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The Disorder disorder – Conflicts of Interest in the Medical or Mental Health Arena
Recently in the media it was announced that there is now a new mental health disorder called ODD being used in the diagnosis of children. This so called disorder equates to Oppositional Defiant Disorder. The condition could be identified where a child has a repetitive pattern of disobedient and disruptive behaviours towards authority figures, which persists for at least 6 months.
ODD is what you and I as parents, adults, and even once children ourself would have called naughty behaviour which has now been quantified into a major mental health disorder. Quite a few of us may consider we had ODD at some stage in our childhood but we emerged and evolved through any such stage of disruptive behaviour.
If children’s disruptive behaviour is a continuum then at the worse end of that spectrum is another disorder known as Conduct Disorder (CD). The Cluster of behaviours under CD include vandalism, lighting fires and cruelty to animals. It starts to look like anti-social and psychopathic disorder behaviours when you read the description of these other disorders.
This alarming trend at Psychiatry in particular, and psychology in general, to apply reductionistic thinking in breaking down the spectrum of human behaviours into behavioural clusters, and naming them as conditions and disorders, matches the physical equivalent in medicine. Both fields are rooted in the same scientific principles of quantifiable and measurable empirical sciences.
Even as far back as Freud we had the coining of the various personality types, various mental health disorders, and conceptual frameworks of the mind as named entities. This convention is needed to allow each one of us to understand and agree on what we are defining, measuring and discussing.
A more recent enabler of condition naming has been the gradual evolution of a psychiatric “bible” of mental health conditions which is known as the “DSM-IV”. This reference manual has the full name of Diagnostic and Services Manual – Release IV (4)” and is the standard and hence “bible” of both psychiatry and psychology.
Psychiatry has in its origins longed for acceptance as a medicine, a psychology or a science. In the pre WW2 era it was denounced as being almost as bad or quackery just like the cure-all tonic sellers of the day.
The industry was given a boost in WW2 and afterwards as a medical science when the U.S. military was to discover the clinical results of the inhumane concentration camp medical research that the Nazis and the Japanese conducted on inmates.
The military and the USA government had its military reasons to “warehouse” this knowledge behind the Psychiatry industry. Released CIA files show the U.S. military colluded with psychiatrists in continuing secret research on the effects of drugs on humans for brain washing, mind control and espionage matters.
Think of the film “The Manchurian Candidate” which while fictional was based on experiments and aims attempted by both American and Chinese/North Korean military “Psychops” sciences at the time to create assassins activated by subconsciously encoded “trigger words”.
The enormous budgets consumed by military functions often lead to the commercialisation of their techniques and findings over time. So it was with psychiatry which benefited from a close post WW2 association with the military and established itself as a mainstream commercial medical/psychological bridge in the 1950’s.
Over time the DSM-IV manual came to represent that body of knowledge which was the pharmacological or drug solutions as applied to mental/emotional conditions and which were explained being primarily a neurological (brain) condition or chemical in-balance.
Psychiatry found a legitimate home in both the medical and psychological communities models and started to receive referrals from both. Many psychiatrists used psycho-analytical techniques we commonly see in counselling/psychology/psychotherapy where past childhood events are examined for links to current conditions. Drug therapy was often complementary to this for quite some time.
The body of mental conditions in the DSM-IV for a long time was considered a useful body of reference knowledge that helped in the diagnostic process for new clients. Psychiatrists were trained with good analytical skills and often provided a client service not unlike that of psychologists albeit though they could prescribe the strong medications needed for some of the more severe and often psychotic conditions they dealt with.
The act of being referred to a Psychiatrist was considered a significant event. It could be done by either a GP or a psychologist, politician, police officer or medical person. There was often significant powers attached to the decision to do so, including the power of involuntary admission, restraint, isolation and detention in facilities without the right to discharge oneself.
In recent time the DSM-IV has blossomed with a range of new disorders such as ODD and CD that start to question the real agenda behind such disorder creation in Psychiatry. This then calls into question the wider ethics and impartiality of the industry.
There is now a common view that the medical model triangle of GP, Psychologist and Psychiatrist live and work in a major conflict of interest. These 3 professions are now considered by numerous commentators as being compromised by the funding and marketing techniques of major drug companies.
