We Will Get Fooled Again

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January 17, 2023 | 25 Comments

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  1. My thanks to this article’s contributor for trying out ChatGPT so saving me from feeling even a tiny bit tempted to do same. I consider medical expert systems (as they used to be called) to be wonderful and useful for diagnosing difficult cases and those very rare cases which a doctor may only see once in a lifetime of practice or if like Dr Graham House MD — once in every episode. But!

    Whilst A.I. may perform faster than a flesh and blood doc and offer good probability scores for physiological conditions, how on earth can they come up with anything useful using a non real psychiatric paradigm? Computer, I have a question for you. How many times should we circle the church on our knees in prayer to stop the volcano burying our village in ash?

    One will have to wait but a short time to find out how good silicon based artificial patients are in vaccines trials. Oh yes! These digital people (who are coded in ones and zeros instead of DNA) will save us from being guinea pigs. OK that’s a bit of an exaggeration ( a habit I must have picked up from reading pharmaceutical literature) but digital patents are already being developed.

    Chemical, manufacturing, and control development timelines occupy a significant part of vaccine end-to-end development. In the on-going race for accelerating timelines, in silico process development constitutes a viable strategy that can be achieved through an artificial intelligence (AI)-driven or a mechanistically oriented approach. In this opinion, we focus on the mechanistic option and report on the modeling competencies required to achieve it. By inspecting the most frequent vaccine process units, we identify fluid mechanics, thermodynamics and transport phenomena, intracellular modeling, hybrid modeling and data science, and model-based design of experiments as the pillars for vaccine development. In addition, we craft a generic pathway for accommodating the modeling competencies into an in silico process development strategy.
    Ref:
    Towards in silico Process Modeling for Vaccines
    https://www.sciencedirect.com/science/article/abs/pii/S0167779921000366

    • To answer your question, I asked ChatGPT, and I find this answer very good, because it shows, that AI knows, that complaining is not a good way of living, but to be looking forward:
      Q: “How many times should we circle the church on our knees in prayer to stop the volcano burying our village in ash?”
      A: “It is not certain that circling the church on one’s knees in prayer would have any impact on the eruption of a volcano. Volcanic activity is a natural phenomenon that is caused by movements in the Earth’s crust and is not typically influenced by human actions. Instead of focusing on religious rituals, it is important for people living near an active volcano to stay informed about its activity and to follow the evacuation and safety instructions provided by local authorities.”

      • except if you take a volcano – an SSRI – and then consult the authorities on how to handle the consequences you’d be better off trusting your instincts or saying prayers

        I imagine CHATGPT is unlikely to say trust your instincts

        David

        • Maybe the creators of CHATGPT would welcome a set of questions with answers that they could insert into their programme, actually, maybe one answer would cover the whole set – it would be “trust your instincts” of course!

      • I wish ChatGPT good luck with convincing this hypothetical priest who has found this method to work without fail ever since the village and church was built there 400 years ago. Perhaps too, if he hadn’t listen to the authorities to get vaccinated he wouldn’t have become crippled and could have walked round the church like everyone else, negating the need to ask the question in the first place.

        Back to a more positive look at AI. Maybe we can get AI to work for us and crush the psychiatric model with logic and the reality of how things work.

        The similarity with the brain in any animal is that it is a pattern recognition ‘organ’, AI being a pattern recognition ‘machine’.
        If we take the more advanced artificial neural network type of AI, it has the functions of adaptive-learning, self-organization, and fault-tolerance just like animal brains. And both rely on ‘negative feedback’ loops.

        Many moons ago I got to know a lot about ‘negative feedback’ circuits. The electronic equipment I used relied upon it to stay in tune. After a while however the modules would drift so much that ad hoc adjustment would no longer keep them working. So I put them on the test bench and recalibrated and retuned them from reliable signal sources and standard voltage sources. It was back then when I started wondering: If even a single cell bacteria have an even more complex bio negative feedback system than our lab equipment to keep its internal environment in balance, how could someone chronically taking diazepam (me in this case) ever hope to retune back to normal. With that the spell broke or rather everything inside my head when into a slow motion crash. I’m certain that I recovered by being able to achieve some objectivity by considering myself in the same detached way that I diagnosed and retuned the lab equipment. What I felt I MUST do and what my detached negative feed back knowledge told me I MUST do were at odds but my floating anxiety had stopped floating and fixed itself to the correct causal problem at last and in withdrawal the anxiety became terror that I could sense as if it was physical standing behind me. Samuel Johnson once wrote — ‘Depend upon it, sir, when a man knows he is to be hanged in a fortnight, it concentrates his mind wonderfully.’ I assessed my situation minute by minute with the same burning focus. Suppose, it was a help too, that the very rapid withdrawal from diazepam gave me an overabundance of mental energy with which to keep this constant self observation and self control going.

        With all the books I’ve read since (and that’s many) I haven’t seen any discussing the disruptive action of chronic psychiatric medication on the bio-chemical and bio-neural negative feed back systems. So if a AI system understands negative feed back in bio-chemical and bio-neural and electrical engineering realm I wouldn’t be asking it to prove a negative. Just come up with a logical and factual reason ‘why’ a person can successfully and fully re tune back to a well balanced mental state whilst their systems are unnaturally biased by psychiatric drugs. The is no known system that relies on multiple negative feedback systems that can be properly balanced as designed, whilst parts are intentional kept out of balance. Haemostasis is the sum of the total. The self healing reorganisation and updating of patterns (which are the processes of recovery) will be different if the functioning of the brain has been modified by drugs during that healing process. Such a brain will therefore attempt to heal again and return again to its natural haemostatic biochemical state AND to modify its neural circuits again to suit reality as it appears when not on drugs — when those drug(s) are finally stopped. But it is reorganising again with neural patterns modified in an unnatural way whilst on medication. Thus parts will be incongruent to some degree to others which will give rise to future mental tensions. For it is these patterns which subconsciously guide us and help us make good decisions — if they are uncorrupted. Whereas a series of poor decisions over time will drag us down again. This is a bit of an over simplification but I hope you can grasp this way of viewing things.

