Thoughts on the Taper Clinic?

[futureapppsy2]

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The Youtube account associated with this clinic came up in my recommended, and the description was all about "clicking here to start your taper package TODAY!" which raised some big red flags. While it's a plus that the clinic has licensed and board certified staff and at least practices gradual taper (i.e., not telling people to just quit their meds today), there are some other red flags like the fact that the "standard package" is all group treatment, the emphasis on "functional medicine" as a psychiatric cure-all, and the fact that there seems to be no assessment of if a patient can indeed safely taper off their psych meds.

 

[randomdoc1]

I wonder if it's set up that way to increase CTR. YouTube has been trying to tighten up on the misinformation war. Supposedly, if a channel is caught with even one instance of giving bad medical advice, it can get banned or demonetized. For a channel/video to have high visibility, there is a required series of hoops to gain some trust with the platform like
-increasing subscriber base (and YT checks if they are similar or just bots or randos that were solicited to hit subscribe)
-consistent engagement that looks organic

Some videos, well, a lot of videos have very very catchy thumbnails, titles and descriptions more for SEO. I'm learning on my own journey. But viewers tend to decide within the first 10 or even 5 seconds if they will watch your video or they click away. Which is a vicious cycle because as your stats tank, it's harder to get visibility. I do see a share of content that looks very wow and in your face but the information within is not terrible. There is also terrible information too of course.

Shorts is even more brutal. If you don't catch the attention within the first 1.5 seconds, viewer swipes away, watch time is less, VVSA tanks and the algo buries your video. But shorts are the only way for organic traffic to discover you and accelerate channel growth.

It's a very very interesting world.

In my own journey, somehow YT within my first week of posting became confident enough that I am actually who I say I am. And it pushed my content to a wider seed audience. Which I was thrilled about. It's just content discussing what we do in evidence based practice. And of course, I was worried it would be too boring or unpopular compared to a cat meme. But I so far got good reception.

 

[futureapppsy2]

I wonder if it's set up that way to increase CTR. YouTube has been trying to tighten up on the misinformation war. Supposedly, if a channel is caught with even one instance of giving bad medical advice, it can get banned or demonetized. For a channel/video to have high visibility, there is a required series of hoops to gain some trust with the platform like
-increasing subscriber base (and YT checks if they are similar or just bots or randos that were solicited to hit subscribe)
-consistent engagement that looks organic

Some videos, well, a lot of videos have very very catchy thumbnails, titles and descriptions more for SEO. I'm learning on my own journey. But viewers tend to decide within the first 10 or even 5 seconds if they will watch your video or they click away. Which is a vicious cycle because as your stats tank, it's harder to get visibility. I do see a share of content that looks very wow and in your face but the information within is not terrible. There is also terrible information too of course.

Shorts is even more brutal. If you don't catch the attention within the first 1.5 seconds, viewer swipes away, watch time is less, VVSA tanks and the algo buries your video. But shorts are the only way for organic traffic to discover you and accelerate channel growth.

It's a very very interesting world.

In my own journey, somehow YT within my first week of posting became confident enough that I am actually who I say I am. And it pushed my content to a wider seed audience. Which I was thrilled about. It's just content discussing what we do in evidence based practice. And of course, I was worried it would be too boring or unpopular compared to a cat meme. But I so far got good reception.

The content of the video I watched from them wasn't awful--it was mostly just talking about discontinuation syndrome and the necessity of a slow taper with medical monitoiring--but the clinic website associated with it has more red flags.

 

[randomdoc1]

The content of the video I watched from them wasn't awful--it was mostly just talking about discontinuation syndrome and the necessity of a slow taper with medical monitoiring--but the clinic website associated with it has more red flags, IMO.

Oh, I see, then that makes sense. Speaking of taper, the Maudsley Deprescribing Guidelines are interesting. I've observed that in practice too. Patient did better on a super super slow taper. Which is an interesting contrast to residency.

 

[comp1]

I'm neutral. Some people on SSRIs can probably be off them and people who are functional enough to be able to afford a starting cash only cost of $30k (up to $60k) per year, may be those people. I'm VERY supportive of tapering off benzos and hypnotics. Obviously literature supports those being used only in the very short term. However, I bet their business in that is very low. I'm pretty scared of them tapering people off antipsychotics and mood stabilizers, but they certainly are charging enough to be closely monitoring people, so it may not result in as many horrific outcomes as I am imagining. In general, I think this is an extremely boutique niche sort of thing that is unlikely to impact much of mental health in general. A lot of people can seriously get by with attention in lieu of medication and this seems to be for them, if wealthy enough.

 

[splik]

Yes functional medicine is total quackery. Lots of red flags. The challenge with this BS is it takes some very legitimate stuff like tapering meds and combines it with pseudoscience. I have no respect for people like this.

 

[psydocc]

Josef, the psychiatrist who started up that clinic, is very popular amongst the antipsychiatry crowd. I think he was hoping for a Paul Saladino-type grift but he is ending up more like Thomas Szasz.

