Dear Congresswoman Bachmann

February 11, 2012

Your “counseling” center in my hometown of Stillwater continues to teach the antiquated idea that homosexuality is sinful and an illness. Religion and science are time dependent, changing based on culture and era. Choose to or not, but know your branch of
Christianity is not the Christianity that was practiced 2000 years ago. Nor should it be. Religion changes to apply to the people and culture it currently serves in order to stay alive.

You choose to ignore that human experience is not limited by your conservative Christian values. Your willed ignorance disgraces the rational intelligent individuals in your district who know gays deserve every bit of respect that any other human experience deserves. Any “love the sinner, hate the sin” attitude is pretense for hate and cannot be legitimized by someone who feels love in abundance.

Nine of my thirteen immediate family live in your district. I will live near them when I have a child. It is probable that one of these children will be gay. Whether or not an environment of hate and ignorance persists, my children, nieces and nephews will love who
they choose and will be loved for their choice. Should such an environment continue, those closest to me will receive a proportionate amount of love and acceptance greater from my family. Your ideals will not determine my family’s happiness. Love is good and powerful and cannot be made an evil. Shame on you.

Watching the ping pong ball sized hail and having humidity and sweat bead off you does not exactly bring this meal to mind, but I made blintzes and cauliflower cream.

Mushroom Blintzes with Cauliflower Cream and Sorrel garnish

Cauliflower cream was a recent discovery at a restaurant called Victory 44.  Megan and I took a field trip to Robbinsdale to sit at a high top and slowly soak up their fare.  Their menu changes frequently but M and I had cauliflower cream with agnolotti, charcuterie, beet terrine, crab spring rolls, and coffee panna cotta.  The detail I could go into about each of these dishes would be sickening, so focus on what I cooked I shall.

The cauliflower cream is simple.  Simmer cauliflower flowerets in milk (a fatty milk – I added some heavy whip) and salt until the flowerets are tender, nearly falling apart.  Strain it, saving the liquid which can be reduced.  Put the flowerets in a food processor with some salt, pepper, butter, and cream cheese or provolone.  Process until a cream, adding some of the reduced hot milk if needed.

The blintzes I made with a mushroom puree (crimini and porcini).  The mushrooms were sautéed with olive oil, white wine, parsley, and garlic.  Pureed and rolled into the blintzes, these were then browned, cut in half and placed on a bed of the cauliflower cream.

The reason this cauliflower cream is so good is its delicate cauliflower taste, unctuousness and smooth texture.  It went well with the earthiness of the mushrooms.  The sorrel garnish was to add color, but it did a nice job of adding a lemony sourness to the aftertaste too.

The cauliflower cream I made still did not do the one from Victory 44 justice.  If you want a great meal in an unexpected place, try V44.  It was fantastic.

Megan and I tilled our soil in our garden and seeds are growing in the sunroom of our apartment.  The frost subsided and the soil black, we are ready to grow some savory herbs, sweet vegetables, and spicy bulbs.  The fantastic part of this: already I have made a meal with spoils from our garden and our kale survived the winter and is nearly ready to pick and sauté.

Planned for the garden we have sugar baby watermelon, butternut squash, beans, carrots, beets, onions, Cherokee Purple tomatoes, tomatillos, blondkopfchen “little blonde girl” tomatoes, and poblano peppers.  Planted already and staying put are mint, chives, sorrel, oregano, rhubarb, some pain in the ass bush I can’t remove, parsley and lavender.  We’ll probably throw a lettuce in where it fits.  The layout is something Megan will plan, with some guidance on sun directionality from the brains of the project.

The next project I am determined to tackle this summer is a Petite Saison.  A saison in the traditional style, fermented hot, estery and malty, and balanced with some grassy hops.  My first attempt was a fail and produced by first blown bottle.  Somehow it became far too carbonated and resulted in one bottle looking like the entrails of a bar fight.

