I found the book to be a page turner (even though I knew a heck of a lot going into it) but also agree that you make some excellent points in your review. The book probably doesn't have the heft that it could. It is a "summer read." And at times I almost felt like she was writing for a movie script down the road. Still several characters really came to life including Martin Teicher, but not Tonya Brookes, who I agree seems to be a footnote to the whole story. Still I got a good feel for how the "corruption" in academic research plays out in the real world through this story and that is darn important stuff to make compelling to the average Joe.

It's simply not the epic tale I would've liked to read. But, then, I know a bit too much about Paxil and anti-depressants, so maybe I am a jaded reader.

So write the epic already, Philip!!

How come you don't have an Amazon.com referral program for the blog? It sounds like it'd be an easy way to make a few extra dollars from the blog.

Phil, you are 100% correct about the withdrawal problems. The suicide issue, although very important, is one that is very hard to prove. However, one cannot ignore the thousands of reported cases of horrendous withdrawal this drug causes. My gripe with the MHRA is that they are not taking this matter seriously.

I have not read the book, like you say, I'm probably pretty much up to speed on its content anyway. Kudos to the author though for standing up and sticking her middle finger up to Pharma.

I am looking forward to getting a copy of this book, but I am sure I would be very familiar with most of the content, as I have been on Paxil and been researching the whole sordid affair for the past 6 years...

The definitive Paxil book has yet to be written, I think you could do it Mr Dawdy! ..

:)

Someone out there get Philip an agent!!!

Philip, you make some excellent points in your review. However, I have a different take.


Yes, it would have been nice if we had heard more user stories. But in my opinion, the story of how Rose Firestein had to overcome severe vision problems to persuade her bosses to sue Glaxo Smith Kline is extraordinary. A person without a disability would have had a very hard time in similar circumstances much less someone like Ms. Firestein.


I also think that Allison Bass did a great job in showing the shannanigans these drugs companies and psychiatrists working for them pull to get these drugs approved. We read about it in bits and pieces on your site and related ones but to get the whole picture is mind blowing.


Maybe because there is such a dearth of books like this that I have low expectations. If someone writes a similar type book, I will have greater expectations.


I think our views are reversed as I was disappointed in Charles Barber's book that you seemed to like alot. I hope I am accurate.


Anyway, I join the chorus of people in urging you to write you own book.

This short film "Side Effects" shows an even worse anti-anxiety medication:
http://welltoldtales.com/2008/07/02/wtt-extra-side-effects-short-film/

thanks aa and everyone who thinks i've got a book in me. btw, one reason i was tough on bass' book is because there is already a damn fine book on all the big ugly stuff on these issues that i think is superior to hers and barber's and that's david healy's "let them eat prozac." (glenmullen's "prozac backlash" is good too.)

i recommend it to one and all. the chapter on the healthy volunteers study he did of zoloft at his university is worth the price of admission alone.

btw, word is that peter breggin has a book on the way.

Having read a lot of the books that are critical of psychiatry and medicine more in general, there are things out there that raise legitimate questions about health care. But what are your solutions to improve the quality of care?

I'll tell you mine, in the order of most to least importance:
1. It's time for this culture, this society, to stop looking for quick fixes and no accountability for poor choices. Practice responsible living by healthy eating, consistent sleep habits, not using addictive substances, staying within the reality of financial abilities, having sympathetic supportive stable relationships, and maintaining reasonable and realistic goals regarding work, intimate relations, and being involved in the community.

2. Managed care should go to hell and any and all choices made to focus on profit should be made felonies and prosecuted to the fullest extent of the law. Preexisting condition limits should be stricken from consideration. Coverage for illnesses should be defined by physicians. Expenses should be incurred by patients, to some degree, to insure accountability on the patient. And finally, doctors should know what is the chain of treatment and not recommend the end intervention at the beginning, and certainly should not be meeting with patients for 5-7 minutes and give a prescription unless it is fully warranted and covered by a reasonable insurance.

3. Doctors should go on strike and tell insurers, politicians, patients, and big pharma to go fuck themselves and let people who get the training to provide the care and aid that they spend 8+ years after college to practice.
If everyone else knows so much better than I do what is the diagnosis, what treatment is needed, and what goals should be pursued, go step into my office and practice my profession for 1 month and get back to me how well you have improved the patients who have come in with legitimate illnesses and problems and have made progress with their issues.

