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Rethinking Psychiatric Drugs :
A Guide for Informed Consent http://www.rethinkingpsychiatricdrugs.com
-- the process by which psychiatric drugs reach the market -- the history and philosophy of Evidence Based Medicine -- the common flaws in research methodologies which negate the validity of the psychiatric RCT (Randomized Controlled Trial) -- the problem of allostatic load (how drugs stress the body) -- the history, long term effects, and utility of the drugs used to suppress symptoms of depression, psychosis, inattention and hyperactivity -- the effectiveness of alternatives to medication Rethinking Psychiatric Drugs: A Guide for Informed Consent exposes the current crisis in medical ethics and epistemology, and attempts to restore to psychiatry an authentically informed consent to care. Dr. Grace
Jackson is a board certified psychiatrist who graduated summa cum laude from
California Lutheran University with a Bachelor of Arts in Political
Science and a Bachelor of Science in Biology, as well as a Masters Degree in
Public Administration. She earned her
Medical Degree from the University of Colorado Health Sciences Center in 1996 and completed her
internship and residency while in the U.S. Navy. Following her service as a staff psychiatrist
at Bethesda Naval Hospital, she worked in the North
Carolina prison system. Dr. Jackson has lectured widely in the United States and Europe, and has testified as an expert witness in forced medication trials. Her interests include philosophy, history, politics, and law. Free PreviewIn 2004, an on-line medical newsletter posted an article with a captivating title: “All the Things They Taught Us That Were Wrong.”1 Penned by an academic psychiatrist who completed his post-graduate training nearly two decades before my own, the essay resonated with my own discoveries during residency and beyond. Probably like him, my patient care and research experiences transformed me until I, too, developed the painful awareness of “all the things my teachers taught me” which proved to be untrue. This book is the culmination of many of those discoveries. It is the result of a five-year (and continuing) process of corrective self-education. It is the philosophically, epidemiologically, and scientifically supported revelation of how and why clinicians have often
failed their mental health patients, partly because the information upon which they have relied (Evidence
Based Medicine) has become increasingly unreliable. This development, along with many more, has
compromised the ability of physicians and patients to participate in the
construction of viable, informed
consents to care: “Informed consent …is about the right to make choices
and the right to refuse consent; it is about the right of individuals to
preserve their integrity and dignity whatever physical and mental deterioration
they may suffer through ill health; it is about our duty always and in all
circumstances to respect each other as fellow human beings and as
persons.”2 The chapters which
follow are intended to facilitate the shared decision making of consumers and
health care providers. First, the
public’s opinion about psychiatric drugs is explored through research conducted
in several countries. Next, the sources
of professional opinion are reviewed, beginning with the drug development
process and the philosophy of Evidence Based Medicine. Chapter four explains the gold standard of
medical research – the Randomized Controlled Trial – along with an emphasis upon
the methodological deficiencies which commonly distort the value of drug
treatments. Chapter five is an overview
of the human brain. This is offered for
the reader who desires a more detailed understanding of the targets of
psychiatric drugs in terms of their chemical and structural effects. Chapter six introduces the concept of allostatic load – a phenomenon of maladaptive changes made by the body in
response to stimuli, such as medication. The chapter includes discussions of tolerance (an important mechanism of decreasing
responsivity to treatment over time) and drug
discontinuation syndromes (withdrawal and rebound). It presents the concept of sensitization as a
possible explanation for the phenomenon through which pharmacological therapies
may effect a progressive worsening or prolongation of initial symptoms. At the heart of the book is a detailed examination of three major classes of psychiatric drugs: antidepressants, antipsychotics, and stimulants (the latter, given for Attention Deficit Hyperactivity Disorder). The history of each drug class is reviewed. A neuroscience section explains contemporary hypotheses about presumed mechanisms of action. A special emphasis is placed upon the topics of drug effectiveness and safety, including long term effects, uncommonly acknowledged dangers, and alternatives to medication. The book closes with a discussion of the current crises in psychiatric research and practice, particularly as these problems continue to undermine the capacity of physicians and patients to collaborate in authentically informed decisions about health care. |
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