What is worth emphasizing is that it is not illegal for MDs to prescribe drugs for off-label uses; it is only illegal for the manufacturer to do any marketing for such purposes. What may have gotten Warner-Lambert (the Pfizer-owned company that pushed Neurontin, whose generic name is gabapentin) in trouble in this case, and netted whistleblowing scientist Franklin more than $26 million himself in the settlement of this lawsuit, is that this is the first anti-epileptic drug developed in the last several decades that does not turn out to have mood-stabilizing properties useful in psychiatric practice; clinical psychiatrists such as myself readily seize upon each newly-introduced anticonvulsant for our own purposes. (There are good scientific reasons to believe that a medicine with the one set of indications will also be effective for the other; in a nutshell, there may be similar physiological instabilities in brain function in at least some mood instability as there are in convulsive conditions.). I used an awful lot of gabapentin with my patients, on the basis of those reasonable assumptions, before my cliical experience and that of my colleagues began to tell me it might not be that useful. (Why did it take so long to figure it out? Because stability is a hard thing to verify except over time…)

I am amazed at Warner-Lambert’s ineptitude in its marketing practices, presumably blinded by the dollar signs in its eyes, in this case. Whenever a drug representative visits me (and I do not let it happen very often, and take no ‘perks’ from them when they do come), I am not interested in learning about the official indications for their products or the research data supporting the medication’s efficacy and tolerability, which is what they want to impart. I learn about medications from reading the peer-reviewed medical journals in my field,not marketing propaganda. I often try to persuade the reps to talk about the off-the-record, experimental, and projected uses of their medications, and 90% of the time they demur, citing FDA guidelines (although they will suggest references in the literature where I can explore these interests.) Maybe they think I’m an FDA ‘ringer’ or ‘narc’, but they usually cannot be trolled in the way Warner-Lambert was seemingly eager to be. By the way, this article is misleading in one sense. Companies do not give doctors speaking fees to induce them to prescribe the drugs; they only hire doctors who are already big users of the drugs (it has long since been the case that the pharnaceutical manufacturers keep a database allowing them to pull up data on every doctor’s prescribing statistics). Hiring a big booster of Neurontin, already in the bag, to do the speaking circuit is a way to get a credible authority to induce their colleagues to prescribe more Neurontin. Putting it more crudely, the doctors doing the speaking tours are the whores, not the johns.

(Footnote: it does turn out that gabapentin is probably useful for a variety of these off-label uses, including chronic headache and other pain conditions.).

I don’t need to try and detect parallel universes; I already live in one. And sometimes I think that, despite its being a parallel universe, I am stuck constantly trying to angle-park…

George Monbiot on the Day After Tomorrow controversy:

Glenn Reynolds is very upset that the media are continuing to focus on Abu Ghraib even after the Nicholas Berg execution. He wants to persuade us that Berg is the story we should care about enough to forget the prison scandal. It is only the left wing conspiracy against the Bu**sh** administration that makes for anything different. Oh, and part of the conspiracy was that the Boston Globe deliberately ran faked Abu Ghraib sexual abuse photos and refused to apologize. Most of the article consists of search engine reports that various “Nick Berg” phrases were its most popular search requests this week, not “Abu Ghraib” phrases. Uhhh, could that be because the Abu Ghraib photos were all over the web while the Berg videotape was hard to find? Desperately watching the sands of public opinion sift through your fingers, are you, Glenn?

FreeRepublic.com: “A Conservative News Forum” — “Here you are, FReepers. Here is the enemy.”

Aljazeera.Net and Pravda’s English-language channel are among those reporting on doubts about the authenticity of the Berg execution video, among them:

• CIA claims it has identified the perpetrator as Zaqrawi
  
• flip-flopping claims of whether Zaqrawi had lost a leg in 2001
  
• the timing of the execution was a little too convenient — reports that it was in retaliation for the Abu Ghraib prison abuses neatly deflected media attention from the latter by making them pale in comparison [This was my suspicion immediately after the news broke as well. — FmH]
  
• “If al-Qaeda were in the business of avenging prison abuse, it would have already done it and probably on several occasions”, and probably would have reacted to Iraqi deaths in US custody rather than just ‘humiliations’
  
• the regulation prison jumpsuit that the victim in the videotape is wearing, which it is difficult to believe al Qaeda would issue
  
• the victim’s lack of resistance to being killed and the inconsistent lack of blood leaking from the freshly severed head; had the victim already been dead?
  

Emails provided by the Berg family yesterday contradict US government denials it ever held Berg as his family contended. A US diplomatic official in Iraq informed the family by email in early April that Berg was being detained by the US military. — Monterey Herald

reportedly gave email password to associated of Zacarias Moussaoui:

“I lived without part of my skull”: “Briana Lane is recovering from surgery – after living with only ‘half of her skull’ for months. The 22-year-old from Midvale, Utah, US, was injured in a car accident in January this year, AP agency reports.

Doctors had to remove part of her skull during surgery, leaving just skin and sutures covering almost half her head.

She remained that way for four months while the hospital and her health insurance program Medicaid argued over who should pay for her surgery.

Briana feels lucky to have survived the accident but says living without a portion of her skull was ‘excruciating’. When she woke up in the morning, she would notice how her brain had shifted during the night to one side.

She was given a plastic street hockey helmet to wear during the day for protection. Briana said: ‘You’d think they could give me something more protective. Like a skull, perhaps.’

Despite being released from the hospital in February, Briana’s skull remained in a hospital freezer until April while the paperwork passed back and forth…” — BBC [thanks, Pam]