Finally, after reading a post from my brother-in-law’s blog, the craving hit and I had to make some cinnamon rolls.  Haven’t had the chance to grub down on these sweet morsels, but if they are anything resembling my mother’s, they will pass my test.  The meal tonight was some herb polenta with smoked mozarella.  The herbs were fresh from the garden and the accompanying Cherokee purple tomatoes was a nice premonition of the fall.  Polenta is a staple in this kitchen.  Cheap, main course or side dish, extremely versatile in flavor profile, and creamy.  It replaces boxed macaroni and cheese for us ( . . . sort of).  They better be good.  Don’t have much time for breakfast tomorrow.

Eating in Olympia

November 13, 2009

There’s . . . this girl.  She coerced me into visiting her in her college town on the sound.  I guess it was a good time.  Here’s a little rehash of the food that slid past my tongue.

“Slid” is actually an appropriate word as the first full meal I had in Washington State was at McCormick and Schmick’s and we ate four pan fried oysters as well as four raw oysters.  Without saying that these tasted great, they tasted better than the rest of the meal which my girlfriend and I walked out of the restaurant unimpressed with.  I ordered the Dover Sole while the girl tried the rockfish with hazelnuts and apples.  The plates came with golden crusted fish and some leafy greens.  They both looked the same and the food tasted the same, greasy.  We were disappointed, we looked forward to this meal.  My sister used to work at this location and I remember going there at 15 years old and my parents, sister, and brother-in-law loving the food.  I think it has gone downhill.

The meal we ate at a mexican restaurant was unexpectedly tremendous. The locals call it “QB,” which made me think this was going to be an adventure at another Q’doba or Chipotle, but I was soon corrected.  I left the “Quality Burrito” very satisfied, and the below pictures show why.  We ate Sweet Potato Chili and Lime soup, Sweet Potato fries with Mango Ketchup, and then I had a Carnitas Burrito with roasted apple.  My food and the appetizers absorbed me so I do not remembebr exactly what the girl ate.  But I tasted it, and I remember liking it.

Sweet Potato soup and fries

I decided I would finnd a recipe for that soup after I ate it at QB and I think I discovered the exact recipe here.  James Peterson published it in his book Splendid Soups.  I love his books.  I am currently waiting to receive Splendid Soups in the mail after ordering it from Amazon.

Our Entres

We made a couple meals too.  One we made for her roommates as well.  I had a hankering for my mother’s asparagus cream casserole (I know, a hot dish!?), my partner made a roasted cauliflower dish with kalamata olives, garlic, and oil as a sauce, and I fried up some make-shift chicken nuggets with breaded chicken thigh chunks.  The vegetarian were clearly better tasting.

cauliflower, asparagus, and chicken nugget dinner

Then when our last night together was on its way we went down to the farmers market and decided we would make a dinner nearly exclusively from ingredients purchased there.  We decided on mussels in a chanterelle, shallot, and garlic sauce, Steelhead with tomato, garlic, and capers, and a dish that has become a staple in my repertoire apparently: celeriac salad.  I think the only things we did not purchase from the market were the mayo and dijon for the salad.  There were also some hot toddies involved.  While the brandy and tea were not local, the honey was.  This meal was fun because I got to bring it up to her bed while she was doing homework and we ate on her bed while she was in awe of how awesome I was.  Maybe I should pop that ego-bubble my head is growing.

Dinner in bed

You know what, for simply the reason of food (not to mention everything else we did, you know, the long walks on the beach, the intellectual conversations, etc. etc.) I have to upgrade this trip to fantastic.

Something a little more educational this time: having schizophrenia can make you a lard ass at no fault of your own.  The two drugs that you will hear most often making this a problem are clozapine (Clozaril – and not clonazepam (Klonopin), which is an anxiolytic), and olanzapine (Zyprexa).  The odd part is recognizing that the greater the increase in BMI while taking the antipsychotic, the better the antipsychotic is controlling the psychosis (generally).  There are a lot of mechanisms that are suggested for this weight gain and they are still finding more.

The simplest explanation is caloric intake v. caloric output.  Easy.  We all know that eating more calories than we use will eventually put on the pounds.  Sad but true.  People with schizophrenia are much more often sedentary than people sans schizophrenia for numerous reasons (quickly: paranoia, avolition, anhedonia, drowsiness from meds, etc.).  But there is the opposite side of the above equation: what kind of caloric intake are we talking about, here?

