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Unresolved Questions About the Specialty Lurk in the Cortex of Psychiatrists

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Unresolved Questions About the Specialty Lurk in the Cortex of Psychiatrists From the Editor Unresolved questions about the specialty lurk in the cortex of psychiatrists Psychiatrists are known for asking disciplinary team of psychiatrists, pri- probing questions as part of the mary care providers, nurses, social workers, psychologists, and pharma- Henry A. Nasrallah, MD necessary excavation of patients’ cists? Why has a brain disease, such as Editor-in-Chief emotional archaeology. We are also psychosis or bipolar disorder, become notorious for often answering pa- a punishable felony instead of a treat- tients’ questions with another strate- able illness? gically focused question. Why did the system of mental health The answers we need care degenerate to the point that a just keep ‘blowin’ in But many of our own questions severely depressed or suicidal, or await an answer acutely psychotic, patient can be hospi- the wind’ The fact is that psychiatrists have seri- talized for only 4 or 5 days, then must ous, nagging questions—in every corti- be discharged before her (his) illness has cal fold of their collective brain—about been fully controlled? Why do health patients’ welfare, psychiatric practice, care insurers exhibit that atrocious com- and professional matters. Their ques- bination of maximum greed and mini- tions about frustrations of daily prac- mal compassion? tice deserve an honest and convincing response, yet go begging—expressed Why does a completely unjustified so well in songwriter Bob Dylan’s lyric, and hurtful stigma continue to plague “The answer is blowin’ in the wind.” mental brain disorders, patients who What follows are long-standing suffer from them, mental health pro- “Why?” questions whose answers are fessionals, and the very discipline of still blowin’ in the wind. (Dylan didn’t psychiatry? specify which wind is blowin’, so I’ve provided the names of 22 atmospheric Why do otherwise intelligent people movements of air molecules in the show compassion toward people with Box [page e3] found in the archive at a brain disorder such as stroke, CurrentPsychiatry.com. Take your pick!) Parkinson’s disease, multiple scle- To comment on this editorial or other topics of interest, rosis, myasthenia gravis, or migraine, visit www.facebook.com/ Why is a jail OK for the mentally ill but express aversion and even disdain CurrentPsychiatry, or go to but an asylum is not? Why is it neces- for psychiatric brain disorders such as CurrentPsychiatry.com and click on the “Contact us” link. sary to put armed guards in charge of schizophrenia, depression, obsessive- psychiatric patients instead of a multi- compulsive disorder, and panic disorder? Current Psychiatry 10 August 2016 And why does this prejudice persist of patients that is clearly spelled out in Editorial Staff despite advances in psychiatric neuro- the package insert? EDITOR John Baranowski science that have used neurogenetics, MANAGING EDITOR Erica Vonderheid ASSOCIATE EDITOR Patrice Kubik neuroimaging, and molecular stud- Why do people demonize the pharma- WEB ASSISTANTS ies to establish, without a doubt, the ceutical industry far more than other Tyler Mundhenk, Kathryn Wighton neurobiological basis of all psychiatric industries? No other entity discovers Art & Production Staff disorders. and develops life-saving medications. CREATIVE DIRECTOR Mary Ellen Niatas ART DIRECTOR Pat Fopma DIRECTOR, JOURNAL MANUFACTURING Why are there still no objective diag- Why don’t people realize that, with- Michael Wendt PRODUCTION MANAGER Donna Pituras nostic criteria for psychiatric disor- out medications, massive numbers of ders? Why do we persist in using patients would be hospitalized and the Publishing Staff PUBLISHER Sharon J. Spector defining symptoms that have been death rate would rise? Why can’t peo- ASSOCIATE DIRECTOR, eBUSINESS volunteered by patients—symptoms ple weigh risks and benefits of having DEVELOPMENT Joshua Norton MARKETPLACE ACCOUNT MANAGER that can be subject to distortion or a pharmaceutical industry, just as they Linda Wilson malingering? Why aren’t the hun- assess the risk-benefit ratio of every- CONFERENCE MARKETING MANAGER Kathy Wenzler dreds of established biomarkers being thing in life? incorporated into the diagnostic for- Should the government impose Editor-in-Chief Emeritus James Randolph Hillard, MD mulation, to lessen subjectivity and a massive ($1 or $2 trillion) tax hike Frontline Medical Communications improve reliability and validity? to establish infrastructure for drug CHAIRMAN Stephen Stoneburn research and development, for the ben- EVP DIGITAL BUSINESS DEVELOPMENT/CFO Douglas E. Grose Why is off-label prescribing, the judi- efit of psychiatry and all other medical PRESIDENT/CEO Alan J. Imhoff cious