A critique of the psych professions

[Scoutfish]

Well, here's the thing: I NEVER EVER said that all Dr's were quacks , nor did I say those who prescribe drugs for behavioral issues were quacks either.

 

I know some kids who ought to have their meds upped. I know some who just need a person to actually stop and listen to them talk about their feelings. And as mentioned earlier in the thread, some kids just need to get out, get fresh air and be allowed to exercise instead of being expected to do nothing but look pretty when needed. I have seen too many kids who get introuble for just making noise or ...God Forbid, getting dirt on their shoes! Do they have play clothes and shoes? NOPE! Playing is too loud and "embarassing" to ..mom and dad. What would their socail network think if they saw the kids..GASP - are you ready for this - Playing and acting like ...kids?

 

Now, I know some kids have hormone imbalances and other endocrine system issues. Nobody ever denied that at all.

 

But to say that Dr's felt pressured to make people happy, who just happened top see a tv ad for a drug that will make their kid perfect...well, that is not what a Dr should do. Nowhere in medical school or in the Hypocratic Oath does it say do your best as a Dr ..unless mom and da really, really want you to do tis instead.

 

I did spend quite a few years in the EMS field. No, not a Dr by any means, but we had people who would tell us we could do this or that when they called us.

 

We told them" NO, This is how it works!" End of discussion. We did not cater to peoples whims or what they "thougfht" was needed. We did what we were trained to do, the way we were trained. PERIOD!

 

Untrained people's opinions add up to exactly squat!

 

Now, as mentuiomned earlier by Dean..I too have seen kids who parents forgot to give meds while camping for the weekend, Dad thought mom did it. Mom thought dad handled it. Turns out neither one did , but they couldn't tell because running around pllaying, chasing each other, playing tag and sometimes...sometimes just having unorganized, unchoreographed, and "nonusefull" fun play can do wonders.

 

This is also after sopending a week of scholl where you sit in s class and listen to a teacher not exactly teach you to think, but to pass minimum standards on a national test. Under harsh flourescent lighting in new age plastic and composite environments.

 

To say all Dr's are quacks or that all are medicating when not necessary is a far, far stretch of anything I ever said.

 

But to say they are all perfect people with the best interest of their patients over their own wallets is just as ludicrous.

Just like saying all troops and all parents do not ever put their own agenda ahead of the scouts, they never have adult run programs, nor do they run eagle mills.

 

It's not right, it's not the majority, nor is it what we want,.........but it's out there and it happens.

 

Just because that isn't what the program is supposed to be about, and just because the books don't suggest it does not mean it doesn't happen.

 

Just like robbing banks - It's against the law, it's not supposed to happen, and it's definantly not honest...so why are there security cameras and guards? Why the high security safes?

 

Because not everybody follows the rules, nor do they care.

 

As far as proof, it seems like proof is in the eye of the beholder. I see one sided links that only support people's opinons, not hard facts. Even global warming is divided by "expert scientists" . Anybody in here can find the proof they want by searching hard enough , then pasting a link to that source. Proof does not exactly prove anything except which way you were already pre disposed to believe.

 

Me. My proof is what I see with my own eyes. When a kid - who cannot make it through 3/4ths of a day without taking his medication....somehow makes it through the whole weekend without it..well. that is proof enough for me. Without being influenced by anybody's agenda.

 

Again, I NEVER said all Drs, all medications or all kids.

 

But as soon as we say that Dr's felt pressure to makes people happy because they saw an ad in a magazine or tv...then acted on it for that reason.....then the system went wrong!

[Beavah]

Yah, I'm sorta with dScouter. Never attribute to wickedness what can be explained by incompetence.

 

I don't think most physicians are engaged in bribery or fraud. I think they're engaged in poor medical practice, in much da way dScouter describes. An office visit and a throat culture are sufficient to diagnose strep throat and prescribe antibiotics. An office visit and a 15 minute conversation are not sufficient to diagnose, prescribe, and properly medicate with psychotropics.

 

Despite whatever we fictionalize as "the dominant norms of 21st century society" or try to excuse by social pressure or societal need for quick fixes (which I think is mostly bunk), I think we can expect professionals to act professionally. And da overprescription of psych meds to youth, in line with da over diagnosis of mental health conditions treated by both counseling and drugs, is not an acceptable professional standard of care.

 

Beavah

(This message has been edited by Beavah)

[Scoutfish]

"I don't think most physicians are engaged in bribery or fraud"

 

Neither do I. But the whole concept of Dr's prescribing because they were trying to make people happy wsn't mine.