Clozapine and Zyprexa are both serotonin and histamine antagonists, meaning they slow the use of these neurotransmitters down (throwing the Dopamine Hypothesis to the wind).  This is a very effective way to control psychosis, on the other hand, I know of people who have come in Andrew at a standard BMI and live there now at a weight of 350 lbs.  The decrease in serotonin activity increases food intake because it decreases the sense of satiety.  The histamine antagonism increases appetite and actually reverses the effects of another neurotransmitter/hormone called leptin that is released by your fat cells that tells your brain to stop consuming.

There were other mechanisms for why people with schizophrenia continue to gain weight on their antipsychotics, but most of them were poorly researched because they were only recently discovered.  So instead of looking at those, I am going to try to discuss some interventions to the weight gain that I found in the literature, both behavioral and medicinal.

Most of the behavioral mechanisms are pretty straightforward: more exercise.  This is done with strict regimens that include nutrition education, frequent weight measurements and group discussions about weight.  The program has shown some success, but I know many patients at Andrew who just don’t care to exercise more or pay attention to their diets.  As much as we want to control some of these things for them, it is their choice.

Metformin (Glucophage) is a commonly used medication with people who are on anti-psychotics (well, at least with the people I work with).  This is because many of them have non-insulin dependent diabetes mellitus (NIDDM).  But it has turned out in one very controlled study (admittedly small number of subjects though) that metformin has helped to control the weight gain better than a placebo.  In some cases, the subjects even lost a little weight to bring their BMI closer to a normal range.  The authors suggested that they might not gain the weight because the metformin makes the glucose available for use rather than storing it as fat right away as well as reducing the production of glucose by the liver.  This sounds very hopeful, but really, there is only one gold standard study showing this and two others showing no conclusive results.

Amantadine has been used for controlling weight gain as well, but this drug increases the use of dopamine in the brain.  All well and good if the dopamine hypothesis is indeed false, but having two drugs that work to decrease psychosis through serotonin release rather than dopamine is not enough to cast away all the evidence for the dopamine hypothesis.

All together it is a tricky issue.  There are other drugs that can be used, but they might increase the side effects of the antipsychotics or have serious side effects of their own.  I think more research should go into this work on metformin personally.  It’s a cheap drug that might be able to prevent a lot of heart ache in the future for these people, as well as allow them to be more active which could increase mood and decrease psychosis.  More money for metformin, please?

Klein, D.K., Cottingham, E.M., Sorter, M., Barton, B.A., Morrison, J.A. (2006). A randomized, double-blind, placebo-controlled trial of metformin treatment of weight gain associated with initiation of atypical antipsychotic therapy in children and adolescents. American Journal of Psychiatry, 163, 2072-2079.

Rege, S. (2008). Antipsychotic induced weight gain in schizophrenia: mechanisms and management. Australian and New Zealand Journal of Psychiatry, 42, 369-381.

DRINK!

October 14, 2009

. . . and eat.

Liqueurs

Long ago, I read an article in the Star Tribune about making liqueur.  I made all of them (except the Very Cherry), and am now awaiting their seasonal ripening.  I have strained them of their ingredients that are more tea-like and now just have to be patient.  I’m learning a virtue as I prepare a vice for xmas.  My girlfriend joked that alcohol would be the only part of xmas I enjoyed.  I responded that the hot-totties from my home prepared liqueurs would just allow me to enjoy the rest of xmas.  I’m looking forward to buying one of the recipe books mentioned in the article and making some different liqueurs.

What we have from left to right up there is a Mexican Coffee Liqueur, Scotish Highland Liqueur, Strawberry Vodka, and Nassau Vanilla Liqueur.  As stated above, I am most excited for the Scotish Highland Liqueur because I recently learned about the Hot Toddy (or Hot Totty/Tottie).  It will be the perfect drink to sit around the tree with the nieces and nephew wailing that they did not get the one gift they really wanted.  Thanks to a coworker for ordering one for me like she was going to pay for it, then smiling ever so sweetly at me when the bill came.  Jerk.

