Sunday, June 29, 2008

PTSD: Diagnosis du Jour

I was drawn to a book review in the Wall Street Journal this weekend: Five Best - Paul McHugh on books about the factions and follies of psychiatry. To me, that the WSJ should review five psychiatric books together is most unusual. One of the books reviewed was: Stolen Valor by B.G. Burkett and Glenna Whitley.

Stolen Valor looks into the diagnoses of Post Traumatic Stress Disorder (PTSD) in Vietnam Veterans, the real heroes and the faked victims. I was rather stunned.

I remember one of my juniors asking me if I believed PTSD existed.

What could I have said? It was new at the time and we just had a few major disasters and the Gulf War. O.K. We did not have Vietnam and The First and Second World Wars seemed a long, long time ago.

It so happened that a lawyer who was acting on behalf of one of my patients specifically asked about PTSD, and for good measure, she sent me all the available literature. All I knew then was psychiatric diagnosis and compensation often created a division, especially in the courts of law, and it all depended on whose side you took.

And why should science depend on belief?

The WSJ book review said:

Psychiatrists who tend to work on social agendas that are remote from patient care constitute the discipline's ‘political faction.’ Almost unfailingly, its politics support left-leaning government policy and can have a pernicious, blame-America-first effect at times of international crisis. In ‘Stolen Valor,’ B.G. Burkett and Glenna Whitley produced a classic indictment of this faction's overreaching.”

It followed:

“The authors describe how Post-Traumatic Stress Disorder (PTSD) emerged as a new diagnosis from the Vietnam War, the result of an alliance of antiwar psychiatrists, VA hospital administrators, and patients who never saw combat or even Vietnam service but found that reciting the PTSD symptoms would result in the awarding of disability payments.”

No mincing of words here.

“These allies combined to cultivate the idea that hundreds of thousands of Vietnam veterans were rendered incapable of normal civilian life because they had suffered an ‘incurable wound’ of the mind.”

An incurable wound? There are numerous examples of those who have "overcome"! What about the likes of Charlize Theron, whose alcoholic father was shot by her mother in front of her eyes at the tender age of 15? She rose to become an extremely successful actress and was awarded an Oscar for Best Actress in 2004.

Over a period of ten years, Mr. Burkett, using the Freedom of Information Act, found that some 1,700 individuals, including some of the most prominent examples of the Vietnam veteran as dysfunctional loser, had fabricated their war stories. Many had never even been in the services. Some even claimed they were in Vietnam long after the war ended. War did funny things, or was it money?

In my years of practice, I have seen many parents who want a diagnosis for their children that allows them to claim compensation. ADHD is one of the most notable one. The problem is that if we are not careful, children may be put on medication just so that their parents can claim Disability Benefit.

We psychiatrists have to be able to tell the fakes in our work so that the real patients get the care they deserve.

There is now a move to tighten the definition of PTSD in DSM V.

“Our Constitution was made only for a moral and religious people. It is wholly inadequate to the government of any other,” so said John Adams, second President of the United States of America. He died on July 4, 1826, aged 90 on the 50th anniversary of independence. He outlived Thomas Jefferson, the third President, who also died on Independence Day, by just a few hours.

President John Adams

The White House Website

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Friday, June 27, 2008

Shrink Rap Grand Rounds: The iPhone 3G Edition

My Three Shrinks hosted the iPhone 3G Grand Rounds and I was away collecting more blogging material under-water, not reachable even via the iPhone. Thank you Three Shrinks for picking Anorexia Nervosa: What If! for the Grand Rounds.

Tuesday, June 17, 2008

Anorexia Nervosa: What If!

There is a misguided belief that Psychiatry is like other branches of medicine, that we make diagnosis as if we know the definitive cause, course of treatment and prognosis.

I accept that even in other branches of medicine, what we used to know sometimes can be turned upside down overnight. We only need to look at the evolution of the understanding and treatment of Leprosy and Tuberculosis over time, and in the modern era, that of HIV/AIDS.

I was brought up to understand that “scientific truth is nothing more than what the top scientists believe in at the time.” In this modern era of “biotech” approach to medicine, new understanding is yet to be found for many conditions. In these cases, are we content to continue with empirical and symptomatic approaches?

