954-792-4663
Defrocking the False Prophets of Pediatric Psychiatry
by Jeffrey Dach MD
A few years ago, Senator Grassley’s Committee exposed the sleazy relationship between the drug industry and Ivy League Academic Psychiatrists like Joseph Biederman and Charles Nemeroff. This relationship involved the transfer of millions of dollars in payoffs to Academic Psychiatrists and their Departments for advancing the commercial interests of the drug industry.
Above Left Image Joseph Biederman photo courtesy of MGH Web Site.
A New Fad: Childhood Bipolar Disorder, the Diagnosis du Jour
In the process, a new diagnostic fad was artificially manufactured called “childhood bipolar syndrome”, and millions of dollars were spent on unethical, pseudoscientific drug trials to convince the medical community that millions of kids were actually “bipolar” and required these “life saving” drugs which were not FDA approved in kids, and prescribed off-label.(78-86)
The Evil Collaboration
This evil collaboration between the drug industry and key opinion leaders of academic child psychiatry exposed millions of children to the harms and adverse effects of the new “atypical antipsychotic” drugs like Risperdal (Risperidone), Zyprexa (Olanzapine) and Seroquel (Quetiapine). These drugs cause permanent brain damage, atypical movement disorders called tardive dyskinesia, gynecomastia, lactation and weight gain.(26) This is all very bad.
Foot Dragging and A Slap on The Wrist
After three years of foot dragging, Harvard Medical School finally announced sanctions against its high priest of pediatric psychopharmacology, Joseph Biederman and two of his colleagues, Thomas J. Spencer, and Timothy E. Wilens. Sanctions involve tightening accountability and reporting of compensation from drug companies, and placing temporary limits on conducting children’s psychoactive drug trials. The sanctions were merely a slap on the wrist for what could be considered criminal activity. The university should have removed these people from the medical school faculty, and banned them from conducting psycho active drug trials in children. A criminal investigation should also be conducted .
A Pattern of Corruption Repeats Itself Throughout Academic Medicine
A pattern has emerged with the previous fall from grace of Dr Charles Nemeroff who was removed as chairman at Emory and banned from NIH research grants for two years. He nimbly jumped ship to the University of Miami where he resumed his activities unhindered.
States Attorneys Go After the Drug Companies
Martha Coakley, Attorney General of the state of Massachusetts, and 40 other states attorney generals have filed civil and/or criminal cases against these same drug companies for illegal marketing of off-label use of psychoactive drugs for kids. The drug companies themselves are facing thousands of lawsuits from parents and children.(20-31)
Critics of Joseph Biederman and the Drugging of Children
Critics of Biederman’s research include heavy weights such as:
1) Marcia Angell MD, previous editor of the New England Journal and Harvard Senior Lecturer. (1-10) See her scathing two part series in the New York Review of Books. Links to part one and part two (7-10). Dr Angell proposes a ban on off-label prescriptions for anti-psychotics for kids.(6)
Left Image: Marcia Angell MD Courtesy of the NIH.(2-3)
2) Stuart Kaplan MD, High Level Academic Child Psychiatrist at Penn State.(45-49) He is author of the book: “Your Child Does Not Have Bipolar Disorder: How Bad Science and Good Public Relations Created the Diagnosis.” He says “pediatric bipolar disorder” does not exist. The bipolar monster was loosed because American university professors, in cooperation with drug companies, created it.
3) Bruce Levine PhD – clinical psychologist and author of Surviving America’s Depression Epidemic: How to Find Morale, Energy, & Community in a World Gone Crazy. (71-72) His article on the Psycho-Pharmaceutical Industrial Complex Profiting from drugging women and children is a must read.(72)
“Mental health treatment in the U.S. has become a major industry and all the rules of industrial complexes apply. Virtually every institution from which doctors, the press, and the general public receive their mental health information is financially interconnected with Big Pharma. In such a system, U.S. doctors and the general public get bombarded with antidepressant pitches rather than getting clued in to the battle to make the United States a less dehumanizing and depressing society.”
4) Jacob Azerrad PhD , Clinical Psychologist in Lexington Mass. (60-62)
“The real scandal perpetrated by Biederman has nothing to do with his consulting fee shenanigans and everything to do with the real life (and death) consequences of the methods now used by modern pediatric psychiatry to tag normal childhood behaviors with diagnoses – like “childhood bipolar” — and the pediatric medical profession’s complicit acquiescence to such malarkey. It has been nothing short an epic assault on our children by those who prescribe antipsychotic medications as an antidote to normal childhood behavior.”
A number of authors have written books critical of Biederman’s Work:
Irving Kirsch PhD – Professor of Psychology University of Connecticutt and author of The Emperor’s New Drugs: Exploding the Antidepressant Myth.
Daniel Carlat MD – psychiatrist in private practice in Newburyport, Massachusetts and an Associate Clinical Professor of Psychiatry at Tufts Medical School and author of Unhinged: The Trouble With Psychiatry—A Doctor’s Revelations About a Profession in Crisis
Robert Whitaker, journalist and author of Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America. The book won the 2010 Investigative Reporters and Editors book award for best investigative journalism.
Drugging Kids for Profit: Iatrogenic Genocide
Readers here will know that I don’t usually write about children’s health issues, since I confine my medical practice to adult patients who can communicate a medical history and reliably follow recommended dosage instructions.
However this topic deserves our attention. What kind of society have we become, in which the sacrifice of our children has become “acceptable”? What kind of society can blind itself to its own evil deeds, and delude itself into believing the drug company propaganda that anti-psychotic drugs should be dispensed to millions of our children ? The “drugging of children for profit” is the “Nightmare Scenario” described in my previous article on the Future of Medicine, and an expression of who we are and what we have become as a society and a nation. This is a very sad thing.
Dr Peter Breggin sums it up:
“The mass drugging of America’s children has become such an outrageous practice with such vast public health and societal implications, it is difficult to know how to conclude my observations. I can understand how parents who feel confused and overwhelmed can be pushed by psychiatrists into trying to control their children’s behavior with drugs. But shame, shame, and more shame should be heaped upon a profession that has forsaken its sacred trust to protect and to care for children, and instead has become a major child abuser of epidemic proportions.” (16)
Update 2014: More from Bruce Levine
Neureleptics for Children: Hsrvard’s Shame by Philip Hickey
Articles with Related Interest
Attention Deficit Disorder Exposed as Drug MArketing Ploy
Modern Medicine, Organized Crime and Peter Gotzsche
SSRI Drugs Are No Better Than Placebo For Most Cases of Depression
Getting Off SSRI Drugs and Overcoming Depression
Protect Your Family From Bad Drugs
Watch the Gary Null Documentary Video on the Drugging of our Children:
Jeffrey Dach MD
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Links and References
Marcia Angell MD
1) www.nybooks.com/articles/archives/2011/aug/18/illusions-psychiatry-exchange/
letters in response to marcia angell
2) http://www.nlm.nih.gov/changingthefaceofmedicine/physicians/biography_10.html
This photo of Dr. Marcia Angel was obtained from her bio on a National Institutes of Health web site. Because its on a government web site, its in the
3) www.nlm.nih.gov/changingthefaceofmedicine/physicians/biography_10.html
Marcia Angell, M.D. (born 1939) is an American physician, author, and the first woman to serve as editor-in-chief of the New England Journal of Medicine (NEJM). She currently is a Senior Lecturer in the Department of Social Medicine at Harvard Medical School in Boston, Massachusetts.[1]
5) videos.med.wisc.edu/videos/940
The Truth about Drug Companies MArcia Angell 11/02/2007
Paying for prescription drugs is no longer a problem just for poor people. As the economy continues to struggle, health insurance is shrinking. Employers are requiring workers to pay more of the costs themselves, and many businesses are dropping health benefits altogether.
BAN the OFF LABEL USE OF PSYCHOACTIVE DRUGS
6) commonhealth.wbur.org/2011/06/psych-drugs-angell/
June 27, 2011 By Carey Goldberg Dr. Marcia Angell: Off-Label Prescribing Of Psych Drugs Should Be Banned
7) www.nybooks.com/articles/archives/2011/jun/23/epidemic-mental-illness-why/
The Epidemic of Mental Illness: Why? June 23, 2011 Marcia Angell
8) www.nybooks.com/articles/archives/2011/jul/14/illusions-of-psychiatry/
The Illusions of Psychiatry July 14, 2011 Marcia Angell
9) www.nybooks.com/articles/archives/2011/aug/18/illusions-psychiatry-exchange/
Letters in response to marcia angell piece
10) www.nybooks.com/articles/archives/2009/jan/15/drug-companies-doctorsa-story-of-corruption/
Drug Companies & Doctors: A Story of Corruption January 15, 2009
by Marcia Angell
Take the case of Dr. Joseph L. Biederman, professor of psychiatry at Harvard Medical School and chief of pediatric psychopharmacology at Harvard’s Massachusetts General Hospital. Thanks largely to him, children as young as two years old are now being diagnosed with bipolar disorder and treated with a cocktail of powerful drugs, many of which were not approved by the Food and Drug Administration (FDA) for that purpose and none of which were approved for children below ten years of age.
