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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 33 to 57 of 57. Go back in thread:
Posted by ed_uk on November 17, 2005, at 15:16:46
In reply to Re: NYT ''new trends'', posted by med_empowered on November 17, 2005, at 6:23:32
Hi Med
I don't like it how the article mentioned your name. It feels like a violation because they didn't ask your permission. You don't have anything to apologise for Med. I didn't like the article personally - far too one-sided.
Kind regards
Ed
Posted by Nickengland on November 17, 2005, at 15:29:32
In reply to Re: NYT ''new trends'' » med_empowered, posted by ed_uk on November 17, 2005, at 15:16:46
Thats a relief Ed :-)
You said it well, what took me quite afew more words! lol
Kind regards
Nick
Posted by linkadge on November 17, 2005, at 15:39:27
In reply to Re: Shafer on Harmon's article » linkadge, posted by ed_uk on November 17, 2005, at 15:13:29
Oh its big alright (at least around here). I new a guy who nearly payed for all his texts and some of his tuition by selling his prescriptions.
Linkadge
Posted by jay on November 17, 2005, at 15:44:54
In reply to Article in NYT RE: Self-Prescribing/Medicating, posted by hawkeye on November 16, 2005, at 9:42:03
See my article below from Scientific American. This is about POLITICS, not SCIENCE. Chances are is you think you are smarter than your psych. doc, you are! Us North Americans are just too uptight about taking a pill. If we where given the knowledge to develop the technology of a pill, we should use it!
Jay
Posted by ed_uk on November 17, 2005, at 16:00:17
In reply to Re: Shafer on Harmon's article, posted by linkadge on November 17, 2005, at 15:39:27
I guess Ritalin is prescribed a lot in Canada? Here, people seem to come off it when they're about 16 - whether they like it or not I suppose!
Ed
Posted by ed_uk on November 17, 2005, at 16:00:48
In reply to Re: NYT ''new trends'' » ed_uk, posted by Nickengland on November 17, 2005, at 15:29:32
Thanks Nick :-)
Ed
Posted by Meri-Tuuli on November 17, 2005, at 17:01:27
In reply to Re: Shafer on Harmon's article, posted by linkadge on November 17, 2005, at 15:39:27
Hey there Link, interesting article huh!?
I don't personally know a single person who has taken ritalin (at uni or otherwise) but then I live in the UK....hahaha, and if I did, I'd get them to give me some....then I too could be one of the people in the trend!!!
Anyway, unfortunately, I'm the only one of my friends to become obsessed by pmeds etc. One of my close friends hates it when I even ask her how she is doing on one of them. They think I am abit weird for it....ah well. Maybe its the British weather or something.
Posted by linkadge on November 17, 2005, at 18:57:23
In reply to Re: Shafer on Harmon's article, posted by Meri-Tuuli on November 17, 2005, at 17:01:27
No, ADD/HD is a lifelong illness here in canada :) and so medicating for it goes on and on.
Linkadge
Posted by Phillipa on November 17, 2005, at 19:39:49
In reply to Re: Shafer on Harmon's article, posted by linkadge on November 17, 2005, at 18:57:23
Just wanted to say that only the college age and young professionals were included in the article. What about all the older people who post here and on other sites. We just get tired of doctors not listening to us. And it's impossible to abuse meds here anyway. The doctor can only prescribe for a month. The only way to abuse legally is to have a pdoc who prescribes more or higher doses than he means you to take. My old pdoc used to do this. He'd prescribe let's say lmg xanax l20tabs a month. And I was only taking .5pills. So I had extas each month. Down the toilet they went when the med was changed. Fondly, Phillipa
Posted by Phillipa on November 17, 2005, at 21:16:06
In reply to One More Thing, posted by Phillipa on November 17, 2005, at 19:39:49
In eating my dinner was watching TV, PBS-WUNG had a panel of experts from UNC and other Public Service Educators who are advocated for the mentally ill and in charge of improving care for the mentally ill. They brought up to the panel the article in the NYT. They all agreed a big problem was people sharing meds, using them to get high and how dangerous it was to take these AD'd and other meds without the supervision of a psychiatrist. They said the older antipsychotics were horrendous drugs that caused dystonia, akathesia, shaking hands. And the newer family of antipsychotics was not much better since they caused diabetes. And they said the reason young people are creating suicide with ADs. Was because when they took them they were really bipolar. They said the AD's caused them to become manic and that's why they committed suicide. They said young children who were fidgety in the classroom and given ritalin were really bipolar. They said only a psychiatrist was capable of diagnosing for anyone. A proper diagnosis is necessary so appropriate mediacation can be prescribed. They said with proper medication people would be productive in society. That