Each of these 3 professions has a basic dictum to “do no harm” and the old symbol of the two entwined snakes around the rod is a symbology that reinforces the “Hippocratic Oath”. However the rise of the multinational reach and incomes of drug companies has seen these 3 professions potentially beholden in varying degrees.
Drug companies are capitalist profit motive entities who do not have a social responsibility ethic nor a “do no harm” ethic. Think of drug companies as being like cigarette companies. Their sole responsibility in their own minds is to make profits for shareholders. There are no other real stakeholders to such companies and their impact and effect on the community is met with a narcissistic indifference.
The impact of their products and services on society and its members is not their concern and they fight aggressively when others try to make them accountable for their conduct or efficacy of their products. The drug companies and some medical technology companies are no different. It’s just that their product is different and the market segment they occupy is different.
Drug companies have worked out long ago that the “black mail” point for GP’s, Psychologists, and Psychiatry is in the area of funded professional training and conferences. These 3 professions have a professional ethic of continuous training and professional development. The rapid advances in medical technology, drugs, and psychology/neurosciences make that a must in order for any professional within these 3 professions to keep up.
There are no clear service providers in the industry to provide such a service in a co-ordinated or funded way as to assist these 3 professions maintain their professional qualifications and standing. The Drug companies and medical technology companies instead often “host” their own professional conferences, trainings and events which satisfy the criteria for ongoing professional development.
The 3 professions (GP’s, Psychologists and Psychiatrists), would normally find such training expensive to attend. They must attend to satisfy the professional development criteria that if not met may render them unable to meet their legal requirements to get professional insurance, to be part of their industry professional bodies, or to practice with competency with these new technologies and drugs.
The drug companies and technology providers know this and the evidence has been that the Sales Representatives who leave company branded note pads, pens, gimmicks and incentives with these 3 professions as they work their rounds, are also those who can get the same professionals onto “conferences” and events.
There is an implied loyalty or mutuality here that creates in my and others minds a conflict of interest. GP’s are under pressure to prescribe drugs and they also are often a primary referral source for psychologists and psychiatrists.
Many members of the public cannot get into seeing a Psychologist or Psychiatrist without a GP referral, and are increasingly referred to specialists for more tests of various kinds. More and more the general public is becoming cynical with these self serving behaviours and believe that many in the 3 professions are working to a “Hippocritic Oath” more so than a “Hippocratic Oath”.
The GP gets paid for the non medical act of writing a referral to another specialist. In addition, most GP’s I know are not trained to work with anxiety, depression or mental health issues but regularly write prescriptions for drugs along the DSM-IV categories of some of these conditions.
There is a predominant attitude of GP’s medicating patients without necessarily first having a proper assessment taken place by a mental health professional. GP’s are trained to work with the body not the mind but the industry allows this boundary to be crossed in professional practice.
It is common that clients on these medications are basically told they are now on these for life or are not given advice on alternatives which may look at causes and cures rather than just numbing out their symptoms to stabilise them which many of these drugs do. In some cases they may be alternatively referred to a psychiatrist or psychologist which is where the relationship between these 3 professions are reinforced.
The various classes of drugs often produce a stunning array of side effects depending on the chemistry of the patient. This is known as the “iatrogenic effect” and means how medicine makes you sick through its side effects. Drug companies produce an origami like folded brochure stuffed inside the packaging of their drugs.
The SSRI Anti-Depressant medication ones I have been given by clients are of such a small font as to be almost unreadable, and the list of possible side effects is such that the cure may be worse than the disorder!! I have yet to meet a client to whom this leaflet was taken out and read to, and explained to them, by anyone in the 3 professions who prescribed them in the first place.
The federal government has for some time had in place a Mental Health Plan which allows GP’s to refer clients to Clinical Psychologists and Psychiatrists for subsidised sessions. There are reporting obligations and invariably a number of GP medical appointment sessions occur between the client and these other professions leading to income generation for all.
The evidence is that many clients get offered or pressured in adopting drug solutions in this environment. The dependency on client referrals, income from both the government Mental Health Fund and those with the required Mental Health Provider numbers locks everyone into a comfortable system.
The learnt dependency on this system was shown recently when the Federal Government announced earlier in 2012 that the subsidy amounts and the number of sessions that were authorised under the Mental Health Scheme was being wound back. The squeals from the trough where the attendant professions gather to feed from this billion dollar subsidy system was pronounced.
