Podcasts about Clozapine

In this second episode of our World Schizophrenia Day series, we revisit a controversial debate.Anti-psychotics like Abilify, Risperdal, and Clozapine are often used to help manage a person's symptoms of schizophrenia, including paranoia, delusions and hallucinations. However, there’s a movement that wants to shift mainstream thinking away from using medication to manage the symptoms of a serious mental illness. It encourages people to accept and live with the symptoms of severe mental illness, such as delusions and hallucinations.To help us navigate this hot-button dilemma, we talk to a Look Again recurring guest, Dr. Diane McIntosh, Psychiatrist and Clinical Assistant Professor at the University of British Columbia.Follow Look Again to listen to insightful conversations like this one that examine the treatment of severe mental illness. Until then, share your thoughts with us here. Leave a review so others can find our show.Resources:Dr. Diane McIntosh - BioBlindsided - Dr. Diane McIntosh's podcastAntipsychotic Selection Is Important for Reduced Nonadherence in SchizophreniaLook Again Season 1, Episode 5: The Truth Behind Psychiatric MedicationAnti-Psychotic Medication - CAMHSee omnystudio.com/listener for privacy information.

Send us a textIn this episode we are discussing the importance of provider-family partnerships for people with complex needs.Cheryl Jameson is our guest and she was in conversation with Emily Webb, host of this podcast, at the Complex Needs Conference in late March for the lived experience stream.A mental health support worker of many years, Cheryl found herself on the other side of systems when her eldest child Josh was 16 and developed psychosis. He was diagnosed with schizophrenia, which was drug-resistant for many years.  We discover how her family has navigated systems and worked with providers to ensure Josh has the support he needs and wants. Josh gave his consent for his mum to speak to us about their journey so far.ermha365 provides mental health and disability support for people in Victoria and the Northern Territory. Find out more about our services at our website.Helplines (Australia):Lifeline 13 11 14QLIFE 1800 184 52713 YARN 13 92 76Suicide Callback Service 1300 659 467ermha365 acknowledges that our work in the community takes place on the Traditional Lands of many Aboriginal and Torres Strait Islander Peoples and therefore respectfully recognise their Elders, past and present, and the ongoing Custodianship of the Land and Water by all Members of these Communities.We recognise people with lived experience who contribute to GET REAL podcast, and those who love, support and care for them. We recognise their strength, courage and unique perspective as a vital contribution so that we can learn, grow and achieve better outcomes together.

There's a care model for schizophrenia that actually works—why isn't it everywhere? On this episode, W. Gordon Frankle, MD, MBA, Vice Chair of Psychiatry at NYU Langone Health, shares how his team in Brooklyn is building a new model for treating serious mental illness—one rooted in long-term, relationship-driven, team-based care. From wraparound services to precision psychiatry, this conversation explores what happens when you bring humanity, structure, and innovation to a population too often left behind.Also discussed:The first novel schizophrenia drug in over 50 years (Cobenfy)Why clozapine is underused—and how that may finally changeThe potential of brain imaging and biomarkers in psychiatric treatmentWhat a real community mental health system looks likeWhy trust, not just treatment, is essential for recovery

Send us a textEric Smith shares his remarkable journey from child piano prodigy to mental health advocate after battling psychosis and addiction. His story reveals how finding the right medication after a decade of failed treatments transformed his life from hospitalization and FBI involvement to becoming a Texas Judicial Commissioner on Mental Health.• Displayed extraordinary musical talent from age three, studying under world-renowned pianists and performing with Grammy winners• Experienced early warning signs when grades declined in middle school, with a psychologist predicting future psychosis• Developed full-blown psychosis after getting sober, believing he had decoded assassination plots involving world leaders• Contacted the FBI about his delusions, leading to multiple meetings before his parents sought help from his former psychiatrist• Required three hospitalizations over several years before finding success with Clozapine after more than 10 years of failed medications• Experienced a profound moment of clarity two weeks after starting Clozapine when the "noise" in his mind quieted• Returned to education, maintaining a perfect 4.0 GPA through graduate school• Now serves as a commissioner with the Texas Judicial Commission on Mental Health and runs his own consulting business• Advocates for better access to effective treatments like Clozapine, which international guidelines recommend after two failed antipsychoticsVisit www.ericwtsmith.com to learn more about Eric's consulting work or to contact him directly.https://tonymantor.comhttps://Facebook.com/tonymantorhttps://instagram.com/tonymantorhttps://twitter.com/tonymantorhttps://youtube.com/tonymantormusicintro/outro music bed written by T. WildWhy Not Me the World music published by Mantor Music (BMI)

Dr. Jose de Leon speaks with Dr. Julia Ann Koretski, the Journal of Clinical Psychopharmacology's Digital Editor, about practical strategies for clinicians prescribing clozapine. This discussion builds on another podcast episode in which Dr. de Leon and a panel of authors and editors discuss recommendations to the FDA to make important changes to the drug's product label to reflect current knowledge about the drug's pharmacology, safety profile, and proper titration. Dr. de Leon, Professor of Psychiatry at the University of Kentucky College of Medicine, is the lead author of two articles on the topic in the May-June 2025 issue of JCP. In this podcast, Dr. de Leon elaborates on some of the complexities involved in managing clozapine use, given individual differences in clozapine metabolism as well as genetic and ethnic variabilities among groups. He stresses, however, that clozapine is a life-saving tool that can reduce the risk of suicide in people with schizophrenia.       Letter to the FDA Proposing Major Changes in the US Clozapine Package Insert Supported by Clozapine Experts Worldwide. Part I   Letter to the FDA Proposing Major Changes in the US Clozapine Package Insert Supported by Clozapine Experts.  Part II

It has been more than 35 years since clozapine was approved by the FDA for use in the United States. Since then, there have been major advances in pharmacokinetics as well as a substantial accumulation of real-world evidence about its use. In two articles in the May-June 2025 issue of the Journal of Clinical Psychopharmacology, Dr. Jose de Leon and dozens of colleagues call on the FDA to make important changes to the drug's product label to reflect current knowledge about the drug's pharmacology, safety profile, and proper titration. The stakes are high: The medication can be used effectively for treatment-resistant schizophrenia, but there has been concern that it has been underused, resulting in poorer outcomes for patients, including a high rate of suicides. Updating the package insert would help to educate clinicians on its proper use and monitoring for adverse effects. In this podcast, Dr. Julia Ann Koretski, JCP's digital editor, leads a panel discussion on the articles by Dr. de Leon and colleagues. In addition to Dr. de Leon, the other panelists include Dr. Larry Alphs, author of an editorial about the topic, Dr. Richard Balon, a coauthor and JCP Associate Editor, and Dr. Anthony Rothschild, a coauthor and Editor-in-Chief of the journal.   Letter to the FDA Proposing Major Changes in the US Clozapine Package Insert Supported by Clozapine Experts Worldwide. Part I   Letter to the FDA Proposing Major Changes in the US Clozapine Package Insert Supported by Clozapine Experts.  Part II   Incorporating Real -World Treatment Data Into Clozapine's Product Label

In this episode, we explore a landmark Finnish study examining the long-term risk of agranulocytosis in patients taking clozapine. The research followed 62,000 patients over 22 years, providing crucial data about this rare but serious side effect. Could these findings change how we approach clozapine prescribing and monitoring requirements? Faculty: Oliver Freudenreich, M.D. Host: Richard Seeber, M.D. Learn more about our membership here Earn 0.75 CME: Quick Take Vol. 66 Does Clozapine's Agranulocytosis Risk Persist Beyond Initial Treatment Period?

Join Dr. David Puder and expert psychopharmacologist Dr. Michael Cummings in a detailed discussion on Clozapine, the gold standard medication for treatment-resistant schizophrenia. They explore recent significant updates, including the removal of the Clozapine REMS program, which simplifies patient care and medication management. This episode covers optimal dosing practices, managing side effects, crucial drug interactions, and approaches to related conditions such as catatonia. An essential resource for psychiatrists and mental health professionals seeking updated clinical insights. By listening to this episode, you can earn 1.75 Psychiatry CME Credits. Link to blog. Link to YouTube video.

REMS requirement removed for schizophrenia treatment; new copper intrauterine device approved; Wegovy, Ozempic no longer in short supply; stem cell therapy for chronic lumbar disc disease fast tracked; ecopipam shows promise for Tourette syndrome.

Sometimes we have a window of opportunity to make a difference. In this series we discuss time-frames where panic, clozapine, and metformin have the greatest benefits.CME: Take the CME Post-Test for this EpisodePublished On: 02/24/2025Duration: 11 minutes, 53 secondsChris Aiken, MD and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Today, we have a very special guest joining us—Dr. John Kane! We will be discussing his experience and history with clozapine, a groundbreaking medication for treatment-resistant schizophrenia.

The questions answered in this podcast are listed below.They were compiled by GPs and health professionals around Australia. Can you start on Ozempic and up titrate to 1 milligram and then switch to Wegovy if one milligram is not enough OR is the goal to up titrate to 2.4 as it is the most effective dose, so prescribing Wegovy instead? How you can switch between Ozempic to Wegovy?  How about switching from semaglutide to tirzepatide, and liraglutide and saxenda? How quickly will you increase the dose and what dose do we aim for? What are your thoughts on patients that are responding to lower doses but are being prescribed a higher dose pen and trying to micro dose with a larger pen. How long do you keep the patients on semaglutide and when do you stop? When do you even think about the intermittent use of such an agent?    Can semaglutide be given for life? Can the medication be given fortnightly instead of weekly? Patients that want to re-start, will they restart at the dose they stopped at or at a lower dose? Is there a BMI target for patients with T2D? Position statement on T2D remission: When are they going to update and add in the GLP ones? Do we use the same dose or higher doses of Wegovy for adolescence?  What do you think about the use of semaglutide for an adolescent with autism or an adolescent using an anti-psychotic medication such as Clozapine who needs to take it on an ongoing basis? Has the use of semaglutide increased the incidence of restrictive eating disorders? Any indication for use in women with polycystic ovarian syndrome?   Host: Dr David Lim | Total Time: 28 mins Expert: A/Prof Ralph Audehm, General Practitioner Register for our fortnightly FREE WEBCASTSEvery second Tuesday | 7:00pm-9:00pm AEDT Click here to register for the next oneSee omnystudio.com/listener for privacy information.

Send a Text to the Moms - please include your contact info if you want a response. thanks!Guests: Robert S Laitman, MD,Mimi Liu, Doro MindAt Doro Mind. the mission is to provide compassionate, accessible, and dynamic care and support for individuals suffering from psychosis and their caregivers.Dr. Robert Laitman is a psychiatric internist dedicated to changing the treatment paradigm for psychosis. He is the author of “Meaningful Recovery from Schizophrenia & Serious Mental Illness with Clozapine” which outlines his families personal story supporting his son through schizophrenia and pioneering a novel evidence based approach to psychosis treatment with clozapine.Mimi Liu is the former COO & CTO of Firefly Health, where she led operations and tech for delivering integrated primary care and behavioral health services. Mimi leads Doro Mind with the personal passion that comes from supporting her brother through his journey with psychosis.Into the Light movie episode : #94Links:https://www.doromind.com/https://www.teamdanielrunningforrecovery.org/Dr. Laitman's book:https://a.co/d/iLrDwvCDaniel Laitman on Youtube:https://youtu.be/uBdJWFvP-uc?si=8ECR7DfhDGc3gdHxMindy and her book: https://mindygreiling.com/Randye and her book: https://www.randyekaye.com/Miriam and her book: https://www.miriam-feldman.com/More Than the Dress“More than the Dress” is a biweekly podcast hosted by Michele C. Meyer-Shipp, Esq.,...Listen on: Apple Podcasts SpotifyWant to know more?Join our facebook page Our websites:Randye KayeMindy Greiling Miriam (Mimi) Feldman

What are the primary barriers to clozapine utilization in the United States, and how do these barriers impact patient care? What are some common misconceptions or negative attitudes among prescribers regarding clozapine, and how can these be addressed? What are some effective strategies for improving the management of clozapine's side effects to encourage its use? What strategies can be implemented to improve education and awareness about clozapine?  Brought to you by the NEI Podcast, the PsychopharmaStahlogy Show tackles the most novel, exciting, and controversial topics in psychopharmacology in a series of themes. This theme is on underutilized psychotropic drugs.  Today, Dr. Andy Cutler interviews Dr. Jonathan Meyer and Dr. Stephen Stahl about factors that have led to the underutilization of clozapine in psychiatry.  Let's listen to Part 3 of our theme: Underutilized Psychiatric Drugs.  Subscribe to the NEI Podcast, so that you don't miss another episode!  Resources  The Clozapine Handbook   Clozapine titrations paper (see Supplementary Material):   de Leon J et al. Pharmacopsychiatry 2022;55(2):73-86.  FDA committees meeting to discuss reevaluation of the Clozapine REMS program (November 19, 2024): click here. 

Internationally renowned bipolar disorder expert Dr. Trisha Suppes unravels the latest science in bipolar disorder treatment by breaking down the proven and cutting-edge treatments available today - exploring traditional solutions such as Lithium and mood stabilizers alongside exciting new options like psilocybin, ketamine, and the Ketogenic diet. Dr. Suppes also navigates the complexities of mania and tackles the perennial question: is lifelong medication necessary to live well with bipolar disorder? (00:00) About Dr. Suppes Medication Treatments (03:00) Is Lithium the Gold Standard? (05:22) Atypical Antipsychotics (07:22) Dangers of Antidepressants? (09:17) Medications Lose Strength? Non-medication Treatments (10:47) Psychotherapy (12:54) Ketogenic Diet & Nutrition (13:28) Cannabis (14:20) Ketamine Brain Stimulation Therapies (15:18) rTMS (Transcranial Magnetic Stimulation) (16:01) VNS (Vagus Nerve Stimulation) (17:07) ECT (Electroconvulsive Therapy) Bipolar Disorder is Complex (18:52) Insight & Denying Bipolar Disorder (22:45) Bipolar I: Need Meds Forever? (23:44) Bipolar II: Need Meds Forever? (26:22) Hypomania Causes Misdiagnosis (28:16) Mixed States Psychedelics (29:28) Psilocybin & Magic Mushrooms (32:33) Microdosing & LSD (34:02) MDMA Closing (35:41) Keeping You "A Little Depressed" (37:55) Why Recovery Is Possible (39:06) Reflecting on Research Impact Dr. Trisha Suppes, M.D., Ph.D., is a distinguished expert on the biology and treatment of bipolar disorder, and mood disorders generally. Dr. Suppes is the Director of Exploratory Therapeutics and Professor at Stanford University in the School of Medicine. At the VA Palo Alto Health Care System, she is Director of the CSP NODES and is the Founder of the Bipolar and Depression Research Program. Her areas of expertise include long-term treatment strategies for bipolar disorder, identification and treatment of bipolar II disorder, treatment of those with bipolar disorders and co-morbid conditions and use of complementary medicine. She has recently launched a new initiative to explore the use of psychedelics for mood disorders and PTSD in Veterans. Dr. Suppes has been integrally involved in numerous initiatives to improve evidence-based treatment for bipolar disorders. Dr. Suppes participated as a member of the DSM-5 Mood Disorders committee on updating the APA DSM-5 criteria for Mood Disorders and was chair of the APA DSM-5 Bipolar Disorder subcommittee. She was the past President of the International Society of Bipolar Disorders (ISBD). Treatments Referenced

In this episode of the Real Life Pharmacology podcast, I cover drugs 16-20 of the top 200 drugs. This podcast includes information about clozapine, furosemide, heparin, tetracycline, and vardenafil. Clozapine has five boxed warnings and these are all items that you may see on your pharmacology and board exams! I've also blogged about these in the past at meded101. Furosemide is a loop diuretic and a common indicator of the prescribing cascade. I discuss this in this podcast episode. Heparin can cause thrombocytopenia. I discuss what HIT (heparin-induced thrombocytopenia) may look like.

In this episode, we welcome back Dr. Michael Cummings to answer questions sent in by podcast listeners. Topics include Valproic Acid, Lithium, Treating Veterans, Restless Leg Syndrome, and much more. 

In this episode, we discuss the management of common adverse effects associated with clozapine treatment, including myocarditis, cardiomyopathy, tachycardia, orthostatic hypotension, and metabolic syndrome. How can clinicians mitigate these risks while optimizing treatment outcomes for patients with treatment-resistant schizophrenia? Faculty: Brian Miller, M.D. Host: Richard Seeber, M.D. Learn more about our memberships here Earn 1.25 CME: Clozapine: Management and Challenges Managing Cardiac and Metabolic Adverse Effects of Clozapine

In this episode, we navigate the complexities of initiating and optimizing clozapine treatment for patients with treatment-resistant schizophrenia. How do you chart the course for successful clozapine therapy while managing side effects and drug interactions? Join us as Dr. Brian Miller shares his expertise and valuable psychopharmacology pearls. Faculty: Brian Miller, M.D. Host: Richard Seeber, M.D. Learn more about our memberships here Earn 1.25 CMEs: Clozapine: Management and Challenges Initiating and Optimizing Clozapine

In this episode, we delve into the use of clozapine for treatment-resistant psychosis and mood disorders. When should clinicians consider clozapine, and what do expert guidelines recommend? Dr. Brian Miller guides us through the evidence and best practices for utilizing this powerful but often underused medication. Faculty: Brian Miller, M.D. Host: Richard Seeber, M.D. Learn more about our memberships here Earn 1.25 CME: Clozapine: Management and Challenges Using Clozapine for Treatment-Resistant Psychosis and Mood Disorders

Embark on an enlightening expedition, as we navigate the vital intricacies of pharmacovigilance and risk management alongside Tom Nichols, zoologist turned PV aficionado and Director of Drive Phase PV. Tom regales us with his unexpected but inspiring foray into the world of drug safety, stemming from a keen interest in epidemiology. His captivating tales underscore the importance of PV in delivering life-saving therapies to market, particularly through his work with Clozapine, an anti-psychotic medication. This conversation is a testament to PV's dual role as both a guardian of public health and a strategic ally in expediting breakthrough medical treatments.Tom then delves into the nuances of integrated clinical trial sponsorship and how this model encourages collaboration across the pharmaceutical landscape. Reflecting on my own career trajectory, he offer's a candid comparison of working within the close-knit fabric of clinical research versus the challenges posed by outsourcing, providing a glimpse into the dynamic nature of our industry.As the journey concludes, Tom explores the landscape of future pharmacovigilance strategies, where the deployment of AI could revolutionize patient safety protocols, and the delicate balance between swift drug access and thorough post-market analysis is ever-present. Tom's insights, coupled with moments of passionate discourse, have been nothing short of invigorating. Join us for a conversation that promises not only to inform but to inspire a deeper appreciation of pharmacovigilance.

In this episode, we discuss the treatment of agranulocytosis or neutropenia in patients on clozapine therapy, a rare yet serious scenario that clinicians may encounter. We delve into the possibility of rechallenging clozapine treatment after such an event and explore the use of colony-stimulating factors. What's the likelihood of agranulocytosis while prescribing clozapine long term? Faculty: Oliver Freudenreich, M.D. Host: Richard Seeber, M.D. Learn more about our membership here Earn 0.5 CMEs: Quick Take Vol. 53 The Impact of Colony-Stimulating Factor on Clozapine Rechallenge Outcomes

Explore how to mitigate, monitor for, and establish clinically relevant thresholds of clozapine-associated inflammation. Access full text of the manuscript at: https://accpjournals.onlinelibrary.wiley.com/doi/10.1002/phar.2887

Caitlin Schanz, PharmD discusses considerations for clozapine-induced myocarditis. For more pharmacy content, follow Mayo Clinic Pharmacy Residency Programs @MayoPharmRes. You can also connect with the Mayo Clinic's School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd. 

In this episode, we discuss the causes of clozapine-induced orthostasis. Although some patients may develop tolerance, it can limit titration and potentially obstruct patients from reaching the plasma level where they respond well to the medication. There are practical management strategies for orthostasis, including slow titration based on patient complaints and encouraging fluid intake, among others. Faculty: Jonathan Meyer, M.D. Host: Richard Seeber, M.D. Learn more about our memberships here Earn 1.25 CME: Managing Some Unique Nonhematologic Adverse Effects of Clozapine Managing Clozapine-Related Orthostasis

In this episode, we explore a common yet severe side effect of clozapine: Constipation. Why does this drug cause such drastic changes in colonic transit times, and how can we manage it effectively? Faculty: Jonathan Meyer, M.D. Host: Richard Seeber, M.D. Learn more about our memberships here Earn 1.25 CME: Managing Some Unique Nonhematologic Adverse Effects of Clozapine Managing Clozapine-Related Constipation

My favorite opening line of an academic article (this week) follows:Mental illnesses are prevalent, cause great suffering, and are burdensome to society.Welcome to the Frontier Psychiatrists. It's a newsletter that I write all by myself. I'm doing a series on medications, largely (but not entirely) in psychiatry. I'm a child and adult psychiatrist, and I still see patients. I've also been a patient since I was 16 years old. Please consider subscribing and sharing widely.The first antipsychotic introduced after clozapine would be a big deal—especially if it didn't cause life-threatening side effects. Risperidone was first developed by the Johnson & Johnson subsidiary Janssen-Cilag between 1988 and 1992 and was first approved by the FDA in 1994. It's one of the very few drugs with data for bipolar disorder that I, personally, have never been prescribed.Risperidone—Risperdal as a trade name—was ready to be a huge hit.It was presented as very atypical—this was the post-clozapine branding of choice. The “second generation” label was added years later. I have a confession to make. After residency, when the attending doctors told me, as a trainee, what to prescribe, I never prescribed risperidone ever again. I think this compound—and paliperidone, the metabolite— still has an important role in managing schizophrenia and bipolar disorder. There are more formulations of long-acting injectable risperidone and related compounds than I can remember. I think those are going to be useful drugs for a long time. Oral risperidone? Nope.Clozapine was an exciting drug. No horrible motor side effects? (Plausibly) More effective? It was better than every drug that came before. It had this pesky adverse effect that could lead to death called agranulocytosis, which I addressed in my first research paper in 2011. We needed more drugs that were this atypical!We—the field of psychiatry, at least— needed things that were not gonna kill you abruptly, in a terrifying manner, like clozapine had the rare potential to do. But we didn't want more of the same old antipsychotics. After Psychiatry got a taste of not having to explain permanent tardive dyskinesia as a likely side effect of antipsychotic medication, we wanted to keep doing that. Editors note: It is still a side effect of all non-clozapine antipsychotics, and we should never have let our guard down.Risperidone was the first antipsychotic that came to market after clozapine rocked the world of psychiatry by being better. Risperidone is similar, and they even use the accidental branding of clozapine— “atypical”—for this medication. The Food and Drug Administration (FDA)-approved indications for oral risperidone (tablets, oral solution, and M-TABs) include the treatment of:* schizophrenia (in adults and children aged 13 and up), * bipolar I acute manic or mixed episodes as monotherapy (in adults and children aged 10 and up), * bipolar I acute manic or mixed episodes adjunctive with lithium or valproate (in adults)* autism-associated irritability (in children aged 5 and up). Also, the long-acting risperidone injection has been approved for the use of schizophrenia and maintenance of bipolar disorder (as monotherapy or adjunctive to valproate or lithium) in adults.The “mechanism of action” of all of the drugs that have efficacy in psychosis was presumed to be dopamine D2 receptor blockade, a mechanism shared with all of the prior medication from Thorazine (chlorpromazine) through Haldol (haloperidol). The assumption—which clozapine disproved—was motor side effects were required for the drug's efficacy in psychosis. This primacy of the D2 blockade as a mechanism of action has since been disproven. This is the mechanism that leads to gynecomastia, leading to a bevy of lawsuits from men who developed breasts. It also causes related side effects like galactorrhea—breast milk from breasts that can be on men or women who are not nursing— and erectile dysfunction. Dopamine—it does a lot of work in the brain, not just pleasure.This motor side effect profile was not true with clozapine. It had various additional receptors, particularly in the serotonergic family (5HT-2a, for example), and alpha-adrenergic, histaminic, and other receptor sites throughout the brain. This broad profile of different receptors explains the wide range of side effects. But more importantly, these are complex, “messy,” and hard-to-predict outcomes given the complexity of the brain. The complex pharmacology allowed psychiatrists like me to think—hard!—about which particular witches brew of receptors we would choose to tickle (agonize) or antagonize. It's very satisfying. I also suspect this is a story we tell ourselves that is not as closely moored to truth as we'd like. We enjoy thinking about science-ish stuff. Receptor binding profiles are seductive— because they are knowable. Our patient's heart, hope, dreams, and heartbreak? Less so.The most important feature of risperidone today—and its 1st order metabolite, paliperidone—is that is deliverable as pills, rapid-acting dissolvable tablets, and long-acting injectable formulations, lasting between 2 weeks and 6 months between doses. A psychiatric treatment that isn't an oral once-daily pill? One you have to take twice a year? Medicine that is intended for people who often—like many—feel conflicted about taking a daily pill? That is a big enough deal. That is a real innovation— it considers human frailty, ambivalence, and common failures of mind. Not because it's a magic drug. Rather, long-acting medicine that doesn't make crippling relapse easy —thanks to good design— is exactly the kind of medicine that works. My second research effort was on the acceptability of such medicines in youth. It's responsible for my presence at the academic conference where I met my now wife.Oral medicines were popular because they were easy to sell. Novel medicines and technologies will be easy to take. The story of my fascination with the risks and benefits of these medicines doesn't end there, though.I still research these medicines and their adverse effects— funded by NIMH— for identifying Tardive Dyskinesia with Machine Learning and closed-loop Internet of Things physical medication compliance tech with my team at iRxReminder and colleagues at Videra. We are enrolling in a study at Fermata in New York and other sites. Thanks for reading.This article is another in my series about one drug or another. Prior installments include Depakote, Geodon, Ambien, Prozac, Xanax, Klonopin, Lurasidone, Olanzapine, Zulranolone, Benzos, Caffeine, Semeglutide, Lamotrigine, Cocaine, Xylazine, Lithium, dextromethorphan/bupropion and Adderall, etc.Sponsored Content!One way of supporting this publication is buying stuff from Amazon, like a nifty box from Apogee that I used to record the voice-over: the BOOM. In fairness, it's just the A/D. I am also using the API 512c mic pre, plugged into an AnaMod 660 500 series compressor, nestled in a reliable RND R6 Lunchbox, and all of that plugs into the Boom into my Mac. It's a Microtech Geffel mic. Most of the audio post-processing is done with Izotope RX 10. I get money if you purchase any of these things— not a trivial amount since they upped my affiliate rewards.In case anyone was wondering if I was an audio nerd… This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit thefrontierpsychiatrists.substack.com/subscribe

