Expansion of Psychiatric Turf

The controversy surrounding Justina Pelletier and her family has expanded its scope in recent months, and has now become a general public scrutiny of Massachusetts’s Department of Children and Families. On April 29, State Governor Deval Patrick gave a press conference in which he announced the resignation of DCF Commissioner Olga Roche. I think there’s a very real risk of confusing some issues here. The sad fact is that, despite the enormous strides we have made as a society, there are still a great many children who are abused and neglected. Every state in the US has a social services department, one of whose statutory responsibilities is to investigate reports of abuse and/or neglect. The case workers who conduct the investigations are required to follow set procedures. Often they find that the allegation is unfounded, and the investigation is terminated. When they do find probable cause, they are required by law to present their findings to a judge, who scrutinizes the evidence in accordance with the normal judicial procedures. The social services department, the parents, and the child are usually represented by attorneys. ...

On April 11, 2014, journalist Alan Schwarz (brief bio here) published an article in the New York Times on this topic, titled Idea of New attention Disorder Spurs Research, and Debate. Alan has written extensively on the rising rates of the condition known as ADHD, and on the abuse of the drugs that are used to “treat” this condition. He has drawn a good deal of criticism from psychiatry’s believers. ...

In 2006, Laurence Jerome, a Canadian psychiatrist, and two colleagues wrote a paper titled What We Know About ADHD and Driving Risk: A Literature Review, Meta-Analysis and Critique. It was published in the Journal of the Canadian Academy of Child and Adolescent Psychiatry in August, 2006. The primary result of the meta-analysis was: "Current data support the utility of stimulant medication in improving driving performance in younger ADHD drivers." The study is lengthy and well-referenced, but in keeping with standard psychiatric practice, it conceptualizes and presents ADHD as a "…common psychiatric disorder…" with symptoms of "…inattention, impulsiveness and hyperactivity…" In other words, they present ADHD as something that a person has rather than as something that a person does. The problem with this approach is that it creates the impression that meaningful or significant correlations/effects have been found, where in fact all that has happened is an elucidation of the terms used. For instance, the authors refer to a study by Fried et al. (2006) and state: ...

On April 1, 2014, Slate published an online article titled Mitochondrial Disease or Medical Child Abuse? The author is Brian Palmer. Slate is a daily, general interest web magazine, founded in 1996, that provides “analysis and commentary about politics, news, business, technology and culture,” and is a subsidiary of the Washington Post. Brian Palmer is Slate’s “chief explainer." As the title suggests, the article tries to explore the central question in Justina’s case: does she have mitochondrial disease or is she a victim of medical child abuse? The author does a good job of defining the various terms, unraveling the issues, and presenting both sides of the argument, though on balance he comes down in favor of Boston Children’s Hospital. Here are some quotes: ...

On March 25, Joseph Johnston, Juvenile Court Justice in Boston, Massachusetts, issued a disposition order in the case: Care and protection of Justina Pelletier. The background to the case is well-known. Justina is 15 years old. Judge Johnston did not return Justina to the care of her parents, but instead granted permanent custody to the Massachusetts Department of Children and Families (DCF), with a right to review in June. In paragraph 4, the disposition order states: ...

On March 19, a new article was posted on Aeon Magazine. It’s titled A Mad World, and was written by Joseph Pierre, MD, who works in Log Angeles as a psychiatric practitioner and professor. Dr. Pierre has authored more than fifty papers, and has received several awards. He has lectured nationally and internationally, and would, I think, be considered an eminent psychiatrist. I am grateful to several readers for the link to the article. ...

On March 27, the US House of Representatives approved by a voice vote with no debate a Medicare bill, HR 4302, Protecting Access to Medicare Act of 2014. The purpose of the bill is to avoid cutting Medicare payments to physicians, and there was, and is, general agreement on both side of the aisle that the bill needed to pass. However, tacked onto the bill was a rider which authorized $60 million to expand involuntary outpatient commitment (IOC) in states that already have provision for commitments of this sort. ...

On March 5, Bruce Levine, PhD, published an interesting article on Mad in America titled Psychiatry Now Admits It’s Been Wrong in Big Ways – But Can It Change? Bruce had interviewed Robert Whitaker, and most of the article is the transcript of this interview. Bruce begins by noting that Robert, in his book Mad in America, had challenged some fundamental tenets of psychiatry, including the validity of its “diagnoses” and the efficacy (especially the long-term efficacy) of its treatments. ...

On February 25, Kristina Fiore published an article on MedPage today. It’s titled Killing Pain: Xanax Tops Charts. The article is based on a study conducted by Jann M et al, and published in the February 2014 issue of the Journal of Pharmacy Practice. The study is titled Benzodiazepines: a major component in unintentional prescription drug overdoses with opioid analgesics. Here’s a quote: "During 2003 to 2009, the 2 prescriptions drugs with the highest increase in death rates were oxycodone 264.6% and alprazolam 233.8%. Therefore, benzodiazepines have a significant impact on prescription drug unintentional overdoses second only to the opioid analgesics. The combination prescribing of benzodiazepines and opioid analgesics commonly takes place. The pharmacokinetic drug interactions between benzodiazepines and opioid analgesics are complex. The pharmacodynamic actions of these agents differ as their combined effects produce significant respiratory depression." ...

Justina Pelletier is the 15-year-old girl who is at the center of a dispute between her parents and the Psychiatry Department at Boston Children’s Hospital. Justina, who lived with her parents in Connecticut, had been diagnosed with mitochondrial disease, a rare and debilitating illness, and had been receiving treatment for this from Mark Korson, MD, Chief of Metabolism Services at Tufts Medical Center in Boston. In February of last year, Justina’s parents took her to Boston Children’s Hospital with flu-like symptoms. Dr. Korson had recommended an admission to Boston Children’s so that Justina could be seen by Alex Flores, MD, a gastrointestinal specialist who had recently transferred from Tufts to BCH. ...