![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 20 to 44 of 57. Go back in thread:
Posted by LLL on September 18, 2002, at 16:47:51
>Oh and BTW, why is there a pharmacy rep on here? >Isn't that kinda like Spam or having a talking >ad for Forrest Labs in a consumer/patient chat >room?
>It seems to cause many reactions from otherwise >well meaning people. Can't we cut the ads and >talk to real patients and doctors?
This was posted on Psycho Babble by another poster. I agree, why do you continue to tolerate having a pharm salesperson on the board. I was told to be civil after pointing out to him that referring to someone as "nasty" is being judgemental. His response to me today? "that's not a judgement, telling someone "no need to get nasty" is a figure of speech!"
I do not understand why you continue to tolerate his presence when it seems to be quite inappropriate.
However, I'm sure that by stating this opinion I will get blocked.
Posted by Dr. Bob on September 18, 2002, at 20:39:46
In reply to Dr. Bob, posted by LLL on September 18, 2002, at 16:47:51
> why do you continue to tolerate having a pharm salesperson on the board.
I've made this a continuation of the previous thread on this issue, please see the earlier posts here.
> However, I'm sure that by stating this opinion I will get blocked.
There's a difference between disagreeing and being uncivil. Though of course there can be overlap, too...
Bob
Posted by dr. dave on October 4, 2002, at 3:37:07
In reply to Re: salesperson, posted by Dr. Bob on September 18, 2002, at 20:39:46
I'm getting a bit concerned about the Lexapro thread. Statements are being made, not as opinions, but as statements of fact from an authoritative source which just aren't remotely justifiable by the evidence. I have no problem having robust discussions about the interpretation of data, and doing my bit to give an alternative point of view, but vulnerable people are turning for advice to a sales representative who is saying things quite at odds with the research.
I would be interested in your views.
Posted by Dr. Bob on October 4, 2002, at 19:03:18
In reply to Re: salesperson, posted by dr. dave on October 4, 2002, at 3:37:07
> I'm getting a bit concerned about the Lexapro thread. Statements are being made, not as opinions, but as statements of fact from an authoritative source which just aren't remotely justifiable by the evidence. I have no problem having robust discussions about the interpretation of data, and doing my bit to give an alternative point of view, but vulnerable people are turning for advice to a sales representative who is saying things quite at odds with the research.
What I like to see is discussion that's open enough to include alternative points of view. Whom then to trust can be a hard -- and subjective -- question:
http://www.dr-bob.org/babble/faq.html#trust
But on a site like this, that's the reader's prerogative -- and responsibility.
As far as evidence, I think there's a continuum from (1) lots of evidence for to (2) not much evidence one way or another or evidence both ways to (3) lots of evidence against. The more towards (3), the more problematic the statement. If you think misinformation like that has been posted, please let me know (in addition to posting an alternative point of view). How does that sound?
Bob
Posted by dr. dave on October 9, 2002, at 4:20:07
In reply to Re: evidence, posted by Dr. Bob on October 4, 2002, at 19:03:18
> > I'm getting a bit concerned about the Lexapro thread. Statements are being made, not as opinions, but as statements of fact from an authoritative source which just aren't remotely justifiable by the evidence. I have no problem having robust discussions about the interpretation of data, and doing my bit to give an alternative point of view, but vulnerable people are turning for advice to a sales representative who is saying things quite at odds with the research.
>
> What I like to see is discussion that's open enough to include alternative points of view. Whom then to trust can be a hard -- and subjective -- question:
>
> http://www.dr-bob.org/babble/faq.html#trust
>
> But on a site like this, that's the reader's prerogative -- and responsibility.
>
> As far as evidence, I think there's a continuum from (1) lots of evidence for to (2) not much evidence one way or another or evidence both ways to (3) lots of evidence against. The more towards (3), the more problematic the statement. If you think misinformation like that has been posted, please let me know (in addition to posting an alternative point of view). How does that sound?
>
> BobThat sounds extremely sensible. I've posted an alternative point of view and a request for back-up of some claims that have been made. I realise it's not your responsibility to check the validity of every last thing anyone says, but I just wanted to register my concern that this was happening.
Posted by Dr. Bob on October 10, 2002, at 21:12:23
In reply to Re: evidence, posted by dr. dave on October 9, 2002, at 4:20:07
> I just wanted to register my concern that this was happening.
I appreciate that concern about what happens here, thanks!
