Psychiatric Madmen? New manual makes everyone mentally sick.

Perhaps an alternate title for this would be “We’re in it for the money.”

See also another related entry entitled “Mental Health Profession has Mental Health problems.”
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“We’re all mad here”

Medication misuse is out of control in the US and more psychiatric labelling in DSM-5 will not help.

by Allen Frances | Tuesday, 21 May 2013

That’s the message of the new edition of the bible for American psychiatrists, DSM-5. Diagnostic inflation is about to become hyperinflation.

“We are all mad here” explains the Cat to Alice when she wonders about the strangeness of Wonderland. Well, life is starting to follow art. If people make the mistake of following DSM-5, the new diagnostic manual in psychiatry that was published on Saturday, pretty soon all of us may be labelled mad.

When I worked on the taskforce for DSM-4, we were very concerned about taming diagnostic inflation – but we only partly succeeded. Then four years ago, I became aware of the excessive enthusiasm around all the new diagnoses being proposed for DSM-5, including many that were untested. I hate to rain on anyone’s parade, but I knew this would be disastrous for the millions of people who were likely to be mislabelled, stigmatised and given excessive treatment.

In the US, the “sick” are distinguished from the “well” by the diagnostic and statistical manuals developed by the American Psychiatric Association.

The problem is that definitions of mental disorders are already written too loosely and are applied much too carelessly by clinicians, especially by the GPs who do most of the prescribing of psychiatric drugs.

And things are about to get much worse. Under DSM-5 diagnostic inflation looks set to become hyperinflation and will lead to an even greater glut of unnecessary medication. I would qualify for a bunch of the new labels myself – and you might too.

The grief I felt when my wife died would now be called “major depressive disorder”; forgetfulness in older age “mild neurocognitive disorder”; my gluttony now “binge eating disorder”; and my hyperactivity “attention deficit disorder”. As for my twin grandsons’ temper tantrums, this could be misunderstood as “disruptive mood dysregulation disorder”. And if you have cancer and your doctor thinks you are too worried about it, there’s “somatic symptom disorder.” It goes on, but you get the idea.

About half of Americans already qualify for a mental disorder at some point in their lives and the rates keep skyrocketing, especially among kids. In the past 20 years, the prevalence of autism has increased, childhood bipolar has multiplied 40-fold and attention deficit disorder has tripled.

One consolation: the kids are not suddenly getting much sicker – human nature is pretty stable. But the way we label symptoms follows fickle fashions, changing quickly and arbitrarily. And freely giving out inaccurate diagnoses can

NYC Seeks to Curb Painkiller Abuse With Hospital Limits

It’s only “deadly” if it’s misused or abused.

And yet, the idea is an excellent one because it limits potential for misuse and abuse by fraud.

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New York City is seeking to curb abuse of potentially addictive and deadly painkillers such as Oxycontin and Vicodin with new limits on how widely the drugs should be prescribed.

Emergency departments at New York’s public hospitals will only prescribe a three-day supply of opioid painkillers, won’t refill lost or stolen prescriptions and shouldn’t prescribe long-acting versions of the drugs, according to voluntary guidelines the city issued today.

The move is aimed at

Fit for Human Consumption, or Rat Poison? High Fructose Corn Syrup Continually Indicted in Obesity Epidemic.

Fit for Human Consumption, or Rat Poison? How many foods use High Fructose Corn Syrup? The answer might surprise you. Or, it may not. Originally uploaded by SouthernBreeze

In the last several years, obesity has become a rampant epidemic in the United States. While there are doubtless many causes, it is my opinion that a wholesale change in our dietary practices – and I specifically do not mean to refer to increased portion sizes, consumption or intake – but rather to an ingredient which has become all too common in commercially prepared food… which, if we were honest with ourselves, is most of what we consume.

