dating in medical school seems hard

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fancymylotus said:
HAY
no trashing my NY.
Brooklyn is not representative of NYC or my suburb

><
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You live in Queens don't you?
And there's a reason everyone wants to come live in the city! (Because life here is awesome!)
 
Winged Scapula said:
Now you're just being ridiculous.

I don't see cases of middle aged women on Effexor stealing to support their Adderal or anabolic habit. Allowing everyone access to drugs with abuse potential is ridiculous.

There just isn't an answer to your question. Yes, there has to be a limit on access to many medications especially those with abuse potential. I personally have a problem with medical students taking stimulants to help them to study or the fact that it seems like every freakin' kid these days has "ADHD". But that doesn't mean NO ONE gets treated (which is what it appears you seem to advocate).

I am off to my Global Entry Interview so I can move easily throughout my international travels, so you guys can continue the conversation without me for the time being.
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I'm not talking about adderal. I'm talking things stronger than that like dextroamphetamine(well technically it is in adderal, but adderal isn't solely composed of dextroamphetamine) used by military and athletes. However I'm not talking about for those usages, what about weight loss? That's not enhancement. What about depression?

I'm not advocating for no one to be treated. It's fine if someone seeks a diagnosis, and the DSM confirms that. My problem is when people don't seek these diagnoses and are characterized with a disease merely due to essentially arbitrary observations seen in people associating with an illness. That's when I think you need physiological proof. As I said before, denial of mental illness is considered one of the signs of mental illness, which is quite an interesting paradox for those diagnosed against their wishes. If my doctor says I have a broken foot and thus aren't medically cleared to compete in an athletic event, if I disagree, I can have it imaged which is a relatively objective analysis. If the same thing happens for a mental illness, you really don't have that capability, because the field itself maintains that questioning such diagnosis would indicate that you do in fact have it.
 
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I have agreed with pretty much everything med jack has said.

That is my final say on this issue
 
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PL198 said:
absolutely. if you don't, it's going to be manipulated to where anyone that does something that an overseeing body thinks is abnormal, that person has a mental disease. this is essentially how psychiatry is trending now and will continue to do so when there are essentially 0 barriers to entry in terms of saying someone has a disease. it's also an even bigger joke when you consider the paradox of mental disease in that denial of mental disease is considered one of the signs. funny how that works.
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Dude what? Are you a doctor?
 
PL198 said:
I'm not talking about adderal. I'm talking things stronger than that like dextroamphetamine(well technically it is in adderal, but adderal isn't solely composed of dextroamphetamine) used by military and athletes. However I'm not talking about for those usages, what about weight loss? That's not enhancement. What about depression?

I'm not advocating for no one to be treated. It's fine if someone seeks a diagnosis, and the DSM confirms that. My problem is when people don't seek these diagnoses and are characterized with a disease merely due to essentially arbitrary observations seen in people associating with an illness. That's when I think you need physiological proof. As I said before, denial of mental illness is considered one of the signs of mental illness, which is quite an interesting paradox for those diagnosed against their wishes. If my doctor says I have a broken foot and thus aren't medically cleared to compete in an athletic event, if I disagree, I can have it imaged which is a relatively objective analysis. If the same thing happens for a mental illness, you really don't have that capability, because the field itself maintains that questioning such diagnosis would indicate that you do in fact have it.
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Ok I kind of see where you are going with this but I disagree. You can't do an MRI for everyone that comes in with depression. You have to make a clinical call about depression since guess what thats your job as a doc. You don't always need tests. You've got to go with instincts a lot of times and that comes with experience


Edit: zoloft is am amazing drug . .
 
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PL198 said:
I'm not talking about adderal. I'm talking things stronger than that like dextroamphetamine(well technically it is in adderal, but adderal isn't solely composed of dextroamphetamine) used by military and athletes. However I'm not talking about for those usages, what about weight loss? That's not enhancement. What about depression?

