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Category Archives: Health Care
On being just crazy enough
Thinking about Psychiatry
Marcia Angell, an internist and pathologist who is a senior lecturer at Harvard Medical School, has recently written two lengthy book reviews for The New York Review of Books — The Epidemic of Mental Illness: Why? and The Illusions of Psychiatry – that has re-ignited a debate among medical professionals regarding the effectiveness of modern psychiatry.
Dr. Angell reviews three books that challenge the effectiveness of psychiatric medications and the hypothesis that disordered neurotransmitters cause psychiatric ailments. Irving Kirsch’s The Emperor’s New Drugs: Exploding the Antidepressant Myth analyzes research on antidepressant medications and concludes that the vast majority of their impact stems from the placebo effect.
Roger Whitaker’s Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America is even more disturbing in that Whitaker contends that the huge increase in diagnosis of serious psychiatric illness is actually caused by the detrimental effects of the medications. According to Whitaker, the problem isn’t that medications don’t help, it’s that they make the problem worse. Yowza!
Finally, in Dr. Angell’s second article, she takes on the entire profession of psychiatry in discussing Daniel Carlet’s Unhinged: The Trouble with Psychiatry — A Doctor’s Revelations About a Profession in Crisis and the American Psychiatric Association’s controversial "Diagnostic and Statistical Manual of Mental Disorders" a/k/a "DSM."
As Harriet Hall points out, Dr. Angell’s criticisms – particularly in regard to DSM – borders on psychiatry-bashing, which is of dubious merit. Sure, psychiatry is less science-based than other medical fields, but it has undeniably saved lives and improved the quality of life of many tortured souls. Are we simply to dispense with that progress?
Nevertheless, Dr. Angell reviews – as well as the books that are their subjects – provide a more nuanced view of human interaction that takes into consideration both the importance of both the "brain" and the "mind" without forcing a choice based on competing pseudo-truths.
These are discussions that need to be nurtured, both for the benefit of developing better protocols for patients afflicted with such disorders and for a society that still struggles on how best to deal with the social impact of such disorders.
Deskbound Physical Therapy
Dying efficiently
As noted in earlier posts here, here and here — as well as in connection with the final years of Dr. Michael DeBakey — one of the thorniest issues confronting effective reform of the U.S. health care and health care finance systems is the extraordinary allocation of health care resources to end-of-life care under the current systems.
My interest in this issue prompted me to note this insightful NY Times op-ed from over the weekend.
The author of the piece — Dudley Clendinen – is a former national correspondent and editorial writer for The Times. He is terminally ill with amyotrophic lateral sclerosis (ALS., more commonly known as Lou Gehrig’s disease) and is preparing to die in the most peaceful and efficient manner possible:
There is no meaningful treatment. No cure. There is one medication, Rilutek, which might make a few months’ difference. It retails for about $14,000 a year. That doesn’t seem worthwhile to me. If I let this run the whole course, with all the human, medical, technological and loving support I will start to need just months from now, it will leave me, in 5 or 8 or 12 or more years, a conscious but motionless, mute, withered, incontinent mummy of my former self. Maintained by feeding and waste tubes, breathing and suctioning machines.
No, thank you. I hate being a drag. I don’t think I’ll stick around for the back half of Lou.
I think it’s important to say that. We obsess in this country about how to eat and dress and drink, about finding a job and a mate. About having sex and children. About how to live. But we don’t talk about how to die. We act as if facing death weren’t one of life’s greatest, most absorbing thrills and challenges. Believe me, it is. This is not dull. But we have to be able to see doctors and machines, medical and insurance systems, family and friends and religions as informative — not governing — in order to be free.
And that’s the point. This is not about one particular disease or even about Death. It’s about Life, when you know there’s not much left. That is the weird blessing of Lou. There is no escape, and nothing much to do. It’s liberating. [. . .]
I’d rather die. I respect the wishes of people who want to live as long as they can. But I would like the same respect for those of us who decide — rationally — not to. . . .
After World War II, the U.S. health care system was a leader in the medical world in embracing the optimistic view of therapeutic intervention in medicine, which was a fundamental change from the sense of therapeutic powerlessness that was widely taught to doctors by pre-WWII professors.
Isn’t it ironic that this remarkable health care system has not yet figured out a way to allow elderly patients to die in a peaceful, dignified and non-wasteful manner?
The remarkable story of Simon Lewis
A special father
I am blessed on this special day for fathers – and every other day – by my remembrances of a special father.
Resolved: America Should Legalize Drugs
Jeffrey Miron and Robert DuPont, M.D. debate at the Cato Institute whether the governmental policy of drug prohibition should be continued or ended.
There’s an app for that diagnosis
Daniel Kraft provides an entertaining overview of medical innovations that will likely redefine the way in which doctors diagnose their patients’ medical problems.
The Cease-Fire that is long overdue
America’s dubious policy of drug prohibition has been a frequent topic on this blog, so I was pleased to see this Mary Anastasia O’Grady/WSJ column (previous posts on O’Grady’s work are here) yesterday on the Global Commission on Drug Policy’s statement last week calling for a “paradigm shift in global drug policy.”
O’Grady’s column is particularly noteworthy because of her citing of this fine Angelo Codevilla’s/Claremont Institute piece that explains how one of the unintended consequences of the failed War on Drugs is the increasing militarization of America’s borders. As Codevilla notes:
A friendly border is like oxygen: when you’ve got it, you don’t think about it. Only when you lose it does its importance seize you. But by then it is difficult to remember the fundamental truth: if borders are friendly, you don’t have to secure them; and if they are unfriendly, you must pay dearly for every bit of partial security, because ever harsher measures produce ever greater hostility.
Thucydides’ account of the Peloponnesian War gives us what may be history’s most poignant description of how a hostile border proved disastrous to a great power. In the war’s 19th year, Sparta put a small garrison in Decelea, in their enemy’s backyard, which, Thucydides tells us, "was one of the principal causes of [the Athenians’] ruin." "[I]nstead of a city, [Athens] became a fortress," with "two wars at once," and in a few years was "worn out by having to keep guard on the fortifications." Having lost a friendly border, Athens turned itself inside out trying to secure an unfriendly one.
For an excellent overview of why America’s drug prohibition policy should be scuttled, check out this Milton Friedman argument. And if you are interested in how a regulatory structure for recreational drug usage could be devised, the University of Chicago’s James Leitzel’s TEDxUChicago presentation below provides a great starting point: