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A Letter from Douglas Beech, M.D.
While reading about the outcome of Dr. Thomas Jensen’s suit against
Kaiser Permanente’s San Diego HMO in the October 6 issue, I was painfully
reminded just how far the collective mentality of psychiatry has plunged into
a managed care paradigm of minimalism.

Dr. Jensen protested the policy of the HMO that "required" psychiatrists to
prescribe without personal examination of a patient. Physicians who
participate in such a practice do not have the HMO policy to blame, but the
outcry suggested that the policy was responsible for physicians’ not
performing their required duty.
Please read:
http://behavioral.kaiserpapers.org/beechy.html

Kaiser Defends Mental Health Coverage As
'team-Based'

LOS ANGELES, Apr 14 (Reuters) - Kaiser Permanente, under
investigation in California for requiring psychiatrists to write drug
prescriptions for mental health patients whom they have not seen,
on Thursday defended its practice as "team-based."

The California State Department of Corporations is investigating Kaiser, the
nation's largest nonprofit health maintenance organization, after a
complaint from a psychiatrist who alleges that he was fired for refusing to
write prescriptions for patients he had not examined. "The model used in
the Kaiser Permanente San Diego department of psychiatry is a team-
based approach to providing quality mental health care services to health
plan members," Dr. Joel Hyatt, assistant associate medical director of
Kaiser's Southern California medical group, said in a statement.

"We believe that some who have expressed concern about our practice are
not fully aware that our patients are very carefully screened, that this
represents a carefully structured process designed by physicians, and that
all decisions ”to examine the patient or to prescribe medication” are made
by physicians," Dr. Hyatt said.

The California department, which regulates managed care, has said that it
plans to hold an inquiry into the matter.

The complaint, filed by San Diego psychiatrist Dr.
Thomas Jensen, alleges that, as a matter of practice,
psychiatrists are required by Kaiser to prescribe medications for
depression and anxiety on the recommendation of nonmedically
qualified personnel, such as psychotherapists, social workers and
even intern social workers, without ever examining the patients.

Dr. Hyatt said that Kaiser's new patients are carefully screened by a
licensed clinical social worker, licensed family therapist or clinical
psychologist. A psychiatrist then reviews the assessment, and, in cases
where a patient is presenting with mild depression or anxiety, the
psychiatrist might prescribe a starter dosage of appropriate medication and
then personally examine the patient in about 3 to 4 weeks. "The personnel
who conduct the initial assessment are licensed mental health professionals
who work closely with the psychiatrists in their unit. They do not prescribe
independently, and do not make diagnoses or prescribing
recommendations to the psychiatrists," he said. Dr. Jensen has also filed a
lawsuit in Alameda County Superior Court in northern California, where
Kaiser has its headquarters, seeking an injunction to force the company to
end the practice. Dr. Jensen told the Los Angeles Times that on his
first day at work with Kaiser, he was presented with cases by social
workers, social work interns and marriage and family therapists who
recommended drug treatments for patients they had diagnosed.

According to California law and the American
Psychiatric Association code of ethics, the
prescribing of drugs by a physician without
"good faith" prior examination by that physician
is classed as "unprofessional conduct."

Copyright © 1999 Reuters Ltd. All rights reserved.

Kaiser [Says] Ends Medication Policy May 5,
2000

LOS ANGELES (AP) - Health maintenance organization Kaiser Permanente
has ended a policy that requires psychiatrists to prescribe depression and
anxiety medications for patients they haven't examined.

Kaiser psychiatrists must now rely on their own examination of patients
before writing prescriptions, the HMO announced Tuesday.

Kaiser is the nation's largest not-for-profit HMO, serving 8 million members
in 11 states and the District of Columbia. Almost 6 million of its patients are
in California.

A former Kaiser psychiatrist, who said he was fired for not following the old
policy, filed a lawsuit last month that drew national attention and prompted
the state Department of Corporations to begin investigating the drug
practice.

The lawsuit, filed by Dr. Thomas S. Jensen of San Diego, sought to halt
Kaiser's prescription policy, which were often delivered at the behest of
social workers or family therapists.

Critics said prescriptions from absentee psychiatrists endanger mental
patients and violate ethics codes of the American Psychiatric Association.

