Anyone know who is on this Task Force?

[[wa...]]

Nathan

A perusal of conflict of interest by the MD s and PhD members or contributing members is really painstaking.  They have to disclose where their funding is coming from for research but I don't know if their personal or family Pharma stock investments could be divulged.  ProPublica and possibly Public Citizen would know something?

Anyway, COVID was a gift to the Pharma-manufacturing benzodiazepines.  From EXpressScripts 2020: https://d11tr245s7jfj6.cloudfront.net/2020-04/Express%20Scripts%20America%27s%20State%20of%20Mind%20Report%20April%202020%20FINAL_p9%20edits_0.pdf

Let me know if this link is wonky. 

This pattern is old.  For instance, when Valium was dipping in sales after the release of "I'm Dancing As Fast as I Can" (book then movie) - Hoff.Laroche sells the patent and subsequently Upjohn came up with faster acting and theoretically less harmful Xanax.  Upjohn distorted their own research on the drug then sold their patent, 

I feel like this latest  "task force" report comes on the heels of COVID  - just when folks might be getting wise to the dangers of benzos since the FDA black box warnings.  Were RXs dipping?  What to do?  Do we screen a troubled society for anxiety and say they need to be "treated" to boost benzo sales?  With generics they're cheap.  Am I cynical?  Damn right I am.

[[cl...]]

I agree with everything you guys have said here.  I don't think it's cynicism, just unfortunate reality.  Just wondering what we can do about it, as so many vulnerable people could be impacted.

 

I also agree it's not good to make this political.  Actually that was my point when I said, though funding may come from the covid relief package, I don't blame Biden.

 

clearbluesky

[[Na...]]

 

This pattern is old.  For instance, when Valium was dipping in sales after release of "I'm Dancing As Fast as I Can" (book then movie) - Hoff.Laroche sells the patent and then Upjohn came up with Xanax.  I feel like this "task force" comes on the heels of COVID but when folks might be getting wise to the dangers of benzos since the FDA black box warnings.  Were RXs dipping?  What to do?  Do we screen a troubled society for anxiety and say they need to be "treated" to boost benzo sales?  With generics they're cheap.  Am I cynical?  Damn right I am.

 

There is at this point over a century long history of making drugs that manipulate GABA receptors, finding out they "have issues", then moving on to the next drug that manipulates GABA receptors that "doesn't have any of the issues of the prior drug". Except that it has exactly the same issues.

 

Barbital (the first barbiturate) was marketed in the early 1900s. Phenobarbital hit the scene about a decade later and really started to come into it's own in the 1930s.

 

Barbiturates acts as positive allosteric modulators (PAM) of GABA receptors. Just like our friend the benzodiazepines.

 

By the late 1940s and 1950s barbiturates were killing Hollywood stars every year or two and people were ending up with nearly insurmountable physical dependence. The barbiturates have an unfortunate characteristic of having a low therapeutic index - the difference between a therapeutic dose and a lethal dose might only be a factor of two or three. People would take something like phenobarbital, get a little zoned out and forget they had taken it, take another, and every so often that would end up in the morgue. 

 

The first benzodiazepine (Librium) hits the market in 1960. They were better in that they had a much wider therapeutic index, but they had all the tolerance and physical dependency problems of barbiturates, which would have been an obvious conclusion to anyone in the know. In fact you can get yourself even more physically dependent on these drugs because you can take much higher doses without killing yourself outright.

 

By the 1970s it begins to be realized that tolerance to benzo builds fairly rapidly and that physical dependence was a frequent outcome.

 

So, by the 1980s the realization that benzos were problematic starts to circulate.  We're now on the 2nd modern drug that monkeys around with GABA receptors.

 

What do the drug companies do? Do they say "Gee, barbiturates and benzos didn't work out so well, maybe we should be super cautious about making drugs that operate on GABA receptors?".

 

Hell no.

 

In the late 1980s early 1990s they come out with the third major class of drug to act as positive alleosteric modulators of GABA receptors - the Z drugs.  Chemically distinct from benzos but with exactly the same mode of action.

 

Now at this point, the drug companies know how this story ends because they've already told it twice. But they tell the world the same damned lie - "These drugs don't have the tolerance and dependency potential of the prior drug. They are totally safe.".  But anyone with any understanding of how these drugs work - i.e. all of the drug developers and the upper management of the various pharmaceutical companies - they all know that these drugs will have exactly the same issues because they do the same things.

