Dr Alan Watkins fascinating talk deepens our knowledge of the emotional hijack and how to deal with it.

Dr Watkins expands on the theme.

What four psychological techniques did the government use to increase Navy SEAL passing rates? By Eric Barker (If it's good enough for them.......)

Ever since reading The Warrior Elite: The Forging of SEAL Class 228 I’ve been interested in Navy SEAL training, particularly the psychological aspects.
In his blog at Psychology Today, Bakari Akil covers a History channel documentary The Brain and what it revealed about the four techniques the Navy used to increase passing rates in the elite SEAL program:

• Goal Setting

“With goal setting the recruits were taught to set goals in extremely short chunks. For instance, one former Navy Seal discussed how he set goals such as making it to lunch, then dinner.”

• Mental Rehearsal

“With mental rehearsal they were taught to visualize themselves succeeding in their activities and going through the motions.”

• Self Talk

“As far as self talk is concerned, the experts in The Brain documentary made the claim that we say 300 to 1000 words to ourselves a minute. By instructing the recruits to speak positively to themselves they could learn how to “override fears” resulting from the amygdala, a primal part of the brain that helps us deal with anxiety.”

• Arousal Control

“And finally, with arousal control the recruits were taught how to breathe to help mitigate the crippling emotions and fears that some of their tasks encouraged.”

How successful were these techniques?

This very simple four step process increased their passing rates from 25 percent to 33 percent, which is excellent in a rigorous program as theirs. It demonstrates that achieving success doesn’t always have to be a complex process. A few minor additions and tweaks may be all that is needed.

Positive Emotions - The Secret to Positive Health? by Dr Alan Watkins listed in heart, originally published in issue 16 - December 1996

Traditional stress management techniques usually deal with stress after the fact, hours after your body has been subjected to heavy tides of adrenaline and pulses of cortisol. ... What is really required are techniques that can be used effectively right when the stress is happening, that can hijack the stress response and prevent the stress hormones sweeping through our bodies. Such techniques have now been developed, and what's more these new approaches are backed up by published scientific research.

It is well known that negative emotions, such as anger, frustration and anxiety, provoked by the stress and pressures of modern day living, can not only suppress your immune system but can also increase your risk of developing and dying from heart disease. Numerous scientific studies have shown that repeated episodes of unmanaged negative emotions, can cause the release of destructive hormones such as adrenaline and cortisol. Constant overproduction of these hormones in response to persistent daily hassles has been shown to profoundly suppress immunity and set the stage for a whole variety of illnesses. Negative emotional states have also been linked to accelerated ageing and decreases in cardiovascular efficiency.
The evidence clearly shows that we are under increasing amounts of stress. The rate of depression has nearly doubled in the last twenty years and our ability to balance home and work pressures is being severely tested. Whether you work in the constantly "downsizing" large corporate world, the insecure small business market or are struggling with the trials and tribulations of modern day parenting, learning how to manage your mental and emotional responses to the daily hassles that are part and parcel of modern day life is not only an intelligent investment in your future, but absolutely necessary for your survival in the twenty first century.
Traditional stress management techniques usually deal with stress after the fact, hours after your body has been subjected to heavy tides of adrenaline and pulses of cortisol. Relaxation techniques, massage, proper diet and exercise are important and help to offset the effects of stressful episodes. However, they still do not totally compensate for the wear and tear on our bodies that comes from experiencing stress producing thoughts and feelings in the first place. What is really required are techniques that can be used effectively right when the stress is happening, that can hijack the stress response and prevent the stress hormones sweeping through our bodies. Such techniques have now been developed, and what's more these new approaches are backed up by published scientific research.
The techniques, developed by The Institute of Heart Math (IHM), a non-profit education and research organisation in the US, are easy to learn and quick to apply. They can rapidly diffuse stressful perceptions and generate more creative and positive responses. Stopping a negative reaction right when it is occurring can be tricky. We've all heard "stop and count to ten" or "think positive". If you try counting to "ten", frequently by "three" your emotions feel like they are ready to explode. The techniques developed by IHM can prevent the explosion, not by suppressing negative emotions rather by transforming them. These techniques employ positive emotions to transform stressful thoughts and feelings. In contrast to the detrimental effect of negative emotions, IHM have shown that their positive emotional focus techniques can produce profoundly beneficial physiological effects on the nervous, hormonal and immune systems. Balancing the physiology through the use of positive emotional focus techniques also promotes a perceptual shift through a mechanism known as cortical facilitation. Such techniques thus save unnecessary wear and tear on the body and promote a positive, healthy balance.
The first of these techniques, called "Freeze-Frame" teaches you how to harness the electrical energy generated by the heart. This may sound unusual, but the energy produced by the heart is the largest source of bio-electricity found in the body and 40 to 60 times greater than the electricity produced by the brain. The energy produced by the power station of the heart reaches every cell in the body and can be measured up to 18 inches away from the body with sophisticated modern electronic instruments called magnetometers. Our light really does shine and it can be measured scientifically!
How do these techniques work? It is well known that the brain sends messages, via the autonomic nervous system, to the heart, and the hormonal and immune systems. What is not well known is that the heart also sends messages back to the brain providing a two-way communication system that directly affects perception, reaction speeds and decision making ability. Researchers at IHM have found that the quality of electricity produced by the heart depends on our thoughts and feelings. By analysing the heart's power output, through studying the ECG spectrum, IHM has demonstrated that thoughts and feelings like appreciation and care produce an ordered and coherent electrical signal. Conversely, thoughts and feelings like anger and frustration produce chaotic jagged, and incoherent signals. This electrical information whether coherent or incoherent is transmitted to the brain and it affects perception. Interestingly, the quality of the energy produced by the heart of an athlete at peak performance looks very similar to the quality of the energy of a person who is experiencing sincere appreciation. Thus, Freeze-Frame allows people to clean up the energy output by the heart, minimising energy wastage and maximising the coherence of the electrical signal that travels from the heart to the brain.
Freeze-Frame, and the other techniques developed by IHM, have now been taught to thousands of Americans. Corporate America is showing particular interest with many of the top Fortune 500 companies, in addition to US government agencies and all four branches of the military, realising that a healthier, happier work force means improved productivity and more effective organisations. Similarly, considerable interest is now being shown by major corporations, NHS Trusts and numerous individuals in the UK and several pilot programmes are under way with some of the UK's leading companies.
Teaching individuals how to bring more order to the electrical output generated by the body's major power station, the heart, using positive emotional focus techniques, helps shift perceptions from stress producing patterns to ones that are more calm and balanced. These perceptual shifts are mirrored by shifts in autonomic, hormonal and immune function. The autonomic changes are measured by changes in heart rate variability. Heart rate variability (HRV) is the measurement of the beat to beat changes in the heart rate, with increased variability being an indication of positive health while reduced variability indicating a dangerous lack of flexibility in a heart on the point of breaking. HRV is also related to the ageing process with HRV and overall cardiovascular flexibility decreasing with age. Research has shown substantial improvement in HRV can be generated and sustained through the use of the positive emotional focus techniques developed by IHM.

