07/30/14

Getting Off the Antidepressant Merry-Go-Round

I told Allison to concentrate on my voice and imitate how I was breathing. My coworker held her head in her lap. Together we kept Allison focused until the paramedics came. Determined to stop all drug use after she came into outpatient drug and alcohol treatment, she decided to stop taking her Paxil … cold turkey. The result was a severe panic attack and ER visit.

The Center for Disease Control and Prevention (CDC) estimated that eleven percent of Americans 12 and over use antidepressants. More than 60% of those taking an antidepressant medication have taken it for 2 years or longer; 14% have taken the medication for 10 years or more. Like Allison, women between the ages of 40 and 59 are those most likely to be taking an antidepressant (22.8%). Antidepressants were the most commonly used medication by persons aged 18-44; they were the third most commonly used prescription drug by all Americans in 2005-2008.

Okay, you’re thinking you want to try to withdraw from antidepressants; but you don’t want to duplicate Allison’s experience. What should you do?

First, do some research on the growing evidence of problems with antidepressants.

Look at some of the material available on the websites “ToxicPsychiatry” by Peter Breggin and PsychRights by Jim Gottstein. Here are a few recommendations.

Start with Patient Online Report of Selective Serotonin Reuptake Inhibitor-Induced Persistent Postwithdrawal Anxiety and Mood Disorders, by Carlotta Belaise,  Alessia Gatti, Virginie-Anne Chouinard, and Guy Chouinard,on Psychrights. It is a short, easy to read study of online self-reports of withdrawal symptoms and postwithdrawal symptoms that they attributed to the discontinuation of SSRI antidepressants.

Then read “Do Antidepressants Cure or Create Abnormal Brain States?” by Joanna Moncrieff, found on ToxicPsychiatry. If you want further information, try her book, The Myth of the Chemical Cure. Dr. Moncrieff effectively challenges the received wisdom of the chemical imbalance theories underlying the use medications for depression, psychosis and bipolar disorder.

If you have used antidepressants for a number of years, also read: “Now Antidepressant-induced Chronic Depression Has a Name: Tardive Dysphoria,” by Robert Whitaker. Try out his website as well, Mad in America.

You can also read two articles that I’ve written and made available here on Faith Seeking Understanding: “Antidepressant Withdrawal or Discontinuation Syndrome?” and “Antidepressants Their Ineffectiveness and Risks.

Second, become familiar with the potential postwithdrawal side effects of antidepressant withdrawal.

There is a website of free resources at RxISK. You can research reported side effects by drug name; and you can report a drug’s side effects. But be sure to look at the “Symptoms-on-Stopping Zone.” Read about the concept of medication spellbinding coined by Peter Breggin on his ToxicPsychiatry site. Try his article, “Intoxication Anosognosia: The Spellbinding Effect of Psychiatric Drugs” or his book, Medication Madness for a more detailed discussion.

Mario Fava has developed a scale to assess withdrawal/discontinuation symptoms during an antidepressant taper. You can see a copy of his DESS Scale here; and read about antidepressant discontinuation here. You can download the original Fava article here after registering with psychiatrist.com.

Finally, don’t try this at home alone.

Read this blog post on Mad in America by Monica Cassani. Locate psychiatric support groups and websites like Beyond Meds by Monica Cassani. RxISK has published a detailed “Guide to Stopping Antidepressants.” Also read Your Drug May Be Your Problem: How and Why to Stop Taking Psychiatric Medications or Psychiatric Drug Withdrawal, both by Peter Breggin.

Make sure you have medical support and monitoring from a doctor or psychiatrist who is supportive of your attempt to taper. Someone who is president of the local chapter of NAMI and believes in the chemical imbalance theory of depression is not a good choice to supervise your drug taper. Postwithdrawal symptoms will be seen as the re-emergence of your underlying psychiatric disorder and proof you need to be on medications for life.

Tell family and friends of your decision and enlist them (those who are receptive to your decision to taper) as members of an accountability or support group. Have them read this material.

In closing, remember this warning by Dr. Peter Breggin on his website:

Most psychiatric drugs can cause withdrawal reactions, sometimes including life-threatening emotional and physical withdrawal problems. In short, it is not only dangerous to start taking psychiatric drugs, it can also be dangerous to stop them. Withdrawal from psychiatric drugs should be done carefully under experienced clinical supervision.

07/28/14

They Tried to Make Me Go to Rehab

Amy Winehouse famously opened her hit song Rehab with the line: “They tried to make me go to rehab but I said, ‘No, no, no.’” The song’s mind-set is the attitude of many who have had to go to “rehab.” Sometimes people just don’t want to stop using drugs or drinking alcohol. And they REALLY don’t like hearing from someone else that they should stop. I work part time as a therapist for a drug and alcohol partial hospitalization program and could see Rehab being the treatment program’s theme song if we ever became a reality TV show.