Bob
Posted by Alan on October 13, 2002, at 2:47:49
In reply to Re: evidence, posted by Dr. Bob on October 4, 2002, at 19:03:18
> > I'm getting a bit concerned about the Lexapro thread. Statements are being made, not as opinions, but as statements of fact from an authoritative source which just aren't remotely justifiable by the evidence. I have no problem having robust discussions about the interpretation of data, and doing my bit to give an alternative point of view, but vulnerable people are turning for advice to a sales representative who is saying things quite at odds with the research.
>
> What I like to see is discussion that's open enough to include alternative points of view. Whom then to trust can be a hard -- and subjective -- question:
>
> http://www.dr-bob.org/babble/faq.html#trust
>
> But on a site like this, that's the reader's prerogative -- and responsibility.
>
> As far as evidence, I think there's a continuum from (1) lots of evidence for to (2) not much evidence one way or another or evidence both ways to (3) lots of evidence against. The more towards (3), the more problematic the statement. If you think misinformation like that has been posted, please let me know (in addition to posting an alternative point of view). How does that sound?
>
> Bob
================================================Dear Dr. Bob,
Most consumers here (which is what babble is mostly made up of) know nothing in the way of how drugs are approved and about test result validities except to trust the FDA and what the drug co's tell us. Babblers are relatively vulnerable by nature of their disorders/diseases and while having critical thinking skills, are not provided the following information - the foundation of which you base your policies regarding commercial "face time" are concerned.
With an undeniably unhealthy (some argue incestuous) relationship between the drug co's and the FDA where drug test results are allowed to be cherry - picked (after the criteria for each new test moves the goal posts to acheive more and more desireable results) and all of the most desireable results are sent to the FDA for approval, how can there be any transparency of content for consumers to trust - most importantly coming from a pharmrep?
Certainly you know the practice allowed by the FDA for co's to throw out undesireable results and change test criteria until they get the results they need (not to mention hiding failures or in the Paxil case, attempting to throw out the failed test results and getting caught by their own internal memos regarding the results of these failed tests)....
So how does this troubling FDA/Pharm co. policy fit into your continuium of allowing "credible" evidence to argue for or against anything at all by a salesman (pharmrep) considering your criteria?
This is not to say that they are inherently corrupt but only that we deserve better and need the most credible sources of information for your illustrious site to maintain it's crediblity.
Visiting doctors (that have exposed their financial or otherwise intersts in a drug company) would seemingly be unqualified to give unbiased information. Why not limit advice and support from those docs that have their hands clean?
Or are you of the opinion that there are so very few of them left that this is an unreasonable request?
There are enough obstacles standing between the doctor/patient relationship such as time constraints, commercial interests, etc, already as I read here at PB. That relationship doesn't need to be complicated further by consumers being fed "face time" to complicate matters further. The saturation of paxil and zoloft adds on TV and Radio, and Newsprint isn't enough face time already? Don't patients deserve to have a sanctuary still waiting for them at here at PB?
Please reconsider your policy of allowing overt commercial interests to permeate this prestigious bboard - a board full of sophisticated and newbies alike....if for no other reason, in the interest of protecting the vulnerable population. Isn't that most of us here? Us that would feel the need to visit a psychological help/support bboard?
Sincerely,
Alan
Posted by judy1 on October 13, 2002, at 13:16:26
In reply to Re: evidence - policy/continum » Dr. Bob, posted by Alan on October 13, 2002, at 2:47:49
for a beautifully written post. I couldn't agree more with your assessment of the pharm industry- and here in CA, I'm particularly distraught that a judge just overturned a ruling made to force the makers of paxil to include habit-forming in their ads. I would hope people reading your post (newbies like you pointed out) will consider what you wrote the next time they pick up a prescription from their pdoc. take care, judy
Posted by Dr. Bob on October 13, 2002, at 13:58:20
In reply to Re: evidence - policy/continum » Dr. Bob, posted by Alan on October 13, 2002, at 2:47:49
> we deserve better and need the most credible sources of information for your illustrious site to maintain it's crediblity.
>
> Visiting doctors (that have exposed their financial or otherwise intersts in a drug company) would seemingly be unqualified to give unbiased information. Why not limit advice and support from those docs that have their hands clean?Only "credible sources of information" should be allowed to post? Only doctors without conflicts of interest?
> Don't patients deserve to have a sanctuary still waiting for them at here at PB?
>
> Please reconsider your policy of allowing overt commercial interests to permeate this prestigious bboard - a board full of sophisticated and newbies alike....if for no other reason, in the interest of protecting the vulnerable population.I understand that you want what's best. The idea here, however, is support and education, not isolation from commercial interests. Alternative points of view could themselves be thought of as a form of protection:
> > The search for truth reminds me of Hegel: it is neither the "thesis" (the claim by the manufacturer that the medication is some sort of wonder drug) nor the "antithesis" (the claim by someone who blames all their problems on the medication), but rather a "synthesis" (a sober analysis of both positive and negative aspects). Information which is balanced and fair is trustworthy, whereas that which comes from either advocacy viewpoint is suspect.
