Psychopharmacology/Advanced Practice Psychology

[edieb]

On the contrary, it is quite accurate. The legislation proposed by the state organizations acting on the APA model call for 300 "contact hours" of training. A 3-hour semester (15 weeks) course is 45 "contact hours". I invite you to do the math, it's 6.6 3-hour courses.

The coursework can be, and in some schools always is, taken online, do you not dispute that?

The training is done by psychology schools not medical training facilities, do you not agree?

1 -Many of the courses are taught by M.D.s. Google NMSU's IN PERSON (not online) coursework and see for yourself. To reiterate what was said earlier, I am sure these physicians do not make a lot of money to teach these courses. Therefore, if it is so dangerous for psychologists to prescribe, I doubt they would be willing to teach.

2 - While you're casting aspesions, you may want to provide sources for things like how much every psychologist in LAMP gives. You're right, it's all about money. I am wondering how much the M.D.s give to their PAC to stop other professions from calling themselves "octor", to stop nurse practitioners from prescribing independently, etc....

---

Members don't see this ad.

 

[CGOPsych]

1 -Many of the courses are taught by M.D.s. Google NMSU's IN PERSON (not online) coursework and see for yourself. To reiterate what was said earlier, I am sure these physicians do not make a lot of money to teach these courses. Therefore, if it is so dangerous for psychologists to prescribe, I doubt they would be willing to teach.

2 - While you're casting aspesions, you may want to provide sources for things like how much every psychologist in LAMP gives. You're right, it's all about money. I am wondering how much the M.D.s give to their PAC to stop other professions from calling themselves "octor", to stop nurse practitioners from prescribing independently, etc....

Thank you for agreeing that RxP is all about money, for some individual psychologists and also APA. You can find all the details of LAMP's funding online, since political action committees have to detail their income and spending, as they are designed to influence public policy, and are NOT professional organizations. http://www.ethics.state.la.us/CampaignFinanceSearch/ViewEFiler.aspx?FilerID=PAC990023 Deep Throat was right ... follow the money to unravel the scandal. By the way, APA has staff members devoted to RxP, spending all that advocacy money that turns out to have been collected by fraud. Do you think the medical people have full-time staffers devoted to opposing RxP? Also, $527,000 of that that fraudulently collected APA money went to Louisiana. Do you think the medical people sent that much money down there to stop RxP? Let's stop this fiction that poor little psychology can't compete with big bad medicine. APA has been collecting $5-6 million a year - fraudulently - to build a national political machine for things like RxP.

 

[edieb]

Thank you for agreeing that RxP is all about money, for some individual psychologists and also APA. You can find all the details of LAMP's funding online, since political action committees have to detail their income and spending, as they are designed to influence public policy, and are NOT professional organizations. http://www.ethics.state.la.us/CampaignFinanceSearch/ViewEFiler.aspx?FilerID=PAC990023 Deep Throat was right ... follow the money to unravel the scandal. By the way, APA has staff members devoted to RxP, spending all that advocacy money that turns out to have been collected by fraud. Do you think the medical people have full-time staffers devoted to opposing RxP? Also, $527,000 of that that fraudulently collected APA money went to Louisiana. Do you think the medical people sent that much money down there to stop RxP? Let's stop this fiction that poor little psychology can't compete with big bad medicine. APA has been collecting $5-6 million a year - fraudulently - to build a national political machine for things like RxP.

Let me get this straight: It's a given that other professions spend money lobbying and trying to advance their profession. However, you think psychology should compete in the health care arena without hiring lobbyists and trying to advance itself while other professions pass us by. Genius

 

[CGOPsych]

Let me get this straight: It's a given that other professions spend money lobbying and trying to advance their profession. However, you think psychology should compete in the health care arena without hiring lobbyists and trying to advance itself while other professions pass us by. Genius

Let's not get huffy now, lol.

Of course I'm not saying that. First, I am all for advocacy for psychology, but not trying to practice medicine on the cheap just for the money. The RxP campaign is a shameless little hustle that brings dishonor and disgrace upon our profession.

However, I reiterate, that APA has been (fraudulently) collecting millions a year to run its political machine, which has put millions into the RxP campaign. In fact, psychologists who want to practice psychology are being cheated by the RxP campaign. I'll note two of APA's patterns:

1. They have never revealed how much money they are spending on RxP.
2. When they try to solicit funds for advocacy money they never mention the RxP campaign ... I suppose because they know it is very unpopular.

Psychologists should be demanding full transparency and a full accounting of how much money they put into this campaign. Here's an example: Montana has 213 psychologists and an RxP campaign funded by APA (they like to try to pick off the smaller states). They have poured the following amounts of money into that state:

2010: $30,000
2009: ??? unknown
2008: $30,000
2007:$25,000
2006: 15,200
2005: 13,500
2004: 20,000

And Montana isn't the only one.

If they were putting that much money into helping us fight for parity or other issues to help psychology, we would be a lot better off.

 

[DynamicDidactic]

The comments of the few prescribing psychologists on this forum only reinforces the monetary aspect of the RxP debate. This seems to be the number one reason to adopt RxP, despite the countless other reasons stated by the the RxP movement. Money is at the forefront and no practicing prescribing psychologists are changing that perception. I think prescribing rights can be very beneficial to psychologists. I would love to be able to complement my clinical work with psychopahrm. Or better yet, be able to assist individuals who are over-medicated and experience horrible side effects. But, I also worry that instituting RxP will lead psychologists down the same rabbit hole as psychiatrist. While it is a lucrative rabbit hole, it is also very much the opposite of why most people enter this field. For those who have not, please read over the NYT article posted recently. http://www.nytimes.com/2011/03/06/health/policy/06doctors.html?_r=1&ref=health Psychologists are people with the same flaws and would be influenced in the same exact way as psychiatrists. Big Pharma would sweep in and swallow up psychology if RxP became the norm; psychologist would become pill pushers. That is the bottom line and the number one reason to not support RxP. If RxP is instituted then in 30 years we will be reading a NYT article about clinical psychologists who feel bad that they need to see 100 patients a day for $200 a pop b/c they just can't afford to see talk-therapy clients for 35 minutes (a little exaggerated to emphasize the trend in the field). I am not here to argue this point, I know I wont change the minds of those who support RxP. I only ask that you just attempt to take on this perspective, just for a little bit. I also appreciate CGOpsych, even if he comes off a bit... um... difficult, he is very dedicated to halting RxP. People are worried about encroachment from other fields but seem to overlook the cost of RxP. We would be giving away our field while counting our millions.

 

[Therapist4Chnge]

However, I reiterate, that APA has been (fraudulently) collecting millions a year to run its political machine, which has put millions into the RxP campaign. In fact, psychologists who want to practice psychology are being cheated by the RxP campaign. I'll note two of APA's patterns:

Nice straw man...arguing that an association is *gasp* funding a PAC to foster specific issues. Thousands of other associations do the exact same thing, with a lot more money, and with many more self-serving intentions. The AMA has directly contributed $25+ MILLION to official PACs (OpenSecrets.org has more on this), and who knows how much to "independant" PACs that lobby on behalf of the AMA. Yes the APA was deceptive with how they assessed the "practice dues" (I believe that is what they termed the fee), and they should be punished for that manuever. Though that poor administrative decision does not detract from the fact that prescribing psychologists have provided services for many folks who otherwise would not have been able to receive them.

 

[stigmata]

Okay so don't be an APA member... I am not. They do not get a penny from me and never have. Of course the APA's reasons are about money as they are losing it every year due to dwindling membership numbers, but this has little to do with individual clinicians and their desire to provide a better service....

 

[medium rare]

Okay so don't be an APA member... I am not. They do not get a penny from me and never have. Of course the APA's reasons are about money as they are losing it every year due to dwindling membership numbers, but this has little to do with individual clinicians and their desire to provide a better service....

Agreed, and nicely stated.

Prescribing for me has never been about the money per se but all about the ability to provide comprehensive, "one-stop-shopping" for my patients. Over 60% of my practice is providing psychotherapy or psychotherapy with med management in the traditional 50-minute hour. I could make much more doing 15-minute med checks all day, but this has never interested me and acquiring Rx authority did not change this for me; I have not become a 'pill-pusher' trying to squeeze out every dollar I can out of each clinical hour. I am more than content in my role providing integrated care.

