Fuck Doctors

[slomo]

^^^I'm glad you are graciously accepting criticism because it can be uncomfortable to point it out, especially when your intentions are well-meaning and I'm not even sure this is what C2W means.

But I do know that I have hurt people in the past by being too honest. As a matter of fact it happened last night. Some friends just bought a new house and spent a lot of money redoing floors, rearranging walls, etc., and the result was beautiful, but the first thing I noticed was a lack of art on the wall and blurted it out! I felt really bad afterwards, because what I meant to say is that it was so beautiful that the lack of artwork to finish it off was something that now stood out. Really small example and nobody was traumatized, but it illustrates what I mean about how we are sometimes insensitive without meaning to be.

[Iamwhomiam]

It saddens me to see two well meaning posters talking about the "patient" as though he were not present.

I should hope that in the future this back and forth banter, which cannot be helpful to anyone, especially a certain someone, should take place via pm.

Too insensitive and non-supportive, imo.

[slomo]

It saddens me to see two well meaning posters talking about the "patient" as though he were not present.

I should hope that in the future this back and forth banter, which cannot be helpful to anyone, especially a certain someone, should take place via pm.

Too insensitive and non-supportive, imo.

I think it's important to have the conversation out in the open so that, regardless of the awkwardness of our mistakes and inadvertent insensitivities, Hammer knows that we are all concerned for his well being and are supportive of whatever his decision is in a very difficult situation. Which I'm sure he knows already (Hammer? please chime in if you feel the need...) but it's worth saying so anyway.

C2W, Eyeno, and I (and others) each have our perspectives on pharmaceutical use, the social forces that dictate medical practice, and how to demonstrate concern for a fellow human being, but it seems clear to me that we all care. And it's worth being public about that.

[eyeno]

Inherent problem in internet communication. Words in black and white carry no smile, body gesture, facial expression, voice inflection, etc.... It is very sterile. Miscommunication is rampant.

Add to that the differences in "style" generated by geographical differences and culture, word usage, slang expressions, and life experiences, filtered through our own experiences and the internet forum is a fertile ground for misunderstandings.

A wise person once told me "you get what you represent." While I see the value in this statement it is not 'always' true. But generally speaking it is true to a large degree.

Other peoples reactions, to our actions, are often a mirror of our actions or output. Our output generates input from others. If the input we receive is negative it is a good sign, but not fool proof, that our output may be flawed, and that we may not be "using language precisely" to paraphrase the wombat. Even when used precisely it may not be filtered correctly by the reader.

I am the last language expert on the planet but I refrain from attacking the messenger. I prefer to deal with the message. I don't do it as well as slomo but I aspire to be so graceful, even though woefully lacking.

When my input stream contains, "your contribution is bullshit, dangerous, you should know better, blah blah blah blah" it provides no form of communication that carries useful data or meaning to my brain. Its an opinionated attack phrase. I don't come here for this. I come here to relax and have fun. This sort of thing makes me want to log out and never return, ever. There are contributions that I don't make to this forum because I know they violate certain peoples hobby horses and that I would have to spend several posts defending against brow beat.

We could all take a lesson from slomo, probably especially myself.

[compared2what?]

Some people find taking them valuable, whatever the class of controversial drug we're speaking of, c2w?. Without question. But, see, that might not be as important a point as you've make it out to be [here and elsewhere]. Let me try to explain why I think that.

The reason "some people" can benefit from Big Pharma products, of course, is because those products are on the market, and they're only on the market because the drug companies were successful at bringing them to market, and they are successful at bringing them to market because the often-quite-negative side effects the drugs have on a portion of those on whom they were tested, have been effectively "managed" [by being elided, diminished, obscured, or downplayed in a variety of ways, often including out-and-out lying on the part of drugs reps to doctors, and lying on the part of companies to their drug reps, and/or those negative aspects of the drug being buried under 'false hype', and the like]. This is a wide-ranging, if not ubiquitous, feature of the system within which these drugs are brought to market. The atypical neuroleptics are not alone in this respect.

No. They're not alone. But I've got to say that if medications that cause unknown, unpublicized dangers are "ubiquitous," I'm not aware of it. (And if you think about it for a moment, how could I be?)

