A Psychiatrist’s Personal Opinions of Donald Trump

As I listen to Mitt Romney and the Republican party speak up against Donald Trump today (Transcript of Mitt Romney’s Speech), I feel compelled by civil duty to express my personal opinions on Donald Trump’s rise in politics.

It has been an interesting, incredible, and horrifying experience to see the rise and success of Donald Trump over the course of the Republican primary elections. When I first saw him during a Republican debate, I was greatly entertained by his theatrics and dramatic dialogue. It really was like watching a comedy show, but a reality comedy show. I had no doubt in the beginning that the American public would be able to see through his bluster, insults, and sales job.  But no.

The whole progression of Trump’s appeal to the public reminds me of the rise in power of Hitler. Before Hitler came into power, he promised a lot of things to the downtrodden, and he used the Jews as a scapegoat for the country’s problems. Hitler arose from an environment where fear and anger could be used to gain power.  People felt disillusioned with the government, and they hoped for a savior. Hitler had the narcissistic grandiosity to say, “Here I am. I will save you.” I see Trump using the same carrot to entice the public. Hitler thought of himself as above the law. I heard Trump tell Jeb Bush, during a debate, that if he had wanted to have a casino built in Florida, he would have. Meaning, he thought of himself as above the governing powers of that state. In other words, his wealth/power makes him above the rule of law. A leader of a democratic or republican nation does not think of himself as above the law or government. Monarchs and dictators, however, do. When Jeb Bush responded, “You would not have.” Donald Trump shoots back, “Oh, yes I could!” Narcissism in action.

When I read books or watched movies about the Holocaust, I wondered what I would have done under the circumstances. Would I try to keep my head down and stay out of trouble, or would I have the courage to speak up about it? Would I try to bring some light and sanity into the country, or would I shrug my shoulders and retreat into a state of powerlessness? When I see what is going on right now in politics, I feel as if I am reliving the beginnings of an old, horrifying chapter of history that I thought would never, ever be allowed to repeat. And certainly not in the United States of America. And I am challenged to speak up, rather than avoid the issues confronting our nation.

Everyone I know thinks Trump is ridiculous and unworthy to be president. It is obvious, isn’t it?  It’s like saying the Emperor has no clothes. Don’t you see he’s naked, parading around like that? If it is not obvious, then here are just a few reasons why Trump would be ridiculous and unworthy to be president:

1. He lacks the ability to be civil to his opponents. That is the whole point of politics, being able to work in a social setting without offending everyone you bump into.  Trump has the opposite ability.  He is an expert at bumping into people and offending everyone.  These are not helpful characteristics for the president of a dog food shop, much less the president of the United States.
2. He does not use logical reasoning to persuade. He uses insults. In any given debate, I lose count of all the times he insults someone. How can such an illogical, abusive person ever hope to work with anyone in relative harmony?
3. He projects all his anger towards another person or group, calls them names, and blames them for problems.  And he has a lot of anger and a lot of blame.  A president of a free nation does not behave in this manner. Dictators do.
4. He has no experience as a law maker or working in government.  He does have a lot of experience bossing people around. He tried to boss around a television network, regarding who would have the right to interview during the debate, and he refused to attend the debate, when he didn’t get his way. This is how he will behave, if he becomes president, but in a larger context. Can you imagine how he will handle volatile nations whose leaders think he’s lower than the dirt on the bottom of their shoes? How do you think he will treat the issues of freedom of speech and the press, if he were to be elected?
5. He denigrates people for their sex, race, and appearance.  These are extremely immature defense mechanisms.  But, in a political leader, this quality would be disastrous.  Hitler denigrated people, and then he acted on his feelings.
6. He ridicules politicians for being the puppet of millionaire donors, claiming that donors control the way lawmakers make decisions in government, missing the point entirely that he is essentially a billionaire donor running for president, holding the same mind set. To elect him would be similar to eliminating other competing special interest groups that attempt to influence government, and electing the head of one special interest group as president of the United States. Do you think that will improve our government?

I hope as the election season progresses that Trump’s tax returns and more information will surface to make him more transparent to the public, as if what we know about him isn’t enough already to help us see him as he truly is. Could the Emperor be more naked than he already is?