 

[AlaskanJustin]

ahh busting out the logic... constantly I read self-refuting and infinite-regress arguments on here... kind of why I stopped arguing on online forums to begin... but ok I will add this...

Who cares about the motives of one or more organizations to the matter? We all should be aware of why states passed legislation of RxP to begin, and it was to serve the underserved, i.e., native american populations...

maybe APA is bandwagoning to gain money... maybe not, I think the arguments I have read over the last 5 pages are utterly useless and unrelated to the legislative problem at hand...

T4P you put up with more flawed logic than I can handle!

sigh

Nice straw man...arguing that an association is *gasp* funding a PAC to foster specific issues. Thousands of other associations do the exact same thing, with a lot more money, and with many more self-serving intentions. The AMA has directly contributed $25+ MILLION to official PACs (OpenSecrets.org has more on this), and who knows how much to "independant" PACs that lobby on behalf of the AMA. Yes the APA was deceptive with how they assessed the "practice dues" (I believe that is what they termed the fee), and they should be punished for that manuever. Though that poor administrative decision does not detract from the fact that prescribing psychologists have provided services for many folks who otherwise would not have been able to receive them.

 

[DynamicDidactic]

We all should be aware of why states passed legislation of RxP to begin, and it was to serve the underserved, i.e., native american populations...

There is absolutely zero empirical evidence that those states that passed RxP have assisted the underserved. Soon enough, we will see the stats proving that there has been no significant increase in access to prescribers for those that need it most (meaning anyone that is not white/middle class).

Furthermore, those who disagree with RxP are pointing out that the argument you are making is only a cover to hide the real reason for RxP - to make money.

 

[AlaskanJustin]

There is absolutely zero empirical evidence that those states that passed RxP have assisted the underserved.

I never said (nor implied) that it was sound nor valid reason, and I especially did not imply that the intended effect was actually achieved... so don't attack my argument based on flawed logic...

Also... you can't attack an argument by saying "There is absolutely no evidence" because by the VERY STATEMENT you make (i.e., there is no evidence) presupposes that the truth-state cannot be known for the argument... All you have successfully achieved is making a statement that leads to an infinite regress... i.e., a statement that regresses onto itself infinitely with no solution one way or the other.

On a more pragmatic level... your statement

There is absolutely zero empirical evidence that those states that passed RxP have assisted the underserved"

is hugely flawed... A simple and albeit plain rebuttal would be that if even ONE american indian were given RxP in a town where a psychiatrist does not exist, then your argument goes flying out the window... the very fact that I have to even make such a ridiculous rebuttal speaks to your ability to make sound arguments... and ultimately your original argument is self-defeating.

Soon enough, we will see the stats proving that there has been no significant increase in access to prescribers for those that need it most (meaning anyone that is not white/middle class

Well... It's been nearly 12 years since NM passed there law, where are these stats and studies? And by the way, this statement in and of itself is absurd and flawed tragically... Absurd because RxP is legal in two states, New Mexico and Louisiana... are you genuinely going to try to tell me that there is even a majority of Middle Class White Americans residing in those states? Are you mad??? Both states have less than 50% Caucasian/White, and not all 50% are middle class or higher (Although Louisana has a slightly higher than 50% White population, the rate of Lower class populations is very high).

I could stop there... but I won't. Your argument is flawed because who are you to judge who needs RxP the most? Are you to tell me, that a "White Middle Class American" with schizophrenia is LESS deserving of RxP than a Lower Class African American that has a mood or anxiety disorder? Really? Furthermore, do you have a crystal ball or gift of foresight that we should know about? How do you know that there has been no significant increase in provision of such things??? That statement alone devalues anything else you may say from here on.

Furthermore, those who disagree with RxP are pointing out that the argument you are making is only a cover to hide the real reason for RxP - to make money

So are you or these other "educated" opponents arguing that there is in fact, NO need for RxP in underserved populations? Their arguments would be CRUSHED by someone that knew how to argue. Their very logic can be flipped on them... i.e. "the only reason they are opposing RxP is because they do not want to A) go back to school to get RxP and/or B) lose money to those that do get RxP"
BOTH yours and this argument are ridiculously unsound, riddled with fallacy. It would genuinely take me all day to list and explain each fallacy these statements make.

And let me ask... who passes legislation for RxP? Is it psychologists? Are they law-makers paid by psychologists??? Before anyone tries to make the argument that public interest and private funding groups are buying a vote, I want to snub that right now... mostly because MANY of the arguments posed by opposition are made without ANY ontological or epistemological certainty...

Maybe if some more sound and valid arguments are stated I will take the time to elaborate more, but these arguments/statements were mere boyish claims resulting in argumentum ad ignorantiam

AJ

 

[nitemagi]

I'll leave it to say that your attempted use of "logic" seems something to be desired. This is about the real world, not a philosophical debate about one patient that ever was helped making an entire point unsound. The one patient "theoretically" helped, compared to how many put at risk?

And the idea that logic plays a role in politics is hilarious!

You don't show much real world understanding of the risks and benefits physicians have to weigh on a daily basis with every minute decision.

Get your head out of the book at look at how the world is actually working, rather than deriding and obfuscating legitimate arguments with useless verbosity.

If you have data to show that RxP serves the underserved, then show it. Put up or shut up.

 

[AlaskanJustin]

Wow I am shocked... it ABSOLUTELY is a philosophical discussion, whether on terms of logic, on moral and ethical grounds, or purely pragmatic grounds, it STILL is philosophical grounds. Everything that has been argued here is on some level philosophical, its absurd to think otherwise.

If you want to be pragmatic about it, and since the scientific method is so important to you, aside from conjecture, where is your evidence that so many people will be or have been harmed? Or put at risk? You are making an argument based on your own subjective feelings, and maybe some anecdote... otherwise your claims have no weight.

Logic absolutely plays a role in politics, the very foundation of politics rests on logic, the law itself rests on the philosophical method... Again you are making a claim based on your own biased interpretation of a legal system in the USA, and blanketing that judgment onto politics as a whole. Your clearly passioned nature has biased your own thinking, making it impossible for you to objectively reason on the issue.

My real world understanding? I could sit here and defend what I know and what I don't know... but it would be in vein. Its sad you would have to reduce your self to making ad hominem attacks... just a side note, having been in med school I do know the risks and benefits that have to be weighed... probably better than you.

How is the world actually working? How can you know something universal from your own biased framework? How are they legitimate arguments when they themselves are backed NEITHER by hard scientific fact NOR legitimate logic? His and other arguments are purely conjecture not grounded in legitimate thinking.

Your last sentence... wow. I am quite shocked, why is it that I have to provide evidence for a claim someone else made? He made the claim that there is or will be evidence, how is it that he is suddenly waved of such responsibility while I am suddenly "wrong until proven right"???

How is it that you think you can get by simply making arguments such as "well you don't have evidence to prove your point therefore we are correct!" How does that make any pragmatic sense?

I'll leave it to say that your attempted use of "logic" seems something to be desired. This is about the real world, not a philosophical debate about one patient that ever was helped making an entire point unsound. The one patient "theoretically" helped, compared to how many put at risk?

And the idea that logic plays a role in politics is hilarious!

You don't show much real world understanding of the risks and benefits physicians have to weigh on a daily basis with every minute decision.

Get your head out of the book at look at how the world is actually working, rather than deriding and obfuscating legitimate arguments with useless verbosity.

If you have data to show that RxP serves the underserved, then show it. Put up or shut up.

 

[histandard]

I'll leave it to say that your attempted use of "logic" seems something to be desired. This is about the real world, not a philosophical debate about one patient that ever was helped making an entire point unsound. The one patient "theoretically" helped, compared to how many put at risk?