 

[comp1]

It seems grifty as heck and he indeed did want to ride an antipsychiatry wave, but honestly our skills can probably be better put to use elsewhere than with people who can just drop $60k. He can have at them. I'm quite sure he'll earn it.

 

[futureapppsy2]

It seems grifty as heck and he indeed did want to ride an antipsychiatry wave, but honestly our skills can probably be better put to use elsewhere than with people who can just drop $60k. He can have at them. I'm quite sure he'll earn it.

As a counterpoint, I could see distressed and not wealthy folks putting themselves into debt thinking this will cure them and then ending up in both significant debt and with untreated or undertreated serious psychiatric symptoms.

 

[comp1]

I've never met such a person, but then I guess I very likely wouldn't.

 

[splik]

Josef, the psychiatrist who started up that clinic, is very popular amongst the antipsychiatry crowd. I think he was hoping for a Paul Saladino-type grift but he is ending up more like Thomas Szasz.

Saladino has moved on from psych now and apparently very successful as in influencer with his wacky ideas. Thomas Szasz, whatever you might think of him, was a brilliant thinker who contributed important thoughts about the nature of mental disorder, the therapeutic state, civil liberties, coercion and control, and the libertarian viewpoint in psychiatry. Dr. Josef is a mental dullard by comparison lacking not only in intellectual rigor but also common sense.

 

[Atreides]

Obviously Josef is grifter but there is a very real niche in tapering patients off unnecessary meds. I'm getting an increasing number of self-referrals from patients who've been put on 6-7 meds by NP's and they want to figure out what's actually indicated and what they can come off of. Some of the most satisfying patients to treat, especially when you're able to whittle away 5 out of 6 meds and get them stabilized on a medium dose of an SSRI (and d/c the stimulant, the benzo, the mood stabilizer, the antipsychotic, and the trazodone).

 

[FatherPsychiatry]

There are some posts on Reddit commenting on their experience with this guy's clinic. I don't think any of them actually did the program but they at least described the pitch. Basically it was Dr. Josef pitching the program, really pushing it in a grifty way. Apparently its over $2000 a month, pushy language like "If its the cost, can you afford NOT to do this?", and of course like any authentic wellness provider, they sell nutritional supplements.

I've seen a few of his videos on Youtube and they are well-produced, which is already a red-flag for me (vs someone more legit like Ghaemi, whose videos are probably straight off the Macbook camera). Some of the content is probably legitimate IMO, like most grifter BS, but then rapidly devolves into clear BS and sales tactics when you dive a little deeper. I can see why people without professional training can get sucked in.

Also I had no idea that Saladino was a psychiatrist. His videos have been popping up on my feed lately as I have been trying to get more fit. I never watched any because I got a grifter vibe right away just from the thumbnails (in addition to all the other grifter thumbnails), and most of it seemed to be centered around eating natural and lots of meat. Then I saw some Twitter post where he started hawking some protein bar he put his name on/behind, and the comments section was grilling him for the hypocrisy.

 

[psydocc]

There are some posts on Reddit commenting on their experience with this guy's clinic. I don't think any of them actually did the program but they at least described the pitch. Basically it was Dr. Josef pitching the program, really pushing it in a grifty way. Apparently its over $2000 a month, pushy language like "If its the cost, can you afford NOT to do this?", and of course like any authentic wellness provider, they sell nutritional supplements.

I've seen a few of his videos on Youtube and they are well-produced, which is already a red-flag for me (vs someone more legit like Ghaemi, whose videos are probably straight off the Macbook camera). Some of the content is probably legitimate IMO, like most grifter BS, but then rapidly devolves into clear BS and sales tactics when you dive a little deeper. I can see why people without professional training can get sucked in.

Also I had no idea that Saladino was a psychiatrist. His videos have been popping up on my feed lately as I have been trying to get more fit. I never watched any because I got a grifter vibe right away just from the thumbnails (in addition to all the other grifter thumbnails), and most of it seemed to be centered around eating natural and lots of meat. Then I saw some Twitter post where he started hawking some protein bar he put his name on/behind, and the comments section was grilling him for the hypocrisy.

Josef has focused on increasing his video production quality, likely to seem more legitimate. It wasn't that long ago that his videos were bare bones with him and his wife just sitting on a couch talking about their recreational experimentation with sertraline:

 

[FatherPsychiatry]

Josef has focused on increasing his video production quality, likely to seem more legitimate. It wasn't that long ago that his videos were bare bones with him and his wife just sitting on a couch talking about their recreational experimentation with sertraline:

Wow I looked up his wife - didn't realize she is a psychiatrist also. Griftie-a deux?

 

[Merovinge]

Josef has focused on increasing his video production quality, likely to seem more legitimate. It wasn't that long ago that his videos were bare bones with him and his wife just sitting on a couch talking about their recreational experimentation with sertraline:

Thanks for sharing. Having spent time with thousands of individuals now on SSRIs the way they make those reactions seem like a common experience on Zoloft is wild.

This is how capitalism works though, if there is a pathway to make money, people are going to take it. The amount of grifting is only going to increase in a digital economy where the profit potential is immense compared to practicing medicine. That said capitalism is the worst form of government, except for every other one...