I am aware of the very widely publicized dangers of a small number of psychotropic medications, some of which are real and some of which are alleged. Because just about everybody is. To the point that resistance and/or condemnation is pretty much the baseline response to any and every mention of them, both at the mass-media level and (as far as I've observed) IRL.

And...Let me think. In the alleged category, I'm also aware of the very widely publicized dangers of vaccines, as is everybody else. And the very widely publicized dangers of flu shots, as is everybody else. And maybe a few others, too.

In the criminally-marketing-meds-without-mentioning-they-kill-and-damage-people category, Vioxx and Phen-Fen are the only two that have really been widely publicized that are springing to my mind right now. I mean, there have certainly been other withdrawn drugs the potential dangers of which were concealed by their makers.

But since they aren't numerous enough to call the phenomenon ubiquitous and weren't widely publicized, they don't really alter the equation towards the outcome of which I'm working here either way. That outcome being:

It's neither meaningfully correct nor true to say that the dangers of pharmaceutical medications are regularly elided diminished, obscured and downplayed if what you mean by it is "There's tons and tons of persuasive evidence that pharmaceutical medications offer few benefits and are rife with concealed danger, and that's just the state of play."

So. Just to recapitulate.

I think it's correct, true, fair and accurate to say that Big Pharma is capable of lying, cheating and killing to make a buck, and that the FDA doesn't give enough of a fuck about that to put any institutional obstacles in their way.

That's criminal and despicable. But it has the real properties and dimensions that it has. And confounding that does more to help than to harm them. Speaking of costs and benefits, as you're about to when I carry the rest of your quote into my very next post.

Cheers to ya, bks.

[compared2what?]

All of which means that the benefits some people find in taking them will come at the cost of consigning others [and often many others] to rather horrible outcomes which they have not been properly warned about [it is another matter whether warning them would necessarily make them safer or allow them to avoid the bad outcomes. The evidence is far from clear that it would, but let's leave that for now]. That is a considerable cost for allowing those who will benefit form the drug to benefit from it, wouldn't you say? And let's be clear: within the current system, protecting the benefit those "some people" get often virtually entails the negative outcomes to those improperly-warned others.

I don't actually understand how a sick person who received a medical benefit from taking a drug would be consigning many others to a horrible outcome. I mean, if the warnings are improper, the fault lies with those responsible for the impropriety, not with the properly warned. Right?

Besides which...I don't know. What are you saying here, bks? Do the benefits that some people find in drinking alcohol, smoking pot or taking entheogens come at the cost of consigning others to horrible outcomes? Because doing all three of those things can and does lead to horrible outcomes for some percentage of the people who were expecting a benefit going in. Reliably, you could even say.

Alcohol much more than the other two, obviously. But still. How is your argument any different than that? What am I missing here?

I'm not arguing, of course, that the pharmaceutical industry is alone among major institutions w/r/t this feature.

Oh. Well, that takes care of the alcohol thing, I guess.

You admit the atypical neuroleptics were "pushed through with shitty trials and released with a whole tsunami of completely false hype," which I'll take your word for. The bigger point - the one I haven't heard you make, or which I may have missed - pertains to the system, and not any one case within it. To paraphrase David Healy, the problem is that the system of industry-based pharmaceutical testing, and not this or that particular set of trials, does not conform to the norms of science. The pharmaceutical companies control the data they generate. They control [or greatly influence] the manner in which the papers interpreting that data are written up, and which purport to provide the scientific basis for the proper prescription and use of the medications in question. They control the major journals in which the data is published. And they understand that the bottom facts about the substances will not come out unless there is a court trial several years after they've made their hundreds of millions if not billions, and perhaps not even then.

I've never made that point because I've never needed to. It's an important one, though. But the whole thing (ie -- all vile misdeeds and shortcomings in the medical/healthcare arena) is a huge HUGE conglomeration of systemic problems, imo.

That's actually one of the reasons I object to the constant focus on the evils of pharmaceutical medications, to be honest with you. It's not like it's accidental that all the most enthusiastic and prolific disseminators of that line of argumentation are heartily supported by groups like Phyllis Schlafly's Eagle Forum and the Association of American Physicians and Surgeons ("founded in 1943 to fight socialized medicine") and....Hmm. There's another one, too. But I can't quite seem to put my finger on it.