        We know enough about negative feed back to show the current psychiatric prolonged drug regime paradigms and its ideological paradigms have not only no real testable bases but is utterly false and harmful.

  2. The volcanoes are still alive in psych and GP land They probably won’t be extinguished until their self serving colleges are abolished and the way they practice is turned on it’s head..
    RCPsych comments on new NICE guidance regarding patients withdrawing from antidepressants
    17 January 2023
    The Royal College of Psychiatrists has today (Tuesday 17 January) responded to new guidance from NICE regarding antidepressant withdrawal for adults with depression.

    The new draft quality standard from NICE recommends that adults who want to stop taking antidepressants should have the dose of their medication reduced in stages (known as ‘tapering’) in order to to help reduce the likelihood and severity of withdrawal symptoms.
    Dr Adrian James, president of the Royal College of Psychiatrists, said:
    ((NOT) .-Before I retire in July ,We/I un-sincerly apologise from the bottom of our non -existent hearts to all those we coerced into taking drugs without warnings/ignoring warnings for decades by mis-using the ‘safe and effective ‘ mantra, by forcibly injecting countless people who knew better than us , for promoting un- proven theories and guidelines by such as NICE and dodgy secretive ‘research’ to protect our corrupt practices and self serving colleges. See our own guidelines using NICE to cover our backs)

    These new guidelines are a positive step forward which will help countless people come off antidepressants across the UK safely. (They won’t unless they are informed)
    ……… They should also inform the patient about the advantages and risks of reducing their dose so that they can take part in the decision-making process.

    “It is important to note that, for many patients, antidepressants are part of a lifesaving treatment programme. Patients should not stop taking antidepressants suddenly and should talk to their doctor beforehand. The College has produced a resource for patients and carers on stopping antidepressants, that offers information on how someone can taper their medication at a pace that suits them and their individual needs.”
    Find out more (Much more will be found From the Daily Mail for example)

    Stopping antidepressants
    This information is for anyone who wants to know more about stopping antidepressants.
    symptoms that you may get when stopping an antidepressant
    some ways to reduce or avoid these symptoms.
    This patient information accurately reflects recommendations in the NICE guidance on depression in adults

    This leaflet provides information, not advice.
    The content in this leaflet is provided for general information only. It is not intended to, and does not, mount to advice which you should rely on. It is not in any way an alternative to specific advice.

    You must therefore obtain the relevant professional or specialist advice before taking, or refraining from, any action based on the information in this leaflet. (Are they not supposed to relevant professionals themselves )

    If you have questions about any medical matter, you should consult your doctor or other professional healthcare provider without delay.
    If you think you are experiencing any medical condition you should seek immediate medical attention from a doctor or other professional healthcare provider. (and just trust to luck you will find one who is clued up)

    Although we make reasonable efforts to compile accurate information in our leaflets and to update the information in our leaflets, we make no representations, warranties or guarantees, whether express or implied, that the content in this leaflet is accurate, complete or up to date. (Why publish it then?!!)

    What are antidepressants?
    What symptoms might you experience when stopping antidepressants and how severe can they be?
    What causes antidepressant withdrawal symptoms?
    Who is affected by antidepressant withdrawal symptoms?
    How can I tell if it is withdrawal symptoms, or my depression/anxiety coming back?
    Does this mean that antidepressants are addictive or can cause dependence?
    When and how to stop antidepressants
    Examples of tapering plans
    Appendix 1: Risk of withdrawal symptoms with individual antidepressants
    Appendix 2: Potential types of withdrawal symptoms
    Credits

    Published: Nov 2020
    Review due: Nov 2023

  3. “By the end of the email sequence I was beginning to get interested.  The original response about rebounds was fair given that PSSD hadn’t been mentioned and the Bot thought it was dealing with withdrawal where the word rebound is appropriate for opioid/opiate withdrawal in particular but much less so for benzodiazepine, SSRI or antipsychotic withdrawal.”

    SSRI Withdrawal, PSSD and much else besides.

    This is not a Bot.

    https://www.youtube.com/watch?v=46deer965Jw

    Interview with Dr. David Healy: The risks of antidepressants

    15 Jan 2023

    Witt-Doerring Psychiatry

    H and Helpful…

    • So good to see the young willing to ask the ‘not so young’ about the best ways of supporting patients – the questions coming from a person who is already an ‘expert’ in his field. Maybe, in time, the initials J W-D will become as popular as DH has been for quite some time now. Could do with many more following the wisdom of J W-D and listening to someone who is so willing to share his knowledge with all who will listen.

    • Thanks for posting that annie as it was I thought a really good interview. Felt appreciative of Josef not interrupting but letting DH have all the time he needed to layout the realities and outcomes of the route that many patients end up following.

