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I believe it's the stranglehold of the pharmaceutical industry on psychology that prevents research like this from going forward. Instances like Isak's ordeal w

I believe it's the stranglehold of the pharmaceutical industry on psychology that prevents research like this from going forward. Instances like Isak's ordeal with PANDAS and Susannah Cahalan's battle with anti-NMDA receptor encephalitis show that more research should go into how infections and autoimmune response can cause some forms of mental illness. I was particuarly appalled when I read that doctors gave Isak anti-depressants to treat his mental illness. These are the medicines the pharmaceutical industry have been pushing on us for decades to treat any malady of the mind, and they have been proven to be barely more effective than placebo treatments. Their first priority is pushing pills, not our well-being.

task_queue 12y ago
> These are the medicines the pharmaceutical industry have been pushing on us for decades to treat any malady of the mind, and they have been proven to be barely more effective than placebo treatments. Weird, the studies where they're given to sufferers of severe depression and anxiety say otherwise.
- untothebreach 12y ago
  Sure, for severe cases studies have shown that depression medication helps, but that is not what the parent said: ...to treat any malady of the mind, and they have been proven to be barely more effective than placebo treatments Which is also shown by studies[1][2] 1: http://www.ncbi.nlm.nih.gov/pubmed/7945737 http://www.ncbi.nlm.nih.gov/pubmed/7945737 2: http://www.ncbi.nlm.nih.gov/pubmed/18303940 http://www.ncbi.nlm.nih.gov/pubmed/18303940
  - task_queue 11y ago
    That is true, but "any malady of the mind" is a blanket statement encompassing severe depression. It gives the impression that the medications are not significantly better than placebo for any mental illness, when in fact they are significantly effective for certain mental illnesses.
epistasis 12y ago
From the article: >They didn’t give it much thought. Periodic strep tests on Isak had always come back negative. And his symptoms seemed too dramatic to be the result of a simple, common childhood infection. I don't think there's any institutional stranglehold stopping research in this direction, just standard human reasoning. As a scientist, there are enticing hypotheses to follow that pop up every single day, and it's hard to judge what should get the investment of time and money. >Their first priority is pushing pills, not our well-being. These were doctors prescribing these, not the pharmaceutical industry, and I believe that the doctors were trying, something, anything, that they believed might work. What's more risky, using a drug that's been proven to help adults (barely better than placebo or not), or going after an as-yet-untested hypothesis about streptococci, that doesn't fit our current understanding of the problems? There are certainly issues where pharmaceutical interests are not aligned with our health and well being, but I don't really see this child's unfortunate trajectory as part of that. The failure rests more on the science just not being there, and us not having a great understanding of the mind.
- jedrek 12y ago
  It really bugs me when people talk about Big Pharma pushing pills, cause really, 8-9 times out of 10, it's patients begging for pills. Are pharmaceutical companies angels? Fuck no, neither are doctors, but if nobody was buying, they wouldn't be selling. There's a great post on reddit from a doctor who wrote about a typical patient-doctor interaction (which I'm too lazy to find right now): Patient comes in with elevated blood pressure, about 30 lb overweight, sedentary lifestyle. Doctors talks about blood pressure, possible future issues with it, recommends patient start getting some exercise, portion control, lose some weight, maybe a dietary consult. Patient comes in a month or three later for a follow up visit. No weight loss, no drop in blood pressure. Doctor writes a script. Hell, when I was checking out doctor review sites for a podiatrist, one of the negative opinions he had said, "He didn't even prescribe me anything!
  - e40 12y ago
    It really bugs me when people talk about Big Pharma pushing pills, cause really, 8-9 times out of 10, it's patients begging for pills. Are pharmaceutical companies angels? Fuck no, neither are doctors, but if nobody was buying, they wouldn't be selling. In this trio, I blame the doctors far more than anyone. Patients have no clue, they just want to be cured. It's the responsibility of the doctors to only prescribe what is necessary. Every time I hear my father say he got antibiotics for his cold I cringe, and wonder WTF the Dr. he saw was thinking. I think the count is up to a dozen times he's received them in the last 10 years.
deleted 12y ago
[deleted]
genericuser 12y ago
They tried anti-depressants after 2 years of his condition persisting. Trying a single anti-depression med is a perfectly reasonable attempt at treating the issue if the information the doctors have lines up with depression. Even when the medication does not work it usually provides them with more information so the solutions they try get closer to something which will work hopefully. The entire field of medicine is heuristic, basically making educated guesses as to what the collections of symptoms indicate. You try something see if it works, if it doesn't try something else based on the information available. When your patient is a young child, you have different problems gathering that information than with an adult, kids may not notice or know how to describe something that is wrong, and adults will often omit things they consider embarrassing. As someone who has had anxiety and depression for the 12 years since I graduated high school, the doctors I have met have been nothing like the notion of doctors you have, and while I am sure there are doctors whose first priority is pushing pills characterizing doctors in general as such I do not believe to be accurate. I've seen physicians and psychiatrists both of which tried to gather as much information as they could asking questions and