In any event. It's not like it's accidental that all the most enthusiastic and prolific disseminators of that line of argumentation are totalitarian extremists looking for a weak and dependent populace to control. They know an Overton Window when they see it. They're gunning for your access to healthcare. By any means necessary.

And it's working. People are a whole hell of a lot more hostile to professional medicine than they were twenty years ago. After all. Ever stop to ask yourself how that came about? Because there's more than one force at work there. But I think it's fair to say that propaganda didn't have nothing to do with it.

That's the big picture, as I see it.
_________________

Oh! Hey! I just remembered something. I'll be right back if I can find a reference for it.

[slomo]

^^^^ C2W, I agree in part with your analysis of the political forces that are fighting against socialized medicine, but there are equally powerful forces (a weird coalition of insurance and pharmaceutical companies the nature of which I do not completely understand) that would like to make access to healthcare a very coercive endeavor that involves mandated treatment for certain maladies and conditions, as well as involvement in a variety of intrusive programs that seem on paper to be about wellness promotion but under the surface are more about building a system that can surveil behaviors and then issue corresponding financial penalties for "unhealthy" lifestyles. In some environments smokers already pay higher premium contributions for supposedly employer-sponsored healthcare - a precedent that as a reasonably fit, non-smoker, healthy gay male I find somewhat chilling, for obvious reasons.

[compared2what?]

FWIW, this goes to the cost-benefit thing, but in the other direction -- ie, you could say that while demonizing psychotropic medications without qualification may be of benefit to some people, it consigns others to a horrible outcome.

Also, I'm a little surprised to find it online. I heard about it from someone who knew it through professional connections, but haven't ever seen it broadcast anywhere in any medium.

• SZASZ SETTLES SUIT FOR $650,000
  
  Thomas Szasz, M.D., psychiatrist and
  longtime critic of involuntary treatment,
  agreed to pay $650,000 to the widow of a
  fellow psychiatrist who committed suicide
  after Szasz suggested that he discontinue
  taking lithium, according to records of
  the complaint recently made public.
  
  Agreed to this spring, the
  settlement was not formally filed until
  August. The terms of the settlement
  decreed that no voluntary publicity be
  sought by either side, and attorneys for
  both sides agreed to respond only after
  direct inquiries by PSYCHIATRIC NEWS.
  
  PSYCHIATRIC NEWS was able to obtain
  a copy of the complaint and terms of the
  settlement from the Onondaga County
  Clerk's office, and Szasz, who at 74
  remains a prolific author and lecturer,
  has written frequently about the proper
  context for a therapeutic relationship.
  
  Szasz, best known as the author of
  THE MYTH OF MENTAL ILLNESS, has long
  maintained that mental illness is a
  misnomer, and there is no firm evidence
  of underlying, organic causation of
  behavioral disorders. Rather, according
  to Szasz, such disorders are
  manifestations of the free will of
  individuals who choose to behave in ways
  deemed unacceptable by the rest of
  society. Szasz has further argued
  repeatedly that since there is no
  evidence of underlying organic causation,
  it makes no sense to give people powerful
  drugs such as lithium and that use of
  such drugs represents not therapy, but
  pharmacological coercion.
  
  "Unlike Nazi psychiatrists,
  democratic psychiatrists do not literally
  kill their patients. They kill them
  metaphorically, by incarcerating,
  shocking, and drugging them," writes
  Szasz in his most recent book, CRUEL
  COMPASSION: PSYCHIATRIC CONTROL OF
  SOCIETYUS UNWANTED (John Wiley Sons
  Inc., New York, 1994).
  
  (Photo of Szasz with following caption:
  "Thomas Szasz, M.D., believes that the
  free market in mental health services has
  effectively been abolished.")
  
  Szasz further argues in the same
  book that the free market in mental
  health services has effectively been
  abolished. "The reason is simple.
  Market relations imply the renunciation
  of the use of force. But unless the
  psychiatrist is willing to run the risk
  of being sued for malpractice, he can no
  longer assume this posture. Today,
  psychiatric practice, both in the office
  and the hospital, rests on the premise
  that it is the therapist's duty to
  protect the patient from killing himself
  or others, by force if necessary. The
  result is that the patient, his
  relatives, and the psychiatrist are
  enmeshed in a relationship that is,
  actually or potentially, coercive.
  Specifically, the therapist coerces the
  patient he deems to be 'dangerous to
  himself or others,' by incarcerating him
  in a mental hospital; reciprocally, the
  patient who 'threatens' to kill himself
  or others coerces the therapist, because,
  if he carries out his threat, his
  relatives or his victims can sue the
  psychiatrist for malpractice. The milieu
  for market relations has thus been
  destroyed."
  
