Allen Frances, MD

Allen Frances is a psychiatrist who blogs at the Huffington Post.

#MeToo shows why women must learn sexual self-defense

Physician

November 7, 2017

This is a special moment of female liberation, sisterhood, and solidarity. Tens of millions of women have used the #MeToo hashtag to share long-held secrets of sexual harassment and assault.

The disgust generated by one extremely slimy Hollywood mogul has triggered a spontaneous worldwide outburst of disgust, righteous anger, and determination to effect social change.

The movement is worldwide and includes women from all races, religions, and social classes. It started with …

The problem of polypharmacy in psychiatry

Allen Frances, MD

Meds

July 14, 2016

Polypharmacy was once the exception in psychiatry; now it seems to have become the rule. Patients frequently are taking 3, 4, even 5 psych meds at one time. And often it’s primary care doctors, not psychiatrists, who are doing the prescribing — usually without adequate training in psychiatry.

Some polypharmacy is rational — e.g., a patient with bipolar disorder who receives the combination of antidepressant and mood stabilizer.

But most polypharmacy is …

Pay primary care doctors what they’re worth

Allen Frances, MD

Physician

February 17, 2016

“It’s more important to know the patient who has the disease, than the disease the patient has.” This was true when Hippocrates said it 2,500 years ago — and it remains true today.

Unfortunately, doctors no longer know their patients. GPs are overworked, underpaid, and must shuttle patients in and out of the office in less than ten minutes. Specialists tend to treat the test, not the patient, and earn their …

Have we gone too far down the road of privatization?

Allen Frances, MD

Policy

July 12, 2015

shutterstock_162447488

Let’s get this straight. I am a penny pincher, who hates waste and wants a lean and efficient government.

But, that said, we have to face the fact that our massive privatization of what once were government functions has been a failure. There are some public services that get really loused up when done privately and for profit.

This is a classic mismatch …

We should strive for a good death that occurs at the proper time and place

Allen Frances, MD

Physician

April 27, 2015

Count no man happy till his end is known.
– Herodotus

This was true in ancient Greece 2,500 years ago. It is even more true today — aggressive end-of-life hospital care, the lack of sufficient palliative care, and unduly restrictive assisted suicide laws make it impossible for most people to die with dignity.

There is no worse death than a hospital death. Dying well means dying at home. This requires preparation and preparation …

Binge eating disorder: Real or disease mongering?

Allen Frances, MD

Conditions

April 2, 2015

A drug company recently received FDA approval to peddle its speed-like pill for “binge eating disorder” (the very same pill that is already widely overused for ADHD). And it is sparing no expense pushing the drug — a former world tennis champ is the shill and commercials are everywhere.

Five years ago, I predicted binge eating disorder (BED) would become a new fad diagnosis and a wonderful target for pharma disease …

Prescribing off-label: It’s gotten out of control

Allen Frances, MD

Meds

February 5, 2015

Doctors prescribe way too many medicines for patients who don’t really need them. A lot of the pressure comes from intense drug company marketing. Some comes from patients who aren’t happy leaving the office without a pill. And doctors have too little time with each patient to explain non-pill solutions to problems. Wild prescribing is not new. For thousands of years, doctors have given patients useless (and often quite harmful) …

Fixing our broken health care system: Sometimes David wins

Allen Frances, MD

Policy

December 30, 2014

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You couldn’t invent a worse health care system than the nightmare we have created in the U.S. Our medical costs are almost twice as high per person as they are in most other similar countries but produce only mediocre outcomes.

There is massive overtreatment of people who don’t need it, while many who desperately do have no coverage at all.

The payment incentives …

Fix the problem of expert testimony

Allen Frances, MD

Physician

December 22, 2014

Dostoevsky’s Brother’s Karamazov cleverly spoofs the careless inexpertness of what often passes for expert legal testimony.

Three medical experts are called to testify whether Dmitri Karamazov was sane or insane when committing the alleged murder of his father. Naturally, the experts all disagree, with each completely convinced of the incontrovertible truth of his own opinion. Expert 1 finds Dmitri insane because he looked to the left as he entered the courtroom. Expert …

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Fix the problem of expert testimony

Medical errors: We can’t trust doctors to get it right

Allen Frances, MD

Physician

December 12, 2014

shutterstock_119657461

“If doctors do no other good, they at least prepare their patients early for death, undermining little by little and cutting off their enjoyment of life.”

These words from Montaigne are 350 years old, but, sadly, too often they describe the results of modern medicine, particularly when it is mindlessly applied in a needlessly heroic way to the end of life.