Legally, physicians may use drugs that have already been approved for a particular purpose for any other purpose they choose, but such use should be based on good published scientific evidence. That seems not to be the case here. Biederman’s own studies of the drugs he advocates to treat childhood bipolar disorder were, as The New York Times summarized the opinions of its expert sources, “so small and loosely designed that they were largely inconclusive.”1
In June, Senator Grassley revealed that drug companies, including those that make drugs he advocates for childhood bipolar disorder, had paid Biederman $1.6 million in consulting and speaking fees between 2000 and 2007. Two of his colleagues received similar amounts. After the revelation, the president of the Massachusetts General Hospital and the chairman of its physician organization sent a letter to the hospital’s physicians expressing not shock over the enormity of the conflicts of interest, but sympathy for the beneficiaries: “We know this is an incredibly painful time for these doctors and their families, and our hearts go out to them.”
11) The Emperor’s New Drugs: Exploding the Antidepressant Myth by Irving Kirsch Basic Books, 226 pp., $15.99 (paper)
12) Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America by Robert Whitaker Crown, 404 pp., $26.00
13) Unhinged: The Trouble with Psychiatry—A Doctor’s Revelations About a Profession in Crisis by Daniel Carlat Free Press, 256 pp., $25.00
14) projects.propublica.org/docdollars/
Dollars for Docs What Drug Companies are Paying Your Health Professionals
15) www.newscientist.com/article/mg21028151.900-bipolar-kids-victims-of-the-madness-industry.html?page=1
Bipolar kids: Victims of the ‘madness industry’? 08 June 2011 by Jon Ronson
Peter R. Breggin M.D.
16) http://www.breggin.com/index.php?option=com_content&task=view&id=166
http://www.huffingtonpost.com/dr-peter-breggin/psychiatry-makes-war-on-b_b_103337.html
Psychiatry makes war on “bipolar children” originally posted on Dr. Breggin’s blog at the Huffington Post
The front cover of the May 26, 2008 Newsweek has a banner headline, “Growing Up Bipolar” with a split-face photograph of a ten-year-old boy. The headline should have read, “Victim of Psychiatric Assault.”
“Having been trained in psychiatry at Harvard, I can confirm that famous Boston psychiatrists are among the most arrogantly pro-drug — and within an hour the toddler had been diagnosed as bipolar. Right away he was put on the adult “mood stabilizer,” Depakote.
“The mass drugging of America’s children has become such an outrageous practice with such vast public health and societal implications, it is difficult to know how to conclude my observations. I can understand how parents who feel confused and overwhelmed can be pushed by psychiatrists into trying to control their children’s behavior with drugs. But shame, shame, and more shame should be heaped upon a profession that has forsaken its sacred trust to protect and to care for children, and instead has become a major child abuser of epidemic proportions. “
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4:1 ratio for medicaid vs private insurance kids on antipsychotic drugs
17) http://content.healthaffairs.org/content/28/5/w770.abstract
Broadened Use Of Atypical Antipsychotics: Safety, Effectiveness, And Policy Challenges Stephen Crystal,Mark Olfson,Cecilia Huang,Harold Pincus and Tobias Gerhard Health Aff September/October 2009 vol. 28 no. 5 w770-w781
The data indicated that more than 4 percent of patients ages 6 to 17 in Medicaid fee-for-service programs received antipsychotic drugs, compared with less than 1 percent of privately insured children and adolescents.
A primary difficulty here is the fact that most psychiatric diagnoses are entirely subjective, based on a set of behavioral symptoms. However, the bipolar profile found in the Diagnostic and Statistical Manual of Mental Disorders (DSM) was written for adults, not children. Symptoms of (adult) bipolar include long bouts of depression and mania, delusions and self-aggrandizement, hypersexuality and other risky behaviors that impact their work and social lives.
18) www.nytimes.com/2009/12/12/health/12medicaid.html
Poor Children Likelier to Get Antipsychotics By DUFF WILSON Published: December 11, 2009 New federally financed drug research reveals a stark disparity: children covered by Medicaid are given powerful antipsychotic medicines at a rate four times higher than children whose parents have private insurance. And the Medicaid children are more likely to receive the drugs for less severe conditions than their middle-class counterparts, the data shows.
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News papers Backing away from bi-polar diagnosis
19) www.startribune.com/lifestyle/wellness/124136764.html
Bipolar label soars among kids by JEREMY OLSON , Star Tribune Updated: June 23, 2011. Psychiatrists are now backing away from the increasingly common diagnosis of bipolar disorder. The number of American children diagnosed with bipolar disorder increased 40-fold in a recent 10-year span, one study found. In Minnesota, spending on powerful antipsychotic drugs to treat bipolar and other disorders in children has risen 17-fold since 2000 and exceeds $6 million annually — just in one state-funded health program.
Now, in a medical reversal with few parallels, psychiatrists are backing away from the diagnosis. While some feel bipolar was once under-diagnosed in children, they worry that thousands of kids have since received the diagnosis in error, due to overzealous doctors, desperate parents, quirks in the health insurance system and aggressive marketing by drug companies.
“Some of the doctors that got going with that early on, they sort of drank their own Kool-Aid,” said Dr. Stephen Setterberg, a child psychiatrist with Maple Grove-based PrairieCare. “They talked themselves into believing that many kids were bipolar. It essentially was a diagnostic fad.”
“A substantial number of those kids, if you take them off the problem medication, those symptoms go away,” said Borchardt, a child psychiatrist with Children’s Hospitals and Clinics of Minnesota.
“And then they don’t have bipolar, they just had a medication-induced problem.”
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Lawsuits
20) www.yourspine.com/Chiropractic/AstraZeneca Facing Lawsuits.aspx
By Herb Newborg AstraZeneca Facing Over 25,000 Lawsuits From Seroquel Users Who Developed Diabetes. The lawsuits contend that patients were not adequately warned about the risks of diabetes, while the manufacturer knew of the risk.
AstraZeneca is facing as many as 26,000 lawsuits over its antipsychotic drug Seroquel as the drugmaker prepares for its first jury trial over claims the medicine causes diabetes, that patients were not adequately warned about the risks of diabetes, while the manufacturer knew of the risk, according to court filings.
Many of the suits also claim AstraZeneca promoted Seroquel, approved for schizophrenic and bipolar patients, for unapproved uses. The company said in a U.S. Securities and Exchange Commission filing last week it faces more than 25,000 claims that Seroquel caused diabetes.
21) http://www.businessweek.com/news/2011-07-28/astrazeneca-resolves-most-seroquel-suits-for-647-million.html
AstraZeneca Resolves Most Seroquel Suits for $647 Million July 28, 2011, 12:46 PM EDT By Jef Feeley
22) dida.library.ucsf.edu/search?query=cs%3Aseroquel*&ct=1&page=1
Documents from Drug Industry Document Archives related to the Seroquel Products Liability Litigation.
23) www.jenner.com/files/tbl_s69NewsDocumentOrder/FileUpload500/3296/In re Seroquel.pdf
United STATES DISTRICT COURT MIDDLE DISTRICT OF FLORIDA ORLANDO DIVISION IN RE: Seroquel Products Liability Litigation.
Case No. 6:06-md-1769-Orl-22DAB
24) www.flmd.uscourts.gov/MDL/documents/644.pdf
UNITED STATES DISTRICT COURT MIDDLE DISTRICT OF FLORIDA ORLANDO DIVISION IN RE: Seroquel Products Liability Litigation. Case No. 6:06-md-1769-Orl-22DAB
25) www.pharmalot.com/2011/08/jj-to-settle-criminal-charge-over-risperdal-marketing-while-40-states-plan-lawsuit/
J&J To Settle Criminal Charge Over Risperdal Marketing, While 40 States Plan Lawsuits
26) www.sec.gov/Archives/edgar/data/200406/000095012311075098/y91358e10vq.htm
The Attorneys General of approximately 40 other states have indicated a potential interest in pursuing similar litigation against JPI, and have obtained a tolling agreement staying the running of the statute of limitations while they pursue a coordinated civil investigation of JPI regarding potential consumer fraud actions in connection with the marketing of RISPERDAL®.
And on pg 21 item #95:“95. The Company also understood that Risperdal had unique disadvantages, including,
“more likely to cause extrapyramidal symptoms (EPS), including tremor and stiffness; higher long-term risk of tardive dyskinesia (TD); more likely to cause increased prolactin levels, gynecomastia, lactation; 4 [and] causes significant weight gain (which can be advantageous in children with ADD who are often too thin).” Id. at JJRE07998951.”
MARTHA COAKLEY ATTORNEY GENERAL Massachusetts
August 01, 2011 AG Coakley’s Office Files Suit Against Ortho-McNeil-Janssen for Illegally Marketing Risperdal
BOSTON – Drug manufacturer Ortho-McNeil-Janssen (“Janssen”) is being sued by Attorney General Martha Coakley’s office for illegally marketing Risperdal, an atypical antipsychotic medication. The lawsuit alleges that Janssen promoted the drug to treat elderly dementia and a number of uses in children and adolescents when these uses had not been shown to be safe and effective and had not been approved by the U.S. Food and Drug Administration (“FDA”).
The complaint, filed in Suffolk Superior Court, further alleges that Janssen failed to disclose serious risks associated with Risperdal’s use, including the risk of excessive weight gain, diabetes and, for elderly dementia patients, an increased risk of death.
“Manufacturers should not promote uses of their pharmaceutical products that have not been established to be safe and effective,” Attorney General Coakley said. “Janssen put profits ahead of patient safety by promoting Risperdal for uses that had not been approved and by failing to disclose serious risks associated with Risperdal’s use.”