  According to the public record,
  Michael Klein was a patient at the
  Benjamin Rush Center from April 12, 1990,
  through May 9, 1990, under the care of
  Yasser Zikry, M.D. Zikry was treating
  Klein for bipolar illness and prescribed
  lithium.
  
  Klein purchased a prescription of
  lithium shortly after his discharge on
  May 9, 1990, and commenced taking the
  medication as prescribed at about that
  time, the record shows. About two weeks
  later, on May 24, 1990, Klein sought care
  from Szasz. He continued to see Szasz
  through December 9, 1990, visiting him
  approximately 27 times during this
  period.
  
  Klein's death at age 49 left his
  wife, Hilde, and two sons, Eric, then age
  16, and Daniel, then age 13, without any
  means of support.
  
  The complaint states that early in
  the course of treatment, "on or about
  June 14," Klein, "pursuant to the
  instructions and advice" of Szasz,
  stopped taking the lithium.
  
  But according to Szasz's attorney,
  Terrence Connors, J.D., of Connors and
  Villardo, Klein stopped using lithium
  prior to consulting Szasz.
  
  "Extrinsic evidence was produced by
  the defense to establish that Dr. Klein
  discontinued the use of lithium on his
  own initiative before he ever consulted
  Dr. Szasz," Connors told PSYCHIATRIC
  NEWS. "The result after that information
  was discovered and disclosed was a
  settlement of a disputed claim. And Dr.
  Szasz did not concede in any way that he
  committed malpractice."
  
  Hilde Klein's attorney, Victor
  Mazzotti, J.D., of Martin, Harding, and
  Mazzotti, said that despite the
  settlement, he and his client believe
  that "the evidence would have supported
  the plaintiff's allegations. We felt
  that the evidence would have shown that
  Dr. Klein's cessation of lithium therapy
  was based on Dr. Szasz's advice. We
  stand by the allegation that the evidence
  would have shown that he failed to
  provide psychiatric care in conformity
  with the customary and accepted standards
  of medical care prevailing."
  
  On December 17, 1990, Klein
  committed suicide by hanging himself with
  battery cables.
  
  The complaint asserts that "the
  negligence and medical malpractice of the
  defendant" consisted of "carelessly and
  negligently" failing to provide
  psychiatric care and treatment "in
  conformity with the customary and
  accepted sound standards of medical care
  then and there prevailing."
  
  The record further states that Szasz
  failed to diagnose and treat Klein's
  condition properly, failed to keep
  adequate records, and "failed to
  establish, follow, or provide proper
  accepted psychiatric practice for the
  treatment of patients, such as the
  decedent, which would have resulted in
  the making of the correct diagnosis and
  the proper treatment of the decedent's
  condition."
  
  The final settlement stated that
  Professional Risk Management Services
  (PRMS) would pay $650,000 to Hilde Klein.
  As a member of APA, Szasz was eligible
  for the PRMS insurance coverage available
  to all APA members.
  
  As part of the final settlement,
  Klein agreed to withdraw the "conscious
  pain and suffering cause of action"
  alleged in her initial complaint against
  Szasz. --R.B.K.

_________________

Szasz's little denial of responsibility/malpractice in there is par for the course in a settlement situation. So I have no opinion wrt its truth or falsity, one way or the other. But even without that, I don't think it's a stretch to say that the late Dr. Klein paid a very high price for whatever benefit others might have gained from the unyielding denunciation of psychotropics as useless and evil. And he's not the only one. He's not necessarily even the only one who....

Well. Never mind. There's no real way of knowing how commonly that occurs due to the withdrawal of meds due to principled opposition on the part of the therapist. Insurance covers it, so it's usually settled without leaving a public record.

So take it at whatever value you think it's worth, I guess. It matters to me. But that's just me.

[compared2what?]