 

I do belive that ..some Dr's spend time checking this med against that med against the level of the dose trying to hone the right amount.

 

No doubt that every single person is an individual who needs something different than the next. There is no "one dose/one drug" miracle cure.

 

I just think some Dr's are too quick to prescribe the drugs to begin with.

 

Yes, some need it. Some.

[acco40]

For those who don't think psychologists or therapy are not useful - my God, what do you think is part of the BSA? We have adult association, Scoutmaster conferences, group/patrol interactions, retreats (we call it camping), etc.

 

Yes, there are bad priests, firemen, policemen, teachers, forum posters, Scoutmasters and psychologists.

 

I'm an engineer by education and vocation. One of the funniest statements I ever heard was by my father who had a BS, MS and PhD in psychology. He saw no humor in his statement, "I don't like the economists, their field is not an exact science like psychology."

 

Please no comments by scientists about us "inexact" engineers.

[packsaddle]

Acco40, I have the utmost respect for engineers and what they can do after spending my first two careers working with them in the power industry and federal government. I love it when I have engineering students in my classes. They are very bright and a nice balance to some of the others who seem to have a heavy dose of undisciplined creativity. But one of my proudest moments was on a class field trip to a nuclear plant. A nuclear engineer with an MIT degree was explaining nuclear reactions. My engineering students helped out by correcting his equations. I think the guy was blown away by the first audience he'd probably ever had who could actually stay with him, maybe even a little ahead. nice.

[vol_scouter]

Scoutfish,

 

Once again, provide evidence that physicians are receiving kickbacks from the pharmaceutical industry. I know and have known hundreds of physicians and none have ever been accused or intimated to me that they have ever received anything like a kickback. I have been asked by pharmaceutical representatives if I have used their medications and what my experience was if I did. I have NEVER been offered any sort of reward or inducement to prescribe something.

 

Why do the companies advertise here? It is simple. First, the socialist nations do not allow a profit so the sales in the US are key to company viability. So if they can encourage patients to request particular medications in particular situations then the company will increase sales. An example that happened to me is illustrative. I was prescribing a statin for a patient's cholesterol issues. I picked one that would best address the patient's problem and had the best side effect profile. The patient then requested a particular brand which then meant that I had to take time to explain to him why my pick was the best for him. That required time that I really did not have to spend as I was behind. I did not change my prescription but others may do so since the differences between drugs in a class are often small.

 

As far as prescribing for Strep throat, the Strep screen and culture are only a little better than 50% by so elaborate studies. The reason to treat is to prevent Rheumatic fever which damages the heart valves. More recent studies indicate that the likelihood of rheumatic fever is more related to virulence than to using antibiotics. So the optimal therapy fr this condition is not clear at this time.

 

Medicine is a business. It is recommended that when it appears that the patient has a viral upper respiratory infection, no antibiotics should be prescribed. It is also true that Staph and Strep pneumonias often follow viral respiratory infections. So if you have a patient with presents with a viral process who 1) expects an antibiotic, 2) is likely to get a post viral bacterial pneumonia, and 3) due to underlying COPD is likely to be hospitalized for a post-viral bacterial pneumonia they, according to guidelines should not be treated. So what is your reputation in the community going to be if you stick with the 'experts' and do not prescribe an antibiotic? The patient waited, was sick, did not receive an antibiotic, and ended up in the hospital. What is the down side to prescribing the antibiotic - possible adverse reaction to the drug and theoretical issues of increased resistance. Positive aspects of prescribing an antibiotic - better business decision and prevent a hospitalization for your patient.

 

It is often true that the 'experts' actually practice very little and those who do practice in environments that usually do not reflect the average medical practice. To compare to law, it would be similar to an attorney who defends only well educated wealthy clients telling an attorney who defends drug addicts with mental issues how best to prepare their clients to take the stand.

 

Physicians are humans. Most are dedicated and competent. A few are not as in any profession. Statements to the contrary are lies. Before leaving full time practice, my payor mix was typically 17-20% medicaid and no pays. Medicaid pays about 11 cents on the dollar. Offices have a fixed cost so for a significant portion of my practice, it cost me money to see these patients. Who else in businesses takes those kinds of loses?