The changes produced in the heart rhythms following Freeze-Frame are mirrored by changes in respiration and pulse transit time, a measure of blood pressure. All these systems synchronise, and dance to the same rhythm – the rhythm of the heart. This phenomenon is called entrainment and is well recognised in nature. The fact that the heart, the lungs, the intestines and the brain all start to perform "in sync" is what generates the inner experience of balance and harmony. The electrical output of all these centres literally locks in and transmits at the same frequency.
The steps of Freeze-Frame are intentionally simple so that the technique can be easily applied in normal day-to-day situations. This is how Freeze-Frame works:
Step 1 Recognize the stressful feeling, and Freeze-Frame it. It's like pushing the pause button on your VCR or taking a time-out!
Step 2 Make a sincere effort to shift your focus away from the racing mind or disturbed emotions to the area around your heart. Pretend you've breathing through your heart to help focus your energy in this area. Keep your focus there for ten second or more.
Step 3 Recall a positive, fun feeling or time you've had in your life and attempt to re-experience it. Focus on the feeling rather than the thoughts or visual image.
Step 4 Now, using your intuition, common sense and sincerity ask your heart, what would be a more efficient response to the situation you are Freeze-Framing, one that will minimise future stress?
As you practice Freeze-Framing, your own intuition, common sense, and sincerity become more active and available. While you won't necessarily have crystal-clear revelations every time you Freeze-Frame, you can at least increase your capacity to arrive at convenient and practical solutions.
Step 5 Listen to what your heart says in answer to your question. The Freeze-Frame technique is simple, powerful, effective, and becomes automatic as you practice.
IHM President Doc Lew Childre's book, Freeze-Frame, describes this technique in more detail and presents numerous stories from people on how they are using Freeze-Frame to stay calm and balanced under pressure. Freeze-Frame can be an especially valuable stress management technique because it is easy to learn, only takes a minute to do and deals with stressful situations when they are actually happening before they take a toll on our bodies.
Positive health is not just about improved physical well-being but requires us to take positive steps to manage our mental and emotional responses, developing our emotional intelligence and emotional maturity instead of draining vitality through non- productive reactions. Such maturity will create the conditions required for perfect mental, emotional and physical health. As Doc Lew Childre says in his book Freeze-Frame "Patterns of mental and emotional chaos can play a major role in strangling the physical body's vitality, aging it before its time".
Thus we no longer have to be at the mercy of the stressful world we live in. We can take positive steps through the use of positive emotional focus techniques to regain control of our health, manage our energy and balance our physiology. We can develop wider perspectives and create more vital and exciting futures full of possibilities and enthusiasm. The hidden power of the heart is the key to unlocking the door to perfect health and Freeze-Frame gives us access to the power within us.

Story telling and brain chemistry

The Evolutionary Advantage of Depression By Brian Gabriel Oct 2 2012, 11:08 AM ET 38

 

Genes influencing depression also bolstered our ancestors' immune systems -- an understanding that's informing experimental therapies. 

Van Gogh, At Eternity's Gate (Wikipedia)

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More people die from suicide than from murder and war combined, throughout the world, every year. In the United States, suicide recently surpassed automobile accidents as the leading cause of violence-related death, according to a study appearing in the American Journal of Public Health.
The majority of individuals who commit suicide suffer from depression or another mood disorder. Depression is a devastating illness characterized by persistent sadness and myriad well-known symptoms. Increasingly, researchers are identifying how genes contribute to depression. As we learn more about the human genome, scientists are finding evidence that while depression seems incredibly maladaptive, it was actually adaptive (helpful) to our ancestors.
Recently Dr. Andrew Miller and Dr. Charles Raison, physicians at Emory University and the University of Arizona, respectively, authored a paper "The evolutionary significance of depression in pathogen host defense" in which they proposed that some of the alleles (forms of genes) that increase one's risk for depression also enhance immune responses to infections.
Commenting on their hypothesis, Dr. Miller noted, "Most of the genetic variations that have been linked to depression turn out to affect the function of the immune system." Dr. Charles Raison of the University of Arizona added, "The basic idea is that depression and the genes that promote it were very adaptive for helping people -- especially young children -- not die of infection in the ancestral environment."
As recently as 1900, the top 3 causes of death in the U.S. were via infectious agents: pneumonia, tuberculosis, and diarrhea. Infants and young children were especially susceptible as 30.4% of all deaths occurred before the age of 5 years.

Depressive symptoms like social withdrawal, lack of energy, and a loss of interest in once enjoyable activities were actually advantageous to our ancestors.

