After first surveying the current outlook for the development of new psychiatric drugs - not good, with many companies pulling out - Stahl laments:
Undoubtedly this is to the great delight of the anti-psychiatry community, lights up the antipsychiatry blogs (e.g., Carlat, http://carlatpsychiatry.blogspot.com/), who attract the Pharmascolds, scientologists and antimedication crowd who believe either there is no such thing as mental illness, that medication should not be used, or both.Stahl ends with the warning: Be careful what you ask for. You might just get it - "it" being an end to drug development in psychiatry.
Did you know that psychiatric illnesses are pure inventions of Pharma and their experts to treat patients that do not exist with drugs that are dangerous and do not work with the purpose only of profiting themselves? Stop the profits! Make mental illness go away by legislation and committee!
Well, I would say the same to him.
Stahl paints opponents of modern pharmaceutical industry behaviour as "antipsychiatrists". They're not. Well, he only names one of them, Daniel Carlat, and he's certainly not. Carlat edits the Carlat Psychiatry Report. Let's take a look at the latest issue:
Benzodiazepines: A Guide to Safe Prescribing - discusses benzodiazepines, including a helpful table of their doses and half-lives. Useful to someone planning to prescribe these drugs, that is, which not many anti-psychiatrists would. Says that "They work quickly and effectively for anxiety and agitation...In most cases benzodiazepines have a benign side-effect profile..." Hardly likely to please the antimedication crowd.
Update on Medications for PTSD - including a review of trials of antidepressants, antipsychotics, and more exotic drugs. Says that psychotherapy is the key to treating PTSD, but that medication can be helpful: "Getting some comfort from meds can often enable a patient to more easily face" the hard task of therapy. Not enormously pro-medication, but very far from being anti.
Combined Antidepressants No More Effective Than Monotherapy - discusses a recent study finding that starting depressed patients on a combo of two antidepressants offers no benefits over just one drug. So, the piece concludes, "We recommend never using antidepressants, and banning them all forever"... no wait, that's what it would have said if Stahl were right. It actually said "we recommend...starting with a single antidepressant". Not none.
Overall Carlat is, as far as I can see, really pretty moderate. Yes, he's been critical of certain drugs, of Pharma-influenced psychiatrists and the culture of giving doctors freebies to promote products. Nonetheless, he believes that mental illness exists, and he thinks that medication can be useful in treating it.
Maybe Stahl's right and Carlat leads a secret double life as a Scientologist. Maybe he is the reincarnation of R. D. Laing, or Thomas Szasz in a rubber mask. If not, though, branding him an antipsychiatrist shows that Stahl is unclear on what "psychiatry" is.
Psychiatry means the diagnosis and treatment of mental illness. Carlat, and indeed many other like-minded critics, are trying to improve that process by encouraging correct diagnosis and appropriate treatment.
When Carlat criticizes, say, the psychiatry textbook that turned out to have been written with "help" from a drug company, he's doing, I assume, because, as a psychiatrist who cares about psychiatry, he doesn't like seeing his field corrupted by propaganda.
This is why Stahl should heed his own warning: Be careful what you ask for.
Because Stahl seems to be asking for all the opponents of the excesses of the modern pharmaceutical industry to be opponents of psychiatry itself. At the moment, they're not. There are many, psychiatrists and others, who are trying to improve psychiatry, by protecting it from what they see as negative influences.
Maybe they're wrong about which influences are negative, maybe Pharma has had a more positive impact than they think, but even if they're wrong, they're not anti-psychiatry, they're pro-psychiatry.
However, if Stahl succeeds in painting all of these people as outside the psychiatric mainstream, he might find that psychiatry, stripped of such voices of sanity, turns into something so crazy that true antipsychiatry becomes the only reasonable option.
10 comments:
FWIW, Szasz isn't an anti-psychiatrist either. See Anti-psychiatry: Quackery Squared, in which he explains the quantum difference between his views and those of R.D. Laing
http://www.amazon.com/Antipsychiatry-Quackery-Squared-Thomas-Szasz/dp/0815609434/ref=sr_1_1?ie=UTF8&qid=1314793476&sr=8-1
Dr Carlat is a competitor of big Pharma continuous medical brainwashing education of psychiatrists in prescribing drugs.
You have to pay for that Carlat's Continuous Medical Education but little and the guy is American.
And for americans if you don't earn money you are rubbish unless you are a billionaire in that case you are rubbish if you don't give away money.
He is very smart and writing under the scrutinty of Big Pharma is no piece of cake.
I would like to know -before i can make my own view on that- if the British guy is on the pay roll of Big pharma.