Dr. Oliver Goldsmith, medical director for Southern California
Permanente Medical Group, said Tuesday the HMO decided to review its
policy amid the public outcry.

"The public attention was a stimulus for us to take another look at this
practice," Goldsmith said. ``We felt that this was a street we had to come
back from."

However, Goldsmith maintained no patients were harmed by the
previous policy, which was restricted to Kaiser's psychiatric clinics
in the San Diego area. About 24,000 patients were treated there last
year, he said.

Kaiser acknowledged its old policy differed from standards
generally accepted by the psychiatric community, but said the
practice was designed to allow psychiatrists to treat more patients.

Jensen's attorney, Cliff Palefsky of San Francisco, cautioned that his client
would not drop the lawsuit against Kaiser until he sees changes that are
"real and complete."

Meantime, a spokeswoman for the Department of Corporations said the
agency intends to continue its investigation.

Former Kaiser
Permanente Physician, Dr.
Daniel Trussell speaking on
the Highway2Health, November
9, 2004 program about the
overuse of psychotropics, the
testing of them and the reality
of how patients might
unnecessarily be
encouraged to use
them to quite frankly,
shut them up. This
program is titled "A Candid
Conversation on Psychotropic
Medications and The Current
State of Psychiatry" by Dr.
Daniel Trussell.
http://behavioral.kaiserpapers.or
g/audio/daniel-trussell-md-nov-9
-2004.mp3

More of Dr. Trussell
presentations are located at:
http://kaiserpapers.org/program
s.html

Kaiser Mental
Health: overusing
medication?

Before you switch insurance
companies make sure you
are off any and all
anti-depressants! -
When Amy M. left her steady
job to become a freelance
advertising copywriter,she had
no idea the antidepressant
she took to combat depression
would have an unexpected
side effect. She couldn't get
health insurance.

"I was turned down by Blue
Cross, Blue Shield and Kaiser,"
said the 35-year-old Oakland
resident, who has been
taking the antidepressant
Celexa for several years.

"My rejection letters from the
insurance companies
stated the reason for the denial:
antidepressants."
Link to story:
http://behavioral.kaiserpapers.or
g/cele.html

Kaiser Permanente is for-profit and its "mental
health" program is a big part of achieving that goal

How it started: KAISERGATE
KaiserPapers.org

The following is how the HMO's actually got off the ground and it was never for your
own good. We believe that the American public has been mislead. Please follow the
following two web links to learn more about what took place between President
Nixon, John Erlichman and how Edgar Kaiser played a role in the creation of
the HMO.

Presented at the Miller Center of Public Affairs - University of Virginia - White House
Tapes.org
http://www.whitehousetapes.org/pages/listen_tapes_rmn.htm

Also hear the sound clip of Nixon here:
http://businesspractices.kaiserpapers.org/media/nixononkaiser.wav

or
http://businesspractices.kaiserpapers.org/media/nixononkaiser.mp3

The transcription has been mirrored on this site because of its relevance to
Kaiser Permanente being a for-profit corporation which is contrary to what
they have publicly claimed to the rest of the world. We cannot imagine what
further proof anyone in this world would need to have presented that Kaiser is a for-
profit corporation.

We also believe that listening to this tape will more clearly explain how Kaiser has
manipulated our government and the public into believing an untruth. It appears that
President Nixon knowing full well that Kaiser was not being honest with their
presentation of the HMO thought he was using this to his advantage. Unfortunately it
has taken decades for this to become public knowledge which is a shame. President
Nixon knew from the time of this conversation that Kaiser was for-profit and he also
knew that they are able to profit because -- "All the incentives are toward
less medical care, because—the less care they give them, the
more money they make." - Mr. Erlichman quoting Edgar Kaiser
to President Nixon on February 17, 1971...

