Insight Matters
Winter, 2002

Candidate for APA Representative: Jonathan E. Dunn, M.D.

Position statement
I would like to take this opportunity to thank the members of the Ohio Psychiatric Association for allowing me another opportunity to serve our association, this time as a representative to the Assembly of the APA.

The Assembly has a long tradition of being the source of important ideas that have had an impact beyond the field of psychiatry. As one of your representatives to the Assembly, I will do my best to continue this tradition. I hope to offer a thought provoking perspective to strengthen our field and continue our leadership tradition in medicine and beyond.

As an addiction psychiatrist, I am very familiar with denial. It has become clear to me that the denial of the effects of addiction extends beyond my patients, to policy makers and to our society as whole. For example, at a recent meeting of the Cleveland Psychiatric Society, the speaker- a cardiologist from MetroHealth Medical Center- Lee Biblo, M.D., told the Society that eliminating tobacco use would bring about a 30% reduction in heart disease! He added that heart disease costs are estimated at 100 billion dollars, yielding a 30 billion dollar cost generated by the tobacco companies!

Like many of us, I have talked repeatedly to state legislators and others about the need for parity for psychiatric disorders. Even friendly legislators express their fear that parity would result in cost increases that would cause some to lose their insurance coverage. We have shown repeatedly that insurance premium increases due to parity would be small. A study done under the auspices of the Ohio legislature showed parity would only result in an average increase of 1% to 1.5% in health insurance premiums in Ohio for plans affected by the legislation. Nevertheless, the increasing cost of medical care is constantly used as a rationale for denying parity to psychiatric patients.

We are all aware that companies in search of profits spend very large sums of money to convince individuals to use addicting substances. If you do not believe me, just watch Monday Night Football or pick up a newspaper or magazine. The result is untold suffering that creates substantial costs in medical care. The Biopsychosocial Model helps us understand the phenomenon. In this case, a social force, specifically, the drive for profits, is generating this cost in medical care. To coin a word and a term, these are PROFITOGENIC DISORDERS - disorders created or exacerbated by the search for profits. These companies help generate a demand for addictive substances that fuels the consumption of both legal and illegal addictive substances.

"Shoveling Up: The Impact of Substance Abuse on State Budgets," a report by The National Center on Addiction and Substance Abuse at Columbia University (www.casacolumbia.org) has demonstrated that the taxes paid by these companies do not cover the costs their search for profits create. For the state of Ohio, tobacco and alcohol tax revenue in 1998 totaled $401,742,000 or $35.87 per capita. State of Ohio spending related to the substance use disorders totaled $263.19 per capita in 1998. Therefore, the profits of the addiction companies are as fictional as those of Enron, since all the true costs are not included. We must hold policy makers responsible. Either they need to do something about what is essentially a subsidy to these companies that create the profitogenic disorders or they cease to complain about the cost of medical care and fully fund health care for all. The profitogenic disorders divert resources that are desperately needed to treat other medical/psychiatric disorders. Of course, as noted above, the profitogenic disorders extend beyond psychiatric illnesses to heart disease, lung cancer, and even diabetes. Clearly, the profitogenic disorders represent a true plague of the 21 first century. In my opinion, expanding Biopsychosocial Model to include profitogenic disorders offers psychiatry an opportunity to play a leadership role in medicine and national policy. There will be a strong reaction from the PRO-ADDICTION COALITION who will fight to defend their profiteering ways. However, I believe that we can help our society overcome its denial as we continue to expose this festering wound to the light of day, clean it with antiseptic of clear discourse and treat this wound with the antibiotic of insight.

Editor's note: there is no opposing candidate

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