Does pseudomonia....knows?
Pseudomonia
Please don't take me wrong.
NS wrote:
"Maybe Stahl's right and Carlat leads a secret double life as a Scientologist. Maybe he is the reincarnation of R. D. Laing, or Thomas Szasz in a rubber mask."
I understood perfectly that "figure de style":
It means that if the British guy is not on the payroll of Big Pharma, then he is doing Carlat Continuous Education worldwide free advertissment.
This is Stahl's disclosure form on his website: "Over the past 12 months (January – December 2008) Dr. Stahl has served as a Consultant to Arena, Azur, Bionevia, BristolMyers Squibb, Eli Lilly, Endo, Forest, Jazz, J & J, Labopharm, Lundbeck, Marinus, Neuronetics, Novartis, Noven, PamLabs, Pfizer, Pierre Fabre, Sanofi, Sepracor, Servier, Shire, SK Corporation, Solvay, Somaxon, Tetragenex and Vanda; he has served on speakers bureaus for Wyeth and Pfizer and has received grant support from Forest, J & J, Novartis, Organon, PamLabs, Pfizer, Sepracor, Shire, Takeda, Vanda and Wyeth."
It's a bit outdated, but no wonder he is concerned. ;)
I think it would literally be quicker to list the ones he hasn't worked with.
The gist of Stahl's rant is that his own funding from pharma is drying up.
Stahl is widely known as a pharma cheerleader.
His whining that anti-psychiatry is driving pharma out of psychiatry is nonsense. The money just isn't there. Two reasons why are the penalties pharma's paid over misrepresentation of drugs and large payouts for injury lawsuits.
To me, that would indicate ethical and product flaws, but to Stahl, that's anti-psychiatry taking the bread from his mouth.
His dumb attack on Dr. Carlat further besmirches his own reputation.
Dr. Stahl should be careful what he wishes for: His clueless, self-centered bid for attention invites scrutiny of his own long-standing, cozy, and highly remunerative relationship with pharma -- and the validity of his publications.
Perhaps Dr. Stahl unconsciously wishes to retire?
Merope3
Thanks a lot and especially for the "speaker bureau" informations.
Altostrata
About your last sentence:
"Perhaps Dr. Stahl unconsciously wishes to retire?"
My guess is that he may be fighting desesperatly like a man who has lost a war and lost much.
I am thinking of the scientific legacy for his popular oversimplistic chemical models for mental illnesses( too much Dopamine and you are hearing voices and too little serotonine and you are depresses)
As dangerous as the oversimplification of the DSM that model of his.
He has lost that war and the Nobel laureat Kandell was always more lucid about that models saying that it was by case that some neurotransmitter have been studied and not others.
This being not exclusive of fighting desesperatly to remain also on the pay roll of Big Pharma for personal money.
Both would go hand in hand -if it were to be the case.
NB: the lost war of the so called Biological psychiatry against psychologists for ones and antipsychiatrists also doesn't show yet in the Big pharma brainwashing Medical Continuous Education in France at least.
Particularly in the USA there does seem to be an excessive reliance on drugs to treat mental disorders. There are a range of treatment options available but the modern medical industry being what it is means that doctors are often left with no choice but to principally rely on drug based interventions.
The problem is being addressed but it is not just about modern psychiatry, it points to a wider issue in medical treatment where economics plays a leading role in dictating treatment options. Not a desirable situation but the economic issues can't be ignored, money and time do not grow on trees.
A few years ago I saw an interview with Bill Oddie form The Goodies(TV comedy show). He stated that when his mother was in a mental institution there were nearly 100,000 people in mental institutions at the time. Now it is circa 10,000 in Britain. For all the problems with drug based interventions, and I am one of those people very concerned about the ever increasing use of psycho drugs in children, especially antipsychotics, the modern psycho drug revolution has enabled millions of people to return to society, to lead productive and happy lives.
As to psychiatrists and other medicos who are prepared to receive gifts from Big Pharma, their hubris is remarkable. As if such behavior does not change a doctor's prescribing habits. Really, why does Big Pharma do it in the first place if it isn't influencing doctor's prescribing habits? Medicos should know better. Perhaps there is too much hubris in the ranks, the belief that they are "objective decisions makers", prescribing in some god like manner.
I've never read either of them, but I don't see where Dr. Stahl has accused Carlat of being a Scientologist. From your quote he does say Carlat's blog "attracts" them. But that's nothing new, my blog attracts all of those groups as well. So do most blogs about recovering from a mental illness, especially when the blogger is using medication and therapy as integral parts of their recovery.
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