WEBVTT 00:00:00.000 --> 00:00:03.240 My father, he was a psychiatrist. He loved the 00:00:03.240 --> 00:00:06.519 field. When he was training in the 50s, it was 00:00:06.519 --> 00:00:09.480 a pretty different field in the sense that most 00:00:09.480 --> 00:00:11.480 of the training revolved around psychotherapy. 00:00:11.519 --> 00:00:14.900 When I started my newsletter, it was just a single 00:00:14.900 --> 00:00:18.559 newsletter, and I was doing literally all of 00:00:18.559 --> 00:00:21.500 the work from doing the initial graphic design 00:00:21.500 --> 00:00:24.960 of the logo to writing all the articles, editing 00:00:24.960 --> 00:00:27.899 the articles. Paxil was very new, and it was 00:00:27.899 --> 00:00:31.550 all about Use Paxil for your patients who are 00:00:31.550 --> 00:00:35.609 anxious and have insomnia. You recently launched 00:00:35.609 --> 00:00:40.289 an AI. clinical tool called Ask Carlette. Any 00:00:40.289 --> 00:00:43.429 information that you get from Ask Carlette AI 00:00:43.429 --> 00:00:45.649 is going to come directly from, you know, the 00:00:45.649 --> 00:00:49.429 23 years or so of hundreds and hundreds of articles 00:00:49.429 --> 00:00:52.210 and textbooks. Deprescribing is not something 00:00:52.210 --> 00:00:55.229 that's terribly new. It's been the idea that 00:00:55.229 --> 00:00:59.350 we over -medicate patients and that we end up 00:00:59.350 --> 00:01:02.409 chasing our tails with having a patient be on 00:01:02.829 --> 00:01:05.670 a med that causes a bunch of side effects. There's 00:01:05.670 --> 00:01:07.810 definitely something to be said for these new 00:01:07.810 --> 00:01:09.629 books that have come out and for us to really 00:01:09.629 --> 00:01:13.689 study deprescribing as its own discipline. Welcome 00:01:13.689 --> 00:01:16.849 to another episode of No Prior Off. This week, 00:01:16.890 --> 00:01:19.489 I'm sitting down with Dr. Daniel Carlatt. Dr. 00:01:19.650 --> 00:01:24.010 Carlatt is the founder of an industry -independent 00:01:24.010 --> 00:01:26.489 CME newsletter that a lot of you already read, 00:01:26.590 --> 00:01:29.510 The Carlatt Psychiatry Report. He wrote a New 00:01:29.510 --> 00:01:32.109 York Times magazine piece called Dr. Drug Rep 00:01:32.109 --> 00:01:34.810 about getting paid by Wyeth to promote Effexor 00:01:34.810 --> 00:01:37.049 and then walking away when the data didn't hold 00:01:37.049 --> 00:01:40.629 up. That article turned into a book called Unhinged, 00:01:40.629 --> 00:01:43.510 which argues that psychiatry traded the therapeutic 00:01:43.510 --> 00:01:46.849 relationship for 15 -minute med checks. His medication 00:01:46.849 --> 00:01:50.569 fact book is in its eighth edition. His podcast 00:01:50.569 --> 00:01:54.349 has over 564 episodes. This is someone who has 00:01:54.349 --> 00:01:57.370 spent two decades asking hard questions about 00:01:57.370 --> 00:01:59.670 how we train prescribers and how the pharmaceutical 00:01:59.670 --> 00:02:02.810 industry shapes what we prescribe. Let's get 00:02:02.810 --> 00:02:06.650 into it. Hi, Dr. Carlatt. Hey, Lindsay. How are 00:02:06.650 --> 00:02:09.750 you? Great to see you and talk to you. Good to 00:02:09.750 --> 00:02:12.030 see you, too. Thanks for being on. We've been 00:02:12.030 --> 00:02:13.969 working together a little bit and collaborating. 00:02:14.090 --> 00:02:16.990 It's been a lot of fun. It really has been. Yeah. 00:02:18.719 --> 00:02:21.939 Couldn't believe that it took me five years into 00:02:21.939 --> 00:02:25.099 my psych NP career to find your resources. That 00:02:25.099 --> 00:02:29.340 floored me. Although I will say I did have this 00:02:29.340 --> 00:02:31.740 book in school, but I didn't know about your 00:02:31.740 --> 00:02:35.719 medication fact book and all of your other resources 00:02:35.719 --> 00:02:38.599 until that long into my psych NP career. And 00:02:38.599 --> 00:02:41.340 I was like, man, I really could have used this 00:02:41.340 --> 00:02:44.840 in school. So I want more people to know about 00:02:44.840 --> 00:02:46.680 your resources. I'm very passionate about that. 00:02:47.050 --> 00:02:50.069 To kick off, I would love to ask you kind of 00:02:50.069 --> 00:02:53.569 what got you into the field of psychiatry to 00:02:53.569 --> 00:02:57.509 begin with. Yeah. So I am the son of a psychiatrist. 00:02:57.629 --> 00:03:03.750 My father, Paul Carlett, who continues at his 00:03:03.750 --> 00:03:10.110 age, he's now 95, and he just retired from his 00:03:10.110 --> 00:03:13.050 practice a few years ago. So he was going strong. 00:03:13.689 --> 00:03:15.610 And he's still going strong to the extent that 00:03:15.610 --> 00:03:18.949 he was just asking me if he could subscribe to 00:03:18.949 --> 00:03:21.810 the Carlet Geriatric Psychiatry Report, even 00:03:21.810 --> 00:03:23.909 though he's not practicing anymore. He gets a 00:03:23.909 --> 00:03:26.530 lifelong subscription, obviously. At any rate, 00:03:26.610 --> 00:03:29.610 he went to University of California, San Francisco, 00:03:29.909 --> 00:03:32.349 which is for medical school, which is where I 00:03:32.349 --> 00:03:35.629 ended up going as well. And he did his psychiatric 00:03:35.629 --> 00:03:39.789 residency at Langley Porter. So he was a psychiatrist. 00:03:39.969 --> 00:03:43.569 He loved the field. When he was doing it, when 00:03:43.569 --> 00:03:47.550 he was training in the 50s, it was a pretty different 00:03:47.550 --> 00:03:50.169 field in the sense that most of the training 00:03:50.169 --> 00:03:53.210 revolved around psychotherapy and psychodynamic 00:03:53.210 --> 00:03:56.349 therapy. And there were some medications out, 00:03:56.509 --> 00:03:59.849 but this was the age when the main medications 00:03:59.849 --> 00:04:01.909 that were used for depression were nipramine 00:04:01.909 --> 00:04:05.229 and the main medications for psychosis were thorazine 00:04:05.229 --> 00:04:07.639 and then a little bit later, Haldol. and there 00:04:07.639 --> 00:04:10.500 weren't too many other meds out there. So he 00:04:10.500 --> 00:04:15.199 always really knew the value of combining psychotherapy 00:04:15.199 --> 00:04:20.399 with medications. And as I grew, I went through 00:04:20.399 --> 00:04:23.600 high school and college, I became Just sort of 00:04:23.600 --> 00:04:26.779 naturally, I naturally gravitated toward psychology 00:04:26.779 --> 00:04:31.920 topics. This was all in San Francisco during 00:04:31.920 --> 00:04:33.959 the sort of tail end of the human potential movement. 