Let us hope we can let go of our desires and fantasies for a savior enough to let us see Trump’s true nature. As disappointing as it may be to see him as a narcissist with grandiose and empty promises, it is far less painful than to face the nation the United States will become under his reign.

Orthomolecular News: No deaths from nutritional supplements

I like this article that presents the safety on nutritional supplements to the public, to correct any misunderstanding of the supposed dangers of nutritional supplementation.

Alice W. Lee, MD, ABIHM

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Orthomolecular Medicine News Service, January 12, 2016

No Deaths from Supplements. No Deaths from Minerals. No Deaths from Amino Acids. No Deaths from Herbs.

by Andrew W. Saul, Editor

(OMNS, Jan 12, 2016) Not only are there no deaths from vitamins, there are also zero deaths from any supplement. The most recent (2014) information collected by the U.S. National Poison Data System, and published in the journal Clinical Toxicology (1), shows no deaths whatsoever from dietary supplements across the board.

No deaths from minerals

There were zero deaths from any dietary mineral supplement. This means there were no fatalities from calcium, magnesium, chromium, zinc, colloidal silver, selenium, iron, or multimineral supplements. Reported in the “Electrolyte and Mineral” category was a fatality from the medical use of “Sodium and sodium salts” and another fatality from non-supplemental iron, which was clearly and specifically excluded from the supplement category.

No deaths from any other nutritional supplement

Additionally, there were zero deaths from any amino acid or single-ingredient herbal product. This means no deaths at all from blue cohosh, echinacea, ginkgo biloba, ginseng, kava kava, St. John’s wort, valerian, yohimbe, Asian medicines, ayurvedic medicines, or any other botanical. There were zero deaths from creatine, blue-green algae, glucosamine, chondroitin, or melatonin. There were zero deaths from any homeopathic remedy.

But when in doubt, blame a supplement. Any supplement.

There was one death attributed to a “Multi-Botanical Without Ma Huang or Citrus Aurantium.” It is interesting that they knew what was not in it but did not know what was in it. This is hearsay at best, and scaremongering at worst. There was one death alleged from some “Unknown Dietary Supplement or Homeopathic Agent.” This, too, indicates complete lack of certainly as to what may or may not have been involved. One fatality was attributed to “Energy Products: Unknown.” First of all, energy drinks or “products” are not nutritional supplements. But more importantly, how can an accusation be based on the unknown? Equally unscientific are the two deaths attributed to “Energy Products: Other.” Well, what products were they? These are no more than vague, unsubstantiated allegations. Claiming causation without even knowing what substance or ingredient to accuse is baseless.

The truth: no man, woman or child died from any nutritional supplement. Period.

If nutritional supplements are allegedly so “dangerous,” as the FDA, the news media, and even some physicians still claim, then where are the bodies?

References:

Mowry JB, Spyker DA, Brooks DE et al. (2015) 2014 Annual Report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 32nd Annual Report, Clinical Toxicology, 53:10, 962-1147, http://dx.doi.org/10.3109/15563650.2015.1102927 .

The lengthy, full text article is also available for free download fromhttps://aapcc.s3.amazonaws.com/pdfs/annual_reports/2014_AAPCC_NPDS_Annual_Report.pdf or fromhttp://www.aapcc.org/annual-reports/ .

Nutritional Medicine is Orthomolecular Medicine

Orthomolecular medicine uses safe, effective nutritional therapy to fight illness. For more information: http://www.orthomolecular.org

Find a Doctor

To locate an orthomolecular physician near you: http://orthomolecular.org/resources/omns/v06n09.shtml

The New York Times: Talk Therapy Eases Symptoms of Schizophrenia

In the New York Times, dated October 20, 2015, an article on the benefits of talk therapy in recovery from schizophrenia.  This is a government funded study, and therefore, with less bias from pharmaceutical agencies, needing to promote their medications as the primary treatment of choice.  Please see an exerpt of the article below.

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More than two million people in the United States have a diagnosis of schizophrenia, and the treatment for most of them mainly involves strong doses of antipsychotic drugs that blunt hallucinations and delusions but can come with unbearable side effects, like severe weight gain or debilitating tremors.

