Science
RFK Jr.’s Push to Curb Antidepressants Has Shaken Psychiatry
Most years, when thousands of psychiatrists gather for the annual meeting of the American Psychiatric Association, they walk past a scattering of protesters. There are Scientologists with megaphones; Falun Gong groups doing their exercises; and, often, former patients, saying they have been harmed by medications or electroconvulsive therapy.
This year, though, the profession is facing criticism from the highest levels of the federal government. The American Psychiatric Association gathered just 10 days after Health Secretary Robert F. Kennedy Jr. announced a set of policies to encourage doctors to deprescribe, or assist patients in stopping, the most widely prescribed class of antidepressants.
A current of anxiety ran through the meeting, held here this week. Many physicians in the crowd said they worried that Mr. Kennedy’s statements would prompt people to refuse medications, or to quit them and relapse. The plenary session erupted in applause when Dr. Marketa Wills, the organization’s chief executive, declared, “We will never support governmental interference in the practice of medicine.”
“We are standing tall for evidence-based care,” she continued. “We are standing tall against stigma, oversimplification, and anything that would move patients further away from the care that they need.”
But there were also signs that the field’s leaders are engaging, albeit cautiously, with Mr. Kennedy’s effort to curb overprescribing. Numerous sessions offered training in helping patients taper off medications. In July, the association’s president will take part in a panel convened by the Department of Health and Human Services to develop clinical guidance on tapering antidepressants.
In an interview, Dr. Wills said she had been “encouraged” by the invitation to participate in the panel, and she credited the administration with “putting mental health front and center.”
“It feels like the beginning of a conversation, one that we welcome,” Dr. Wills said. She added, “It would be odd to have that conversation without psychiatrists at the table.”
Outside in the corridors, some rank-and-file attendees were less diplomatic.
Many providers took issue with Mr. Kennedy’s negative characterization of selective serotonin reuptake inhibitors, or S.S.R.I. s, the most widely prescribed class of psychiatric medications. Clinical trials have found that most patients’ depressive symptoms improved with S.S.R.I.s, and they are considered safe enough to be prescribed by general practitioners.
A 2026 study found that 16.6 percent of U.S. adults, or roughly one in six, reported currently taking an antidepressant.
“He just doesn’t like S.S.R.I.s,” said Dr. Sung Hyon, a psychiatrist from Pasadena, referring to Mr. Kennedy. Dr. Hyon said S.S.R.I.s had been “foundational” in his practice — “boring drugs that are well established, have good safety evidence and have zero chance to cause addiction.” He called them “God’s gift to psychiatry.”
And patients know it, he added. “So many millions” of Americans already take S.S.R.I.s, he said, and the vast majority are fully aware of their downside, like sexual side effects and withdrawal symptoms.
“And they say, ‘You know what? It’s worth it,’” Dr. Hyon said. “Because there are so many of them, it would be a pretty big political firestorm if he really tried to restrict access. And there is very, very little medical evidence to do so.”
Mr. Kennedy has long signaled that curbing the use of psychiatric drugs was a goal of his. Earlier this month he began taking steps in that direction, announcing guidelines and regulatory changes meant to provide an incentive for clinicians to help patients taper off psychiatric medications. The steps would not affect patients’ access to antidepressants.
Andrew Nixon, a spokesman for the Department of Health and Human Services, said the agency had had no discussions about banning S.S.R.I.s., “and any claims suggesting otherwise are false.” The aim of the new initiative, he said, is to “promote appropriate psychiatric prescribing and drive deprescribing when clinically indicated.”
Some psychiatrists said they worried that Mr. Kennedy’s deprescribing initiative was the beginning of a wider effort that might, in later stages, discredit psychiatry more broadly and restrict access to care.
“I think it is actually putting more questions in people’s minds about whether psychiatric treatment is safe or effective,” said Dr. Eric Rafla-Yuan, who chairs the A.P.A.’s caucus on the social determinants of health. “The data has not changed on S.S.R.I.s. It’s the narrative that has changed.”
He said the A.P.A. should be pushing back forcefully against Mr. Kennedy’s claims about psychiatric treatments, and should steer clear of seeming to endorse any part of the initiative.
“It’s a fine line between having a seat at the table and being used as a tool to legitimize their agenda,” he said.