Anorexia Nervosa comes to mind and this is one of the conditions that have for want of a better word captured the imagination of sufferers and public alike. I have already posted an earlier blog on its brief history.

Sometimes a diagnosis as powerful as Anorexia Nervosa can be a hindrance to the improvement of “sufferers”. Over my years of practice, I found that those who did well were cases where we indeed moved away from the medical/conventional psychiatric model to a somewhat paradoxical approach.

Let us consider a couple of “WHAT IF” scenarios.

What if in DSM V (the next edition of DSM), Anorexia Nervosa was voted out by the psychiatrists as a mental condition? (As they did with Homosexuality in 1973.) What if the European Court of Human Rights deemed it against human rights to forcibly treat Anorexia Nervosa? (Remember Ghandi?)

My speculations are that under these circumstances:

1:A third of the parents would take over and make sure that their bright young offsprings eat properly and stop blaming adolescent units for failing them.

2:A third would have rich enough parents who would pay for their expensive treatment in health farms.

3:Some would be snapped up by modelling agencies as the world is hungry for skinny models.

That is not 100%, you may observe.

Ah, what about mortality rate? That would be same as now or lower.

This is only one child psychiatrist’s conjecture.

The reality is that the availability of force feeding as a last resort often leads to complacency in the Psychiatric Team. Creativity is key to the resolution of many Child Psychiatric problems and the fact that Anorexia Nervosa patients can change dramatically in a split second is testament to the need for such an approach. (The Chapter “Seven Minute Cure” in The Cockroach Catcher describes such a case.) I am not advocating the declassification of Anorexia Nervosa, but would just like to encourage those of us dealing with these cases to try to understand the underlying dynamics and be innovative in their management. It could be a worthwhile experience.

Perhaps we can set up the new iPhone 3G as iAnorexphone and the Psychiatrist’s computer can watch his patients at meal time, gym and wherever else while he is busy blogging.

We need to think outside the box, and not just treat symptoms.


Grand Rounds from the South Pacific

David (as he likes to be called) of Marianas Eye hosted this weeks Grand Rounds from the South Pacific.

He has written a book called:
World Peace, a Blind Wife, and Gecko Tails.

DAVID KHORRAM, MD. As a young eye surgeon, Dr. David Khorram left the offers awaiting him in American's leading medical centers, and boarded a plane for the South Pacific, never to return. Starting in exotic Pago Pago, David has traveled, worked and lectured in villages, hospitals and huts throughout the Pacific. As a writer, he is the recipient of a Governor's Humanities Award. The founder of Marianas Eye Institute, Dr. Khorram is listed in Guide to America's Top Ophthalmologists. David, his wife Mara, and their four energetic children live on the island of Saipan, in the Marianas archipelago.”

Here is how he described my blog:

Cool Kid Reject ADHD in Favor of Bipolar Disorder

Did you know that 500,000 children and teenagers were given at least one prescription for an antipsychotic in 2007, including over 20,000 children under age six? What I want to know is, why didn’t anyone tell me? A half-million prescriptions, and not a single one of my four kids was offered the stuff! I feel gypped. Dr. Zhang who is the author of the book, Cockroach Catcher, writes about Bipolar Disorder in Children at Cockroach Catcher Blog, "ADHD was the old black. Bipolar became the new black.”

He catches them too.

Thank you David for some interesting picks.

Friday, June 13, 2008

Golf, Cholera and Tiger Woods

“Do what the doctors do, not what they say” has a lot of truth in life.
When it comes to replenishing energy in sports activities, we look at top athletes, and “Do what the top athletes do, not what they say.”
Annika Sorenstam Golf Channel Photos
Recently I was fortunate enough to be at the Ginn Tribute, hosted by Annika (an LPGA event). I am a firm believer that amateur men golfers stand to gain a good deal more watching top women players than top men players.
Sitting at the first Tee one got to learn the etiquette of the top players. They all shook hands with the Official Starter and the LPGA Rules Official, of course, but they also shook hands with and thanked the volunteers on the first tee. Such tournament requires a large number of volunteers – 900 in fact for the Ginn Tribute.
Then you watched their stretching and warm-up swings, and it was interesting to watch their “energy” preparation.

