Patients die in 'third-world' hospital
The headline in The Independent, 17 March 2009
"If patients were dying shouldn’t the doctors be there to save their lives?"
So The Cockroach Catcher asked the most naïve of questions and I am sure the answers are somewhere at Jobbing Doctor:
……“You haven't listened to doctors who pointed out failings. Look what the establishment did to Dr Rita Pal. Just read militant nurse Anne. I'll wager that there are trusts up and down the country just like Mid-Staffordshire.”……
Or Dr Crippen:
……“Allowing this appalling lack of care to continue should be grounds for disciplinary proceedings against any doctor who was involved. So why did the Staffordshire doctors not complain? Once upon a time, one of them did. A courageous doctor then working in a hospital a few miles away in North Staffordshire NHS Trust complained about the appalling medical care she had witnessed in her hospital. Look what happened to her. She was treated by the GMC in the way that Stalin used to treat political dissidents, including being accused of being mentally ill.”……
But perhaps the GMC knew something was not right with NHS hospitals as they all have full PPP Health Insurance.
“Previous medical conditions are covered under the scheme? What kind of premium do you have to pay to insure your house once the fire had started?Having stuffed their faces with roast swan and swilled their 1961 clarets, our masters at the GMC must be relieved to know that they can have their heart attacks in a private, HCP free hospital, rather than having to mix it with the common folk in an NHS hospital.” Dr Crippen.
From the Independent:
“Between 400 and 1,200 more people died than would have been expected in a three-year period, the head of the investigation for the Healthcare Commission said.
“Families have described ‘Third World’ conditions at the trust, with some patients drinking water from vases because they were so thirsty and others screaming in pain.
“The Commission launched an inquiry after concerns were raised about higher than normal death rates in emergency care, in particular at Stafford Hospital.
“The trust argued the anomalies were due to ‘problems with its recording of data and not problems with the quality of care for patients’, the report said.”
How creative, perhaps they should help save the banking crises.
“The investigation found heart monitors were turned off on wards because nurses did not know how to use them and some patients were left dehydrated because nurses did not know how to work intravenous fluid systems properly.”
Where were the junior doctors, perhaps they were all suspended?! And the consultants?!
“The report also found that the Government's target for patients to be seen within four hours at A&E meant patients could be taken to ‘dumping grounds’ to avoid breaching the target.”
Poor managers, trying to save £10 million, meet four hour targets and a whole range of other ones on a £120 million Annual budget all set by central government.
“Chief Executive Martin Yeates, stepped down and has now been formally suspended on full pay, while chairman, Toni Brisby, resigned.”
On full pay!!! No details of compensation and no charges either reported!!!
In Japan, the Health Minister would at least go to the Emperor and offer to have his little finger chopped off.
"Between 400 to 1200 patients died unnecessary and that is only at this Trust."
This surely is culpable homicide. What about other trusts?
You will need to read the details in The Independent here.
The official report is here. I wonder what the cost of the whole report is including all the legal representations of all the parties concerned. Money is again diverted from direct health care to lawyers and others as with child abuse enquiries over the years.
The Climbie enquiry: a cool £3.8 million.
Jobbing Doctor thought:
“Isn't it time for the bottle of whisky and the pearly-handled revolver?”
He is naïve too like The Cockroach Catcher. Whisky, yes they drink a lot at the Westminster bars; but revolver, I don’t think so.
Leading Article: The Independent
Tuesday, March 17, 2009
Monday, March 16, 2009
Mysterious Psychosis: One Patient One Disease
I have often wondered if the government is right after all: most of the time we do not need doctors.
What is the point of spending years studying about some fairly rare conditions and then when the time comes we still miss it. This was covered in the recent uproar about the boy with Addison’s disease by Dr Crippen and Jobbing Doctor. Then we have the X-Factor boy with a 2 Kilogram tumour that remained undiagnosed till late, the inquest hearing continues so I cannot comment any further.
I remembered graduating from medical school quite worried about treating patients as we seemed to know all the rare conditions but little about coughs and colds.
We all know about Hodgkin, Von Recklinghausen and Rett.
Have they done such a good job dumbing down the new generation of doctors or were they too busy with Hemlock to have time for much else?
Even in the US were they too busy working for the big drug firms to have time to teach them real medicine?! Has everything got to be ADHD, Bipolar or psychosis. Especially ADHD for a 39 year old?!
In this week’s Sunday New York Times:
March 15, 2009
“She was 39. Divorced. Lived alone. She took two medications for high blood pressure, as well as an antidepressant and a stimulant, Concerta, a long-acting form of Ritalin, for a diagnosis of attention-deficit disorder.”
“Psychosis and mania were rare but documented side effects of Concerta. Was that the cause of her symptoms or was this simply a manic episode in an underlying bipolar disorder?”
A mysterious psychosis!
The consultant stopped the stimulant and tried to start the patient on antipsychotic and mood-stabilizing medications.
“She refused to take them, so he gave the medication by injection. Slowly her behavior began to change. The wild swings of emotion and outbursts of anger became less frequent. But strangely, her disordered thinking and paranoid delusions persisted. Usually these symptoms improved and worsened together.”
The psychiatrist was called because the nurse could not get her blood pressure.
No, she was not in shock. It was so high it went off the scale.
The Internist was called and she got a high reading of 240/110 and the patient was put into ICU.
I hope by now you have guessed what the diagnosis was.
PHEOCHROMOCYTOMA: the one we all know about. Used to!
But why should the patient not have pheochromocytoma and ADHD and paranoid psychosis and a touch of bipolar. She was after all suicidal and she thought the police came after her seven times!
Perhaps the psychiatrist was still brought up on ONE PATIENT ONE DISEASE.
The Sunday paper continued:
“The psychiatrist had taken her off Concerta, the stimulant, because he knew that it sometimes causes psychosis and mania. That drug works, in part, by causing an overproduction of adrenaline.
“If the drug could sometimes cause psychosis and mania, could this adrenaline-producing tumor do the same thing? He found several papers describing patients who, like this woman, had pheochromocytomas as well as mania and psychosis. The symptoms resolved once the tumor was removed. It was unusual, but it had been reported.”