A yearly survey done by the federal government, The National Survey on Drug Use and Health (NSDUH) estimated in 2007 that of the 19.3 million people who needed treatment for an alcohol use problem, 17.7 million (92%) did not receive it. I’m simply noting here that the vast majority of people who would say “No, no, no” to a rehab recommendation can and do avoid it.  But what about that 8%, those 1.6 million individuals who get to “go, go, go” to rehab?

Reluctant rehabbers through the legal system can be quite resentful when they are court ordered to attend A.A. (Alcoholics Anonymous) meetings. One such person who had a bad experience is Juliet Abram, writing in The Fix’s blog section. Her post has the provocative title: “Activists or AA Bashers?” She has her own blog, A.A.R.M.E.D. with Facts (Against Abuse in Recovery Meetings & Eliminating the Danger) and a Facebook page. Clearly, she doesn’t like A.A. and seems to have made her critique of it part of her lifestyle changes (I don’t know if she’d want the term “recovery” used). I want to share some of my thoughts on her post, “Activists or AA Bashers?” here.

She objected to the spirituality of A.A., saying it made her uncomfortable to talk about it. With a year left on probation, she started an S.O.S. (Secular Organization for Sobriety) meeting and was told by her probation officer that refusing to go to A.A. could lead to jail time. She also said: “I believe it is beyond the government’s scope of power to prescribe prayer under threat of imprisonment.”

First, it appears she was “court ordered” to 12-Step meetings for the third time, meaning three OVIs (operating a vehicle under the influence). DrivingLaws.org indicated that in Ohio, with a 3rd offense, she faced 30 days to 1 year in jail, a 1 to 10 year license suspension, and $350 to $1,500 in fines and penalties. The higher the BAC level and the more frequent the OVI offenses, the greater the consequences. I’d be mad too. But was going to A.A. meetings and probation initially offered to her instead of jail time? If it was, that’s not a bad deal, even for an atheist.

The threat by her probation officer doesn’t sit right with me unless part of her probation requirements was that she had to attend A.A. or other 12 Step meetings. Then she could potentially face jail time for a probation violation. Her S.O.S. meeting should count for at least one weekly meeting. Maybe she was expected to go to more and didn’t have easy access to alternatives to the A.A. meetings she despised. She also could have had a “hard ass” probation officer. She could have been resistant and challenging to him, which drew the threat of jail time.

Her rhetoric about the government proscribing prayer under threat of imprisonment is over the top. I’ve not heard of forced prayer at A.A. meetings; even those in the Cleveland area. The Cleveland area is historically “hard core.” Dr. Bob lived just south in Akron. But forced prayer is not what happens at an A.A. meeting.

In the A.A. published book, Pass It On, is the story of how the A.A. message reached the world. There, Bill Wilson described how changes like the phrase “God as we understand Him” in the Third Step were suggested as a concession “to those of little or no faith.” These changes were “the great contribution of our atheists and agnostics. They widened our gateway so that all who suffer might pass through, regardless of their belief or lack of belief.” (emphasis in the original)

In 1961, Bill Wilson wrote in the AA Grapevine, “Our concepts of a Higher Power and God—as we understand Him—afford everyone a nearly unlimited choice of spiritual belief and action.”  He suggested that this was perhaps the most important expression in be found in the entire vocabulary of A.A. Every kind and degree of faith, together with the assurance that each person could choose his or her own version of it opened a door “over whose threshold the unbeliever can take his first easy step into . . . the realm of faith.”

The spiritual aspects of A.A. aren’t forced upon anyone. And if there are individuals or a group who sees it as their mission for a newcomer to “get the spiritual angle,” there are plenty of others who aren’t like that. Try an experiment. Pay for access to the A.A. journal, The Grapevine. Then do a search on atheist or atheism and read some of the articles that go back to the 1940s. They seemed to have worked through the spiritual angle to be able to take what they needed for recovery, despite the “God stuff.”

 

Do you think that mandated attendance to A.A. meetings is akin to “the government proscribing prayer”?

07/25/14

Was John the Baptist an Apostle?

image of John the Baptist jurand / 123RF Stock Photo

image of John the Baptist
jurand / 123RF Stock Photo

I was intrigued by the research done by the Barna Group for the American Bible Society. Since 2011, The American Bible Society has commissioned the Barna Group to conduct a yearly survey called  “The State of the Bible.” The survey looks at what Americans believe about the Bible and what role it plays in their lives. The data described here was taken from the 2013 survey. You can review infographics of the surveys results or read the full yearly reports by following the above link.