running tests before recommending any treatment or even really suggesting what was wrong with me. They would often recommend things like more exercise, less time in front of computers and sitting, and finding hobbies after all tests came back showing nothing abnormal with my body. Both seemed to agree it was probably not a physical malady with physicians eventually recommending psychiatrists and psychiatrists recommending psychologists. Every time after a couple months of therapy not working they would try another; they were very hesitant to recommend medication. When they did they would have me check in weekly to give them updates, always switching me off of it if I indicated any side effects or just that things hadn't gotten better after a period of time in which it should. Eventually I would give up and stop trying new treatments even though they indicated they had not exhausted all options. After a few years I would try again. Only recently, after starting up this chain of diagnoses again about 8 months ago, did I find relief. The psychiatrist tried yet another therapy and two medications, which I had not been on before but were similar to the ones which had more positive effects previously. Both wound up having the same negative side effects. He then reluctantly tried a third, which was in a completely different class of meds, saying he tries his best not to prescribe it due to it having nasty withdrawal. Low and behold, 2 weeks in for the first time in 12 years I was feeling like I remember normal being on month 4 now and still feel great. Different things work for different people because depression and many other things in the medical world are effectively a name for a collection of symptoms and not a specific malady. The doctors I have seen seem to recognize that and respect that, and generally seem to prefer non-medication based treatments when they have hope it would work.
marincounty 11y ago
"and they have been proven to be barely more effective than placebo treatments." I think barely is giving them too much credit. And the barely better than placebo was only for the worst cases of only clinical depression, and even the worst naysayers can't seem to say the truth--they just don't work; probably out of compassion? I can say this (feeling terrible)will get better with time. (Psychiatrists and psychotropic drug companies really did a number on their patients and consumers over the last few decades?)
petegrif 12y ago
I don't think it's that simple. Bear in mind that whilst one may say that the US healthcare system, including a good deal of research, is corrupted by financial interests, that is not true either (a) universally in the US - there is still government funded research, or (b) overseas, where the norm in most industrialized societies is socialized medicine, with a lot of medical research being publicly funded without the ability to sell a profitable remedy being the prime motivator.
- Lawtonfogle 12y ago
  Even government funded research becomes corrupted. Special interest groups, inconvenient results giving lesser weight, laws and policy limiting what can be studied, manipulation of results to portray a pre-determined narrative. My goto example is the NISVS 2010 where a man being forced to have sex but not being forcefully penetrate was defined to not be rape but only sexual assault, and then the summary section showing how few men were raped (while leaving the particular definition of rape buried in the details). This same corruption is all the harder to see as you deal with studies moving towards biology and neurology as the base level of knowledge needed to understand a given paper to the same degree increases (per my own experiences and those of others I've talked to).
pinaceae 12y ago
bullshit. the big bad pharmaceutical industry is full of biotech startups that all race to find something new. it is not a monolithic cabal of lizard people. like this: http://www.npr.org/blogs/health/2013/12/24/256839330/orenitram-united-therapeutics-names-pill-after-ceo-who-sought-daughters-cure http://www.npr.org/blogs/health/2013/12/24/256839330/orenitr... the pharma industry cares more about the well-being of its customers than most of the companies HN usually covers. now go back to coding your mobile/social/dating app that actually cares about the well being of anyone. opposition to pharma, opposition to vaccines, opposition to science.
- pjonesdotca 11y ago
  This tho: Orenitram won't be available for sale for about six months, the company said, and its exact price hasn't been determined either. But it will be very expensive, about $150,000 a year, according to an estimate by Dr. Mark Schoenebaum, an industry analyst with ISI. $150k/yr? Is that really necessary?
  - snikeris 11y ago
    Yes. The R/D is expensive and there are many more failed drugs than those that make it to market.
  - pinaceae 11y ago
    yes, it needs to cover the cost in development and getting it through approval. however, this also establishes a market - a competitor will now either come with something cheaper or something better (for the same or higher price). same thing is happening with Hep-C, which is now curable (boo, bad pharma). initial drug was/is super expensive, record profits for the company. every single contender is driving the price down. and there contenders as the market has been proven. this is the capitalist system at work, in full glory. even with patents in play. amazing shit right there.
snowwrestler 11y ago
> I believe it's the stranglehold of the pharmaceutical industry on psychology... This might be pedantic, but psychology is study and treatment of the mind that does not involve drugs. Study and treatment of the mind that involves drugs is called psychiatry.
tim333 11y ago
>stranglehold of the pharmaceutical industry on psychology that prevents research I think that may be a bit backwards. Evidently research like this is going forward and looking at the references it mostly seems to be in the US, with one researcher in the UK, countries with big and medium sized pharma. It would seem more the case that research like this does not happen much in countries without large pharmaceutical industries, presumably because the money is not there.