      At 34 mins in and following a point made by Josef about the dampening effect of some of the drugs DH says something along the lines of they leave patients ‘not bothering about a thing that they ought to be bothered about’. Harking back to what I said about negative feed back systems and AI, I think of ‘worry’ as an awareness that one’s neural network can not model a suitable simulation run of a future scenario and as it searches through its database of patterns for a suitable ‘patch’ to add to the mental model it has of the problem and the process require the conscious part of the brain to act as a critic, judge and go-finder for more data when data is lacking. Have a gut feeling that people (perfectly normal people at that) find their minds sometimes stuck in a circler thought pattern but upon being asked a few questions about the problem, suddenly find themselves being able to think out-side-the-box at last. Although I’m left wondering from witnessing this, if a simultaneously large dose of psychoactive α-acid component 2-methyl-3-buten-2-ol and ethanol (several pints of real English hoppy beer) might not have had something to do with brain becoming more plastic to considering new thoughts. Analogous to AI being ‘taken off line’ to give corrective ‘feedback’ to its inputs so that it improves its performance ( in auto-associative neural type networks), fellow drinkers around the bar give ‘feed back’ via comments, frowns, smiles, grunts or roars of laughter about how they see the issue. With the troubled individual now being a little bit ‘off line’ by the effects of beer, the pain or hurt of realising one’s possibly been making mistakes is dulled, allowing a window of opportunity to think afresh. In this analogy it should be obvious that regardless of whether the psychoactive agent to dull the pain is handed to one by a barmaid or pharmacist, over reliance on this method is very unwise. Equally, Ronald Siegel Ph.D has studied the history of intoxication and considers the human drive to use mind altering substances to be our fourth drive (after hunger, thirst and sex) which indicates we evolved with them and we as a specie are the better for it. Therefore, it would be wrong to not to ever employ psychoactive drugs either.

      So in short. Thought that in all, the interview between Josef & DH put fairly, both the good and the bad of psychiatric treatment into an everyday context and in a way that anyone can understand.

  4. There is a significant addition to this post – that begins just over half way down. Worth looking at

    David

    • DH writes in his letter to Smith: “Leaving the misunderstanding of the role of MHRA to one side, there is either a deliberate failure here to engage with a difficult issue or a complete lack of awareness of the issue. Both scenarios are alarming”. That’s a bit ‘binary’ if you don’t mind me saying. There are always other possibilities. One is simply deliberate stone walling whilst all of Scottish Health Care gets linked up to local government hubs and ultimately to WHO.

      Better add here for the uninitiated who may have found their way onto RxISK. A barrier to seeing or discovering the more important aspects of a situation which is complex is that we have to rely most of the time on heuristic reasoning which is faster than critical reasoning. It served our ancestor well when speed of decision was paramount. For example: If a friend returning in the twilight from a hunting trip cracks a few twigs underfoot whilst he is still in shadow, causing ones adrenaline to rush at the thought it is a sabretooth cat approaching, we have evolved to get up the nearest tree or other safe place pronto. It is better to jump to conclusions in the natural jungle than waste time thinking about it. So heuristic reasoning can get it wrong and it has very much an emotional component. Emotions in a heuristic mind-set can be a blinder to believing anything other than what one’s clan believes in. It also totally useless in dealing with complex problems.

      Even with critical reasoning there has to be the will to cross-examine the many beliefs one holds with certainty when wanting to get to the bottom of a complex issue and it takes a very, very long time.

      In England (and I hear in other countries too) much of IT hub infrastructure appears to be in place now. For instance, for some time the police can contact the Community Mental Health Resource Centres (CMHRC) to find out if someone is ‘known’ to them and two-way discuss. In some instances this may be a good thing, but thats another matter. Looks like Scotland is still behind in all this but I haven’t looked deeper than a cursory glance. For instance the City of Edinburgh Council lack any references to hubs, whereas (say) the Royal Borough of Kensington and Chelsea website does. Excerpt of what English Local Councils ‘can now legally’ know about you:
      Personal information (NHS number, name, age, postcode, phone number ([mobile and landline]) is provided under a data sharing agreement with North West London Integrated Care System (NWL ICS) for residents who qualify for a vaccine but have not yet received it.
      NWL ICS are the Joint Data Controllers defined in the Whole Systems Integrated Care (WSIC) Interoperability Service Specification and include primary care, providers (acute, community and mental health) and social care (local authorities).

      https://www.rbkc.gov.uk/data-protection/data-protection/covid-19-hub-privacy-notice
      These hubs link up to other hubs.

      The UK government is currently holding a ‘Open consultation’
      Consultation on draft legislation to support identity verification Published 4 January 2023 https://www.gov.uk/government/consultations/draft-legislation-to-help-more-people-prove-their-identity-online/consultation-on-draft-legislation-to-support-identity-verification

      Yet, we in England, more or less, already have it ready to roll out with the commencement of the next pandemic in the form of having to use a digital online ID to access any government service including the NHS. So ‘consultation’ seems just PR window dressing exercise. A parliamentary declaration of an Emergency is all thats needed, for the all legalization necessary for ID implementation was placed in different subsections of the previous Covid Acts.

      I must assume that the BMJ has chosen not to post any RR’s explaining how this scaling up of the system is probably delaying NHS patients from getting access to their medical records online. My guess is that with a big marketing campaign for vaccination planed to start November, this new ID system will go live about this time in England.

      Once this is up and running, these hubs will prepare to link to the main international hub in Switzerland so that healthcare can be unified (?) across the world.

      Back to my proposition that these responses from all Scottish mandarins —so far approached by DH — is due to this massive unpublicized restructuring of healthcare. Come to your own conclusion and if you have the time, do watch an interview with a WHO whistle blower who describes what she has witnesses going on behind the scenes to join all these hubs together. The interview starts at 47:55 minutes in to the program so you can just skip straight to it. If they repost it on the site it is ‘Episode 303: Timeline Of Tyranny’
      https://thehighwire.com/watch/

    • The responses to your correspondence with the Office of the Minister of Mental Wellbeing and Social Care appear to convey arrogance and complacency in addition to ignorance of those failed clinical practices and injurious ‘clinical guidelines’ which maimed our loved ones and destroyed their lives.
      It also appears that those responsible for misdiagnosing adverse drug reactions as serious mental illness and then using detention, and forced toxic drugging – (following ‘guidelines’) – ignore the terrible injuries they then cause and are unaccountable for their sequential, serious critical incidents. They are in effect unaccountable, not least, because they followed guidelines.