For example, the majority of Americans do NOT grow their own vegetables, raise their own groceries (meat, dairy, poultry, eggs, pork, etc.), nor do they eat homegrown, locally grown, or even “freshly prepared” vegetables, even if those vegetables were imported to the United States. Consider even pineapples, for example. Once, the exceeding majority of the world’s supply of pineapples were grown in Hawaii. The highest quality pineapples are sold to Japanese markets, where they pay top price for the highest quality fruit. Not so in the United States, where American customers balk at high prices, even if it’s associated with higher quality.

Historically, Hawaii was the world’s largest pineapple producer and source for pineapples. Relatively recently however, rapacious corporate profit seekers abandoned Hawaii for cheaper production (translate “cheap labor” & “no health & safety regulation”), and there now remain only two fresh pineapple operations remaining in Hawaii: one on Maui, and another on Oahu. And that quandary is an entirely separate, yet related, problematic issue.

However, much of what we eat has been commercially processed in volume. And I mean in HUGE volumes! In America’s factory food processors, a fairly common ingredient is

Reaching the End of Life: What Do We & Loved Ones REALLY Need?

Recollecting, one of my patients was similarly diagnosed, suffering terminal lung cancer of the small cell carcinoma type, and had one lung removed. He had presented to the ED (Emergency Department) with extreme hypoxia (lack of oxygen), to such an extent that his lips had a distinctive blue cast to them. His oxygenation was so exceedingly poor, that he would turn in bed, and his sats (oxygen saturation level) would drop to 70% – neither a good, nor one that would sustain life.

In conversation with him, I asked him what he wanted to have happen to him, how he wanted things to turn out for him. He wasn’t under any misguided notion about his state of well-being or health and wanted to depart the ICU.

He said, “I want to go home to die.”

I responded by saying, “We want you to go home too. Let’s see what we can do to get you back there.” At that point, I began some very simple teaching about his breathing. He was a habitual mouth breather, and he knew it. I’d glance up at him, and his mouth would be gaping open as he watched teevee. Problem was, that every time his mouth opened, his sats dropped, even though he was receiving high flow O2 therapy via specialized nasal cannula.

So I instructed him that by keeping his mouth closed and breathing through his nose, his sats would increase. And barring any other unforeseen circumstance, were his sats to consistently maintain above 90%, that would be the greatest step toward his objective to go home.

At the end of my shift, he was consistently satting 98%.

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Doctors are practicing irrational medicine at the end of life

by Monica Williams-Murphy, MD on September 22nd, 2012, in Physician

I just took care of a precious little lady, Ms. King (not her real name), who reminded me that, too often, we doctors are practicing irrational medicine at the end of life. We are like cows walking mindlessly in the same paths; only because we have always done things the same way, never questioning ourselves. What I mean is that we are often too focused on using our routine pills and procedures used to address abnormal lab values or abnormal organ function, to rightly perceive what might be best for the whole person, or even what may no longer be needed. Our typical practice habits may in fact become inappropriate medical practiceat life’s end.Ms. King was a case in point: She was a 92-year-old nursing homepatient on hospice for metastatic breast cancer. Ms King had been transferred to the ER for a sudden drop in blood sugar, presumably due to her oral diabetes medication. Her appetite had apparently been trailing off, as is common at the end of life, and her medication appeared to have become “too strong.” Her glucose level had been corrected by EMS during her trip from the nursing home to the Hospital, so when I came into see Ms King she was at her ‘baseline.’I opened the door to bed 24 and a grinning little white-haired lady peered at me from over her sheet. “Hi,” she said greeting me first.“Hi, Ms King,” I smiled back at her and picked up her hand.

She reached over with her free hand to pat me on my forearm, “You sure are a cute little doctor,” she said smiling.

I couldn’t hold back a little laughter. “Well, you sure are a cute patient too,” I smiled and winked at her.

She winked back at me.

“Wow, this is the most pleasant 90-year-old I have cared for in a while,” I thought to myself.

As we chatted it became clear to me that she had some mild dementia but had no pain or complaints at the time. She just said, “I think I had a ‘spell’” ( a “Southernism” for some type of unusual and undefined episode of feeling ill or fainting); and “I’m not hungry” when I offered her food.

