I find it odd that medical treatment insists on being so causal—diagnosing a specific illness, and then treating for that illness, but never, ever treating if you don't have evidence of a particular illness.
It makes sense if you're dealing with hypochondriacs or drug-seekers, and it makes epidemiological sense to withhold some treatments from prophylactic use (like antibiotics) to preserve their efficacy. But if you're dealing with an idiopathic illness for over four years, I would think there would come a time where you'd ask the doctor, "can I just try some antibiotics to see what happens? And how about some antiretrovirals, antiparasitics, and antifungals while you're at it?"
Just methodically working through the safe, first-line treatments to the major disease classes, taking each for a month or so and seeing what happens, would probably fix 90% of people's chronic illnesses. Even if it didn't, paying attention to people's reactions to being on various medications are some of the best diagnostic tools there are—which second-line treatment regime to pursue would likely become rapidly apparent.
But instead, people can go years slowly dying from something that they could fix with a few pills from the corner pharmacy, if a doctor would deign to "tinker" rather than working from theory.
Given the side effects, and the huge number of potential treatments, I don't think that the course pursued in this case was in any way unreasonable. They did try something "random" after a while.
Doctors are not infallible, but neither are they idiots. Before suggesting a radical departure for how medicine works, it may be worthwhile to learn a lot more about why it is the way it is right now.
>Just methodically working through the safe, first-line treatments to the major disease classes, taking each for a month or so and seeing what happens, would probably fix 90% of people's chronic illnesses.
90% huh? I'm in no way confident that we have a diverse enough set of interventions in our medical toolkit to fix that much, or that we could find the proper one in a suitable amount of time.
My (unsupported) hypothesis is that the causative agents behind chronic idiopathic illnesses obey a power law: that there should be one treatment that will help an extremely large percentage of people (greater than 30%, say) that should be a "first-line idiopathic treatment regime", and then another treatment that covers another 10%, and then a rapid decline into a long tail of interventions that will only help a few percent of people each.
I say this because the causes of idiopathic diseases, when revealed, seem to be similar in structure to the causes of idiopathically failing companies, or idiopathically broken computers, or idiopathically recidivist criminals: namely, that there is some obvious-after-the-fact property of the environment, which combines with a person who never learned how to deal with/be hygienic in the case of/avoid that property. Computers choke on dust; criminals have friends/family who are in debt and need money; companies hire workers based on status rather than efficacy. None of the subjects of these forces realize that they need to do something about them (clean the computer; get their family to declare bankruptcy; give objective tests to their workers), so they get worse and worse until someone who actually knows enough about their life, while also not being immersed in the subculture that is missing the hygienic knowledge, comes along and helps them.
For the case of criminals (and bad parents), this is the job of social workers. For dentistry, you've got dental hygienists. But who is supposed to teach people how to avoid fungal infections, if it's not part of their implicit cultural package of knowledge? Who's supposed to teach them why they should care about the effects of their diet on their blood pressure, if hey have no family history of hypertension? Etc.
And because of that gap in cultural hygiene-knowledge transmission, I have a strong feeling that a few interventions that directly target the knowledge gaps equivalent to "have you tried blowing compressed air into the computer's vent?" Would have an extremely outsized impact in these cases.
But maybe antibiotics are not the first line. The first line is probably: eat fiber, avoid sugar, drink water, sleep 8 hours, and exercise 2 hours per day.
Then nobody would do the first line, and the whole point would be moot.
Doctors are rightfully conservative. There have been eras (the '50's, for example) where this was not such a big deal, and the results were generally not good. Today's doctors are still working in the shadow of those events, with even more powerful tools.
So while I do see the point you are making, it isn't really that odd that doctors are loathe to treat in the absense of a diagnosis.
> people can go years slowly dying from something that they could fix with a few pills from the corner pharmacy, if a doctor would deign to "tinker" rather than working from theory.
This is a principal-agent problem. Doctors don't have much incentive to cure you. They have a strong incentive to avoid malpractice lawsuits. Thus they are extremely risk-averse.
Sorry that's a terrible blog article. He's having half a conversation and out of context. The tweets he has linked to are no longer there so you just have to figure it out.
In addition I think he's just ridiculing whatever Mark Cuban said and not really engaging with it.
All in all I'd say that article is an example of what health care professionals can say that makes people doubt their ability to think outside any sort of box.
Edit: Coming back to say that I've just reread that article again and want to downgrade my summary to say that it is a really really terrible piece of writing contributing nothing at all to any debate.
Doesn't you're asking for does happen in the practice of medicine? I thought part of why discussions about medicine become confusing is the difference between medical research and clinical practice of medicine.
A particular course of action can sound unscientific by the standards of research where you are trying to to solve the disease, but something that sounds like a shot in the dark when nothing else is working could advance the primary goal of improving the patient's health as long as close attention is paid to increased risks.