      A Basic Human Right:
      Those who have their entire futures so destroyed do not enjoy Franklin D.Roosevelt’s ‘Freedom from Fear’. They live in terror of any medical contact as a result of the injuries, incarceration and abuse they have experienced despite having no mental illness whatsoever. Fear of further misdiagnosis, injury and abuse prevents them receiving any State Benefits, year after year. Failure to receive benefits denies them of National Insurance contributions, so if they do not die 15 to 20 years prematurely from their psychotropic drug injuries, they do not receive even a basic old age pension when those who loved and supported them have gone.
      If ‘doctors’ applying these guidelines are unable to differentiate a toxic delusion from a newly presenting psychosis, then those in High Office are missing this great opportunity to learn and to improve both the quality of patient/family experience, and to improve upon the abysmal outcomes of the disaster that currently passes for ‘care’ by engaging with you.
      It would afford them valuable insight were they to listen to your two outstanding new podcasts. Wisdom, science, insight, awareness and patient/family centred real medicine, discussed with empathy and integrity. Would it be too much trouble for them to do so, and thus to afford themselves an opportunity to prevent the tragedy experienced by our families?

  5. https://www.youtube.com/watch?v=46deer965Jw
    Interview with Dr. David Healy: The risks of antidepressants

    They are on the same wavelength although obviously there are reservations about no face to face meetings and the prohibitive cost for most people
    It’s a choice which suits some people though – and if it was affordable would be a preferable option to avoid the disgraceful ‘services in the UK NHS

    Joseph and Marissa Witt-Doerring run an on line consultancy
    Witt-Doerring Psychiatric Consulting, LLC

    Witt-Doerring Psychiatric Consulting, LLC
    Psychiatrist, MD

    We practice exclusively online via videoconferencing. Please email us your name, birthdate, number, state of residence & reason for visit.
    About
    Welcome! Please check us out on YouTube – Witt-Doerring Psychiatry – to learn more about our philosophy. Our goal is to treat your mental health symptoms with the least amount of medication possible. Set up a discovery visit to learn more. We assist with patient-led taper plans and the management of adverse reactions to medications. We can also provide a second opinion/diagnostic clarification and expert witness services. We are board-certified psychiatrists who together have worked in pharmaceutical, regulatory, academic, and clinical settings.
    Please email us with your name, number, DOB, state of residence, and reason for treatment to inquire about our new patient process. We will meet you virtually for most visits unless we are prescribing controlled substances (once a year in-person visit is required).
    Current rates: $150 for a discovery visit, $750 for 80 minute intake, $500 for 50 minute follow ups, $250 for 25 minute follow ups, and $175 for short 10 minute medication check ups. We do not accept insurance. Credit card on file charged at time of service. PDMP checked regularly. We do not provide psychotherapy visits.
    Take the first step to help. Email Witt-Doerring Psychiatric Consulting, LLC now
    Finances
    Cost per Session: $175 – $750
    Pay By: American Express, Discover, Mastercard, Visa
    We do not take insurance. Credit card is kept on file and charged at time of service. Superbill provided for out-of-network reimbursement.
    Email us or call with questions.

    Josef Witt-Doerring, M.D.

    Dr. Josef Witt-Doerring is a board-certified psychiatrist who runs a private practice that specializes in helping patients safely discontinue psychiatric medications. Dr. Witt-Doerring interest in psychiatric drug withdrawal developed after he began researching the clinical experience of protracted withdrawal on the online withdrawal communities.

    Marissa W-D
    Dr. Marissa Witt-Doerring is board-certified psychiatrist with a background in neurology and consult-liaison psychiatry (psychiatric care in medically ill patients or psychiatric symptoms arising from medical problems). She started this virtual practice to support patients with limited time or geographic access to convenient and high-quality psychiatric care.

    • Dear susanne,
      Reading your phrase “[…] obviously there are reservations about no face to face meetings […]” and thinking about the NHS plans to rely more and more on virtual consultations has given me an itch I need to scratch and this is also a ‘note to self’ for the next time I meet a man-of-the-Cloth.

      Religious leaders have been bleating for a long time that people have drifted away from religion as though they no longer find it relevant. The current mental crisis is their opportunity to demonstrate how ‘they’ themselves can be still relevant to the hoi polloi (thats you and me) of the modern world. It is not in DH’s remit to make such an appeal to them as it would be taken the wrong way and both shoe-makers-should-stick-to their-lasts as they say.

      For many people who’s fate drives them down into a dark blind ally of stress, just having opportunities to talk to someone, who is living in the same part of town and so knows the neighbourhood, who can ‘really listen’ to them and converse with them, face to face in the same room, in the home that they live in, is often all they so desperately need in order to discover how to take back control of the wheel, and steer themselves out of that ally. Various studies have found that people with a religious belief or sound philosophy of life tend to enjoy better mental health.

      Just as there are still many enlightened medical doctors, there are still many enlightened doctors of theology. I seem to remember that part of their remit is to go forth into the land and be fishers-of-men and perform the works of Jesus. Here is their opportunity!

