The Carlat Psychiatry Blog: Dirty Thirty Update

Saturday, January 5, 2008

Dirty Thirty Update

Apologies for my hiatus in postings. I've been in California researching an article on the limits of functional neuroimaging for Wired Magazine. I interviewed Daniel Amen of the Amen Clinics, Joel Huizenga of No Lie MRI, Joshua Freedman of FKF, and Robert Rubin, chief of the Wadsworth VA Psych Department. Interesting trip--next up: interviews with Ryuta Kawashima, the inspiration for Nintendo's Brain Age game, and Roy Johns, a leader in the use of EEG brain mapping.

Regarding what this week's British Medical Journal is calling my "March of Shame," so far I've given grand rounds at Lenox Hill Hospital in Manhattan (Dec. 12) and a talk for Tufts' Progressive Student Association (Dec 10). Okay, two talks in a month is not exactly sprinting out of the gates, but I have various other talks scheduled, including one for the Vermont Psychiatric Association and another for Eastern Virginia Medical School. I'll keep you updated.

My goal is to do thirty free counterdetailing talks in 2008. Here are the specifics. I charge no honorarium, but for talks that involve extensive travel (defined as requiring either a plane flight or an overnight stay) I am requesting reimbursement for these travel expenses. Accuse me of not being a purist, but I'm not interested in becoming a pauper over the course of the year. I expect most of my talks will be at local PCP offices, and this next week I will be calling the same doctors I visited in 2002 in order to offer them my counterdetailing services.

6 comments:

Anonymous said...: I'd just like to add that if you were really serious about your "Walk of Shame," you'd return all the money you earned.

The idea that your counterdetailing is valuable is certainly not evidence-based. It clears your conscience and you don't have to do anything hard.; January 6, 2008 at 2:17 PM
Anonymous said...: What would returning the money accomplish other than giving the pharmaceutical company the added bonus of having gotten his detailing services for free? Visiting the same practices to provide unbiased information to counter his earlier biased statements will help correct the wrong he did. I applaud his initiative.; January 6, 2008 at 5:21 PM
soulful sepulcher said...: I'm curious about the Amen Clinic interview; is that the one in OC? My mom has told me to have my daughter's SPECT done there for years. I asked one psych about it in 2005, and he waved his hand in the [hospital inpatient lobby] air, and said it was junk science.

I've heard other people swear by their psych meds, per the results of a SPECT being a 'right on target' predictor of medication need/result/diagnoses.

I have a few questions, in a "just suppose" setting: [I'm always thinking]

What do you think about SPECT, and would you use this as a diagnostic tool?

What would you tell a patient that came to you with a scan, and asked you to continue their care, for instance as a new patient in the area?

Would you consider their dx valid?, or do your own diagnosing method? and what is that?

(I would also like to have airfare and hotel expenses paid to teach doctors.); January 7, 2008 at 2:26 AM
soulful sepulcher said...: You were so right when you said "you don't know who to trust", on the PBS Frontline show, "The Medicated Child."; January 9, 2008 at 1:55 AM
Daniel Carlat said...: Stephany,

I'm still gathering thoughts about SPECT and the Amen Clinic but my first impression is that there is little in the way of legitimate science to endorse using SPECT in most psychiatric settings. The one exception: differentiating frontotemporal lobe dementia from Alzheimer's, which is a Medicare-approved indication for the use of PET scans (higher resolution than SPECT).; January 9, 2008 at 12:40 PM
soulful sepulcher said...: Thank you for answering my question,I appreciate it. This brings me to another: frontotemporal lobe seizures?

I've read over the years that bipolar can often be dx'd when in fact patients are having seizures, and this is why Lamictal, etc. often "works". I work with autistic children who have many types of seizures, and the moodswings go along with the territory.; January 10, 2008 at 3:39 PM