Thanks to improvements in public health and medicine (improvements like antibiotics), not a single one of the previous 3 leading causes of death are among the top 5 killers in the U.S today. Over the past century, infant mortality has dropped substantially, so that by 1997 only 1.4% of all deaths occurred before the age of 5 years. Although infection is no longer a top killer, infection was the primary cause of death for many of our ancestors.
Today, certain mutated versions of a gene called "NPY" are associated with increased inflammation (an immune process helpful in fighting off infections). Mutated NPY genes likely allowed our ancestors to better fight off infections (especially in childhood), and individuals with the mutated NPY gene were more likely to pass along the mutated NPY gene to offspring.
Interestingly, researchers at the University of Michigan's Molecular and Behavioral Neuroscience Institute discovered that individuals with major depressive disorder were more likely to have the mutated NPY gene. The normal NPY gene codes for higher levels of a neurotransmitter known as Neuropeptide Y, which appears to help ward off depression by increasing one's tolerance of stress. So the same mutated NPY gene that likely protected our ancestors against pathogens also increases our chance of developing depression.
Drs. Miller and Raison believe that acute (or severe but short-term) stress can not only lead to depression, but also jump-start the immune system. The physicians note that in the environments in which our ancestors lived, acute stress was often associated with the threat of physical harm or physical wounds. And unlike today, wounds readily led to infection and death. Therefore, Drs. Miller and Raison believe that evolution favored individuals whose immune systems operated under a "smoke-detector principle."
Although smoke detectors often react to false alarms (for me, burnt toast), if you removed the detector's battery and a real fire occurred, the consequences could be severe. Similarly, immune responses to acute stress are typically not necessary -- not every stressful situation results in a wound and infection. However, if our ancestors became wounded even a single time and didn't experience a piqued immune response, they might die from an infection.
It turns out that depression may not be a mere trade-off for a vigorous immune response. Dr. Miller suggests that depressive symptoms like social withdrawal, lack of energy, and a loss of interest in once enjoyable activities were actually advantageous to our ancestors. For example, a loss of energy might ensure that the body can leverage all of its energy to fight an infection. Also, social withdrawal minimizes the likelihood of being exposed to additional infectious agents. In this way, Drs. Miller and Raison note that "depressive symptoms are inextricably intertwined with -- and generated by -- physiological responses to infection that, on average, have been selected as a result of reducing infectious mortality across mammalian evolution."
Recently Dr. Miller and Dr. Raison completed a separate study in which they attempted to treat patients with "difficult to treat" depression with a novel drug infliximab. Infliximab works by disrupting communication between immune cells and consequently reduce inflammation.
While infliximab did not significantly improve depression symptoms in the group being studied as a whole, it did reduce depression symptoms among a subset of study participants who showed elevated levels of inflammation. Inflammation was measured using blood tests for "C-reactive protein" (CRP). The higher the participants' level of CRP, the more likely the participant was to respond positively to infliximab.
As Drs. Miller and Raison suggest, the theory that depression evolved to better resist infectious agents could lead to improvements within the field of immunology and novel treatments for depression. The physicians also suggest that in the future, we may be able to utilize simple biomarkers (like CRP) to predict which individuals will best respond depression treatments that modulate our immune systems (like infliximab).
Drs. Miller and Raison concede that chronic stress has been shown to impair the immune system. However, evolutionary processes may still allow for improved infection responses to acute (or short-term) stressors.


The physicians also noted that inflammatory biomarkers are not elevated in all individuals with depression. Individuals with major depressive disorder and elevated levels of inflammation may represent a unique subset of individuals with depression. Therefore, while immune-modulating therapies may be effective in treating some cases of depression, these therapies may not be effective against all types of depression.

Learned Optimism: Martin Seligman on Happiness, Depression, and the Meaningful Life by Maria Popova

“The illiterate of the 21st century,” Alvin Toffler famously said, “will not be those who cannot read and write, but those who cannot learn, unlearn, and relearn.” Our outlook on the world and our daily choices of disposition and behavior are in many ways learned patterns to which Toffler’s insight applies with all the greater urgency — the capacity to “learn, unlearn, and relearn” emotional behaviors and psychological patterns is, indeed, a form of existential literacy.
Last week, Oliver Burkeman’s provocatively titled new book, The Antidote: Happiness for People Who Can’t Stand Positive Thinking, prompted me to revisit an old favorite by Dr. Martin Seligman, father of the Positive Psychology movement, who was once elected President of the American Psychological Association by the largest vote in the organization’s history and under whom I studied in my college days. Learned Optimism: How to Change Your Mind and Your Life (public library), one of these 7 must-read books on optimism, was originally published 20 years ago and remains an indispensable tool for learning the cognitive skills that decades of research have shown to be essential to well-being — an unlearning those that hold us back from authentic happiness.
Seligman begins by identifying the three types of happiness of which our favorite psychology grab-bag term is composed:

‘Happiness’ is a scientifically unwieldy notion, but there are three different forms of it if you can pursue. For the ‘Pleasant Life,’ you aim to have as much positive emotion as possible and learn the skills to amplify positive emotion. For the ‘Engaged Life,’ you identify your highest strengths and talents and recraft your life to use them as much as you can in work, love, friendship, parenting, and leisure. For the ‘Meaningful Life,’ you use your highest strengths and talents to belong to and serve something you believe is larger than the self.

He then defines optimism and pessimism, pointing out the challenge to self-identify as either, and offers a heartening, heavily researched reassurance:

The optimists and the pessimists: I have been studying them for the past twenty-five years. The defining characteristic of pessimists is that they tend to believe bad events will last a long time, will undermine everything they do, and are their own fault. The optimists, who are confronted with the same hard knocks of this world, think about misfortune in the opposite way. They tend to believe defeat is just a temporary setback, that its causes are confined to this one case. The optimists believe defeat is not their fault: Circumstances, bad luck, or other people brought it about. Such people are unfazed by defeat. Confronted by a bad situation, they perceive it as a challenge and try harder.
[...]
I have seen that, in tests of hundreds of thousands of people, a surprisingly large number will be found to be deep-dyed pessimists and another large portion will have serious, debilitating tendencies towards pessimism. I have learned that it is not always easy to know if you are a pessimist, and that far more people than realize it are living in this shadow.
[...]
A pessimistic attitude may seem so deeply rooted as to be permanent. I have found, however, that pessimism is escapable. Pessimists can in fact learn to be optimists, and not through mindless devices like whistling a happy tune or mouthing platitudes…but by learning a new set of cognitive skills. Far from being the creations of boosters or of the popular media, these skills were discovered in the laboratories and clinics of leading psychologists and psychiatrists and then rigorously validated.

Seligman, however, also corroborates what’s perhaps Burkeman’s most central admonition — that the extreme individualism and ambition our society worships has created a culture in which the fear of failure dictates all. As Seligman puts it:

Depression is a disorder of the ‘I,’ failing in your own eyes relative to your goals. In a society in which individualism is becoming rampant, people more and more believe that they are the center of the world. Such a belief system makes individual failure almost inconsolable.
[...]
Teaching children learned optimism before puberty, but late enough in childhood so that they are metacognitive (capable of thinking about thinking), is a fruitful strategy. When the immunized children use these skills to cope with the first rejections of puberty, they get better and better at using these skills. Our analysis shows that the change from pessimism to optimism is at least partly responsible for the prevention of depressive symptoms.

Ultimately, Seligman points to optimism not only as a means to individual well-being, but also as a powerful aid in finding your purpose and contributing to the world:

Optimism is invaluable for the meaningful life. With a firm belief in a positive future you can throw yourself into the service of that which is larger than you are.

One-Fifth of Spine Surgery Patients Develop PTSD Symptoms

ScienceDaily (Sep. 27, 2012) — Nearly 20 percent of people who underwent low back fusion surgery developed post-traumatic stress disorder symptoms associated with that surgery, according to a recent Oregon Health & Science University study published in the journal Spine.

