Modern Medicine

From a recent article in the New York Times, Mind Over Meds:

A psychiatric interview has a certain rhythm to it. You start by listening to what your patient says for a few minutes, without interrupting, all the while sorting through possible diagnoses. This vast landscape of distress has been mapped into a series of categories in psychiatry’s diagnostic manual, DSM-IV. The book breaks down mental suffering into 16 groups of disorders, like mood disorders, anxiety disorders, psychotic disorders, eating disorders and several others.

I’ve sat in on over 200 of these types of interviews, thanks to my work, briefly, at a psychiatric hospital. Though I’m not trained as a physician, I’ve had my DSM-IV at the ready, and took it upon myself to learn the diagnostic criteria, talk with the members of the treatment team (PhD’s, RN’s, MD’s) and learn about the intricacies of mental health, from diagnosis to treatment.

This article, by Daniel Carlat, a psychopharmacologist, details his experience in the field of psychiatry that is different from his father’s (who was also a psychiatrist.) To sum, this shift in education has been away from learning talk-therapy and practicing talk-therapy with patients, and instead, going down a list of symptoms and finding the medication to match the symptomology. The therapy, he says, is then left “to a professional lower in the mental-health hierarchy, like a social worker or a psychologist.”

This was a common complaint from my clients, when I worked outside of the hospital with the court system. My clients (who were all on public assistance) wanted to talk to an MD for not just their medications, but for therapy. What they often got was an ARNP for their prescriptions, and a Masters level therapist, who even then, would not be their major point of contact. (There are still people lower on the food-chain, such as Bachelor and Associate Degree level case managers.) Dr. Carlat writes, “The unspoken implication is that therapy is menial work — tedious and poorly paid.”

Dr. Carlat, though, came to a realization that there is more to treating his patients than simply diagnosing, medicating and referring. He notes that studies show that “about three-quarters of the apparent response to antidepressants pills is actually due to the placebo effect” and that non-biological therapy (talk therapy) can also be an effective treatment.

I’ll let you go over and read the rest of the article – which is full of insight into the way psychiatry is being practiced, including some of his anecdotal experience of changing his routine with his patients. This story is informative not just to other psychiatrists, but to other people practicing medicine. Healing is not just about finding the pill to match the symptom. Sometimes healing is about standing by, bearing witness, listening, and understanding that we don’t have all the answers.

I’d say some of the best medicine is a human connection. That’s not profitable, though, is it?

Placebos are Awesome

It’s not that the old meds are getting weaker, drug developers say. It’s as if the placebo effect is somehow getting stronger.

Some of you may have seen this article in wired about the placebo effect, but if not – I highly recommend it.

Now, after 15 years of experimentation, he has succeeded in mapping many of the biochemical reactions responsible for the placebo effect, uncovering a broad repertoire of self-healing responses. Placebo-activated opioids, for example, not only relieve pain; they also modulate heart rate and respiration. The neurotransmitter dopamine, when released by placebo treatment, helps improve motor function in Parkinson’s patients. Mechanisms like these can elevate mood, sharpen cognitive ability, alleviate digestive disorders, relieve insomnia, and limit the secretion of stress-related hormones like insulin and cortisol.

I stand by my previous assertion that placebos are my favorite drugs. It may be nothing but lactose in those little blue Bioron vials, or brandy and water in the Bach Flower Essences, or lumps of rock in a quartz pendant – but if it makes me or anyone else feel better, I’ll take it.

There’s obviously no assurance that homeopathic remedies will work better than allopathic remedies, and when facing life or death, I’ll go for the substance with the most verifiably, scientifically sound data from clinical trials. However, it’s going to be another doozy of a flu season, I’m guessing. I’ll take my FDA approved vaccine with a side of Oscillococcinum.

My Favorite Medicine: Placebo

I love placebos. They’re my most favorite drug in the world. Part of my love, no doubt, comes from an episode of M*A*S*H , which Wikipedia notes is episode 24 of the 6th season, “Major Topper.” In this episode, a shortage of morphine leads the fine doctors of 4077 to count on the placebo effect to help the wounded.

