![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 20 to 44 of 69. Go back in thread:
Posted by Ken Blades on March 10, 2007, at 14:50:38
In reply to Peter R. Breggin is well covered on Quackwatch, posted by notfred on March 10, 2007, at 11:39:09
This guy pooh-poohs everything...he must be
a Scientologist or has some emotional issue.
Posted by crabwalk on March 10, 2007, at 15:02:09
In reply to Re: Please be civil » madeline, posted by linkadge on March 10, 2007, at 13:29:02
> I'm not saying they don't help some people, I'm just agreeing that they can really hurt some people.
>
> LinkadgeIn my view the issue with ad's comes down to this argument. The stats show that a good number of people do well on them. They also show adverse reactions. What they don't show is the severity or perseverance of these reactions -- there is pretty much no such measurement of long-term effects of these drugs.
So two questions arise...One is how often are people pretty much screwed over (meaning severely reducing quality of life, I'm one of them at this point) by these drugs? It's probably a relatively small number because the number of people taking ad's is astronomical, but assuredly the suffering and loss of these people is devastating and is not at all mollified by the fact that others are lucky enough to escape such suffering.
This then leads to the second question, which is how many people does it take to get screwed over before the whole practice of prescribing these drugs becomes unjustifiable? This is a moral issue, like asking is it right to steal bread to feed your starving family, i.e. there's no easy answer. However, the bioethical foundation of health care was laid down in the 20th century expressly says that no suffering is justifiable in the name of a statistical majority. Of course, the flip side is if we deprive people of drugs that may help them, how do we measure their suffering?
I've struggled with this issue for years now, since I realized that prozac had done what Linkadge has described -- caused possibly permanent anhedonia. I think the people this happens to automatically point the finger at psychiatry as a practice and some go as far as to say it's thoroughly evil. As a sufferer, I've definitely felt the same things at times, but unfortunately I think the issue is more complicated. While there are definitely some victims of malpractice and ignorance in the name of convenience or even profit, I think the majority of damage done by ad's is a combination of bad luck and selective ignorance. The luck part is obviously uncontrollable, the ignorance part oppositely, and inexcusably, so. So, I think the FDA and doctors have seriously dropped the ball in evaluating long-term safety of ad's. This has created a general perception that they are almost infallible, and it will take a long time for anyone to go against this. When people realize the subtle yet devastating dangers of ad's, a paradigm shift will occur, and those moral questions will be at the heart of it, I hope. I also hope it will happen in my lifetime, but I'm not sure that it will.
Wow, that was long. I'd appreciate any feedback...
Posted by flmm on March 10, 2007, at 16:10:10
In reply to the real issue » linkadge, posted by crabwalk on March 10, 2007, at 15:02:09
Oh great, this subject again! How about this,drugs are all we have. clearly people have mental disorders. Drugs can only treat symptoms. Either take them or don't, but I personally believe I function better with them! I do not think there is any evidence they "Rewire" your brain. There is a definate "withdrawal, adjustment, whatever you want to call it, when you stop taking these meds! Maybe "certain" people forgot what massive anxiety or depression felt like while on meds hence, the feeling of being worse off them. Whatever, it is not a perfect world. Just get off the couch and try to improve your life!
Posted by linkadge on March 10, 2007, at 16:21:13
In reply to the real issue » linkadge, posted by crabwalk on March 10, 2007, at 15:02:09
>So two questions arise...One is how often are >people pretty much screwed over (meaning >severely reducing quality of life, I'm one of >them at this point) by these drugs? It's >probably a relatively small number because the >number of people taking ad's is astronomical,
Well, thats the thing. The use of the TCA's was not this widespread. So, we really don't have any idea yet on how the SSRI's are affecting people long term. They havn't been out long enough.
People need to come off the drugs in order to know how they have been affected.
>I've struggled with this issue for years now, >since I realized that prozac had done what >Linkadge has described -- caused possibly >permanent anhedonia.
>As a sufferer, I've definitely felt the same >things at times, but unfortunately I think the >issue is more complicated.
I never said psychiatry was evil. There is a difference between people and drugs. People often have good intentions, while drugs cannot have intentions. We simply don't know the long term implications of what we are doing. Its a world of bandwagons and subsequent mass panic.