I was totally surprised. Perhaps I should not have been. Apples and bananas remained the top favourites, together with plain bottled water. I must be fair, some, especially the Caddies, did pick up the proprietary drink: Gatorade. Perhaps it was because the caddies had to carry the heavy bags and the temperature was drifting into the 90s, but the lady players were probably concerned with the high glucose/fructose/sucrose content of the drinks.

Then I saw this in the New York Times:
DR. MARK TARNOPOLSKY, a muscle physiology researcher at McMaster University in Canada and a physician, knows all about the exhortations by supplement makers and many nutritionists on what to eat and when to eat it for optimal performance. (He won the Ontario trail running series in 2004, 2005 and 2006.)
……So might his colleague, Stuart Phillips, a 41-year-old associate professor of kinesiology at McMaster who played rugby for Canada’s national team and now plays it for fun.”
Would it surprise anyone as to what they actually do:
“……neither researcher regularly uses energy drinks or energy bars. They just drink water, and eat real food. Dr. Tarnopolsky drinks fruit juice; Dr. Phillips eats fruit. And neither one feels a need to ingest a special combination of protein and carbohydrates within a short window of time, a few hours after exercising.”

Put simply: eat real food and have regular meals.
What has Cholera got to do with all of this? You may well ask.

“Few afflictions have attracted as much attention and impacted on as many societal and biomedical areas as cholera…….The finding that cholera was due to the ingestion of contaminated water lent to the demise of the prevalent ‘miasmatic theory of contagion, set the platform for the ‘germ theory of disease,’ and promoted the growth of public health concerns for water purification and sanitation. More recent attention to this disease led to the notion of ‘secretory diarrhea’ and the translation of basic principles to the development of oral rehydration therapy and its ‘spin-offs’ (Gatorade and Pedilyte).

Stanley G. Schultz University of Texas Medical School
Cholera is caused by the organism Vibrio cholerae. Alert readers will note that Vibrio has caused much excitement because of the phenomenon of Quorum Sensing.

I well remember Hong Kong’s cholera epidemic in 1961 and the major cause of death was the rapid loss of fluid due to a specific secretive action of the cholera germ. Patients could die in a matter of hours. The medical profession has long been of the strong belief that Intravenous Fluid (IV Fluid) is the only answer. In that situation, the patient is in shock and to find a vein means a cut-down: literally cutting through the skin to find one. It is a messy business as the patient is violently pumping out fluid in the most horrendous fashion.
Johns Hopkins established a centre in Calcutta in the 1960s to study precisely a better way to replenish the fluid. IV fluids were expensive to manufacture and required medical personnel to administer. Their Clinicians sought help from basic physiology and carried out the first carefully controlled study which showed that intestinal perfusion of cholera patients with saline solutions containing glucose strikingly reduced fluid loss. Put simply, the patients could just drink a glucose and salt solution and the glucose would allow the salt to be piggy backed and absorbed, thus sparing the need to use IV fluids.
“……These compelling findings, however, did not convince the medical establishment, who remained skeptical that such a simple therapy could substitute for traditional intravenous fluid replacement in severely stricken patients under epidemic conditions in the field.”

The World had to wait for a war, this time in Pakistan, when Bangladesh fought for its independence in 1971 and 9 million refugees poured into India and with them cholera. When IV saline treatment was exhausted, Dr Mahalanabis, who had worked at the Johns Hopkins Centre in Calcutta, took the gamble and decided to prescribe a simple solution of glucose and salt in the right proportion for the friends and relatives of the cholera patients, thus saving at least 3.5 million people. Since that time it was estimated that such a simple and cheap remedy saved at least 40 million more lives.

No wonder The Lancet hailed the development of oral rehydration therapy (ORT) as "the most important medical discovery of the 20th century".

The scientists at Johns Hopkins and Dr Mahalanabis received the Pollin Prize of $100,000 in 2002.

In 1965 Robert Cade, Director of University of Florida College of Medicine’s renal and electrolyte division, hit on the idea of mixing the sodium and potassium salts with sugar for the University Gator footballers:
“'The solution,’ Cade recalls, ‘was to give them water, but with salt in it to replace the salt they were losing in sweat. Also, give them sugar to keep their blood sugar up, but not so much sugar that it would upset their stomachs.’
By all accounts, the first batch tasted so bad none of the scientists could stomach it, but when Cade’s wife suggested adding lemon juice, the drink that would soon become known as Gatorade was born.

