Samuel Gershon: Lithium history

Donald Klein’s comment on Hector Warnes’ comment

            Sam Gershon is an astute, remarkably experienced, expert clinical scientist, clinician and administrator, as well as unfashionably clear and outspoken. When he poignantly regrets the current dehumanizing state of medical practice and corrupted research, it should be persuasively registered far beyond the range of  INHN. That  Dr. Warnes entirely agrees testifies to his good sense. Their views have been reinforced by many authorities who agree that before about 1970, medical concern, sympathy and hopefulness was central to practice. Time was easily committed to patients, their family, colleagues and students because of kindliness, collegiality and faithfulness to Hippocratic dicta.  Honesty abounded.

            Implicit is an obscure general shift in attitude. Patients, staff, professionals and industry have turned nasty and dishonest. Therefore, the apparent cure is renewed attention to past virtues. Unfortunately, this has not improved matters.

            A better formulation was provided by the late, great Barney Carroll who pithily said that it’s the money. We expand on this causal insight regarding changes in reinforcement contingencies. After World War II there was a  flood of therapeutic discoveries. In 1962 legislation finally responded , by a publicly reassuring commitment to an objective, scientific determination of therapeutic efficacy before marketing (except for surgery, psychotherapy, vitamins,  various nostrums and reality). 

            Demand for therapeutic care became effective as general income rose so that medical practitioners, hospitals and industry became much more profitable; attention to the new realistic sources of profit rose. The rapid growth of managed care, health insurance, marketers (salesmen), senior and junior  clinically  untrained administrators ballooned. The industrial evidence of the importance of documentation and time management on the assembly line was willy-nilly, transferred to both practice and research. The relatively leisured, boss independent, time generous approach of the clinician, who previously had little else to sell, was now under stern financial and documentary scrutiny. The gratifying pursuit of clinical research, during time therapeutically funded, disappeared.  Even many web-informed patients became unfruitfully discussion demanding regarding latest curative fads. Except for the major positive reinforcement provided by income level, many direct  gratifications of the clinical and independent research  life have been replaced by frustrations.  These increase contagious nastiness. 

            This emendation of Barney's insight is also quite unrewarding. We focus on its destruction of hope for an attitudinal reversion toward prior warm virtues. Changing our society's leaders concern for material comfort, but whose  profit-seeking, in the context of competitive destruction, has become an  unreflective pursuit  appears impossible. 

April 4, 2019