January 26, 2010

The Massacre Of The Unicorns II

zebra.JPG
if it had a horn, I'm sure it would be a rhinoceros

There's a debate of sorts in psychiatry: to what extent should we rely on evidenced based medicine?

It's almost a trivial point-- we're going to rely on it anyway, why debate it? So the question should better be phrased, "to what extent should the future of psychiatry rely on evidence generated now?"

In a series of articles Nassir Ghaemi tries to justify Evidence Based Medicine in psychiatry; specifically, the primacy of evidence over theories or models. 

Ghaemi's says clinical realities are more important than theories, and EBM allows for the study of clinical realities.  Any deficiencies in the evidence-- confounding bias, diagnostic uncertainties, etc, are really a problem about the application of the studies, and not about the possibility of EBM in psychiatry.  In other words, psychiatry is sound, but we need more and better data.

Ghaemi is arguing for an empiricist's approach, as opposed to a top-down theoretical approach-- one that starts with a theory, with concepts, and either ignores evidence or bends the evidence to conform to an existing theory.  (His eg: psychoanalysis.)

II.

He asserts that the foundation is clinical observation, which is then studied further using scientific methods.  For example, hormone replacement therapy done on thousands, later determined to be ineffective if not harmful.  See?  More evidence, better practice. 

Hormone replacement therapy was the cure for many female illnesses.  Decades of experience with millions of patients, huge observational studies with thousands of subjects, and the almost unanimous consensus of experts all came to naught when randomized studies proved the futility of the belief in that treatment (not to mention its carcinogenic harm).

A moment's reflection  shows this argument to be illogical.  Hormone replacement therapy did work.  It had great risks, but to say that it was a failure is wrong.  "It was the cure for many female illnesses, but..."  So it was adequately tested in all of them, indicating its futility?

Ghaemi would respond that we would need more studies to determine the efficacy and risks in each indication, in each population.  That would be right, but that's not what happened: doctors generalized the failure of a medication based on the outcomes in a restricted symptom set.

"Not better than placebo" is another false start.  If a medication and a placebo both show a 25% response rate, it doesn't mean the drug is "no better than placebo": what if two different 25%s responded?  Would the group that "responded" to the drug also have responded if crossed over to placebo?

The same is true for symptoms: if placebo and drug both result in a 25% reduction in symptom severity, it neither means the drug is a failure, nor, indeed, that the placebo is a placebo.

"Well, we'd need more and better studies."  Of course.  I'll wait at the bar.

III.  Pay No Attention To The....

This story is apocryphal, so consider it a parable:

Pierre Eymard and friends were studying novel antieplieptics, and used dipropylacetic acid (a solvent) as both an intravenous  vehicle for the drug, and as placebo.  They observed that the placebo worked, too, preventing seizures at the higher concentrations.

If this had been a phenotype without visible effects, it would have been a perfectly ordinary conclusion that drug was not better than dipropylacetic acid-- aka Depakote.

"But placebos nowadays are inert."  Is the fluorescent lighting in the office a placebo-- maybe it makes the anxious depressed patients more anxious?  "Come on, those studies are from 1990."  I guess that means the question had been satisfactorily resolved, requiring no further investigation?

"Well, more studies are needed..."  Tell the bartender I take my rum straight.


IV.  Improvement In Depression

Take the simple example of depression, as measured by the popular Hamilton Scale.  The scale measures insomnia and weight loss, but not hypersomnia and weight gain.   Using this scale, a patient who sleeps too much and eats too much is less depressed than someone who sleeps too little and has lost weight.  And, any drug that fixes sleep and makes you gain weight has an advantage over drugs that don't.  In fact, a third to half of the improvement on the Hamilton could be accomplished by improved sleep and appetite alone.  Go Zyprexa.

Note that the results of drug trials are reported only as total scores; you have no idea what symptoms the drug is fixing, or not.  "But it's not powered to detect those effects."  Ok, but it isn't designed to tell you if it's an "antidepressant," either; only if it lowers scores on the  Hamilton in this single sample group.

"We need more studies, more scales."   But in the meantime we're left with "X is an effective antidepressant." 

The standard academic line is that the evidence indicates all antidepressants are generally equally efficacious.  Think about this.   Have you ever met a single patient for whom that was true? 

For a hundred reasons, none of that data applies to the patient sitting in front of you, yet it is the best information you have to go on.  You have nothing else.  Ok, go.  The problem is not in the application of evidence to your patients, the problem is in the application of the theory that the evidence is creating in you onto your patient. 

The Tohen data may show that Zyprexa is efficacious in depression, but when you prescribe it you are thinking, "antipsychotics in general are efficacious in depression in general, and I need a sedating one."  You are doomed.

"But more studies are needed..."  I look forward to reading them, or passing out, whichever comes first.

V. 

That's the issue.  In order for this to be a science, there has to be a testable hypothesis. There isn't any of that in psychiatry. 

Example: antidepressant induced mania is the kind of testable question amenable to scientific investigation.  Do they cause it, or not?   But it's not easily answered, indeed, it cannot be answered.  Which antidepressant?  What's an "antidepressant?"  Cymbalta, Pamelor, or Seroquel? Or CBT?  What about semen?  Which  symptom of depression is it treating or not treating that allows you to call it an "antidepressant"?   You could do a billion studies on every drug ever made, in every description of "depression" imaginable and that would only allow you to say, "ah, I know the answer in a billion specific situations" but would still have no insights into the nature of the phenomenon.

Why don't all antidepressants cause it?  "Well, there are exceptions to the rule."  You've been infected: the rule is meaningless. 

When you give someone Paxil, you are playing the odds: this worked in 25% of the guys we gave it to in 1997.  There's nothing wrong with doing this, that's what you're supposed to do; but it does not allow you to speculate on either the nature "antidepressants" or "depression."

Simply put, the problem with "Evidenced Based Medicine" isn't the evidence, but the "based."  Existing evidence can guide practice, but cannot be used to create a general practice model.  "Mood stabilizers are the cornerstone of treatment in bipolar disorder."  While I have no idea what you're talking about, I'm certain to be punished if I don't oblige.

In physics, such empty theories don't hurt anyone, and there's value in the theory itself.  String theory may turn out to be wrong, but you at least are going to be really good at math.  Okay.

But in psychiatry these empty questions and empty answers are still applied to social concepts as if they carried the weight of scientific validity.  The question of "antidepressant induced mania" may be empty, but that doesn't stop the legal system from using it.  You can't imagine the defense proposing that at the precise moment of the murder, the universe split into two equivalent eigenstates and the defendant, in this eigenstate, had been already determined to have had to have been committing the act of murder, which he already had even before he started; but that explanation carries considerably more scientific merit than the psychiatric one, by which I mean both have absolutely none at all.  Wovon man nicht sprechen kann...


VI.  Here There Must Be Dragons

"But you're not really arguing against the primacy of empirical evidence, you're arguing about the misapplication of that evidence.  You're arguing against incorrect generalizations, against lumping data sets together to invent a clinical model."

No, it's much worse than that.

The problem isn't that the data is sound, but we shouldn't hastily extrapolate or generalize from that evidence.  The problem is it is impossible not to do this. 

The first reason is because of the use of words.  "I met a blonde girl last night."  Oh really? he replied knowingly.  The words "depression" or "bipolar" or "antidepressant" all existed before we started using them.  "Bi" and "anti" and "relapse vs. recurrence" all have connotations that may have no relevance to the way they are used now, yet those connotations will inevitably surface.   It seems as though "evidence based medicine" has discovered that the antipsychotic Seroquel is also good for depression,  but that's not science, it's an accident of history: 15 years ago the molecule could have been tested for depression, only to now be approved for psychosis.  The evidence, the science, may be neutral on the drug's identity, but it will never be equivalent to an SSRI in your mind.  In order for it to be successfully rebranded, everyone who learned it the other way has to die.