According to legend, the first on-the-field tests of Gatorade came in a scrimmage between the Gators B team and the freshmen.”

Since 1973 royalties from Gatorade brought $80 million to the University.
Cade died last year at 80 years of age.

The latest development is that Gatorade just launched Gatorade Tiger, a sports drink endorsed by Tiger Woods for a reported fee of $100 million over the next 5 years.

Compared to this endorsement fee, the $100,000 prize money for the inventors of ORT that saved at least 3.5 million lives seems like a small figure.
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Tuesday, June 10, 2008

Grand Rounds (4) 38

Thank you to NHS Blog Doctor for including my post about Trauma and Human Resilience in this week's edition of Grand Rounds. Grand Rounds is a weekly compilation of posts related to health care compiled by a host; NHS Blog Doctor last hosted Grand Rounds in 2006.

Sunday, June 8, 2008

Bipolar Disorder in Children

Recently a U.S. Senator uncovered something close to the Cockroach Catcher’s heart: bipolar disorder in children.

Over the last ten years or so, I kept meeting friends in the U.S. whose children seemed to progress from one psychiatric diagnosis to another with frightening regularity, the most common being from ADHD to Bipolar. One grandmother recently asked me what I thought of Bipolar illness in children.

Being an experienced and seasoned psychiatrist, I was able to bounce the question back.

“Well my grandson of five has just been diagnosed. To me he is just an imaginative bright young thing and I never really had any problems with him when he spent part of the school holidays with me. But now he is on all these medications……” she told me.

Well, a few years ago I was at an American Psychiatric Association conference, where a strong case was made for diagnosing children with Bipolar and giving them the modern anti-psychotic drug. I was impressed then.

Later I was more impressed that a single person seemed to have been able to push through a whole new agenda for the diagnosis of Bipolar disorder in children and their treatment.

ADHD was the old black. Bipolar became the new black.

Until now.

In the New York Times, the headline reads:

Researchers Fail to Reveal Full Drug Pay

“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.”

Who is the psychiatrist?

“By failing to report income, the psychiatrist, Dr. Joseph Biederman, and a colleague in the psychiatry department at Harvard Medical School, Dr. Timothy E. Wilens, may have violated federal and university research rules designed to police potential conflicts of interest, according to Senator Charles E. Grassley, Republican of Iowa. Some of their research is financed by government grants.”

It was Dr Biederman’s presentation I heard at the conference I mentioned earlier. This is interesting!

“Like Dr. Biederman, Dr. Wilens belatedly reported earning at least $1.6 million from 2000 to 2007, and another Harvard colleague, Dr. Thomas Spencer, reported earning at least $1 million after being pressed by Mr. Grassley’s investigators.”
The New York Times was quick to point out that these figures were most likely an under-estimate.
“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. The Grassley investigation did not address research quality…..

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….
Doctors have known for years that antipsychotic drugs, sometimes called major tranquilizers, can quickly subdue children. But youngsters appear to be especially susceptible to the weight gain and metabolic problems caused by the drugs, and it is far from clear that the medications improve children’s lives over time, experts say.
What is the number of children involved?
“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.”

Under 6 years of age!!! Take a look at this tragedy in The Boston Globe.

A girl of 4 died. These are the words in The Boston Globe;

“Finally, it's sad but true -- the field of child psychiatry is afraid of Biederman. One can hear the worries and fears whispered in the academic halls and clinics over where Biederman has taken the profession. Yet to politely challenge Biederman in public is to risk public retribution and ridicule from him and his team. Also academic researchers in child psychiatry risk losing their funding if they criticize this darling of the pharmaceutical industry, which provides most of the money these days for psychiatric research.” Dr. Lawrence Diller

Looking back at my career
as child psychiatrist for over 30 years, I can count six bipolar cases, one at age 11, three between 13 and 16 and two over 16. All of them responded extremely well to Lithium.

Although the Grassley investigation did not address research quality, the New York Times article reported dissenting voices from other top psychiatrists:
“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.”

This is why I have always argued that reports from parents, teachers and children cannot entirely replace direct clinical observation.

“More broadly, they said, revelations of undisclosed payments from drug makers to leading researchers are especially damaging for psychiatry.”

Money corrupts.

Saturday, June 7, 2008

Review on Amazon

The Cockroach Catcher has a full review on Amazon.

