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The New York Times reported yesterday that many of the authors of the DSM-IV, the sine qua non diagnostic manual (I’m 300.00, thanks for asking) for mental health professionals had ties, either before or after their involvement in creating the manual, with the pharmaceutical industry. The implication being that there was something wrong with this.

Now, I realize there is a potential conflict of interest here. But don’t we want the DSM consulting people who know about drugs that can treat mental health problems? And don’t we want drug makers consulting experts on mental health? How do we keep the last two without falling into the dangers of the first?

Discuss!

Comments

  1. #1 IndianCowboy
    April 21, 2006

    Don’t know how involved with the psych establishment you are. My experience has eben that of an outsider who studied in related fields (neurobiology first, then evolution of human behavior in graduate school). I’ll be going onto psych in 3 years when i’m finished with med school.

    One thing you learn is that a lot of psych meds are touted as cures when they are really just symptom reducers. Now, personally, if I’m a Big Pharma rep, would I rather have a person come back every month for 10-30 years for their pills? or have them go through the ‘talking cure’ and maybe only use my pills for a year?

    And if I were a fully informed patient, would I want to be alleviating symptoms for 10-30 years? or rooting out the cause of my mental health woes?

  2. #2 Lee Billings
    April 21, 2006

    I think IndianCowboy’s on the right track.

    In short, yes, we want experts in these medications to be the ones telling us how to use them.

    But I think the real question is: Why are we being told by anyone that popping a pill every day for the rest of our lives is the best way to treat a mental illness? Could it have anything to do with the business models that Big Pharma has developed?

    That’s the real conflict of interest – most of the pharmaceutical industry is built around selling products, not curing illnesses.

    I addressed this a little in my earlier post about cannabis as a potential treatment for multiple sclerosis.

    In my opinion, perfectly valid and useful treatments for several illnesses are being overlooked, despite the fact that often these overlooked treatments have fewer adverse side effects than Big Pharma’s solution.

    Look at ayahuasca as a treatment for alcoholism, for instance. There are decent clinical results (mostly from work done by Charles Grob and Dennis McKenna in Brazil) that indicate it’s a therapy with a high success rate. But the “trouble” is, you often only have to do it once or twice to exhibit long-term beneficial effects, which totally breaks Big Pharma’s business model.

  3. #3 paultullis
    April 21, 2006

    We may be being told by anyone that popping a pill every day is the best treatment because, in fact, it is the best treatment. Not everything is a big conspiracy theory by evil corporations. My understanding is that there are some patients who have what is known as a chemical imbalance which pharmaceuticals are essential at alleviating, whatever therapy regimen they may be undergoing or Amazonian wonderdrug as may exist. In fact I’m personally acquainted with loads of people who have been helped by these drugs, which perhaps says more about the kinds of people I hang out with than anything else.

  4. #4 Lee Billings
    April 21, 2006

    I like having it both ways. It’s not as simple as an “either/or” dichotomy when it comes to treating mental problems.

    I don’t think antidepressants and antipsychotics and other similar medications are bad. And I think for some patients, they are the best treatments. But not necessarily for all.

    Anecdotal story: In college I lived next door to a poor guy named Pete. He was a bit of a sociopath – whether that was due to “chemical imbalance” or traumatic childhood or something else entirely, I have no idea.

    To make a long story short, he started taking Paxil. The effects were quickly noticeable. He slept a lot more and became less social. His “peaks” and “valleys” of behavior, his highs and lows, were flattened out into one dull plateau. He spoke in a monotone, and he gained in excess of 40 pounds in 2 months. He seemed pretty miserable, and arguable worse off than before.

    Soon after, he dropped out of school and I lost track of him.

    I’m acquainted with a good number of people who are also helped by these drugs, but I’ve also been acquainted with people who have reacted very, very badly to them. And in those cases, I wonder if there isn’t a better way.

  5. #5 tgibbs
    April 21, 2006

    It is worth noting that psychological problems are frequently chronic, whether or not pharmacotherapy is used or not. Even those who use “talk therapy” (which for many conditions has statistical efficacy comparable to drugs) frequently end up in long-term relationships with their therapists. So rather than some conspiracy of pharmaceutical companies to withhold cures (and wouldn’t these supposed cures occasionally fall into the hands of a company without chronic treatment drug revenue to protect?) isn’t it more plausible that nobody really knows how to cure these psychiatric ailments?

  6. #6 IndianCowboy
    April 21, 2006

    paultullis et al, visit my blog and click on ‘psych’ to see some of the lack of science that currently infests psych.

    this post is probably the best overview of knowledge about the brain that hasn’t been incorporated into psych theory and practice

    I’m not denying the ability of many of these drugs to treat symptoms of psychiatric illness effectively. And unfortunately in some cases that’s all one can do (schizophrenia, some forms of bipolar, etc). But in many other cases, we more or less know that there are behavioral or cognitive issues behind the ailment, yet it’s a-pill-popping we go.

    Symptom management is all fine and good but I certainly wouldn’t tell my patient I”m curing them if all I’m doing is covering up their symptoms (which unfortunately is what a lot of the psych community appears to be doing). Furthermore, I woudln’t consider a patient cured if they’re still undergoing treatment.

  7. #7 blader
    September 8, 2006

    Would you mind sharing with us the name of a single drug that is known to cure a psychiatric illness?

    For that matter, with the exception of antibiotics and infectious diseases, what drugs out there can, in fact, cure ANY disease?

    Of course, the answers are none and very, very few. And if you omit the word ‘cure’ from the lexicon of cancer, which is what we now do clinically, the number of drugs that cure disease becomes vanishingly small.

    That is not a pharmaceutical industry conspiracy. That is just the way the field of pharmacology has evolved. And one has to question the qualifications, or at least the class attendance habits, of any med student who doesn’t understand that.

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