Nitemagi. I think you are seriously confused and this is preventing you from seeing AlaskanJustin's point (don't get me wrong, i am not taking sides per se nor praising AJ, for I don't even know him). The point AJ was trying to make was that one should be careful in making a claim that "there is absolutely no evidence" to suggest that, given that all it would take is one (and yes, albeit theoretically, although likely that this theoretical is de facto the case at minimal) patient is helped in order to make the claim false. Perhaps it would have been better to state that there is little evidence, if that were to be the case based upon whatever criterion of evidence being taken up to be valid (i.e., empirical research; surveys,etc.). What is astonishing is that, even admitted that AJ's point was "theoretical", you then go on to compare this one patient "theoretically" helped to how many put at risk (theoretical? de facto?). What is baffling is that you take it valid or reasonable to compare the many put at risk you claim to the one "theoretical" person helped that you take AJ to allude to? This goes to show how shallow of a level your mind works at. It would have been better to simply state (and give evidence) that there are more ppl put at risk than there are ppl helped. It's baffling that you would think that this one "theoretical" person would be ANYONE's argumentative thrust or point of departure for comparison to the contrary (if that were to be case, we might as well all be caged in a zoo).

And the idea that logic plays a role in politics is hilarious!

You don't show much real world understanding of the risks and benefits physicians have to weigh on a daily basis with every minute decision.

Get your head out of the book at look at how the world is actually working, rather than deriding and obfuscating legitimate arguments with useless verbosity.

If you have data to show that RxP serves the underserved, then show it. Put up or shut up.

I think the same goes to you, because you haven't shown much. i suppose after your initial shallow comment, one can't expect too much from you.

 

[nitemagi]

Nitemagi. I think you are seriously confused and this is preventing you from seeing AlaskanJustin's point (don't get me wrong, i am not taking sides per se nor praising AJ, for I don't even know him). The point AJ was trying to make was that one should be careful in making a claim that "there is absolutely no evidence" to suggest that, given that all it would take is one (and yes, albeit theoretically, although likely that this theoretical is de facto the case at minimal) patient is helped in order to make the claim false. Perhaps it would have been better to state that there is little evidence, if that were to be the case based upon whatever criterion of evidence being taken up to be valid (i.e., empirical research; surveys,etc.). What is astonishing is that, even admitted that AJ's point was "theoretical", you then go on to compare this one patient "theoretically" helped to how many put at risk (theoretical? de facto?). What is baffling is that you take it valid or reasonable to compare the many put at risk you claim to the one "theoretical" person helped that you take AJ to allude to? This goes to show how shallow of a level your mind works at. It would have been better to simply state (and give evidence) that there are more ppl put at risk than there are ppl helped. It's baffling that you would think that this one "theoretical" person would be ANYONE's argumentative thrust or point of departure for comparison to the contrary (if that were to be case, we might as well all be caged in a zoo).

I think the same goes to you, because you haven't shown much. i suppose after your initial shallow comment, one can't expect too much from you.

Sure there may be theoretically one patient out there helped, or a hundred for all I know. Nothing published. The evidence cited (on this forum) for the success of RxP is the lack of negative complaints filed, which is not evidence, IMHO, of anything aside from that those in mental health are rarely sued at all.

Why one can continue to pretend that the goals are altruistic, the evidence to show that the outcome actually backs up the altruistic claims are lacking. Whereas there is a long history of dangerousness to ALL medications, and higher medical errors in the undertrained (see the Institute of Medicine for further data on this). My view on AJ's post is that he was focusing more on the process of debate and logic, and essentially missed the content of the debate itself. This is again my view, but reflects the disconnect of academia at times from the practicality of care. While AJ said he was in medical school, that just doesn't cover it. That's just more studying. Being on the frontline seeing the incredible complexity of illness and facing decisions where there is no evidence to make one decision better than another - and you are on the line as the decision-maker, is an experience unique to practice that your schooling isn't going to encompass.

What bothers me is not the amount of information so many in the RxP movement don't know, but that they don't even know they don't know it. I work in the field and I'm incredibly aware how little I know, and I'm completing residency at a top academic center with essentially the gold standard of psychopharm training.

AJ, we all have biased frameworks. To ignore that your own schooling hasn't biased you is naive. My frame of reference (and bias) is informed by the medical system, 4 years of medical school, 4 years of residency, working at multiple hospitals in emergency rooms, private hospitals, county hospital, outpatient clinics.

We both have our experience that informs our opinion. The difference is that mine isn't limited to the classroom alone.

 

[nitemagi]

Logic absolutely plays a role in politics, the very foundation of politics rests on logic, the law itself rests on the philosophical method... Again you are making a claim based on your own biased interpretation of a legal system in the USA, and blanketing that judgment onto politics as a whole. Your clearly passioned nature has biased your own thinking, making it impossible for you to objectively reason on the issue.

Your presupposition is that I am biased, and you are logical. Which I see no evidence to support.
While philosophy and logic may have played a role in the design of the government, the economic biases at work with PAC's, lobbyists, and self-interest skews the system away from the original intentions.
You make the argument that the legal system follows the philosophical method, but my understanding is there is no one philosophical method. It's not like the scientific method. Correct me if I'm wrong. I'm open to learning on this. I'm not trained in philosophy. And provide a reference so I can read a bit more on it.

My real world understanding? I could sit here and defend what I know and what I don't know... but it would be in vein.

So I should take your credentials at your word? And just assume you're capable of defending your position?

Its sad you would have to reduce your self to making ad hominem attacks... just a side note, having been in med school I do know the risks and benefits that have to be weighed... probably better than you.

So if I'm understanding this correctly, your experience in med school (you dropped out?) qualifies you to weigh risks and benefits of medication management of mental illness compared to a specialty trained MD? Care to substantiate that?

 

[AcronymAllergy]

Well, to put the "one theoretical patient" issue to rest, I personally know of two medical psychologists working in community mental health who prescribe to underserved populations in an area where psychiatrists were hard to attract. Thus, while this is obviously anecdotal evidence, it does at least refute the point (assuming you accept that I'm not lying) that absolutely no underserved individuals are receiving services via RxP.

However, I don't think anyone is actually trying to make that specific point; rather, professionals are (justifiably) questioning whether RxP is doing what it was at least partially purported to do (i.e., provide services to those individuals in areas where psychiatric care is not immediately available), and whether it is doing so in a safe manner. I don't have the answers to those questions.

I can say that, from what I've heard, RxP advocates and providers were/have been able to find support in the non-psychiatric medical community. Also, the training process is informed by those most qualified to provide said training (physicians). Beyond that, I really don't have a clue how thing are working out on a large scale.

 

[Occlumentia]

Are there really no published evaluations of RxP outcomes in the US states where it's legal? It seems to me that if there were, some of the arguments in this thread would be put to rest.

It seems almost inconceivable that important health policy would not be held up to scrutiny - especially when there's a lot riding on it, on all sides.

The demographics, the health (physical and mental) background, and if possible, the outcome of treatment, would be very useful in determining if those who have the greatest need/traditionally find it hard to access mental health services are using medical psychologists. Also number and type of prescription per provider would be great, as this can be compared with other health providers. Etc. How can you prove a scheme is working/not working if there is no systematic evaluation?

A lot of people are using arguments such as RxP is "safe, because there have been no/not many adverse effects reported", of that "it's not safe, because the education standard isn't high enough". If NM has had RxP for 12 years, that's absolutely long enough to find out if either of these positions has any actual support...

 

[histandard]

Sure there may be theoretically one patient out there helped, or a hundred for all I know. Nothing published. The evidence cited (on this forum) for the success of RxP is the lack of negative complaints filed, which is not evidence, IMHO, of anything aside from that those in mental health are rarely sued at all.

Your reply was annoying on the one hand because you still continue with shallow comments, but also pleasing on the other hand because it validates how shallow your mind is. I take it that you readily *concede* with my initial point that your way of arguing back at AJ was off the mark. Yet, you clearly miss the point of *why* it was off the mark. So, I will reiterate so that you might more clearly understand where you made the mistake and to humbly learn a thing or two about argumentation: the point isn't whether, theoretically speaking, it is conceivable that one or a million patients were helped. The point is that what is at stake is: whether *relatively speaking* which side (helped or put at risk) the evidence sways after thorough investigation. Therefore, you initial point of comparing AJ's theoretical one to your own (perhaps backed by evidence) that many were placed at risk is just moot. If you can't recognize this, then, I'm sorry to say that, your years of schooling in a MD program and beyond, provided you with little ability to properly think. You really should stick to your "real life" abilities; although one is left wondering how someone with your credentials can't seem to articulate oneself beyond a 1st year undergrad level. That said, at the least, you didn't come back arguing against my point, given that you probably had the capacity to readily recognize that I was correct, but you backed off by trying to mask your mistake by correcting (albiet failed to) your stance. That said, the fact that the evidence cited in the forum falls short of the standard I have been advocating seems something we can both (now) agree on.