> I find it odd that medical treatment insists on being so causal
Actually the IOM says that the best practice is to try different treatments first, and then try to figure out the cause later. (You can see this in their report on pain management.) But the government continues to pass new laws to criminalize the suggested best practices of its own top doctors and medical researchers.
> But instead, people can go years slowly dying from something that they could fix with a few pills from the corner pharmacy, if a doctor would deign to "tinker" rather than working from theory.
Sure! Except the corner pharmacy has literally thousands of different pills in it. How does your daring doctor know where to start? How do they know where to go next, if that doesn't work?
I completely agree with this article, based on my own experiences.
My wife acquired Bipolar 2 after a prolonged systemic infection at 30 years old. After years of hospitals, tests, virtual bankruptcy and little to no progress, I decided to do something.
I started by looking at human population studies which showed lower incidences of her mental illness, and based on differences in diet, exercise, and medicines I discovered a possible difference in India from WHO publications and .
After reviewing several PubMed and other academic papers on the subject, I thought perhaps that dietary difference may account for disease incidence differences. So, comparing the most common Indian food ingredients versus US diets, I came across turmeric.
Turmeric has shown strong anti-inflammatory properties, positive effects on astocyte cell regrowth, and may improve neural myelination. It is used in many Indian dishes but relatively few American dishes. It's used throughout the middle east and asia, but mostly for grilling.
So I purchased imported Indian turmeric, and started cooking it into all that I could every day, especially soups and other combinations with pepper and oil as it's done in India.
Inside two months and she started to sleep less than her typical 16 hours a day. She quit listening to music all her waking hours. Her mood made positive strides. She played with the children. It was a small, however exceptionally positive change.
Following five years of improvements, the outcomes have been great. She is again driving, teaching, and just needs her single medication at the most minimal measurement essential. She now has clear thinking, great memory, and no longer experiences the symptoms of side effects.
She has not been hospitalized since.
Take it as quackery, miracle, or however you like. Perhaps it may help someone, someday. I know studies are in being proposed, and perhaps it may improve the lives of others.
I've actually heard good things about turmeric. If you don't mind me asking, why imported Indian turmeric though? Is it different from what you would get in the States (aka what I've got in my pantry)?
I've had the opportunity to play around with turmeric in a medical/biological setting. Turns out, the compound most likely responsible for a lot of turmeric's biologically active properties (basically inflammation reduction/anti-tumor effects) is curcumin[1].
A lot of the spices used for cooking (especially ones sold cheaply and in bulk) may contain less curcumin[absolutely no citation here] because:
1. Spices and herbs grown for bulk may be grown in poorer conditions with higher stressors in the environment and growth accelerants added to the feed. This may result in a (non-processed) spice with a lower amount of nutrition relative to a spice grown with TLC. Empirically, there is a fairly significant gulf between the flavor (to me) of plants grown organically vs agriindustrial techniques. However, the community seems to be divided as to if the nutritional content significantly differs[2].
2. Industrial processing techniques may destroy or modify many of the taste-inactive compounds in an attempt to optimize for maximum flavor. It's interesting to note here that curcumin's coloration is what gives turmeric it's golden sheen. At home, my Safeway turmeric contains dyes. I sort of assume that the processing that the spice goes though removes/destroys some of the coloration compounds (curcumin likely included).
In conclusion, it's possible that the imported turmeric has come from a location where the plant is grown with more TLC, processed less harshly, and is more fresh.
However, to be perfectly honest, it's likely far more efficient to consume curcumin pills. Like most alternative medication (unregulated pills), it's fairly difficult to actually get any sort of guarantee. And though you can purchase lab-grade curcumin from Sigma Aldrich, it's fairly pricey (approximately 6 $/g). Also...it's lab grade so I'm very unsure if I'd be bold enough to try eating it. As a pure powder, it's also a pretty severe irritant. When was working with it, I worked with it wearing a full mask on.
Also, I'd also like to point out that while the compound itself has been shown to do a bunch of neat things, it's biologically tricky for it to actually become absorbed by the human body. (Side note, since my research, there has been apparently further work done documenting delivery mechanisms and bioavailibility of curcumin. It's actually pretty neat.[3])
It's interesting you say this. I took a similar approach to working on my anxiety disorder. Basically, found places with low anxiety instances and tried to emulate things that they did. Within a few months I went from daily, almost constant, panic attacks to weekly. Now three years later, I sit at maybe a panic attack a month and it's very manageable rather than debilitating.
I thought this was going to be an article about Dr. Donald Ewen Cameron, notoriously associated with Project MKUltra, and his curious hypothesis of contagious mental illnesses and how psychiatric conditions might possibly be transmitted by way of the mere interactions of differing personalities, and institutional social norms:
Cameron stated, "Get it understood how dangerous these
damaged, sick personalities are to ourselves - and above
all, to our children, whose traits are taking form and
we shall find ways to put an end to them." [1]
I believe it's the stranglehold of the pharmaceutical industry on psychology that prevents research like this from going forward. Instances like Isak's ordeal with PANDAS and Susannah Cahalan's battle with anti-NMDA receptor encephalitis show that more research should go into how infections and autoimmune response can cause some forms of mental illness.