00:04:34.079 --> 00:04:37.100 So I was also doing yoga and Zen Buddhism and 00:04:37.100 --> 00:04:40.339 like all the rest of my peer group. So, you know, 00:04:40.360 --> 00:04:43.459 interested in self -help and psych stuff. So 00:04:43.459 --> 00:04:48.060 I ended up going to college at UC Berkeley. and 00:04:48.060 --> 00:04:50.319 then was trying to decide what I wanted to do. 00:04:50.540 --> 00:04:53.040 Was I going to be a psychologist, like a PhD 00:04:53.040 --> 00:04:57.160 in clinical psychology, or a psychiatrist? At 00:04:57.160 --> 00:04:59.699 that point, my dad gave me some, in retrospect, 00:04:59.819 --> 00:05:02.899 pretty good advice, which is that while he worked 00:05:02.899 --> 00:05:05.839 a lot with clinical psychologists and found them 00:05:05.839 --> 00:05:08.480 to be extremely smart and extremely effective 00:05:08.480 --> 00:05:12.560 in their field, He noted that they were often 00:05:12.560 --> 00:05:15.720 frustrated because they were not able to use 00:05:15.720 --> 00:05:18.279 these very powerful tools, i .e. the medications 00:05:18.279 --> 00:05:22.199 that were so helpful when combined with therapy. 00:05:22.560 --> 00:05:24.779 So he didn't want me to go through that same 00:05:24.779 --> 00:05:28.959 level of frustration. And so I took his advice 00:05:28.959 --> 00:05:31.120 and applied to medical school and ended up going 00:05:31.120 --> 00:05:33.439 to medical school to become a psychiatrist. That's 00:05:33.439 --> 00:05:38.199 great. That's awesome. You live in Boston now, 00:05:38.319 --> 00:05:42.800 correct? Just north. Okay. And you have two adult 00:05:42.800 --> 00:05:45.920 children. I do. Is that right? Did either of 00:05:45.920 --> 00:05:49.399 your children ever consider going into the field 00:05:49.399 --> 00:05:52.399 of psychiatry? Not really, no. They followed 00:05:52.399 --> 00:05:57.300 different paths. So for whatever reason, they 00:05:57.300 --> 00:06:02.779 never really decided that the medical or the 00:06:02.779 --> 00:06:08.370 healing paths were for them. Okay. And you have 00:06:08.370 --> 00:06:11.689 a private practice where you live now? I did. 00:06:11.870 --> 00:06:16.550 And so, yeah, I mean, like a lot of psychiatrists 00:06:16.550 --> 00:06:18.610 and nurse practitioners, the trajectory of my 00:06:18.610 --> 00:06:21.930 career has really been variable. I mean, for 00:06:21.930 --> 00:06:24.189 many, many years, I did have a private practice, 00:06:24.269 --> 00:06:29.889 which was crucial for teaching me how to be a 00:06:29.889 --> 00:06:32.649 healer. Absolutely. You need to have some kind 00:06:32.649 --> 00:06:34.730 of outpatient practice at some point in your 00:06:34.730 --> 00:06:37.529 career. to really learn your craft, which I did 00:06:37.529 --> 00:06:40.529 right after residency. For many years, continued 00:06:40.529 --> 00:06:44.949 that as I also did some inpatient work and eventually 00:06:44.949 --> 00:06:48.470 got into the publishing work that I'm doing now. 00:06:48.569 --> 00:06:52.470 And then probably the last major clinical stage 00:06:52.470 --> 00:06:57.170 of my life was working as vice chair of the Department 00:06:57.170 --> 00:07:00.110 of Psychiatry at Tufts Medical School. where 00:07:00.110 --> 00:07:03.430 I sort of oversaw a lot of the community psychiatric 00:07:03.430 --> 00:07:07.250 work that Tufts does with various area hospitals. 00:07:07.569 --> 00:07:10.069 So I was essentially being medical director or 00:07:10.069 --> 00:07:12.750 chair of departments of psychiatric hospitals 00:07:12.750 --> 00:07:17.569 or of psychiatric emergency rooms of hospitals. 00:07:17.889 --> 00:07:20.970 And about two years ago, I retired from the clinical 00:07:20.970 --> 00:07:24.189 stuff so that I could dive more deeply into the 00:07:24.189 --> 00:07:27.329 publishing, the editing, and the writing. Yeah. 00:07:27.430 --> 00:07:31.089 Did you ever see... Carlap Publishing kind of 00:07:31.089 --> 00:07:35.430 becoming what it is today? No, I mean, I definitely 00:07:35.430 --> 00:07:39.290 had no idea that I would be continuing to work 00:07:39.290 --> 00:07:42.089 within it and to grow it. It's really, I founded 00:07:42.089 --> 00:07:47.050 it in 2003. It has grown little by little over 00:07:47.050 --> 00:07:51.449 that time. But, you know, from little acorns, 00:07:51.449 --> 00:07:53.610 mighty oaks grow, right? I mean, you just sort 00:07:53.610 --> 00:07:56.569 of have to stick with it. And when I started 00:07:57.100 --> 00:07:59.180 My newsletter, it was just a single newsletter, 00:07:59.319 --> 00:08:03.319 and I was doing literally all of the work from 00:08:03.319 --> 00:08:06.319 doing the initial graphic design of the logo 00:08:06.319 --> 00:08:09.860 to writing all the articles, editing the articles, 00:08:09.939 --> 00:08:13.519 doing the marketing, opening the checks when 00:08:13.519 --> 00:08:16.439 they finally started to come in. And it really 00:08:16.439 --> 00:08:20.620 took a long time for it to become successful 00:08:20.620 --> 00:08:23.540 enough where I could say, well, this is an actual 00:08:23.540 --> 00:08:26.189 business. that could actually sustain itself. 00:08:26.509 --> 00:08:29.149 And then eventually I hired some people. We're 00:08:29.149 --> 00:08:32.590 still small, but eventually I did hire some great, 00:08:32.629 --> 00:08:35.889 great employees, many of whom are still with 00:08:35.889 --> 00:08:38.769 me from some of the early days. It has grown, 00:08:38.889 --> 00:08:40.889 definitely grown more than I thought it would, 00:08:40.950 --> 00:08:44.370 but that's been a good thing. Yeah, yeah, that's 00:08:44.370 --> 00:08:50.309 awesome. How has not working with pharma impacted 00:08:50.309 --> 00:08:55.220 your career, making that decision? Yeah, I mean, 00:08:55.220 --> 00:08:58.500 it was interesting when I was doing my residency. 00:08:58.500 --> 00:09:06.799 So I graduated from medical school in 91. I did 00:09:06.799 --> 00:09:10.059 an internship in San Francisco, a medical internship. 00:09:10.159 --> 00:09:13.419 And then I went to do my psychiatric residency 00:09:13.419 --> 00:09:16.879 for 92 to 95. And I was a mass general in Boston. 