Now, results of a landmark government-funded study call that approach into question. The findings, from by far the most rigorous trial to date conducted in the United States, concluded that schizophrenia patients who received smaller doses of antipsychotic medication and a bigger emphasis on one-on-one talk therapy and family support made greater strides in recovery over the first two years of treatment than patients who got the usual drug-focused care.

The report, to be published on Tuesday in The American Journal of Psychiatry and funded by the National Institute of Mental Health, comes as Congress debates mental health reform and as interest in the effectiveness of treatments grows amid a debate over the possible role of mental illness in mass shootings.

More than two million people in the United States have a diagnosis of schizophrenia, and the treatment for most of them mainly involves strong doses of antipsychotic drugs that blunt hallucinations and delusions but can come with unbearable side effects, like severe weight gain or debilitating tremors.

Now, results of a landmark government-funded study call that approach into question. The findings, from by far the most rigorous trial to date conducted in the United States, concluded that schizophrenia patients who received smaller doses of antipsychotic medication and a bigger emphasis on one-on-one talk therapy and family support made greater strides in recovery over the first two years of treatment than patients who got the usual drug-focused care.

Continue reading the main story

mental health

NY Times: Drowned in a Stream of Prescriptions, Abuse of Medications

Please see this article in the New York Times for the story of a young man who was prescribed stimulants by psychiatrists, despite his parents’ repeated warnings of their son’s abuse of the medication and repeated psychotic symptoms, until the patient committed suicide:

Drowned in Prescriptions

Prescription medications can often cause addiction. Often a psychiatrist will not tell you this important fact before they prescribe the medication to you. Some are addictive because the patient end up craving the medication for the high it gives, or the patient will suddenly experience severe dips in their mood and cognition. Others are addictive because the patient end up depending on the medication, or the withdrawal symptoms, which are often far worse than the actual disorder, return quickly upon cessation of the medication.

As a psychiatrist who regularly help patients get off psychiatric medications, I know about the addictive potential of psychiatric medications, and what can happen to patients, if they try to get off their medications without understanding the risks of withdrawal. I also understand how to help patients taper medications gradually, safely, and comfortably.

Avoid the cycle of addiction by using nutritional supports, proper diet, and other stress reducing approaches such as meditation or acupressure techniques. Give your mind the chance to heal naturally and safely.

Food as Medicine: Applying an Old Adage in a New Way

As Mark Hyman succinctly stated in his concluding statement at the Food As Medicine conference at Bethesda, Maryland (June, 2012), “It’s not ‘Food As Medicine.’  It’s ‘Food Is Medicine’.”

As a physician, I was taught to rely on prescription, pharmaceutical medications.  I made a big leap of faith when I changed my paradigm and began using nutritional supplements for healing underlying physiology.  But it still came in pills and tablets.  Then I made another leap of faith, when I incorporated the use of acupressure and meditation into my practice.  It was pill-less and tab-less.  But at the Food as Medicine conference, I am being reminded that food should be viewed just as seriously as an intervention as any supplement or technique.  We should take the foods we eat more seriously, and if we do, we will be surprised and quickly rewarded with a rapid return to health.  What a concept!

With this in mind, I was struck by an article posted today by the Orthomolecular Medicine News Service.  The article highlighted the ambivalence demonstrated by a Reader’s Digest article on the dangers of eating red meat.  Apparently, the Reader’s Digest used research to substantiate the negative health consequences of eating red meat, and then, in the same article, recommended that its readers eat red meat.  It is the Standard American Diet at war with the new scientific evidence, which points to a new and better way of eating, demonstrated in the same article.  Here is the article below:

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This article may be reprinted free of charge provided 1) that there is clear attribution to the Orthomolecular Medicine News Service, and 2) that both the OMNS free subscription linkhttp://orthomolecular.org/subscribe.html and also the OMNS archive linkhttp://orthomolecular.org/resources/omns/index.shtml are included.

Orthomolecular Medicine News Service, June 19, 2012

Another Reader’s Digest Absurdity:
Red meat is bad – no, wait – good for you!

