I was kind of surprised how much letting the EMA decisions sit for a day softened my reaction, because my first take was to catalog what was missing from my wish list and privately groan [worry…, beyond the blind…]. I’m hungry too. And so there was more reflection to be done, and what I came up with may well be idiosyncratic – but that’s not for me to decide. So I’ll just say what I think.
I think what happened with PHARMA and Medicine was at least as much our own fault as PHARMA’s, and I’m including myself in the indictment. I’m not talking about the KOLs or in the case of psychiatry, the ones who jumped into the quick visit/psychopharmacology-for-symptoms mode because it was lucrative or because "it just was what happened." They deserve whatever blame comes their way. I’m talking about all of us who passed responsibility to others to maintain a standard of scientific integrity and medical ethics. We just didn’t pay attention.
When the great reform of requiring clinical trials came along in 1962, it was seen as a plan that would keep PHARMA honest. It worked for a while and we stopped looking. In psychiatry, when the DSM-III came along, it made an equal place for the biological side of the equation, but opened the door to making that the only side. It was obvious the day it was published, but we didn’t keep on top of it. When the CROs and PHARMA took control of Clinical Trials, we just didn’t pay attention. Many of us didn’t even notice. When the reform of ClinicalTrials.gov was added, PHARMA basically ignored many parts of it, mostly the reporting requirements, and that continued even when they were strengthened. We acted like reforms solved the problem, and ignored the fact that such things need constant monitoring – because the response to reforms from the other side is to evolve creative solutions that undermine their essence. And like what happened to the great reform of state mental hospitals, things festered when they were out of sight and out of mind.
At least in medicine, there have been some watchdogs along the way: David Healy, Bernard Carroll, Bob Rubin, Danny Carlat come quickly to mind in psychiatry, but they are exceptions in a sea of sheep who didn’t pay enough attention to the wolves in drag wandering among the flock. So in my view, we can’t expect the EMA, or NICE, or the FDA to maintain the scientific and ethical standards of medicine or psychiatry. The forces of Hospital Corporations, Managed Care, Governmental Agencies, and the Pharmaceutical and Device Industries are powerful, but they all feed off of medicine. Only medicine can provide the required ongoing oversight, and we just haven’t done it. The "good guys" have been so quiet that many have forgotten that there are still any left.
La Trahison des Clercs – Julien Benda.
Doctors or wolfs in drag… The ball is in our court, ie in the court of medicine.You hit the nail on the head, as usual, think.
Einstein is supposed to have said that one cannot expect those who created the problem to be part of the solution. Just now untold numbers of citizens and good doctors are waking up. We are the people, the majority, fed up with the treason of the clerks, loathe to join them to be clerks on the take or serfs.
I read your blog, dr Nardo, learning from your honest appraisals, good judgement and wisdom, and lots of good comments, to expand my understanding of how psychiatry, medicine too, embedded and grew with big pharma, big business, global finance. It’s a mess, not to be trusted by citizens in need of uncorrupted services. The honest, responsible practicioners of medicine need the passionate anger and competencies of users and survivors of psychiatry, who know we have been betrayed, to turn the tide against “deadly medicine and organized crime”
Just a week ago BMA awarded Peter Goetzsche’s book first prize in the category Basis of Medicine. We are hosting him and Robert Whitaker in Oslo later this fall, getting their books onto the Norwegian market to reinforce change, human rights and uncorrupted services.
I used to think that the horror, the angst I felt as eyewitness to cold, unthinking brutality in an acute ward was a limited, local problem, due to tyrannical leadership, incompetence and cowardice. I’m learning, and I’m thankfull that so many are engaged in this good cause. We Shall Overcome, some day…
Interesting comment above indirectly quoting that Einstein may have said those who are part of creating the problem can’t be part of the solution.
But, those who have failed and see the failure first hand should have a voice in the efforts to correct the mistake, if the efforts are genuine and remorseful.
Besides, who are adequate and responsible alternatives for physicians to help make these corrections? That is part of the ongoing problem, other professions that have less commitment to the public, and some of these alternates in fact want to prescribe with even less accountability, are going to supplant doctors?
What the speakers out here like Dr Nardo et al I think are still inherently afraid to say outwardly is simply this: doctors who genuinely still care and want the system rerouted to do right need to actively, passionately, loudly, and persistently shame and ostracize the cretins in our profession who are the antithesis to being doctors.
Mensch behavior only goes so far when you are dealing with narcicists or antisocials these days. Greed and lust for power and money won’t respond to kind criticism and pleasant dissent. It ain’t gonna cut it with the KOLs and academic whores out there.
Dr Nardo is right in the post here, but those who hijacked the care process won’t be negotiated with now that the monies are outwardly known per pharma’s agenda. Continue to minimize or rationalize that point, and the whores and cowards continue to rule.
How anyone wants to go into psychiatry as it is today makes me view them very wary. To be naively clueless or have an agenda to profit are fairly much the only reasons someone would chose to be a psychiatrist until proven otherwise.
It’s a meds only model now, so why practice this?!
I could not help but think of this post in the broader sense. Politicians at all levels win by often a handful of votes or even a few percentage points and declare a mandate from the people. Corporate leaders and those in hospitals and medical societies declare themselves to be above average and work to secure the power they have achieved. The clergy have done likewise and reflect society’s values over their religious theology. Keeping the job and eliminating any question of competency has become the major thrust of many in the clergy.
This atmosphere of buy off the many and launch straw man argument, logical fallacies and personal attacks on any who oppose your authority has become the norm in much of our world, and medicine is no exception. A recent Gruntdoc post highlighted how to discourage doctors. Demands for increased production, an increase in responsibility with a decrease in authority, are but two ideas we see not only in psychiatry but in general medicine and society.
Our go along to get along attitude has reached the point of tearing society apart. Social structures cannot function where every person is their own authority and every group has equal standing on an issue. The resulting chaos and compromise has produced gridlock that is easy to take advantage of and leverage for one’s own use.
Blogs such as this are allowing people to realize they are not alone, and are lending a cohesive voice to the discontent of a large, marginalized and maligned population. Leaders of this movement in the past had to rely on the publication of books and the resulting lag was easily dismissed as out of date.
We on this and other blogs, while not all MD’s are an intuitively smart group that benefit from our shared broad perspective. The problem is we are fighting the good fight against those who see financial gain in the current system.
People ask why I am passionate about these issues. We spent twice what other countries do on health care, a full 10% of a vary large GDP above other countries, and still have less than optimal results. Where is this money going? Into the pockets of a very few and into the large body of people who will support this system since it supports them and their families.
There is no logic in our current medical system other than feed the monster.
Steve Lucas
I’d like to expand Steve Lucas’ conclusion: The logic of the current system of business and government is to feed the monster, and recommend
http://thearchdruidreport.blogspot.no/2014/10/the-buffalo-wind.htm
We treat the natural world – humans included – like machines, expecting it/us to perform like machines we control, and “get blindsided when it (the world) behaves as a whole system instead.”
About the responsibility of physicians — two patient’s stories:
http://www.theatlantic.com/health/archive/2014/10/i-stalked-my-psychiatrist/380845/
http://wp.rxisk.org/monicas-story-the-aftermath-of-polypsychopharmacology/