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More Big Pharma Payola.
Posted: 10 November 2013 04:11 PM   [ Ignore ]   [ # 16 ]
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Vyazma you started the thread off with the title “More Big Pharma Payola” and then posted an article that describes a specific practice whereby doctors become consultants for or give talks for pharma exchange for monetary compensation. My position from the beginning has been that this represents a very small proportion of the medical community and I already have gone on record saying that physicians who do this should be forced to post signs in their office outlining the companies and drugs they have represented.

My experience is not as you claim only valid for me. I am a member of a large local medical community, dozens of whom i deal with every day. This may only represent a few hundred doctors but my experience is far more extensive than yours and far more than the author of the article you site so when I say that the claims in the article are the exception rather than the rule I stand on more solid ground than either you or the author.

My goal was not to defend myself. I have nothing to defend. My goal was to introduce a more accurate perspective into a sensationalized claim and thread posted by someone who appears ready to believe the worst of an entire group of professionals because it fits his world view.  A little confirmation bias goes a long way even around here it seems

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Posted: 11 November 2013 09:54 AM   [ Ignore ]   [ # 17 ]
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Yes Mac I get it.  I’m not really looking to make this a personal discussion.
Thanks for all of your helpful input.

What do you think the overall percentage is of doctors who are paid to lecture and the doctors who attend those lectures(like yourself)?
What percentage of doctors is that number?  Would you happen to know?
Because it’s not just about the doctors who get paid to lecture, it’s about all the doctors who attend those lectures.
After all, they are the target audience so to speak. 

It’s important to highlight all of the doctors taking part in the whole lecture process.  Not just the paid lecturers.
After all a Giant Pharmaceutical Co. isn’t paying some doctor hundreds of thousands of dollars to lecture to pigeons from a park bench…

Also I wonder about the amenities that are provided these doctors at the lectures.
Food, drinks…
You wouldn’t believe what you can accomplish with that old soft-shoe.  Suggestion rates go up noticeably.

I just have an intense interest to find out what is behind the massive increase in psychotropic drug treatments in the past decade.

I have another question.
Can any doctor prescribe those type meds? Or does the doctor have to be a psychiatrist?
Who can prescribe these anti-depressants. These anti-psychotics, the ADHD drugs, etc etc, the anxiety drugs?

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Posted: 11 November 2013 11:06 AM   [ Ignore ]   [ # 18 ]
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Obviously the total number of doctors who attend a lecture is much higher than the number who give lectures. Lectures come in many sizes from those given to hundreds of doctors ( usually these are at symposiums where pharma is not providing any food etc to the doctor) to smaller meeting hosting only a handful. I can’t really give you a good figure on where the mean is though except that my experience at the dozen or so I have gone to over the past 23 years is that most are attended by 10-20 doctors. That may simply be due to the fact that I don’t often travel to places where they would have large meetings.

While it would be naive to believe that people are not influenced at these meetings I think its a lot like any sort of marketing. Some people are heavily influenced, others mildly so and some not at all by the message. I tend to be an inherently skeptical and suspicious person ( hence my time here). I don’t trust a source unless I can verify it. Other people are more than happy to accept what they hear as gospel if it seems to be coming from a friendly somewhat reliable source.

Patients ( consumers) are equally if not more vulnerable to this sort of marketing. I am deluged daily with men asking about “Low-T” because they saw the ads on TV and are convinced this is their issue. Patients also ask almost exclusively for Viagra even though there are two other drugs that actually work better. Name recognition is everything in marketing and that’s the biggest reason pharm markets to patients and doctors because they know we are more likely to ask for or prescribe something that is familiar.

As far as the amenities, as I said earlier there are strict limits on how much can be spent to provide food at a meeting and to whom. Since the rules changed about 10 years ago doctors are not allowed to bring a spouse, family member, or any member of their office staff who is not a doctor. A meal can be provided but as I also mentioned it may be provided but that is where it ends. There was a time when the meeting could take place at a ball game or a show but that is no longer permitted and rightfully so. I just wish the people in washington who passed these rules applied the same rules to themselves.

Regarding your question about psychotropic drugs, This requires the longest answer and I will try to organize it as best I can.

First of all anyone who is an MD can prescribe these. Obviously you don’t want to limit this to psychiatrists since there are no where near enough psychiatrists as it currently stands to treat all of these people, and many patients who need help refuse go to one. The vast majority of meds that are used for these conditions are used to treat depression and anxiety which are not difficult conditions to recognize or treat in most cases. Due to the way our health care system has evolved, the way professionals are trained and the way reimbursements are designed psychiatrists (MD’s) rarely provide what you would think of as psychotherapy or talk therapy. They use meds as their primary tool. Psychologists ( PhD’s) do most of the psychotherapy and are not allowed to prescribe at all. Because their skills are so labor intensive ( an hour is an hour is an hour. You can;t work faster and squeeze more patients into an hour session), many psychologists do not accept insurance. Because of all these limitations the lions share of people with psychological disorders are diagnosed and treated by their primary care doctor. 99% of this is depression and anxiety though. Patients with bipolar disorder and schizophrenia would almost exclusively be treated by a psychiatrist.