Editorial by Helen Saul Case

(OMNS June 19, 2012) Browsing through the latest issue of Reader’s Digest, it’s not those witty “Laughter Is the Best Medicine” sections that are making me chuckle. It’s the ridiculous, contradictory health advice that the magazine gives to the reader.

Let’s start with what makes sense. In the article “Is Meat Good or Bad for You?” [1] the author explains that red meat might be killing us. He references a Harvard study [2] that tracked over 121,000 adults for up to 28 years and shares with us that “people who ate three ounces of red meat every day were about 13 percent more likely to die-often from heart disease or cancer-before the study ended than people who didn’t eat meat.”[1] And, folks who eat processed meat fared worse. They increased their risk of early death by 20 percent. This sounds like pretty important information, not to be taken lightly. He writes, “It’s no wonder that many experts recommend reducing or eliminating red meat from your diet.” That’s certainly true.

Alas, the author’s common sense ends there. As my grandmother said, “Common sense isn’t common.” Well, Grandma, is right again.

The author mentions in his rebuttal that regular eaters of lean beef get more protein, zinc, potassium, and B vitamins. Ah yes, protein. Good thing we have red meat! I mean, you can’t find adequate amounts of protein inanything else but red meat. Except for beans, of course. Oh, and cheese. And it’s also in tofu, nuts, lentils, eggs, yogurt, milk, seafood, and more. Still, how do those vegetarians survive!? Apparently they do, if the Harvard study is to be believed, and in greater numbers than the meat-eaters.

Okay, vitamins and minerals sure are important. You can’t get them anywhere but in a steak. Yeah, right.

With all that evidence the author just provided, we still want to know the final verdict: is red meat good or bad? Apparently, “You can still fit a daily serving of red meat into a healthy diet.” [1]

Really? A “daily serving” is considered to be about three ounces. Awesome! I get to eat three ounces of red meat a day!

Wait, didn’t the Harvard study just say that three ounces of red meat a day was killing people? Did the author read his own article? Qualifying the eating of red meat by using the phrase “as part of a healthy diet” makes about as much sense as the huge bowl of sugar-laden breakfast cereal pictured on the front of the cereal box that boasts being “part of a complete breakfast.” But this is only when presented next to a pile of whole wheat toast, fresh fruit, orange juice, and a pound of spinach. Okay, I made up the spinach part.

So, red meat is bad for us. But, according to the article that said so, we’re supposed to go ahead and eat it anyway.

Isn’t that what the reader of the Digest takes from the article? Must be. In the oxymoron box (or maybe just the “moron” box) entitled “How Healthy Carnivores Eat,” it recommends the “perfect” portion of meat is about the size of a deck of playing cards. Perfect for what? A coronary? Goodness knows, when many people eat red meat, the serving is larger than any “deck of cards” outside of a novelty shop. Nor will this advice likely prevent Americans from consuming their 100 pounds or more of red meat a year, an amount way out of proportion to our intake of fruits and vegetables.[3] Oh, but if red meat is a part of a healthy diet, we’ll be A-okay, says Reader’s Digest.

Uh huh. Because that’s your average American: fit and healthy. Eating lots of vegetables every day to deliberately offset that chunk of red flesh. Oh, please. Only about 30 percent of us get either two servings of fruit or three servings of vegetables [4], and only 11 percent of Americans are meeting U.S. Department of Agriculture (USDA) guidelines for both. [5] Surveys have found that there are a whopping 20 percent of folks out there that eat absolutely no veggies at all. [6]

Is it really so daring to recommend we skip red meat altogether? Would the Digest lose subscribers? Would the Digest lose advertisers? Well, they must be losing somebody, because the advice in the article encourages continuing to consume red meat and risk death and disease.

Folks, we don’t need to cow down on cow to obtain our daily dose of zinc and B vitamins. Vegetables have plenty. [7] And though the carnivore in us may be quick to disagree, plenty of widely available plant-based protein-packed foods can be placed in the shopping bag. Healthy sources of potassium are easy to find. Virtually all fruits and vegetables are an excellent source of potassium. [7] A vegetarian diet, selected with care, provides generous amounts of protein and all the other essential nutrients necessary for excellent health.

