Medicating Grief

The Diagnostic and Statistical Manual, or DSM, is the coding "bible" for those in the field of mental health and psychiatry.  Generally speaking it is the guide used to categorize "disorders" so you can get paid by third party payers.

The issue discussed in this article is not new to me because I have seen this model applied since the late 80s when I was working in community mental health.  The practice predates my experience.

I cannot think of a more inhumane treatment offered in health care.  To conspire to deprive people of the important participation in their grief is a grievous disservice. 

As Allen Frances, emeritus professor and former chairman of psychiatry at Duke University, writes : A startling suggestion is buried in the fine print describing proposed changes for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders — perhaps better known as the D.S.M. 5, the book that will set the new boundary between mental disorder and normality. If this suggestion is adopted, many people who experience completely normal grief could be mislabeled as having a psychiatric problem.

His complete article is here and I strongly encourage everyone to read this.

Another No Suprise News Piece: Doctors too lazy to properly diagnose

HealthierTalk is a website that publishes some of the articles I write that are not posted on Natural Health News.  This note is from their editor and it is certainly worth sharing with NHN readers.

To me, it is certainly no surprise because I hear this from so many people and see it with my clients. It is one of the key reasons when over a decade ago we created our sleuthing service.

Read related article

As we are moving into unchartered territory under health insurance reform, it is best to be well advised, and aware!

What would you say if I told you that your doctor was going to put you on heavy-duty anti-depressants...but not because you are depressed...simple because he was just too lazy to read? It sounds crazy right? Unfortunately--as a new study about to be published in the Journal of Clinical Psychiatry reveals--it's quite common.

Turns out that an astounding 75% of general practice docs...and an additional 25% of psychiatrists...are choosing to ignore their own guidelines when diagnosing major depressive disorder (MDD).

Those guidelines, set out in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), exist to give doctors the guidance they need and to protect us from being misdiagnosed and improperly treated. But, of course, they only can work if doctors follow them.

When a group of doctors were asked how often they are using the DSM-IV when diagnosing depression, the majority of them answered the multiple-choice question with "less than half of the time."

The author of the study, psychiatrist Dr. Mark Zimmerman, offered up the whiz-bang theory that doctors may not be using the DSM-IV criteria because it's very long and some may not be able to recall all of it.

Umm...excuse me?! He's got to be kidding. The results of the study would have been ridiculous enough on their own. But Dr. Zimmerman's observations send this one right past ridiculous straight to shocking.

Let's see if I can break this one down:

1. The criteria for diagnosing a person with a serious illness are just too long for doctors to recall.
2. And apparently it is too much trouble for them to actually pull them out and read through them when they can't remember them.
3. So, instead, my doctor embracing his laziness, chooses to throw caution to the wind, ignore the guidelines, and pronounces me "seriously depressed."
4. Out comes the prescription pad and, next thing I know, I am doped up on some serious medication(s) to treat my illness. Only problem is, I wasn't even depressed to begin with.

Zimmerman went on to helpfully suggest that perhaps we should shorten up the definition of MDD to assist the docs...who are blatantly ignoring the guidelines...to get their diagnoses right.

I suppose just expecting doctors to do their job would be too much to ask?

If you'd like to see what's in the DSM-IV you can take a look at it here. Better yet, you might want to be sure your doctor has the link.

Low Sex Drive, poor quality of life?

On January 27 I posted an article by Carolyn Dean MD, ND about medical codes and insurance billing. I'd read the article when it was first published and had a copy of it in my archives. I hope many of you were able to listen to Dr. Dean discuss this issue with Jeff Rense on his program.

I started laughing when I read the following article because I didn't have to get any further than the first sentence to see the focus of the article: A new DSM category and a new CPT billing code. Now all we need to do is wait for some drug company to come along and bring us a new drug that will have so many side effects it will cause some one to suffer terrible side effects.

And then there will be the insipid TV ads to go along with the effort to condition everyone in the baby boomer or younger group to start to believe the answer to sex drive is in their little pill. I wonder if the profit ratio and margins are already calculated.

This picture isn't too much more than a re-run of PMDD so there was an excuse to get you on Prozac or some other SSRI to lead you down the slippery slope of suicide, homicide or osteoporosis.

Where's the beef in this picture? (cynic that I am) Referring to a good whole food diet, and a few vitamins or herbs that will get you straightened out with no long term side effects.

I have to admit when I read this article this article my mind went directly to last night's NPR program awarding George Carlin the Kennedy Center Twain Award and a later story on Petey Greene with a young Howard Stern in the hot seat.

For those of you that don't understand abstract thinking, apparently like the several people who have been verbally attacking me and this blog in the last week or so, this means that it's all in the rhetoric.

And boy do the drug and insurance company script writers have a corner on this market.

Women's low sex drive tied to poor quality of life Wed Feb 4, 2009
NEW YORK (Reuters Health) – Postmenopausal women who have hypoactive sexual desire disorder (HSDD) - a low level of sexual desire -- have a worse health-related quality of life than their counterparts who are happy with their sex lives, according to a new study.

In fact, the researchers say, HSDD can cause in impairments in well-being on par with those seen in chronic diseases such as diabetes, hypertension, osteoarthritis and asthma.

HSDD, the "persistent lack of sexual desire causing 'marked stress or interpersonal difficulties,'" is included in the Fourth Edition of the Diagnostic and Statistical Manual of Mental Disorders, which lists and defines mental illnesses widely accepted by the psychiatric establishment.

But questions remain about whether HSDD is a real problem for women or "represents a disorder that has become 'medicalised' because of its pharmaceutical market potential,'" Dr. Andrea K. Biddle of the University of North Carolina at Chapel Hill and colleagues write in Value of Health, a journal published by the International Society for Pharmacoeconomics and Outcomes Research.

One member of Biddle's research team works for Procter & Gamble Pharmaceuticals, Inc., which also funded the research and provided consultation for the survey. Procter & Gamble makes a testosterone patch, Intrinsa, which is approved for treating HSDD in Europe. A U.S. Food and Drug Administration advisory panel voted against approving Intrinsa in December 2004, citing lack of evidence for its long-term safety.

In the current study, Biddle and her team looked at data for 1,189 women who had gone through natural menopause or surgical menopause, in which their ovaries were removed, to test the impact of HSDD on women's health and well-being. All of the women, who ranged in age from 30 to 70 years, were in a stable relationship for at least 3 months.

Among women who underwent natural menopause, 6.6 percent met the criteria for HSDD, while 12.5 percent of women who had surgical menopause met the criteria.

Women considered to have HSDD were less satisfied with their home life and their emotional and physical relationship with their sexual partner, and were also more likely to be depressed, the researchers found.

They were also about twice as likely to have back pain, fatigue, problems with memory, and depression.

The women with HSDD scored lower on several measures of health-related quality of life including mental health, vitality, social function and bodily pain.

Overall, the researchers conclude that their findings "suggest that HSDD represents a significant and clinically relevant problem."

SOURCE: Value in Health, online. Copyright © 2009 Reuters Limited