The enemy must bleed! I heard one of their organizations whimper this morning in a radio ad informing all of us that a psychiatrist is the only professional qualified by training the match medications to other methods in mental health treatment.

Psychiatry, however, experiences Internet outcomes: as information becomes more public, it also becomes less costly. Dealers in car insurance, auto prices, and real estate have all reduced their prices, often $250 to walk in the door. A second, more fundamental outcome: patients walk in the door with a diagnosis and medication already in mind. One shrink remarked that he generally gives his patients whatever they ask for!

Psychiatry's ad brought to mind a rant I have made before:

1) Pharmaceutical companies are in an arms race to reduce side effects while providing some illusion of benefit. Changes are slow and usually small variations of last year's drug.

2) Individual responses vary, however, and any physician of any training, will have to "trial and error" you. The day may come when a lock of your hair tells what pills to give and in what circumstances, but we ain't there yet.

3) Foreign medical graduates are as plentiful as Muslims in the Russian army...a near majority! I understand a FMG's ability to splice a femur but am skeptical about their ability to transcend cultures to fine-tune an angry Celt. Again, the pill-designers prevent that need from occurring and protect many psychiatrists from charges of incompetence.

4) The main business of a psychiatrist is often "medication checks." (These practitioners often call themselves "neuropsychiatrists" in the same manner that a plumber is a "sanitary engineer." The doc asks "How's it going?," scribbles a note, and often gets you out in seven minutes. Within those seven minutes the practitioner must convey sincerity and kindness while not poisoning you. After all, the more abrupt or arrogant the healer, the greater his chances of being sued.

5) There are no genes for plumbers but some of the bags for carpenter genes attended medical school rather than VoTech. Nonetheless, psychiatrists must work in a plumber's shared environment. (Psychologists, a different genome, obsess about ethics, rules, and appropriate treatment. They write grand unifying theories. Psychiatrists produce few GUTs and tend to be pragmatists and sometime risk-takers who want to find their own recipes for their cafe visitors.)

6) Psychiatry, however, survives because of an accident: Suicide is considered as an emotional problem but medications for "depression" were once lethal and no other physician would write an order for them! Psychiatrists, I suspect, remain the exploratory edge for medications management in the treatment of emotional distress. GPs and Nurse Practitioners wait for the preliminary results from what is known in the computer world as "beta testing."

7) Psychiatrists are reputed to be the lowest paid medical specialty and to have the lowest aptitude scores. According to Kay Jamison, a gifted psychologist who can be bipolar herself and studies creativity and bipolar disorder, psychiatrists and female therapists share high risks for suicide.

End of rant, no extra charge...