Speaker: Robert O. Cotes, MD Associate Professor at Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences Director Clinical & Research Program for Psychosis at Grady Health System Title: Psychiatry Grand Rounds: From Red Tape to Recovery: How You Can Unlock Clozapine's Game-Changing Potential Disclosures: Grant/Research Support: Otsuka, Roche, Alkermes, Karuna Consultant: Saladax Biomedical, HLS Therapeutics (unpaid) Speakers bureau: Saldax Biomedical Objectives: - List three scenarios for when to obtain TDM for clozapine as per the ASCP/AGNP guideline - List one clinically relevant example of how someone from a specific ethnic or cultural background may metabolize clozapine differently - Describe one possible change the FDA could make to the Clozapine REMS system to improve access

In this episode, we delve into the problem of sialorrhea or excessive salivation in patients on clozapine. Why does this occur, and how can it be managed? Join us as Dr. Jonathan Meyer shares his expertise on this unique side effect. Faculty: Jonathan Meyer, M.D. Host: Richard Seeber, M.D. Learn more about our memberships here Earn 1.25 CME: Managing Some Unique Nonhematologic Adverse Effects of Clozapine Managing Clozapine-Related Sialorrhea

Clozapine is an important drug in the treatment of schizophrenia, and adherence is generally thought to be as good as, if not better than, other antipsychotics. Nonadherence, however, is difficult to detect and potentially dangerous. Tolerance to the cardiovascular effects of the drug is easily lost; restarting at a “normal” dose can prove fatal after a period of abstinence. Nonadherence also increases the risk of self-harm. In this podcast, Dr. Robert Flanagan, a now-retired clinical scientist at Kings College Hospital in London, discusses his study of nonadherence, as measured by plasma levels of clozapine, in samples submitted to a clozapine therapeutic drug monitoring service from 1993–2017. In thousands of submitted samples, nonadherence was 1.1% for men and 1% for women. Dr. Flanagan discusses both the implications of his research as well its limits. The research is published in the September–October 2023 issue of the Journal of Clinical Psychopharmacology, in an article titled “Assessing Adherence to Clozapine: Practical Considerations.” Dr. Flanagan's coauthors are Samora Hunter and Stephen J. Obee, also of Kings College Hospital.

In this episode, we welcome Dr. John M. Kane, Dr. Lauren Hanna, Dr. Julia Tartaglia, and Dr. Joseph Flaxer to discuss Clozapine and treatment-resistant schizophrenia. 

Jonathan Leung, PharmD, BCPS, BCPP provides updates on the clozapine REMS program, reviews the therapeutic benefits of clozapine, as well as key adverse events.   For more pharmacy content, follow Mayo Clinic Pharmacy Residency Programs @MayoPharmRes. You can also connect with the Mayo Clinic's School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd. 

Drs Madhukar H. Trivedi and Christoph U. Correll discuss the predictors of suicidal ideation, attempt, and death as well as how to address the topic of suicidality with patients and their loved ones. Relevant disclosures can be found with the episode show notes on Medscape (https://www.medscape.com/viewarticle/984464). The topics and discussions are planned, produced, and reviewed independently of advertisers. This podcast is intended only for US healthcare professionals. Resources Depression https://emedicine.medscape.com/article/286759-overview Prevalence of Suicidality in Major Depressive Disorder: A Systematic Review and Meta-Analysis of Comparative Studies https://pubmed.ncbi.nlm.nih.gov/34603096/ Twelve-Month Prevalence of and Risk Factors for Suicide Attempts in the World Health Organization World Mental Health Surveys https://pubmed.ncbi.nlm.nih.gov/20816034/ Persistent Depressive Disorder https://www.ncbi.nlm.nih.gov/books/NBK541052/ Risk and Protective Factors for Suicide and Suicidal Behavior https://www.div12.org/wp-content/uploads/2012/10/Suicide-Risk-Factors-with-Graphics-Div12.pdf Prevention of Suicide by Clozapine in Mental Disorders: Systematic Review https://pubmed.ncbi.nlm.nih.gov/36640481/ Lithium Suicide Prevention: A Brief Review and Reminder https://pubmed.ncbi.nlm.nih.gov/30834169/ Trauma-Focused Psychotherapies for Post-Traumatic Stress Disorder: A Systematic Review and Network Meta-analysis https://pubmed.ncbi.nlm.nih.gov/34473342/ Intranasal Esketamine and Current Suicidal Ideation With Intent in Major Depression Disorder: Beat the Clock, Save a Life, Start a Strategy https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7203410/ Dextromethorphan/Bupropion (Rx) https://reference.medscape.com/drug/auvelity-dextromethorphan-bupropion-4000211 Status Update on the Sheehan-Suicidality Tracking Scale (S-STS) 2014 https://pubmed.ncbi.nlm.nih.gov/25520892/ Psychometric Properties of the Beck Depression Inventory-II: A Comprehensive Review https://pubmed.ncbi.nlm.nih.gov/24402217/ The 9-Item Concise Health Risk Tracking – Self-Report (CHRT-SR9) Measure of Suicidal Risk: Performance in Adult Primary Care Patients https://pubmed.ncbi.nlm.nih.gov/36865066/ Maximizing the Adequacy of Medication Treatment in Controlled Trials and Clinical Practice: STAR(*)D Measurement-Based Care https://pubmed.ncbi.nlm.nih.gov/17406651/ Psychometrics of the Self-Report Concise Associated Symptoms Tracking Scale (CAST-SR): Results From the STRIDE (CTN-0037) Study https://pubmed.ncbi.nlm.nih.gov/29325238/ Mechanisms of Action and Clinical Efficacy of NMDA Receptor Modulators in Mood Disorders https://pubmed.ncbi.nlm.nih.gov/28711661/ Psychoplastogens: A Promising Class of Plasticity-Promoting Neurotherapeutics https://pubmed.ncbi.nlm.nih.gov/30262987/ Zuranolone in Major Depressive Disorder: Results From MOUNTAIN-A Phase 3, Multicenter, Double-Blind, Randomized, Placebo-Controlled Trial https://pubmed.ncbi.nlm.nih.gov/36811520/ GABA Receptor Positive Allosteric Modulators https://www.ncbi.nlm.nih.gov/books/NBK554443/# Conjoint Therapy https://dictionary.apa.org/conjoint-therapy

This is the 16th podcast episode for the Psychiatric Medication Podcast Series. Series Description: Current literature indicates that podcasts can be an effective educational format to reach health professionals across the continuum of medical education, addressing a myriad of topics pertinent to providers. This episode serves as an overview of Clozapine/Clozaril. This podcast season is the second released by East Carolina University's Office of Continuing Medical Education and may be beneficial for physicians, residents, fellows, nurse practitioners, physician assistants, and nurses. This podcast season is comprised of approximately 30 episodes, each focusing on different psychiatric medications for the non-psychiatric provider. Those tuning into the podcast's second season will receive a primer on the "bread and butter" behavioral health medications for primary care: antidepressants, antipsychotics, and mood stabilizers. Episodes will be released weekly on Wednesdays.Rachel Gooding, MD & Amizetta Clark, MD

Drs John M. Kane and Jonathan Meyer discuss treatment-resistant schizophrenia, how common it is, how to detect and manage it, and how delays in the initiation of treatment negatively affect patients. Relevant disclosures can be found with the episode show notes on Medscape (https://www.medscape.com/viewarticle/984480). The topics and discussions are planned, produced, and reviewed independently of advertisers. This podcast is intended only for US healthcare professionals. Resources The Clozapine Handbook: Stahl's Handbooks (Stahl's Essential Psychopharmacology Handbooks) https://www.amazon.com/Clozapine-Handbook-Handbooks-Essential-Psychopharmacology/dp/1108447465 Treatment Resistant Schizophrenia: Clinical, Biological, and Therapeutic Perspectives https://pubmed.ncbi.nlm.nih.gov/30170114/ Predictors of Treatment-Resistant and Clozapine-Resistant Schizophrenia: A 12-Year Follow-up Study of First-Episode Schizophrenia-Spectrum Disorders https://pubmed.ncbi.nlm.nih.gov/33043960/ Mortality in People With Schizophrenia: A Systematic Review and Meta-analysis of Relative Risk and Aggravating or Attenuating Factors https://pubmed.ncbi.nlm.nih.gov/35524619/ Pharmacological Interventions for Clozapine-Induced Hypersalivation https://pubmed.ncbi.nlm.nih.gov/18646130/ The Effect of Clozapine on Premature Mortality: An Assessment of Clinical Monitoring and Other Potential Confounders https://pubmed.ncbi.nlm.nih.gov/25154620/ Antipsychotic Plasma Levels in the Assessment of Poor Treatment Response in Schizophrenia https://pubmed.ncbi.nlm.nih.gov/29072776/ Treatment-Resistant Schizophrenia: Treatment Response and Resistance in Psychosis (TRRIP) Working Group Consensus Guidelines on Diagnosis and Terminology https://pubmed.ncbi.nlm.nih.gov/27919182/ An International Adult Guideline for Making Clozapine Titration Safer by Using Six Ancestry-Based Personalized Dosing Titrations, CRP, and Clozapine Levels https://pubmed.ncbi.nlm.nih.gov/34911124/ FDA Strengthens Warning That Untreated Constipation Caused by Schizophrenia Medicine Clozapine (Clozaril) Can Lead to Serious Bowel Problems https://www.fda.gov/drugs/drug-safety-and-availability/fda-strengthens-warning-untreated-constipation-caused-schizophrenia-medicine-clozapine-clozaril-can Cariprazine https://reference.medscape.com/drug/vraylar-cariprazine-999874 Lumateperone https://reference.medscape.com/drug/caplyta-lumateperone-1000316 Lurasidone https://reference.medscape.com/drug/latuda-lurasidone-999605

https://psychiatry.dev/wp-content/uploads/speaker/post-12045.mp3?cb=1677419726.mp3 Playback speed: 0.8x 1x 1.3x 1.6x 2x Download: Is Clozapine-induced Weight Gain Dose-dependent? Results From a Prospective Cohort Study – Marianna Piras et al. Schizophrenia Bulletin. 2023. Antipsychotic-induced metabolic adverseFull EntryIs Clozapine-induced Weight Gain Dose-dependent? Results From a Prospective Cohort Study –

Clozapine is a unique antipsychotic with superior efficacy in treatment-resistant schizophrenia (TRS). Unfortunately, approximately 40% to 70% of patients on clozapine continue to experience psychotic symptoms. Nevertheless, there is a concern about how high of a dose to prescribe because adverse effects are related to plasma levels of the drug. In this podcast, Dr. Jan Bogers discusses his research involving stepwise increases in clozapine doses in severely ill, long-stay patients with TRS. The study, conducted at Rivierduinen Mental Health Organization in the Netherlands, concludes that most patients older than 60 years could not tolerate high clozapine levels and so this should not be attempted in older or otherwise physically vulnerable patients. Increasing clozapine levels to approximately 750 ng/mL in middle-aged patients with longstanding TRS may modestly reduce the severity of positive symptoms and improve the response rate. The article appears in the March-April 2023 issue of the Journal of Clinical Psychopharmacology.

CardioNerds co-founder Daniel Ambinder joins Dr. Essa Hariri, Dr. Anna Scandinaro, Dr. Beka Bekhdatze, and Dr. Ashley Kasper (Cleveland Clinic cardiology fellows) as well as Dr. Craig Parris from Ohio State University Medical Center for a walk at Edgewater Park in Cleveland, Ohio. Dr. Andrew Higgins (Crtitical Care Cardiology and Advanced HF / Transplant Cardiology at Cleveland Clinic) provides the ECPR for this episode. They discuss the following case involving a rare cause of non-ischemic cardiomyopathy. A young African American male was admitted for cardiogenic shock following an admission a month earlier for treatment resistant psychosis. He was diagnosed with medication-induced non-ischemic cardiomyopathy, which resolved with a remarkable recovery of his systolic function after discontinuation of the culprit medication, Clozapine. Episode notes were drafted by Dr. Essa Hariri. Audio editing by CardioNerds Academy Intern, student doctor Shivani Reddy. Enjoy this case report co-published in US Cardiology Review: Clozapine-induced Cardiomyopathy: A Case Report CardioNerds is collaborating with Radcliffe Cardiology and US Cardiology Review journal (USC) for a ‘call for cases', with the intention to co-publish high impact cardiovascular case reports, subject to double-blind peer review. Case Reports that are accepted in USC journal and published as the version of record (VOR), will also be indexed in Scopus and the Directory of Open Access Journals (DOAJ). CardioNerds Case Reports PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls - An Unusual Case of Non-ischemic Cardiomyopathy The diagnosis of drug-induced non-ischemic cardiomyopathy is usually one of exclusion. High clinical suspicion is needed to diagnose drug-induced cardiomyopathy. Missing the culprit medication causing drug-induced cardiomyopathy could be detrimental as there is a high probability of reversing a systolic dysfunction after stopping the offending medication. Clozapine is an effective medication for the treatment-resistant schizophrenia and is associated with reduced suicide risk. Clozapine is reported to cause drug-induced cardiomyopathy and is more common with rapid drug titration. Clozapine is more commonly associated with myocarditis. Close monitoring and vigilance are critical to preventing cardiac complications associated with initiating clozapine. The management of clozapine-associated cardiomyopathy includes clozapine cessation and heart failure guideline-directed medical therapy. Show Notes - An Unusual Case of Non-ischemic Cardiomyopathy We treated a case of clozapine-associated cardiomyopathy presenting in cardiogenic shock. Drug-induced cardiomyopathy is a common yet under-recognized etiology of non-ischemic cardiomyopathy. Clozapine is an FDA-approved atypical antipsychotic medication frequently prescribed for treatment-resistant schizophrenia and the only antipsychotic agent that has been proven to significantly reduce suicide among this patient population. However, Clozapine is reported to be associated with several forms of cardiotoxicity, including myocarditis (most common), subclinical clozapine associated cardiotoxicity, and least commonly, drug-induced cardiomyopathy. Clozapine-associated cardiomyopathy should be considered as a differential diagnosis in schizophrenic patients presenting with signs of acute heart failure.  Rapid titration of clozapine is a risk factor for clozapine-associated cardiomyopathy and clozapine-associated myocarditis. To date, there is no evidence or consensus supporting preemptive screening. According to the American Psychiatric Association, whenever clozapine-induced myocarditis or cardiomyopathy is suspected, a cardiology consult is warranted. Experts recommend, when initiating clozapine,

Clozapine is a antipsychotic drug that has been marketed for decades. In this interview, Dr. Friedman shares his thoughts on its utility in Parkinson's disease along with some practical advices on how to use it in the clinic. Read the article.

Should we start prescribing metformin to our patients on clozapine? In this episode, we discuss several articles on the efficacy of clozapine in preventing clozapine-induced weight gain, including some evidence on when metformin is more effective. Faculty: Jim Phelps, M.D. Host: Richard Seeber, M.D. Learn more about our membership here Earn 0.5 CMEs: Quick Take Vol. 42 Metformin for the Prevention of Clozapine-Induced Weight Gain: A Retrospective Naturalistic Cohort Study

Like any prescription medication, Abilify, Risperdal, Clozapine, and other anti-psychotics have side effects. And like any medication, they are prescribed to help a person manage an illness. Anti-psychotics can help with a number of different illnesses, but often used to help manage a person's symptoms of schizophrenia, including paranoia, delusions and hallucinations. However, there's a movement that wants to shift mainstream thinking away from using medication to manage the symptoms of a serious mental illness. It's encouraging people to accept and live with the symptoms of serious mental illness, symptoms like voices, hallucinations, and other symptoms. It's a controversial topic and we've brought back a familiar voice from our first season – Dr. Diane McIntosh, Psychiatrist and Clinical Assistant Professor at the University of British Columbia. In this episode, we talk about the use of medications in treating serious mental illnesses like schizophrenia. Resources:Dr. Diane McIntosh - BioBlindsided - Dr. Diane McIntosh's podcastAntipsychotic Selection Is Important for Reduced Nonadherence in SchizophreniaLook Again Season 1, Episode 5: The Truth Behind Psychiatric MedicationAnti-Psychotic Medication - CAMHSee omnystudio.com/listener for privacy information.

In this podcast episode, Marwan Sabbagh, MD, FAAN, and Marta San Luciano, MD, MS, FAAN, have a conversation about Parkinson's disease psychosis (PDP). Their discussion provides information on the disease itself—covering symptoms, risk factors, and mechanism—before moving into clinical strategies for diagnosis and disease and comorbidity management. The experts emphasize the importance of ruling out an underlying cause of psychosis before making a diagnosis of PDP, calling out common culprits such as urinary and respiratory tract infections. Following diagnosis, they comment on the value of implementing nonpharmacologic measures in tandem with pharmacologic interventions for PDP. Within the discussion of pharmacologic interventions, Drs Sabbagh and San Luciano give a well-rounded explanation of patient and medication factors they consider when choosing a treatment for their patients with PDP, including patient outcomes they have experienced in clinical practice. Rounding out the podcast, the experts touch on their approach to managing the very common comorbidity of sleep disturbances in patients with PDP.Presenters:Marwan Sabbagh, MD, FAANProfessor of NeurologyAlzheimer's and Memory Disorders DivisionDepartment of NeurologyBarrow Neurological InstitutePhoenix, ArizonaMarta San Luciano, MD, MS, FAANAssociate Professor of NeurologyUniversity of California, San FranciscoAttending NeurologistNeurology/Movement Disorders and Neuromodulation CenterUniversity of California, San Francisco Medical CenterSan Francisco, CaliforniaThis content is based on a CE/CME program supported by an independent educational grant from Acadia Pharmaceuticals, Inc.For additional activities in this program, visithttp://bit.ly/3tPMqnr

Why is clozapine underutilized, even though it's a very effective antipsychotic for treatment-resistant schizophrenia? What led you to write The Clozapine Handbook? In this episode, Dr. Andrew Cutler interviews Dr. Jonathan Meyer about the use of clozapine in clinical practice.  With this special series, brought to you by the NEI Podcast we will address a different theme in psychopharmacology every 3 months. Each theme is split into 3 parts, with one part released each month. This theme is on practical psychopharmacology. Episodes to be released under this theme include: Part 1: Management of Complex Treatment-Resistant Psychotic Disorders with Dr. Michael Cummings Part 2: The Clozapine Handbook with Dr. Jonathan Meyer Part 3: Don't Guess! Measure: The Clinical Use of Antipsychotic Plasma Levels with Dr. Jonathan Meyer Subscribe to the NEI Podcast, so that you don't miss another episode!

USPSTF recommendations on estrogen and progesterone; semaglutide assessed in obese teenagers; efficacy and safety data released for maternal RSV vaccine; updates to clozapine REMS; FDA panel vote on investigational CNS/leptomeningeal metastasis treatment.

In this podcast, Dr. Jonathan Leung discusses the article, “The Modernization of Clozapine: A Recapitulation of the Past in the United States and the View Forward,” published with several colleagues in the November-December 2022 issue of the Journal of Clinical Psychopharmacology (Volume 42, Issue 6). Dr. Leung, lead author of the review article, is a psychiatric pharmacist at the Mayo Clinic in Rochester, MN, and faculty member at the Mayo Clinic College of Medicine. Clozapine is a unique life-saving drug for treatment-resistant schizophrenia and reduction in risk of recurrent suicidal behavior in schizophrenia or schizoaffective disorder, but it is underused in the United States despite its established efficacy. Clozapine's benefits for reduction of suicidality may extend to other uses as well, although more rigorous studies are needed. The article and podcast discuss the history of FDA approval for clozapine, hematologic monitoring requirements that have been viewed as cumbersome, as well as other barriers related to clozapine use.

