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Military Psychiatrists Under Fire for Doing Their Jobs

by Brian L. Grant, MD

In recent months, forensic psychiatrists in Washington State have been pummeled in the media for taking on the task of reviewing PTSD diagnoses. Based upon media accounts rather than any specific knowledge of individual cases, purported statements implying bias by psychiatrists as well as reversal of some prior PTSD diagnoses, have landed some clinicians and the work of the unit in political hot water. The alleged statements were a common sense remark that claims of PTSD cost money and should be evaluated carefully. This is obvious and acknowledging the cost of such claims does not imply bias against proper diagnoses, but merely places it in a social context by the person making the comment. Diagnoses should be evidence based and any clinician who has familiarity with PTSD may be quite aware that the diagnosis can be made in a sloppy and inaccurate manner by those who lack expertise or possess strong biases. Washington’s Senator Patty Murray has perhaps been the loudest in her criticism of the forensic unit. We attach two articles from the Tacoma News Tribune that address the controversy. The long investigative piece does a nice job of laying out the many issues. We look forward to learning more about the outcome of the investigation and the outcome of the careers of the clinicians under fire. Those who dare to challenge popular wisdom do so at their peril.

Madigan Psychiatrists Who Made PTSD Calls Had National Renown
Senator Murray Begins Investigation into Hospitals’ PTSD Designations

The Nothing Cure

By Matthew Herper and Robert Langreth, From Forbes Magazine, Issue Date March 29, 2010

Instead of ignoring the placebo effect, doctors should try to enhance it, says a Harvard Medical School professor.

This interesting discussion on the placebo effect is worth a read. The presence of the placebo effect is well-known and generally accepted in medicine, though it may be frequently argued as to when it is taking place or not – especially when one’s own treatment is being questioned.

From a policy standpoint, a legitimate question is whether those treatments that have a significant placebo component are ethical to the degree there may be conscious deception on the part of the practitioner – on behalf of helping their patient. In addition, should third parties such as insurance or government be asked and expected to pay for placebo interventions?