Two women have been sacked by a state funded Te Atutu based addiction treatment centre "Higher Ground" for taking their prescribed medication (citalopram) for depression.
Both of them presented to their GP with depression and were prescribed a standard, evidence-based treatment. Their employer, on learning of this from one of the women, suggested that they instead take St. Johns Wort - an unlicensed drug of unproven effectiveness. When they did not take this advice, they were fired.
The Employment Relations Authority has rejected one of the womens claims on the grounds that she did not follow correct process in challenging the authority (the other has complained directly to the Human Rights Commission).
I think this is unacceptable on several grounds:
- Psychiatric illness is a disability and a prohibited ground of discrimination under the Human Rights Act. It should be as unacceptable to sack someone on these grounds as to sack them for being black. And I don't believe the ERA would accept a race-based dismissal on grounds of incorrect process.
- Organisations which systematically breach the HRA should not be funded or endorsed by the state.
- The public health system is based around evidence-based medicine - encouraging people to uptake appropriate treatment is part of this. The system should not be funding organisations that actively work against the uptake of such treatment.
Wednesday, May 09, 2007
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7 comments:
From that Herald article:
Higher Ground Drug Rehabilitation Trust runs a drug and alcohol residential recovery programme from Te Atatu, West Auckland, and states in its code of ethics that staff who have previously had problems with drugs or alcohol "will remain abstinent of mood and mind-altering drugs".
There are good clinical reasons why addiction treatment programmes have rules about what substances staff and clients can use, although what those rules are or should be is hotly debated by many. I have no idea whether it's reasonable in that centre for them the have the policy they do but anti-depressants are not inherently biologically, psychologically or socially benign. Would it be acceptable for someone who reacts badly to antidepressants to use cannabis to control their depression while they worked in an addiction centre (illegality aside)?
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As an aside, depression is not inherently or necessarily a 'psychiatric' illness. Often it is a normal part of life, sometimes it is a mental illness, and more rarely it is a serious psychiatric condition.
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SJW is not a drug, it is a herbal medicine. It has been proven to be more effective than placebo in treatment of mild to medium depression (but not severe depression), and on par with or better than anti-depressants with fewer side effects. All that is in the wiki link you give so I'm not sure why you say that it is of unproven effectiveness:
Other, more recent trials have also shown greater efficacy than placebo, and comparable efficacy to standard antidepressants with a superior adverse effect profile
agreed - quite franky I find the rationale given by scott to be bizzare and I can't help feeling she is sympathetic to the employers nonsense application of their policy.
Fish includes Omega 3 fatty acids which are know to have an effect on brain chemistry - does that mean fish would be banned as well or only if you take Omega 3 in a dietary supp form? But St Johns Wort is a dietary supp so what is the difference?
St Johns wort is either a drug or a n placebo - the whole rationale for prefering it over anti-depresants appears to be based on the mistaken notion things that are natural are less harmfull - nonsense!
These people need to be reminded Hemlock killed Socrates very effectively, and no matter how many millions they spend on making new weapons each year the most effective poisons are found in nature.
Weka
"As an aside, depression is not inherently or necessarily a 'psychiatric' illness. Often it is a normal part of life, sometimes it is a mental illness, and more rarely it is a serious psychiatric condition."
Nonsense - I do not understand why people feel the need to insist psychological/psychiatric illness is any less serious than physical illnesses. It is simple and unwarranted discrimination.
If you scratch your knee it is still a medical condition, even if you decide to do nothing about it.
St Johns wort is either a drug or a n placebo - the whole rationale for prefering it over anti-depresants appears to be based on the mistaken notion things that are natural are less harmfull - nonsense!
No, the rationale for SJW use is the very long historical use, plus the recent medical science research that has proved it's efficacy.
There are significant differences between drugs and herbs. Drugs are usually single substances that have very specific actions in the body. Their use is predicated on that specificity i.e. you want them to act in ways that affect the body strongly in quite distinct ways (and you simply cannot get herbs to do that which is why drugs are the refined substances that they are). That is what they are good for.