The drug and some medical technology companies sit outside this system feeding everyone inside with samples, trainings, paid for trips, holidays, and incentives. If one thinks this is not true then just look to the Western Australian Health Department scandals of recent years.
There has been two separate instances and investigations of public servants in the W.A. Health Department being found to have been compromised by medical technology companies with free trips, free trainings, free air flights and accommodation, free gifts and incentives. These same companies lobbied and were involved in tendering for contracts with this same Department before and during these instances of “gifting”.
The governance of tenders means that companies participating in tenders are legally not to cross boundaries by compromising the integrity of the tender process through solicitation or gifting or inducing favours, and the Department public servants are to resist and report any attempt to do so.
The scandals revealed a culture of entitlement within this department and a systemic or pervasive set of compromised relationships or interactions between the public servants and the companies concerned. The investigations concerned contracts for the public health system potentially worth hundreds of millions of dollars over time.
This was reported by commentators as being the tip of the iceberg in terms of the manner in which Drug and Medical technology companies pursue their aggressive marketing agendas with stakeholders and market “touchpoints”. The 3 professions are “touchpoints” under this marketing speak
There is no leap of faith here required to think that Drug companies would not exploit their relationships with the 3 mentioned professions if they could. The evidence is that this has been occurring for many years in other countries and within Australia.
The tie-in with the DSM-IV manual and the rise of disorders is seen by concerned commentators as being yet another strategy to legitimise the selling of more drugs to a wider population over time. A global strategy of drug companies is to normalise the lifestyle and behaviour of taking drugs and medication as part of a “normal lifestyle”.
The goal then becomes to get as many members of a population as possible being medicated under some legitimate guise. The 3 professions are the camouflage and delivery channels that execute this strategy.
The American experience and commentary is that for some time there has been a widening number of new disorders being coined within the 3 professions. The logic is that the more disorders that exist means the more new drugs that can be created or the number of existing drugs that can be associated with new disorders. This legitimises their existence.
An example was ADD and ADHD conditions that hit Western Australia like a plague 10 to 15 years ago. Western Australia had the highest incidence by state population of these two disorders in Australia by some 130% according to some reports. Was it something in our water that singled us out?
These two conditions were treated with some strong drugs such as Ritalin, and sometimes in a cocktail of other drugs mixed in. The disturbing conclusion reached in some quarters since then is that we medicated a vast number of school children with serious amphetamine–like drugs as a result.
Not only that but we labelled these inattentive and distracted youth with a negative connotation and disorder label that probably traumatised them just as much as whatever was going on for them. There is evidence from neuroscience circles now emerging that these children were exhibiting a form of inattention based on early childhood trauma.
Childhood developmental trauma is now increasingly being understood as the field of Neurobiology evolves. Schools of thought within neuroscience see ADD and ADHD behaviours as possibly a lack of attachment with parental figures, which created a hyper-aroused nervous system.
Such children have been found to as a result have a defence where their brains are distracted by tracking their environments in a form of “hyper-vigilance” arising from living more or less in “fight or flight” mode of their Autonomic Nervous System.
What is disturbing now and which parallels the cigarette industry is that year’s later evidence is emerging that these Ritalin style drugs have created health issues only now being realised and understood. There is statistical evidence showing a high proportion of Ritalin style medical child drug users growing up and becoming adult addicts of heavy illegal drug users, particularly with “Speed”, “Ice”, and the Methyl-Amphetamine class of illegal drugs.
We may come to regret the choices we were guided or forced into those years ago with our children. There is now debate about how and if this condition really exists outside it being trauma and if the drugs recommended by the 3 professions are fit for purpose. Drug companies remain silent.
The American commentary and arguments are that the drug companies are looking around for new disorders to coin and classify such that they can create a new class of drugs for, and then legitimise them through inclusion in the 3 professions via lobbying, training, and inclusion in journals and “bibles” such as DSM-IV.
Psychologists are saying that ODD does not involve the prescribing of drugs but it does normalise the labelling of children as they having something wrong with them. Some senior psychologists claim ODD “is not rare” and may represent 6 to 10% of the population of children. It is also not considered a serious mental health problem by the same senior psychologists.
Why then do we create a negative label over our vulnerable children and start to shape their emerging identities in a negative way so young. Research has repeatedly shown that children give negative nicknames, labels and outcomes such as ugly, stupid or bad, then are likely to go onto have social adjustment issues, low self esteem issues, depression, addictions and suicidal ideation issues as adults.