I was particuarly appalled when I read that doctors gave Isak anti-depressants to treat his mental illness. These are the medicines the pharmaceutical industry have been pushing on us for decades to treat any malady of the mind, and they have been proven to be barely more effective than placebo treatments.
Their first priority is pushing pills, not our well-being.
>They didn’t give it much thought. Periodic strep tests on Isak had always come back negative. And his symptoms seemed too dramatic to be the result of a simple, common childhood infection.
I don't think there's any institutional stranglehold stopping research in this direction, just standard human reasoning. As a scientist, there are enticing hypotheses to follow that pop up every single day, and it's hard to judge what should get the investment of time and money.
>Their first priority is pushing pills, not our well-being.
These were doctors prescribing these, not the pharmaceutical industry, and I believe that the doctors were trying, something, anything, that they believed might work. What's more risky, using a drug that's been proven to help adults (barely better than placebo or not), or going after an as-yet-untested hypothesis about streptococci, that doesn't fit our current understanding of the problems? There are certainly issues where pharmaceutical interests are not aligned with our health and well being, but I don't really see this child's unfortunate trajectory as part of that. The failure rests more on the science just not being there, and us not having a great understanding of the mind.
It really bugs me when people talk about Big Pharma pushing pills, cause really, 8-9 times out of 10, it's patients begging for pills. Are pharmaceutical companies angels? Fuck no, neither are doctors, but if nobody was buying, they wouldn't be selling.
There's a great post on reddit from a doctor who wrote about a typical patient-doctor interaction (which I'm too lazy to find right now):
Patient comes in with elevated blood pressure, about 30 lb overweight, sedentary lifestyle. Doctors talks about blood pressure, possible future issues with it, recommends patient start getting some exercise, portion control, lose some weight, maybe a dietary consult.
Patient comes in a month or three later for a follow up visit. No weight loss, no drop in blood pressure. Doctor writes a script.
Hell, when I was checking out doctor review sites for a podiatrist, one of the negative opinions he had said, "He didn't even prescribe me anything!
> It really bugs me when people talk about Big Pharma pushing pills, cause really, 8-9 times out of 10, it's patients begging for pills. Are pharmaceutical companies angels? Fuck no, neither are doctors, but if nobody was buying, they wouldn't be selling.
Pharmaceutical companies don't help their image when they behave as poorly as Roche has in the UK with avastin and lucentis.
Avastin and Lucentis are very similar compounds. A astin is older and much cheaper than Lucentis. Lucentis is licenced for use in macular degeneration - the leading cause of blindess outside poor countries. Avastin is not licenced for macular degeneration.
Despite numerous safety and efficiency trials Roche are refusing to allow Aventis to be licenced for macular degeneration, and they intend to use the law to its full extent to prevent aventis being used for macular degeneration. (Off label rules are stricter in England).
This is a scumbag move. Roche have chosen to let people go blind because they want the profit from lucentis.
Between the constant TV ads shouting "BUG YOUR DOCTOR FOR PILLS!" and the vacations, free samples, and outright cash bribes lavished on doctors, I can't see how you can characterize what's going on as anything but pill-pushing by Big Pharma.
There may have been things lavished on doctors in the past, but as of a few years ago docs effectively can't get anything free unless it is under $10 an instance and less than $100/year.
$10/instance and $100/year are only the threshold for reporting, not the threshold for banning. Plenty of doctors are still getting lots of perks from the pharmaceutical industry.
In some circles, most notably in academia, doctors even consider it a mark of prestige to get expensive perks from multiple pharmaceutical companies. "Pfizer just asked me to speak at their conference in the Bahamas. Too bad I already agreed to attend Novartis's event in France!" The Sunshine Act does nothing to curb their corruption and only fuels their pride.
>It really bugs me when people talk about Big Pharma pushing pills, cause really, 8-9 times out of 10, it's patients begging for pills. Are pharmaceutical companies angels? Fuck no, neither are doctors, but if nobody was buying, they wouldn't be selling.
In the case of children it is the parents begging, but the real question is why do they beg. If you met large populations who begged for something dangerous or bad to be done to them that would benefit another, would you think they truly wanted it of their free will having made fully informed decisions, or would you suspect that for many, there had been some manipulation/misinformation/etc.?
That particular story seems like reasonable behavior on the doctor's part. But my personal experience has been that no doctor has ever brought up anything but pills to treat any condition I've had or my wife has had (and we've each had a condition that we later mitigated with a relatively small amount of experimentation, once we sort of realized it was up to us).
So to me the answer is "The doctor needs to start with non-pill solutions (if they make sense), then if the patient gets pushy or is uncooperative resort to pills, with fair warning that for the most part she's treating symptoms instead of the root cause." Does that sound like a reasonable compromise that we should all be able to agree on?
The doctor should do what their training and experience leads them to believe will lead to the best outcome for the patient. Pills are not evil. Optimise for good outcomes.
