Posted on Friday 24 June 2016

    June 24, 2016 | 8:11 AM

    Hmm, Obama told the Brits to stay, and they didn’t. Maybe Americans can take note, fairly much everything he champions is a lost cause.

    Like, starting with Obamacare…

    James OBrien, M.D.
    June 24, 2016 | 10:17 AM

    All that fearmongering from the plutocrats and the DOW is down a whopping 1.9 percent…

    Congrats to the Brits who have stopped being ruled by threats from unelected rent seekers…and central planners

    Now if we can convince doctors to stop participating in MOC…which is very much like the EU except the EU is occasionally useful

    June 24, 2016 | 3:01 PM

    nice tie in from my earlier comment:


    “This law is failing across the board: On spiraling premiums, on out-of-pocket costs, on enrollment figures, on economic impact, and on cost curves. It’s hurting real, hardworking people and harming more Americans than it’s helping, which is why it remains unpopular with voters. Hillary Clinton, who effectively designed the scheme, believes it’s working. ”

    The pervasive disconnect by the Democrats alone is beyond frightening. I honestly, truly think this is their way of pruning the population. The middle class is expendable because they aren’t inherently partisan to Democrats…

    Now back to Britain and their future……………..

    Greg J Martin
    June 24, 2016 | 4:09 PM

    “Persistent proselytizing or dominating the space with personal agenda is likewise unwelcome.”

    James OBrien, M.D.
    June 24, 2016 | 6:51 PM

    The tie in to the main theme of this blog is the failure of the following proposition…that the brightest people at the best academies with the best connections know best how to create financial and social and psychological utopia…this is increasingly proven to be demonstrably wrong…two reasons…the educational elite are incredibly out of touch with real world experience…witness the Lieberman talks on Collabocare…this is the mentality of the Brussels bureaucrat…and the fatal conceit of central planning….the triumph of ideology over ethics…it does not work for economic and psychological reasons, among which are the venality and greed of the central planners themselves, whom are overrated by the hangers-on and the biased press.

    June 25, 2016 | 1:34 AM

    “fairly much everything he champions is a lost cause.”

    I agree– I do not think this really isn’t the place for proselytizing or parroting catchphrases from mainstream media.

    Not that I’m offended, or even taking you seriously (on this particular point, there are plenty of your posts I take very seriously.) The risk here is alienating newcomers whose minds haven’t slammed shut.

    Reducing this to ideology over ethics, the elite being out of touch, bureaucrats in Brussels, or even talking about what “the Democrats” think… it’s the kind of broad-brush, finger-pointing, big-media, talking-heads-screaming at each other, 20th-century way of framing the problem that’s only going to make this worse. It’s also a buzz-kill, and a total soft-on.

    And no, I disagree about the point of the blog, or where this thread is going, anyway. Dr. Nardo’s next post spells it out– this story is *complicated.* It’s not heroes and villains. The devil is in the details.

    We’ll see what happens on Monday, but the Dow is actually down 3.4%. And even with “Leave,” we may wind up with the worst of TTIP in some ghastly side-deal, or that’s what people seem to be hinting at.

    I would like nothing more than to rip into a few of the pet theories noted above AND scream out a few of my own BUT… alas, one of my specialties is anger management, and I do not do that anymore. I’d also have to tell my sponsor about it, and then I would have to make amends later, and it’s Friday night, and I haven’t even eaten dinner.

    I’m not suggesting that anyone actually violated the rules or that they be silenced, either. Just… suggesting that we can all benefit from working a little harder to frame issues in ways that haven’t been heard before.

    I was going to play a little acoustic guitar tonight, but actually I’m feeling a little bit more like cranking up the electric.

    June 25, 2016 | 1:39 AM

    Sorry about the double negative. I meant, “I don’t think this is the place for parroting catchphrases form mainstream media.” And I agree with Greg Martin, not Dr. Hassman.

    It’s late and my brain has turned to jello from writing reauthorization requests to insurance companies.

    June 25, 2016 | 10:26 AM

    Um, I think my comments above somewhat relate to the point of this post. Dr. Nardo put out how the British people chose to end the relationship with the European Union, and the fact that Barack Obama went to Britain in April and try to tell him that they should stay is part of that discussion.