      This is something we can start doing ourselves individually, by finding opportunities to make suggestions to the right people and being ready to back those suggestions up with good augments. Remind them too, that patients can grow to feel very close to whichever therapist succeeds in helping them get their lives back in control. Often telling their friends how brilliant their Dr. X is and “I can recommend him” (which always goes down better than ‘you should visit him’). That small vignette might just present God’s representatives with a dangling carrot they can move towards.

      • Thanks Pogo I think people need space and freedom to seek their own path Sadly this is restricted by needs for income, ‘benefits’ and so on where bureaucracy imposes regulations applied to all individuals in specified groups with certain labels . We all know about the tick box horror of diagnosis equals ‘treatment’ including a faux kind of relationship with therapists. One of the things which does appeals to me about J and M Witt Doerring is that they do not use the insulting term to ‘assess’ a person Instead they use the term of a ‘discovery’ meeting. Demonstrates a lot .

  6. Two weeks before, chat with David Healy

    https://www.youtube.com/watch?v=sX5dy115SgA&t=1s

    It’s really great that Josef goes along with David, and he has a nice, soft voice, like Mark Horowitz, but bringing history back in to the frame.
    The MHRA did a four-and-a half-year investigation in to Seroxat/Paxil and at the end it was thought that the MHRA could not bring a case.

    https://jme.bmj.com/content/35/2/107

    On the back of this, GSK was fined $3 billion dollars which included Paxil fraud.
    Panorama produced four programmes on Seroxat.

    Panorama produced one programme on Sertraline.

    So the deal for Kevin Stewart is, why is he so appallingly ignorant?

  7. Josef has had DH back on for another chat. This time:
    “Antidepressants and Mass Shootings/Murder Suicide: An interview with Dr. David Healy”
    https://www.youtube.com/watch?v=CLgt3zhJ0hk

    Another interview which would help reinforce for proscribing doctors — in case they have forgotten – that with the power granted to them to cure, used unwisely it can lead to not only their patients deaths but to the deaths of others.

    An aside: The Witt-Doerring’s have only been on Youtube since Dec 12, 2022 hence only 122 subscribers so far. The more subscribers a channel gets the more the YT algorithm promotes the channel making it more likely more people will view their channel if their number subscribers increases(hint).

    Interesting Trivia: Videos put out by Bill Gates et. al., use ‘click farms’ which are private companies which will insure that the moment these pharmaceutical corporate sponsored videos are uploaded they have a couple of million views and so always appears at the top of YT’s viewer suggestions and trending lists.

  8. They will always find a way of ‘fooling again’ sadly. There are some truly decent doctors left still . like David T.but the next generation are already being trained to manage using more and more AI

    Home Views David Turner Guidelines and conveyor-belt medicine
    20 January 2023

    Dr David Turner on how guidelines are hindering the development of independent thinking when it comes to problem solving as a doctor
    I was reflecting recently on the themes that emerged from the Pulse PCN conference in November.

    My notes from the day reflect some general themes: streamlined processing, electronic algorithms, group consulting, mechanised systems and herding of patients.

    The days of tailored care – if not already gone – are certainly close to the end.

    Many of the medical students I teach have also recognised this. I was talking about the importance of developing the art of independent thinking in problem solving as a doctor and one student said, ‘The university seems to focus excessively on teaching and testing us on NICE guidelines.’

    This is wrong. UK medical students are at medical school, not NHS school. They are paying good money to learn the art of medicine, not how to be automatons of a centrally controlled taxpayer funded health service. Yes, most will probably end up working in the NHS, but that is not the point. The NHS should train them in the skills needed to work in its organisation, not medical schools.

    The reason it takes a long time to become a doctor is because it is difficult. I do not believe that you need to be super intelligent to be a good doctor, but I do believe that you need to have the ability to work very hard, persevere and endure adverse circumstances and, most of all, think independently and make decisions based on your training and experience.

    Guidelines are just that: guides. Ultimately, the buck stops with you as a senior doctor and you need to be able to defend your action. Sadly, I am not sure that medical schools are emphasising the importance of this enough.

    In the technological age, the temptation is to believe that computers can solve all our problems. It is true that artificial intelligence can now write prose and produce art, but I doubt the work of any computer will be serious competition for Van Gogh or Fyodor Dostoevsky any time soon.

    Maybe a faceless, algorithm-driven health service is good enough for some patients, but it is certainly not suitable for all. In the same way that computer-generated music might be adequate entertainment in a lift, but not in the Royal Albert Hall.

    After 22 years as a GP, I am still regularly surprised by the quirky and unusual way symptoms and conditions present. There is no software in the world that could untangle the convoluted way some patients express themselves and what they are suffering from.

    Perhaps the brave new world after my retirement will involve diagnosis by circuit boards, but while I continue to have the strength to wield a stethoscope, NICE guidelines and IT will very much continue to play second fiddle to my cerebral hemispheres.

    Dr David Turner is a GP in Hertfordshire. Read more of his blogs here

    • S

      you need to give people a link to David Turner – the way google works, google his name and people in canada get canadians

      D

      • @DH
        Josef also didn’t put links to either of your two blogs in the descriptions box as he said he would, so have just sent off an email reminder.

  9. Good job, Pogo.

    Let’s hope the views go up from 133, now 134 as I just watched it.

    This is the sort of discussion that should be shared far and wide.

    In the UK, there have been attempts to address the ‘delirium and and agitation’ conspired by GSK to be ’emotionally labile’.

    Does it fall on deaf ears?

    ​Pretty much.