The Beginning of
the Kaiser
Permanent e Mental
Health Benefit
KaiserPapers

The following is from "Nicholas
A. Cummings Collected Papers
Vol. I" - Page 128 - 129
Note: Nicolas A. Cummings led
the Behavioral Health Division
and worked it into a money
making enterprise. He also is
the person that made sure
psychiatric services were
provided by HMO's. That
sounds good doesn't it? Read
the following to learn the
motives behind the actions:

"Kaiser Permanente soon
found, to its dismay, that once a
health system makes it easy
and free to see a physician,
there occurs an alarming
inundation of medical utilization
by seemingly physically health
persons. In private practice the
physician's fee has served as a
partial deterrent to
over-utilization, until the recent
growth of third party payment
for health care services. The
financial base at Kaiser
Permanente is one of per
capitation, and neither the
physician nor the Health Plan
derives an additional fee for
seeing the patient. Rather than
becoming wealthy from
imagined physical ills, the
system could be bankrupted by
what was regarded as abuse by
the hypochondriac.

Early in its history, Kaiser
Permanente added
psychotherapy to its list of
services, first on a courtesy
reduced fee of five dollars per
visit and eventually as a
prepaid benefit. This was
initially motivated not by a belief
in the efficacy of
psychotherapy, but by the
urgent need to get the so-called
hypochondriac out of the
doctor's office. From this initial
perception of mental health as
a dumping ground for
bothersome patients, twenty
years of research has led to the
conclusion that no
comprehensive prepaid health
system can survive that does
not provide a psychotherapy
benefit.

Early investigations confirmed
physicians fears they were
being inundated, for it was
found that 60% of all visits were
by patients who had nothing
physically wrong with them.
Add to this the medical visits by
patients whose physical
illnesses are stress related
(peptic ulcer, ulcerative colitis,
hypertension, etc.), and the
total approaches a staggering
80 to 90% of all physician visits.
Surprisingly as these findings
were 25 years ago, nationally
accepted estimates today range
from 50 to 80% (Shapiro, 1971)
Interestingly, over 2,000 years
ago Galen pointed out that 60%
of all persons visiting a doctor
suffered from symptoms that
were caused emotionally, rather
than physically (Shapiro, 1971).

Timothy Leary was
the Director of the
Kaiser Foundation
Psychological
Research from 1952 to
1958. He did a lot of
research on how to
control and
manipulate a
population. He led a wild
lifestyle up at Kaiser where -

"In the mid-1950s Leary worked
as director of Psychological
Research at the Kaiser
Foundation and taught at
Berkeley University. There he
and his wife were involved in
heavy drinking and adulterous
wife swapping. In early 1960,
he joined the Harvard
Center for Personality
Research. That same year
Leary took his first dosage of
hallucinogenic mushrooms, and
he was permanently changed.
Believing that psilocybin
mushrooms created mystical
perception that could
reprogram the brain, Leary
persuaded the school
authorities to allow him to
devise and administer the
"Harvard Drug Research
Program."

http://behavioral.kaiserpapers.or
g/tleary.html

There are several variations of
why Tim Leary was fired from
Kaiser. Most of the explanations
sound petty. Only one sounds
logical and provides a
reasonable explanation. The
following version is from
Nicholas A. Cummings who
replaced Timothy Leary.
Quotes are from: "The
Entrepreneur of Psychology:
The Collected Papers of
Nicholas A. Cummings"
pages 5 and 6 -
The Role of the Somatizer inb
the Development of the Health
Plan

Early in the 1950's, the
Permanente physicians
discovered that 60% of all visits
to physicians were by patients
who either had no physical
illness, or had a physical illness
that was being exacerbated by
psychological factors. Today,
this is a nationally recognized
phenomenon, and the American
Medical Association (AMA)
accepts 60% to 70% as the
national figure. The reason it
was first discovered at Kaiser
Permanente was the nature of
the health plan itself. See:
http://behavioral.kaiserpapers.or
g/tleary.html#leary1

The Leary material is very
important as it sources all that
has followed while providing
somewhat of a road map for
understanding what in the world
these people are really doing.

http://govinfo.library.unt.edu/whc
camp/meetings/transcript
_9_8_00_s3_4_5.html
"Targeting the insurance
companies of the nation is
important to identify the idea
that upstream intervention is
going to save the insurance
dollar. There is cost savings
and the business department
of Kaiser has data to support
that.

As long as the outcomes are
behaviorally based, we can
measure the outcomes in terms
of reduced medical visits and
reduced medical visits
translates to dollars, savings. "
mirrored at:
http://behavioral.kaiserpapers.or
g/cam1.html

Now Learn how this branch of
medicine is used to control,
bribe and sometimes treat
people.