“And finally, after a year and a half, she was medication free and remains so to this day, three years after her surgery.”
You can read the full story here. New York Times, Lisa Saunders, M. D.
Pheochromocytoma: One Patient One Disease.
What is the point of spending years studying about some fairly rare conditions and then when the time comes we still miss it. This was covered in the recent uproar about the boy with Addison’s disease by Dr Crippen and Jobbing Doctor. Then we have the X-Factor boy with a 2 Kilogram tumour that remained undiagnosed till late, the inquest hearing continues so I cannot comment any further.
I remembered graduating from medical school quite worried about treating patients as we seemed to know all the rare conditions but little about coughs and colds.
We all know about Hodgkin, Von Recklinghausen and Rett.
Have they done such a good job dumbing down the new generation of doctors or were they too busy with Hemlock to have time for much else?
Even in the US were they too busy working for the big drug firms to have time to teach them real medicine?! Has everything got to be ADHD, Bipolar or psychosis. Especially ADHD for a 39 year old?!
In this week’s Sunday New York Times:
March 15, 2009
“She was 39. Divorced. Lived alone. She took two medications for high blood pressure, as well as an antidepressant and a stimulant, Concerta, a long-acting form of Ritalin, for a diagnosis of attention-deficit disorder.”
“Psychosis and mania were rare but documented side effects of Concerta. Was that the cause of her symptoms or was this simply a manic episode in an underlying bipolar disorder?”
A mysterious psychosis!
The consultant stopped the stimulant and tried to start the patient on antipsychotic and mood-stabilizing medications.
“She refused to take them, so he gave the medication by injection. Slowly her behavior began to change. The wild swings of emotion and outbursts of anger became less frequent. But strangely, her disordered thinking and paranoid delusions persisted. Usually these symptoms improved and worsened together.”
The psychiatrist was called because the nurse could not get her blood pressure.
No, she was not in shock. It was so high it went off the scale.
The Internist was called and she got a high reading of 240/110 and the patient was put into ICU.
I hope by now you have guessed what the diagnosis was.
PHEOCHROMOCYTOMA: the one we all know about. Used to!
But why should the patient not have pheochromocytoma and ADHD and paranoid psychosis and a touch of bipolar. She was after all suicidal and she thought the police came after her seven times!
Perhaps the psychiatrist was still brought up on ONE PATIENT ONE DISEASE.
The Sunday paper continued:
“The psychiatrist had taken her off Concerta, the stimulant, because he knew that it sometimes causes psychosis and mania. That drug works, in part, by causing an overproduction of adrenaline.
“If the drug could sometimes cause psychosis and mania, could this adrenaline-producing tumor do the same thing? He found several papers describing patients who, like this woman, had pheochromocytomas as well as mania and psychosis. The symptoms resolved once the tumor was removed. It was unusual, but it had been reported.”
“And finally, after a year and a half, she was medication free and remains so to this day, three years after her surgery.”
You can read the full story here. New York Times, Lisa Saunders, M. D.
Pheochromocytoma: One Patient One Disease.
Narrowing of the renal artery.
Tumour
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Thursday, March 12, 2009
Abuse Abuse Abuse: Lord Laming & Tick-box Assessment
I published my book The Cockroach Catcher in January, 2008 and in it I lamented:
………“As we move into the new century child psychiatrists are faced with more and more guidelines and protocols.
Since Maria Colwell Social Services have been working under revised Guidelines and Child Protection Procedures. The sad truth is that more children continue to be abused and killed despite these tighter guidelines and procedures.
My hunch is that despite media coverage many of us still fail to grasp the dark side – the dark side of human nature. Until we do, we shall continue to read about child abuse, abductions and murders of the worst kind.
In our work, it is sometimes necessary not to follow strictly some of these protocols.”……
I have long suspected that guidelines and protocols are there to protect the staff but perhaps not anymore.
In The Times today:
Lord Laming: Social services failings are 'causing child deaths'
March 12, 2009
"A complete overhaul of operations within social services departments is urgently needed after serious flaws were exposed which put the lives of children at risk, the author of a Government-commissioned report said today.
"In a damning verdict in response to the Baby P murder, Lord Laming disclosed that many of the recommmendations he gave in a 2003 report into the death of Victoria Climbie had not been implemented and that society was 'letting children down' as a result.
"Outlining a catalogue of problems with the way social workers operate and are managed, he said breakdowns in information-sharing between agencies, poor training gvien to overstretched frontline staff, red tape preventing social workers from doing their jobs, and an obsession with targets had left the system inadequate.
"Disclosing that 55 children or babies were murdered by someone who knew them last year, the report said that 200,000 still live in homes where there is a high risk of abuse or domestic violence."
55 Children, that is a large number of children.
………“As we move into the new century child psychiatrists are faced with more and more guidelines and protocols.
Since Maria Colwell Social Services have been working under revised Guidelines and Child Protection Procedures. The sad truth is that more children continue to be abused and killed despite these tighter guidelines and procedures.
My hunch is that despite media coverage many of us still fail to grasp the dark side – the dark side of human nature. Until we do, we shall continue to read about child abuse, abductions and murders of the worst kind.
In our work, it is sometimes necessary not to follow strictly some of these protocols.”……
I have long suspected that guidelines and protocols are there to protect the staff but perhaps not anymore.
In The Times today:
Lord Laming: Social services failings are 'causing child deaths'
March 12, 2009
"A complete overhaul of operations within social services departments is urgently needed after serious flaws were exposed which put the lives of children at risk, the author of a Government-commissioned report said today.
"In a damning verdict in response to the Baby P murder, Lord Laming disclosed that many of the recommmendations he gave in a 2003 report into the death of Victoria Climbie had not been implemented and that society was 'letting children down' as a result.
"Outlining a catalogue of problems with the way social workers operate and are managed, he said breakdowns in information-sharing between agencies, poor training gvien to overstretched frontline staff, red tape preventing social workers from doing their jobs, and an obsession with targets had left the system inadequate.
"Disclosing that 55 children or babies were murdered by someone who knew them last year, the report said that 200,000 still live in homes where there is a high risk of abuse or domestic violence."