‘Much Too Medicated’
At the same time, deprescribing seemed, at the meeting, to be on everyone’s lips. A new book, “Stahl’s Deprescriber’s Guide,” was selling like hot cakes in the exhibition hall. There were panels titled, “Deprescribing Antipsychotics,” “The Much Too Medicated Patient” and “Stimulants for A.D.H.D.: Did We Get It Wrong?”
Dr. Chris Aiken, who delivered an address about multidrug cocktails, said a generational change is moving through the psychiatric association, as a younger cohort of physicians, in their 30s and 40s, take a more prominent role.
Millennials were part of the first generation to be prescribed stimulants and antidepressants as children and teens, he said, and physicians in that group are more conscious of poor outcomes years later. “Meds are not the answer, and they have seen this in their own lives,” he said.
Some senior physicians had a similar message.
“If I have any regrets about my recommendations as a physician, it’s about the medications that I did not withdraw sooner,” said Dr. Ronald Winchel, an assistant clinical professor of psychiatry at Columbia University’s medical school, at one panel.
He said a number of concerns had prevented him from doing so: Sometimes, patients were taking multiple medications and it was difficult to say which was effective. Sometimes, patients were doing well, and he was afraid of setting them back. And there was a dearth of research on how patients do after they quit medications.
“The fear of withdrawing medications has really complicated our work,” he said.
Dr. Winchel compared this year’s churning discussion to a watershed moment in the A.P.A.’s history: In 1973, sustained pressure from protesters caused the organization to reverse its century-old position and declare that homosexuality was not a mental disorder.
“Instead of getting into a defensive crouch, they looked at themselves and they made progress,” Dr. Winchel said. The same kind of advancement, he added, could result from a rigorous discussion about prescribing practices. “If some of this agitation is coming from outside,” he said, “what is wrong with that?”
In his presentation, Dr. Aiken urged colleagues not to dismiss the stories Mr. Kennedy has highlighted of patients who have encountered serious difficulties quitting antidepressants.
“I don’t really know how common it is, but I do know that when it does happen, it can be quite severe,” he said. “It may be rare, but let’s take it seriously, because it can really burn people when it happens.”
Others said working with Mr. Kennedy around mental health policies was a matter of simple pragmatism.
“There’s definitely a need for us to be talking to the people who are making decisions,” said Dr. Hammad Khan of Sacramento. “We can’t let Joe Rogan decide what the F.D.A. approves or doesn’t approve.”
An Inflection Point
Dr. Awais Aftab, the author of “Psychiatry at the Margins,” a popular mental health Substack, said he expects the H.H.S. effort to focus on raising awareness about tapering off medications. There are few pathways for the government to reduce the prescription of drugs like S.S.R.I.s, which have gone through F.D.A.-approval pathways and are widely used by the public, he said.
He described “a sense of alarm” among psychiatrists at the virulent critique of the field coming from Mr. Kennedy’s circle. Psychiatry, he said, has been late to acknowledge the complaints of patients like Laura Delano, an author and activist, who say they were overmedicated as children or teenagers and got little support from doctors when they wanted to reduce or stop the drugs.
“The mainstream psychiatric community has been fairly insulated, and suddenly they are hearing now about this issue,” said Dr. Aftab, a psychiatrist at Case Western Reserve University.
He added that he believes that the use of antidepressants in the United States may have reached a natural limit. “The demand is going to, at some point, go into an equilibrium with the reality of the lack of effectiveness and the reality of the tolerability issue,” he said.
But the experience of some other countries suggests that the demand for antidepressants may continue to rise, even amid warnings about overprescribing.
In 2017, Britain commissioned a major report on overprescribing and then followed up with a series of reforms, including updating clinical guidelines to require regular prescribing reviews and instituting a national audit program to monitor drug use.
But a study of prescribing in Britain found that the use of antidepressants continued its steady rise through 2023, the last year for which data was available. In contrast, recent years have seen a decline in the use of anxiety medications and hypnotics, which were also the subject of updated clinical guidelines.
The study’s authors said the rise was most likely driven by patient demand, reductions in stigma and the lower cost of antidepressant medications available in generic form.
