Bitter Pill

a chronicle of psychiatric harm

Bitter Pill by Rachel Aviv
The New Yorker, April 8, 2019
Link to Full Article.
This significant article chronicles the life of a young woman who was given multiple psychiatric diagnoses by some of the "best" psychiatrists in the country. She was placed on almost every imaginable psychiatric medicine that appear to have done her great harm. It's a cautionary tale that is well worth a close reading. The article is quite long and rambles a bit but much in it of teaching value.

The protagonist of “Bitter Pill” is Laura Delano, who was diagnosed with bipolar disorder shortly before she entered Harvard as a freshman in 2001. She saw psychiatrists at McLean Hospital in Belmont Massachusetts. There she was initially placed on Prozac, Provigil and Ambien.

Link to DJE's notes.

Here is a moving lecture by Laura Delano.

Don't Demonize Opioids

Our preoccupation with opioid misuse could become the tail wagging the dogBob Roehr biomedical journalist. Washington, DC, USABMJ 2017;359:j4727

It is rare that we hear from those who use prescription opioids on a chronic basis. Their voices are important counterpoints to the loud, self-righteous jeremiads of physicians, politicians and law enforcement professionals.
Roehr tells us:

• Demonising prescription opioids can come to no good end.
• I use an opioid drug, hydrocodone, every six hours, and have done so for about a decade.
• The surge in opioid related deaths in the US is troubling. But it is important to remember that it is fueled by street drugs and by fentanyl and its analogues, either alone or laced into a variety of illicit drugs.
• People who have lost access to prescription opioids have turned to cheaper, more accessible, and more dangerous, potent black market options, according to experts, and the death toll has soared.

Full BMJ article: Download Roehr Don't Demonize Opioids

Notes on Morphine by FW Peabody (1927)

Notes on Morphine by F.W. Peabody

Notes on the Effects of Morphine 
For full essay Download Notes on the Effects of Morphine
By Francis W. PeabodyFrom The Caring PhysicianThe Life of Dr. Francis W. PeabodyBy Oglesby Paul
The following unpublished essay is “[a]n example of how FWP, the scientist/physician, used his terminal illness to make clinical observations on himself with his description of his reactions to injections of morphine. This document was completed in October, 1927, five days before his death, and is an unique and vivid record of one patient’s response to the powerful narcotic.” This is an extraordinary essay. Why it was never published is a great mystery; but may lie in the fact that morphine and its derivatives are a much-maligned drugs.. Herein, we see how it allowed FWP to be lucid and function masterfully until the end.

Download Notes on the Effects of Morphine

My Three Livers

My Three Livers: how transplants gave me my life back

Photo from Ms. Walker's Twitter page

Patient Commentary by Erin Walker patient insight and involvement lead UCL Partners, London, UK.  Ms. Walker, now aged 36 has survived > 30 years post her first liver transplant. (BMJ, 3 March, 2019)

By the time Erin Walker turned 20 she was on her third liver, after a second transplant. Seventeen years on she reflects how organ donation has enabled her to experience many of life’s rites of passage.

The Full Article is well-worth reading.

A Mentor's Legacy

Through the Undulations of a Long Career — A Mentor’s Legacy is a moving tribute to her teacher by Ranjana Srivastava, a humanistic oncologist from Melbourne, Australia. 

I heard Ranjana speak a few years ago at a conference and was impressed. Since then, I've read a number of her moving essays in the NEJM. A friend from Australia got me a copy of her book, Dying for a Chat (not available in the U.S.).  This short 75 page volume starts by describing the case of a 90-year-old woman whose care went terribly wrong in a sophisticated Australian medical center. The experience led her to reflect upon medicine, especially about doctor-patient communication. The book is a gem, available only in Australia.

Through the Undulations of a Long Career — A Mentor’s Legacy, in the March 7, 2019 NEJM, will resonate with medical students, trainees, and practitioners at all stages of our careers.  The author visits a retired physician who had mentored her as a student and trainee.  “Students loved him because he wasn’t just erudite but also humane. His concern for and interest in the whole person were plain to see.”

Her declining mentor “was someone who was less interested in pointing out my shortcomings and fixing my defects than in helping me find my way. When I slowed down, he persevered. When I found my feet, he stepped into the background. As a result, I am a better person and a more contented physician.”

For those who don’t have access to the NEJM, I have placed a PDF online.

Pain in Girls is Being Dismissed

It is a common experience for young women. We have long known that women with some conditions are more likely than men to be under-treated for pain, and that doctors are more likely to dismiss reports of illness as psychosomatic when they come from women. Now, a recent study from Yale researchers shows how early this gender bias starts. The study found that when adult participants were asked to rate the perceived pain of a child receiving a finger prick to draw blood, they attributed more pain to the child they thought was a boy than they did to the child they thought was a girl.

This is from “Why Are We Still Dismissing Girls’ Pain?” an Op-Ed piece in the February 18, 2019, NY Times by Laurie Edwards. 

Also see Cell2Soul Statistics of Sexual Violence.

The Informed Patient

by Helen Salisbury, BMJ February 2019

Admittedly, there are risks for patients who use the internet for health information: searches about the most innocuous of symptoms can lead down a terrifying rabbit hole to a terminal diagnosis within minutes However, there are many reliable and balanced sources of information, and people increasingly seem to be able to find them.

Dr. Salisbury feels that “as doctors it’s imperative that we find a way to ask our patients, ‘What have you found out so far?’”  This way we can learn from them and when necessary dispel false, frightening information.

This short piece is pregnant with meaning.  Full Text.