I like to write because it clears my thoughts akin to the journaling often recommended by therapists. I compare writing to psychotherapy, where telling one’s story helps a person sort things out. AODA counselors often do supportive therapy, mirroring and clarifying what a patient says. As I have explained in a prior post the more advanced the psychotherapy, the less the therapist says. I guess in the extreme I would pay $500 per hour to sit next to a very-educated rock! Joking of course… the rock would need to make scribbling sounds and ‘hmmmm’ noises every few minutes, which would be a lot to ask of a rock.

The expressive types of psychotherapy – psychodynamic and analytic – are inefficient. I warn patients who expect to be transformed within weeks that they should plan on years or decades. Writing is faster and far cheaper, but lacks the pressure of having another person reading in real time. It also lacks feedback, although the comment section helps. Angry ad hominem comments tell me that I’m on the right track. A good counter-argument is the most valuable, as that prompts me to reconsider. I don’t think I get great coverage on LinkedIN, so if you disagree with me please share with your contacts!

After my last post my main thought was ‘why do I care?’ Why does the issue irritate me? The US government made people choose between a new technology injected into their bodies or their jobs, but why does that bother ME?’ What irritates me the most are the inconsistencies of everything lately, and the lazy media who refuse to challenge the inconsistencies. Today’s media would have bought Nixon’s explanation that his dictations would be a far-better description of the recordings than the actual recordings (if Nixon was a Democrat anyway). Only three years ago transcripts of ‘perfect’ calls between our President and world leaders were being leaked left and right, and Presidents were impeached over them. A few months ago Xi Jinping insisted that his call with Biden was not-at-all similar to what Biden described on matters of National Security, Taiwan, and human rights. The same happened in Saudi Arabia before that. Nobody cares. That’ inconsistent.

Fran, my grumpy editor

A longstanding principle in medicine is the concept of ‘informed consent’. The principle is a central ethical tenet of medicine and is dissected and presented routinely in Board exams. There are two halves to the ethical principle. Consent requires that a patient give permission before undergoing any procedure and before taking a newly prescribed medication. So psychiatrists often have consent forms signed by the patient, or a statement in the record that the risks were discussed and the patient consented to the medication. Patients cannot be medicated without their consent without a court order. An order that says a patient is committed to a psychiatric hospital isn’t enough; a separate order from the court is required to force medication on a person, even if everyone, including the doctors and family members, know that the medication would be very helpful.

The meaning of consent is important to understand. It is relatively common for a psychiatrist to have a patient with bipolar mania with psychotic features who refuses medication. Family members beg for help of any kind, as they watch sons or daughters spend all their money, create pregnancies, are get arrested multiple times for disorderly conduct. But no medication can be forced on the patient without a court order, and the ease of getting that order varies considerably from one state to another . Medication is unlikely to be forced on a person if the person is simply psychotic. Usually a court order requires the patient to be dangerous, violent, or at immediate risk of harm to him/herself. Forcing a medication on another person has always been a very big deal in this country.

In order to count as consent, the consent must be ‘informed’. Consent doesn’t count if I tell a patient that ‘this medication will fix your problems.’ It doesn’t count if I just say ‘take this, it is good for the country’, or ‘this will help you keep your job. Even with a psychotic patient in a psychiatric ward, it would be illegal to slip a mickey of olanzapine. The doctor must tell the patient that the new medication might not work. It might make things worse. In the case of an antipsychotic medication it might cause involuntary muscle movements or rigidity. Long-term, it might cause tardive dyskinesia with abnormal movements that are permanent and untreatable. It might cause malignant hyperthermia, where the core body temperature rises and muscle breaks down , causing damage to the kidneys to the point of needing dialysis or a kidney transplant.

The challenge is to determine how far to go with the potential bad news. That decision is largely up to the doctor, and the rarest possibilities don’t always get mentioned. I used to work with an anesthesiologist who would say ‘do you want to hear the bad things that can happen?’ and if patients said no, he moved on. I do not think that would pass muster in court.

Valid informed consent must occur in the absence of any coercion or pressure. A doctor cannot discuss the pros and cons of a medication and then say ‘if you don’t take it, I can’t treat you any longer.’ Of course, many people DID have to decide whether to get vaccinated, or to miss visiting loved ones in nursing homes or relatives on their deathbeds in hospitals. That, for the record, was coercion.

If a medication is advertised on TV, the FDA requires the manufacturer to spend equal TIME discussing the benefits and the risks. I emphasize time because that is the issue. If the ad spends 15 seconds saying the medication can do something good, the ad must spend 15 seconds or more discussing bad things that the medication might do. That’s why we have to sit through comments about the potential for ‘suicidality, serotonin syndrome, mood swings, temperature abnormalities, and excessive bleeding’ after hearing about an SSRI that might treat depression.

The principle of informed consent isn’t only in medicine. A financial contract can be nullified if the risks were not adequately explained, usually in writing. If I invest in a great new technology but I wasn’t told that it might fail causing me to lose everything, I have a strong case to get my money back.

For the COVID vaccines there was no informed consent. In fact, there was hardly any consent at all. I realize we all got a bundle of paperwork when we were vaccinated, but nobody held up the line to read the whole thing. Besides, the FDA would jump all over a company that did that with medication, especially a new medication. Informed consent means that the patient heard about the risks, and had time to carefully consider the options.

We all heard government spokespersons tell us, over and over, the benefits of the vaccine. Many of the benefits described are now known to be gross exaggerations, including claims that the vaccine would prevent infection and ‘end the pandemic.’ We never heard those government vaccinators mention the risks, let alone spend equal time on such a discussion. True, government dicta were not advertisements placed by the manufacturers. But with all of the government hype, why would the two companies making mRNA shots need to advertise? They accomplished the same thing without spending a dime, and without spending a minute to discuss potential risks.

And shouldn’t there be even GREATER pressure to disclose risks when the ‘recommedation’ (or coercion) comes from the Government? We all know to take comments by pharmaceutical manufacturers with a grain of salt. But some people place trust in the government, so there should be MORE effort to release all sides of the argument, not less.

Could you imagine if the US Government applied their rules for businesses to themselves? They now could be sued for all sorts of mistatements about vaccine efficacy, and sued again for failing to disclose the risks of clotting abnormalities and myocarditis, just two of the things we now know to be risks from the vaccine. What if a person with a low cardiac ejection fraction develops myocarditis? Could that be fatal? Was that risk given the same amount of time as discussions about the potential benefits? Did anyone mention that infection may still occur? Or that a vaccinated person can still spread COVID?

Of course not. Our leaders decided that they didn’t have to follow the rules and norms applied to every business and every other medication. It was assumed that we were too ignorant to make our own informed consent. The decision was made by our leaders that the American people could not handle the truth, so the truth was suppressed for our own good. I don’t know about anyone else, but I find that to be an insulting view of me and my fellow citizens.

I could see that happening in Cuba or China. But here? Coerced vaccinations are inconsistent with ethical medicine, and inconsistent with how we normally do things in this country.


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