Here is the full review:
BOOK REVIEW, by Peter Chang.

Reading this book was truly a trip down memory lane for me.

Not only was I in the same medical school as the author (hereinafter referred to as "Zhang"), he and I were assigned to the same study group in our 5-year sojourn at the University of Hong Kong. I too caught cockroaches in my matriculation years in order to practice the dissection of their salivary glands and digestive system, just as Zhang describes in the book. After we graduated in 1968 with the degree of M.B.,B.S. (Bachelor of Medicine and Bachelor of Surgery, we served as "housemen" (known as "interns" in North America) for one year in different hospitals. In 1969, Zhang and I, together with several other classmates, went into Castle Peak Hospital, the only mental hospital in Hong Kong at the time, to work as "medical officers", which was essentially an apprenticeship in psychiatry. We both took the examinations of the Royal College of Physicians in London, England, to obtain the D.P.M. (Diploma in Psychological Medicine) around 1972.

Although Zhang settled in the United Kingdom, and I in Canada, I can identify with much of his experience as a psychiatrist. This book helps to demystify mental illness and humanize the doctor-patient relationship. I am very impressed by Zhang's down to earth approach to problem solving. The secret to his success in therapy is the respect that he gives to his patients, their families and his colleagues. Just by listening to his patients and believing in their stories, Zhang is able to perform miracles, such as the "Seven Minute Cure" (Chapter 1), Ping Pong (Chapter 24), and "Bullying" (Chapter 23).

Zhang has a special talent for engaging difficult patient in therapy, as exemplified in "Wrong Foot" (Chapter 12), "Hiccup Boy" (Chapter 13), "Failure" (Chapter 34), and "Yellow Card" (Chapter 46). As Zhang finds coercive treatment distasteful, such as force feeding an anorexic patient, he is good at negotiating with patients so that they would voluntarily eat again to achieve their own individual goals. For instance, the patient in Chapter 34 started to eat again because she did not want to be "sectioned" (meaning certified under mental health laws) which would prevent her from going to the United States to pursue higher education.

While most doctors are content with taking a medical history, Zhang would listen to his secretary and cleaning staff to learn about the milieu, thus gleaning useful information that can help his patients. It reminds me of Confucian humility. Confucius says: "When three men walk together, I have a teacher among them".

As Western trained psychiatrists with Chinese heritage, Zhang and I are not confined to particular schools of thought. Neither of us has felt the compunction to subscribe to a particular theory, such as being Freudian, Jungian or a behaviorist. We aim to be "eclectic", that is, to use whatever that works. In 1970's, psychoanalysis dominated training institutions for psychiatrists in U.K. as well as in Canada. I can see in the book that while Zhang is educated in psychoanalysis, he is not bound by it in his practice. His creative and innovative approaches to clinical problems remind me of the now popular "C.B.T." (cognitive behavior therapy).

Zhang laments the dawning of the age of red tape in psychiatry, which is the same all over the world. The emphasis on "guidelines", also known as "evidence based medicine", and artificial restraints on access to services, have changed the landscapes of our practice. If everyone practices cookie cutter type of medicine, where will we find new thinking and new treatments?

This book is a "must read" for all professionals in the mental health field, and for all interested individuals. It is a kaleidoscope of life seen from the eyes of the therapist who genuinely cares about his patients as people. Zhang provides an in-depth understanding of the human condition.

In my view, this book gives us a glimpse into the soul of psychiatry, into holistic medicine at its best.

Tuesday, June 3, 2008

Trauma and Human Resilience

Mental Nurse alerted us to the results of some new research in the US on coping with collective Trauma.

University of Buffalo News Release:
“It's Okay to Keep Those Feelings Inside, New Study Suggests”
“……Contrary to popular notions about what is normal or healthy, new research has found that it is okay not to express one's thoughts and feelings after experiencing a collective trauma, such as a school shooting or terrorist attack.
[The author] points out that immediately after last year's tragic shootings at Virginia Tech University there were many ‘talking head’ psychiatrists in the media describing how important it is to get all the students expressing their feelings.
‘This perfectly exemplifies the assumption in popular culture, and even in clinical practice, that people need to talk in order to overcome a collective trauma,’ he said……”

The Cockroach Catcher, Dr Zhang remembered attending a lunch time talk at his hospital: “What have we learnt from King’s Cross?”