Leaving her room still smiling after our pleasant exchange, I went back to look at her medical record from the nursing home and two things immediately struck me:

Former Tennessee Senator & Cardiothoracic Surgeon Bill Frist, MD enters healthcare dialogue

Face it. Sooner or later, you’re going to die. Death is a part of life. Making a decision about whether or not you want to be connected to belts, tubes, hoses & pumps to circulate your blood, food & oxygen when your body would have naturally expired is essentially what the discussion is about.

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The Bill Frist ℞

By: Brett Norman
September 16, 2012 11:06 PM EDT

Meet former Sen. Bill Frist, a renegade “Obamacare”-loving Republican who is in the mood for some real bipartisanship.

Yes, the same Frist who as Senate majority leader led an army into the culture wars over Terri Schiavo and whose efforts in 2004 to unseat his then-rival, Minority Leader Tom Daschle, led to a nasty — and personal — Washington battle royal.

Now, Frist is pushing for a national conversation on end-of-life care and dismissing “caricatured”talk of death panels. He’s committing Republican heresy in endorsing elements of the loathed Affordable Care Act. He’s standing shoulder to shoulder with Daschle in search of a bipartisan way to tackle one of the thorniest problems around: how to get control of health care costs before they sink the economy.

Frist is pushing for a national conversation on end-of-life care. | AP Photo

The Frist-Daschle reconciliation, in particular, is a source of amazement to some longtime Washington observers.

“I didn’t think they would ever talk again,” said Bill Hoagland, a budget expert and former aide to Frist who has joined the duo on a health cost control initiative at the Bipartisan Policy Center. “I was surprised, pleasantly, that they would work together.”

Daschle told POLITICO, “He’s been a very important partner and I would say has become a friend in spite of the fact that we’ve had a difficult history.”

“That is past and we now find much more in common than not,” he added. “We both know that we need to find a consensus way forward.”

Frist, a heart and lung transplant surgeon who is now focused on research and policy, is working on

News for the “Medical Marijuana”/420 crowd: Israeli firm grows “highless” marijuana strain

What if the so-called “medical marijuana” proponents could have their cake, and eat it to?

That is, what if they could have the “benefits” they claim they derive from smoking marijuana, while NOT having its intoxicating effects?

Would they still smoke it?

That would tell the story.

It certainly would.

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What a drag, Israeli firm grows “highless” marijuana

A worker tends to cannabis plants at a plantation near the northern Israeli city of Safed June 11, 2012. REUTERS-Baz Ratner

By Maayan Lubell SAFED, Israel | Tue Jul 3, 2012 9:48am EDT

(Reuters) – They grow in a secret location in northern Israel. A tall fence, security cameras and an armed guard protect them from criminals. A hint of their sweet-scented blossom carries in the air: rows and rows of cannabis plants, as far as the eye can see.

It is here, at a medical marijuana plantation atop the hills of the Galilee, where researchers say they have developed marijuana that can be used to ease the symptoms of some ailments without getting patients high.

A worker tends to cannabis plants at a plantation near the northern Israeli city of Safed June 11, 2012. Credit: REUTERS/Baz Ratner

“Sometimes the high is not always what they need. Sometimes it is an unwanted side effect. For some of the people it’s not even pleasant,” said Zack Klein, head of development at Tikun Olam, the company that developed the plant.

Cannabis has more than 60 constituents called cannabinoids. THC is perhaps the best known of those, less so for its medical benefits and more for its psychoactive properties that give people a “high” feeling.

A worker tends to cannabis plants at a plantation near the northern Israeli city of Safed June 11, 2012. Credit: REUTERS/Baz Ratner

But cannabis also contains Cannabidiol, or CBD, a substance that some researchers say has

“Physician, heal thyself.”

For many years, patients have increasingly complained that physicians “bedside manner” toward their infirm patients has been less than compassionate.

Such charges have led to decreased patient satisfaction, among other undesirable results.

So, what we really wanna’ know is…

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Can Doctors Learn Empathy?

June 21, 2012, 2:52 pm, By PAULINE W. CHEN, M.D.