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Past studies have noted PTSD symptoms in some trauma, cancer and organ transplant patients. But this is the first study, its authors believe, to monitor for PTSD symptoms in patients undergoing an elective medical procedure.
"It is maybe not surprising that significant surgical interventions have psychological as well as physical impacts," said Robert Hart, M.D., an orthopedic surgeon, professor of orthopedics and rehabilitation at OHSU and senior author of the study. "I think it means that we in the medical community need to monitor for these effects in our patients and to manage them when they occur."
The study found that the strongest factor in determining whether a spine surgery patient suffered PTSD symptoms after the surgery was whether the patient had a psychiatric disturbance -- depression or anxiety disorders, for example -- before the surgery. But some patients who had no such pre-surgery diagnoses also suffered PTSD symptoms after the spine surgery, the study found.
The OHSU study involved 73 of Hart's surgical patients who underwent lumbar spinal fusion surgery, a procedure in which two or more lumbar vertebrae in the back are fused together, usually including implantation of metal screws and rods as part of the procedure.
Surgeons at the OHSU Spine Center always look for other ways to deal with back pain before surgery. But sometimes, surgery is the only option. And spinal fusion is often major surgery that may involve complications and often involves a long recuperation period. The majority of patients in the study reported a good experience and had substantial relief of their pre-operative pain.
Hart said the study results might offer guidance to doctors and surgeons in advising potential spine surgery patients about the surgery. For patients at higher risk, the results suggest doctors and surgeons might offer treatment for them prior to surgery, Hart said.
"At the end of the day, I hope this will make changes in the way we prepare people for surgery, to reduce these psychological impacts. This is analogous to how we currently optimize patients' physical condition before major surgery," Hart said.
Hart said he wants to study that issue next -- and measure which pre-surgery interventions might work best to reduce or eliminate any PTSD effects.

One-Fifth of Spine Surgery Patients Develop PTSD SymptomsScienceDaily (Sep. 27, 2012) — Nearly 20 percent of people who underwent low back fusion surgery developed post-traumatic stress disorder symptoms associated with that surgery, according to a recent Oregon Health & Science University study published in the journal Spine. Share This: 50 See Also: Health & Medicine Today's Healthcare Wounds and Healing Cosmetic Surgery Mind & Brain PTSD Psychiatry Mental Health Reference Scoliosis Hysterectomy Urology Minimally invasive procedure Past studies have noted PTSD symptoms in some trauma, cancer and organ transplant patients. But this is the first study, its authors believe, to monitor for PTSD symptoms in patients undergoing an elective medical procedure. "It is maybe not surprising that significant surgical interventions have psychological as well as physical impacts," said Robert Hart, M.D., an orthopedic surgeon, professor of orthopedics and rehabilitation at OHSU and senior author of the study. "I think it means that we in the medical community need to monitor for these effects in our patients and to manage them when they occur." The study found that the strongest factor in determining whether a spine surgery patient suffered PTSD symptoms after the surgery was whether the patient had a psychiatric disturbance -- depression or anxiety disorders, for example -- before the surgery. But some patients who had no such pre-surgery diagnoses also suffered PTSD symptoms after the spine surgery, the study found. The OHSU study involved 73 of Hart's surgical patients who underwent lumbar spinal fusion surgery, a procedure in which two or more lumbar

Diet Sodas: Changing Your Brain And Your Waistline - from Lumosity.com

Diet sodas may not be helping you lose weight—in fact, these and other artificially sweetened foods may sabotage your diet by confusing and rewiring your brain’s reward centers. This study from the journal Physiology & Behavior is yet another example of how lifestyle choices can alter your brain—negatively or positively.

Scanning diet soda drinkers' brains

The University of San Diego study followed 24 young adults: half the group drank at least one serving of diet soda every day, while the other half avoided the artificially sweetened drinks. These adults were then hooked up to brain scanning equipment while scientists fed them water alternately flavored by natural and artificial sweeteners—then the researchers sat back and watched what unfolded in the brain.
The results, according to University of California San Diego researchers Green and Murphy, were pronounced: “[Diet soda drinkers] who consumed a greater number of diet sodas had reduced caudate head activation. These findings may provide some insight into the link between diet soda consumption and obesity.”

Artificial sweeteners confuse reward

A little bit of background: the caudate head is a part of the brain involved in signaling reward and controlling food intake—and its decreased activity in the brains of diet soda drinkers has substantial implications.
Researchers posit that consumption of diet soda had confused the reward loops normally processed by the caudate head: because sweetness was no longer a reliable indicator of incoming calories, the brain had trained itself to respond less in the face of sweet flavors. Unreliable sweet tastes threw off normal predictions about calories and energy in the changed brains of diet soda drinkers—making it more likely that these people would consume additional calories later in the day.

Small choices can affect your brain

This newest study is pretty preliminary; it’s difficult to say how drastically diet sodas can affect bigger questions of lifestyle and health based on such short-term brain activation patterns. Still, this recent investigation provides an interesting reflection on how choices and actions made in everyday life can powerfully influence the way your brain is wired—in other words, the concept of neuroplasticity.
We can’t always foresee the unintended negative responses our brain makes—who would have thought diet coke might do quite the opposite of what its name suggests?—but there are positive ways to harness your brain’s ability to change. Just a little Lumosity training every day, for example, can change your brain for the better: instead of confused reward signals, you could experience faster processing speed, quicker flexibility, and improved problem solving.

South Carolina: Military to Study Benefits of Fish Oil By THE ASSOCIATED PRESS Published: October 9, 2012

A $10 million study over three years will investigate whether a dietary supplement could help curb the number of suicides among military personnel and veterans, researchers said on Monday. The study, which is scheduled to begin in South Carolina in January, is part of the Defense Department’s focus on suicide prevention. The first part of the trial will examine the effects of daily supplements of omega-3 fatty acids on about 320 at-risk military personnel and veterans. Omega-3 fatty acids, found in fish oil, are instrumental in the repair and regeneration of brain cells.