55 Children, that is a large number of children.
You can read the full report here. ©Crown Copyright 2009
"I think that maybe I failed in the Victoria Climbie report," he said, at the report's central London launch. 'Maybe I didn’t manage to get across the need to achieve that everywhere as well as I should.'"
"The report said that social workers’ professional practice and judgment were being compromised by an 'over-complicated, lengthy and tick-box assessment and recording system' which failed to therefore respond properly to individual cases."
An over-complicated, lengthy and tick-box assessment and recording system!!!
"I think that maybe I failed in the Victoria Climbie report," he said, at the report's central London launch. 'Maybe I didn’t manage to get across the need to achieve that everywhere as well as I should.'"
"The report said that social workers’ professional practice and judgment were being compromised by an 'over-complicated, lengthy and tick-box assessment and recording system' which failed to therefore respond properly to individual cases."
An over-complicated, lengthy and tick-box assessment and recording system!!!
Wednesday, March 11, 2009
Food and Medicine: Fat Duck to Reopen ?Giardia or Thallium
Reuters News Flash:“The only thing that won't be on the menu is seafood, which the health authorities have asked not to be served until all their test results are back.”
So what happened to the Cockroach Catcher’s speculations: was it Giardia or was it Thallium?
Food and Medicine: Fat Duck
Saturday, February 28, 2009
Blumenthal also suspected that as some of his staff had returned from Venezuela they might have picked up some bug and he is waiting for tests on them. Some of us can be symptomless carriers of germs or even protozoa such as Giardia lamblia. Good luck with the tests.
Saturday, February 28, 2009
Blumenthal also suspected that as some of his staff had returned from Venezuela they might have picked up some bug and he is waiting for tests on them. Some of us can be symptomless carriers of germs or even protozoa such as Giardia lamblia. Good luck with the tests.
Food and Medicine: Fat Duck-An Update
Friday, March 6, 2009
If it is sabotage, then thallium, which is still available as a rat poison in some countries, will be the main suspect as it is so tasteless that even the highly sophisticated rat cannot tell. Nausea, vomiting, and diarrhoea are indeed the first symptoms that appear within 48 hours after thallium exposure.
Friday, March 6, 2009
If it is sabotage, then thallium, which is still available as a rat poison in some countries, will be the main suspect as it is so tasteless that even the highly sophisticated rat cannot tell. Nausea, vomiting, and diarrhoea are indeed the first symptoms that appear within 48 hours after thallium exposure.
Latest: HPA,Colchester Oyster Fishery
See also: Times The Independent WSJ
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Monday, March 9, 2009
FSA: Probes Probes Probes
Reuters
UPDATE 3-Resolution's Cowdery, chairman, execs probed by FSA
Mar 9, 2009 9:42am EDT
"LONDON, - The founder of British buy-out company Resolution Ltd, insurance entrepreneur Clive Cowdery, is being investigated by Britain's financial watchdog (FSA), as is company chairman Mike Biggs and three others.
"Resolution Ltd said the probe into their actions as directors of Cowdery's previous investment vehicle, also called Resolution (Plc), would undermine its core business acquiring financial services firms because such deals needed Financial Services Authority approval.
"‘The company would not expect to ... complete any acquisition until this matter has been resolved,’ Resolution Ltd said in a statement on Monday.
"The FSA is also investigating three other former Resolution Plc executives who along with Cowdery are involved in running the new venture under the stewardship of John Tiner, a former chief executive of the FSA."
From the FSA Web site:
“John Tiner joined the FSA in April 2001 after a 25-year career at Arthur Andersen, the accountancy and management consultancy firm. He was an Andersen partner for 13 years and was appointed head of the global financial services practice in 1997.”
He left Andersen just nine months before it collapsed in the wake of the Enron scandal.
The Independent
FSA chief Tiner to quit for top job in private sector
Wednesday, 17 January 2007
“The chief executive of Britain's City watchdog yesterday said he planned to quit his £572,000 post in July to seek work in the private sector.
"John Tiner, 49, will have been with the Financial Services Authority for six years when he departs, becoming chief executive in 2003. He will remain on the FSA payroll until 2008 and will not be able to work for any financial services business or listed company during that time.
"Mr Tiner has picked a good time to leave the FSA, with tributes from the City ringing in his ears and no major crises on the horizon.
"It follows the decisions of both Richard Harvey, the Aviva chief executive, and James Crosby, who held the top job at HBOS, to depart at times of their own choosing.”
He left the FSA in good time indeed. I wonder if they pay our Chief Medical Officer £572,000.
Then I found this in the Financial Times Website High Net Worth.
From gamekeeper to poacher – mandarins easily shed their skins
Pádraig Floyd
Published: 01 September, 2008
"Until I got on the train this morning, I knew exactly what I was going to write about in this column. It was then, as I sat thumbing through the press releases on my BlackBerry, that I saw something that changed my mind.
"That something wasn’t that Resolution boss Clive Cowdery is going to float his business, although that was of course very interesting. No, what caught my attention was that he had managed to land the transfer of the season, by securing Jon Tiner, former chief executive of the Financial Services Authority (FSA), as the new CEO.
"Maybe I am the only person who has a problem with this, because as I write this some hours later, there has been no commentary from any quarter outlining concerns about such an appointment.
"But can it really be right that a man who held the shape and direction of the financial services industry under his control between 2001 and 2007 should then be allowed to work for a company that operates within that regulatory regime?"
You can read the full article here.
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UPDATE 3-Resolution's Cowdery, chairman, execs probed by FSA
Mar 9, 2009 9:42am EDT
"LONDON, - The founder of British buy-out company Resolution Ltd, insurance entrepreneur Clive Cowdery, is being investigated by Britain's financial watchdog (FSA), as is company chairman Mike Biggs and three others.
"Resolution Ltd said the probe into their actions as directors of Cowdery's previous investment vehicle, also called Resolution (Plc), would undermine its core business acquiring financial services firms because such deals needed Financial Services Authority approval.
"‘The company would not expect to ... complete any acquisition until this matter has been resolved,’ Resolution Ltd said in a statement on Monday.