The speaker was a Senior Registrar from the Maudsley."......He was a Registrar at the time of the King’s Cross fire. He was just coming out of the station when the accident happened, and so was at the front line so to speak not just as a pedestrian but also as a psychiatrist. He became interested in PTSD (Post Traumatic Stress Disorder) and did a fair bit of research on King’s Cross and other disasters.
He quoted a number of cases, including the Herald of Free Enterprise disaster. There were those who despite help of all kinds would commit suicide. Many were heroes in that they saved many lives. Yet the feeling that they did not deserve to live eventually overtook them and they committed suicide.
What was most surprising was how the group that had counselling generally fared worse, much worse than those without any counselling. The group that did best were the ones that drank, and drank a fair amount.
It was not his intention to promote vodka but he thought we could not be kept from the truth……
His research showed that talking about the incident seemed to make things worse, much worse than anyone ever imagined……”
Then he remembered
Kim Phuc:
“By rights possibly one of the most damaged psychologically and physically. She underwent no fewer than seventeen operations. The photo of her running down the street of Saigon naked probably changed the course of the Vietnam War and the world’s perception of good and bad. Then came her dramatic escape in 1992 to Newfoundland and her eventual settling down in Canada. Human resilience is not to be underestimated and the imposition of psychological intervention could represent a great under-estimation of our genetical endowment. At one of her public lectures, one of the war veterans who was a helicopter gunner broke down.”
Kim Phuc never had any therapy.

We have to be aware that a whole industry has sprung up based on very inexact theories and it is nice to know that the earlier findings in England have now been confirmed across the pond. In cases where mental conditions are entangled with compensation claims it becomes especially difficult to be truly objective.

On the matter of psychotherapy, a good deal of current blog comments are hostile to therapists and their methods. A good therapist is hard to come by, and should be like a wise aunt or uncle to whom one turns to for advice that one may or may not accept or act on. A good therapist needs to be intelligent and broad-minded, and mature with rich life experience. A bad therapist, on the other hand, takes over and does not allow for any leeway on how one should continue with life.

We may forget too that good therapy is for life, and may be more useful for the mentally healthy than for the mentally sick. What government or insurer would allow for that?

Here I will have to quote my Guru again:
“A Therapist is like a toilet really: some may need it three or five times a week; others once in a while. Some patients may have a sort of mental diarrhoea and require therapy sessions more often.”

My only gripe is that where money is involved, one needs to be cautious: the best advice in life is free, like those from your wise aunt or uncle, if you are lucky enough to have one.
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Monday, June 2, 2008

Picasso, Medicine and Lloyds

Photo © Am Ang Zhang/Bauhinia Press 2008

Trivia question: What is the link between Picasso, medicine and Lloyds (of London)?

Here is the answer.

Retinitis Pigmentosa – latest advance in Medicine

Retinitis Pigmentosa is the name given to a group of hereditary disorders of the retina, a sort of sensor like those on digital cameras that is responsible for transmitting images formed by the lens to the brain for interpretation. The disorder can affect different receptor cells and some sufferers may have a slower rate of deterioration than others. There is often a gradual loss of peripheral vision which makes sufferers more vulnerable to knocking things around them.

(In case you are wondering – no, Picasso did not suffer from retinitis pigmentosa.)

Very recently
London’s Moorfield Hospital did a trial of an artificial eye device (called Argus II) developed by a US firm Second Sight for such sufferers. A tiny camera and transmitter is attached to a pair of glasses, powered by a wireless microprocessor and battery pack that can be worn on the belt. An ultra-thin electronic receiver and electrode panel is implanted in the eye

Exciting news indeed, though it is too late to prevent the damage to one famous Picasso painting.

Le Rêve by Picasso

There were many women in Picasso’s life, and a number of them have been immortalized in his paintings, giving the proud owners a highly valuable asset and of course in some cases a very pleasant picture to look at.

Picasso: Woman in White Metropolitan Museum of Art

“Although the model was always thought to be the artist's Russian wife Olga Khokhlova, it has recently been suggested that Picasso's muse was actually an American beauty, Sara Murphy, wife of the painter Gerald Murphy, with whom Picasso was infatuated between 1921 and 1924.