Why one can continue to pretend that the goals are altruistic, the evidence to show that the outcome actually backs up the altruistic claims are lacking. Whereas there is a long history of dangerousness to ALL medications, and higher medical errors in the undertrained (see the Institute of Medicine for further data on this). My view on AJ's post is that he was focusing more on the process of debate and logic, and essentially missed the content of the debate itself. This is again my view, but reflects the disconnect of academia at times from the practicality of care. While AJ said he was in medical school, that just doesn't cover it. That's just more studying. Being on the frontline seeing the incredible complexity of illness and facing decisions where there is no evidence to make one decision better than another - and you are on the line as the decision-maker, is an experience unique to practice that your schooling isn't going to encompass.

Fair enough. But what you might fail to recognize is that, equally, being disconnected not from academia, but broad-level philosophical thinking is valuable for practice and enriching one's outlook in general.

What bothers me is not the amount of information so many in the RxP movement don't know, but that they don't even know they don't know it. I work in the field and I'm incredibly aware how little I know, and I'm completing residency at a top academic center with essentially the gold standard of psychopharm training.

AJ, we all have biased frameworks. To ignore that your own schooling hasn't biased you is naive. My frame of reference (and bias) is informed by the medical system, 4 years of medical school, 4 years of residency, working at multiple hospitals in emergency rooms, private hospitals, county hospital, outpatient clinics.

We both have our experience that informs our opinion. The difference is that mine isn't limited to the classroom alone.

LOL. AJ, he may be right on this point. However, once again, nitemagi, your writing falls short of being sharp and thoughtful despite the fact that you are at a "top academic center" and have so much training. It is important to point out that whatever claims we make and indeed our very experience of the "world" is shaped by the framework through we operate (which, are in turn shaped by multiple factors including experience, the presuppositions inherit in the schooling/teaching we've had, culture, etc.). However, recourse to the fact that you, AJ, and I have our experiences that informs our opinion, does seem to do little to settle the issue because who gives a **** about mere opinion. We care not about opinion, but, about that which transcends mere opinion. That isn't to suggest that I think we can have a totally presuppositionless or unbiased view; and having a view presupposes it being biased to an extent, but not just mere opinion sir.

I'm a first year PhD student. Clearly you have more experience in schooling and life, but you can't seem to make solid points. Shame. Next time I go to the doctor who cited being at top academic institutions, I'll be more wary.

 

[AlaskanJustin]

Sure there may be theoretically one patient out there helped, or a hundred for all I know. Nothing published. The evidence cited (on this forum) for the success of RxP is the lack of negative complaints filed, which is not evidence, IMHO, of anything aside from that those in mental health are rarely sued at all.

Fair enough, I would agree, and your argument absolutely holds (a logical argument by the way, meaning even YOU can use logic )

The flipside was my original point too. Look, I never once have made a claim "Psychologists should have RxP because it would help more people" nor even the more generalized "Psychologists should have Rxp" I merely have said what the intent of such policy was, or at least what the justification given by politicians was. Having said this, I concede there is NO WAY for us to know true motivations, and I would especially NEVER claim this to be altruist, but the discussion of altruism leads us into a talk far too off topic. My argument is that those opposing, at least what I have read on here, have arguments that are ridiculous on many levels, and only supported by anecdote, particularly anecdote from physicians such as yourself that have a BIASED interest in whether or not we get RxP.

Why one can continue to pretend that the goals are altruistic, the evidence to show that the outcome actually backs up the altruistic claims are lacking. Whereas there is a long history of dangerousness to ALL medications, and higher medical errors in the undertrained (see the Institute of Medicine for further data on this).

This simply achieves in suggesting that ALL RxP use, by physicians, dentists, PAs, Nurses, psychologists etc should be better regulated, managed etc... So in essense you CONCEDE that psychologists should have limited RxP, but just that it should be regulated. I could concur.

My view on AJ's post is that he was focusing more on the process of debate and logic, and essentially missed the content of the debate itself. This is again my view, but reflects the disconnect of academia at times from the practicality of care.

You can view it this way but that would be wrong. You would be wrong because you are missing the entire process of public policy formulation to begin with. I refer you to any one of these books for enlightenment
http://www.amazon.com/s/ref=nb_sb_noss?url=search-alias%3Daps&field-keywords=public+policy&x=0&y=0

While AJ said he was in medical school, that just doesn't cover it. That's just more studying. Being on the frontline seeing the incredible complexity of illness and facing decisions where there is no evidence to make one decision better than another - and you are on the line as the decision-maker, is an experience unique to practice that your schooling isn't going to encompass.

I am glad you brought up your time as a Physician (albeit a very new physician) because that itself can help already account for your negative view towards RxP... I understand, hey if I were a psychiatrist I too would not want to lose the money I get from RxP, it could seriously hurt your income.

"...there is no evidence to make one decision better than another..." But I thought you said there was ample evidence? One minute there is evidence and another minute there is no? I am sure you will retort by saying that "gee well these are two different scenarios" but I will preemptive refute that by saying absolutely not.

Also, your completely uninformed understanding of how clinical psychology works limits yours capability to input in this argument. Do you think that a clinical psychologist working in a hospital having to decide X vs Y is any less a decision maker on the front line than a psychiatrist having to make X decision over Y???? Are you mad?

Are you a psychiatrist? If not than we can automatically discount you, but if so, then let me ask. Are the clinical populations any different than psychologists see that psychiatrists don't? If your answer is yes, than I would seriously doubt your training, and if your answer is no, then you acknowledge that in fact training as a clinical psychologist is at least equal when it comes to experience with "psychiatric" populations.

How many years of Rx training did you have? And answer this one careful because I know the answer. Lets say, for arguments sake, that you had 4 years of med and 4 years of residency that all involved Rx training, although we know that not all of your training was Rx-focused. So 8 years. Well ok, so a clinical psychologist gets ~5 years of training, at least 2-3 of those years is spent with 15-20hr a week of direct clinical/patient interaction. Then a postdoc of at least 1 year of training, then with NM standard you have 2 years of DEDICATED Rx training plus 1-2 years of dedicated Rx supervision... That seems like plenty of training and FRONT-LINE experience as you say...

So now that we have successfully refuted your frontline training argument, what is your next argument?

What bothers me is not the amount of information so many in the RxP movement don't know, but that they don't even know they don't know it. I work in the field and I'm incredibly aware how little I know, and I'm completing residency at a top academic center with essentially the gold standard of psychopharm training.

Refering to credentials again, we will discuss this more below. But to address this comment is that, look, have you practiced in NM or Louisiana? Have you had even a single clerkship or rotation in either of these states? If no, then your experience is irrelevant since you already discount logical argument the only foundation for argument you have is by experience, but we will now prove that you haven't even had experience in a state where RxP is legal for psychologists. On these grounds anything you say are utterly incompatible.

Furthermore, you now admit how little you know, maybe you should have two years of dedicated Rx training plus 1-2 years of dedicated Rx supervision? I may even be willing to conjecture that some of the prescribing psychologists may know more than you! I will concede this is merely conjecture based on your statement of a lack of knowledge.

AJ, we all have biased frameworks. To ignore that your own schooling hasn't biased you is naive. My frame of reference (and bias) is informed by the medical system, 4 years of medical school, 4 years of residency, working at multiple hospitals in emergency rooms, private hospitals, county hospital, outpatient clinics.

We both have our experience that informs our opinion. The difference is that mine isn't limited to the classroom alone.

YES, EXACTLY!!! Your framework cannot be trusted because you have a vested interest in psychologists NOT having RxP.