Did you know that 56% of adult Americans believe the Bible has too little influence in U.S. society today? Only 13% thought it had too much influence. A significant majority of Americans (77%) believed that morality is on the decline. And one in three of them (32%) said that a lack of Bible reading is the primary cause.

What’s with the 45% of Americans who thought that the Bible teaches that God helps those who help themselves? Sorry. That really came from the ancient Greeks.

Four out of five adults (80%) believe the Bible to be a sacred or holy book. The Koran (8%) was the next most recognized sacred book, followed by the Torah (4%) and the book of Mormon (3%). Previous research conducted by the Barna Group in their report “Americans Identify What They Consider ‘Holy’ Books” found that some individuals (less than one-half of one percent) said that even I Ching, Dianetics by L. Ron Hubbard and Mein Kampf by Adolph Hitler were sacred books.

The vast majority of adults (88%) have a Bible in their home. Even those who align with other faith groups (69%) and atheists and adults with no faith (59%) live in a household with at least one Bible. One hundred percent of evangelicals said that they have a Bible in their home; 93% of Catholics. Mosaics, individuals between the ages of 18 and 28, were the age group least likely to have a Bible (79%). Fifty percent of American households have four or more Bibles.

Given several options on how to describe the Bible, more adults believed it to be the inspired word of God without errors, but with some symbolism (27%) rather than believing the Bible was the actual word of God that should be taken literally, word for word (22%). A smaller percentage (15%) thought that while the Bible was inspired by God, it also contained factual or historical errors. Sixteen percent thought it was just another book of teachings written by men that contain stories and advice.

This last reported finding of the survey, captures an interesting tension I see within the evangelical debate over defining what the inspiration of Scripture means today. Sixty-four percent of Americans affirm some sort of inspiration within the Bible. There is significant percentage of literalists (22%); a larger percentage of inerrantists that allow for some symbolism in Scripture (27%); and a notable group who affirms the inspiration of Scripture, but readily acknowledges that it has factual or historical errors (15%). Given the categories of the survey, I’d see myself as an inerrantist that allows for some symbolism in Scripture.

When given true and false statements beginning with, “According to the Bible”, 14% of Americans thought Sodom and Gomorrah were married; 8% though Noah was married to Joan of Arc. And 40% of Americans thought John the Baptist was an apostle; 12% weren’t sure. Hmm … I think we need to spend a bit more time reading our Bibles.

Do you think the Bible contains everything a person needs to know to live a meaningful life?

07/23/14

Creation of a Psychiatric Disorder

I became interested in the history of Premenstral Dysphoric Disorder (PMDD) when I met two husbands in marital counseling who believed their wife’s mood changes during menstruation caused most of their fights. They even kept track of their wife’s menstrual cycle and charted it in conjunction with their marital conflict.

Robert Spitzer, the “creator of the modern DSM” was the first to propose that severe PMS symptoms should be classified as a psychiatric disorder. According to Alix Spiegel of NPR, Spitzer has personally conceived of more mental disorders “than any other living person on the face of the earth.” But despite his efforts, in June of 1986 the APA Board of Trustees voted against making PMDD (then known as Late Luteal Phase Dysphoric Disorder, LLPDD) an official DSM diagnosis. This outcome was largely through the efforts of people like Paula Caplan.

Caplan and others opposed adding LLPDD to the DSM–III-R and later the DSM-IV. They (rightly) felt it would pathologize women. Caplan gives a detailed description of her efforts to keep LLPDD and out of the DSM in her book, They Say You’re Crazy.

But LLPDD was added to a specially created appendix of the DSM-III-R for “provisional categories needing further study.” Following the advice of Robert Spitzer, it was also given an official number just like the approved diagnoses in the main part of the manual. Psychiatrists were encouraged to use the diagnosis as if it was official. LLPDD even appeared in the main text of the DSM-III-R, where only fully tested and scientifically supported diagnoses were supposed to be included.

When the DSM-IV was published in 1994, LLPDD was renamed as PMDD and kept in the appendix. But PMDD was still a pseudo-diagnosis in the sense that it was still in the appendix and not in the main section of the manual.

About one year before Eli Lilly’s patent rights were about to run out on Prozac (fluoxetine) in August of 2001, the FDA approved Serafem to treat the pseudo-diagnosis of PMDD. Although both Zoloft and Celexa had been used to “treat” PMDD, Serafem was the first prescription drug that the FDA said could be marketed specifically for treating PMDD. What were these changes that warranted the approval of a newly patented form of fluxetine for Eli Lily? In “Sarafem: The Pimping of Prozac for PMS” Alicia Rebensdorf said:

The company changed the color of the pill from green to girly pink and turned the depression-stigmatized label Prozac to the oh-so-feminine name Sarafem. Yet Sarafem/Prozac both require daily 20 mg. doses of fluoxetine hydrochloride. You don’t take Sarafem any less often. You don’t take it any smaller doses.