I'm not advocating for no one to be treated. It's fine if someone seeks a diagnosis, and the DSM confirms that. My problem is when people don't seek these diagnoses and are characterized with a disease merely due to essentially arbitrary observations seen in people associating with an illness. That's when I think you need physiological proof. As I said before, denial of mental illness is considered one of the signs of mental illness, which is quite an interesting paradox for those diagnosed against their wishes. If my doctor says I have a broken foot and thus aren't medically cleared to compete in an athletic event, if I disagree, I can have it imaged which is a relatively objective analysis. If the same thing happens for a mental illness, you really don't have that capability, because the field itself maintains that questioning such diagnosis would indicate that you do in fact have it.
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I have very little knowledge of psych (I don't have my m2 psych block until January), but I'm going to assume that 'the denial of a mental illness' is one of many criteria that can result in a diagnosis of a particular mental illness. In other words, the denial of of a mental illness does not automatically result in the diagnosis of a mental illness. That would be a true paradox. What you're commenting on is that a patient's denial of a mental illness may actually have a different etiology (e.g. they don't actually have a mental illness and consequently they believe that). This is why most diagnoses of conditions that don't have obvious objective diagnostic components require multiple criteria, such as metabolic syndrome. Because you may have some of the required conditions that have completely separate etiologies. Diagnostic criteria for the kinds of conditions we're talking about aren't perfect (again, because you can have the required diagnostic criteria that happen to have unrelated etiologies), but that doesn't mean they are useless.

How many times do you think legitimate denial of mental illness (by legitimate I mean that the person who holds the belief is not actually mentally ill) has actually resulted in the diagnosis of said mental illness? I think what you're doing is focusing on inherent imperfections of psychiatry/psychiatric diagnoses and using that as justification to discredit all of (or much of) psychiatry.
 
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sinombre said:
I was alluding to the clean needle program argument in another thread... really I just wanted an excuse to use that bad joke. But I agree with what he has said in this thread.
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Looks like I have a lot of catching up to do on SDN. However mnf is about to start.
 
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sinombre said:
I have very little knowledge of psych (I don't have my m2 psych block until January), but I'm going to assume that 'the denial of a mental illness' is one of many criteria that can result in a diagnosis of a particular mental illness. In other words, the denial of of a mental illness does not automatically result in the diagnosis of a mental illness. That would be a true paradox. What you're commenting on is that a patient's denial of a mental illness may actually have a different etiology (e.g. they don't actually have a mental illness and consequently they believe that). This is why most diagnoses of conditions that don't have obvious objective diagnostic components require multiple criteria, such as metabolic syndrome. Because you may have some of the required conditions that have completely separate etiologies. Diagnostic criteria for the kinds of conditions we're talking about aren't perfect (again, because you can have the required diagnostic criteria that happen to have unrelated etiologies), but that doesn't mean they are useless.

How common do you think legitimate denial of mental illness (by legitimate I mean that the person who holds the belief is not actually mentally ill) has actually resulted in the diagnosis of said mental illness? I think what you're doing is focusing on inherent imperfections of psychiatry/psychiatric diagnoses and using that as justification to discredit all of (or much of) psychiatry.
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That's impossible to assess. Nor would it necessarily matter if it resulted in the diagnosis or not. The fact is, for a large part of mental illness, it is a factor to the diagnosis. Metabolic syndrome is just as shady... That's something half the population has, it's not like it's rare and would somehow increase the PPV of a diagnosis. nearly every single office worker who doesn't have a high level of activity and doesn't have great genetics for cholesterol and BP could be said to have metabolic syndrome. I mean come on, if you show me some co-criteria that are actually specific and something hat not everyone can easily have it would absolutely weaken my position. My whole point is that since psych diagnoses are so subjective, patients that don't agree with the diagnosis get screwed. You retort to that by talking about another subjectively unrelated condition which huge amounts of people have?
 
it's like you just said " well one of the co-conditions of ADHD is breathing O2" well **** that sure narrows it down, clearly no one is gonna get screwed by that
 
sinombre said:
I have as well. He is a rare voice of reason on SDN. Like finding a used heroin needle in a haystack.
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I haven't been reading Mad Jack's posts, but I found that particularly hilarious.
 
