Panic focused psychodynamic psychotherapy hard to say but may make life easier

Having panic attacks? Looking for an alternative to talk therapy or cognitive-behavioral therapy (CBT)? You might consider panic-focused psychodynamic psychotherapy (PFPP), a 24-week course of therapy that's kind of a psychological exposure therapy, helping the patient explore and manage the hidden psychological conflicts that are contributing to their panic. From the link:

The treatment is divided into 3 phases. In the initial phase, the therapist focuses on identifying the meaning and content of panic symptoms, derived from exploring the circumstances, stressors, and feelings surrounding panic onset. Elucidation of a developmental history, including previous panic episodes, helps determine early life experiences and self and object representations that may play an active part in panic. The initial phase aims at relief of panic symptoms.

In the second phase, the therapist works with the patient to identify core conflicts underlying panic disorder. Conflicts surrounding anger and autonomy, as well as other contributing dynamics, are brought to the patient's attention. Defense mechanisms, including reaction formation, undoing, and denial, are addressed as efforts—often unconscious—to avoid facing emotional contributions to panic symptoms. Emergence of the transference allows for exploration of these conflicts and defenses in the relationship between therapist and patient. This phase focuses on addressing vulnerability to panic and relapse.

In the third (termination) phase, mixed feelings surrounding anger, autonomy, and separation are addressed as they emerge in ending the therapeutic relationship. The therapist helps the patient articulate feelings about the loss of the therapist, allowing for further recognition of conflicts and a reduced risk of panic recurrence. Increased assertiveness, encouraged by this patient-directed approach, and an increased sense of safety in being more able to tolerate mixed feelings, helps improve psychosocial function.

Multi Pronged Pharmaceutical Company Marketing Can Make Evidenced Based Medicine a Joke

The above quote was taken from a talk by Ben Goldacre at the TED conference.

Of course, readers of this blog know that misleading pharmaceutical company marketing strategies and techniques are a recurring theme here. Deep sixing studies that show that their products don't work very well is just the tip of the proverbial iceberg.

One of the more impressive attributes of their marketing strategies is how multi-faceted they are. They target both physicians and the public at every possible turn, and affect every step of the process of generating the accepted “evidence base” for medical treatment in the minds of anyone potentially involved.

In a new article in the European Journal of Clinical Investigation, authors Emmanuel Stamatakis, Richard Weiler, and John P.A. Loannidis point out that just one drug, Lipitor, brought in $130 billion dollars in 14 years - an amount higher than the 2010 gross domestic product of 129 different countries.

They go on to enumerate many of the misleading marketing strategies, and describe the obvious biases that results from them. I will briefly review them here.

1.   Evidence production:

a.     Pharma designs and controls a large portion of the most influential studies.

b.    Industry-sponsored trials are more likely to compare their drug against an inactive or “straw man” comparator.

c.    They almost never compare their drugs to a variety of different possible interventions – including mere life style changes. I would add that when it comes to child psychiatry, they never compare their results to that of Supernanny-style family therapy. (Come to think of it, neither do most of the purveyors of various psychotherapy treatment paradigms).

d.   Their studies often guide the content of subsequent clinical research.

e.    Their studies are more likely to state favorable results and slyly avoid “inconvenient” findings.

f.     They raise the status of studies that they have actually writen up themselves by attaching the names of well-known academically-affiliated investigators (ghost writing) who are then paid off.

2.   Evidence synthesis

a.      Systematic reviews that they sponsor review prior studies that had asked the wrong questions to begin with.

b.     They limit access to the raw data on which their studies are based.

c.      With meta-analysis, or combining statistics from many previous studies, 100% of industry sponsored meta-analyses recommended using their drug, compared to 0% (you heard right) of independent meta-analyses, even though the actual statistics presented in both cases were quite similar. Conflicts of interest are generally not reported in meta-analyses (not that anyone would pay attention if the were).

3.   Understating risks of drugs

a.      Recent withdrawals of previously FDA-approved drugs seem to indicate that manufacturers intentionally distort the presentation of clinical trial safety data.

b.     Companies carefully train their sales representatives to tactfully avoid physician questions about the safety of their products.

