and effectiveness of prescribing antidepressant medication for troubled young patients.

"The disappointing reality is that antidepressant medications have minimal to no effectiveness in childhood depression beyond a placebo effect," Dr. Garland said in a commentary in Tuesday's Canadian Medical Association Journal.

Dr. Garland, head of the Mood and Anxiety Disorders Clinic at Children's Hospital here, said the lack of evidence showing significant benefits from adolescent use of the drugs is stunning, given the huge increase in such prescriptions over the past few years.

Seven drugs known as SSRIs (selective serotonin reuptake inhibitors) are under fire, one of them is well-known Prozac. Although no national figures for adolescent use are available, in British Columbia, an estimated 6,200 children and teens were prescribed SSRIs in 2002, more than double the number four years earlier. All told, nearly 14 million SSRI prescriptions were written for Canadians of all ages in 2002 and cost $869-million.

Drug manufacturers have come under increasing attack for withholding trial results indicating slight increases in suicidal behavior, adverse side effects and only minimal effectiveness of SSRIs in children and teenagers.

Several drug tests that came to light last year prompted British authorities in effect to ban prescription of all SSRIs except Prozac to patients under 18.

RITALIN MAY DAMAGE BRAIN RESEARCH SUGGESTS

PRAVIN CHAR, ASSOCIATED MEDIA, UK - Children given Ritalin to control hyperactivity could be permanently brain damaged, it was claimed yesterday. Research suggests the controversial 'chemical cosh' drug raises the risk of depression and anxiety in adulthood. Ritalin alters the brain's chemical composition so that it has a lasting effect on mental health, US scientists believe. Because these changes take place while a child's brain is growing, they could cause irreversible damage. . . . British GPs dispensed a record 254,000 Ritalin prescriptions last year, up from 208,500 in 2001. One in 20 children is said to have ADHD, which makes them boisterous and unfocused.

In one test, giving Ritalin to young, healthy rats increased the presence of certain chemicals linked to depression in adults. A second study found higher levels of stress hormones and anxiety-like behaviors.

THE PSYCHOTROPIC DRUG DEBATE

A weblogger takes on Dr. Bruce Levine whose criticisms of psychotropic drugs we cited yesterday. But on one point they agree, when Dr. Levine says:

"Our society is perhaps the most economically successful culture in the history of the world, materially. But in our one-dimensional quest for productivity, consumption and efficiency, we have forgotten about a whole bunch of things that people need to stay human -- like community, autonomy, diversity. All of those things have shrunk. Taken together, this may help to explain why so many kids are being diagnosed with attention deficit disorder and all these other various childhood disorders. The largest increases we have seen in new illnesses are the ones that affect children...We have created that. And that is what we, as a culture, don't want to admit: We've created fewer and fewer places for different kinds of personalities to feel good about themselves and to make a living.

BRITISH GOVERNMENT BANS MAJOR ANTI-DEPRESSANTS FOR CHILDREN AS SUICIDE RISK

All major antidepressant drugs other than Prozac, known as SSRIs, are set to be banned for children under 18 by the Government today, amid concerns that the drugs cause young patients to commit suicide. . . Doctors will be told not to prescribe Lustral, Cipramil, Cipralex and Faverin to under-18s. Fifty thousand children are estimated to be on antidepressants in Britain.

The MHRA was said to have told doctors last night they should not prescribe any selective serotonin reuptake inhibitors, other than Prozac. It will also warn that Prozac will help only one child out of 10. However, the agency will say that patients already on medication should not stop it suddenly, to avoid withdrawal symptoms.

GROUPS BLAST NEW CHOLESTEROL GUIDELINES

LINDA A. JOHNSON, ASSOCIATED PRESS - Most of the heart disease experts who urged more people to take cholesterol-lowering drugs this week have made money from the companies selling those medicines. Consumer groups on Friday blasted the new cholesterol guidelines as being tainted by the influence of major pharmaceuticals that make blockbusters such as Lipitor and Pravachol. Last year, drug makers earned $26 billion worldwide on cholesterol-lowering medicines, the top-selling class of drugs.

The new guidelines issued Monday by the American Heart Association and the federal government were aimed at preventing heart attacks. They were written by nine of the country's top cholesterol experts. At least six have received consulting or speaking fees, research money or other support from makers of the most widely used anti-cholesterol drugs. . .

"It's outrageous they didn't provide disclosure of the conflicts of interest," said Merrill Goozner, with the Center for Science in the Public Interest. "It doesn't mean that their research is wrong," Goozner added, but doctors and the public need to know "that the people who are giving you this advice have their research funded by a party who has a self interest in the outcome of that research." . . .

