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I reposted this to the bipolar forums at about.com. Following is a reposted discussion with Brian, one of their moderators.

Brian> I was reading your post and like many posts like this I find good points and then it goes downhill when people attempt to mix clincal data with subjective opinion and attempt to blend the two in an attempt to make it look like you are presenting facts. Bruce> Sure, I started this thread by stating an opinion. But it is one seasoned by 26 years since first diagnosis and about 18 years since starting on regular pdrugs. I spent 10 years on lithium and have used about 10 pdrugs. My intention is to throw a bucket of cold water over the conventional wisdom. Why? Because it is riddled with myths favorable to self-interests, including those of patients and their others who would rather have an external scapegoat, a disease, rather than deal with their problematic behaviors.

Brian> In your post you site very valid points the problem is you add onto them with your own subjective opinion and try to pass them off as clinical data, which they are not. Bruce> Isn't this what you said in the first paragraph? Anyway, what are the valid points in your opinion?

Brian> I am a doctor, I have my Ph.d in Pharmacology so I see examples like this all day long. There will be several here that have a problem with your viewpoint, I am not one of them, the only problem I have is when you take your viewpoint and try to pawn it off as medical data. Bruce> Are you really an MD/PhD?! I have only sampled the professional literature on mental illness. What statements have I made that suggest otherwise? I have spent a lot of time thinking about mental illness and its fundamental causes. Sure, I draw heavily on my own experience but people really are pretty much the same when you look at the mechanisms of the mind. There surely are genetic co-factors for mental illness but the search for genetic markers for bipolar has not found anything obvious. When predisposing genes for bipolar are positively identified, I'll give you 10:1 odds that the current day "mood stabilizers" will go down like so many other quack remedies in history. I've tried most of them and found that if anything, they tend to be mood destabilizers. Pdocs have zero theory to explain their "efficacy", only statistics derived from the industry's deeply biased and corrupted studies. Do you remember what the tobacco industry used to say about smoking? Well, exactly the same forces are at work in the psych industry. Just this last year, the press exposed the fact that industries run multiple trials and somehow they just don't manage to publish the ones that did not work out for them. Imagine that I started 10 mutual funds. 9 turn out to be dogs. 1 does unusually well (the market, like drug testing, is largely a lottery). Then I put out expensive ads touting my really successful fund. You buy it. What do you think happens then? Remember that this is only one way in which the drug studies and the interpretation of them gets biased. I'd like to write a book that draws on other lives as well. In the end, what people are really concerned about are behaviors and environment. Stressful environments like war cause mental illness. But equally potent stressors can exist in schools, workplaces, families or wholly inside one's head.

Brian> I could spend days picking this post apart, just let me site a few examples. " HAM-A is a wildly unbalanced scale omitting many things like creativity, productivity and joyfulness." Joyfulness, Productivity and Creativity can't not be measured by a clincial scale they are subjective this is why they are not listed. Bruce> That is loco, Brian. Just because some things are difficult to measure (perhaps impossible but I doubt that) does not mean that they should not be considered. Take smoking, for example. What do you think are the primary health risks from smoking? Well, if you go by the deaths attributed, I believe the rank ordered list is: heart attacks, lung cancer, emphysema. But what about premature senility? That's a bitch to measure but it's still really important. Would you really want to go to a pdoc who doesn't care about your productivity, joy in living or creativity?

Brian> Let me now give you an example of blending. " I strongly suggest you study dependency on the most common atypical anti-psychotic medications which, as you know very well, are also very strongly linked to obesity and adult onset diabetes to say nothing of loss of ambition and joy in living.)" Excellent point until the end when you added "abition and joy of living" Bruce> Well, in fact I will re-write that sentence (at the Harvard post where I can change it). It will read, "I strongly suggest you study psychosis due to withdrawal from the most common atypical anti-psychotic medications which, as you know very well, are also very strongly linked to obesity and adult onset diabetes. You might also start using a scale that does make an effort to account for things that are important to patients like productivity, creativity and joy.)" Thank you for helping to improve my blog. If the all mighty NIH wills it and pays for it, Kinrys or his colleagues might even do some original and good reasearch.

Brian> True clincial data will support onset diabetes, weight gain and possible dependency issue, you then negate the entire clinical statement by adding something subjective which is a blending of facts with opinion and trying to site it as clincial data. This is something first year med students do all the time in nearly every field of medicine, its something we learn to stop doing if we every want to make it to our second year. Bruce> The dependency issue is huge. I would tell patients being given atypical anti-psychotics, "This drug will help you in the short term but if you don't manage to get you off it, you will probably become dependent to the extent that your mania is likely to return when you stop taking the drug." That plus the expense and the other long term health risks are really very important, don't you think? Or, like far too many docs, do you not believe in telling patients about the risks? Otherwise, I already handled your point.

Brian> Now if you want my opinion if you want to be taken seriously then site data, the pure data and when you are giving your opinion don't try to embellish the data by making it look more dramatic. Brian> 'site' is a place. PhDs 'cite' research. Ahem. As for the data, it is hard to get. People like me who become asymptomatic and leave treatment move on and don't get studied. The system is designed to retain clients. In other words, it makes them sick. This was most clearly shown by the World Health Organization studies circa 1990 (see Mad in America by Robert Whitaker). They looked at outcomes for people diagnosed with schizophrenia in 3 less developed countries that did not use pdrugs and in the US and Great Britain which did. Accoding to Whitaker, the first study was so shocking that WHO immediately repeated it. 2/3 of the LDC patients returned to a productive life after a year or so. Only 1/3 in the US and GB. High dose Haldol was the treatment most of the time back then so things have improved. But how much do you think the methololgy and motives have changed since then? Not much. And remember, most studies are relatively short, a couple of years at most. What do you think happens when patients become dependent on pdrugs and pdocs for decades? I've hung around psych waiting rooms so I have some idea. We're no longer in the days of insulin shock or Metrazole or frontal lobotomy but there are a lot of drug dependent zombies out there and hundreds of thousands who have settled for a diminished life as if congenitally disabled.

Bruce> To recap: When someone is stressed and unable to get their mind off a treadmill, then intervening with a downer drug seems quite appropriate to me. But all of the drugs I've used have negative side-effects. Though I use Zyprexa, it surely invites tolerance and is likely to cause psychosis upon withdrawal. It makes daily users want to eat, basically in order to couteract its main side-effects: sluggishness and dysphoria. So Zyprexa frequently leads to obesity and even diabetes if used long term. Risperdal is similar. I believe both are also implicated in tardive-dyskinesia (Parkinson like symptoms) if used long-term. I do not know about low dose Haldol. (At the doses which Haldol used to be given, it's like slamming your head against a wall. At McLean Hospital in 1992, I was knocked out and woke up after a long sleep that was more like a semi-coma - I didn't know where I was - with a 10 point headache and a bad case of dehydration.)

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