4. Health care is not a right, but it is not a privilege either. Doctors have taken an oath to help those who are truly impaired by illness, and patients should at least listen to the recommmendations for diagnosis and treatment and have responsible and definable alternatives if the recommendations are not acceptable. Government should get the fuck out of the health care industry and focus on motivating prevention and general societal issues, not individual ones.

The doctor who told me the following was a jerk, but his comment was right on the money and is still applicable today as it was back in 1990:

"everyone is a psychiatrist until the shit hits the fan, then everyone ducks and runs and leaves you, the true expert in the matter, to stand there and be hit full force."

Well, I am tired of getting covered with shit by all the idiots who made the poor or bad choices and expect me to bail them out while they sit on their asses and expect to be pulled up and cleaned up. Society made this mess of third world health care environments in this country and everyone is at fault: doctors, patients, insurers, politicians, medical product providers, and anyone else involved in the health care system.

No pain, no gain. For any and all of you who want better health care and be at peace with what you need and want, hold people accountable, and start with yourself.

THERE IS NO SUCH THING AS PROFIT IN HEALTH CARE. AS SOON AS THERE IS A BUCK TO BE MADE ABOVE REASONABLE REIMBURSEMENT, CARING IS LOST!

Don't believe me, look at anyone who is wealthy in the health care system. They do not give a shit about anyone else but themselves. And that has no place in health care.

Just an opinion, but one formed from 23 years of being in the system. Harsh, but my reality. I am not going to write a book, because the point is summed up in a pamphlet.

I tell you what TF, find an agent and a publisher to give me a year to write a book; and take it up a notch and have Philip write it.

Then, we might have a book worth a review. My reality is a harsh one in this system, and so is Philip's. The entire length of time he was struggling on psych meds, my daughter lived her entire life, only to end up with a worse result.

Is this the thread where Fiddy said bravo to the woman who held her middle finger up at Pharma?

I hope so.

Gutless wonders dream of pamphlets.

Philip,

I love your "style" of writing on the Website and I think you have enough knowledge about the subject now that you could write a terrific book, if that is your desire.

I would be the first in line to buy the book and to call the Library System in my city and recommend that they order it.

Just wanted you to know.

TF,

1)Why should society stop looking for that quick fix when psychiatrist's have a pill for every ill? Your profession does absolutely nothing but encourage people to look for medications to fix every problem possible. When your profession doesn't have enough to treat you make up diseases/disorders. You have made this society's problem, not the patient. If the patient knew he couldn't get a prescrition he wouldn't be seeking one, no?

2) Your profession was bought off by big pharma! Managed care had to do something. It is not the patients fault! Why should patients be held accountable for problems your profession caused? It's your profession that claimed they could cure everything that ails a person with a pill, why one earth would managed care not go along with this? Again, not the patients fault! Psychiatry needs to take full responsibility for their problems with managed care! You made Psychiatry biological disorders that required nothing more than a pill in order to give your profession some crediability. Managed Care has taken advantage of this, yes, but Psychiatry allowed it too by claiming you could fix everyone with a pill.

3) Again you blame everyone except Psychiatry for your problems. I personally do not understand why a psychiatrist needs 8+ years of schooling? You do nothing medical once you begin your practice. All you do is write prescriptions. You don't even have people in your offices that draw blood or take BP readings. You expect other medical professionals to take you seriously? No, they just send you patients they would rather not deal with. Anyone can give anyone a diagnosis. Really it's not that hard. You seem to think there is some trick to it. Look at all the psychiatrist on the net diagnosing someone based on something they wrote and never having any face to face interaction.

4)The problem here is Psychiatry isn't helping the "truely impaired". You have allowed yourself to be used by big pharma to peddled their medications. You made it the right of every citizen to get these medications by claiming they are safe and effective. Why shouldn't the government step in now to fix all their citizens?

I know of a lot of patients that have been covered in "shit" by the presciptopaths who thought they could fix life expereinces with a pill. It was these same presciptopaths who never informed their patients they needed to make changes in their lives to fix their problems. No they just keep shitting on the patients for the problems they allowed to happen within their profession. Psychiatrist made their own problems, stop blaming the patients and everyone else and start taking responsibly for letting yourselves become whores to the pharma companies. I will hold no one but Psychiatry responisble. You are the ones that allowed shitty research to run rampant with the flied. You are the ones that sat back and allowed shitty practicing padigrams to shape you profession. Trust me on this one doc! Your not the one being shit on. It's the patients!