"The FSA is also investigating three other former Resolution Plc executives who along with Cowdery are involved in running the new venture under the stewardship of John Tiner, a former chief executive of the FSA."
From the FSA Web site:
“John Tiner joined the FSA in April 2001 after a 25-year career at Arthur Andersen, the accountancy and management consultancy firm. He was an Andersen partner for 13 years and was appointed head of the global financial services practice in 1997.”
He left Andersen just nine months before it collapsed in the wake of the Enron scandal.
The Independent
FSA chief Tiner to quit for top job in private sector
Wednesday, 17 January 2007
“The chief executive of Britain's City watchdog yesterday said he planned to quit his £572,000 post in July to seek work in the private sector.
"John Tiner, 49, will have been with the Financial Services Authority for six years when he departs, becoming chief executive in 2003. He will remain on the FSA payroll until 2008 and will not be able to work for any financial services business or listed company during that time.
"Mr Tiner has picked a good time to leave the FSA, with tributes from the City ringing in his ears and no major crises on the horizon.
"It follows the decisions of both Richard Harvey, the Aviva chief executive, and James Crosby, who held the top job at HBOS, to depart at times of their own choosing.”
He left the FSA in good time indeed. I wonder if they pay our Chief Medical Officer £572,000.
Then I found this in the Financial Times Website High Net Worth.
From gamekeeper to poacher – mandarins easily shed their skins
Pádraig Floyd
Published: 01 September, 2008
"Until I got on the train this morning, I knew exactly what I was going to write about in this column. It was then, as I sat thumbing through the press releases on my BlackBerry, that I saw something that changed my mind.
"That something wasn’t that Resolution boss Clive Cowdery is going to float his business, although that was of course very interesting. No, what caught my attention was that he had managed to land the transfer of the season, by securing Jon Tiner, former chief executive of the Financial Services Authority (FSA), as the new CEO.
"Maybe I am the only person who has a problem with this, because as I write this some hours later, there has been no commentary from any quarter outlining concerns about such an appointment.
"But can it really be right that a man who held the shape and direction of the financial services industry under his control between 2001 and 2007 should then be allowed to work for a company that operates within that regulatory regime?"
You can read the full article here.
New: from The Guardian.
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Friday, March 6, 2009
Food and Medicine: Fat Duck-An Update
Latest: HPA,Colchester Oyster FisheryBlumenthal savaged by health watchdog
Previous Post: Food And Medicine: Fat Duck.
Related Posts: Hospital Infection: Quorum Sensing
It May Not Be All In The Mind
The Independent reported:
A thousand of Heston's diners face medical tests
By Martin Hickman, March 6, 2009.
“In its first statement about the outbreak, the Health Protection Agency (HPA), which was called in by the council, said the Fat Duck's managers were ‘co-operating fully’, and added: ‘The number of possible cases reported to the restaurant has risen since media coverage of the outbreak, to about 400 going back to late January and mostly through February.’
“The HPA said it was investigating the characteristics of every person affected, their symptoms and the food they ate. It added that it was planning further tests on ‘all those who ate at the restaurant during this time, whether they reported being ill or not’.
When a large number of people are affected then a chemical poison has to be the prime suspect because some individuals have acquired resistance to infective agents, viral or bacterial. The exception is the highly virulent E. Coli O157:H7 where as little as 10 can cause serious problems. There often would be fatalities though with E. Coli O157:H7.
Nausea, vomiting, and diarrhoea are indeed the first symptoms that appear within 48 hours after thallium exposure.
That is serious sabotage though.
The race is on to find the culprit.
Good luck Fat Duck.
News Update: The New York Times
Blumenthal savaged by health watchdog
Previous Post: Food And Medicine: Fat Duck. Related Posts: Hospital Infection: Quorum Sensing
It May Not Be All In The Mind
The Independent reported:
A thousand of Heston's diners face medical tests
By Martin Hickman, March 6, 2009.
“In its first statement about the outbreak, the Health Protection Agency (HPA), which was called in by the council, said the Fat Duck's managers were ‘co-operating fully’, and added: ‘The number of possible cases reported to the restaurant has risen since media coverage of the outbreak, to about 400 going back to late January and mostly through February.’
“The HPA said it was investigating the characteristics of every person affected, their symptoms and the food they ate. It added that it was planning further tests on ‘all those who ate at the restaurant during this time, whether they reported being ill or not’.
When a large number of people are affected then a chemical poison has to be the prime suspect because some individuals have acquired resistance to infective agents, viral or bacterial. The exception is the highly virulent E. Coli O157:H7 where as little as 10 can cause serious problems. There often would be fatalities though with E. Coli O157:H7.
Ducks in Teochiu, China © 2008 Am Ang Zhang
In one of my postings It May Not Be All In The Mind it was eventually proved that thallium was the culprit.
If it is sabotage, then thallium, which is still available as a rat poison in some countries, will be the main suspect as it is so tasteless that even the highly sophisticated rat cannot tell.Nausea, vomiting, and diarrhoea are indeed the first symptoms that appear within 48 hours after thallium exposure.
That is serious sabotage though.
The race is on to find the culprit.
Good luck Fat Duck.
News Update: The New York Times
Thursday, March 5, 2009
Tasmania: Whales & Dolphins-Mother & Baby
The scene of a mass whale and dolphin stranding on King Island
Photographer: John Nievaart of Naracoopa Holiday units
Photographer: John Nievaart of Naracoopa Holiday units
“We see dolphins and whales beaching and dying for reasons we do not understand and men make all the effort to save them and nearly all the time fail.” The Cockroach Catcher
Jemma Blomhoff with her 4 months old daughter Jordyn on her back cares for this dolphin
Photographer: JAY TOWN
Someday Jordyn Blomhoff who was only 4 months old could tell her friends: I was there saving a dolphin. Would being taken to save whales and dolphins at 4 months of age appear on the new DSM or ICD code?
"When I heard, I grabbed some buckets. Jordyn was still in her pyjamas," said Ms Blomhoff, her mother.
"They told us to find one [animal] and stick to it. Ours was a dolphin. We just tipped water over him continuously. When the water was on his face he would lift his face and open his blowhole as if he was really enjoying it.
