{"id":50537,"date":"2014-10-08T08:00:25","date_gmt":"2014-10-08T12:00:25","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=50537"},"modified":"2014-10-08T12:27:05","modified_gmt":"2014-10-08T16:27:05","slug":"unanswered-questions","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2014\/10\/08\/unanswered-questions\/","title":{"rendered":"unanswered questions…"},"content":{"rendered":"\n

In my home town, there was a 19th century bridge across the Tennessee River. It was designed with bolts that were intended to be tightened and loosened with the seasons, but that never happened. Over a 90 year period, the subtle stresses and strains of seasonal expansion and contraction rendered it unsafe for auto traffic – unfixable. It’s now a tourist attraction as a pedestrian bridge<\/em>.<\/p>\n

The APA’s DSM-III revision in 1980 ultimately lead mainstream psychiatry to an exclusively biological focus and a deep entanglement with the pharmaceutical industry. My primary "dog in this hunt" has been the resulting corruption of the industry sponsored clinical drug trials in our peer reviewed psychiatric literature, and the collusion of the academic KOLs who signed on as authors. But the ‘subtle <\/em>stresses and strains<\/em>‘ from the ensuing three plus decades of inattention to the traditional domains of psychiatry have taken their toll in many arenas, and left the specialty ill prepared for the challenge of a dramatic change in the healthcare landscape and a growing disillusionment with the medication-heavy approach to matters mental.<\/p>\n

Beginning in 2007 when Senator Grassley exposed a number of academic psychiatrists who were failing to report personal drug-company income, there followed a steady stream of revelations of scientific misbehavior and corrupt practices eroding confidence in psychiatry in general. Then, the exit of PHARMA from CNS drug development three years ago took things from bad to worse. The DSM-5 Revision had begun life a decade earlier dreaming of a triumphant transition to a biologically based diagnostic system, but floundered in a desert of non-confirmation – limping to its release barely even revised. Periods of paradigm exhaustion in science are rarely smooth, but this one has been abetted by disillusioning revelations and a reactionary and paralyzed establishment unwilling to deal directly with much of anything.<\/p>\n

Comes now Paul Summergrad<\/a> as an APA President and Saul Levin<\/a> as Medical Director. I know very little about either one of them. Unlike Jeffrey Leiberman, the immediate past president, Dr. Summergrad isn’t part of the identified KOL establishment that has been such a problem and he doesn’t seem to be writing things like Leiberman’s «Time to Re-Engage With Pharma?<\/a>» or «DSM-5<\/em>: Caught between Mental Illness Stigma and Anti-Psychiatry Prejudice<\/a>». Looking over the From the President<\/a> blogs for the last several presidents, they seem to see the future of psychiatry in something called Integrative Care<\/font> or Collaborative Care<\/font>. Just looking at today’s Psychiatric<\/font>News<\/font><\/strong>, there are new things these days: a course for psychiatrists on Recovery Oriented Care [as in the Recovery Movement<\/em> – see the other guy…<\/a>]…<\/div>\n
\n
APA Offers Online Course Focusing on Recovery<\/a><\/div>\n
Psychiatric<\/font>News<\/font><\/strong><\/div>\n
by Vabren Watts<\/div>\n
September 15, 2014<\/div>\n<\/blockquote>\n
an innovative<\/em> and heavily jargoned piece on Population Health… <\/div>\n
\n
Shift to Population Health Called Critical to Psychiatry’s Future<\/a><\/div>\n
Psychiatric<\/font>News<\/font><\/strong><\/div>\n
by Mark Moran<\/div>\n
September 23, 2014<\/div>\n<\/blockquote>\n
And a big president’s blog on Integrative\/Collaborative Care highlighting the APA’s 2014 Institute on Psychiatric Services<\/font> at the end of the month entitled, Integrating Science and Care in a New Era of Population Health<\/a>.<\/div>\n
\n
IPS: Learn About Integrating Care and Expanding Partnerships<\/a><\/div>\n
Psychiatric<\/font>News<\/font><\/strong><\/div>\n
From the President<\/font><\/strong><\/div>\n
by Hunter McQuistion and Paul Summergrad<\/div>\n
September 26, 2014 <\/div>\n<\/blockquote>\n
and it was there last year… <\/div>\n
\n
Collaborative Care: An Integral Part of Psychiatry’s Future<\/a><\/div>\n
Psychiatric<\/font>News<\/font><\/strong><\/div>\n
From the President<\/font><\/strong><\/div>\n
by Jurgen Unützer and Jeffrey Lieberman<\/div>\n
November 12, 2013<\/div>\n<\/blockquote>\n
At least they’ve stopped talking exclusively about medications, the coming magical advances around the corner, and using that tiredest of lines about the global burden of depression. <\/div>\n

All healthcare specialties are currently trying to figure out how to fit into the new world of the Affordable Care Act – adapting their traditional identities to a new set of rules and a new theater of operations. Psychiatry doesn’t have that luxury – more starting from scratch, trying to create a new brand – a consultative identity that is as yet amorphous and very different from medication manager of recent years or the general psychiatrist of the past. It’s hard to see through the upbeat rhetoric what they envision psychiatrists actually spending their time doing, or if the primary care physicians they plan for psychiatrists to collaborate with are interested, or if psychiatrists are interested in filling that particular role. And it’s unknown how [or if] they intend to address the widespread misadventures of their predecessors – those longstanding ignored stresses and strains<\/em>. <\/p>\n

In 1980, the American Psychiatric Association<\/font> was able to effect a dramatic, specialty wide change in practice aided by the pharmaceutical industry and the third party payers who, for different reasons, supported the change. Can the APA bring it off again? …going it alone? Will practitioners follow their lead? Should they follow this lead? All unanswered questions with no guarantees… <\/div>\n","protected":false},"excerpt":{"rendered":"

In my home town, there was a 19th century bridge across the Tennessee River. It was designed with bolts that were intended to be tightened and loosened with the seasons, but that never happened. Over a 90 year period, the subtle stresses and strains of seasonal expansion and contraction rendered it unsafe for auto traffic […]<\/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_topic_count_hidden":0,"_bbp_reply_count_hidden":0,"_bbp_forum_subforum_count":0,"footnotes":""},"categories":[5],"tags":[],"class_list":["post-50537","post","type-post","status-publish","format-standard","hentry","category-opinion"],"_links":{"self":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/50537","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=50537"}],"version-history":[{"count":28,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/50537\/revisions"}],"predecessor-version":[{"id":50566,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/50537\/revisions\/50566"}],"wp:attachment":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/media?parent=50537"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/categories?post=50537"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/tags?post=50537"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}