Thursday, January 21, 2010


One of the interesting things about modern psychiatry, is the number of conditions of which there is no approved medicine by the Federal Government's agency the FDA. Take for example dysthymia or cyclothymia or bipolar II. Hmm no FDA approved med, so there are no medications available as sanctioned by the government after careful review of drug company literature- 2 placebo controlled studies that show a drug is statistically significant over placebo, and who knows whatever else, and the government will approve the medicine. Doctors often prescribe "off label", meaning taking a medicaiton for example that is apporved to treat major depression and use it to treat dysthymia or minor depression. Research shows in can be helpful and any decent clinician knows it, but it is still off label.
You don't send a patient away that is suffering and tell them to come back when they fit a diagnosis of which the government has signed off on an FDA approved med. You try to actually help the patient and allenivate pain and suffering.
SECRET NUMBER ONE: A med can be helpful for a condition and never get approval because a drug company has to spend a lot of money on research to get the government to sign off.-It might be effective but not effective enough. Or there is good data, but the federal government for some reason or another may recognize one drug companies data over another's, but that has been going on a long time
Not a big secret but something that affects clinicians daily practices all day, and certainly sets up more mistrust and suspiciousness of treatment.
SECRET NUMBER TWO-the NOCEBO affect- a med at a small dose of little or no biological significance, make a person worse or have terrible side effects that would not otherwise be accounted for or expected, based on any physiological or biologial cause. usually from a homeopathic dose.
SECRET NUMBER TWO B- the doctor is not interested in hurting a patient or making a patient worse- when they treat a patient they are not experimenting or treating a patient like a guinea pig, its amazing how many patients in psychiatry have had that experience.
Bottom line is the nocebo effect is way bigger than the placebo affect. in areas like psychiatry.
The placebo affect is probably over-rated and there is probably more biological basis and psychological basis for the affect than science knows.
In other words, if you think you are getting better, you probably are and there is probably more biological basis for it.

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Talking about the book with the Lake Superior wind....... a calm day