Author Archive

Banning health clinics

Thanks to Glenn Reynolds for pointing out this story at the Boston Globe. Apparently there’s talk of banning the new clinics housed inside various Walmarts and CVS stores in Boston. As Glenn ponders, why would the lawmakers there want to eliminate affordable health care operated by the private sector? Also, Glenn links to this post which highlights how these clinics are doing things right.

Florida Mulls Lawsuit Over Antipsychotic Programs

That’s the title of a post by Ed Silverman over at Pharalot. The issue is the use if atypical antipsychotics in children:

Florida Medicaid records show the number of children – some just months old – who were prescribed the drugs went from 9,364 seven years ago to 18,137 in 2006. No records for privately insured patients are available.

As I mentioned earlier this week, putting the blame on the pharmaceutical industry is an oversimplistic reaction to how psychiatry, psychology,and our culture have transformed childhood into a diagnostic checklist. As mentioned in Ed’s post, the litigation in Florida appears to be the recommendation by agencies receiving Medicaid funds to use these drugs in children with ADHD who also had tics. While none of the atypical antipsychotics, to my knowledge, are FDA approved for this condition, it is common knowledge among mental health professionals that the most effective treatment for tics are dopaminergic antagonists such as atypical antipsychotics. True, the recent National Institute of Health’s CATIE study demonstrated that most of the atypicals were no better than the older ones. But that doesn’t mean that the newer atypicals aren’t effective or an appropriate treatment. Perhaps, our current social construction of adolescence is partly to blame for the boom in mental health diagnosis in our children.

Even more on autism and thimerosal

Ronald Bailey at Reason’s blog Hit & Run discusses a recent article by Stephanie Desmon in the Baltimore Sun on the topic. Ron rightly mentions the end result of all the fuss over thimerosal in vaccines: worried parents, unvaccinated kids and more expensive vaccines. As I mentioned earlier this week, a recent study in the Archives of General Psychiatry also cast doubt on the supposed link.

Cerqueira v. American Airlines

“Robert Loblaw” at the blog Decision of the Day, has this post on the case of Cerqueira v. American Airlines. In sum, after being booted off the plane for some suspicious behavior, plaintiff John Cerqueiia, thought he would sue. After winning an award $130,000 in compensatory damages and $270,000 in punitive damages the case was appealed. The First Circuit reversed:

On appeal, the First Circuit vacates the award and grants judgment for the defendants. In an opinion that is heavy on the factual details of the incident – and particularly the facts as they appeared at the time to the key decision makers – the First concludes that the jury instructions were incorrect. Among other things, the district court refused to provide instructions about the security provisions of Federal Aviation Act that governed the captain’s actions. In light of the flawed instructions, the Court concludes that the verdict cannot stand.

Moreover, the Court concludes that there is no evidence to sustain the jury’s conclusion that the plaintiff was discriminated against because he appeared to be middle eastern. In particular, neither of the two key decision makers – the captain and a manager in American’s Dallas headquarters – even saw the plaintiff until trial, and there is no other evidence to suggest that their decision was based on assumptions about the plaintiff’s race. Accordingly, the defendants are entitled to judgment notwithstanding the verdict.

Irrespective of the appellate decision, the initial jury verdict of $400,000 says a lot about how justice seems proportionality unfair and unmeasured given the facts of this case.

(Earlier at Overlawyered: Jan. 17.) Update Mar. 2: Cerqueira responds.

The confused world of child psychiatry

There’s been a lot of news lately involving child psychiatry. As noted by others, the Supreme Court may grant cert in the case of Pittman v. South Carolina which has the interesting twist that the defendant, age 12 at the time of the crime, was taking antidepressants when he killed his grandparents. Yet, as I mentioned the link between antidepressants and violence is tenuous at best.

On the heels of the Pittman case, comes this weeks Frontline program which explored the explosive growth of children being diagnosed with bipolar disorder. Unlike ADHD, bipolar disorder is generally treated with antipsychotic medications which can have profound and lasting side-effects. Yet, the desire to place the blame at the foot of the pharmaceutical industry is misplaced; the psychiatric community has a long tradition of capturing behaviors within their diagnostic net and transforming them into pathologies. All of the pharmaceuticals in the world do nothing to our children without a mental health culture which favors medicine as the first line of treatment for troubled children. And that mental health culture is not just a product of myopic physicians or Big Pharma, but very much one of our own creation.

Maternity leave during high school

Jeremy Meyer has this article in the The Denver Post about a proposed plan to offer pregnant teenage mothers 4 weeks of maternity leave as official school policy. It surely is commendable when schools allow new mothers time to be with their newborns and adjust to parenthood; yet to make such accommodations official policy essentially means that it becomes a right — and all rights are ripe for litigation.

Cometh the Regulation

Ed Silverman reports that pharmaceutical reps will now have to be licensed in D.C. From the story in the Washington Business Journal:

The measure makes D.C. the first in the country to license pharmaceutical company sales representatives, able to revoke that license if a salesperson’s activities were deemed fraudulent… The bill, dubbed SafeRx, also mandates that drug reps have a bachelor’s degree, adhere to a code of ethics and refrain from giving doctors gifts.”

As the Journal alludes to later in the story, the lawsuits have begun.

Thimerosal Disappears but Autism Remains

That’s the title of this commentary in the latest issue of Archives of General Psychiatry. The author, Dr. Eric Fombonne of Montreal Children’s Hospital, provides his two cents regarding a new study in the same issue: Continuing Increases in Autism Reported to California’s Developmental Services System: Mercury in Retrograde. In sum, as Dr. Frombonne concludes:

The study by Schechter and Grether in this issue of the Archives provides additional evidence of the lack of association between thimerosal exposure and the risk of autism in the US population. Using an ecologic design and data from the California Department of Developmental Services, the authors showed that the prevalence rate of autism increased continuously during the study period even after the discontinuation of the use of thimerosal in US vaccines in 2001. Had there been any risk association between thimerosal-containing vaccines and autism, the rate of autism should have decreased in young children between 2004 and 2007. Instead, the rate increase did not attenuate, indicating that thimerosal exposure bears no relationship to the risk of autism.

Whatever the science says, there’s at least three reasons why people continue to believe in a vaccine-autism link. Yet like the Vioxx litigation, science only gets you so far once litigation is introduced to the mix.

When is it nobody’s fault?

I’d like to thank Walter Olson for inviting me to contribute to one of my favorite blogs, Overlawyered. As an attorney and psychologist, I’ve worked in a number of different hospitals across the country. Health care institutions are unique places to work for in many respects because the decisions made there can directly lead to serious or even fatal outcomes. Of course this is obvious, as should be the fact that despite the best intentions of everyone involved in a patient’s care, bad outcomes occur.

Alison Cowan has this article in last Friday’s New York Times highlighting a recent case involving the suicide of Ruth Farrell. By all accounts Farrell had been quite depressed for a very long time. As is the case with some people who struggle with chronic depression, Ms. Ferrell was admitted to the hospital for care and observation related to her depression and suicidal ideation. Sadly, Ms. Farell hanged herself with her own pants between the standard 15 minute “checks” performed by staff on psychiatric wards. In turn, her estate sued her doctors and the hospital claiming improper care.

Read On…