The following transcription is mirrored here from the University of Virginia
because of the interest to The Justice Department the Internal Revenue
Service and the American public. Again I refer everyone to: http://www.
whitehousetapes.org/pages/listen_tapes_rmn.htm
for the clearest possible presentation.

February 17, 1971
5:26 pm - 5:53 pm
Oval Office
Conversation 450-23

John D. Ehrlichman: On the—on the health business—

President Nixon: Yeah.

Ehrlichman: —we have now narrowed down the vice president's
problems on this thing to one issue and that is whether we should
include these health maintenance organizations like Edgar Kaiser's
Permanente thing. The vice president just cannot see it. We tried 15
ways from Friday to explain it to him and then help him to understand it.
He finally says, “Well, I don't think they'll work, but if the president thinks
it's a good idea, I'll support him a hundred percent.”

President Nixon: Well, what's—what's the judgment?

Ehrlichman: Well, everybody else's judgment very strongly is that we go
with it.

President Nixon: All right.

Ehrlichman: And, uh, uh, he's the one holdout that we have in the whole
office.

President Nixon: Say that I—I—I'd tell him I have doubts about it, but I
think that it's, uh, now let me ask you, now you give me your judgment.
You know I'm not to keen on any of these damn medical programs.

Ehrlichman: This, uh, let me, let me tell you how I am—

President Nixon: [Unclear.]

Ehrlichman: This—this is a—

President Nixon: I don't [unclear]—

Ehrlichman: —private enterprise one.

President Nixon: Well, that appeals to me.

Ehrlichman: Edgar Kaiser is running his Permanente deal for profit. And
the reason that he can—the reason he can do it—I had Edgar Kaiser
come in—talk to me about this and I went into it in some depth. All the
incentives are toward less medical care, because—

President Nixon: [Unclear.]

Ehrlichman: —the less care they give them, the more money they make.

President Nixon: Fine. [Unclear.]

Ehrlichman: [Unclear] and the incentives run the right way.
President Nixon: Not bad.

Tape at: http://whitehousetapes.org/pages/listen_tapes_rmn.htm
you need to look for:tape rmn_e450c
It is 12 MGS if using Windows Media Player

The very next day Mr. Nixon had a message for
Congress proposing a National Health Strategy.
Read what he said on February 18, 1971:
http://www.presidency.ucsb.edu/ws/print.php?pid=3311
and mirrored here for historical purposes and in the event the content is
taken down by the americanpresidency.org for any reason:

Richard Nixon
Special Message to the Congress Proposing a National Health Strategy
February 18th, 1971

...BUILDING A NATIONAL HEALTH STRATEGY

...This new strategy should be built on four basic principles.

1. Assuring Equal Access. Although the Federal Government should be
viewed as only one of several partners in this reforming effort, it does bear a
special responsibility to help all citizens achieve equal access to our health
care system....

2. Balancing Supply and Demand. It does little good, however, to increase the
demand for care unless we also increase the supply...

3. Organizing for Efficiency.... It must be our goal not merely to finance a more
expensive medical system but to organize a more efficient one.

There are two particularly useful ways of doing this:

A. Emphasizing Health Maintenance. In most cases our present medical
system operates episodically--people come to it in moments of distress--when
they require its most expensive services...

B. Preserving Cost Consciousness. As we determine just who should bear the
various costs of health care, we should remember that only as people are
aware of those costs will they be motivated to reduce them. When consumers
pay virtually nothing for services and when, at the same time, those who
provide services know that all their costs will also be met, then neither the
consumer nor the provider has an incentive to use the system efficiently...

4. Building on Strengths. We should also avoid holding the whole of our
health care system responsible for failures in some of its parts. There is a
natural temptation in dealing with any complex problem to say: "Let us wipe
the slate clean and start from scratch." But to do this-to dismantle our entire
health insurance system, for example--would be to ignore those important
parts of the system which have provided useful service...

A. REORGANIZING THE DELIVERY OF SERVICE

In recent years, a new method for delivering health services has
achieved growing respect. This new approach has two essential
attributes. It brings together a comprehensive range of medical
services in a single organization so that a patient is assured of
convenient access to all of them. And it provides needed services for
a fixed contract fee which is paid in advance by all subscribers.

