1 Boring Old Man

Rarely has an issue grabbed my attention like the hiring of Dr. Charles Nemeroff as Chairman of the Department of Psychiatry at the University of Miami. I’ve said more than enough about that in my last two posts [the trivialization of america…, accentuate the positive, eliminate the negative…]. But I find that there’s still more that I want to say. Medicine, as we know it, emerged from among the many healing cults in Ancient Greece because of one simple principle – something we know as the Hippocratic Oath. The essence of that oath was simple, "Do no harm." At that time, very little was known about the treatment of illnesses and so the treatments were guesswork. What distinguished the cult that became modern medicine from the others was those early physicians realized that in their zeal to help people, they could actually do harm – and they swore to avoid it. Obviously, that tradition lives on evidenced by the number of malpractice suits settled these days. Those cases aren’t just lousy doctors, they’re doctors who have not weighed the harm sufficiently against the gain, or have not adequately informed their patients of the risks in a given treatment plan.

So back to Dr. Nemeroff. He and his colleague, Dr. Zach Stowe, were on the payroll of GlaxoSmithKlein, the makers of Paxil, an antidepressant. They published and presented that Paxil was a safe drug during pregnancy, and they were wrong. [see strike two…] Furthermore, they had no basis to make that recommendation [other than GSK’s drive to make Paxil the ‘woman’s antidepressant’]. There are now a sea of suits being filed since it seems that Paxil is associated with congenital heart defects in the baby’s of mothers who took Paxil during pregnancy. They did harm. They went out of their way to join in a lucrative marketing campaign for something that hurt people, acting as experts when there was no basis for expertise and they made no acknowledgment that they were part of the marketing campaign. It was a for-profit venture, for GSK and for them. It was certainly not profitable for the women who took the drugs, nor their offspring with un-necessary holes in their hearts.

I didn’t go into Psychiatry to prescribe medications, but of course I do that. It’s a double edged sword because weighing therapeutic benefits versus "harm" isn’t always easy. Our major anti-psychotics, a breakthrough in the treatment of devastating mental illnesses can cause equally devastating diseases in some people. Our anti-anxiety drugs are among the most addictive and abused drugs in the country. And some of the other, usually benign drugs, can cause problems in certain circumstances as in this example. Such things are very hard to keep up with in a modern world because much of the information available to physicians comes from the drug companies or their paid agents, so it’s hard to find the science for all the hype [frankly, there’s a lot more of the latter rather than the former]. And the advent of those ads on television have made things remarkably worse. "Ask your doctor if ______ is right for you?" I say, "Please don’t ask me that!" Those advertised drugs are among the most expensive, and the least tried. So, please don’t ask me to consider the latest infomercial drug. In my opinion, you’re asking me to potentially do you harm. Let me prescribe a drug that has been around for a while and has a known track record. And most of all,. let me tell you when there’s not a drug that would really help, and that the real solution involves making changes in your life.