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Going to med school to pay off your loans is crazy! I had no debt from college. Even with some scholarship help, my loan statements from med school would make you lightheaded. Not to mention the new legislation in the works trying to make residents, who don't make a whole lot for the hours they work, pay their loans right out of school. Stop the madness! Quote:
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SoEnchanting and BigRedBeta, I totally see what you mean about the student loans. Fortunately I have no federal debt, but I will by 2011. I think a lot of students that do take the higher paying med jobs that they really don't want, I think they just wanna live comfortable lives. Meaning, being able to pay back federal debt while still being able to do the things they want to do. I know, that sucks, but school isn't cheap, and now it would kind of seem like a big waste of time going to school for a business type job and end up becomming an office manager or car salesman. Nothing against those professions, but a lot of times fields that aren't really considered to be specialized, those graduating students sometimes, if not a lot of times, find themselves doing something they didn't go to school for, and then they end up living check to check after the student loans kick in.
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Nope, it isn't the same program. If you wanna go into a specialty program such as marine veterinary medicine, you have to go through a residency program after completing 4 years of veterinary school, then you go into that specialty. |
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What interests you about Surg and Family? Do you have an interest in eventually ending up in a rural community? When do you start putting together your 4th year schedules? Are you going to try to do a surgery sub-I? Any away rotations? Anything you're REALLY excited to do for a month? |
Medicated Americans
Close to 10% of men and women in America are now taking drugs to combat depression. At one time this was a rare condition, but now it's become so common. I subscribe to "Scientific American Mind" magazine and I was reading this article on depression. It was saying that in the past three generations, increasing numbers of Americans have been prescribed antidepressants. In many cases, such prescriptions are the only mental health care the patients receive. One cause of the rise in antidepressant use is that many doctors combine conventional sadness as from the loss of a loved one or a life changing event such as a divorce with the more serious condition of clinical depression. Also, a second contributing factor, is a change in the standard diagnostic guide which caused many milder mental ailments to fall under "disorder" which I think would be considered kind of a neutral label. That could be anything. It was saying that a clinically depressed person may not be able to drag her/himself out of bed. I just wonder why it has gotten so bad, and how does medication really stop this problem?
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I have things that I love about both FM and Surgery. I like the continuity and relationships that are formed with patients in FM, but I think the OR and procedures in general are fun. I don't like that FM is all outpatient (I get bored doing one thing or being in one place for too long), but I hate surgeons' hours... especially if I have any hopes of having a life/family outside of medicine one day. We're in the process of putting together our schedules now, focusing mostly on the few required 4th year rotations. Our sub-I's and electives will be scheduled within the next month or two. And of course, no away rotations want to hear from you until the summer. I'm not sure what sub-I's I'll do next summer/fall, but I'm avoiding surgery until I'm pretty sure that's what I want to do. I have been so indecisive lately. I don't know what I want to do when 3rd year ends! It seems like this point in life has come rather quickly - so many decisions to make in a short period of time... |
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I don't think depression has gotten worse or situations for depression are worse, I think there is increased reporting. Moreover, most depressive episodes are considered reason to arrest, making the treatment absent and worse. Medication used solely alone does not treat depression. Dr. David Burns one of the foremost psychiatrists on depression and bipolar disorders states it MUST be in combination with various talk therapies and/or mindfulness trainings. Cognitive is the best therapy with medication treatment. Mindfulness with yoga breath and exercises seems to have good preliminary responses at this time. 40 years ago, most people attended church to get that meditative experience. However, now, there are a variety of practices and quite a few people are cynical. That does not negate the importance of some "spiritual/soul" work to ease the neurohormones involved in the stress response. |
Well, if statistics are correct then there's a very good chance that many patients have no psychiactric diagnosis. A study of antidepressant use in private health insurance plans found that over 40% of those who had been prescribed antidepressants had no psychiatric diagnosis or any mental health care beyond the prescription of the drug. No, the medications don't cure depression, but honestly how many people who are on these prescription drugs are really depressed? How many people are depressed and don't know it, and are not on any kind of prescription drugs?
