Do we have to believe psychiatry concerns itself with "diseased brains" to be a relevant medical specialty?

[ObsequiousAplomb]

Medicine cannot progress scientifically without rigorous, actual, objective data.
Personalized medicine does not mean non-evidence based medicine, or one where you just omit the rigor part.
Of course no amount of research will answer every single question. And you will always involve judgement and how to apply the scientific knowledge to individual cases.
But if most of your decisions are not based on actual objective data then you're pretty much practicing quackery.

Frankly I see this attitude in our field and I believe it's a bane that we encourage it and tolerate it. The reality we just don't have the data and we need to deal with what we have, but it's not something that we should encourage. See the thread about mania.
If anyone suggests to use a medication that has no evidence vs one with evidence because 'in their experience it doesn't work', they would be roasted in every other field of medicine.

So on internal medicine services there aren't attendings who think you need to give Toradol because "it's more effective in {their} experience" than oral NSAIDs who argue with the attendings who say that oral NSAIDs, if dosed appropriately, are equally effective? Same thing with Tylenol dosing and intervals? Whether to administer Tylenol and Motrin at the same time or rotating?

Attendings who choose one antibiotic over another due to personal experience ignoring guidelines surely get laughed out of every department, right? Not encouraged to promote their dogma to every intern they encounter?

Psychiatry is the only specialty ever influenced by drug marketers to prescribe things against the evidence base? ... Just look at the other forums on SDN for countless examples in every specialty of a similar issue.

---

Members don't see this ad.

 

[G Sheb]

So on internal medicine services there aren't attendings who think you need to give Toradol because "it's more effective in {their} experience" than oral NSAIDs who argue with the attendings who say that oral NSAIDs, if dosed appropriately, are equally effective? Same thing with Tylenol dosing and intervals? Whether to administer Tylenol and Motrin at the same time or rotating?

Attendings who choose one antibiotic over another due to personal experience ignoring guidelines surely get laughed out of every department, right? Not encouraged to promote their dogma to every intern they encounter?

Psychiatry is the only specialty ever influenced by drug marketers to prescribe things against the evidence base? ... Just look at the other forums on SDN for countless examples in every specialty of a similar issue.

Not sure what point you're making here.
It's fairly trivial though, if you think this kind of thing is excusable because you read it on other SDN forums.

 

[ObsequiousAplomb]

Not sure what point you're making here.
It's fairly trivial though, if you think this kind of thing is excusable because you read it on other SDN forums.

The point I'm making is that what you were saying is inaccurate. All of medicine has this phenomena. It was a fairly clear post, so don't know why you say you're not sure what point I'm making here.

 

[clozareal]

One way to get more prestige that dl2dp2 would probably agree with is to provide higher risk/higher reward services that no one else wants to do (which are by definition exclusive and thus "prestigious"): ECT, TMS, ketamine, psilocybin, stellate ganglion blocks (non-pain fellowship trained anesthesiologists won't even do these), transcranial ultrasound neuromodulation, suboxone, clozapine, lithium, benzo tapers, stimulant replacement therapy, long-acting injectables, botox for depression, working with neurosurgeons on deep brain stimulation for psychiatric conditions, gender affirming hormone therapy, infectious disease/autoimmune psychiatry (HIV, HCV, neurosyphilis, autoimmune encephalitis), chemical castration for use in sex offenders, amytal interviews, hypnotherapy. Any of these have a risk of making the field less prestigious if they go awry or the public perceives it badly though (see: lobotomies, ECT, false traumatic memory implantation from hypnosis, therapists sexually assaulting patients under ketamine-assisted psychotherapy).

What OP was getting at is more than that though. If you know how to do those, while integrating it with the psychosocial aspects such as knowing how to deliver behavioral/lifestyle interventions in a way that the patient believes and will accept (and thus probably increasing the placebo effect), holding the frame in psychotherapy, working on a patient's interpersonal relationships, being able to understand a person's developmental impingements and resultant maladaptive personality patterns, figuring out the obstacles that are getting in the way of adequate improvement, then that becomes much more compelling for our field since it can lead to more lasting changes.