In this podcast episode, Robert O. Cotes, MD, and Jonathan M. Meyer, MD, discuss tardive dyskinesia from identification to follow-up and ongoing management. They provide valuable insights on pharmacologic options to both consider and avoid to optimize outcomes in patients with tardive dyskinesia, including a focus on clinical strategies for use of VMAT2 inhibitors.Presenters:Robert O. Cotes, MDAssociate ProfessorDepartment of Psychiatry and Behavioral SciencesEmory University School of MedicineAtlanta, GeorgiaJonathan M. Meyer, MDVoluntary Clinical Professor, Department of PsychiatryUniversity of California, San DiegoPsychopharmacology ConsultantBalboa Naval Medical Center First Episode Psychosis ProgramState of Nevada Project ECHO First Episode Psychosis Program

How to titrate clozapine in inpatients and outpatients? In this episode, we discuss important considerations for switching to clozapine, including the indications and clinical scenarios for using it. This episode also explains precautions while titrating clozapine and how to reduce the preswitch antipsychotic.  Faculty: Brian Miller, M.D.  Host: Richard Seeber, M.D. Learn more about our memberships here Earn 1 CME: Antipsychotic Switching: Intersection of Art and Science Important Considerations for Switching to Clozapine

https://psychiatry.dev/wp-content/uploads/speaker/post-9761.mp3?cb=1663564458.mp3 Playback speed: 0.8x 1x 1.3x 1.6x 2x Download: Clozapine as a treatment for catatonia: A systematic review – PubMed Aman Saini et al. Schizophrenia Research. 2022. Catatonia is a neuropsychiatricFull EntryClozapine as a treatment for catatonia: A systematic review – PubMed

Why do patients stop clozapine?  This episode discusses clozapine discontinuation rates and reasons for doing so among patients who later recommenced clozapine therapy.  Faculty: Jim Phelps, M.D.  Host: Jessica Diaz, M.D. Learn more about Premium Membership here Earn 0.5 CMEs: Quick Take Vol. 38 Demographic and Clinical Characteristics of Patients Who Recommence Clozapine Following Therapy Interruptions

Theme: Toxicology. Participants: A/Prof. Naren Gunja (clinical toxicologist), Pramod Chandru, Amanda De Silva, Mariez Gorgi, Tim Selvaraj and Kit Rowe. Discussion:De Fazio, P., Gaetano, R., Caroleo, M., Cerminara, G., Maida, F., Bruno, A., Muscatello, M. R., Moreno, M. J., Russo, E., & Segura-García, C. (2015). Rare and very rare adverse effects of clozapine. Neuropsychiatric disease and treatment, 11, 1995–2003. https://doi.org/10.2147/NDT.S83989.Presenter: Pramod Chandru. Music/Sound Effects: Descriptions by RYYZN | https://soundcloud.com/ryyzn, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Get Away by LiQWYD | https://www.liqwydmusic.com, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Last Summer by Ikson | https://youtube.com/ikson, Music promoted by https://www.free-stock-music.com. Slipz (audio logo) by tubebackr | https://soundcloud.com/tubebackr, Music promoted by https://www.free-stock-music.com. Disclaimer:Please be advised that the individual views and opinions expressed in this recording strive to improve clinical practice, are our own, and do not represent the views of any organization or affiliated body. Therapies discussed are general and should not be a substitute for an individualized assessment from a medical professional.Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time!~

Drs John Kane and Stefan Leucht discuss the effectiveness and optimal dosing of antipsychotic medications in the treatment of schizophrenia. Relevant disclosures can be found with the episode show notes on Medscape (https://www.medscape.com/viewarticle/969527). The topics and discussions are planned, produced, and reviewed independently of advertiser. This podcast is intended only for US healthcare professionals. Resources Toward a Phenomenological Psychotherapy for Schizophrenia https://www.karger.com/Article/FullText/500163 APA Releases New Practice Guideline on Treatment of Patients with Schizophrenia https://www.psychiatry.org/newsroom/news-releases/apa-releases-new-practice-guideline-on-treatment-of-patients-with-schizophrenia Pharmacological Treatments for First-Episode Schizophrenia https://academic.oup.com/schizophreniabulletin/article/31/3/705/1894509?login=false Putting the Efficacy of Psychiatric and General Medicine Medication Into Perspective: Review of Meta-analyses https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/putting-the-efficacy-of-psychiatric-and-general-medicine-medication-into-perspective-review-of-metaanalyses/39C15F3428BDD1F8A4C152B67C06A5A6 The Nature of Relapse in Schizophrenia https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3599855 20-Year Nationwide Follow-Up Study on Discontinuation of Antipsychotic Treatment in First-Episode Schizophrenia https://pubmed.ncbi.nlm.nih.gov/29621900/ Amisulpride and Olanzapine Followed by Open-Label Treatment With Clozapine in First-Episode Schizophrenia and Schizophreniform Disorder (OPTiMiSE): A Three-Phase Switching Study https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(18)30252-9/fulltext Clozapine https://reference.medscape.com/drug/clozaril-versacloz-clozapine-342972 Lurasidone Dose Escalation in Early Nonresponding Patients With Schizophrenia: A Randomized, Placebo-Controlled Study https://www.psychiatrist.com/jcp/schizophrenia/lurasidone-in-early-nonresponding-schizophrenia/ Dose-Response Meta-Analysis of Antipsychotic Drugs for Acute Schizophrenia https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2019.19010034 Examination of Dosing of Antipsychotic Drugs for Relapse Prevention in Patients With Stable Schizophrenia: A Meta-analysis https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2783296 Association of Antipsychotic Polypharmacy vs Monotherapy With Psychiatric Rehospitalization Among Adults With Schizophrenia https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2725088

  Clozapine is often prescribed for patients with treatment-resistant schizophrenia, but its use is sometimes discontinued if it is suspected of inducing neutropenia. In this podcast, author Laurent Béchard discusses a consecutive case series published in the July-August 2022 issue of the Journal of Clinical Psychopharmacology assessing the continuation or reintroduction of this drug despite a neutropenia episode. In addition to suggesting further research to better define severe vs. moderate cases, Dr. Béchard proposes the use of pharmacovigilance tools to assess possible causes of neutropenia so clinicians can better determine if this highly effective antipsychotic should remain part of a patient's treatment plan.

This episode discusses whether clozapine and other medications can reduce the risk of suicide. Is it a "class effect" of antipsychotics, or is it specific to clozapine?  Faculty: Jim Phelps, M.D.  Hosts: Jessica Diaz, M.D.; Flavio Guzman, M.D. Learn more about Premium Membership here Earn 0.5 CMEs: Quick Take Vol. 33 Effects on Suicidal Risk: Comparison of Clozapine to Other Newer Medicines Indicated to Treat Schizophrenia or Bipolar Disorder

When should you suspect clozapine-induced myocarditis? Myocarditis has nonspecific manifestations. In this episode, Dr. Phelps explains the clinical presentation and the steps to take if you suspect myocarditis. Faculty: Jim Phelps, M.D. Hosts: Jessica Diaz, M.D.; Flavio Guzman, M.D. Learn more about Premium Membership here Earn 0.5 CMEs: Quick Take Vol. 32 Clozapine-Induced Myocarditis: Electronic Health Register Analysis of Incidence, Timing, Clinical Markers, and Diagnostic Accuracy  

Have you ever had a system stand in your way that the solution could be just empowering the other person? Clozapine is medication that has it's own REMS program, and for good reason, but at what point does delaying the patient access due to this program cause more harm than it does protect them? Krista Samimi joins the podcast to discuss a recent experience she had with the Clozapine REMS program and a pharmacist, that she luckily was able to get solved before she ran out of medication. If nothing else, this episode shows why pharmacists need to be better empowered to help patients, given most do not feel that way these days. See more of Krista's clozaril story here: https://www.linkedin.com/posts/krista-samimi_mentalhealth-bipolar-entrepreneur-activity-6884877518923550720-Uh5Y Follow Krista here: https://www.linkedin.com/in/krista-samimi/ Join or follow NAMI here: https://nami.org/Home