Second, the explicit purpose of psychiatry is to apply the discoveries immediately.  The hasty generalizations and applications aren't a byproduct of the field, they're the whole point.  We don't have time to wait for a physiological explanation for bipolar, we have to get people better now.  But while extrapolating from "kindling theory" or one antiepileptic's mania data to a theory of "mood stabilization" is a noble attempt, it's still wrong.

Third, our brains have no alternative but to assume causality.  No matter how many times you say "X is associated with Y" we will think "X causes Y."  Academics like to point this mistake out when residents do it, but everyone is guilty of it, all the time. This isn't a criticism of human laziness, this is how we're designed.  Our brains can't help it, they do not allow for a vacuum,  they force causality.  The brain may not let it become conscious, but you'll act like it, breathe like it.  Even when you know it's wrong.  I know how a mobile phone works, yet I still yell louder when it starts breaking up.  The only way to stop assuming one explanation is to be given another explanation. 

Fourth, while 1 + (-1) = 0, a positive study is never completely refuted by a negative one-- and vise versa.  Even if studies are of identical design in the exact same patients, the marketing of a study-- who wrote it, where it was published, how many "thought leaders" got behind it, how many pages, tables-- all of this supersedes the content.  Even if you successfully appraise a single study on its merits, the rest of the vastness of psychiatric literature is available to you only by rumor.  When the fashion turns away from SSRIs and North Face jackets, you'll frown when they occasionally reappear.

Fifth, simply asking the question often overwhelms the evidence.  If you ask, "does Geodon cause QTc prolongation?" it immediately stops mattering whether the evidence shows conclusively that it doesn't, or that it was a mistake; it even stops mattering whether you even understand what "QTc prolongation" means.  The moment the question is asked, you are forever condemned to pause before prescribing Geodon.

VII.

I've avoided discussions about groupthink or specific biases in studies as they are incidental to the fundamental problem of psychiatry, which is a faith in the primacy of evidence in the absence of any interest in a theory of mind.  Evidence can, should, and does inform practice, and none of its shortcomings should change the way we use it today.  But faith in evidence hasn't moved psychiatry forward at all in 50 years.  More evidence will not fix this, because there's nothing guiding the evidence.

The unfortunate truth is that most of the evidence in "evidenced based medicine" is at best too limited for general application, at worst wrong.  Many of you will reflexively recoil from this, retreating from the vertigo to the crowded safety of your peers, journals, and false idols, but this empiricism is only another kind of apostasy.  Repent.







Comments

What's the solution, then? ... (Below threshold)

January 26, 2010 12:06 PM | Posted by HP: | Reply

What's the solution, then? If faith in evidence hasn't moved psychiatry forward at all in 50 years...what will?

Vote up Vote down Report this comment Score: 0 (0 votes cast)
Please, for the love of God... (Below threshold)

January 26, 2010 12:30 PM | Posted by Anonymous: | Reply

Please, for the love of God, write a book and distribute it to every hospital, medical school, and high school science class in the country. You're our only hope.

Vote up Vote down Report this comment Score: 13 (13 votes cast)
Since you referenced physic... (Below threshold)

January 26, 2010 1:29 PM | Posted by Basil Valentine: | Reply

Since you referenced physics and math, I think it might be useful to note how the problems of connotation vs. denotation were resolved there: by a change of font.

Take geometry for instance. There once was a guy named Euclid, who was more or less responsible for setting up the geometry most of us are intuitively familiar with, involving things like planes and lines and solids and points. For someone who lived thousands of years ago, he was unusually rigorous, too-- his geometry involved five axioms, any one of which could be proved from the others... except the last one, which was that two parallel lines don't intersect (or intersect at infinity). Centuries of effort confirmed most of his results, but failed to provide a justification for that last axiom.

That's because that last axiom did not necessarily have to be true. Lobachevsky imagined a type of geometry where that was not necessarily the case, leading to a hyperbolic, or non-Euclidean geometry, which is used in, amongst other things, Einstein's relativity.

Problems occurred because Euclidean geometry had been around for centuries, and though there's a great deal of similarity between the two types of geometry, if you slipped up and started thinking of one in terms of the other, you'd very naturally lead to a contradiction (and you can prove anything from a contradiction). So what did the mathematical community do? They stopped thinking in terms of the easily visualizable "point" and started thinking of a POINT as a set of coordinates in a particular geometry. A "line" became a LINE, which would be a set of such points, constructed according to certain rules.

My point (so to speak) is that it's not necessary to wallow in ambiguity: what psychiatry needs is the same sort of rigor in its naming conventions. An "antidepressant", instead of 'a thing that makes you less depressed' ought to be thought of as something that, when applied, correlates with an improved score on certain metrics for depression. If you start thinking like that, you automatically keep in mind not only the fact that it's only a correlation, but also the validity of the studies that noted this effect as well as the validity of the metrics on which the study relies.

...which is, of course, what I think you're aiming for. Physics, even with its amazingly expensive modern machines, is comparatively cheap to test-- once you've got your Large Hadron Collider built, you can test for particle interactions all day. If you choose to apply your results, then the application is only as successful as the theory you've made based on these results, and so you're very careful to take into account everything right down to statistically anomolous things like solar radiation or equipment miscalibration.

Psychiatric testing is much more expensive: even after research and development costs, you've still got to round up the people for the actual studies, and attempt to control for a whole forest of variables. If it was sunny one day, might that not improve the disposition of certain depressed people? How could you possibly control for that? Also, companies that test the efficacy of psychiatric drugs aren't just looking to find out if their product works-- they're looking to sell that product if it shows any promise at all.

As you've noted, the business of psychiatry is business: it would be great to have a drug that genuinely does cure depression, but if you can't have that, it's almost as good to have a drug that people think cures depression. Here at least, a top-down approach might be more helpful: if you can understand how depression works, rather than just relying on ad-hoc, extremely specific and possibly faulty data, you stand a better chance of designing something that works to combat it.

Which is, of course, just a long-winded way of saying "I agree", I guess.

Vote up Vote down Report this comment Score: 9 (9 votes cast)
LP writes: But faith in ev... (Below threshold)

January 26, 2010 7:55 PM | Posted by Anonymous: | Reply

LP writes: But faith in evidence hasn't moved psychiatry forward at all in 50 years.


Psychiatry has no place to go, but away. Neurology and Psychology can handle it from here. Thanks, it's been fun.

Vote up Vote down Report this comment Score: -1 (9 votes cast)
Basil, many of your comment... (Below threshold)

January 26, 2010 8:00 PM | Posted by Anonymous: | Reply

Basil, many of your comments suggest that you do not understand LP's post. You write: An "antidepressant", instead of 'a thing that makes you less depressed'...". As LP correctly noted, "antidperssants" don't even necessarily make you less depressed. If the med sedates you and makes you fat, that's good enough to get approval. As LP once wrote, Ambien and a box of donuts will get Hamilton D scores down.

And you write of a cure for depression? Just WTF is depression, for starters? A cure for an abstraction?

Vote up Vote down Report this comment Score: -1 (5 votes cast)
That isn't what I meant at ... (Below threshold)

January 26, 2010 10:58 PM | Posted, in reply to Anonymous's comment, by Anonymous: | Reply

That isn't what I meant at all.