clinical repurposing of psycho- specialties? PRESIDENT, CUSTOM SOLUTIONS JoAnn Wahl tropic medications, criticized and VICE PRESIDENT, FINANCE Dennis Quirk Jim Chicca panned, even though there are no Why is there a severe shortage of psy- VICE PRESIDENT, OPERATIONS VICE PRESIDENT, AUDIENCE DEVELOPMENT approved drugs for 88.5% psychiat- chiatrists but a glut of lawyers? Why Donna Sickles 1 VICE PRESIDENT, CUSTOM PROGRAMS ric diagnoses? Why allow insurers to doesn’t society rationally deploy its Carol Nathan refuse to pay for a medication that can resources to meet urgent social needs VICE PRESIDENT, CUSTOM SOLUTIONS help a patient, just because the patient and priorities? And why do lawyers Wendy Raupers VICE PRESIDENT, eBUSINESS DEVELOPMENT has not been given the “official” diag- bill us for every minute we talk to Lee Schweizer nosis for which the FDA approved them, while we field telephone calls VICE PRESIDENT, HUMAN RESOURCES & FACILITY OPERATIONS Carolyn Caccavelli that drug? and e-mail messages from patients VICE PRESIDENT, MARKETING & CUSTOMER And why doesn’t the FDA solve this without compensation? ADVOCACY Jim McDonough VICE PRESIDENT, SALES Mike Guire problem by revising its requirements VICE PRESIDENT, SOCIETY PARTNERS that registration trials for new medi- Why did the FDA allow the pharma- Mark Branca cations test their efficacy for a single ceutical industry to develop direct-to- CORPORATE DIRECTOR, RESEARCH & COMMUNICATIONS Lori Raskin symptom, rather than a diagnosis com- consumer advertising? Why do they EDITORIAL DIRECTOR Karen J. Clemments prising multiple symptoms? not realize how that decision has com- Subscription Services: (800) 480-4851 plicated the doctor–patient relation- In affiliation with Global Academy for Medical Education, LLC Why do people not accept the fact that ship, and how it preempts physicians’ VICE PRESIDENT, MEDICAL EDUCATION all drugs have benefits and risks, and evidence-based decision-making by & CONFERENCES Sylvia H. Reitman, MBA VICE PRESIDENT, EVENTS David J. Small, MBA that it is impossible to have pure efficacy encouraging consumers to demand without side effects? Why empower a drug that they saw on television— lawyers to make clinical care adversar- a contorted version of prescribing ial? Why do lawyers refrain from suing by proxy? 7 Century Drive, Suite 302 Parsippany, NJ 07054 oncologists or manufacturers of life- Tel: (973) 206-3434 saving chemotherapy drugs because Why (speaking of prescribing without a Fax: (973) 206-9378 www.frontlinemedcom.com of terrible adverse effects, but pounce license), do politicians pass laws allow- Published through an on other medications that might cause ing people who do not have required educational partnership a serious side effect in a tiny percentage medical training to take a short-cut to with Saint Louis University continued on page 19 Current Psychiatry Vol. 15, No. 8 11 From the Editor continued from page 11 becoming a prescriber? Why not man- support research by referring patients date that politicians, and their families, to clinical trials of medications or to receive medical care exclusively from National Institutes of Health-funded unqualified practitioners on whom they investigations of the neurobiology of bestow prescribing privileges with- psychiatric disorders? out requisite comprehensive medical training? Are these just rhetorical questions? Why do some psychiatrists resist Some might sound that way. But they changing their practice patterns despite are not. These questions are brewing continuous advances that update the inside the hearts and minds of many care they provide? Why do reports of psychiatrists, although only a few seem exciting therapeutic breakthroughs, determined to relentlessly seek answers Why did the FDA allow published in top-tier journals, go unread on which medical science and society by so many practitioners? Why do they can act. the pharmaceutical say they are too busy to read journals or We should collectively pose these industry to develop peruse PubMed? “why” questions and not accept long- winded, hollow answers. We need to direct-to-consumer Why don’t people realize that today’s foster the winds of change—not resign advertising? research is tomorrow’s treatment? That ourselves to winds in which answers research is not a luxury but an ongo- blow about but, ultimately, disappear. ing necessity? Why don’t more freshly minted, young psychiatrists pursue a career in research to accelerate the pace of progress about the biological Henry A. Nasrallah, MD causes and treatments of serious psy- Editor-in-Chief chiatric disorders? Why aren’t there more incentives to grow the next gen- Reference eration of psychiatric discoverers and 1. Devulapalli KK, Nasrallah HA. An analysis of the high psychotropic off-label use in psychiatric Nobel laureates? Why don’t clinicians disorders. Asian J Psychiatr.
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