Imagine being 13 years old, standing in front of a judge, accused of the "crime" of being fat. Imagine the incredible pain you would feel as the judge announces that in the interests of your 'health', you will be removed from your family. But there's no need to imagine. During the height of the UK COVID-19 pandemic, two children were removed from their loving home and put into foster care. The ONLY reason was that both kids were fat. This harrowing story raised the ire of the fabulous Fat Doctor UK, who advocated and pleaded and offered to help educate the social workers, judge, and anyone who would listen, but her valiant attempts have so far been ignored. Two kids have lost their families, thanks to fatphobia. Join me and the fabulous Fat Doctor UK as we get UTTERLY fired up about this travesty of justice. This is a tough listen so please make sure you have adequate spoons. Show Transcript 0:00:12.7 Louise: Welcome to All Fired Up. I'm Louise, your host. And this is the podcast where we talk all things anti-diet. Has diet culture got you in a fit of rage? Is the injustice of the beauty ideal? Getting your knickers in a twist? Does fitspo, make you wanna spit spo? Are you ready to hurl if you hear one more weight loss tip? Are you ready to be mad, loud and proud? Well, you've come to the right place. Let's get all fired up. 0:00:40.3 Louise: Hello, diet culture drop-outs. I'm so pleased to be with you again and very excited about today's episode. Okay, so first of all, I wanna say a massive thank you to all of the listeners who are so faithful and loving. And I love all your messages and emails, so keep them coming. And if you love the show, don't forget to subscribe so you don't miss the episodes as they pop out on a roughly monthly basis. And if you love us, give us five stars because the more five star reviews we get, particularly on Apple Podcasts, the louder the message is, the more listeners we get and the quicker we can topple diet culture. And that's the objective here. 0:01:24.7 Louise: If you're looking for some free stuff to help you with your anti-diet journey, gosh I hate that word. Let's call it an adventure. Anti-Diet Adventure, 'cause that's what it is. It's rocking and rolling. It's up and down. It's not predictable. But if you're looking for a resource where you might be going to medical visit, you might be trying to explain just what you're doing to friends and family, look no further than the free e-book; Everything You've Been Told About Weightloss Is Bullshit, written by me and the Anti-Diet Advanced doctor dietician, Dr Fiona Willer. In it we're busting the top 10 myths that float around diet culture like poo in a swimming pool, about the relationship between health and weight, and we're busting myths left, right and centre. 0:02:06.8 Louise: It's a really awesome resource. It's crammed full of science and facts and it will really help steel you and give you the armour that you need to push back against diet culture. So if you wanna grab a copy, it's absolutely free. Like I said, you can go to Instagram which is untrapped_ au and click on the link in the bio and grab a copy there. Or you can go to the website untrapped.com.au and a little pop-up will come and you will grab it there. More free stuff, if you are struggling with relationship with your body during the last couple of years in particular, Befriending Your Body is my free e-course. All about self-compassion, this amazing skill of being kind and befriending your body. And it's like a super power, self-compassion, because we're all taught from the moment we're born, practically, to disconnect and dislike and judge and body police ourselves. Not exactly a recipe for happiness and satisfaction. 0:03:05.9 Louise: So, this little e-course will help build the skill of self-compassion, which is absolutely awesome because if we can learn to connect with our imperfect bodies, we can learn to inhabit them, to look after them and to push back against the forces that are still trying to get us separate from them. You can find the Befriending Your Body e-course from Instagram. So, untrapped_au. Click on the link, Befriending Your Body, it's all free, it's beautiful. It's just so lovely to practice self-compassion meditations. Self-compassion is built for difficult times. And my friends, we're in a difficult time. So, get hold of that if you haven't already. 0:03:47.6 Louise: Big shout out and hello to all of the Untrapped community, the Master Class and online community, who we meet every week. We push back against diet culture together. We share our stories, we've been supporting each other through the various challenges of lockdown and it's just a wonderful community of awesome human beings. So, if you're struggling and you want to join a community, as well as learning all of the skills of how to do things like intuitive eating, returning to a relationship with moving your body that doesn't feel like hard work. Understanding weight stigma and weight prejudice, relationship with body, all of that kind of stuff is covered in this comprehensive course, Untrapped, which I co-created in 2017 with 11 other amazing anti-diet health professionals. 0:04:39.9 Louise: So if you wanna grab a hold of this program and join our online community, please do and now's the time. We're meeting weekly. So every Saturday, I meet with the whole community and we have an awesome chinwag about everything that's going on. You also get all of the material. And there's other things that happened throughout the year like events and retreats. Well, if they're not scuppered by COVID. [chuckle] In usual times, we are able to do that. Well, if that's not being scuppered by COVID, of course. But in ordinary times, we do extra stuff. So find out more about Untrapped on the website, untrapped.com.au. You can also find a link from Insta. So, I think that's a run through all of the preamble. 0:05:23.5 Louise: Now, we arrive at the exciting time. I am so excited to bring you today's episode. You would have heard of the Fat Doctor UK by now, because she burst onto the internet a few months ago. And it seems like she's everywhere and she is loud and she is angry and she's a GP. So, here we have a very fierce, fat-positive voice, straight out of the UK medical profession, which is sorely needed. And I've just got so much admiration for Natasha and everything that she's doing. And I was actually listening to the Mindful Dietician podcast when I first heard Natasha being interviewed by the wonderful, Fi Sutherland. And during that conversation, she mentioned an awful situation in the UK where two kids were removed from their family for being fat. 0:06:13.9 Louise: And I'd actually seen that story and was so horrified that I kind of shelved it a way. But hearing Natasha talk about it and what she decided to do about it herself, it just inspired me. I just knew I had to talk to her. So this episode is everything. It's a long one, and it's a bloody rollercoaster. We go a lot of places during this epic, fantastic conversation. So you are going to laugh, you are going to cry. You're gonna cry more than once, because I know I did. You're gonna be absolutely furious, because just what we're talking about is just so horrific. We are in the 21st century and kids are being removed from loving homes simply because of BMI and a failure to do the impossible, which is lose weight and keep it off via the epic fail of dieting. 0:07:06.8 Louise: So look, this is really a challenging episode to listen to. It's a horrible story but the conversation with The Fat Doctor, Natasha herself is nothing short of inspiring. This woman is on a crusade. She has got heaps of other people involved in changing the landscape in a meaningful way. She is a real champion in the UK and across the planet, and I know you're gonna enjoy this conversation, but have some tissues close by and keep your slow breathing going to help contain the rage 'cause it's real. So without further ado, I give you me and The Fat Doctor herself, Natasha Larmie. So Tash, thank you so much for coming on the show. 0:07:49.0 Natasha Larmie: Thank you so much for having me, I am so excited. Due to the time difference, it's past midnight now and I've never been this awake past midnight before, so I'm really looking forward to this talk. 0:07:58.8 Louise: Oh my god, I am so impressed with your fired up-ness. [laughter] [laughter] 0:08:04.6 Louise: Tell me what is firing you up. 0:08:07.3 NL: Just in general or specifically about this case? 'Cause obviously a lot of things are firing me up, but I mean, obviously... 0:08:11.7 Louise: Yes. 0:08:12.5 NL: We wanna talk about this particular case that's firing me up. 0:08:16.3 Louise: Yes, what is this case? 0:08:17.9 NL: Yeah, what's going on with this case. So I think it was back in September, October last year that it happened, but I became aware of it a few months later, where two young people, one was actually over the age of 16 and his sibling, his younger sibling is under the age of 16, had been removed from a very loving home, for all intents and purposes, a very loving, happy home and placed into foster care by a judge simply because they were fat, and there is really no other reason at all. There was no other signs of child abuse, neglect, physical abuse, emotional abuse, nothing. It's just because they were fat and they failed to lose weight, a judge removed them from a loving home and placed them in foster care, and the older sibling, I think he's 16, 17, didn't actually have to go in because he was too old and the younger girl, she's 13, and she was removed from her home. 0:09:11.5 NL: And when I read about it I think I was so disgusted, it sort of broke... One newspaper reports on it in the UK, and it was several weeks later I guess, because the court transcript had come out, and I read it, I read the article, and I just thought, "Well, this is just the press over-exaggerating." And then someone said... One friend of mine sent me a text message saying, "No, no, no, just read the court's transcript. Transcript, read it," and sent me a link to the court transcript. I read the whole thing and within an hour I think I read the whole thing, and I was in tears. I was so full of rage that I just felt like something had to be done and started a petition. Have tried really hard to get answers, to push people to look into this case but unfortunately, haven't got very far because we're dealing with people who have very much kind of shut us down and have said, "It's not your concern. This is a judge who made this decision and there's nothing you can do about it." 0:10:05.4 Louise: Really? 0:10:05.7 NL: So I'm pretty fired up. Yeah. 0:10:07.2 Louise: Oh, god. Oh, I mean, when you say it out loud, like my whole body is responding. When I read the court transcripts last night, I put it off because I knew that I just probably would have a massive reaction and I was crying too, because this transcript is literally fucking heartbreaking. 0:10:26.5 NL: Tears. 0:10:27.2 Louise: That they're all admitting that this is... No one wants to be split up, they love each other but there's this stupid idea, as if everybody is completely unaware of science and weight science and how fucked dieting is. 0:10:41.5 NL: Yeah. 0:10:42.2 Louise: And how it doesn't fucking work. 0:10:44.4 NL: No. 0:10:44.7 Louise: And it's in a pandemic. 0:10:46.0 NL: Yeah, yeah. 0:10:46.7 Louise: If I fail to lose weight in a lockdown, when the world was going mad... 0:10:51.6 NL: And I mean, actually, the story begins I think 10 years previously, the story begins when they were three and six. These were two children, a three-year-old and a six-year-old who were picked up most likely because... I don't know if it's the same in Australia, but in the UK we have a screening program, so in year one, which is between the age of five and six, you are weighed and measured by a school nurse, and they... 0:11:13.4 Louise: Really? 0:11:13.9 NL: Yeah. And do you not have that? No. 0:11:15.6 Louise: No. 0:11:15.7 NL: We have. This is the National Child Measurement Programme, there's a acronym, but I didn't bother to learn. 0:11:21.2 Louise: Oh my god. 0:11:21.6 NL: But it happens in year one, which is when you're between five and six, and again in year six, which is when you're between 10 and 11. 0:11:29.0 Louise: Oh Christ. 0:11:29.2 NL: Two of the worst times to weigh people... 0:11:30.0 Louise: Correct, yeah. 0:11:32.0 NL: If you're think about it, because of course, especially around the 10, 11 stage some people are heading towards puberty, pre-puberty, some people are not, and so those that are heading towards pre-puberty will often have gained quite a bit of weight because you know that always happens before you go through puberty, you kind of go out before you go up, and that's completely normal, but they get penalised. But anyway, so I imagine... I don't know, because that's not actually in the transcripts but I'm guessing that at six, the older sibling, the boy was shown to be grossly overweight or whatever they call it, morbidly obese. They probably just measured his BMI, even though he was six, they probably measured it, which is just ridiculous 'cause that's not what BMI is for, and rather than looking at growth charts, which is what we should be doing at that age, they will have just sent a letter home and the teachers would have got involved and somewhere along the line, social services would have been called just because of the weight, nothing else, just because of the weight, and social services... 0:12:25.8 Louise: Just because of the percentile of a BMI. 0:12:28.5 NL: That was all it was. It was just weight. There was literally no concerns of ever been raised about these kids apart from their weight. And at the age of three and six, social services got involved and started forcing these children to diet, and they will say that's not what they did, they tried to promote healthy eating, but when you take a three-year-old and a six-year-old and you tell them... You restrict what they eat, you force them to exercise, and you tell them there's something wrong with them, you are putting them on a diet at the age of three to six, and we know, for sure, with evidence, you know, I know, and everyone listening should know by now that when you put young children on a diet like that at such a young age and you make such a big deal out of their weight, they are going to develop disordered eating patterns, and they are going to... 0:13:06.8 Louise: Of course. 0:13:07.8 NL: Gain weight, so... 0:13:09.3 Louise: They're going to instead, that's a trauma process happening. 0:13:12.2 NL: That's true. Yeah, it's... 0:13:13.8 Louise: A trauma to get child protective services involved. 0:13:17.8 NL: Yeah, and live there for 10 years, and then... 0:13:21.4 Louise: Ten years? 0:13:22.5 NL: Got to the stage where they took the proceedings further and further, so that they kept getting more and more involved. And eventually, they decided to make this a child protection issue. Up until that point, child social services were involved, but then, about a year before the court proceedings, something like that, before the pandemic. What happened then was that they gave these children a set amount of time to lose weight, and they enforced it. They bought them Fitbits so that they could monitor how much exercise they were doing, they bought them gym subscriptions, they sent them to Weight Watchers. [chuckle] 0:13:55.9 Louise: Fantastic, 'cause we know that works. 0:13:58.4 NL: We know that works. And of course, as you said, it was during a lockdown. So, Corona hits and there was lockdown, there was schools were closed, and for us, it was really quite a difficult time. And in spite of all of that... 0:14:13.0 Louise: I can't believe it. 0:14:14.9 NL: When the children failed to lose weight, the judge decided that it was in their best interest to remove them from their loving parents. And dad, from what I can tell from the court transcripts. I don't know if you noticed this as well. I think mom was trying very hard to be as compliant as possible. 0:14:26.9 Louise: She was, and even she lost weight, the poor thing. 0:14:30.0 NL: Yes, but I think dad almost seems to be trying to protect them, saying, "This is ridiculous. You can't take my kids away just because of their weight," and I... 0:14:38.1 Louise: Seems like he was in denial, which I fully understand. 0:14:41.1 NL: I would be too, I would be outraged. And it sounds like this young girl... I don't know much about the boy, but from what I can see from the transcripts, this young girl really became quite sad and low and depressed, and obviously, shockingly enough, her self esteem has been completely ruined by this process. 0:14:58.7 Louise: I know, I know. I really saw that in the transcript. This poor little girl was so depressed and getting bullied. And in the transcript, the way that that is attributed to her size and not what abuse they're inflicting on this family. 0:15:13.3 NL: Right. Yeah, really quite shocking. And then of course, the other thing you probably noticed from the transcript is there is no expert testimony at this court proceeding. None whatsoever. There is no psychologist. 0:15:24.0 Louise: Actually, there was. 0:15:25.8 NL: There was... 0:15:26.6 Louise: Dr... What's her name? 0:15:29.4 NL: Yes. You're right, there was a psychologist, and you're absolutely right. She was not an eating disorder specialist or a... She was just a psychologist. 0:15:37.3 Louise: She's a clinical psychologist. Dr. Van Rooyen, and she's based in Kent, and she does court reports for child abuse. Yes, and I can see her weight stigma in there. She's on the one hand acknowledging that the kids don't wanna go, that the kids will suffer mentally from being removed, but you can also see her unexamined weight stigma. And that you're right, where the hell are the weight scientists saying, "Actually, it's biologically impossible to lose weight and maintain it"? Because in the transcripts, they do mention that the kids have lost weight, failed to keep it off. 0:16:16.5 NL: Exactly, exactly. And it's just shocking to me that there would be such a lack of understanding and no desire to actually establish the science or the facts behind this. If I was a judge... I'm not a judge, I'm not an expert, but if I was a judge and I was making a decision to remove a child from a home based purely on the child's inability to lose weight, I would want to find out if it was possible that this child simply couldn't lose weight on their own. I would want to consult experts. I would want to find out if there was a genetic condition. I'm not saying she has a genetic condition. You and I know that she doesn't need to have a genetic condition in order to struggle to lose weight, that actually, the psychology behind this explains it. But even if you've not got to that stage yet, there was no doctors, there was no dietitians, there was no... No one was consulted. It was a psychologist who had no understanding of these specific issues, who, as you said, was clearly biased. There was social workers who said, "We've done everything we can because we've given them a Fitbit and we've sent them to Weight Watchers and sent them to the gym, but they refuse to comply." 0:17:24.9 Louise: I know. It's shocking. 0:17:28.4 NL: Yeah, it strikes me that we live in a world where you just can get away with this. It's just universally accepted that being fat is bad, and it's also your fault, your responsibility. The blame lies solely on the individual, even if that individual is a three-year-old child, it is. And if it's not the child, then of course, it's the parent. The parent has done something wrong. 0:17:52.1 Louise: Specifically the mother, okay. 0:17:53.5 NL: The mother, yeah. 0:17:54.4 Louise: The one with the penis, okay, let's not talk about him, 'cause that was absent. It was the mom. And the only possibility that was examined in this is that it's mom's fault for not being compliant, like you said. That's the only thing. Nothing else like the whole method is a stink-fest of ineffective bullshit. 0:18:13.5 NL: And there's the one point in the transcript when they talk about the fact that she had ice cream or chips or something in the house. 0:18:19.7 Louise: That's Ms. Keeley, their social worker, who went in and judged them. And did you notice that she took different scales in during that last visit? That last visit that was gonna determine whether or not they'd be removed, she took different scales in and weighed them. And they say, "Look, we acknowledge that that could've screwed up the results, but we're just gonna push on with removal." 0:18:43.0 NL: It was their agenda. 0:18:45.0 Louise: It was. It's terrifying, and it's long-term foster care for this poor little girl who doesn't wanna leave her mom. I'm so fired up about this, because the impact of removing yourself from your home because of your body, how on earth is this poor kid gonna be okay? 0:19:05.7 NL: This is my worry. How is mom going to be okay? How is that boy going to be okay? And how is that young, impressionable girl... My oldest son is a little bit older, and my younger son is a little bit younger, she's literally in between the two, and I'm watching what the last two years or last year and a half has done to them in terms of their mental and emotional well-being. And to me, even without social services' involvement, my children's mental health has deteriorated massively. And I cannot even begin to comprehend what this poor girl is going through. I cannot imagine how traumatized she is, and I cannot see how is she ever going to get over this, because she's been going through it since she was three, and it's not at the hand of a parent, it's at the hand of a social worker, it is the social worker's negligence. And what's interesting is a lot of social workers and people who work in social services have reached out to me since I first talked about this case, and they have all said the same thing, the amount of weight stigma in social services in the UK is shocking. It is shocking. It is perfectly acceptable to call parents abusers just because their children are overweight. 0:20:21.8 Louise: Jesus. 0:20:22.2 NL: No other reason, just your child is over the limit, is on the 90th percentile or whatever it is, your child is overweight and therefore you as a mother, usually as you said, it's a mother, are an abusive mother, because you've brought your child up in a loving environment but they failed to look the way that you want them to look, that's it. 0:20:41.0 Louise: Okay. So, that's me, right. My eldest is in the 99th percentile, so I am an abuser, I'm a child abuser. 0:20:47.3 NL: Child abuser, I can't believe I'm probably talking to one. 0:20:49.3 Louise: I know. [laughter] 0:20:49.9 NL: I can't believe I'm probably talking to one. And you know, the irony, my son's been really poorly recently and he's been up in... I mean we've spent most of our life in the hospital the last few weeks, and... 0:20:58.1 Louise: Oh dear. 0:20:58.3 NL: Went to see a paediatrician and they did the height and weight, and he is on the 98th percentile, my son has a 28-inch waist. He is a skeleton at the moment because he's been really ill, but he is mixed race, and we all know that the BMI is not particularly... 0:21:12.9 Louise: It's racist. 0:21:13.2 NL: Useful anyway, but it's massively racist, so my children have always been, if you weigh them, a lot heavier than they look, because I mean he's... There isn't an ounce of fat on him. My point is that BMI is complete utter bullshit and it doesn't deserve to exist. The fact that we've been using up until now is shameful and as a doctor, I cannot accept that we use this as a measure of whether a person is healthy and certainly as a measure of whether a child is healthy, because until recently, we were told you don't do BMIs on anyone under the age of 16 but that's just gone out the window now, everyone... 0:21:48.5 Louise: I know. 0:21:48.6 NL: Gets a BMI, even a six-year-old. 0:21:50.1 Louise: You get a BMI, you get a BMI. [laughter] I think it's not supposed to be used for an individual anything, it's a population level statistic. 0:22:01.1 NL: And a pretty crappy one at that. 0:22:02.3 Louise: It's a shitty one. 0:22:02.6 NL: It is like you said. 0:22:04.2 Louise: Yes. 0:22:04.6 NL: It's based on what European men, it's not particularly useful for men, it's not particularly useful for any other race, it's just useful perhaps. Even when it came out, like even when... What's his face? I forget his name right now, Ancel Keys. When he did that study that first look, brought in the BMI into our medical world as it were, yeah, even he said at the time it was alright. It's not the best, it's not the worst, it will do. It's the best out of the bunch. I mean he didn't even have much enthusiasm at the time. He said specifically it's not meant to be used as an individual assessment. And even the guy who kind of didn't invent it, but he sort of invented it as a measure of "obesity" and yet... And even he didn't have much good stuff to say about it. If he was selling the latest iPhone, Apple would have a lot to say about that. [laughter] I just... This fact that we've become obsessed and we know why this is. We know this is because of the diet industry, we know this is because of people trying to make money out of us and succeeding, very successful at making money out of us. 0:23:02.9 Louise: It's actually terrifying how successful this is because when I read this transcript, I've been doing a lot of work against the Novo Nordisk impact and how our modern oh, narrative has been essentially created by the pharmaceutical company that's producing all of the weight loss drugs, they have 80% of the weight loss drugs market and they've shamelessly said in their marketing that this is their drive to increase... That it's to create a sense of urgency for the medical management of obesity. And here it is, this is where it bleeds, because they're telling us this bullshit that it's going to reduce stigma. No, it's going to create eugenics. This is hideous what's happening here and I can't believe that the world didn't stop and that the front page of newspapers aren't saying like get fucked, like get these kids back. There's no outrage. 0:24:04.2 NL: No, there is none whatsoever. We got just over 2,000 people supporting the petition and as grateful as I am for that, that's just what the fuck, that's 2,000 people who live in a country of 68 million and only 2,000 people had something to say about this and, we... That's how much we hate fat kids and how much we hate fat people. We just don't see them as worthy and nobody wants to defend this young girl, nobody sort of feels sorry for her and I just... I can't get my head around this whole thing. It's funny because I didn't really know about it, a year ago I was completely clueless. It's all happened rather quickly for me that I've begun to understand Haze and begun to understand who Novo Nordisk was and what they are doing and what Semaglutide actually is and how it's going to completely change the world as we know it. 0:24:56.5 NL: I think this particular drug is going to become part of popular culture in the same way that Viagra is, we use that word now in novels and in movies. It's so popular and so understood, nobody talks about... I don't know, give me a name of any drug, like some blood pressure medication, they don't talk about it in the same way they talk about Viagra. But Semaglutide is going to be that next drug because they have tapped into this incredibly large population of people who are desperate to lose weight and they've got this medication that was originally used to treat diabetes, just like Viagra was originally used to treat blood pressure and have said, "Wow, look at this amazing side effect. It makes people lose weight as long as you run it. Let's market this." And the FDA approved it. I mean, no... 0:25:45.1 Louise: I know. 0:25:45.8 NL: No thought as to whether or not this drug is gonna have a massive impact on people in their insulin resistance and whether they're gonna develop diabetes down the line. I don't think they care. I don't think anybody actually cares. I think it's just that everybody is happy, woo-hoo, another way to treat fat people and make a good deal of money out of it. 0:26:03.9 Louise: Right? So, Semaglutide is... It's the latest weight loss drug to be approved by the FDA from Novo Nordisk and it is like the Mark II. So, they were selling Saxenda, Saxenda's here in Australia, they're pushing it out and this Semaglutide is like the Mark II, like I think of Saxenda as like Jan Brady, and Semaglutide is like Marcia. [laughter] 0:26:29.3 Louise: 'Cause it's like, "Oh my God, look at Semaglutide. Look at this amazing one year trial." [laughter] Marcia, Marcia, Marcia, like oh my God, we can make so much weight loss happen from this intervention. Why? Why do we need all of this weight loss, all these percentages? And, "Oh, we can lose 15% and 20%," and we don't need to for health, but okay. 0:26:53.3 NL: Yeah. The other thing that we have to remember about it, I don't think it's actually that much better. I've used all of these drugs in treating diabetes. So many years, I used these drugs. The beauty of it, of course, is that it's a tablet, and Saxenda is an injection. I'm assuming you have the injectable form, yeah? 0:27:09.9 Louise: That's right. You have to inject, and it's very expensive. 0:27:14.0 NL: It's extremely expensive, as will... Marcia Brady will be more expensive, I'm sure. 0:27:18.6 Louise: So high maintenance. [chuckle] 0:27:20.2 NL: Absolutely, but she is easier to administer. A lot of people don't like the idea of injecting themselves, but taking a tablet is dead easy. So, that's what makes this special, as it were, because it's the only one of that whole family that is oral, as opposed to injectable. 0:27:37.6 Louise: Well, that's interesting, because the paper with all of the big, shiny weight loss was injectable, it wasn't tablet. 0:27:43.7 NL: Oh, really? Oh, but they're marketing it as the oral version, definitely. That's the one that's got approved. It's brand name is... 0:27:51.3 Louise: Wegovy. 0:27:52.2 NL: Oh no, well, I have a completely different brand name. Is it different, maybe, in Australia? 0:27:57.1 Louise: Well, this is in America. In Australia, they haven't cornered us yet. I'm sure that they're trying to do it, but it was the FDA approval for Wegovy, [0:28:05.4] ____. 0:28:05.9 NL: So, they obviously changed the name. That's not the same one we use in diabetes. Clearly, they've had to revamp it a bit. Irrespective of oral, injectable, whatever, I think that this is going to... Novo Nordisk is sitting on a gold mine, and they know it. And it's going to change our lives, I think, because bariatric surgery is quite a big thing, and it's something that often people will say, "I'm not keen on doing." And the uptake is quite low still, and so, in bariatric... 0:28:35.2 Louise: In the UK, not here. 0:28:36.2 NL: Yeah, [chuckle] yeah, but bariatric surgeons are probably very afraid right now, because there's drugs coming along and taking all of their business away from them. 0:28:43.5 Louise: Actually, you know what Novo were doing? They're partnering with the bariatric surgeons. 0:28:46.2 NL: Of course they are. 0:28:46.9 Louise: And they're saying to them, "Hey, let's use your power and kudos, and our drugs can help your patients when they start to regain." 0:28:56.4 NL: Oh my gosh. 0:28:58.0 Louise: It's literally gateway drug. Once you start using a drug to reduce your weight, you have medicalized your weight, and it's a small upsell from there. So, I think this is all part of a giant marketing genius that is Novo Nordisk. But I'm interested to hear your concerns, 'cause I'm concerned as well with the use of diabetes drugs as weight loss medications, and I read about it being that they're hoping that people will take this drug like we take statins. So, everyone will take it preventatively for the rest of their lives. What's the long-term impact, do you think, of taking a double dose of a diabetes drug when you don't have diabetes? 0:29:43.5 NL: Well, first of all, they don't know. Nobody knows, because they've only done a study for a year, and just how many diet drugs have we put out there into the universe since the 1970s, and then taken them back a few years later, 'cause we've gone, "Oh, this kills"? If you've got diabetes and you take this drug because you've got insulin resistance and this drug helps you to combat your insulin resistance in the way that it works, you've already got diabetes. And so, there is no risk of you developing diabetes, and this drug does work, and so, I have no issue with the GLP-1 analogs in their use in diabetes. I think all the diabetes drugs are important, and I'm not an expert. But you've really got to ask yourself, if you take a healthy body and you act on a system within the pancreas and within the body, in a healthy, essentially, healthy body, healthy pancreas, you've got to ask yourself if it's going to worsen insulin resistance over time. It's actually going to lead to increased cases of diabetes. Now, they say it won't, but... 0:30:47.4 Louise: How do they know that? 'Cause I've read a study by Novo, sponsored, in rats, that showed that it did lead to insulin resistance long-term. 0:30:57.6 NL: Right, I think common sense, because we understand that the way that the body works, just common sense. The way the body works suggests to me that over long periods of time, taking this medication in a healthy person is going to lead to increased insulin resistance, which in turn will lead to diabetes. That is what common sense dictates. But of course, as you said, we don't know. We don't have a study. Nobody has looked into this. And it makes me sad that we are using a drug to treat a condition that isn't a condition. 0:31:30.2 Louise: I know, yeah. [chuckle] 0:31:32.4 NL: And inadvertently, potentially giving people a whole... 0:31:36.0 Louise: Creating a condition. 0:31:36.6 NL: Creating an actual medical condition, which we all know to be life-threatening if untreated. And so, I cannot fathom why... Well, I can, I understand. It's for financial reasons only, but I can't understand why there are doctors out there that want to prescribe this. This is the issue that I have. I'm a doctor, and I can't speak on behalf of drug companies or politicians or anyone else, but I can speak to what doctors are supposed to be doing, and we have a very strong code of conduct that we have to abide by. We have ethical and moral principles and legal obligations to our patients. And so, doing no harm and doing what is in your patients' best interest, and practising fairly and without discrimination, and giving people... Allowing them to make an informed choice where they are aware of the risks and the side effects and all the different treatment options. 0:32:28.0 NL: When it comes to being fat, again, it seems to have gone out the window. None of these things are happening. We wouldn't dream of addressing other issues this way, it's just fatness, because it's just so commonly, widely accepted that fatness is bad and you've got to do whatever you can to get rid of it. I've had someone tell me today that they are pregnant with their first child and they had their first conversation with the anesthetist, who told them they had to do whatever they could to lose weight before they had their baby. This is a pregnant woman. 0:32:58.1 Louise: Whatever they had to do? 0:33:00.1 NL: Whatever they had to do, and she said, "What do you want me to do, buy drugs off the streets?" And the anesthetist said... Wait for it. The anesthetist said, "It would be safer for you to use a Class A drugs than it would for you to be fat in pregnancy". The anesthetist said that to this woman. She told me this and I just went "Please just... Can you just report him?" 0:33:21.7 Louise: Shut the front door, Jesus Christ! 0:33:24.6 NL: Can you imagine? First of all, that's not true. Second of all, he is saying that it is better to be a drug addict than to be a fat person. This is no judgment on drug addicts, but you do not encourage your patients to use Class A drugs to lose weight. That's stupid. Imagine if he'd said that about anything else, but in his... And it was a man, in his world, for whatever reason, his ethics just abandons them all in favor of fat shaming a woman. 0:33:52.4 Louise: This is where we're at with, it's self examined. It's like there's a massive black hole of stigma just operating unchallenged effortlessly and actually growing, thanks to this massive marketing department, Novo. It's terrify... That poor lady, I'm so glad she's found you and I hope she's not gonna go down the Class A drug route. [laughter] 0:34:19.3 NL: She's definitely not, but she was quite traumatized. She's on a Facebook group that I started and it's great because it's 500 people who are just so supportive of each other and it was within a few minutes 50 comments going "What a load of crap, I can't believe this," "You're great, this doctor is terrible". But it just stuck to me that one of my colleagues would dare, would have the audacity to do something as negligent as that. And I'm gonna call it what it is. That's negligence. But I'm seeing it all the time. I'm seeing it in healthcare, I'm seeing it in Social Services, I'm seeing it in schools, I'm seeing it in the workplace, I'm seeing it everywhere. You cannot escape it. And as a fat person, who was in the morbidly, super fat, super obese stage where she's just basically needs to just be put down like a... 0:35:16.3 Louise: Oh my gosh, it's awful. 0:35:18.5 NL: And as that person, I hear all of these things and I just think "I'm actually a fairly useful member of society, I've actually never been ill, never required any medication, managed to give birth to my children, actually to be fair, they had to come out my zip as opposed to through the tunnel." But that wasn't because I was fat, that was because they were awkward. But this anesthetist telling this woman that she's too fat to have a baby. I was just like "But I am the same weight. I am the same BMI as you". And I had three and I had no problems with my anesthetics. In fact after my third cesarean section, I walked out the hospital 24 hours later, happy as Larry, didn't have any problems. And I know people who were very, very thin that had a massive problems after their cesarean. So there's not even evidence to show how dangerous it is to have a BMI over 35 and still... And then caught when it comes to an anesthetic. This isn't even evidence-based, it's just superstition at this point. 0:36:12.8 Louise: It's a biased based and the guidelines here in Australia, so I think above 35 women are advised to have a cesarean because it's too dangerous. And women are not allowed to give birth in rural hospitals, they have to fly to major cities. So imagine all of... And don't even get me started on bias in medical care for women. It's everywhere, like you said, and it's unexamined and all of this discrimination in the name of, apparently, healthcare. It's scary. 0:36:43.9 NL: It really is. Gosh, you've got me fired up, it's almost 1:00 in the morning and I'm fired up. I'm never gonna get to sleep now. [laughter] 0:36:51.7 Louise: Okay, I don't wanna tell you this, but I will. 'Cause we're talking about how on earth is this possible, like why aren't there any medical experts involved to talk about this from a scientific basis, and I'm worried that even if they did have medical people in the court, they wouldn't have actually stuck up for the kid. I found this JAMA article from 2011. It's a commentary on whether or not large kids should be removed from their families, and it was supportive of that. 0:37:18.0 NL: Oh gosh. Of course it was. 0:37:22.0 Louise: And in response to that commentary, the medpage, which is a medical website, a newsletter kind of thing. They did a poll of health professionals asking should larger kids removed from their families, and 54% said yes. 0:37:40.7 NL: Of course. 0:37:41.3 Louise: I know. Isn't that dreadful? One comment on that said "It seems to me the children in a home where they have become morbidly obese might be suffering many other kinds of abuse as well, viewing in the size of a child. 'Cause we've all gotten bigger since the '80s. We're a larger population and viewing that as abuse and as a fault of parenting. Unbelievable. I also had a little dig around Australia, 'cause it's not isolated in the UK, there's so many more cases. 0:38:16.9 NL: They have. Yeah. 0:38:17.8 Louise: And I think actually in the UK, it might be a lot more common than in Australia. 0:38:22.1 NL: Yeah, I can believe that. 0:38:23.5 Louise: But it did happen here in 2012, there was some report of two children being removed from their families because of the size of the kids. And the media coverage was actually quite dreadful. I'll put in the show notes, this article, and the title is "Victorian authorities remove obese children, removed from their parents". So even the title is wrong, couldn't even get their semantics right. There's a picture, you can imagine what picture would accompany... 0:38:55.2 NL: Well of course it can't be of the actual children, because I think it leads to lawsuit. I'm assuming it's a belly. Is there a belly? Is there a fat person in it or a fat child eating a burger? 0:39:06.2 Louise: Yes. [laughter] 0:39:07.1 NL: Sorry, it's either the belly or the fat person eating the burger. So, a fat child eating the burger, sorry. 0:39:11.9 Louise: Helpfully, to help the visually impaired, the picture had caption and the caption reads "Overweight brother and sister sitting side by side on a sofa eating takeaway food and watching the TV." So not at all stereotyped, very sensitive, nuanced article this one. And then we hear from Professor John Dixon, who is a big part of obesity Inc here in Australia. He told the ABC that "Sometimes taking children away from their parents is the best option." In the same article, he also admits "There's no services available that can actually help kids lose weight", and he says that it's not the parents fault. Helpfully, this article also states that "Obesity is the leading cause of illness and death in Australia." [laughter] 0:39:58.7 NL: I love it when I hear that. How have they figured that out? What do they do to decide that? Where does this... 0:40:08.4 Louise: They don't have to provide any actual evidence. 0:40:10.5 NL: Right. They just say it. 0:40:12.1 Louise: Got it. 0:40:13.0 NL: Just say it. 0:40:14.4 Louise: Diet. And I checked just to make sure, 'cause in case I've missed anything. 0:40:18.4 NL: Yeah. 0:40:19.6 Louise: The top five causes of death in Australia in 2019; heart disease, number two dementia, number three stroke, number four malignant neoplasm of trachea bronchus and lung. 0:40:30.4 NL: Lung cancer. 0:40:30.9 Louise: Lung cancer. 0:40:31.5 NL: That's lung cancer. 0:40:32.3 Louise: And number five chronic lower respiratory disease. 0:40:38.4 NL: So translation. Heart attacks, dementia... In the UK it's actually dementia first, then heart attacks. So dementia, heart attacks, stroke, same thing in the UK, and then lung cancer and COPD. Both of those are smoking-related illnesses. And I can say quite safely that they are smoking-related illness because the chance of developing lung cancer or COPD if you haven't smoked is minuscule. So what the people are doing is they're saying, "Well, we can attribute all of these heart attacks and strokes and dementia to "obesity". And the way we can do that is we just look at all these people that have died, and if they are fat we'll just assume it's their fat that caused their heart disease. 0:41:20.0 NL: To make it very clear to everybody that is listening, if you have a BMI of 40, we can calculate your risk of developing a heart attack or a stroke over the next 10 years using a very sophisticated calculator actually, it's been around for some time. It's what we use in the UK. I'm assuming Australia has a similar one, don't know what it's called there. In the UK it's called a QRISK. So I've done this. I have calculated. I have found a woman, I called her Jane. I gave her a set of blood pressure and cholesterol, and I filled in a template. And then I gave her a BMI of 20. And then I gave her a BMI of 40. And I calculated the difference in her risk. I calculated the difference in her risk, and the difference in her risk was exactly 3%. The difference in her risk if she was a smoker was 50%. She was 50% more likely to have a heart attack if she was a smoker, but only 3% more likely to have a heart attack if she had a BMI of 40 instead of a BMI of 25. 0:42:15.0 NL: To put it into perspective, she was significantly more likely to have a heart attack if she was a migraine sufferer, if she had a mental health condition, if she had lupus or rheumatoid arthritis, if she was Asian, if she was a man, and all of those things dramatically increased her risk more than having a BMI of 40. So it's just very important that doctors will admit, 'cause it's about admitting to a simple fact, this calculator we use to predict people's risks. So if we know that weight only has a 3-4% impact on our cardiovascular risk as opposed to smoking which has a 50% impact, as opposed to aging which is why most people die because they get old and let's face it everybody dies some time. 0:43:04.0 NL: So what's happening is the... Whoever they are, are taking all these deaths from heart disease which was likely caused by the person aging, by the person being male or just being old and being over the age of 75, your risk of heart disease goes up massively irrespective of your weight. So instead of saying, "Well, it's just heart disease", they've gone, "Well, it's heart disease in a fat person and therefore it was the fatness that caused the heart disease." And that is offensive to me to the point that now, I have heard... And this is awful in this year, our patients that are dying of COVID, if they die of COVID in the UK, it's actually quite heart breaking, it's happened to someone that I was close to. If they die of COVID in the UK, and they happen to be fat, the doctor writes "obesity" on their death certificate... 0:43:51.8 Louise: No way. 0:43:52.4 NL: As a cause of death. They died of COVID. 0:43:55.2 Louise: What? 0:43:55.5 NL: They died of COVID. That's what they died of. They died of this terrible virus that is killing people in their droves but people are under the misguided impression that being fat predisposes you to death from COVID, which is not true. It's not true. That is a complete gross misrepresentation of the facts. But we've now got doctors placing that on a person's death certificate. Can you imagine how that family feels? Can you imagine what it feels like to get this death certificate saying, "Your family member is dead from COVID but it's their fault 'cause they were obese." And how can the doctor know? How could the doctor know that? 0:44:34.2 Louise: How can they do that? 0:44:35.6 NL: How can they do that? And this is my point, this doctor that's turning around and saying it's safer for children to be removed from their loving home. Obviously, this person has no idea of the psychological consequences of being removed from your family. But it's safer for that person to be removed from their home than to remain in their home and remain fat. What will you achieve? Is this person going to lose weight? No. I can tell you what this person is going to do. This person is going to develop... 0:44:58.9 Louise: They even say that. They even say that in the transcripts. We don't think that they'll get any more supervision. 0:45:03.1 NL: Yeah. In fact, we're gonna get less supervision because it's not a loving parent. You're going to develop, most likely an eating disorder. You're going to develop serious psychological scars. That trauma is going to lead to mental health problems down the line. And chances are you're just gonna get bigger. You're not gonna get smaller because we know that 95% of people who lose weight gain it all back again. We know that two-thirds of them end up heavier. We know that the more you diet, the heavier you're gonna get. And that actually, this has been shown to be like a dose-response thing in some studies. So the more diets you go on, the higher your weight is going to get. If you don't diet ever in your life, chances are you're not gonna have as many weight problems later on down the line. So, as you're saying, we are living in a society that's got fatter. And there's lots of reasons for that. It's got to do with the food that we're eating now. That we're all eating. That we're all consuming. 0:45:55.1 Louise: Food supply. Only some of us will express from there the epigenetic glory of becoming higher weight. 0:46:02.0 NL: Right. And that's the thing, isn't it? Genetics, hormones, trauma, medications. How many people do I know that are on psychiatric medications and have gained weight as a result, Clozapine or... It's just what's gonna happen. You name it. Being female, having babies, so many things will determine your weight. 0:46:21.0 Louise: Getting older. We're allowed to get... We're supposed to get bigger as we get older. 0:46:25.1 NL: And then you know that actually, there are so many studies nowadays, so many studies that we've labeled it now that show that actually being fat can be beneficial to you. There's studies that show that if you end up in ICU with sepsis, you're far more likely to survive if you're fat. If you've got a BMI over 30, you're more likely to survive. There's studies that show that if you have chronic kidney disease and you're on dialysis, the chances of you surviving more long-term are significantly higher if you're fat. Heart failure, kidney disease, ICU admissions, in fact, even after a heart attack, there's evidence to show that you're more likely to survive if you're fat. And they call this the obesity paradox. We have to call it a paradox because we cannot, for one moment, admit that actually there's a possibility that being fat isn't all that bad for you in the first place and we got it wrong. Rather than admit that we got it wrong, we've labeled a paradox because we have to be right here, we have to... 0:47:18.0 Louise: Yeah, it's like how totally bad and wrong, except in certain rare, weird conditions, as opposed to, "Let's just drop the judgment and look at all of this much less hysterically." 0:47:29.5 NL: Yeah. And studies have shown that putting children on a diet, talking about weight, weight-shaming them, weighing them, any of these things, have been linked to and have been demonstrated to cause disordered eating and be a serious risk for direct factor for weight gain. And that, in my opinion, is the important thing to remember in this particular case, because as I said, social services start in weight-shaming, judging, and talking about weight when these children were three and six, and they did that for 10 years. And in doing so, they are responsible for the fact that these children went on to gain weight, because that's what the evidence shows. And there's no question about this evidence, there's multiple papers to back it up. 0:48:14.1 NL: There's an article published in Germany in 2016, there was an article published last year by the University of Cambridge, and even the American Academy of Pediatrics agrees that talking about weight, putting children on a diet, in fact, even a parent going on a diet is enough to damage that child and increase their risk of developing disordered eating patterns and weight gain. 0:48:37.9 NL: And so, as far as I'm concerned, that to me, is evidence enough to say that it's actually social services that should be in front of a judge, not these children, but it's the social workers that should be held to account. And I have written... And this is something that is very important to say. I wrote to the council, the local authority, and I've written a very long letter, I've published it on my website. You can read it anytime, anyone can read it. And I wrote to them and I said, "This is the evidence. Here are all the links. As far as I'm concerned, you guys got it terribly wrong and you have demonstrated that there is a high degree of weight bias that is actually causing damage to children. I am prepared to come and train you for free and teach all of your social workers all about weight bias, weight stigma, and to basically dispel the myths that obviously are pervading your social work department." And they ignored me. I wrote to politicians in the area. They ignored me. I wrote to a counselor who's a member of my political party, who just claimed, "Yeah, I'll look into it for you." Never heard from her again. Yeah, nobody cares. 0:49:44.0 Louise: It's just such a lack of concern. 0:49:45.7 NL: I didn't even do it in a critical way. I had to do it in a kind of, "I will help you. Let me help you. I'm offering my services for free. I do charge, normally, but I'll do it for free for you guys." No one is interested. Nobody wants to know. And that makes me really sad, that they weren't even willing to hear me out. 0:50:03.0 Louise: I can't believe they didn't actually even answer you. 0:50:06.5 NL: Didn't answer me, didn't respond to any of my messages, none of the counselors, none of the... Nobody has responded, and I've tried repeatedly. 0:50:14.4 Louise: So, this is in West Sussex, yeah? 0:50:16.7 NL: That's right, West Sussex, that's right. 0:50:18.0 Louise: You know what's weird about that? I've actually attended a wedding at that council, that my ex-father-in-law got married there. And when I saw the picture there, I'm like, "Oh my God, I've actually been there." So, I had a poke, and I don't know if you know this, but hopefully, in the future, when those children, C and D, finally decide to sue the council, that they can use this as evidence. There is a report from a... It's called a commissioner's progress report on children services in West Sussex from October 2020, which details how awful the service has been for the past few years, and huge issues with how they're running things. And it says, "Quite fragile and unstable services in West Sussex." So, this family who've had their kids removed were being cared for by a service with massive problems, are being referred to programs that don't work, and that there's a massive miscarriage of justice. 0:51:17.3 NL: And I'm glad you're talking about it, and I'm glad we're talking about it. And I wish that we had the platform to talk about it more vocally. I'd want to be able to reach out to these... To see patients... They're not patients, child C and D. I want to be able to reach out to mum as well, and say... 0:51:36.3 Louise: I just wanna land in Sussex and just walk around the street saying, "Where are you? I wanna help." 0:51:40.2 NL: "Where are you? And let me hug you." And I'm very interest to know, I'd be very interested to know the ethnic origin of these young people. 0:51:48.9 Louise: And the socio-economic status of these people. 0:51:50.2 NL: Socio-economic status, 100%. I would very much like to know that. That would make a huge... I think that I can guess, I'm not going to speculate, but I had a very lovely young woman contact me from a... She was now an adult, but she had experienced this as a child. She had been removed from her home and was now an adult, and she had been in foster care, in social services, for a few years, and had obviously contact with her mum but hadn't been reunited with her mum ever. So it wasn't like it was for a time and then she went back. And we talked about this. She was in a London borough, I shall not name the borough, but I know for a fact that her race would've played a role in this, because she was half-Black, half-Turkish. 0:52:39.2 NL: And there're a few things in that court transcript that caught my attention. I don't know if you noticed there was a mention of the smell from the kitchen, and they didn't specifically said, you know, mould, or you know that there was mould in the kitchen, or there was something in the kitchen that was rotting, something like that, 'cause I think they would have specified. It was just a smell. And that made me wonder, is this to do with just the fact that maybe this family lived in poor housing or was it the type of food that they were cooking for their children? Is there a language issue, is there a cultural issue. What exactly is going on? 'cause we don't know that from the court transcript, so that's another thing that... Another piece of the puzzle that I would really be interested in. Is this a white wealthy family? Probably not. I don't think they are. 0:53:27.2 Louise: Yeah it didn't struck me that way either. Yeah, yeah this is potentially marginalization and racism happening that... 0:53:35.1 NL: Yeah. 0:53:35.9 Louise: And here in Australia, we've got an awful history of how we treated First Nations people and we removed indigenous kids from their families, on the basis of like we know better, and I just... Yeah honestly, elements of that here, like we know better. 0:53:51.5 NL: Yes. Right, this is it. We know better than you have to parent your child. I am have always been a big believer of not restricting my children's feed in any way. I was restricted, and I made the decision when we had the kids that there would just be no restriction at all. I have like been one of those parents that had just been like, that's the draw with all the sweet treats in it. They're not called treats, they're just sweets and chocolate and candy, there it is. It's within reachable distance. Help yourself whenever you want, ice pops in the freezer, there's no like you have to eat that to get your pudding. None of that. 0:54:27.6 NL: My kids have just been able to eat whatever they wanted, whenever they wanted, I never restricted anything, I wanted them to be intuitive eaters. And of course they are, and what amazes me is now my teenage son, when we were on lockdown, and he was like homeschooled, he would come downstairs, make himself a breakfast, and there was like three portions of fruit and veg on his plate, and not because someone told him that he had to, but just because he knew it was good for him and he knew it was healthy, there was like a selection, his plate was always multi-colored, he was drinking plenty of water. He would go and cook it, he cooked himself lunch, he knew that he can eat sweets and crisps and chocolate whenever he wanted to, and he didn't, he just didn't. Like it was there, that drawn, it gets emptied out because it's become a bit... But no, they don't take it, and sometimes they do, 'cause they fancy it, but most of the times they don't. And that is my decision as a parent, I believe that I have done what is in their best interest, I believe that I will prove over time that this has had a much better impact on their health, not restricting them. 0:55:26.4 Louise: Absolutely, Yeah. 0:55:27.6 NL: But the point is they're my children, and it was my damn choice, and even if my child is on the 98th percentile, it's still my damn choice, nobody gets to tell me how to parent my child. That is my child, I know what's best for them. And I believe that my children are going to prove the fact that this is a great way of parenting, and I know that actually most of their friends who had, were not allowed to eat the food that they wanted to eat used to come over to our house and just kind of like wide eyed. And they binge, they binge, you know, to the point that I have to restrict them and say I actually I don't think mom would like that if I gave that to you. 0:56:00.0 Louise: We know that that's what we do when we put kids in food deserts, we breed binge eating and food insecurity, and trying to teach our kids to have a relaxed and enjoyable relationship with food is what intuitive eating is all about. And without a side salad of fat phobia, we're not doing this relationship with food stuff in order to make sure you're thin, we're doing this to make sure that you feel really safe and secure in the world, and you know health is sometimes controllable and sometimes not, and this kind of mad obsession we have with controlling our food and the ability it will give us like everlasting life is weird. 0:56:39.0 NL: Yeah. 0:56:39.7 Louise: Yeah. Gosh, I'm so glad you're parenting those kids in that way and I've noticed the same thing with my kids. Like my kids, we are a family of intuitive eaters and it's just really relaxed, and there's variety, and they go through these little love affairs with foods, and it's really cute. [chuckle] And they're developing their palettes, and their size is not up to me. 0:57:05.8 NL: Yeah. 0:57:06.4 Louise: Yeah. 0:57:07.4 NL: Right. 0:57:08.1 Louise: It's up to me to help them thrive. 0:57:10.7 NL: That's right. And when people talk about health, I often hear people talking about health, and whenever they ask me that question, you know, surely you can agree that being fat is not good for your health, well, I'll always kinda go, "Oh Really? Could you just do me a favor here and define health?" Because I spend my whole life trying to define health, and I'm not sure that I've got there yet, but I can tell you without a doubt that this for me, in my personal experience as a doctor... And I've been a doctor for a long time now, and I see patients all the time, and I'm telling you that in my experience, the most important thing for your health is your mental and emotional well-being, that if you are not mentally and emotionally well, it doesn't matter how good your cholesterol is, it doesn't matter whether or not you've got diabetes, that is irrelevant, because if you're not mental and emotional... I'm not saying that 'cause you won't enjoy life, I mean, it has an impact on your physical health. And I spend most of my day dealing with either people who are depressed or anxious, and that's what they've presented with, or they've presented with symptoms that are being made worse or exacerbated by their mental and emotional pull, mental and emotional well-being. 0:58:19.1 NL: So giving my children the best start in life has always been about giving them a good mental and emotional well, start. It's about giving... It's not just teaching them resilience, but teaching them to love themselves, to be happy with who they are, to not feel judged or to not feel that they are anything other than the brilliant human beings that they are. And I believe that that is what's going to stand them in the greatest... In the greatest... I've lost my words now, but that's what's gonna get them through life, and that's why they're going to be healthy. And how much sugar they eat actually is quite irrelevant compared to the fact that they love themselves and their bodies, and they are great self-esteem, we all know that happiness is... Happiness is the most important thing when it comes to quality of life and happiness is the most important thing when it comes to length of life and illness, all of it. Happiness trumps everything else. 0:59:07.0 Louise: And to you know what that comes from. Happiness comes from a sense of belonging, belonging in our bodies, belonging in ourselves, belonging in the community, and all of this othering that's happening with the message that everyone belongs unless they're fat. That sucks ass and that needs to stop. This poor little kid when, in the transcript it mentioned that they found a suicide note... 0:59:29.9 NL: Yes. 0:59:30.1 Louise: And some pills. And she's fucking like 13. 0:59:34.8 NL: Yeah, and they called it a cry for help. 0:59:36.0 Louise: They called it cry for help 'cause of her body. 0:59:38.1 NL: Yeah. 0:59:38.4 Louise: They didn't recognize it since they've been sniffing around threatening to take her off her mom, and because she's being bullied for her size at school. This is like a calamitous failure to see the impact of weight stigma. 0:59:52.9 NL: She's been told that it's her fault that she's been taken away from her mum. They had told her that because she didn't succeed in losing weight, that she doesn't get to live with her mother anymore. Can you imagine? 1:00:02.4 Louise: So her mom. I can't even wrap my head around that. I can't. 1:00:07.2 NL: Well, she feels suicidal, I think I would too. I felt suicidal at her age and for a lot less. It's terrible, it's terrible. And I hope she's hanging on and I hope that... 1:00:14.6 Louise: I wanna tell her that she is awesome. 1:00:17.4 NL: Yes. 1:00:17.9 Louise: If she ever gets to listen to this. But I know the impact. So like when I was 11, my mom left and I remember how much it tore out my heart. 1:00:26.4 NL: Yeah. 1:00:26.9 Louise: You're 11... 1:00:27.5 NL: Yeah. 1:00:28.3 Louise: 12, 13. This is not the time to do this to kids, and this whole idea... The judge said something like, "Oh, you know, gosh, this is gonna be bad... " But here it is, I will read it to you. This is... She actually wrote a letter to the kids. 1:00:42.5 NL: Oh, gosh. 1:00:43.7 Louise: "I know you will feel that in making this o