the State was providing services to help the mentallly ill. And a nursing home enviorment was not appropriate for a young adult mixed in with an Alziemers pt. And that with support groups for self and family, theraphy and medication . A person would become well. And that people had to stay in the closet and not disclose that had mental illness. The show presented all types of mental illness as being the same as diabetes or heart disease. For anyone whatching the TV program it appeared just see psychiatrist, get dx and attend support groups for self and family. So they could understand what was going on and respite for families of pts with mental illness. They had an expert who said his problem was a frontal lesion of the brain. Who was now in charge of an agency for the mentally ill. It made it seem like mental illness was very common and no one would notice. That appropriate meds returned the person to an active and productive life. Does anyone else have all these services available. That suffering was a thing of the past and anyone could recover with meds. That all meds when they were no longer necessary be disposed of appropriately. That way meds would not be shared, sold or abused by those they were not prescribed for. Is this the real world or what?Fondly, Phillipa
Posted by med_empowered on November 17, 2005, at 23:51:31
In reply to Wow It's Now On TV!, posted by Phillipa on November 17, 2005, at 21:16:06
ugh...no, its not the real world. A bad response to an AD doesn't mean "you must be bipolar". Antidepressants raise the levels of neurotransmitters to *unusually high* levels--so really, you're inducing an unusual, patholigical state in the brain; any improvements you see are more from unusually high serotonin or whatever than they are from "restoring balance" or whatever marketing BS drug companies are saying these days. Whats remarkable is that MORE people DONT go crazy--I mean, you soak your brain in serotonin, for a LOOOONG time.
Now, Im not saying antidepressants dont help some people--they do--but lets be honest here: psychiatric drugs don't really "fix" any underlying problem. Yes, they can alter brain chemistry so that *symptoms* go away and life overall becomes easier, but this doesn't mean that they somehow *fix* a *disorder*.Weirdly enough, the newer breed of psychiatric meds actually seems to sometimes threaten *psychiatrists*--something like 70% of all psychotropic med RXs are written by non-psychiatrists; GPs, nurse practitioners, that kind of thing. Psychiatrists tend to see the affluent and the more complicated cases. Also, theres a move to allow psychologists to prescribe--they're doing this in New Mexico, with no apparent problems as of yet. Of course, shrinks fought against this and continue to fight against it. Its weird, isn't it--the idea that a 15minute session every 2-3 months could somehow offer them insight that other docs don't have? Plus, they don't usually do blood work or anything themselves so...really, many of todays shrinks are highly skilled drug pushers. This whole "we have all the answers" schtick is really just a power grab.
Posted by linkadge on November 18, 2005, at 9:08:10
In reply to Wow It's Now On TV!, posted by Phillipa on November 17, 2005, at 21:16:06
I think the explaination that antidepressants cause suicide via mania activation is "very convenient". It is another example of psychiatry directing attention away from itself, and back on to the patient.
I think that SSRI's can cause suicidal thinking independant of any bipoliarity via a little thing called "akathesia"
Linadge
Posted by linkadge on November 18, 2005, at 9:09:01
In reply to Re: Wow It's Now On TV!, posted by med_empowered on November 17, 2005, at 23:51:31
Posted by linkadge on November 18, 2005, at 9:12:25
In reply to Re: Wow It's Now On TV!, posted by med_empowered on November 17, 2005, at 23:51:31
My example is coffee. Drinking enough can make anyone nervous, it is not unmasking a latent anxiety disorder just because it makes you nervous.
Linkadge
Posted by thuso on November 18, 2005, at 13:04:28
In reply to Re: Wow It's Now On TV!, posted by med_empowered on November 17, 2005, at 23:51:31
> Weirdly enough, the newer breed of psychiatric meds actually seems to sometimes threaten *psychiatrists*--something like 70% of all psychotropic med RXs are written by non-psychiatrists; GPs, nurse practitioners, that kind of thing. Psychiatrists tend to see the affluent and the more complicated cases. Also, theres a move to allow psychologists to prescribe--they're doing this in New Mexico, with no apparent problems as of yet. Of course, shrinks fought against this and continue to fight against it. Its weird, isn't it--the idea that a 15minute session every 2-3 months could somehow offer them insight that other docs don't have? Plus, they don't usually do blood work or anything themselves so...really, many of todays shrinks are highly skilled drug pushers. This whole "we have all the answers" schtick is really just a power grab.
