For the most part, psychiatric hospitals, institutions that house people for their lifetimes, are things of the past. In Oregon most hospitals are shutting down their inpatient wards. At OHSU we only have 10 inpatient beds for psychiatric patients. This in a hospital of 550+ beds.
One reason: they lose money. Another reason: there's no need for them. It's better for people to stay in the community, even the chronically mentally ill.
Across the country this is true; in upstate New York one mental institution was closed completely in 1995. When they went to clean out the building they found a stack of suitcases in the attic of the main building. These suitcases were the possessions of the inmates, brought with them when they checked into the hospital. A few curious people decided to sort through these things with great care and ended up writing a book about what they found. It is a bittersweet story. There's a display at the New York Public Library, chronicling the lives of some of the inmates. Many of them appear to be immigrants who had some horrible temporary circumstance in their lives, which led to incarceration. Over half of those committed to these institutions spent their entire lives there, and ultimately died there.
Oregon still has two state mental hospitals up and running. One is in Pendleton. The other in Salem. The hospital in Salem is in deplorable physical condition, and is being replaced by a new hospital. Where? Junction City. Stay tuned....I will know more about this when I start my job....
Showing posts with label psychiatry. Show all posts
Showing posts with label psychiatry. Show all posts
Monday, December 31, 2007
Monday, July 23, 2007
Ethical Dilemmas in Health Care: the special case of psychiatrists
The health care business in this country is full of conflicts of interest and insider dealing. It's rife with ethical dilemmas, however most healthcare professionals act as if they couldn't find an ethical dilemma if their lives depended on it.
Consider today's press release by the American Psychiatric Association. They have formed a national committee of experts to go through the DSM, the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). This manual is used by everyone in the mental health profession to diagnose a mental disorder and encourages best practices for treating diagnoses. Certain diagnoses encourage prescribing of certain very expensive medications. So there's lots of incentives for drug companies to influence psychiatrists and their diagnoses. So who would you want inventing the diagnoses? Somebody who isn't conflicted, correct?
According to their press release: "Of the 27 task force members, eight had no relationship with industry and 19 disclosed relationships with industry during any of the 36 months leading up to their nominations. The APA made all task force members' disclosures available during the announcement of the task force. Several otherwise highly qualified indivduals were ruled ineligible fortask force appointments due to their competing interests."The press release goes on to say "The APA Board of Trustees established limits on relationship with industry that are more stringent than federal agency limits," said APA President Carolyn Robinowitz, M.D."What makes the DSM powerful is its value in clinical practice. Patients deserve a diagnostic manual based upon the latest science and free of conflicts of interest."
So I took a look at the disclosures made by the committee members to see what they must attest to before becoming a committee member. They must disclose the last 36 months of connections to the pharmaceutical industry, and they must limit their income from the industry (excluding unrestricted grants) to $10,000 per year for the next year.
70% of these committee members are ONLY taking $10,000 a year from industry while they work on reworking the DSM-V. When I look at what they're getting from industry, it's really astounding to me. It includes things like: consulting fees, speakers bureau, honoraria, stock options, royalties and much much more. It makes me ask: who did they NOT accept on their committee?
One of the grantees for the AG program, Elissa Ladd (who signed a conflict of interest form which says that she has not taken - in the last two years - and will not accept for the duration of the grant any of this kind of funding from industry) has put together curricula in a movie format that you can watch to tell you why these kinds of conflicts are not good for consumers. Watch it, and weep for the psychiatrists. They evidently have no clue what a conflict of interest is and why people shouldn't trust them. For any reason, let alone medical reasons.
Consider today's press release by the American Psychiatric Association. They have formed a national committee of experts to go through the DSM, the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). This manual is used by everyone in the mental health profession to diagnose a mental disorder and encourages best practices for treating diagnoses. Certain diagnoses encourage prescribing of certain very expensive medications. So there's lots of incentives for drug companies to influence psychiatrists and their diagnoses. So who would you want inventing the diagnoses? Somebody who isn't conflicted, correct?
According to their press release: "Of the 27 task force members, eight had no relationship with industry and 19 disclosed relationships with industry during any of the 36 months leading up to their nominations. The APA made all task force members' disclosures available during the announcement of the task force. Several otherwise highly qualified indivduals were ruled ineligible fortask force appointments due to their competing interests."The press release goes on to say "The APA Board of Trustees established limits on relationship with industry that are more stringent than federal agency limits," said APA President Carolyn Robinowitz, M.D."What makes the DSM powerful is its value in clinical practice. Patients deserve a diagnostic manual based upon the latest science and free of conflicts of interest."
So I took a look at the disclosures made by the committee members to see what they must attest to before becoming a committee member. They must disclose the last 36 months of connections to the pharmaceutical industry, and they must limit their income from the industry (excluding unrestricted grants) to $10,000 per year for the next year.
70% of these committee members are ONLY taking $10,000 a year from industry while they work on reworking the DSM-V. When I look at what they're getting from industry, it's really astounding to me. It includes things like: consulting fees, speakers bureau, honoraria, stock options, royalties and much much more. It makes me ask: who did they NOT accept on their committee?
One of the grantees for the AG program, Elissa Ladd (who signed a conflict of interest form which says that she has not taken - in the last two years - and will not accept for the duration of the grant any of this kind of funding from industry) has put together curricula in a movie format that you can watch to tell you why these kinds of conflicts are not good for consumers. Watch it, and weep for the psychiatrists. They evidently have no clue what a conflict of interest is and why people shouldn't trust them. For any reason, let alone medical reasons.
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