According to the Attorney General’s lawsuit, Janssen’s unfair and deceptive practices included:
Omitting and/or concealing material facts regarding Risperdal’s efficacy and safety in its communications with Massachusetts health care providers and consumers;
Concealing, omitting or minimizing the side effects and risks associated with Risperdal’s use;
Promoting Risperdal to treat elderly dementia without disclosing to prescribers the serious risks associated with Risperdal’s use in dementia patients, including an increased risk of death;
Promoting Risperdal to treat elderly dementia without disclosing to prescribers that the U.S. Food & Drug Administration had rejected the company’s request to market Risperdal for this use because of unaddressed safety concerns;
Promoting Risperdal’s use as safe and effective to treat conduct disorder and other conditions in children for more than a decade before receiving FDA approval to market Risperdal to treat any conditions in children;
Making misleading and deceptive statements to prescribers about Risperdal’s safety, particularly with respect to weight gain and the risk of developing diabetes;
Paying physicians to participate in sham consulting programs that were, in fact, thinly disguised marketing programs touting unapproved uses;
Targeting its sales and marketing efforts to prescribers who rarely, if ever, prescribe Risperdal for its FDA-approved uses, primarily the treatment of schizophrenia and bipolar mood disorder.
Janssen’s illegal marketing and sales tactics helped the company generate hundreds of millions of dollars in sales in the Commonwealth, according to the complaint. Citing company documents, the lawsuit notes that these illegal tactics helped make Risperdal a market leader in both the children and adolescent and elderly market segments.
This matter is being handled by Assistant Attorneys General Sarah Ragland, Wendoly Langlois and Emiliano Mazlen, with assistance from division chief Thomas O’Brien and paralegal Marie Defer, all of the Attorney General Coakley’s Health Care Division.
28) www.genengnews.com/gen-news-highlights/astrazeneca-to-pay-520m-settlement-in-seroquel-lawsuit/78565333/
GEN News Highlights: Apr 28, 2010 AstraZeneca to Pay $520M Settlement in Seroquel Lawsuit
29) www.nytimes.com/2009/02/28/business/28drug.html
Drug Maker’s E-Mail Released in Seroquel Lawsuit By DUFF WILSON NY Times February 27, 2009
In addition to facing about 9,000 personal-injury lawsuits from more than 15,000 former users of Seroquel, AstraZeneca has said that federal authorities are investigating its marketing of the drug.
30) www.psychsearch.net/lawsuits.html
Summary of all State Lawsuits against Companys Making Atypical Antipsychotics
31) www.pbn.com/Mass-attorney-generalsues-Johnson-Johnson,60287
RHODE ISLAND & MASSACHUSETTS NEWS BRIEFS From the Aug 8, 2011 Mass. attorney general sues Johnson & Johnson, BOSTON – Massachusetts’ attorney general sued Johnson & Johnson’s Ortho-McNeil-Janssen unit for improper marketing of the anti-psychotic drug Risperdal, Bloomberg News reported last week.
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Other Blogs
Cheating Culture David Callahan
32) www.cheatingculture.com/harvard-medical-school/
“Harvard University and Dr. Joseph Biederman . Court documents released in November 2008 portray Biederman as courting drug company money by promising that his work at Massachusetts General Hospital would promote the use of antipsychotic drugs for youngsters. He is one of the country’s most prominent advocates of diagnosing bipolar disorder in children, some under the age of 6, and using these drugs to treat them, even when federal regulators had yet to approve that specific use drugs.
Things only got worse for Biederman in late November: court documents from Johnson & Johnson revealed that Biederman pushed the drug company to finance a research center at the Massachusetts General Hospital with the goal to “move forward the commercial goals of J&J” (they gave over $700,000 to the center in 2002 alone). J&J makes the popular antipsychotic drug Risperdal, more than a quarter of which is prescribed to young kids. FDA panels have argued that the use of anti-pyschotics in children is overdone, though Biederman has been instrumental in pushing this specific use of the drugs (he was named in many lawsuits filed by parents suing drug companies for negative effects of drugs being taken by their children).
Grassley, however, wasn’t through with the nation’s most famous medical institution. In response to a New York Times article in March 2009 describing a Pfizer representative caught taking cellphone pictures of Harvard Medical students during a campus demonstration against industry influence, Senator Charles Grassley demanded the very next day that the pharmaceutical company disclose information about its payments to the school’s doctors. The Iowa senator feared that “pharmaceutical companies have attempted to intimidate academic critics of drugs.”
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1 Boring Old Man Blog
33) 1boringoldman.com/index.php/2011/07/03/bipolar-kids-postscript-detestable/
Bipolar kids: postscript, detestable?…Sunday 3 July 2011.
“I wanted to be done with Biederman, but something was stuck in my mind. One of the Biederman articles about treating disruptive, low intelligence kids with Risperdal [Risperidone for the treatment of affective symptoms in children with disruptive behavior disorder: a post hoc analysis of data from a 6-week, multicenter, randomized, double-blind, parallel-arm study] didn’t make any sense to me. It just didn’t fit. It was a retrospective reanalysis of a previously published study, and that previously published study was five years old and didn’t come from anywhere near Massachusetts General Hospital: “
Blog comment anonymous
“This goes far beyond detestable! These are premeditated crimes against humanity for profit disguised as medicine…the only corresponding examples that come to mind are the atrocities of NAZI Germany medical experimentation or the early 1900’s U.S. eugenics movement.”
34) 1boringoldman.com/index.php/2011/07/03/bipolar-kids-biedermania-and-super-angrygrouchycranky-irritability/
bipolar kids: biedermania and super angry/grouchy/cranky irritability… Posted on Sunday 3 July 2011
35) 1boringoldman.com/index.php/2011/06/29/not-someone-to-jerk-around/
bipolar kids: not someone to jerk around…Posted on Wednesday 29 June 2011 Somewhere in the future, when the definitive history of the alliance between academic psychiatrists and the pharmaceutical industry is finally written, this exchange between Dr. Joseph Biederman of Harvard and a lawyer in a suit against Janssen [J&J] in 2009 will surely be a featured exhibit:
36) 1boringoldman.com/index.php/2011/06/29/harvard-for-sale/
bipolar kids: harvard for sale… 29 June 2011
37) 1boringoldman.com/index.php/2011/07/01/harvard-acts/
bipolar kids: harvard acts…Friday 1 July 2011
38) 1boringoldman.com/index.php/2011/07/08/conduct-unbecoming-2/
Biederman’s response to Paren’s Perspective article is available [NEJM 2010 363:1187-1189.] in full text:
The Perspective article by Parens et al. misleads, misinforms, and is missing relevant facts. The authors imply that the increase in the diagnosis of pediatric bipolar disorder was due to a cabal of child psychiatrists rather than the increase in published, peer-reviewed research.
They argue that “no existing DSM [Diagnostic and Statistical Manual of Mental Disorders] diagnosis conveys the appropriate severity” of the moods and behaviors of children “who can be explosively angry, irritable, frantically active, suicidal, or even homicidal.” An adult with these symptoms would very likely be diagnosed with bipolar disorder, and 65% of adults with bipolar disorder report an early onset of the condition. Research from multiple sites supports the validity of pediatric bipolar disorder.
The authors cite “sparse” evidence supporting the efficacy of medications. Large-scale pediatric trials documenting safety and efficacy have led to Food and Drug Administration approval of two agents. They describe nonmedical treatments as “first-line,” even though few studies document the usefulness of these resource-consuming therapies; those that do consider them adjuncts to medication, not replacements…
Dr. Biederman reports receiving grant support from Alza, AstraZeneca, Bristol-Myers Squibb, Eli Lilly, Janssen, McNeil, Merck, Organon, Otsuka, and Shire, lecture fees from Fundación Ramón Areces, Medice Pharmaceuticals, the Spanish Child Psychiatry Association, Janssen, McNeil, Novartis, Shire, and UCB Pharma, and consulting fees from Janssen, McNeil, Novartis, and Shire…
It’s an arrogant response, a defensive response, a response that only makes sense if you believe Biederman’s group’s papers and ignore others [and reality]. In addition, it misses the point of Parens’ article by a country mile. And his contemptuous “resource-consuming therapies” comment isn’t going to win him any accolades. For that matter, “misleads, misinforms, and is missing relevant facts” is neither correct nor appropriate. And he speaks as if giving Atypical Antipsychotics to these very difficult children actually works – it doesn’t. First, very few of them actually really have a bipolar disorder. Second, while the medications are helpful sometimes, they’re just not that helpful in most of the kind of kids he’s talking about.
But I’m on a different tack in this post. Dr. Joseph Biederman is a bully. It’s in the emails about his dealings with the pharmaceutical people. It’s in his contentious responses during his court deposition. And it’s in this retort to Parens’ article. At the time he wrote this particular nasty-gram, he was being investigated because he took a small fortune in unreported pharmaceutical payola; he had been exposed as signing off on ghost-written literature; and there is public documentation of his active participation in pharmaceutical marketing schemes.
I’ve preached against ad hominem arguments in this blog for years, but this time I defend criticizing not just his science, but also his persona. He’s earned it in spades: conduct unbecoming a scientist; conduct unbecoming a child psychiatrist; conduct unbecoming a physician…
Kurt Larsen
39) kurtlarsen.net/?p=243
Dr. Biederman: Killing Children For Fame, Fortune And Influence. The horrors of a society where ambitious greed perverts every honorable profession, the depravities to which some men will sink when lured by fabulous wealth and influence, can find no better example than the vicious Dr. Joseph Beiderman.