> > http://www.dr-bob.org/babble/20011025/msgs/82706.htmlBob
Posted by Alan on October 13, 2002, at 16:47:21
In reply to Re: sources of information, posted by Dr. Bob on October 13, 2002, at 13:58:20
> > we deserve better and need the most credible sources of information for your illustrious site to maintain it's crediblity.
> >
> > Visiting doctors (that have exposed their financial or otherwise intersts in a drug company) would seemingly be unqualified to give unbiased information. Why not limit advice and support from those docs that have their hands clean?
>
--------------------------------------------
Bob:
> Only "credible sources of information" should be allowed to post? Only doctors without conflicts of interest?
=========================================
Alan:
Yes the conflicts that I speak of negates credibility by a good margin.I'm not meaning to speak provocatively or rhetorically but why is that unrealistic or unworkable via-a-vis doctors full disclosure of lobbying influences? Is there a complication that I am nievely unaware of? Is the pharmecutical industry so pervasive in medicine that this idea is untenable?
=========================================
>
> > Don't patients deserve to have a sanctuary still waiting for them at here at PB?
> >
> > Please reconsider your policy of allowing overt commercial interests to permeate this prestigious bboard - a board full of sophisticated and newbies alike....if for no other reason, in the interest of protecting the vulnerable population.
>
-------------------------------------------------
Bob:
> I understand that you want what's best. The idea here, however, is support and education, not isolation from commercial interests. Alternative points of view could themselves be thought of as a form of protection:
==============================================
Alan:
I have outlined why I think comercialism is neither support or education in the effective and ethical sense. The "Isolation" that you speak of is not the same as differentiation.Relying on alternative points of view to "police" those commercial interests for the benefit of those that are vulnerable (most who visit the board I suspect are), are, by their very nature less credible in the unsuspecting eyes of the vulnerable - at least moreso than the naturally hope-giving business-speak of salesman.
Is the bboard going to become one of those "free - market" test cases where the theory of the free market solves most all of our problems - is that going to be the underpinning of it's philosophy? A medical model ever more inching closer to embracing the concept of further entangling commercialism with medicine? What's needed by all accounts that I observe - by press accounts, internet bboards, my doctor's account, my own experience with corporate doctors is that more distancing and oversight by the FDA is needed...not the other way around. And until that's done, the playing field is not a level one.
===========================================
Bob:
> > > The search for truth reminds me of Hegel: it is neither the "thesis" (the claim by the manufacturer that the medication is some sort of wonder drug) nor the "antithesis" (the claim by someone who blames all their problems on the medication), but rather a "synthesis" (a sober analysis of both positive and negative aspects). Information which is balanced and fair is trustworthy, whereas that which comes from either advocacy viewpoint is suspect.
> > > http://www.dr-bob.org/babble/20011025/msgs/82706.html
>
> Bob
===============================================
With all due respect Dr. Bob,Your analysis seems to sets out a false dichotomy - two extremes for the sake of illustrating the concept of synthesis.
There are other alternative models of synthesis that, pragmatically speaking, are doeable and perhaps more appropriate for this site in order to get at the truth that you speak of.
For instance, I've noticed over the years your wise practice of separating subject matter for different bboards so that entanglement of issues are minimised. This seems (paradoxically so) to be a form of synthesis - at least of some type that we seem to all agree is to our mutual benefit.
Issues as complicated as mental health with its plethora of rationale, treatment modalities, and the need to explore the nuanced aspects of it's nature have been well served by this administrative decision.
Why then is commercialism then allowed to creep into the med board (next will CBT influenced Lucinda Bassett's reps be "contributing" to Psycho-Social babble?) entangling further the one most incendiary problem in medicine today - the mixing of politics known as "face time" with the discipline of medicine?
For one example, why not clearly identify a separate board for pharmecutical companies or anxiety/depression gurus to hawk their wares with questions from the crowd - rather than have them be offered up in a forum asking for personal support about med experiences as anything other than what they are, salesmen?
Do you realistically think there will be replys from a pharmrep that will be anything other than resembling happy talk/support/ and sterile arguments about facts? That takes the whole concept (a not unimportant one) of informing and ultimately treating individual patients as individuals out of the equation...an assembly line mentality that more often than not encourages the patient to fit the medicine's criteria than the medicine to fit the patient's criteria...a cookie cutter mentality not condusive to respect of the individual - especially the vulnerable individual.