Many psychiatrists at the conference in San Francisco said that they routinely urge patients to try therapy as an alternative or a complement to medications, but that many patients have no access to that care, because their insurance will not pay for it.
Dr. Michael Bostwick, a suicide researcher and professor of psychiatry at Mayo Medical School, in Rochester. Minn., said it remained unclear what alternative treatments Mr. Kennedy is recommending to patients who quit antidepressants.
“Toward what end?” he said. “Is he going to put more resources toward therapists? Is he going to tell us to eat more red meat, or work out more, or take psychedelics, like the president has advocated? There is no alternative plan.”
Science
Oliver Tree, musician and Santa Cruz native, dies in helicopter crash
Oliver Tree, a genre-defying singer-songwriter and Santa Cruz native, was one of six people killed when two helicopters collided Sunday morning in Brazil, according to the Associated Press. He was 32.
Tree, a quirky artist known for his highly theatrical music videos and crisp bowl cut, had been traveling through South America as a part of his world tour. CNN Brazil reported Argentinian YouTuber Gaspar Prim, also known as Gaspi, was among those killed in the crash.
The mid-air collision occurred in Rio de Janeiro, with one of the helicopters landing in the parking lot of a car dealership, the AP reports. Local authorities have launched an investigation into the cause of the crash.
Tree, born Oliver Tree Nickell, broke out in the electronic music world first performing as, simply, Tree. He released an e.p., “Demons,” in 2013, which included a cover of Radiohead’s “Karma Police” that caught the ear of Thom Yorke. He later attended CalArts north of Los Angeles, and signed to Atlantic Records for his major-label debut e.p. “Alien Boy” in 2018.
To find his distinct look, he told the Santa Cruz Sentinel that “I was making a statement with it. Everybody’s trying to look so beautiful and sexy nowadays. It was my way of rebelling against that. So, I tried to make myself look as silly and ridiculous as possible.”
Tree was an instant hit on the festival circuit for his outlandish stage productions and outsider charisma, performing at Lollapalooza, Coachella and Outside Lands. He collaborated with Skrillex, David Guetta and Zeds Dead, and was fiercely protective of his meticulously weird visual identity and video concepts, telling Rolling Stone that “That’s kind of my signature. The people who do f- with me know me because of my videos..Music is my day job but my real dream is to be making feature films.
He released his major label debut LP, “Ugly Is Beautiful,” in 2020. His hit song “Life Goes On” and collaboration “Miss You” with German DJ Robin Schulz earned him international recognition and climbed onto the Billboard Hot 100. He released four full length albums as Oliver Tree, most recently April’s independent LP “Love You Madly Hate You Badly.”
Tree had performed in Buenos Aires on June 4.
From July to October, he had shows scheduled throughout Europe, Australia and China. This year, he performed at the Coachella Valley Music and Arts Festival this year as a special guest of electronic producer Subtronics. In one of his last social media posts, he made a point to spotlight an upcoming show on Aug. 9 in his hometown at the Quarry Amphitheater at UC Santa Cruz.
“I can’t believe Oliver is gone,” Schulz posted on Instagram. “You were such a lovely soul and a one of a kind character. Working with you on ‘Miss You’ was an honor. My deepest condolences to his family, friends and everyone who loved him.”
Science
New MLK hospital program brings amputations to zero for at-risk diabetic patients
More than three decades after a diagnosis of Type 2 diabetes, Michelle Caldwell says her disease is better controlled than ever.
She keeps regular appointments with her endocrinologist, primary care provider, dietician and pharmacist at MLK Community Medical Group, the outpatient arm of MLK Community Healthcare.
She picks up weekly produce deliveries in the South Los Angeles hospital’s cafeteria and attends its occasional cooking classes. She has learned to decode nutrition labels and developed a taste for salads and nuts.
Just one hurdle remains: the shoes.
Diabetes can damage foot nerves, making it easier for patients to miss small scratches and wounds that could lead to serious infections. Her care team was gently urging her to switch to supportive, closed-toe footwear.
But Caldwell loves a sandal, and the podiatrist-approved options were crimping her style.
“It doesn’t have to be, like, fashion fashion,” she said with a laugh during a recent visit with primary care provider Dr. Edward Cardenas at his East Compton office. But were there any options that didn’t look like “Frankenstein feet”?