Claudia Gold MD Psychology Today
40) www.psychologytoday.com/blog/child-in-mind/201107/beyond-biederman-and-antipsychotics-young-children
Child in Mind. Promoting children’s healthy development by Claudia M. Gold, M.D. Beyond Biederman and Antipsychotics for Young Children. With Biederman guilty, a new path for children with explosive behavior. Published on July 14, 2011 Now that it has, I believe, been clearly established that this explosion of bipolar disorder diagnoses and antipsychotic use in young children was the wrong path, we need to move on.
David Maller MD
41) davidmallenmd.blogspot.com/2011/03/debunking-de-biederman.html
Wednesday, March 23, 2011 Debunking De Biederman.
Joseph Biederman, the Harvard guru of drugging children, is a psychiatrist who almost single-handedly started the current craze of psychiatrists and primary care doctors diagnosing acting-out children as having bipolar disorder. I discussed in previous posts some of the issues involved both in Dr. Biederman’s behavior and in the diagnosis of “pediatric bipolar disorder,” particularly in my post of March 9, 2010, Recipe for Producing Frequent Temper Tantrums in Children
Dr. Biederman argued that the symptoms of bipolar disorder in children are very different from those of adult bipolar disorder. In particular, he said that manic or depressed mood episodes, required by the DSM to last for a minimum of four to seven days in adults for mania and two weeks for bipolar depression, could last for mere minutes in children. Symptoms of bipolar disorder seen in children but not in adults, he opined, included temper tantrums and “explosive irritability.” Not that he had any clear scientific evidence connecting such symptoms to adult bipolar disorder. I’m guessing he just pulled these ideas out of his butt.
42) davidmallenmd.blogspot.com/2010/03/recipe-for-producing-frequent-tantrums.html
Biederman argues against the use of any duration criteria for manic or depressive episodes in these so-called bipolar children. In the current DSM, hypomania – a mild form of mania – must be present constantly for at least four days, and a full-blown manic episode has to last seven. Although these time lengths are obviously arbitrary, they were put in the DSM so psychiatrists would not label normal mood reactivity as being due to bipolar disorder.
Biederman argues that mood swings in bipolar children can last just a few minutes and rapidly alternate. He further argues that pediatric bipolar disorder is unlike adult mania and is manifested by the key symptoms of temper tantrums and “explosive irritability.” There is no credible scientific evidence that such behavior is related to bipolar disorder. He just MADE THIS UP.
The folks writing the DSM-V are somewhat concerned about the widespread adoption of this ridiculous idea by doctors who only dispense drugs and do no psychotherapy, so they decided they might come up with a whole new mental disorder, discussed in an earlier post, called “temper dysregulation disorder.”
David Deutsch
43) www.settingtheworldtorights.com/node/269
On Fake Diseases David Deutsch
When children behave in ways that schools or parents dislike, this behaviour is often characterised as an illness. Depending on the nuances of the behaviour concerned, a child might be deemed to have Attention Deficit/Hyperactivity Disorder (ADHD),
Oppositional Defiant Disorder (ODD) or any one of a growing range of other illnesses.
However, there is something unusual about these diseases. First of all, they are defined entirely in terms of their symptoms, not in terms of some malfunction of the body. Why is this unusual? After all, before the underlying cause was known, diseases like AIDS and SARS, too, were recognised in terms of their symptoms. But that is different. It is perfectly meaningful to say: “that looks like SARS, but it might just be a bad cold, or the person might be deliberately exaggerating his symptoms”. Hence also, with real diseases, it is possible to have an asymptomatic disease, like asymptomatic Hepatitis C. But it is not possible, even in principle, to have asymptomatic ADHD.
There is another unusual feature of diseases like ODD that should give us pause: they are typically treated without the patient’s consent; and indeed the “treatments” are often physically identical to what would in a non-medical context be called punishments. This breach of human rights is casually justified as being “for their own good”.
ADHD and its ilk really aren’t diseases in the same sense as, say, Hepatitis C. They are metaphorical diseases, the names of which denote behaviours that are deemed to be morally unacceptable. In other words, the child has a certain opinion about what he ought to be doing and this opinion is different from his parents’ opinion about what he ought to be doing.
Take ODD as an example, the diagnostic criteria are: A pattern of negativistic, hostile, and defiant behavior lasting at least 6 months, during which four (or more) of the following are present:
1. often loses temper
2. often argues with adults
3. often actively defies or refuses to comply with adults’ requests or rules
4. often deliberately annoys people
5. often blames others for his or her mistakes or misbehavior
6. is often touchy or easily annoyed by others
7. is often angry and resentful
8. is often spiteful or vindictive
Note the many moral judgements that are necessary to make any diagnosis according to this definition: “actively defies”, “deliberately annoys” and so on. These are not deemed to be disease symptoms when a child does them to an intending kidnapper, or to the parents’ political opponents at a demonstration, for example. These states of the child’s brain become diseases only when a certain condition – disapproval – exists in the brain of another person – the parent or other authority. The treatment is also metaphorical and for ODD it consists of conversations and discipline. Again, this is very different from other diseases: bacteria are not great conversationalists, one cannot debate diabetes, but apparently ODD can be disposed of by talking to it.
The entire purpose of these diseases is, in fact, to give these vile “treatments” a gloss of medical and scientific respectability. Then no attention need be paid to whether the child is right to behave defiantly toward his parents in specific cases. No effort needs to be wasted on such fripperies as rational argument or considering that the child might have a point if they repeatedly refuse to obey their parents or say that they are bored in school. How very convenient for the force-users.
44) www.npr.org/templates/story/story.php?storyId=123544191
Children Labeled ‘Bipolar’ May Get A New Diagnosis by Alix Spiegel
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Stuart Kaplan MD – High Level Academic Child Psychiatrist at Penn State
45) psychiatricnews.wordpress.com/2011/07/16/967/
Childhood Bipolar Disorder: A Convenient Illusion July 16, 2011 by Philip
Interview with Stuart kaplan by MArilyn Wedge
46) www.huffingtonpost.com/marilyn-wedge-phd/childhood-bipolar-disorder-myth_b_895733.html
Marilyn Wedge, Ph.D. Family therapist, author Stuart Kaplan, M.D., a child psychiatrist and clinical professor of psychiatry at Penn State College of Medicine, has written a new book called “Your Child Does Not Have Bipolar Disorder: How Bad Science and Good Public Relations Created the Diagnosis.”
Pediatric bipolar disorder, in contrast, was largely a media fiction sustained by NIMH and the pharmaceutical industry.
47) www.psychologytoday.com/blog/your-child-does-not-have-bipolar-disorder/201107/child-bipolar-disorder-imperiled-conflict-inte
Your Child Does Not Have Bipolar Disorder. The bad science and misdiagnosis of childhood bipolar disorder. by Stuart L. Kaplan, M.D.
48) www.thedailybeast.com/newsweek/2011/06/19/mommy-am-i-really-bipolar.html
Mommy, Am I Really Bipolar? Jun 19, 2011 Stuart L Kaplan M.D.
Hundreds of thousands of children in the U.S. have been wrongly diagnosed with the trendy disorder, argues a noted psychiatrist. And the results can be tragic.
I have been a child psychiatrist for nearly five decades and have seen diagnostic fads come and go. But I have never witnessed anything like the tidal wave of unwarranted enthusiasm for the diagnosis of bipolar disorder in children that now engulfs the public and the profession. Before 1995, bipolar disorder, once known as manic-depressive illness, was rarely diagnosed in children; today nearly one third of all children and adolescents discharged from child psychiatric hospitals are diagnosed with the disorder and medicated accordingly. The rise of outpatient office visits for children and adolescents with bipolar disorder increased 40-fold from 20,000 in 1994–95 to 800,000 in 2002–03.
A Harvard child-psychiatry group led by Dr. Joseph Biederman, a prominent supporter of the diagnosis, recently insisted, “Juvenile bipolar disorder is a serious illness that is estimated to affect approximately 1 percent to 4 percent of children.”
Kaplan is a child psychiatrist and a clinical professor of psychiatry at Penn State College of Medicine. This article is an adaptation from his book, Your Child Does Not Have Bipolar Disorder: How Bad Science and Good Public Relations Created the Diagnosis.
Your Child Does Not Have Bipolar Disorder: How Bad Science and Good Public Relations Created the Diagnosis (Childhood in America) Stuart L Kaplan M.D. (Author)
Stuart L. Kaplan, M.D., is a board certified child psychiatrist and Clinical Professor of Psychiatry with 40 years of experience. He has authored over 100 scientific articles, book chapters, and presentations, and has treated thousands of children.
Currently, Dr. Kaplan is Clinical Professor of Psychiatry at Penn State College of Medicine and sees patients at the Philadelphia Mental Health Clinic at 1235 Pine Street, Philadelphia, PA 19107 (215) 735-9379. His current clinical interests in addition to pediatric bipolar disorder include ADHD, developmental disabilities, and anxiety disorders of childhood.
49) notchildbipolardisorder.com/blog/2011/02/welcome/
My book, Your Child Does Not Have Bipolar Disorder: How Bad Science and Good Public Relations Created the Diagnosis, describes the failures of organized psychiatry, the pharmaceutical industry and the media that led to the adoption and frequent diagnosis of a rare or nonexistent disorder. Making the diagnosis of bipolar disorder in youth proved harmful to the health of children and the reputation of psychiatry as a science. An important measure of the extent of the problem is found in the statistics of changes in diagnosis rates. Between 1994 and 2003 the percentages of mental health office visits for bipolar disorder in youth increased from less than half a percent (0.42%) to more than six and a half percent (6.67%), and between 1996 and 2004 the percent of youth leaving psychiatric hospitals with a diagnosis of bipolar disorder went up 400%!
