Friday, October 23, 2020

Comments by slc89do

Showing 3 of 3 comments.

  • I did have a more holistic medical training than most, as I am a DO physician (Doctor of osteopathy, equal to but different from our allopathic MD colleagues in that we have a philosophy placing body mind and spirit as equally important components of a person, and putting it on our shoulders to treat all 3. Also, we learn physical manipulation medicine as well as the same rigorous pharm and procedural care as our allopathic colleagues. We have to be certified by our own medical associations as well as the allopathic ones. Many people have a DO as their physician and do not realize it. We make up a growing 15% of the physicians in the us and can practice in any specialty. We are uniquely capable of balancing allopathic, naturopathic, homeopathic and holistic medicines to create a personalized treatment plan).

    I want you and others to know that I hear you and am sorry to learn of such troubles. I could envision instances where the physicians were actually providing the best for their patients and still have these poor outcomes, but it is also possible that the physicians were burnt out and not doing their best. It’s impossible to know from this level of separation. Finding the right doctor for you is very important, and our system puts up roadblocks for many. I hope access and transparency improves.

    As for psyc meds and their adverse effects: the adverse effects of not treating someone should be worse than those likely to result from treatment, or the treatment is not clinically indicated. If the doctor is wrong, it could be a lack of knowledge or incompetence, but it could also be that an individual had a very unusual reaction. It’s really traffic the stories people on this page are telling, but I would urge people to keep faith that there are many good doctors that can provide the care that one might need. Please don’t give up on the medical profession, and don’t give up on psychiatry.

    Anecdotally, I can say that I’ve noticed different medical cultures with different agreed physicians. The typical Reagan era medical graduate were more business minded, looking to help themselves more than patients; this isn’t true for everybody and again is completely my experience. I’ve noticed younger doctors, especially those like me who were inspired to pursue medicine by the promises of health care reform in 08, are hungry to learn about what makes each patient unique, and creatively use that to tailor the best possible plan for each individual patient.

    I’ve seen bad doctors, even bad hospitals with nary a good doctor. But I’ve also seen good doctors. And I’d caution a layperson audience for assuming they can determine if a treatment given to a loved one was the cause of a downward spiral, because it may have put off a downward spiral bit couldn’t actually avoid it.

    As far as schizophrenics getting worse after long courses of therapy, without therapy they wouldn’t function as well for as long. I spend half my days on a ward. I see people brought in after stopping their meds or new diagnoses. Sometimes they’re violent, sometimes so confused they can’t feed themselves or find their homes, sometimes after not bathing for weeks. And then antipsychotic meds bring them to a place where they experience reality, they bathe, they can feed themselves and often even hold down a job. So no study about meds not working long term is going to convince any psych professionals that antipsychotic meds aren’t helpful. There is ongoing study to decrease glycoprotein 3 transporter activity to keep med concentrations in brain at higher levels, as research is beginning to show the reason some long term patients become refractory to therapy is increased transport that flushes the drugs from the brain.

    People that are more attentive to internal stimuli than external stimuli need help, urgently, or they will die. Before the meds, people would tie such patients up and forcefeed them. The meds have some major side effects, but they are worlds better than the alternative.

    And on depression being a chemical imbalance: this is not a scientific statement because it’s nearly impossible to ethically prove. Sometimes such oversimplification is necessary when explaining complex medical realities to patients. Sometimes it is just a lazy doctor. But we do have reason to believe that synaptic serotonin in certain neural pathways does play a role in depression. We do have reason to believe this is a major mechanism responsible for the effect seen in ssri meds. We do have reason to believe that ssri meds do work in most people, with a direct correlation between severity of depression and effect of ssri (or snri). So if someone heard that depression is a chemical imbalance from their doctor, that doesn’t necessarily mean that such doctor is misleading.

    But don’t think that I don’t blame the doctors who have hurt you. It is a doctor’s job to guide a team, including the patient and their loved ones. It seems these hard feelings are borne from a lack of necessary inclusion and education, and I’m sorry that do many bad doctors have touched the lives of people on this forum.