That down-to-the-toes level of care is a feature of a program that has transformed the way MLK Community Healthcare treats diabetes, a chronic condition that affects one in every six South Los Angeles residents and nearly a quarter of MLK’s outpatients.
Four years after MLK launched an intensive management program for the most at-risk patients, more than 80% of enrollees have seen blood sugar levels decline. More than 70% have brought their blood pressure under control.
And diabetic-related amputations — which are painful and life-altering procedure that were the hospital’s most common surgery for years — have plummeted to zero for program patients.
No novel medications or treatments are behind these results, said Dr. Jorge Reyno, MLK’s senior vice president for population health.
Dr. Edward Cardenas examines a patient with diabetes.
(Christina House / Los Angeles Times)
Rather, a relatively modest one-time grant has allowed the hospital system — whose service area includes some of L.A.’s poorest and most disadvantaged neighborhoods — to provide the same level of care for its diabetic patients that people in wealthier areas would expect as standard.
“What we’ve demonstrated here is that we can get best-in-class care — we can even beat national benchmarks for care — if there’s the appropriate commitment and investment. And that people’s health doesn’t have to be determined just by their zip code,” Reyno said. “Because what we’ve created here is not necessarily incredibly innovative. It’s just what needs to be available — and is available in other locations.”
Some 1.3 million people live in MLK’s South Los Angeles service area. More than 90% are Black or Latino, and nearly 70% are either uninsured or have health coverage through Medi-Cal, Medicare or both.
Medi-Cal’s low provider payment rates is one reason South L.A. has only one-third of the full-time physicians necessary to treat a population of its size — a 1,500-doctor shortage, according to MLK’s research.
For many locals, MLK’s emergency department is about the only place they can see a doctor, given the challenge they face securing a timely appointment with a physician who accepts their health coverage.
Roughly 123,000 patients arrived last year at the hospital’s emergency department, which was designed to treat 40,000 people annually. About 40% were seeking primary care.
Emergency room physicians were diagnosing diabetes in severely ill people who did not know they had the disease and treating life-threatening complications for those whose disease had long gone unmanaged.
Patients arrived with gangrenous foot wounds that harried providers elsewhere brushed off as athlete’s foot. Rates of diabetic ketoacidosis, a life-threatening complication that occurs when insulin levels are so low that cells can no longer convert glucose into energy, were three times that of the rest of Los Angeles County.
For many, care arrived too late to prevent one of the disease’s most serious complications: amputation.
Nerve damage means a blister or pebble in the shoe can go unnoticed until it creates a serious wound. High blood sugar impairs immune function and narrows vessels that carry oxygen-rich blood, making it harder for skin to heal. Once serious infection sets in, amputating a foot or limb may be the only option to save a patient’s life. Across the U.S., diabetes complications are responsible for roughly 80% of all non-trauma related amputations, according to the Centers for Disease Control and Prevention.
Broaching amputation with a patient “is really tough,” Cardenas said. “You’re taking such a big part of them away. It’s identity, it’s confidence, it’s [the] ability to walk and do things for themselves. It’s a huge, huge thing.”
It’s also costly. Diabetes cost $306.6 billion in U.S. direct medical spending in 2022, the most recent year for which numbers are available, and foot ulcer-related issues were responsible for about one-third of that, said Dr. David G. Armstrong, director of USC’s limb preservation program and the Southwestern Academic Limb Salvage Alliance.
Indirect costs are also steep. One study of post-surgery outcomes found that only about one-third of patients were able to return to work after the amputation surgery, despite an average age of 54.
“The economic ramifications aren’t just the fact that you’re not working. It’s also that people in your family are taking off of work to be able to help accommodate this, or having to provide extra resources that they previously weren’t having to, so it has sort of a multi-generational effect,” said Dr. Caitlin Hicks, a vascular surgeon and director of research at Johns Hopkins University’s Multidisciplinary Diabetic Foot and Wound Clinic.
In California, the households most likely to bear that cost are those that can least afford it.
Diabetic residents in MLK’s service area and other economically impoverished parts of California were more than 10 times more likely to have a toe, foot or leg amputated than diabetic people in more affluent areas, according to one 2014 UCLA study.
