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Wall Street Journal
15-05-2025
- Health
- Wall Street Journal
‘Unshrunk' Review: The Toll of the Treatment
For nearly 15 years, Laura Delano was, in her own words, a 'professional psychiatric patient.' She believed she had an incurable psychiatric disease that could be managed only with medication, therapy and the occasional hospitalization. Over the course of her long career as a patient, Ms. Delano was medicated with Seroquel, Geodon, Abilify, Zyprexa, Risperdal, Depakote, Topamax, Lamictal, Klonopin, Ativan, Ambien, Provigil, Prozac, Effexor, Celexa, Cymbalta, Wellbutrin, Lexapro, and lithium. So convinced of her condition was Ms. Delano that if anyone had handed her a memoir like the one she has now written, 'Unshrunk: A Story of Psychiatric Treatment Resistance,' she would have been insulted and outraged. Her story begins when she was 13 years old. A competitive squash player and the soon-to-be president of her eighth-grade class, Ms. Delano was brushing her teeth in front of a mirror one evening when she had a harrowing experience: The edges of her vision blurred; she felt a terrifying sense of disembodiment and fragmentation; and the figure in the mirror was no longer recognizable as her. The episode didn't last very long, but it left her with a profound sense of unease. Reflecting on it in bed later that night, Ms. Delano began to see herself from the outside. The view was unsettling. Convinced that her life was all fakery and mindless rule-following, she resolved to escape. What followed was a self-destructive spiral that went far beyond adolescent rebellion. Ms. Delano gives us an unsparing account of her alcoholism, cocaine abuse, eating disorders and episodes of self-harm. In the ninth grade, she was diagnosed with bipolar disorder and given prescriptions for an antidepressant and a mood stabilizer. Later came an antipsychotic and a drug to help her sleep. If anything, medication accelerated her decline. By age 19, when she was a sophomore at Harvard, she writes, 'I'd morphed from a raw, suffering, lost young woman . . . into a detached, absorbed, empathyless machine.' Ms. Delano marks her eventual turnaround at age 27 to a moment of profound revelation in a Vermont bookstore. That was where she encountered Robert Whitaker's 2010 book, 'Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America.' The question Mr. Whitaker asked was simple: How is it possible that rates of mental illness have skyrocketed in parallel with the development of so many supposedly groundbreaking psychiatric drugs? Mr. Whitaker's book forced Ms. Delano to pose a question that had never before occurred to her. 'What if it wasn't treatment-resistant mental illness that had been sending me ever deeper into the depths of despair and dysfunction, but the treatment itself?'
Daily Mirror
14-05-2025
- Daily Mirror
Shopping centre killer was 'under Satanic control' before stabbing six to death
Joel Cauchi Cauchi killed six people at a shopping centre in Sydney, Australia, in April 2023, and an inquest has heard how he claimed to be 'under satanic control' before the attack A man who went on a killing spree in a shopping centre left notes suggesting that he was 'under satanic control of religious beings', an inquest has heard. Joel Cauchi, 40, killed Ashlee Good, 38, Jade Young, 47, Yixuan Cheng, 27, Pikria Darchia, 55, Dawn Singleton, 25, and Faraz Tahir, 30, and injured 10 others at Westfield Bondi Junction on 13 April last year before he was shot and killed by police inspector Amy Scott. Clinical notes, personal writings, and emails from Cauchi's mother have revealed a troubling descent into mental illness in the years leading up to his deadly attack. The coronial inquest into the mass stabbing resumed its third week on Monday, focusing on testimony from psychiatrists and registered nurses who had treated Cauchi in his hometown of Toowoomba, Queensland. One registered nurse, who worked closely with Cauchi between 2011 and 2019, recalled the shock of discovering he was the attacker behind the tragedy. 'I turned the TV off so my children wouldn't see the news,' said the nurse, who cannot be named for legal reasons. 'Then his name came up on my phone - I vomited when I saw it was him. It just didn't make sense. It didn't match the Joel I knew.' Cauchi, who had been diagnosed with treatment-resistant schizophrenia and obsessive-compulsive disorder, was under long-term psychiatric care and had been taking a powerful antipsychotic medication. According to the nurse, he was extremely conscientious about his health. 'He didn't want to get unwell. He was always anxious about relapsing,' she told the inquest. 