Posted by Cam W. on August 15, 2001, at 19:24:14
In reply to that other thread » Cam W., posted by Elizabeth on August 15, 2001, at 18:02:02
Elizabeth - • I believe that a lot of my tirade against Sal is just me refocusing the anger (fear?) that I have been experiencing, lately. I have said my piece (peace?) and will leave Sal alone, from now on (except to correct obvious mistakes, or to add more information). I'm sure he is a nice, compassionate guy, who just wants to help people. Hey, you can't knock a guy for that!
•I hope that you don't mind, but I will answer or explain under your comments.
> > He never refutes that claim, except to say that he has taken all of these drugs (hardly an objective opinion), usually in megadoses, and has access to all of the world's medical journals.
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> As I'm sure we all realise, "access" doesn't imply reading and understanding.
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•I am not sure that all of the posters and lurkers would understand the implications.
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> > I feel that his statements are tantamount to the Beatles taking LSD to attain nirvana.
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> Umm...this was before my time. ?
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• The Beatles went to India(?) to learn from a yogi about life and beyond when they were heavy into LSD. They thought that taking LSD would be a shortcut to nirvana. They found out it wasn't, especially when the yogi tried to sleep with one of the girls that were brought along. In the same light,just having access to all the medical journals in the world does not make one an expert in the field. I was trying to use an analogy, but I still suck when it comes to writing clearly.
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> > For example, if a person is not sleeping after an adequate trial of olanzapine, ...
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> I think you're stretching it here. :-)
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• Yeah, I'll give you that one; it was off the top of my head. ;^/
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> > Switching meds is by far not the first step in modifying most medication regimens.
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> I think it depends on the situation.
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• I guess that I should have added, "when a psychotropic medication has shown some efficacy", but as a rule, their are no rules, as you state.
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> > I am not saying that subjective experience is not important; it is extremely important, but this type of information should not be given the same level of import, as longterm, naturalistic studies, until they have been shown that subjective experience can be incorporated into the theory.
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> On the other hand, theories that ignore subjective experience (of the patient, that is) aren't necessarily so meaningful either. I think that objective studies aren't always sufficient (even when subjective evaluations contribute to the results -- e.g., by the use of pseudo-objective rating scales).
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• Subjective experience leads to the objective theory which can be studied using scientific method. I think that you need, as a good base, the objective theory (with it's corresponding studies showing proof), but that base needs to be malleable, so that subjective experience from post-marketing surveillance can be integrated into the theory, when the subjective experience is proven to exist. The delayed weight gain with Paxil or the increase in non-insulin-dependent diabetes with Clozaril or Zyprexa users are examples of subjective experiences that were pooh-poohed because there was no objective information in the literature. In other words, you are right, objective theory is only as good as the studies that confirm it; subjectiveness will always be needed. The posts we answer here are of the subjective nature, where we have to be careful not to read into the case, something that isn't there (hard to do sometimes).
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> > You cannot ignore Sal's posts, as you ignore a troll.
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> That's a good point.
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> > The incident which scared me most was when Sal told a person with schizophrenia to stop his risperidone cold turkey, and that there would be no problems (James called him on that on).
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> I missed that one, I guess. I agree, though: prescribing (or de-prescribing < g >) is not something that should be going on here.
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> > Shelli, I was taking it as a personal affront to the 22 years I have been learning this stuff.
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> I understand. Your knowledge includes knowledge of your limitations; a person without such knowledge might be unaware of his limitations.
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• I shouldn't take his advice as a personal affront, though. He is not crowding my space or anything. I don't feel that I need to mentor him, either. I guess the best bet is to monitor his posts. He will learn what to say, and not to say, as time goes by.
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> > If he thinks that posting abstracts and links gives him knowledge into psychopharmacology, he is just taking LSD.
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> This is where you lose me. < g >
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• I was alluding to the analogy of the Beatles, where knowledge and insight come only from hard work, and a lot of reading for understanding.
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> > We may end up at loggerheads at times, but hey, that's science.
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> It sure is.
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• Thanks for your comments, Elizabeth.• Sincerely, Cam
poster:Cam W.
thread:67742
URL: http://www.dr-bob.org/babble/20010814/msgs/75213.html