“The finding that residents living in lower income areas bear a disproportionate share of disability and disfigurement from amputations is deeply disturbing in a society that espouses equality and outspends all other nations on health care for its more affluent citizens,” the paper’s authors wrote.
It was a problem MLK decided to do something about.
Clinical Nutrition Manager Jackie Juarez, left, chats with Claudette Meeks, a member of the community and a hospital patient, following a cooking class at MLK Community Hospital.
(Christina House / Los Angeles Times)
The hospital secured a $2 million grant from the Good Hope Medical Foundation, a private foundation based in Pasadena, with additional funding from the Rose Hills Foundation and L.A. Care Health Plan.
In October 2021, it began officially enrolling patients in its Diabetes Management Center of Excellence. Within this was an intensive-management program for a subset of high-risk patients, including those with Type 1 diabetes, gestational diabetes or hemoglobin A1C levels — an indicator of blood sugar — at 9.0% or more. (For people without diabetes, a level below 5.7% is considered normal.)
For the most part, the system already had the endocrinologists, nephrologists and primary care physicians it needed. The money let MLK build a network of dedicated support staff who could take care of diabetic patients outside the exam room.
Between visits, patients in the intensive-management program had access to a clinical care pharmacist who reviewed and coordinated medications; a diabetes educator who walked them through blood sugar monitoring, meal planning and other daily concerns; community health workers who could make home visits; and a nurse care manager who served as their primary advocate and point of contact.
Through the hospital’s Recipes for Health program, they could pick up weekly bundles of fresh produce and take bimonthly classes on diabetic-friendly recipes.
They were more likely to stick to their treatment plan, and had more time at doctor visits to discuss medical issues.
Diabetes patient Jose Magallanes tries a cheesecake during a cooking class at MLK Community Hospital.
(Christina House / Los Angeles Times)
“We have multiple people reaching out and interacting with the patients in between physician visits,” said MLK endocrinologist Dr. Megan Jacobs. “They have someone reaching out to them [and] talking to them about the social aspects of things — how they have to take into account their diabetes when they go out to dinner and when they’re at a party.”
By year three, 66% of patients in the intensive-management program had lower blood sugar levels than they did at enrollment; by the fourth year, 81% did. In the third year 63% of patients had brought their blood pressure under control, rising to 71% the following year.
Four years after the program started, appointment compliance hit 84%, up from 50% at baseline. The hospital’s most severely diabetic patients were hospitalized for diabetes at less than half the rate of the area’s general population.
Most significantly, amputations among the intensive-management group dropped to virtually zero.
Over the course of four years, only one of the 1,165 patients in the high-risk group required an amputation. The surgery took place less than a month after their enrollment, indicating they likely entered the program with a wound at critical levels.
Diabetic-related amputations and wound care are now MLK’s third-most common type of surgical procedures, after holding the top spot since the hospital’s 2015 opening.
“This is absolutely, positively spectacular,” USC’s Armstrong said of MLK’s results. “This is life affirming stuff.”
The primary grant ends next year. After that, the program’s future is uncertain.
MLK is eligible to reapply to the Good Hope Medical Foundation, which has been “very happy” with the program’s outcomes, said Howard A. Kahn, the foundation’s chair.
The hospital is also talking to L.A. Care, the largest publicly operated health plan in the U.S., about a potential partnership, Reyno said. It could be a win for both sides.
“The benefit of cost savings usually goes to the state Medicaid plan or to the insurance carrier, who doesn’t have as high a cost to pay,” Reyno said. “If a program like this could be replicated in other safety net communities and have a wider impact, then certainly the return on investment would be even greater.”
Care providers also said they see improvements the data doesn’t capture.
“I hear [patients] say, ‘Oh, I walked to the park with my grandchildren,’ or ‘I was able to move around because I’ve lost the weight’ … maybe they had a sore on their foot that was kind of questionable, [and] ‘Now it’s healed because my sugars are under control,” said nurse care manager Monica Garcia. “Just seeing the benefits when they are compliant is the satisfaction.”
Back at the clinic office in East Compton — the shoe issue set aside for now — Cardenas examined Caldwell’s feet and lower limbs.
The doctor was optimistic that Caldwell’s recent discomfort came from tight muscles, rather than nerve damage, and recommended a stretching and strengthening regimen.