Doctors are trained to use pills to treat conditions, so that's what their experience is in. Few have training in other treatment modalities; you can't get reimbursed for many other treatment modalities; you can't carry out an effective CBT session or really work on behavioral change in 12-15 minutes. Doctors are very well-trained in a very narrow area, which emphasizes pharmaceutical approaches.
That's why many good docs refer you (to a physical therapist or dietician or psychologist) if they are aware of other effective non-pharmaceutical treatments for your condition.
I'm assuming this is specific to the United States? My anecdotal experience in Canada has been that it is not unusual for doctors to misdiagnose, but pill pushing isn't particularly a problem.
Yeah, not much of a problem in the UK either. The US system is a bit unusual. I daresay they'll still prescribe the pills if you ask - there are an awful lot of people on antidepressants.
It really bugs me when people talk about Big Pharma pushing pills, cause really, 8-9 times out of 10, it's patients begging for pills. Are pharmaceutical companies angels? Fuck no, neither are doctors, but if nobody was buying, they wouldn't be selling.
In this trio, I blame the doctors far more than anyone. Patients have no clue, they just want to be cured. It's the responsibility of the doctors to only prescribe what is necessary.
Every time I hear my father say he got antibiotics for his cold I cringe, and wonder WTF the Dr. he saw was thinking. I think the count is up to a dozen times he's received them in the last 10 years.
> In this trio, I blame the doctors far more than anyone. Patients have no clue, they just want to be cured. It's the responsibility of the doctors to only prescribe what is necessary.
That's a bit naive. Many patients practically demand pills, and if you displease them all you'll take a hit on your "patient satisfaction" metrics, which in turn displeases the hospital administration as things like Medicare funding are tied to these metrics. So unfortunately, doing what's best for the patient doesn't always correspond with what's best for the doctor keeping their job.[1]
Blaming the doctor for having to make an impossible choice is not entirely fair. I think the federal government (Medicare) and hospital administrators need to reevaluate the weight they put on patient satisfaction and the pressure it puts on physicians as well as patient outcomes.
Maybe if a patient demands pills, fine, the patient has already been brainwashed and lost and you have to give them what they want or you will get a bad score.
Yet whenever I visit a doctor for some minor issue, I have never asked for antibiotics, yet Doctors ALWAYS just straight away say I'm going to prescribe you such and such antibiotics.
I always push back and say is that really necessary? And they just get all glassy eyed and spout that this is the standard course they always do, as a preventative measure. (Despite that usually these interactions are over some issue that resolves without any difficulty when I don't take their prescription).
Would it be so hard for them to just stop the bullshit when it is clear the patient has a brain and is not going to be angry with them for not "givin them their pills"?
I completely agree with this, but also think that it's important for patients who are sick to leave their doctor experience somewhat soothed.
I think that if a patient listens to explanations about how antibiotics won't help with their viral infection, but still wants something to be done, that perhaps doctors should be allowed to prescribe cheap placebos of some sort. Though this is in some ways incredibly disrespectful to the patient, perhaps if it wasn't a sugar pill and something truly soothing, like bed rest and warm soup, it may pass ethical muster.
There's a reason that unsound treatments like homeopathy gain traction. Some people just want to be cared for and told that they are in good hands and will get better faster than if they were on their own.
I like this idea. Just have a can of ready-made soup - store-bought if necessary - and just add something somewhat odd-but-good-tasting. A patient with half a brain will understand they're being fooled, but whoever seeks homeopathy wants to be fooled anyway, so that won't be an issue.
The masses are what they are. Big phrama is the one taking advantage of the natural state of the masses. We could blame a child for being dumb, but instead we make laws protecting children from those who would take advantage of them (banning child labor, lots of rules to protect children concerning contracts, banning predatory lending, etc.).
Or maybe you aren't a doctor and shouldn't be judging if your father needed abx based on a few google searches.
Get a second opinion from a professional if you think your dads doc is over prescribing.
While colds are not dangerous for the young -- they can be very dangerous for the elderly and easily progress to a pneumonia that can kill. Pneumonia used to be called 'old mans best friend' because it caused such a swift and painless death.
So what is 'just a cold' for you isnt for others and that isn't even taking into account that the elderly often have baseline lung disease.
Yep, that's really strange. Have you reported the doctor? Their name should be on the scripts.
That said, I don't see how your father's health is entirely the responsibility of the doctor. He has the majority of the responsibility for his own body. Yes, when you are sick and scared, a doctor has enormous discretion over you. They take these oaths for a reason and the legal system is very tough on them when they fail (as things should be). However, your father has much more responsibility for his health, especially for something as simple as a common cold. I mean, the excuses that you 'don't know' are gone these days. Google is literally in your pocket for most people.
That said, we have issues with filter bubbles and getting good information. There is a lot of chaff for the seed online.