Imagine being 13 years old, standing in front of a judge, accused of the "crime" of being fat. Imagine the incredible pain you would feel as the judge announces that in the interests of your 'health', you will be removed from your family. But there's no need to imagine. During the height of the UK COVID-19 pandemic, two children were removed from their loving home and put into foster care. The ONLY reason was that both kids were fat. This harrowing story raised the ire of the fabulous Fat Doctor UK, who advocated and pleaded and offered to help educate the social workers, judge, and anyone who would listen, but her valiant attempts have so far been ignored. Two kids have lost their families, thanks to fatphobia. Join me and the fabulous Fat Doctor UK as we get UTTERLY fired up about this travesty of justice. This is a tough listen so please make sure you have adequate spoons. Show Transcript 0:00:12.7 Louise: Welcome to All Fired Up. I'm Louise, your host. And this is the podcast where we talk all things anti-diet. Has diet culture got you in a fit of rage? Is the injustice of the beauty ideal? Getting your knickers in a twist? Does fitspo, make you wanna spit spo? Are you ready to hurl if you hear one more weight loss tip? Are you ready to be mad, loud and proud? Well, you've come to the right place. Let's get all fired up. 0:00:40.3 Louise: Hello, diet culture drop-outs. I'm so pleased to be with you again and very excited about today's episode. Okay, so first of all, I wanna say a massive thank you to all of the listeners who are so faithful and loving. And I love all your messages and emails, so keep them coming. And if you love the show, don't forget to subscribe so you don't miss the episodes as they pop out on a roughly monthly basis. And if you love us, give us five stars because the more five star reviews we get, particularly on Apple Podcasts, the louder the message is, the more listeners we get and the quicker we can topple diet culture. And that's the objective here. 0:01:24.7 Louise: If you're looking for some free stuff to help you with your anti-diet journey, gosh I hate that word. Let's call it an adventure. Anti-Diet Adventure, 'cause that's what it is. It's rocking and rolling. It's up and down. It's not predictable. But if you're looking for a resource where you might be going to medical visit, you might be trying to explain just what you're doing to friends and family, look no further than the free e-book; Everything You've Been Told About Weightloss Is Bullshit, written by me and the Anti-Diet Advanced doctor dietician, Dr Fiona Willer. In it we're busting the top 10 myths that float around diet culture like poo in a swimming pool, about the relationship between health and weight, and we're busting myths left, right and centre. 0:02:06.8 Louise: It's a really awesome resource. It's crammed full of science and facts and it will really help steel you and give you the armour that you need to push back against diet culture. So if you wanna grab a copy, it's absolutely free. Like I said, you can go to Instagram which is untrapped_ au and click on the link in the bio and grab a copy there. Or you can go to the website untrapped.com.au and a little pop-up will come and you will grab it there. More free stuff, if you are struggling with relationship with your body during the last couple of years in particular, Befriending Your Body is my free e-course. All about self-compassion, this amazing skill of being kind and befriending your body. And it's like a super power, self-compassion, because we're all taught from the moment we're born, practically, to disconnect and dislike and judge and body police ourselves. Not exactly a recipe for happiness and satisfaction. 0:03:05.9 Louise: So, this little e-course will help build the skill of self-compassion, which is absolutely awesome because if we can learn to connect with our imperfect bodies, we can learn to inhabit them, to look after them and to push back against the forces that are still trying to get us separate from them. You can find the Befriending Your Body e-course from Instagram. So, untrapped_au. Click on the link, Befriending Your Body, it's all free, it's beautiful. It's just so lovely to practice self-compassion meditations. Self-compassion is built for difficult times. And my friends, we're in a difficult time. So, get hold of that if you haven't already. 0:03:47.6 Louise: Big shout out and hello to all of the Untrapped community, the Master Class and online community, who we meet every week. We push back against diet culture together. We share our stories, we've been supporting each other through the various challenges of lockdown and it's just a wonderful community of awesome human beings. So, if you're struggling and you want to join a community, as well as learning all of the skills of how to do things like intuitive eating, returning to a relationship with moving your body that doesn't feel like hard work. Understanding weight stigma and weight prejudice, relationship with body, all of that kind of stuff is covered in this comprehensive course, Untrapped, which I co-created in 2017 with 11 other amazing anti-diet health professionals. 0:04:39.9 Louise: So if you wanna grab a hold of this program and join our online community, please do and now's the time. We're meeting weekly. So every Saturday, I meet with the whole community and we have an awesome chinwag about everything that's going on. You also get all of the material. And there's other things that happened throughout the year like events and retreats. Well, if they're not scuppered by COVID. [chuckle] In usual times, we are able to do that. Well, if that's not being scuppered by COVID, of course. But in ordinary times, we do extra stuff. So find out more about Untrapped on the website, untrapped.com.au. You can also find a link from Insta. So, I think that's a run through all of the preamble. 0:05:23.5 Louise: Now, we arrive at the exciting time. I am so excited to bring you today's episode. You would have heard of the Fat Doctor UK by now, because she burst onto the internet a few months ago. And it seems like she's everywhere and she is loud and she is angry and she's a GP. So, here we have a very fierce, fat-positive voice, straight out of the UK medical profession, which is sorely needed. And I've just got so much admiration for Natasha and everything that she's doing. And I was actually listening to the Mindful Dietician podcast when I first heard Natasha being interviewed by the wonderful, Fi Sutherland. And during that conversation, she mentioned an awful situation in the UK where two kids were removed from their family for being fat. 0:06:13.9 Louise: And I'd actually seen that story and was so horrified that I kind of shelved it a way. But hearing Natasha talk about it and what she decided to do about it herself, it just inspired me. I just knew I had to talk to her. So this episode is everything. It's a long one, and it's a bloody rollercoaster. We go a lot of places during this epic, fantastic conversation. So you are going to laugh, you are going to cry. You're gonna cry more than once, because I know I did. You're gonna be absolutely furious, because just what we're talking about is just so horrific. We are in the 21st century and kids are being removed from loving homes simply because of BMI and a failure to do the impossible, which is lose weight and keep it off via the epic fail of dieting. 0:07:06.8 Louise: So look, this is really a challenging episode to listen to. It's a horrible story but the conversation with The Fat Doctor, Natasha herself is nothing short of inspiring. This woman is on a crusade. She has got heaps of other people involved in changing the landscape in a meaningful way. She is a real champion in the UK and across the planet, and I know you're gonna enjoy this conversation, but have some tissues close by and keep your slow breathing going to help contain the rage 'cause it's real. So without further ado, I give you me and The Fat Doctor herself, Natasha Larmie. So Tash, thank you so much for coming on the show. 0:07:49.0 Natasha Larmie: Thank you so much for having me, I am so excited. Due to the time difference, it's past midnight now and I've never been this awake past midnight before, so I'm really looking forward to this talk. 0:07:58.8 Louise: Oh my god, I am so impressed with your fired up-ness. [laughter] [laughter] 0:08:04.6 Louise: Tell me what is firing you up. 0:08:07.3 NL: Just in general or specifically about this case? 'Cause obviously a lot of things are firing me up, but I mean, obviously... 0:08:11.7 Louise: Yes. 0:08:12.5 NL: We wanna talk about this particular case that's firing me up. 0:08:16.3 Louise: Yes, what is this case? 0:08:17.9 NL: Yeah, what's going on with this case. So I think it was back in September, October last year that it happened, but I became aware of it a few months later, where two young people, one was actually over the age of 16 and his sibling, his younger sibling is under the age of 16, had been removed from a very loving home, for all intents and purposes, a very loving, happy home and placed into foster care by a judge simply because they were fat, and there is really no other reason at all. There was no other signs of child abuse, neglect, physical abuse, emotional abuse, nothing. It's just because they were fat and they failed to lose weight, a judge removed them from a loving home and placed them in foster care, and the older sibling, I think he's 16, 17, didn't actually have to go in because he was too old and the younger girl, she's 13, and she was removed from her home. 0:09:11.5 NL: And when I read about it I think I was so disgusted, it sort of broke... One newspaper reports on it in the UK, and it was several weeks later I guess, because the court transcript had come out, and I read it, I read the article, and I just thought, "Well, this is just the press over-exaggerating." And then someone said... One friend of mine sent me a text message saying, "No, no, no, just read the court's transcript. Transcript, read it," and sent me a link to the court transcript. I read the whole thing and within an hour I think I read the whole thing, and I was in tears. I was so full of rage that I just felt like something had to be done and started a petition. Have tried really hard to get answers, to push people to look into this case but unfortunately, haven't got very far because we're dealing with people who have very much kind of shut us down and have said, "It's not your concern. This is a judge who made this decision and there's nothing you can do about it." 0:10:05.4 Louise: Really? 0:10:05.7 NL: So I'm pretty fired up. Yeah. 0:10:07.2 Louise: Oh, god. Oh, I mean, when you say it out loud, like my whole body is responding. When I read the court transcripts last night, I put it off because I knew that I just probably would have a massive reaction and I was crying too, because this transcript is literally fucking heartbreaking. 0:10:26.5 NL: Tears. 0:10:27.2 Louise: That they're all admitting that this is... No one wants to be split up, they love each other but there's this stupid idea, as if everybody is completely unaware of science and weight science and how fucked dieting is. 0:10:41.5 NL: Yeah. 0:10:42.2 Louise: And how it doesn't fucking work. 0:10:44.4 NL: No. 0:10:44.7 Louise: And it's in a pandemic. 0:10:46.0 NL: Yeah, yeah. 0:10:46.7 Louise: If I fail to lose weight in a lockdown, when the world was going mad... 0:10:51.6 NL: And I mean, actually, the story begins I think 10 years previously, the story begins when they were three and six. These were two children, a three-year-old and a six-year-old who were picked up most likely because... I don't know if it's the same in Australia, but in the UK we have a screening program, so in year one, which is between the age of five and six, you are weighed and measured by a school nurse, and they... 0:11:13.4 Louise: Really? 0:11:13.9 NL: Yeah. And do you not have that? No. 0:11:15.6 Louise: No. 0:11:15.7 NL: We have. This is the National Child Measurement Programme, there's a acronym, but I didn't bother to learn. 0:11:21.2 Louise: Oh my god. 0:11:21.6 NL: But it happens in year one, which is when you're between five and six, and again in year six, which is when you're between 10 and 11. 0:11:29.0 Louise: Oh Christ. 0:11:29.2 NL: Two of the worst times to weigh people... 0:11:30.0 Louise: Correct, yeah. 0:11:32.0 NL: If you're think about it, because of course, especially around the 10, 11 stage some people are heading towards puberty, pre-puberty, some people are not, and so those that are heading towards pre-puberty will often have gained quite a bit of weight because you know that always happens before you go through puberty, you kind of go out before you go up, and that's completely normal, but they get penalised. But anyway, so I imagine... I don't know, because that's not actually in the transcripts but I'm guessing that at six, the older sibling, the boy was shown to be grossly overweight or whatever they call it, morbidly obese. They probably just measured his BMI, even though he was six, they probably measured it, which is just ridiculous 'cause that's not what BMI is for, and rather than looking at growth charts, which is what we should be doing at that age, they will have just sent a letter home and the teachers would have got involved and somewhere along the line, social services would have been called just because of the weight, nothing else, just because of the weight, and social services... 0:12:25.8 Louise: Just because of the percentile of a BMI. 0:12:28.5 NL: That was all it was. It was just weight. There was literally no concerns of ever been raised about these kids apart from their weight. And at the age of three and six, social services got involved and started forcing these children to diet, and they will say that's not what they did, they tried to promote healthy eating, but when you take a three-year-old and a six-year-old and you tell them... You restrict what they eat, you force them to exercise, and you tell them there's something wrong with them, you are putting them on a diet at the age of three to six, and we know, for sure, with evidence, you know, I know, and everyone listening should know by now that when you put young children on a diet like that at such a young age and you make such a big deal out of their weight, they are going to develop disordered eating patterns, and they are going to... 0:13:06.8 Louise: Of course. 0:13:07.8 NL: Gain weight, so... 0:13:09.3 Louise: They're going to instead, that's a trauma process happening. 0:13:12.2 NL: That's true. Yeah, it's... 0:13:13.8 Louise: A trauma to get child protective services involved. 0:13:17.8 NL: Yeah, and live there for 10 years, and then... 0:13:21.4 Louise: Ten years? 0:13:22.5 NL: Got to the stage where they took the proceedings further and further, so that they kept getting more and more involved. And eventually, they decided to make this a child protection issue. Up until that point, child social services were involved, but then, about a year before the court proceedings, something like that, before the pandemic. What happened then was that they gave these children a set amount of time to lose weight, and they enforced it. They bought them Fitbits so that they could monitor how much exercise they were doing, they bought them gym subscriptions, they sent them to Weight Watchers. [chuckle] 0:13:55.9 Louise: Fantastic, 'cause we know that works. 0:13:58.4 NL: We know that works. And of course, as you said, it was during a lockdown. So, Corona hits and there was lockdown, there was schools were closed, and for us, it was really quite a difficult time. And in spite of all of that... 0:14:13.0 Louise: I can't believe it. 0:14:14.9 NL: When the children failed to lose weight, the judge decided that it was in their best interest to remove them from their loving parents. And dad, from what I can tell from the court transcripts. I don't know if you noticed this as well. I think mom was trying very hard to be as compliant as possible. 0:14:26.9 Louise: She was, and even she lost weight, the poor thing. 0:14:30.0 NL: Yes, but I think dad almost seems to be trying to protect them, saying, "This is ridiculous. You can't take my kids away just because of their weight," and I... 0:14:38.1 Louise: Seems like he was in denial, which I fully understand. 0:14:41.1 NL: I would be too, I would be outraged. And it sounds like this young girl... I don't know much about the boy, but from what I can see from the transcripts, this young girl really became quite sad and low and depressed, and obviously, shockingly enough, her self esteem has been completely ruined by this process. 0:14:58.7 Louise: I know, I know. I really saw that in the transcript. This poor little girl was so depressed and getting bullied. And in the transcript, the way that that is attributed to her size and not what abuse they're inflicting on this family. 0:15:13.3 NL: Right. Yeah, really quite shocking. And then of course, the other thing you probably noticed from the transcript is there is no expert testimony at this court proceeding. None whatsoever. There is no psychologist. 0:15:24.0 Louise: Actually, there was. 0:15:25.8 NL: There was... 0:15:26.6 Louise: Dr... What's her name? 0:15:29.4 NL: Yes. You're right, there was a psychologist, and you're absolutely right. She was not an eating disorder specialist or a... She was just a psychologist. 0:15:37.3 Louise: She's a clinical psychologist. Dr. Van Rooyen, and she's based in Kent, and she does court reports for child abuse. Yes, and I can see her weight stigma in there. She's on the one hand acknowledging that the kids don't wanna go, that the kids will suffer mentally from being removed, but you can also see her unexamined weight stigma. And that you're right, where the hell are the weight scientists saying, "Actually, it's biologically impossible to lose weight and maintain it"? Because in the transcripts, they do mention that the kids have lost weight, failed to keep it off. 0:16:16.5 NL: Exactly, exactly. And it's just shocking to me that there would be such a lack of understanding and no desire to actually establish the science or the facts behind this. If I was a judge... I'm not a judge, I'm not an expert, but if I was a judge and I was making a decision to remove a child from a home based purely on the child's inability to lose weight, I would want to find out if it was possible that this child simply couldn't lose weight on their own. I would want to consult experts. I would want to find out if there was a genetic condition. I'm not saying she has a genetic condition. You and I know that she doesn't need to have a genetic condition in order to struggle to lose weight, that actually, the psychology behind this explains it. But even if you've not got to that stage yet, there was no doctors, there was no dietitians, there was no... No one was consulted. It was a psychologist who had no understanding of these specific issues, who, as you said, was clearly biased. There was social workers who said, "We've done everything we can because we've given them a Fitbit and we've sent them to Weight Watchers and sent them to the gym, but they refuse to comply." 0:17:24.9 Louise: I know. It's shocking. 0:17:28.4 NL: Yeah, it strikes me that we live in a world where you just can get away with this. It's just universally accepted that being fat is bad, and it's also your fault, your responsibility. The blame lies solely on the individual, even if that individual is a three-year-old child, it is. And if it's not the child, then of course, it's the parent. The parent has done something wrong. 0:17:52.1 Louise: Specifically the mother, okay. 0:17:53.5 NL: The mother, yeah. 0:17:54.4 Louise: The one with the penis, okay, let's not talk about him, 'cause that was absent. It was the mom. And the only possibility that was examined in this is that it's mom's fault for not being compliant, like you said. That's the only thing. Nothing else like the whole method is a stink-fest of ineffective bullshit. 0:18:13.5 NL: And there's the one point in the transcript when they talk about the fact that she had ice cream or chips or something in the house. 0:18:19.7 Louise: That's Ms. Keeley, their social worker, who went in and judged them. And did you notice that she took different scales in during that last visit? That last visit that was gonna determine whether or not they'd be removed, she took different scales in and weighed them. And they say, "Look, we acknowledge that that could've screwed up the results, but we're just gonna push on with removal." 0:18:43.0 NL: It was their agenda. 0:18:45.0 Louise: It was. It's terrifying, and it's long-term foster care for this poor little girl who doesn't wanna leave her mom. I'm so fired up about this, because the impact of removing yourself from your home because of your body, how on earth is this poor kid gonna be okay? 0:19:05.7 NL: This is my worry. How is mom going to be okay? How is that boy going to be okay? And how is that young, impressionable girl... My oldest son is a little bit older, and my younger son is a little bit younger, she's literally in between the two, and I'm watching what the last two years or last year and a half has done to them in terms of their mental and emotional well-being. And to me, even without social services' involvement, my children's mental health has deteriorated massively. And I cannot even begin to comprehend what this poor girl is going through. I cannot imagine how traumatized she is, and I cannot see how is she ever going to get over this, because she's been going through it since she was three, and it's not at the hand of a parent, it's at the hand of a social worker, it is the social worker's negligence. And what's interesting is a lot of social workers and people who work in social services have reached out to me since I first talked about this case, and they have all said the same thing, the amount of weight stigma in social services in the UK is shocking. It is shocking. It is perfectly acceptable to call parents abusers just because their children are overweight. 0:20:21.8 Louise: Jesus. 0:20:22.2 NL: No other reason, just your child is over the limit, is on the 90th percentile or whatever it is, your child is overweight and therefore you as a mother, usually as you said, it's a mother, are an abusive mother, because you've brought your child up in a loving environment but they failed to look the way that you want them to look, that's it. 0:20:41.0 Louise: Okay. So, that's me, right. My eldest is in the 99th percentile, so I am an abuser, I'm a child abuser. 0:20:47.3 NL: Child abuser, I can't believe I'm probably talking to one. 0:20:49.3 Louise: I know. [laughter] 0:20:49.9 NL: I can't believe I'm probably talking to one. And you know, the irony, my son's been really poorly recently and he's been up in... I mean we've spent most of our life in the hospital the last few weeks, and... 0:20:58.1 Louise: Oh dear. 0:20:58.3 NL: Went to see a paediatrician and they did the height and weight, and he is on the 98th percentile, my son has a 28-inch waist. He is a skeleton at the moment because he's been really ill, but he is mixed race, and we all know that the BMI is not particularly... 0:21:12.9 Louise: It's racist. 0:21:13.2 NL: Useful anyway, but it's massively racist, so my children have always been, if you weigh them, a lot heavier than they look, because I mean he's... There isn't an ounce of fat on him. My point is that BMI is complete utter bullshit and it doesn't deserve to exist. The fact that we've been using up until now is shameful and as a doctor, I cannot accept that we use this as a measure of whether a person is healthy and certainly as a measure of whether a child is healthy, because until recently, we were told you don't do BMIs on anyone under the age of 16 but that's just gone out the window now, everyone... 0:21:48.5 Louise: I know. 0:21:48.6 NL: Gets a BMI, even a six-year-old. 0:21:50.1 Louise: You get a BMI, you get a BMI. [laughter] I think it's not supposed to be used for an individual anything, it's a population level statistic. 0:22:01.1 NL: And a pretty crappy one at that. 0:22:02.3 Louise: It's a shitty one. 0:22:02.6 NL: It is like you said. 0:22:04.2 Louise: Yes. 0:22:04.6 NL: It's based on what European men, it's not particularly useful for men, it's not particularly useful for any other race, it's just useful perhaps. Even when it came out, like even when... What's his face? I forget his name right now, Ancel Keys. When he did that study that first look, brought in the BMI into our medical world as it were, yeah, even he said at the time it was alright. It's not the best, it's not the worst, it will do. It's the best out of the bunch. I mean he didn't even have much enthusiasm at the time. He said specifically it's not meant to be used as an individual assessment. And even the guy who kind of didn't invent it, but he sort of invented it as a measure of "obesity" and yet... And even he didn't have much good stuff to say about it. If he was selling the latest iPhone, Apple would have a lot to say about that. [laughter] I just... This fact that we've become obsessed and we know why this is. We know this is because of the diet industry, we know this is because of people trying to make money out of us and succeeding, very successful at making money out of us. 0:23:02.9 Louise: It's actually terrifying how successful this is because when I read this transcript, I've been doing a lot of work against the Novo Nordisk impact and how our modern oh, narrative has been essentially created by the pharmaceutical company that's producing all of the weight loss drugs, they have 80% of the weight loss drugs market and they've shamelessly said in their marketing that this is their drive to increase... That it's to create a sense of urgency for the medical management of obesity. And here it is, this is where it bleeds, because they're telling us this bullshit that it's going to reduce stigma. No, it's going to create eugenics. This is hideous what's happening here and I can't believe that the world didn't stop and that the front page of newspapers aren't saying like get fucked, like get these kids back. There's no outrage. 0:24:04.2 NL: No, there is none whatsoever. We got just over 2,000 people supporting the petition and as grateful as I am for that, that's just what the fuck, that's 2,000 people who live in a country of 68 million and only 2,000 people had something to say about this and, we... That's how much we hate fat kids and how much we hate fat people. We just don't see them as worthy and nobody wants to defend this young girl, nobody sort of feels sorry for her and I just... I can't get my head around this whole thing. It's funny because I didn't really know about it, a year ago I was completely clueless. It's all happened rather quickly for me that I've begun to understand Haze and begun to understand who Novo Nordisk was and what they are doing and what Semaglutide actually is and how it's going to completely change the world as we know it. 0:24:56.5 NL: I think this particular drug is going to become part of popular culture in the same way that Viagra is, we use that word now in novels and in movies. It's so popular and so understood, nobody talks about... I don't know, give me a name of any drug, like some blood pressure medication, they don't talk about it in the same way they talk about Viagra. But Semaglutide is going to be that next drug because they have tapped into this incredibly large population of people who are desperate to lose weight and they've got this medication that was originally used to treat diabetes, just like Viagra was originally used to treat blood pressure and have said, "Wow, look at this amazing side effect. It makes people lose weight as long as you run it. Let's market this." And the FDA approved it. I mean, no... 0:25:45.1 Louise: I know. 0:25:45.8 NL: No thought as to whether or not this drug is gonna have a massive impact on people in their insulin resistance and whether they're gonna develop diabetes down the line. I don't think they care. I don't think anybody actually cares. I think it's just that everybody is happy, woo-hoo, another way to treat fat people and make a good deal of money out of it. 0:26:03.9 Louise: Right? So, Semaglutide is... It's the latest weight loss drug to be approved by the FDA from Novo Nordisk and it is like the Mark II. So, they were selling Saxenda, Saxenda's here in Australia, they're pushing it out and this Semaglutide is like the Mark II, like I think of Saxenda as like Jan Brady, and Semaglutide is like Marcia. [laughter] 0:26:29.3 Louise: 'Cause it's like, "Oh my God, look at Semaglutide. Look at this amazing one year trial." [laughter] Marcia, Marcia, Marcia, like oh my God, we can make so much weight loss happen from this intervention. Why? Why do we need all of this weight loss, all these percentages? And, "Oh, we can lose 15% and 20%," and we don't need to for health, but okay. 0:26:53.3 NL: Yeah. The other thing that we have to remember about it, I don't think it's actually that much better. I've used all of these drugs in treating diabetes. So many years, I used these drugs. The beauty of it, of course, is that it's a tablet, and Saxenda is an injection. I'm assuming you have the injectable form, yeah? 0:27:09.9 Louise: That's right. You have to inject, and it's very expensive. 0:27:14.0 NL: It's extremely expensive, as will... Marcia Brady will be more expensive, I'm sure. 0:27:18.6 Louise: So high maintenance. [chuckle] 0:27:20.2 NL: Absolutely, but she is easier to administer. A lot of people don't like the idea of injecting themselves, but taking a tablet is dead easy. So, that's what makes this special, as it were, because it's the only one of that whole family that is oral, as opposed to injectable. 0:27:37.6 Louise: Well, that's interesting, because the paper with all of the big, shiny weight loss was injectable, it wasn't tablet. 0:27:43.7 NL: Oh, really? Oh, but they're marketing it as the oral version, definitely. That's the one that's got approved. It's brand name is... 0:27:51.3 Louise: Wegovy. 0:27:52.2 NL: Oh no, well, I have a completely different brand name. Is it different, maybe, in Australia? 0:27:57.1 Louise: Well, this is in America. In Australia, they haven't cornered us yet. I'm sure that they're trying to do it, but it was the FDA approval for Wegovy, [0:28:05.4] ____. 0:28:05.9 NL: So, they obviously changed the name. That's not the same one we use in diabetes. Clearly, they've had to revamp it a bit. Irrespective of oral, injectable, whatever, I think that this is going to... Novo Nordisk is sitting on a gold mine, and they know it. And it's going to change our lives, I think, because bariatric surgery is quite a big thing, and it's something that often people will say, "I'm not keen on doing." And the uptake is quite low still, and so, in bariatric... 0:28:35.2 Louise: In the UK, not here. 0:28:36.2 NL: Yeah, [chuckle] yeah, but bariatric surgeons are probably very afraid right now, because there's drugs coming along and taking all of their business away from them. 0:28:43.5 Louise: Actually, you know what Novo were doing? They're partnering with the bariatric surgeons. 0:28:46.2 NL: Of course they are. 0:28:46.9 Louise: And they're saying to them, "Hey, let's use your power and kudos, and our drugs can help your patients when they start to regain." 0:28:56.4 NL: Oh my gosh. 0:28:58.0 Louise: It's literally gateway drug. Once you start using a drug to reduce your weight, you have medicalized your weight, and it's a small upsell from there. So, I think this is all part of a giant marketing genius that is Novo Nordisk. But I'm interested to hear your concerns, 'cause I'm concerned as well with the use of diabetes drugs as weight loss medications, and I read about it being that they're hoping that people will take this drug like we take statins. So, everyone will take it preventatively for the rest of their lives. What's the long-term impact, do you think, of taking a double dose of a diabetes drug when you don't have diabetes? 