Via Ben Goldacre I’ve read this morning about the copyright owners of the Folstein Mini Mental State Examination, and their efforts to extract money for its use (which in one sense is fair, but they’ve ignored their copyright for the last thirty years, during which the test has become ubiquitous and pretty much indispensable), and, it seems, to get rid of an open-access alternative developed and validated at Harvard.

Dick move, PAR. Totes dick move.

As the NEJM said:

For clinicians, the risk of infringement is real. Photocopying or downloading the MMSE probably constitutes infringement; those who publish the MMSE on a Web site or pocket card could incur more severe penalties for distribution. Even more chilling is the “takedown” of the Sweet 16, apparently under threat of legal action from PAR (although PAR has not commented publicly). Are the creators of any new cognitive test that includes orientation questions or requires a patient to recall three items subject to action by PAR? However disputable the legal niceties, few physicians or institutions would want to have to argue their case in court.

So … If we ask someone where they are, and to remember a few things, we’re infringing copyright? And a screening tool that does so must be pulled down and kept away from use? I guess if it might impede money-making then that’s only right and proper….

You know, I think the Mind Hacks blog said it best:

Cashing-in on a simple and now, clinically essential, bedside test that you’ve ignored for three decades makes you seem, at best, greedy.

Taking down open-access equivalents because they also ask people the location and date and to remember a handful of words and numbers makes you a seem like a cock and a danger to clinical progress.

Yep.

Cocks.

So as I said: self-publishing … I feel like photocopying thousands of copies, and just handing them out on street corners, and leaving them in letterboxes, and giving it to everyone.

Maybe I’ll post PAR a bunch of IOUs…

And a photo of my middle finger.

I knew about bile-farming. I did not know that the bears try to suicide by hitting themselves in the abdomen – so they are kept in iron vests to prevent them from doing so.

And we have the temerity, the bald-faced audacity to describe such cruelty as “inhumane”. As far as I’m aware, the only animal to behave so fucking abominably is homo sapiens.

Seriously, fuck humans.

Maybe the rest of this planet will be better off if/when we do wipe ourselves out. Maybe rather than representing the pinnacle of evolution, as so many of us think, hominid evolution was actually the greatest evolutionary mistake on this world.

Oh, and even if one doesn’t want to consider the idea that this behaviour strongly suggests consciousness, and thinks that the mother bear was just hugging her cub, and was maddened by pain so didn’t realise she was hugging too hard, so it died – and then just happened to run into the wall and die because she was maddened by the pain… That’s not really any better. Is it?

Personally I would suggest that a bear knows very well that hugging very hard, and hitting things in the head are a couple of ways it kills things – so it could well have known exactly what it was doing. Not that it’s any better or worse that way.

And all of this incredible cruelty and lack of empathy for a so-called treatment to “remove ‘heat’ from the body as well as treat high fever, liver ailments and sore eyes” based on a bloody ridiculous irrational belief-system. So also fuck Traditional Chinese Pretend-Medicine.

Unfortunately, in order to do so, they chose to use a fairly egregious caricature of a psychiatrically ill person – and conflates that with fringe conspiracy theorists … and with regular people with concerns about privacy.

Here’s the video:

So what do we have here? The stereotypical tinfoil hat of the conspiracy “nut-job”; a surveillance camera; a computer displaying green text on black screen (clearly a hardcore computer geek matrix paranoiac); the caricature talking about revealing his “true identity” to “you people” and asking “who are you working for?” so he’s pretty paranoid, right?

They are clearly conflating serious psychiatric illness, with conspiracy theorists – which is superficial, insulting, and wrong – and laughing at both groups. This is no more evident than at the end when the caricature is about to infiltrate a party, disguised. He goes to the wardrobe and pulls out a dress, while the soundtrack throws up a mocking waah waah waah waaaaaaaah.

For shame. This is absolutely stupid, childish, and insulting. Could the Australian Bureau of Statistics not find a way to reassure people about privacy concerns without giving the psychiatrically ill a virtual punch in the face?

Yuck.

Update: CensusAustralia appear to have removed the video or made it private:

Updated update: new linky added already.

First, as I’ve whinged about before, the apparent ease with which other services or other parts of our service say no – and the way that becomes my team’s and my problem. The situation that comes up a lot is when another team, due to inadequate resources, says they are unable to see a patient (for a review planned or unplanned) and so they refer them to us in the acute/crisis team. Because apparently we can just absorb an infinite amount of work. We’re like black holes. We are a psychiatric fucking singularity, and I don’t yet know where our event horizon is, but it’s far out enough that an awful lot of work gets sucked inexorably in.

Second, the disturbing, frustratingly awkward (for us), non-evidence-based, smacks-of-social-control trend for giving quetiapine to people with no psychiatric illness. Then send them to us for follow-up. Cool. Thanks a bunch. Quetiapine is an antipsychotic medication. It treats psychotic symptoms. It also treats mania, and possibly depression. It’s also sedating and calming, so people with problems with anger and violence will indeed tend to be somewhat less angry and violent if given it. That’s great for the staff on the ward who admit these people, and then give them quetiapine (so they’re nice and calm while there). It sucks for us, who receive a referral to follow them up. This person now has been admitted to a psychiatric ward, and given an antipsychotic medication, and referred for follow-up to a psychiatric team … BUT DOES NOT HAVE A PSYCHIATRIC ILLNESS! (Sorry, but this drives me up the wall.)

I think it’s quite reasonable for the person to have an expectation that what they were prescribed (and found helpful) would be continued. We have to tell them why they won’t get it. Oh, and … angry person, remember?

Great.

RrrraaaaaarrrrrRrRrRr

As I’ve written recently (well, not that recently; I have been slack and haven’t written much at all recently…), the efficacy of antidepressants has been called ini to question by a few meta-analyses – and while there are real problems with those studies, I do think there might be some truth to what they say. I’ve also written often about psychiatry’s lamentable role in social control or engineering, and being thrown at all of society’s ills, when people might not be actually ill, but just distressed by their life situations.

So why would I now be extolling the virtues of antidepressants?

Because I’ve had a wee cluster of patients suffering major life stressors (job stuff, marriage stuff, children stuff, losing a home stuff… Yu know: the real biggies), who have also presented with serious depression. In such situations I generally tell people my aim is not to make them happy, as I think that would be unrealistic – and in fact diminishes the importance of the stressors – but rather to treat that part that is illness, and thus allow them to function. (That distinction was somewhat more clear in these recent cases I’m thinking of, by virtue of pre-existing diagnoses.)

Anyhow, so I set about treating the illness part of their problems, and on review, despite no change in circumstances (in some cases a worsening) the illness is resolving (not just because I think so; not just because the patient thinks so; because we both agree AND a well-validated rating scale says so). Again, I wouldn’t say any of them are exactly happy, but they’re physically and functionally improved.

That’s what I want to do. That’s what I’m here to do. I can’t fix the vicissitudes of people’s lives, but I can treat the illnesses that stop my patients from addressing them (or just coping with them) adequately.

So: FUCKYEAHANTIDEPRESSANTS! (And mood stabilisers and antipsychotics, of course – for exactly the same reasons.)