In hindsight I don't really see the point of taking the drugs. I mean, if I wanted a quick fix, I would have taken illegal drugs. They were not a long term solution for me. This may not be the case for everybody, but I can only know how to deal with myself.
>While there are definitely some victims of >malpractice and ignorance in the name of >convenience or even profit, I think the majority >of damage done by ad's is a combination of bad >luck and selective ignorance. The luck part is >obviously uncontrollable, the ignorance part >oppositely, and inexcusably, so.
Clearly there needs to be constant reassesment of a drugs benifits and drawbacks. Unfortunatley, doctors are unwilling to make that assessment untill a new (better) class of drugs comes along. I am sure that once a new class of drugs is established, the public view on SSRI's will be quickly and easily shifted.
>So, I think the FDA and doctors have seriously >dropped the ball in evaluating long-term safety >of ad's.
Thats the problem. Once they're out, and used so widespread, there is a problem. You can't just go around revealing the dangers of these meds. Afterall nobody wants to panic about their anti-panic meds, or get depressed about their depression pills.
So, its a double whammy. The fact that the patient population would be so sensitive to such negative data gives more reason for experts to keep it behind closed doors. They think they are acting in the patient's best interest, I suppose.
>This has created a general perception that they >are almost infallible, and it will take a long >time for anyone to go against this. When people >realize the subtle yet devastating dangers of >ad's, a paradigm shift will occur, and those >moral questions will be at the heart of it, I >hope. I also hope it will happen in my lifetime, >but I'm not sure that it will.
This is it. People have worked so hard to establish the efficacy of the drugs, that it cannot be reversed over night.Its all about giving people hope. If people believe in drugs, then they have hope. Thats why most of us are here, we are looking for hope. Faith in a pill is powerful. Its the kind of thing people would like to belive in because it is whatever you want it to be.
Linkadge
Posted by notfred on March 10, 2007, at 16:55:14
In reply to Quackwatch itself has received criticism.........., posted by Quintal on March 10, 2007, at 14:30:00
Quackwatch has been mentioned in the media, reviews and various journals, as well as receiving several awards and honors.[13][14] In 1998, Quackwatch was recognized by the Journal of the American Medical Association as one of nine "select sites that provide reliable health information and resources."[15] It was also listed as one of three medical sites of U.S. News & World Report's "Best of the Web" in 1999:[16]
Posted by flmm on March 10, 2007, at 16:55:59
In reply to Re: the real issue, posted by linkadge on March 10, 2007, at 16:21:13
Maybe you are looking for cures in the wrong places........
Posted by notfred on March 10, 2007, at 17:11:32
In reply to Re: 'Dr. Breggin's opinions not based on good science' » notfred, posted by ralphrost on March 10, 2007, at 13:26:08
" Antidepressants are not good science, they don't even know how they work (or don't work)..."
NOr do we know why many drugs work. But AD's work for me.
Posted by Meri-Tuuli on March 10, 2007, at 17:26:01
In reply to Re: the real issue, posted by linkadge on March 10, 2007, at 16:21:13
Well said Link. I'm of a very similar opinion (but I'm not as well read as you so I won't say that I have the same opinion as you!).
It also gives me courage in my 'au naturale' state I'm in at the moment.
kind regards
Meri
Posted by yxibow on March 10, 2007, at 17:29:06
In reply to Re: the real issue, posted by linkadge on March 10, 2007, at 16:21:13
> >So two questions arise...One is how often are >people pretty much screwed over (meaning >severely reducing quality of life, I'm one of >them at this point) by these drugs? It's >probably a relatively small number because the >number of people taking ad's is astronomical,
>
> Well, thats the thing. The use of the TCA's was not this widespread. So, we really don't have any idea yet on how the SSRI's are affecting people long term. They havn't been out long enough.SSRIs have been in the lab since the early 1960s (Prozac has its roots in Benadryl) and Luvox was released in Switzerland in 1984. We have about 25 years of experience with the proof of concept of SSRIs and if you trace it to the earliest, we have over 40 years of proof of concept. With the introduction of Prozac here we have 20 years of history of use. That equals to millions of patients times 20 years, which is millions of patient-years of proof of side effects and positive effects and what long term use of SSRIs do.