Such an organization can have a variety of forms and names and sponsors.
One of the strengths of this new concept, in fact, is its great flexibility. The
general term which has been applied to all of these
units is "HMO"--"Health Maintenance Organization."

The most important advantage of Health Maintenance Organizations is
that they increase the value of the services a consumer receives for each
health dollar. This happens, first, because such organizations provide a
strong financial incentive for better preventive care and for greater efficiency...

A fixed-price contract for comprehensive care reverses this illogical incentive.
Under this arrangement, income grows not with the number of days a person
is sick but with the number of days he is well. HMO's therefore have a strong
financial interest in preventing illness, or, failing that, in treating it in its early
stages, promoting a thorough recovery, and preventing any reoccurrence.
Like doctors in ancient China, they are paid to keep their clients healthy. For
them, economic interests work to re-enforce their professional interests...

In an HMO, in other words, cost consciousness is fostered. Such an
organization cannot afford to waste resources-that costs more money in the
short run. But neither can it afford to economize in ways which hurt patients
for that increases long-run expenses.

The HMO also organizes medical resources in a way that is more convenient
for patients and more responsive to their needs. There was a time when every
housewife had to go to a variety of shops and markets and pushcarts to buy
her family's groceries. Then along came the supermarket-- making her
shopping chores much easier and also giving her a wider range of choice and
lower prices. The HMO provides similar advantages in the medical field...

Because a team can often work more efficiently than isolated individuals, each
doctor's energies go further in a Health Maintenance Organization--twice as
far according to some studies. At the same time, each patient retains the
freedom to choose his own personal doctor...

Some seven million Americans are now enrolled in HMO's--and the
number is growing. Studies show that they are receiving high quality
care at a significantly lower cost--as much as one-fourth to one-third
lower than traditional care in some areas. They go to hospitals less
often and they spend less time there when they go. Days spent in the
hospital each year for those who belong to HMO's are only three-
fourths of the national average.

Patients and practitioners alike are enthusiastic about this
organizational concept. So is this administration. That is why we
proposed legislation last March to enable Medicare recipients to join
such programs. That is why I am now making the following additional
recommendations:

1. We should require public and private health insurance plans to
allow beneficiaries to use their plan to purchase membership in a
Health Maintenance Organization when one is available...

2. To help new HMO's get started-an expensive and complicated task--
we should establish a new $23 million program of planning grants to
aid potential sponsors--in both the private and public sector.

3. At the same time, we should provide additional support to help
sponsors raise the necessary capital, construct needed facilities, and
sustain initial operating deficits until they achieve an enrollment
which allows them to pay their own way. For this purpose, I propose a
program of Federal loan guarantees which will enable private
sponsors to raise some $300 million in private loans during the first
year of the program.

4. Other barriers to the development of HMO's include archaic laws in
22 States which prohibit or limit the group practice of medicine and
laws in most States which prevent doctors from delegating certain
responsibilities (like giving injections) to their assistants. To help
remove such barriers, I am instructing the Secretary of Health,
Education, and Welfare to develop a model statute which the States
themselves can adopt to correct these anomalies. In addition, the
Federal Government will facilitate the development of HMO's in all
States by entering into contracts with them to provide service to
Medicare recipients and other Federal beneficiaries who elect such
programs. Under the supremacy clause of the Constitution, these
contracts will operate to preempt any inconsistent State statutes...

Kaiser Drug Policy
Prompts State
Inquiry
April 12, 2000
DAVAN MAHARAJ and
SHARON BERNSTEIN
LOS ANGELES TIMES

Kaiser Permanente, the
state's biggest health
maintenance
organization, routinely
requires its psychiatrists
to prescribe psychiatric
drugs to some mental
health patients whom
they have not personally
examined, a practice that
leading experts say
endangers patients and
violates professional
codes of ethics.

State regulators are
investigating complaints
that Kaiser may be running
afoul of long-established
medical procedures by
requiring psychiatrists to
prescribe medications for
depression and anxiety at
the recommendation of
nonmedical
psychotherapists, such as
social workers and
social-work interns.
Ads by Google

Kaiser PermanenteGet free
health insurance quotes.
Find individual and group
plans. KaiserQuotes.com

Both California law and the
American Psychiatric Assn.
code of ethics declare that
prescribing drugs without a
"good faith" prior
examination is
unprofessional conduct.