"They took him to the water in the carrier and when they put him back, he went silly. They had to hold him so he could get some strength back. He was lifting his tail. It was excellent. So it had a happy ending." From Tasmania’s paper
The Mercury
Others are not so lucky.
It has been a horror summer for Tasmanian whale strandings.
Pilot whales stranded on Seven Mile beach.
Photo: Peter Lord
On November 22, 64 long-fined pilot whales stranded at Stanley in the state's northwest. Eleven were rescued.
The rugged coast of Tasmania which claimed the lives of 155 whales.
Photo: The Examiner Newspaper
On November 29, 155 long-finned pilot whales died south of Arthur River on the West Coast and 32 were saved.
And in January, 48 sperm whales -- the huge species mythologised in the novel Moby-Dick -- died on a sandbar near Smithton in the state's North-West.
Some strandings have been linked to naval sonar activity. In 2005 the Royal Australian Navy said it would avoid areas where whales were known to be stranding.
There is still so little we know about the natural world and the last words go to Sir Peter Scott:
Photographer: JAY TOWN
"We shan't save all we should like to,
but we shall save a great deal more than if we had never tried."
Sir Peter Scott (1909-89)
WWF founder 1961
"We shan't save all we should like to,
but we shall save a great deal more than if we had never tried."
Sir Peter Scott (1909-89)
WWF founder 1961
Grand Rounds Live: Doc Gurly
Nature Posts
Tuesday, March 3, 2009
Seroquel and Sex: Tigger and Eeyore
Cockroach News Catches
For all the news that the Cockroach Catcher finds interesting!
“According to Ed over at Pharmalot, ‘the idea was conveyed at a national sales meeting and on field rides with sales reps, who were told to use Tigger as a bipolar patient and Eeyore — the down-in-the-mouth donkey — as a depressed patient. The reps were allegedly encouraged to use Tigger dolls (licenced to Disney) as giveaways, for instance.’”
Tigger bipolar! Com'on, something should remain sacred for our children’s sake.
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Lithium Bipolar and Nanking
Bipolar Disorder in Children
Bipolar and ADHD: Boys and Breasts
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Link: Reidbord's Reflections--- Et tu, Seroquel?
For all the news that the Cockroach Catcher finds interesting!
News Updates: Reuters
The domino effect is not just hitting banks but the big Pharmaceutical companies.
Now it is AstraZenica’s turn, AstraZenica is the maker of Seroquel (Quetiapine).
In the Times Business Section:
AstraZeneca tried to 'bury' bad news on Seroquel drug
March 2, 2009
“AstraZeneca tried to “bury” adverse medical studies about Seroquel, its blockbuster drug, internal company memos released in an American court case have revealed.
"The Anglo-Swedish drugs group is being sued by a total of 9,200 patients, most of whom allege that the Seroquel treatment for psychiatric disorders gave them diabetes. As part of a class-action case before a federal court in Florida, AstraZeneca released 102 documents, including an e-mail in which a member of staff praised a colleague for doing a ‘great smoke and mirrors job’ on company research known as ‘study 15’, which found that Haldol, a cheaper generic rival, was more effective than Seroquel.
"John Tumas, head of the company's publications team, said that it had “buried” three studies and was considering burying a fourth, called Costar. Mr Tumas said:
“The larger issue is how do we face the outside world when they begin to criticise us for suppressing data.” Another e-mail implied that the Costar study showed that Risperdal, a rival medicine, was more effective than Seroquel.”
Just as you might think there is some off-label sex use of Seroquel that you are not aware of, calm down. No such luck.
From Florida (not Alaska) The St Petersburg Times:
Facing numerous Seroquel lawsuits, drugmaker AstraZeneca releases documents By Kris Hundley, February 28, 2009
“The public got a glimpse into the inner workings of a global pharmaceutical company Friday when AstraZeneca released more than 100 sealed documents in a tsunami of lawsuits claiming its powerful antipsychotic Seroquel caused diabetes, weight gain and other health problems.”
Among the documents:
“A Chicago psychiatrist who claimed patients lost weight on Seroquel had his research touted in AstraZeneca's marketing materials — then trashed in interoffice memos.”
Amongst the arguments:
“Steve McConnell, AstraZeneca's attorney, argued that the remaining papers must remain confidential because they contain trade secrets and other proprietary information. Among the sealed documents are results of two clinical studies, sales' reps call notes since January 2004 and correspondence with foreign regulatory authorities.”
“But U.S. Magistrate Judge David Baker was skeptical. ‘What about the public interest in reviewing the integrity of the FDA's administrative process?’ he asked from the bench.”
Could it be this that AstraZeneca wanted to hide?
From BNET Pharma:
AstraZeneca's Sex-for-Studies Seroquel Scandal: Did Research Chief Bias the Science?
By Jim Edwards February 25th, 2009
“An AstraZeneca executive in charge of clinical research on Seroquel had sexual affairs with a researcher and a study writer, plaintiffs in a Florida lawsuit claim. BNET first wrote about the sex-for-secrets aspect of the Seroquel litigation on Feb. 17.
Now Furious Seasons blogger Philip Dawdy revealed a dynamite legal filing describing how Dr. Wayne MacFadden, AZ’s former US medical director for Seroquel and director clincial research in CNS had affairs with a clinical researcher who authored publications favorable to Seroquel, and a medical marketer who promoted Seroquel through medical publications and other means.”
The plaintiffs claim the affairs may have biased the science. AstraZenca is seeking to exclude the evidence.
AstraZenca made this statement to Furious Season (apparently the only organization that did reply and to a blogger!):
“MacFadden became involved in a sexual relationship with an Institute of Psychiatry (London, England) researcher who, as well as being involved in other Seroquel-related projects, participated in the clinical research and abstract preparation relating to the effectiveness of Seroquel for use in the treatment of schizophrenia. Their affair lasted from 2002 to 2006.
“Sometime during 2004, while collaborating with Parexel and while still involved in a sexual relationship with the IOP researcher, MacFadden became involved in a sexual relationship with the Parexel Program Manager responsible for AstraZeneca.