    Dr. Peter Gordon, psychiatrist, in Scotland, knew it was the drugs not long after his episode of attempting to hang himself. The fall-out from this affected his family life severely and to be castigated henceforth from three members of the Royal College of Psychiatrists, in particular, Simon Wessely, who in typical form and jocular fashion, decided that Peter was someone to be mocked.

    Barbaric.

    If Stewart Dolin, ‘pacing and agitated’ on the platform of a Chicago train station, had been pulled back, before throwing himself under a train, was here today, what would he say.

    His wife, Wendy Dolin, said that Stewart had said that he didn’t get it, why was he agitated; we now know why.

    I don’t think for a lawyer like Stewart, it would have taken him long to join the dots and say, thank god, there was someone to pull me back.

    For those who weren’t pulled back from the pharma drugs, you have to know that, without question, the drugs were possibly complicit, whilst families say they didn’t know their family member was so near the edge – and take the lesson from David and Josef – the dead are gone and they take their medication with them –

    Enquiring minds have a long way to go – bring on the Bodies

    Did regulators fail over selective serotonin reuptake inhibitors?

    BMJ 2006; 333 doi: https://doi.org/10.1136/bmj.333.7558.92 (Published 06 July 2006)Cite this as: BMJ 2006;333:92

    David Healy, professor of psychiatry 

    https://www.bmj.com/content/333/7558/92

    Controversy over the safety of antidepressants has shaken public confidence. Were mistakes made and could they have been avoided?

    GlaxoSmithKline’s recent letter to doctors points to a sixfold increase in risk of suicidal behaviour in adults taking paroxetine.1 This contrasts with the data in the UK Medicines and Healthcare Products Regulatory Authority’s expert working group report on suicide and antidepressants published in December 2004.2 Many people expect drug companies to be slow to concede that a drug causes hazards, but we do not expect our regulators to be even slower, so any hint that this might have been the case needs to be examined.

    Regulatory problem

    In February 1990 an article raised concerns that the recently licensed fluoxetine might trigger suicide acts in depressed patients.3 A series of meta-analyses of published and unpublished antidepressant trials subsequently failed to show benefit in terms of suicidal acts with active treatment compared with placebo.4–9 In fact, each analysis showed a small excess risk with active treatment for all classes of antidepressants, although the increases are compatible with chance and the original authors concluded there were no differences. For much of the 1990s campaigners were saying trials with placebo controls in depression were unethical, and these analyses were attempts to justify placebo controlled trials.

    I recently participated in a cumulative meta-analysis of published trials that found an excess of suicide attempts in patients taking selective serotonin reuptake inhibitors (SSRIs) compared with those taking placebo.10 The numbers in the individual trials are small, so that although from 1988 onwards the point estimate indicates roughly a doubling of the risks of suicidal acts with SSRIs, the effect has only recently been consistently significant. Nevertheless, the trend should have been seen by both companies and regulators as something that required investigation before …

    https://www.bmj.com/content/333/7558/92/rapid-responses

    EDITOR – Healy’s article ‘Did regulators fail over selective
    serotonin reuptake inhibitors’ makes allegations about failure of MHRA to
    warn about suicidal behaviour with SSRIs which require response1.

    The MHRA moved swiftly in June 2003 to contraindicate the use of
    paroxetine in children with depressive illness (for which it had never
    been licensed) based on a lack of evidence of efficacy and an increased
    risk of suicidal behaviour. The data on risk of suicidal behaviour were
    clearly communicated at that time and are prominently displayed in the
    Patient Information Leaflet.

    In relation to suicide risk in adults, Healy states that no warnings
    were issued until May 2006, and criticises regulators for “failing either
    to warn or to demand suitably powered studies of the risks of treatment”.

    Warnings issued by the Medicines Control Agency in 2000 and the MHRA in
    2003 raised the possibility that SSRIs may increase the risk of suicidal
    behaviour in some people. The Committee on Safety of Medicines’ Expert
    Working Group on SSRIs was clear in its findings published in December
    2004 that the available clinical trial data could not rule out an
    increased risk of suicidal behaviour in adults on SSRIs compared with
    placebo and advised careful and frequent monitoring of all patients taking
    SSRIs as a result. In reaching its conclusions the Expert Working Group
    fully recognised the limitations of statistical power in examining safety
    rather than efficacy end points.

    Bad job, Kent Woods…

    • From an earlier Blog discussing Managing Effexor and SSRI Withdrawal
      June 24, 2020 | 16 Comments

      Josef Witt-Doerring
      Josef is a medical doctor who in 2018 had a feature on the front-page of Psychiatric Times with an inside spread on Antidepressant Withdrawal and the need to listen to patients and patient groups – astonishing views to see expressed in the heart of US psychiatry.

      Do you think this lady has Effexor withdrawal?
      I believe this lady has a tardive (late onset) and chronic sensory disorder likely caused by Effexor. The descriptions of the sensory disturbance sound partially similar to akathisia and restless leg syndrome (minus the confinement to the legs of course). The sensory pain in those conditions appear to match what this woman is describing: a hard to explain, deep scaly, crawling, agonising sensation. It has become more recognized recently that antidepressants have the potential to cause these types of disturbances – tardive sensory problems.

      The onset of the sensory difficulties also fits a pattern common with tardive syndromes caused by long term use of certain monoamine modulating drugs (antipsychotics and antidepressants) : onset during withdrawal and persistent for many months after discontinuation and thankfully for this lady partial remittance on reinstitution of treatment – there are reports of these syndromes persisting despite reinstitution of the causative drug.