 

Back to the question at hand. Until the DSM-IV changes and/or the medical/legal climate greatly improves, children will continue to receive, in my opinion, more therapy than needed. The current direction of medicine will exacerbate rather than improve that situation. It is not good for the future because it also teaches that we can 'fix' people with medications which is not a good approach to life.

 

[Lisabob]

Beavah writes: "Despite whatever we fictionalize as "the dominant norms of 21st century society" or try to excuse by social pressure or societal need for quick fixes (which I think is mostly bunk), I think we can expect professionals to act professionally. "

 

Beavah, whether intended or not, I think you dodged my question. So let me clarify, and ask again.

 

You are not in favor of medication, or of counseling. So what do you see as appropriate ways to try to help kids who are having behavioral problems?

 

By telling you not to assume you can change the "dominant norms of 21st century society" I meant that it is unrealistic to say that you'd "solve" the behavioral problems some kids have by single handedly re-ordering society. For example, by saying that school days/years should be shorter, mothers should never work outside the home, or kids shouldn't be exposed to large doses of mass media. While we might argue about the relative influences of any of these factors, reality is that a parent with a child who is exhibiting behavioral issues cannot realistically change the school calendar, we are unlikely to return to a time when most women stayed home, and mass media is an inescapable part of our culture. We could tinker with these things around the edges, but we can't wish them away.

 

[dScouter15]

Scoutfish - If its true that there are "many more" poor doctors than great doctors, I would think it would be fairly easy to support some of your claims with factual evidence. "Read the papers"? "Watch the news"? In the past year, how many doctors have been exposed in the news for taking kick backs, being accused of malpractice, etc. Whatever number you come up with, what percentage of the approximately 853,000 physicians in the country does it work out to? My hypothesis is that the proportion of "bad apples" to good physicians will be comparable, if not better, than a similar study of other professions - teachers, ministers, bus drivers, police officers, whatever. Please prove me wrong.

 

Vol_scouter - great points and a great perspective.

 

Beavah - when you started this thread you reckoned you'd learn something - what do you think thus far?

[vol_scouter]

Lisabob,

 

From my standpoint, the issue is trying to discriminate between normal development variations and abnormal. As a child, I would have probably been diagnosed as hyperactive, and by today's standards may have been prescribed medications. I had to learn to concentrate but part of that was boredom. When I started college in Engineering Physics, my problems disappeared when I was challenged. I have earned a BS, an MS & PhD in theoretical physics and an MD. Clearly, this is anecdotal at best but it illustrates the dilemma in the mental health disciplines. Some children have ADHD and will benefit from medications whereas others are just normal variations in development. It is my belief that the diagnostic criteria and techniques currently available are not sensitive and specific enough to make those distinctions. This also means that some children are not receiving the medications that would benefit them. It is my belief and understanding that currently the scales are tipped toward treating and I believe that the children would be best served by the scales being tipped towards not treating. That is my opinion and I do not have studies to support my opinion on what is the best treatment window.

[Scoutfish]

Last month, the Office of the Inspector General, Department of Health and Human Services (DHHS) issued a "Special Fraud Alert" targeting aggressive drug industry marketing involving cash and other payments to doctors and pharmacists to promote specific products. The Inspector General warned that such schemes may be in violation of Medicare and Medicaid anti-kickback laws (American Medical News, 29 August 1994). DHHS is concerned that aggressive promotional incentives could harm patients if they influence doctors to make medically inappropriate prescribing choices.-----

 

http://findarticles.com/p/articles/mi_m0815/is_n185_v19/ai_15852403/

 

 

"Federal investigators looking into kickbacks in the orthopedic device industry have apparently set their sites on another target doctors who received these illegal incentives. The physician investigation is just the latest chapter in the governments ongoing probe of the financial arrangements often made between medical device makers and the doctors who use their products. So far, the kickback investigation has uncovered excessive consulting agreements, lavish trips and other perks the makers of hip and knee implants handed out as rewards to surgeons who used their products."--------

 

http://www.newsinferno.com/archives/2784

 

Husband-and-wife physicians pleaded guilty in Los Angeles federal court Monday to accepting illegal kickbacks from a medical laboratory that analyzed patient specimens for them----------

 

http://articles.latimes.com/2005/jul/26/local/me-medfraud26

 

 

It takes two to kickback. So federal officials aiming to stop the practice--and tired of knocking at Big Pharma's door--are approaching the problem from the opposite end. Yep, they're now targeting doctors.

