A "must read" post on Pharma and Psychiatry by "1 Boring Old Man"

It’s been a long holiday, frozen here in the Georgia Mountains. Today, there’s a blue sky and balmy weather. I think people around here have had their life-time White Christmas and are ready to put it behind us. I’ve spent my cooped up time with David Healy’s Let Them Eat Prozac, Alison Bass’ Side Effects, Astrazeneca’s $eroquel Study 15, and the blogs Healthcare Renewal, Furious Seasons, Carlat, Soulful Sepulcher, Pharmalot, and countless others. I guess I felt like a late comer to the PHARMA Wars, and I needed to catch up [I'm plenty caught up now]. Probably the most instructive thing I’ve read in all of it is the Introduction to Dr. Healy’s book entitled Introduction: Before Prozac. If you haven’t read it or don’t recall it, read it [again]. It’s an insightful narrative in its own right, but it was personally relevant for my life because I left academic medicine in the same year Prozac was put on the market. In many ways, I missed the brunt of what came after. I didn’t go to many Psychiatry meetings after that - too boring and too confusing. I stayed in a cocoon of Object Relations and Trauma theory, things that pertained to the patients I treated and I was blissfully isolated from the DSM/Psychopharm/PHARMA cosmos that so changed the world that I was avoiding. I learned a ton in the post-Prozac years, but it was from reading, my patients, and my colleagues - not from the "scene" of Academic Medicine or Organized Psychiatry [which I increasingly no longer recognized].

I’ve been surprised at my internal reaction to all of this stuff I’ve been reading. It’s a deep anger, in the general vicinity of rage. It’s not primarily focused on the immorality of it all - the buying of Psychiatry by Industry, the deceit in the studies and ad campaigns, the Doctors getting rich selling out. I sure feel plenty of that, but that’s not the rage part. It’s about having been left in the wilderness all alone and having to figure everything out by myself. I got most of it on my own, but it was hard work. I had to learn to start people low on SSRIs and tiptoe up. I had to learn to warn them about agitation early on. I never heard of akathisia in this context until this week reading these books. I had to learn that the Atypical Antipsychotics made people gain a ton of weight and that they were weak sisters in treating Psychosis. I also had to learn by trying that they didn’t do much for severe depression, much less the "blues." I had to figure out that my 1980s view of Bipolar Disorder was right after all, and that much of the "new stuff" was made up [I'm still waiting for a Depakote cure]. That’s where my rage lies. I "kept up" but didn’t learn much from it. I had to figure it out myself. And I would’ve loved to know that starting people on Benzodiazepines or Inderal with the SSRI to manage the initial akasthisia would’ve helped. Nobody told me that. Being a reasonably contientious Psychiatrist wasn’t enough.

That’s why Healy’s Introduction was so helpful. He is quite good at summarizing the essence of things and is a keen historian [I suspect him of a literary undergraduate degree]. Alison Bass is equally facile at giving out the pertinent facts that allow one to feel confident of her conclusions. There’s a "believability" factor in their writing that’s refreshing - after becoming so paranoid about anything I read that has to do with psychopharmacology. Medications are a tool in the practice of Psychiatry, and every single drug is a double edged sword. My own approach was to stay way back on the trailing edge of things, and to not try anything until my partners or friends had already tested the waters - and even then to move slowly and carefully. But even that wasn’t slow enough and I did some harm along the way - nothing fatal, but more than I would’ve liked.

Academic Medicine and our professional organizations let us down. The FDA and the people formulating the Diagnostic and Statistical Manual let us down. The Insurance Industry and the Pharmaceutical Industry let us down. And we let ourselves down, because we passed on some fuzzy medicine to our patients. I feel rage at being let down, but some of that might be a cover for that last part. Most of us that weren’t in "the game" just didn’t pay attention and were complicit and apathetic, rather than raising holy hell. I think I feel ashamed that I stayed in my psychoanalytic cocoon. I have enormous respect for people like Dr. Carlat, Dr. Carroll, Dr. Healy, Dr. Poses - the people who’ve been fighting the good fight for a long time now.

I’m encouraged by how much attention the PHARMA Wars have gotten lately, and feel some reform in the winds. But some in the face of the magnitude of the problem just isn’t enough. The tide doesn’t seem to have turned sufficiently quite yet. I don’t know what to call this era, but 2011 needs to be the final date on its tombstone…

 

It’s not psychopharmacology that needs to die. It’s the shameful mockery many have made of their own rallying cry - "evidence based medicine"…

via 1boringoldman.com

Posted via email from Jack's posterous