STOP lawmakers from letting talk therapists practice MEDICINE on people. RE: SB 966 AAC.

STOP lawmakers from letting talk therapists practice MEDICINE on people. RE: SB 966 AAC.

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Karen Gentle started this petition to connecticut's public health committee

To: Connecticut's Public Health Committee and Public Health Committees who make decisions involving citizens' rights in receiving adequate, yet also safe and appropriate mental healthcare 

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I am a physician and am writing you regarding SB 966 AAC. I am not a CT resident, and I have no economic advantage or disadvantage from this bill passing or failing. I do feel it is within my jurisdiction as a physician to express my concerns given my DEA license is a Federally issued one, the rigorous standards for becoming a physician in the US--including the four part USMLE licensing exams for state licensure are exactly the state for all physicians regardless of state, and my specialty certification is from the American Board of Psychiatry & Neurology--a national medical board. The practice of medicine is highly standardized nationally--this recent advent of state by state divvying up medical powers to the highest bidding lobby by legislatures is new, and frankly unethical.

It is a disservice to patients who are having lawmakers decide who gets to play doctor in the place of a real doctor. A similar parallel would be if physicians proposed a bill to allow paralegals the right to ‘trial privileges’ due to the large number of cases held up in DA offices around the country.

The greatest evidence of this ‘medicine up for sale’ is the language of this bill which suggests that “prescribing” is a separate privilege from the practice of medicine. It may be useful for the constituents to know that there is no carve out in medicine for the act of ‘prescribing’. Medical schools do not offer a separate ‘prescribing’ class at night or online that allows students to skip the other 3.5 years of rigorous schooling and the four years of tireless residency at 80 hr/week. Prescribing medications is a complex, high-risk treatment modality that is embedded within the practice of medicine. And psychiatrists are medical doctors who have completed that training.

What is most concerning is that the public--whether they are patients in CT or CA--are having the wool pulled over their eyes so that insurance companies can once again get away with not meeting MH Parity laws. Yes, Psychiatrist and Psychologists sound similar. But, I am quite certain that the constituents of CT are smart enough to know that psychiatrists are medical doctors and psychologists have no medical training, rather are talk therapists. Americans deserve more, especially those with mental illness when you consider suicide is the 2nd leading cause of death for teenagers and the 11th cause of death overall. The life expectancy in the US dropped for the first time since WWII, despite a historic low in tobacco use and 2.2% drop in cancer deaths. The reason? Suicides and overdoses. Psychiatry is not about happy pills. It is about life and death just as much as cardiology is.

And speaking of happy pills, these are some of the most dangerous medications we have on the market. While the American Psychological Assn lobby will have legislators convinced that these are as easy to prescribe as skittles--most psychotropics have an FDA black box warning on them. The brain it seems, is actually connected to the other organs--like the heart, the kidneys, the liver, the the thyroid. About 90% of what a psychiatrist does is rule out an organic cause of psychiatric illness, such as a malignancy, thyroid disease, temporal lobe epilepsy, dementia, paraneoplastic syndrome, anticholinergic side effects from other medications before we assign a psychiatric diagnosis.

And that is why one has to be a medical doctor to practice medicine in the field of psychiatry. It is extremely complicated to diagnose and utilize psychotropic medications safely in a population already at risk (those with mental illness have a lower life expectancy at baseline by 7 years). Why on earth would we think it would be safe to replace 8 years of medical training with even one year of a pharmacology class? Is it because these are mentally ill patients? Would we do this with cardiac patients? To address a shortage--perhaps give the echocardiogram techs ‘prescribing privileges’? Why should this be different given the lethality of mental illness?

Further, if one really wants to increase access to physicians--one needs to look to congress to expand residency positions as Congress holds the purse strings. And telepsychiatry is an effective modality which does not require expanding the scope of talk therapists. But psychiatrists are more costly than talk therapists who won’t mind doling out more medications that pharmaceutical companies will now have more prescribers for.


Perhaps most importantly, it is the ability to convey understanding with clarity and integrity to the patient for true informed consent—a critical component of good care--especially when prescribing psychotropic medications to the mentally ill. If someone is prescribing medications with enough risk to summon a black box warning from the FDA, they should be able to address all the issues raised (risk of teratogens, Steven Johnson Syndrome, SIADH, nephrotoxicity, hepatotoxicity, 2D6 interactions including those with Tamoxifen, neurotoxicity, prolonged QTc interval and Torsades de pointes, tardive dyskinesia vs EPS vs akathisia, vs an acute dystonic reaction such as laryngomalacia, and metabolic syndrome--DM2, HTN, and hyperlipidemia which most of our medications increase the risk for). Without the adequate knowledge--one cannot claim to have collected informed consent.
There are only shortcuts to acting like a physician. Americans, including those in CT, deserve real physicians, not those acting the part. In fact, psychologists are critical as members of mental health teams given the expertise they bring in the therapeutic modalities. Our patients would benefit greatly by more access to such treatment options. Given the opioid crisis and its effects on the life expectancy, the last thing we should do is to hand therapists prescription pads.

Sincerely,
Torang “Torie” Shatzmiller Sepah, MD
Diplomate, American Board of Psychiatry & Neurology
Pasadena, CA

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