The Pipeline


I’m overwhelmed by the complicated multi-issue medical reform legislation being batted about. I feel hopeless that any such massive reform bill can survive the hazing of the cash-for-lobby, tit-for-tat, back scratch for back scratch political process. All the well-thought, well-meant, carefully constructed and intelligent but enormous documents have about as much chance of making real change as that old camel has to make it through the eye of  a needle.

I’ve been looking for a simple place to start. Something that could have a bigger impact than my one doctor’s teaspoon in our ocean of despair.

And I think I’m on to something. Rattling around with readers in the comments and replies this week has been good. I feel more hope than I have in a long time.

Please bear with a piece of my personal history here. History is important.   

When I took my oath in 1983 to be licensed to practice medicine in the State of Louisiana and to abide by the governing laws of the state, we had to study the legal code beforehand. How else were we to know the laws to abide by?

I remember one set of laws to this day because it took me by surprise. I don’t remember any of the other rules specifically because I expected them. The ones I expected were the common sense laws about professional conduct, medical conditions that must be reported to the state and tort liability limitations particular to that region of the country. Those sorts of things.

The one section that caught my attention out of the pages I was given to study were lines of legal code that were scrupulously clear about the ways in which physicians, and all other medical providers, could advertise themselves. I don’t recall the specific dimensions, but the law stated the precise size one could post one’s name on the shingle when you hung it out and the smaller size of the lettering allowed below your name for your specialty of practice. Even on business cards and in the phone book, the same size ratio of name to specialty held. No other general advertising was allowed.

I recall feeling first astonished and then pleased to discover that advertising by medical providers was forbidden by law. It was fun to imagine the situations that must have lead to the need to enact such legislation, perhaps competing doctors with sign wars across a neighborhood street. I couldn’t imagine how medical advertising could get out of hand in these modern times. We were professionals providing necessary care, after all. There is no need for big signs. When people get sick, they go to the doctor’s office. Simple.

I assumed these advertising rules to be national laws. I must have slept through high school civics class back in Ohio and missed the state’s rights part.

When I moved to Oregon in 1985 and read their laws before being sworn in to abide by the laws of that fine state, I was equally astonished to find no such rules. Although I was aware that the laws in Louisiana grew out of French Napoleonic law and were different from the rest of our country, I didn’t notice the differences till I moved away. I can only see the inside of the box once I’ve stepped outside.

At first I was sure that this lack of advertising rules meant that the medical providers in the lovely, green state of Oregon had been naturally discrete and well-behaved in the way they let people know they were in business. At the time, the range of advertising and signage was not too far out of line.

Remember, this was all a long time ago. I’m old. I remember the ban of cigarette advertising on television in this country and the liquor ad ban. There was a strong grassroots sense during the sixties and seventies that one of the government’s jobs involved public health and safety. As television became a stronger force in our culture it was clear, especially to parents, that industries were incapable of policing their own marketing campaigns. There is simply too much money at stake. The government had to step in and police the media of known public health hazards. This made sense to me.

I haven’t taken a course in economics but I’m certain I recall hearing of the effects of “supply and demand”. I also know that demand can be increased by effective marketing campaigns and by lowering the perception of supply. We’ve all seen this.

You will be better at knowing the prevalence and tenor of the current media advertising frenzy of pharmaceutical products than I. Remember, I turned off the broadcast media in my home ten years ago. Through lack of exposure, I have been so sensitized to the media that even an old movie played without sound across a crowded room snares my attention. I have to remember to rip my eyes away from it and attend to the real people right in front of me.

Last month I was in a motel lobby while on a trip. A wide television screen played behind the counter when I walked in with my children. On the wall, an achingly handsome, larger than life man with carved mahogany cheekbones was filling the tank of his vintage muscle car at a gas station in the middle of the American west. We stood entranced. I was reminded of the cigarette ads of my childhood for a moment. He looked like that cowboy.

Snap to attention. This is an ad for the pharmaceutical product that fills my spam filter every day, just what I want my kids absorbing at the end of a long day’s drive. Strangers who do not have our best personal interests at heart are handed access to our deep unconscious minds, given a straight pipeline.

