JFK Conspiracy Theories and Breaches of Medical Ethics

A narcissistic psychiatrist googles himself (salerian) and discovers that someone doesn’t find his JFK neurotoxin conspiracy theory to be very convincing. The offensive post is the second hit, above the link to his own blog.

So Dr. Alen J. Salerian [or perhaps one of his devout fans] submits an indignant comment and doesn’t expect it to be published. WRONG!

The Neurocritic took this as an opportunity to do a quick Google search, and discovered a link to an official court document (on the first page of results). Dr. Salerian was placed on probation for two years in the state of Maryland because of a sensational and self-serving breach of confidentiality, as outlined in detail below.

Action Taken:

The Board has issued the Physician a Reprimand, a Fine of $3500.00 and placed his license on Probation for two years to include completion of an Ethics course.

 

The court opinion finding Dr. Alen J. Salerian guilty of a professional ethics violation is informative:

REPORTED IN THE COURT OF SPECIAL APPEALS OF MARYLAND No.624 [PDF]

To spare you the 35 page legal document, here’s a news article:

Md. Court of Special Appeals upholds spy consultant setback

The Maryland State Board of Physicians rightly disciplined a psychiatrist who evaluated accused spy Robert P. Hanssen, then revealed Hanssen’s disclosures to the media and Hanssen’s wife, the Court of Special Appeals held.

The board found Alen J. Salerian guilty of “immoral or unprofessional conduct in the practice of medicine” and punished him with probation and a $5,000 fine. Salerian challenged the decision on multiple grounds, all of which the appellate court rejected on Wednesday.

In 2001, Salerian contacted Hanssen’s attorney, Plato Cacheris, with an offer to perform a psychiatric evaluation of his client. Salerian was eventually hired on a limited basis, with the obvious stipulation that he should not approach the media or otherwise disclose confidential information.

During the interviews, Hanssen disclosed personal information about his unsavory sexual activities (including secret videotaping and other gross stuff) kept hidden from his wife:

On May 11, 2001, appellant disclosed to Cacheris what Evaluee had told him about his “sexual exploitation” of his wife. Cacheris instructed appellant not to reveal this information to anyone, including Evaluee’s wife. Yet, one day later, appellant disclosed Evaluee’s sexual activities to Evaluee’s wife. He did so, appellant explained in a letter to Cacheris, to “engender enhanced understanding and reconcilment [sic] between [Evaluee] and his wife . . . .”

But the prohibited disclosure went beyond the perhaps understandable desire to inform the wife of grave offenses committed against her. Salerian then contacted the media, thereby invalidating any noble intentions one might have attributed to him:

On June 12, 2001, Cacheris wrote to appellant, informing him that a producer for “Sixty Minutes” told Cacheris that appellant “had discussions with him concerning confidential matters involving [Evaluee].” Cacheris again warned appellant that appellant was “not permitted to disclose to anybody communications [he] may have had with [Evaluee] and members of his family” and that “any such disclosures will be violative of the attorney/client privilege and [appellant’s] own canons of medical ethics prohibiting disclosures,” and, furthermore, he reminded appellant that appellant signed the United States government’s “Special Administrative Measures,” which “prohibit public disclosures.”

[Two quotations above taken from the court document. Here’s the transcript from a CBS interview: Reveals Impressions Of Accused Spy Hanssen]

Let’s conclude with a link to a Dr. Drew-like ethical violation: offering vacuous “expert” psychiatric opinion on a celebrity:

‘Is Kobe Bryant Guilty?’ — Commentary by Psychiatrist Alen J. Salerian

The comments are quite amusing…

Mindy McCready’s Neuroanatomy Lesson

Mindy McCready Teaches Dr. Drew and Dr. Amen About Traumatic Brain Injury

She tells the good doctors about the terrible assault that potentially caused the temporal lobe injury they attributed to alcohol damage. A cheesy animation shows degeneration of orbitofrontal cortex while Amen discusses the cerebellum. Totally laughable.