task_queue 12y ago

> These are the medicines the pharmaceutical industry have been pushing on us for decades to treat any malady of the mind, and they have been proven to be barely more effective than placebo treatments. Weird, the studies where they're given to sufferers of severe depression and anxiety say otherwise.

untothebreach 12y ago
Sure, for severe cases studies have shown that depression medication helps, but that is not what the parent said: ...to treat any malady of the mind, and they have been proven to be barely more effective than placebo treatments Which is also shown by studies[1][2] 1: http://www.ncbi.nlm.nih.gov/pubmed/7945737 http://www.ncbi.nlm.nih.gov/pubmed/7945737 2: http://www.ncbi.nlm.nih.gov/pubmed/18303940 http://www.ncbi.nlm.nih.gov/pubmed/18303940
- task_queue 11y ago
  That is true, but "any malady of the mind" is a blanket statement encompassing severe depression. It gives the impression that the medications are not significantly better than placebo for any mental illness, when in fact they are significantly effective for certain mental illnesses.

epistasis 12y ago

From the article: >They didn’t give it much thought. Periodic strep tests on Isak had always come back negative. And his symptoms seemed too dramatic to be the result of a simple, common childhood infection. I don't think there's any institutional stranglehold stopping research in this direction, just standard human reasoning. As a scientist, there are enticing hypotheses to follow that pop up every single day, and it's hard to judge what should get the investment of time and money. >Their first priority is pushing pills, not our well-being. These were doctors prescribing these, not the pharmaceutical industry, and I believe that the doctors were trying, something, anything, that they believed might work. What's more risky, using a drug that's been proven to help adults (barely better than placebo or not), or going after an as-yet-untested hypothesis about streptococci, that doesn't fit our current understanding of the problems? There are certainly issues where pharmaceutical interests are not aligned with our health and well being, but I don't really see this child's unfortunate trajectory as part of that. The failure rests more on the science just not being there, and us not having a great understanding of the mind.

jedrek 12y ago
It really bugs me when people talk about Big Pharma pushing pills, cause really, 8-9 times out of 10, it's patients begging for pills. Are pharmaceutical companies angels? Fuck no, neither are doctors, but if nobody was buying, they wouldn't be selling. There's a great post on reddit from a doctor who wrote about a typical patient-doctor interaction (which I'm too lazy to find right now): Patient comes in with elevated blood pressure, about 30 lb overweight, sedentary lifestyle. Doctors talks about blood pressure, possible future issues with it, recommends patient start getting some exercise, portion control, lose some weight, maybe a dietary consult. Patient comes in a month or three later for a follow up visit. No weight loss, no drop in blood pressure. Doctor writes a script. Hell, when I was checking out doctor review sites for a podiatrist, one of the negative opinions he had said, "He didn't even prescribe me anything!
- e40 12y ago
  It really bugs me when people talk about Big Pharma pushing pills, cause really, 8-9 times out of 10, it's patients begging for pills. Are pharmaceutical companies angels? Fuck no, neither are doctors, but if nobody was buying, they wouldn't be selling. In this trio, I blame the doctors far more than anyone. Patients have no clue, they just want to be cured. It's the responsibility of the doctors to only prescribe what is necessary. Every time I hear my father say he got antibiotics for his cold I cringe, and wonder WTF the Dr. he saw was thinking. I think the count is up to a dozen times he's received them in the last 10 years.

deleted 12y ago

[deleted]