My whole point was that using PERSONAL EXPERIENCE as a way in which to make argument whether on scientific or logical grounds is utterly useless, ESPECIALLY since you have never even practiced in a state that has RxP for psychologists (I am waiting to hear about this of course, but based on your profile and where you trained I would guess not).

How do you KNOW that my experience is limited to the classroom?? You don;t know me, you can't have experienced my experiences, and I have never offered them up because they would be equally useless as your limited personal experience in this debate.

 

[histandard]

I just want to say that medical students in general and medical school is a joke relative to CPysch and philosophy studnets, and CPsych programs in general.

Fair enough, I would agree, and your argument absolutely holds (a logical argument by the way, meaning even YOU can use logic )

The flipside was my original point too. Look, I never once have made a claim "Psychologists should have RxP because it would help more people" nor even the more generalized "Psychologists should have Rxp" I merely have said what the intent of such policy was, or at least what the justification given by politicians was. Having said this, I concede there is NO WAY for us to know true motivations, and I would especially NEVER claim this to be altruist, but the discussion of altruism leads us into a talk far too off topic. My argument is that those opposing, at least what I have read on here, have arguments that are ridiculous on many levels, and only supported by anecdote, particularly anecdote from physicians such as yourself that have a BIASED interest in whether or not we get RxP.



This simply achieves in suggesting that ALL RxP use, by physicians, dentists, PAs, Nurses, psychologists etc should be better regulated, managed etc... So in essense you CONCEDE that psychologists should have limited RxP, but just that it should be regulated. I could concur.



You can view it this way but that would be wrong. You would be wrong because you are missing the entire process of public policy formulation to begin with. I refer you to any one of these books for enlightenment
http://www.amazon.com/s/ref=nb_sb_noss?url=search-alias%3Daps&field-keywords=public+policy&x=0&y=0



I am glad you brought up your time as a Physician (albeit a very new physician) because that itself can help already account for your negative view towards RxP... I understand, hey if I were a psychiatrist I too would not want to lose the money I get from RxP, it could seriously hurt your income.

"...there is no evidence to make one decision better than another..." But I thought you said there was ample evidence? One minute there is evidence and another minute there is no? I am sure you will retort by saying that "gee well these are two different scenarios" but I will preemptive refute that by saying absolutely not.

Also, your completely uninformed understanding of how clinical psychology works limits yours capability to input in this argument. Do you think that a clinical psychologist working in a hospital having to decide X vs Y is any less a decision maker on the front line than a psychiatrist having to make X decision over Y???? Are you mad?

Are you a psychiatrist? If not than we can automatically discount you, but if so, then let me ask. Are the clinical populations any different than psychologists see that psychiatrists don't? If your answer is yes, than I would seriously doubt your training, and if your answer is no, then you acknowledge that in fact training as a clinical psychologist is at least equal when it comes to experience with "psychiatric" populations.

How many years of Rx training did you have? And answer this one careful because I know the answer. Lets say, for arguments sake, that you had 4 years of med and 4 years of residency that all involved Rx training, although we know that not all of your training was Rx-focused. So 8 years. Well ok, so a clinical psychologist gets ~5 years of training, at least 2-3 of those years is spent with 15-20hr a week of direct clinical/patient interaction. Then a postdoc of at least 1 year of training, then with NM standard you have 2 years of DEDICATED Rx training plus 1-2 years of dedicated Rx supervision... That seems like plenty of training and FRONT-LINE experience as you say...

So now that we have successfully refuted your frontline training argument, what is your next argument?



Refering to credentials again, we will discuss this more below. But to address this comment is that, look, have you practiced in NM or Louisiana? Have you had even a single clerkship or rotation in either of these states? If no, then your experience is irrelevant since you already discount logical argument the only foundation for argument you have is by experience, but we will now prove that you haven't even had experience in a state where RxP is legal for psychologists. On these grounds anything you say are utterly incompatible.

Furthermore, you now admit how little you know, maybe you should have two years of dedicated Rx training plus 1-2 years of dedicated Rx supervision? I may even be willing to conjecture that some of the prescribing psychologists may know more than you! I will concede this is merely conjecture based on your statement of a lack of knowledge.



YES, EXACTLY!!! Your framework cannot be trusted because you have a vested interest in psychologists NOT having RxP.

My whole point was that using PERSONAL EXPERIENCE as a way in which to make argument whether on scientific or logical grounds is utterly useless, ESPECIALLY since you have never even practiced in a state that has RxP for psychologists (I am waiting to hear about this of course, but based on your profile and where you trained I would guess not).

How do you KNOW that my experience is limited to the classroom?? You don;t know me, you can't have experienced my experiences, and I have never offered them up because they would be equally useless as your limited personal experience in this debate.

 

[AcronymAllergy]

Your reply was annoying on the one hand because you still continue with shallow comments, but also pleasing on the other hand because it validates how shallow your mind is. I take it that you readily *concede* with my initial point that your way of arguing back at AJ was off the mark. Yet, you clearly miss the point of *why* it was off the mark. So, I will reiterate so that you might more clearly understand where you made the mistake and to humbly learn a thing or two about argumentation: the point isn't whether, theoretically speaking, it is conceivable that one or a million patients were helped. The point is that what is at stake is: whether *relatively speaking* which side (helped or put at risk) the evidence sways after thorough investigation. Therefore, you initial point of comparing AJ's theoretical one to your own (perhaps backed by evidence) that many were placed at risk is just moot. If you can't recognize this, then, I'm sorry to say that, your years of schooling in a MD program and beyond, provided you with little ability to properly think. You really should stick to your "real life" abilities; although one is left wondering how someone with your credentials can't seem to articulate oneself beyond a 1st year undergrad level. That said, at the least, you didn't come back arguing against my point, given that you probably had the capacity to readily recognize that I was correct, but you backed off by trying to mask your mistake by correcting (albiet failed to) your stance. That said, the fact that the evidence cited in the forum falls short of the standard I have been advocating seems something we can both (now) agree on.



LOL. AJ, he may be right on this point. However, once again, nitemagi, your writing falls short of being sharp and thoughtful despite the fact that you are at a "top academic center" and have so much training. It is important to point out that whatever claims we make and indeed our very experience of the "world" is shaped by the framework through we operate (which, are in turn shaped by multiple factors including experience, the presuppositions inherit in the schooling/teaching we've had, culture, etc.). However, recourse to the fact that you, AJ, and I have our experiences that informs our opinion, does seem to do little to settle the issue because who gives a **** about mere opinion. We care not about opinion, but, about that which transcends mere opinion. That isn't to suggest that I think we can have a totally presuppositionless or unbiased view; and having a view presupposes it being biased to an extent, but not just mere opinion sir.

I'm a first year PhD student. Clearly you have more experience in schooling and life, but you can't seem to make solid points. Shame. Next time I go to the doctor who cited being at top academic institutions, I'll be more wary.

Even I would say that the personal snipes made in this and your most recent posts are completely unnecessary, as is the holier-than-thou attitude. It's quite possible to have a debate without trying to insult one of the other participants.

Physicians, like many other healthcare and mental health professionals, are our colleagues and in many cases our friends. Their training system and students are different than ours, but are in no way "a joke."

 

[AlaskanJustin]

Your presupposition is that I am biased, and you are logical. Which I see no evidence to support.

How did I presuppose this? I was simply using YOUR logic of how people for RxP are biased for money AGAINST you, saying that hey you are equally biased as a physician who does not want to LOSE money... If we are to hold that your presuppositions are true THEN my claim about your bias must be equally as true.

While philosophy and logic may have played a role in the design of the government, the economic biases at work with PAC's, lobbyists, and self-interest skews the system away from the original intentions.

This has never not been the case, even back to the early republic. The very existence of PAC's lobbyists etc are NECESSARY to inform policy makers, otherwise where else should policy makers get their information from. Do you even know who makes up the cabinet of a Senator etc??? If not I would take a moment before responding and look it up, but a hint... it includes scientific advisers...

How do you know it SKEWS anything? Has there ever been a public policy that was in the best interests of everyone??? Of course not, so to say that it SKEWS from intentions is ludicrous because by its very nature, public policy will be skewed against some people and favorable to others! This does not mean its bad, ill-informed, or even solely for money as you seem to think, it just means that public policy will favor some and not others, just like public policy of RxP will favor psychologists and not psychiatrists.