The problem is connotation: you say antidepressant, you mean "a drug that correlates with movement along a certain scale", but you're also thinking about what it suggests, which is "something that makes you less depressed". You ask what is depression. Well, it's got a clinical definition, but the word is used elsewhere, too, referring to melancholia, the blues, post-traumatic grief, and yes, abstraction. So long as you keep using the words "depression" and "antidepressant" you're going to have these associations at the back of your mind. What with cognitive biases and fallacious reasoning, sometimes this is worse than knowing nothing at all.

I then made an analogy to math, which had similar nomenclatural problems, and physics, which has a slightly different relationship with evidence-based and theoretical, top-down approaches. I suggested that there would continue to be problems with evidence-based approaches due to the difficulty involved in testing and the conflicts of interest.

I suggested that it would be necessary to resolve the issues with regards to connotation vs. denotation, and pointed out that evidence without any theoretical underpinnings tended towards ambiguity and misinterpretation due to at best, carelessness, and at worst wilful misrepresentation to sell products.

I'm sorry if you misunderstood.

Vote up Vote down Report this comment Score: 3 (5 votes cast)
Ok I think we all agree tha... (Below threshold)

January 26, 2010 11:38 PM | Posted by y: | Reply

Ok I think we all agree that "anonymous" is pretty fckg annoying. Time for you to pick a name dumbass(es). You are free to choose your identity, I think that is a theme here, is it not? And we get it, anonymous, you think psychiatry is irrelevant. Ok, thanks, but we all know that Meat Robot totally destroyed your argument in the comment section of an earlier post, so say something new and meaningful or shut the fck up and go away. Thank you.

Anyway, what is entirely relevant and equally frustrating is the point that psychiatry seems to be ruled by a small group of doctors (or excuse me, "thought leaders") who, while sharing narrow minds and working in concert with drugmakers, determine the rules and direction of the field. It seems to work much like modern government the world over. Minority leadership, big business blah blah blah etc.

It is hard sometimes to read the posts here. There is a feeling of powerlessness that is evoked by some of Alone's writings. How long has he been stuck inside the system I wonder? I can't tell, but I want to say that he is somewhere in his 40's. Whatever his age, I think it is time for a name change because he is not alone.

1st: We're all suffering from this type of top-down structure and narrow-minded leadership (i.e. washington d.c.) And old broken ideas and thinking.
2nd) You have the power to be a game changer. When you ally. With like-minded peers.
3rd) Fck S. Nasser Ghaemi. Seriously, what's with the S. ?
4th) I am young enough to still get outraged. And refuse to accept the dysfunction and corruption that pervades our lives. Thanks for your voice and sharing your thoughts.

Vote up Vote down Report this comment Score: 1 (7 votes cast)
<a href="http://carlatpsych... (Below threshold) "Ok, thanks, but we all kno... (Below threshold)

January 27, 2010 12:46 AM | Posted by Anonymous: | Reply

"Ok, thanks, but we all know that Meat Robot totally destroyed your argument in the comment section of an earlier post."

Hmm... but I forget what the third magical thing was that psychiatry was...perhaps you can remind me...he (you) answered that, right?

Or, maybe you can. Mind, brain, and __________ .

Vote up Vote down Report this comment Score: 1 (1 votes cast)
"Ok, thanks, but we all kno... (Below threshold)

January 27, 2010 12:50 AM | Posted by Anonymous: | Reply

"Ok, thanks, but we all know that Meat Robot totally destroyed your argument in the comment section of an earlier post."

Hmm... but I forget what the third magical thing was that psychiatry was studying...perhaps you can remind me...he (you) answered that, right?

My argument was that there isn't a third thing, and, yet,no one has answered that. Brain, mind, and _____________ ? When that is answered, my argument will be, like, totally destroyed, dude.


If you're annoyed, just fill in the blank.

Vote up Vote down Report this comment Score: 0 (0 votes cast)
In anon's defense, the best... (Below threshold)

January 27, 2010 1:07 AM | Posted by kurlos: | Reply

In anon's defense, the best posts by LP are not psychiatry. His entire Narcisissm angle is psychology. No study of medicine or the brain is necessary for that. Regardless of his degree, Freud clearly was a Psychologist by today's standards. And this is true of all of the famous M.D.'s from psychiatry's past--there is no similarity at all today's M.Ds. A past that was interesting because it was REALLY psychology. This isn't evolution, or growth, but something completely different. Now it doesn't want to be psychology, it wants to study "brain" diseases. Brain diseases are already taken, however. Now what?

Today, psychiatry's thought leaders (Stahl, Nasrallah,etc.) have nothing interesting to say about the human experience, mostly talking about medicines and the brain and what truly IS Neurology.

So, I can't really fill in the blank. LPs most intersting posts are psychology, with the occasional bit about receptor affinity or systemic failures.

I don't really see a lot of psychiatry on this blog, fortunately. Probably because psychiatry is not very interesting, unlike psychology, which is what LP's intersting posts are.

Vote up Vote down Report this comment Score: 5 (7 votes cast)
They'll pry my HRT drugs ou... (Below threshold)

January 27, 2010 8:51 AM | Posted by La BellaDonna: | Reply

They'll pry my HRT drugs out of my cold, dead hands. Speaking anecdotally, they do exactly what I expected and wanted them to do - and I don't care if the flip side is a shortened lifespan, because an extended lifespan without them isn't worth having.

Vote up Vote down Report this comment Score: 0 (0 votes cast)
kurlos - "In anon's defense... (Below threshold)

January 27, 2010 11:00 AM | Posted, in reply to kurlos's comment, by brainchild: | Reply

kurlos - "In anon's defense, the best posts by LP are not psychiatry. His entire Narcisissm angle is psychology. No study of medicine or the brain is necessary for that. Regardless of his degree, Freud clearly was a Psychologist by today's standards."

Ah, but "best" is a highly subjective judgment unless one is critiquing purely on formal aspects - which you aren't. From my subjective viewpoint, many of Alone's "best" posts are actually about culture and could be classified as cultural theory. However, classifications are permeable - particularly if someone is thinking outside of the box. Culture is constructed by people, just as culture can and often does construct who we are. And my considering his discussions about things that I find the most interesting as "the best" is simply a confirmation or interest bias on my part. I'm interested in culture, cognition, medicine, identity and NPD - and how they intersect - so I appreciate Alone's interest in these subjects, though I also appreciate his discussion of other topics and ability to challenge conventional beliefs and thinking without simply being an ideologue or oppositional. (Including challenging some of my own beliefs - though we're pretty aligned regarding culture and identity so far - and also exposing me to topics that I probably wouldn't consider otherwise.) Simply being against something isn't being skeptical or thinking critically, it's really just being ideologically opposed to something (anti and pro are two sides of the same dualistic coin, being able to think critically involves understanding context and looking at multiple aspects..this is where new insights emerge from).

Putting Freud in the time machine doesn't make him a psychologist, if Freud existed now he'd be a totally different person and type of doctor than he was in his own time. There are quite a few different approaches to psychiatry, certainly the American one isn't universal. Being anti-psychiatry without being specific is just an ideological anti-psychiatry position (a la Scientology), it's not particularly critical or rational.

Vote up Vote down Report this comment Score: -2 (4 votes cast)
Well, my question is -- und... (Below threshold)

January 27, 2010 12:04 PM | Posted, in reply to HP's comment, by caeia: | Reply

Well, my question is -- under what "evidence" does psychiatry practice? even Psychology is more art than science. It's based on what "seems to work" not what works. Leeches seemed to work in the middle ages. Today it's paxil and zoloft to lift the blues, but I'm not convinced it's much better.