    Furthermore, Obamacare, which I think has played a sizable role in the way medication has been forced on the public even more so these past four or five years than prior, again reflects what Barack Obama is doing per his legislative onslaught the public can’t vote to reject!

    Maybe most of Dr. Nardo’s prior posts are about medication issues that precede Obama’s arrival, but, Obamacare is just raining down simplistic and quick fix solutions even more so than what we saw prior to 2012.

    I know this because I’m seeing it in every Avenue of mental health care I have traveled as a temp these past six years.

    Therefore, I’m just pointing out how this man and his blatant self interest agendas affects people. And, how he is the tip of the iceberg of how arrogance, frank cronyism and blatant special interest gains are what drives how the public is treated, perhaps more accurately mistreated. Hence, what, 80% or more of the topics here?!

    If this is in fact proselytizing, as I seem to be accused of, then Dr. Nardo will strike the comment, and the thread will continue as people want it.

    I’m just trying to note, since the point of this post is about Britain making their own choice as a democracy, I wish we could do that too.

    and I’m done here for this thread…

    Greg J Martin
    June 25, 2016 | 4:27 PM

    Dr Nardo’s blog has been one of the best finds I’ve made since trying to figure out what happened to me (dealing with a nightmare of withdrawal issues from p-meds). I always read his new posts as soon as they are up and I have learned much wisdom from him regarding both the state of psychiatry and the manipulative, dehumanizing ways of the pharmaceutical industry.

    I also happen to be a liberal and one who thinks Brexit was a huge mistake for the UK. And that is neither here nor there.

    Except, I don’t want to read someone spouting paragraph after paragraph of their political animosity against Obama. For one, I disagree with it but more importantly, for two, it has no place in this blog – that is read by people of different political stripes, clearly. I’m not about to at any point write polemics down here regardless of what Dr Nardo posts.

    I see Dr Hassman has his own blog where his views are aired. I recommend keeping them there.

    June 25, 2016 | 6:21 PM

    Thank you, Dr. Hassman– I appreciate the clarification, and the additional detail, in your June 25 post.

    One thing that may account for our differing opinions on this is that I am actually seeing much less polypharmacy since the passage of the Affordable Care Act than I was during my internship (though of course the slice of life that I see in Los Angeles is very narrow, and I am very much a newcomer to the field.)

    Part of it may be that in California, at the particular clinic where I worked, the ACA’s passage was anticipated by several years. During the frantic preparations, there was a lot more chart review as we transitioned to new models of care, and I think more critical thinking about prescribing.

    As much as I hate to admit it, the EMR may have played a role, too. Despite all the complaining that I’ve done, here and elsewhere, about how confusing it is to keep track of a patient’s medications using the awful software we were forced to use– I think of it as a virus more than software, actually– the reality was that a patient’s medication history was stored in the system somewhere, even if it took forever to find it.

    Anyway, I do appreciate your thoughts on exactly what you are observing and where you are observing it. And I certainly confess that though our opinions are very different, there have been many times I wished we could put some issues to a popular vote.

    James OBrien, M.D.
    June 25, 2016 | 9:23 PM

    I’m just curious about the psychiatrists who support the ACA…do you take CMS insurance or insurance at all? If not, do you have the self-awareness that this is blatantly hypocritical?

    I have no intellectual beef with psychiatrists who believe in ACA who participate in it. They are ethical and consistent in this position. I disagree, but I respect. The rest like to look good at cocktail parties and avoid the hard work of their phony convictions.

    June 26, 2016 | 1:04 AM

    That is a valid point, Dr. OBrien. It is easy for me as an MFT to take insurance and also have private pay, because I am part of a lower fee structure, and there is not such a huge discrepancy in the rate for insurance vs. private pay. Sometimes private pay is a lot more, occasionally, of course, it is less.

    It does seem reasonable to assume that a psychiatrist who supports the ACA should, at a minimum, set aside several slots for CMS or other insurance.

