Friday, November 22, 2019

Comments by Steve Balt MD

Showing 7 of 7 comments.

  • Great post.

    Coincidentally, I was cursed out by a patient today to whom I refused to prescribe Seroquel. He has been requesting it by name for the last 4 months, without any obvious symptoms to justify its use. It just helped him feel “mellow.”

    I don’t practice psychiatry that way. To him, however, that makes me a “f*cking b*stard.”

  • “…a U.S. medical school turned a young man, impassioned to care for the sick, and alleviate their suffering, into an impotent whiner who is forced to LIE to put food on his table…”

    Other than the “whiner” part, I think this pretty well captures how I feel on a daily basis.

    (Ah, who am I kidding— I whine all the time.)

  • This entire discussion, like so much else in psychiatry, would not be happening if we had a reliable way to diagnose “real” ADHD, or to prove that there is such a thing in the first place.

    The downfall of psychiatry, in my opinion, will not come at the hands of reckless prescribers or a public outcry at the harms it causes (although those are certainly valid reasons), but when the profession wakes up to the fact that most of its basic premises have been built on thin air, and yet have been adopted as truth by a legion of “experts” whose medical eyes, to borrow Mr Whitaker’s phrase, are decidedly not wide open.

  • “What do we tell people who say, ‘My meds work.’?”

    I agree, this is incredibly frustrating. Even though there is no way to prove that a given medication “works” (particularly in the long-term), patients and providers want to believe this, so meds are continued. As we all know, some patients end up suffering greatly as a result.

    But a large number of people (perhaps the majority?) stay on meds indefinitely without even knowing that they don’t need them. Do these people “suffer” too? Maybe not in a physical, biochemical, objectively verifiable way (eg, by a lab value). But I maintain that the dependence– even if it’s purely psychological– on a drug, a diagnosis, or monthly visits to a doctor for the rest of one’s life, constitutes a form of spiritual suffering. If nothing else, it takes the power away from the individual and puts it in the hands of an entity (the doctor, an insurance company, the government, Pharma) that doesn’t always have that person’s best interests in mind.

  • Speaking as a psychiatrist and an observer of the behavior of my fellow psychopharmacologists (a label I wear only reluctantly, myself), I find this science-vs-anecdote issue fascinating.

    In an attempt to be “scientific,” we (and the FDA) uphold the sacred p value as the sole, valid indicator of whether a drug “works.” And we’ll cite studies till we’re blue in the face about which drug showed a statistically significant signal over placebo, etc, to back up our prescribing habits.

    But we are also just as quick to brag about the 1 or 2 “success stories” we had with a particular off-label medication, or about the clever combination of 3 or 4 meds (for which there is no scientific support, and never will be) that “cured” a particularly complicated case.

    It seems like a double-standard to be able to move so easily between hard (i.e., “real”) science and personal (i.e., biased) observations. But when the former is often pseudoscience, and the latter is often nothing more than faith, it’s no wonder we pick and choose the logic that minimizes our own cognitive dissonance the most.