Dr. Sidney Wolfe, co-founder of Public Citizen's Health Research Group, said disclosure, even in a publication, is not adequate. "These people should be disqualified from being the principal authors of publications that have the imprimatur of the government on it," he said. He noted that side effects such as possible liver and muscle damage can make the drugs more dangerous than beneficial to people who have only a moderate risk of heart attack.

MEDIA MALPRACTICE

A DRAMATIC CHANGE in recommended levels of cholesterol was reported by both the NY Times and the Washington Post with hardly a hint of the possible economic factors behind the decision. This is an increasingly important issue for if pharmaceutical companies are successful in defining health downward, millions of new customers for its drugs are created.

What follows is the sum total of the two papers' references to possible problems with the drugs followed by a sample of concerns that have been raised elsewhere. Note that the NY Times makes only passing mention that the decision had no effect on the drug companies' stock prices and the Washington Post, at the very end of its article, admits that "most heart disease researchers receive at least some funding from drug companies."

No conclusion is suggested other than that the NY Times and Washington Post do their readers a huge disservice by not presenting this issue in its true complexity.

NY TIMES - No one doubts that the new recommendations will be expensive. But, Dr. Cleeman said, statins, which cost about $100 a month, are cost effective in those who should be taking them, because heart disease costs "hundreds of billions of dollars." Statins, which can reduce the risk of heart disease by 30 percent to 40 percent, he said, "compare very favorably to other standard treatments, like treatments for hypertension."

The stock of Pfizer and Merck, two manufacturers of statin drugs, showed little change yesterday.

Heart disease researchers say they are taken aback by the speed at which the old rules of cholesterol lowering are being rewritten in response to growing evidence that lower is better.

"It is really quite extraordinary," said Dr. Steven Nissen, a cardiologist at the Cleveland Clinic. He said, "When I was in medical school, I was taught that any cholesterol level under 300 was normal.". . . "Now here we are a few decades later saying that patients at high risk should take their L.D.L. levels to 70 or less," Dr. Nissen said. He and others, like Dr. Valentin Fuster, director of the Cardiovascular Institute at the Mount Sinai School of Medicine in New York, predict that the optimal levels for L.D.L. cholesterol will go lower still.

WASHINGTON POST - The panel endorsed a combination of diet, exercise and cholesterol-lowering drugs to cut LDL levels. The most commonly used drugs, statins, are considered very safe but in rare cases can cause serious muscle and liver problems. . . Most heart disease researchers receive at least some funding from drug companies but maintain that their work is not influenced by such connections.

[And this from the same issue of the NY Times]

NY TIMES - Four medical and scientific journals recently published studies that failed to disclose the authors' financial conflicts of interest, according to a report by the Center for Science in the Public Interest. Many journals have tightened disclosure policies in recent years as ties between pharmaceutical companies and researchers have come under increasing scrutiny, and the journals cited in the report have conflict-of-interest disclosure policies.

The study, which was released yesterday, looked at four journals from last December to February. It examined the 163 articles that had no disclosure statements for the major authors. In 13 of the articles, or roughly 8 percent, at least one of the authors did not reveal ties to companies that stood to profit from the research or other information that could have influenced the findings, the researchers found.

In most of the 13 cases, the researchers determined that the authors violated disclosure policies by neglecting to provide the journals with appropriate information.

[One publication got it right. . . the business journal, Forbes]

MATTHEW HERPER, FORBES - New guidelines issued by the United States government could increase the number of people who take cholesterol-lowering medicines; already the top-selling medication in the world with $26 billion in annual sales. Under previously existing guidelines, 36 million people should be taking cholesterol-lowering pills such as Lipitor, Zocor, or Pravachol to prevent heart attacks. In reality, only about 11 million do. . . Now, that figure will increase by millions of people, as the new guidelines suggest treating diabetics and people who at one time would have been considered healthy. Those at high risk, or who have had recent heart attacks, should be treated even more aggressively. . .

Christopher P. Cannon, a cardiologist at Brigham & Woman's hospital, says 50 million people should take the drugs. Another cardiologist, Steven E. Nissen of the Cleveland Clinic, said that number looked reasonable, although James I. Cleeman, a researcher at the National Heart Blood and Lung Institute and a co-author of the report said it was "a little high." The cost of treating that many people with even the lowest dose of Pfizer's Lipitor could approach $40 billion.

[And now some earlier stories]

ASSOCIATED PRESS - A 39-year-old woman has died of a muscle-destroying condition linked to the controversial new anti-cholesterol drug Crestor, a consumer advocate said Thursday, citing 16 cases of serious side effects in urging a ban of the drug. Crestor is in the popular family of cholesterol-lowering drugs called statins.

It won Food and Drug Administration approval in August, after a delay because of safety concerns: Seven cases of the potentially fatal, muscle-destroying condition called rhabdomyolysis occurred during studies involving patients on an 80-milligram dose. For that rare condition to pop up in clinical trials was unusual - and particularly worrisome since another statin, Baycol, had been pulled off the market in 2001, linked to dozens of rhabdomyolysis-caused deaths worldwide. In studies, Crestor also was linked to some cases of kidney abnormalities not seen with other statins.