Certainly one (medicine) can not or should not do without the other (pharmecutical co's). They need to work together to find solutions for all of us.
But with all of the aforementioned conflict of interest at this stage of the game, in this present climate of relative lack of unbiased FDA oversight and doctors being lobbied and influence-pedaled at ever breathtaking rates - many of the best being co-opted to join and tow the company line - even believe themselves that their company line is comparatively enough "the answer" about how the brain actually functions and responds to the point that this is what they go back to the classroom to teach!
...why NOT take the conflict of interest out of the equation? The time has never seemed so ripe. Talk about a positive opportunity to keep these conflicts of interest out of the regular PB med board! Talk about an opportunity to remain a beacon for patient advocacy!
Why can't the administration of PB take the lead with this opportunity to creatively find a way to stop encouraging this unethical trend and acknowledge it for what it is rather than pretending what it isn't?
The search for the truth deserves no less in my opinion.
Respectfully submitted,
Alan
Posted by Dr. Bob on October 14, 2002, at 17:10:18
In reply to Re: sources of information » Dr. Bob, posted by Alan on October 13, 2002, at 16:47:21
> > Only "credible sources of information" should be allowed to post? Only doctors without conflicts of interest?
>
> Yes the conflicts that I speak of negates credibility by a good margin.Well, this would be a completely different site if only doctors were allowed to post...
> > Alternative points of view could themselves be thought of as a form of protection
>
> Relying on alternative points of view to "police" those commercial interests for the benefit of those that are vulnerable (most who visit the board I suspect are), are, by their very nature less credible in the unsuspecting eyes of the vulnerable - at least moreso than the naturally hope-giving business-speak of salesman.Maybe we should just agree to disagree on this. I think the people here, especially with input (including alternative posts of view) from others, can make up their own minds.
> For one example, why not clearly identify a separate board for pharmecutical companies or anxiety/depression gurus to hawk their wares with questions from the crowd - rather than have them be offered up in a forum asking for personal support about med experiences as anything other than what they are, salesmen?
That's an interesting idea, but how would I know who belonged where? Pharmrep hasn't pretended to be anything other than a salesman, but others might...
Bob
Posted by Alan on October 14, 2002, at 20:20:35
In reply to Re: sources of information, posted by Dr. Bob on October 14, 2002, at 17:10:18
> > > Only "credible sources of information" should be allowed to post? Only doctors without conflicts of interest?
> >
> > Yes the conflicts that I speak of negates credibility by a good margin.
>
> Well, this would be a completely different site if only doctors were allowed to post...
=========================================
Oh, you misunderstood me...or the other way around.I did not mean that only doctors should be posting, but that when they do, such as your previous "guest" doctors, that they have full disclosure of their affiliations with commercial interests or with any commercial product.
===========================================
>
> > > Alternative points of view could themselves be thought of as a form of protection
> >
> > Relying on alternative points of view to "police" those commercial interests for the benefit of those that are vulnerable (most who visit the board I suspect are), are, by their very nature less credible in the unsuspecting eyes of the vulnerable - at least moreso than the naturally hope-giving business-speak of salesman.
>
> Maybe we should just agree to disagree on this. I think the people here, especially with input (including alternative posts of view) from others, can make up their own minds.
============================================
I can agree with you that many can make up their own minds - but under the influence of whom seems to me to be the question that is still relevant.There are no rescources to contradict a pharmrep when they hold all of the cards and ask for scientific evidence to disprove them when they are contradicted. They are in positions of authority and the members of this bboard are by and large not able to contradict their claims on equivalent terms (for instance does any one of us have access to the tests Forest lab did including the ones they discarded in order to change the test parameters to be able to cherry-pick their results submitted to the FDA?). This seems to me to be a relatively important question in light of present FDA proceedures.
Most of us here are not doctors after all. This is the type of unlevel playing field I'm talking about when the two are mixing.It blurs a healthy line of distinction between commercialism and medicine, many times without the average joe's awareness of this problem even existing.
================================================
>
> > For one example, why not clearly identify a separate board for pharmecutical companies or anxiety/depression gurus to hawk their wares with questions from the crowd - rather than have them be offered up in a forum asking for personal support about med experiences as anything other than what they are, salesmen?
>
> That's an interesting idea, but how would I know who belonged where? Pharmrep hasn't pretended to be anything other than a salesman, but others might...