Kaiser's little-known policy
has come under attack in a
lawsuit filed this week by a
former Kaiser psychiatrist
who was fired for refusing
to prescribe medications for
patients whom he did not
personally examine. The
physician, Dr. Thomas S.
Jensen of San Diego, has
asked a state court to halt
Kaiser's practice.

Based on complaints by
Jensen and another Kaiser
psychiatrist in Sacramento,
the state Department of
Corporations has begun
investigating the practice, a
department spokeswoman
said.

Jensen said he told state
regulators that he saw
cases where nonmedical
personnel had
recommended drugs that
could have jeopardized
patients' health.

Kaiser, which has 30 days
to answer the allegations in
Jensen's lawsuit,
acknowledged that its policy
differs from standards
generally accepted by the
psychiatric community. But
Dr. Dennis Cook,
coordinating chief of
psychiatrists for Kaiser's
Southern California
operations, defended the
procedure, saying that it
allowed Kaiser's
psychiatrists to see more
patients by eliminating a
potentially duplicative initial
interview.

Cook said the contention
that the practice was
unethical was self-serving
on the part of psychiatrists
in private practice, who
don't know and trust the
therapists making the
recommendations, and who
stand to make money from
an extra office visit.

"We think it's very
ethical," Cook said. He
denied that any injuries
have resulted from Kaiser's
policy.

Some of the nation's top
psychiatrists, contacted by
The Times, said Kaiser's
policy of allowing
nonmedical personnel to
examine patients and
recommend drugs stopped
far short of the competent
standard of care.

Social workers, family
therapists and social-work
interns are not trained to
know the risks, benefits and
side effects of psychotropic
drugs, the experts say.

"It's not trivial to put
someone on
psychotropic
medications," said Dr.
Joseph T. Coyle,
chairman of the
department of psychiatry
at Harvard Medical
School. "If you haven't
evaluated the patient
when you start the
treatment, then it's
impossible to follow the
patient and see how [he or
she] is responding to
powerful drugs that could
cause harmful side effects.

"I'm surprised that an
ethical insurer would
require such a practice,"
Coyle said. "They say
California tells what the
future is. I hope that's not
the case for the psychiatric
practice."

William Baak, a
psychiatry professor at
UC San Diego School of
Medicine, called the
HMO's policy
"outrageous."

"If that's modernity, I don't
want any part of it," Baak
said.

And Dr. William Arroyo, a
psychiatry professor at
USC School of Medicine
and a member of the
APA's ethics committee,
said Kaiser's practice
clearly violates the
professional body's code
of ethics.

"This undermines patient
care," he said.

The state investigation and
the whistle-blower suit focus
in part on Kaiser's
contention--made in
advertisements--that
"physicians alone manage
all aspects of care."

"At Kaiser Permanente,
medical decisions are made
by physicians in
consultation with their
patients, not by health plan
administrators," Kaiser
states on its Web site. The
HMO's doctors "can order
any tests, medications,
medical procedures or
referrals they need without
approval from someone in
the health plan."...

Is it always about profit for Kaiser Permanente? One good thing about the
profit motive is that if very large numbers of people are being harmed in
ways that cost Kaiser money, it will do something about it. Kaiser loves to
prescribe antidepressants, but it doesn't love to care for autistic patients!

Pregnant question
The possible link of antidepressants to autism has expectant mothers
worried, though the risk may be small
By Neena Satija
Boston Globe
July 25, 2011

Try Googling “Prozac pregnancy’’ and you’ll get a sense of the fear and
confusion surrounding the relationship between the two.

“Anyone with experience on Prozac?’’ asks a woman on the community
page of www.babycenter.com. Prescribed the antidepressant by her doctor,
she writes, “I’m just really concerned and frankly scared to take them after
reading all these articles and research. I’m 20 weeks 2 days, and I’m
supposed to start on 10mg of Prozac this morning, but I’m staring at it right
now and I don’t know what to do - should I take it?’’