My brother was home from out of state and I got the luxery of preparing dinner for him.  I felt like it was an important moment for my father and I as well: he trusted me to make a good meal for the whole family.  So what did I prepare?  I followed the chef’s law (never prepare a dish for guests that you have not made previously) for two of the dishes and broke it for one.  I made Lamb and Polenta Lasange, Celeriac Salad, and Jalapeno Creamed Spinach (but the latter turned out ok).

Lamb and Polenta Lasagna Jalapeno creamed spinach and celeriac salad

The Lamb and Polenta Lasange had been previously prepared by my girlfriend and I.  We made it for a picnic to the beach, but that is a whole nother story involving anarchists, ruphenol, and a wizard’s sleeve.  Anyway, the theme is that the polenta is made, placed in a cookie sheet, cooled, and cut into lasange noodles.  It is then used just like you would use lasange noodles.  The recipe is excedingly simple otherwise and can be found on Epicurious.

The Celeriac Salad came together easily as well.

Peel a celery root.  Julienne it.  Put enough mayo over it to moisten the whole of it.  A couple tablespoons of your fave dijon and a couple teaspoons of lemon and you got it made.  Eh . . . Cracked pepper for good measure.

Finally, the creamed spinach.  Not complicated, just a lot of steps.  Sauté a chopped onion, poblano pepper, and jalapeno (until soft – but not brown).  Make a white béchamel and add the sautéed items. Steam, drain, and chop up the fresh spinach adding it to the white sauce.  Like I said, not difficult, just requiring too any dishes.

My family loved everything.  The polenta was a bit of a challenge to make into the noodles.  I spread the polenta on a cookie sheet with wax paper and got it off of there in slices with a rubber spatula.  Frequent breaks occurred, but whatever, it did not change the flavor.  The celeriac salad was my favorite.  Most likely due to the novely of the food item.  The creamed spinach could use some work.  I just cannot get over the flavor of the creamed spinach at Brasa.  Good god.  I could break into that place in the middle of the night for some of that creamed spinach.

As always, leave a comment if you would like any recipes.

Op-Ed: Locavores

September 11, 2009

I keep hearing Michael Pollan and the random professor of blah-blah on NPR lately.  The guy has turned into a superstar for the local organic movement.  I find myself playing devil’s advocate more often than taking a stance.  My roommates probably think I would eat all local, all organic, all the time if I could afford it, while my girl probably knows that I have my qualms with the self righteous granolas at The Wedge.  First they go argue that local and organic is the healthiest way with all their scientific environmental reasons, then they go to the homeopathy isle for their home remedies.  Dumb.

Sustainable agriculture.  It’s rough out there.  It takes an incredible amount of resources to feed an American, much less (a projected) 310,000,000 of us.  If I had it my way, we would all be growing our own victory gardens again (amazing stuff – those gardens).  It simply is not realistic to suppose that Americans can subsist on our corn, soybean, and beef diet for the remainder of our future.  Meat takes an immense amount of land so that each of us can have our burgers, steaks and chops (according to Pollan it takes 32 lbs of corn to make four lbs of beef – meaning we could eat about 32 meals of vegetables or 4-8 meals of meat and consume the same amount of land doing so).  Besides the amount of land it takes to make so little meat, the detrimental effects of corn production are pretty serious: fertilizers in the water system sucking all the oxygen out of the lakes and Mississippi Delta, nitrogen fixation’s effects on global warming, corn’s sucking of nutrients out of the soil eventually turning the land into waste, etc.  Agribusiness just is not good for the earth (referring to the planet and the dirt).

But is local organic much better?  For one, lets just put to rest that idea that organic is healthier for you.  It is not.  Organic products are not healthier for you than genetically modified organisms (GMOs; for a pdf about this click here).  If you feel healthier eating organic products, you succumbed to the placebo effect.  You’ve been had.  Can I beat this horse anymore?