>
> Bob
============================================
Firstly, anyone that claims to be a doc or in similar position of authority that dispenses medical advice (which is what pharmrep is actually doing) - that deliberately comes here putting themselves in a position of authority should have their credentials verified in some way shouldn't they?There aren't that many posting that are MHP's so why not for our own protection asking privately by screening for pertinent information (liscence no. for verification comes to mind) as a means of being fully informed? This way we could rely on them as at least sources of some sort of authority and be able to identify fradulent ones. Everyone would benefit from advice sources being identified.
Secondly perhaps start a board called something like "Professional Psycho-babble corner" or something of the sort where these verified MHP's that have received verification could take place before MHP's are allowed to speak from a position of authority.
It's the mixing of authority with inquisitive but vulnerable consumers that bother me on the main babble board. Having two seperate boards would at least identify things for what they really are rather than pretending what they aren't.
In light of the concerns expressed by myself and several others about keeping a healthy differentiation between the commercial and medical interests, how do these suggestions sound?
All ears,
Alan
Posted by ZeeZee on October 15, 2002, at 19:22:41
In reply to Re: evidence - policy/continum » Dr. Bob, posted by Alan on October 13, 2002, at 2:47:49
Amen!
Posted by Dr. Bob on October 15, 2002, at 22:56:17
In reply to Re: sources of information » Dr. Bob, posted by Alan on October 14, 2002, at 20:20:35
> I did not mean that only doctors should be posting, but that when they do, such as your previous "guest" doctors, that they have full disclosure of their affiliations with commercial interests or with any commercial product.
Hmm, that's not such a bad idea. How much disclosure would you consider "full"? And would you settle for disclosures -- or require that they not have any affiliations?
> There are no rescources to contradict a pharmrep when they hold all of the cards and ask for scientific evidence to disprove them when they are contradicted. They are in positions of authority and the members of this bboard are by and large not able to contradict their claims on equivalent terms (for instance does any one of us have access to the tests Forest lab did including the ones they discarded in order to change the test parameters to be able to cherry-pick their results submitted to the FDA?).
If there aren't any resources to contradict him, why don't you necessarily believe him? And if you don't necessarily believe him, why would others?
> Firstly, anyone that claims to be a doc or in similar position of authority that dispenses medical advice (which is what pharmrep is actually doing) - that deliberately comes here putting themselves in a position of authority should have their credentials verified in some way shouldn't they?
If you assume people believe everything they hear, yes. Voluntary verification of credentials might be interesting. But exactly what credentials would I need to verify? And how would I verify them?
> (liscence no. for verification comes to mind)
But someone could just make up a license number. Or give me someone else's...
> Secondly perhaps start a board called something like "Professional Psycho-babble corner" or something of the sort where these verified MHP's that have received verification could take place before MHP's are allowed to speak from a position of authority.
Yes, but wasn't part of the idea also keeping them from posting on other boards? How would I do that? Especially since they might not say they're MHPs?
> It's the mixing of authority with inquisitive but vulnerable consumers that bother me on the main babble board. Having two seperate boards would at least identify things for what they really are rather than pretending what they aren't.
Sorry, are you saying I'm pretending that there's no mixing of professionals and consumers on PB?
Bob
Posted by wcfrench on October 20, 2002, at 14:31:21
In reply to Re: sources of information, posted by Dr. Bob on October 15, 2002, at 22:56:17
I think the most important thing to keep in mind for posters here is that you can only take the information and recommendations people give you about meds with a grain of salt. All meds work differently for everyone, and if someone tells you that a med "works great" in general, they're lying. Because everyone has different reactions.
Although there might be a lot of undisclosed professionals posting here, I think we can safely assume that the base of Psycho Babble is composed of well-meaning consumers seeking advice. Think about it. What would be more important, more likely: if you were a professional trying to push the internet toward a medicine of your choice, receiving little benefit, if any, from the process, OR an honest consumer in search of advice that could possibly benefit the quality of his/her life. If you were each of these people, who do you think is more likely to seek out a site such as Psycho Babble? Put yourself in the "salesman" shoes. Now in the consumer's shoes. And if you were a salesman, or a doctor pushing pharmaceutical companies that you made money from, how many customers could you really "convert" to your medicine, and would they even be your customers? This isn't an insurance sales site, no one comes here to be sold. People come here seeking opinions, empathy, understanding, and the comfort of talking to someone else that has been in the same boat you have. And in the rare occasion that someone asks another about a specific drug recommendation, they should know that who they are talking to, though friendly and personable, is albeit still a stranger. We can't go around listening to strangers on the internet who tell us to try medicines. We seek opinions, experiences, and a general sense of how the medicine works, but never should listen to a direct recommendation. And anyone posting here, salesman, doctor, or otherwise, saying that "you should take this" is taking this board way out of context and shouldn't be listened to. You should listen to people's experience on a medicine, several people, and read as many threads as you can find on it before you even consider talking to your doctor about it. No one listens to one person who says "take this, it's better than this." Every knowledgable Psycho Babble member knows that no one drug is "better" than another, because they all have a unique mechanism of action that works differently on all people.