What is funny, is that if you have a public policy, i.e., psychologists should have RxP, what could it possibly be skewed towards??? Your claim does not make any sense on any level.

I will add the caveat that of course there will always be biases, for instance states that oppose abortion do so on religious and not logical grounds, I agree its an inevitability, but to say that the opposition of abortion (for instance) and the promotion of RxP for psychologists are equal because of personal bias is ludicrous. There is clearly the POTENTIAL for positive outcome by allowing for RxP whereas the same cannot be shown for the former.

You make the argument that the legal system follows the philosophical method, but my understanding is there is no one philosophical method. It's not like the scientific method. Correct me if I'm wrong. I'm open to learning on this. I'm not trained in philosophy. And provide a reference so I can read a bit more on it.

I agree that being more informed about different ways of thinking is important for all of us. The following link is for a book highly regarded that could help give you the basic level of knowledge necessary to debate with us. Particularly pay attention in the first couple of chapters where he discusses the differences in approaches from the scientific method vs the legal system/public policy (philosophical method)
http://www.amazon.com/Law-Mental-Health-Case-Based-Approach/dp/1593852215

So I should take your credentials at your word? And just assume you're capable of defending your position?

my very point was that credentials are irrelevant if the person with the credentials is making uninformed, unintelligent arguments.

So if I'm understanding this correctly, your experience in med school (you dropped out?) qualifies you to weigh risks and benefits of medication management of mental illness compared to a specialty trained MD? Care to substantiate that?

Again, my very point above stands, it does not matter what your or my credentials are, what matters is your understanding of the arguments, of how the legal decision making process works, and of how to actually argue... which irregardless of your credentials you seem to not get.

 

[AlaskanJustin]

double post

 

[AlaskanJustin]

Well, to put the "one theoretical patient" issue to rest, I personally know of two medical psychologists working in community mental health who prescribe to underserved populations in an area where psychiatrists were hard to attract. Thus, while this is obviously anecdotal evidence, it does at least refute the point (assuming you accept that I'm not lying) that absolutely no underserved individuals are receiving services via RxP.

Fair.

However, I don't think anyone is actually trying to make that specific point; rather, professionals are (justifiably) questioning whether RxP is doing what it was at least partially purported to do (i.e., provide services to those individuals in areas where psychiatric care is not immediately available), and whether it is doing so in a safe manner. I don't have the answers to those questions.

There is a kew difference between QUESTIONING and KNOWING, one presupposed NOT knowing the answer whereas the other (circularly) presupposes KNOWING the answer.

I can say that, from what I've heard, RxP advocates and providers were/have been able to find support in the non-psychiatric medical community. Also, the training process is informed by those most qualified to provide said training (physicians). Beyond that, I really don't have a clue how thing are working out on a large scale.

In fact I don't think anyone is any longer questioning the level of training received, its quite intense. The ultimate point is that none of us yet know, therefore the debate has to be on purely logical grounds until grounds for scientific debate are met.

 

[AlaskanJustin]

I just want to say that medical students in general and medical school is a joke relative to CPysch and philosophy studnets, and CPsych programs in general.

On what grounds do you hold this claim? Do you yourself have training in medicine? Have you any direct non-anecdotal experience of such? How can you make such a claim X is relative to Y and Z... against what framework are we making such a claim.

If you are to say X (medical school) is a joke relative to Y (CPsych) and Z (philosophy) then you are making a claim of epistemic justification, and on that regard I must refer you to Boghossian's book located here http://www.amazon.com/Fear-Knowledge-Against-Relativism-Constructivism/dp/0199230412 so you may understand the error in your ways.

 

[AcronymAllergy]

In fact I don't think anyone is any longer questioning the level of training received, its quite intense. The ultimate point is that none of us yet know, therefore the debate has to be on purely logical grounds until grounds for scientific debate are met.

I do think there are actually quite a few people (psychologists and physicians both) still questioning whether the current two-year program is, in fact, intensive enough to adequately train psychologists to prescribe. I know a few individuals who've gone through it, and while it does seem somewhat intense, I have absolutely no idea if it's intense enough to train these individuals to safely prescribe. It would seem to be the case, as some have been doing so for a couple years without incident, but as has already been said, a lack of publicized complaints or lawsuits definitely can't be seen as the only metric necessary to determine adequacy of training.

I believe part of the reason that something hasn't come out of NM yet is that, to the best of my knowledge, there were no RxP psychologists there for a few years after legislation was passed.

 

[histandard]

Even I would say that the personal snipes made in this and your most recent posts are completely unnecessary, as is the holier-than-thou attitude. It's quite possible to have a debate without trying to insult one of the other participants.

what makes you think this is personal? I have no ****ing clue who any of these correspondents are? i don't know what you are adding by saying "it's quite possible to have ....", that's a given, unless you take me to suffer from psychopathy.

[/quote]
Physicians, like many other healthcare and mental health professionals, are our colleagues and in many cases our friends. Their training system and students are different than ours, but are in no way "a joke."[/QUOTE]

lol. ok

 

[histandard]

On what grounds do you hold this claim? Do you yourself have training in medicine? Have you any direct non-anecdotal experience of such? How can you make such a claim X is relative to Y and Z... against what framework are we making such a claim.

If you are to say X (medical school) is a joke relative to Y (CPsych) and Z (philosophy) then you are making a claim of epistemic justification, and on that regard I must refer you to Boghossian's book located here http://www.amazon.com/Fear-Knowledge-Against-Relativism-Constructivism/dp/0199230412 so you may understand the error in your ways.

AJ. I'm afraid I have read that book and am very familiar with the philosophical claims you bring up, and the fact that you believe think to apply to my quote is a joke.

 

[AlaskanJustin]

AJ. I'm afraid I have read that book and am very familiar with the philosophical claims you bring up, and the fact that you believe think to apply to my quote is a joke.

First, I'm afraid this sentence makes no sense "and the fact that you believe think to apply to my quote is a joke"

Second, I think its not a joke, so now we have a quandary because you haven't justified your original claim, you are simply dodging my original post. But that's ok its not for this board we can discuss this over PM if you would like although my time I am sure would be better suited keeping my arguments on this topic and not tearing you a new one on why your claim is ABSURD.

I bid you adieu sir.

 

[histandard]

First, I'm afraid this sentence makes no sense "and the fact that you believe think to apply to my quote is a joke"

Second, I think its not a joke, so now we have a quandary because you haven't justified your original claim, you are simply dodging my original post. But that's ok its not for this board we can discuss this over PM if you would like although my time I am sure would be better suited keeping my arguments on this topic and not tearing you a new one on why your claim is ABSURD.

I bid you adieu sir.

Y'all a joke. can't touch this.

 

[nitemagi]

AJ, your posts are just too long and bloated for me to counter every point. I started typing responses but just making the list of incorrect statements got into the 20's. Suffice to say I'm quite open to having an actual debate verbally where I don't have to copy/paste quote/unquote 20+ times just to respond. PM me if you're actually interested.

A few things I will leave with -
1. I have no financial incentive to limit prescribers. Being a physician, there is more than enough work for me personally, and the argument for a financial incentive to restrict prescribing assumes a finite pool of patients in my area, and my being in competition with other prescribers, which I am not. Nor do I live in LA or NM.
2. We agree there should be higher standards for prescribing in general. This is a problem on multiple levels, from FDA regulation to physician training, to overdiagnosis and overprescribing. I just don't see how RxP helps any of those issues, but instead introduces a group of prescribers with even less training.
3. HisStandard seems like a troll.
4. Try not to come off as quite so pompous and superior in everything you write. I'd bet it turns people off.

 

[AlaskanJustin]

AJ, your posts are just too long and bloated for me to counter every point. I started typing responses but just making the list of incorrect statements got into the 20's. Suffice to say I'm quite open to having an actual debate verbally where I don't have to copy/paste quote/unquote 20+ times just to respond. PM me if you're actually interested.

Look, you can't just end, or think you have won a debate by simply saying "gee its too long and bloated and makes no sense" when you have clearly not even shown why any of that is true.

