Docsplainin' -- it's what I do

Docsplainin'--it's what I do.
After all, I'm a doc, aren't I?

Thursday, August 20, 2009

GlaxoSmithKline used ghostwriting to promote Paxil - The Boston Globe

Just a quick note, as, if I had any sense at all, I should already be in the car on the way to the office, not sitting here in my jammies blogging.

In a new article in the on-line version of the paper today, The Boston Globe adds GSK to the list of pharma con artists.

GlaxoSmithKline used ghostwriting to promote Paxil - The Boston Globe

The fact that five ghost-written articles were placed in at least two prestigious professional medical journals is significant. When you perform a literature search on a medication, you would typically get a handful of review articles. If five out of that handful are bogus, that is going to significantly slant your view of the medication. Add to that the fact that most physicians do not do lit searches but rely on articles handed to them by the reps, and you have trouble.

In and of itself this is no indictment of the drug. But it does mean that your physician may not have had all the facts when she prescribed this medication for you.

Posted using ShareThis

Tuesday, August 18, 2009

soulful sepulcher: honesty on the rocks and make it a double

soulful sepulcher: honesty on the rocks and make it a double is another great post, and right on target.

Drug reps are so ubiquitous, I always assume a doc is influenced by them. I was impressed that Stephany's doc banned them. Good for him!

It never occurred to me to ask my doc if he has ever accepted trips or speaker fees, or ghost-written an article: I thought that was stuff reserved for the big names at the universities. Apparently I have been naïve. I intend to start asking, every time I'm handed a 'scrip.

The Carlat Psychiatry Blog: Eli Lilly Posts its Grand Deception

The Carlat Psychiatry Blog: Eli Lilly Posts its Grand Deception

Funny, a client and I were just discussing pharmaceutical marketing this morning.

This one's for you, T.!

The most important part of Dr. Carlat's post is the line about medical "educators" having to use the slides the pharmaceutical company provides. Real teachers don't do that, folks.

Saturday, August 1, 2009

With friends like this. . .

. . . who needs enemies?

There I was, minding my own business, when an old friend from my high school and college days just up and slapped me in the face.

Some people read the daily news over their morning coffee. I log on to see what's happening in the world. And this morning, when I logged in to FaceBook, there it was: I almost blew my breakfast. My entire laptop screen, it seemed, filled with some of the ugliest hate speech I've seen since--well, come to think of it, since I read that cop's e-mail the day before yesterday. But that's another story for another day.

There's a poll on facebook asking whether people think gays should be able to adopt. As I said in my comment when I voted, these surveys are ridiculously unscientific, but at least some of them get people talking. The talk swirling around this one, however, is frighteningly ugly. Here's what my erstwhile friend had to say:

If queers want children, they should not be queers. Keep hoping natural selection would weed them out eventually.

That's just so hateful, and such a shock hearing it come out of his mouth, I don't even know where to start with him. I suppose I could start with the assumption we're all straight and will agree with him (or at least not be hurt or offended), or that people choose to be gay, but I've had that argument so many times that, frankly, the prospect exhausts me. Or I could start with the evolutionary angle, but, again, I have had that argument so many times that, frankly, the prospect exhausts me.

The subject of hate in general, and homophobia in particular,
is easier to handle from an objective psychological-science-y standpoint than it is when I'm suddenly feeling viciously othered, in a very personally threatening way, in a space that no longer feels safe, and by someone I once loved and trusted.

So if you will kindly indulge me, I'm gonna go all clinical on y'all for a bit.

Search "homophobia" on PsycNET and you get a whopping 1,878 returns. Here's the Cliff's Notes version, along with some personal experience and clinical wisdom.

Psychodynamic theory originally posited that people who loudly proclaim that 'gay is awful' are actually gay themselves and just don't know it. Research results are mixed on that one. What does clearly seem to be going on is that people who express prejudicial attitudes have (a) defined the minority target as 'bad' and (b) are shoring up their own identity as 'not bad', distancing themselves through expressions of hate. So while homophobia may not be related to one's own sexual preferences, conscious or otherwise, the expression of homophobia may occur precisely as one's identity has been threatened--for whatever reason.

In plain English, the secure are not prejudiced: Expressed prejudice is a sign of insecurity according to this theory. If this is true, then when prejudicial statements are made in the context of a therapy session, the therapist need not address the prejudice at all, but may choose instead to hone in on the feeling behind it. Resolve that, and the prejudice should follow. Education won't work, if this theory is correct, because the person whose identity as 'good' is threatened needs some action (expressed attitude) to shore it up. If lesbian/gay people become 'not bad' through education and the dissolution of stereotypes, some other target will have to take its place.