 

The New York Times reports that prosecutors have historically avoided putting physicians in the hot seat, because they figured juries would sympathize with them (and we all know that public opinion of pharma leaves a bit to be desired). Now, though, the feds are plotting civil and criminal charges against surgeons who allegedly demanded kickbacks from device makers. "The strategy of looking at the companies alone was not completely successful in terms of our objective to deter health care fraud," U.S. Attorney Michael Sullivan told the paper.

 

 

 

Read more: Feds cracking down on doctor kickbacks - FiercePharma http://www.fiercepharma.com/story/feds-cracking-down-doctor-kickbacks/2009-03-05#ixzz10ab36URm'>http://www.fiercepharma.com/story/feds-cracking-down-doctor-kickbacks/2009-03-05#ixzz10ab36URm

Subscribe: http://www.fiercepharma.com/signup?sourceform=Viral-Tynt-FiercePharma-FiercePharma ---------

 

http://www.fiercepharma.com/story/feds-cracking-down-doctor-kickbacks/2009-03-05

 

 

A common problem in illegal drug and device marketing cases is doctors willingness to delude themselves into thinking that cash, lucrative trips and other kickbacks do not affect them, said Mr. Morris, the chief counsel.

 

 

Somehow physicians think theyre different from the rest of us, Mr. Morris said. But money works on them just like everybody else."----------

 

http://lcmedia.typepad.com/pharmola/2009/03/feds-to-doctors-stop-illegal-kickbacks-or-face-.html

 

"Dr. Mudd's prescribing habits came to the attention of GrowTall's manufacturer, DrugCo, Inc, who approached Dr. Mudd and asked him to enter into an exclusive marketing agreement, under which he would help them in their post-market research by prescribing only GrowTall and reporting patient outcomes to DrugCo."----------------

 

http://virtualmentor.ama-assn.org/2003/07/hlaw1-0307.html

 

 

 

I'm only guessing, but I suppose none of these guys called and told you they were taking kickbacks? So I supose you really didn't know!

 

 

 

[Scoutfish]

While we are at it, I NEVER said a majority, or most doctors. I said SOME.

 

Matter of fact, I actually said: "too many" and even one is too many in my opinion.

 

And it is my opinion that the moment a Dr chabges his diagnosis just to make a patient happy, he has strayed from the whole point of medicine.

 

Drug companies do not need to sell to people. They do not need to advertise to those who are not trained to make the deciseon of what drug, if any, to use.

 

Instead, they could save a freaking ton of money by not advertising something to people who have no control or deciseon over it, and in effect, save us from paying $30.00 a pill instead of $.30 a pill.

 

And for the record, the socialist contries cannot make those companies sell or set up shop. Those companies are making some profit lest they would have closed down already. They are just not making 1000% profit per pill.

[Scoutfish]

 

 

You want to hear something funny? I have been in the garage door industry for over 15 years, I have NEVER had any other garage door installer or other company tell me that they lied to, swindled or mis stated a product to a customer or inspector.

 

Yet, I have been to jobs where a company instaled a non wind rated door, stuck 1 single reinforcement bracket on the door and then put a 130 mph windload sticker on it. They told the homeowner, builder and inspector that the door was indeed rated for up to 130 mph winds.

 

I was there just to service the door because it ran badly, I then easily pulled the manufacturee's specs to show it did not meet any wind load designs.

 

Why the lie? Because the company could sell a cheap door at a high cost, while having minimal labor or material expense involved. Oh, sorry, that means more profits!

 

I have seen other door companies sell homeowners an entirely new remote garage door opener because the battery on the remote control died.

 

People on the beaches are told that garage doors are aluminum and rust proof in order to get the sale,. Guess what, most garage doors are steel. Painted in layers just like cars, but steel. The average garage door on a house will not be aluminum because it costs about 4 times as much.

 

So the door company charges double for an regulatr door.

 

But they didn't tell me about it.

 

As a 14 year firefighter,I NEVER EVER had another fireman come up to me and say:

" Dude! I love fires soooo much I sometimes set them myself, wait for them to grow and then call 911!:

 

Yet, I have seen people get arrested for it. I have discovered the evidence that proved that one of my friends who was on my FD did it. Yet he never said a thing to me! Can you believe that?

 

I have known people get arrested for drugs, embezellment, and assault, They never told me a thing about it.

 

And you read about it too in the papers, see it on tv and maybe even hear the morning DJ on the radoi joke about it. Can you cite a specific source or give me proof? Not off the top of your head, but you know that it very well happens.

 

Not all people do that,. Not even most, but it happens!