Negative and competitive social interactions are related to heightened proinflammatory cytokine activity

Jessica J. Chiang,^a Naomi I. Eisenberger,^a Teresa E. Seeman,^b and Shelley E. Taylor^a,1

Author information ► Copyright and License information ►

Abstract

Research has consistently documented that social relationships influence physical health, a link that may implicate systemic inflammation. We examined whether daily social interactions predict levels of proinflammatory cytokines IL-6 and the soluble receptor for tumor necrosis factor-α (sTNFαRII) and their reactivity to a social stressor. One-hundred twenty-two healthy young adults completed daily diaries for 8 d that assessed positive, negative, and competitive social interactions. Participants then engaged in laboratory stress challenges, and IL-6 and sTNFαRII were collected at baseline and at 25- and 80-min poststressor, from oral mucosal transudate. Negative social interactions predicted elevated sTNFαRII at baseline, and IL-6 and sTNFαRII 25-min poststressor, as well as total output of sTNFαRII. Competitive social interactions predicted elevated baseline levels of IL-6 and sTNFαRII and total output of both cytokines. These findings suggest that daily social interactions that are negative and competitive are associated prospectively with heightened proinflammatory cytokine activity.

Keywords: competition, social stress, immunology

 

For full text go to:

 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3277534/

Inflammation Selectively Enhances Amygdala Activity to Socially Threatening Images

Tristen K. Inagaki, M. A.,¹ Keely A. Muscatell, M. A.,¹ Michael R. Irwin, M. D.,² Steve W. Cole, Ph.D.,^2,3 and Naomi I. Eisenberger, Ph.D.¹

Author information ► Copyright and License information ►

The publisher's final edited version of this article is available at Neuroimage

Abstract

Although social withdrawal is a prominent symptom of sickness, the mechanisms associated with this behavioral change remain unclear. In animals, the amygdala is a key neural region involved in sickness-induced social withdrawal. Consistent with this, in humans, heightened amygdala activity to negative social cues is associated with social avoidance tendencies. Based on these findings, we investigated whether an experimental inflammatory challenge selectively increased amygdala activity to socially threatening images as well as whether this activity related to feelings of social disconnection. Thirty-nine participants were randomly assigned to receive either placebo or low-dose endotoxin, which increases inflammatory activity. Pro-inflammatory cytokines were assessed at 7 hourly time points via blood draws; self-reported feelings of social disconnection and physical sickness symptoms were assessed hourly as well. Two hours post-injection, participants underwent an fMRI procedure to assess amygdala reactivity during the presentation of socially threatening images (fear faces) as well as non-socially threatening images (guns), socially non-threatening images (happy faces), and non-social, non-threatening images (household objects). Endotoxin led to greater amygdala activity in response to socially threatening vs. all other types of images. No such differences were found for placebo participants. Additionally, increased amygdala activity in endotoxin participants during the viewing of socially vs. non-socially threatening images was associated with increased feelings of social disconnection. These findings highlight the amygdala as a neural region that may be important for sickness-induced social withdrawal. The implications of amygdalar involvement in sickness-induced social withdrawal are discussed.

Keywords: amygdala, inflammation, social, functional magnetic resonance imaging, cytokines, social withdrawal

 

For full text of article go to:

 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3348143/  

Of 2 Minds: How Fast and Slow Thinking Shape Perception and Choice [Excerpt] In psychologist Daniel Kahneman's recent book, he reveals the dual systems of your brain, their pitfalls and their power By Daniel Kahneman, Scientific American Mind and Brain e-newsletter, June 15, 2012

To survive physically or psychologically, we sometimes need to react automatically to a speeding taxi as we step off the curb or to the subtle facial cues of an angry boss. That automatic mode of thinking, not under voluntary control, contrasts with the need to slow down and deliberately fiddle with pencil and paper when working through an algebra problem. These two systems that the brain uses to process information are the focus of Nobelist Daniel Kahneman's new book, Thinking, Fast and Slow (Farrar, Straus and Giroux, LLC., 2011). The following excerpt is the first chapter, entitled "The Characters of the Story," which introduces readers to these systems. (Used with permission.)
Understanding fast and slow thinking could help us find more rational solutions to problems that we as a society face. For example, a commentary in the March issue of the journal Nature Climate Change outlined how carbon labeling that appeals to both systems could be more successful than previous efforts to change consumer habits. (Scientific American is part of Nature Publishing Group.) Understanding how we think can also guide more personal decisions. Last month, Kahneman highlighted in a lecture given at the National Academy of Sciences "The Science of Science Communication" conference how realizing the limitations of each system can help us catch our own mistakes.


