Friday, November 15, 2019

Comments by Jack McCullough

Showing 4 of 4 comments.

  • This is an interesting post. One thing makes me wonder, though. I remember reading the Jonah Lehrer article when it was published in the New Yorker. Now that his work as a whole has been called into serious question by his history of plagiarism and fabrication, I have to wonder about the validity of anything he says.On the other hand, nothing in Lehrer’s weaknesses does anything to undermine the report in J. Clin. Psych.

  • Sandy, thank you for bringing us the news of this important study.

    This is a mainstream study. It’s big, with over 300 participants, and one of the authors is Dilip Jeste, the current president of the American Psychiatric Association. Nobody could claim that it was somehow fringe science.

    I think this is good for my legal practice, but there are questions that I’m not clear on how they fit in with what we do.

    First, I’m not sure about dosages. For instance in Risperidone, the drug I’m most familiar with dosing of, the mean dose was 1.8 milligrams, which is considerably lower than what they give most of our clients. It’s unclear whether a higher dose would have led to better results, although it’s worth noting that the treating docs were allowed to raise the dose as part of the study; I think we can infer from this that anyone who thought a higher dose was needed administered a higher dose.

    Second, it appears that the study participants were all or primarily outpatients, which would leave the door open for the state to argue that someone requiring an emergency inpatient admission can be distinguished from the participants of this study. This might also play into the discussion of dosing.

    Third, while the study finds essentially no benefits from the drugs, I don’t read it to say anything about the course of the subjects’ condition after meds were discontinued, which would be useful for cases involving continued treatment.

    We’ve reached the point where almost every week there’s a new revelation of the shortcomings of psychiatric drugs and practices. Any psychiatrist, particularly in the involuntary system, who is not seriously reevaluating his or her practices is seriously neglecting his or her professional and moral responsibilities.

  • This is encouraging. As you might guess, in our cases there is no sign of introspection or consideration.

    For example, just last week I had an involuntary med case and the state psychiatrist was asking for permission to administer up to 16 mg of Risperidone, even though the prescribing information is clear that there is no clinical benefit to go above 6, and the only result of going higher is to increase the risk of side effects. He claims that he has never given anyone a dose that high and that he probably won’t have to go that high, but requesting permission to go that high is incredibly cavalier.

  • Sandy, another great diary. I wish your views were more widely shared. Unfortunately, there is not another psychiatrist in the involuntary mental health system in Vermont who believes, as you do, that we should be careful and judicious in how we use anitpsychotics and that they are not as effective as is commonly thought.

    In fact, “careful and judicious” is pretty much the opposite of how other psychiatrists use them. I hope that they are listening to you. I’m pretty sure that you have a better chance of reaching them than I do.