In the past decade there has been a flurry of research into the effects of
antidepressants on pregnancy - in particular, on selective seratonin
reuptake inhibitors (SSRIs), which include Prozac and are the most
commonly prescribed such drugs. So far, findings published on their
possible effects have been all over the map - from increased likelihood of
pre-term delivery to poor adaptation by newborns because of withdrawal
symptoms from the drugs.

This month, a report in the Archives of General Psychiatry by Kaiser
Permanente researchers suggested that pregnant women who use SSRIs
might increase their likelihood of having a child with an autism spectrum
disorder (autism, Asperger’s syndrome, or other unspecified pervasive
developmental disorders). Released in conjunction with a landmark study
reporting that environmental factors may play a much larger role in autism
than previously thought, the findings on antidepressants have fueled the
debate over whether SSRIs can be harmful during pregnancy. (Some of the
same researchers participated in both studies.)

Between 14 percent and 23 percent of women experience a depressive
disorder while pregnant, according to a 2009 report by the American
Psychiatric Association and the American College of Obstetricians and
Gynecologists. The numbers are similar to those for women in the general
population. Left untreated in pregnant women, depression has been shown
to lead to such problems as poor fetal development and mother-infant
bonding, and pre-term delivery.

What’s an expectant mother to do? How does she make a decision about
whether it’s safe to use antidepressants when she’s suffering from a
disorder that makes her more anxious to begin with?

“In pregnancy in general, we tend to be afraid of all medicine,’’ said Dr. Lori
Wroble, the chief obstetrician for Harvard Vanguard Medical Associates at
Newton-Wellesley Hospital. “And I think it’s actually scarier when you don’t
have enough studies, because it’s an open-ended question that you’ll
always wonder about.’’

There are so many new studies about the possible effects of medication on
pregnancy that physicians can have trouble keeping up. At Newton-
Wellesley, the Harvard-Vanguard group holds monthly meetings to discuss
research trends - sessions that helped Wroble decide to usually prescribe
sertraline, the generic equivalent of Zoloft, if her pregnant patients need
medication for depression.

But try Googling “Zoloft pregnancy.’’ One of the first results? A TV
commercial uploaded to YouTube called “Zoloft and Pregnancy Lawsuit.’’
The minute-long video lists the birth defects that allegedly have been linked
to Zoloft, complete with background music of ominous piano chords. The
website Zoloft-lawsuit.com has added the autism study to its information
page, urging women to call for a free consultation.

One of the problems with linking medications to conditions like birth defects
or autism is that while statistics on risk increases can seem alarming, the
conditions themselves are relatively rare.

“People always concentrate on the risk, but the probability of having a
perfectly healthy, vibrant little baby is very high,’’ says Dr. Lisa Croen, the
study’s principal author and the director of the autism research program at
Kaiser Permanente in Northern California.

Croen’s research team looked at the medical records of 1,805 mothers -
298 had children with autism, and 1,507 did not. Of the 1,507 mothers, 50,
or 3.3 percent, had received at least one prescription for an SSRI in the
year before giving birth. Of the 298 mothers with children found to have an
autism-spectrum disorder, 20, or 6.7 percent, were prescribed SSRIs during
the same time period.

Despite those numbers, Croen says that in the general population of all
pregnant women, “99 times out of 100, you’re going to have a child without
an autism-spectrum disorder.’’ Her study did not prove that antidepressants
during pregnancy increase the risk of having a child with autism, and even
if further research does establish that link is correct, Croen said, the odds
of having a child without autism “might be 98 out of 100 times.’’

Another reason it’s difficult to draw conclusions about the advisability of
SSRIs during pregnancy is that researchers don’t know how to tease apart
the risks of using the antidepressants from the risk posed by the
depression itself.

“It’s very hard to know whether any effect that you know and see is due to
the medications themselves or to the depression,’’ said Dr. Sengwee
Darren Toh, an instructor at Harvard Medical School whose research
focuses on the effects of different medications on pregnancy. “I don’t think
we have an answer for that.’’

While the autism study’s design is good, he said, it’s too preliminary to use
for any clinical recommendations.

So is it worth the risk for a pregnant woman suffering from depression to
take an antidepressant?