00:09:17.309 --> 00:09:20.509 So that was a time when the pharmaceutical industry 00:09:20.509 --> 00:09:23.889 and academia were very, very closely intertwined 00:09:23.889 --> 00:09:27.250 for better or worse. But it was certainly, if 00:09:27.250 --> 00:09:29.350 there's anybody listening to this podcast that 00:09:29.350 --> 00:09:32.350 is as old as I am and that can remember being 00:09:32.350 --> 00:09:35.429 in training back then, I think you'll be nodding 00:09:35.429 --> 00:09:38.690 your head with memories of how many drug reps 00:09:38.690 --> 00:09:42.990 there were in academic medical centers, how many 00:09:42.990 --> 00:09:46.940 lunches were being offered and sponsored by drug 00:09:46.940 --> 00:09:50.759 reps and how much the drug industry was really 00:09:50.759 --> 00:09:55.000 insinuating itself into the education. And I 00:09:55.000 --> 00:09:58.840 remember very clearly George the Paxil guy who 00:09:58.840 --> 00:10:01.779 would bring in bagels to the psych emergency 00:10:01.779 --> 00:10:05.039 room at Mass General. And we loved our morning 00:10:05.039 --> 00:10:07.100 bagels. He would provide us, you know, with the 00:10:07.100 --> 00:10:10.440 mugs and the pens and all that. And his educational 00:10:10.440 --> 00:10:13.700 pitch at that point, Paxil was very new and it 00:10:13.700 --> 00:10:17.090 was all about use Paxil for your patients who 00:10:17.090 --> 00:10:21.970 are anxious and have insomnia. But, of course, 00:10:22.049 --> 00:10:24.850 he didn't emphasize all of the many side effects 00:10:24.850 --> 00:10:28.710 of Paxil, such as sedation, which obviously does 00:10:28.710 --> 00:10:32.490 help insomnia, and sexual side effects, and subcognitive 00:10:32.490 --> 00:10:35.190 side effects, etc. So those were the kinds of 00:10:35.190 --> 00:10:38.450 things that we were sort of undergoing on a day 00:10:38.450 --> 00:10:41.429 -by -day basis during my training. And then there 00:10:41.429 --> 00:10:44.960 was more sort of drug company involvement. after 00:10:44.960 --> 00:10:48.860 training was over as well. Gotcha. Gotcha. What 00:10:48.860 --> 00:10:51.460 does your dad think of your career? I know you 00:10:51.460 --> 00:10:55.460 guys just recently attended APA together. Is 00:10:55.460 --> 00:10:59.240 that correct? Yeah. So I just got back from the 00:10:59.240 --> 00:11:02.679 APA meeting in San Francisco. My dad is no longer 00:11:02.679 --> 00:11:06.240 going to APA meetings. He still follows the field. 00:11:06.539 --> 00:11:10.240 The APA, the education that you can get from 00:11:10.830 --> 00:11:13.789 going to the meetings from just wandering through 00:11:13.789 --> 00:11:19.210 the exhibit hall is still something that i recommend 00:11:19.210 --> 00:11:22.610 everybody i i don't go to every meeting it's 00:11:22.610 --> 00:11:24.750 a little bit overwhelming not all the lectures 00:11:24.750 --> 00:11:28.350 are top -notch these are academics who haven't 00:11:28.350 --> 00:11:30.389 necessarily trained in how to give talks but 00:11:30.389 --> 00:11:32.110 they're very smart people they know their stuff 00:11:32.110 --> 00:11:38.029 yeah gotcha so When I look online to find any 00:11:38.029 --> 00:11:41.830 like video media of you, it's very hard to find 00:11:41.830 --> 00:11:45.370 any. Are you like a pretty private person? Are 00:11:45.370 --> 00:11:50.309 you introverted? Or did you do more of the public 00:11:50.309 --> 00:11:53.970 facing stuff at one point? Oh, yeah. I mean, 00:11:54.009 --> 00:11:56.970 you know, I think as I was coming up through 00:11:56.970 --> 00:12:01.610 media, it was all mainly print media and sort 00:12:01.610 --> 00:12:04.620 of. print in HTML that was then published online. 00:12:05.139 --> 00:12:09.500 So that's kind of how I cut my teeth journalistically. 00:12:09.779 --> 00:12:12.700 And then, yeah, multimedia came on the scene. 00:12:12.980 --> 00:12:15.419 We got to a point where you just had to have 00:12:15.419 --> 00:12:19.320 podcasts. You had to have webinars to stay relevant. 00:12:19.559 --> 00:12:21.899 And I never really got into it. Personally, I 00:12:21.899 --> 00:12:23.960 am generally an introvert and I am generally 00:12:23.960 --> 00:12:28.840 a private. person. So I'm sure if I were a gregarious 00:12:28.840 --> 00:12:30.580 extrovert, I probably would be doing a lot more 00:12:30.580 --> 00:12:34.200 multimedia than I am now. Yeah, that makes sense. 00:12:34.480 --> 00:12:36.919 I am too, actually, which is kind of funny that 00:12:36.919 --> 00:12:39.639 I have a podcast and whatnot, but I am pretty 00:12:39.639 --> 00:12:43.460 introverted myself, so I can relate. Do you think 00:12:43.460 --> 00:12:49.440 that you will retire at some point, or do you 00:12:49.440 --> 00:12:52.480 think that this is something that you just love? 00:12:53.159 --> 00:12:55.139 want to continue doing for as long as possible? 00:12:55.320 --> 00:12:57.500 I'm sure I'll retire at some point, but I have 00:12:57.500 --> 00:13:01.960 no plans. It is something that I love. Not every 00:13:01.960 --> 00:13:08.179 single aspect of it. So as the president CEO 00:13:08.179 --> 00:13:12.740 of the company, I have about seven regular payroll 00:13:12.740 --> 00:13:17.600 employees. And then I work with probably at least 00:13:17.600 --> 00:13:20.419 50 contractors who do different things for the 00:13:20.419 --> 00:13:25.019 publication. So The aspect of having to manage 00:13:25.019 --> 00:13:29.480 and oversee all of that complexity is not my 00:13:29.480 --> 00:13:32.159 favorite thing. But luckily, I have a great COO, 00:13:32.240 --> 00:13:35.320 Jeff, who I know you've met, who keeps things 00:13:35.320 --> 00:13:37.480 running on a day -to -day basis so I don't have 00:13:37.480 --> 00:13:41.019 to do all that stuff. What really gets me up 00:13:41.019 --> 00:13:43.379 in the morning and gets me revved up is project 00:13:43.379 --> 00:13:47.220 work. So I love coming up with a new product, 00:13:47.519 --> 00:13:52.409 a new project. whether it's helping you with 00:13:52.409 --> 00:13:56.169 your work with your boot camp and with nurse 00:13:56.169 --> 00:13:59.450 practitioners or meeting somebody on LinkedIn 00:13:59.450 --> 00:14:03.490 and coming up with a new book project and helping 00:14:03.490 --> 00:14:06.070 them to develop it and helping to do sort of 00:14:06.070 --> 00:14:09.649 high -level developmental editing, or now with 