MDs and Truth in Advertising, err Blogging

Isn’t it great when psychiatrists publish websites or blogs that help you decide if they might be the right (or very wrong) choice for you? Isn’t it really great when their guest comments on other blogs provide an entirely different picture of their approach than you would get by reading the pro forma info on their websites?  Buyer beware!

Readers nationwide often write to me asking for referrals to psychiatrists or therapists in their area who are competent in treating ADHD.  I do my best to help, still emphasizing the importance of patients being pro-active. No matter how good the expert, it’s important to take a team approach. I routinely recommend a Google search for the professional’s website or blog to learn more about approach, training, and so forth. Even Yelp.com reviews might provide some inkling of a physician’s or therapist’s reputation.

Never have I seen such a clear case of “truth in advertising” about a psychiatrist’s approach to ADHD, however, than this blog post from a David Allen, MD (it’s unclear where he is practicing now but he received his medical degree at UCSF, a local medical school that will receive future attention in my blog).

To partially quote Allen’s manifesto at the top of his blog:

“It discusses how family systems issues have been denigrated in psychiatry in favor of a disease model for everything by a combination of greedy pharmaceutical and managed care insurance companies, naïve and corrupt experts, twisted science, and desperate parents who want to believe that their children have a brain disease to avoid an overwhelming sense of guilt.”

Never mind that the “family systems model” obscured multi-generational ADHD for so many years and postponed true help for millions of people affected by ADHD. Some ideas die hard. And when you’ve staked your career on it  but can’t adapt your specialty to include evolving science, well, I guess bitterness can ensue. Especially if the goal is to be “right” rather than helpful.

Anyway, here is a snippet of Allen’s recent post about ADHD:

Here’s a song I wrote for some of my symptom-obsessed fellow psychiatrists who are – what’s the word? – oh, yes – incompetent:

Take some of these and you’ll feel better
Forget about those hippies who claimed, “speed kills”
You’ve got ADHD and just a touch of bipolar
Things are always better when you’re taking pills

Also not to be missed: one of the comments to this post, from a fellow psychiatrist, Steve Malt:

Here’s my idea. Let’s just stop calling ADHD a “disorder,” thereby giving it credence it doesn’t deserve (at least not yet).

I’m serious. We can still prescribe ADHD meds to people if they say they help– along with the proper safeguards, of course– in the name of “cosmetic pharmacology.” Heck, dermatologists, plastic surgeons, and bariatric specialists do procedures for more dubious “conditions” all the time.

In the meantime, we should continue to do genetic, neuroimaging, psychological investigations to determine the root cause of inattention & hyperactivity– and, perhaps, to determine whether a sub-population of our “ADHD” people actually have a biologically based disorder, and if so, how best to treat them.

If you seek help from this psychiatrist then, you should know that any prescribing will be done with a placating attitude and not one of informed skill.

Was I surprised to learn that this came from a psychiatrist in San Rafael, California? No, such attitudes in Northern California are more the rule than the exception. I also see that this psychiatrist did his residency at Stanford. (Stanford is another  veritable hotbed of ignorance about Adult ADHD, according to all the reports I’ve received over the years. That’s not to say that some competent psychiatrists don’t hail from the medical school there but I suspect they learned about ADHD afterwards or elsewhere.)

Between UCSF grad David Mallen’s sarcastic, demeaning attack on ADHD as a legitimate diagnosis and this Stanford grad’s arrogant denial of the huge body of evidence documenting ADHD as a legitimate condition, you can see why I often despair of the San Francisco Bay Area’s support for the ADHD community.

People are always surprised to hear me say this; isn’t the Bay Area supposed to be a technological forefront? Yes, if you like gadgets. Aren’t there lots of Nobel Laureates at both Stanford and UCSF? Yes, both are widely respected universities and not without reason. But when it comes to ADHD, I don’t know what can account for the obstinate, even cruel refusal to give ADHD its due.  I have some ideas, but I’m more interested in hearing yours.

By the way, if you read only Steve Balt’s website, you would not know his true attitudes towards ADHD. This is what he writes there:

I am a psychiatrist practicing in San Rafael, California, and specializing in comprehensive, individualized care for adults with a variety of mental health conditions, including mood disorders such as depression and bipolar disorder; anxiety; PTSD; obsessive-compulsive disorder; attention deficit/hyperactivity disorder (ADHD); eating disorders; addictions to alcohol, drugs, food, and behaviors; and lifestyle problems pertaining to relationships, life transitions, grief and loss, and inability to achieve one’s personal goals.

My Approach

I believe in developing an individualized treatment plan for each patient, which capitalizes upon each person’s distinct strengths while identifying the areas in which further growth is necessary or desired.  I provide medication management as well as ongoing psychotherapy.  I absolutely respect each individual’s feelings regarding medications, and I will work with each patient to establish a treatment plan that is acceptable to both patient and physician, as I believe this is essential for treatment success.  When medications are prescribed, I wish to help the patient understand the impact of such interventions on his or her life, as well as the areas in which medications will have little or no effect.

As I said, buyer beware.

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