Yesterday, I had a grocery order coming – or, at least, I thought I did. When there was just a half hour left in the delivery window, I refreshed the tracking page and it said it had been cancelled. It appears to have been rescheduled for today in the same window – of course I will do my best to confirm that. Good thing I always try to order well ahead of need.
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Short Takes –
No More Mister Nice Blog – Republicans Live In A Disinformation Bubble Just Like Russians
Quote – In the same way that we’ve come to realize, with astonishment, that Russians simply weren’t told that their troops had invaded Ukraine, and didn’t believe there was a war, Republican voters, I’m sure, don’t believe President Biden is doing anything effective on Ukraine’s behalf, and that only Republicans could save Ukraine. Russian citizens have an excuse for their ignorance: Media outlets that don’t toe the Kremlin line are suppressed. In America, it’s purely voluntary: Click through for full post. From last week, but timeless – and putting information and disinformatin side by side does help us see what we are up against.
The New Yorker – The Shaming-Industrial Complex
Quote – Owen Flanagan, a professor of philosophy and neurobiology at Duke University, suggests that our tense political climate is the product of poor emotional regulation…. [T]he data-scientist-cum-journalist Cathy O’Neil suggests that shaming is structural: its ubiquity is the fault not of individual vigilantes but, rather, of the many industries that manufacture and exploit mortification for profit. At the heart of these diverging perspectives is an ambiguity built into the very concept at issue. Shame is an emotion—a person can suffer from its bilious bite, as Sacco did—but it is also a state of affairs. Click through for full article. There’s no solution here, but lots think about. I’ll add a few thoughts of mine to the brew: Emotions cannot be controlled, but our actions in response to them can. People who shame others may need to be shamed for it, as it may be the only language they understand (however, the shameless cannot be shamed.) And anger is in itself not only a bad thing, but the only motivation for change – it’s all in how one uses it.
A military veteran knows why your employees are leaving
Quote – It has been an intense period full of unknowns. It’s hard to be self-aware enough to see the full impact of all these changes. I redeployed five times, and I got better at reintegrating each time. I had the benefit of practice, which allowed me to acknowledge what I was feeling, understand it better, and move forward. But the pandemic is a one-time thing, and most people never got a briefing from their chaplain about what to expect. Click through for article. This is addressed to busines leaders, and it’s a couple of months old. But it has life lessons whichare far from stale. It’s sort of like a different kind of PTSD – one to which the pandemic made everyone vulnerable.
Experts in autocracies have pointed out that it is, unfortunately, easy to slip into normalizing the tyrant, hence it is important to hang on to outrage. These incidents which seem to call for the efforts of the Greek Furies (Erinyes) to come and deal with them will, I hope, help with that. As a reminder, though no one really knows how many there were supposed to be, the three names we have are Alecto, Megaera, and Tisiphone. These roughly translate as “unceasing,” “grudging,” and “vengeful destruction.”
If by any chance you were looking for a good example of the law of unintended consequences, here is one. Although “good” is probably not the appropriate word – it isn’t good at all. It is strong and convincing, however. What to do about it, I really don’t know. I wsh I did – although that might even be more frustrating if no one would listen.
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After the FDA issued warnings about antidepressants, youth suicides rose and mental health care dropped
The link between antidepressant use and increases in suicidal thoughts or behaviors among treated youth is unproven. FatCamera/E+ via Getty Images
Depression in young people is vastly undertreated. About two-thirds of depressed youth don’t receive any mental health care at all. Of those who do, a significant proportion rely on antidepressant medications.
Since 2003, however, the U.S. Food and Drug Administration has warned that young people might experience suicidal thinking and behavior during the first months of treatment with antidepressants.
The FDA issued this warning to urge clinicians to monitor suicidal thoughts at the start of treatment. These warnings appear everywhere: on TV and the internet, in print ads and news stories. The most strongly worded warnings appear in black boxes on medication containers themselves.
We have found that FDA drug warnings can sometimes prevent life-threatening adverse effects, but that unintended consequences of these warnings are also common. In 2013, working for the FDA itself, we published a systematic review of the effects of previous FDA warnings on a variety of medications. We found that about a third backfired, resulting in underuse of needed care and other adverse effects.