[vol_scouter]

Scoutfish,

 

If too many is one then there is no group of professionals in any field that will live up to that standard. You sited a 1994 article that accused the medical profession of being guilty of kickbacks but I do not recall a string of convictions in the 1990's. We were discussing pharmaceuticals and you site medical device and lab kickbacks. I do not ever deal with medical devices and I did not comment on them. There was a single couple charged that you cited for the lab kickback that resulted in a successful prosecution. fiercepharma I am certain is a legitimate source for relatively unbiased information - please. We have been told for over a decade that the feds were going to come after us for a variety of things but there have never been many prosecutions that I have read about in any of the areas that they mention.

 

As to the fellow doing a study, the FDA has legitimate phase IV studies. They can be legitimate or can be borderline. A legitimate phase IV or post-marketing study involved Viagra. After Viagra was released, there were reports of death which raised the question of whether the drug directly caused the deaths. The results of the study showed that it was increased activity in previously sedentary males was the cause. According to the US Department of Labor Statistics, there were 661,400 physicians holding jobs in the US in 2004 so 1 percent indulging in such activities would involve 6,614 physicians - 130 or so per state - I think that you would have heard quite a bit about it.

 

Finally, I am sorry that you are struggling to understand the economics of medicine - it is complex -but the drug companies are not the big bad entities that you believe that they are. They are like other companies who are pushed by stock market pressures to maximize their profits. Physicians are human and not perfect as you demand so that the drug company marketing to the public must work or it would not be done.

 

The drug companies cover their base costs in the socialized countries. The government's involvement in medicine both here and abroad makes the economics difficult to explain and understand. If you run a business, I doubt that you will give away ~20% of your services but many of us do so.

 

By your standards, almost no one will ever receive the 'correct care' because medicine is still an art - that is the root of this discussion.

 

 

[dScouter15]

Scoutfish, in your post here: http://www.scouter.com/forums/viewThread.asp?threadID=287814&p=2#id_288175 , you said "there are great Dr's out there. But there are many more that are not!" So you did in fact argue that a majority of doctors are not up to par. This was the position that I found to be problematic, and I'm relieved that its not actually what you're arguing.

 

So now that we're clear on where everyone stands on that issue, I guess I don't know what it has to do with the original question, which involves the benefits vs. disadvantages of psychiatric/psychologic care for children. If doctors receiving kickbacks from pharma companies is only affected a minority of medication prescriptions (some of which may actually be beneficial, regardless of the doctors' motivations), what are the actual factors affecting this issue?

[Scoutfish]

Okay,I'll bow to that one. Must have been planning on writing "many" or "more out there" (meaning also) , but not intending to write both.

 

My stance on the original post?

 

I agree with Beavah:

 

Sure, there may be legit cases, but todays soceity somehow had become one that judges individuals with a stringent set of standards that we think are ideal. We somehow come up with a particular set of parameters that we think are the norm, and do not allow any variation.

 

Some are for social reasons, some are just bad judgement.

 

Look at Einstien. He didn't walk until he was 3 and didn't talk until he was 5...or pretty close to that.Labled a "retard" and by societies standards back then, should have been institutionalized.

Turned out that he is either really, really smart, or just talks ina way as to make us think he is!

 

Look at Picasso; In all honesty, I see his paintings as a bunch of scribble. Maybe he just needed contacts?

Seroiusly though,the man was off his rocker, but was regarded as a genious.

Why? Because of the standards that society came up with at the time

But suppose the next einstien was born today. He'd be classified as "learning impared, special needs, and possibly sent to so many therapies to fix his "concieved" problems, that he might be a drooling idiot afterward.

 

So we look at people, realize that no two people are alike, yet we expect everybody to fit into sa few molds that we think are ideal. When a child doesn't, we think something is wrong. I wonder how many times the next Einstien was looked at as flawwed and instead of being allowed to develop the way he/she was supoposed to, instead was given a shot of this, a pill of that to take, and considered cured because they fell into the same routine everybody else is in.

 

 

Yeah, I know some kids really do need meds. Some need alot. some need less, Some may actually outgrow the needs, but mistakenly get viewed as needing a higher/ different dose.

 

And honestly, some kids just need a momn or dad who won't put up with a bunch of crap from the kid.

 

toomany parnets want to be "frien/parents" They want to be their cghild best friend and buddy, and are scared to tell their kid no. That kid soon has a meltdown or cannot handle not getting his/ her way.