I do think people are more willing to talk about it now than they were in the very distant past, but I think some of the prescription drugs are unnecessary based on what I said earlier in this post. |
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Zyban et al. is used to help people to stop smoking. So if that drug was included, that is why they might be saying massive increases in anti-depressants. Also, when Prozac was admitted to the formulary, Eli Lilly did attempt to stop the selling of the nutritional supplement L-Tryptophan saying it caused a rare eosinophilia. But many drugs cause odd side-effects, including Prozac, which has more dangerous ones and that is why Pharma started making extended release tabs. Tryptophan has repeated shown to have better effects than Prozac or Wellbutrin. I think we see new drug systems to treat psychotropic conditions or mental conditions without the full knowledge of neurology or biochemical genetics that are in play to developing the "true" mental disorders. However, I would rather someone with Schizo-affective disorder be treated with Olazapine, anyday... I am not following your concern: Is your thinking that there is something wrong with people globally? Or how come the poorest of the poor do not suffer from depression? Or you were merely shocked at the number of US citizens using (abusing) antidepressants? Let's not talk about the amount of antidepressent drugs in flushed down the toilet and may be in our drinking water... :eek: I can tell you that very few people actively do have bipolar I or II and are NOT medicated, and had no idea they have it. Some depression and bipolars do correlate with type 2 diabetes development. The research as to why is sketchy at best. |
Why do you think you have lupus?
If you truly do have lupus, then a physician can provide treatment that will greatly improve your condition and make you feel a lot better. Given the significant progression of the disease, the medications can prevent a number of the eventual complications the lupus causes. |
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I just reposted your second paragraph because I thought it was awesome!!! Very succinct Dr.!!! :) |
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I saw that other thread once, then never looked at it again...it's amazing to me that I've been on GC for almost 6 1/2 years now and managed to avoid most of the major arguments that have arisen here. |
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Just so you guys know this isn't the real PrettyBoy. It's a troll and he's been going from thread to thread causing problems. The real PrettyBoy has over 1000 posts and has a join date in October. |
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Some of the things you were posting about took place in the 70s and 80s, but what I think modern psychiatry has done is to confuse the two. Depression and depression. I know that sounds crazy but I couldn't think of a better way to word it. It's kind of like a creation of depression, so pharmaceutical and other health care companies are more into making profits from health rather than contributing to it. Did I lose you here?:o Basically they're telling patients they're depressed and they're not.:p:( Seriously, there's probably about one in four people who appear to be depressed and is treated as such, but in reality the patient is pretty much dealing with the aftermath of a recent blow, like the end of a marriage, or the loss of a job or something related to those things. |
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However, many of these drugs used to treat depression (Major Clinical, and/or biopolar I or II, with psychotic episodes) according to the exact definitions of the DSM, MD Consult and Online consult schedules with full case conference review, are legit for the treatment of this illness... That is why psychiatrists are scheduled to prescribe these medications, rather than a GP or Family Doctor... I know a Family Doc, Internal Med doc or a GP is not going to want the DEA asking questions as to why they prescribed one too many antidepressants without a mental eval referral... But, that does not go to say that a FEW shrinks are not prescribing random chit... However, underlying crap that people have in general may get uncovered through traumatic incidences. You never know what the "triggers" are in adults. It is my understanding that "triggers" are well studied in abused (physically, verbally and sexually) children... But, by the time an adult has some issues that never happened as a child, the ability for "brain plasticity" is amenable? I dunno? But that's how it was explained to me... Like negotiation skills are better as one ages... Also, you need to start practicing appropriate medical terminology here... It is easier to practice with us than with your attending... Don't get busted like my husband did in vet school when he did not go thru the entire list of differentials - he just said the 3-4 top things and what would help the sick animal... :rolleyes: |
