J. Wesley Boyd, MD, PhD

To think that individuals are completely separate from one another, unmoved or unaffected by our connections to others, is almost always simple minded.  Although theoretically such a notion might be neat and tidy, it neglects the obvious fact that we are intimately tied to those persons we care about and and love.  Furthermore, we are also connected to those we know and care about and, by extention, countless others.  Turning away from this fact does not negate its veracity.  This basic truth has significant social, political, and psychological ramifications.  I ask:  are we, individually or collectively, ready to embrace this obvious fact and accept its implications and consequences?

The diagnostic manual in psychiatry is currently being rewritten.

Given the conflicts of interest among past authors of the psychiatric diagnostic manual, the psychiatrists who are currently in the process of creating a new diagnostic manual have pledged to limit their income from the pharmaceutical industry to $10,000 or less per year until the completion of their work on the manual.  They did so because of the perception that the authors of the previous versions of the manual have had close ties to the pharmaceutical industry and therefore might have been biased toward creating labels and diagnoses that would serve to benefit the pharmaceutical industry.

After all, pharmaceutical companies market drugs to treat these “illnesses.”  The more illness there are, the larger the potential market for drugs . . .

Although it is nice that the manual’s authors will limit their income from industry during the time they work on the diagnostic manual, several questions remain:  Will anyone question the manual’s authors’ self disclosures and/or investigate their actual income from such sources?  Secondly, even if the authors personally adhere to the self imposed limits, how much pharmaceutical funding is being funneled into the authors’ respective departments by way of lectureships, endowed chairs, or sponsored research?  For example, some of the authors chair departments of psychiatry that collectively receive substantial sums of money annually from pharma.  Furthermore, given that many of the authors have received substantial payouts in the recent past from industry—and are free to do so again after the manual is published—is there any question that their judgment might be influenced by their past pharmaceutical payouts or the possibility of more in the future?

Why is this significant?  Apart from what these diagnoses potentially mean for the pharmaceutical industry or the insurance industry—which in part bases payment for treatment upon the diagnostic label used–labels carry with them power, especially when they are couched in scientific terminology and possess an air of objectivity. 

I hope to explore the dynamics of power in future posts

Although I completely empathize with those who want to turn away from a pharmaceutical industry that relentlessly markets drugs as panaceas and goes so far as to create “illnesses” almost out of thin air in order to market drugs to cure them, the reaction of embracing everything marketed as “natural” or “herbal” is misguided.

Isaac Newton (via his Third Law—a bit paraphrased) and others remind us that anything that has the possibility of helping us can also harm us.  Merely being “natural” confers no inherent safety.  That means that herbal treatments, acupuncture, homeopathic remedies, and anything else that can claim to be “all natural” is not guaranteed to be free of side effects.  I’ve seen people made anxious and irritable by herbal treatments and people wind up in psychiatric emergency rooms after receiving acupuncture treatments.  (Just to make sure the allopathic folks aren’t gloating right now:  I’ve seen as much and worse in folks who’ve taken psychiatric medications.)

Still clinging to the notion that being natural means being safe?  Our two biggest killers, tobacco and alcohol, are in and of themselves perfectly natural substances.

Not only are they not inherently safe, but natural treatments aren’t necessarily efficacious.  Therefore to claim, as some have, that because many herbal treatments are centuries old their efficacy is obvious, is specious.  Slavery and the oppression of women—to name just a couple of centuries old traditions–also have been around for eons but that certainly doesn’t mean that they are correct, true, ought to be embraced, or are beyond scrutiny.

Torture is wrong, regardless of the justification given for it and irrespective of whether a case is made that what’s happening is not torture.  Doctors, especially, need to refuse to participate in torture in any way, shape, or form.  And they need to go even further and work to prevent and prohibit torture in any form.

Want more?  See:  http://www.youtube.com/watch?v=9H4fKgAF13ECheers.

No availability, long waits, no response to phone messages.   And this in Massachusetts which mandates that everyone have health insurance.  If it’s this hard to find a psychiatrist in a state that mandates coverage, imagine what that means for folks in other states.

Please see:

http://www.medscape.com/viewarticle/746935

for details . . . .

Health Care Blues

            Imagine the following exchange on the phone:

“Is this 911?”

“Yes.”

“I have an armed intruder in my house.  Please send the police right away.  I’m afraid he’s going to kill us all.”

“I’m sorry.  From our database, I see the household you are calling from does not have anyone who is employed and therefore you are not entitled to police protection.  You’ll have to fend off the intruder yourself. Bye.” (Click.)

Or imagine this scenario, which might hit a bit closer to home for those of us who have a family member who is employed:

“Is this 911?”

“Yes.”

“I have an armed intruder in my house.  Please send the police right away.  I’m afraid he’s going to kill us all.”

“I see from our database that your employment provides you with our Best Blue  police coverage.  Best Blue is a wonderful protection plan.  We will be able to send an officer out just as soon as we receive your credit card number for your $10  copay.  Also, once the officer arrivees–assuming your credit card payment is approved by Mastercard–he will be able to use his revolver to stop the intruder but not his shotgun.  You’ll have to pay the full cost of shotgun coverage yourself.  With the Blue plan, the officer can pursue a suspect on foot free of charge to you, but if the officer needs to pursue in his cruiser, you would have to foot (I’m so sorry for the pun) that bill yourself.  Also, we would not be able to provide you with the aerial support that we provide our Gold members but, don’t worry, almost nobody needs that kind of service.  And finally, as it states on page 28 of your coverage manual, Blue coverage does assume you are at least a Brown Belt in Karate, so that statistically you would be able to fend off intruders half of the time by yourself . . .”

Sounds pretty bizarre, right?  But we Americans accept the same reasoning all of the time with respect to our health care coverage.  And it’s going to get even more interesting— and that’s a euphemism—once national health reform is fully implemented.

Why is that?  Because the simplest and fairest and most ethical and least costly option for health reform, namely single payer national health insurance, is not the law of the land.

For more see:  pnhp.org

Steven Pinker says that the level of violence we are currently exposed to is less than ever in history.    The chances of being murdered or killed in war or the victim of an assault are far lower now than they were in any previous era and the conclusion is clear:  our age is far safer than any that has preceded it.

So why do so many people feel targeted, feel like they are in the crosshairs of  disease or fate or terrorist attacks or so many other potential sources of pain  from without?  Because it’s easier to look outside ourselves for threats to our well-being than to look within at the biggest threat, namely things we do to ourselves willingly day in and day out.

Exactly what am I talking about?  Cigarette smoking kills a minimum of 400,000  Americans every year.  Poor diet and lack of exercise take out another 300,000 people nnually.   So why all of the hype about bad lettuce (last year it was pistachios, by the way), sharks, earthquakes, terrorists, and so many other things that are almost definitely NOT going to kill you? Because tobacco, bad driving, and virtually all of the other things likely to actually kill any one of us are, alas, boring.

For a similar discussion, see my piece at Time.com from 2001 after the anthrax attacks:   http://www.time.com/time/nation/article/0,8599,180457,00.html