> This is it. People have worked so hard to establish the efficacy of the drugs, that it cannot be reversed over night.
>
> Its all about giving people hope. If people believe in drugs, then they have hope. Thats why most of us are here, we are looking for hope. Faith in a pill is powerful. Its the kind of thing people would like to belive in because it is whatever you want it to be.
Hope comes from within. It doesn't just come from a drug, but real hope for success in one's life is not something that is only given by a drug or therapy, it is a concept that builds up over time. If you have hope take and run with it.
At the same time, most people argue when will the next big thing in psychiatry be. Well with the idea that "people have worked so hard to establish the efficacy of the drugs, that it cannot be reversed over night.", you will never get new agents to the market. What is the ultimate thing, to reverse all agents overnight so we're left back with lobotomy drills, cold baths, and insulin injections ? I think we'd all implode. Its 2007.
Yes, there have been egregious examples of drug failure. There will always be drug failure. One can complain all sorts of conspiracy theories but at the end of the day, stifling innovation, which by the way I'm not saying is Big Pharma alone -- a lot of good innovation actually starts in universities and government labs and then is sold to drug companies. Some research is done by drug companies alone but its not by means the only route.
Without failures we can't have successes. Of any sort. And this is an unfortunate truth.
As for Breggin, well, I can't even go there, this descends into a please be civil discussion, but what can I say, in my opinion only he contributes far worse to psychiatry than any benefit.
I'm sure we'll have this discussion again, we always do. Its the I want a perfect agent without side effects and long term problems (which don't have to be measured in actual years, patient-years is a medically sound concept.)
And then when there aren't any agents on the market, then there's a complaint argument as to when the next proof of concept will be. With multiple suing and torts and all sorts of things, maybe never. I agree, people have the right to address egregious grievances, but how far can we go?
As for whether the proof of concept that transmitters are changed, I worked for a leading expert in OCD and brain chemistry. This was still in the earlier days of PET scans but it conclusively showed that brain chemical changes occurred whether an SSRI was used, behaviour therapy was used, or both. It didn't matter, electrical changes in the caudate nucleus was apparent in all cases.
So, is everything a palleative and is nothing a curative or vice versa -- I think it lies inbetween. But for me the proof of palleative does at least give me hope that the fight to regain more than 5 years of my life that has been lost to a rare disorder I didn't sign on to -- yes hope gives that maybe it will be more than a palleative. I hope that is the case. Because I have a Somatiform disorder that I only recently discovered that there was even one person on here who had a different form of Somatiform disorder. Longterm Somatiform disorders are more rare and harder to treat. Somatiform disorders themselves are common though -- pseudoseizures being seen frequently in ERs.I don't like the bag of medication that I carry behind me but it helps me get through the day at this point and at least do some things that I used to do before everything fell apart.
And by this point I've taken for granted almost the side effects that have hit my body -- they're awful and I would never have stood them years ago but what can I do? Go back to square one when I was suicidal ? That certainly isn't positive.
These things aren't easy choices -- they're unfortunately "informed consent."
And that's all I can say speaking for myself.-- Jay
Posted by clint878 on March 10, 2007, at 18:52:39
In reply to Psychotropics harm *trigger*, posted by ralphrost on March 10, 2007, at 9:29:03
Of course these drugs "rewire" the brain. If nothing was "rewired," then there would be no clinical effect. Mind and matter are not two separate things in psychiatry.
And, interestingly, other things rewire the brain as well. For example, Post-Traumatic Stress Disorder (PTSD) is probably a re-wiring of the brain in response to a horrific event. People get picked on as a kid and have their brains rewired permanently. Heck, even reading this post and remembering it rewires your brain in some way.
Just because it's been wired one way doesn't mean you can't just re-wire it again. A lot of people here experience a considerable amount of anxiety, which makes things seem much worse than they actually are. Even if there is some sort of long-lasting change, I would bet the effect is relatively small and hardly noticeable.
I used to believe that my illness was preventing me from participating in life. Perhaps it's not participating in life that is causing the illness, instead.