00:14:09.649 --> 00:14:12.649 AI overtaking everything, trying to figure out 00:14:12.649 --> 00:14:16.649 how to bring AI into our... publication so that 00:14:16.649 --> 00:14:20.149 we can more efficiently provide some great, great 00:14:20.149 --> 00:14:23.149 education for people. Absolutely. Speaking of 00:14:23.149 --> 00:14:27.830 AI, you recently launched an AI clinical tool 00:14:27.830 --> 00:14:31.129 called Ask Carlette. Can you tell us a little 00:14:31.129 --> 00:14:34.470 bit about what it does, what it's not allowed 00:14:34.470 --> 00:14:37.009 to do? Just tell us a little bit more about it. 00:14:37.509 --> 00:14:44.139 Yeah, yeah. So Ask Carlette AI is sort of a large 00:14:44.139 --> 00:14:49.419 language model type of AI tool. And, you know, 00:14:49.480 --> 00:14:52.460 I think we're all pretty familiar these days 00:14:52.460 --> 00:14:55.820 with what LLMs are, but basically they're, you 00:14:55.820 --> 00:14:58.139 know, filled in the blank, very elaborate, filled 00:14:58.139 --> 00:15:01.019 in the blank kind of tools that are trained on 00:15:01.019 --> 00:15:04.600 lots and lots of articles where the software 00:15:04.600 --> 00:15:07.759 program reads the articles and then learns how 00:15:07.759 --> 00:15:12.289 to answer questions based on that content. It 00:15:12.289 --> 00:15:14.570 has no native intelligence, but it's basically 00:15:14.570 --> 00:15:19.070 just learning in a very complicated way how to 00:15:19.070 --> 00:15:22.309 move from the first part of a paragraph to the 00:15:22.309 --> 00:15:24.110 next, to answering it with the next part of the 00:15:24.110 --> 00:15:27.470 paragraph. So I think the difference with the 00:15:27.470 --> 00:15:30.789 LLM that we have in Carlat Publishing is that 00:15:30.789 --> 00:15:35.230 it's not affiliated with any of the large frontier 00:15:35.230 --> 00:15:41.799 LLMs, such as Anthropics Cloud or OpenAI's ChachiPT 00:15:41.799 --> 00:15:45.980 or Gemini, et cetera. So it has its own sort 00:15:45.980 --> 00:15:48.220 of very limited universe. It's not going to go 00:15:48.220 --> 00:15:51.600 outside of Carlet. So any information that you 00:15:51.600 --> 00:15:54.539 get from Ask Carlet AI is going to come directly 00:15:54.539 --> 00:15:58.940 from, you know, the 23 years or so of hundreds 00:15:58.940 --> 00:16:02.779 and hundreds of articles and textbooks and material 00:16:02.779 --> 00:16:05.740 from our webinars and from podcasts even that 00:16:05.740 --> 00:16:09.259 we published. So it's, yeah, it's a work in progress. 00:16:10.240 --> 00:16:12.820 And, you know, in some ways we felt like we had 00:16:12.820 --> 00:16:15.899 to put out an AI, I mean, a chatbot. I mean, 00:16:15.940 --> 00:16:20.179 kind of many, many publishers are feeling the 00:16:20.179 --> 00:16:24.340 need to do that because our audience is assuming 00:16:24.340 --> 00:16:28.500 now and expecting that most publishers are going 00:16:28.500 --> 00:16:31.360 to have some sort of a chatbot to help them better 00:16:31.360 --> 00:16:33.200 consume the information or more efficiently. 00:16:34.080 --> 00:16:38.690 Yeah. Yeah, I think it's great because so many 00:16:38.690 --> 00:16:41.509 of the practitioners I talk to are using open 00:16:41.509 --> 00:16:46.250 evidence or some type of AI. And so to know that 00:16:46.250 --> 00:16:49.730 there's a non -biased resource out there, too. 00:16:51.240 --> 00:16:53.899 playing around with it and i really love the 00:16:53.899 --> 00:16:57.399 answers how in -depth they are and just kind 00:16:57.399 --> 00:17:00.200 of i mean it's in line with your what you teach 00:17:00.200 --> 00:17:03.159 clinically and it makes sense and it's digestible 00:17:03.159 --> 00:17:08.079 and kind of easy to apply so i think nurse practitioners 00:17:08.079 --> 00:17:10.259 especially are going to be really excited about 00:17:10.259 --> 00:17:13.160 this tool in clinical practice that's great and 00:17:13.160 --> 00:17:18.140 i hope you and any of the mps that test it will 00:17:18.140 --> 00:17:22.119 let us know when they ask an answer that should 00:17:22.119 --> 00:17:24.480 they ask a question that should provide an answer 00:17:24.480 --> 00:17:26.099 but it's not providing the right answer because 00:17:26.099 --> 00:17:28.640 we're we're constantly tweaking it and refining 00:17:28.640 --> 00:17:32.940 it yeah that's great yeah um i remember you know 00:17:32.940 --> 00:17:37.779 the the nei prescribe app was kind of like my 00:17:37.779 --> 00:17:41.599 go -to as a new grad as far as a resource that 00:17:41.599 --> 00:17:44.400 i could have pulled up that i could easily get 00:17:44.400 --> 00:17:48.670 to information on a medication you know while 00:17:48.670 --> 00:17:50.970 I'm with clients sometimes even so I think just 00:17:50.970 --> 00:17:53.309 having an accessible resource like that that 00:17:53.309 --> 00:17:57.089 has access to all of your clinical information 00:17:57.089 --> 00:18:00.250 that you've put out there is going to be really 00:18:00.250 --> 00:18:04.369 really incredible so yeah you guys should you 00:18:04.369 --> 00:18:06.750 guys should try it out if you have not already 00:18:06.750 --> 00:18:09.650 what do you have in the works right now as far 00:18:09.650 --> 00:18:14.480 as like upcoming projects anything that you're 00:18:14.480 --> 00:18:18.480 excited about that you could share with us? Absolutely, 00:18:18.839 --> 00:18:22.059 absolutely. And some of it I've shared already 00:18:22.059 --> 00:18:25.180 on LinkedIn posts. So, you know, there's nothing 00:18:25.180 --> 00:18:31.619 secretive. I think we have four or five books 00:18:31.619 --> 00:18:35.779 in various stages of production currently, all 00:18:35.779 --> 00:18:39.500 of which are going to be published sometime in 00:18:39.500 --> 00:18:42.500 the fall, this fall timeframe, around October, 00:18:42.599 --> 00:18:45.740 November, December. Probably of most interest 00:18:45.740 --> 00:18:50.220 to your listeners would be, number one, a book, 00:18:50.279 --> 00:18:53.799 a fact sheet on alternative, complementary and 00:18:53.799 --> 00:18:57.500 alternative and lifestyle remedies in psychiatry, 00:18:57.519 --> 00:19:01.880 whether that's the Mediterranean diet, exercise, 00:19:02.420 --> 00:19:07.480 saffron for anxiety and depression, various other 00:19:07.480 --> 00:19:10.539 herbal remedies. And