Back to this economic concept of supply and demand. The most simple way to reduce the clamor for pills that has been artificially induced by advertising is to shut off the flood of advertising. This will cause a gradual softening of market demand.

We have to take a lesson from other first world countries and outlaw marketing of pharmaceutical products directly to the public. Removing the advertising pipeline from our heads is good place to start because we have successfully done things just like this in the past.

Since we’ve done it before, we can do it again. Others have walked this path around the world. We, the people, have walked this path together as well.

As always, thanks for reading me.


Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.


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  1. Yeah! quite right, a political demand to be campaigned for.

    You can’t advertise prescription drugs here in the UK, but we still have these problems, but not nearly so much as you do in the USA. Here they use PR – getting products mentioned on the radio and TV or the generics rather than the particular drug. So people talk as lack of serotonin as being related to being miserable or depressed, which is nonsense, but help sell the pills. Also drug reps take out medical staff for lunch and pay for their parties and that influences prescribing.

    But yes, this is a political and social problem which requires the limiting of drug company power and influence and practical proposals like this are needed as part of that struggle.

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    • John,
      Thanks for your show of support. Yes, there is much to do beyond this.

      Some medical schools have thrown out the drug reps, drug samples, drug lunch “lectures”. It is an individual institutional moral stance. Oregon Health Sciences University is one who has a “no drug samples” policy. I know they still do a lot of drug funded research there. Drug company funded research is a well-known path to academic tenured teaching positions.

      It’s a tangled mess everywhere I look.

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  2. I too am old enough to remember when they took ads for beer and cigs off of the television. I think you have a good idea for a first start but somehow we need to develop a movement that demands the removal of ads for psychiatric drugs from the media. We were able to do this against two big business groups which had a lot of lobbying power. But we have to convince the government to do this in the interest of public health and this is the stickler. The FDA basically supports Big Pharma and gives them almost free rein to do as they please. So, getting the government to step in is going to be difficult. The public is convinced by all of this advertising that their “health” depends on taking these toxic drugs. How do we begin and maintain our own advertising? How was it done against the tobacco and alcohol interests?

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    • Stephen,
      Here we are today, beginning our own marketing through this webzine. Move the information outward like ripples in a pond.

      Our government is us. Perhaps government representatives could be convinced by a “cost savings approach”, less tax dollars going for expensive drugs through medicare and medicaid. Money talks.

      Not only psychiatric drugs but all medical drug ads need to go. The whole of medicine is in the same boat. Patients show up demanding specific pills, the newer, the most expensive, the most advertised.

      The psychiatric field does not have the market cornered on toxic drugs and deceptive marketing. For example, most cholesterol lowering drugs work by poisoning mitochondrial function throughout the body and brain. We require healthy mitochondrial fuction for life. How can we hope health to be conferred by this process? A friend’s husband nearly died from the muscle breakdown side-effect of cholesterol lowering drugs last year.

      Blocking drug ads to the public needs to be for all drugs, not a pick and choose category. It’s too easy to side-slip categories.

      Let’s begin today. Spread the word.

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      • indeed.

        The issue of psychiatric drugging is huge and driven by two forces: the drug companies profit motive and the historical idea from psychiatry that says that mental distress is a medical problem.

        It will take an awful lot of political and social pressure to have a significant dint on this. Mr Wittaker has bought a lot of people together to discuss this problem on this excellent website and this proposal is one of the few practical ideas I have seen here on how to develop a campaign to address the problem.

        Occupy the APA and promoting social enterprises to provide drug free help for people experiencing extreme mental distress are others. All these approaches are needed: confrontational public protest, viable alternatives and more lobbying for better regulation and policy change.

        Other articles on the site are about the damage of psychiatric drugs and excellent and fascinating examples of good psycho-social approaches to helping people experiencing severe mental distress which show us how things could be if the power of the drug companies were limited and government and societal ideas of how to appropriately help people changed.

        Although Alice’s proposal is just an idea at the moment and not a fully thought out and well funded campaign (which is what would be needed to have a decent chance of getting the law changed) as long as we keep talking about the problems, the alternatives and encouraging each other then either this or other ideas on how to get these changes will form and be put into action.