Here are the first two Serafem commercials.

With the publication of the DSM-5, PMDD finally came out of the closet appendix. In their recent article reviewing the DSM history of PMDD, Peter Zachar and Kenneth Kendler commented: “When the DSM-5 was published in 2013, PMDD was moved to the main section of the manual as a diagnosis approved for routine clinical use.” But functionally, it was approved for “routine clinical use” when Spitzer and the APA gave it a DSM number and created an appendix for it in 1987 as LLPDD. The reason that officially moving PMDD to the main section was not controversial was because the above actions placed it there in 1987, BEFORE THE RESEARCH INTO PMDD as a psychiatric disorder was done.

According to Caplan in a May 12 1986 press conference, Robert Spitzer admitted that there no proposed treatment for PMDD/LLPDD at that point. However, “that is the very reason we need to put the category in the DSM, because that will make it possible to conduct research to find out what will help.” So PMDD had to be coined as a disorder so research could be done to help women with a disorder … that wasn’t yet an official disorder. As Zachar and Kendler said:

By the time that the DSM-5 development process began, PMDD was no longer a new diagnosis, and conservatism favored keeping it a disorder subject to routine clinical use. The approval of Sarafem played a role, but so did giving PMDD an official code number in the DSM-IV and listing it in the main text as an example of mood disorder NOS.

This history of how PMDD became a DSM diagnosis illustrates the unscientific manner in which many psychiatric disorders are created. Paula Caplan cautioned that the danger of the DSM is that it is used with so little monitoring of when the line is crossed from normalcy to disorder in its decisions.

In his essay, “Mental Illness is Still a Myth,” Thomas Szasz said that psychiatrists have succeeded in persuading us that the conditions they call “mental disorders” are diseases—phenomena independent of human motivation or will. “Until recently, only psychiatrists—who know little about medicine and less about science—embraced such blind physical reductionism.”

Does the DSM need independent monitoring and accountability? 

07/21/14

The Consequences of Ignoring the Past

In 1964, Drs. Marie Nyswander and Vincent Dole read about methadone in the drug literature, thought it could be useful in treating heroin addicts, and methadone maintenance treatment was born. For the next three decades, methadone was primarily used in opioid maintenance treatment. Then in the mid-1990s methadone began to be used as an alternative medication for chronic pain. But there were problems when methadone was used for pain relief—people began dying from accidental overdoses.

Methadone has some advantages as a pain reliever. Its longer duration of action meant it could be taken only 2 or 3 times a day rather than 4 to 6 times a day. It is also lower in cost than other prescription painkillers. Insurance plans see methadone as a cheaper, generic alternative to other long-lasting painkillers like OxyContin. A Consumer Reports comparison of the estimated costs for long-acting opioids indicated that the average monthly cost for 5 mg methadone pills was about $17. The monthly cost for 10 mg sustained-release OxyContin was $164. Fentanyl extended-release 25 mg was $303.

By 2009, methadone accounted for almost 1 in 3 prescription painkiller deaths. More people overdosed on methadone than heroin. SIX TIMES as many people died from methadone overdoses in 2009 than in 1999. See the following chart taken from the CDC “Morbidity and Mortality Weekly Report” for July 6, 2012.

methadoneOne of the issues was that the FDA-approved package insert for methadone recommended high initial doses of up to 80 mg per day. As reported in the NYT article, “Methadone Rises as a Painkiller With Big Risks,” Dr. Robert Newman, an expert on addiction said: “This could unequivocally cause death in patients who have not recently been using narcotics.” In November of 2006, after overdose deaths from methadone became more widely known, the FDA decreased the recommended starting limit to no more than 30 mg per day.

However, it has been reported that lethal respiratory problems can still occur with doses as low as 30 mg daily with some individuals. The problem is that methadone can take as long as two weeks to be converted into inactive metabolites with methadone-naïve patients. So the accumulation of methadone, especially with methadone-naïve individuals, can lead to “sedation, respiratory depression respiratory arrest and even death.” These same effects can occur with someone who is tolerant of opioids, but generally takes higher doses.

The respiratory depressant effect from methadone typically peaks later and lasts longer than its analgesic effect. In other words, someone taking methadone for pain will have relief for about 4 to 8 hours. But the methadone is still pharmacologically active. Taking more methadone for pain relief could mean greater toxicity and the danger of respiratory problems, since the recent dose for pain relief combines with the still-not-fully metabolized methadone of the first dose.

Sadly, if the history of methadone had been taken to heart, perhaps some of these problems could have been avoided. Maybe some of the accidental overdoses could have been prevented.

