Friday, October 14, 2011

INTRODUCTION; Please don't call it treatment; or The treatment that isn't

(I am looking for a cartoon by Sidney Harris on Hippocratic where the readers of the documents want to return medicine back to a mystic art because a professional would be require to actually learn and study to continue to improve and become a lot more effective and safe health to their patients.


This blog is based in South Florida, but from my understanding these issues of mental health and substance use treatment crisis is nationwide.  Practitioners in the psychological allied professions seem to have forgotten that treatment is about health and not about anything they wise it would be but actually what science as supported to be effective and safe. To many practitioners have accepted at face value (the apparent worth or meaning of something, which may be better than its true worth or meaning less.  For most medical condition the latter is more frequent. Meaning that what is being offer has no true value at all and it is totally invented without evidence of its effectiveness or safety). Most practitioners continue to place the public at risk oblivious to the fact that they may be doing harm (hopefully repairable if caught) to their patients.

This problems seem to have occurred because United States general public has lag behind in science and so many European countries have taken their own scientific lead and is leaving the United States fairly behind in technical know how.  More on this on other later posts, but for now I want to establish that what we call substance use and a substantial part of mental health treatment does not meet standards of the medical science but rather something that has been developed independent with little if any evidence of it's efficacy and safety.  In fact, the practitioners are ignorant to the possibility they are harming their patients, they make the presupposition that their techniques are bening, kindly, compassionate to all patients with out the possibility of malignant effect. Not many professionals have question the wisdom under which substance use treatment is being performed. (Robert Westermeyer, Ph.D. Addiction Treatment: What On Earth Are We Doing?)  Quote from this scientific based article; "However, the field of substance abuse treatment is lagging significantly. The field of addiction has been dominated by a model that has not changed much since its beginning. I am referring to the disease model and the 12-step model of recovery."  I personally think that the 12 Step program is religious indoctrinations and it was never designed to be a treatment protocol.  Even tradition 6th, 8th, and 11th clearly give us the understanding that it was designed to be a Fellowship or a Society of man and women with a common interest to assist each other reach goal of alcohol or substance abstinence.  It clearly states that they should never lend their name to any related facility (like a treatment center), will never be professional (like the counselors in those programs) and that the 12Step program is based on attraction not promotion. Once it is made to go to meeting their is no attraction but demand

I do not expect the general public to fully understand medical science, but my task is to write with the intention of you becoming an educated consumer.  What I CAN EXPECT is that you are rational enough to understand the fairly simple explanations am about to provide you in this blog.  I do believe in full interaction with the readers, so if I am insulting your intelligence or you feel I am talking down at you please let me know. I like nothing better than writing at a level where the words I use will be a lot more accurate than an extensive explanation.  I like to explain to you that while these are widely held concerns of mine not much of it is my own opinion. I am not that original. And I am not too sure these concerns maybe opinions I think that they are a lot closer to facts that are based on scientific consensus.  The credit goes to a number of professionals that will be introducing in later post. I will give a some explanation about my concern and link you with the appropriate article that may go with the post. These professionals have been expressing my interest and worries for a lot longer than I and they have the background in science I am now only learning.

We as patients have a long history with the field of medicine. When we do not feel well the first people we usually approach is our family physician. This is a profession we literary trust with our lives. From past experiences we have counted on these professionals for all our health needs. Most physicians keep up with the latest medical development, and if your illness is beyond their expertise they refer you to a specialist. Today we enjoy the highest standard of health and life expectancy ever. No doubt greater than our grandparents ever did. As a group, the human race lives up to ripe old age.

If you are like me when we go to our physician for say an infection (for example), we can almost take for granted that the medicine the doctor prescribe us has been rigorously pharmaceutics empirically quantitative study before the FDA allows for the medication be marketed.  I can give assurance with high degree of certainty that not such research exist for most medical care in substance and mental health treatment. That is of no surprise when we note that the professionals do not read scientific articles such as those of their own professional journals (see "Purpose of the Blog" Beutler, William & Wakefield,(1993)). Psychotherapies (appear to be worldwide,but the research surveies were done in USA and Canada

When anyone speak to them it becomes clear that these professionals are not readily prepared and are terribly unknowable of the science required to produce the quality of treatment patients deserved and take their time and attention to receive.  There have been a call among the professions that clinicians should first be scientist and then practitioners. Why is it that patients for all other medical condition receive the best and latest scientific findings and substance use and mental health patients does not receive the same courtesy? 