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        • John,

          My recollection of the history of what is being passed around as “the medical model” of psychiatry today is that this “medical model” came about after the advent of pharmaceuticals. I started training in a program that was based in psychoanalytic psychotherapy. At that time, the foundations of the program were under attack by the purveyors of “rapid tranquilization” drugs for acute psychosis; big, fast, injected doses. The pharmceautical company was paying a young staff psychiatrist to do the “research” there at Charity Hospital.It was a time of validating psychiatry as a “real” branch of medicine. We had our drug treatments.

          What we call the “medical model” in psychiatry today is actually the “pill model”, a marketing strategy initially rolled out for doctors and which now saturates our entire culture. The “chemical imbalances” are marketing inventions. Antibiotics and vaccines were designed to treat and prevent medical disorders with known pathogens and causes. The “chemical imbalance” theories are all made up.

          This “medical model” (pill model) has its hands around the throat of all of medicine today. We no longer describe a medical condition and explore its pathology and cause. We now reason backwards from pill effecst and infer the cause from this. I recall being taught in school that one can never, ever do this. Faulty ad hoc reasoning. NOT medical, scientific thought at all. For example. Your car is running too hot. You open the hood and hit it hard with a big rock. It stops running and cools down. Therefore, the overheating problem was due to a rock definciency.

          Thanks for your participation in these discussions,

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  3. Dr. Keys,

    I’d like to see states provide more latitude for integrative medicine practitioners –

    I know a former board-certified psychiatrist who began to learn about thyroid conditions, and found that many of his patients got well by a more natural approach (treating underlying thryoid problems). The state medical board stepped into his life, not once, but twice. He fought it to the tune of his life savings.

    IMO, there is no freedom more valuable than health freedom. And, I’d like to see the day that MDs and DOs, others who also went to medical school, but choose to practice integrative medicine are allowed to treat patients, without a nanny-state interfering.

    On the flip-side, I think the FDA ought to stop caving in to NAMI and other groups, in approving drugs that should never be approved – especially for children and elderly in nursing homes.

    At the risk of talking out of both sides of my mouth, I’m for more freedom for informed adults, and more oversight for children and elderly. On the issue of pharma ads, I’m not sure what to say… Our youngest son, always asks me, when he sees the ads on the television for drugs, “Dad, why would anyone take that stuff?… They said it can cause… ”

    He asks a good question.


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    • There is a lot of money and power in our one-size-fits-all medical model (not only in psychiatry, but other branches of medicine as well).

      Ron Paul introduced the ‘Health Freedom Act’ a few years ago. I was curious about what the bill entailed. One of his staff faxed it over. It was only a couple of sentences in length.

      It called on the enforcement branch of the FDA to exercise due process of law before shutting down the doors of a supplement manufacturer. The bill never made it out of committee.

      I’m not a conspiracy nut, hardly. But to ignore the money and power, of pharma, the FDA, NIH, NIMH is to bury one’s head in the sand.

      The one-size-fits-all medical model is not going to replaced easily, or overnight, unfortunately.


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    • Duane,
      Ah,smart kid. The old advertising premise is that even bad advertising is good advertising. If it catches your attention you remember it. Hence annoying ads are good ads. Ads that blither of about side-effects catch your attention. It all sells. We imagine our concious screening process does a better job of protecting us than it does.

      Drugging kids worries me as well. Drugging old people worries me. Drugging pregnant ladies worries me. Drugging everyone else worries me. Drugs are a worrisome treatment modality.

      Here’s worrisome. In the state of Oregon the Naturopaths recently fought and won the privelege of prescibing all medical and psychiatric drugs (except one). How much “integrative” work do you think they will be doing now? To me it seemed a movement in the wrong direction for them, away from their professional specialty and into mainstream prescription expectations.


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      • “smart kid?”


        not sure about that, just a kid learning like everyone else out there, with a (redundant?) message that we can do better, we can do a lot better.

        naturopaths selling out?
        i’d be lyin’ if i said that doesn’t make me sadder than sad

        but i’m not givin’ up…i’m gonna wake up tomorrow, and find some joy.

        i’m gonna enjoy it like it was both the first day of my life, and the very last day…

        a must-see video –

        be well,


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