    All this raises some intriguing questions when the spread between private pay and insurance rates is much greater. How about a psychiatrist who believes in the ACA, does not take insurance, BUT sets aside several low-or-no fee slots for patients with no resources? Is that hypocritical?

    I can see situations where such a scenario would be tempting… what if your normal rate were $400 an hour but you would get paid $90 for taking a patient with insurance? One would have to invest about an extra half hour of time processing paperwork on the insurance client, and that has to be factored into the equation. That means giving up $200 worth of time for every $90 client.

    Thus, seeing four clients for $20 private pay would cost $1520 instead of costing $2040 = 1600 + 800 – (90 x 4). And this psychiatrist could see more low fee clients if he just charged them $20 and did not take insurance.

    I suppose such a position would be ethical, but hypocritical.

    James OBrien, M.D.
    June 26, 2016 | 7:39 AM

    The FDA is another group of unelected bureaucrats who determine how we may live and die.

    Health was never meant to be controlled by the federal government but only by the states, much like licensing of doctors.

    Call me quaint, but I trust the wisdom of Enlightenment visionaries over post-modern busybodies.

    Speaking of the founders, the Hamilton original cast recording is my summer 2016 soundtrack. I highly recommend it to all if you have not heard it. It is breathtakingly original and groundbreaking. I am going to make a futile attempt to see it in August.

    Greg J Martin
    June 26, 2016 | 2:46 PM

    The FDA is riddled with revolving door industry-influenced cronyism and corruption. It’s a driving influence of the very problems described in this blog. But it is not the FDA conceptually that is the problem. As seems patently obvious in these posts, we need now more than ever, a stronger more effective FDA that would play a far more pro-active role in assessing the validity of industry-funded clinical trials and drug marketing. To think these problems would disappear without a central regulatory agency, while at the same time living in a private global economy, is beyond my comprehension.

    If not by the federal government (a democratic institution), is health meant to be controlled by profit-driven multi-national healthcare conglomerates? Because that’s what’s left if you remove the FDA.

    “Enlightenment visionaries” clearly underestimated the unchecked self-interest of institutions driven by profit – even in a field focused on general health and well being. (See every post written here for proof.)

    James OBrien, M.D.
    June 26, 2016 | 3:57 PM

    So how big were the piles of dead bodies before and after the FDA was created?

    The FDA conceptually is the problem because any powerful government institution will eventually be corrupted by money.

    We can talk all we want about how the Soviet Union would have worked if Trotsky had lived. Meanwhile there the dead bodies did pile up.

    Capitalism sucks compared to everything else especially utopia. I love how the media is predicting disaster in Britain while ignoring the actual disaster in Venezuela.

    Greg J Martin
    June 26, 2016 | 6:11 PM

    You’re joking, right?

    Before the FDA,, there were untold deaths from numerous public health hazards including contaminated vaccines, radiathor, and elixir sulfanilamide, to name a few, not to mention people harmed from the marketing of false “cures” for diabetes, tuburculosis, etc, etc. You might want to read some Upton Sinclair and other histories of the early American industrial era when a nearly non-existent federal regulatory government could to nothing to stop the proliferation of numerous toxic agents as well as poisoned food, and ineffective or harmful drugs.

    The scourge of thalidomide was largely avoided in the US because an FDA reviewer prevented its approval.

    The current failings of the FDA are a result of the agency not doing it’s job or being watered-down by deregulation.

    June 26, 2016 | 6:50 PM

    There is no longer any difference between private and public institutions. You couldn’t find that dead horse even if you wanted to beat it.

    Every single metric has been corrupted from election results to P&E ratios and unemployment stats– and clinical trials results. Trying to define the ideological persuasion of the organizations that generate bad data is a hopeless– and endless– proposition.

    What I like about this blog is that it looks beyond that. What is the process by which bad data is generated? How has logical fallacy come to replace scientific method, and what can we do to stop it?

    James OBrien, M.D.
    June 26, 2016 | 8:40 PM

    You know that thalidomide was reapproved, right?