Chris Aiken. who a lot of 00:19:10.539 --> 00:19:12.240 people know from the Carlyle Psychiatry Podcast, 00:19:12.700 --> 00:19:15.240 is the author of that. He's had a long interest 00:19:15.240 --> 00:19:20.160 in complementary and alternatives, mainly clinically, 00:19:20.319 --> 00:19:22.660 because his patients have always wanted to learn 00:19:22.660 --> 00:19:24.539 more about them, and he realized there just weren't 00:19:24.539 --> 00:19:27.380 that many good resources. That's coming out soon. 00:19:28.000 --> 00:19:31.980 And then we have a book that is going to be called 00:19:31.980 --> 00:19:34.759 The 20 -Minute Therapist, which is actually written 00:19:34.759 --> 00:19:37.980 by a doctoral -level NP, Deb Granik, who I think 00:19:37.980 --> 00:19:42.029 you may know. who is really has developed a great 00:19:42.029 --> 00:19:46.869 way of teaching us all who are doing, you know, 00:19:46.869 --> 00:19:49.130 30, many of us are doing sort of like 30 minute 00:19:49.130 --> 00:19:52.049 medication visits and finding that, you know, 00:19:52.049 --> 00:19:54.349 it really often only takes five or 10 minutes 00:19:54.349 --> 00:19:57.549 to do the medication piece and that you have 00:19:57.549 --> 00:20:00.829 a good chunk of time, 20 minutes potentially 00:20:00.829 --> 00:20:04.670 left over to do therapy. And so she's developed 00:20:04.670 --> 00:20:08.660 a framework for figuring out what modalities 00:20:08.660 --> 00:20:12.759 to use for patients and which patients to use 00:20:12.759 --> 00:20:16.240 them for. So those are, I think those are two 00:20:16.240 --> 00:20:19.039 kinds of books that would have really helped 00:20:19.039 --> 00:20:20.839 me if I had had them earlier in my training. 00:20:20.960 --> 00:20:23.819 And so I'm excited about those. Yeah, I'm really 00:20:23.819 --> 00:20:27.059 excited about both of those because I'm constantly 00:20:27.059 --> 00:20:30.400 referencing Chris Aiken's website where he has 00:20:30.400 --> 00:20:33.240 just a lot of great information on supplements. 00:20:33.339 --> 00:20:35.900 I've even shared it with patients. And then, 00:20:35.900 --> 00:20:39.720 yeah, Deb Granik's content, when I found her 00:20:39.720 --> 00:20:43.059 stuff, I was like, man, I wish I could have heard 00:20:43.059 --> 00:20:45.640 this masterclass while I was in school. Like 00:20:45.640 --> 00:20:48.000 this would have helped me to make so much more 00:20:48.000 --> 00:20:52.259 sense of the brief psychotherapy aspect of being 00:20:52.259 --> 00:20:56.140 a psych NP. Yeah. And I think I'm not as familiar, 00:20:56.279 --> 00:21:00.599 obviously, with the current training that psych 00:21:00.599 --> 00:21:03.380 NPs are getting. But my impression is that there's 00:21:03.380 --> 00:21:06.460 a lot of concentration on diagnostic techniques 00:21:06.460 --> 00:21:10.960 and medication techniques in a typical master's 00:21:10.960 --> 00:21:14.000 program. But by virtue of the limited amount 00:21:14.000 --> 00:21:17.140 of time, there just isn't necessarily that much 00:21:17.140 --> 00:21:19.940 on all of the different psychotherapy modalities. 00:21:20.059 --> 00:21:22.230 So that's the thing that I think that a lot of 00:21:22.230 --> 00:21:25.829 MPs will find helpful. Not as the only way to 00:21:25.829 --> 00:21:27.289 learn therapy because the only way to really 00:21:27.289 --> 00:21:29.349 learn it is by doing it over and over again, 00:21:29.430 --> 00:21:32.529 but at least to have that mental framework for 00:21:32.529 --> 00:21:35.829 understanding the techniques. Right. Yeah, no, 00:21:35.890 --> 00:21:39.650 100%. Was this kind of the first book that kind 00:21:39.650 --> 00:21:43.849 of took off as far as like people adopting it 00:21:43.849 --> 00:21:49.069 and using it in residencies? Yeah, yeah. The 00:21:49.069 --> 00:21:51.829 psychiatric interview book, that was something 00:21:51.829 --> 00:21:56.490 that I developed when I was in residency at MS 00:21:56.490 --> 00:22:00.529 General. During our last year of residency, during 00:22:00.529 --> 00:22:03.230 the chief residency year, I was the chief resident 00:22:03.230 --> 00:22:06.529 of the inpatient unit, which is in the Blake 00:22:06.529 --> 00:22:08.190 building. It used to be in the Bullfinch building. 00:22:08.329 --> 00:22:11.210 Blake 11. So I was in charge of teaching the 00:22:11.210 --> 00:22:14.069 residents who were rotating through that. So 00:22:14.069 --> 00:22:18.009 I had gotten to become friends with Sean Shea, 00:22:18.130 --> 00:22:21.150 who some of you may have read some of his books, 00:22:21.190 --> 00:22:22.950 but he has a wonderful book on the psychiatric 00:22:22.950 --> 00:22:27.089 interview and on another book on the assessment 00:22:27.089 --> 00:22:30.630 of suicidal ideation. Really charismatic lecturer, 00:22:30.750 --> 00:22:33.829 great, great human being, and elegant writer 00:22:33.829 --> 00:22:37.750 too. You read his books and you can't believe 00:22:37.750 --> 00:22:39.990 you're reading a textbook because it's just, 00:22:40.069 --> 00:22:43.039 you really want to finish it. He became my mentor 00:22:43.039 --> 00:22:45.460 with the psychiatric interview, and I decided 00:22:45.460 --> 00:22:49.119 to use some of his ideas to write what I thought 00:22:49.119 --> 00:22:51.140 would be a somewhat more accessible version, 00:22:51.240 --> 00:22:55.740 which was a very small sort of a handbook. And 00:22:55.740 --> 00:22:58.400 that's how I developed it during my last year 00:22:58.400 --> 00:23:01.779 of residency. And then soon after that, I began 00:23:01.779 --> 00:23:04.759 to turn it into a book, and eventually it was 00:23:04.759 --> 00:23:08.089 published. Gotcha. Gotcha. Gotcha. Yeah, I do 00:23:08.089 --> 00:23:10.210 think that that is something that sets your resources 00:23:10.210 --> 00:23:15.410 apart is what a great writer you are. Like this, 00:23:15.450 --> 00:23:17.430 this book, for instance, look at all the stickies. 00:23:17.430 --> 00:23:19.769 I have stickies like that and all of your resources. 