{"id":19268,"date":"2012-02-06T13:51:16","date_gmt":"2012-02-06T18:51:16","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=19268"},"modified":"2012-02-06T15:03:16","modified_gmt":"2012-02-06T20:03:16","slug":"wisdom-in-his-pages","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2012\/02\/06\/wisdom-in-his-pages\/","title":{"rendered":"wisdom in his pages…"},"content":{"rendered":"
<\/a>Dr. Healy’s Pharmageddon<\/font><\/strong><\/em> is one of those books to be read, not summarized. It’s not that it’s filled with new information. He sees what the rest of us see, albeit from the position more interior than most – a neuroscientist who has been embedded in the scene. He writes about the primacy of the pharmaceutical industry, the corruption of academic medicine, the rise of the clinical research industry and the sequestration of their data, the deification of statistics, ghost-writing, etc – the things many of us decry and can’t seem to stop writing about. But what’s different about this book is first that Dr. Healy doesn’t stop with this obvious symptom list<\/em>, he goes on to generalize these symptoms beyond the boundaries of psychiatry and mental health to the entire domain of modern medicine [and perhaps beyond]. While most of us remain preoccupied with the self-serving greed that lies just under the surface of these symptoms<\/em>, Dr. Healy rises above [or gets underneath?] the obvious and tells us stories of how former attempts to keep this predictable human force [greed] in check in previous times have backfired and lead us to the present – the law of unintended consequences prevails [with a lot of help from a determined industry].<\/div>\n

I keep saying that I’m not going to review the book, but it’s not because I don’t want to. It’s because even though I’ve come to see many of the same things Dr. Healy sees in my travels as a physician and psychiatrist, his explanations feel intuitively correct and illuminating while at the same time inducing a feeling of cognitive dissonance. My last post [on being a Medicine-Man…<\/font><\/a><\/strong><\/u>] seemed silly to me even as I wrote it, but it was an attempt to say something about the cognitive dissonance I feel after reading Healy’s book. I hardly think of myself as a Medicine-Man<\/font><\/strong> like Professor Marvel in the Wizard of Oz, but I feel like one in my current role in the clinic. The only resources available to me are short sessions and a prescription pad. That’s hardly the way I ever wanted to practice medicine. So my only choice is to be a good Medicine-Man <\/font><\/strong>rather than a bad Medicine-Man<\/font><\/strong>. I suppose the other choice is to stop volunteering, which seems wrong because those patients would go back to being on multiple medicines piled on by doctors who understand neither mental illnesses nor these medicines – doctors I know personally and like, doctors who are also working for free in retirement because they like people and want to help them [and do]. But the point here is that Dr. Healy’s book is editorial enough to make me aware that even in my retirement, I find myself being a part of the very thing I decry on this blog – being a Medicine-Man<\/font><\/strong> – something I largely escaped in my career.<\/p>\n

\"DavidAnother place Dr. Healy bores deeply into the problem is his take on medical science – specifically clinical trials, the sequestering of primary data, and the deification of statistics. I can only paraphrase what he has to say about all of this with an example from this blog. I started adult life as a mathematician with a math mind<\/em> and graduate work in statistics during a hard science<\/em> NIH fellowship. I can’t really escape that, so this blog is covered with graphs. I’m teased about that to this day by my friends – in that I can’t seem to talk without a pad and pencil making some kind of drawing, timeline, graph, etc. And yet you’d be hard put to find any comment about statistics in this blog except an occasional wise-crack about their misuse. And as I’ve gone through the FDA studies and publications in our literature, I’ve spent hours looking for the elusive primary data, to no avail. Statistical significance<\/em> is not proof<\/em>. Proof<\/em> is something else. Dr. Healy makes this point in spades with example after example. I’ll forgo my version [because I’d probably start making diagrams and graphs]. He shows with narrative clarity how these tools of science have been perverted beyond recognition. He effectively takes on the whole enterprise of the clinical trials industry and its wierd science that has become a medical standard.<\/p>\n

\"EstesBut where Healy shines even more brightly than usual is in his careful parsing of the history that’s lead us here – the history of how physicians became gatekeepers with the power of writing prescriptions, the rise and vicissitudes of the FDA, the story of the Kefauver Harris Amendment that was intended to insure efficacy, but has actually ended up perverting the very meaning of the term beyond recognition. He tells the story in a compelling way, so that the current trajectory of medicine, treating lifestyle and life rather than disease under the direction of industries with various motives makes very good sense [even though the cloud of cognitive dissonance hovers over each of his chapters because his analysis challenges so many current concepts]. His predictions are dour, because he fears that his solution – that physicians recall what they are actually for and reclaim their place – will be lost as the new doctors trained in these modern ways [Medicine-Men<\/font><\/strong>] take over and the old doctors fade away.<\/p>\n

I share Healy’s alarm [though not all of his gloom]. The way things are now in medicine deserve every bit if his scrutiny and worry. It’s a mess – uninsured people everywhere creating a Caste System for the sick while focusing on taking statins and phosphates to prevent the statistical possibility of future unlikely problems; doctors and patients lost in a tangle between selling products and cost containment, preventive medicine, amazing new devices<\/em>, and deteriorating healthcare. If there’s a conundrum to be found, modern medicine has its foot firmly planted in its midst. Something will have to change – and the direction of that change is not at all clear. But the best tradition of medicine in the face of diseases of unclear origin is to study them carefully, clarifying what can be understood, reformulating questions into increasingly precise packets for future understanding, focusing attention on the essential factors that have been overlooked, grappling with the increasing complexity and ambiguity of the exploration until the time when simplicity is justifed, and making sure that action is curbed until one is sure that the action does no harm<\/em>, now and in the future. By that standard, Pharmageddon is a medical masterpiece<\/font><\/strong>. So, I’m going to read it again [maybe more than once] until the cognitive dissonance finally subsides. Maybe then I’ll be able to do that book review I can’t yet muster. There’s a wisdom in his pages beyond that available on a first sitting…<\/div>\n","protected":false},"excerpt":{"rendered":"

Dr. Healy’s Pharmageddon is one of those books to be read, not summarized. It’s not that it’s filled with new information. He sees what the rest of us see, albeit from the position more interior than most – a neuroscientist who has been embedded in the scene. He writes about the primacy of the pharmaceutical […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_bbp_topic_count":0,"_bbp_reply_count":0,"_bbp_total_topic_count":0,"_bbp_total_reply_count":0,"_bbp_voice_count":0,"_bbp_anonymous_reply_count":0,"_bbp_forum_subforum_count":0,"footnotes":""},"categories":[2],"tags":[],"class_list":["post-19268","post","type-post","status-publish","format-standard","hentry","category-politics"],"_links":{"self":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/19268","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/comments?post=19268"}],"version-history":[{"count":26,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/19268\/revisions"}],"predecessor-version":[{"id":19287,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/19268\/revisions\/19287"}],"wp:attachment":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/media?parent=19268"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/categories?post=19268"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/tags?post=19268"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}