“we” and “us”…

Posted on Wednesday 28 August 2013

I had  weathered the massive changes in psychiatry I described in the last post pretty well I thought. I had learned that the people on my side of the street weren’t without sin and made a lot of changes of my own from what I learned. I still loved the profession I’d gravitated to even if the formal version had fallen out of love with my kind. I was tolerant of the naiveté of the new medical psychiatrists, many playing in an as yet unfamiliar hard science arena with the typical lack of humility seen among newbies. And I was able to continue to develop in my chosen corner of the world, getting better at knowing when I could help and how to do it. I retired with a sense that I’d come through a tough time learning more than I bargained for, but none the worse for the journey. I settled away from the maddening crowd to think about other things.

After about five years, I agreed to help out as a volunteer in a charity clinic. Knowing it would be very different from my practice, I hit the books to catch up, particularly on my pharmacology.  The combination of what I read and the medication regimens of the patients I saw threw me for a loop. In the last post, I talked about cognitive dissonance. But that phrase isn’t big enough to describe that feeling five years ago. About that time, the chairman of the department I’ve been affiliated with from the start was exposed as a crook by a US Senate Investigation, along with several other chairmen including the APA President-Elect. That was a formidable combination and I began to read and write, my way of mastering unimaginable things.

I tell my oft told story once again for a reason. For the next five years, I vetted  drug trials, read blogs and papers, learned about things I never thought about before like how the FDA or the NIMH work. At the outset, I didn’t even know which companies made which drugs, what the HAM-D was, or what a LOCF stood for – much less what it meant. I think it took most of the last five years to even catch up with all that had gone on. I had already learned on my own about the withdrawal syndromes, Akathisia, and suicidality with SSRIs the hard way – from patients – but I’d never prescribed an Atypical Antipsychotic, so all of that was new. My writing wandered from place to place without clear focus as I happened on one thing, then another. I wasn’t even sure why I got so involved except that it was about bad things happening in my own field that had gone on literally under my nose, but I had positioned myself off the grid and hadn’t seen. And there was a boatload to see.

I remember when it finally began to crystallize where I ought to direct my attention. One day almost exactly a year ago, quite by accident I came across something new on the GSK web site [a movement…]. Like everyone who has ever read it, I had focused a lot of attention on Paxil Study 329 as a paradigm of something very wrong. That day, the something new was the 329 data laid out in Appendix after Appendix [quietly added a week or so earlier]. I started writing the people I’d met along the way, and David Healy pointed me to Peter Doshi [the Tamiflu guy] who told me how he got it published by looking back at a GSK settlement agreement eight years before with Elliot Spitzer then Attorney General for NY State. So I dusted off my science from a former career and had a go at analyzing that data, starting with the lesson of Study 329: the basics…. Even with all my rusty joints and only an Excel SpreadSheet, I could see that if you had the data in front of you, things got very clear very quickly. All the indirect speculating and sleuthing I’d been learning paled in the face of the real numbers. So a year ago tomorrow, I wrote a short post entitled, the lesson of Study 329: data transparency…. To quote the enigmatic Jacques Lacan, the whole thing moved for me from the symbolic and imaginary registers to the real. That’s a lousy way of saying that I knew what I thought needed to be done about the mess I’d been writing about for four years.

While that was a moment of enlightenment for me, it was old hat for a lot of other people. I just didn’t know who a lot of them were, and I hadn’t figured out what the ones I knew about were really saying. I first thought about David Healy, Ben Goldacre, Fiona Godlee, Ian Chalmers, Peter Doshi, Tom Jefferson. But as I kept looking, just about everyone else I’d cataloged as right thinking along the way was talking in one way or another about data transparency, just under some other name or from some other angle. I don’t mean to go overly simplistic here. But for the last year, I’ve become increasingly convinced that data transparency is the essential next step. Without it, we stay where we are, complaining and chasing rainbows, impotently pointing fingers, guessing at things we have every right and every obligation to know intimately. A lot of people had already figured that out, but I hadn’t. What comes after data transparency? I don’t really know the answer to that question, but something comes next. Without it, there’s nothing.