No, the doctor has no such responsibility, they only have responsibility to their patients. They are bound to operate based on the standard of care in the profession and location (this varies widely between states, cities, and countries). The doctor, likely, can easily stand up to pushy patients and, likely, has been doing so for years. The alternative of censure is much more harming than some patient that knows exactly the opioid and dosage they want. if they are not doing so, then it is the responsibility of the patients and other staff to report the doctor to the appropriate medical boards such that the doctor continue to practice safely.(http://www.ehow.com/how_5106471_report-bad-doctors.html).
Also, yes, the issue with Google is that your filter bubble gets in the way and you make bad choices about what to listen to. Honestly, it's really bad. You point out the autism-vaccine controversy (...good God, what the hell has happened to us...Jesus...) and I'm sure there are a million other nutters out there with even more dangerous ideas. I.... I'm at a loss here. I can only say that you just have to research more, but I know that is beyond the reach of most people to do so. The excuses are gone, but not the stupid. We have all this information, but it's like a library with pages just thrown everywhere and there are no curators. I can't expect people to know what to do. My own father would say 'Well, life sucks, and it sucks a lot more if you're stupid'.
Man alive, is that a cop-out. It's true, but saying that life just sucks for stupid people is heartless and against all of medicine as an ethos. Still, the question remains, how do you get people to be responsible for their own damn asses?
Yeah, tell them to ask a doctor while shutting up and listening. Telling stupid people to Google stuff is how we ended up in this mess to begin with. Maybe we could tell them to consult a medicine textbook, at which point they'll be begging for option 1.
> These were doctors prescribing these, not the pharmaceutical industry, and I believe that the doctors were trying, something, anything, that they believed might work.
It wasn't until I was a parent that I realized a big part of what doctors do is guesswork. Not all of the time, and they are making educated guesses, but it's still guesswork.
Lots of people don't understand this - unfortunately even some doctors.
the pharma industry cares more about the well-being of its customers than most of the companies HN usually covers. now go back to coding your mobile/social/dating app that actually cares about the well being of anyone.
opposition to pharma, opposition to vaccines, opposition to science.
This tho:
Orenitram won't be available for sale for about six months, the company said, and its exact price hasn't been determined either. But it will be very expensive, about $150,000 a year, according to an estimate by Dr. Mark Schoenebaum, an industry analyst with ISI.
yes, it needs to cover the cost in development and getting it through approval.
however, this also establishes a market - a competitor will now either come with something cheaper or something better (for the same or higher price).
same thing is happening with Hep-C, which is now curable (boo, bad pharma). initial drug was/is super expensive, record profits for the company. every single contender is driving the price down. and there contenders as the market has been proven.
this is the capitalist system at work, in full glory. even with patents in play. amazing shit right there.
> These are the medicines the pharmaceutical industry have been pushing on us for decades to treat any malady of the mind, and they have been proven to be barely more effective than placebo treatments.
Weird, the studies where they're given to sufferers of severe depression and anxiety say otherwise.
That is true, but "any malady of the mind" is a blanket statement encompassing severe depression.
It gives the impression that the medications are not significantly better than placebo for any mental illness, when in fact they are significantly effective for certain mental illnesses.
> I believe it's the stranglehold of the pharmaceutical industry on psychology...
This might be pedantic, but psychology is study and treatment of the mind that does not involve drugs. Study and treatment of the mind that involves drugs is called psychiatry.
They tried anti-depressants after 2 years of his condition persisting. Trying a single anti-depression med is a perfectly reasonable attempt at treating the issue if the information the doctors have lines up with depression. Even when the medication does not work it usually provides them with more information so the solutions they try get closer to something which will work hopefully.
The entire field of medicine is heuristic, basically making educated guesses as to what the collections of symptoms indicate. You try something see if it works, if it doesn't try something else based on the information available. When your patient is a young child, you have different problems gathering that information than with an adult, kids may not notice or know how to describe something that is wrong, and adults will often omit things they consider embarrassing.
As someone who has had anxiety and depression for the 12 years since I graduated high school, the doctors I have met have been nothing like the notion of doctors you have, and while I am sure there are doctors whose first priority is pushing pills characterizing doctors in general as such I do not believe to be accurate. I've seen physicians and psychiatrists both of which tried to gather as much information as they could asking questions and running tests before recommending any treatment or even really suggesting what was wrong with me. They would often recommend things like more exercise, less time in front of computers and sitting, and finding hobbies after all tests came back showing nothing abnormal with my body. Both seemed to agree it was probably not a physical malady with physicians eventually recommending psychiatrists and psychiatrists recommending psychologists. Every time after a couple months of therapy not working they would try another; they were very hesitant to recommend medication. When they did they would have me check in weekly to give them updates, always switching me off of it if I indicated any side effects or just that things hadn't gotten better after a period of time in which it should. Eventually I would give up and stop trying new treatments even though they indicated they had not exhausted all options. After a few years I would try again.