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Who said I was arguing? lol at the popping pills to feel better. I'm not saying anything to negate the DSM. Infact each successive edition of the DSM has proclaimed an increasing number of diagnoses that cover a large number of human behaviors. The 1st DSM published covered over 150 diagnoses, the next over 350 and so on. I think the next one is supposedly scheduled for 2011, and the number will only increase. AKA_Monet, I'm not arguing with you, infact I agree with most of what you posted, but I'm just saying in contrast to the DSM manuals, large percentages of people with a severe and persistent mental illness get no care whatsoever. The majority of those with a diagnosable mental disorder are not receiving treatment. Also, studies have shown that about 42-50% of people with a serious mental illness were receiving no treatment for their conditions. I also read that a seperate study published in 2002 found that of those in the U.S. receiving treatment for a serious mental illness, only 40% were receiving what is considered minimally adequate treatment. Out of all those with serious mental disorders, then, only 15% were getting the high quality care they needed. This goes back to my earlier post about profits vs. actual health care. I'm not negating anything you've said, but I still believe the profits are overshadowing the care that is really needed for serious mentally ill patients. lol at your husband. May I ask what happened to him for taking short cuts? :) |
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I probably should say "discuss" as the appropriate terminology... What we are trying to do is persuade each other of our concepts to learn what is really going on here. We are not yet in debate... @bolded: With these comments, I agree with you, most people fail to get adequate mental health care, if at all. The profits from Big Pharma probably overshadowing appropriate care of these patients. What I am saying is that there has been a shift in mental health care from talk therapy to that of the concrete, biological, evidence based neurochemical provable... The two should be working together because in mental illnesses 1) quite a few people are born with imbalances; and 2) learning, environment and nurturing as well as personality development play a huge role into someone's behavior. The drug treatment and efficacy should be used on someone who cannot sift through a difficulty, BUT more importantly, that person should undergo somekind of talk treatment to validate and confirm societal standards on civil behavior... Long time ago, a child acting out in a public setting was unheard of and a parent could physically discipline their child, publicly, if they wanted to. Today, a child can act out in a public setting, no one will say anything, and clients are disturbed. It has caused some places of business not to allow children into the establishments. The parent usually takes the child to the restroom and resolves the issue, what some would say placating... No one questions how it might damage the psyche on one identifying boundaries on this growing child. If a child has a predisposition to ADHD, will adderall, ritalin or whatever treatment really enable child to be functional in behavior? But without treatment, that child would be lost to the system of violent outbursts and uneducated due to behavioral problems. What to do... Then we haven't gotten to appropriate diagnosis... |
for AKAMonet and Cheerful Greek
your discussion has been wonderful. the dialogue has been on point. from personal experience, the benefit of proper medication and talk therapy does help in the treatment of mental illness. there are many people who do not have the benefit of both whether it's accessibility or cost, OR even culture, which plays a huge role in proper treatment.