So, let’s see… eat red meat and risk death. Or, skip the meat, actually try to eat the healthy diet we should be eating anyway, packed with vegetables. And, while we are at it, take vitamins and eat fresh fruit. I think that’s doable.

Do yourself a favor and don’t “digest” Reader’s Digest ridiculousness. Toss it in the trash bin, and you’ll actually be a whole lot healthier for it.

(Helen Saul Case’s paper, “Raising Student Achievement through Better Nutrition,” is available for free access athttp://orthomolecular.org/library/jom/2006/pdf/2006-v21n02-p79.pdf . She is also the author ofThe Vitamin Cure for Women’s Health Problems.)

References:

1. Woolston, Chris. “Is Meat Good or Bad for you?” Reader’s Digest (July/August 2012): 36-38.

2. Pan A, Sun Q, Bernstein AM, Schulze MB et al. (2012) Red meat consumption and mortality: results from 2 prospective cohort studies. Arch Intern Med. 172(7):555-63. doi: 10.1001/archinternmed.2011.2287.

3. Putnam, J., J. Allshouse, L. S. Kantor. U.S. per capita food supply trends: More calories, refined carbohydrates, and fats.” Food Review 25(3) (2002):2-15.http://ers.usda.gov/publications/FoodReview/DEC2002/frvol25i3a.pdf .

4. Centers for Disease Control. CDC Online Newsroom. Majority of Americans not meeting recommendations for fruit and vegetable consumption.” Press Release, September 29, 2009.http://www.cdc.gov/media/pressrel/2009/r090929.htm .

5. Casagrande, S. S., Y. Wang, C. Anderson, et al. Have Americans increased their fruit and vegetable intake? The trends between 1988 and 2002. Am J Prev Med 32(4) (Apr 2007):257-263. Available online:http://www.ajpmonline.org/article/S0749-3797%2806%2900551-4/abstract

6. Balch, J. F., P. A. Balch. Prescriptions for Natural Healing. New York, NY: Avery Publishing Group, 1990.

7. USDA nutrient database, SR24. http://www.ars.usda.gov/Services/docs.htm?docid=22114

Nutritional Medicine is Orthomolecular Medicine

Orthomolecular medicine uses safe, effective nutritional therapy to fight illness. For more information:http://www.orthomolecular.org

Find a Doctor

To locate an orthomolecular physician near you:http://orthomolecular.org/resources/omns/v06n09.shtml

The peer-reviewed Orthomolecular Medicine News Service is a non-profit and non-commercial informational resource.

Editorial Review Board:

Ian Brighthope, M.D. (Australia)
Ralph K. Campbell, M.D. (USA)
Carolyn Dean, M.D., N.D. (USA)
Damien Downing, M.D. (United Kingdom)
Dean Elledge, D.D.S., M.S. (USA)
Michael Ellis, M.D. (Australia)
Martin P. Gallagher, M.D., D.C. (USA)
Michael Gonzalez, D.Sc., Ph.D. (Puerto Rico)
William B. Grant, Ph.D. (USA)
Steve Hickey, Ph.D. (United Kingdom)
James A. Jackson, Ph.D. (USA)
Michael Janson, M.D. (USA)
Robert E. Jenkins, D.C. (USA)
Bo H. Jonsson, M.D., Ph.D. (Sweden)
Thomas Levy, M.D., J.D. (USA)
Stuart Lindsey, Pharm.D. (USA)
Jorge R. Miranda-Massari, Pharm.D. (Puerto Rico)
Karin Munsterhjelm-Ahumada, M.D. (Finland)
Erik Paterson, M.D. (Canada)
W. Todd Penberthy, Ph.D. (USA)
Gert E. Schuitemaker, Ph.D. (Netherlands)
Robert G. Smith, Ph.D. (USA)
Jagan Nathan Vamanan, M.D. (India)

Andrew W. Saul, Ph.D. (USA), Editor and contact person. Email: omns@orthomolecular.org Readers may write in with their comments and questions for consideration for publication and as topic suggestions. However, OMNS is unable to respond to individual emails.