Only recently, after starting up this chain of diagnoses again about 8 months ago, did I find relief. The psychiatrist tried yet another therapy and two medications, which I had not been on before but were similar to the ones which had more positive effects previously. Both wound up having the same negative side effects. He then reluctantly tried a third, which was in a completely different class of meds, saying he tries his best not to prescribe it due to it having nasty withdrawal. Low and behold, 2 weeks in for the first time in 12 years I was feeling like I remember normal being on month 4 now and still feel great.
Different things work for different people because depression and many other things in the medical world are effectively a name for a collection of symptoms and not a specific malady. The doctors I have seen seem to recognize that and respect that, and generally seem to prefer non-medication based treatments when they have hope it would work.
"and they have been proven to be barely more effective than placebo treatments."
I think barely is giving them too much credit. And the barely better than placebo was only for the worst cases of only clinical depression, and even the worst naysayers can't seem to say the truth--they just don't work; probably out of compassion? I can say this (feeling terrible)will get better with time.
(Psychiatrists and psychotropic drug companies really did a number on their patients and consumers over the last few decades?)
I don't think it's that simple. Bear in mind that whilst one may say that the US healthcare system, including a good deal of research, is corrupted by financial interests, that is not true either (a) universally in the US - there is still government funded research, or (b) overseas, where the norm in most industrialized societies is socialized medicine, with a lot of medical research being publicly funded without the ability to sell a profitable remedy being the prime motivator.
Even government funded research becomes corrupted. Special interest groups, inconvenient results giving lesser weight, laws and policy limiting what can be studied, manipulation of results to portray a pre-determined narrative.
My goto example is the NISVS 2010 where a man being forced to have sex but not being forcefully penetrate was defined to not be rape but only sexual assault, and then the summary section showing how few men were raped (while leaving the particular definition of rape buried in the details).
This same corruption is all the harder to see as you deal with studies moving towards biology and neurology as the base level of knowledge needed to understand a given paper to the same degree increases (per my own experiences and those of others I've talked to).
>stranglehold of the pharmaceutical industry on psychology that prevents research
I think that may be a bit backwards. Evidently research like this is going forward and looking at the references it mostly seems to be in the US, with one researcher in the UK, countries with big and medium sized pharma. It would seem more the case that research like this does not happen much in countries without large pharmaceutical industries, presumably because the money is not there.
Schizophrenia's a complex one. It seems to be associated with human endogenous retrovirus-W (HERV-W):
>Several other studies have since found similar active elements of HERV-W in the blood or brain fluids of people with schizophrenia. One, published by Perron in 2008, found HERV-W in the blood of 49 percent of people with schizophrenia, compared with just 4 percent of healthy people. “The more HERV-W they had,” Perron says, “the more inflammation they had.”
The odd thing is HERV-W is a viral sequence which entered the human genome many millions of years ago. It is normally suppressed but can cause problems sometimes triggered by other infections.
I find it interesting because strep is very easy to test for and very easy to cure (for the most part - although the test failed in this case), but I've seen such a wide variety of responses to it.
When I was young, the doctors would always test and almost always prescribe antibiotics. Initially they gave shots, which of course I hated as a kid, but they were effective and very fast - within a few days I'd be better. Then they switched to multiple week courses of pills, which also worked but left you sick a lot longer. (Now I wish they'd go back to shots.)
Then something weird happened - they quit testing and started guessing. A quick glance down the throat followed by either "May be strep, here's a prescription." or "Might go away on its own. Come back in a couple weeks if it hasn't gone away." I know people who ended up hospitalized because of this. Even if it might not get worse, why make them suffer extra weeks, miss school/work, and risk it getting worse when it could so easily be tested and treated with a cheap, readily-available cure?
I wonder why testing and applying an appropriate response to test results fell out of fashion in general. How much more advanced might psychiatric medicine be if doctors generally did test like scientists (not just for strep, but whatever) instead of guessing like astrologers? There's probably a lot that could have already been discovered.
Here is a related story about a urinary tract infection causing psychotic symptoms and
some additional thoughts on immune system, psychosis, and evolution.
Insanity is an outdated term that usually refers to psychosis type illnesses.
When a person has a conversation with their God figure this happens in (roughly) one of two ways.
1) they say a prayer and spend some introspective time thinking
2) they have an actual conversation with a real voice. Is someone in the room with you? Ask them to say something. An auditory hallucination voice is as real as that voice; it just happens to come from something that isn't there.
EDIT {this second one is what we would call"insane" or "ill" or "pathalogical". But the vast majority of religious people do not experience this, ever, no matter how religious they are.}
Describing religious behaviour as insanity isn't helpful. It shows a lack of understanding of mental illness. It's not an effective attack on the harms that some forms of religion can do.
Whether you want to call it mental illness or insanity (I am neither a doctor nor a lawyer, do I don't have any preference for either term..), I cannot fathom how the second possibility that you list does not qualify. People who are experiencing auditory hallucinations while fully awake and rested should seek professional help.
The first possibility would not be so worrying if people were not attributing their own introspective thoughts to a flawless perfect benevolent supernatural being. Nobody should ever be that confident of their own ideas.
