First “do no harm”

“I haven’t experienced the past two decades in psychiatry in quite the same way. As I’ve seen it, this period has been an age of corruption unequaled in the history of medicine. The main body of research has been interminable drug trials, a patchwork grid of the all available drugs tested against all available diseases. The ancillary new industry of Clinical Research Organizations [CROs], Clinical Research Centers [CRCs], and Clinical Rating Scales [HAM-D, QIDS, PANS, MADRS, SANS, BPRS, CGI, etc.] has produced an infinite array of monotonous graphs in monotonous journal articles about pharmaceutical industry financed studies, often written by professional writers with guest author psychiatrists who may or may not have been involved in the process. It has been an a time when psychopharmacologic agents have been introduced one after another following a predictable life cycle. First, there’s a exuberant marketing phase supported by an army of psychiatrists which accentuates the positive and eliminates the negative. Then comes a period when the unreported adverse effects start to come to light and are denied, while the army of psychiatrists deploys to hawk the medications across the land. By the time the adverse effects are finally undeniable, warnings are issued but the earlier momentum carries the drug to the end of its patent life. And, by the way, beside the adverse effects, it usually turns out that the drugs weren’t so effective after all. Then come the legal suits for damages and false advertising and the drug companies end up parting with some small fraction of their profit – ready for another go-around. That’s the front page of the last several decades that I’ve known in psychiatry.”
And all this just gets better:
“Meanwhile, the love affair with brain biology has been sustained by a literature of future-think, review articles and opinion pieces about what’s coming soon – just around the corner. I have little doubt that somewhere down the line, neuroimaging will actually show us some interesting things about brain circuitry that might even lead us to an understanding of something that has to do with clinical mental illness. But it hasn’t really happened yet. I remember in around 1985 being told by our new chairman that neuroimaging was about to revolutionize our understanding of mental illness. So by my reckoning, neuroimaging is entering its second quarter century being the coming revolution in psychiatry. Nor do I doubt that we’ll learn something from genomics, but it’s not here yet. And “the lifelong influences of genes and environment on a person’s health and behavior” is no great conceptual leap.”
This is about the DSM-5-found here:
http://1boringoldman.com/index.php/2011/11/07/should-psychiatrists-sign-the-petition-to-reform-the-dsm-5-absolutely/

Back with the Presidential Commission for Bioethics:
“Ethically Impossible” STD Research in Guatemala from 1946 to 1948

Following the revelation last fall that the PHS supported research on sexually transmitted diseases in Guatemala from 1946 to 1948, President Obama asked the Bioethics Commission to oversee a thorough fact-finding investigation into the studies. Commission staff carefully reviewed more than 125,000 original pages of documents and approximately 550 secondary sources collected from public and private archives around the country. Commission staff also completed a fact finding trip to Guatemala and met with Guatemala’s own internal investigation committee.

The PHS research involved intentionally exposing and infecting vulnerable populations to sexually transmitted diseases without the subjects’ consent. “In the Commission’s view, the Guatemala experiments involved unconscionable basic violations of ethics, even as judged against the researchers’ own recognition of the requirements of the medical ethics of the day,” Commission Chair Amy Gutmann, Ph.D., said. “The individuals who approved, conducted, facilitated and funded these experiments are morally culpable to various degrees for these wrongs.”

The full report, “Ethically Impossible” STD Research in Guatemala from 1946 to 1948, also includes the Commission’s ethical analysis of the case.

* Read media coverage on the issue.
* Read the press release.
* Read the spanish language press release.
* Read the charge from the President.”

http://www.bioethics.gov/cms/node/306

First “do no harm”
Secondly “do not question our judgement”

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