Methadone was first synthesized in the mid-1930s as an alternative painkiller to morphine, which the Germans anticipated the Allies would not be willing to share with them once war was declared. Known at the time as polamidon, it was never brought into commercial use. An American doctor, who did a good bit of the early clinical research with it after the war, said a former employee of the German company that invented polamidon (methadone) told him they had discounted its usefulness because of the side effects.

The factory where polamidon was invented came under the control of the Americans after the war. All German patents, including those for polamidon, were requisitioned as spoils of war. Eli-Lilly and other pharmaceutical companies began clinical trials on what was thought to be a revolutionary new painkiller, now with the name of dolophine—combining the Latin word dolor (pain) and the French word fin (end).

A 1947 study by Isbell et al. noted that volunteer subjects had problems with rapidly developing tolerance and euphoria. There were also signs of toxicity, inflammation of the skin, deep narcosis (unconsciousness) and a general appearance of illness with high doses. They also observed that: “morphine addicts responded very positively” to dolophine. They concluded that dolophine could be highly addictive: “We believe that unless the manufacture and use of methadon [methadone] are controlled addiction to it will become a serious health problem.”

The philosopher George Santayna said: “Those who cannot remember the past are condemned to repeat it.” In the case of methadone, it seems that those who don’t remember the past are condemned to suffer the consequences.

Also read, “Chained to a Dragon.”

 
07/18/14

How God Became Real for Two Modern People

Soon after Bill admitted himself to the Towns Hospital for what would be the last time, he cried out: “If there be a God, let Him show Himself!” His hospital room was filled with a white light. He was seized with an “ecstasy beyond description.” In his mind’s eye, he stood on the summit of a mountain, where a great wind of spirit blew right threw him. “Then came the blazing thought: ‘You are a free man.’” He became aware of a Presence, like a sea of living spirit. “This,” he thought, “must be the Great Reality. The God of the preachers.” Bill Wilson never took another drink. He had started down the path to become one of the cofounders of Alcoholic Anonymous.

Within our modern culture, “sensory override” encounters with the supernatural are met with skepticism or viewed as the ravings of fanatical individuals and groups. But rejecting the reality of the supernatural contradicts what William James described in The Varieties of Religious Experience and what T. M. Luhrmann reported in When God Talks Back.  Bill Wilson read VRE to help him make sense of his encounter with the God of the preachers. And Bill would later refer to James as a “cofounder” of A.A.

Like William James, Luhrmann persuasively validated these experiences of the supernatural in When God Talks Back. She even provided some experimental evidence that “sensory override” experiences were not pathological. See a description here in “How Does God Become Real for Modern People?

I have never worshipped in a Vineyard church. But I did spend some time in charismatic evangelical churches after my own personal encounter with God. A friend challenged me to read the book, More Than A Carpenter, by Josh McDowell. He said it had played a role in his own conversion. I remember being surprised by McDowell’s effective use of logical argument. But, I still wasn’t persuaded, as my friend had been.

One Saturday afternoon, I found myself wondering why McDowell said the death, resurrection and ascension of Jesus Christ was necessary for the redemption of humanity. Then in my mind (not audibly) I heard a voice say: “There was no other way.” I immediately knew the statement was true. And I immediately knew that voice was God.

I grew up in the Roman Catholic church, but had never been told that God would speak to you like that. Ironically, at that time one of the individuals I counseled actually believed he was Jesus Christ when he was in a psychotic state. I returned the book to Jerry, not saying anything about God speaking to me. My plan was to never speak of that experience to anyone. A few months later, some further, less profound experiences led me to acknowledge Jesus as my savior and Lord. I eventually did contact Jerry and tell him about God talking to me; and I have periodically told others of the experience as well.

God speaking to me is a part of my personal spiritual journey. But it is not an experience that I intentionally sought to cultivate (then or now), like the members of the Vineyard Christian Fellowship. This was over thirty years ago, and I have not had a spiritual experience of the divine that has ever come close to this encounter since then. I agree with T. M. Luhrmann that: “the problem of faith is not finding the idea of God plausible but sustaining that belief in the face of disconfirmation.”

You don’t have to have God talk to you in order to believe in Him. But if He does, it can make Him real to you in a profound way. Thanks Tanya for helping me to better understand my personal encounter with God. I look forward to your next project. And I have some suggestions, if you’re interested.

Have you had any sensory override experiences of your own?

07/16/14

I Guess I’m a Little Bit Socialist

Aaron (not his real name) walked into my office and said he needed my help. We were the two therapists scheduled to work that weekend with the inpatient adolescent unit at a drug and alcohol treatment center. He had been in an individual session with a sixteen year-old Hispanic girl who was always getting into trouble; usually from losing her temper. For weeks he’d been trying to get her to open up and talk about what was behind her anger. And she finally decided to tell him—she had witnessed the ritual killing of an infant.