The Simple Idea That Is Transforming Health Care (WSJ article, April 18, 2012))

The Wall Street Journal wrote an article called “The Simple Idea That is Transforming Health Care. I like simple ideas, so I read the article.  The simple idea is about clinicians asking patients how their health is affecting their quality of life.  Imagine that.

One patient in the article had severe asthma for over 25 years, with repeated hospitalizations, and she had never been asked questions concerning her quality of life, during the course of her medical treatment.

This question is especially relevant in the field of psychiatry, where medications often create more problems than they solve.  I remember that my first “orthomolecular” patient in 2002 was a young woman in her twenties who came to me loaded on medications.  Due to the side effects of her medications, she wore a diaper and had to sit on her hands to keep them from trembling.  In addition, her eyes constantly moved around and were unable to stay still.  Needless to say, she couldn’t date either.  She told me that the side effects from her medications were worse than her original illness.  I was desperate to help her in any way that I could, so I turned to nutritional supplements, and she got remarkably better.

Patients in my practice have significantly improved their quality of life since I’ve added alternative approaches to mental health.  I like that.  It’s fun and rewarding to see patients smile (or cry) in happiness.  Please see the original article by clicking on the link below:

The Simple Idea That Is Transforming Health Care

Drug Shortage Unravels Lives: Alternative Approaches in Demand

Hi Dr Lee,

I read the following article and thought about you.  http://vitals.msnbc.msn.com/_news/2011/12/15/9472468-lingering-shortage-of-adhd-drugs-unravels-lives

One of my motivations during our process was the realization that I needed (or should) keep a separate “stash” of Effexor at work in case of an emergency (i.e. earthquake, terrorist incident, etc).  It really hit home that it was necessary for me to have that stuff to be able to function even in case of an emergency.

When I read the article, I am sure there are many, many people who need your services to end their dependency on these pharmaceutical drugs. It is sad!  Based on my experiences this year and last year I have come to understand that my nature is to question and research and learn.  I have also come to realize that many people do not do this and go with the flow, or what they have been told.

This is all to say that I hope you can get the word out that there is an alternative.  They do not have to be dependent on the whims of a pharmaceutical company and their profit margin.  Many people may not seek you out because they do not know … what they do not know.  They are gong with the flow.

I hope you get the message out!  It is a critically important one for so many people.

Thank you for all you do!

Best regards,

P.W.

New York Times Article: A Drug Maker’s Playbook Reveals a Marketing Strategy

The following article by the New York Times highlights one of the problems in medicine today that limits physicians from being open to alternative approaches to healing mental illness. With pharmaceutical companies paying doctors to laud their products, and doctors being seduced to believe that they are “experts” rather than “customers,” it is difficult for doctors to remain unbiased in their judgment of treatment efficacy.

As a psychiatrist, my last encounter with a drug representative occurred after he dropped by unannounced in my waiting room with lunch and a salad, along with other office supplies marked with the company logo. When I gently said to the young man that I cannot develop a relationship with him that would bias my judgment of the medication he is promoting, he blushed a bright red. I felt bad about embarrassing him, but it was clear that the drug company was not sending me a handsome young male sales rep instead of a beautiful young female sales rep by accident.

I feel the same way about nutraceutical (nutritional supplements sold only to practitioners) companies and their rising practice of sending their drug reps to holistic doctors’ offices. I do not want a sales pitch from either a drug company or a supplement company.

If I want information, I will go to a conference where the lecturers are not paid by a company to lecture. It’s pure naivete to believe that one can obtain any unbiased information on a product from a company sales rep.

Alice W. Lee-Bloem, M.D., ABIHM

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A Drug Maker’s Playbook Reveals a Marketing Strategy

By GARDINER HARRIS

The pharmaceutical industry has developed thousands of medicines that have saved millions of lives, but it has also used its marketing muscle to successfully peddle expensive pills that are no more effective than older drugs sold at a fraction of the cost.

No drug better demonstrates the industry’s salesmanship than Lexapro, an antidepressant sold by Forest Laboratories. And a document quietly made public recently by the Senate’s Special Committee on Aging demonstrates just how Forest managed to turn a medicinal afterthought into a best seller.