You guys are clouding the issue. Instead of worrying about who's posting here and how to control them, you have to realize that the internet is full of strangers, and you can't control who's posting here. You will never be able to. And whether a pharmaceutical representative posts under the name "pharmrep" or "johndoe" will always be a mystery to us. That's how the internet works! That's why so many people use it! You think all these people would be on Psycho Babble if they had to put their driver's licenses and birth certificates on file? All you can do is keep in mind who we are talking to and remember how to deal with them. Yes, most of the people here are great people all in search of similar information, but some are not, and we will never be able to control that.
Dr. Bob, I agree with you, but I don't like the way you argue. You ask questions in response to a question, and it seems to further delude the issue. This, of course, is just a civil disagreement.
I think you are both right in a lot of respects, but you simply cannot control who visits and posts to this website, just as you cannot control who uses the internet for bad deeds. The only thing you can do is educate the ones that use it.
-Charlie
Posted by Alan on October 23, 2002, at 11:54:14
In reply to Educate members. You can't police the internet., posted by wcfrench on October 20, 2002, at 14:31:21
> I think the most important thing to keep in mind for posters here is that you can only take the information and recommendations people give you about meds with a grain of salt. All meds work differently for everyone, and if someone tells you that a med "works great" in general, they're lying. Because everyone has different reactions.
>
> Although there might be a lot of undisclosed professionals posting here, I think we can safely assume that the base of Psycho Babble is composed of well-meaning consumers seeking advice. Think about it. What would be more important, more likely: if you were a professional trying to push the internet toward a medicine of your choice, receiving little benefit, if any, from the process, OR an honest consumer in search of advice that could possibly benefit the quality of his/her life. If you were each of these people, who do you think is more likely to seek out a site such as Psycho Babble? Put yourself in the "salesman" shoes. Now in the consumer's shoes. And if you were a salesman, or a doctor pushing pharmaceutical companies that you made money from, how many customers could you really "convert" to your medicine, and would they even be your customers? This isn't an insurance sales site, no one comes here to be sold. People come here seeking opinions, empathy, understanding, and the comfort of talking to someone else that has been in the same boat you have. And in the rare occasion that someone asks another about a specific drug recommendation, they should know that who they are talking to, though friendly and personable, is albeit still a stranger. We can't go around listening to strangers on the internet who tell us to try medicines. We seek opinions, experiences, and a general sense of how the medicine works, but never should listen to a direct recommendation. And anyone posting here, salesman, doctor, or otherwise, saying that "you should take this" is taking this board way out of context and shouldn't be listened to. You should listen to people's experience on a medicine, several people, and read as many threads as you can find on it before you even consider talking to your doctor about it. No one listens to one person who says "take this, it's better than this." Every knowledgable Psycho Babble member knows that no one drug is "better" than another, because they all have a unique mechanism of action that works differently on all people.
>
> You guys are clouding the issue. Instead of worrying about who's posting here and how to control them, you have to realize that the internet is full of strangers, and you can't control who's posting here. You will never be able to. And whether a pharmaceutical representative posts under the name "pharmrep" or "johndoe" will always be a mystery to us. That's how the internet works! That's why so many people use it! You think all these people would be on Psycho Babble if they had to put their driver's licenses and birth certificates on file? All you can do is keep in mind who we are talking to and remember how to deal with them. Yes, most of the people here are great people all in search of similar information, but some are not, and we will never be able to control that.
>
> Dr. Bob, I agree with you, but I don't like the way you argue. You ask questions in response to a question, and it seems to further delude the issue. This, of course, is just a civil disagreement.
>
> I think you are both right in a lot of respects, but you simply cannot control who visits and posts to this website, just as you cannot control who uses the internet for bad deeds. The only thing you can do is educate the ones that use it.
>
> -Charlie
==============================================
It is not simply a matter of policing the entire internet. That subject is too broad to be considered here.Specifically the issue is, how far is a specific site devoted argueably to helping one of the most emotionally vulnerable population of the internet, going to be allowing the emboldening of the pharmecutical industry to hawk their wares as *a position of authority*.