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PL198 said:
That's impossible to assess. Nor would it necessarily matter if it resulted in the diagnosis or not. The fact is, for a large part of mental illness, it is a factor to the diagnosis. Metabolic syndrome is just as shady... That's something half the population has, it's not like it's rare and would somehow increase the PPV of a diagnosis. nearly every single office worker who doesn't have a high level of activity and doesn't have great genetics for cholesterol and BP could be said to have metabolic syndrome. I mean come on, if you show me some co-criteria that are actually specific and something hat not everyone can easily have it would absolutely weaken my position. My whole point is that since psych diagnoses are so subjective, patients that don't agree with the diagnosis get screwed. You retort to that by talking about another subjectively unrelated condition which huge amounts of people have?
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>25% of of people over 65 in the US have type 2 diabetes. Should we not consider that a disease because it's so common?

I hear what you're saying about not wanting to mistake normal physiology for pathology, but I don't think you can automatically assume that just because a condition has a high prevalence it shouldn't be considered a disease. I agree that it should make us at least suspicious though.
 
sinombre said:
>25% of of people over 65 in the US have type 2 diabetes. Should we not consider that a disease because it's so common?

I hear what you're saying about not wanting to mistake normal physiology for pathology, but I don't think you can automatically assume that just because a condition has a high prevalence it shouldn't be considered a disease. I agree that it should make us at least suspicious though.
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This is pretty arbitrary, but if it gets over 50-60% in my opinion, no we shouldn't. I don't really know of any diseases that are prevalent in the majority of the population. At some point, you change the definitions for normal phys, because the definition of normal literally means statistically common.
 
PL198 said:
This is pretty arbitrary, but if it gets over 50-60% in my opinion, no we shouldn't. I don't really know of any diseases that are prevalent in the majority of the population. At some point, you change the definitions for normal phys, because the definition of normal literally means statistically common.
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It would be like obesity. It's not really a disease, but it is not an ideal condition, and it used to be abnormal. Now it's common.
 
RJGOP said:
It would be like obesity. It's not really a disease, but it is not an ideal condition, and it used to be abnormal. Now it's common.
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yeah if we change it to "obesity + overweight" I guess. I'm a numbers guy so for all intents and purposes, it seems logical to me to expect the state of being overweight in normal patients and that being less than overweight(by body fat definitions, not BMI) would be a positive circumstance, however still abnormal
 
PL198 said:
yeah if we change it to "obesity + overweight" I guess. I'm a numbers guy so for all intents and purposes, it seems logical to me to expect the state of being overweight in normal patients and that being less than overweight(by body fat definitions, not BMI) would be a positive circumstance, however still abnormal
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This is the given medical definition for disease:
: an impairment of the normal state of the living animal or plant body or one of its parts that interrupts or modifies the performance of the vital functions, is typically manifested by distinguishing signs and symptoms, and is a response to environmental factors (as malnutrition, industrial hazards, or climate), to specific infective agents (as worms, bacteria, or viruses), to inherent defects of the organism (as genetic anomalies), or to combinations of these factors :
So, nothing is stated about the rarity, or lack thereof, for something to be classified as a disease. So, it would be hard to no longer classify diabetes as a disease.
 
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PL198 said:
This is pretty arbitrary, but if it gets over 50-60% in my opinion, no we shouldn't. I don't really know of any diseases that are prevalent in the majority of the population. At some point, you change the definitions for normal phys, because the definition of normal literally means statistically common.
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It is estimated that 50% of Pima Native Americans have type 2 diabetes. From an evolutionary standpoint, a majority of a given population could absolutely have a disease/some kind of aberrant pathology. For example, a mutated gene might give a population a huge advantage early in life but cause a clinically relevant disease process down the line. Just because it becomes 'normal' in this population doesn't mean we shouldn't treat it.

I think this is more of a semantics issue than anything. I have no problem with accepting an arbitrary definition that once a majority of a population is affected with a certain condition that we don't consider it a 'disease,' but I don't think that has any bearing on treatment.
 