Sooner or later, Neurology will take over the psuedosciences of Psychiarty and Psychology.

Vote up Vote down Report this comment Score: 1 (1 votes cast)
So antidepressant induced m... (Below threshold)

January 27, 2010 12:32 PM | Posted by Time Tested: | Reply

So antidepressant induced mania is just an instance of collapse into a quantum eigenstate.

Brilliant! And so obvious all along.

Love this blog.

Vote up Vote down Report this comment Score: 0 (0 votes cast)
Kurlos - "His entire Narcis... (Below threshold)

January 27, 2010 2:39 PM | Posted, in reply to brainchild's comment, by brainchild: | Reply

Kurlos - "His entire Narcisissm angle is psychology. No study of medicine or the brain is necessary for that."

Actually, upon reflection I'm going to have to call you out on promoting fallacies here too. Psychology overlaps with neuroscience and neuroanatomy - so much so that neurobiology is often part of the psychology departments in universities. (Which isn't to say there isn't some friction between the disciplines at times, or the people who study one or the other always get along.) Cognitive science - which is multidisciplinary studies the physical brain and the experience of mind. The cut and dried distinction you keep trying to make between disciplines isn't quite as cut and dried as you'd like to believe.

Narcissism and NPD are very much the realm of psychiatry. Whether we'll discover a neurobiological basis for it or not is to be seen. Even if it does end up having a neurobiological aspect, it may well still needed to be treated via a form of cognitive therapy because there may be no pharmaceutical or surgical intervention - and it's generally preferable to choose non-invasive treatments when possible anyway.

It seems the promotion of neurology here has little to do with any true understanding of neurology (or psychology for that matter) and is mainly motivated by a prejudice against psychiatry. (With little understanding of psychiatry evident as well.) On the positive side, at least no one's promoting e-meters and Scientology. What's most entertaining about it all is that Alone is often actually being quite critical of many aspects of contemporary psychiatry.

Vote up Vote down Report this comment Score: 0 (2 votes cast)
"Sooner or later, Neurology... (Below threshold)

January 27, 2010 2:49 PM | Posted, in reply to caeia's comment, by Nope: | Reply

"Sooner or later, Neurology will take over the psuedosciences of Psychiarty and Psychology."

There exists therapy beyond (and in addition to) medication. It is quite useful and life-changing and helps to improve people's lives. You misspelled pseudoscience.
Neurologists would have to incorporate this and have the ability to offer this type of therapy to patients.

Vote up Vote down Report this comment Score: 0 (0 votes cast)
Leeches are actually good f... (Below threshold)

January 27, 2010 3:51 PM | Posted, in reply to caeia's comment, by A Girl: | Reply

Leeches are actually good for a lot of things, and are being rediscovered in modern medicine. They are just not panacea.

And now, can anyone tell me with what wonder methods the neurologists are going to fix us all, once we have the shrinks safely out of the way? Exactly what tools, what methods will they have that are so much better, and why aren't these methods being employed today? We don't have to start with depression - we can just look at MS ... nopes, not cured. Alzheimers? Sorry. Parkinsons? ... no, not really. Schizophrenia? Presumably you are genetically 'predisposed' but after that it becomes a bit of a blur, but of course we have the evil shrinks exerting their influence there.

For crying out loud, I am not a big fan. I think many in the profession need a giant wake up call. But to go from there to anointing the neurologists to the great white hope - nopes. They are just human like the rest of us.

Vote up Vote down Report this comment Score: 1 (1 votes cast)
All of medicine is business... (Below threshold)

January 27, 2010 4:46 PM | Posted by bbj: | Reply

All of medicine is business. The question is if it is helpful to the patient, the customer, or results in iatrogenic harm and shorter life. Anyway, business is booming.

As for psychiatry as a medical speciality, any mom having lost a child to this hoax, knows it to be exatly that. An expensive hoax, totally unscientific, yet immensively lucrative to hoardes of people. Thank you, Alone. Terrific post.

Vote up Vote down Report this comment Score: 1 (1 votes cast)
A Girl: "Neurologis... (Below threshold)

January 27, 2010 5:35 PM | Posted by kurlos: | Reply


A Girl: "Neurologists would have to incorporate this and have the ability to offer this type of therapy to patients."

Well, if therapy was needed, the patient would be referred to a Psychologist. In cases where a psychologist suspected a brain abnormality like neurotransmitter deficits, the patient would be referred to a Neurologist.

Vote up Vote down Report this comment Score: 1 (1 votes cast)
"But to go from there to an... (Below threshold)

January 27, 2010 5:40 PM | Posted by kurlos: | Reply

"But to go from there to anointing the neurologists to the great white hope - nopes."

I think you misunderstand. The argument, unless I misunderstand, is not that Neurologists will offer DIFFERENT answers, but that there is no such thing as Psychiatric knowledge. If there is a Serotonin Deficit Disorder, it is Neurological disorder and treated by a Neurologist.

Vote up Vote down Report this comment Score: 3 (3 votes cast)
Kurlos, are you related to ... (Below threshold)

January 27, 2010 6:26 PM | Posted, in reply to kurlos's comment, by Al Anon: | Reply

Kurlos, are you related to the barkeep that I met last summer in Crete? He said his last name was Kurlos and that he was from the village of Almyrida which was founded by his family. I happened to be in a friendly debate with a few medical tourists about this very subject- neurology vs. the pseudosciences of psychology and psychiatry- when Kurlos interrupted us to talk about his father who was a psychiatrist in Chania. He said that his father was a genius and was writing a paper about Serotonin Deficit Disorder. The medical tourists were incredulous, insisting that Kurlos' father must be a neurologist. Eventually I became bored and walked back to my boat.

Vote up Vote down Report this comment Score: 0 (0 votes cast)
kurlos - "The argument, unl... (Below threshold)

January 27, 2010 6:30 PM | Posted, in reply to kurlos's comment, by brainchild: | Reply

kurlos - "The argument, unless I misunderstand, is not that Neurologists will offer DIFFERENT answers, but that there is no such thing as Psychiatric knowledge. If there is a Serotonin Deficit Disorder, it is Neurological disorder and treated by a Neurologist."

I'd hope you'd understand the argument you're making/supporting.

What so many people making absolutist arguments don't seem to understand is the relationship between brain and mind (or body and mind). In very simple terms, what we do with our mind shapes our brain, what we do to the brain changes our mind....it's a little thing called neuroplasticity. This means that treating some disorders can be done via mind or brain - generally speaking, treating the mind is less invasive and less likely to have undesirable side effects and is a lower risk form of treatment. Psychiatry often treats both mind (via talk therapy) and brain (through pharmacological interventions and sometimes other forms of physical treatment). A serotonin disorder may well be a result of environmental factors or a cognitive problem, why not treat the root of the problem rather than just medicating the symptoms? The danger in believing that all psychological problems are merely biological and that biology is the cause ignores the very real possibility that the biological problem is a symptom of an environmental/social cause. We're social creatures, we're shaped by our cultural and social environment, if our culture/environment is making us crazy then changing our culture/environment makes more sense than simply taking a pill so we can function in a damaging environment.

Vote up Vote down Report this comment Score: 1 (1 votes cast)
Gosh, how lovely to see the... (Below threshold)

January 28, 2010 3:53 AM | Posted by Meat Robot: | Reply

Gosh, how lovely to see the Cartesian Dualists back on the prowl insisting that psychologists treat "psychological" disorders and neurologists treat "brain" disorders. With poor old psychiatrists treating ____________. (Hey anon, you sure are clever. *Nobody* has filled in your blank. You're one of god's special angels. Ugh.)