Posted by yxibow on March 10, 2007, at 19:12:53
In reply to Cherry-picking evidence, posted by clint878 on March 10, 2007, at 18:52:39
> I used to believe that my illness was preventing me from participating in life. Perhaps it's not participating in life that is causing the illness, instead.
That's a very sage comment. And sort of partially at the crux of a double disorder I have -- both Somatiform and a certain sense of peter-pan ness. I have to find the hope within, medications may help, but I have to participate in life. I don't know how I'm going to, I am not handicapped but I am "challenged" and downright depressed (MDD) at times about my illness.
And that's why I always encourage people to get out a bit each day if they seem to be sort of shut in. Today was kind of a blah day, I really didn't get out much. I have things on my mind worrying me alot of course like everyone does, but I should have done something. Maybe I'll at least do something later on.-- tidings
Jay
Posted by linkadge on March 10, 2007, at 20:12:22
In reply to Re: the real issue, posted by yxibow on March 10, 2007, at 17:29:06
>SSRIs have been in the lab since the early 1960s >(Prozac has its roots in Benadryl) and Luvox was >released in Switzerland in 1984. We have about >25 years of experience with the proof of concept >of SSRIs and if you trace it to the earliest, we >have over 40 years of proof of concept. With the >introduction of Prozac here we have 20 years of >history of use. That equals to millions of >patients times 20 years, which is millions of >patient-years of proof of side effects and >positive effects and what long term use of SSRIs >do.
Well I'm not so sure. The term poop-out is a recent term. The term poop-out can't be more than 10 years old. So it hasn't been too long that we have admitted that the drug effects can fade.
In addition, the true incidence of sexual side effects from SSRI's has only been revealed in recent years. Data from 15 years ago would have said that 10-15% of people experience some mild sexual side effects.
In addition, the propensity for SSRI's to cause suicidal ideation in some people is a recent discovery to come to the forefront.
So, I would argue that there are clearly a number of issues with the drug that have only started to be revealed recently.
Other issues, such as the possable propensity for SSRI's to cause cardiac valve problems, would likely take even longer to come to the forefront.
Doctors aren't always so great at connecting the dots.
More importanlty, efficacy data has been debated, and re-evaluated in recent years. Early data falsely suggested that 80% of people get better on antidepressants. More recent (sobering) data suggests that less than half of people get better. Inteed less than half of all clincial trials for antidepressants show superiority of drug over placebo.
So, you're right, we do have accumulating data, but its not all as positive as some people would like to believe.
>What is the ultimate thing, to reverse all >agents overnight so we're left back with >lobotomy drills, cold baths, and insulin >injections ? I think we'd all implode. Its 2007.I'm not saying that. I am just saying that when a new, presumably superior drug comes to the market, drug companies all of a sudden become less concerned about the image of their previous blockbuster.
>As for Breggin, well, I can't even go there, >this descends into a please be civil discussion, >but what can I say, in my opinion only he >contributes far worse to psychiatry than any >benefit.I see him as a necessary voice. He goes places, and asks people to concider possabilities that people would rather not consider. What if ECT does cause irreversable brain dammage? What if SSRI's corkscrew serotonin receptors? etc. etc. Its important, since we are trying to make the brain healthier, and a lifetime is a very long time. It would be a horrable thing to waste on a fad.
>As for whether the proof of concept that >transmitters are changed, I worked for a leading >expert in OCD and brain chemistry. This was >still in the earlier days of PET scans but it >conclusively showed that brain chemical changes >occurred whether an SSRI was used, behaviour >therapy was used, or both. It didn't matter, >electrical changes in the caudate nucleus was >apparent in all cases.I agree with you. There are abnormalities in brain metabolism. Recovery, in any form, is associated with ameleoration of those abnormalities. I would assume that those on the SSRI's who didn't get better still maintained the pathalogical metabolism. So, it prooves that recovery is associated with brain changes, not necessarily that a drug was responsable for brain changes.