In our more recent study from 2020, we found that the FDA antidepressant warnings have led to reduced mental health care and increased suicides among youth – even though researchers have yet to find a clear link between antidepressants and increased suicidality in young people.
Further, despite the warnings, monitoring by clinicians of suicidal thoughts at the start of treatment has not increased from its tiny rate of less than 5%.
Youth suicides rose following FDA warnings
For our 2020 study, we obtained 28 years of data, between 1990 and 2017, on actual suicide deaths in the U.S. among adolescents and young adults. We used data from the WONDER Database, maintained by the U.S. Centers for Disease Control and Prevention, which contains mortality counts based on death certificates for U.S. residents and population counts for all U.S. counties.
We found that during the pre-warning period, there was a 13-year stable downward trend in youth suicides, following availability of new and safer antidepressants.
That trend reversed, we found, soon after the FDA began antidepressant warnings in late 2003. Youth suicide deaths increased significantly.
Then we applied our findings to the whole U.S. population of adolescents and young adults. The results of that analysis suggest that there were almost 6,000 additional suicide deaths in just the first six years after the FDA issued the boxed warnings, from 2005 through 2010. The rates also continued to rise thereafter.
Over this same time period, older adults – whose depression is not targeted by the warnings – experienced much lower increases in suicide.
Fewer depressed youths got treatment
Our findings align with a growing body of research that confirms these warnings have had serious unintended effects: scaring many patients, as well as their parents and doctors, away from both antidepressant medications and psychotherapy that can reduce major symptoms of depression.
These studies include a rigorous 2017 study that analyzed mental health care trends among 11 million youths who rely on Medicaid for insurance coverage. This research documented that immediately after the FDA warnings began in 2003, there was a sudden and sustained 30%-40% drop in youth visits to doctors for all depression care, including antidepressant prescriptions.
Seven years after the first FDA warning, doctor visits for depression by young people had dropped by around 50%, compared with the pre-warning trend, thus severely reducing treatment and suicide prevention.
Almost simultaneously, youth poisonings via prescription drugs, such as sleeping pills, went up. Research has shown that prescribed medications are a widespread method by which young people attempt suicide. This finding adds to the evidence that the antidepressant warnings increased suicidal behavior.
In 2018, researchers reported on two patients in their 20s whose experiences illustrate the potential real-life impacts of the black-box warnings. Both young adults had been prescribed antidepressants for major depression and severe panic attacks, but they refused to take them because of the FDA’s message.
Their conditions worsened, and eventually both attempted suicide. Fortunately, family members were able to intervene in time, and each young adult was then hospitalized.
After they accepted the reassurances of hospital psychiatrists that the benefits of the medications would likely exceed any risks, both patients began to take their prescribed antidepressants. These medications, combined with talk therapy, alleviated their symptoms without intensifying suicidal thoughts.
As scientists, we are trained to always seek potential alternative explanations – some additional factor not included in the research – that could explain the reduction in care or increase in suicides that we and others have recorded in our studies.
However, the sudden, simultaneous and large effects – all of which directly reduced treatment and increased suicidal behavior – strongly suggest this is not a coincidence. It is unlikely that any outside factor can account for the multiple parallel effects on depression care, suicidal behavior and suicide deaths.
A large and growing body of evidence shows that the FDA’s black-box warnings on antidepressants need to be reevaluated.
More generally, there’s a need for independent researchers to monitor the effects of FDA warnings on public health – both intended and unintended.
Stephen Soumerai, Professor of Population Medicine, Harvard Medical School, Harvard University and Ross Koppel, Professor of Medical Informatics and Adjunct Professor of Sociology, University of Pennsylvania; Professor of Biomedical Informatics, University at Buffalo
============================================================== Alecto, Megaera, and Tisiphone, This is another situation in which I have been very fortunate and thrived while too many others have suffered. When I decided to seek prescriptive help for my condition, I had done dome research and had a particular drug in mind. The Doctor and I were not in total agreement on what the condition actually was – but the drug I had researched was used for both, and he was amenable to prescribing it for me. It worked very well, and I ave been stable on it for – well, actually decades. But not everyone can find (or trip over) the right places to research, not everyone can find a doctor who listens, and matbe even more to the point, not everyone can safely make it into their 40’s without self-harn.