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I can't decide if PL is purposefully misrepresenting things or just naive. A few things:

1) Yes sometimes the psych patient doesn't believe they have a disease. One example of this would be in eating disorders. You have patients who are killing themselves and don't believe that they have a problem, that they aren't sick, that they are fat, when any outside observer can tell they are not well. Another would be schizophrenia, obviously in that case the patient doesn't believe they have a mental illness because they believe their disillusions are reality. Same goes for the dementia patient. It's not like psychiatrists are grabbing people off the street, asking if they are crazy and then locking them up. I'm not sure what you think goes on, but psychiatrists treat sick patients.

2) Prevalence doesn't tell you crap, and many other posters already covered this

3) Like WS mentioned, not every patient on SSRIs is being treated for depression. They are really cool drugs that can do a lot of different things

4) One of the first things we learned at my school was that the vast majority of diagnoses can be made on patient history alone. Not being able to test for a disease doesn't make it not real. Especially when it comes to anything with the brain, a part of the body we don't really know that much about.

-I'm still kind of unsure what your issue is. Do you actually believe that psych disorders aren't real, or that we shouldn't use pharmaceuticals to treat it? I'm really not seeing the harm here.
 
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touchpause13 said:
I can't decide if PL is purposefully misrepresenting things or just naive. A few things:

1) Yes sometimes the psych patient doesn't believe they have a disease. One example of this would be in eating disorders. You have patients who are killing themselves and don't believe that they have a problem, that they aren't sick, that they are fat, when any outside observer can tell they are not well. Another would be schizophrenia, obviously in that case the patient doesn't believe they have a mental illness because they believe their disillusions are reality. Same goes for the dementia patient. It's not like psychiatrists are grabbing people off the street, asking if they are crazy and then locking them up. I'm not sure what you think goes on, but psychiatrists treat sick patients.

2) Prevalence doesn't tell you crap, and many other posters already covered this

3) Like WS mentioned, not every patient on SSRIs is being treated for depression. They are really cool drugs that can do a lot of different things

4) One of the first things we learned at my school was that the vast majority of diagnoses can be made on patient history alone. Not being able to test for a disease doesn't make it not real. Especially when it comes to anything with the brain, a part of the body we don't really know that much about.

-I'm still kind of unsure what your issue is. Do you actually believe that psych disorders aren't real, or that we shouldn't use pharmaceuticals to treat it? I'm really not seeing the harm here.
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That's what I'm wondering too. It seems as if he's saying if something doesn't show on a diagnostic test, you should base your treatment plan on that, for pysch disorders.
 
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RJGOP said:
This is the given medical definition for disease:
: an impairment of the normal state of the living animal or plant body or one of its parts that interrupts or modifies the performance of the vital functions, is typically manifested by distinguishing signs and symptoms, and is a response to environmental factors (as malnutrition, industrial hazards, or climate), to specific infective agents (as worms, bacteria, or viruses), to inherent defects of the organism (as genetic anomalies), or to combinations of these factors :
So, nothing is stated about the rarity, or lack thereof, for something to be classified as a disease. So, it would be hard to no longer classify diabetes as a disease.
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the word normal is used. normal isn't defined by arbitrarily saying " lean people are cool, being fat is a disease." it's defined by what is common.
 
touchpause13 said:
I can't decide if PL is purposefully misrepresenting things or just naive. A few things:

1) Yes sometimes the psych patient doesn't believe they have a disease. One example of this would be in eating disorders. You have patients who are killing themselves and don't believe that they have a problem, that they aren't sick, that they are fat, when any outside observer can tell they are not well. Another would be schizophrenia, obviously in that case the patient doesn't believe they have a mental illness because they believe their disillusions are reality. Same goes for the dementia patient. It's not like psychiatrists are grabbing people off the street, asking if they are crazy and then locking them up. I'm not sure what you think goes on, but psychiatrists treat sick patients.

2) Prevalence doesn't tell you crap, and many other posters already covered this

3) Like WS mentioned, not every patient on SSRIs is being treated for depression. They are really cool drugs that can do a lot of different things

4) One of the first things we learned at my school was that the vast majority of diagnoses can be made on patient history alone. Not being able to test for a disease doesn't make it not real. Especially when it comes to anything with the brain, a part of the body we don't really know that much about.