00:23:19.869 --> 00:23:22.710 It's kind of funny, but it's because so much 00:23:22.710 --> 00:23:25.390 of it is stuff that we can actually use in clinical 00:23:25.390 --> 00:23:28.930 practice, which is really. Nice. You know, there 00:23:28.930 --> 00:23:30.990 are some books I have a hard time getting through, 00:23:31.049 --> 00:23:34.569 academic books, like the deprescribing guidelines 00:23:34.569 --> 00:23:37.009 is one of those that I'm trying to get through 00:23:37.009 --> 00:23:39.329 right now. But I just I love how accessible you 00:23:39.329 --> 00:23:42.569 make it. What do you think about deprescribing 00:23:42.569 --> 00:23:46.750 and kind of everything going on in that realm? 00:23:47.069 --> 00:23:50.950 Also, have you read this book? No, I haven't. 00:23:50.950 --> 00:23:52.369 I've heard of it, though. Yeah, I've Stahl's 00:23:52.369 --> 00:23:56.740 Deprescribing Guide. Yeah, there's the Bonsley 00:23:56.740 --> 00:23:58.339 Deep Prescribing Guide. There's the Stahl Deep 00:23:58.339 --> 00:24:00.779 Prescribing Guide. And then there was recently 00:24:00.779 --> 00:24:04.339 a large article that came out in one of the major 00:24:04.339 --> 00:24:08.619 psych journals from a group of mostly American 00:24:08.619 --> 00:24:11.599 academics on deep prescribing. And then, of course, 00:24:11.660 --> 00:24:15.500 there was RFK Jr.'s announcement that, you know, 00:24:15.500 --> 00:24:18.059 at a national level, there would be more resources 00:24:18.059 --> 00:24:21.980 put into helping patients to come off of medications. 00:24:22.779 --> 00:24:26.079 which was controversial mostly because I think 00:24:26.079 --> 00:24:28.839 a lot of people interpreted what he was saying 00:24:28.839 --> 00:24:33.160 as encouraging people just to come off antidepressants, 00:24:33.160 --> 00:24:36.380 which I don't know what was on his mind when 00:24:36.380 --> 00:24:38.279 he was talking about that. But I think ultimately 00:24:38.279 --> 00:24:40.339 that initiative will be a good thing because 00:24:40.339 --> 00:24:43.640 it will put more more resources and more awareness 00:24:43.640 --> 00:24:46.859 into psych treatment and into alternatives to 00:24:46.859 --> 00:24:50.599 medications. But generally, deprescribing is 00:24:50.599 --> 00:24:53.079 not something that's terribly new. It's been 00:24:53.079 --> 00:24:57.359 the idea that we over -medicate patients and 00:24:57.359 --> 00:25:01.380 that we end up chasing our tails with having 00:25:01.380 --> 00:25:04.960 a patient be on a med that causes a bunch of 00:25:04.960 --> 00:25:07.299 side effects, and then we're following that up 00:25:07.299 --> 00:25:09.720 with other medications sometimes to treat the 00:25:09.720 --> 00:25:12.880 side effects. or sometimes just to add additional 00:25:12.880 --> 00:25:15.279 augmenting agents to treat the underlying symptoms. 00:25:15.579 --> 00:25:18.759 I mean, these are the tools that we have had 00:25:18.759 --> 00:25:23.160 mostly, and we may have overused them. So I think 00:25:23.160 --> 00:25:25.799 there's definitely something to be said for these 00:25:25.799 --> 00:25:28.480 new books that have come out and for us to really 00:25:28.480 --> 00:25:31.259 study deprescribing as its own discipline. Yeah, 00:25:31.279 --> 00:25:34.240 absolutely. I know one of your most recent... 00:25:35.759 --> 00:25:37.559 addressed deprescribing to and had some really 00:25:37.559 --> 00:25:41.000 great information. But it would be really cool 00:25:41.000 --> 00:25:44.380 to have a deprescribing book from you, like one 00:25:44.380 --> 00:25:47.700 of these small little, you know. So just throwing 00:25:47.700 --> 00:25:49.839 that out there in case you're ever inspired for 00:25:49.839 --> 00:25:51.700 a new project. I know you need more projects. 00:25:52.000 --> 00:25:54.559 Sounds like a great one. You've been a long time 00:25:54.559 --> 00:25:59.579 supporter of psych NPs. And I think that's one 00:25:59.579 --> 00:26:03.319 of the things that we. really appreciate that 00:26:03.319 --> 00:26:07.380 you've supported psych NPs kind of from the beginning. 00:26:07.619 --> 00:26:10.740 It's felt authentic. What kind of, because I 00:26:10.740 --> 00:26:13.240 feel like not all psychiatrists have that mindset. 00:26:13.940 --> 00:26:18.559 So what, how did that kind of, I don't know, 00:26:18.579 --> 00:26:22.039 support or approach come about for you? Yeah. 00:26:22.299 --> 00:26:26.740 I mean, I think it really came about as I was 00:26:26.740 --> 00:26:31.380 doing a lot of my inpatient work because I mean, 00:26:31.420 --> 00:26:34.500 I know there's a lot of pathways now to become 00:26:34.500 --> 00:26:38.000 a psych NP, but the traditional pathway, at least 00:26:38.000 --> 00:26:40.680 in the past, was that you would first be an RN, 00:26:40.859 --> 00:26:46.220 and you might then log some years under your 00:26:46.220 --> 00:26:48.259 belt. Maybe some of those years would be in a 00:26:48.259 --> 00:26:50.640 psych hospital where you'd get a lot of experience 00:26:50.640 --> 00:26:53.140 working with psych patients, and then you would 00:26:53.140 --> 00:26:55.940 move on to getting a master's and do some clinical 00:26:55.940 --> 00:26:58.720 hours and supervision hours and then become an 00:26:58.720 --> 00:27:03.640 independent psych NP. It was always apparent 00:27:03.640 --> 00:27:08.400 to me that the engines of treatment in inpatient 00:27:08.400 --> 00:27:10.380 units were the RNs, and they were the ones that 00:27:10.380 --> 00:27:14.259 were really front and center dealing with the 00:27:14.259 --> 00:27:18.240 psychosis, the agitation, all the things that 00:27:18.240 --> 00:27:22.740 are really difficult but are really the symptoms. 00:27:23.549 --> 00:27:26.089 that we need to be treating and we need to be 00:27:26.089 --> 00:27:30.170 able to feel comfortable diagnosing. And we have 00:27:30.170 --> 00:27:32.829 to be comfortable being with these people who 00:27:32.829 --> 00:27:35.170 are hard to be with sometimes. So, you know, 00:27:35.170 --> 00:27:37.690 the nurses were the ones who were doing it. I 00:27:37.690 --> 00:27:39.630 was always learning from the nurses I was working 00:27:39.630 --> 00:27:43.410 with. And then over the years, I think really 00:27:43.410 --> 00:27:49.250 from maybe 2010 on is really when the field of 00:27:49.250 --> 00:27:52.680 psych MPs really exploded. And we had... I think 00:27:52.680 --> 00:27:56.180 we went from about 10 % of prescribers being 00:27:56.180 --> 00:28:00.180 psych MPs in 2010 to about 30 % in 2020 is the 00:28:00.180 --> 00:28:04.019 latest research that I've seen. You may have 00:28:04.019 --> 00:28:07.279 more of those figures at your fingertips. So 00:28:07.279 --> 00:28:10.900 there's been a lot more. And as I was doing my 00:28:10.900 --> 00:28:13.559 work at Tufts, by far the majority of people 00:28:13.559 --> 00:28:17.119 that I was hiring were psych MPs, in part because... 