>I actually disagree with you on that. If that was true, then what is the point of going to any specialist? Any doctor can prescribe me the same meds any specialist can, but a lot of the times they don't because they understand that their knowledge is not at the same level as the specialist. Also, specialists should be more caught up in the literature than a general doctor. Now I think for simple cases a general doctor can administer the meds, but I think people should get their initial opinions and periodic checkups from specialists.
That's why I try and go to an Endocronologist for my thyroid issues. My regular doctor can very easily give me the meds I need, but they probably won't catch any subtle signs that my Endo will quickly catch. I've benefitted from this type of instance often. You will never see me getting any psychiatric drugs from my general doctor no matter how simple my problem. I trust the knowledge of a good specialist much more. <note that I said "good">
Posted by Nickengland on November 18, 2005, at 13:42:11
In reply to Article in NYT RE: Self-Prescribing/Medicating, posted by hawkeye on November 16, 2005, at 9:42:03
Whilst neutral in my stance to the right and left.
This paper swings to the right I believe in the UK.
Depression gene discovered
09:00am 18th November 2005Researchers have hailed the discovery of a new gene linked to depression as a step towards unravelling the mystery of mental illness.
The team behind the breakthrough say it could lead to the development of new drugs to beat the condition, along with schizophrenia and bi polar disorder.
Scientists at Glasgow and Edinburgh universities found that damage to the gene, known as PDE4B, can increase the risk of developing the illnesses.
Though known to play an important role in how the brain thinks and builds memories, it had not been linked to mental disorder.
It's also been connected with another gene, DISC1, previously found to increase the chances of developing the conditions.
Professor David Porteous at the University of Edinburgh said: "This is another important breakthrough in our still limited understanding of major mental illness.
"It is the result of a long term research commitment to use the tools of genetics to better understand the root causes of mental disorder.
"The new genetic link we have made to PDE4B and how that links back to DISC1 sheds much needed light on these debilitating disorders.
"It also suggests a new way of thinking about developing better and effective medicines."
The discovery was made by researchers working with scientists from the pharmaceutical firm Merck Sharpe and Dohme.
The company's Peter Hutson said: "Mental illness remains a scourge of society.
"Our insights into the important role that the proteins PDE4B and DISC1 may play in the mis-function of the brain that leads to schizophrenia and will lead our thinking in the development of new treatments for this disorder."
Professor Miles Houslay, of the University of Glasgow, who also worked on the study, said: "Over the past few years we've been working hard to help in the development of medicines for treating asthma and chronic obstructive pulmonary disease by inhibiting very similar enzymes to PDE4B.
"It has been so exciting to work together with the Edinburgh and Merck groups in finding this new link between the gene coding for PDE4B and schizophrenia.
"This new research has the potential for developing novel ways of diagnosing and treating this debilitating disease."
Posted by Laurie Beth on November 18, 2005, at 14:49:02
In reply to Re: Wow It's Now On TV!, posted by med_empowered on November 17, 2005, at 23:51:31
"many of todays shrinks are highly skilled drug pushers"
I agree, with the exception of the part about "highly skilled." ;-)
Okay, don't really want to be pdoc bashing here; I'm partly kidding. I feel frustrated lately because, among other reasons, my pdoc pretty much tells me at every visit, as I try desperately to figure out whether a drug will help me, or dramatically and possibly irreparably harm me, BEFORE I take it, that there's simply no way to predict individual reactions to specific medications, and it's just gonna have to be trial and error. Okay, fair enough, and thanks for the honesty, but then ... ummm ... why do I need him?
I'm not impressed by the psychiatrist blog and responses mcd cited above. Most of these pdocs seem to react to patient concern about psychiatrists condescending to them and not listening to their perceptions of their illnesses and the effects of meds (which are, after all, first hand!) with more condescension and more refusal to listen. I'm sure that there are good pdocs out there (that guy Sobo, whom I read after seeing him mentioned somewhere on psychobabble, at least seems very thoughtful about individual cases), but there seem to be a lot of them that simply don't listen or care much about individual experience, despite all this jabbering about how "dangerous" it is for patients to self-prescribe and how subtle all the pdoc decision-making about meds is. The pdocs cited above make it sound like it's bipolar *patients* who are doing most of the self-prescribing of antidepressants, leading to manic reactions. I'm not a reporter and haven't done adequate research to back up this claim (!), but I am sure that far, far, far more patients have been pushed into mania, hypomania, or some kind of akisthetic (word?) crisis by prescription antidepressants legally obtained from MDs, whether generalists or pdocs, than have done the same by self-prescribing. And yet, it's made to sound the opposite.