Let's try this one. Psychiatrists, knowing neurotransmission, treat the brain. Psychiatrists, knowing psychodynamics and cognitivism, treat the mind. So, neurologists and psychologists treat ________________. (Dear Anon, please feel free to fill in the blank.)

In fact, come to think of it, I recall a very kindly lunch-lady when I was at school. Her hot meals nourished my brain, and her kind words nourished my mind. So, what is it that medicine or clinical psychology treat, Anon?

I sometimes advise patients in crisis to consider volunteering once a week for a few hours, to get their focus off themselves and de-energize the crisis. Some find it helpful. Some even become kindly lunch-ladies. Is that treating the brain, or the mind, or the _________? (Please, Anon, help us all out.) Is that in any sense "treatment", or is it some sort of _________? (once again, anon, please show us the way).

When my Catholic patients go to confession, perform penance, receive the mass and come into session feeling wonderful, was the priest a neurologist, or more of a psychologist? Which evidence based therapy was administered? Maybe it was more of a ___________.

How many more times does this point need to be made? Apparently we're not there yet.

Vote up Vote down Report this comment Score: 1 (3 votes cast)
"When my Catholic patients ... (Below threshold)

January 28, 2010 10:20 AM | Posted, in reply to Meat Robot's comment, by thelastpsychiatrist: | Reply

"When my Catholic patients go to confession, perform penance, receive the mass and come into session feeling wonderful, was the priest a neurologist, or more of a psychologist?"

Story not verified, but:

Some six months before Dr Winnicott's death in January 1971, a group of young Anglican priests invited him to come to talk to them. He accepted, and in a casual exchange of conversation they told him that what they needed guidance about was how to differentiate between a person who seeks their help because he is sick and needs psychiatric treatment, and one who is capable of helping himself through talking with them. Telling this story to me, Winnicott said that he had been taken aback by the awesome simplicity of their question. He had paused a long while, thought and then replied:

‘If a person comes and talks to you and, listening to him, you feel he is boring you, then he is sick, and needs psychiatric treatment. But if he sustains your interest, no matter how grave his distress, you can help him [yourself]."

Vote up Vote down Report this comment Score: 2 (2 votes cast)
"Well, if therapy was neede... (Below threshold)

January 28, 2010 10:39 AM | Posted, in reply to kurlos's comment, by A Girl: | Reply

"Well, if therapy was needed, the patient would be referred to a Psychologist. In cases where a psychologist suspected a brain abnormality like neurotransmitter deficits, the patient would be referred to a Neurologist. "

Two really quick comments to that: First off, I don't see how that will help anything then. As far as I can tell, the neurologists will be working with nearly the same knowledge basis, sans the psycho-part, and be reduced to using the same tools, but the patients will have two primary caretakers instead of one. I cannot see what that will improve?

Secondly, like Brainchild pointed out, then depression to me at least is an intricate dance between your physical brain and your mind. There is the kind of depression that can be medicated, and then there is the kind of depression that just makes you unable to get up in the morning, makes you feel suicidal and trapped. These two should not be confused: One of them can be fixed with meds, the other with a bit of heart-to-heart, a pat on the back and some help to find a new direction.

In my mind, a good psychiatrist should be able to tell these two apart (and they may well live within the same mind), medicate one and resolve the other. That would be the advantage of getting it all in one bundle. The disadvantage is of course that if you get a crappy one, you are more or less stuck.

To summarize, I guess I have yet to see a valid argument for why substituting a psychiatrist with a neurologist is a good idea, when it essentially changes nothing at all?

Vote up Vote down Report this comment Score: 1 (1 votes cast)
Meatrobot - Spot on about c... (Below threshold)

January 28, 2010 10:42 AM | Posted, in reply to Meat Robot's comment, by brainchild: | Reply

Meatrobot - Spot on about calling out anon on being a dualist (though they just seem to have a hate on for psychiatry than any real understanding of any of the professions being discussed). I know you're asking Alone to fill in the blanks but what springs to my mind in that regards is "person". Psychiatry treats "the person". When done well it means treating and understanding the brain, mind and environment of an individual person.

Vote up Vote down Report this comment Score: 0 (0 votes cast)
I hope the Winnicott story ... (Below threshold)

January 28, 2010 11:11 AM | Posted by Meat Robot: | Reply

I hope the Winnicott story is true! Lovely and insightful to the last, old DW.

@brainchild: it would be a delight if Alone filled in the blanks, but I'm actually aiming my curmudgeonliness at the obtuse Anon(s).

As to psychiatry drowning in data and starved for theory, and how! But aren't there tantalizing early signs that this is going to change or at least could change? Inroads in neuroscience and psychology may finally be giving us real pegs on which to hang our protean observations. Freud's attempt at an all-encompassing theory of mind was magnificent but simply too soon.

Vote up Vote down Report this comment Score: 0 (0 votes cast)
@A Girl Substituti... (Below threshold)

January 28, 2010 1:56 PM | Posted by Anonymous: | Reply

@A Girl

Substituting a neurologist for a psychiatrist would definitely change a few things. Psychiatric care would now be handled by a physician with neither the training, nor the experience, one who furthermore went into neurology, in part at least, to get *away* from psychiatric patients.

(What a pity that so many neurology clinics are in fact clogged with patients suffering from somatization or conversion, with neurologists who darn well know it, but feel very disempowered to actually make the call and begin confronting the real issues.)

Vote up Vote down Report this comment Score: 0 (0 votes cast)
Some years ago, before loos... (Below threshold)

January 28, 2010 5:26 PM | Posted by bbj: | Reply

Some years ago, before loosing confidence in what is mainstream psychiatry, ideologically coloured diagnoses and chemical (mis)-treatments of young and old patients, I attended the ISPS conference in Stavanger,Norway, where the late Loren Mosher made a lasting impression. Warm, no-nonsens, straight and downtoearth.

One poster was equally memorable. Young female patient,in longstay UK hospital, lost, hopeless case, constantly muttering about mortal sin. Fresh young female nurse gets interested. Researches history. Finds clues in strickt, pious, Irish catholic upbringing. Patiently establishes relationship of trust. Unwanted pregnancy. Abortion in England = mortal sin.

Nurse contacts catholic priest. Patient slowly improving. End of story: Priest gives Gods forgiveness and holy sacraments. Patient well. Discharged.

Is this psychiatry, psychology, nevrology, theology or simply ? Winnicott and Loren Mosher?

Vote up Vote down Report this comment Score: 1 (1 votes cast)
Midnight here. Cold. Lots o... (Below threshold)

January 28, 2010 5:56 PM | Posted by bbj: | Reply

Midnight here. Cold. Lots of snow. Beautiful.

I think it is called absolution? One confesses to whatever sins one has perpetrated. The priest is authorized to give absolution. Which is taken to heart, believed to be true, and is able to forgive oneself..

Simple, beautiful, liberating.

More smallscale industry, the churches, without Big Pharma

Vote up Vote down Report this comment Score: 1 (1 votes cast)
"one who furthermore wen... (Below threshold)

January 29, 2010 4:42 AM | Posted, in reply to Anonymous's comment, by A Girl: | Reply

"one who furthermore went into neurology, in part at least, to get *away* from psychiatric patients."

Ah, you mean neurologists don't fancy dealing with boring wackos who spew snot all over their office.

Can't say I can blame them.