So the details to follow… are what people are doing to move the cause of data transparency forward and what people are doing on the opposite front to block it happening. There’s a lot going on as most of us know:
  • the AllTrials Initiative with Ben Goldacre, Fiona Godlee
  • the RIAT Project from Peter Doshi, Kay Dickersin, David Healy, Swaroop Vedula and Tom Jefferson supported by the BMJ and PLoS Medicine
  • RxISK and the recent posts and petition on the DavidHealy.com
  • the Cochrane Collaborations group with Ian Chalmers, Peter Doshi, and Tom Jefferson focused on Tamiflu
  • the calls for Transparency from Mad in America
  • the European Medicines Agency [EMA]
  • the TEST Act
On the other side are:
  • the efforts of PhRMA and EFPIA
  • the suits by AbbVie and  InterMune blocking the EMA
  • every pore in the skin around PHARMA
  • the as yet unknown support from organized medicine
for starters. That’s off the top of my head. I’m going away for the long weekend, and I hope to fill out those lists in what spaces offer themselves. I hope commenters will expand them with whatever occurs to them as well. I’d like to make a roster of things we can all follow as this campaign goes forward. I noticed that I used the words "we" and "us" throughout this post as if it refers to some grouping of people. I didn’t do that on purpose, but noticing it, I hope my unconscious processes are right – that there really is a "we" and "us" on this front. I’m sure there’s a "they" and "them"…
    August 28, 2013 | 10:42 PM

    Thank you so much.

    August 28, 2013 | 11:28 PM

    Thanks for your honesty Mickey.

    As for my 2 cents, I think that the real next step is the abolition of coercive psychiatry. And I do not mean this in a utopian way but as a serious prescription.

    All the evils of psychiatry, including it getting a pass with its corrupted practices that go beyond anything one can see in other areas of medicine, are derived from its status as a coercive force.

    If a medical doctor in a different area of medicine attempted to publish something like Study 329, he/she would be accused of scientific misconduct. In psychiatry, the study was not even retracted after it was publicly known that it was a ghostwritten study whose conclusions were misleading.

    There is a lot of fear in general to oppose the “mind guardians” with legal capacity to send one to the psychiatric ward by force if necessary. You can call it “the emperor has no cloths” effect or whatever, but that is reality.

    When you come to think about it, the “efficacy” of psychiatry’s so called “treatments” are no better than homeopathy’s. Its foundations are no better either. Both psychiatry and homeopathy hypothesize about why their respective treatments seem to “work for some people” yet none of the two has provided evidence backing those claims. The reason psychiatry enjoys the influence it does, while homeopathy doesn’t, is because psychiatry has the role the Inquisition centuries ago. Just as then, opposing or questioning the Inquisition can only bring trouble to those who do. So for the public at large, as long as those targeted by “the inquisition” of the day were “other” people, no problem.

    The real reason psychiatry has been beaten recently is because with DSM-5 the APA thought it could submit to its control not just a minority that would justify psychiatrists’ existence and salaries, as they have been doing for decades, but a majority of the American people. That greed was their undoing.

    The overwhelming majority of psychiatric survivors didn’t chose to be one, but with an increasing number of us in society, our voices cannot be silenced as easily as they were just 10 years ago.

    August 29, 2013 | 12:07 AM

    I have to wonder if there’s not a relationship between House 501c3 Faith Base and Contract Research?
    “Nonprofit Faith Based Grants”

    August 29, 2013 | 8:45 AM


    Medal of Honor Recipient Thanks His Shrink
    It’s another act of valor.

    “The video below, from Stars and Stripes, shows Staff Sgt. Ty Carter’s speech at a ceremony awarding him the Medal of Honor on Monday. Carter, one of only five living recipients of the medal who fought in post-9/11 conflicts, was cited for his actions during a battle in Afghanistan in which he attempted to rescue a fellow soldier, Spc. Stephan Mace. Carter pulled Mace to safety and treated him amid a 12-hour-long battle. Mace, wounded grievously, eventually died.