00:28:17.559 --> 00:28:20.180 It has been very difficult to recruit psychiatrists 00:28:20.180 --> 00:28:22.980 for roles because there's a shortage, and in 00:28:22.980 --> 00:28:27.960 part because the psych NPs just have the experience 00:28:27.960 --> 00:28:32.539 built from their prior roles, sometimes as RNs, 00:28:32.539 --> 00:28:34.559 and they have that sort of natural compassion 00:28:34.559 --> 00:28:36.819 that serves them very well when they're working 00:28:36.819 --> 00:28:40.400 with psych patients. Yeah, absolutely. What do 00:28:40.400 --> 00:28:44.940 you think needs to change about psych NP education? 00:28:45.720 --> 00:28:48.160 There has to just be more of it. Your boot camp 00:28:48.160 --> 00:28:50.779 is great. I mean, the thing that most people 00:28:50.779 --> 00:28:54.819 say about psych MP education is that, you know, 00:28:54.839 --> 00:29:00.920 you graduate from psych MP school and you do 00:29:00.920 --> 00:29:03.740 not do a residency. Whereas when you graduate 00:29:03.740 --> 00:29:07.779 from medical school as a physician, you then 00:29:07.779 --> 00:29:10.359 do four years of structured residency training 00:29:10.359 --> 00:29:15.339 in your field. And typically, The quote residency 00:29:15.339 --> 00:29:18.380 training is the first job that you get as an 00:29:18.380 --> 00:29:23.200 NP. And so what a lot of people are trying to 00:29:23.200 --> 00:29:27.480 do is to create fellowships and residencies that 00:29:27.480 --> 00:29:30.500 may not be four years, but even if you had a 00:29:30.500 --> 00:29:35.099 six -month or a 12 -month residency slash fellowship, 00:29:35.319 --> 00:29:40.279 that could be tacked on to your first job. I 00:29:40.279 --> 00:29:42.240 think that would make a huge difference or even 00:29:42.240 --> 00:29:44.720 more than one year, you know, maybe one year 00:29:44.720 --> 00:29:48.420 of more intensive education and then maybe another 00:29:48.420 --> 00:29:51.500 year of sort of gradually tapering less intensive 00:29:51.500 --> 00:29:56.960 education. Yeah. Okay. Good to know. Where should 00:29:56.960 --> 00:30:00.099 people who want to follow your work and what 00:30:00.099 --> 00:30:03.980 you're doing, where should we send them to kind 00:30:03.980 --> 00:30:06.279 of follow along with all these new exciting projects 00:30:06.279 --> 00:30:09.789 coming out? What's the best place, would you 00:30:09.789 --> 00:30:12.690 say? Yeah, the best place would just be to go 00:30:12.690 --> 00:30:16.609 to thecarlatreport .com and to just Google Carlat. 00:30:16.809 --> 00:30:21.730 And so from there, you can get to a number of 00:30:21.730 --> 00:30:26.210 both paid and free resources. And a lot of people 00:30:26.210 --> 00:30:29.890 I know have gotten aware of Carlat through Chris 00:30:29.890 --> 00:30:33.589 Aiken and Kelly Newsom's podcast, which is free 00:30:33.589 --> 00:30:37.799 to listen to and the way we monetize it. is, 00:30:37.799 --> 00:30:41.200 is to charge people for getting CME credit if 00:30:41.200 --> 00:30:44.740 they choose to. But that's, that's a great, that's 00:30:44.740 --> 00:30:47.420 a great way to get it introduced. And then, you 00:30:47.420 --> 00:30:49.480 know, on, on the website, we have a lot of sort 00:30:49.480 --> 00:30:53.359 of special offers and free materials that you 00:30:53.359 --> 00:30:56.339 can look at to get a feel for whether it's the 00:30:56.339 --> 00:30:59.259 right product for you. Okay, great. And you're 00:30:59.259 --> 00:31:00.880 on LinkedIn. You're pretty active on LinkedIn 00:31:00.880 --> 00:31:04.319 too. Yeah, I'm active on LinkedIn. So I post. 00:31:04.730 --> 00:31:07.670 sort of mini articles. Some of them are based 00:31:07.670 --> 00:31:09.789 on articles that are published in the newsletter 00:31:09.789 --> 00:31:12.990 or based on some chapters that are published 00:31:12.990 --> 00:31:15.390 in some of our books to whet people's appetite 00:31:15.390 --> 00:31:17.529 to kind of give them a sense of what's going 00:31:17.529 --> 00:31:20.829 on with us. That's great. Have you ever thought 00:31:20.829 --> 00:31:22.970 about starting a Substack? I just was curious 00:31:22.970 --> 00:31:26.410 because, you know, I see other psychiatrists, 00:31:26.410 --> 00:31:29.309 thought leaders on there, and I just was curious. 00:31:29.960 --> 00:31:32.319 I mean, I could. I've always thought that, you 00:31:32.319 --> 00:31:34.980 know, since we do publish newsletters, Substacks 00:31:34.980 --> 00:31:39.380 are essentially newsletters. Some of them are 00:31:39.380 --> 00:31:42.779 free and some of them people start charging for. 00:31:43.259 --> 00:31:46.059 It's not even that new anymore. But I think when 00:31:46.059 --> 00:31:47.940 I first heard about Substack, I thought, you 00:31:47.940 --> 00:31:50.720 know, those are basically newsletters and we 00:31:50.720 --> 00:31:52.420 already publish a bunch of newsletters. So why 00:31:52.420 --> 00:31:54.839 would we get involved in Substack? But maybe 00:31:54.839 --> 00:31:58.690 it's time. You tell me. Should we? I think so. 00:31:58.789 --> 00:32:01.970 I think, you know, I think it would be in line 00:32:01.970 --> 00:32:05.430 with just kind of giving people like a taste 00:32:05.430 --> 00:32:07.390 of your content. And then it's like, if you want 00:32:07.390 --> 00:32:10.869 more, this is where you can go to find it. You 00:32:10.869 --> 00:32:14.869 know, I know I've subscribed to like Dr. Nasir 00:32:14.869 --> 00:32:17.710 Ghami's sub stack and, you know, different thought 00:32:17.710 --> 00:32:20.849 leaders like that. And it's been, it's been helpful, 00:32:20.930 --> 00:32:23.809 you know, because I think, yeah, you're writing. 00:32:23.890 --> 00:32:27.089 It's just. it helps a lot of people. It's accessible. 00:32:27.329 --> 00:32:31.029 It makes sense. Again, one of the, I can't just 00:32:31.029 --> 00:32:33.430 read clinical textbooks typically, you know what 00:32:33.430 --> 00:32:36.049 I mean? But I can, I can read through a lot of 00:32:36.049 --> 00:32:39.450 your books and be like interested to your point, 00:32:39.509 --> 00:32:42.829 you know, Dr. Sean Shea's psychiatric interviewing. 