The organic movement has some ground in that the product being purchased has been grown on land that is not treated with tons of fertilizers (in theory, I plan on exploring this more in the future because I have heard this is not entirely true either).  But when you buy organic, what is the point of purchasing that product that was grown on sustainable land if it traveled from Peru orJamaica and you drove to the market to get it?  The damage to the land is miniscule compared to the damage it did to get to you.  So buy the GMO.  It is cheaper and you are not supporting the local economy anyway.  But when faced with two options of potatoes, russets from Idaho or russets from Wisconsin, why not buy the one that was grown closer to you?

It is nice that you and I can purchase some of our groceries at the local co-op for their outrageous prices, but this local organic movement is not going to feed 7,000,000,000 people.  We have plenty of food on the planet to feed everyone now (even an excess beyond that), but it does not reach everyone.  But to feed 7,000,000,000 people agribusiness is nearly a necessary evil.  That is not to say that we should not try to solve our overpopulation problem too, but we cannot solve it by starving people.

Finally, my roommate brought up another good point.  Yes, it is good to recycle money into the community that you live in (I have read that money spent locally generates a lot more revenue for everyone involved).  But really, capitalism works on competition.  It’s probably good that my co-op has to keep their prices at least somewhat reasonable, because otherwise – I do not care how environmental it is to shop organic – I am hitting up Rainbow.  We can all decry the evils of Wal-Mart, but the fact of the matter is they have some majorly cheap shit there that makes my wallet a little happier, and allows me to buy another drink out with my friends.

So basically, I think we all need to cut the crap.  Anything we do is going to be overshadowed by some evil we forgot to take into account – I am sure there are many that I have forgotten – it is just that some of us look at our silver lining and praise ourselves more for it.  Wrongly.  Too strongly worded?

I fixed it.

August 31, 2009

Ceviche and Tomato Confit in the bowl, Tomato Tartar with Mozarella, and Pomeganate French Soda

Ceviche and Tomato Confit in the bowl, Tomato Tartar with Mozarella, and Pomeganate French Soda

I made a ceviche a while ago and was not very pleased with it.  Then I got a suggestion from Dean of Alchemy Farms (my brother-in-law) and I worked out a new ceviche.  Pleased, I shared it with my roommate.  I originally wanted to make the  ceviche in the tomato confit I was making to pair it with.  I became wary of this after consulting some of my foody friends and decided to make tomato tartar, put it on some toasted ciabatta, and place with some fresh mozarella instead.  In the dish I put the ceviche on a bed of arugula and put some toasted ciabatta and tomato confit around it.  That was my compromise for not being able to marinate the sea bass in it.

Tomato Confit fresh out of the oven
Tomato Confit fresh out of the oven

The drink I paired it all with has a story.  I used to work at a cafe in a basement.  The owner of this cafe was Armenian and antisemitic (exhibited by by clear factual references to The Protocols of the Elders of Zion), but he was a pretty damn good cook of his region’s food.  Often making me (there was non turnning this guy down – he would get so excited about it) try new drinks (e.g. anise seed tea, english breakfast and clove tea) and new foods (e.g. pita with olive oil, za’atar, and labna).  The drink we had this night was kind of a pomegranate french soda.  Just a bit of pomeganate molasses, soda water, sugar, half and half, and ice.  Very good.  It has a pleasant tartness to it.

Sadly, while I fixed the ceviche, I did run into another problem: BLUE SCREEN OF DEATH.  My computer will only run in Safe Mode now.  I was planning on building another computer soon, but I was hoping this one would last me until I saved a few dollars to build the new one.  AHH!!! Lame!

Decartes’ (Other) Error

August 22, 2009

There is something called Descartes’ Error; it’s too hard for me to explain.  But Descartes did say that we should doubt everything, and that includes our senses.  Blasphemy!  Our senses are all we have to live by, and if I can’t be sure about them, how can I even be sure of my thinking or doubting since all I think or doubt is that which I perceive?  Well, that was enough armchair philosophy for the day.

You might expect that doubting your senses would induce you to check that pilot light once more (did you really see it was lit, or did you forget), but it turns out that perseverative checking, that is, looking at a word over and over again or looking at the pilot light now and now and now, can create a doubt of your senses, doubt of your memory, and dissociation of the self.