Laura Hibbard Huff Post
50) www.huffingtonpost.com/2011/06/21/bipolar-disorder-diagnosis_n_880851.html
Bipolar Diagnoses Up 40 Times From Decade Ago. The Huffington Post Laura Hibbard First Posted: 6/21/11 “It’s nearly impossible to distinguish between children alleged to have bipolar disorder and those with straightforward anger-control issues. … Most of these symptoms can easily be matched to less-trendy conditions like attention-deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD). My view is that a diagnosis of bipolar disorder in a child is almost always a case of severe ADHD combined with severe ODD, both fairly common in elementary-school children.”
LA TImes
51) articles.latimes.com/2010/may/17/health/la-he-pro-con-20100517
Time to reexamine bipolar diagnosis in children? Pro/Con Psychiatrists in favor of a new label, temper dysregulation disorder, cite a spike in bipolar diagnoses. But others worry it will add uncertainty to the treatment of an already confusing condition. Some psychiatrists argue that many of these children are being misdiagnosed.
Some psychiatrists argue that many of these children are being misdiagnosed. (Susan Tibbles / For The Times)
May 17, 2010|By Brendan Borrell | Special to the Los Angeles Times
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Pharmalot-Ed Silverman
52) www.pharmalot.com/2011/07/harvard-docs-disciplined-for-conflicts-of-interest/
Harvard Docs Disciplined For Conflicts Of Interest By Ed Silverman // July 2nd, 2011
Three years after they were fingered in a US Senate probe into the interplay between academics who receive grant money from both pharma and the National Institutes of Health, three prominent psychiatrists from Harvard Medical School and Massachusetts General Hospital have been sanctioned for violating conflict of interest rules and failing to report the extent of their payments.
Biederman, in particular (see photo), had been one of the most influential researchers in child psychiatry. Although his studies were small and often financed by drugmakers, his work helped fuel a 40-fold increase from 1994 to 2003 in the diagnosis of pediatric bipolar disorder.
For more than a decade, Biederman and his colleagues aggressively promoted the diagnosis and use of antipsychotics to treat childhood bipolar disorder, a problem that once was largely believed to be confined to adults. But the docs maintained this was underdiagnosed in kids and the meds could be used for treatment, even though they had not been approved for most pediatric use at the time. Meanwhile, the relationships with drugmakers were never properly disclose
Wall Street Journal
53) blogs.wsj.com/health/2008/11/24/jj-backed-child-psychiatry-institute-to-support-risperdal-sales/
WSJ’s blog on health and the business of health. November 24, 2008, J&J Backed Child Psychiatry Institute to Support Risperdal Sales. Harvard child psychiatrist Joseph Biederman and and his ties to the drug industry are back in the news today.
The New York Times and the Journal are reporting that documents released as part of litigation show that Johnson & Johnson, maker of antipsychotic Risperdal, provided financial support for a research institute for pediatric psychopathology that Biederman wanted funded. Click here for a J&J email describing discussions about the institute and here for a breakdown of J&J’s goals and budget to support work on Risperdal for children and adolescents.
Biederman, an advocate for antipsychotic medication for children, has received at least $1.6 million in consulting fees from drugmakers in recent years and has taken fire for failing to properly disclose the full extent of the industry’s support.
The Times cites documents that say a goal of the institute at Massachusetts General Hospital, a Harvard teaching hospital, was “to move forward the commercial goals of J&J.” A spokesman for Harvard said the institute is not affiliated with the school.
54) www.wallsofsilence.com/forum2/viewtopic.php?f=1&t=219
Backlash on bipolar diagnoses in children MGH psychiatrist’s work stirs debate By Scott Allen, Globe Staff | June 17, 2007
55) psychcentral.com/blog/archives/2007/06/17/the-growing-backlash-on-bipolar-in-kids/
The Growing Backlash on Bipolar in Kids By John M. Grohol, PsyD Founder & Editor-in-Chief
56) digitaljournal.com/article/276135
Op-Ed: Dr. Joseph Biederman Plays God With ADHD Meds Jul 18, 2009 by Paul Solomon. The pharmaceutical-industrial complex, according to Levine, is part of a “wave of evil” that “washes not only the financial-industrial complex, the military-industrial complex, the energy-industrial complex, and predatory executives at AIG, Citibank, Halliburton, Blackwater/Xe, Enron, and Exxon.”
Levine was quoting Ralph Waldo Emerson, who wrote: “The wave of evil washes all our institutions alike.” According to Levine, the pharmaceutical-industrial complex has “virtually annexed the mental health profession, whose all-star opportunist team is captained by Harvard psychiatrist Joseph Biederman.”
Mass General Biederman Biography CV
57) www2.massgeneral.org/allpsych/pedipsych/staff/biederman.html
Joseph Biederman, M.D.Professor of Psychiatry Harvard University Chief, Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital
As of March 2007, Dr. Biederman has been ranked as the second highest producer of high-impact papers in psychiatry overall throughout the world with 235 papers cited a total of 7048 times over the past 10 years as determined by the Institute for Scientific Information (ISI). The same organization ranked Dr. Biederman at #1 in terms of total citations to his papers published on ADD/ADHD in the past decade.
Dr. Biederman is Chief of the Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD at the Massachusetts General Hospital, and Professor of Psychiatry at the Harvard Medical School. Dr. Biederman is Board Certified in General and Child Psychiatry.
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Margaret Soltan– English professor at George Washington University, in Washington, DC.
58) www.margaretsoltan.com/?s=biederman
June 22nd, 2011
Biederman, Nemeroff, and Zdeblick aren’t the only controversial high-profile medical school professors in America; but no other professors have been so enduringly under attack – for conflict of interest, for suppression of negative evidence, for personal greed – by the media, professional organizations, and Congress. All three men, for years and years and years, have been accused of serious misbehavior. Their names are always in the papers, and always for the wrong reasons.
59) www.margaretsoltan.com/?s=biederman
July 31st, 2011 – Joseph and His Brothers
Harvard University’s Joseph Biederman, world’s biggest bi-polar diagnosis booster, is making life a little difficult for his psychiatry colleagues at Mass General. Short version: You don’t want to be too closely associated with his antidepressants-for-tots drive, his undisclosed financial conflicts of interest, and his influential insistence that zillions of American children, teens, and adults are bi-polar.
Look at the cover of …… this book. It shows a child’s hand grabbing a massive number of pills.
Your Child Does Not Have Bipolar Disorder by Stuart Kaplan is a richly deserved attack on one of Harvard University’s most prominent professors, Joseph Biederman, a man whose financially self-interested insistence on this serious diagnosis continues to damage and stigmatize millions of young children.
The book’s author, Stuart Kaplan, a professor at Penn State, also has a blog on which he worries, in a day-to-day way, about the psychiatric profession maintaining Buy-Bipolar Biederman’s regime. He notes that although the diagnosis is gradually (thanks to books like Kaplan’s, and to Biederman’s having been sanctioned for taking and not disclosing drug money) being discredited, the editors of the latest, in-progress DSMV are still saying things like this:
There is a startling lack of precision in the discussion of the existence of pediatric bipolar disorder in childhood by the DSM- V Work Group. Many people, myself included, believe it is closer to the truth to assume, until proven otherwise, that this prepubertal “disorder” does not exist at all.
The misdiagnosis monster lives: the stake must still be driven in to the heart of the beast. Beast? Why the strong language? Because the diagnosis is doing terrible things to children; and because the only people benefiting seem to be the people who sell all those pills under the child’s hand on the book’s cover. The bipolar monster was loosed because American university professors, in cooperation with drug companies, created it. Indeed the problem that confronts us now, as Kaplan says, is how to kill it.
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Jacob Azerad
60) www.ahrp.org/cms/content/view/829/9/
The Real Biederman Scandal By Jacob Azerrad, PhD ” The real scandal perpetrated by Biederman has nothing to do with his consulting fee shenanigans and everything to do with the real life (and death) consequences of the methods now used by modern pediatric psychiatry to tag normal childhood behaviors with diagnoses – like “childhood bipolar” — and the pediatric medical profession’s complicit acquiescence to such malarkey. It has been nothing short an epic assault on our children by those who prescribe antipsychotic medications as an antidote to normal childhood behavior.”
Jacob Azerrad
61) www.jacobazerrad.com/
Drugged Children – A New Epidemic A Crime Against Childhood
62) www.jacobazerrad.com/art_crime.html
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NY Times
63) www.nytimes.com/2008/06/08/us/08conflict.html
Researchers Fail to Reveal Full Drug Pay By GARDINER HARRIS and BENEDICT CAREY Published: June 8, 2008
A world-renowned Harvard child psychiatrist whose work has helped fuel an explosion in the use of powerful antipsychotic medicines in children earned at least $1.6 million in consulting fees from drug makers from 2000 to 2007 but for years did not report much of this income to university officials, according to information given Congressional investigators.
Dr. Biederman is one of the most influential researchers in child psychiatry and is widely admired for focusing the field’s attention on its most troubled young patients. Although many of his studies are small and often financed by drug makers, his work helped to fuel a controversial 40-fold increase from 1994 to 2003 in the diagnosis of pediatric bipolar disorder, which is characterized by severe mood swings, and a rapid rise in the use of antipsychotic medicines in children.
In the past decade, Dr. Biederman and his colleagues have promoted the aggressive diagnosis and drug treatment of childhood bipolar disorder, a mood problem once thought confined to adults. They have maintained that the disorder was underdiagnosed in children and could be treated with antipsychotic drugs, medications invented to treat schizophrenia.
