talkpolitics | Healthcare Delusion: Criminal Insanity in Modern Medicine‏

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In her book on the history of ECT and the patients' rights movement, Linda Andre quotes ECT advocate Max Fink as saying, "We like to think that we know what's best for our patients." This prompted two responses from our students. On the one hand, it comes across as rather priestly. It is the kind of attitude one is likely to encounter in a Roman cleric. On the other hand, it comes across as rather delusional. A scientist would never profess to knowing what is best for someone else. In fact a scientist might have difficulty determining the optimal path for her own life.

I recalled an incident that occurred with a friend who was studying psychotherapy. She made a remark about trying to figure out what made another person tick. I commented that as a psychotherapist, her role would not be to wrap her head around her clients, but to get them to better understand themselves. People like Max Fink make the mistake of losing self-control in an effort to control others.

The Finks of the world promote brain damaging medical procedures under the pretense that these procedures help people. Many of the people who suffer from the procedures regret having gone through the experience. Ms. Andre remarks that had she been given the choice between brain damage and death, she might have selected the latter. The ECT procedure inflicted damage to the point of turning her into a different person than she was before it. It is as if her originally personality had been killed and a whole new personality took over her body.

Another individual who experienced the criminal aspects of the medical field is himself a trained physician. David Healy was attacked for blowing the whistle on medical fraud. He provides some of the details of that attack in his book on his own role in product liability trials. Healy discovered that Eli Lilly was dishonest in failing to inform physicians about certain aspects of Prozac that have caused problems for uninformed patients. Had Eli Lilly been more forthcoming, some dead people might now still be alive and some drug addicts might now be clean and sober. Healy focuses on the sinister practices of Eli Lilly, but he points out that other manufacturers are not completely innocent.

The real criminal insanity went down when detractors, such as Charles Nemeroff, attacked Healy professionally. They defamed him to the point of having him dismissed from an academic position and having his research papers excluded from journals. He was characterized as being a threat to vulnerable patients. If anyone was vulnerable to his analysis, it was shareholders in lucrative pharmaceutical ventures. Misinforming doctors and patients does not protect patients' interests. It can, however, lead to death and substance dependency.

Do you believe that people like Max Fink can possibly know what is best for their patients?

Links: Linda Andre, David Healy and here, TV interview on the Nemeroff/Healy battle, Robert Whitaker on addiction, Peter Breggin on suicide and SSRI drugs.

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From:

dexeron.livejournal.com

Healy's settlement with U of Toronto and CAMH is still undisclosed, iirc, so we may never know exactly why he was "dismissed" (he was offered position and the offer was retracted.) CAMH has denied that the Lilly business had anything to do with it, but who knows? These decisions are made by people, and people can be petty. It's certainly fishy enough to raise eyebrows.

You make one statement that I have to disagree with, at least partially: " A scientist would never profess to knowing what is best for someone else. In fact a scientist might have difficulty determining the optimal path for her own life."

Stepping away from psychiatry for a moment: we can all agree that doctors who deal with physical ailments are scientists who are often far better equipped to determine what is wrong with a patient than the patient him/herself. The doctor can diagnose and prescribe a treatment course that is optimal to cure a disease. Now, obviously there's a line that should not be crossed here; we've all heard of doctors who dismiss patient opinions and reported symptoms because the doctor "knows best". (Far too often those horror stories are held up as reasons to avoid medicine altogether, usually in the promotion of some worthless - but profitable - alternative.) For the most part, though, we're right to trust in medical doctors when it comes to making decisions on our behalf.

I can't see it being far different when dealing with psychiatry: yes there are abuses, but at the end of the day these are scientists who are trained and educated to be in the best position to know what is best for someone else. That's their job. It doesn't mean there aren't bad apples, and there might even be the elements of corruption some argue exist, but ultimately we're talking about educated vs. uneducated judgements. A scientist can absolutely know what's best, even for someone else, provided that we're talking about a field in which that scientist is an expert.

And whether or not a scientist has difficulty in his/her own life has little bearing on their ability to diagnose/treat others.

From:

sophia-sadek.livejournal.com

There is now something called "informed consent" which is practiced much more by general practitioners than by psychiatrists. If a patient does not consent to an invasive procedure, a physician generally honors that wish. If I go to a general practitioner with a viral infection, she may prescribe antihistamines to relieve the symptoms, but she will not contend that the treatment is anything other than one that affects symptoms. She will admit that she has no way to stop the viral infection. Also, a physician who prescribes chemotherapy as a cancer treatment will inform a patient about the risks involved and the possibility that the treatment will not work. This basic aspect of medical practice is one that psychiatrists avoid like the plague. There is an assumption that patients are too "irrational" to understand such information and act on it appropriately. This denies the humanity of the patients.

The case of Healy and Nemeroff is especially of interest because it shows how some psychiatrists seek to keep information from other psychiatrists and general practitioners. The same dehumanizing approach was taken by Nemeroff to attack the validity of Healy's presentation as psychiatrists use to misinform patients.

From:

dexeron.livejournal.com

Absolutely. It's terrible that many practitioners seem to have this attitude that patients are too irrational to make informed decisions about their care. The word you use is perfectly apt: dehumanizing. And it has pretty far-reaching consequences for trust in the medical field, the uninformed use of useless (or harmful!) alternatives, and general distrust of experts by those who need their opinion the most. Also, the attitude had led practitioners to ignore complains or symptoms by patients (meaning harmful side effects are sometimes written off or handwaved!) So you've got some valid points there too. I don't know all the specifics of Healy, but I hate hearing about situations where personal politics and investment (not just monetary, but perhaps emotional!) trump science and fact. Dunno if that's exactly what happened in Healy's case, but it certainly has happened before, and it's kind of horrible.

Anyway, while I'm pretty firmly of the opinion that the bad apples you describe are the tiny minority, I can understand why some folks are more distrustful, and part of that IS the fault of practitioners who treat their patients like helpless children. It's pretty terrible, and responsible for actual patient harm (directly through refusal to consider patient testimony or indirectly through driving patients to unsafe alternatives.)

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Healthcare Delusion: Criminal Insanity in Modern Medicine‏