Too many of our patients smoke, especially those with schizophrenia. Amazingly, the best estimate is that 85% of patients with schizophrenia are regular smokers (Am J Psychiatry 1986; 143:993-997). While we may not have a whole lot of time during our sessions to discuss smoking, it’s still helpful to tuck away some smoking cessation tools in your arsenal.

Archeological evidence suggests that tobacco grew in the Americas as long ago as 6000 B.C., and that the custom of smoking it began with the Mayans, sometime around 1000 B.C. The first European to smoke is thought to be Rodrigo de Jerez, who, with Christopher Columbus, observed the custom in Cuba in 1493.

Okay, we’re assuming, number one, that you have done a good job diagnosing ADD or ADHD, and that ADHD is the primary diagnosis, far out-shadowing any comorbid problems that may also be present. And number two, we are assuming that you, the patient, and the parents (if the patient is under age) have all agreed that now is the time for a medication trial.

Six short years ago, an influential study came out in Archives of General Psychiatry that was widely interpreted as showing that therapy adds little of value to the treatment of ADHD (Arch Gen Psychiatry 1999; 56:1073-1086).

On February 9, 2005, Health Canada (HC) announced that it was suspending sales of Adderall XR in Canada because of concerns that it might lead to sudden death and stroke. The FDA, however, has begged to differ.

Amphetamine was first synthesized in Germany in 1887. It became popular as a recreational drug in the US in the 1930s. While cocaine was declared illegal in 1914, amphetamines were widely available, and were often used by college students and truck drivers.

So, you want to be a bias-buster? Gird yourself, because it’s not an easy task. In order to establish the presence of commercial bias, you have to demonstrate two things: first, that the activity is funded by industry; and second, that the content of the program is unreasonably slanted toward the sponsor’s product.

It probably comes as little surprise to most readers that manufacturer-sponsored research is more likely to yield an outcome favorable to the sponsored product than similar non-sponsored research. What may be surprising is that there is actually a good-sized body of published research (non-sponsored, of course!) on this very topic.

There is trouble for the pharmaceutical industry in CME City. The ACCME (Accreditation Council for Continuing Medical Education), which sets national standards for accredited CME activities, has tightened up its requirements for commercial support, which is giving drug companies, private medical education firms, and assorted hired guns a collective case of indigestion.

Many readers have wondered why I decided to publish The Carlat Report. Well, back in the day, I was a member of the speaker’s bureau of four pharmaceutical companies. I would typically travel to the offices of primary care physicians nearby and talk up the sponsor’s drug.