 

When I was handed my first prescription for Ambien I asked if these pills were addictive and was told "No, you don't have to worry about that with this drug - it's new". The doctor that told me that was a kind and caring physician. He believed what he told me because his drug rep had told it to him.

 

Apparently we refuse to learn from our prior mistakes with these sorts of things. And it's not because the people in this business are stupid nor are they incapable of learning. It is because it's so damned profitable not to learn from these mistakes.

 

So if you're not cynical at this point .... well you're just not paying attention.

[[cl...]]

That's a very well-written, interesting and informative overview.  Thank you!

 

From another thread:

 

https://journals.sagepub.com/doi/full/10.1177/20451253221082386

 

In so many of these threads people say the same things.  The issues are clear to us, but won't be to millions potentially identified in "anxiety screenings."  They will just be sucked down the rabbit hole like we were.  I feel like there must be more we can and should do to speak up.  But how, I don't know.....

 

clearbluesky

 

 

[[Pa...]]

Canadian reaction to the proposed screening.  http://www.benzobuddies.org/forum/index.php?topic=271754.0

[[cl...]]

Yes yes yes!  Apparently at best "anxiety screening" could only be expected to yield "moderate" benefits.  There seem to be no American projections on negatives.  But the Canadians get it. 

 

clearbluesky

[[cl...]]

Check this out:

 

https://pubmed.ncbi.nlm.nih.gov/30921478/

 

Excerpt:

 

AUTHORS' CONCLUSIONS:  "Low-quality evidence shows a possible superiority of benzodiazepine over placebo in the short-term treatment of panic disorders. The validity of the included studies is questionable due to possible unmasking of allocated treatments, high dropout rates, and probable publication bias. Moreover, the included studies were only short-term studies and did not examine the long-term efficacy nor the risks of dependency and withdrawal symptoms. Due to these limitations, our results regarding the efficacy of benzodiazepines versus placebo provide only limited guidance for clinical practice. Furthermore, the clinician's choice is not between benzodiazepines and placebo, but between benzodiazepines and other agents, notably SSRIs, both in terms of efficacy and adverse effects. The choice of treatment should therefore be guided by the patient's preference and should balance benefits and harms from treatment in a long-term perspective."

 

(my take)..... "Possible" "low quality" evidence.  So there is only marginal proof of benzo effectiveness with panic disorder, even without comparative analysis of risks and negative outcomes.  That's pretty bad, imo.

 

But just for the sake of argument, let's imagine there really was proven benzo effectiveness over placebo.  Even then, recommended use would be limited to 6 weeks, hardly long enough to make a difference.  Moreover, if effective, the patient would be highly motivated to continue use past the recommended 6-week treatment period, setting in motion a psychological dependency that encourages further use that would create physical dependency, aka "addiction."  So even if benzos were effective over placebo, which apparently hasn't been well-proven, ultimately it leads to either a no-gain or negative outcome.

 

Haven't claims of SSRI/SNRI effectiveness been disproven, too?

 

This study only looks at panic disorder, but would it not apply to other conditions benzos are prescribed for?  What can be effectively treated in just 6 weeks?

 

"Anxiety screening" would pick up the gamut from circumstantial anxiety to more entrenched conditions.  But even circumstantial anxiety, stress from loss of job or spouse, for instance, is not likely resolved in 6 weeks.  Much less ongoing social/political/economic circumstances.....and who isn't anxious about those?

 

At best 6 weeks of benzo use could help a patient until another form of treatment is in place.  But what would that be?  There aren't enough talk therapists as it is, and many insurance plans don't cover them.

 

Being on the front lines of such dilemmas, I would think primary physicians would oppose "anxiety screening."  Has the AMA taken a position on it?

 

clearbluesky

 

 

[[Ti...]]

Just found another one from April of this year recommending anxiety screening in kids 8-18. This is outrageous. I’m going to try to find a journalist or someone with a platform that would be interested in digging into all of this. Also, in the absence of a formal response from any organizations what if we reached out to all of the influencer accounts that have pharma awareness as their main subject?  They are all over YouTube and other social media accounts.