I think the attribution of the introspective thought to a supernatural being (not the introspective thought itself) can reasonably be thought of as "crazy". I'm not saying it is in DSM, that there is some sort of recognized illness that it can be attributed to, but it certainly isn't rational thinking.
Yes! Sorry, i hadn't finished. You're quite right, the second one is insanity. But most religious people don't have that experience. I'll edit my comment.
No, you can't catch insanity, seeing as "insanity" is strictly a legal term; "insanity" is not a vaild diagnosis per any psychological standard that I'm aware of (most notably the DSM-IV).
There are some people who argue anti-fungal and anti-bacterial activity are actually behind the effectiveness of a variety drugs that are not thought of as such. Statins, for one example, clearly do save people from having a second heart attack, even though the official cholesterol story justifying the drug is problematic. Some say the statins are actually killing off a fungal infection.
The article didn't even mention toxoplasmosis infection and links to mental illness and other behaviors.
I don't think it's crazy to predict we're going to see more and more health and behavior problems directly linked to infectious agents over time. People bought this simple story that antibiotics saved us from all the infections 60 years ago.
Huh. Similarly, I have managed to "cure" a number of infections in my own body, both fungal and bacterial—and even, apparently, a few cavities—purely with a course of extra-strength expectorants and mucosal-membrane rinses containing biologically-safe surfactants (e.g. baby shampoo.)
Basically, we think of diseases as things we have to fight with drugs—but our immune systems are perfectly adequate at fighting blood-borne diseases, most of the time. The only thing the body really struggles with is plaques/biofilms—whether in the heart, in the liver, in the tonsils, in the teeth, in the appendix, etc.
And we've invented tons of things that break up plaques/biofilms: surfactants, mucosal thinners, ultrasound, etc. But we only apply them in very specific cases (ultrasound only for free-floating stones, mucosal thinners only for lung problems, scraping for arterial plaque, etc.) instead of thinking that this is a class of problems, that will have a class of solutions that all apply to any instance of the problem.
I bring this up because, by your statement, statins sound like yet another item in that "biofilm-reducing" class of treatments that all happen to have some miraculous and mysterious effect on both chronic fungal/bacterial infections and inflammatory disease (Chron's, IBS, etc.)
I found permanent relief from a couple long lasting problems with the application of xylitol, tea tree oil, and taking high dose aspirin. Antibiotics had been useless. In my unfortunately personal experience doctors are almost entirely ignorant on the matter of biofilms at the moment and will simply keep blasting you with antibiotics.
To be fair, Superman locks himself in a closet because his powers are too scary, but yeah, this is totally a different case.
There's this trope that people with mental illnesses—like John Nash, or Rain Man, or Sheldon Cooper, or all of these people who can paint perfect landscapes because they're on the autism spectrum or have brain trauma—are more advanced than people who aren't. And yeah, these people can do things that the rest of us would have a much harder time doing. But it also comes with the fact that the world is going to be a much harder place for them. For people who do have brain quirks that they can take advantage of, it can be a really empowering narrative. It can also be harmful for people whose brain quirks don't fit well into a role that's valued by society.
There's a difficult line to find there; what kind of neuroatypical behaviour should or shouldn't be treated? Most people can agree that depression needs to be treated, because it's harmful to the sufferer with no benefit. Or if someone is hearing messages from aliens and running away from home and wandering about alone in altered mental states, it's fairly uncontroversial to put them on antipsychotics, even with the negative side-effects.
But on the other hand, the idea of medicating ADHD kids is massively controversial, because the argument can be made that for many people diagnosed with it are either misdiagnosed, or are just bored or learn differently. But I also know ADHD people who legitimately cannot function if they don't take their medicine. What should be medicated or what shouldn't?
Or here's an even more borderline case: what if someone is convinced that they're hearing messages from the beyond, and decides to spend the next ten years writing a book about how to live at peace with the world? What if the book doesn't make sense? Should they be medicated, because they've clearly broken with reality? Or should they be let alone, because there's a remote outside chance that maybe we're all wrong and they're on to something? Should they see a psychiatrist or a counsellor, who they can talk to and can keep track of how well they're doing? If so, should that person take an authority role, or should they be someone to be worked with to reach a mutually agreeable course of medication (which may be none at all)?
Hence movements centred around neuroatypical people, and this narrative that they're potentially a next stage in human evolution. Certainly, there are plenty of neuroatypical people who have desirable traits because of it that could very well become the norm, but there are also plenty of people whose traits are simply going to be selected against. It's an incredibly attractive narrative for those people, though, because society doesn't tend to value them as people as much as 'neurotypical' people, which is absolutely terrible.
I personally think that there are three big takeaways for this:
1. People are people, and should be valued as such.
2. Not everyone has a special talent that is valued by society, and that's okay. See #1.
3. Medication isn't fire-and-forget. It's something that needs to be constantly re-evaluated and carefully managed.
> There's a difficult line to find there; what kind of neuroatypical behaviour should or shouldn't be treated?