To observe your mind in automatic mode, glance at the image below.
Your experience as you look at the woman’s face seamlessly combines what we normally call seeing and intuitive thinking. As surely and quickly as you saw that the young woman’s hair is dark, you knew she is angry. Furthermore, what you saw extended into the future. You sensed that this woman is about to say some very unkind words, probably in a loud and strident voice. A premonition of what she was going to do next came to mind automatically and effortlessly. You did not intend to assess her mood or to anticipate what she might do, and your reaction to the picture did not have the feel of something you did. It just happened to you. It was an instance of fast thinking.
Now look at the following problem:
17 × 24
You knew immediately that this is a multiplication problem, and probably knew that you could solve it, with paper and pencil, if not without. You also had some vague intuitive knowledge of the range of possible results. You would be quick to recognize that both 12,609 and 123 are implausible. Without spending some time on the problem, however, you would not be certain that the answer is not 568. A precise solution did not come to mind, and you felt that you could choose whether or not to engage in the computation. If you have not done so yet, you should attempt the multiplication problem now, completing at least part of it.
You experienced slow thinking as you proceeded through a sequence of steps. You first retrieved from memory the cognitive program for multiplication that you learned in school, then you implemented it. Carrying out the computation was a strain. You felt the burden of holding much material in memory, as you needed to keep track of where you were and of where you were going, while holding on to the intermediate result. The process was mental work: deliberate, effortful, and orderly—a prototype of slow thinking. The computation was not only an event in your mind; your body was also involved. Your muscles tensed up, your blood pressure rose, and your heart rate increased. Someone looking closely at your eyes while you tackled this problem would have seen your pupils dilate. Your pupils contracted back to normal size as soon as you ended your work—when you found the answer (which is 408, by the way) or when you gave up.
TWO SYSTEMS
Psychologists have been intensely interested for several decades in the two modes of thinking evoked by the picture of the angry woman and by the multiplication problem, and have offered many labels for them. I adopt terms originally proposed by the psychologists Keith Stanovich and Richard West, and will refer to two systems in the mind, System 1 and System 2.
• System 1 operates automatically and quickly, with little or no effort and no sense of voluntary control.
• System 2 allocates attention to the effortful mental activities that demand it, including complex computations. The operations of System 2 are often associated with the subjective experience of agency, choice, and concentration.
The labels of System 1 and System 2 are widely used in psychology, but I go further than most in this book, which you can read as a psychodrama with two characters.
When we think of ourselves, we identify with System 2, the conscious, reasoning self that has beliefs, makes choices, and decides what to think about and what to do. Although System 2 believes itself to be where the action is, the automatic System 1 is the hero of the book. I describe System 1 as effortlessly originating impressions and feelings that are the main sources of the explicit beliefs and deliberate choices of System 2. The automatic operations of System 1 generate surprisingly complex patterns of ideas, but only the slower System 2 can construct thoughts in an orderly series of steps. I also describe circumstances in which System 2 takes over, overruling the freewheeling impulses and associations of System 1. You will be invited to think of the two systems as agents with their individual abilities, limitations, and functions.
In rough order of complexity, here are some examples of the automatic activities that are attributed to System 1:
• Detect that one object is more distant than another.
• Orient to the source of a sudden sound.
• Complete the phrase “bread and . . .”
• Make a “disgust face” when shown a horrible picture.
• Detect hostility in a voice.
• Answer to 2 + 2 = ?
• Read words on large billboards.
• Drive a car on an empty road.
• Find a strong move in chess (if you are a chess master).
• Understand simple sentences.
• Recognize that a “meek and tidy soul with a passion for detail” resembles an occupational stereotype.
All these mental events belong with the angry woman—they occur automatically and require little or no effort. The capabilities of System 1 include innate skills that we share with other animals. We are born prepared to perceive the world around us, recognize objects, orient attention, avoid losses, and fear spiders. Other mental activities become fast and automatic through prolonged practice. System 1 has learned associations between ideas (the capital of France?); it has also learned skills such as reading and understanding nuances of social situations. Some skills, such as finding strong chess moves, are acquired only by specialized experts. Others are widely shared. Detecting the similarity of a personality sketch to an occupational stereotype requires broad knowledge of the language and the culture, which most of us possess. The knowledge is stored in memory and accessed without intention and without effort.
Several of the mental actions in the list are completely involuntary. You cannot refrain from understanding simple sentences in your own language or from orienting to a loud unexpected sound, nor can you prevent yourself from knowing that 2 + 2 = 4 or from thinking of Paris when the capital of France is mentioned. Other activities, such as chewing, are susceptible to voluntary control but normally run on automatic pilot. The control of attention is shared by the two systems. Orienting to a loud sound is normally an involuntary operation of System 1, which immediately mobilizes the voluntary attention of System 2. You may be able to resist turning toward the source of a loud and offensive comment at a crowded party, but even if your head does not move, your attention is initially directed to it, at least for a while. However, attention can be moved away from an unwanted focus, primarily by focusing intently on another target.
The highly diverse operations of System 2 have one feature in common: they require attention and are disrupted when attention is drawn away. Here are some examples:
• Brace for the starter gun in a race.
• Focus attention on the clowns in the circus.
• Focus on the voice of a particular person in a crowded and noisy room.
• Look for a woman with white hair.
• Search memory to identify a surprising sound.
• Maintain a faster walking speed than is natural for you.
• Monitor the appropriateness of your behavior in a social situation.
• Count the occurrences of the letter a in a page of text.
• Tell someone your phone number.
• Park in a narrow space (for most people except garage attendants).
• Compare two washing machines for overall value.
• Fill out a tax form.
• Check the validity of a complex logical argument.
In all these situations you must pay attention, and you will perform less well, or not at all, if you are not ready or if your attention is directed inappropriately. System 2 has some ability to change the way System 1 works, by programming the normally automatic functions of attention and memory. When waiting for a relative at a busy train station, for example, you can set yourself at will to look for a white-haired woman or a bearded man, and thereby increase the likelihood of detecting your relative from a distance. You can set your memory to search for capital cities that start with N or for French existentialist novels. And when you rent a car at London’s Heathrow Airport, the attendant will probably remind you that “we drive on the left side of the road over here.” In all these cases, you are asked to do something that does not come naturally, and you will find that the consistent maintenance of a set requires continuous exertion of at least some effort.
The often-used phrase “pay attention” is apt: you dispose of a limited budget of attention that you can allocate to activities, and if you try to go beyond your budget, you will fail. It is the mark of effortful activities that they interfere with each other, which is why it is difficult or impossible to conduct several at once. You could not compute the product of 17 × 24 while making a left turn into dense traffic, and you certainly should not try. You can do several things at once, but only if they are easy and undemanding. You are probably safe carrying on a conversation with a passenger while driving on an empty highway, and many parents have discovered, perhaps with some guilt, that they can read a story to a child while thinking of something else.
Everyone has some awareness of the limited capacity of attention, and our social behavior makes allowances for these limitations. When the driver of a car is overtaking a truck on a narrow road, for example, adult passengers quite sensibly stop talking. They know that distracting the driver is not a good idea, and they also suspect that he is temporarily deaf and will not hear what they say.
Intense focusing on a task can make people effectively blind, even to stimuli that normally attract attention. The most dramatic demonstration was offered by Christopher Chabris and Daniel Simons in their book The Invisible Gorilla. They constructed a short film of two teams passing basketballs, one team wearing white shirts, the other wearing black. The viewers of the film are instructed to count the number of passes made by the white team, ignoring the black players. This task is difficult and completely absorbing. Halfway through the video, a woman wearing a gorilla suit appears, crosses the court, thumps her chest, and moves on. The gorilla is in view for 9 seconds. Many thousands of people have seen the video, and about half of them do not notice anything unusual. It is the counting task—and especially the instruction to ignore one of the teams—that causes the blindness. No one who watches the video without that task would miss the gorilla. Seeing and orienting are automatic functions of System 1, but they depend on the allocation of some attention to the relevant stimulus. The authors note that the most remarkable observation of their study is that people find its results very surprising. Indeed, the viewers who fail to see the gorilla are initially sure that it was not there—they cannot imagine missing such a striking event. The gorilla study illustrates two important facts about our minds: we can be blind to the obvious, and we are also blind to our blindness.
PLOT SYNOPSIS
The interaction of the two systems is a recurrent theme of the book, and a brief synopsis of the plot is in order. In the story I will tell, Systems 1 and 2 are both active whenever we are awake. System 1 runs automatically and System 2 is normally in a comfortable low-effort mode, in which only a fraction of its capacity is engaged. System 1 continuously generates suggestions for System 2: impressions, intuitions, intentions, and feelings. If endorsed by System 2, impressions and intuitions turn into beliefs, and impulses turn into voluntary actions. When all goes smoothly, which is most of the time, System 2 adopts the suggestions of System 1 with little or no modification. You generally believe your impressions and act on your desires, and that is fine—usually.
When System 1 runs into difficulty, it calls on System 2 to support more detailed and specific processing that may solve the problem of the moment. System 2 is mobilized when a question arises for which System 1 does not offer an answer, as probably happened to you when you encountered the multiplication problem 17 × 24. You can also feel a surge of conscious attention whenever you are surprised. System 2 is activated when an event is detected that violates the model of the world that System 1 maintains. In that world, lamps do not jump, cats do not bark, and gorillas do not cross basketball courts. The gorilla experiment demonstrates that some attention is needed for the surprising stimulus to be detected. Surprise then activates and orients your attention: you will stare, and you will search your memory for a story that makes sense of the surprising event. System 2 is also credited with the continuous monitoring of your own behavior—the control that keeps you polite when you are angry, and alert when you are driving at night. System 2 is mobilized to increased effort when it detects an error about to be made. Remember a time when you almost blurted out an offensive remark and note how hard you worked to restore control. In summary, most of what you (your System 2) think and do originates in your System 1, but System 2 takes over when things get difficult, and it normally has the last word.
The division of labor between System 1 and System 2 is highly efficient: it minimizes effort and optimizes performance. The arrangement works well most of the time because System 1 is generally very good at what it does: its models of familiar situations are accurate, its short-term predictions are usually accurate as well, and its initial reactions to challenges are swift and generally appropriate. System 1 has biases, however, systematic errors that it is prone to make in specified circumstances. As we shall see, it sometimes answers easier questions than the one it was asked, and it has little understanding of logic and statistics. One further limitation of System 1 is that it cannot be turned off. If you are shown a word on the screen in a language you know, you will read it—unless your attention is totally focused elsewhere.
 