This is not an insult to the intelligence of the PB populace but rather a serious matter of how one dispute those in a position of authority representing themselves as members of the medical community, and most importantly, those dispensing actual medical advice in that position of authority (in this case through real or imaginary doctors to try to bypass the *direct medical advice* part).
Alan
Posted by Alan on October 23, 2002, at 11:55:18
In reply to Re: sources of information, posted by Dr. Bob on October 15, 2002, at 22:56:17
Posted by wcfrench on October 23, 2002, at 15:36:46
In reply to Re: Educate members. You can't police the internet., posted by Alan on October 23, 2002, at 11:54:14
How would a pharmaceutical rep know better than your doctor what dosage to take and what changes you should make to your medicine? Don't listen to him! Seeking the experience of a plethora of people on Psycho Babble who have actually been on the medicine is INVALUABLE compared to a pharmaceutical representative's statistical proof. This guy has never even taken Lexapro, and no one should listen to him if he says to alter dosages. And, if I were Dr. Bob, I'd allow him to post with the EXPLICIT restraint of medication recommendations. He can "sell," or give "proof" or tell us "we shouldn't be experiencing that," but never should he say, you should up your dosage. Pharm reps know very little compared to doctors and patients.
-Charlie
Posted by Dr. Bob on October 23, 2002, at 16:22:47
In reply to Re: Educate members. You can't police the internet., posted by Alan on October 23, 2002, at 11:54:14
> the issue is, how far is a specific site ... going to be allowing the emboldening of the pharmecutical industry to hawk their wares as *a position of authority*.
In what sense do you see them as in a position of authority? And do you think it would be OK for them to "hawk their wares" if they weren't in such a position?
Bob
Posted by IsoM on October 23, 2002, at 16:45:11
In reply to Re: Educate members, posted by Dr. Bob on October 23, 2002, at 16:22:47
No matter how good the intentions someone may have, "my" experiences have been that unless a person has had an 'opportunity' to walk in similar shoes, they have no idea of what it is. I think pharmrep has no ulterior motive in extolling the virtues of Lexapro. I do believe he really wishes to be helpful. I'd hestitate to say, but I bet he's young, brash, full of enthusiasm in most things, & rather idealistic about most things. All very good attributes!! But maybe the years & experience will temper his methods (but not I hope, his enthusisam & ideals).
But pharmrep has never had depression & despite Phil's view that he shows remarkable insight, I don't think he knows what it can do & what it feels like - just how much it can alter a person. His comments & advice is going to come from someone never knowing what it can do to the soul of a person. Living with a depressed person, being around them, even treating them is NOT the same. I prefer pdocs that have suffered from depression myself. They're much more empathetic, understanding, determined, AND knowledgable about treating it.
Pharmrep is digging through the info available to him, trying his best to help anyone taking Lexapro. If people accept that his advice has limitations, there's still good that can be gleaned from it.
Posted by Alan on October 23, 2002, at 18:26:18
In reply to Re: Educate members, posted by Dr. Bob on October 23, 2002, at 16:22:47
> > the issue is, how far is a specific site ... going to be allowing the emboldening of the pharmecutical industry to hawk their wares as *a position of authority*.
>
> In what sense do you see them as in a position of authority?In much the same way as the face time they have w/you and your colleagues. They are authorities to you. You take the time to listen and make judgements....but based on critical thinking skills that cuts through all of the "Goober talk" that the simplified pitch is designed to appeal to.
However, you have the knowledge and experience to know where they are coming from and know - as one also being in a position of authority - how to think critically in order to form critical medical judgements and distinctions concerning the details of their pitch.
Consumers do not. That's what makes the playing field so skewed in favor of the commercial pitches that us regular people are subjected to.
For instance, how are we going to know what questions to ask to critically break down their company line when we're not doctors? Re: comparative efficacy rates, what an isomer is, what part of the test results matter and what is simply hype? By taking the package insert into our docs so they can compare them side by side and then read peer-review studies about comparative benefit/analysis of different drugs in med-speak that appears in clinical journals?
>And do you think it would be OK for them to "hawk their wares" if they weren't in such a position?
>
> BobHow could they hawk their commercial wares if they were not in such a declared position anyway? Maybe I'm misunderstanding the question.
Basically, no. Not on a bulletin board that best serves as a sanctuary for exchanging personal information and experiences to best make our own judgements. We have ads for these medications in mags, TV spots and the doc's office brochure stand already.
Why would one consider allowing the same commercial interests infiltrate our board? In the form of virtual "face time" to consumers looking for unbiased answers to be able to make judgements about...?
It makes no sense to put commercial interests between the already intruded upon and complicated doctor/patient relationship. Allowing representatives of corporations to come here and give us the corporate line seems obvious to me, to cloud thatn already intruded upon relationship.