'He never missed an appointment.' Around 2016–2017, Cauchi's Clopine dosage was slightly reduced under supervision. He reported feeling better physically and mentally, with increased energy and no signs of hallucinations or violence. By mid-2018, he had fully stopped taking Clopine. In June 2019, he began refusing Abilify as well - leaving him completely unmedicated for the first time in 15 years. Both nurses who testified Monday expressed concern, saying they had never seen a patient come off Clopine without transitioning to another antipsychotic. By late 2019, Cauchi's mental health had begun to unravel. His mother, Michele Cauchi, contacted the clinic, expressing growing alarm. In an email dated November 2019, she wrote: 'I know you thought that it wasn't having any effect, but I have noticed a gradual decline in his condition. I have a feeling he is now hearing voices. I would hate to see him have to go back into hospital after 20 years of being stable on medication.' She also reported disturbing signs. Cauchi believed he was under satanic control, exhibited compulsive showering, developed a strange gait, and began layering clothes to protect himself from illness. He also became obsessively concerned with pornography, asking the clinic for help finding an internet provider that could block it. The following day, Joel's nurse spoke with his father, Andrew Cauchi, who strongly opposed any return to medication. A clinical note from that conversation read: "Father became adamant that he did not want his son to go on medication as it will kill him… He said he himself had been traumatised by demons and hears voices, and is not on medication.' The family's deeply religious background, coupled with Andrew Cauchi's own mental health struggles, became a significant factor in Joel's care. Despite multiple efforts by medical professionals to convince Joel to resume treatment, he refused. By 2020, his behaviour had become increasingly erratic. Police were called multiple times due to his obsession with military knives and confrontations with his parents. By early 2024, he was homeless and sleeping on a Sydney beach. On March 13, 2024, Cauchi entered Westfield Bondi Junction with a large military knife and fatally stabbed six people before being shot dead by a NSW Police inspector. His mother's earlier fears had tragically come true. The inquest continues.
Yahoo
13-05-2025
- Health
- Yahoo
Trump's order on drug prices isn't what it seems
Earlier this week, President Donald Trump signed an executive order that he claims will force Big Pharma to lower prescription drug prices paid by Americans to match the prices paid in other countries. It certainly sounds like a good idea. We pay — by far — the highest prices in the world, for everything from the antipsychotic Abilify to the weight loss drug Zepbound. But don't get your hopes up just yet — and not just because the proposal is, in the view of many experts, of dubious legality. The order is framed around the absurd premise that high prices stem from the U.S. subsidizing a bunch of 'freeloader' countries around the world. In truth, we pay more because we subsidize corporate monopolies, including Big Pharma and pharmacy benefit managers (PBM), that drive up drug prices at home. Though Trump's order criticizes drug manufacturers, it would tolerate continued profiteering and price gouging from Big Pharma. It would leave the biggest PBMs — middlemen whose identities Trump claims not to know, even as his administration is suing them for jacking up insulin prices — unscathed. And it would deflect scrutiny from those PBMs' parent companies, like UnitedHealth Group, whose bottom lines depend on anticompetitive business models. Trump is right that drug prices are too high. A January 2024 RAND study found that we pay nearly three times as much for prescriptions as other high-income countries. In 2023, the median annual list price for new brand-name drugs increased 35% to an eye-popping $300,000. So it's understandable that a July 2023 KFF poll found a majority of Americans are worried about being able to afford their medicines, with 3 in 10 reporting they haven't taken them as prescribed due to costs. All too often, patients pay with their lives. Trump is also right that Big Pharma plays a big role in this crisis. Manufacturers game the patent process for brand-name drugs to keep prices high and block more affordable generic and biosimilar options from coming to market. Although they claim these high prices fund research and development of new medicines, their own records show greed also plays a leading role. A 2024 report from consumer advocacy group Public Citizen found the excessive prices paid by Americans for prescription drugs fund 'self-enriching activities, including stock buybacks, dividends to shareholders, and executive compensation, that far exceed their investments in innovation.' There is no way to lower drug costs for American patients without costing Big Pharma, whose executives can afford patio dinners at Mar-a-Lago and hefty donations to Trump's inauguration fund, and the biggest PBMs, which even Trump admits are 'worse than the drug companies. They don't even make a product, and they make a fortune.' So Trump's order — so vaguely worded that it's not clear if the rules would only