>And by this point I've taken for granted almost >the side effects that have hit my body -- >they're awful and I would never have stood them >years ago but what can I do? Go back to square >one when I was suicidal ? That certainly isn't >positive.Its not my place to tell people what to do. If they work for you then great. I just think it is important to note the cases where things got much worse, that way people who encounter a similar issue won't feel so alienated.
Linkadge
Posted by linkadge on March 10, 2007, at 20:17:11
In reply to Cherry-picking evidence, posted by clint878 on March 10, 2007, at 18:52:39
In my case, the rewiring was not a positive rewiring.
My brain is now rewired to walk funny, to have strange head rotation sensations, to have zero sexual function, to have less hedonic capacity than prior drug exposure, to have really messed up sleeping patterns, to have brain zaps (years later), list goes on.
Most of these problems resolve within 20 minautes of taking a test dose of an SSRI. (years after quitting a test SSRI dose still undoes most of these problems instantly), which tells me that my brain is still looking for the substance.
Mind you, I was given these drugs during teen years when my brain was probably still growing.
Linkadge
Posted by Declan on March 10, 2007, at 20:37:46
In reply to Re: the real issue, posted by flmm on March 10, 2007, at 16:55:59
There are people who have been helped by drugs.
And people who have been damaged by them.
What's the big deal?
Why cannot we have some empathy for the point of view we do not share?
It is possible to entertain a view without sharing it.
Posted by Declan on March 10, 2007, at 20:39:22
In reply to Re: 'Dr. Breggin's opinions not based on good scie, posted by notfred on March 10, 2007, at 17:11:32
Hands up those who have actually read "Talking Back to Prozac".
I have. I thought it was a little basic, but not so bad as I recall.
Posted by Declan on March 10, 2007, at 20:42:45
In reply to the real issue » linkadge, posted by crabwalk on March 10, 2007, at 15:02:09
>When people realize the subtle yet devastating dangers of ad's, a paradigm shift will occur<
Well, it has around here with my doctors.
Posted by Declan on March 10, 2007, at 20:50:23
In reply to Re: 'Dr. Breggin's opinions not based on good science' » notfred, posted by ralphrost on March 10, 2007, at 13:26:08
Are we reduced to quoting the opinion of judges from Maryland to win an adversarial argument? Crikey!
If someone has been really helped by whatever, hats off to them.
The reputation of psychiatry in the wider community comes at least in part from imact on the families of those who have been damaged or not helped by it.
Posted by notfred on March 10, 2007, at 20:54:34
In reply to Judges from Maryland, posted by Declan on March 10, 2007, at 20:50:23
At least they know a quack when they see one.
Posted by Ken Blades on March 10, 2007, at 23:08:53
In reply to Peter Breggin, posted by Declan on March 10, 2007, at 20:39:22
[hand is up]
>>>Hands up those who have actually read "Talking Back to Prozac".<<<<
It had some info that no one argues with,
mainly BIG PHARMA and its business practices.But it was rather one-sided regarding
psychotropic drug use.... all horror
stories and no successes.Not much on MAOIs in his book as I recall,
but when he panned THOSE, he lost all
credibility with this MAOI user....Breggin: "The sky is falling..."
Posted by Declan on March 11, 2007, at 1:59:49
In reply to Re: Peter Breggin » Declan, posted by Ken Blades on March 10, 2007, at 23:08:53
Good to see someone's read it.
No, nothing on MAOIs.
Posted by Meri-Tuuli on March 11, 2007, at 4:00:06
In reply to Judges from Maryland, posted by Declan on March 10, 2007, at 20:50:23
Yeah exactly. I think people were talking about this earlier so I'm somewhat late. I went to some introductory law lectures once, and apparently alot of laws and therefore decisions made by judges, are um, based on what are the soceital norms and customs and things like that are. So in such a pharmacological driven society as the US, well I expect their decisions (and therefore the resulting laws, or precedents or whatever its called) will be influenced by that.
Well that was crap explanation. Anyway. I'm going away.
Posted by linkadge on March 11, 2007, at 9:52:50
In reply to Re: Judges from Maryland, posted by notfred on March 10, 2007, at 20:54:34
But whats the point of labling somebody a quack, and then subsequently dismissing everything they say?
Life isn't black and white like that. Even quacks can make good points.