The study took healthy students and asked them to stare at a light or flame for a period of time. There were three staring sessions per student ordered by time (10 sec-10min-10sec) – some with gas-gas-gas, some light-light-light, some gas-light-gas, and finally some light-gas-light in order to see if changing stimuli changed derealization and uncertainty.  After the first and last staring session  the students completed a questionnaire that measured derealization and uncertainty.

It turned out that these healthy students who had no history of mental illness were induced to show symptoms extremely similar to patients with Obsessive-Compulsive Disorder (OCD).  Though not statistically significant, the students who stared at the same thing for all three sessions showed the symptoms more strongly.  I would guess that if the number of subject were increased this would come out to be a significant difference.  What the researchers found in this case was that uncertainty of memory and perception increased more than dissociation, but there was a moderately strong positive correlation between the two (pearson’s r=0.43).

Another interesting thing the authors talk about in the discussion is that OCD behaviors seem to be the person explicitly taking over and implicit process.   Most of the time people read words without conciously trying to read them – hence the stroop task for experiments which try to induce error – but in OCD it seems that individuals try to conciously take over this process.  The authors mention something that it is likely everyone has experienced – reading a word many times and suddenly, the word seems strange and foreign to you, for some reason it is odd that this word goes with the definition it has been given, why is it spelled that way, wait . . . what is the word?  Many of our brain processes actually work better in automatic than in forced overdrive: immediately think of 9 negative memories from your childhood.  Pretty hard.  But if you are promted by a stimulus suddenly a memory will come rushing back to you.

That prompting is called spreading activation in cognitive psychology.  There are memories, items, places, smells, tastes, etc. that are interlinked in our minds (we all know this already, but sometimes we can be oblivious to the obvious), when one of those things becomes reactivated it gives some activation to those ideas that surround it.  This is just an analogy, but think of each individual sense, like the taste of peanut butter as a neuron connected to 5 other neurons: Nelson’s chocolate peanut butter icecream, mom’s PB&J’s, PB in your hair, thai peanut sauce, and toast.  When you take the peanut butter out of the cupboard that one neuron gets activated and sends out a little spark to all those connected to it and all of a sudden you have a bunch of ideas about what to do with the PB, a craving for ice cream, and memories of eating PB&J with mommy in the park.

It turns out that taking that automatic process over with explicit functioning weakens it by raising performance standards and makes one less confident of one’s memory and/or perceptions.  Maybe Descartes was a bit OCD and that’s why he hated his senses.

The authors finish up the paper with the conclusion that the best therapy for OCD and checking behaviors are then Exposure and Ritual Prevention Therapies, which are already conducted with people with OCD.  However, this does shed new light on why they work, and it may allow clinicians to focus their energies on therapies that are more effective, thus making treatment a shorter period (and more appealling for insurance companies to pay for).

van den Hout, M.A., Engelhard, I.M., de Boer, C., du Bois, A., & Dek, E. (2008). Perseverative and compulsive-like staring causes uncertainty about perception. Behavior Research and Therapy, 46, 1300-1304.

Regimented

August 15, 2009

9am. 1pm. 5pm. 9pm.  And sometimes between those times.  Usually the psych meds are only given in the morning and evening, unless there are anxiolytics involved (anti-anxiety medications e.g. Ativan, Klonopin, Xanax, Valium), then the physical medications are given throughout the day.  The medications are scheduled like this because the psych meds have lots of side effects that can slow you down during the day e.g. drowsiness, dizziness, restlessness, agitation, etc.), so sometimes it is better to take them at night.

I kind of played a trick on you.  I’m actually going to talk about medication effectiveness and cost.  It is a huge deal with antipsychotics because some of the newer ones (“atypical” or “2nd generation” antipsychotics) can be extremely expensive.  We’re talking about thousands of dollars a month.  And any of you who pay taxes are footing the bill for them through Medicaid, which pays for about 75% of the antipsychotics used to treat people with psychosis in the U.S.  This frustrates me to no end, and not because I am mad about helping people stay sane, but because the pharmaceutical companies know they get their money from the government, and yet, they charge exorbitant amounts for their drugs.  The amount of money this comes out to every year: $10, 000, 000, 000.  Amount paid for by taxes via Medicaid: $7, 500, 000, 000.