The document, ‘Lexapro Fiscal 2004 Marketing Plan,’ is an outline of the many steps Forest used to make Lexapro a success. Because of concerns from Forest, the Senate committee released only 88 pages of the document, which may have originally run longer than 270 pages. ‘Confidential’ is stamped on every page.

But those 88 pages make clear that one of the principal means by which Forest hoped to persuade psychiatrists, primary care doctors and other medical specialists to prescribe Lexapro was by finding many ways to put money into doctors’ pockets and food into their mouths.

Frank Murdolo, a Forest spokesman, said the company was ‘aware’ that its marketing plan was circulating around the Senate.

‘We’re aware of it but I can’t give you any other comment on it,’ he said.

In February, federal prosecutors in Boston announced a civil lawsuit against Forest claiming that the company illegally marketed both Lexapro and a closely related antidepressant, Celexa, for use in children and paid kickbacks to doctors to induce them to prescribe the medicines to children.

It is illegal to pay doctors to prescribe certain medicines to their patients. It is not illegal to pay doctors to educate their colleagues about a medicine. In recent years, federal prosecutors have accused many drug makers of deliberately crossing that line.

Lexapro was the sixth drug in a class of medicines that includes Prozac, Paxil, Zoloft, Luvox and Celexa. Forest licensed Celexa from Lundbeck of Denmark and introduced the medicine into the United States in 1998. But because Celexa’s patent life was relatively short, the company quickly developed a new version of Celexa by tinkering with the molecule in a way that is standard in the industry. The company called the new medicine Lexapro and introduced it into the United States in 2002.

Forest’s executives and paid consultants have long implied that Lexapro is superior to Celexa and other antidepressants. But the Food and Drug Administration did not require Forest to test this theory in any statistically valid way. The F.D.A. views the two medicines as so interchangeable that the agency recently approved Lexapro’s use in depressed adolescents based in part on the results of a study Forest conducted using Celexa.

Lexapro had $2.3 billion in sales in 2008 even though generic versions of Celexa and every other drug in the class sell for a fraction of Lexapro’s price. For example, a month’s supply of 5-milligram tablets of Lexapro costs $87.99 at drugstore.com, compared to $14.99 for a month’s supply of a generic version of Prozac. Forest has recently been raising the price of Lexapro to make up for a decline in its use.

Many doctors say they believe that Lexapro is the best antidepressant, so they prescribe the drug despite its relatively high cost.

It is impossible to unpack all of the reasons for these prescriptions, but some industry critics say one reason could be the money doctors make from Forest. Psychiatrists make more money from drug makers than any other medical specialty, according to analyses of payment data. And Forest gives more money and food to doctors than many of its far larger rivals. Vermont officials found that Forest’s payments to doctors in 2008 were surpassed only by those of Eli Lilly, Pfizer, Novartis and Merck ‘? companies with annual sales that are five to 10 times larger than Forest’s.

Forest’s 2004 plan for marketing Lexapro offers detailed information about how the company planned to direct this money to doctors.

Under ‘Rep Promotional Programs,’ the document said the company planned to spend $34.7 million to pay 2,000 psychiatrists and primary care doctors to deliver 15,000 marketing lectures to their peers over the course of one year.

‘These meetings may be large-scale dinner programs with a slide presentation, small roundtable discussions or one-on-one advocate lunches,’ the document states.

Under ‘Lunch and Learns,’ the company intended to spend $36 million providing lunch to doctors in their offices. ‘Providing lunch for a physician creates an extended amount of selling time for representatives,’ the document states.

An entire section of the marketing plan, titled ‘Continuing Medical Education,’ outlines how the company intended to use educational seminars for doctors to teach them about Lexapro. The Senate’s Special Committee on Aging held a hearing in July on whether industry funding of medical education classes leads to tainted talks.

‘At our recent hearing we asked the question, ‘?Is the line between medical education and marketing blurred?’ ‘ said Senator Herb Kohl, a Democrat from Wisconsin who is chairman of the committee on aging. His panel was given the Lexapro document by the Senate Finance Committee, which has long been investigating drug maker marketing efforts. ‘These documents show that for these companies, there is no line,’ Mr. Kohl said.

http://www.nytimes.com/2009/09/02/business/02drug.html?8au&emc=au