My colleague loved performing surgery as much as anyone I had ever met. Every morning he bounded into the hospital, full of energy and cheerful anticipation of the day’s surgical schedule, his prominent mouth stretched into a broad grin.

“Too bad his foot is always in it,” another doctor whispered one day as our colleague passed by.

The sad truth was that despite his gusto, patients often complained about our colleague. He was brusque when the moment required sensitivity, flip when the conversation was grave, and heavy-handed when the situation called for a light touch. Just a few days earlier, we were shocked to learn he’d bluntly told an elderly war hero in the hospital for his diabetes, “I need to cut off your leg.”

“He sure doesn’t lack

Pradaxa & Xarelto: Are they worth the risks & costs?

What dangers lurk ahead for new “blood thinner” medications?

Could we unwittingly be participating in our own destruction?

Not only that, but these new medications are exorbitantly expensive, as well.

Are they worth it in the long run?

Should we continue to use the ready stand-by?

The new meds have no antidote. The old one does.

Too little too late, or too much too soon?

Are we playing with fire?

Only time will tell.

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Insight: Top heart doctors fret over new blood thinners

6:50am EDT, 14 June 2012

By Ransdell Pierson

NEW YORK (Reuters) – For millions of heart patients, a pair of new blood thinners have been heralded as the first replacements in 60 years for warfarin, a pill whose hardships and risks have deterred many from using the stroke-prevention medicine.

But growing complaints of risks and deaths tied to the new crop of drugs have made some top U.S. cardiologists hesitant to prescribe them. Some are proposing a more rigorous monitoring regimen for when they are used.

Most concerns revolve around Pradaxa, a twice daily pill from Boehringer Ingelheim that was approved by the U.S. Food and Drug Administration in October 2010 to prevent strokes in patients with an irregular heartbeat called atrial fibrillation. It was the first new oral treatment for that use since warfarin was introduced in the 1950s.

“The good news is

New Hope in Cancer Treatment May Soon Be Widely Available

In a nutshell, cancer is simply a case of good and normal cells which have “gone bad,” which are typically characterized by rapid reproduction of those mutated cells, accompanied by the development of its own network of blood vessels to feed its growth (angiogenesis).

The initial findings in this research are indeed promising.

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Drug Helps Defense System Fight Cancer

June 1, 2012 By ANDREW POLLACK

CHICAGO — One of the great frustrations for researchers in the war on cancer is that the body’s own defense system does not do a better job fighting the disease. Tumors, it turns out, have a molecular shield that repels attacks from the immune system.

Now, a new study says, an experimental drug is showing promise in disabling that shield, unleashing the immune system and causing shrinkage of some lung, skin and kidney cancers that had defied treatment with existing drugs.

“We are seeing responses in heavily treated patients — three different cancers, one drug,” Dr. Suzanne L. Topalian, a melanoma specialist at Johns Hopkins University and lead investigator in the study, said in an interview. “This is a group of patients whose life expectancy was measured in a few months.”

The results are from

MDs abandon Family Care, NPs step up to Care

A long-term trend in medicine in the United States has been that medical school students continue to abandon Family Care and Rural Practice.

The corollary trend among Advance Practice Nurses & Nurse Practitioners – many whom must also pass National Board Certifications in their area of practice – has been to fill the void formed in the delivery of healthcare by physician abandonment. Typically, the argument given for such abandonment is pecuniary. That is, by the time the medical student graduates from medical school & residency to assume full and independent practice, their debt load is not merely burdensome or impractical, but almost wholly impossible to repay.

More recently, however, medical schools and public health authorities have acknowledged the error of allowing that deterioration and abandonment to occur, and have begun to promote Primary & Family Care among medical schools and their students. Such strategies include not merely the promotion of community and the advantages of rural independent practice, but include full-ride scholarships while in medical school.

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Nurse practitioners look to fill gap with expected spike in demand for health services

By Sarah Kliff, Published: May 12

President Obama’s health-care law is expected to expand health insurance to 32 million Americans over the next decade. Health policy experts anticipate that