“The nature of their communications suggest a level of control and dependence between Macfadden and these women.
“The IOP researcher suggested that Macfadden would ‘punish’ her if she even looked at studies that were favorable to Seroquel’s competitors. He actively encouraged her to conduct research the results of which would be favorable to Seroquel and AstraZeneca, and promised sexual favors in exchange for intelligence on Astrazeneca’s competitiors.
“In addition to his sexual involvement with the Parexel program manager, it appears he [Macfadden] also provided her with prescription painkillers.”
Now would the FDA need to look at Bolder 1 and Bolder 2 again and revise its approval of Seroquel for Bipolar Disorder. The Cockroach Catcher always feels that there is great snobbery in Psychiatry. Bipolar is an acceptable diagnosis but not Schizophrenia. So drug firms preferred to have their anti-psychotics approved for Bipolar.
An eight week trial for Bipolar (which Bolders were) is hardly long enough in my book but it would not have mattered:
“Macfadden agreed that sexual relationships between clinical researchers and management members of pharmaceutical companies can create bias which can affect the integrity of the science. Macfadden also acknowledged that sexual relationships can affect a person’s judgment. Although Macfadden denies that his multiple sexual relationships with these women created a conflict of interest, he in fact teased the IOP researcher about the obvious conflict of interest as he reviewed drafts of her papers on Seroquel.”
You can download the filing for yourself here.
Last year BNET had an interesting report on AstraZeneca.
AstraZeneca Allegedly Recruits Tigger and Eeyore to Sell Seroquel
By Jim Edwards November 6th, 2008
The domino effect is not just hitting banks but the big Pharmaceutical companies.
Now it is AstraZenica’s turn, AstraZenica is the maker of Seroquel (Quetiapine).
In the Times Business Section:
AstraZeneca tried to 'bury' bad news on Seroquel drug
March 2, 2009
“AstraZeneca tried to “bury” adverse medical studies about Seroquel, its blockbuster drug, internal company memos released in an American court case have revealed.
"The Anglo-Swedish drugs group is being sued by a total of 9,200 patients, most of whom allege that the Seroquel treatment for psychiatric disorders gave them diabetes. As part of a class-action case before a federal court in Florida, AstraZeneca released 102 documents, including an e-mail in which a member of staff praised a colleague for doing a ‘great smoke and mirrors job’ on company research known as ‘study 15’, which found that Haldol, a cheaper generic rival, was more effective than Seroquel.
"John Tumas, head of the company's publications team, said that it had “buried” three studies and was considering burying a fourth, called Costar. Mr Tumas said:
“The larger issue is how do we face the outside world when they begin to criticise us for suppressing data.” Another e-mail implied that the Costar study showed that Risperdal, a rival medicine, was more effective than Seroquel.”
Just as you might think there is some off-label sex use of Seroquel that you are not aware of, calm down. No such luck.
From Florida (not Alaska) The St Petersburg Times:
Facing numerous Seroquel lawsuits, drugmaker AstraZeneca releases documents By Kris Hundley, February 28, 2009
“The public got a glimpse into the inner workings of a global pharmaceutical company Friday when AstraZeneca released more than 100 sealed documents in a tsunami of lawsuits claiming its powerful antipsychotic Seroquel caused diabetes, weight gain and other health problems.”
Among the documents:
“A Chicago psychiatrist who claimed patients lost weight on Seroquel had his research touted in AstraZeneca's marketing materials — then trashed in interoffice memos.”
Amongst the arguments:
“Steve McConnell, AstraZeneca's attorney, argued that the remaining papers must remain confidential because they contain trade secrets and other proprietary information. Among the sealed documents are results of two clinical studies, sales' reps call notes since January 2004 and correspondence with foreign regulatory authorities.”
“But U.S. Magistrate Judge David Baker was skeptical. ‘What about the public interest in reviewing the integrity of the FDA's administrative process?’ he asked from the bench.”
Could it be this that AstraZeneca wanted to hide?
From BNET Pharma:
AstraZeneca's Sex-for-Studies Seroquel Scandal: Did Research Chief Bias the Science?
By Jim Edwards February 25th, 2009
“An AstraZeneca executive in charge of clinical research on Seroquel had sexual affairs with a researcher and a study writer, plaintiffs in a Florida lawsuit claim. BNET first wrote about the sex-for-secrets aspect of the Seroquel litigation on Feb. 17.
Now Furious Seasons blogger Philip Dawdy revealed a dynamite legal filing describing how Dr. Wayne MacFadden, AZ’s former US medical director for Seroquel and director clincial research in CNS had affairs with a clinical researcher who authored publications favorable to Seroquel, and a medical marketer who promoted Seroquel through medical publications and other means.”
The plaintiffs claim the affairs may have biased the science. AstraZenca is seeking to exclude the evidence.
AstraZenca made this statement to Furious Season (apparently the only organization that did reply and to a blogger!):
“MacFadden became involved in a sexual relationship with an Institute of Psychiatry (London, England) researcher who, as well as being involved in other Seroquel-related projects, participated in the clinical research and abstract preparation relating to the effectiveness of Seroquel for use in the treatment of schizophrenia. Their affair lasted from 2002 to 2006.
“Sometime during 2004, while collaborating with Parexel and while still involved in a sexual relationship with the IOP researcher, MacFadden became involved in a sexual relationship with the Parexel Program Manager responsible for AstraZeneca.
“The nature of their communications suggest a level of control and dependence between Macfadden and these women.
“The IOP researcher suggested that Macfadden would ‘punish’ her if she even looked at studies that were favorable to Seroquel’s competitors. He actively encouraged her to conduct research the results of which would be favorable to Seroquel and AstraZeneca, and promised sexual favors in exchange for intelligence on Astrazeneca’s competitiors.
“In addition to his sexual involvement with the Parexel program manager, it appears he [Macfadden] also provided her with prescription painkillers.”
Now would the FDA need to look at Bolder 1 and Bolder 2 again and revise its approval of Seroquel for Bipolar Disorder. The Cockroach Catcher always feels that there is great snobbery in Psychiatry. Bipolar is an acceptable diagnosis but not Schizophrenia. So drug firms preferred to have their anti-psychotics approved for Bipolar.