  • I think your claim that I am defensive is entirely unfounded and projection on your part. Fact based criticism is always not only welcomed, but appreciated.
    And as for how I would feel if a loved one were subject to misconduct, id be truly furious, lacking objectivity.
    But I think this page strives to be more than an echochamber for grievances. I think this page is meant to provide objective critique. I think this post fell short in several ways, and may be capitalizing on the strong feelings of those who have factual grievances without being well rooted in objective analysis and without providing prudent incite necessary to bring about the remarkable improvements in psychiatry that we both would like to see.
    I’m from a school of medicine that from day one emphasizes a person as being comprised equally of mind, body and spirit, and that a body is only telly healed by itself. Treatment needs to focus on removing obstacles from the bodies innate self healing mechanisms, and must look at outcomes including mind and spirit. Psychiatry is too prescription heavy, I’m not getting to say anything contrary to that point.

    But fear tactics and one sided journalism won’t inform enough people on enough of the important truths such that they can enter into discourse with the establishment of psychiatry armed with enough information to achieve such zealous goals. Much the opposite,such journalism will convince you of the merits of your emotions, and determine that any discourse with establishment psychiatry would be one without common ground where people can engage and good intentions can topple mistaken paradigms. I encourage you to seek medical arguments steeped in medical journal peer reviewed literature rather than medical essays filed with opinion and published as books. If one is to look at financial disclosures, someone teeing to sell a book needs to have edgy controversy, while someone publishing a study needs to have good analytic method and logic.

    And if I offended you in my previous comment, it was not intended. I do apologize completely. I would never stand to defend a medical professional who committed injustice on anyone. Please believe me when I say I am 1000 times sorry.

  • I’m open minded on the subject, coming from the DO side of things, but I find much of these myths that seem to convince so many people to be either fair but obvious criticisms that are mainstream in psychiatry or poorly sourced novel ideas presented without evidence to refute claims supported by good medical studies.

    Furthermore, the comments section seems to be an echo chamber for people who believe in some giant conspiracy of guild protecting psychiatrists despite the inherent likelihood that US capitalist medicine will foster enough competition to publish scientific studies, and if such a minority had the preponderance of fact on their side, their studies would have greater and more readily reproducible effects. That would afford this minority much publicity and exposure beyond any guild protective privilege. So the incentive is very lacking in this theory that the entire field is colluding in some organized way. Then the theory could be afforded the benefit of the doubt that perhaps ample incentives could be provided by the pharm companies; to this i would say the pharm companies themselves compete enough to make a unilateral psychiatrist cabal very very unlikely. Not to mention the growing number of salaried physicians who can’t receive money in any way from pharm companies, even speaking fees or fancy meals.

    Some of your first myths seem to imply to a lay audience that the medical field does not regularly engage in chart review studies, retrospective cohort studies, and other ways that medication harm can be identified, and that help medicine of all forms constantly improve and respond to knew evidence.

    On the subject of neurotransmitter imballance, while the burden of proof required ‘proove’ the theory has yet to be met, that is a high burden to expect before a physician can administer treatment. We do not know the exact neurons that carry the mu opiod receptors that cause analgesia, yet opioids are a major and important treatment for acute and short term pain.

    As for antidepresants (SSRIs), you are shooting fast and loose with the facts here. Good, multicenter studies without financial ties to pharm have found that the suicide risk and medication relationship is dependent on age. The only group shown to have increased suicidality is that of youths (under 24 years old), with people over 30 showing a decrease in suicidality. You claim that all studies done have failed to show anything but an increase in suicide (not true) and that they have all been pharm industry funded (not true). Such allegations are interesting, rather interesting, in the setting of this article not citing a single piece of peer reviewed journal writing.

    More on SSRIs, the strawman that any professional claims that SSRIs are to depression what insulin is to diabetes…is truly juvenile. It may prove a clinically helpful way to describe the medication to someone without much medical knowledge, sophistication, or inclination to learn more detail. Do we have to start telling diabetics on pioglitazone about gene expression pathways that increase insulin receptor prevalence? I think not.

    Other myths revolve around the huge harm that medications can cause. That is empirically true. However, you seem to be encouraging a layperson audience to ignore the central role of a physician in weighing positives against negatives of any treatment. And if your intended point is that good treatment may be first attempting non-pharm interventions, then I would agree. However, you present a unilaterally negative view here, not allowing the reader into the realm of medicine where every choice will have both good and bad associated outcomes. It’s a hard job, and things don’t always go the way you want, but there are good psychiatrists out there and this page does a disservice to readers and medical professionals alike.