And as far as the strict supervision that pdocs are supposed to be doing to assure that patients take effective meds in a safe fashion ... mine just this month gave me a Wellbutrin sample (despite the fact that I'm already suffering from irritability and some obsessiveness and have said so), told me to finish the 7-pill pack and then absolutely positively to call him before proceeding ... then disappeared out of town for 10 days (probably to give speeches, though I don't know this - sometimes I wonder if he's having some kind of emotional crisis of his own) with no one covering for him. So I don't have anyone but myself to consult about whether I should continue a med that doesn't seem to be helping and may possibly be increasing feelings of rage. Fortunately or unfortunately, the staff just complied with my request to call in a continuation of the med so I didn't have to go cold turkey just because he had disappeared. But that means I *am* "self-prescribing" - unwillingly in this case. It seems like it's absolutely crucial that pdocs carefully supervise administration of prescription psychiatric meds ... unless it happens to be inconvenient for them.
Posted by linkadge on November 18, 2005, at 15:39:17
In reply to Great Article For a sizable group of people ;-), posted by Nickengland on November 18, 2005, at 13:42:11
I read another article that said depression was releated to CREB1.
Linkadge
Posted by Nickengland on November 18, 2005, at 16:48:12
In reply to Re: Great Article For a sizable group of people ;-), posted by linkadge on November 18, 2005, at 15:39:17
Is it a case that multiple genes could be involved - CREB1, DISC1, phosphodiesterase 4B (PDE4B)...and possibly various others depending on the severity of the illness with epigenetic and environmental factors...
In an ideal world, or at least a step forward would be better diagnostic tools so that when for example you went to the doctor, there could be a test given to see which genes are affected/faulty when you're ill. Then with newer drugs specifically targeted to treat not just the symptoms ~ but more of the cause. Thing is though - no drug will treat your environment...but then its a step closer. Also could work out that treating the gene will help you better respond to environmental triggers - better than the current drugs that is..
Kind regards
Nick
Posted by greenhornet on November 19, 2005, at 15:41:27
In reply to pdocs as the gatekeepers to meds, posted by Laurie Beth on November 18, 2005, at 14:49:02
Since I do have a life beyond "Babble", I totally missed this discussion and the article that stimulated it. I have just finished reading all of the posts about the issue. Whew, try that sometime!!
1.My "family doc" "monitors" all of my medications, psych and otherwise because he and I feel that he knows me better all around. He knows my body, my illnesses, etc.
2. The psychiatrist that I saw his time around saw me for a year and then made it clear that ANY physician could do what he had been doing - and in fact, some could do it better!
3. One can sometimes become TOO close to an issue, and therefore probably should NOT prescribe for family and/or friends. (It may not have become clear by now, but my husband and two of our sons are physicians, and a very firm rule in this family has been for forty years, no matter how tempting, NEVER WRITE A SCRIPT FOR A FAMILY MEMBER!!!
4. No offense to anyone on the board, but I would hope that everyone realizes that journalists ALL have agendas and preconcieved ideas when they choose to write an article/book.
It's a good discussion, and without a doubt, Dr. Bob offers a valuable service via the internet. Whether we agree with him at all times or not, he does so with relative objectivity!
greenhornet
-------------------> "many of todays shrinks are highly skilled drug pushers"
>
> I agree, with the exception of the part about "highly skilled." ;-)
>
> Okay, don't really want to be pdoc bashing here; I'm partly kidding. I feel frustrated lately because, among other reasons, my pdoc pretty much tells me at every visit, as I try desperately to figure out whether a drug will help me, or dramatically and possibly irreparably harm me, BEFORE I take it, that there's simply no way to predict individual reactions to specific medications, and it's just gonna have to be trial and error. Okay, fair enough, and thanks for the honesty, but then ... ummm ... why do I need him?
>
> I'm not impressed by the psychiatrist blog and responses mcd cited above. Most of these pdocs seem to react to patient concern about psychiatrists condescending to them and not listening to their perceptions of their illnesses and the effects of meds (which are, after all, first hand!) with more condescension and more refusal to listen. I'm sure that there are good pdocs out there (that guy Sobo, whom I read after seeing him mentioned somewhere on psychobabble, at least seems very thoughtful about individual cases), but there seem to be a lot of them that simply don't listen or care much about individual experience, despite all this jabbering about how "dangerous" it is for patients to self-prescribe and how subtle all the pdoc decision-making about meds is. The pdocs cited above make it sound like it's bipolar *patients* who are doing most of the self-prescribing of antidepressants, leading to manic reactions. I'm not a reporter and haven't done adequate research to back up this claim (!), but I am sure that far, far, far more patients have been pushed into mania, hypomania, or some kind of akisthetic (word?) crisis by prescription antidepressants legally obtained from MDs, whether generalists or pdocs, than have done the same by self-prescribing. And yet, it's made to sound the opposite.