Celebrity Rehab 3: Mindy’s Brain

 

Edronax (reboxetine) is another crappy antidepressant

Bad news for Pfizer:

Inclusion of previously unpublished data demonstrated that reboxetine (a norepinephrine reuptake inhibitor) is an ineffective and potentially harmful antidepressant. The efficacy of reboxetine was inferior to SSRIs (fluoxetine, paroxetine, and citalopram), and its response rate was not significantly different from placebo.

 

Reference

Eyding D, Lelgemann M, Grouven U, Härter M, Kromp M, Kaiser T, Kerekes MF, Gerken M, Wieseler B. (2010). Reboxetine for acute treatment of major depression: systematic review and meta-analysis of published and unpublished placebo and selective serotonin reuptake inhibitor controlled trials. BMJ Oct 12.

Objectives To assess the benefits and harms of reboxetine versus placebo or selective serotonin reuptake inhibitors (SSRIs) in the acute treatment of depression, and to measure the impact of potential publication bias in trials of reboxetine.

Design Systematic review and meta-analysis including unpublished data.

Data sources Bibliographic databases (Medline, Embase, PsycINFO, BIOSIS, and Cochrane Library), clinical trial registries, trial results databases, and regulatory authority websites up until February 2009, as well as unpublished data from the manufacturer of reboxetine (Pfizer, Berlin).

Eligibility criteria Double blind, randomised, controlled trials of acute treatment (six weeks or more) with reboxetine versus placebo or SSRIs in adults with major depression.

Outcome measures Remission and response rates (benefit outcomes), as well as rates of patients with at least one adverse event and withdrawals owing to adverse events (harm outcomes).

Data extraction and data synthesis The procedures for data extraction and assessment of risk of bias were always conducted by one person and checked by another. If feasible, data were pooled by meta-analyses (random effects model). Publication bias was measured by comparing results of published and unpublished trials.

Results We analysed 13 acute treatment trials that were placebo controlled, SSRI controlled, or both, which included 4098 patients. Data on 74% (3033/4098) of these patients were unpublished. In the reboxetine versus placebo comparison, no significant differences in remission rates were shown (odds ratio 1.17, 95% confidence interval 0.91 to 1.51; P=0.216). Substantial heterogeneity (I2=67.3%) was shown in the meta-analysis of the eight trials that investigated response rates for reboxetine versus placebo. A sensitivity analysis that excluded a small inpatient trial showed no significant difference in response rates between patients receiving reboxetine and those receiving placebo (OR 1.24, 95% CI 0.98 to 1.56; P=0.071; I2=42.1%). Reboxetine was inferior to SSRIs (fluoxetine, paroxetine, and citalopram) for remission rates (OR 0.80, 95% CI 0.67 to 0.96; P=0.015) and response rates (OR 0.80, 95% CI 0.67 to 0.95; P=0.01). Reboxetine was inferior to placebo for both harm outcomes (P<0.001 for both), and to fluoxetine for withdrawals owing to adverse events (OR 1.79, 95% CI 1.06 to 3.05; P=0.031). Published data overestimated the benefit of reboxetine versus placebo by up to 115% and reboxetine versus SSRIs by up to 23%, and also underestimated harm.

Conclusions Reboxetine is, overall, an ineffective and potentially harmful antidepressant. Published evidence is affected by publication bias, underlining the urgent need for mandatory publication of trial data.

The Bioethics of BODY WORLDS

Gunther von Hagens’ BODY WORLDS: selling beautiful education

Gunther von Hagens’ BODY WORLDS 1, 2 and 3 (hereafter referred to collectively as BODY WORLDS) are traveling exhibitions of “real human bodies” that have attracted very large crowds and a great deal of controversy.  The bodies in question are human corpses that have been plastinated through a process that infuses body tissue with polymers and resins to prevent decay and that allows whole bodies to be posed. The strong yet ambivalent public response is partly due to the multiple levels on which the exhibit operates. In large part, BODY WORLDS expresses a “museum ethos” oriented to public education.  Its didactic aim is to communicate the importance of preserving one’s health and the complexity of the human body. However, BODY WORLDS is also an art show. Some of the “whole-body plastinates” are outfitted with sports gear such as skis and skateboards to “bring them to life” as dynamic sculptures. Other bodies are transformed into surreal body-sculptures, for example, a man holding his own skin or a body opened up like a chest of drawers. Small cards that bear a title, the stylized signature of Gunther von Hagens, and the date of creation are placed alongside many of the plastinates, marking them as artwork and von Hagens as the artist. Finally, BODY WORLDS also entertains the public in the manner of a circus or freak show that presents a shocking and fascinating spectacle of death in exchange for a fee.