i hope this type of discussion continues:D. |
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AKA_Monet, I'm not trying to persuade you to change your opinion. You've made some very valid points. I just want you see my side just a little. What grabbed my attention from your last post, was the fact that you were talking about how things were with children years ago, and how things are different now. Yes, it is. My point precisely! Going back to the DSM manuals, the prevailing term to describe specific psychiatric conditions in the 1st DSM manual was kind of odd. The term reaction is what was used back then. Like Schizophrenia for example was described as a schizophrenic "reaction". Depression was considered a depressive "reaction". The concept of "reaction" derived from psychoanalytic thinking, and as such, mental torment was thought to come about as a result of a reaction to "environmental", pschological and biological problems, as you stated above. By the time the 2nd DSM manual was published, the term "reaction" had been tossed aside. It described depression in more psychological terms such as depressive neurosis and depressive psychosis. Now, by the time the 3rd DSM manual was published, it was an attempt to strike somewhat of a middle ground between the psychoanalytic parts, which had no interesest in biology, nor the scientists who were starting to gain more knowledge as psychiatric drugs were becoming more prevalant and often successfully treating people with severe mental illness. From the 1st DSM manual to the 3rd one, there a was a significant change. That being somewhere around the 50s to the 60s. Things have changed again and it will continue. I'm just trying to reiterate what you stated about how things were with children years ago and how things are now. I'm just using a different approach. Now, you tell me. Why is that "years" ago you NEVER, EVER, EVER, saw prescription drugs being advertised on televison? Now it's like every day. I can't watch t.v. without some random commercial about some prescription drug being shown to the public for all to see. Oh, and lets not talk about all the side effects.:rolleyes: The advertising is about what I've been trying to get you to see, if I haven't already, that it's more about the profits than it is about the actual health care of the patient, and this is what it has CHANGED into. Period. |
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Wow. This is too much information to take in.
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If only psychiatrists and psychologists (in states that give prescribing rights to pyschologists) were the only people able to treat mental illness, then there would be a lot of people with no access to mental health care. There are many areas with few psychiatrist. These practitioners stay full for appointments. Any physician who is willing to follow the outcome of a disease can appropriately prescribe these medications. The side effects are very rare for this class of medications, and I'm sure a board certified physician can assess for those effects as well as a psychiatrist. As for whether every person with depression should get "talk therapy," that's the ideal but not the practical solution to a very common disease. |
New topic
While we're on the subject of medication, How much is too much? In some cases is it even necessary? Like autism for example. I think some of the vaccines are the problem with this epidemic. I don't know much about it, but I do believe that deliberating symptoms of autism typically become apparent at a very early age, like age 2 or 3, not long after infants have received vaccinations for a host of diseases. Many parents claim that their children developed autism shortly after inoculations(tests) either following a vaccine series of mumps, or measles, or vaccines that contain mercury.
I'm not sure if anyone heard of this, but has anyone heard of the MMR vaccine? There's a disease called "rumbella" which is often referred to as the German Measles. MMR means mumps, measles, and rumbella. I remember reading about a study regarding this vaccine. The study showed that symptoms of autism emerged shortly after children received the MMR vaccine. How much research is being done with the medications that are being prescribed to patients? How much research is being done on some of the vaccines we're taking into our bodies? I know there's lot a lot of research being done, but how much is a lot? |
There is no credible study that has linked vaccines to autism.
It's rubella. The rise in autism diagnoses is at least in part to expanding the diagnosis and increasing awareness of parents. A shocking number of parents asked me if their child was autistic when I was on my peds rotation when their kids were right on track or even developmentally advanced. |
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The FDA may need to track these drugs now because these days, with kids committing suicide on these medications... Actually, the blood tests to monitor the effectiveness of these drugs is a different issue but also plays a role on the side effects. Some side effects are not a rare as one would think: such as buproprion, lamotragine, amitryptaline or olanzapine. SOME Family physicians do not pick up these symptoms or care... This comes with experience in the field. And "talk therapy" may be impractical for many, but when the patient is an adult, the nature of these illnesses and why the behave the way they do, at this time and the only course of research that has been shown effective. Drugs cannot do this alone. And none of these classes of illnesses have been show to be directly caused by infection, yet... |