Other researchers have made similar assertions. As a result, pediatric bipolar diagnoses and antipsychotic drug use in children have soared. Some 500,000 children and teenagers were given at least one prescription for an antipsychotic in 2007, including 20,500 under 6 years of age, according to Medco Health Solutions, a pharmacy benefit manager.
Few psychiatrists today doubt that bipolar disorder can strike in the early teenage years, or that many of the children being given the diagnosis are deeply distressed.
“I consider Dr. Biederman a true visionary in recognizing this illness in children,” said Susan Resko, director of the Child and Adolescent Bipolar Foundation, “and he’s not only saved many lives but restored hope to thousands of families across the country.”
Longtime critics of the group see its influence differently. “They have given the Harvard imprimatur to this commercial experimentation on children,” said Vera Sharav, president and founder of the Alliance for Human Research Protection, a patient advocacy group.
Many researchers strongly disagree over what bipolar looks like in youngsters, and some now fear the definition has been expanded unnecessarily, due in part to the Harvard group.
The group published the results of a string of drug trials from 2001 to 2006, but the studies were so small and loosely designed that they were largely inconclusive, experts say. In some studies testing antipsychotic drugs, the group defined improvement as a decline of 30 percent or more on a scale called the Young Mania Rating Scale — well below the 50 percent change that most researchers now use as the standard.
Controlling for bias is especially important in such work, given that the scale is subjective, and raters often depend on reports from parents and children, several top psychiatrists said.
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Mass General Disciplines Biederman
64) www.bizjournals.com/mobile/boston/news/2011/07/01/mass-general-punishes-three.html
Mass. General disciplines three psychiatrists. Massachusetts General Hospital on Friday disclosed sanctions against three psychiatrists for violating hospital ethics guidelines by failing to adequately report, internally, seven-figure payments they received from drug companies.
Drs. Joseph Biederman, Thomas Spencer and Timothy Wilens disclosed the disciplinary actions against them in a note to colleagues.
According to a copy of the note made public upon request by the hospital, the three doctors:
• Must refrain from “all industry-sponsored outside activities” for one year.
• For two years after the ban ends must obtain permission from Mass. General and Harvard Medical School before engaging in any industry-sponsored, paid outside activities and then must report back afterward.
• Must undergo certain training.
• Face delays before being considered for “promotion or advancement.”
The three doctors came under the political microscope in June 2008 during remarks Sen. Charles Grassley, R-Iowa, made to a committee investigating conflicts of interest involving clinicians. “Dr. Biederman suddenly admitted to over $1.6 million dollars from the drug companies,” Grassley said. “And Dr. Spencer also admitted to over $1 million. Meanwhile, Dr. Wilens also reported over $1.6 million in payments from the drug companies.”
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65) www.npr.org/blogs/health/2011/07/02/137572941/harvard-punishes-3-psychiatrists-over-undisclosed-industry-pay
Harvard Punishes 3 Psychiatrists Over Undisclosed Industry Pay Saturday, 07/02/11 10:36am Richard Knox
Harvard Medical School and Massachusetts General Hospital have disciplined three faculty members in a long-running conflict-of-interest case that became a prime exhibit in the debate over the federal Physician Payments Sunshine Act of 2010.
Drs. Joseph Biederman, Thomas Spencer and Timothy Wilens stood accused of accepting more than $4.2 million from drug companies for psychiatric research and other activities between 2000-2007 without reporting the income to Harvard, MGH or the federal government.
The accusation carried more weight because Biederman is a leading proponent of the off-label use of antipsychotic drugs to treat bipolar illness in children. His work is widely seen as contributing to an explosive growth in such prescriptions, and much of his support came from companies that benefited from his research.
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Interview with Joseph Biederman
66) www.esi-topics.com/add/interviews/JosephBiederman.html
Attention Deficit Hyperactivity Disorder An INTERVIEW with Dr. Joseph Biederman
Dramatically! Our work has helped to support the notion accepted today that ADHD is a treatable, serious brain disorder of genetic etiology associated with high levels of psychiatric and cognitive comorbidity.
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Evelyn Pringle
67) www.counterpunch.org/pringle04202010.html
An American Phenomenon The Psychiatric Drugging of Infants and Toddlers
By EVELYN PRINGLE
“As for bipolar disorder in kids (meaning pre-teens and younger), it’s simply not an issue in the rest of the world,” Dawdy told Lane. “The bipolar child is a purely American phenomenon.”
“The pharma companies and the Harvard crew worked hand-in-hand to bring America a generation of ADHD kids and bipolar children, and their profound influence can be seen in the millions of children and teens who now carry lifetime diagnoses and take gobs of psychotropic drugs each day, often to their detriment,” he advised.
68) www.counterpunch.org/pringle03072007.html
March 7, 2007 Psychosis and Mania ADHD Drug Warnings Come Too Late for Many
By EVELYN PRINGLE
69) www.counterpunch.org/pringle04212010.html
The Psychiatric Drugging of Children: Inventing Disorders EVELYN PRINGLE
70) altreligion.about.com/b/2009/05/22/no-mercy-for-those-who-invent-facts.htm
Evelyn Pringle says: : The tactic of targeting Scientologists as whackos because they object to the profit-driven disease mongering involved in the bogus invention of an epidemic of mental disorders in this country is getting old.
There are many groups involved in the campaign against the passage of the Mothers Act and given the number of pharma funded front groups that we’re up against we are going to stand together.
I have written numerous article pointing out that this bill is not what it purports to be. If the bill was really aimed at only conducting research to help the relatively few women who suffer from true postpartum depression and psychosis you would not hear a word from me.
It’s the sick and obvious plot to reel in all pregnant and nursing mothers with screenings for a whole slew of mood and anxiety disorders that has me steaming.
The poster above, Katherine Stone provides the best example of what is going to happen to all these women when she explained on her website how she ended up taking “Effexor, Celexa, Seroquel, Risperdal, Wellbutrin, Luvox, Cymbalta, etc.” for a simple diagnosis of postpartum obsessive compulsive disorder.
And furthermore, she said she was still on meds five years later. Deceptively, after I wrote the article, she removed the above list of drugs from her website page and claimed her doctor didn’t know what he was doing.
I have been covering the development of this bogus epidemic by the psychopharmceutical cartel since 2004 and the same off-label drug marketing scheme that targets subgroups for mental illness screening has been used too many times to count.
The latest Mothers Act scam is certainly nothing new to those of us who cover the pharmaceutical industry.
Evelyn Pringle
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Bruce Levine
71) counterpunch.org/levine04282010.html
A Conversation with Robert Whitaker.
The Astonishing Rise of Mental Illness in America By BRUCE E. LEVINE
Whitaker:
When you research the rise of juvenile bipolar illness in this country, you see that it appears in lockstep with the prescribing of stimulants for ADHD and antidepressants for depression. Prior to the use of those medications, you find that researchers reported that manic-depressive illness, which is what bipolar illness was called at the time, virtually never occurred in prepubertal children.
But once psychiatrists started putting “hyperactive” children on Ritalin, they started to see prepubertal children with manic symptoms. Same thing happened when psychiatrists started prescribing antidepressants to children and teenagers. A significant percentage had manic or hypomanic reactions to the antidepressants.
Thus, we see these two iatrogenic pathways to a juvenile bipolar diagnosis documented in the medical literature.
And then what happens to the children and teenagers who end up with this diagnosis? They are now put on heavier-duty drugs and often on a drug cocktail, and you find that they do poorly on that treatment. You find that a high percentage end up “rapid cyclers,” which means they have severe “bipolar” symptoms, and that they can now be expected to be chronically ill throughout their lives.
We also know that the atypical antipsychotics [such as Risperdal and Zyprexa] prescribed to bipolar children cause a host of physical problems, and there is pretty good evidence that they cause cognitive decline over the long term. When you add up all this information, you end up documenting a story of how the lives of hundreds of thousands of children in the United States have been destroyed in this way. In fact, I think that the number of children and teenagers that have ended up “bipolar” after being treated with a stimulant or an antidepressant is now well over one million. This is a story of harm done on an unimaginable scale.
So why hasn’t the media reported on this? The answer is that the media, when it covers medicine, basically repeats the narrative fashioned by the academic doctors who are leaders in the particular discipline, and in this case, academic psychiatrists have told a story of new illnesses — like juvenile bipolar illness — being “discovered,” and of drugs for those treatments that are safe, effective and necessary. They tell this story to the public even as their own studies find that their juvenile bipolar patients — who when they first came to a psychiatrist might simply have been “hyperactive” or struggling with a momentary bout of depression — are ending up with severe bipolar symptoms and can now expect to be chronically ill for life. The problem is that our society trusts academic doctors to tell an honest story, and in this corner of medicine, it’s quite easy to document — and I did document this in Anatomy of an Epidemic — that academic psychiatry has belied that trust.
Bruce Levine
Bruce E. Levine, a clinical psychologist, is author of Surviving America’s Depression Epidemic: How to Find Morale, Energy, & Community in a World Gone Crazy.