Herbal medicines are usually based on whole plants, and so include a very wide range of constituents and actions. The actions are less about direct intervention in specific ways and more about supporting the body's own mechanisms.
The idea that herbs are natural therefore safe is based on the reality that herbs, despite being used by millions of people worldwide account for an incredibly small amount of deaths. Compare that to the very large number of deaths caused directly by pharmaceuticals (go read the research on this). This isn't to say that herbs are good and drugs are bad, or even that herbs are always benign, just that they are different things and need to be understood differently.
And of course anyone who has any actual knowledge about herbal medicine knows that 'herbs' can mean a plant like hemlock that can kill or a plant like basil that you can eat in your salad. Both can be used as medicines if you know what you are doing (the poison is in the dose).
What reactionaries against herbal medicine often don't seem to be aware of is the very high rate of adverse effects, including disability and death, that are associated with pharmaceutical drugs. Again I am not saying that drugs are bad, just that let's be real about their limitations as well as their strengths.
Fish includes Omega 3 fatty acids which are know to have an effect on brain chemistry - does that mean fish would be banned as well or only if you take Omega 3 in a dietary supp form?
The critical thing in the rehab centre's policy is that they want abstinence from "mood and mind altering drugs". We can argue semantics here probably, but in this context I don't think that Fish oil counts as a mood altering drug. Many things alter brain function, but in an addiction context the concern is for substances that have the potential to be abused. This is about safety for the clients, and the wellbeing of staff that are former/recovering addicts (eg one concern is that addicts give up one drug and switch to another, more acceptable one, but don't address the addiction issues themselves. That is a general example not a comment on the women in the article obviously).
I would be interested to know the centres rationale, and if they require recovering/former addicts to not drink coffee ;-) and I'll repeat that there are varying opinions about to what extent it is helpful to promote total abstinence from drugs, but it is still a relevant clinical issue.
Nonsense - I do not understand why people feel the need to insist psychological/psychiatric illness is any less serious than physical illnesses. It is simple and unwarranted discrimination.
I didn't say, or even imply, that mental health is less important than physical health. Not sure what you are on about there.
What I am saying is that for something like depression, there are a range of experiences from normal life ups and downs through to severe psychiatric illness. My comment was in response to Rich's implication that the two women were psychiatrically ill, when we don't actually know if they were. Many people who are depressed get medication without seeing a psychiatrist i.e. they don't have a psychiatric diagnosis. And many people who are depressed get medication at all, they use other methods to manage the depression.
I don't like seeing all mental health woes pathologised as 'psychiatric' when they're not.
If you scratch your knee it is still a medical condition, even if you decide to do nothing about it.
Er, not it's not. It's simply a scratch. Our bodies do actually exist independantly of the medical profession you know ;-)
That should have been: "And many people who are depressed don't get medication at all, they use other methods to manage the depression"
My first point on this is that it's the womens' decision as to whether they consider their depression amounts to an illness and whether they seek medical help for it. Not their employers.
I think the best basis for employer/employer relationships is that one is entitled to do anything outside the work context that doesn't affect the ability to perform a job. Further, an employee is entitled to exercise certain basic rights *even* if they affect their job (a company is not entitled to fire a black employee even if their customers
are a bunch of racists).
I think that taking prescription medicine falls into the latter category - if it interferes with the centres dogmatic anti-drug policy, they have to work around that.
Incidentally, anything you put into your body to affect its biochemical systems is a drug. Science has developed a system of gauging the effectiveness and safety of drugs through standardised testing and continuous monitoring, taking account of placebo effects, differences in people, etc. This system is not perfect, but it's better than anything else. The idea that a drug can be thought useful because many people have taken it for a long time is useful - but not as useful as a controlled trial that tells you accurately how well it does or does not work. (and it's to be noted that there have been numerous instances of persistent chronic self-poisoning by populations unaware of the toxic nature of a substance - cosmetic use of lead is a good example).
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