      2. Are her “skin” difficulties anything you have come across before?

      I haven’t heard about the red-pin spots before as being a common symptom directly stemming from these tardive syndromes, but I have heard of emergent drug sensitivity (such as with antibiotics). If this isn’t simply a symptom of these tardive syndrome I’m yet to encounter, it may be worth looking for other exposures in her environment which, did not precipitant skin reactions in the past but may now be doing so. Perhaps, other drugs, laundry detergents etc.

      3. When people have enduring difficulties on withdrawal – do you advise them to go back on treatment and taper even more slowly?

      Hard to say. Depending on the experience during the withdrawal. If for example there was absolutely no improvement in 6 months, that appears to me to be a reasonable sign that the condition may be permanent. E.g the body does not appear to be capable of correcting whatever biological aberration that has been induced. If there was a trend towards improvement, but the withdrawal failed due to the enduring difficulty of the symptoms, despite slight improvements, then I would be more hopeful in re-attempting withdrawal again in the future at a much slower pace. Additionally, in conditions such as Tardive dyskinesia which can often be permanent, old age can be a poor prognostic sign for recovery, I would be more encouraging in younger patients than older ones in reattempting withdrawal with the hope of cure. Also, the level of support someone has would be important in gauging how well they would tolerate another withdrawal.

      4. Do you see people who can’t increase or decrease?

      I’ve read many cases and heard from many individuals first-hand about being unable to decrease without severe symptoms. However I have not read cases like this where even dropping half a pellet from a very high dose — 375 mg, causes symptoms to emerge, typically these small drops only cause problems at the lower end of tapering.

      5. How does a case like this fit into current models – like reducing receptor occupancy in 10% steps?

      A good question. The idea behind reducing dosages in increasingly small amounts in order to drop receptor occupancy in a controlled linear fashion is that it will give the brain a greater chance to modulate receptor expression/sensitivity as previously modulated synaptic neurotransmitter levels return to normal. This is intuitively appealing and does appear to be the experience of many people who taper of psychiatric drugs – smaller drops confer better chance of success and reduced severity of withdrawal symptoms.

      The problem here that I can see is that there does exist tardive syndromes which simply don’t improve, regardless of the time that someone is off the drug: Tardive Dyskinesia being the paradigm. Although it is very bleak and disheartening, I think there might need to be a place where some, after attempting to discontinue for long periods of time, might have to come to the conclusion that the problems will not go away. In these cases, hopefully reinstitution of the drug can improve these symptoms.

      6. What would you do for this woman now?

      There appears to be two options: One which manages symptoms and one which tries to cure the condition.

      1) Symptomatic Management:
      Persist with the Effexor which is at least masking the sensory disturbance and work on finding a combination of therapies: pharmacologic and others which allow this lady to live as comfortable as is possible.

      2) Curative:
      Proceed on the assumption that a long taper of miniscule decreases might allow this lady to come off the medication. Liquid formulations might be useful for titration, switching to fluoxetine might be useful as it could have less inter-dose fluctuations given the long half-life. Although given this patients demonstrated sensitivity to even minuscule changes in Effexor dose, this sounds frightening to attempt.

      There would likely need to be pharmacologic and other therapeutic treatments to be used regularly and as needed if the withdrawal symptoms are severe during the taper.

      Both are hard choices, with 1 there is always a chance the symptoms might break through in the future necessitating higher and potentially more dangerous doses of Effexor to suppress them, and with 2 there is a chance it may not work, or simply be too be excruciating.

      Both plans would need a knowledgeable doctor who can be flexible as treatment proceeds. The worst-case scenario would be getting treated by someone who simply throws meds at her off an algorithm or writes these symptoms off as hysteric manifestations of her depression.

  10. Here is one decent group of doctors who did the right thing when people realised they were being fooled by the research company by swerving the right to opt out of sharing their information with researchers. They claimed the gadget was being used for direct care and so exempt from opting out of sharing these records which included personal identified information . Many more won’t have been properly informed and many will not have spoken about it if they have found out. (I was able to pick up the whole article somewhere else – maybe here; An official website of the United States government) Worth a read to protect from breach of privacy and donating personal info to this private company without consent
    BMJ
    . 2023 Jan 20;380:p157. doi: 10.1136/bmj.p157.
    Data privacy: GP surgery withdraws from kidney screening pilot after
    PMID: 36669773
    DOI: 10.1136/bmj.p157

    Data privacy: GP surgery withdraws from kidney screening pilot after patients voice concerns
    BMJ 2023; 380 doi: https://doi.org/10.1136/bmj.p157 (Published 20 January 2023)
    Cite this as: BMJ 2023;380:p157

    A general practice in Oxford has withdrawn from an NHS commissioned pilot with a private company to provide kidney screening at home, after patients raised data privacy concerns, The BMJ has learnt.

    The service,12 provided by the technology company Healthy.io, enables patients at risk of kidney disease to use a test kit and mobile phone app to conduct urine tests at home without having to go to their GP surgery. The pilot is being funded by NHS England’s Accelerated Access Collaborative (AAC).3 Local commissioning bodies in England have signed up to trial the service through practices in their area,4 with eligible patients receiving texts offering them the chance to monitor their kidney function at home.

    Data privacy: GP surgery withdraws from kidney screening pilot after patients voice concerns
    BMJ 2023; 380 doi: https://doi.org/10.1136/bmj.p157 (Published 20 January 2023)
    Cite this as: BMJ 2023;380:p157

    The service,12 provided by the technology company Healthy.io, enables patients at risk of kidney disease to use a test kit and mobile phone app to conduct urine tests at home without having to go to their GP surgery. The pilot is being funded by NHS England’s Accelerated Access Collaborative (AAC).3 Local commissioning bodies in England have signed up to trial the service through practices in their area,4 with eligible patients receiving texts offering them the chance to monitor their kidney function at home.
    Complexities
    The case has highlighted the …(what they call ‘complexities ‘amounts to deception)

    healthy.io logo

    NHS
    Modality
    Care City
    ACR video
    Testing at home with Minuteful Kidney
    From 0% to 72% adherence1
    A majority of at-risk people don’t take their annual urine test. Reach the untested population by shifting testing to the home.