We knew she had been a runaway with a guy in his forties and thought we had a pretty good guess of what her past trauma issues were. But we were way off. Aaron and I were friends and part of the same bible study. I‘d heard his testimony and knew that his commitment to Christ came after the accidental drowning of his young son. When he heard what the Hispanic girl had to say, all his past grief and loss came back to him.

He took me back to his office and he told her why I was there; he was just too close to his own loss to help her just then. We listened to her story of being forced to witness the ritual killing and I helped her as best I could with the memories and feelings she expressed. She kept crying and repeating how bad she felt for the baby; the baby. In closing the session, I told her that Aaron and I would pray for the dead infant and she could too if she wanted. We were not Roman Catholic, but knew that the girl was. So the prayer was intended to give her a time of closure with what she had just shared with us. We prayed; and she did also, asking God to protect and care for the dead baby.

The girl was placed on suicide watch; we told other staff about what she had disclosed. In a day or two there was a treatment review of the incident by the newly hired treatment director and newly appointed facility administrator. Our center had been recently bought by a much larger corporation. Aaron said later that everything went fine with the review—until he told them of the closing prayer we had done. Then our new bosses suddenly wanted to go over the whole thing again with a fine-toothed comb.

We had been therapeutically on the money. There wasn’t anything that could be said to be clinically wrong with what we did. But Aaron and I were told in no uncertain terms to never pray with anyone ever again. I distinctly thought that if they could have pointed to anything out of order, it would have been used to fire us on the spot. I’ve always thought that one of the greatest ironies of this was that the administrator was a former minister. It was after this incident that I began to think it was time for me to move on and I did. I went to seminary.

I didn’t stay in touch with Aaron over the years. But I ran into a mutual friend at a Christian counseling conference last year. The friend had taught the bible study Aaron and I were part of. He also had been the former director of treatment let go at our facility. The new corporate owners came in with their new treatment direction and he hadn’t been part of their plans. We caught up on what had been happening in each others lives and I began asking about other people from that time. My friend told me that Aaron had died a couple of years ago because of complications from hepatitis C. Even though we hadn’t been in touch, I still felt the loss.

Recently I posted two links on Facebook about an outrageously expensive treatment for hepatitis C, Sovaldi, which is listed to cost $1,000 per pill. Both times I received comments justifying the cost by pointing to the right of the drug company Gilead Science to charge what they consider a competitive market price; that the company has to recoup its research and development costs, etc. The first time I was upset enough to impulsively delete the person’s comments. That led to me being “unfriended.” The second time, I responded by posting links indicating how drug companies have been shown to carry out a misleading campaign to justify their profits to fund expensive, “risky” research and development. Here the organization, Public Citizen, was noted to be in favor of government control of the economy and therefore socialist.

A Yahoo News report indicated: “An estimated 15,000 people died from hepatitis C in the U.S. in 2007, when it surpassed AIDS as a cause of death.” Health care costs related to hepatitis C are expected to increase 1,800 percent by 2016. Additionally, more than a dozen European countries are joining forces to negotiate a lower rate for the drug treatment. And two U.S.  senators have written to the Gilead chief executive, saying: “the pricing had raised serious questions about the extent to which the market for this drug is operating efficiently and rationally.”

So I guess when it comes to Hepatitis C treatment, I’m a little bit socialist. Either that or I take profiteering by drug companies personally. Probably both. Rest in peace Aaron.

Do you think the costs of some medical treatments should be regulated?

Also read, “Is There No Balm in Gilead?”

07/14/14

Is There No Balm in Gilead?

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balm of Gilead in an olive wood scoop. marilyna / 123RF Stock Photo

I’ve always felt there was great irony in the fact that my favorite concert memory turned out to be a way of enabling David Crosby’s drug habit. When David Crosby and Kenny Rankin came to the Syria Mosque in Pittsburgh, I made sure I had tickets. Kenny Rankin sang his cover of the Beatles song: Blackbird. David Crosby came on stage with just his acoustic guitar and went through many of his hits with CSN&Y (Crosby Stills, Nash and Young for those born after the Boomer generation). It was great. Then I read in a magazine about David Crosby’s cocaine problem. In the article, Crosby described how he arranged quick solo acoustic concert tours when he was running low on drug money.

In a Rolling Stone interview, David Crosby reflected on his unlikely survival: “‘I don’t know why I’m alive and Jimi isn’t and Janis isn’t and Mama Cass isn’t and all my other friends,’ says Crosby. ‘I have no idea why me, but I got lucky.’” Well he hasn’t been as lucky with his health. He had hepatitis C and needed a liver transplant in 1994. Phil Collins paid for his transplant.