This target article in the American Journal of Bioethics is followed by 12 Peer Commentaries ranging from No Dignity in BODY WORLDS: A Silent Minority Speaks and Metamorphosis: Beautiful Education to Smarmy Edutainment to The Virtues of Blurring Boundaries in BODY WORLDS.

BODY WORLDS exhibitions have seen their share of controversy:

In January 2004, the German news magazine Der Spiegel reported that von Hagens had acquired corpses of executed prisoners in China; he countered that he did not know the origin of the bodies, and returned seven disputed cadavers to China.[38]

and

In 2003, while promoting a display in the Hamburg Museum of Erotica Von Hagens announced his intention to create a sex plastinate.[31] In May 2009 he unveiled a plastinate of a couple having sex, intended for a Berlin exhibition.[32]

Body Worlds is going XXX

Gunther_von_hagens_and_necrophilia

Corpse artist/anatomist Gunther von Hagens poses near his latest creation (designed for the necrophiliac, presumably).

 

Finally, Lady Gaga might incorporate the theatrically flayed bodies into her act (in case her plastinated feminist meat dress wasn’t enough for you):

 Lady GaGa’s Aupopsy

LADY GAGA has come up with a way to make her live shows even more shocking – having dead bodies on stage.

The singer is teaming up with corpse-preserving scientist GUNTHER VON HAGENS to spice up her already blood-soaked Monster Ball Tour.

. . .

Now GaGa wants the gruesome body pickler to design the set for her tour when it reaches Las Vegas next March.

For more info, see Cadaver Shows: Voyeuristic or Educational?

Reference

Burns L. (2007). Gunther von Hagens’ BODY WORLDS: selling beautiful education. Am J Bioeth. 7:12-23.

via @channelNvideo

Cymbalta (duloxetine) is a crappy antidepressant

Bad news for Lilly:

Duloxetine offers no advantages in efficacy and is less well-tolerated than SSRIs, TCAs, and even venlafaxine (Effexor), another SNRI.

 

Reference

Schueler Y-B, Koesters M, Wieseler B, Grouven U, Kromp M, Kerekes MF, Kreis J, Kaiser T, Becker T, Weinmann S. (2010). A systematic review of duloxetine and venlafaxine in major depression, including unpublished data. Acta Psychiatrica Scandinavica. DOI: 10.1111/j.1600-0447.2010.01599.x

Objective:  To determine the short-term antidepressant efficacy and tolerability of duloxetine and venlafaxine vs. each other, placebo, selective serotonin reuptake inhibitors (SSRIs), and tri- and tetracyclic antidepressants (TCAs) in adults with major depression.

Method:  Meta-analysis of randomised controlled trials identified through bibliographical databases and other sources, including unpublished manufacturer reports.

Results:  Fifty-four studies including venlafaxine arms (n = 12 816), 14 including duloxetine arms (n = 4528), and two direct comparisons (n = 836) were analysed. Twenty-three studies were previously unpublished. In the meta-analysis, both duloxetine and venlafaxine showed superior efficacy (higher remission and response rates) and inferior tolerability (higher discontinuation rates due to adverse events) to placebo. Venlafaxine had superior efficacy in response rates but inferior tolerability to SSRIs (OR = 1.20, 95% CI 1.07–1.35 and 1.38, 95% CI 1.15–1.66, respectively), and no differences in efficacy and tolerability to TCAs. Duloxetine did not show any advantages over other antidepressants and was less well tolerated than SSRIs and venlafaxine (OR = 1.53, 95% CI 1.10–2.13 and OR 1.79, 95% CI 1.16–2.78, respectively).

Conclusion:  Rather than being a first-line option, venlafaxine appears to be a valid alternative in patients who do not tolerate or respond to SSRIs or TCAs. Duloxetine does not seem to be indicated as a first-line treatment.