Linkadge
Posted by Larry Hoover on March 11, 2007, at 10:46:47
In reply to Re: Judges from Maryland, posted by linkadge on March 11, 2007, at 9:52:50
> But whats the point of labling somebody a quack, and then subsequently dismissing everything they say?
>
> Life isn't black and white like that. Even quacks can make good points.
>
> LinkadgeCredibility is easier lost than gained. Breggin went over the top with his hypotheses, and it is no longer possible to simply accept his seemingly studious and considered approach as being able to support the conclusions he reaches.
I never read the book, but I read excerpts from it. They are found on the 'net. And when I read the referenced pieces, and looked at his reasoning, I found real problems in his logic. I had to really work hard to even find his argument, in some cases. I'm just going to avoid considering the man's product as it is too much work for too little benefit.
There's another guy, Dr. Mercola. He's into hyping (and selling) various health foods, and books and such. I just got a newsletter from this guy which included supposed proof (and supposedly suppressed proof) that GM potatoes were linked to cancer in lab rats. He's a doctor. You're supposed to trust this guy, right? But when I went to the primary cited source, and read it, I found no mention of neoplasm, in any context. Moreover, non-GM potatoes demonstrated similar and sometimes greater adverse effects. My only conclusion is that it is not wise to feed Russet Burbank potatoes to rats, instead of lab rat chow. In no way can I conclude that GM Russet Burbanks are associated with cancer induction in humans. Ya know? His credibility is blown.
You happened to have mentioned the corkscrewing of neurons. Just for the record, the paper upon which that argument was first (and ever) raised is worthless. The primary reference is unreliable. Junk science. Any decent scientist would see that, upon reading it. If I recall correctly, Breggin used it to support one of his hypotheses. Then he is not credible, either. You see?
Lar
Posted by Honore on March 11, 2007, at 10:49:19
In reply to Re: Judges from Maryland, posted by linkadge on March 11, 2007, at 9:52:50
I've read "Talking Back to Prozac." It seemed pretty unbalanced to me, although at the time, I was in agreement with parts of it.
I'm not in agreement with the basic point. Maois are good ADs-- and are, I believe, underused. I hope that will change.
But Breggin is not, from anything I know, a Scientologist, or in it for the money. He seems to be someone who has some good science in his favor, and a lot of good science against his position, but who believes the part of the science that he believes.
I wanted to add that being an expert witness is a perfectly respectable thing to be. Expert Witnesses are paid not to have a point of view==as is the common belief-- but are hired because they genuinely, legitimately and authoritatively have the ability to give facts that are relevant. In cases with complex factual bases, such as cases involving science or certain types of law not generally understood (the law of corporations, or taxation), expert witnesses are brought into court to explain, either to judges or juries, some important facts about the area of science or institutional relationships.My Sig O has testified as an expert witnesses a bunch of times. He only takes cases where he thinks the position he's articulating is right. Often he supplies arguments for a person's position, because he knows more about that area of law than anyone on the defense or prosecution team. If he doesn't think the person is correct or he doesn't believe the arguments they want to make, he turns down the case. He never takes a case just to get paid, or testifies under oath that he belives certain facts or ideas, if he doesn't. His testimony is only worth the money, actually, if he can come into court free of the suggestion that he does say something just for money-- if you see what I mean.
While I don't agree with Breggin, I think he does believe what he says. I think he takes cases, even if he's paid, where he believes the position he's being asked to testify to. There's nothing wrong or phoney about that. It's what expert witnesses do.
Is he doing harm? quite possibly. Is he completely without any justification or leg to stand on? probably not. I wish he didn't enter into these discussions, because I think he's propagating hurtful ideas. But that's an opinion.
Honore
Posted by linkadge on March 11, 2007, at 11:11:22
In reply to Re: Judges from Maryland » linkadge, posted by Larry Hoover on March 11, 2007, at 10:46:47
When evaluating statments independantly it is of no use (IMO) to lable somebody credable or not.
I can make 100 statements, 99 being false and one being true.
Regardless of the proportion of true to false, the 99 false statements do not make the 1 true statement false.
I see what you are saying, I just have a slightly different approach.
Linkadge
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