72) beta.zcommunications.org/psycho-pharmaceutical-industrial-complex-by-bruce-e-levine
Psycho-Pharmaceutical Industrial Complex Profiting from drugging women and children October 2008 By Bruce E. Levine
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Mercola and Natasha Campbell GAPS
73) articles.mercola.com/sites/articles/archive/2099/12/31/dr-natasha-campbell-mcbride-on-gaps-nutritional-program.aspx
How a Physician Cured Her Son’s Autism… Posted By Dr. Mercola | July 31 2011
74) articles.mercola.com/sites/articles/archive/2011/07/30/why-did-bipolar-disorder-increase-40x-over-last-ten-years.aspx
How Can a 4000% Increase in Bipolar Disorder Be Possible? Posted By Dr. Mercola | July 30 2011
Here are a few additional guidelines to help you address these underlying toxins in your child, without, or at least BEFORE, you resort to drugs:
Severely limit or eliminate fructose
Avoid giving your child ANY processed foods, especially those containing artificial colors, flavors, and preservatives. This includes lunch meats and hot dogs, which are common food staples in many households.
Replace soft drinks, fruit juices, and pasteurized milk with pure water. This is HUGE since high fructose corn syrup is the NUMBER ONE source of calories in children.
Eliminating the sugars and processed foods are key but following close behind are to make sure your child is getting large regular doses of healthy bacteria, either with high quality fermented organic foods and/or high quality probiotic supplements.
Give your child plenty of high-quality, animal-based omega-3 fats like krill oil. Also, make sure to balance your child’s intake of omega-3 and omega-6 fats, by simultaneously limiting their intake of vegetable oils.
Include as many whole organic foods as possible in your child’s diet, both to reduce chemical exposure and increase nutrient content of each meal.
Also reduce or eliminate grains from your child’s diet. Yes, even healthy organic whole grains can cause problems as they too break down into sugars.
Additionally, whole wheat in particular contains high amounts of wheat germ agglutinin (WGA), which can have adverse effects on mental health due to its neurotoxic actions. Wheat also inhibits production of serotonin. Neurotransmitters like serotonin can be found not just in your brain, but the largest concentration of serotonin, which is involved in mood control, depression and aggression is actually found in your intestines, not your brain. Try eliminating them first for 1-2 weeks and see if you don’t notice a radical and amazing improvement in your child’s behavior.
Avoid artificial sweeteners of all kinds.
exercise and outdoor playtime.
maintain optimal vitamin D levels.
Give your child a way to address his or her emotions. Even children can benefit from the Emotional Freedom Technique (EFT), which you or an EFT practitioner can teach them how to use.
Prevent exposure to toxic metals and chemical by replacing personal care products, detergents and household cleaners with all natural varieties. Metals like aluminum, cadmium, lead and mercury are commonly found in thousands of different food products, household products, personal products and untold numbers of industrial products and chemicals. The presence of toxic metals in your child’s body is highly significant for they are capable of causing serious health problems by interfering with normal biological functioning. The health effects range from minor physical ailments to chronic diseases, and altered mood and behavior.
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75) mercola.fileburst.com/PDF/ExpertInterviewTranscripts/InterviewNatashaCampbell-McBrideGAPS.pdf
Transcript of Mercola interview with Dr Campbell
Autism is a digestive disorder essentially. ADHD is a digestive disorder essentially. Dyslexia, dyspraxia, other learning disabilities
and psychological problems in children and adults are digestive disorders.
What GAPS diet does, it removes all the foods which are difficult to digest. It provides foods which are easy to digest and which are very dense in nutrition. Because these patients are not able to digest and absorb food properly they have got multiple nutritional deficiencies. Their brains are starving. Their immune systems are starving. The rest of their body is starving.
These patients need an effective probiotic because we need to introduce beneficial bacteria into their gut that should kill the parasites, drive them out, and to replace them with beneficial flora. Probiotics are an important part of the treatment.
The second supplement that is important for these people are vitamin A and vitamin D in a nutshell form. I recommend cod liver oil for these patients.
For quite a large percent of patients, fish oils and omega-6 oils from plants are helpful for a period of time as well. For a group of patients also digestive enzymes particularly stomach acid supplement can be helpful as well.
The third part of the GAPS nutritional protocol is detoxification.I recommend juicing which is a very old and a very effective and gentle way of removing all sort of toxins out of the body. It has been around for many decades now and has been used by millions of people around the world. I recommend baths with Epson salt and sea salt and seaweed powder and cider vinegar and bicarbonate of soda. These
are very gentle interventions but can be incredibly effective in detoxifying the patient and supplementing the patient with certain elements which are needed for
detoxification.
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Alternative Treatment Campbell GAPS
76) www.gaps.me/
Dr Natasha Campbell–McBride, MD, MMedSci (neurology), MMedSci (human nutrition)
Gut and Psychology Syndrome (GAPS™) – Natural treatment for autism, ADHD/ADD, dyslexia, dyspraxia, depression and schizophrenia
Did your child have normal development in the first year of life, and then in the second year became autistic, hyperactive, defiant, oppositional, aggressive, obsessive, compulsive or developed other abnormal behaviours?
77) www.gaps.me/?page_id=20
Gut and Psychology Syndrome (GAP Syndrome or GAPS) By Dr. N. Campbell-McBride
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Biederman articles pubmed
78) www.ncbi.nlm.nih.gov/pubmed/11018219
Biol Psychiatry. 2000 Sep 15;48(6):458-66.Pediatric mania: a developmental subtype of bipolar disorder?
Biederman J, Mick E, Faraone SV, Spencer T, Wilens TE, Wozniak J.
Despite ongoing controversy, the view that pediatric mania is rare or nonexistent has been increasingly challenged not only by case reports, but also by systematic research. This research strongly suggests that pediatric mania may not be rare but that it may be difficult to diagnose. Since children with mania are likely to become adults with bipolar disorder, the recognition and characterization of childhood-onset mania may help identify a meaningful developmental subtype of bipolar disorder worthy of further investigation. The major difficulties that complicate the diagnosis of pediatric mania include: 1) its pattern of comorbidity may be unique by adult standards, especially its overlap with attention-deficit/hyperactivity disorder, aggression, and conduct disorder; 2) its overlap with substance use disorders; 3) its association with trauma and adversity; and 4) its response to treatment is atypical by adult standards.
79) www.ncbi.nlm.nih.gov/pubmed/9256584
J Am Acad Child Adolesc Psychiatry. 1997 Aug;36(8):1046-55.
Is comorbidity with ADHD a marker for juvenile-onset mania?
To compare the characteristics and correlates of mania in referred adolescents and to determine whether attention-deficit hyperactivity disorder (ADHD) is a marker of very early onset mania.
From 637 consecutive admissions, 68 children (< or = 12 years) and 42 adolescents (> 13 years) who satisfied criteria for mania were recruited. These were compared with the 527 nonmanic referrals and 100 normal controls.
With the exception of comorbidity with ADHD, there were more similarities than differences between the children and adolescents with mania in course and correlates. There was an inverse relationship between the rates of comorbid ADHD and age of onset of mania: higher in manic children intermediate in adolescents with childhood-onset mania, and lower in adolescents with adolescent-onset mania.
CONCLUSIONS:ADHD is more common in childhood-onset compared with adolescent-onset cases of bipolar disorder, suggesting that in some cases, ADHD may signal a very early onset of bipolar disorder. Clinical similarities between the child- and adolescent-onset cases provide evidence for the clinical validity of childhood-onset mania.
80) www.ncbi.nlm.nih.gov/pubmed/10434487/
J Am Acad Child Adolesc Psychiatry. 1999 Aug;38(8):960-5. Risperidone treatment for juvenile bipolar disorder: a retrospective chart review.
Frazier JA, Meyer MC, Biederman J, Wozniak J, Wilens TE, Spencer TJ, Kim GS, Shapiro S.
To investigate the effectiveness and tolerability of the atypical neuroleptic risperidone in the treatment of juvenile mania.
This is a retrospective chart review of outpatients with the diagnosis of bipolar disorder (DSM-IV) treated with risperidone at a university center. Response to treatment was evaluated using the Clinical Global Impression Scale (CGI) with separate assessments of mania, psychosis, aggression, and attention-deficit/hyperactivity disorder (ADHD).
Twenty-eight youths (mean +/- SD age, 10.4 +/- 3.8 years) with bipolar disorder (25 mixed and 3 hypomanic) who had been treated with risperidone were identified. These children received a mean dose of 1.7 +/- 1.3 mg over an average period of 6.1 +/- 8.5 months. Using a CGI Improvement score of < or = 2 (very much/much improved) to define robust improvement, 82% showed improvement in both their manic and aggressive symptoms, 69% in psychotic symptoms, but only 8% in ADHD symptoms.
CONCLUSIONS: Although limited by its retrospective nature, this study suggests that risperidone may be effective in the treatment of manic young people and indicates the need for controlled clinical trials of risperidone and other atypical neuroleptics in juvenile mania.
81) www.psych.umn.edu/courses/fall06/mcguem/psy8993/readings/Biederman ’06 Young adult outcome of ADHD.pdf
Young adult outcome of attention deficit hyperactivity disorder: a controlled 10-year follow-up study JOSEPH BIEDERMAN1*, MICHAEL C. MONUTEAUX1, ERIC MICK1 , THOMAS SPENCER1, TIMOTHY E. WILENS1, JULIE M. SILVA1 , LINDSEY E. SNYDER1
AND STEPHEN V. FARAONE2
Conclusions. By their young adult years, ADHD youth were at high risk for a wide range of adverse psychiatric outcomes including markedly elevated rates of antisocial, addictive, mood and anxiety disorders. These prospective findings provide further evidence for the high morbidity associated with ADHD across the life-cycle and stress the importance of early recognition of this disorder for prevention and intervention strategies.
82) www.ncbi.nlm.nih.gov/pubmed/10560028
Biol Psychiatry. 1999 Nov 1;46(9):1234-42. Attention-deficit/hyperactivity disorder (ADHD) as a noradrenergic disorder. Biederman J, Spencer T.Source Pediatric Psychopharmacology Unit, Massachusetts General Hospital, Boston 02114, USA.