>
> And as far as the strict supervision that pdocs are supposed to be doing to assure that patients take effective meds in a safe fashion ... mine just this month gave me a Wellbutrin sample (despite the fact that I'm already suffering from irritability and some obsessiveness and have said so), told me to finish the 7-pill pack and then absolutely positively to call him before proceeding ... then disappeared out of town for 10 days (probably to give speeches, though I don't know this - sometimes I wonder if he's having some kind of emotional crisis of his own) with no one covering for him. So I don't have anyone but myself to consult about whether I should continue a med that doesn't seem to be helping and may possibly be increasing feelings of rage. Fortunately or unfortunately, the staff just complied with my request to call in a continuation of the med so I didn't have to go cold turkey just because he had disappeared. But that means I *am* "self-prescribing" - unwillingly in this case. It seems like it's absolutely crucial that pdocs carefully supervise administration of prescription psychiatric meds ... unless it happens to be inconvenient for them.
Posted by pseudoname on November 20, 2005, at 8:15:14
In reply to Interesting response by a psychiatrist, posted by mcd on November 17, 2005, at 12:54:25
In addition to the Shrinkette blog mcd linked to (by a Eugene, Oregon, pdoc — anybody know who she is?), "Medpundit," an anonymous GP blogger, says the NYT's self-prescribers suffer from "arrogance and stupidity." She later says about psych meds...
<quote>
And by the way, the article makes it sound as if general practice physicians can't keep up with the literature, so they just give whatever the patient asks for. The true reason doctors often give patients the drug they request rather than one of the doctor's choosing in this age of direct to consumer advertising is that there's a strong placebo affect with anti-depressants. Give a patient a drug they believe to be inferior and it won't work. Give them one they believe to be superior and they're more likely to get better.
<unquote>Um, excuse me? GPs actually CAN'T keep up with psychiatric literature. How could they? Does this one think she can? Talk about arrogance and stupidity!
The condescension in her post! "Psych problems: they're all in your head! Give the patient dog treats and he'll get better as long as he's seen some slick advertising for them."
I think this is an unbridgeable gulf. I don't know how to deal with such a physician except by not going to see her for anything, and certainly not for any sort of mental health issue.
http://medpundit.blogspot.com/2005/11/trading-pills-its-impossible-to.html
Posted by Laurie Beth on November 20, 2005, at 13:25:03
In reply to an unbridgeable gulf, posted by pseudoname on November 20, 2005, at 8:15:14
"I think this is an unbridgeable gulf. I don't know how to deal with such a physician except by not going to see her for anything, and certainly not for any sort of mental health issue."
Yep, but the hard thing is figuring out which physicians are which. Yes, *eventually* it becomes clear which MDs have too little respect for the client's own self-awareness (which isn't infallible, but is always important), which keep up better with the literature, which overestimate their own abilities, and which are secure enough and smart enough to be able to use suggestions from an educated lay person ... but sometimes only after much time and money has been committed.
Posted by mcd on November 20, 2005, at 22:04:36
In reply to an unbridgeable gulf, posted by pseudoname on November 20, 2005, at 8:15:14
I don't know Shrinkette's name, but you can hear an interview with her at http://tinyurl.com/djy7t (scroll down to #4 under "Technology").
There's also an interview with Medpundit - #40 under "General Practice Management"
Posted by pseudoname on November 23, 2005, at 18:48:46
In reply to Re: an unbridgeable gulf-pseudoname, posted by mcd on November 20, 2005, at 22:04:36
Thanks for the link, mcd.
I really want to hear these, but I can't listen on my computer anymore because RealAudio no longer supports Windows 95. (And yes, my computer is THAT old, LOL.) And our library is closed for the next 5 days, when I'd have time!
Posted by mcd on November 23, 2005, at 18:55:14
In reply to listening » mcd, posted by pseudoname on November 23, 2005, at 18:48:46
Sorry you can't hear them - they're pretty interesting.
> I really want to hear these, but I can't listen on my computer anymore because RealAudio no longer supports Windows 95.
I feel your pain. I just upgraded from a 1996 computer and I can't believe the difference!
>(And yes, my computer is THAT old, LOL.) And our library is closed for the next 5 days, when I'd have time!
I know - they're always closed when I have time to go too - the holidays!
This is the end of the thread.
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