Does it cause you to pose a risk of harm to other people or yourself? If yes then treatment is strongly suggested and sometimes forced.
Does it interfere with your day to day life? Does it stop you from living an independant life or from being part of society (usually defined on your terms, not someone elses)? If yes then treatment is offered and the plan should be to help you achieve what you realistically want.
> There's this trope that people with mental illnesses—like John Nash, or Rain Man, or Sheldon Cooper,
A minor point but only one of those people has a mental illness. John Nash has a psychosis type mental illness. The fictional character Sheldon Cooper will probably be thought to have Asperger's Syndrome by most of the audience (although the writers haven't declared any diagnosis and shift between others). Asperger's isn't a mental illness, it's (in the US) a learning disability (learning difficulty in the UK). Rain Man probably has Autism which again is a learning disability (in US and UK).
> Or here's an even more borderline case: what if someone is convinced that they're hearing messages from the beyond, and decides to spend the next ten years writing a book about how to live at peace with the world? What if the book doesn't make sense? Should they be medicated, because they've clearly broken with reality? Or should they be let alone, because there's a remote outside chance that maybe we're all wrong and they're on to something? Should they see a psychiatrist or a counsellor, who they can talk to and can keep track of how well they're doing? If so, should that person take an authority role, or should they be someone to be worked with to reach a mutually agreeable course of medication (which may be none at all)?
You've posed this as if it's some big question but it really isn't. At least, in England. Maybe it used to be different or it's different over there. People who hear voices are provided support for that if they want it, but medication is reserved for times when the voices are intrusive or distressing. Anti-psychotic medication isn't fun and has considerable side effects.
I think the most useful, helpful thing for mainstream society to do is not to treat "neuroatypicality" as a unified category. And I say this as a very neuroatypical person.
But the thing is, when you get to the tails of the normal distributions for various cognitive and neurological functions, most of the individuals you find are cognitively and neurologically uneven. We may be significantly higher-functioning in one aspect, while being average in most other aspects, and sometimes lower-functioning in one or another aspect. The biggest mistake mainstream society makes is treating cognitive functioning as a uniform, one-dimensional spectrum from low-functioning (autistic people, low-IQ people, the "mentally ill", etc.) to very high functioning (so-called "geniuses" and "very well-balanced" people).
I'll use myself as an example. The educational system simply never knew what the bloody hell to do with a small child who obviously suffered from nasty emotional disturbances, which were at least partially due to parental violence, and who obviously had difficulty interacting with others, and yet who simultaneously tested at the 98th percentile of intelligence and obviously wanted to make friends. "Gifted and talented" classes were designed for kids who were just as gifted in their self-organization as in their ability to read, write, and do maths, and who also cooperated easily with adults and wanted to work within the system. "Special education" was designed for the intellectually weak, the especially violent, and those utterly unable to direct themselves. I didn't fit into any category the system had.
So I only started getting a really decent education when I entered university, where I was, pretty much for the first time, allowed to take mostly smart-kid classes and allowed to socialize without being branded as the dangerous idiot first thing. It worked great: I learned how to make friends and graduated with a solid circle of them, and I managed honors in computer science. Admittedly: I now wish I'd been able to weedle out the opportunities and privileges those Good Little Children got, since in adulthood I'm seeing just how much they were able to accomplish while I was having to push to be treated as a non-moron, but oh well.
Weirdly enough, other than a post-undergrad bout of depression that apparently happens to everyone (but which nobody is ever told about...), the post-school world of work and research has been a pretty great experience!
And here's the freakish thing: among the very... anything - the very intelligent, the very creative, the very emotional - none of this story has turned out all that unusual! I attend lesswrong.com meet-ups sometimes and find that pretty much everyone else there has stories just like mine.
TL;DR: Society thinks that cognitive functioning ranges from "really great" to "really bad", with each particular aspect of mental functioning co-varying along a single dimension. This is approximately correct for middling cases - a person who's average all-around will usually be roughly the same level of average in each particular - but almost entirely wrong for people at the tails.
It makes sense if you're dealing with hypochondriacs or drug-seekers, and it makes epidemiological sense to withhold some treatments from prophylactic use (like antibiotics) to preserve their efficacy. But if you're dealing with an idiopathic illness for over four years, I would think there would come a time where you'd ask the doctor, "can I just try some antibiotics to see what happens? And how about some antiretrovirals, antiparasitics, and antifungals while you're at it?"
Just methodically working through the safe, first-line treatments to the major disease classes, taking each for a month or so and seeing what happens, would probably fix 90% of people's chronic illnesses. Even if it didn't, paying attention to people's reactions to being on various medications are some of the best diagnostic tools there are—which second-line treatment regime to pursue would likely become rapidly apparent.
But instead, people can go years slowly dying from something that they could fix with a few pills from the corner pharmacy, if a doctor would deign to "tinker" rather than working from theory.