-I'm still kind of unsure what your issue is. Do you actually believe that psych disorders aren't real, or that we shouldn't use pharmaceuticals to treat it? I'm really not seeing the harm here.
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you keep misrepresenting my point, because you're unwilling to admit it. it's not going to be a good discussion. you continually do this in debates. it's whatever though.

P.s. suicide does not indicate a mental illness. it is completely possible to rationally commit suicide.
 
PL198 said:
the word normal is used. normal isn't defined by arbitrarily saying " lean people are cool, being fat is a disease." it's defined by what is common.
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So if everyone was obese and had diabetes, you'd just say, "well, that's normal!"

I'd bet if you went to North Korea and surveyed the population, 95% of them would be depressed because they live in such **** conditions under a crazy dictator. Would you say, "oh, it's cool, that's how everyone feels, so it must just be normal! Happiness is in the minority, so it must be pathological!"
 
sinombre said:
It is estimated that 50% of Pima Native Americans have type 2 diabetes. From an evolutionary standpoint, a majority of a given population could absolutely have a disease/some kind of aberrant pathology. For example, a mutated gene might give a population a huge advantage early in life but cause a clinically relevant disease process down the line. Just because it becomes 'normal' in this population doesn't mean we shouldn't treat it.

I think this is more of a semantics issue than anything. I have no problem with accepting an arbitrary definition that once a majority of a population is affected with a certain condition that we don't consider it a 'disease,' but I don't think that has any bearing on treatment.
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literally look at the words you are using. it's not aberrant if 50-60 % have it. the definition of aberrant is : " departing from the usual" I think we all understand what usual means. I'm fine with treating it too, but that's enhancement and not restoration of function, which then would tie in ethically to what I've previously been talking about. you're taking a condition that is normal in people and treating it, meanwhile vilifying people that want a boost in their focus or anabolism. it's no different.
 
Mad Jack said:
So if everyone was obese and had diabetes, you'd just say, "well, that's normal!"

I'd bet if you went to North Korea and surveyed the population, 95% of them would be depressed because they live in such **** conditions under a crazy dictator. Would you say, "oh, it's cool, that's how everyone feels, so it must just be normal! Happiness is in the minority, so it must be pathological!"
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yeah, because by definition, it would be normal. that doesn't mean its advantageous... you guys really seem to be struggling with the concept that normal =!= beneficial traits. it's normal for teenagers to try drinking alcohol. is this necessarily beneficial for them?
 
PL198 said:
yeah, because by definition, it would be normal. that doesn't mean its advantageous... you guys really seem to be struggling with the concept that normal =!= beneficial traits. it's normal for teenagers to try drinking alcohol. is this necessarily beneficial for them?
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Normal doesn't necessarily have to mean "the average." We're physicians, not statisticians. Normal can also mean "conforming to an established standard." That standard is a person that is ideally healthy, optimally functioning, and least prone to disease. If everyone in a town has heavy metal poisoning from the well water, you don't just say, "well, looks like that's normal since everyone's got it! Nothing to do here!"
 
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Mad Jack said:
Normal doesn't necessarily have to mean "the average." We're physicians, not statisticians. Normal can also mean "conforming to an established standard." That standard is a person that is ideally healthy, optimally functioning, and least prone to disease. If everyone in a town has heavy metal poisoning from the well water, you don't just say, "well, looks like that's normal since everyone's got it! Nothing to do here!"
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you also keep making the connection that if something is normal, that we shouldn't treat it. I've never said that. the established standard is based on the wild type. if 60 percent of people have diabetes, that is the wild type.
 
PL198 said:
you also keep making the connection that if something is normal, that we shouldn't treat it. I've never said that. the established standard is based on the wild type. if 60 percent of people have diabetes, that is the wild type.
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Wild type and the mean presentation of a population does not mean "normal" in a medical sense. You're trying to apply statistical terms to an area in which they have no place. Normal is healthy, in a medical sense. If everyone had cancer, cancer wouldn't be normal, everyone would have disease. If everyone had diabetes, everyone wouldn't be normal, they would have a disease. Disease is a pathological process. If you are born with diabetes, it may be your baseline normal, but it is still a disease.
 