The reason we debate publicly is because then other people can read what we write and hopefully come to a solid conclusion for themselves, but when people such as yourself contribute absolutely nothing to a genuinely good debate by others like Acronym etc., it really detriments the quality of this board.

Hey there is no shame in simply admitting that you don't understand the arguments presented before you, or even simply admitting that you have been crushed, we all get crushed once in a while, even the best of minds get crushed, so I would think you or I could be. In this case, you have been.

A few things I will leave with -
1. I have no financial incentive to limit prescribers. Being a physician, there is more than enough work for me personally, and the argument for a financial incentive to restrict prescribing assumes a finite pool of patients in my area, and my being in competition with other prescribers, which I am not. Nor do I live in LA or NM.

Again, this lends clear evidence that you just don't get what is being argued here by myself or others. You take an argument too literal. What I was saying is, is that IF you or others are to make the claim that people FOR RxP are out for money, then the claim "People against RxP are also doing so for money" or more broadly "People against RxP are doing so to protect their own best interests" is EQUALLY as valid...

You CLEARLY have no grasp as to what is going on in this discussion, so I ask of you please no longer respond to posts if you do not clearly understand the arguments, because then that ultimately compels myself and others to waste our own valuable time to have to respond to such nonsense.

2. We agree there should be higher standards for prescribing in general. This is a problem on multiple levels, from FDA regulation to physician training, to overdiagnosis and overprescribing. I just don't see how RxP helps any of those issues, but instead introduces a group of prescribers with even less training.

This has now become a circular argument of which I could continue arguing to infinity. Look, you have no evidence that psychologists with RxP have any less training than psychiatrists with RxP. If you are saying they have less general medical training, CLEARLY no one would argue, but RxP does not mean that any ol' psychologist can Rx vancomycin, hell they can't even Rx pain killers, all they can prescribe are drugs that are relevant to psychological disorders, i.e., psychotropic drugs

Therefore within the scope of training for RxP within psychological disorders, you have NO evidence lending support that psychologists with RxP are any less (or more) trained than a psychiatrist. You are merely arguing on conjecture and VERY limited personal experience.

Also, who do you think is doing the supervision post-two years of intensive training??? A physician does the two years of supervision AND the physician is held accountable!

I refer you to this site so you can better inform yourself. I know it's NAMI and not necessarily official, but if I posted NM legislature no one would read it. http://www.nami.org/Template.cfm?Se...tManagement/ContentDisplay.cfm&ContentID=8375

3. HisStandard seems like a troll.

This may be, but it does not make his arguments any less sound, aside from his argument against the medical profession which could equally be crushed by arguing against the ease of training in all professional programs.

The phrase P=MD is equally as valid for PhD students...

4. Try not to come off as quite so pompous and superior in everything you write. I'd bet it turns people off.

If you are to take arguments this way then clearly you shouldn't be arguing at all.

Again, look, if you don't understand the arguments, then don't speak. You are simply diluting the quality of previous discussion on here, and making people such as Acronym or others trying to make legitimate argumentation look bad.

I am not personally attacking you, but clearly you are missing the points of arguments here, possibly because you don't understand them. Regardless, do NOT try to criticize my arguments by saying they are bloated and illogical without even quoting them or showing why that's the case.

To add a side note, does no one remember the DoD study? Small sample size I know, but pretty compelling nonetheless.

 

[nitemagi]

AJ-

I congratulate you on declaring yourself the winner. Enjoy your ongoing monologues.

 

[histandard]

AJ, your posts are just too long and bloated for me to counter every point. I started typing responses but just making the list of incorrect statements got into the 20's. Suffice to say I'm quite open to having an actual debate verbally where I don't have to copy/paste quote/unquote 20+ times just to respond. PM me if you're actually interested.

A few things I will leave with -
1. I have no financial incentive to limit prescribers. Being a physician, there is more than enough work for me personally, and the argument for a financial incentive to restrict prescribing assumes a finite pool of patients in my area, and my being in competition with other prescribers, which I am not. Nor do I live in LA or NM.
2. We agree there should be higher standards for prescribing in general. This is a problem on multiple levels, from FDA regulation to physician training, to overdiagnosis and overprescribing. I just don't see how RxP helps any of those issues, but instead introduces a group of prescribers with even less training.
3. HisStandard seems like a troll.
4. Try not to come off as quite so pompous and superior in everything you write. I'd bet it turns people off.

Nitemagi. my comments against your points must have really hit home because your only recourse was to say that i seem like a troll. you must feel bitter about the fact that your 8 years of training has led you to think, write, and argue at the level of an undergrad. i guess that's all that is typically left to say when one is literally pummeled to the ground.

 

[nitemagi]

Nitemagi. my comments against your points must have really hit home because your only recourse was to say that i seem like a troll. you must feel bitter about the fact that your 8 years of training has led you to think, write, and argue at the level of an undergrad. i guess that's all that is typically left to say when one is literally pummeled to the ground.

Your insults of my credentials doesn't lend credence to your posts. But continue on. Tell me more about how my posts show how immature I am, how "Clearly" I have attained my level of education without the ability to have an intelligent discussion. Please say it all the more. As with most posts, you reveal more about yourself than you do about me.

 

[Therapist4Chnge]

So how about that RxP stuff....from the previous 20+ pages? Let's talk about that maybe?

 

[histandard]

Your insults of my credentials doesn't lend credence to your posts. But continue on. Tell me more about how my posts show how immature I am, how "Clearly" I have attained my level of education without the ability to have an intelligent discussion. Please say it all the more. As with most posts, you reveal more about yourself than you do about me.

Sigh. Nitemagi. I almost can't believe that I am speaking to even an adult, let alone one within a overall respectable profession. Let me illustrate how your thinking or at least the manner in which you articulate your responses reveal a lack of sharp thought by way of simply re-stating your first sentence above: Nitemagi writes "your insults *of my credentials* doesn't lend credence to your posts". What is sad is that even before going on to the second sentence, you've made a *baffling* statement. Each time I write a response to you that seems elementary for an undergrad (let alone a doctor) to understand why they were in error in some important manner, you respond by responses that demonstrate that you *never got the point in the first place*. So, carefully follow this one, and find the humility in yourself to contemplate whether you ought to correspond more carefully.
First you say I insulted your credentials. I didn't so much insult your credentials as much as I am really explicitly insulting that *DESPITE YOUR TOUTED CREDENTIALS*, you display a marked lack of ability to argue. This is mostly demonstrated by your responses overall, but, partly simply by view of the fact that in my exchange with you, you haven't responded back with anything to argue against my points.

In other words, you are left quite speechless about the fact that you *did in fact make a callous mistake* in wording and precision, and all you are left to say is something quite *immature* (by the way, I readily admit that I can post immature comments, and so, please don't respond by saying you are more immature) comment that I seem like a troll? If my insults to your credentials cannot lend credence to my arguments, certainty I would imagine that your insult about how I am perceived by you as a troll cannot lend credence to your comments, nor rectify your lack of precision and argumentation. Perhaps, it fills that lacunae of silence in your mind for not being able to come to a single response in serious defense or some acknowledgment of improvement needed. Once again, I didn't attack your credentials so much as criticized your very own criticism against AJ, and your rather lack of precision and thoughtfulness via your responses *DESPITE YOUR CREDENTIALS*. Perhaps you are under the belief or pretense that HAVING CREDENTIAL IS necessarily TANTAMOUNT TO HAVING INTELLECT OR ABILITY TO ARGUE. if you sincerely believe that, this argument is over. you're an utter joke. Just because you have a tendency to misinterpret, despite my clear writing, let me explain to you the difference:

X attacks credential B to discredit Y is completely different from
X attacks argument A to discredit the VALUE OF credential B for person A (in so far as intellectual conversation goes)


The fact that you make the comment that I attempt to lend credence to any argument (let alone a solid claim that 2 + 2 = 4) by way of attacking your credential (which I have btw already mentioned are solid relatively speaking) is *immature* and beyond comprehension. Besides, *EVEN taking into account my comment about med school being a joke*, what makes you think that this would be the main thrust against you? PRIOR to that I responded to your comments to AJ, and those comments are what discredited your arguments. How convenient that you forgot that. It's okay. I know you know you can't say ****** about my original post against your comments because your speechless.