We may never know the true identity of the sitter, but since Picasso frequently fused the features of different people into a single idealized portrait, it is possible that this is just such a case. If so, the features of Olga and Sara are integrated here into a masterful and striking composition, full of tenderness and classical beauty.”

Metropolitan Museum of Art

This painting really shows that Picasso could truly paint and draw. We cannot say the same of some modern artists who should perhaps remain nameless.

Could you however imagine how Picasso’s style evolved from this to Le Rêve?

This is a painting of Picasso’s 24-year old mistress, Marie-Thérèse Walter.

“Le Rêve” by Picasso
Christie's file photo via AP

Le Rêve was first bought for $7,000 in 1941 by Victor and Sally Ganz of New York City. It was sold at Christie's auction house on

November 11, 1997 for an unexpectedly high $48.4 million, apparently to Wolfgang Flöttl, an Austrian born financier who later sold it to casino magnate Steve Wynn for an undisclosed sum, estimated to be about $60 million.

On October 9th 2006, news first broke on the pages of the New York Post:

Cubist Killer was the headline and apparently the painting had suffered a six-inch tear.

Two weeks later the New Yorker revealed the full story in The $40-Million Elbow.

Nora Ephron, who wrote Heartburn (inspired by the affair of her second husband, Carl Bernstein of Watergate fame, with Margaret Jay, daughter of Jim Callaghan), When Harry Met Sally, Sleepless in Seattle, etc. wrote about the episode after the New York Post let the cat out of the bag. As you might expect, her account was most entertaining.

“The buyer of the painting, Wynn told us, was a man named Steven Cohen. Everyone seemed to know who Steven Cohen was, a hedge fund billionaire who lived in Connecticut in a house with a fabulous art collection he had just recently amassed. ‘This is the most money ever paid for a painting,’ Steve Wynn said. The price was $4 million more than Ronald Lauder had recently paid for a Klimt. Oh, that Klimt. It had set a bar, no question of that, and Wynn was thrilled to have beaten it. He invited us to come see the painting before it moved to Connecticut, never to be seen again by anyone but people who know Steven Cohen.
There, on the wall, were two large Picassos, one of them Le Reve. Steve Wynn launched into a long story about the painting -- he told us that it was a painting of Picasso's mistress, Marie-Therese Walter, that it was extremely erotic, and that if you looked at it carefully (which I did, for the first time, although I'd seen it before at the Bellagio) you could see that the head of Marie-Therese was divided in two sections and that one of them was a penis. This was not a good moment for me vis a vis the painting. In fact, I would have to say that it made me pretty much think I wouldn't pay five dollars for it.”

My sentiment completely. On the other hand, I would have the Woman in Whilte hanging all the time in my best room.

“He raised his hand to show us something about the painting -- and at that moment, his elbow crashed backwards right through the canvas.
There was a terrible noise.
Wynn stepped away from the painting, and there, smack in the middle of Marie-Therese Walter's plump and allegedly-erotic forearm, was a black hole the size of a silver dollar - or, to be more exactly, the size of the tip of Steve Wynn's elbow -- with two three-inch long rips coming off it in either direction.”

Steve Wynn has retinitis pigmentosa.

For further detail I urge you read Nora’s full account.

The Lloyds of London Connection

Where did Lloyds of London come into this drama?

Well, Mr Wynn would not have the painting worth $139m uninsured, would he? What is interesting is that he then tried to make a claim for $54 million in lost value due to damage, and not surprisingly, Lloyds was not exactly forthcoming.
USA Today on Jan,13th 2007 reported:

“A day after filing a lawsuit against Lloyd's, Wynn on Friday attacked the insurance industry as a whole, accusing insurance companies of ‘irresponsible, careless, inconsiderate and deliberate evasive behavior’ that too often works for them.

He said insurers play ‘dirty tricks’ and habitually delay responding to claims, hoping to wear down those making claims and get them to settle for much less than what they are owed.

‘Most folks that have insurance can't afford the legal fees, so they take what they get,’ Wynn said in a telephone interview. ‘There's only one way to stop this kind of thing, and that is to go to court.’”

Guess what, Lloyds eventually settled for an undisclosed sum. Perhaps Nora could find out for us how much he got. Steve Wynn can certainly afford his legal fees. Hopefully Argus II will be ready soon enough before another painting gets damaged.

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