0:29:43.5 NL: Well, first of all, they don't know. Nobody knows, because they've only done a study for a year, and just how many diet drugs have we put out there into the universe since the 1970s, and then taken them back a few years later, 'cause we've gone, "Oh, this kills"? If you've got diabetes and you take this drug because you've got insulin resistance and this drug helps you to combat your insulin resistance in the way that it works, you've already got diabetes. And so, there is no risk of you developing diabetes, and this drug does work, and so, I have no issue with the GLP-1 analogs in their use in diabetes. I think all the diabetes drugs are important, and I'm not an expert. But you've really got to ask yourself, if you take a healthy body and you act on a system within the pancreas and within the body, in a healthy, essentially, healthy body, healthy pancreas, you've got to ask yourself if it's going to worsen insulin resistance over time. It's actually going to lead to increased cases of diabetes. Now, they say it won't, but... 0:30:47.4 Louise: How do they know that? 'Cause I've read a study by Novo, sponsored, in rats, that showed that it did lead to insulin resistance long-term. 0:30:57.6 NL: Right, I think common sense, because we understand that the way that the body works, just common sense. The way the body works suggests to me that over long periods of time, taking this medication in a healthy person is going to lead to increased insulin resistance, which in turn will lead to diabetes. That is what common sense dictates. But of course, as you said, we don't know. We don't have a study. Nobody has looked into this. And it makes me sad that we are using a drug to treat a condition that isn't a condition. 0:31:30.2 Louise: I know, yeah. [chuckle] 0:31:32.4 NL: And inadvertently, potentially giving people a whole... 0:31:36.0 Louise: Creating a condition. 0:31:36.6 NL: Creating an actual medical condition, which we all know to be life-threatening if untreated. And so, I cannot fathom why... Well, I can, I understand. It's for financial reasons only, but I can't understand why there are doctors out there that want to prescribe this. This is the issue that I have. I'm a doctor, and I can't speak on behalf of drug companies or politicians or anyone else, but I can speak to what doctors are supposed to be doing, and we have a very strong code of conduct that we have to abide by. We have ethical and moral principles and legal obligations to our patients. And so, doing no harm and doing what is in your patients' best interest, and practising fairly and without discrimination, and giving people... Allowing them to make an informed choice where they are aware of the risks and the side effects and all the different treatment options. 0:32:28.0 NL: When it comes to being fat, again, it seems to have gone out the window. None of these things are happening. We wouldn't dream of addressing other issues this way, it's just fatness, because it's just so commonly, widely accepted that fatness is bad and you've got to do whatever you can to get rid of it. I've had someone tell me today that they are pregnant with their first child and they had their first conversation with the anesthetist, who told them they had to do whatever they could to lose weight before they had their baby. This is a pregnant woman. 0:32:58.1 Louise: Whatever they had to do? 0:33:00.1 NL: Whatever they had to do, and she said, "What do you want me to do, buy drugs off the streets?" And the anesthetist said... Wait for it. The anesthetist said, "It would be safer for you to use a Class A drugs than it would for you to be fat in pregnancy". The anesthetist said that to this woman. She told me this and I just went "Please just... Can you just report him?" 0:33:21.7 Louise: Shut the front door, Jesus Christ! 0:33:24.6 NL: Can you imagine? First of all, that's not true. Second of all, he is saying that it is better to be a drug addict than to be a fat person. This is no judgment on drug addicts, but you do not encourage your patients to use Class A drugs to lose weight. That's stupid. Imagine if he'd said that about anything else, but in his... And it was a man, in his world, for whatever reason, his ethics just abandons them all in favor of fat shaming a woman. 0:33:52.4 Louise: This is where we're at with, it's self examined. It's like there's a massive black hole of stigma just operating unchallenged effortlessly and actually growing, thanks to this massive marketing department, Novo. It's terrify... That poor lady, I'm so glad she's found you and I hope she's not gonna go down the Class A drug route. [laughter] 0:34:19.3 NL: She's definitely not, but she was quite traumatized. She's on a Facebook group that I started and it's great because it's 500 people who are just so supportive of each other and it was within a few minutes 50 comments going "What a load of crap, I can't believe this," "You're great, this doctor is terrible". But it just stuck to me that one of my colleagues would dare, would have the audacity to do something as negligent as that. And I'm gonna call it what it is. That's negligence. But I'm seeing it all the time. I'm seeing it in healthcare, I'm seeing it in Social Services, I'm seeing it in schools, I'm seeing it in the workplace, I'm seeing it everywhere. You cannot escape it. And as a fat person, who was in the morbidly, super fat, super obese stage where she's just basically needs to just be put down like a... 0:35:16.3 Louise: Oh my gosh, it's awful. 0:35:18.5 NL: And as that person, I hear all of these things and I just think "I'm actually a fairly useful member of society, I've actually never been ill, never required any medication, managed to give birth to my children, actually to be fair, they had to come out my zip as opposed to through the tunnel." But that wasn't because I was fat, that was because they were awkward. But this anesthetist telling this woman that she's too fat to have a baby. I was just like "But I am the same weight. I am the same BMI as you". And I had three and I had no problems with my anesthetics. In fact after my third cesarean section, I walked out the hospital 24 hours later, happy as Larry, didn't have any problems. And I know people who were very, very thin that had a massive problems after their cesarean. So there's not even evidence to show how dangerous it is to have a BMI over 35 and still... And then caught when it comes to an anesthetic. This isn't even evidence-based, it's just superstition at this point. 0:36:12.8 Louise: It's a biased based and the guidelines here in Australia, so I think above 35 women are advised to have a cesarean because it's too dangerous. And women are not allowed to give birth in rural hospitals, they have to fly to major cities. So imagine all of... And don't even get me started on bias in medical care for women. It's everywhere, like you said, and it's unexamined and all of this discrimination in the name of, apparently, healthcare. It's scary. 0:36:43.9 NL: It really is. Gosh, you've got me fired up, it's almost 1:00 in the morning and I'm fired up. I'm never gonna get to sleep now. [laughter] 0:36:51.7 Louise: Okay, I don't wanna tell you this, but I will. 'Cause we're talking about how on earth is this possible, like why aren't there any medical experts involved to talk about this from a scientific basis, and I'm worried that even if they did have medical people in the court, they wouldn't have actually stuck up for the kid. I found this JAMA article from 2011. It's a commentary on whether or not large kids should be removed from their families, and it was supportive of that. 0:37:18.0 NL: Oh gosh. Of course it was. 0:37:22.0 Louise: And in response to that commentary, the medpage, which is a medical website, a newsletter kind of thing. They did a poll of health professionals asking should larger kids removed from their families, and 54% said yes. 0:37:40.7 NL: Of course. 0:37:41.3 Louise: I know. Isn't that dreadful? One comment on that said "It seems to me the children in a home where they have become morbidly obese might be suffering many other kinds of abuse as well, viewing in the size of a child. 'Cause we've all gotten bigger since the '80s. We're a larger population and viewing that as abuse and as a fault of parenting. Unbelievable. I also had a little dig around Australia, 'cause it's not isolated in the UK, there's so many more cases. 0:38:16.9 NL: They have. Yeah. 0:38:17.8 Louise: And I think actually in the UK, it might be a lot more common than in Australia. 0:38:22.1 NL: Yeah, I can believe that. 0:38:23.5 Louise: But it did happen here in 2012, there was some report of two children being removed from their families because of the size of the kids. And the media coverage was actually quite dreadful. I'll put in the show notes, this article, and the title is "Victorian authorities remove obese children, removed from their parents". So even the title is wrong, couldn't even get their semantics right. There's a picture, you can imagine what picture would accompany... 0:38:55.2 NL: Well of course it can't be of the actual children, because I think it leads to lawsuit. I'm assuming it's a belly. Is there a belly? Is there a fat person in it or a fat child eating a burger? 0:39:06.2 Louise: Yes. [laughter] 0:39:07.1 NL: Sorry, it's either the belly or the fat person eating the burger. So, a fat child eating the burger, sorry. 0:39:11.9 Louise: Helpfully, to help the visually impaired, the picture had caption and the caption reads "Overweight brother and sister sitting side by side on a sofa eating takeaway food and watching the TV." So not at all stereotyped, very sensitive, nuanced article this one. And then we hear from Professor John Dixon, who is a big part of obesity Inc here in Australia. He told the ABC that "Sometimes taking children away from their parents is the best option." In the same article, he also admits "There's no services available that can actually help kids lose weight", and he says that it's not the parents fault. Helpfully, this article also states that "Obesity is the leading cause of illness and death in Australia." [laughter] 0:39:58.7 NL: I love it when I hear that. How have they figured that out? What do they do to decide that? Where does this... 0:40:08.4 Louise: They don't have to provide any actual evidence. 0:40:10.5 NL: Right. They just say it. 0:40:12.1 Louise: Got it. 0:40:13.0 NL: Just say it. 0:40:14.4 Louise: Diet. And I checked just to make sure, 'cause in case I've missed anything. 0:40:18.4 NL: Yeah. 0:40:19.6 Louise: The top five causes of death in Australia in 2019; heart disease, number two dementia, number three stroke, number four malignant neoplasm of trachea bronchus and lung. 0:40:30.4 NL: Lung cancer. 0:40:30.9 Louise: Lung cancer. 0:40:31.5 NL: That's lung cancer. 0:40:32.3 Louise: And number five chronic lower respiratory disease. 0:40:38.4 NL: So translation. Heart attacks, dementia... In the UK it's actually dementia first, then heart attacks. So dementia, heart attacks, stroke, same thing in the UK, and then lung cancer and COPD. Both of those are smoking-related illnesses. And I can say quite safely that they are smoking-related illness because the chance of developing lung cancer or COPD if you haven't smoked is minuscule. So what the people are doing is they're saying, "Well, we can attribute all of these heart attacks and strokes and dementia to "obesity". And the way we can do that is we just look at all these people that have died, and if they are fat we'll just assume it's their fat that caused their heart disease. 0:41:20.0 NL: To make it very clear to everybody that is listening, if you have a BMI of 40, we can calculate your risk of developing a heart attack or a stroke over the next 10 years using a very sophisticated calculator actually, it's been around for some time. It's what we use in the UK. I'm assuming Australia has a similar one, don't know what it's called there. In the UK it's called a QRISK. So I've done this. I have calculated. I have found a woman, I called her Jane. I gave her a set of blood pressure and cholesterol, and I filled in a template. And then I gave her a BMI of 20. And then I gave her a BMI of 40. And I calculated the difference in her risk. I calculated the difference in her risk, and the difference in her risk was exactly 3%. The difference in her risk if she was a smoker was 50%. She was 50% more likely to have a heart attack if she was a smoker, but only 3% more likely to have a heart attack if she had a BMI of 40 instead of a BMI of 25. 0:42:15.0 NL: To put it into perspective, she was significantly more likely to have a heart attack if she was a migraine sufferer, if she had a mental health condition, if she had lupus or rheumatoid arthritis, if she was Asian, if she was a man, and all of those things dramatically increased her risk more than having a BMI of 40. So it's just very important that doctors will admit, 'cause it's about admitting to a simple fact, this calculator we use to predict people's risks. So if we know that weight only has a 3-4% impact on our cardiovascular risk as opposed to smoking which has a 50% impact, as opposed to aging which is why most people die because they get old and let's face it everybody dies some time. 0:43:04.0 NL: So what's happening is the... Whoever they are, are taking all these deaths from heart disease which was likely caused by the person aging, by the person being male or just being old and being over the age of 75, your risk of heart disease goes up massively irrespective of your weight. So instead of saying, "Well, it's just heart disease", they've gone, "Well, it's heart disease in a fat person and therefore it was the fatness that caused the heart disease." And that is offensive to me to the point that now, I have heard... And this is awful in this year, our patients that are dying of COVID, if they die of COVID in the UK, it's actually quite heart breaking, it's happened to someone that I was close to. If they die of COVID in the UK, and they happen to be fat, the doctor writes "obesity" on their death certificate... 0:43:51.8 Louise: No way. 0:43:52.4 NL: As a cause of death. They died of COVID. 0:43:55.2 Louise: What? 0:43:55.5 NL: They died of COVID. That's what they died of. They died of this terrible virus that is killing people in their droves but people are under the misguided impression that being fat predisposes you to death from COVID, which is not true. It's not true. That is a complete gross misrepresentation of the facts. But we've now got doctors placing that on a person's death certificate. Can you imagine how that family feels? Can you imagine what it feels like to get this death certificate saying, "Your family member is dead from COVID but it's their fault 'cause they were obese." And how can the doctor know? How could the doctor know that? 0:44:34.2 Louise: How can they do that? 0:44:35.6 NL: How can they do that? And this is my point, this doctor that's turning around and saying it's safer for children to be removed from their loving home. Obviously, this person has no idea of the psychological consequences of being removed from your family. But it's safer for that person to be removed from their home than to remain in their home and remain fat. What will you achieve? Is this person going to lose weight? No. I can tell you what this person is going to do. This person is going to develop... 0:44:58.9 Louise: They even say that. They even say that in the transcripts. We don't think that they'll get any more supervision. 0:45:03.1 NL: Yeah. In fact, we're gonna get less supervision because it's not a loving parent. You're going to develop, most likely an eating disorder. You're going to develop serious psychological scars. That trauma is going to lead to mental health problems down the line. And chances are you're just gonna get bigger. You're not gonna get smaller because we know that 95% of people who lose weight gain it all back again. We know that two-thirds of them end up heavier. We know that the more you diet, the heavier you're gonna get. And that actually, this has been shown to be like a dose-response thing in some studies. So the more diets you go on, the higher your weight is going to get. If you don't diet ever in your life, chances are you're not gonna have as many weight problems later on down the line. So, as you're saying, we are living in a society that's got fatter. And there's lots of reasons for that. It's got to do with the food that we're eating now. That we're all eating. That we're all consuming. 0:45:55.1 Louise: Food supply. Only some of us will express from there the epigenetic glory of becoming higher weight. 0:46:02.0 NL: Right. And that's the thing, isn't it? Genetics, hormones, trauma, medications. How many people do I know that are on psychiatric medications and have gained weight as a result, Clozapine or... It's just what's gonna happen. You name it. Being female, having babies, so many things will determine your weight. 0:46:21.0 Louise: Getting older. We're allowed to get... We're supposed to get bigger as we get older. 0:46:25.1 NL: And then you know that actually, there are so many studies nowadays, so many studies that we've labeled it now that show that actually being fat can be beneficial to you. There's studies that show that if you end up in ICU with sepsis, you're far more likely to survive if you're fat. If you've got a BMI over 30, you're more likely to survive. There's studies that show that if you have chronic kidney disease and you're on dialysis, the chances of you surviving more long-term are significantly higher if you're fat. Heart failure, kidney disease, ICU admissions, in fact, even after a heart attack, there's evidence to show that you're more likely to survive if you're fat. And they call this the obesity paradox. We have to call it a paradox because we cannot, for one moment, admit that actually there's a possibility that being fat isn't all that bad for you in the first place and we got it wrong. Rather than admit that we got it wrong, we've labeled a paradox because we have to be right here, we have to... 0:47:18.0 Louise: Yeah, it's like how totally bad and wrong, except in certain rare, weird conditions, as opposed to, "Let's just drop the judgment and look at all of this much less hysterically." 0:47:29.5 NL: Yeah. And studies have shown that putting children on a diet, talking about weight, weight-shaming them, weighing them, any of these things, have been linked to and have been demonstrated to cause disordered eating and be a serious risk for direct factor for weight gain. And that, in my opinion, is the important thing to remember in this particular case, because as I said, social services start in weight-shaming, judging, and talking about weight when these children were three and six, and they did that for 10 years. And in doing so, they are responsible for the fact that these children went on to gain weight, because that's what the evidence shows. And there's no question about this evidence, there's multiple papers to back it up. 0:48:14.1 NL: There's an article published in Germany in 2016, there was an article published last year by the University of Cambridge, and even the American Academy of Pediatrics agrees that talking about weight, putting children on a diet, in fact, even a parent going on a diet is enough to damage that child and increase their risk of developing disordered eating patterns and weight gain. 0:48:37.9 NL: And so, as far as I'm concerned, that to me, is evidence enough to say that it's actually social services that should be in front of a judge, not these children, but it's the social workers that should be held to account. And I have written... And this is something that is very important to say. I wrote to the council, the local authority, and I've written a very long letter, I've published it on my website. You can read it anytime, anyone can read it. And I wrote to them and I said, "This is the evidence. Here are all the links. As far as I'm concerned, you guys got it terribly wrong and you have demonstrated that there is a high degree of weight bias that is actually causing damage to children. I am prepared to come and train you for free and teach all of your social workers all about weight bias, weight stigma, and to basically dispel the myths that obviously are pervading your social work department." And they ignored me. I wrote to politicians in the area. They ignored me. I wrote to a counselor who's a member of my political party, who just claimed, "Yeah, I'll look into it for you." Never heard from her again. Yeah, nobody cares. 0:49:44.0 Louise: It's just such a lack of concern. 0:49:45.7 NL: I didn't even do it in a critical way. I had to do it in a kind of, "I will help you. Let me help you. I'm offering my services for free. I do charge, normally, but I'll do it for free for you guys." No one is interested. Nobody wants to know. And that makes me really sad, that they weren't even willing to hear me out. 0:50:03.0 Louise: I can't believe they didn't actually even answer you. 0:50:06.5 NL: Didn't answer me, didn't respond to any of my messages, none of the counselors, none of the... Nobody has responded, and I've tried repeatedly. 0:50:14.4 Louise: So, this is in West Sussex, yeah? 0:50:16.7 NL: That's right, West Sussex, that's right. 0:50:18.0 Louise: You know what's weird about that? I've actually attended a wedding at that council, that my ex-father-in-law got married there. And when I saw the picture there, I'm like, "Oh my God, I've actually been there." So, I had a poke, and I don't know if you know this, but hopefully, in the future, when those children, C and D, finally decide to sue the council, that they can use this as evidence. There is a report from a... It's called a commissioner's progress report on children services in West Sussex from October 2020, which details how awful the service has been for the past few years, and huge issues with how they're running things. And it says, "Quite fragile and unstable services in West Sussex." So, this family who've had their kids removed were being cared for by a service with massive problems, are being referred to programs that don't work, and that there's a massive miscarriage of justice. 0:51:17.3 NL: And I'm glad you're talking about it, and I'm glad we're talking about it. And I wish that we had the platform to talk about it more vocally. I'd want to be able to reach out to these... To see patients... They're not patients, child C and D. I want to be able to reach out to mum as well, and say... 0:51:36.3 Louise: I just wanna land in Sussex and just walk around the street saying, "Where are you? I wanna help." 0:51:40.2 NL: "Where are you? And let me hug you." And I'm very interest to know, I'd be very interested to know the ethnic origin of these young people. 0:51:48.9 Louise: And the socio-economic status of these people. 0:51:50.2 NL: Socio-economic status, 100%. I would very much like to know that. That would make a huge... I think that I can guess, I'm not going to speculate, but I had a very lovely young woman contact me from a... She was now an adult, but she had experienced this as a child. She had been removed from her home and was now an adult, and she had been in foster care, in social services, for a few years, and had obviously contact with her mum but hadn't been reunited with her mum ever. So it wasn't like it was for a time and then she went back. And we talked about this. She was in a London borough, I shall not name the borough, but I know for a fact that her race would've played a role in this, because she was half-Black, half-Turkish. 0:52:39.2 NL: And there're a few things in that court transcript that caught my attention. I don't know if you noticed there was a mention of the smell from the kitchen, and they didn't specifically said, you know, mould, or you know that there was mould in the kitchen, or there was something in the kitchen that was rotting, something like that, 'cause I think they would have specified. It was just a smell. And that made me wonder, is this to do with just the fact that maybe this family lived in poor housing or was it the type of food that they were cooking for their children? Is there a language issue, is there a cultural issue. What exactly is going on? 'cause we don't know that from the court transcript, so that's another thing that... Another piece of the puzzle that I would really be interested in. Is this a white wealthy family? Probably not. I don't think they are. 0:53:27.2 Louise: Yeah it didn't struck me that way either. Yeah, yeah this is potentially marginalization and racism happening that... 0:53:35.1 NL: Yeah. 0:53:35.9 Louise: And here in Australia, we've got an awful history of how we treated First Nations people and we removed indigenous kids from their families, on the basis of like we know better, and I just... Yeah honestly, elements of that here, like we know better. 0:53:51.5 NL: Yes. Right, this is it. We know better than you have to parent your child. I am have always been a big believer of not restricting my children's feed in any way. I was restricted, and I made the decision when we had the kids that there would just be no restriction at all. I have like been one of those parents that had just been like, that's the draw with all the sweet treats in it. They're not called treats, they're just sweets and chocolate and candy, there it is. It's within reachable distance. Help yourself whenever you want, ice pops in the freezer, there's no like you have to eat that to get your pudding. None of that. 0:54:27.6 NL: My kids have just been able to eat whatever they wanted, whenever they wanted, I never restricted anything, I wanted them to be intuitive eaters. And of course they are, and what amazes me is now my teenage son, when we were on lockdown, and he was like homeschooled, he would come downstairs, make himself a breakfast, and there was like three portions of fruit and veg on his plate, and not because someone told him that he had to, but just because he knew it was good for him and he knew it was healthy, there was like a selection, his plate was always multi-colored, he was drinking plenty of water. He would go and cook it, he cooked himself lunch, he knew that he can eat sweets and crisps and chocolate whenever he wanted to, and he didn't, he just didn't. Like it was there, that drawn, it gets emptied out because it's become a bit... But no, they don't take it, and sometimes they do, 'cause they fancy it, but most of the times they don't. And that is my decision as a parent, I believe that I have done what is in their best interest, I believe that I will prove over time that this has had a much better impact on their health, not restricting them. 0:55:26.4 Louise: Absolutely, Yeah. 0:55:27.6 NL: But the point is they're my children, and it was my damn choice, and even if my child is on the 98th percentile, it's still my damn choice, nobody gets to tell me how to parent my child. That is my child, I know what's best for them. And I believe that my children are going to prove the fact that this is a great way of parenting, and I know that actually most of their friends who had, were not allowed to eat the food that they wanted to eat used to come over to our house and just kind of like wide eyed. And they binge, they binge, you know, to the point that I have to restrict them and say I actually I don't think mom would like that if I gave that to you. 0:56:00.0 Louise: We know that that's what we do when we put kids in food deserts, we breed binge eating and food insecurity, and trying to teach our kids to have a relaxed and enjoyable relationship with food is what intuitive eating is all about. And without a side salad of fat phobia, we're not doing this relationship with food stuff in order to make sure you're thin, we're doing this to make sure that you feel really safe and secure in the world, and you know health is sometimes controllable and sometimes not, and this kind of mad obsession we have with controlling our food and the ability it will give us like everlasting life is weird. 0:56:39.0 NL: Yeah. 0:56:39.7 Louise: Yeah. Gosh, I'm so glad you're parenting those kids in that way and I've noticed the same thing with my kids. Like my kids, we are a family of intuitive eaters and it's just really relaxed, and there's variety, and they go through these little love affairs with foods, and it's really cute. [chuckle] And they're developing their palettes, and their size is not up to me. 0:57:05.8 NL: Yeah. 0:57:06.4 Louise: Yeah. 0:57:07.4 NL: Right. 0:57:08.1 Louise: It's up to me to help them thrive. 0:57:10.7 NL: That's right. And when people talk about health, I often hear people talking about health, and whenever they ask me that question, you know, surely you can agree that being fat is not good for your health, well, I'll always kinda go, "Oh Really? Could you just do me a favor here and define health?" Because I spend my whole life trying to define health, and I'm not sure that I've got there yet, but I can tell you without a doubt that this for me, in my personal experience as a doctor... And I've been a doctor for a long time now, and I see patients all the time, and I'm telling you that in my experience, the most important thing for your health is your mental and emotional well-being, that if you are not mentally and emotionally well, it doesn't matter how good your cholesterol is, it doesn't matter whether or not you've got diabetes, that is irrelevant, because if you're not mental and emotional... I'm not saying that 'cause you won't enjoy life, I mean, it has an impact on your physical health. And I spend most of my day dealing with either people who are depressed or anxious, and that's what they've presented with, or they've presented with symptoms that are being made worse or exacerbated by their mental and emotional pull, mental and emotional well-being. 0:58:19.1 NL: So giving my children the best start in life has always been about giving them a good mental and emotional well, start. It's about giving... It's not just teaching them resilience, but teaching them to love themselves, to be happy with who they are, to not feel judged or to not feel that they are anything other than the brilliant human beings that they are. And I believe that that is what's going to stand them in the greatest... In the greatest... I've lost my words now, but that's what's gonna get them through life, and that's why they're going to be healthy. And how much sugar they eat actually is quite irrelevant compared to the fact that they love themselves and their bodies, and they are great self-esteem, we all know that happiness is... Happiness is the most important thing when it comes to quality of life and happiness is the most important thing when it comes to length of life and illness, all of it. Happiness trumps everything else. 0:59:07.0 Louise: And to you know what that comes from. Happiness comes from a sense of belonging, belonging in our bodies, belonging in ourselves, belonging in the community, and all of this othering that's happening with the message that everyone belongs unless they're fat. That sucks ass and that needs to stop. This poor little kid when, in the transcript it mentioned that they found a suicide note... 0:59:29.9 NL: Yes. 0:59:30.1 Louise: And some pills. And she's fucking like 13. 0:59:34.8 NL: Yeah, and they called it a cry for help. 0:59:36.0 Louise: They called it cry for help 'cause of her body. 0:59:38.1 NL: Yeah. 0:59:38.4 Louise: They didn't recognize it since they've been sniffing around threatening to take her off her mom, and because she's being bullied for her size at school. This is like a calamitous failure to see the impact of weight stigma. 0:59:52.9 NL: She's been told that it's her fault that she's been taken away from her mum. They had told her that because she didn't succeed in losing weight, that she doesn't get to live with her mother anymore. Can you imagine? 1:00:02.4 Louise: So her mom. I can't even wrap my head around that. I can't. 1:00:07.2 NL: Well, she feels suicidal, I think I would too. I felt suicidal at her age and for a lot less. It's terrible, it's terrible. And I hope she's hanging on and I hope that... 1:00:14.6 Louise: I wanna tell her that she is awesome. 1:00:17.4 NL: Yes. 1:00:17.9 Louise: If she ever gets to listen to this. But I know the impact. So like when I was 11, my mom left and I remember how much it tore out my heart. 1:00:26.4 NL: Yeah. 1:00:26.9 Louise: You're 11... 1:00:27.5 NL: Yeah. 1:00:28.3 Louise: 12, 13. This is not the time to do this to kids, and this whole idea... The judge said something like, "Oh, you know, gosh, this is gonna be bad... " But here it is, I will read it to you. This is... She actually wrote a letter to the kids. 1:00:42.5 NL: Oh, gosh. 1:00:43.7 Louise: "I know you will feel that in making this o

