[Magdalen] Drug research.

[Jay Weigel]

I did not say "board cerified psychiatrists". I said them *and* other
doctors who had taken a course in psychopharmacology, passed an exam, and
gooten a certification. Please do not misquote me.

On Sunday, August 28, 2016, James Oppenheimer-Crawford <
oppenheimerjw at gmail.com> wrote:

> It's a dicey business.  On the one hand, you're absolutely right: only
> board certified psychiatrists ought to be able to prescribe.  On the other
> hand I can think of two serious considerations here:
> First of all, many psychiatric facilities run by the states have a history
> of employing MDs who are not board certified. It's not too extreme to say
> that if only board certified MDs could prescribe, we would not be able to
> hire the people at the price they are willing to pay. They simply wouldn't
> be able to get the personnel.
> And the other matter is the rapidly changing pharmacological picture.  I
> recall when I first began to work back in 1975, there were not a lot of
> meds available. But that quickly changed.  I had kept current on
> medications' main purposes, side effects, general dose range, etc., but in
> just a few years it became a hopeless case.  Every year brought some new
> validated medication and new protocols. And also, the sudden terror of
> retinitis pigmentosa from Mellaril and the general concern about tardive
> dyskinesia suddenly changed utterly the way medication was prescribed.
> Also, we would welcome a new antipsychotic with the hope that this one
> might be that magic bullet. And it almost never happened that way.  I say
> this to illustrate how a physician completely up to date and certified in,
> say 1990, might quite easily be completely out of touch in just a few years
> unless she or he conscientiously takes refresher courses.
>
> Rehabilitation was a known factor from years back (I still remember an old
> film we watched, made in England in the 1950s, which introduced the basics
> of what we ended up doing for years), and it gradually gained traction over
> time in my facilities. By the time I retired about ten years ago, the
> strategy had become medication to stabilize and then a lot of day programs
> of various types, designed to build on each consumer's strengths.  We
> talked about the illness, how the consumer had to understand the nature of
> their illness and learn to avoid trigger situations, and move toward things
> that helped. Meds were merely a very beginning step.
> Early on, I was taught that we expect the psychiatric patient to require
> constant medication to compensate for their chemical imbalance for the rest
> of their lives.  As time went by, we found that was simply not true.  A
> person can be acutely psychotic and then, after a robust rehabilitation
> intervention, can learn to live a fairly normal life with reduced
> medication. I had the pleasure of meeting and talking to some of these at a
> psychiatric rehabilitation convention. I wanted to get these folks into my
> facility; there's nothing so powerful as someone standing there talking to
> a very ill consumer, saying, "I used to be right where you are now, and I
> took my meds, talked with my doctor, and went to programs, and today I'm
> working a fulltime job.  You can too."
> I've seen some amazing accomplishments too -- folks I really never expected
> to leave the facility did in fact get it together with the help of titrated
> meds and the right programming.  We sometimes were able to do some very
> good work.
> By the time I retired, most physicians had bought pretty solidly into the
> rehab model, although the drug companies kept up their promotions, claiming
> that certain difficult psychiatric patients could be cured with the
> particular pill they were selling that month.
> I was hired into a hospital whose Director was a psychiatrist (one who was
> deeply committed to psych rehab, but still a psychiatrist). After that, the
> head was an administrator who had come up through some other career ladder.
> We have all those pictures of those psychiatrists (male, of course) who
> used to be the director. Now, the pictures are just as often female as
> male, and we have not had a physician director after the one previously
> mentioned.
> When I was hired in one facility, the sister facility across the county was
> still directed by the old style director, and nurses generally wore their
> whites. I only saw a nurse in whites in the medical clinic. I can imagine
> that if I were to go to another state, things may well be very different.
> Sometimes, folks would say that New York State was the best of the best.  I
> had to wonder, if we were "the best," then how was the rest of the world
> doing? We certainly had our share of dropped balls...
>
> So meds still plays an important part, and always will, but it's also only
> a piece of the puzzle. Each consumer is a separate puzzle, requiring her or
> his own special interventions.
>
> James W. Oppenheimer-Crawford
> *“A life is like a garden. Perfect moments can be had, but not preserved,
> except in memory. LLAP**”  -- *Leonard Nimoy
>
> On Sun, Aug 28, 2016 at 11:01 AM, Jay Weigel <jay.weigel at gmail.com
> <javascript:;>> wrote:
>
> > Here in the U.S., only M.D.s may prescribe psychoactive drugs.
> > Unfortunately, Drug companies have put big bucks into advertising ("Ask
> > your doctor if this medication is right for YOU!" blares the TV) and
> this,
> > plus loose regulations on which doctors may prescribe such, can lead to
> > some awful messes. IMNSHO, no doctor should be allowed to prescribe such
> > medications who has not taken an intensive course in psychopharmacology,
> > passed an exam with a sufficiently high score and been certified.
> > Furthermore, also IMNSHO, prescription drug advertising should be
> outlawed.
> > It is coercive and leads to patients who are poorly informed pestering
> > their doctors for medications which may not be in their best interests
> and
> > are generally very high-priced.
> >
> > Stepping off my soapbox,
> > Jay
> >
> > On Sun, Aug 28, 2016 at 12:54 AM, Sally Davies <sally.davies at gmail.com
> <javascript:;>>
> > wrote:
> >
> > > For me this is an interesting and helpful thread, aside from the
> personal
> > > rebukes.
> > >
> > > As a psychologist who does not prescibe but has to work with medicated
> > > patients, I feel confused at the moment regarding best practice in
> mental
> > > health. There has been so much manipulation and outright corruption in
> > > mental health, and the (thinking, reading) public is also confused
> > > especially regarding children. Meanwhile MH problems in the elderly
> often
> > > go undiagnosed or treate.
> > >
> > > I seldom advise anyone to consult a psychiatrist any more but these
> days
> > > most of my patients are hospitalised in a general hospital, and the
> > > physicians - you would call them internists - often prescribe calming,
> > > sleeping and antidepressant medication.
> >
>