Vote up Vote down Report this comment Score: -1 (1 votes cast)
A girl - "Ah, you mean neur... (Below threshold)

January 29, 2010 8:57 AM | Posted, in reply to A Girl's comment, by brainchild: | Reply

A girl - "Ah, you mean neurologists don't fancy dealing with boring wackos who spew snot all over their office."

Ah, I get it. You simply have no compassion for people with neurological or psychological problems (or with the cold or a flu). Your post seems to lack empathy and show disdain for people with neurological and psychological problems AND you have an irrational hatred of psychiatrists. Hmmm, and you're here on a blog that tends to focus on narcissism taking poorly aimed potshots at psychiatry, and being a boring wacko spewing snot.... Tres entertaining!

Vote up Vote down Report this comment Score: 0 (0 votes cast)
Well, yes, and I'm not sugg... (Below threshold)

January 29, 2010 11:28 AM | Posted, in reply to Nope's comment, by caeia : | Reply

Well, yes, and I'm not suggesting that all mental diseases be treated with drugs, but, in fact that many (one big one being ADD/ADHD) may not actually exist except in the mind of the beholder. Neurology can find nothing different about an ADHD brain and a "normal" brain. There isn't a pathology, just behavioral symptoms. So the question is why are we treating these people -- especially kids as young a 6 years old -- with drugs when we can't find a pathology. That just doesn't happen with any other science -- you don't go around opperating on people who complain of muscle aches until you've scanned the human body to find out what's wrong. You don't randomly prescribe antibiotics to everybody who sneezes, you do a bacteria culture and make sure that the drugs are actually needed.

Only in mental health do we seem to be randomly handing out pills without knowing precisely what is causing the symptoms. Call that what you want, but it's not very scientific.

Vote up Vote down Report this comment Score: 1 (1 votes cast)
caeia - "Only in mental hea... (Below threshold)

January 29, 2010 11:52 AM | Posted, in reply to caeia 's comment, by brainchild: | Reply

caeia - "Only in mental health do we seem to be randomly handing out pills without knowing precisely what is causing the symptoms. Call that what you want, but it's not very scientific."

Actually medicine does treat all kinds of things based on the symptoms without really knowing the cause (and have vague diagnoses as well). In fact, there are even surgical interventions that are done without any "proof" (knee surgery is only one example). There isn't absolute knowledge in any field of medicine. The actual practice of medicine is just as much an art as it is a science, that's not exclusive to psychiatry. Don't mistake science for a religion and expect absolute certainty from it! It's really not how science works! (I say this as someone who loves science and thinks the scientific method is a great way to understand the objective world. Of course, our experiences are subjective which is where psychiatry, psychology, art and culture come into the picture and need to be considered.)

In many ways, it's the side of psychiatry that claims to be the most science-based (not that it is) that tends to hand out pills rather than considering the patient in their context (psychotherapy/analysis much more directly addresses this than pharmacological interventions). Of course, it's not really more science-based, that's just what the drug companies would like people to believe so they can sell more pills.

Vote up Vote down Report this comment Score: -1 (1 votes cast)
A girl - "Ah, you mean neur... (Below threshold)

January 29, 2010 12:06 PM | Posted, in reply to A Girl's comment, by brainchild: | Reply

A girl - "Ah, you mean neurologists don't fancy dealing with boring wackos who spew snot all over their office."

Or are you trying to be sarcastic? It's hard to discern sarcasm over the interwebs.

Vote up Vote down Report this comment Score: 0 (0 votes cast)
caeiaYou should ta... (Below threshold)

January 29, 2010 2:40 PM | Posted by Meat Robot: | Reply

caeia

You should take a closer look at the neuroscience of ADHD. There are plenty of differences, all with moderately sized empirical foundations, between the brains of normals, brains of ADHD sufferers, and again in both groups when taking psychostimulants.

Be careful before launching a Grand Theory of Scientific Medicine vs Corrupt and Blind Psychiatry on a foundation of sand.

Vote up Vote down Report this comment Score: 0 (2 votes cast)
You would enjoy reading the... (Below threshold)

January 29, 2010 5:13 PM | Posted, in reply to bbj's comment, by Claudius: | Reply

You would enjoy reading the book (if you already haven't) Monsters and Magical Sticks: There is no such thing as hypnosis

Vote up Vote down Report this comment Score: 0 (0 votes cast)
man...i LOVED how you group... (Below threshold)

January 30, 2010 12:03 AM | Posted by the0ther: | Reply

man...i LOVED how you grouped in semen as an antidepressant. i saw that article a long time ago. i tried showing it to a few different women but they still would not let me f*** them.

Vote up Vote down Report this comment Score: 2 (2 votes cast)
I was aiming for sarcasm ye... (Below threshold)

January 30, 2010 6:18 AM | Posted, in reply to brainchild's comment, by Anonymous: | Reply

I was aiming for sarcasm yes - I'm sorry if it offended you.

My apologies.

Vote up Vote down Report this comment Score: 0 (0 votes cast)
Claudius, thank you.<... (Below threshold)

January 30, 2010 9:38 AM | Posted by bbj: | Reply

Claudius, thank you.

Never heard of Monsters and Magical Sticks, here, in my frosty,snowed-under scandinavian woods. I immediately googled and found - the late - Steven Hellers only? book, co-authored with Terry Steel. Have placed orders. Look forward to reading words of practical wisdom? Sounds like it, from you and reviews, available by fantastic internet. I don`t understand how it works. I am not technically inclined to try and find out. It works!

Medications obviously works too, for those who believe they will, provided they survive the effects of the chemicals. The statistics on shortened lifespan and other harmful effects, however, are as deplorabel as the size of lies, lobbying, sales and revenue of Big Pharma. The industries of academic, biological psychiatry and Big Pharma feeds and grows by downsizing human beings. We have incredibly able and complex brains, fully capable of helping ourselves and each other, doing no harm.

The Last Psychiatrist is doing good work. I believe the day will come when people in deep trouble, who is not, at some stage in life?, will know what works, not necessarily how and why, and where to find it. For now I go to the woods with Loren Mosher and Steven Heller. Thanks Claudius and TLP.

Vote up Vote down Report this comment Score: 1 (1 votes cast)
My mom takes HRT's, and I t... (Below threshold)

January 30, 2010 6:35 PM | Posted, in reply to La BellaDonna's comment, by Lexi: | Reply

My mom takes HRT's, and I think everyone around her has an improved life because of them. Since I mostly don't think she could handle the consequences of the choice not to take any. I had a roommate once who is the same age as my mom, who chose not to take HRT's, and looks 20 years older than my mom, although she has a much better personality . . . but that's a different story.

Not saying btw that yo have a bad personality, as from what I've read from you in the past is FTW. Just saying I support HRTs for various reasons. I will probably take them myself when it comes to that point, even if I do refuse to take "the pill" now.

Vote up Vote down Report this comment Score: 0 (0 votes cast)
Evidence based medicine det... (Below threshold)

January 30, 2010 9:48 PM | Posted by Rosiecee: | Reply

Evidence based medicine determined that smoking tobacco was associated with lung cancer. Eighty-five percent of those who developed lung cancer were also smokers or former smokers. At www.SSRIstories.com, where studies go back to the early 1960's, it has been determined that 85% of all school shootings were associated with the perpetrators being on antidepressants. http://www.ssristories.com/index.php?p=school

This is evidence based medicine but the former case regarding lung cancer is believed & mainstream now and the latter case is not believed. Why is this?