Homophobia has also been associated with hypermasculinity: Together, these two theories might explain the otherwise puzzling behavior on my friend's part. You see, we both have disabilities. We both have experienced ableism. Wouldn't you think that we would be especially sensitive toward other minorities? But society almost ungenders the disabled, we are so perceived as 'not sexy'. Perhaps my friend is dealing with an internalized sense of self
as 'less of a man', triggered recently by some bit of ableist aggression directed at him, by being 'not gay'.

Homophobia specifically by men against men has been related to a specific type of identity disturbance whereby feminine aspects of the self are disavowed (split off). Of course, this only works if you stereotype (gay=fey) and only works for hatred of gay men. It is also at present theoretical, not empirical.

Homophobia has been associated with a general lack of empathy (difficulties in perspective-taking), low Openness to Experience in trait theory, and with (in)tolerance for ambiguity. Contrary to many homophobes' claims to moral superiority, there actually may be a negative correlation between moral development and homophobia. From a psychodynamic perspective, homophobia has been found to correlate with the defenses of denial and isolation.

One thing researchers have learned is that
right-wing authoritarianism and traditional gender role attitudes are associated with homophobia. And we know that right-wing authoritarianism is a personality trait before it is a political identity. Studies also support the idea that the various "isms"--racism, sexism, etc.--are related. If my friend hates gays, he may well also hate me as a woman, doubly hate me as one who eschews traditional roles, and Maud knows how he feels about my politics: Radical feminists are, after all, nothing if not anti-authoritarian.

Or maybe he's never noticed. Maybe, as a female, I'm invisible to him. Either way, we apparently have some talking to do. The prospect overwhelms me though, so I'm going to take refuge again, with your indulgence, in a little more science.

There is some evidence that education can reduce prejudice, but insofar as it works at all, it seems to have more impact on women. My personal experience has been that you can talk to prejudiced people until you turn blue in the face and it will not put a dent in their attitudes. Perhaps that's because it's inborn: One enterprising research team did a humonguous twin study which seemed to demonstrate that, via assortative mating, homophobia (or lack thereof) is transmitted genetically. Interestingly, they found support for the common observation that males are more likely to be homophobic than females.

Perhaps I am naïve; any road, this kind of thing challenges my assumptions about the world's benevolence. My review of the research literature on homophobia did not help. While I have happily maintained the fantasy of late that things are getting better, I found that in reality they are not. There are a number of recent studies on, for example, nurses that show that health providers in mind-boggling numbers would refuse to treat gay patients if they could. Other recent studies show the effects of homophobia in academe and the halls of justice. And therapists are not immune: Studies show that large numbers of therapists discriminate. I have personally known therapists who treat lesbians and gays while making extra-session statements to the effect that same-gender sex is "gross".

A couple of interesting sources I found via PsycNET:

By Aosved, Allison C.; Long, Patricia J.
Sex Roles. Vol 55(7-8), Oct 2006, 481-492.

By Barrett, Kimberly Ann
Dissertation Abstracts International Section A: Humanities and Social Sciences. 57(6-A), Dec 1996, pp. 2331.

By Debiak, Dennis Michael
Dissertation Abstracts International: Section B: The Sciences and Engineering. 56(4-B), Oct 1995, pp. 2320.

By Finken, Laura L.
Journal of Psychology & Human Sexuality. Vol 14(1), 2002, 37-46.

By Moradi, Bonnie; van den Berg, Jacob J.; Epting, Franz R.
Journal of Counseling Psychology. Vol 53(1), Jan 2006, 57-66.

By Verweij, Karin J. H.; Shekar, Sri N.; Zietsch, Brendan P.; Eaves, Lindon J.; Bailey, Michael; Boomsma, Dorret I.; Martin, Nicholas G.
Behavior Genetics. Vol 38(3), 2008, 257-265.

By Wood, Peter B.; Bartkowski, John P.
Social Science Quarterly. Vol 85(1), Mar 2004, 58-74.

I am not entirely sure that these links will work if you don't have a subscription to PsycNET: If it turns out that they don't, please consider this my advance apology. College students and faculty can access them free through Galileo; others may be able to find some available open-source.