Typical treatment for hepatitis C is 6 to 12 months of a drug cocktail consisting of interferon and ribavirin plus a protease inhibitor. Interferon treatment has both physical and psychiatric side effects. Physical side effects can include flu-like symptoms (41 to 70%), nausea (29 to 46%), anorexia (21 to 32%), and diarrhea (22%). Psychiatric side effects can include: depression (22 to 36%), irritability (24 to 35%), and insomnia 37 to 40%).  Suffice it to say that treatment is not very pleasant.

When I heard the announcement about Gilead Science’s new drug Sovaldi being approved in December of 2013, I was pleased and encouraged. Sovaldi sounded like a real medical break through. It blocks a specific protein needed by the hepatitis C virus to replicate. When Sovaldi is used in conjunction with existing hepatitis C medications such as ribavirin and peginterferon-alfa, a study showed that 12 weeks after the end of the 12 to 24 week treatment regimen, 91% of untreated hepatitis C patients tested negative for hepatitis C!

This is simply amazing. Many of the people I’ve known that began interferon treatment stopped at some point because of the side effects. They simply can’t go on with their daily lives because of the medications. If Sovaldi can cut the treatment time in half and provide a 90% “cure” rate, more people will get and complete treatment.

So it seemed Gilead Science was attempting to live up to its name. Gilead Science’s name and logo intentionally uses the Biblical reference to the balm of Gilead. Gilead was a mountainous region east of the Jordan River that was famous for it healing ointment. The chorus of a classic spiritual, “There is a Balm in Gilead,” goes:

There is a balm in Gilead,

To make the wounded whole;

There is a balm in Gilead

To heal the sin-sick soul.

The existing cost for standard hepatitis C treatment (combination interferon and ribavirin therapy) before Sovaldi was steep, between $10,000 and $12,000. Maybe Sovaldi was going to be the “Hep C balm from Gilead”—or not. I was outraged to see that Gilead was charging $1,000-a-pill for Sovaldi.   A full course of Sovaldi costs $84,000. The full treatment for Hepatitis C will cost over $90,000! And get this—Sovaldi costs about $130 to manufacture.

Other industrialized countries are paying roughly half of the $84,000 cost for Sovaldi. Third world countries like Egypt and India get a 99% discount. According to Dr. Steve Miller on Forbes.com, “Hepatitis C patients in the U.S. are mostly uninsured, underinsured and/or incarcerated. Medicaid, the VA and our prison system bear the brunt of the cost impact, and by extension so do all of us as taxpayers.” So it would seem that in the U.S. there is a balm from Gilead—but you’re going to pay through the nose for it.

Is there no balm [for hepatitis C] in Gilead?

Is there no physician there?

Why then has the health of the daughter of my people

not been restored? (Jeremiah 8:22)

Yes, there is a Hep C balm in Gilead; and yes, there are physicians there to oversee the treatment. But the health of the daughter of your people will not be restored if she doesn’t have good health insurance, or someone like Phil Collins able and willing to make up your financial shortfall.

By the way, first quarter total sales in 2014 for Gilead’s Hep C balm was $2.27 BILLION. It was the fastest drug launch on record.  The Senate Finance Committee is inquiring about the drug. They have requested information for documents related to research and development costs of Sovaldi. Karen Ignagni, chief executive of the trade group America’s Health Insurance Plans, noted that treating all hepatitis C patients would cost $268 billion, which is $5 billion more than was spent on all prescription drugs in 2012. “This pricing, which Gilead attempts to justify as the cost of medical advancement, will have a tsunami effect across or entire health-care system.”

Is it profiteering to have such a high mark up on drugs like Sovaldi? 

Also read, “I Guess I’m a Little Bit Socialist.”

07/11/14

Restoring the Ancient Ministerial Work

BaxterJ. I. Packer called Richard Baxter the most outstanding pastor, evangelist and writer that Puritanism produced. He was the vicar of the church in Kidderminster from 1647 to 1661. When he arrived in Kidderminster, Baxter said the towns people were “an ignorant, rude and reveling people.” Yet in 1743, when George Whitfield visited Kidderminster over eighty years later, he said to a friend: “I was greatly refreshed to find what a sweet savour of good Mr. Baxter’s doctrine, works and discipline remained to this day.”

According to Baxter, pastoral ministry should be a combination of public preaching and private conference (counseling). He thought the two activities complemented each other. First, members of the congregation would better understand the sermons. Second, getting to know your people would help the pastor know what he should preach on.