I spend …

Giving extremists a fake psychiatric diagnosis

Allen Frances, MD

Conditions

November 11, 2014

Every time there is a terrorist act or a mass murder, reporters start calling with questions on the psychiatric diagnosis of the perp. The default position seems to be that every religious extremist or political fanatic or mass murderer must be crazy. How else to account for their weird behavior?

Naming a diagnosis somehow satisfies a deep human need to explain what otherwise seems an unexplainable act. But names can only …

A civil war in psychiatry: Is there common ground?

Allen Frances, MD

Physician

October 29, 2014

There will never be any compromise acceptable to the die hard defenders of psychiatry or to its most fanatic critics.

Some inflexible psychiatrists are blind biological reductionists who assume that genes are destiny and that there is a pill for every problem.

Some inflexible anti-psychiatrists are blind ideologues who see only the limits and harms of mental health treatment, not its necessity or any of its benefits.

I have spent a good deal …

How to talk to a patient with terminal cancer? Not like this.

Allen Frances, MD

Physician

October 6, 2014

A friend of mine has been living well with lung cancer for five years — working, running several miles a day, traveling, doing good stuff with his family, and generally enjoying the pleasures of everyday life. He knows the cancer will eventually kill him, but has been making the most of every remaining minute.

Then, a month ago, things suddenly turned dramatically south. Severe shortness of breath, constant coughing, sleeplessness, fatigue, …

Society’s mismanagement of the mentally ill is a disgrace

Allen Frances, MD

Conditions

August 20, 2014

We are civilized people in the United States. We don’t set up leper colonies or concentration camps or psychiatric snake pits to banish people with severe mental illness. Instead we send them to jail or prison — almost 400,000 of them, more than 10 times the number receiving care in hospitals. And we also blithely ignore the fact that additional hundreds of thousands live homeless on the streets or in …

A cruel paradox when it comes to mental disorders

Allen Frances, MD

Physician

August 3, 2014

I am a great supporter of mental health research but worry that it has lost its sense of proportion and is chasing the wrong priorities.

The really glamorous stuff consumes almost all of the enormous NIMH budget and now has behind it the huge addition of a $650-million private donation aimed at solving the genetics of mental illness.

Neuroscience is an extremely easy sell to Congress and rich philanthropists because it promises …

The economic case against the death penalty

Allen Frances, MD

Physician

July 17, 2014

I am not strongly against the death penalty on principle or on moral grounds — assuming, of course, that it could somehow be narrowly and efficiently restricted to a very few egregiously deserving and certainly guilty criminals.

I don’t even find it particularly appalling (or cruel and unusual) punishment that a killer may have some few minutes of physical discomfort before expiring during a clumsily administered execution. My experience as a …

Exploring the mind of a mass murderer

Allen Frances, MD

Conditions

June 18, 2014

Mass murders are becoming a depressingly familiar routine in the United States — we can now expect to experience a media grabbing shooting about once a month. And the frequency can only increase as future cohorts of copycat killers are spawned by the seductive opportunity to temporarily gain the spotlight.

Amidst the anguish and heartbreak felt by the victims’ families, there are always two haunting questions. What motivates someone to kill …

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Exploring the mind of a mass murderer

Have ADHD diagnoses reached a tipping point?

Allen Frances, MD

Conditions

June 13, 2014

I have been blogging and tweeting about ADHD a lot lately because I believe that change is in the air.

This is the worst of times for ADHD diagnosis because statistics show it is wildly overdiagnosed and overtreated. This is possibly the best of times for ADHD diagnosis because I think we have reached the tipping point and feel hopeful that the ADHD fad will soon begin to fade.

We humans are …

The military is off-track when dealing with mental health problems

Allen Frances, MD

Conditions

June 4, 2014

The headline reads, “Study: Mental illness rate higher in soldiers.”

The article goes on to offer alarming statistics:

The rate of major depression is five times as high among soldiers as civilians; intermittent explosive disorder, which results in episodes of extreme anger, is six times as high; and post-traumatic stress disorder was nearly 15 times higher than among civilians, the study found.

This would be pretty scary if true — but …

Treating babies with stimulants is reckless

Allen Frances, MD

Meds

May 27, 2014

How crazy is it to drug babies?

It was shocking enough to discover that 20% of teenage boys get labelled as having ADHD, and 10% are on stimulant medications for it. That 11% of all kids aged 4-18 get the diagnosis of ADHD, and 6% the drugs. That stimulant prescriptions and pharma profits are skyrocketing all around the world. And that ADHD guidelines encourage making the diagnosis and starting the drugs …

Allen Frances, MD

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