 

https://www.uspreventiveservicestaskforce.org/uspstf/draft-recommendation/screening-anxiety-children-adolescents

 

“ Patient Population Under Consideration -

This recommendation applies to children and adolescents age 18 years or younger who have no signs or symptoms of anxiety.”

 

This is criminal to go after kids with brains that aren’t fully devolped. I’m livid right now over this.

 

 

[[cl...]]

Here are 3 investigative journalism orgs:

 

ProPublica:

https://www.propublica.org/topics

 

PBS Frontline:

https://www.pbs.org/about/about-pbs/contact-information/pbs-program-contacts/

 

Reveal:

https://revealnews.org/about-us/contact-us/

 

 

clearbluesky

 

 

[[Ms...]]

Is anyone else having trouble getting the comments link to load?

[[Li...]]

According to Downdetector and several other outage detection sites, www.uspreventiveservicestaskforce.org is not responding as of the day/time of this post.

[[Pa...]]

This links isn't loading either.

 

 

https://www.uspreventiveservicestaskforce.org/uspstf/draft-recommendation/screening-anxiety-children-adolescents

 

[[Li...]]

According to Downdetector and several other outage detection sites, www.uspreventiveservicestaskforce.org is not responding as of the day/time of this post.

 

This links isn't loading either.

 

 

https://www.uspreventiveservicestaskforce.org/uspstf/draft-recommendation/screening-anxiety-children-adolescents

 

 

The entire website is offline.

[[Li...]]

The US Preventive Service Task Force website is back online. Here is the link to the draft recommendation statement on screening for anxiety in adults:

 

https://www.uspreventiveservicestaskforce.org/uspstf/draft-recommendation/anxiety-adults-screening

 

To read the statement, you may need to scroll down the page.

 

To comment, click the ‘Leave a Comment’ link located in the yellow box near the top of the page. 

 

The deadline for submitting comments is Oct 17, 2022 11:59 PM EDT (US).

[[Pa...]]

Thank you Libertas for outlining the steps needed to leave a comment, lets fill it up! 

[[Li...]]

You are welcome, Pamster.  For readers who wish to comment, below are the questions asked on the online form followed by directions on how to provide additional feedback by uploading a document or by mail.

 

Based on the evidence presented in this draft Recommendation Statement, do you believe that the USPSTF came to the right conclusions?

- Yes; I believe the USPSTF came to the right conclusions.

- Somewhat; I believe the USPSTF came to the right conclusions in some ways but not in others.

- No; I do not believe the USPSTF came to the right conclusions.

- Unsure; I am not sure if the USPSTF came to the right conclusions

 

Please provide additional evidence or viewpoints that you think should have been considered.

 

How could the USPSTF make this draft Recommendation Statement clearer?

 

What information, if any, did you expect to find in this draft Recommendation Statement that was not included?

 

What resources or tools could the USPSTF provide that would make this Recommendation Statement more useful to you in its final form?

 

The USPSTF is committed to understanding the needs and perspectives of the public it serves. Please share any experiences that you think could further inform the USPSTF on this draft Recommendation Statement.

 

Do you have other comments on this draft Recommendation Statement?

 

If you would like to provide additional feedback, please upload a document … Your comments should be no more than 15 pages single spaced, including all tables, figures, and appendices.

 

To submit comments by mail, please send them to:

 

USPSTF Coordinator

c/o USPSTF

5600 Fishers Lane

Mail Stop 06E53A

Rockville, MD 20857

 

Written comments must be received by the comment period closing date [Oct  17, 2022] in order to be considered.

[[Pa...]]

Excellent step by step guidance Libertas, thank you.

[[Li...]]

DEADLINE REMINDER: Tomorrow — October 17 at 11:59 PM EDT, US — is the deadline for commenting on the draft recommendations on screening for anxiety in adults from the US Preventive Services Task Force.

 

Here is the link to the draft recommendation statement:

 

https://www.uspreventiveservicestaskforce.org/uspstf/draft-recommendation/anxiety-adults-screening

 

To read the statement, scroll down the page.

 

To comment, click the ‘Leave a Comment’ link located in the yellow box near the top of the page. 

 

To preview the questions asked on the online form, visit:

 

http://www.benzobuddies.org/forum/index.php?topic=271675.msg3407929#msg3407929