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the … era (1987-2011)

Posted on Friday 31 December 2010

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 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].

sonally 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 " …

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