EBM cannot work in the present situation in our country because grants, research money, etc. are not available for the majority of problems associated with psychiatric medications. For instance, in the Journal of Clinical Psychiatry 2001: 62: 30-33 titled: Antidepressant-Associated Mania and Psychosis Resulting in Psychiatric Admissions by Adrian Preda, M.D.; Rebecca W. MacLean, M.D.; Carolyn M. Mazure, Ph.D.; and Malcolm B. Bowers, Jr., M.D., it was shown that 11% of all psychiatric hospital admissions were associated with antidepressant induced mania or psychosis. However, this research article was ignored. Why is this? Second drink, please.

However, there are some people in our society who are willing to volunteer their time and effort to determine what some of the adverse reactions from psychiatric drugs may consist of. For instance, a man in West Virginia, whose 23 year old son in the military died in his sleep, investigated 12 cases of young soldiers dying in their sleep and they were all taking the combo of Seroquel, plus an SSRI, usually Paxil and a benzo, usually Klonopin. This newspaper article explains about the four cases in West Virginia http://www.ssristories.com/show.php?item=2572 This father then investigated further and has found close to 100 cases of young soldiers, healthy in body, dying in their sleep. I don't know the results of his investigation yet but I imagine there was a lot of Seroquel or antipsychotics involved, plus some SSRIs and benzos. Maybe this country needs less APA and NAMI and more fathers. Why is this? Belly up to the bar.

A massive study run in China between 1983 and 1993 determined that eleven percent of all schizophrenics died of a heart aliment within 10 years. The study showed that the main culprit was Mellaril at a high dosage. Since then, Mellaril is considered a 'second' line of defense against schizophrenia - never a first line as the heart's QT prolongation is rampant with this drug.

Although most people complain of loss of libido on antidepressants, there is the reverse side where one of the manias associated with antidepressants starts coming through. It seems that woman school teachers in the throes of hypomania or mania are experiencing a 'strange kind' of nymphomania and are molesting their minor aged male students. The O'Reilly Factor announced that it is receiving one report a week of this kind of case. Here are some of the reports from SSRI Stories: http://www.ssristories.com/index.php?p=teacher Why is this? Fourth drink, please.

It was also recently discovered that antidepressants can either accelerate or shut down cancer growth. http://www.ssristories.com/show.php?item=2845 Seems that antidepressants disrupt protaglandin activity and adjusting prostagladins can accelerate cancer growth. Perhaps this is why there has been a doubling of lymphoma cases since 1970 which is about the first year that antidepressants began to be prescribed in massive amounts.

Also, scientists in Germany have reported that antidepressants in low doses act as an antidepressant but in higher doses act as a depressant. Why is this? Fifth drink. "Hurry up, please, it's time."

In the Journal of American Physicians and Surgeons: Volume 14: number 1: Spring 2009, there is an article by Joel M. Kauffman, Ph.D., [Professor of chemistry emeritus at the University of the Sciences, Philadelphia, Pa.] which is titled: Selective Serotonin Reuptake Inhibior [SSRI] Drugs: More Risk Than Benefits?"

In regard to SSRI Stories, www.SSRIstories.com Dr. Kaufmann made the following statement: "Since no clinical trial involving multiple homicides is ever likely to be run, no firmer evidence is likely to be found. Healy noted that much of the evidence for suicide and murder came from the efforts of journalists and lawyers".

To read the full article go to:

http://www.jpands.org/jpands1401.htm



Vote up Vote down Report this comment Score: 1 (3 votes cast)
I too wish these people wou... (Below threshold)

January 31, 2010 3:06 AM | Posted, in reply to y's comment, by Lexi: | Reply

I too wish these people would just pick something other than anonymous and stick to it. 'y' is equally as anonymous, and allows a conversation to track more easily.

There was a psychiatrist named Abram Hoffer, who recently died who tried to go against the 'medical standard of care'. His credibility was more or less ruined by the APA. They put together a Task Force (7), to study his methodology and concluded it didn't work. However the problem with the way APA did their research was that they did not actually recreate Hoffer's work in terms of dosages, just in terms of substances. So, of course it failed. What is relevant is that they designed a study to skew the results in their favor, rather than actually recreating Hoffer's work.

Additionally there is not a lot of money in non-pharmaceutical treatments, so there is not a lot of money for proper testing. The two companies that seem to be doing decent research on pharmaceutical/synthetic alternatives are Vitamin Research Products and The Life Extension Foundation.

There's another psychiatrist, William Glasser, author of books on "Choice Theory" who also seems to go against the grain, but more in terms of not prescribing pharmaceuticals rather than over prescribing them.

Vote up Vote down Report this comment Score: 1 (1 votes cast)
i agree with this comment "... (Below threshold)

January 31, 2010 3:29 AM | Posted, in reply to brainchild's comment, by Lexi: | Reply

i agree with this comment "Actually medicine does treat all kinds of things based on the symptoms without really knowing the cause (and have vague diagnoses as well)." etc

Vote up Vote down Report this comment Score: 0 (0 votes cast)
Lexi - Just to be clear, ju... (Below threshold)

January 31, 2010 9:46 AM | Posted, in reply to Lexi's comment, by brainchild: | Reply

Lexi - Just to be clear, just because medicine doesn't always know the exact cause of an illness or disorder or provide a cure, doesn't mean that treating the symptoms can't be a useful and sometimes lifesaving thing to do. My point was simply that if people are ill or in distress we need to treat them and at least attempt to alleviate suffering even if we don't have absolute knowledge.

Vote up Vote down Report this comment Score: 0 (0 votes cast)
If your mom and your family... (Below threshold)

January 31, 2010 11:28 AM | Posted, in reply to Lexi's comment, by bbj: | Reply

If your mom and your family is content with her taking extra hormones, who should object, except perhaps the payer, Greenpeace and citizens alerted to the dangers of contamination of drinking water, soil and oceans?

In my country the government pays for necessary medication, for instance after removal of womens ovaries. In USA it would, hopefully, be an insurer.

I have no objection, provided the cost and harm of hormonal medications carry less weight than overall benefits, to the individual, in this case your mom, preferably without harming our environment.

But isn`t this endocrinology, not psychiatry?

Vote up Vote down Report this comment Score: 1 (1 votes cast)
Why do only western women u... (Below threshold)

January 31, 2010 2:02 PM | Posted by this is weird: | Reply

Why do only western women use HRT? Even better: why do only western women FEEL THE NEED to use HRT?

I found out gallstones are related to hormones in pills, among other things. But your gyno will never tell you this, nor will the pharmaceutic industry.

The use of hormone therapy and contraceptives is the greatest scientific study performed on human beings in the history of mankind. Women get sick from it every year. And yet...

Vote up Vote down Report this comment Score: 1 (1 votes cast)
Marvelous weather, another ... (Below threshold)

January 31, 2010 2:05 PM | Posted by bbj: | Reply

Marvelous weather, another half meter of snow, freezing temperatures. If unicorns were outdoor creatures, they would never survive this blizzard.

Which made me think of all the disturbed animals, unable to breed successfully because of feminization of males, due to chemical contamination. And fishes in our harbour, way up north, containing antidepressants, prescribed by well educated, conscientious MDs and shrinks.

I don't think the fish were depressed, maybe the docs were, and there are certainly people who are, or are on the verge of asking for more, so maybe we should/could skip the docs and go straight to the fish and save, not the unicorns, but the rest of us creatures..

Came to think of those schizophrenic rats I read about on the internet the other day with blizzard raging. Their brains had been successfully manipulated until they displayed schizophrenic behaviour. Serious! The article did not say if they, the rats that is, displayed disturbed thinking or were hallucinating.But I dare say the researchers were, finding those huge unicorns. Maybe I could find that article, instead of shoveling snow off the porch..