This episode will hopefully convince you to never suddenly discontinue clozapine (and to do a thorough home medication review) Click HERE to leave a review of the podcast!Subscribe HERE!References:All references for Episode 58 are found on my Read by QxMD collectionSupport the show (https://www.buymeacoffee.com/errxpodcast)

The FDA authorizes a postexposure prophylaxis for COVID-19; a new treatment is okay'd for lupus; a higher dose naloxone nasal spray became available; the risk evaluation and mitigation program for Clozapine has had important changes, and finally, Istodax has had an indication withdrawn. 

Clozapine blood levels can be influenced by many factors. These include dose, gender, age, body weight, caffeine, medications, and of course, smoking. How much is the reduction in clozapine levels actually due to cigarette smoking? Faculty: Jim Phelps, M.D. Hosts: Jessica Diaz, M.D.; Flavio Guzman, M.D. Learn more about Premium Membership here Earn 0.5 CMEs: Quick Take Vol. 24 Impact of Smoking Behavior on Clozapine Blood Levels—A Systematic Review and Meta-Analysis

In this episode, Dr Cheryl Buhay will discuss Clozapine and primary care- what you need to know.

In this episode, we talk meds with an MD. Specifically: Clozapine. Many of us are told that it's the “last resort” medication, “when nothing else works”. Is that really true?Guest :  Robert S Laitman, MD, is an internal medicine physician at Bronx Westchester Medical Group in New York. Over the last 10 years, he has developed a practice taking care of people with psychotic disorders after his son, Daniel, received a diagnosis of schizophrenia in 2006.Dr Laitman, his family, and his colleague authored the book, "Clozapine: Meaningful Recovery from Schizophrenia."We talk about:1.       Why do you say clozapine should be the drug used first? Why isn't it? 2.       Why is clozapine used more in other countries compared to the United States? Why isn't it marketed more here? 3.       Why does clozapine take so long to fully kick in (a year in some cases) compared to other antipsychotics? Your son continues to improve, even after being on it for 9 years. In what ways does he improve?  4.    How does clozapine can benefit patients, besides addressing the classic symptoms of schizophrenia, e.g., suicidality, illicit drug use, smoking. 5.       Mitigating predictable side effects - e.g., weight gain, salivation, sedation.  (Med therapy management and how it works) 6.      We need Engagement, Access, Treatment, Support 7. What can families do, to advocate for their loved ones to get best treatment? What should practitioners know, and do?  What can families do? Educate yourself about clozapine and talk with your loved one's psychiatrist. Links and explanations:TeamDanielRunningForRecovery.orgClozapine facebook pageTeam Daniel facebook pageSZ 3 Moms Facebook pageGet on the mailing list:rslaitman@aol.comDr. Laitman's Book:https://www.amazon.com/MEANINGFUL-RECOVERY-Schizophrenia-Serious-Clozapine/dp/172748424XNew finger-prick Point-of-service testPsychiatrists were once referred to as Alienists - Psych. Today articleDeborah Levy was director of the Psychology Research Laboratory at McLean Hospital and an associate professor of psychology in the Department of Psychiatry at Harvard Medical School,

Antidepressants, mood stabilizers, antipsychotics, benzodiazepines, stimulants.....READY SET GO!Med cheat sheetSSRIs (selective serotonin reuptake inhibitors)-- Prozac, Lexapro, Paxil, Celexa, Zoloft, Luvox, Trintellix, Viibryd-- They are generally NOT antidepressantsMainly helpful for OCD, body dysmorphia,  panic (if not from trauma), depression if postpartum or fueled by neuroticism or ruminative anxietySNRIs (serotonin norepinephrine reuptake inhibitors)-- Effexor/venlafaxine, Cymbalta/duloxetineMostly helpful for combined depression/anxiety, especially with insomniaWellbutrin/bupropion-- very stimulating (prison crack!), true antidepressant; can trigger/worsen anxietyMAO  (monoamine oxidase) inhibitors-- powerful antidepressants, lots of side effects and med interactionsLamictal/lamotrigine-- definitely ALL THAT and a bag of chips (see My Desert Island Meds in Season 1)Atypical antipsychotics-  Abilify/aripiprazole, Latuda/lurasidone, Seroquel/quetiapine, Saphris/asenapine, Vraylar/cariprazine, Risperdal/risperidone, Zyprexa/olanzapine, Geodon/ziprasidone, Invega/paliperidone Generally good mood stabilizers (in contrast to the putative "mood stabilizers" below); typically more helpful for severe depression and bipolar disorder than true psychosis (Zyprexa and Risperdal excepted)"Mood stabilizers"- (big misnomer, most effective for  mania/agitation, not depression)-- Depakote/valproic acid, Trileptal/oxcarbazepine, Tegretol/carbamazepineLithium- it's not clozapine, but gets the silver medal as a true mood stabilizer (see My Desert Island Meds in Season 1)Clozapine- the winner of the psychiatric med decathlon in most every event; needs weekly blood monitoring and has a few very serious potential side effectsBenzodiazepines- Xanax/alprazolam; Klonopin/clonazepam, Librium/chlordiazepoxide, Ativan/lorazepam, Valium/diazepamStimulants- Adderall/amphetamine; Vyvanse; Ritalin/Concerta/Focalin/methylphenidateAmphetamines are more euphoria-inducing, thus more abused and addictive and also tend to have more side effects; both amphetamines and methylphenidate are roughly equally effective for ADD/ADHDBFTAhttps://www.craigheacockmd.com/podcast-page/

Can clozapine increase the risk of COVID-19 infection? What is the role of hypersalivation? Faculty: Jim Phelps, M.D. Hosts: Jessica Diaz, M.D.; Flavio Guzman, M.D. Learn more about Premium Membership here Earn 0.5 CME: Quick Take Vol. 19 Clozapine Treatment and Risk of COVID-19

A new track by DJ Habett from the album "Les forces de l'esprit" (2021-02-16). Tags: Dark, Moods, Epic, Bass, Triphop, Memories, Psycho, Schizophrenia, Mental, Glow, Images, Coaxial, Dawn CC(by)

Dr. Deepak Sarpal is Assistant Professor of Psychiatry/Medical Director of Services for Treatment of Early Psychosis at WPH. This Podcast focuses upon Clozapine, a very valuable but underused treatment for refractory schizophrenia, also brain science involving functional imaging associated with patient improvement on anti-psychotic drugs. Findings include brain pre-frontal cortex connectivity and synchronization of function with brain striatum, limbic system structures, Globus Pallidus.