The argument for many years has been that the second generation antipsychotics, though more expensive, cause fewer medical problems for the patients so the overall cost is reduced.  If it is true that the 2nd gen drugs cause fewer medical issues and do in fact reduce the symptoms of the mental illness, then it can be said that the patients are experiencing a higher quality of life.  Fantastic!  Only, that’s not how it works out.

The National Institute of Mental Health (NIMH) put up some major funding for a research project called Clinical Antipsychotic Trials of Intervention Effectiveness, affectionately called CATIE.  The investigation pitted four 2nd gen antipsychotics (generic names: olanzapine, risperidone, quetiapine, ziprasidone; trade names: zyprexa, risperdal, seroquel, geodon respectively) against a 1st gen (generic name: perphenazine; trade name: trilafon).  Following about 1500 patients over 18 months of treatment this is probably the most extensive antipsychotic test put out.  Even though this research may have cost a million dollars to conduct, if the results favor a cheaper drug and psychiatrists’ prescribing habits can thus be changed, think of how much it could save tax payers and the government.

The reason that such and extensive study was needed is that drug companies like to fund and publish only data that supports their chemical.  It’s bad advertising to put out a study that points out that your drug is less effective and causes more side effects than the other drug company’s drug.  Many of the studies that are published have issues with validity.  That is, they should not be applied to the patient population because of major flaws in how the study was conducted such as measuring effectiveness simply by levels of symptom management rather than quality of life, or measuring cost effectiveness only by taking into account direct health care costs to the patient, when leaving cost to the family out (family’s ability to work and play i.e. earn and spend, due to patients illness).  Sadly, the complete truth is not always what you get out of the studies, so an impartial party (or economically cheap party, in this case), needs to step in and do the comparisons.

The results were unsurprising to me.  Perphenazine was consistently cheaper than all of the 2nd gen antipsychotics, by about $200-$300 a month.  Over time, the difference between perphenazine and the 2nd gens did close, but it still remained significantly lower.  And the reason the costs closed in near one another is because people with schizophrenia generally discontinue taking their medications after some time (after about 18 months, you can count on 70% of a given population of people with schizophrenia discontinuing their medications due to a delusion or believing they are healthy now).  In the case of this study, those people taking perphenazine were then switched to a 2nd gen medication, but were kept track of as the “perphenazine group.”  In the end, the total amount saved by the perphenazine group was about $300-$600 per person.  The great part: along with olanzapine, perphenazine outperformed all the other 2nd gen medications and olanzapine is going to go generic any time now, which means the other highly effective drug is going to be cheap too.  The one benefit that olanzapine had was that people were likely to stay on it longer than perphenazine (9.2 months compared to 5.6 months).

The problem with olanzapine is that the weight gain issue is well . . . huge.  I know residents that came into Andrew Residence at 150 lbs and are now weighing in somewhere around 300 lbs.  Because of this they are also either shooting insulin frequently, or taking metformin (trade name: glucophage), which is a non-insulin dependent diabetes mellitus (NIDDM) drug.  It turns out that a metformin prescription may help control weight gain if it is prescribed right with the antipsychotic though, which is what I plan on researching next.

Polsky, D., Doshi, J.A., Bauer, M.S., & Glick, H.A. (2006). Clinical trial-based cost-effectiveness analyses of antipsychotic use. American Journal of Psychiatry, 163, 2047-2056.

Rosenheck, R.A., Leslie, D.L., Sindelar, J., Miller, E.A., Lin, H., Stroup, T.S., McEvoy, J., Davis, S.M., Keefe, R.S.E., Swartz, M., Perkins, D.O., Hsaio, J.K., & Lieberman, J. (2006). Cost-effectiveness of second-generation antipsychotics and perphenazine in a randomized trial of treatment for chronic schizophrenia. American Journal of Psychiatry, 163, 2080-2089.

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