Baxter saw personal catechizing and instruction of every willing person within the congregation as the duty of the pastor. He said: “It is but the more diligent and effectual management of the ministerial work. It is not a new invention, but simply the restoration of the ancient ministerial work.” He suggested that a pastor should set aside two days out of six for the personal instruction of individuals within his parish. If the pastoral work grew to the point that he could not keep up with the need, then another minister should be hired.

He hoped that no one would be silly enough to say that individual conferences weren’t preaching. “What? Do the number we speak to make it preaching? Or doth interlocution [dialogue] make it none? Surely a man may as truly preach to one, as to a thousand.” If you examined the New Testament, “you will find that most of the preaching [there] was by conference.”

Anticipating the objections to his advocacy of private conferences, Baxter commented how some ministers may point to their labors in the public teaching. Why then should they obligated to teach congregants individually besides this? Baxter’s answer went to the heart of the matter. Some who come for private meetings would be “grossly ignorant” in matters of their faith. Yet in one hour of private, instruction, “they seem to understand more, and better entertain it than they did in all their lives before.”

Among the seventeen benefits of private conference, Baxter said:

  • It would help to convert individuals.
  • It would promote the orderly building up of those who are converted and help establish them in the faith.
  • It will make the public preaching better understood and regarded.
  • By it you will become familiar with your people and possibly win their hearts.
  • In becoming better acquainted with each person’s spiritual state, you can better know how to watch over him or her.
  • It will help with the better ordering of families.

In a previous post on preaching and counseling, “Preaching and Counseling Are Complementary” I referred to Carl Truemen’s article for Reformation 21, “Why is So Much Preaching So Poor?” Perhaps the answer to Trueman’s question should be that modern preaching is so poor because modern pastors have largely lost the connection with their church members that Richard Baxter had because of his private conferences.

Do you think that Biblical counseling can be a restoration of an ancient ministerial work of the church?

Also read, “Preaching and Counseling Are Complementary.”

07/9/14

Preaching and Counseling Are Complementary

John Wesley

image credit: iStock

Carl Trueman wrote a helpful article for Reformation 21 that discussed why much of modern Protestant preaching was so poor. But in his third point, he said something that I found troubling since I am a counselor by profession and calling. Dr. Trueman said in our culture, there was a “relativizing of the preached word and the growth of emphasis on one-to-one counseling.” He quickly acknowledged the usefulness of one-to-one counseling. But then commented how he thought most of the problems people experienced could be adequately dealt with from the pulpit.

What Dr. Trueman said next seems to be why he sees counseling and preaching at odds with one another in our culture. The world tells us we are unique, with unique problems. “Talk of our uniqueness is greatly exaggerated. We need to create a church culture where uniqueness is relativized and where people come to church expecting that the preached word will meet their particular problem.” True, but oftentimes this may not be enough.

In The Reformed Pastor, Richard Baxter noted how he met with people who had sat under his preaching for eight or ten years and yet did not know whether Christ was God or man. Even when an individual knew the gospel, they often had an ungrounded trust in Christ. They hoped He would pardon, justify and save them; but the world had their hearts.

Dr. Trueman is correct. There is individualism and self-centeredness in American culture and in counseling. In Psychology as Religion: The Cult of Self-Worship, Paul Vitz called it selfism. He described Americans as having a Burger King mentality: Have it your way!

Counseling that panders to selfism is theologically wrong and spiritually damaging. Preaching that panders to selfism is also theologically wrong and spiritually damaging. But counseling and preaching can and should be co-laborers in the ministry of the gospel. They don’t have to be opposed to one another. Again, Richard Baxter spoke to this concern.

Baxter said preaching the gospel publicly is the preferred means, because we can speak to many people at once. “But it is usually far more effectual to preach it privately to a particular sinner.” Public sermons are long and can over-run a person’s understanding and memory. People may become confused and therefore are not able to follow the preacher. So then they do not understand what was said, regardless of how effectual the preaching was to others.

“But in private we can take our work gradatim, [step by step] and take our hearers along with us.” By the questions we ask and their answers, we can see how far they understand us. Publicly, we lose their attention through the length of what is said and the lack of an opportunity to respond to what was said. Privately, we can easily cause them to pay attention. And we can more effectively engage them and answer their questions. Baxter urged that his fellow ministers would see preaching and personal instruction (counseling) as complementary:

I conclude, therefore, that public preaching will not be sufficient: for though it may be an effectual means to convert many, yet not so many, as experience, and God’s appointment of further means, may assure us. Long may you study and preach to little purpose if you neglect this duty.

Counseling that is biblically-based complements preaching. In the Introduction to Competent to Counsel, Jay Adams said: “It is amazing to discover how much the Bible has to say about counseling, and how fresh the biblical approach is.”

Do you think that public preaching is adequate for people to address most of their problems? 

Also read, Restoring the Ancient Ministerial Work.