apply to federal programs like Medicare and Medicaid or more broadly to commercial plans — ignores the greed inflating American pharmaceutical prices. His order, for example, has just about nothing to say about the role of PBMs. These middlemen negotiate pharmacy benefits on behalf of health plans with drug manufacturers and pharmacies. The 'Big Three' — CVS Caremark, Cigna Group's Express Scripts and UnitedHealth Group's OptumRx — account for nearly 80% of U.S. prescription drug claims, giving them enormous leverage to demand rebates from drug manufacturers in exchange for coverage. Because rebates are based on list prices, PBMs are incentivized to prefer drugs with higher list prices, even when cheaper generics and biosimilars are available. Indeed, PBM rebates and fees account for 42% of every dollar spent on brand-name drugs in the commercial market, according to a health care research firm Nephron Research. Other high-income countries provide universal health care and directly negotiate drug prices with manufacturers, eliminating the need for PBMs. So rather than target Big Pharma's patent abuses or PBMs' market power, Trump's executive order would require manufacturers to sell their drugs to American patients at the lowest price available abroad. If manufacturers won't comply voluntarily with this 'most favored-nation' policy, Trump's order directs Health Secretary Robert F. Kennedy Jr. to propose rules that would tie the drug prices paid in the U.S. to those in other countries. And, yes, those prices are often significantly lower. For instance, a one-month supply of Novo Nordisk's Ozempic costs $969 in the U.S. compared with $59 in Germany. Sounds great. But Trump's order assumes Big Pharma won't just choose to raise prices charged outside the U.S., bringing them more in line with the inflated prices we pay. It also assumes that Trump has the power to do all this — a very big if. Trump issued a similar executive order during his first term, but a federal judge blocked it for procedural reasons. Health policy experts predict Monday's order will run into similar legal challenges, and the markets seem to think so as well, with drug manufacturer shares surging more than 6% in some cases following the announcement. Even if Trump's order were to take effect, however, it would do nothing to address the root causes of the problem it purports to solve. That would require prohibiting the pharmaceutical industry's patent abuse and pursuing enforcement action against those that have violated antitrust laws. It would mean banning PBMs from accepting rebates. Finally, it would mean taking on the PBMs' parent companies — that is, the giant health insurance conglomerates that own them, which similarly gouge patients and taxpayers for medical services — by breaking them up. Anything less than those structural reforms is unlikely to bring about significant change. 'Until policymakers address the growing gap between inflated list prices of medicines and the actual costs of those medicines, we should expect the same system[ic] dysfunction that exists today to only fester and worsen in the future,' says Antonio Ciaccia, CEO of the nonprofit drug price research firm 46brooklyn. In other words, we can't export our homegrown drug pricing crisis. It's something we have to fix ourselves. This article was originally published on
Yahoo
13-05-2025
- Health
- Yahoo
Man Who Killed 6 in Sydney Mall Stabbing Was 'Not Psychotic,' Likely Acted Out of 'Hatred for Women,' Ex-Doctor Testifies
Joel Cauchi, the man who fatally stabbed six people in a Sydney mall on April 13, 2024, carried out the attack due to his "hatred towards women,' his former doctor has reportedly testified in court 'That was nothing to do with psychosis. He couldn't have organized himself to do what he did. I think it might have been due to his frustrations, sexual frustration, pornography and hatred towards women," the doctor reportedly told an inquest on Tuesday, May 13 The suggestion goes against evidence from other psychiatric experts that Cauchi did have a psychotic episode during the attackJoel Cauchi, the man who fatally stabbed six people in a Sydney mall on April 13, 2024, did not have a psychotic episode and most likely acted out due to 'his hatred towards women,' his doctor has reportedly revealed in court. A psychiatrist who previously treated Cauchi, 40, for several years before the attack made the bombshell claim in an inquest on Tuesday, May 13, 2025. This contradicts evidence from other psychiatric experts suggesting that Cauchi was 'floridly psychic' during the attack, The Sydney Morning Herald and The Guardian reported. The Queensland doctor, referred to as "Dr. A" for legal reasons, alleged in court that Cauchi did not have a psychotic episode, as this didn't fall in line with him having the capabilities to organize the planned attack, according to the outlets. 'That was nothing to do with psychosis,' Dr. A said, per The Guardian. 