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PL198 said:
you keep misrepresenting my point, because you're unwilling to admit it. it's not going to be a good discussion. you continually do this in debates. it's whatever though.

P.s. suicide does not indicate a mental illness. it is completely possible to rationally commit suicide.
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I'm asking you to clarify what you mean

Also i didn't bring up suicide so I have no idea what you are getting at there
 
Mad Jack said:
Wild type and the mean presentation of a population does not mean "normal" in a medical sense. You're trying to apply statistical terms to an area in which they have no place. Normal is healthy, in a medical sense. If everyone had cancer, cancer wouldn't be normal, everyone would have disease. If everyone had diabetes, everyone wouldn't be normal, they would have a disease. Disease is a pathological process. If you are born with diabetes, it may be your baseline normal, but it is still a disease.
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but yes they do. because normal is assumed to be what the average person exemplifies. initially there weren't books that said " oh ****, skinny people are awesome, that's normal." they were the most common and thus it was deemed to be normal. the 6th word in the definition of disease is abnormal.

it's enhancement, just like taking adderall. if I'm in a population that has 60 % of people with diabetes, treating that diabetes is absolutely enhancement. once again(since you all seem to fail to grasp this) I'm not advocating that treating that would be wrong. I am however saying that you cannot say it's ok to treat it and then villify someone that uses adderall or anabolics. the concept of whether something is enhancement or restoration of function is dependent on the population base the person is from. a child that has a growth disorder can get prescribed HGH and that's not enhancement, because most children don't have growth disorders and thus comparatively, their function is at a disadvantage. conversely, if I used it, it would be enhancement, since I have normal(typical) function with regards to anabolic hormones. when you have a population with 60 % exhibiting a certain trait, altering the function to be superior to that trait is undoubtedly enhancement.
 
touchpause13 said:
I'm asking you to clarify what you mean

Also i didn't bring up suicide so I have no idea what you are getting at there
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yeah "killing themselves" =!= suicide, I forgot. honestly discussions with both of you are pointless because you have to falsely represent the position of the other person. it's your go-to for avoiding actual discussion.
 
PL198 said:
but yes they do. because normal is assumed to be what the average person exemplifies. initially there weren't books that said " oh ****, skinny people are awesome, that's normal." they were the most common and thus it was deemed to be normal. the 6th word in the definition of disease is abnormal.

it's enhancement, just like taking adderall. if I'm in a population that has 60 % of people with diabetes, treating that diabetes is absolutely enhancement. once again(since you all seem to fail to grasp this) I'm not advocating that treating that would be wrong. I am however saying that you cannot say it's ok to treat it and then villify someone that uses adderall or anabolics. the concept of whether something is enhancement or restoration of function is dependent on the population base the person is from. a child that has a growth disorder can get prescribed HGH and that's not enhancement, because most children don't have growth disorders and thus comparatively, their function is at a disadvantage. conversely, if I used it, it would be enhancement, since I have normal(typical) function with regards to anabolic hormones. when you have a population with 60 % exhibiting a certain trait, altering the function to be superior to that trait is undoubtedly enhancement.
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You really suck at this. And I never said that you weren't advocating for treatment, just that you're wrong about what normal means in a medical context. It isn't "normal" as most people think of "normal." It is "normal" as in how the body ideally functions if healthy for a person of a given age.

If we had a nuclear war and everyone ended up with cancer, cancer still wouldn't be normal. It would be pathologic. It would be disease. Disease is, by definition, a deviation from normal function and the pathological findings that result. If you consider cancer normal because everyone has it, it is not a deviation from normal function, and thus is not a disease, it's just a thing people have.

Treatment is prescribed for the diagnosis or treatment of a disease. You don't treat normal, by definition.
 
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PL198 said:
yeah "killing themselves" =!= suicide, I forgot. honestly discussions with both of you are pointless because you have to falsely represent the position of the other person. it's your go-to for avoiding actual discussion.
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I wasn't talking about people with eating disorders commiting suicide. They don't want to die, they want to be skinny and in order to do that they participate in behaviors that can and do result in their demise. Make sense?
 
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