Physician Delusions about Neurotoxicity

May 2nd, 2007

The NY Times printed my letter regarding their article concerning “Chemo Brain”. That article described how, until recently, many physicians disregarded the cognitive side effects of toxic chemicals used to treat cancer as being ‘illusions’ on the part of patients (particularly females).

Chemotherapy Fog Is No Longer Ignored as Illusion By Jane Gross (April 29, 2007)


Once, women complaining of a constellation of symptoms after undergoing chemotherapy — including short-term memory loss, an inability to concentrate, difficulty retrieving words, trouble with multitasking and an overarching sense that they had lost their mental edge — were often sent home with a patronizing “There, there.”

But attitudes are changing as a result of a flurry of research and new attention to the after-effects of life-saving treatment. There is now widespread acknowledgment that patients with cognitive symptoms are not imagining things, and a growing number of oncologists are rushing to offer remedies, including stimulants commonly used for attention-deficit disorder and acupuncture.

“Until recently, oncologists would discount it, trivialize it, make patients feel it was all in their heads,” said Dr. Daniel Silverman, a cancer researcher at the University of California, Los Angeles, who studies the cognitive side effects of chemotherapy. “Now there’s enough literature, even if it’s controversial, that not mentioning it as a possibility is either ignorant or an evasion of professional duty.”

My letter is directed at the use of ‘standby’ psychiatric labels to explain physicians’ lack of understanding about brain injury resulting from toxic treatments. Brain injury is not uncommon as a side effect of the neurotoxic effects of many types of chemicals:

To the Editor:

It is one thing for physicians to ignore unfamiliar symptom constellations. It is another to project a lack of information (the “illusions”) onto patients and to diagnose “delusions.”

The use of psychiatric labels as default diagnoses (somatization, anxiety) carries with it some unimaginable penalties. These include harmful medical interventions; social stigma and loss of familial support; reductions in medical insurance coverage; and inability to qualify for disability.

Such misdiagnoses are also a disservice to psychiatry, a branch of medicine in dire need of positive signs for diagnostic validity rather than reliance upon an absence of data.

The phrase “I don’t know” leads to research, which ultimately provides answers. It also does no harm to the patient. Hippocrates had the right idea.

Barbara Rubin

Categories: Letters, NY Times, Published

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  1. I agree

    I think the reason these fake diagnoses are ‘required’ is because of the health ‘insurance’ companies, who will not pay unless someone is given a label by the doctor.

    But then, unfortunately, the label is stored by the MIB medical insurance database, and that label can lead to someone not getting insurance in the future, or another job. Many otherwise progressive companies check prospective employees health status before hiring (or to be on the safe side, don’t hire older people – i.e. people over 35)

    This is why many people prefer to pay out of pocket rather than participate in a dysfunctional healthcare system that penalyzes them for participating.

    Which is of course what they want. None of the Democratic candidates has even begun to address any of these problems when they talk about healthcare. We are headed towards a real crisis, and nobody seems to care.

  2. agasaya

    I understand your frustration with insurance companies but no political candidate can alter the actions of professionals who don’t know their jobs. Physician invoices to insurers must contain a diagnostic category but the physician has an obligation to provide the CORRECT one. If unknown, many categories exist under symptoms observed. If memory problems are present, it isn’t hard to note that and then refer to a neurologist for assessement.
    An oncologist is also not a psychiatrist and should not be dispensing quick and easy names for patient symptoms under the heading of ‘anxiety’ etc.

    But then referring patients to other doctors may take up some of their time and the consultation may not be billable. Time is money unless you are a patient who is no longer employable. . .


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