^^^^ C2W, I agree in part with your analysis of the political forces that are fighting against socialized medicine, but there are equally powerful forces (a weird coalition of insurance and pharmaceutical companies the nature of which I do not completely understand) that would like to make access to healthcare a very coercive endeavor that involves mandated treatment for certain maladies and conditions, as well as involvement in a variety of intrusive programs that seem on paper to be about wellness promotion but under the surface are more about building a system that can surveil behaviors and then issue corresponding financial penalties for "unhealthy" lifestyles. In some environments smokers already pay higher premium contributions for supposedly employer-sponsored healthcare - a precedent that as a reasonably fit, non-smoker, healthy gay male I find somewhat chilling, for obvious reasons.

Yes. I do too.

But that makes accuracy and discernment more important, not less important.

Honestly, slomo. I think that if you read what I've said on this subject without preconceptions, you won't exactly see me cheerleading for the scientific validity of psychiatry or the efficacy of psychiatric treatment under all circumstances, come what may.

I wouldn't be surprised if you'd formed another impression. And neither would I blame you for it. Because a lot of that shit has gotten projected my way so repeatedly that I've sometimes idly wondered whether it was being done methodically.

But that notwithstanding: I'm not a booster for those interests. I never have been. And I'm a woman of strong opinions, it's not like that's the kind of thing I'd be likely to get confused about.

I just try to keep my eye on the ball, that's all. And I really do strongly object to the thoughtless demonization of medications that are -- like it or not, and I personally do not -- the only thing keeping a large, underrepresented, very vulnerable part of the population alive.

Incidentally, one reason I don't like it is that it's not fucking good enough to just keep people alive (though possibly hampered or even sidelined by unpleasant side effects) and call that medical care. But there are others. Believe it or not.

ON EDIT:

Sorry, I forgot to say:

In some environments smokers already pay higher premium contributions for supposedly employer-sponsored healthcare - a precedent that as a reasonably fit, non-smoker, healthy gay male I find somewhat chilling, for obvious reasons.

I'd say that one's actually another iteration of the same thing I described -- ie, blaming/demonizing/partitioning people who require costly, long-term care. It's worth bearing in mind that most psychotropics aren't big money-makers. And none of them are once they go off patent. Prozac was huge, and it opened up a much bigger market for SSRIs. But nobody's getting rich off of any of them at this point. I believe that....Risperdal? Seroquel?...I can't remember. Anyway. One of those drugs is still on patent and therefore still being hyped to the max by whoever still stands to gain by investing in that. Or at least it was, the last time I checked it, which was within the last year. But even in that case, it's not like a bread-and-butter drug for whoever makes it. So. Pharma's not interested in making psychotropic medications mandatory for some subset of the population. It just wouldn't be profitable enough for them to care.

Which is not to say that they and others don't make money off the over-prescription of commonly over-prescribed psychotropic medications. They do. Plus, they and their insurance-industry cronies are slowly eliminating general access to all other (more costly to reimburse) forms of psychiatric treatment by making meds the standard. So they kind of get to kill two birds with one stone.

[slomo]

Well, OK, you've succeeded in showing that healthcare in the US is a very complicated game involving a number of players with complex and vastly different motivations, and there is no one-size-fits-all approach to the issue. Which is reasonable, and a statement with which I wholeheartedly agree.

I think the basic issue here - again I could very well be wrong - is that while the general public understands the motivations of political forces that seek to deny healthcare entirely, there is less appreciation for the extent to which the entire healthcare industry is trying to build a system that is coercive and punitive so that certain players can optimally profit from the suffering of others (which is not entirely inconsistent with the former dynamic, obviously). This second issue is something that RI regulars have their antennae up about, since we tend to focus on the more hidden dimensions of reality. I don't think people are misunderstanding your position (I certainly am not, in all its complexity) but I would guess that they are hearing you downplay the second aspect in order, perhaps, to give voice to the former. Or something like that.

These issues come to a head in psychiatry because the problem of informed consent is so murky. Is resistance to medication evidence of illness that if left untreated has dangerous consequences? Sometimes. Is an insistence on medication a desire to profit over another person's social misfortune, physical consequences to the unlucky individual be damned? Sometimes. Every case is different. I don't think you would disagree with this sentiment.

And I am certainly not adverse to your desire for greater discernment and more careful language. But not everybody has your writing skills.

[MacCruiskeen]

SZASZ SETTLES SUIT FOR $650,000

I just try to keep my eye on the ball, that's all. And I really do strongly object to the thoughtless demonization of medications that are -- like it or not, and I personally do not -- the only thing keeping a large, underrepresented, very vulnerable part of the population alive.