'He couldn't have organized himself to do what he did. I think it might have been due to his frustrations, sexual frustration, pornography and hatred towards women.' Cauchi stabbed and killed six people and injured 12 others at a Westfield mall in Sydney on April 13. He was fatally shot by a responding police officer. Ash Good, 38, whose 9-month-old daughter was also injured in the attack, died in the hospital, and The Telegraph previously reported. Dr. A treated Cauchi at a private clinic from 2012 to 2020. He had been completely unmedicated since 2019 and was weaned off the antipsychotic medications, Clopine and Abilify, years before the attack. The doctor reportedly told the inquest the medication 'would have made no difference," per SMH. According to the outlet, Cauchi's mother, Michele, had tried to warn Dr. A and his nurses that her son was declining in late 2019, saying that Cauchi was scrawling messages about being under 'satanic' control and was obsessing over pornography and sexually transmitted diseases. Dr. A denied in the inquest that his former client showed signs of reemerging psychosis at the time and stands by the decision to wean him off his medication, per SMH. 'It was my decision, and his decision,' Dr A told the inquest on Tuesday, per SMH. 'I was listening to the patient … I did not fail in my care of Joel. I have no error on my behalf.' 'It wasn't psychosis, it wasn't even early warning signs of relapse, it was based on his fear of STDs, it was based on his sexual frustration, he told us later about prostitutes and women and sex,' Dr. A added. Want to keep up with the latest crime coverage? Sign up for for breaking crime news, ongoing trial coverage and details of intriguing unsolved cases. During a press conference on April 14, per 9 News Australia, Queensland Police Acting Asst. Comm. Roger Lowe said that he was "aware this individual has suffered from mental health" issues, referring to Cauchi. Cauchi's family said in a statement after the April 13 attack, per the BBC, "We are absolutely devastated by the traumatic events that occurred in Sydney yesterday. Our thoughts and prayers are with the families and friends of the victims and those still undergoing treatment at this time. Joel's actions were truly horrific, and we are still trying to comprehend what has happened." Read the original article on People
The Age
13-05-2025
- Health
- The Age
‘Hatred toward women': Killer's psychiatrist makes bombshell claim at Bondi inquest
Dr A's evidence contradicts a panel of psychiatric experts whose evidence to the inquest suggests Cauchi was 'floridly psychotic' and stabbed people at random. They concluded he was not motivated by any hatred or fixation on women after reviewing evidence from his phones and internet history. The evidence from Dr A has become central to the inquest as she weaned Cauchi off two antipsychotic medications, Clopine and Abilify, in the years before the attack. He was completely unmedicated from mid-2019. 'Do you take responsibility for the decision-making in removing Joel from Clopine and Abilify?' Dwyer asked. 'It was my decision, and his decision,' Dr A shot back. Loading 'I was listening to the patient,' she later added. By his late 20s and 30s Cauchi was highly intelligent, spoke multiple languages, and eager to establish a full life outside his parents' care, clinical notes show. But his decline from late 2019 was swift and dramatic. His mother tried desperately to raise the alarm with Dr A and the clinic. Michele Cauchi warned doctors and nurses that her son was scrawling notes about being under 'satanic' control, wearing layers of clothing to avoid illness, and was walking strangely. 'You had an agreement with (Cauchi), if there would be signs and symptoms of psychosis, he would take the medication?' Dwyer asked Dr A. 'He was a private patient, he decides if he wants to take the medication,' Dr A said. By November 2019 Cauchi was obsessing over pornography and sexually transmitted diseases. Loading But Dr A denied Cauchi showed early warning signs of relapse into psychosis in the final years of her care. 'Sitting in the witness box today … do you accept he did develop a psychosis?' Dwyer asked. 'It wasn't psychosis, it wasn't even early warning signs of relapse, it was based on his fear of STDs, it was based on his sexual frustration, he told us later about prostitutes and women and sex,' Dr A said. '(Re-medicating Cauchi) wouldn't have changed the outcome and, in hindsight, it wasn't necessary – the medication.' Cauchi's father, who has his own mental health problems, had spoken with his son's carers and described hearing the 'voice of God' and 'demons' of his own in 2019. He did not want his son to take any medication, and feared it could kill him. Dr A told the inquest that schizophrenia is hereditary, and required lifelong psychiatric care and monitoring. Cauchi was discharged from Dr A's clinic in 2020 and moved to Brisbane. Around that time, he began running into problems with police and became fixated with knives.