An eight week trial for Bipolar (which Bolders were) is hardly long enough in my book but it would not have mattered:
“Macfadden agreed that sexual relationships between clinical researchers and management members of pharmaceutical companies can create bias which can affect the integrity of the science. Macfadden also acknowledged that sexual relationships can affect a person’s judgment. Although Macfadden denies that his multiple sexual relationships with these women created a conflict of interest, he in fact teased the IOP researcher about the obvious conflict of interest as he reviewed drafts of her papers on Seroquel.”
You can download the filing for yourself here.
Last year BNET had an interesting report on AstraZeneca.
AstraZeneca Allegedly Recruits Tigger and Eeyore to Sell Seroquel
By Jim Edwards November 6th, 2008
A. A. Milne /E. H. Shepard
“According to Ed over at Pharmalot, ‘the idea was conveyed at a national sales meeting and on field rides with sales reps, who were told to use Tigger as a bipolar patient and Eeyore — the down-in-the-mouth donkey — as a depressed patient. The reps were allegedly encouraged to use Tigger dolls (licenced to Disney) as giveaways, for instance.’”
Tigger bipolar! Com'on, something should remain sacred for our children’s sake.
Related Posts:
Old and New: Multiple Sclerosis & Elgar
Lithium Bipolar and Nanking
Bipolar Disorder in Children
Bipolar and ADHD: Boys and Breasts
Antipsychotics: Really?
Saturday, February 28, 2009
Food And Medicine: Fat Duck.
Latest: HPA,Colchester Oyster Fishery
The Guardian Headline:
Heston Blumenthal's Fat Duck shut over food poisoning scare
Friday 27 February 2009
"He is often described as a 'culinary alchemist' and tonight the owner of the Michelin starred Fat Duck restaurant was desperately seeking a panacea after a food poisoning scare closed his dining room.
Heston Blumenthal has shut the award-winning eatery - described in 2005 as the 'the best place to eat on earth' - after up to 40 diners called in to say they were feeling unwell."
The first idea that came to my head was that it must be the work of the Norovirus which normally hits luxury cruise ships such as the QE II in 2007.
Unlikely though as the environment was different.
The time lag of symptom emergence points to some clever bacteria, perhaps the ones equipped with quorum sensing powers. Salmonella and E. Coli all carry such power. E. Coli would have been detected by now and the symptoms a good deal more serious.
“In 2004 - the same year it was awarded a third Michelin star - food and safety officers found 'borderline' levels of listeria in the foie gras and expressed concern that 'no core temperatures of the meat are taken'. The problems were swiftly dealt with, however, and Blumenthal has since introduced stringent procedures.” The Telegraph.
Listeria can be a problem and as so many customers were involved, they must all have had some foie gras! Chef’s compliments perhaps!
Or was it the cheese table? Many cheeses harbour listeria.
Blumenthal also suspected that as some of his staff had returned from Venezuela they might have picked up some bug and he is waiting for tests on them. Some of us can be symptomless carriers of germs or even protozoa such as Giardia lamblia. Good luck with the tests.
Then there is Ciguatera poisoning, from exotic tropical fish but as the symptoms did not seem to include rash it is unlikely.
Of course one cannot rule out sabotage. Being at the top, you are likely to upset someone some time.
The race is on to find the culprit.
Good luck Fat Duck.
Heston Blumenthal's Fat Duck shut over food poisoning scare
Friday 27 February 2009
"He is often described as a 'culinary alchemist' and tonight the owner of the Michelin starred Fat Duck restaurant was desperately seeking a panacea after a food poisoning scare closed his dining room.
Heston Blumenthal has shut the award-winning eatery - described in 2005 as the 'the best place to eat on earth' - after up to 40 diners called in to say they were feeling unwell."
The first idea that came to my head was that it must be the work of the Norovirus which normally hits luxury cruise ships such as the QE II in 2007.
Unlikely though as the environment was different.
The time lag of symptom emergence points to some clever bacteria, perhaps the ones equipped with quorum sensing powers. Salmonella and E. Coli all carry such power. E. Coli would have been detected by now and the symptoms a good deal more serious.
Ducks in Teochiu, China © 2008 Am Ang Zhang
Duck is famous for harbouring
Salmonella typhimurium which of course is hitting the headlines in the USA for peanut butter contamination. I doubt if Heston Blumenthal would be using any contaminated peanut butter in his “alchemy”.“In 2004 - the same year it was awarded a third Michelin star - food and safety officers found 'borderline' levels of listeria in the foie gras and expressed concern that 'no core temperatures of the meat are taken'. The problems were swiftly dealt with, however, and Blumenthal has since introduced stringent procedures.” The Telegraph.
Listeria can be a problem and as so many customers were involved, they must all have had some foie gras! Chef’s compliments perhaps!
Or was it the cheese table? Many cheeses harbour listeria.
Blumenthal also suspected that as some of his staff had returned from Venezuela they might have picked up some bug and he is waiting for tests on them. Some of us can be symptomless carriers of germs or even protozoa such as Giardia lamblia. Good luck with the tests.
Then there is Ciguatera poisoning, from exotic tropical fish but as the symptoms did not seem to include rash it is unlikely.
Of course one cannot rule out sabotage. Being at the top, you are likely to upset someone some time.
The race is on to find the culprit.
Good luck Fat Duck.
Thursday, February 26, 2009
Cockroach News Catches: Paroxetine and Citalopram
For all the news that the Cockroach Catcher finds interesting!
Looks like GlaxoSmithKline PLC (GSK) is in the news again and this time it is not about Ribena.
In today’s Wall Street Journal:
U.S. Probes Emory Doctor's Glaxo Ties
FEBRUARY 26, 2009, 12:02 A.M. ET
By DAVID ARMSTRONG
“Federal officials are investigating Emory University to determine if the school misled the National Institutes of Health about its star psychiatrist's lucrative consulting work for big drug makers, people familiar with the matter said.
