Wear Clean Draws  (because there’s 5 million ways to kill a ceo)

i kind of agreed with daisy’s reaction to amber’s post. (www.amberrhea.com) i was going to comment, but thought better of it. yeah, i know amber, you might read it here, but i feel that it would be inappropriate to post at your blog given how you feel on the topic. here, however, it’s my blog.

from things you’ve said amber, it seems as if people shouldn’t speak up at all — at least directly to you — if you happen to be outlining your own position. when you write about the topic, I really get the impression you are not apt to welcome responses if they depart from your own view.

OK. I can deal. And i do i understand about how people shouldn’t just hand out advice to you when you haven’t asked. But I’m not doing the that. Instead, I’ll disagree, but in my own space. What I’m saying is not advice; rather, it’s outlining my own position and support for what Susie Bright said on her blog.

i do think that, while you might be very informed about yourself and the drugs you are taking, a lot of people aren’t. i know this from lots of personal experience — including my own response to taking prozac. because of all the drug company bullshit, i had no idea it could have harmful effets. from reading about the pharma co. shenanigans, the doctor probably didn’t either.

side effects weren’t mentioned. in fact, the company that made prozac was later sued or investigated or both for supressing research about the side effects i experienced. but at the time, no one knew.

to boot, people were popping prozac pills like candy. there were books written about the transformative character of prozac and how we could all happily alter our very personalities. Listening to Prozac. People thought it would be a great thing to use drug therapies to permanently alter who we are. it was all the rage. There were Time cover stories on it.

that was until the news reports couldn’t be stifled any longer: there were people going on murderous rampages under the influence of the drug.

It isn’t just the drug that could potentially harm the person taking it. In some cases, they’ve done harm to others. Petersen writes about some compelling evidence that our traffic death rates are increasingly being impacted by people driving under the influence of drugs. she recounts story after story, lawsuit after lawsuit. Nevermind the fact that a lot of these drugs end up in our water supply! Which is another entire chapter she pursues: the way drugs in the water supply effect humans and animals, including our food sources. Think of the concerns over all the hormones in our water supply and the increasingly early onset of menstruation among young girls.

Or think of the epidemic of breast cancer due to all the affluent women popping hormone pills lefft and right to look young. They died because of it. When the government stepped in, the breast cancer rate decreased sharply. This stuff matters, not just to the individuals who take drugs, but to the rest of the community that bears the burden of the side effects: drugs in the water supply and people driving under the influence. This isn’t meant to demonize anyone who takes drugs — the drugs in the water supply are for all kinds of things, including drugs most of us think of as treating physical conditions that we all think of as safe treatments. Rather, it’s important information we all need to think through our public health policy.

while you are a smart person who questions things, i can tell you very confidentally that i, equally as smart and questioning, even with training about the gullibility of the health profession and personal experience about doctors’ misbehavior, even i didn’t put it all together and question the doctor who prescribed prozac. i wanted to feel better and didn’t care.

i can tell you that my ex0husbands entire family was not informed. Indeed, they are from an entire strata of society my mother, a nurse, deals with dailyl: people who think doctors are gods and never question a word they say. the wasband’s mother was given a pill for everything under the sun. when she, a woman with heart problems in her 60s, complained of dizziness, the doctor prescribed prescription strength dramamine. i can assure you that for most people in their sixties who present with dizziness, the last thing on the radar ought to be motion sickness. it could be a sign of internal bleeding — or anything having to do with not enough blood getting to the brain. but no, this guy prescribed dramamine. he was an award winnning doctor in the community who people thought of as a god.

when i asked why she was on 17 diff kinds of meds her doc said, “at your mother’s age, she’s ready to die. it’s a matter of just giving them pills that they think will help them and allowing them to pass on. besides, your mother thinks that pills help her, so i give them to her because it helps her think she is better, even if the pill doesn’t treat the problem.”

now, he had given her medications in a combination that caused her to exhibit symptoms of alzheimer’s disease — which masked the symptoms of what was really wrong with her. we had to pull her off all those drugs and try to find the drug or drug interaction that was making her so sick.

they are now putting people on alzheimer’s drugs and they aren’t being tested on elderly populations! they do this crap all the time: test only the healthiest populations, when we know damn well there are differences in drug metabolism and bioavailability. they test this way to purposefully skew the results in favor of the pharma company.

as i mentioned before, this is not cool! it is not cool that we can’t even trust the research we can read on our own. we now know that one study by a reputable organization has shown that 52 percent of all drug research is never published, and what’s never published are the findings that are negative or that fail to prove benefits of the drugs.

i know, amber, you don’t object to people talking about those issues. and yet at the same, when i did when I initiated my discussion of Petersen’s Our Daily Meds, you immediately assumed that she had to be on the wrong side of the issue because i wasn’t saying what you believed or perhaps preferred me to be saying. i had to keep on writing to be understood as someone who wasn’t necessarily the enemy and to represent Petersen’s book as a book that wasn’t necessarily the enemy.

there are people out there like the wasband’s family who don’t question a word a doctor has to say. you wrote about your own doctor who told you ambien wasn’t addictive and that it was safe to take for a long time. this directly contradicts findings on ambien, which is highly addictive. you probably know that already. i still find it incredibly disturbing that your doctor told you that. i got the sense you did too. alas, you don’t have a lot of choice about it, i guess, so have to take that kind of info in stride, just as i have to take info in stride when i have seen doctors who clearly don’t keep up on the latest issues around heart disease. doctors don’t know everything and its up to us, as patients, to be vigilant. but this puts us in a sucky situation, too. i find it especially sucky when i further learn that i can’t trust the research on heart medications.