Vote up Vote down Report this comment Score: 1 (1 votes cast)
All western women do not us... (Below threshold)

January 31, 2010 2:47 PM | Posted, in reply to this is weird's comment, by bbj: | Reply

All western women do not use HRT, but way too many did, for a while. Because they believed their MDs and MDs probabely believed the sales pitch from big pharma.

First and foremost: There is a lot of MONEY to be made - also when there are serious, deadly consequences like more cancer and so on and so forth. And the environmental consequences of producing, transporting, ingesting and digesting hyped-up products for naturally occuring conditions like aging. I must shovel or I'll get the blues.

Vote up Vote down Report this comment Score: 1 (1 votes cast)
this is weird - "The use of... (Below threshold)

January 31, 2010 4:26 PM | Posted, in reply to this is weird's comment, by brainchild: | Reply

this is weird - "The use of hormone therapy and contraceptives is the greatest scientific study performed on human beings in the history of mankind. Women get sick from it every year."

Actually, no it's not a scientific study (apparently you're unclear on what constitutes a scientific study). You, of course, are free not to use birth control or HRT. However, you're not free to determine what the rest of us do with our bodies or decisions we make about our lives. Few women are interested in returning to the dark ages before we had a choice, and many women in developing countries welcome the opportunity to have some control over fertility and lives. Each woman gets to decide this for herself.

Your body, your choice. My body, my choice. Her body, her choice. Many women die from childbirth every year or become suicidally depressed from hormonal fluctuations during menopause. Certainly we should all have the best information available to make our choices, however you're clearly not advocating informed choice!

Vote up Vote down Report this comment Score: 0 (0 votes cast)
Brainchild: Thank you. Als... (Below threshold)

February 1, 2010 9:18 AM | Posted by La BellaDonna: | Reply

Brainchild: Thank you. Also? What brainchild said.

Lexi: No offense taken! Merely, that, for me, HRTs were the correct solution to my own problem. I'm willing to trade off a shorter life for an improved quality of life. I don't require that anyone else do so - just offering my own personal experience. My body is happier and at least FEELS better for taking them. If it means a shorter lifespan for me, I accept that.

Vote up Vote down Report this comment Score: 0 (0 votes cast)
Brainchild, why did you rea... (Below threshold)

February 2, 2010 3:25 AM | Posted, in reply to brainchild's comment, by this is weird: | Reply

Brainchild, why did you read my comment and decided to answer as if I had ranted against "women rights" or "reproductive rights"? It's kinda baffling, even. I could hear your knee jerking from here.

Listen: contraceptive methods are great and all, but in a post about medical culture and pharmaceutic industries, all of us are concerned about informed choice, not only you. WOMEN DO NOT HAVE INFORMED CHOICE. YOUR DOCTORS LIE TO YOU. THE LABS LIE TO YOU. Sorry for the caps, but had to make it clear. Women get sick from synthetic hormones every year, some of them die from it.

Please, google the story of the 17-year-old girl who died from an Evra-induced pulmonary embolism. She was a HEALTHY seventeen-year-old woman. Or try to find out how Premarin is made. Can't you see? They want to make women lifelong patients, regardless of the consequences. The joke is on you, on all of us.

I'm on your side, I'm not the enemy. I don't think you want to have a "choice", as you say, to the detriment of your health.

Vote up Vote down Report this comment Score: 2 (2 votes cast)
Good grief, I must have ove... (Below threshold)

February 2, 2010 8:19 AM | Posted, in reply to Rosiecee's comment, by bbj: | Reply

Good grief, I must have overlooked your posting, containing so much valuable information!!

My answer to why harm from tobacco finally was accepted as fact, while harm from antidepressants still is denied:

The fact that tobacco causes illeness and death was fought from courts to Congress. Battles. War. Billions and trillions of dollars at stake on both sides. Lies vs truth. Death vs life. Industry vs public health.

But cigarettes are outside the realm of medicine. SSRIs called antidepressants are not, as we all know. The common factor is, as always MONEY. Mountains of it. Those facts complicate the matter.

The Cigarette Century by one of America's leading historians of public health Allan M. Brandt can teach lessons on how to conduct our opposition to deadly pharmaceuticals. Some may be useful for some people. Many are not. That's complexity. But medicine cannot exist without overall confidence and trust. Benefit to patients and society must exceed harm. That's were big pharma is loosing ground. More people know about lying, cheating, corruption of medicine and politicians. Heavy smoke from all that money. Quite a few lawyers, government officials and civilians at large are on to hard evidence.

Vote up Vote down Report this comment Score: 0 (0 votes cast)
this is weird - "Can't you ... (Below threshold)

February 2, 2010 9:19 AM | Posted, in reply to this is weird's comment, by brainchild: | Reply

this is weird - "Can't you see? They want to make women lifelong patients, regardless of the consequences. The joke is on you, on all of us.

I'm on your side, I'm not the enemy. I don't think you want to have a "choice", as you say, to the detriment of your health."

Yelling at me by using all caps does nothing to actually support your argument - it just makes you look hysterical and as if you think shouting makes you right. And, no, it's pretty clear that you're not on "my side" from what you wrote (and because you think yelling at me about YOUR fears is being "on my side" when it's just being patronizing, as is your assumption you know more than me). And, no, "they" aren't behind reproductive rights - women fought long and hard to get them and I know enough about the history of the pill to know it's not an evil plot to control women, quite the opposite. Now, the people and religions that want to control women often try to demonize various forms of reproductive control. (And, yes, there are usually evangelical connotations to the propaganda promoted by those who want to control women by controlling our right to choose.)

Nothing in life is risk free, that definitely includes sex with others, being pregnant and giving birth. Sure there are risks associated with the pill and HRT for some people, that's why knowing one's family medical history is important. For others both can be a very good option at different points in our lives. Taking responsibility for our health means informing ourselves and not just expecting our doctors or drug manufacturers to be omniscient - that's an entirely unrealistic (and infantile) expectation.

And, yes, I know how Premarin is made and can weigh the risks and benefits for myself and make my own choices about my health and body. So, please, you can stop with your ill informed and patronizing claims to be protecting me when you're really just promoting your own agenda. And who are you to tell women how we should age? We have choices, they're ours to make. Personally I'm extremely glad to live in a time when I do have these choices.

Vote up Vote down Report this comment Score: 0 (0 votes cast)
You're being ironic. Tell m... (Below threshold)

March 15, 2010 4:38 PM | Posted, in reply to kurlos's comment, by Zo: | Reply

You're being ironic. Tell me this is irony.

Vote up Vote down Report this comment Score: 0 (0 votes cast)
Semen made me manic. Just s... (Below threshold)

March 15, 2010 4:43 PM | Posted, in reply to the0ther's comment, by Zo: | Reply

Semen made me manic. Just saying.

Vote up Vote down Report this comment Score: 1 (1 votes cast)
I was looking out the windo... (Below threshold)

January 11, 2011 7:38 AM | Posted by dre beats: | Reply

I was looking out the window. I was waiting for the plane to take off. I was wearing Monster Cable's Beats by Dr. Dre Studio headphones .

Vote up Vote down Report this comment Score: -1 (1 votes cast)
Chocolate boots... (Below threshold)

August 8, 2011 11:07 PM | Posted by http://chocolate-boots.weebly.com/: | Reply

Chocolate boots

Vote up Vote down Report this comment Score: -1 (1 votes cast)