The probe by the inspector general for the Health and Human Services agency, which investigates fraud in NIH programs, concerns the work of Charles Nemeroff. From 2003 until last year, Dr. Nemeroff served as primary investigator on an NIH-funded research effort to study five GlaxoSmithKline PLC drugs for use as antidepressants. During that time, Dr. Nemeroff also received hundreds of thousands of dollars from Glaxo.
The NIH requires universities to report potential conflicts of interest to the agency and to ensure research is carried out objectively.
Schools that violate those policies could face sanctions, ranging from fines to a freeze on funding. Emory received $251 million in NIH grants last year, more than half of all the Atlanta school's outside research funding.
An Emory investigation of the matter in December concluded that Dr. Nemeroff failed to report more than $800,000 he received from Glaxo from 2000 to 2006. Dr. Nemeroff stepped down as chairman of the psychiatry department and the school said it wouldn't submit any research requests to the NIH involving Dr. Nemeroff for at least two years.”
This bit in the WSJ is worrying:
“Records obtained by Mr. Grassley show that Dr. Nemeroff played a role in a Glaxo program that was established to aggressively promote the British company's top-selling antidepressant, Paxil (Paroxetine).
Glaxo described this "PsychNet" program in an internal 2000 document as "an ideal way for key opinion leaders to influence clinicians...on the benefits of Paxil versus competitors" and to train doctors to "help build Paxil advocacy."
Dr. Nemeroff was listed as one of two speakers at a March 2000 session in Naples, Fla., to train doctors "on the efficacy of Paxil and the PsychNet presentations." Doctors were paid $2,500 per talk and required to sign agreements barring them from saying how much they were paid or sharing materials Glaxo provided.”
Paroxetine has been in the UK news before now.
But GSK may not be alone and this time it involves the company directly.
In the New York Times:
Drug Maker Is Accused of Fraud
By BARRY MEIER and BENEDICT CAREY
Published: February 25, 2009
The Justice Department charged the drug maker Forest Laboratories on Wednesday with defrauding the government of millions of dollars by illegally marketing the popular antidepressants Celexa and Lexapro (versions of citalopram) for unapproved uses in children and teenagers.
In a civil complaint filed by the United States attorney’s office in Boston, federal prosecutors alleged that former top executives at Forest concealed for several years a clinical study that showed that the drugs were not effective in children and might even pose risks to them, including causing some to become suicidal.
From 2001 to 2004, Forest heavily promoted results from another clinical trial it had financed that showed that the drugs were effective, without disclosing the negative study to those researchers, its own medical advisers or its sales representatives, the complaint said.
Celexa and Lexapro are two versions of the same drug, citalopram. The drugs are currently approved by the Food and Drug Administration only for adults.
Prosecutors said in the complaint:
“Forest told prescribing physicians a half-truth and thereby prevented them and the public from having all potentially available information when making decisions about how to treat a serious medical condition in pediatric patients.”
Looks like GlaxoSmithKline PLC (GSK) is in the news again and this time it is not about Ribena.
In today’s Wall Street Journal:
U.S. Probes Emory Doctor's Glaxo Ties
FEBRUARY 26, 2009, 12:02 A.M. ET
By DAVID ARMSTRONG
“Federal officials are investigating Emory University to determine if the school misled the National Institutes of Health about its star psychiatrist's lucrative consulting work for big drug makers, people familiar with the matter said.
The probe by the inspector general for the Health and Human Services agency, which investigates fraud in NIH programs, concerns the work of Charles Nemeroff. From 2003 until last year, Dr. Nemeroff served as primary investigator on an NIH-funded research effort to study five GlaxoSmithKline PLC drugs for use as antidepressants. During that time, Dr. Nemeroff also received hundreds of thousands of dollars from Glaxo.
The NIH requires universities to report potential conflicts of interest to the agency and to ensure research is carried out objectively.
Schools that violate those policies could face sanctions, ranging from fines to a freeze on funding. Emory received $251 million in NIH grants last year, more than half of all the Atlanta school's outside research funding.
An Emory investigation of the matter in December concluded that Dr. Nemeroff failed to report more than $800,000 he received from Glaxo from 2000 to 2006. Dr. Nemeroff stepped down as chairman of the psychiatry department and the school said it wouldn't submit any research requests to the NIH involving Dr. Nemeroff for at least two years.”
This bit in the WSJ is worrying:
“Records obtained by Mr. Grassley show that Dr. Nemeroff played a role in a Glaxo program that was established to aggressively promote the British company's top-selling antidepressant, Paxil (Paroxetine).
Glaxo described this "PsychNet" program in an internal 2000 document as "an ideal way for key opinion leaders to influence clinicians...on the benefits of Paxil versus competitors" and to train doctors to "help build Paxil advocacy."
Dr. Nemeroff was listed as one of two speakers at a March 2000 session in Naples, Fla., to train doctors "on the efficacy of Paxil and the PsychNet presentations." Doctors were paid $2,500 per talk and required to sign agreements barring them from saying how much they were paid or sharing materials Glaxo provided.”
Paroxetine has been in the UK news before now.
But GSK may not be alone and this time it involves the company directly.
In the New York Times:
Drug Maker Is Accused of Fraud
By BARRY MEIER and BENEDICT CAREY
Published: February 25, 2009
The Justice Department charged the drug maker Forest Laboratories on Wednesday with defrauding the government of millions of dollars by illegally marketing the popular antidepressants Celexa and Lexapro (versions of citalopram) for unapproved uses in children and teenagers.
In a civil complaint filed by the United States attorney’s office in Boston, federal prosecutors alleged that former top executives at Forest concealed for several years a clinical study that showed that the drugs were not effective in children and might even pose risks to them, including causing some to become suicidal.
From 2001 to 2004, Forest heavily promoted results from another clinical trial it had financed that showed that the drugs were effective, without disclosing the negative study to those researchers, its own medical advisers or its sales representatives, the complaint said.
Celexa and Lexapro are two versions of the same drug, citalopram. The drugs are currently approved by the Food and Drug Administration only for adults.
Prosecutors said in the complaint:
“Forest told prescribing physicians a half-truth and thereby prevented them and the public from having all potentially available information when making decisions about how to treat a serious medical condition in pediatric patients.”
The Book: The Cockroach Catcher
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