Why then would we create and impose another negative label over our children. The condition is considered not to be a serious mental health disorder but the outcome of being negatively labelled can in fact produce later serious mental health disorders and low happiness and achievement outcomes.
Could we just be paving the way for normalising more of us to be in need of drugs or medication because we are found to be medically having a disorder of some type? It is far easier to start with a less severe disorder and then shape and shift perceptions over time towards a more severe outcome. The negative label may be the agent that creates that real outcome and so is the gateway to a true later mental health issue.
There has also been numerous scandals over the last 40 years around the so called “independent” research undertaken by drug companies. This research is often later outed and exposed as being a heavily conflicted research carried out by drug industry appointed professors and researchers, paid and funded by the drug company concerned.
An example was the drug Vioxx which was a heart condition drug that was allowed into the Australian market. It was later found to have contributed to fatal heart attacks in some users. A government enquiry found misleading sales techniques, altered research, and conflicts of interest by the company concerned and sales representatives when promoting the drug.
In general, the research is compromised from the start and the pressure is on to distort or falsify results to a favourable result for the drug and the company creating the drug or medicine. The medical and drug industries have become corporatized and now we find even doctors surgeries becoming corporate entities where doctors are “employee”.
The existence of these scandals reveals the tentacles that exist in the whole industry where drug companies are stakeholders. The same problem exists that exists with training of the 3 professions. Who pays for the research?
It is legitimate that drug companies do extensive product research as this is a valid part of the methodology of developing and commercialising drugs to market. This process can take 7 to 10 years to execute and may involve the investment of hundreds of millions of dollars. There is a lot at stake as each new drug is what creates the “pipeline” of business for these drug companies.
A drug trial that fails or produces bad side effects can cost the sponsoring drug company billions of dollars in future earnings. The company is typically only concerned with shareholder outcomes and profit motives so the risk of corruption is real and has been shown to exist as they seek to satisfy these drivers.
At the other end of the drug service delivery chain we have the 3 professions. The advent of the corporatized medical centre run on business principles means that these entities are now setup to serve shareholders and the profit motive. The owners are typically entrepreneurs who by definition are seeking wealth.
To whom do the employees who are often one of the 3 professions now serve and make primary in their ethics? The patient or the boss? The medical centres and surgeries are end-to-end supply chains of medical services often with a cluster of pathology, eye services, hearing, pharmacy, physiotherapy and psychology all bundled up in one centre.
As in any business the profit motive is primary and customer service is secondary. One notices that many of the Medicare subsidised services are clustered under one roof. The pressure is on for GP’s to over-service as this creates the highest income return from any one customer or patient.
This strategy is borrowed from banking which worked out long ago that it costs five times as much to attract a new customer than to over-service and up-sell to an existing customer. There are certain business sectors that deal with customers in emotional or vulnerable circumstances and so can effectively exploit their customer base in these emotional or vulnerable moments. Think of funeral services.
Patients at Doctors’ surgeries or with Mental Health Professionals are also in an “emotional contract” with their clients. What I mean is that when we go to the doctor or a mental health professional our physical or mental health brings emotionally to a place of vulnerability and concern. We are ripe emotionally for exploitation.
A simple raised eyebrow by a doctor, a simple “tut-tut” while he looks down our throat with his torch, a pronouncement of a disorder by a mental health professional, and we are rushing to get out our Medicare and HBF cards to pay for and line up for those battery of tests or take the drugs he/she now feels we better take in case it is something serious.
In many cases the drugs serve a useful purpose in a short term setting. One may need to stabilise and become functional and in present time consciousness. The severe disorders and the severe drugs have a place in our understanding and treatment of human bodymind disorders and conditions.
The growth of new disorders and the growth industry of medication of the masses based on suspect motives and justifications is the elephant in the room very few speak about. There are too many benefitting from a system that sloshes with billions of dollars in federal and state funding, private health care and consumer dollars.
The whole industry has degenerated into a morass of conflict of interest. Just watch out for when you next mention to your GP or your psych that your 5 year old son and your 4 year old daughter were fighting over crayons.
You may get that feigned look of concern and the writing of a referral to your local psychiatrist or a script for some form of drug for your now ODD or CD labelled children.