“It shouldn’t be painful, just like a tug,” he said, demonstrating a standing calf stretch. “If you like, I can refer you to physical therapy as well.”
Having providers take the time to explain her disease, rather than just scribbling out prescriptions, has made a world of difference for Caldwell, she said.
“It’s an awesome experience. I’ve changed my eating habits, I’m learning to read labels more clearly,” she said. “Even at my age, you think you know, but you don’t know.”
Science
NorCal braces for dry, dangerous fire season as SoCal faces typical conditions
Southern California’s top fire officials met behind closed doors in East Los Angeles Friday to discuss the outlook for this year’s peak fire season and how to coordinate the region’s world-class firefighters to keep communities safe.
At a press conference afterward, officials stressed that even though coastal Southern California is not expected to have an exceptionally dangerous fire season, they are doing everything they can to protect Californians. They urged residents to do the same.
“It is clear that wildfires are no longer solely a fire-service problem. They are an all-of-us problem,” said Orange County Fire Authority Interim Chief T.J. McGovern, standing in front of a suite of emergency response vehicles at L.A. County Fire Department’s headquarters. “They can only be mitigated by all of us working together.”
Coastal Southern California, which had the third-wettest season in record within the last 15 years, can expect a typical wildfire season, fire weather analysts predict. That’s in sharp contrast to Northern California, which saw a record-breaking March heat wave melt mountain snowpack early. Fire officials typically rely on the snowpack to keep vegetation green and moist into summer.
“The interesting thing about last year is that it was the southern half of the state that was significantly drier,” said Cal Fire Director Joe Tyler at a wildfire season outlook briefing last month. This year, he said, “we’re seeing that critical condition really spreading across Northern California.”
Coastal Southern California must still endure a particularly dry June before reaching typical conditions July through September — and even “typical” conditions remain dangerous, which is why officials urged Southern Californians Friday to remain vigilant.
A series of fires mid-May served as a warning shot for the region. The Sandy fire in Ventura County destroyed one home and damaged two more structures. The Santa Rosa Island fire burned through a third of the second-largest Channel island.
Officials at Friday’s Southern California meeting urged homeowners to do what they can to harden their homes against wildfire — including covering vents with mesh to prevent embers from entering the home and using multi-paned tempered windows that are less likely to shatter in extreme heat.
They also asked homeowners to maintain defensible space around homes by clearing dead vegetation in their yards, making sure there is space between shrubs and trees and creating a 5-foot buffer around homes with nothing combustible, including plants.
Homeowners should also make sure they’re signed up for evacuation alerts from their local fire department, the chiefs added, and should not hesitate to evacuate at the sight or smell of smoke — regardless of whether an official evacuation has been ordered.
As for their part, Southern California fire departments have been working to thin out hazardous vegetation surrounding communities and remain at the ready to respond to fires.
“We will show up. We show up every time, across every jurisdiction … That’s not a question,” said Los Angeles City Fire Department Chief Jaime Moore. However, without defensible space at individual homes, it is “very difficult for us to be able to combat those fires.”
The Los Angeles and Ventura county fire departments have been working to remove flammable vegetation surrounding communities in the Santa Monica Mountains with fire department crews, goats and prescribed fire. The U.S. Forest Service has been doing similar work in the San Gabriel Mountains.
The crews are working to create a network of vegetation-free pathways, called fuel breaks, that can slow fires and give firefighters strategic access to wildlands to combat blazes. They are also working to remove particularly flammable invasive grasses.
“As we share our preparation to defend communities and build wildfire resilience, it’s a call to action,” Angeles National Forest Fire Chief Robert Garcia said. “It’s now a shift to individual homeowners and communities to start leveraging some of that work that your agencies are doing.”
While this kind of landscape-wide work has significantly increased in the state over the past five years, California is running out of money to complete such projects.
Meanwhile, the U.S. Forest Service saw a decrease in how much work it could complete after the Trump administration significantly reduced the size of the service’s workforce.
Neither the state’s funding woes nor the shrinking of the federal workforce are expected to impact firefighting ability.
“It is absolutely as strong as ever,” Tyler said last month of the federal and state government’s ability to respond to fires.
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