This review revisits the thesis that a dysregulation of the central noradrenergic networks may underlie the pathophysiology of ADHD. We review the pertinent neurobiological and pharmacological literature on ADHD. The noradrenergic system has been intimately associated with the modulation of higher cortical functions including attention, alertness, vigilance and executive function. Noradrenergic activation is known to profoundly affect the performance of attention, especially the maintenance of arousal, a cognitive function known to be deficient in ADHD. Data from family, adoption, twin, and segregation analysis strongly support a genetic hypothesis for this disorder. Although molecular genetic studies of ADHD are relatively new and far from definitive, several replicated reports have found associations between ADHD with DAT and D4 receptor genes. Brain imaging studies fit well with the idea that dysfunction in fronto-subcortical pathways occurs in ADHD with its underlying dysregulation of noradrenergic function. A wealth of pharmacological data (within and without the stimulant literature) provides strong evidence for selective clinical activity in ADHD for drugs with noradrenergic and dopaminergic pharmacological profiles. Available research provides compelling theoretic, basic biologic and clinical support for the notion that ADHD is a brain disorder of likely genetic etiology with etiologic and pathophysiologic heterogeneity. Neurobiological and pharmacological data provide compelling support for a noradrenergic hypothesis of ADHD and suggest that drugs with noradrenergic activity may play an important role in the therapeutics of this disorder.
83) www.ncbi.nlm.nih.gov/pubmed/15949990/
Biol Psychiatry. 2005 Jun 1;57(11):1215-20. Epub 2004 Dec 18.Attention-deficit/hyperactivity disorder: a selective overview. Biederman J.
Department of Pediatric Psychopharmacology Research, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA.
Attention-deficit/hyperactivity disorder (ADHD) is a multifactorial and clinically heterogeneous disorder that is associated with tremendous financial burden, stress to families, and adverse academic and vocational outcomes. Attention-deficit/hyperactivity disorder is highly prevalent in children worldwide, and the prevalence of this disorder in adults is increasingly recognized. Studies of adults with a diagnosis of childhood-onset ADHD indicate that clinical correlates–demographic, psychosocial, psychiatric, and cognitive features–mirror findings among children with ADHD. Predictors of persistence of ADHD include family history of the disorder, psychiatric comorbidity, and psychosocial adversity. Family studies of ADHD have consistently supported its strong familial nature. Psychiatric disorders comorbid with childhood ADHD include oppositional defiant and conduct disorders, whereas mood and anxiety disorders are comorbid with ADHD in both children and adults. Pregnancy and delivery complications, maternal smoking during pregnancy, and adverse family environment variables are considered important risk factors for ADHD. The etiology of ADHD has not been clearly identified, although evidence supports neurobiologic and genetic origins. Structural and functional imaging studies suggest that dysfunction in the fronto-subcortical pathways, as well as imbalances in the dopaminergic and noradrenergic systems, contribute to the pathophysiology of ADHD. Medication with dopaminergic and noradrenergic activity seems to reduce ADHD symptoms by blocking dopamine and norepinephrine reuptake. Such alterations in dopaminergic and noradrenergic function are apparently necessary for the clinical efficacy of pharmacologic treatments of ADHD.
84) www.ncbi.nlm.nih.gov/pubmed/7649957
J Am Acad Child Adolesc Psychiatry. 1995 Jul;34(7):867-76.
Mania-like symptoms suggestive of childhood-onset bipolar disorder in clinically referred children.
Wozniak J, Biederman J, Kiely K, Ablon JS, Faraone SV, Mundy E, Mennin D. Pediatric Psychopharmacology Unit, Massachusetts General Hospital, Boston 02114, USA.
To examine the prevalence, characteristics, and correlates of mania among referred children aged 12 or younger. Many case reports challenge the widely accepted belief that childhood-onset mania is rare. Sources of diagnostic confusion include the variable developmental expression of mania and its symptomatic overlap with attention-deficit hyperactivity disorder (ADHD).
METHOD:The authors compared 43 children aged 12 years or younger who satisfied criteria for mania, 164 ADHD children without mania, and 84 non-ADHD control children.
RESULTS:The clinical picture was fully compatible with the DSM-III-R diagnosis of mania in 16% (n = 43) of referred children. All but one of the children meeting criteria for mania also met criteria for ADHD. Compared with ADHD children without mania, manic children had significantly higher rates of major depression, psychosis, multiple anxiety disorders, conduct disorder, and oppositional defiant disorder as well as evidence of significantly more impaired psychosocial functioning. In addition, 21% (n = 9) of manic children had had at least one previous psychiatric hospitalization.
CONCLUSIONS:Mania may be relatively common among psychiatrically referred children. The clinical picture of childhood-onset mania is very severe and frequently comorbid with ADHD and other psychiatric disorders. Because of the high comorbidity with ADHD, more work is needed to clarify whether these children have ADHD, bipolar disorder, or both.
http://www.ncbi.nlm.nih.gov/pubmed/8755796
To evaluate the psychiatric, cognitive, and functional correlates of attention-deficit hyperactivity disorder (ADHD) children with and without comorbid bipolar disorder (BPD).
DSM-III-R structured diagnostic interviews and blind raters were used to examine psychiatric diagnoses at baseline and 4-year follow-up in ADHD and control children. In addition, subjects were evaluated for cognitive, academic, social, school, and family functioning.
BPD was diagnosed in 11% of ADHD children at baseline and in an additional 12% at 4-year follow-up. These rates were significantly higher than those of controls at each assessment. ADHD children with comorbid BPD at either baseline or follow-up assessment had significantly higher rates of additional psychopathology, psychiatric hospitalization, and severely impaired psychosocial functioning than other ADHD children. The clinical picture of bipolarity was mostly irritable and mixed. ADHD children with comorbid BPD also had a very severe symptomatic picture of ADHD as well as prototypical correlates of the disorder. Comorbidity between ADHD and BPD was not due to symptom overlap. ADHD children who developed BPD at the 4-year follow-up had higher initial rates of comorbidity, more symptoms of ADHD, worse scores on the CBCL, and a greater family history of mood disorder compared with non-BPD, ADHD children.
The results extend previous results documenting that children with ADHD are at increased risk of developing BPD with its associated severe morbidity, dysfunction, and incapacitation.
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85) www.ncbi.nlm.nih.gov/pubmed/8755796
J Am Acad Child Adolesc Psychiatry. 1996 Aug;35(8):997-1008. Attention-deficit hyperactivity disorder and juvenile mania: an overlooked comorbidity?
Biederman J, Faraone S, Mick E, Wozniak J, Chen L, Ouellette C, Marrs A, Moore P, Garcia J, Mennin D, Lelon E. Pediatric Psychopharmacology Unit, Massachusetts General Hospital, Boston 02114, USA.
AbstractOBJECTIVE:To evaluate the psychiatric, cognitive, and functional correlates of attention-deficit hyperactivity disorder (ADHD) children with and without comorbid bipolar disorder (BPD).
METHOD SM-III-R structured diagnostic interviews and blind raters were used to examine psychiatric diagnoses at baseline and 4-year follow-up in ADHD and control children. In addition, subjects were evaluated for cognitive, academic, social, school, and family functioning.
RESULTS:BPD was diagnosed in 11% of ADHD children at baseline and in an additional 12% at 4-year follow-up. These rates were significantly higher than those of controls at each assessment. ADHD children with comorbid BPD at either baseline or follow-up assessment had significantly higher rates of additional psychopathology, psychiatric hospitalization, and severely impaired psychosocial functioning than other ADHD children. The clinical picture of bipolarity was mostly irritable and mixed. ADHD children with comorbid BPD also had a very severe symptomatic picture of ADHD as well as prototypical correlates of the disorder. Comorbidity between ADHD and BPD was not due to symptom overlap. ADHD children who developed BPD at the 4-year follow-up had higher initial rates of comorbidity, more symptoms of ADHD, worse scores on the CBCL, and a greater family history of mood disorder compared with non-BPD, ADHD children.
CONCLUSIONS:The results extend previous results documenting that children with ADHD are at increased risk of developing BPD with its associated severe morbidity, dysfunction, and incapacitation.
86) http://archpsyc.ama-assn.org/cgi/content/abstract/64/9/1032
National Trends in the Outpatient Diagnosis and Treatment of Bipolar Disorder in Youth Carmen Moreno, MD; Gonzalo Laje, MD; Carlos Blanco, MD, PhD; Huiping Jiang, PhD; Andrew B. Schmidt, CSW; Mark Olfson, MD, MPH.
Arch Gen Psychiatry. 2007;64(9):1032-1039.
Conclusions There has been a recent rapid increase in the diagnosis of youth bipolar disorder in office-based medical settings. This increase highlights a need for clinical epidemiological reliability studies to determine the accuracy of clinical diagnoses of child and adolescent bipolar disorder in community practice.
http://ajp.psychiatryonline.org/cgi/content/abstract/168/2/129
Am J Psychiatry 2011; 168:129-142
Severe Mood Dysregulation, Irritability, and the Diagnostic Boundaries of Bipolar Disorder in Youths Ellen Leibenluft, M.D.
From the Section on Bipolar Spectrum Disorders, Emotion and Development Branch, NIMH.
nonepisodic irritability in youths is common and is associated with an elevated risk for anxiety and unipolar depressive disorders, but not bipolar disorder, in adulthood.
Jeffrey Dach MD
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