CONFLICT
Figure 2 is a variant of a classic experiment that produces a conflict between the two systems. You should try the exercise before reading on.
You were almost certainly successful in saying the correct words in both tasks, and you surely discovered that some parts of each task were much easier than others. When you identified upper- and lowercase, the left-hand column was easy and the right-hand column caused you to slow down and perhaps to stammer or stumble. When you named the position of words, the left-hand column was difficult and the right-hand column was much easier.
These tasks engage System 2, because saying “upper/lower” or “right/ left” is not what you routinely do when looking down a column of words. One of the things you did to set yourself for the task was to program your memory so that the relevant words (upper and lower for the first task) were “on the tip of your tongue.” The prioritizing of the chosen words is effective and the mild temptation to read other words was fairly easy to resist when you went through the first column. But the second column was different, because it contained words for which you were set, and you could not ignore them. You were mostly able to respond correctly, but overcoming the competing response was a strain, and it slowed you down. You experienced a conflict between a task that you intended to carry out and an automatic response that interfered with it.
Conflict between an automatic reaction and an intention to control it is common in our lives. We are all familiar with the experience of trying not to stare at the oddly dressed couple at the neighboring table in a restaurant. We also know what it is like to force our attention on a boring book, when we constantly find ourselves returning to the point at which the reading lost its meaning. Where winters are hard, many drivers have memories of their car skidding out of control on the ice and of the struggle to follow well-rehearsed instructions that negate what they would naturally do: “Steer into the skid, and whatever you do, do not touch the brakes!” And every human being has had the experience of not telling someone to go to hell. One of the tasks of System 2 is to overcome the impulses of System 1. In other words, System 2 is in charge of self-control.
 
ILLUSIONS
To appreciate the autonomy of System 1, as well as the distinction between impressions and beliefs, take a good look at figure 3.
This picture is unremarkable: two horizontal lines of different lengths, with fins appended, pointing in different directions. The bottom line is obviously longer than the one above it. That is what we all see, and we naturally believe what we see. If you have already encountered this image, however, you recognize it as the famous Müller-Lyer illusion. As you can easily confirm by measuring them with a ruler, the horizontal lines are in fact identical in length.
Now that you have measured the lines, you—your System 2, the conscious being you call “I”—have a new belief: you know that the lines are equally long. If asked about their length, you will say what you know. But you still see the bottom line as longer. You have chosen to believe the measurement, but you cannot prevent System 1 from doing its thing; you cannot decide to see the lines as equal, although you know they are. To resist the illusion, there is only one thing you can do: you must learn to mistrust your impressions of the length of lines when fins are attached to them. To implement that rule, you must be able to recognize the illusory pattern and recall what you know about it. If you can do this, you will never again be fooled by the Müller-Lyer illusion. But you will still see one line as longer than the other.
Not all illusions are visual. There are illusions of thought, which we call cognitive illusions. As a graduate student, I attended some courses on the art and science of psychotherapy. During one of these lectures, our teacher imparted a morsel of clinical wisdom. This is what he told us: “You will from time to time meet a patient who shares a disturbing tale of multiple mistakes in his previous treatment. He has been seen by several clinicians, and all failed him. The patient can lucidly describe how his therapists misunderstood him, but he has quickly perceived that you are different. You share the same feeling, are convinced that you understand him, and will be able to help.” At this point my teacher raised his voice as he said, “Do not even think of taking on this patient! Throw him out of the office! He is most likely a psychopath and you will not be able to help him.”
Many years later I learned that the teacher had warned us against psychopathic charm, and the leading authority in the study of psychopathy confirmed that the teacher’s advice was sound. The analogy to the Müller-Lyer illusion is close. What we were being taught was not how to feel about that patient. Our teacher took it for granted that the sympathy we would feel for the patient would not be under our control; it would arise from System 1. Furthermore, we were not being taught to be generally suspicious of our feelings about patients. We were told that a strong attraction to a patient with a repeated history of failed treatment is a danger sign—like the fins on the parallel lines. It is an illusion—a cognitive illusion—and I (System 2) was taught how to recognize it and advised not to believe it or act on it.
The question that is most often asked about cognitive illusions is whether they can be overcome. The message of these examples is not encouraging. Because System 1 operates automatically and cannot be turned off at will, errors of intuitive thought are often difficult to prevent. Biases cannot always be avoided, because System 2 may have no clue to the error. Even when cues to likely errors are available, errors can be prevented only by the enhanced monitoring and effortful activity of System 2. As a way to live your life, however, continuous vigilance is not necessarily good, and it is certainly impractical. Constantly questioning our own thinking would be impossibly tedious, and System 2 is much too slow and inefficient to serve as a substitute for System 1 in making routine decisions. The best we can do is a compromise: learn to recognize situations in which mistakes are likely and try harder to avoid significant mistakes when the stakes are high. The premise of this book is that it is easier to recognize other people’s mistakes than our own.
 