00:32:42.890 --> 00:32:45.410 That was one of the first ones too, that I really 00:32:45.410 --> 00:32:50.069 like got a lot out of and was able to really 00:32:50.069 --> 00:32:53.170 engage with on a meaningful level. So I think 00:32:53.170 --> 00:32:57.400 it's really, Amazing how accessible you're making 00:32:57.400 --> 00:33:00.019 this information for us. So we are very appreciative. 00:33:00.299 --> 00:33:05.380 Anything else that you would tell psychiatric 00:33:05.380 --> 00:33:09.240 nurse practitioners graduating in 2026? Any words 00:33:09.240 --> 00:33:14.160 of advice? Yeah, I mean, one thing that was central 00:33:14.160 --> 00:33:17.819 to my early career was looking at the influence 00:33:17.819 --> 00:33:19.859 of the pharmaceutical industry on medical education. 00:33:20.140 --> 00:33:22.839 Because, you know, like I said earlier, it was 00:33:22.839 --> 00:33:25.849 such a big part of it. And what has happened 00:33:25.849 --> 00:33:29.329 over the last 10 years or so is because the Open 00:33:29.329 --> 00:33:31.529 Payments website, which provides transparency 00:33:31.529 --> 00:33:34.930 to all payments to doctors for marketing purposes, 00:33:35.289 --> 00:33:38.250 a lot of the drug companies have been going to 00:33:38.250 --> 00:33:40.869 nurse practitioners to give those marketing talks. 00:33:41.309 --> 00:33:44.450 And there are now a much higher percentage of 00:33:44.450 --> 00:33:46.390 nurse practitioners, psychiatric nurse practitioners 00:33:46.390 --> 00:33:49.319 giving. taking drug company money and giving 00:33:49.319 --> 00:33:53.000 marketing talks then for psychiatrists. And in 00:33:53.000 --> 00:33:56.559 part, that was because NPs were exempt from the 00:33:56.559 --> 00:33:59.759 open payments website for many years until 2021, 00:34:00.059 --> 00:34:03.400 when now they are reportable. Maybe you don't 00:34:03.400 --> 00:34:06.599 know that. A lot of people don't know that. Yeah. 00:34:06.819 --> 00:34:09.400 I would just, you know, if I were a nurse practitioner 00:34:09.400 --> 00:34:11.820 coming up, I know that I would be approached 00:34:11.820 --> 00:34:14.829 by a lot of drug company drug reps. Certainly, 00:34:14.909 --> 00:34:17.570 you know, asking them to take samples, but also 00:34:17.570 --> 00:34:21.329 asking them if they would like to give marketing 00:34:21.329 --> 00:34:23.289 talks for doctors or for nurse practitioners. 00:34:23.710 --> 00:34:26.570 My advice is just to think twice about doing 00:34:26.570 --> 00:34:29.289 that because it ends up being a very slippery 00:34:29.289 --> 00:34:32.210 road. At first, you think you're just getting 00:34:32.210 --> 00:34:34.530 some money to say things that you already believe, 00:34:34.750 --> 00:34:38.130 but it doesn't take too long for you to start 00:34:38.130 --> 00:34:40.960 to... change your opinions or to start editing 00:34:40.960 --> 00:34:43.800 the things that you say because you want to make 00:34:43.800 --> 00:34:46.719 sure those checks from the drug company keep 00:34:46.719 --> 00:34:49.300 rolling in. Think twice about being on a drug 00:34:49.300 --> 00:34:51.480 company payroll if you're treating patients. 00:34:51.840 --> 00:34:55.360 Yeah. Yeah. I'm in an integrative fellowship 00:34:55.360 --> 00:35:00.039 right now. And even navigating some of that has 00:35:00.039 --> 00:35:02.559 been tricky for me as far as like, you know, 00:35:02.599 --> 00:35:05.400 lithium orotate and some of the stuff that's 00:35:05.400 --> 00:35:08.510 recommended in there and wondering. What kind 00:35:08.510 --> 00:35:11.449 of influence big wellness could have on some 00:35:11.449 --> 00:35:13.210 of the things that were some of the interventions 00:35:13.210 --> 00:35:14.769 we're talking about when we're talking about 00:35:14.769 --> 00:35:17.150 integrative psych. And I like that I can kind 00:35:17.150 --> 00:35:22.269 of go back to your resources to really vet, you 00:35:22.269 --> 00:35:27.170 know, what has solid research behind it and trust 00:35:27.170 --> 00:35:30.530 that it's non -biased. It's important for us 00:35:30.530 --> 00:35:34.230 to keep it non -biased and to refuse pharmaceutical 00:35:34.230 --> 00:35:38.809 money just so that. our readers know that they 00:35:38.809 --> 00:35:41.590 can, they can trust what they're reading. Yeah. 00:35:42.590 --> 00:35:45.889 I had done a little bit of work with pharma right 00:35:45.889 --> 00:35:49.190 before I started collaborating with you more 00:35:49.190 --> 00:35:51.469 closely. And I think it was just kind of meant 00:35:51.469 --> 00:35:55.449 to be because I stepped away from that and it 00:35:55.449 --> 00:35:57.969 just feels much more aligned and it feels, it 00:35:57.969 --> 00:36:00.010 feels good that the content that we're creating 00:36:00.010 --> 00:36:03.510 in my programs is, is non -biased. So I'd like 00:36:03.510 --> 00:36:07.329 to, I'd like to keep it that way. Great. Yeah. 00:36:07.610 --> 00:36:10.750 Thank you so much for taking the time out of 00:36:10.750 --> 00:36:13.849 your busy schedule to be on the podcast. For 00:36:13.849 --> 00:36:19.210 the AI tool, Carlat AI, is there a free trial 00:36:19.210 --> 00:36:22.789 or is it just kind of a monthly subscription 00:36:22.789 --> 00:36:26.289 for people wanting to check that out? There are 00:36:26.289 --> 00:36:29.789 various offers that are going on. There is a 00:36:29.789 --> 00:36:32.030 kind of a free trial offer, I think, for people 00:36:32.030 --> 00:36:35.940 who have already purchased the toolkit. Uh, right. 00:36:36.059 --> 00:36:39.760 The toolkit being the, with a web app that gives 00:36:39.760 --> 00:36:42.760 you access to six of our textbooks and a bunch 00:36:42.760 --> 00:36:45.019 of what actually it's, but you're attacking AI 00:36:45.019 --> 00:36:47.099 onto that. There's some sort of trial going on 00:36:47.099 --> 00:36:51.760 now. Okay. Awesome. Yes. Perfect. All right. 00:36:51.760 --> 00:36:54.559 Well, we'd love to have you on again, maybe in 00:36:54.559 --> 00:36:57.559 six months to hear what you're up to and yeah, 00:36:57.599 --> 00:37:00.619 hear about. the two books too that you guys are 00:37:00.619 --> 00:37:03.880 going to be releasing. So thank you so much for 00:37:03.880 --> 00:37:06.659 being on. Oh, thank you so much, Lindsay.