    Give me the number of “untold deaths” pre-FDA vs. post-FDA. Objective number, not feelings, not emotions, not hyperbole, not turn of the nineteenth century hype. Please include in the second number the number of deaths due to the FDA banning or delaying treatments. It’s not as simple as the nanny state reflex.

    Yeah yeah, I read Upton Sinclair when I was 14. It’s not 1905.

    Hey if you hate big corporations, you should hate big government, their BFFs.

    James OBrien, M.D.
    June 26, 2016 | 9:45 PM


    Also, if we want to do a tally of death by pharma vs. government in the past 100 years, I’ll run the math on that (excluding genocide).

    Anyway, this statement in the tenth amendment is unambiguous:

    “The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people.”

    Nowhere in the Constitution is health delegated to the federal government.

    Even a Federalist like Hamilton would not approve of the FDA.

    Greg J Martin
    June 26, 2016 | 9:52 PM

    You bring up that thalidomide was re-approved without mentioning the context that its use is restricted to late stage cancer, Crohn’s Disease, and a few other serious conditions that don’t respond to other treatments. It’s not given to pregnant women for morning sickness anymore. Which was my point.

    You know very well that I’m not going to be able to give you a “number” of pre-FDA deaths v post-FDA deaths. That would require a level of research that neither of us have the capacity to conduct and I can’t imagine any such endeavor not being hampered by significant holes and unprovable suppositions. For one thing, such a discussion would have to include the number of lives saved — which is again something beyond both of our abilities to convincingly produce.

    Your actual point about the lives lost due to the FDA banning or delaying treatment is a good argument to have in this discussion. (I have repeatedly said I’m not defending everything about how the agency is run,and I’m definitely open to learning more about its failures.) You could have explored that with more sophistication than condescendingly telling me that it’s “not as simple as the nanny state reflex,” or that big corporations and big government are “BFF’s.”

    Yes, thankfully, it’s not 1905 any more. I imagine the hard won efforts of the Progressive Movement – many laws from which were championed by the great Republican Theodore Roosevelt – has a lot to do with the fact that we’ve made major strides in health and public safety since then.

    James OBrien, M.D.
    June 27, 2016 | 8:31 AM

    Here’s the thing about muckrakers and nanny staters as heroes and big pharma and big ag as villains…Rachel Carson killed possibly tens of millions in the third world..


    while Norman Borlaug working for big ag saved billions:


    It’s not as simple as the heroes/villains narrative those horribly biased freshman classes we we are force fed. And I am not fan of current big ag policies at all, which is another example of big government in bed with big industry.

    As far as the progressive movement, there is a strong case that Wilson was the worst President of all time given the completely unnecessary US participation in WW1.

    The thalidomide issue could have been dealt with by a black box teratogenicity warning, and theres no evidence that it couldn’t have been handled by the states. You’re buying into the idea if Washington doesn’t take charge, no one will. BTW, they’re not doing such a good job with opioids and they promoted pain as the fifth vital sign.

    Like I said, if you hate big evil corporations, you should be against big government.

    James OBrien, M.D.
    June 27, 2016 | 9:03 AM

    BTW there is nothing inherently incompatible between federalism/states rights and progressivism. Workers’ comp, a progressive reform, was hatched in Wisconsin in 1911 as the initial laboratory and then quickly spread to the other fifty states without being controlled by DC. This is much more democratic and “progressive” that a sudden top down edict from Washington.

    Work comp has many issues but it essentially did solve the problem of workers’ being denied treatment and having to fight unaffordable legal battles and employers having potentially unlimited liability for accidents.

    Fred Wolfe
    June 27, 2016 | 10:04 AM

    “Persistent proselytizing or dominating the space with personal agenda is likewise unwelcome.” Enough already.

    Greg J Martin
    June 27, 2016 | 10:29 AM

    Correct. My apologies. I would delete my comments if I could.

    June 27, 2016 | 3:49 PM

    Time to hear “snip”…

    James OBrien, M.D.
    June 27, 2016 | 7:03 PM

    Wasn’t trying to promote an agenda but tie it into issues that the blog deals with including FDA and KOLs.

    EHR would be another example of rent seeking billionaire elites being out of touch with needs of user and patients.

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