Doctors are the ones that should appropriately be given "face time" - and that is pervasive enough (some would say too pervasive already). A community such as psychobabble is not the appropriate forum for such commercial representation. There is simply too clearly a conflict of interest.
Alan
Posted by Alan on October 23, 2002, at 18:35:11
In reply to Re: Educate members » Dr. Bob, posted by IsoM on October 23, 2002, at 16:45:11
> Pharmrep is digging through the info available to him, trying his best to help anyone taking Lexapro. If people accept that his advice has limitations, there's still good that can be gleaned from it.
>=============================================
Yes, but the point is that there is no way of knowing what those "limitations" are specifically. Sure, good can be gleaned from anything - but the lack of knowledge to go toe to toe with such a representative as a well educated doctor would seems to me to be the issue.
Their position of authority or expertise can hardly be challenged by citing this and that study that in the eyes of the regular PB consumer, legitimately challenges their claims...or even personal experience when the mission of the expert is to field all questions and dispense medical advice the same way they are advising doctors to dispense their corporate medical advice.
Heck, most doctors just shove a pill in the newest and latest version and repeats the mantra they've been fed. Why should we be shoveled the same - and many without even knowing that we're being shoveled upon?
Posted by Dr. Bob on October 23, 2002, at 19:43:09
In reply to Re: Educate members » Dr. Bob, posted by Alan on October 23, 2002, at 18:26:18
> > In what sense do you see them as in a position of authority?
>
> In much the same way as the face time they have w/you and your colleagues.I mean, do you see them as experts?
authority
1 c : an individual cited or appealed to as an expert
http://m-w.com/cgi-bin/dictionary?authority> you have the knowledge and experience to know where they are coming from and know - as one also being in a position of authority - how to think critically in order to form critical medical judgements and distinctions concerning the details of their pitch.
>
> Consumers do not.Maybe we should just agree to disagree on this. I think the people here, especially with input (including alternative posts of view) from others, can make up their own minds.
http://www.dr-bob.org/babble/admin/20020918/msgs/7693.html
Bob
Posted by wcfrench on October 23, 2002, at 21:34:43
In reply to Educate members. You can't police the internet., posted by wcfrench on October 20, 2002, at 14:31:21
Yes.
I think most members know that a pharm rep knows far less about a med than doctors, and to a greater extent, fellow patients do. As long as he is not giving direct orders on medication, his opinion or proof is welcome as anyone else's is. Don't you think anyone else on this board could find the info he has presented to us and pitch Lexapro? We make up our own mind, and listen to patients who have taken the medicine over a sales representative. It's not that difficult.
-Charlie
Posted by Alan on October 23, 2002, at 22:46:38
In reply to Re: Educate members. You can't police the internet., posted by wcfrench on October 23, 2002, at 21:34:43
> I think most members know that a pharm rep knows far less about a med than doctors, and to a greater extent, fellow patients do. As long as he is not giving direct orders on medication, his opinion or proof is welcome as anyone else's is. Don't you think anyone else on this board could find the info he has presented to us and pitch Lexapro? We make up our own mind, and listen to patients who have taken the medicine over a sales representative. It's not that difficult.
>
> -Charlie===============================================
What do you mean? Many *doctors* are making their decisions based largely on info from pharm reps! That's part of the problem. Why do you think "face time" is the be all and end all in the business today? If doctors are indeed swayed by the cherry-picked test results, why then wouldn't suggestable psychological or psychiatric participants on PB be?Unfortunately pharm rep is indeed instructing how to medicate and from a from a self-claimed position of relative authority (consistently using Forest's own documented test results as evidence) and covering themselves by saying that their advice is based on contact with what a few doctor "friends" are telling them.
What? The docs that they've had face time with producing highly suggestable docs and PBabblers only their proprietary test results? Based on what? If individual responses are so highly idiosyncratic, why would this method of giving cookie-cutter corporate medical advice even be allowed? Has everyone lost it regarding the need for some degree of objectivity?
Why is it alright for a pharmrep to dispense medical advice to a suggestable group in need of psychological help? The people that come here aren't here to pass the time I suspect. They're here to hear personal stories about medications...not the same corporate line that docs get every day but in reconstituted "Goober-talk". And if it's in medspeak, the average joe on this board isn't going to know what the hell they're talking about anyway....technically just far enough above their heads to have the consumer collectively nod their heads in bewilderment and agreement?
Yes, I agree. It's not that difficult to figure what is really going on here.
Alan
Go forward in thread:
Psycho-Babble Administration | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.