Dear TF,
Why the hell shouldn't health care--good health care--be a right in the wealthiest country on earth??? It's a right in almost every third world country I've been in. And don't tell me how terrific US medicine is. The majority of doctor visits are for pretty humdrum things. And as far as waiting lists, there's no bigger waiting list than "no insurance". My friend who's an ICU RN is always telling me how "people with no insurance get care". Yes. In the ICU, where they mostly die. How many could have avoided that fate with proper medical care? She never sees the families whose lives are wrecked as the bloodsuckers in the hospital billing department bankrupts them. She never sees the people BEFORE they become ill enough so they can no longer be ignored, when they are terrified watching their health decline with no access to a doctor.

So, what's up with this statement about health care not being a right? I'm curious about it. If health care isn't a right, who's going to dole it out. Who do you think should decide who's "worthy" of health care???

I've made it a point to take responsibility for my health--lost weight, walk regularly, eat a great diet, wear my seat belt, etc., etc. so don't bother to lecture me about how I've brought this crisis about. (Interestingly, no one in the medical profession has bothered to weigh me in years, nor has anyone asked what I've done to take off over 60 pounds and keep it off for five years. No one ever asked why I gained the weight or displayed any interest in it, either. I don't really care, but do find all that odd.)

What has your profession brought me? Many labels, most of them perjorative. Lots and lots and LOTS of pills. Castigation when I failed to respond "properly" to the pills--which are the ONLY thing any psychiatrist ever offered me. NO information about side effects OR withdrawl--other than the apparently acceptable "dry mouth and slight weight gain". Pressure to get my brains fried. And last, but not least, a spectacular experience of malpractice which caused a mental health worker to get fired--but in which the doctors lied like rugs, tore my family doc to shreds and left me with a nasty false record, all in the service of protecting the prescribing psychiatrist's lily white ass.

I'm with Jane, really. And I have to remind you that it's my EXPERIENCES with your profession that has caused me to feel the way I do. I certainly had no pre-conceived notions initially, other than the usual cultural brainwashing of reverence for anyone in a white coat. YOUR colleagues--and no one else--are the ones who've taught me what you folks are about.

I haven't a scintilla of sympathy for doctors. You talk about the wealthy members of your profession. I'm sure you do not consider yourself wealthy and probably in your world you aren't. I'm also quite sure that many of us here would consider you far, far wealthier than we can ever dream of being. (And yes, I'm also sure you work hard. As do many of us.)

I've worked in hospitals, read many medical records. In fact, for years I was paid to do almost nothing but read medical records. In any place I worked there were always some bad doctors, people you wouldn't want treating your mom or wife or brother. But the medicos did NOTHING whatsoever to clean up their profession's act. They did everything they could to protect their brethren from the consequences of truly horrible malpractice--malpractice that caused agonizing deaths that went on for days in some cases--even if it meant lying and smearing the very people they swore to and are paid to protect from harm.

The day I see doctors willing to put themselves on the line and testify in court to get rid of the few bad apples will be the day I respect your profession. The day I see a doctor do something but push pills--my husband and I ALWAYS have to bring up lifestyle alternatives--is the day I'll get behind your profession. Really. It would be great to be able to trust a medical professional for a change. I do really like my family doc, but it's obvious he has absolutely no power in the medical structure. I was in the room when the psychiatrist ripped this kind, intelligent, caring a new a**hole. All in the service of not admitting he could possibly have made a mistake.

What Jane said.
Sherry

Jane:
what part of "it's just an opinion" did you not get. Also, when did you see me professionally to make these comments about how I run my office, or if you were speaking in the third person, you made the error of including me in this generalization.

Do people who come back in their attack really read the postings? Did I just say patients were at fault? I seem to recall and read I noted others were involved in this failure of care, including doctors, yet the attack is just about the doctor.

I am glad I am going away for a few days and not have to read this rejection crap from people who have never spent one personal moment with me. You want respect and consideration with your replies, as I said above, start with yourself.

the way some people present themselves at this site, it wouldn't surprise me if such individuals would agree if someone suggested psychiatrists should be lined up and shot.

Sort of like Nazi Germany thinking, eh?

By the way, missed your offering of solutions from your point of view in your rebuttal. Oh, I forgot, people don't have mental illness, it's all a scam. That is why I go to school and training for another 8 years, so I can waste my time and money to recoup it later. My suggestion patients reexamine their choices in lifestyle and pursuits is blame? Or maybe a cop-out by those who reject that suggestion.