This is the last episode in the narrow therapeutic index drugs mini-series, and we're rounding it off with two of the most fascinating drugs ever, methotrexate and clozapine. Remember to follow us on Instagram, Twitter, LinkedIn and join us in the Telegram group! Link to the masterclasses and re-runs: https://www.eventbrite.com/o/primary-healthcare-development-19857293813

Link to bioRxiv paper: http://biorxiv.org/cgi/content/short/2020.08.05.238212v1?rss=1 Authors: Das, D., Peng, X., Lam, A.-T., Bader, J. S., Avramopoulos, D. Abstract: Antipsychotics are known to modulate dopamine and other neurotransmitters which is often thought to be the mechanism underlying their therapeutic effects. Nevertheless, other less studied consequences of antipsychotics on neuronal function may contribute to their efficacy. Revealing the complete picture behind their action is of paramount importance for precision medicine and accurate drug selection. Progress in cell engineering allows the generation of induced pluripotent stem cells (iPSCs) and their differentiation to a variety of neuronal types, providing new tools to study antipsychotics. Here we use excitatory cortical neurons derived from iPSCs to explore their response to therapeutic levels of Clozapine as measured by their transcriptomic output, a proxy for neuronal homeostasis. To our surprise, but in agreement with the results of many investigators studying glial-like cells, Clozapine had a very strong effect on cholesterol metabolism. More than a quarter (12) of all annotated cholesterol genes (46) in the genome were significantly changed at FDR

Link to bioRxiv paper: http://biorxiv.org/cgi/content/short/2020.05.26.116343v1?rss=1 Authors: Sun, D., Kermani, M., Hudson, M., He, X., Unnithan, R. R., French, C. Abstract: Local field potentials (LFPs) recorded intracranially display a range of location specific oscillatory spectra which have been related to cognitive processes. Although the exact mechanisms producing LFPs are not completely understood, it is likely that voltage-gated ion channels which produce action potentials and patterned discharges play a significant role. It is also known that antipsychotic drugs (APDs) affect LFPs spectra and a direct inhibitory effect on voltage-gated potassium (K_v) channels has been reported. Additionally, K_v channels have been implicated in the pathophysiology of schizophrenia, a disorder for which APDs are primary therapies. In this study we sought to: i) better characterise the effects of two APDs on LFPs and connectivity measures and ii) examine the effects of potassium channel modulators on LFPs and potential overlap of effects with APDs. Intracranial electrodes were implanted in the hippocampus (HIP) and pre-frontal cortex (PFC) of C57BL/6 mice; power spectra, coherence and phase-amplitude cross frequency coupling were measured. Drugs tested were the APDs haloperidol and clozapine as well as voltage-gated potassium channel modulators (KVMs) 4-aminopyridine(4AP), tetraethylammonium (TEA), E-4031 and retigabine. All drugs and vehicle controls were administered intraperitoneally. Both APDs and KVMs significantly reduced gamma power with the exception of 4AP, which conversely increased slow-gamma power. Clozapine and retigabine additionally reduced coherence between HIP and PFC. Phase-amplitude coupling between theta and gamma oscillations in HIP was significantly reduced by the administration of haloperidol and retigabine. These results provide previously undescribed effects of APDs on LFP properties and demonstrate novel modulation of LFP characteristics by KVMs that intriguingly overlaps with the effects of APDs. The possibility of a common mechanism of action deserves further study. Copy rights belong to original authors. Visit the link for more info

Matthew Goldman, M.D., M.S., joins Dr. Dixon and Dr. Berezin to discuss the significant changes in mental health policy prompted by the COVID-19 crisis across five major areas: legislation, regulation, financing, accountability, and workforce development. Special considerations for mental health policy are discussed, including social determinants of health, innovative technologies, and research and evaluation. The manuscript being discussed has been peer reviewed and accepted for publication but not copyedited or formatted for publication. It is freely available from the Psychiatric Services homepage (https://ps.psychiatryonline.org), in addition to other manuscripts pertaining to the COVID-19 pandemic. The article was authored by the members of the Psychiatric Services Policy Advisory Group, which aims to guide the journal on how to maximize its relevance and impact on mental health policy. Dr. Goldman's research interests, and how his responsibilities have changed during the COVID-19 pandemic [3:29] What is mental health policy, and how is policy evolving during the pandemic? [6:35] Differences between legislative and regulatory frameworks [9:13] Discussion of changes involving financing, accountability, and workforce development [14:14] Discussion of changes involving state licensing [17:41] Umbrella issues that affect policy [19:57] Dr. Goldman is a Public Psychiatry Fellow at the University of California, San Francisco, and is a clinical instructor in the Department of Psychiatry at UCSF. Subscribe to the podcast here. Check out Editor's Choice, a set of curated collections from the rich resource of articles published in the journal. Sign up to receive notification of new Editor's Choice collections. Browse other articles on our web site. Be sure to let your colleagues know about the podcast, and please rate and review it wherever you listen to it. Listen to other podcasts produced by the American Psychiatric Association. Follow the journal on Twitter. E-mail us at psjournal@psych.org

Listen to an audio podcast of the January 28, 2020 FDA Drug Safety Communication that FDA is strengthening an existing warning that constipation caused by the schizophrenia medicine clozapine (Clozaril, Fazaclo ODT, Versacloz, generics) can, uncommonly, progress to serious bowel complications.

This is a moderate yield podcast about Clozapine, high yield for this rotation with key information at the beginning. There appears to be one mistake describing the mechanism of action of Clozapine. It is an antagonist not a partial antagonist at the D2 receptor. Thank you Peter Huang, MSIV for taking time to prepare this podcast and for attempting to focus the key Shelf exam information near the beginning!

Alberto J. Espay, MD, MSc, conducts a Masterclass lecture on treating patients with Parkinson’s-related psychosis from the Psychopharmacology Update in Cincinnati. The meeting was sponsored by Global Academy for Medical Education and Current Psychiatry. Dr. Espay is professor of neurology at the University of Cincinnati. He also serves as director of the James J. and Joan A. Gardner Family Center Research Chair for Parkinson’s Disease and Movement Disorders. And later, in the “Dr. RK” segment, Renee Kohanski, MD, asks you to think about some of the complex issues tied to getting treatment for people who are both homeless and have serious mental illness.  *  *  *  Treatment of Parkinson’s-related psychosis  Psychosis related to Parkinson’s disease (PD) is a common reason for hospitalization, institutionalization, and decline of patients with PD. The diagnosis of PD is required before the development of psychosis to diagnose patients with Parkinson's-related psychosis. Parkinsonism that appears after development of psychosis is Lewy body dementia. Many factors influence the development of psychosis in PD. Extrinsic factors include medical illnesses or metabolic derangement causing delirium with psychosis; nonessential dopaminergic medications such as ropinirole and selegiline; anticholinergic medications such as benztropine, amantadine, and bladder antispasmodics; and insomnia. The last resort for treatment of psychosis is levodopa because patients will experience motoric decline and loss of functioning. There are several mechanisms for psychosis to occur via the dopaminergic, serotonergic, and glutamatergic pathways; thus, three neurotransmitters – serotonin, dopamine, and glutamate – can be manipulated to treat psychosis. Quetiapine, clozapine, and pimavanserin are the three antipsychotics safe for use in Parkinson’s disease. Clozapine is infrequently used, because of the risk of neutropenia and required blood work monitoring, but evidence shows that the benefits usually outweigh the risks of motor decline. Quetiapine is commonly used, because it has a favorable effect on sleep and psychosis, but it negatively affects the movement disorder of Parkinson's disease. Pimavanserin (Nuplazid), the only medication FDA approved for hallucinations and delusions associated with psychosis in Parkinson’s disease, is highly selective for the 5-HT2A receptor as both an inverse agonist and antagonist. Primary adverse effects are peripheral edema and confusion, but overall the adverse effects profile is similar to that of placebo. In the pimavanserin clinical trials, a subset of patients worsened and experienced more visual hallucinations. In addition, pimavanserin can prolong the QT interval, so patients taking other QT-prolonging medications or who have cardiac comorbidities should be monitored with an EKG. Post hoc data analysis from as pivotal phase 3 study suggests that patients with cognitive impairment and dementia may receive more benefit from pimavanserin.   *  *  *  References Cruz MP. Pimavanserin (Nuplazid): A treatment for hallucinations and delusions associated with Parkinson’s disease. P T. 2017 Jun;42(6):368-71. Cummings J et al. Pimavanserin: Potential treatment for dementia-related psychosis. J Prev Alzheimers Dis. 2018;5(4):253-8. Huot P. 5HT2A receptors and Parkinson’s disease psychosis: A pharmacological discussion. Neurodegenerative Disease Management. 2018 Nov 19. doi: 10.2217/nmt-2018-0039.  *  *  *  For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgePsych  

Show Notes By Jacqueline Posada, MD, 4th-year resident in the department of psychiatry & behavioral sciences at George Washington University, Washington. In this episode, Lorenzo Norris, MD, host of the MDedge Psychcast, interviews Jonathan M. Meyer, MD, about prescribing clozapine and understanding barriers of use. Dr. Meyer is clinical professor of psychiatry, University of California, San Diego, and a psychopharmacology consultant with the California Department of State Hospitals. Overview of clozapine Clozapine is an effective medication for treatment-resistant schizophrenia and lethality/suicide. Clozapine is underused by clinicians for many reasons. Clinicians have less comfort with prescribing clozapine. Too few trainees are exposed during residency to prescribing clozapine. Using clozapine during training provides the knowledge and comfort necessary to prescribe it once out in practice. Fear of prescribing clozapine outweighs the benefits to patients who need it. Other barriers include monitoring burdens in confluence with systems issues. Indications for use Treatment-resistant schizophrenia is defined as an inadequate response to two antipsychotic trials, and treatment-resistant schizophrenia occurs in about 30% of patients with schizophrenia. People with treatment-resistant schizophrenia have a 5% chance of responding to other antipsychotic medications, while the response rate to clozapine is about 40%. In light of those statistics, getting patients with schizophrenia on clozapine should be a priority. Everyone benefits when a patient with treatment-resistant schizophrenia is started on clozapine. Clozapine treatment leads to decreased symptoms and suffering, improved quality of life, decreased suicidality and aggression, and lower hospitalization rates, which in turn, lead to decreased health care costs. Barriers to using clozapine Education is key to empowering physicians to start prescribing clozapine and overcoming the initial resistance to prescribing. SMI Adviser is a website sponsored by the American Psychiatric Association (APA) and the Substance Abuse and Mental Health Services Administration (SAMHSA) that provides access to education, data, and consultations for clinicians who treat serious mental illness. SAMHSA also has sponsored “centers of excellence” in New York state and the Netherlands that provide consultation and on-demand answers to questions about prescribing. The Clozapine Handbook, written by Dr. Meyer and Stephen M. Stahl, MD, PhD, is another centralized resource for prescribers. Dr. Meyer and Dr. Stahl wrote the handbook to educate and encourage clinicians to prescribe clozapine and improve patient outcomes.  Adverse events and monitoring Myocarditis: Rate of myocarditis ranges from 0.5% to 3% (most rates from Australia), an adverse event that happens primarily within the first 6 weeks of clozapine therapy. Symptoms suggesting myocarditis include fever and elevated troponin level more than twice the upper limit of normal. Clinicians can order a C-reactive protein test, which can help rule in myocarditis if troponins are elevated but not at twice the upper limit range. In the first 6 weeks of therapy, clinicians are encouraged to order a troponin test during the patients' weekly labs. Isolated fever does not mean myocarditis, because fever is a common side effect during titration, and clinicians can complete the fever work-up. Cigarette smoke can induce cytochrome P450 (CYP) enzyme, including CYP1A2. It is not necessary to have patients stop smoking when they start clozapine. Clinicians can adjust the clozapine dose based on response and clozapine level. Induction of CYP1A2 enzyme happens only when people smoke or burn the actual leaf of tobacco or marijuana. Vaping or e-cigarettes will not induce CYP1A2 and change clozapine levels. Threshold of response is 350 ng/mL, however levels that lead to response differ with each individual and will be influenced by smoking habits. Other common side effects include orthostasis, sedation, and sialorrhea. New technologies are available to reduce barriers of prescribing clozapine and to improve patient adherence to hematologic monitoring. Athelas is a company that manufactures a Food and Drug Administration–cleared point-of-care device to measure neutrophil count by way of a finger stick. Results are dispensed real time. Athelas also will take care of medication dispensing. A point-of-care device is in development for plasma clozapine levels with fingerstick, which will allow clinicians to make titration decisions in real time instead of 1 week after levels. The device already is available in Europe. Creating a system that allows for adherence Using case managers to improve clozapine adherence is cost effective when the amount saved from avoiding hospitalization is taken into account. Clozapine can lead to a functional recovery in terms of how a patient interacts with family, friends, and society at large. Clozapine has the ability to improve productivity leading to employment, which is another way the benefits of creating a system to improve clozapine adherence outweigh financial costs.   References Kane JM et al. Clinical guidance on the identification and management of treatment-resistant schizophrenia. J Clin Psychiatry. 2019 Mar 5;80(2): doi: 10.4088/JCP.18com12123. Suskind D et al. Clozapine response rates among people with treatment-resistant schizophrenia: Data from a systematic review and meta-analysis. Can J Psychiatry. 2017 Nov;62(11):772-7. doi: 10.1177/0706743717718167. Kelly DL et al. Addressing barriers to clozapine underutilization: A national effort. Psychiatr Serv. 2018 Feb 1;69(2):224-7. Bui HN et al. Evaluation of the performance of a point-of-care method for total and differential white blood cell count in clozapine users. Int J Lab Hematol. 2016 Dec;38(6):703-9.   Other resources SMI Adviser: Clozapine Center of Excellence, sponsored by the APA and SAMHSA. The Clozapine Handbook (Cambridge University Press, 2019). Clozapine and smoking cessation (NSW Health, Australia). Point of care neutrophil measurement. https://athelas.com/fda/. https://curesz.org/.   For more MDedge Podcasts, go to mdedge.com/podcasts   Email the show: podcasts@mdedge.com   Interact with us on Twitter: @MDedgePsych              

Dr. Ken reviews the book "Clozapine" by Meyer & Stahl. He explains the aspects of the book that might make you want to read it.

What is clozapine? Not only is clozapine the gold standard medication for treatment-resistant schizophrenia, it is also one of the most unique drugs used in psychiatry. It was synthesized 1958, only eight years after chlorpromazine, the first antipsychotic drug, was created. At that time, researchers tested for antipsychotic properties by taking various compounds and testing to see if lab mice developed dystonia and catalepsy. When researchers tested clozapine, they found that it did not cause dystonia, but instead made the mice sleepy. Because of this, clozapine was almost missed entirely as an antipsychotic medication. Eventually, however, clozapine was found to be more successful than other antipsychotic drugs. By the 1970s, Austria, Germany, and Finland had produced positive data on clozapine proving its efficacy. However, clozapine was also found to have caused severe neutropenia in sixteen patients in Finland, and even caused the death of eight of those patients. For this reason, clozapine did not enter the United States until it was approved by the FDA in 1989. Link to full episode: notes Resource Library: here Link to sign up for CME go: here Member Login to do CME activity go: here Instagram:dr.davidpuder Twitter:@DavidPuder Facebook: DrDavidPuder Youtube channel

On this episode, I discuss clozapine pharmacology. This drug has multiple mechanisms of action: Dopamine blockade, anticholinergic activity, and alpha blocking activity all contribute to the complexity of this drug. Smoking cessation can significantly increase the concentrations of clozapine. This is because smoking can induce CYP1A2. Listen to the podcast for more details on how this can impact our patients clinically. Clozapine has 5 boxed warnings. I discuss them all in this podcast. The most well-known boxed warning is for agranulocytosis. Because clozapine has alpha blocking activity, it can cause orthostasis. We need to monitor for this. Clozapine can cause QTc prolongation. Keep an eye out for other medications that the patient may be taking that can also cause this. Examples include: amiodarone, ondansetron, quinolones, and macrolides

Today’s question is: How to manage the non-hematological adverse effects of clozapine? Here is a summary of this episode: Clozapine can commonly cause a benign fever. If a patient is feverish, do a workup to exclude infections, myocarditis, NMS and inflammatory conditions. For orthostatic hypotension, slowly titrate, encourage fluid intake and avoid other alpha 1 blockers and benzodiazepines. You can consider using 9-fludrocortisone for volume expansion. In cases of tachycardia, manage orthostasis first and if it persists, use atenolol. Keep the resting heart rate under 100 beats per minute. If you suspect myocarditis, measure troponin, and CRP levels. If positive, stop clozapine and cover with an anticholinergic. For the metabolic effects of clozapine, behavioral control techniques are worth a try. You can also start metformin concurrently with clozapine as an effective and safe option. Download a PDF of this interview here Become a premium member of the Psychopharmacology Institute

We’re delighted to be joined by Dr Sophie Legge and Dr Antonio Pardiñas for our latest minisode to discuss their latest research study.Sophie, Antonio and colleagues at Cardiff University’s MRC Centre for Neuropsychiatric Genetics and Genomics examined genetic data from more than 500 people of African descent taking clozapine, an anti-psychotic medication prescribed to people with treatment resistant schizophrenia.Clozapine is currently the most effective treatment for people with treatment-resistant schizophrenia, but it can cause a rare side effect called neutropenia. In the most extreme cases, this can develop into agranulocytosis; a severe and potentially life-threatening condition.These side-effects are characterised by lower neutrophil levels, a type of white blood cell, and these lower levels appear to be more common in people of African descent. The team were interested in learning whether genetic factors were at play, and in this minisode Sophie and Antonio explain what they found and how their results could help improve the management of clozapine treatment.For links and resources mentioned in this episode, visit https://www.ncmh.info/podcastWe hope you enjoy and we would be really grateful if you could leave us a review and help others find our podcast! If you've got any questions about this episode, get in touch at info@ncmh.info. See acast.com/privacy for privacy and opt-out information.

Today’s question is: How to manage the non-hematological adverse effects of clozapine? Here is a summary of this episode: For sialorrhea start with local agents like sublingual atropine drops or mouth ipratropium spray. If that fails, systemic agents like glycopyrrolate or terazosin can be used. For constipation, bulk agents can make constipation worse and should be avoided. After docusate, the next agent to add is PEG 3350 and then a stimulant and then lastly, if needed, lubiprostone. For sedation, titrate clozapine slowly, use bedtime dosing and reduce other sedating medications. A trial with modafinil or methylphenidate can be attempted, but the evidence is not strong. Tonic-clonic and myoclonic seizures can occur with clozapine. Titrate down and divide into multiple doses. Divalproex is the drug of choice in preventing clozapine-induced seizures.   Download a PDF of this interview here Become a premium member of the Psychopharmacology Institute

Schizophrenia is not a death sentence, says Dr Robert S Laitman from Bronx Westchester Medical Group and SARDAA. In part 2 of his podcast series with Consultant360, Dr Laitman explains how his approach to treatment has helped the majority of his patients achieve meaningful recovery. For more, visit www.consultant360.com.

Afin de discuter des effets indésirables et des interactions associées à la clozapine, nous recevons Marie Auclair, pharmacienne au CISSS de l'Outaouais et membre du RPE en psychiatrie. Références pour cet épisode : https://bit.ly/2PEmQLQ

Dr Emilio Fernandez is a consultant psychiatrist and lead clinician at CPFT’s Clozapine Clinics. In this episode he discusses the nature of schizophrenia, the treatments and research into this area of mental health. Clozapine is the gold standard for treatment resistant schizophrenia (TRS), a group of patients suffering with the severe end of the disorder. Transcripts are available here: http://www.cpft.nhs.uk/Latest-news/AI-and-VR---CPFT-experts-share-vision-of-healthcare-in-podcasts.htm

This week on the Mad in America podcast we interview Olga Runciman.  Olga is an international trainer and speaker, writer, campaigner, and artist. She co-founded the Danish Hearing Voices Network and sees the role of the Hearing Voices Movement as post-psychiatric, working towards the recognition of human rights while offering hope, empowerment, and access to making sense of individual experiences.  Olga was a psychiatric nurse working in social psychiatry but today she is a psychologist and since 2013 she has had her own private practice in Denmark, working with people who have been labelled schizophrenic or psychotic. Olga is herself a psychiatric survivor and a voice hearer too. In this interview we discuss Olga’s professional and personal experiences of the psychiatric system and how she now helps and supports healing and recovery in others. In the episode we discuss: How Olga became a specialist psychiatric nurse in Denmark, believing at the time the reasons given for psychiatric diagnoses. How she came to see that there was little evidence or corroboration to underpin the diagnosis and treatment that she witnessed. How Olga was also a voice hearer, but kept this hidden from her psychiatric colleagues. How, when experiencing stress and trauma, Olga came to be admitted to a psychiatric ward, diagnosed as schizophrenic and treated with a cocktail of psychiatric drugs. Olga’s experiences of the antipsychotic drug Clozapine. How Olga came to stop her psychiatric drugs which she had been taking for ten years. Psychiatry’s story of hopelessness and chronic illness that is so often sold to patients. How Olga now views her work from a post-psychiatry perspective. Relevant links: Psycovery Olga’s posts on Mad in America  The Hearing Voices network International Institute for Psychiatric Drug Withdrawal  Postpsychiatry: a new direction for mental health  To get in touch with us email: podcasts@madinamerica.com © Mad in America 2017

This month, Deputy Editor Susan K. Schultz, M.D., discusses the efficacy of psychodynamic therapy, the protective effect of pregnancy on the risk for drug abuse, the relation of ovarian hormone levels to symptoms in premenstrual dysphoric disorder, rates of mortality and self-harm in patients taking clozapine, and pharmacogenomic testing in psychiatry. Articles may be viewed online at ajp.psychiatryonline.org. Also visit the online edition of this month’s Journal to watch a video of Deputy Editor Daniel S. Pine, M.D., present highlights from the issue (ajp.psychiatryonline.org/toc/ajp/174/10). We are conducting a listener survey. Please go to ajp.psychiatryonline.org/audio and select the link to the survey. It won’t take more than a few minutes to complete, and your feedback will remain anonymous. We appreciate your responses. Thank you.

Javier González-Maeso explains how ligand binding to one member of a heteromeric GPCR complex can activate its binding partner.

The schizophrenia drug linked to six fatal adverse reactions a week. It changes lives but serious side effects can prove fatal if the patient is not properly monitored. Also, the business rates avoidance scheme costing town halls in England and Wales millions of pounds a year. Is the government doing enough to plug the loophole?

John Davis from the University of Illinois discusses the research article about antipsychotic drugs for schizophrenia.

The widely used atypical antipsychotic clozapine is a potent competitive antagonist at 5-HT(3) receptors which may contribute to its unique psychopharmacological profile. Clozapine binds to 5-HT(3) receptors of various species. However, the structural requirements of the respective binding site for clozapine remain to be determined. Differences in the primary sequences within the 5-HT(3A) receptor gene in schizophrenic patients may result in an alteration of the antipsychotic potency and/or the side effect profile of clozapine. To determine these structural requirements we constructed chimeras with different 5-HT(3A) receptor sequences of murine and human origin and expressed these mutants in human embryonic kidney (HEK) 293 cells. Clozapine antagonises recombinant mouse 5-HT(3A) receptors with higher potency compared to recombinant human 5-HT(3A) receptors. 5-HT activation curves and clozapine inhibition curves yielded the parameters EC(50) and IC(50) for all receptors tested in the range of 0.6 - 2.7 microM and 1.5 - 83.3 nM, respectively. The use of the Cheng-Prusoff equation to calculate the dissociation constant K(b) values for clozapine revealed that an extracellular sequence (length 86 aa) close to the transmembrane domain M1 strongly determines the binding affinity of clozapine. K(b) values of clozapine were significantly lower (0.3-1.1 nM) for receptors containing the murine sequence and higher when compared with receptors containing the respective human sequence (5.8-13.4 nM). Thus, individual differences in the primary sequence of 5-HT(3) receptors may be crucial for the antipsychotic potency and/or the side effect profile of clozapine.

Atypical neuroleptics are increasingly used in the treatment of bipolar and schizoaffective disorders. Currently, numerous controlled short-term studies are available for clozapine, olanzapine, risperidone or quetiapine, but long-term data are still missing. Three patients (2 with bipolar disorder, 1 with schizoaffective disorder) are described who showed a marked reduction of affective symptomatology after clozapine had been added to mood stabilizer pretreatment. The patients were seen once a month before and after the introduction of clozapine for at least 6 months. Treatment response was evaluated using different rating scales (IDS, YMRS; GAF; CGIBP) and the NIMH Life Chart Methodology. All patients showed a marked improvement after the add-on treatment with clozapine had been initiated. Clozapine was tolerated well with only transient and moderate weight gain and fatigue as only side effects. This case series underlines the safety and efficacy of clozapine as add-on medication in the treatment of bipolar and schizoaffective disorders. Copyright (C) 2002 S. Karger AG, Basel.