In medicine, when microscope was developed by Galileo Galilee (amongst others who also worked on the devised).  Optical science improved not only the telescope to look at the Astros, but the microscope to look at much smaller objects such as insects, microbes, germs, infection, virus, bacteria which improved provide advantages to the science of medicine.  The development of the microscope went on to the development of the Electron Microscope which allows for us to see much smaller and smaller objects and microbes for scientific studies.  The refinement of the microscope gave scientists their first opportunity to examine animal tissue at high magnifications.  The cell theory was proposed in 1839 establishing that all tissues are composed of microscopic units call cells.  Brain cells were identified and eventually came the development of the neuroscience that done so much for brain research that is done today and its continue development. The same is true with the discovery of X-Ray machine.  The photographs you see below is the 1st Copy of an X-Ray done by Wilhelm Rontgen on his wife's hand does not take much to notice that today’s X-Rays have become digital without a need for film.  Do I need to say more? In medicine as well as in science produce and treatment improve with the advances in scientific investigation. Basically what I am saying is that honest and valid medical treatment has been based on science since the Greek Hippocrates of Kos.  The advances in medical treatment has basically been based on science and no other field like philosophy, arts, literature science, science and only science has been the major influence and standard where medicine and the therapeutic modalities are based on.  Yet, at least in the psychology allied professions, the field have been falling off and have been trying to developed treatment based solly on untested hypothesis ( a propose explanation for a phenomenon).  What patients and even clinical practioners do not realized is that eventhough there is a sizeable core of psychological scientific research, the practice of substance use treatment and mental health is prevesably based on pseudoscience and untested hypothesis.  This poor attitude of clinical practioners is kin to believe the world is flat and the sun rotates around the earth. To believe that because one has education in one of the psychological allied professions, a license and number of years of experience and disregard the science behind the field of study is like believing one is ammune to the same congnitive limitation that the rest of the human race sufferes.  This can be dangerous, and places the patients at risk, given that they are oblivious of the errors that are being committed in the name of treatment and recovery.

Although there is a substantial and significant core research based in psychology and it's allied professions.  We most stand and demand that such treatment and advances be duplicated and honestly provided to the patients.  While for decades the Substance Abuse Mental Health Service Administration, patient advocates as well as researchers and clinical scientist have been talking and discussing "Evidence (Research) Based Treatment".  Treatment staff in the grand majority of the facilities, clinics and private practices has been basically twirling their fingers about the science behind psychology; patients suffer from misinformation and maltreatment (malpractice in legal terms).  I think it is outright laziness that a substantial group of professionals (remember the Butler, William & Wakefield, survey that only 28% of the mental health professionals read science articles) basically ignored the science they are supposed to know.   They will imply that what they do is based on some kind of science but in fact they can not back up their methods with any actual compelling scientific findings.  Do not think for one minute that they attitude these professionals have is benign or benevolent to the patients, it is outright unethical (see Value: Competence; Standards; 1.04 Competence; 2.10 Incompetence of Colleagues; 3.08 Continuing Education and Staff Development for example in social workers but it is true for psychologist and mental health counselors   Continuing education and staff development should address current knowledge and emerging developments related to social work practice and ethics. )for any of the helping professions to ignore developments in their field.  There is questionable attitude much unethical behavior and ignorant of the science, biological, even the legal civil rights of patients IS MAJOR UNETHICAL behavior. Even the professional organizations like the American Psychological Association, the National Association Social Workers, American Mental Health Counselors Association as well as other medical and help related professions have not been very good at policing themselves. They seem to be a lot more interested in keeping the "professionals' " membership fees and other monetary monetary funds that the organization may get from "followers of quack theory" that are ineffective and even potentially harmful than the complains and concerns from you and me who are consumers of the services and unlike the professional members WE do NOT PAY THEM ANY MEMBERSHIP FEES or any other monetary benefits to the organizations.  So unless we as consumers do not place any pressure through malpractice suites and criminal conduct. So when you start suspecting unethical behavior on the part of the professionals. Document document documents
We as consumers are already on the wrong side of sanity. Most professionals are already oblivious to the fact that they are biased against us consumers we are in their arena, we are 'not professionals"<although frequently we may behave a lot more professionals than they do, who seem to be more interested in covering their assess up than to solve the problem within their staff behavior

  All patients are suggested to read and become familiar with the Code of Ethical behavior of all of the professions that are to treating you.  I assert that specially in alcoholic treatment facilities the violations of ethics is prevalent except that patients are not aware of those principles of ethics and their own patients rights. Not until patient begin to make complains of those violations to state licensing boards and professionals associations are their going to be any justice in treatment for these patients.

Those who have ever been in treatment for substance use and mental health would realize that we are doing the same and the same and the same without the benefit of development and scientific improvement.  Substance use and mental health have basically made no improvement in the past 30 years because is not based on the same science and the continuity of improvement that is required to maintain a system call TREATMENT.  What we call treatment in substance use and mental health is basically treatment by declaration as it has very little if any basis in science. In reality what we call treatment is no more than the professionals personal indoctrination of what they think the patient should do. When the patient does not respond appropriately, the patients are blamed and it is said to be resisting treatment enough reason to discharge any one from treatment (in their mind but not legally, specially when  they require treatment exist patients have the human rights to receive science-evidence based treatment rather than much of the counterfeit therapy or remedies that is currently dispence by substantial number of mental health practitioners.

I encourage your participation by not believeing any of the claims I make on this blog. I welcome your studing and your skepticism you may have in any of

The Research-Practice Gap: Clinical Scientists and Independent Practitioners Speak

Alcoholism treatment  
outcome research on AA alone has been rare, and when examinedexperimentally, its efficacy has not been well supported compared with other treatment interventions. However, some have suggested that such studies may not truly reflect the efficacy of AA (see Emrick, 1987; McCrady & Delaney, 1995), as they have relied on"coerced" samples (e.g., DUI offenders).

Mental Health

Stanovich, Keith S. "How to Think Straight About Psychology" 1998 Longman

Barry L. Beyerstein, Ph.D.  Why Bogus Therapies Often Seem to Work
short version:
Longer explanation:
Those who sell therapies of any kind have an obligation to prove, first, that their treatments are safe and, second, that they are effective.

Stephen Barrett, M.D. William T. Jarvis, Ph.D How Quackery Sells

 Quack Watch. Com
Is an organization of science based professionals
Blog Note: To be continued