genericuser 12y ago

They tried anti-depressants after 2 years of his condition persisting. Trying a single anti-depression med is a perfectly reasonable attempt at treating the issue if the information the doctors have lines up with depression. Even when the medication does not work it usually provides them with more information so the solutions they try get closer to something which will work hopefully. The entire field of medicine is heuristic, basically making educated guesses as to what the collections of symptoms indicate. You try something see if it works, if it doesn't try something else based on the information available. When your patient is a young child, you have different problems gathering that information than with an adult, kids may not notice or know how to describe something that is wrong, and adults will often omit things they consider embarrassing. As someone who has had anxiety and depression for the 12 years since I graduated high school, the doctors I have met have been nothing like the notion of doctors you have, and while I am sure there are doctors whose first priority is pushing pills characterizing doctors in general as such I do not believe to be accurate. I've seen physicians and psychiatrists both of which tried to gather as much information as they could asking questions and running tests before recommending any treatment or even really suggesting what was wrong with me. They would often recommend things like more exercise, less time in front of computers and sitting, and finding hobbies after all tests came back showing nothing abnormal with my body. Both seemed to agree it was probably not a physical malady with physicians eventually recommending psychiatrists and psychiatrists recommending psychologists. Every time after a couple months of therapy not working they would try another; they were very hesitant to recommend medication. When they did they would have me check in weekly to give them updates, always switching me off of it if I indicated any side effects or just that things hadn't gotten better after a period of time in which it should. Eventually I would give up and stop trying new treatments even though they indicated they had not exhausted all options. After a few years I would try again. Only recently, after starting up this chain of diagnoses again about 8 months ago, did I find relief. The psychiatrist tried yet another therapy and two medications, which I had not been on before but were similar to the ones which had more positive effects previously. Both wound up having the same negative side effects. He then reluctantly tried a third, which was in a completely different class of meds, saying he tries his best not to prescribe it due to it having nasty withdrawal. Low and behold, 2 weeks in for the first time in 12 years I was feeling like I remember normal being on month 4 now and still feel great. Different things work for different people because depression and many other things in the medical world are effectively a name for a collection of symptoms and not a specific malady. The doctors I have seen seem to recognize that and respect that, and generally seem to prefer non-medication based treatments when they have hope it would work.

marincounty 11y ago

"and they have been proven to be barely more effective than placebo treatments." I think barely is giving them too much credit. And the barely better than placebo was only for the worst cases of only clinical depression, and even the worst naysayers can't seem to say the truth--they just don't work; probably out of compassion? I can say this (feeling terrible)will get better with time. (Psychiatrists and psychotropic drug companies really did a number on their patients and consumers over the last few decades?)

petegrif 12y ago

I don't think it's that simple. Bear in mind that whilst one may say that the US healthcare system, including a good deal of research, is corrupted by financial interests, that is not true either (a) universally in the US - there is still government funded research, or (b) overseas, where the norm in most industrialized societies is socialized medicine, with a lot of medical research being publicly funded without the ability to sell a profitable remedy being the prime motivator.

Lawtonfogle 12y ago
Even government funded research becomes corrupted. Special interest groups, inconvenient results giving lesser weight, laws and policy limiting what can be studied, manipulation of results to portray a pre-determined narrative. My goto example is the NISVS 2010 where a man being forced to have sex but not being forcefully penetrate was defined to not be rape but only sexual assault, and then the summary section showing how few men were raped (while leaving the particular definition of rape buried in the details). This same corruption is all the harder to see as you deal with studies moving towards biology and neurology as the base level of knowledge needed to understand a given paper to the same degree increases (per my own experiences and those of others I've talked to).

pinaceae 12y ago

bullshit. the big bad pharmaceutical industry is full of biotech startups that all race to find something new. it is not a monolithic cabal of lizard people. like this: http://www.npr.org/blogs/health/2013/12/24/256839330/orenitram-united-therapeutics-names-pill-after-ceo-who-sought-daughters-cure http://www.npr.org/blogs/health/2013/12/24/256839330/orenitr... the pharma industry cares more about the well-being of its customers than most of the companies HN usually covers. now go back to coding your mobile/social/dating app that actually cares about the well being of anyone. opposition to pharma, opposition to vaccines, opposition to science.

pjonesdotca 11y ago
This tho: Orenitram won't be available for sale for about six months, the company said, and its exact price hasn't been determined either. But it will be very expensive, about $150,000 a year, according to an estimate by Dr. Mark Schoenebaum, an industry analyst with ISI. $150k/yr? Is that really necessary?
- snikeris 11y ago
  Yes. The R/D is expensive and there are many more failed drugs than those that make it to market.
- pinaceae 11y ago
  yes, it needs to cover the cost in development and getting it through approval. however, this also establishes a market - a competitor will now either come with something cheaper or something better (for the same or higher price). same thing is happening with Hep-C, which is now curable (boo, bad pharma). initial drug was/is super expensive, record profits for the company. every single contender is driving the price down. and there contenders as the market has been proven. this is the capitalist system at work, in full glory. even with patents in play. amazing shit right there.

snowwrestler 11y ago

> I believe it's the stranglehold of the pharmaceutical industry on psychology... This might be pedantic, but psychology is study and treatment of the mind that does not involve drugs. Study and treatment of the mind that involves drugs is called psychiatry.

tim333 11y ago

>stranglehold of the pharmaceutical industry on psychology that prevents research I think that may be a bit backwards. Evidently research like this is going forward and looking at the references it mostly seems to be in the US, with one researcher in the UK, countries with big and medium sized pharma. It would seem more the case that research like this does not happen much in countries without large pharmaceutical industries, presumably because the money is not there.