    Carter’s speech is notably different from the popular image of a war hero receiving a medal. In lieu of crisp salutes and talk of duty, Carter spends much of his time speaking about loss and frankly discussing his own mental health after the ordeal. To be clear, Staff Sgt. Carter appears to be a person of extraordinary mettle. In his presentation, however, he does not mind projecting another image, of a young man who has seen too many terrible things. Speaking in what can only be called a tone of vulnerability, he tells the White House audience, including President Obama:

    “Only those closest to me can see the scars that come from seeing good men take their last breath. During the battle, I lost some of the hearing in my left ear. But I will always hear the voice of Specialist Stephan Mace. I will hear his plea for help for the rest of my life.”

    He goes on to talk about how he recovered from the experience.

    “However, thanks to the professionalism of my platoon sergeant, Sergeant Hill, and my behavioral health provider, Captain Cobb, and my friends and family, I will heal.”

    “Behavioral health” is a synonym for mental health. A “behavioral health provider” is a therapist. In a ceremony traditionally designed to showcase bravery in battle, Carter is taking the extraordinary step of focusing on how he, the classic American war hero, came home from Afghanistan with his head in a bad place. He goes on to speak of the anguished families of the soldiers lost in the same violent battle for which he received the medal. President Obama also remarks on the mental health issue.

    Certainly what the video below displays is a cultural shift, from the 1940s image of the hard-bitten GI, to the modern, human hero like Carter. It’s also tempting to read the focus of this week’s ceremony as a tacit pushback against an emerging skepticism about war’s role in a wave of military suicides over the past half-decade-plus. Coincidentally, two weeks ago a study published in the Journal of the American Medical Association claimed that military deployments were not to blame for the widely reported rise in suicides among service members since 2005.

    The study, which has sparked intense debate, found “suicide risk was independently associated with male sex and mental disorders but not with military-specific variables.” It cited a rise in alcohol and drug abuse among the soldiers studied as likely causes for the increase in suicides, but did not consider those influences “military-specific.””


    Steve Lucas
    August 29, 2013 | 9:02 AM

    As I have prattled along about the clergy I have found myself in much of the same mind set. Meeting clergy from a past time with a passion for religion and theology I have been completely taken aback by a new breed who view the church as much more of a marketing problem.

    Several years ago I ended up dealing with a passive/aggressive, pathological liar, who’s only interest was in self. The family was only a prop for self satisfaction and nearly led to the destruction of a child.

    Looking for clarity and wanting the animosity directed towards me from announcing the emperor has no cloths to settle we found an old style minister. Retirement thrust us back into the same situation we had tried to avoid of dealing with deeply flawed individuals who viewed the clergy as a safe haven with soft rules.

    We found a large group of us had been more than disappointed by what has happened to the church. Large membership losses are swept away with a wave of the hand, much like poor trial results, and an explanation is it is the members fault for not understanding the leadership’s greatness.

    Short tenures are explained away as a poor fit and there is no transparency regarding past job performance. We have also been bombarded with the message that we have an obligation to employ ministers no matter what their skill level.

    The result has been the “marketing” of the major denominations not realizing the growth of the mega-church is due to the adherence of those ministers to an old time view of the church and its place in a person’s life.

    There is no longer a we and us but us vs. them.

    Much like the car buyer rejecting an auto due to cost then being subject to the car salesman repeating over and over; but you like the color.

    Psychiatry, and by extension psychology, has been subject to: but we have drugs.

    Steve Lucas

    August 30, 2013 | 2:45 AM

    I hope there’s a ‘we’ and an ‘us’, everyone has their own motivations, but these things can be used for a great deal of good either way.

    Thats a great list to follow, thanks Mickey!

    September 11, 2013 | 4:36 AM

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