Incidentally, one reason I don't like it is that it's not fucking good enough to just keep people alive (though possibly hampered or even sidelined by unpleasant side effects) and call that medical care. But there are others. Believe it or not.

Thanks for this, c2w, and for all your contributions to this thread, I didn't know that about Szasz's fine, but it doesn''t really surprise me. I picked up one of his later books recently and put it down again very quickly. It is is amazing how an originally humane impulse can harden into a callous habit, or how an intelligent insight can become an obstacle to thought.

[slomo]

I'd say that one's actually another iteration of the same thing I described -- ie, blaming/demonizing/partitioning people who require costly, long-term care. It's worth bearing in mind that most psychotropics aren't big money-makers. And none of them are once they go off patent. Prozac was huge, and it opened up a much bigger market for SSRIs. But nobody's getting rich off of any of them at this point. I believe that....Risperdal? Seroquel?...I can't remember. Anyway. One of those drugs is still on patent and therefore still being hyped to the max by whoever still stands to gain by investing in that. Or at least it was, the last time I checked it, which was within the last year. But even in that case, it's not like a bread-and-butter drug for whoever makes it. So. Pharma's not interested in making psychotropic medications mandatory for some subset of the population. It just wouldn't be profitable enough for them to care.

Which is not to say that they and others don't make money off the over-prescription of commonly over-prescribed psychotropic medications. They do. Plus, they and their insurance-industry cronies are slowly eliminating general access to all other (more costly to reimburse) forms of psychiatric treatment by making meds the standard. So they kind of get to kill two birds with one stone.

I am looking at a much longer trajectory, in which the concept of Against-Medical-Advice could be used as a cudgel. The infrastructure is slowly being laid, along with the corresponding indoctrination, for tracking minute health decisions and using them as a way to deny care or extract higher premiums, or even worse. Think about the onerous social stratification caused by the credit rating, and then imagine how much worse it will be (and yes it's coming) when we have an analogous rating system for our health choices.

Obviously we are both talking about the same ultimate fate - denial of care - but I'm looking at the system being put in place to make healthcare a dystopian panopticon that, along with the usual medical blackmail, becomes a larger tool of social control. This is a process I can see very clearly from where I sit, though it is hard to document (I could give some specific examples but they would out me more than I wish at this point).

[slomo]

And by the way, I personally possess no knee-jerk reaction towards doctors or towards pharmaceuticals. My job is very tied up with science that leads to pharmaceuticals, ones that I happen to believe in (cancer treatments, including chemotherapy), with all the usual caveats of course.

And people who hate doctors as a class probably don't know any. I know a great many, and they are ordinary people, some good, some bad, some (like myself*) unhappy that they've got themselves embroiled in a system that rewards them for doing stuff that they think is harmful on the balance.

*Not that I'm an MD, but I'm a PhD in the research arm of the same system.

[MacCruiskeen]

Adorno: "Es gibt kein richtiges Leben im falschen." Literally translated: There is no right life in the Wrong. Freely translated: When the world around you is totally fucked, you can't expect to live well and ethically all by yourself.

I don't want to deflect this very serious and illuminating argument (now mainly between c2w and slomo) with random Famous Quotes, but the title of this thread is no help to anyone. You might as well say Fuck Artists, and in fact I am sorely tempted to start a thread with that title. Because christ knows there have been any number of artists who have had a dreadfully destructive effect on any number of people, including but certainly not only themselves. Maybe this is an argument against art, but maybe even artists can't have a right life in the Wrong, and maybe even most doctors are doing their best, FWIW (and that's often a lot), while submerged in the Wrong, as we all are.

[slomo]

Yes, and I would have liked to rename the thread I started on food "Fuck Farmers".

I don't think C2W and I are disagreeing on much besides emphasis and style. Frankly, I agree with much of what she's saying. I just think that she is underemphasizing the point that Eyeno and others are touching on (as clumsy as some of their posts may have come across), the issue of patient autonomy, and autonomy in general.

And of course, this is a particularly difficult issue to deal with in the context of mental health, where (yes, unfortunately) some people really do need some pharmaceutical help, and others are simply medicated for reasons of convenience to larger systems.