4.   Cost-effectiveness evaluation

a.      Studies funded by industry are more than twice as likely to show good cost-effectiveness of their drug than independently financed studies.

b.     This is accomplished through the use of subtly biased assumptions about the intervention and its comparators.

5.   Clinical practice guidelines

     Because many of the authors of treatment guidelines produced by various medical specialty and subspecialty groups have a financial conflict of interest because they are paid by drug companies via consultancies, research support, or stock ownership, these guideline are often heavily focus on new, costly interventions and only loosely follow all of the available evidence.

6.   Healthcare professional education

a.     Gifts to medical students, which lately have been banned by many medical schools, were routinely given for decades. These are often given during “academic” presentations that are sponsored by industry and which are given by influential medical school professors.

b.   Industry-sponsored continuing medical education (CME) for practicing physicians accounted of approximately half of all CME as recently as 2010.

c.    The doctors who present CME usually use slides provided by the drug companies that manufacture the drugs prominently featured during the presentation.  Pharma also pays the presenters hefty fees.

7.    Direct influence on docs

a.    Drug sales representatives frequently visit doctors’ offices to “share” information with both the doctors and their staffs.

b.   Regular interactions with sales reps increases the chances that a company’s drug will be added to a hospital drug formulary (their list of preferred medications) by over 300%.

8.   Direct of consumer advertising

    Industry spending on TV and media adds increased from $11 billion dollars to $30 billion dollars per year over the period of 1996-2005.

Need they say more?

PLEASE FOLLOW When magical numbers make us do desperate things

I am in New York today to film some author interview/promo stuff. I know--that sounds cool, right? It is! Especially because I get to hang out with interesting people like Walter Jury, Dan Krokos, and Cora Carmack (we're all repped by New Leaf Literary), and of course, my awesome agent Kathleen Ortiz and the other lovely ladies of New Leaf. The only real drawback: I must put make-up on my face and, you know, be filmed. I love public speaking and teaching, but for some reason, speaking to a camera renders me a seriously awkward duck.

So wish me luck.

NOW, I wanted to chat with you about something I find so very interesting, and have experienced myself on a number of occasions. As I write this, I have exactly 999 Twitter followers. I'm running this Malachi's journal giveaway (*ahem* maybe you'd like to enter ...), and so my follower count has gone up rapidly in the last few days, and here we are.

The temptation, of course, is to attempt to push this process along. I see this ALL the time on Twitter, blogs, Facebook (likes), and Goodreads (adds). People say things like "I would like to get to XX number of followers!" They offer incentives sometimes, and other times they just ask. And ask and ask and ask. Perhaps the round, even number is appealing, or perhaps adding another digit represents a milestone, or maybe it's simply the idea of having that many people hooked to your online self. It feels good, right? You feel popular? Secure? Like it's a badge of acceptance or something?

Like I said, I feel it sometimes, the urge to say COME ON, TWITTER, GIVE ME SOME LOVE (IN THE EXACT AMOUNT OF [insert seemingly meaningful yet actually arbitrary number] FOLLOWERS).

Then I recall how I feel when I see those bleated requests from others. Sometimes I feel generous and I follow, but mostly I endure it because I like the person and am willing to wait it out until they reach this somewhat artificial goal.

But I have to admit that sometimes I unfollow, especially if the request is made several times. It grates.

And here's the primary reason why I don't make requests for specific amounts of followers: It happens anyway.

At some point, maybe even by the time this posts, I'll have 1K Twitter followers. And also: it doesn't mean anything different than having 999 followers.

When I feel the urge to ask people to follow me just so I can reach some magical number that's only magical when I don't have it (because once I do have it, I start wanting to reach the next somewhat artificial milestone) ... I forcefully remind myself that it's eventually going to happen naturally, a by-product of this career and of consistently participating in this community in a positive way. I also remind myself that those magical round numbers don't actually mean anything real, and reaching those numbers in a specific amount of time doesn't mean anything, either.

Have you done this? (it's okay! It's a natural thing to want!) How do you feel when others make these requests? Is it just part of the game? What does it say about us?