Psychiatry: Man up and own responsibility to patients

[Altostrata]

With public criticism of psychiatry becoming more intense, the Wild West days of psychiatrists prescribing whatever they want to whomever they want -- basically, experimenting on patients -- are coming to a close.

 

Some psychiatrists, such as Stephen Stahl, head of the Neuroscience Education Institute, are incensed. They claim they're being unfairly attacked by "pharma-scolds," Scientologists, assorted nuts, and deniers of mental illness. They don't understand why ethics demand a separation between pharmaceutical company interests and psychiatric education and practice. They are afraid that, without the patronage of pharma -- and the flood of money to individual psychiatrists as researchers -- the field of psychiatry will stall.

 

They don't understand that the cozy symbiosis between pharma and psychiatry has resulted in patient harm.

 

Pharma has glossed over side effects and adverse events from psychiatric drugs for many years. Prescribing practices are based on inadequate risk-benefit assessments, and inadequate post-marketing reporting.

 

If you don't know what the risks are, how can you responsibly evaluate the risk-benefit profile for any individual patient?

 

This has led to vast overprescribing of, for example, newer antipsychotics, for conditions far removed from psychosis. Somehow someone has communicated to psychiatrists and primary care physicians alike that there is little downside to chronically prescribed psychiatric drugs. Who could that be?

 

Just, for example, in terms of diabetes risk, unnecessarily chronically prescribed antipsychotics AND antidepressants clearly add to a public health epidemic. Which would you rather have, occasional insomnia or diabetes? Moderate depression or diabetes? Especially when there are other treatment options for insomnia and moderate depression?

 

Let us also remember it's not just bad form to allow oneself to be influenced by pharma company misrepresentation of risks and benefits. It's not just a breach of a gentleman's agreement. It doesn't merely look bad ethically. It's not just an embarrassment. It's not just a shaking of doctorly egos.

 

Underestimate of risks for any individual patient results in patient harm, sometimes long-lasting. The reason there are so many pharma-scolds and antimedication patients is because, at the absurdly high rate of chronically prescribed psychiatric medications, there are a lot of dissatisfied customers out there, and they're not keeping quiet.

 

This is something medicine and psychiatry needs to come to grips with. Your activities are no longer being carried on in private in hushed sacrosanct environments. This is the age of information-sharing, and flaws in psychiatric practice are coming to light in very public ways. Time to man up and own your responsibilities to patients, and stop whining about the criticism. The days of the Wild West in psychiatry are over, and you are now accountable.

 

(I posted this comment on Dr. Stephen Stahl's article http://go.neiglobal.com/Blog/tabid/83/EntryId/16/Are-future-psychiatric-treatments-doomed-Be-careful-what-you-ask-for-you-just-might-get-it.aspx)

[alexjuice]

Well said. Put this in resolution form and you'll have my siggy....

 

I am actually embarrassed for Dr. Stahl.

 

Finally, I don't know if the big Pharam corps are shuttering their research facilities devoted to psychiatric meds. Those meds have been a huge gravy train. Doc seems to believe they are pulling the plug because of pressure from 'scientologists' and mental-illness-deniers??

 

There's an old joke about how little doctors understand business. James Cramer writes that wannabe brokers like himself were trained at business school to market the highest commission, hardest-to-sell products to doctors who, highly invested in a self-image defined by their own genius, shied from asking questions that might show their investing naivete and ignorance. Rather than ask for details, docs were more likely to accept the premise and buy the product. Ring ($), ring for the salesman.

 

Anyway, Stahl provides one of the more laughable explanations I've ever come across, even from a doc. If pharma is going in another direction it's because, internally, they don't anticipate the present risk/reward profile continuing into the future. It's unlikely 'scolders', scientologists and mental-illness crackpots have the resources to affect giant corporations in this way.

 

More likely, they have a lot of internal evidence suggesting investing more money in R&D of psych meds won't pay off. I'd guess they have data indicating their meds aren't sufficiently effective in comparison to the litigation liability they create. Whatever the reason, I'd bet it's based on the business fundies.

 

The alternative, that which Dr. Stahl suggests, is that people like Alto and Peter Breggin and Bob Whittaker have amassed such power that they can now essentially dictate business strategy to a group of some of the most powerful corporations on the planet. In fact the combined market cap of just GSK, Lilly, Pfizer, AstraZ, & Abbott ($434Bn) would make a confederation of the five the 27th most productive nation on earth by GDP. (This is for point-making only, no need for wonks or accountants to explain how GDP and m cap are nonsynonymous, thanks.)

 

I guess it's a pretty reasonable position that a scattered group of unfunded activists and a religious cult have forced this industry to completely stop research needed to continue to create newer versions of their most effective, useful and profitable products to the detriment of hundreds of millions of needy, sick people.

 

I had no idea that the lunatics had taken over not just the asylum, but, it would appear, the FDA, the US Congress, the media, academia... and not just in the states but in the entirety of the west. Heavens no!

 

...

 

I have a bridge for sale, Mr. Stahl, should you ever consider getting out of psychiatry and into real estate.

 

Alex.i

[summer]

Next time I see my internist, I'm going to ask her if she thinks there is a connection between ADs and diabetes. I'm curious what her answer will be.

 

My guess is that she will say that age, weight, and not much exercise play a much bigger role.

 

I'll report back.

[Altostrata]

There's a huge body of research showing antidepressants increase diabetes risk substantially.

[summer]

There's a huge body of research showing antidepressants increase diabetes risk substantially.

 

I know that. I wonder if my doctor does.

 

So, what is worse? Hearing I have early onset diabetes with the possibility of meds soon to follow (her words)... or, CTing the 10mg of Celexa?

