Sunday, June 28, 2009

UD destroys Schulz article

Immediately after getting up my own little post about a rather pompous article by Dr. Shulz - in which I noted the straw man nature of his argument - Margaret Soltan destroyed the article with one of her patented SOS [Scathing Online Schoolmarm] do-overs:

SOS offers a perfect example of the straw man argument.

Straw man plus just the sort of bland vapid reassurance you’d expect from a certain sort of doctor. This is ultimately arrogant writing that thinks you’re stupid. Don’t be taken in by it.

It’s written by the chair of the University of Minnesota psychiatry department, a locus of conflict of interest.

Let’s take a look.

Much has been written over the past few years about the relationship between doctors and the pharmaceutical industry. So I would like to disclose the following right now: I have worked with multiple companies over the years on sponsored research and as a consultant, and I continue to do so. During this time I have published a number of papers regarding this work — including some pertinent negative results concerning the drugs these companies make. [Dull but okay writing. He needs to provide at least one link to a study he's been involved in, funded by a pertinent drug company, that arrived at seriously negative results. This is the first instance of bland reassurance in an opinion piece rife with it.]

A recent Pioneer Press report noted I have received less money from industry in the last year. Why? Because nothing is more important to me than the reputation of the Department of Psychiatry at the University of Minnesota Medical School, and I am concerned that the media portrayal of all physician-industry relationships as bad could affect public perception. [This is just weird. Wacky. Where's the logic? We need hard numbers first of all -- the sort of thing notoriously missing from conflict of interest forms psychiatry professors give their universities -- if, of course, they give their universities the forms at all. Quite a number of them don't seem to bother with the paperwork. Many of those who do fudge the numbers like hell. This writer needs to talk to us about that... But as to the logic: Why should his caring so much about his school's rep mean he's received less money? And I mean -- we need to know if it's five or five thousand or five hundred thousand less, don't we? And here comes the straw man: Absolutely no one believes, argues, or writes that all of these relationships are bad. Set up a straw man and knock him down. How powerful.]

What the media stories do not mention are the advances that have been made because of these relationships, which are managed carefully by institutions such as the University of Minnesota, where the Institutional Review Board approves all studies for human subjects and the Sponsored Projects Administration negotiates all contracts with industry. [He thinks you're stupid, doesn't he? Doesn't he know that you know that things aren't managed carefully at all? That this is an ongoing national scandal? You know what he's doing? He's saying There there little woman. There there little man. It's all fine. You don't need to understand -- you don't have the capacity to understand -- the details and complexities here. Trust me.]

Physician-researchers need to partner with industry to develop new treatments. It is the system we have in place. The National Institutes of Mental Health do not fund development of new compounds in psychiatry; their focus is on funding basic science and mechanisms of action after approval. [Sure. True. No one has a problem with this. Get to the point.]

When it comes to clinical research to improve and develop medicines and bring them to market, it is industry that funds that work. And the research to develop new drugs is very expensive, costing $800 million and even up to $1 billion to get a drug discovered and available for patients. [How much improved are the improved meds you're talking about? Isn't one of the big points here that professors with financial interests in new, more expensive, but by no means better pills, are pushing those, thereby contributing to the health costs crisis? When do you plan to say something about this?]

When I consider the field of psychiatry, the advances made because of new medicines — studied in research institutions and developed by pharmaceutical companies — have been enormous and life-changing. Before we had effective medications, one out of two hospital beds was taken by a mentally ill patient. We no longer warehouse psychotic patients and drug them with opiates to “manage” them. Now, we have better ways. Better medications. [Who says? Do you think I'm dumb? Do you think I'm not aware of studies showing that many, many psychiatric meds are no more effective than placebos?]

Because of the partnerships between physicians and industry and the medications that have resulted from these relationships, many psychiatric patients were able to leave institutions. Now, because of the advances in psychiatric medicine, patients in our department — who are mothers, fathers, sons, daughters and friends — can be treated as outpatients. Many have jobs, support families and contribute to society. [Bland, bland, prose to match Dr. Pangloss's happyface. At this point in reading, you should be telling this writer to eat shit.]

Are the psychiatric drugs we have now perfect? No. All drugs have side effects, and the drugs I prescribe my patients are no different. [Why don't you talk not merely about side effects but effectiveness? Relative effectiveness of new, expensive and old, inexpensive? Why don't you talk about all the people who shouldn't be taking these strong-side-effect, expensive drugs in the first place? About the fact that the pills are being over-prescribed unconscionably by you and your colleagues? Where is all that?] The leading edge of our research now focuses on predicting which medications, which compounds, will be effective for our patients. The goal remains to help people live independently, or with the fewest restraints on their freedom. In our department, we develop programs that integrate efficacious medications with effective psychosocial treatments. [Gag me. You're letting Mister Doctor use pompous big words -- efficacious?? -- and how's that different from effective?? Oh. It ain't -- you're letting him do that in order to make you think he's a big ol' authority and all that you shouldn't question. Tell him one more time to eat shit.] There are always new discoveries to be made, and it is truly unfortunate that the public is hearing only one side of the story from the media.

Do physician-industry relationships need to be managed? Absolutely. Has the increased scrutiny in the past couple of years resulted in constructive changes? Yes. But the answer is not to break these ties completely. My patients of the future are counting on them. [Pompous, self-righteous, self-serving. Why did the paper publish it? Because of who the writer is. But the writer is lazy and cynical and he thinks you're stupid.]

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