USEFUL FICTIONS
You have been invited to think of the two systems as agents within the mind, with their individual personalities, abilities, and limitations. I will often use sentences in which the systems are the subjects, such as, “System 2 calculates products.”
The use of such language is considered a sin in the professional circles in which I travel, because it seems to explain the thoughts and actions of a person by the thoughts and actions of little people inside the person’s head. Grammatically the sentence about System 2 is similar to “The butler steals the petty cash.” My colleagues would point out that the butler’s action actually explains the disappearance of the cash, and they rightly question whether the sentence about System 2 explains how products are calculated. My answer is that the brief active sentence that attributes calculation to System 2 is intended as a description, not an explanation. It is meaningful only because of what you already know about System 2. It is shorthand for the following: “Mental arithmetic is a voluntary activity that requires effort, should not be performed while making a left turn, and is associated with dilated pupils and an accelerated heart rate.”
Similarly, the statement that “highway driving under routine conditions is left to System 1” means that steering the car around a bend is automatic and almost effortless. It also implies that an experienced driver can drive on an empty highway while conducting a conversation. Finally, “System 2 prevented James from reacting foolishly to the insult” means that James would have been more aggressive in his response if his capacity for effortful control had been disrupted (for example, if he had been drunk).
System 1 and System 2 are so central to the story I tell in this book that I must make it absolutely clear that they are fictitious characters. Systems 1 and 2 are not systems in the standard sense of entities with interacting aspects or parts. And there is no one part of the brain that either of the systems would call home. You may well ask: What is the point of introducing fictitious characters with ugly names into a serious book? The answer is that the characters are useful because of some quirks of our minds, yours and mine. A sentence is understood more easily if it describes what an agent (System 2) does than if it describes what something is, what properties it has. In other words, “System 2” is a better subject for a sentence than “mental arithmetic.” The mind—especially System 1—appears to have a special aptitude for the construction and interpretation of stories about active agents, who have personalities, habits, and abilities. You quickly formed a bad opinion of the thieving butler, you expect more bad behavior from him, and you will remember him for a while. This is also my hope for the language of systems.
Why call them System 1 and System 2 rather than the more descriptive “automatic system” and “effortful system”? The reason is simple: “Automatic system” takes longer to say than “System 1” and therefore takes more space in your working memory. This matters, because anything that occupies your working memory reduces your ability to think. You should treat “System 1” and “System 2” as nicknames, like Bob and Joe, identifying characters that you will get to know over the course of this book. The fictitious systems make it easier for me to think about judgment and choice, and will make it easier for you to understand what I say.
 
SPEAKING OF SYSTEM 1 AND SYSTEM 2
“He had an impression, but some of his impressions are illusions.”
“This was a pure System 1 response. She reacted to the threat before she recognized it.”
“This is your System 1 talking. Slow down and let your System 2 take control.”
Reprinted from Thinking, Fast and Slow by Daniel Kahneman, published by Farrar, Straus and Giroux, LLC. Copyright © 2011 by Daniel Kahneman. All rights reserved.

Unfair practices: Pharma companies fined $13bn in 4 years (Times of India)

Subodh Varma, TNN | Jul 16, 2012, 03.52AM IST

In the past four years, leading members of Big Pharma like GlaxoSmithkline, Pfizer, Johnson & Johnson, AstraZeneca, Merck, Abbot, Eli Lilly and Allergen have paid about $13 billion in fines to settle charges of misleading marketing, promising what drugs don't do, bribing doctors to get their drugs prescribed, causing sometimes fatal side-effects, and other crimes. The patients targeted by them ranged from children to dementia afflicted senior citizens. An analysis of their total revenues and the income from the drugs they are charged with shows that while huge, the fines are at best slaps on the wrist — their jaw-dropping revenues far outweigh the penalties.

Here are the facts: GlaxoSmithKline was fined $3 billion by the US justice department for marketing drugs for unapproved uses, paying kickbacks to doctors and Medicare system, downplaying known risks of certain drugs. They sold Paxil, an antidepressant, to children for whom it was not shown to work. They sold Wellbutrin, another anti-depressant, as a pill for weight-loss and erectile dysfunction. They sold the anti-diabetic pill Avandia concealing data that showed it increased cardiac risks. But in the years it took for all this to come through GlaxoSmithkline had made $11.6 billion on Paxil, $5.9 billion on Wellbutrin and $10.4 billion on Avandia. That's $27.3 billion — about 9 times the fine they are paying now to settle investigations.

Pfizer, the world's biggest pharma company with annual revenue of over $67 billion last year, paid up $2.3 billion in 2009 to settle a similar investigation. The drugs involved were Bextra, Geodon, Zyvox and Lyrica. Pfizer had been using illegal methods to sell them, like giving junkets and cash to sales reps for pushing the anti-arthritic pain killer Bextra as an all-purpose pain killer.

The reason for Pfizer's huge fine was that it included $1.3 billion for criminal liability - because this was the second time they had been caught. Earlier, in 2004, their subsidiary Warner-Lambert had been fined $430 million for the same violations, and they had promised never to repeat.

All four of Pfizer's controversial drugs had topped $1 billion in sales before coming under a cloud. And so it goes on. Johnson & Johnson has appealed against an Arkansas judge's ruling to cough up $1.2 billion for off-label marketing of Risperdal, Medicaid fraud and paying kickbacks to nursing care provider Omnicare. But industry experts say that J&J is going to settle with justice department for $2.2 billion and avoid nationwide penalties which would run into billions. Risperdal is estimated by industry analysts to have earned $24 billion for J&J since it went on sale in 2003 as an antipsychotic drug.

Abbott Laboratories aggressively pushed the anti-epilepsy blockbuster drug Depakote on elderly dementia patients saying that it helped control their agitation. There was no evidence that it did so. In fact, there was evidence of adverse effects. They also sold it as an anti-schizophrenia drug whereas it was approved only for seizures and bipolar mania. This year, Abbott agreed to settle all claims for $1.6 billion. Abbott had $38.85 billion sales last year. In 2011, Merck agreed to pay a fine of $950 million for selling Vioxx, a painkiller for four years before withdrawing it in 2004. It earned about $11 billion from Vioxx, but left behind a trail of patients with heart seizures and strokes.