The Scam: Labels and Medicines

There are a couple of scams:

1) Medicines are not specific to a disorder. Benzodiazepines, neuroleptics, and mood stabilizers have all been used, alone and in combination, to treat BPD. Even Ritalin works in some instances. The fact of a response to a medicine does not imply a particular affliction. Ritalin, for example, makes even normal kids more mature, more attentive, and less impulsive.

2) As medicines become safer, they are more freely given by RNs, physician assistants, and general practitioners. The great justification for psychiatry is an operational one: psychiatrists give medicines that frighten GPs.

3) More and more "subclinical" or "off label" uses emerge for many of these medicines. Risperidone, for example, was designed to treat psychosis but with smaller risk of tardive dyskinesia. It now is used, and often with very good results, to treat adolescents who assault their parents, ignore curfews, and refuse to do schoolwork. The improvement is sometimes overnight and durable. More importantly, the adolescent will report feeling closer to his friends, teachers, and parents. They like these effects if not accompanied by weight gain, or depression.

4) The Physician-Knowledge-Coupler completes diagnoses for an incredible array of physical illnesses. Designed by Lawrence Weed, MD, and intended to correct your physician's tendency to use the same few diagnoses even when they are incorrect. The PKC, however, also lists tests to rule out alternative diagnoses and potentially eliminates the need for a physician. (Psychologists faced this difficult lesson when data showed that clinical judgment was always inferior to computer predictions for such things as MMPI profiles.)

JimB

As some great mind at a ChADD conference remarked: "Someone will respond to some medicine in a particular way at some time."

Replies:

Re:The Scam: Labels and Medicines, by Todd, 02/25/04

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