[Altostrata]

Difficult situation. I wouldn't cold turkey. How is the Celexa taper going?

 

I believe you can reverse mild diabetes with non-drug means.

[Punarbhava]

As usual.............such an excellent letter Alto! I love the use of "Man Up" and "The Days of the Wild West".

 

 

So many excellent points made within the letter as well.

 

 

 

I wish to take this opportunity to sincerely thank you, as well as Cine for all the passion, persistence and effort you both put forth responding to various blogs, news articles etc., not to mention constructing threads on such subject matter to keep us all informed etc.

 

 

As I expressed to CS, you are all speaking for those of us, who at this moment in time, are unable to effectively speak for ourselves due to being immersed in stages of WD which inhibit our abilities to be involved in similar fashion.

 

I very much wish to write my own letters someday. I'm too traumatized to even go there right now...... The anger and pain towards the forces who have permitted these crimes against us, is too big for my CNS to handle. In fact, it further traumatizes me to think about it too much and thus, for now (but not forever) I must suppress my emotions, as much as possible, in order to physically heal from the damaging chemical assaults of psyche drugs exposure.

 

However, as my CNS further recovers I will be more capable of expressing that which very much needs to be expressed. In fact, I believe that letter writing will be instrumental in healing the psychological, emotional and spiritual that needs to heal within me.

 

Occasionally, on an okish day, I am able to purge a few of my thoughts however, I still must regulate the degree/intensity of these short bursts of anger. But at least I'm able to get out bits and pieces which is progress etc.

 

 

My wish is to become more proactive in the future when I recover to a greater degree. In the meantime, I am deeply and I mean deeply grateful for the efforts that all three of you consistently put forth. In fact, it moves me to tears. THANK YOU! Really...THANK YOU from the bottom of my heart!!

 

 

Your efforts are changing the climate. As you know, it's so important to make these unethical people accountable. They need to be regularly challenged............made to feel unsafe, and very uncomfortable. All three of you are doing just that.

 

BTW, there are so many incredible posts made by Cine, yourself (Alto) and CS and I just wish I had the cognitive abilities, mental stamina, not to mention the absence of computer sensitivities to reply to all of them.........to share my thoughts, as well as express my thanks. Please know, I highly respect the intellect, passion, commitment and talent exhibited by each one of you.

 

 

Most Sincerely,

 

Punar

[Altostrata]

Oh, Punar, thank you. You are strong and courageous and add immeasurably to our community.

 

When you are able, I'm sure you will be kicking rear ends wherever they need kicked.

[cinephile]

I wish to take this opportunity to sincerely thank you, as well as Cine for all the passion, persistence and effort you both put forth responding to various blogs, news articles etc., not to mention constructing threads on such subject matter to keep us all informed etc.

Wow. Thank you so much! This really made my day. I have had NO ELECTRICITY (or hot water!) due to Hurricane Irene for FOUR SOLID DAYS and only now have my power back. Utter hell. It sure is nice to come back to the 'net and read something like this!

[Punarbhava]

Oh, Punar, thank you. You are strong and courageous and add immeasurably to our community.

 

You're most welcome. Thank you on all acc'ts Alto. I will accept "strong" but I can't fully take ownership in regard to courage. Those who walked this journey before me, gave courage to me. Without their courage, knowledge, experience and compassionate desire to assist others, I likely wouldn't be here today.

 

 

They showed me that it was possible to endure. They showed me how to get off these drugs in a safer manner etc. etc. They did what you (SA) are now doing........SAVING LIVES. You are on the most sacred mission ever!

 

So, it has been my pleasure to give back. color]

 

When you are able, I'm sure you will be kicking rear ends wherever they need kicked.

I believe 6 more months of recovery will allow me the luxury of being able to fully express myself. That day can't come soon enough!

 

 

Punar

[Punarbhava]

I wish to take this opportunity to sincerely thank you, as well as Cine for all the passion, persistence and effort you both put forth responding to various blogs, news articles etc., not to mention constructing threads on such subject matter to keep us all informed etc.

Wow. Thank you so much! This really made my day. I have had NO ELECTRICITY (or hot water!) due to Hurricane Irene for FOUR SOLID DAYS and only now have my power back. Utter hell. It sure is nice to come back to the 'net and read something like this!

 

 

My pleasure Cine! Oh my Gosh re: Hurricane. So sorry to hear what you're going through. It sounds horrible!

 

 

BTW, keep writing. You are such a skilled and gifted writer........with so much passion, intellect, insight and wisdom. Honestly, it's really something to witness. I believe you have a very promising future.

 

Much More Healing and Full Recovery to You!

 

Punar

[cinephile]

BTW, keep writing. You are such a skilled and gifted writer........with so much passion, intellect, insight and wisdom. Honestly, it's really something to witness. I believe you have a very promising future.

Thank you so much for these words! They really are fuel to keep fighting the good fight and get the word out about psychiatry.

[Rhiannon]

 

The alternative, that which Dr. Stahl suggests, is that people like Alto and Peter Breggin and Bob Whittaker have amassed such power that they can now essentially dictate business strategy to a group of some of the most powerful corporations on the planet. In fact the combined market cap of just GSK, Lilly, Pfizer, AstraZ, & Abbott ($434Bn) would make a confederation of the five the 27th most productive nation on earth by GDP. (This is for point-making only, no need for wonks or accountants to explain how GDP and m cap are nonsynonymous, thanks.)

 

I guess it's a pretty reasonable position that a scattered group of unfunded activists and a religious cult have forced this industry to completely stop research needed to continue to create newer versions of their most effective, useful and profitable products to the detriment of hundreds of millions of needy, sick people.

 

 

 

Alex.i

 

LOL--exactly what I thought. WTF? !