Still, FDA ultimately decided to approve Crestor, saying it appeared to be slightly more potent than other statins and thus may be important for some patients. To lower the risk of side effects, FDA recommended starting doses of 5 mg. to 10 mg, and said patients should never exceed 40 mg. But records from the FDA and health agencies in Canada and Britain show life-threatening side effects occur even at those lower doses, said Dr. Sidney Wolfe of the consumer advocacy group Public Citizen, in a petition filed with FDA Thursday seeking a ban.

Among the records:

- Seven patients with rhabdomyolysis, including the 39-year-old American who died after using a 20-mg dose, and a second death from an unspecified country.

- Four patients with acute kidney failure, including a 79-year-old U.S. man who died.

- Five additional patients with less severe kidney damage.

Also, among six patients, Crestor interacted dangerously with the blood-thinner Coumadin, commonly used by heart-disease patients. One had a hemorrhage, Wolfe said.

PUBLIC CITIZEN, AUGUST 2001 - Doctors and the public must be warned to immediately discontinue use of statin drugs at the onset of muscle pain, muscle tenderness, muscle weakness or tiredness. Renal damage due to myoglobinuria (a pigment resulting from massive breakdown of muscle) as a result of rhabdomyolysis is potentially fatal. Prompt cessation of the use of statins at the first sign of muscle pain, muscle tenderness, muscle weakness or tiredness and prompt evaluation by a physician including a blood test for creatine phosphokinase ( a measure of muscle destruction) may avoid the progression to more extensive muscle damage, rhabdomyolysis, and death. . . Increased use of statins without additional warnings of potentially dangerous adverse effects is likely to lead to an increase in the number of statin-induced rhabdomyolysis cases and resulting hospitalizations and deaths.

PREVENTION - In a small study, researchers found that there may be a link between statins and severe muscle damage--of a sneaky sort that eludes the standard blood test (creatine kinase) for muscle breakdown. Researchers in large cholesterol clinics think that up to 1 in 10 people who take statins may have a mild form of this muscle toxicity. They may just feel tired, or have trouble getting out of a low chair. Meanwhile, a huge Danish study found that long-term statin users had a 4 to 14 times higher risk of peripheral neuropathy, nerve damage that can cause weakness, pain, and trouble walking.

NOTE: If some 100 million people take statins - a conservative estimate - a side effect is found in just two percent - as suggested by the drug makers own warnings - this would amount to two million persons being affected. And this is just for one side effect.

HEALTH JOURNAL, FEB 2001 - The Wall Street Journal reports that doctors and patients have noted several side effects of the most widely prescribed drugs in the U.S. - statins (some brand names are Lipitor, Zocor, and Provachol). Common complaints of patients taking statins include memory loss, personality changes, irritability, and aching muscle pain. . . The article quotes Dr. Peter Lansjoen, a Tyler, Texas cardiologist as follows: " You take these fragile elderly people, lower their cholesterol in half and deplete them of this essential nutrient and it makes sense they're going to have trouble. I think we're going to see some real trouble if we're not careful."

CBS, MAY 24, 2004 - When Jim Matthews needed to slash his cholesterol and heart attack risk, he joined the millions taking the world's top-selling drug, Lipitor. After five weeks, he was struck by cognitive chaos and confusion. All of a sudden, he found himself asking: "Did I go get the mail or did I just think I was going to go get the mail? Did I give my dog her thyroid pill, or did I just think I gave the dog the thyroid pill?" He couldn't function for hours.

When he came back to his senses, he suspected Lipitor was to blame, but only found one glowing report after another on Lipitor and similar drugs - all called statins. In fact, some doctors are so high on statins, they seem to think most everyone should take them, that there's no down side. Lipitor's maker even says it may help Alzheimer's patients.

But researcher Dr. Beatrice Golomb warns the studies generating the bulk of the positive press were funded by the companies that make the drugs, like Pfizer, which earns $9 billion a year from Lipitor.
"I made the decision that I really didn't want to take money from the drug industry," says Golomb.

Funded by the government and not the drug makers, Golomb is taking an independent look at studies already done on statins, pinpointing severe muscle problems, which Pfizer has disclosed, and cognitive dysfunction -- not mentioned in patient leaflets. "We have people who have lost thinking ability so rapidly that within the course of a couple of months they went from being head of major divisions of companies to not being able to balance a checkbook and being fired from their company," says Golomb, an assistant professor or medicine at the University of California in San Diego.

Golomb says statins do help the heart, but may also hamper the brain's performance and trigger other serious problems. She's leading an independent clinical trial to find out what harm statins may be doing. The results should be out in a few months.