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Most vaccines nowadays are DNA vaccines. Very few are still heat-killed live virus to boost ones immunity. What is vaccination biologically? Injection of nucleic acids into the body? By microbes and viruses alone do this. Does that change who we are? Depends. Humans generally care several different viruses that does not cause them to get sick, all the time. Adenovirus and AAV, cytomegalovirus (until one has HIV), etc. Generally, there are standard curves with LC50 based on the nonhuman primate studies and/or cell biology studies. That is how they decide the concentrations for these things. |
Oh dear GOD!!!!! I am so embarrassed!!:o Rubella, Rubella, Rubella!! I seriously thought it was "rumbella". (giggling) Thanks?:o Well, you guys knew what I meant. Right?:p
o.k. you guys may be right, there is little evidence that vaccines cause autism, but it is possible that vaccines trigger autism in a small subset of children, but if so, that subset has yet to be identified. A study really was done in the 90s that investigated 12 children, and the study did reveal that symptoms of autism did emerge shortly after the MMR vaccine was given to them. If it can't be proven that vaccines play a role in the increase of autism, can someone explain why the rates of autism continue to rise? Do you think genetic factors play a role? I honestly don't believe that genetic influences alone can account for such an astronomical rise in a disorder's prevalence over a matter of just a few years. Could environmental factors be a potential explanation? AKA_Monet mentioned something about environmental factors in an earlier post. We were discussing a different topic, but could this also fall under environmental factors? |
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Autism's symptoms has been shown to be EXACERBATED by environment. As far as what is causing it, it could be too much lead or other minute items that we regularly do now and consume -- hayle, it could be that we have too much tech chit abound that fries our brains and gets transmitted to a developing fetus... Who knows? |
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No, I just wanna read other opinions. I do wanna see that movie though. Does anyone know when it starts?:) I just want to mention one more thing. Back to the DSM manual....o.k. I promise I won't bring up the the DSM anymore...lol.:rolleyes::p I just wanted to mention something about the vaccines. There may be an overlooked alternative explanantion for this epidemic. Over time the the criteria for a diagnosis of autism have loosened, resulting in the labeling of substantially more mildly afflicted individuals as autistic. The 1980 version of the DSM required individuals to meet six of six criteria for an autism diagnosis, In contrast to that, the 1994 version, which is the version we're currently using requires individuals to meet any 8 of 16 criteria. The 1980 version contained only two diagnosis relevant to autism, DSM IV contains five including Asperger's syndrome which most researchers regard as a high functioning variant of autism. |
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Clinton did establish a research center at the National Institutes of Health, at the same time involving other nations in the effort. There was an HIV vaccine back in the 80s, "VaxSyn" which is based on some kind of viral protein. I can't remember the name exactly, but I do know it was based on a viral protein. Anyway, it was unsuccessful, but then again, back in the 80s it was also thought that AIDS was gay related.:rolleyes: So what do you think? Do you think a successful vaccine can be created soon? Bill Clinton started this program some 10 years ago. Well, we're still waiting.:confused::( |
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There is the issue that MAYBE HSV-2 infection has some protection against HIV, BUT I just read in JAMA that may not be all the accurate... I do not understand why a vaccine cannot be made against HIV... It does not make sense? And what bakes my noodle even more is how come folks with advance HIV disease do not get "polio" or "MMR"? |
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Back to mental illness treated by medication:
Do you the "mentally ill treated with meds" should have restricted freedoms in the US due to the "possibility" being a detriment to themselves or others? What would/would not be the medical relevancy for that? |
It's certainly a very touchy subject given the recent shootings across the country.
Medically, I'm not sure that it's up to doctors to make the decision on whether or not people can have guns. If the law states that those with diagnosed mental illnesses aren't allowed to possess firearms then that's the consequence of having a mental illness, but doctors should focus on disease and health. This isn't to say that doctors must ignore social issues with their patients, but that I think that's more of a one way street - doctors focus on social issues that affect the health of their patient (ie domestic abuse, inability to pay for meds, difficulty patients have getting to appointments b/c they don't have transportation), but shouldn't worry about how the health decisions affect the social issues in their patients. That's a very simplified view for sure, going with the one way street analogy, and I'm sure that if I thought about it, I'd be able to come up with some situations in which I don't agree with what I've just said, but on first glance, that looks like a good starting point. I probably didn't explain it that very well though... Of course I'm of the opinion that we'd be better off with out the 2nd Amendment, but recognize it's not that easy... |
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