The US Food and Drug Administration gives most SSRIs a “C’’ grade in its
categorization for safety of medications during pregnancy. That means the
drugs have shown adverse effects on fetuses in animal studies, but there
isn’t enough data available on humans.

(The only exception is paroxetine, the generic equivalent of Paxil, which the
FDA gave a “D’’ after two studies found that taking the drug early in
pregnancy increased the risk of heart defects in babies from about 1
percent in the general population to 1.5-2 percent.)

Still, the FDA notes that the benefits of taking categories C and D
medications may outweigh the risks.

“Women take these drugs for good reasons,’’ said Toh.

But some pregnant women are so hesitant to take any medications that
even their doctor can’t convince them otherwise. Vaccines are a case in
point: Claims that autism is linked to thimerosal, a mercury-based
preservative that is used in vials for medications and vaccines, were
debunked years ago. Yet Wroble’s practice offers thimerosal-free flu
immunizations.

“The fear factor is so great,’’ she said.

When it comes to antidepressants, if the patient is too scared to take them
but Wroble believes they would help, the two find a compromise. Wroble will
make sure the patient’s friends and family keep an especially close watch,
schedule more regular doctor’s appointments, and set up counseling.

“We’ve had contracts that say, OK, we’re going to see you more frequently,
we’re going to set up this support system,’’ Wroble said. “It is something
that we make prominent on their chart.’’

Then she’ll start the patient on antidepressants the morning after delivery.

Police: Maryland
psychiatrist, son die in
murder-suicide
By ERIC TUCKER
Associated Press
08/03/2011

WASHINGTON—A psychiatrist
specializing in women's health
shot and killed her 13-year-old
son at their home in suburban
Washington, and fatally shot
herself, police said Wednesday.

The bodies of Margaret Ferne
Jensvold, 54, and her son,
Benjamin Barnhard, were found
Tuesday afternoon in their
bedrooms. Police were called
after one of Jensvold's co-
workers reported being unable
to contact her for several days.
Jensvold was divorced and lived
with her son in the upper-
middle-class suburb of
Kensington, Md.

Each died of gunshot wounds,
police said late Wednesday,
and the state Medical
Examiner's office confirmed that
Benjamin was slain and
Jensvold committed suicide.
The deaths remain under
investigation.

Jensvold was most recently
working with Kaiser Permanente
in Kensington, said her ex-
husband and Benjamin's father,
James Barnhard. He said he
had last spoken with Jensvold
several days ago to arrange a
time to pick up his only son from
her house.

"Ben was a very sweet and
loving child. I mean, he was just
one of the kindest and sweetest
kids a parent could ever wish to
have," Barnhard said. He said
his son had spent the last year
at a weight-loss program in
North Carolina and had shed
more than 100 pounds and
loved sailing and other water
activities.

He said he had no indication of
any problems between his son
and ex-wife.

"She was always nice to Ben.
Sometimes she could get a little
frustrated with him, but she was
always nice to
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Ben," he added.

Robert Baum, Jensvold's
divorce attorney, said his client
was a devoted mother who
limited her medical practice to
care for her son, who had a
variety of health problems. She
also insisted that Benjamin's
father receive visitation rights,
even after a judicial master said
he was inclined to deny
visitation, Baum said.

"Countless people will miss her
warmth and compassion," Baum
said in a statement.

In 1990, Jensvold filed a federal
lawsuit against the National
Institutes of Mental Health,
where she had been a medical
staff fellow.

She alleged that a male
superior harassed her because
she was female and fired her in
1989 before she could
complete the third year of her
fellowship program. An eight-
person jury found in Jensvold's
favor, but that decision was
rendered moot in 1996 when a
judge held that she did not
have the right to a jury trial and
called her version of events an
"illusion" and "widely
exaggerated and skewed."

"She's an incredible person. I
know she struggled against
significant adversity, personally
and in her career, and
overcame a lot of hurdles to do
some wonderful research and
be a really good practitioner,"
said Lynne Bernabei, an
attorney who represented
Jensvold in her case.

"I think she had a great
compassion for women and
improving the lives of women
through good health research,
and she had a real passion for
that," Bernabei said. "It wasn't
just a 9-to-5 job for her. She
really cared."

———

Associated Press writer Ben
Nuckols contributed to this
report.

San Diego

Kaiser Psychiatry