my response to daisy was this:

the weird thing is, i thought susie bright was saying largely what amber approved of. i didn’t see a whole lot in what she said, as a general principle, that was wrong. ETA: her post at jezebel seemed extremely compassionate. Indeed, she didn’t seem to be denying that the woman should work with her doctor and that she should try to get her parents tosee that her problem was just as important as a broken leg. they’d pay for her treatment if a leg was broken, why not mental health? susie was actually advocating something i should think we should support, on that one.

but to daisy’s point, as daisy said, the writer *did* ask for someone’s opinion. you can hardly put yourself in front of an opinion writer/advice giver like that - especially someone writing for the internet where the name of the game is to get hits (jezebel writers are paid by hit counts last i knew) and, thus, are rewarded for controversy — and not expect to be given advice.

i know amber: you have said that you accept that there are bad things about drug companies, but i’m not sure you really accept that those critiques aren’t necessarily the enemy of stories about people who do well on medications. as i mentioned above, i was immediately treated as someone writing from the enemy’s perspective, and Petersen was as well. Not by just you, but by a slew of people at another discussion forum. It was as if i had no experiences of my own that were authentic and legitimate, just not the same ones experiences you’ve had. ETA: I did NOT have a positive experience with drug treatment. I do think that I am a case of a person who got well without drugs, but had I been treated, I would have been one of those people who had a drug foisted on them for no good reason.

i said it on my blog. my own experiences with medication — very tiny compared to most b/c, without health insurance, i never went to a doctor — was that being given an antidepressant nearly killed me.

my story needs to be told, just as much as your story needs to be told, just as much as the story about the person who got no benefits from drugs, just as much as the person who benefited from placebo effects, or who got better from exercise and sunlight. that’s my story: exercise, sunlight, putting one foot in front of the other, etc. that was my approach. i had no choice.

but those different stories are reflections of the fact that there are differences among us — often patterned differences, sometimes so chaotic that it makes it hard to discern what cause/effect is involved and thus if we can even categorize a single similarity in response.

when i said on my blog that the author (Melody Petersen) of the book i reviewed, our daily meds, says that we ought to try non-drug therapies first — and she meant that for everything but the stuff that is proven extremely effective — there’s nothing wrong with that. it’s a way of practicing the principle of least harm. Given what we know about, for example, the response to antidepressants, that it’s about 33/33/33 — with 1/3 of the pop responding well to talk therapy, 1/3 to drug therapy, 1/3 to placebo — then 2/3 of people are going to respond to non-drug treatments. if you go with drug therapy first, only 1/3 are going to respond. the principle of least harm holds here: these drugs have side effects. some kill people. some permanently change your body forever and not necessarily for the good. some are addictive.

and so forth.

there is nothing inappropriately normalizing about a principle which says: let’s treat depression with non-drug therapies first, then try drugs. there is nothing normalizing about Susie’s prescription that drug therapies ought to come in conjunction with diet, exercise, behavioral, stress reducing, etc other therapies.

ETA and an aside: You once pointed to an article about Generalized Anxiety Disorder. At the bottom of that page it recommended that the person have a variety of facets to their treatment and that inclued things like yoga — as well as pursuing drug therapies. this is no different than what susie said.

advising that people pursue non-drug therapies first, as Petersen did, is a standard that reflects the reality: 2/3 benefit from non drug therapy. 1/3 might be harmed by having to wait awhile. if you reversed it, you give drugs with side effects that could be damaging, and permanently, to 2/3 of people who, according to lots of excellent research, will not benefit from the drug but will benefit from talk therapy and/or from other forms of therapy such as exercise/diet/rational behavioral modification (or even no treatment at all).

i know. you benefited from drug therapy. but for every one of you, there are two more who do not. health care professionals have to take those numbers into consideration if their basic ethic is to do the least harm.

the principle of least harm applies and it makes sense to go with non-drug therapies first so as to do the least harm. just as we pursue cancer treatments that do the least harm first. people go with chemotherapy and so forth, before a mastectomy. the idea is least harm. that chemo may not help them. they may need a mastectomy eventually. but the principle of doing the least invasive treatment first is being applied.

similarly, when it comes to heart disease, my grandmother went through diet and exercise therapy first, in order to see if she responded first. she was eventually told she had to do all three: diet, exercise, drugs because we have heart disease that requires drugs. but the principle was: do the least harm, first.

my dad and diabetes. the first approach was try diet and exercise first, then use drugs. my dad has a death wish, so it was a pointless exercise. he preferred to abuse his body with lack of exercise, bad food, etc. drugs were inevitable. but my great aunt and my grandma? they have managed diabetes with exercise and diet, first, and haven’t had to take drugs for it.

someone sent me the placebo article which was linked to at susie’s. it’s pretty damn excellent. http://www.wired.com/medtech/drugs/magazine/17-09/ff_placebo_effect?currentPage=all

when people say that diet and exercise might work, and other forms of behavioral modification might work — or add to or increase the benefits of drug therapy, they are sometimes talking about research we have that shows that, yes, environment does change the structure of the brain (as per that article in Sci Am I read some years ago): diet, exercise, behavior modification, talk therapy — these are all non-drug, environmental ways of changing the structure of the brain. it is another way of treating depression and it works for some people. the principle still applies: the external behavior and diet and lifestyle modifications, as well as the excellent attention and feedback they get from other people, are actually working to change their brains. which is why it is working. that was from that Sci Am article I read.

so, the people who advocate non-drug therapies don’t think that it’s all in your head in a bad way. they don’t think that the problem doesn’t exist. they think it’s all in your head in the same way you do: that it’s the chemical structure of your brain, and that chemical structure can be altered by non-drug therapy. they aren’t saying you are faking it. rather, they are taking you seriously: you are in pain and they are advocating for a way to mitigate that pain.