    Send a kit
    ACR (albumin to creatinine ratio) test kit sent to the individual’s home

    Saving Lives and Cutting Costs2
    Projected five-year outcomes for the NHS by rolling out our service, based on an independent evaluation undertaken by the York Health Economics Consortium.

    276,845
    Identified CKD cases

    11,621
    cases of ESRD avoided

    £660 m
    net cost savings

    Using Minuteful Kidney

    The Minuteful Kidney test app and kit allow people to test themselves at home for signs of CKD and receive immediate clinical results. Using colourimetric analysis, computer vision, and AI we transform the smartphone camera into a clinical-grade medical device. The app walks the user through a simple test, making it as easy as snapping a photo.

    Smartphone-powered CKD early detection service

    We take care of the whole process. Once you provide us with a list of eligible people, we post them kits and ensure they take the test. Their clinician receives the results for follow-up.

  11. New Numb Study splashed from the India Times to Forbes…

    Scientists explain emotional ‘blunting’ caused by common antidepressants

    recovery&renewal Retweeted

    James Moore
    @jf_moore
    ·
    3h

    Psychiatrists will no doubt take the party line that emotional blunting is how #antidepressants ‘work’ but is it really helpful if the drugs are preventing people from connecting to the positive emotions that might lead them out of some very dark places?

    recovery&renewal Retweeted

    John Read
    @ReadReadj
    ·
    3h

    Important confirmation of what antidepressant users have been saying for years and our online surveys. ‘Antidepressants’ shut down positive as well as negative felling. Should be called ‘antifeelings’ drugs?

    @JdaviesPhD @ClinpsychLucy @Altostrata

    Scientists have worked out why common anti-depressants cause around a half of users to feel emotionally ‘blunted’. In a study published today, they show that the drugs affect reinforcement learning, an important behavioural process that allows us to learn from our environment.

    https://www.cam.ac.uk/research/news/scientists-explain-emotional-blunting-caused-by-common-antidepressants

    Antidepressants can cause ‘emotional blunting’, study shows

    https://www.theguardian.com/society/2023/jan/23/antidepressants-emotional-blunting-study

    Prof Catherine Harmer, of the University of Oxford, said the paper gave important insights into the action of SSRI drugs that are relevant for patients and also could help guide the development of drugs with an improved side-effect profile. “It’s really useful to have an objective measure of what people are telling us is a side-effect,” she said. “Once you have a measure you can look at how new treatments affect that.”

    She added that the suggestion that as many as 60% of patients experienced emotional blunting “might be an overestimate”. She added: “My worry is that people would see this and think the message is, don’t take the medication. This is exactly the sort of work we need, but this doesn’t affect everyone – everyone’s unique, and the treatments are still therapeutic.”

    Antidepressants can numb enjoyment as well as pain by making patients feel emotionally dull, scientists say

    Selective serotonin reuptake inhibitors (SSRIS) cause ‘blunting’ of enjoyment
    They target serotonin and take away emotional pain but also some enjoyment
    ‘Blunting’ could affect between 40 and 60 per cent of patients taking SSRIs 

    https://www.dailymail.co.uk/sciencetech/article-11664895/Antidepressants-numb-enjoyment-pain-scientists-say.html

    She said: ‘They take away some of the emotional pain that people who experience depression feel, but, unfortunately, it seems that they also take away some of the enjoyment.’

    Between 40 and 60 per cent of patients taking SSRIs are thought to experience blunting. 

    The study, published in Neuropsychopharmacology, was made up of 66 volunteers.

    ‘antifeelings’ drugs…

  12. Feel sure that others here reading that above will have the same thoughts.

    Prof Catherine Harmer, of the University of Oxford, may ‘say’ the paper gives important insights into the action of SSRI drugs that are relevant for patients, but it is in my opinion this adds just superfluous detail which is of no interest to anyone other than neurologists studying the brain. Therefore her utterance “could help guide the development of drugs with an improved side-effect profile” sounds no more than another of many empty promises.

    The study just confirms that these drugs interfere in the normal state of people who are locked in to a circle of thoughts (as I previously suggested) or in other words: mentally stuck, ruminating, stuck in a rut,.. etc. and to chronically employ ‘blunting’ effect drugs to reduce them ruminating inhibits recovery. So what do we know now, in the every day practical way, that we didn’t know decades ago?

    Splashing non-news like this across main stream media is often a sign too, that the research team are coming to the end of their current round of funding and they are soliciting for more money rather than an indication that their research is worth while or of high merit.

    Post script:
    It is not only in medical science that money (and often our tax $$$) is not being spent wisely (and sometimes grossly wasted) but across all sciences now. Sabine Hossenfelder is a Ph.D. physicist and has been quite vocal over the years, speaking at seminars and so on about how science has lost it way in her field. If you’re interested in physics (if not give it a miss) you might like to watch this short synopsis type video where she breaks her gripes down into a few simple points of what she finds irritating – empty promises being one of them. If the physics terms she uses had been ‘bleeped out’ one would think she was talking about medical research due to the similarities of bad and worsening practices across all academic cultures.
    ‘Can Physics Be Too Speculative? An Honest Opinion’ by Sabine Hossenfelder
    https://www.youtube.com/watch?v=f23eWOquFQ0

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