When I worked at a psych hospital, there were a few vocal critics of homeopathic therapies. (By homeopathic, I’m specifically referring to those remedies with NDC codes including the range of Boiron pellets to Bach Flower Remedies.) This isn’t surprising on a few levels – first of all being that the medical establishment has it in their own best interests to poo-poo homeopathy, second being that homeopathic remedies have a heck of a lot of pseudo-science (and magical thinking) backing their efficacy. I wouldn’t dare say that homeopathic remedies have the same power and efficacy as modern pharmaceuticals, but one thing that they do have is the worst case scenario that is better than Big Pharm – at it’s worst, it just won’t work at all.

Not a bad side-effect, huh? Homeopathic remedies can often be used in conjunction with pharmaceuticals, can be combined together, and at best will work, and at worst, will have no effect, with no side-effects or interactions. The actual efficacy of homeopathic remedies is debatable, and may be attributed ONLY to the placebo effect. The third major argument is that it’s a waste of money to take a placebo. Maybe, the transaction of money, plus ingestion of the little sugar pills, is what makes you stave off that cold and flu or lower your anxiety.

Since I worked at Whole Foods, specifically with these remedies at my fingertips, I have tried a few of them and have found some work better for me than others. There’s actually a difference between how some remedies, for the same problem, work for me. For instance, Hyland’s – Calms Forte did not help me at all with getting to sleep, but their other formulation, Insomnia works so well that I sometimes wonder if there’s a secret narcotic ingredient. It could be that my own expectations of efficacy has influenced my body’s response to the placebo. I did read an article, which I can’t find right now, that showed that the expectations of a medication/placebo can influence the reaction a person has, including doing the opposite of what the person may expect.

The past six months have been allopathic-medication heavy. I appreciate the need for modern medicine, and definitely appreciate the need to use it when appropriate. When I was discharged from the ER with a 15 page document telling me the full dangers of my new medication regimen, I both understood the need to take the medication as prescribed, and longed for the simplicity of my ‘bos. During those first few months, I took full advantage of my Bach Flower Remedies, which are, by far, some of the most ridiculous homeopathic remedies around. The way I understand, these concoctions, in brandy, are pretty much just the dew off of specific flowers carrying a vibrational energy that is conducive to emotional health.

I’m fond of them, nevertheless.

Bach Essence Star of Bethlehem
Bach Essence Aspen
Rescue Remedy Sleep

I don’t go for that woo-woo stuff, mostly cos my belief in the supernatural is that it’s all in the mind. However, I’ll take the vibrational properties of flower essences over getting hooked on Xanax any day. (Disclaimer: there is a medical purpose for Xanax, but doctors need to be very careful in doling it out, and need a defined exit strategy. That’s another post for another time, though.)

Choose your placebo.

The Alantic Monthly has a special issue on China for July/August. Unfortunately, the article China Makes, The World Takes is only available for subscribers — but if you have an interest in the issue of American and European companies that have their products made in China, I recommend reading it.

Of course, I have Jon to blame for bringing it to my attention. And how could I not be interested, when I see the cover featuring all of those containers ready for shipping? I see them every day on trucks going up and down I-5 from the Ports of Seattle and Tacoma. The photo on the lead article comes from Shenzhen, but I see so many of those same containers here on the roads, and stacked up in the ports. (btw and slightly off-topic, the second Season of The Wire, which is filmed in Baltimore, feature some of these same containers and the yards.)

The gist of the article, as far as I can tell, is that American companies making goods in China isn’t all bad. Well, crap. That stalls my continuing trek to the polar end of consumerism. This is inevitably what happens to me whenever I start trying to define a position that I’ve shown an interest in taking. I get introduced new data that rounds out my view point, and makes it harder for me to rally on one side of the issue. Maybe it’s my diplomatic nature – or even a Buddha-nature of finding the Middle Way. All choices have their positives and negatives, and when it comes to consuming products the only answer is what to consume, as opposed to not consuming at all.

And then choosing who and what you value the most.
Continue reading “Choose your placebo.”