I don't need to go into specifying further why you are immature nor how you got to your level without the ability for an intellectual discussion. The answer already lies in the idiocy of your first sentence. You'd imagine that you could make it past the first sentence without writing something that utterly discredits your ability to articulate or make some reasonable claim ha! Thanks for saving me the time!

*btw, it's shocking how proud you are about your *level* of education. lol. it's not that hard to get into medical school and go onto residency, insofar as true intellect goes. you probably are good at memorizing and rely on being a MD for your self-esteem. how hegemonic and "immature" shallow that seems from here. all you can recourse to is your "level" as though saying that you are an MD already is a justification on its own. I wonder what people or you would think If George Bush said, well, I'm president, explain how I got here to my level if I didn't have intellect. LOLLLL. *UR BAFFLING*

 

[nitemagi]

Keep going, tell me more. So now I'm not even equivalent to an undergrad. Rant on, I'm all ears (or eyes in this context).

Choosing not to engage in your tirades is different from a lack of ability to argue.

 

[AlaskanJustin]

So how about that RxP stuff....from the previous 20+ pages? Let's talk about that maybe?

You know T4P, I think what is a more interesting debate is not why we should or should not have RxP, but rather what happens after all 50 states and the US territories legalize RxP...

 

[histandard]

Keep going, tell me more. So now I'm not even equivalent to an undergrad. Rant on, I'm all ears (or eyes in this context).

Choosing not to engage in your tirades is different from a lack of ability to argue.

Choosing not to engage in your tirades is different from a lack of ability to argue.

uh. duh? is that suppose to inform me of something?
do you mean to say that you are choosing not to engage in my tirades? lol. you responded previously, and now you are backing off? lol. you are the one who invited me to explain to you why XYZ. I respond. and now you simply say you are choosing not to being you don't lack the ability to argue? HAHAHAHAHAHA

in other words, you have the ability to, but each time you just keep silent, DESPITE responding and DESPITE asking for me to explain myself.

Saying that one is or implyiing that one is "choosing not to engage in another's tirdes is different from a lack of ability to argue" is quite different from actually having an ability to do so or the balls to because you are afraid that you can't seem to defend yourself well.

well. you certainly haven't shown any. i was hoping for at least a come back.

 

[nitemagi]

well. you certainly haven't shown any. i was hoping for at least a come back.

That's right, I'm not in 6th grade anymore. I recognized the futility of feeding the tirades, and so have stepped out of the discussion. But continue on, first my intellect, then my credentials, now my manhood. Anything else? At this rate maybe I'm not even a human being.

 

[loveoforganic]

You appear mostly muppet.

 

[histandard]

opps.

 

[histandard]

That's right, I'm not in 6th grade anymore. I recognized the futility of feeding the tirades, and so have stepped out of the discussion. But continue on, first my intellect, then my credentials, now my manhood. Anything else? At this rate maybe I'm not even a human being.

yeah there's something else: I suppose in 6th grade or since you didn't recognize the futility of rectifying oneself by way of calling another a troll.

 

[nitemagi]

yeah there's something else: I suppose in 6th grade or since you didn't recognize the futility of rectifying oneself by way of calling another a troll.

Organic - I get that a lot

Histandard - sorry about that, but your first posts came off as inflammatory from an account with very few posts overall. In forums like this that often suggests a troll.

T4C - I was just passed this by a colleague. Interesting site:
http://www.poppp.org
Hope it furthers the discussion, and lends evidence that not all psychologists are in favor of psychologist prescribing.

 

[histandard]

Histandard - sorry about that, but your first posts came off as inflammatory from an account with very few posts overall. In forums like this that often suggests a troll.

.

that's fine. perhaps i could have been more prudent in coming across less inflammatory, more engaging.

best wishes,

 

[AlaskanJustin]

Organic - I get that a lot

Histandard - sorry about that, but your first posts came off as inflammatory from an account with very few posts overall. In forums like this that often suggests a troll.

T4C - I was just passed this by a colleague. Interesting site:
http://www.poppp.org
Hope it furthers the discussion, and lends evidence that not all psychologists are in favor of psychologist prescribing.

Interesting site... http://psychologistsopposedtoprescribingbypsychologists.org/?page_id=5 some inaccuracies i.e., Figure 1, but nonetheless at least some things to debate over. A nice perspective on the other side of the argument.

*btw. Please remember I've never once claimed to be for or against RxP. I don't think a truly logical or practical decision can be made yet, so it is important to weigh ACCURATE information and sound argumentation on each side... not anecdotal, personally biased information.

 

[histandard]

This has devolved into ridiculousness with this "histandard" person.

I'm a very soon-to-be psychologist and I do not support RxP. We need a preponderance of empirical evidence for it before we start changing state laws in a way that might be harmful to consumers, and the data is not in yet.

If psychologists wish to prescribe, then they should push to create MD/PhD programs with a Ph.D. concentration in Clinical Psychology. Anything less is doing the same thing that we get all up in arms about when the master's levels claim that with an extra class or two, they can give and interpret complex neuropsychological batteries.

lol. what a funny advice: psychologists pushing to create a MD/PhD program with a focus on clinical psychology. i suppose they would
still remain psychologists and not MDs?

clinical psychologists should or will gain prescriptions privelege by way of going to and MD program to become a doctor to prescribe. lol.

good one. looks like your comments are allowing for evolving into a a fruitful one, unlike mine


either way, i can't give a flying dung about prescription privileges despite being a clinical psych doctoral student

 

[AlaskanJustin]

This has devolved into ridiculousness with this "histandard" person.

I'm a very soon-to-be psychologist and I do not support RxP. We need a preponderance of empirical evidence for it before we start changing state laws in a way that might be harmful to consumers, and the data is not in yet.

If psychologists wish to prescribe, then they should push to create MD/PhD programs with a Ph.D. concentration in Clinical Psychology. Anything less is doing the same thing that we get all up in arms about when the master's levels claim that with an extra class or two, they can give and interpret complex neuropsychological batteries.

Let me ask. How do we gain a preponderance of evidence without first making it legal to actually do so? Not attacking you I am just genuinely curious how this should be done. Yeah there was the DoD study several years ago but how else should we do these studies? Also, what studies do you mean? Should we give X number of psychologists privileges and follow them over a few years?

This was sincerely not the process followed for other professions, i.e., dentistry... I suppose you could make the argument that dentists get some medical training, but then again if one were to look at the dental curriculum they might change that thought.

Next, do you know what the purpose of an MD/PhD program is? It's clinical research. Also, let me ask, how do you propose this is done? There are (I think up to) 3 schools including UCSF that allow for the phd training to be done in Psychology, but that is purely research, its like doing a masters in psychology with an MD. Anyways could you imagine the sheer amount of training that would take, Initial two years of med school, then 4-5 years of psychology training (including ALL the classes necessary to appease APA) then the final 2 years of medical school... eeeyyyaa... No I don't think that necessarily is the solution...

I think one must also consider the curriculum set up for achieving RxP... two years of dedicated training in things like neuroscience, pharmacokinetics etc (kind of like the first two years of med school, but without the intense dedication to things like infectious disease etc)... yes this training is focused SOLELY on areas effected by psychotropic drugs, but nevertheless how is two years of dedicated training any less than the first two years of med school training in regards to level of information?

Then you have the two years of shadowing/training with a physician, in essence, this is to mimic the two years of clerkships that medical students have to do, but instead of having to do rotations in OBGYN, ER etc, you are only doing psychiatric work/prescribing of psychotropic drugs... so in essence your training is better at this stage.

Yes then you might not have the residency stage, but one could argue that the intensity of the two year practice stage is sufficient.

You are probably right that there needs to be evidence... unfortunately that also is not how the legal system works... legal system and scientific method dont go hand to hand very well. Lets say in ten years 10 studies come out saying RxP has a detrimental effect, THEN yeah the evidence might go to a senate committee hearing and it would be shut down... but it hasnt been shut down in other professions with restricted access, I dont see any logical reason why it would for psychologists either.

AJ