Everyone is to blame, Jane, you and me too. I didn't take a harsh enough stand to fight insurance and colleagues' poor care interventions. NOT! When you get ostracized from your community for taking a stand and dealing with rigid, inflexible people who masquerade as providers and force you to move away from where you live and had developed a social network, get back to me.

I have validity for what I write. Respect it or ignore it. Don't tell me what I am if you don't know me. That is ignorance to me, and I don't respect it. Sorry there are fuck ups with an MD degree; hold them accountable, as I said above, and get their licenses pulled if they are engaging in malpractice or malfesance. That is what State Medical Boards are supposed to do. Oh, again wait, they don't do their job either. How do I know? 'Cause I made a complaint against a colleague and my state board did nothing. Again, I have practiced what I preach, been burned, but tried it.

Solutions!? Are there any?

Have a nice weekend!

Shoot them!

TF,
You asked Jane:
"Did I just say patients were at fault?"

I remembered reading in your previous posting (emphasis mine):
"I'll tell you mine, in the order of *most* to least importance:
*1.* It's time for this culture, this society, to stop looking for quick fixes and no accountability for poor choices. Practice responsible living by healthy eating, consistent sleep habits, not using addictive substances, staying within the reality of financial abilities, having sympathetic supportive stable relationships, and maintaining reasonable and realistic goals regarding work, intimate relations, and being involved in the community."

It's really hard to read that statement and not take it as patient blaming, especially the "responsible living" part. I'm not sure what you think I personally can do to change this very real trend in our culture--in which you play your part. You seem to want to think you're one of the Good Guys in the White Hats. But you are drinking from a poisoned well and are part of a profession that does not serve people well, that is clearly part of the problem. It's how you make your living, for heaven's sake! I'm sure you work hard, but I'm also sure you're paid very well for it.

As for not knowing you personally, of course we don't. That's not very relevant in online discussions--it's the very nature of the beast. The only means we have of knowing you is by what you yourself say and the manner in which you respond to the statements of others. And that's what people are reacting to. Transference NEVER occurs out of the blue--there is ALWAYS a triggering behaviour on the part of the "transferee", a blindingly simple concept that seems to elude people who earn their living in mental health.

If anything, your constant reminders that you're a Good Guy Psychiatrist would reasonably lead me to believe that you would be/should be strong enough, compassionate enough to respond in a kind, compassionate manner to criticism.

But you don't. You become defensive, whine to Philip about how he should moderate his blog better to protect you from the Evil Patients who hang out here, whine about how long your training was and generally seem to think the place should revolve around you--because, after all, you're a Good Guy Psychiatrist, right? You're just not getting the reception and respect you expected.

It's all pretty interesting, really.

Have a great day.
Sherry

I've worked with bitter teachers who just need to retire or change careers. Just a thought, it could apply to doctors, psychiatrists, etc. It's just not healthy to remain in a field for a living harboring hostility, and burn out and in the end quality of care.

I speak from personal viewpoint here: my job is intense, and I am burned out. Not good for me or anyone else if I'm not there 100%.

Mental health field is hardcore, full of defunct and awful treatment models, then goes the entire system details, hell, if I was TF (and I am not, nor do I know him)I'd quit and do something else.

TF probably remembers me saying months ago on Carlat's blog he needed to take time off.....from work, period.

Just my .02, sorry if this reads as an insult to TF...just saying

this is my sign off to those of you who, through your writings, have nothing but contempt and disdain for anything written by a psychiatrist:

from Bladerunner (as I like movie quotes)
the candle that burns brightest burns fastest, and oh how bright you have been.

Rage is a bright flame, and it burns you out. Hereon my comments are strictly intended for Philip and put in the commentary section for anyone who has an interest in a psychiatric perspective to one of his postings. If one has a rebuttal, then what is said will be printed. Somewhat related to Stephany's above comment, I have enough patients I work with in person to try to help and encourage, so I'll stick with them. I like this site as Philip encourages dialogue on legit issues; in my opinion it is a shame it seems to drive less than legit rebuttals at times, but opinion is personal and hopefully based on facts that are respected in the end.

I sincerely hope your lives are filled with faith and hope, and you are surrounded by others who practice sympathy, support, and stability. Because in the end, hopefully it will be brought out in you.

Have a nice weekend.

TF, Surely you realize that Philip lists his email address here so if you really intend your comments only for him, you could email him directly as spare the rest of us your tragic, passive aggressive insults.