Monday, May 08, 2006

A Shrink Rap

I don’t want to discuss what happened at GA while I was away for the weekend (besides, our in-house counsel at SoF has advised me not to). So I thought maybe you’d all enjoy a quick update on the general news in psychiatry instead.

First, an encouraging development in the realm of psychopharmacology: coming out shortly, the first antidepressant in patch form. On the surface (so to speak) this sounds gimmicky, and smacks of yet another drug company trying to extend its patent on a medication by “inventing” a “new delivery system”. But in this case, may be some real benefits. The med involved, selegiline, comes from a class of antidepressants which are sometimes effective when others fail—- but are little-used because they require special dietary restrictions which, if transgressed, can cause serious hypertensive crisis. The patch, though, puts the medication right into the bloodstream, bypassing the GI system where the dietary problems arise. So, at least at lower doses, no changes in diet needed. I don’t get worked up about new drugs very often, but this one I’m optimistic about for some of my folks with intractable depression.

Also we’ve been talking a lot at the hospital about the results of the CATIE (Clinical Antipsychotic Trials of Intervention Effectiveness) studies. At a conference last week we reviewed some of the latest data, showing that people with schizophrenia who did poorly on their first antipsychotic trial tended to do best when switched to one particular antipsychotic (clozapine) compared to several others. They did better both in terms of fewer symptoms, and sticking with the medication. Unfortunately clozapine can cause a rare but potentially dangerous blood disorder, so patients taking it have to come in weekly for a blood draw. That’s caused people to speculate that part of clozapine’s benefit may not come from the medication at all, but from the mandated weekly contact with caregivers, a theory we tossed around again in the meeting. It suddenly crossed my mind that no one’s ever considered whether the blood-letting itself might be the therapeutic bonus. I mean, for hundreds of years, bleeding was considered excellent therapy for everything. I couldn’t resist bringing up the idea, but my colleagues were not favorably impressed. I’m considering how to do a study of this…

Lastly, some demographic observations. Below, a map from the latest issue of Psychiatric News, showing the variable concentration of psychiatrists around the country. Look familiar? Compare to the map of election results from the 2004 presidential election. Eerie, no? Consider: with the exception of Michigan, Minnesota, and Delaware, every state that voted for Kerry has more than 13 psychiatrists per 100k population. And, every state with more than 17 shrinks per 100k voted for Kerry. I started making a more detailed analysis of both sets of data, and the correlation started to look even stronger. Example: Washington, DC has the highest per capita shrink concentration in the country, and the highest percentage vote for Kerry. Massachusetts was #2 in the nation, for both.

Coincidence? What to make of this? The most obvious explanation, to me, is that vast portions of the country are suffering from untreated mental illness, causing them to vote erratically and irrationally. I am sure the counter argument can be made—that the northeast and California are full of shrinks because the people are so nuts. But my daily experience argues against that theory: every day in the mail I get multiple letters from headhunters in Red States promising me enormous salaries if I would please just consider coming to practice psychiatry in their communities. I’ve not had much interest in that, but after looking at this data, I’m wondering if it’s my political duty to relocate to Nebraska.


Blogger charlsiekate said...

Okay - I understand the political duty - but nebraska? There are too many other pretty red states. Even though I believe nebraska to be full of great people, I think it might be a little barren. If you want to be out west you could go to Colorado - down south - North Carolina or Georgia. Obviously, I'm sort of bias, but it is a thought.

5/8/06, 3:03 PM  
Anonymous hilllady said...

I'd resist making a move until there's solid evidence of the efficacy of the treatment.

5/11/06, 12:15 PM  

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