Why is there such an increase in the number of people being treated? I hate to sound like a broken record but this is multifactorial answer. I’ll list as many as I can think of.

* Public acceptance - psych illness used to be kept in the closet. People suffered and wouldn’t go to the doctor or admit they had a problem because it as deeply stigmatized. That has changed a lot in recent years. We can all have misgivings about pharm marketing but one of the positive things that comes out of it is that it can also make something seem normal that was previously snickered about. Before Viagra came to market men almost never admitted to me that they had ED. now its common and no one seems embarrassed. I think the same is true for psych disorders.

* Public awareness - As the public becomes more aware of what to look for many people may be gong to the doctor for depression who previously thought they were just sad and had to suffer through this sadness. This has resulted in more legitimately ill people being treated but unfortunately has also led to a lot of people being treated with meds who might be able to work through their problems easily on their own.

*We have a tool we didnt have before -Obviously if you don’t have the tools to build a house not a lot of homes get built. If we don’t have meds to treat psych illness not a lot of people will be treated. Prior to the development of Prozac 20 years ago the only meds we had for depression and anxiety were less effective and had far more side effects and drug interactions. Prozac and the drugs that came after it changed that.

*There are few alternatives - psych illness is difficult to treat with non medical means Its time consuming, It requires the help of highly trained expensive professionals, and its inconsistent in its application and results. Primary care doctors are not trained to do psychotherapy nor do they have the time so they have few options when treating a desperately depressed or anxious patient then to offer them medication especially if availability to psychotherapists is limited.

*Marketing - both to patients and to doctors. No doubt this is playing a big role in both good and bad ways. Marketing affects usage because it influences the factors mentioned above. The more you hear about a treatment the more the doctor and the patient will become comfortable talking about the disease and accepting the medication as a solution. It also may lead to over usage if it becomes the cur all for every anxious or sad individual. If society is unwilling or unable to pay for other forms of treatment then we have no other option.

I think we all need to look at ourselves too. I find these days that an awful lot of people are unwilling to wait for things to get better on their own, whether its a cold, a back ache, or depression. A lot of people also have difficulty accepting the changes that come with age. When thats the case many people look for an easy answer and something that works quickly. The result is often a prescription.

From the viewpoint of the physician, time is money and non-med psych care takes a lot of time.  The invention of managed care 20 years ago forced physicians to find ways to see more patients in less time. If a patient comes in with a complaint of depression and I spend 15 minutes with him and write a prescription I may get paid $50. If I spend an hour talking to him about the problem I get paid $50 or maybe $65. When it costs nearly $170/hr just to pay the overhead to run the office you can see pretty quickly why physicians are under intense pressure to try and provide the best care they are able to in the least amount to time they can. If we aren;t trained to provide psychotherapy, are forced to treat most psych illnesses rather than refer them out, and aren’t given the opportunity to spend the time we would need with the patient the only option is often to use medication.

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Posted: 11 November 2013 12:05 PM   [ Ignore ]   [ # 19 ]
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Absolutely an A-One response. Very insightful.
To my untrained ears and eyes I find it fascinating that any doctor can prescribe these drugs.

And you made an excellent point regarding the necessity of this, and the more open attitudes regarding these issues.

However perhaps a point could be made that expediency of this kind could lead to a percentage of over diagnosis? Maybe?

And your point is well understood about the marketing being focused towards the patient too.

Which again has good and bad points. I would cite the 250% increase in women aged 20-44 who take these meds since 2001.
This illustrates the following paragraph…..

MacGeyver, as you have shown there are numerous factors contributing to the increase.
However special care must be given when analyzing statistical data which shows a huge 100%-250% increase over a decade.
This overwhelmingly points to some specific factor.  I’m not sure what that factor is-I’m guessing aggressive marketing through
all facets by Big Pharma.

And this takes us right back to the title of this thread, and the news article I cited.
I didn’t write that article, and obviously this type of corporate behavior is under heavy scrutiny by at least some concerned citizens.
So when you call this type of journalism “sensational” I get a little “perplexed”.  Maybe “vexed” too.

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Posted: 11 November 2013 12:26 PM   [ Ignore ]   [ # 20 ]
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VYAZMA - 11 November 2013 12:05 PM

However perhaps a point could be made that expediency of this kind could lead to a percentage of over diagnosis? Maybe?

 

Absolutely. I mentioned that above that people are being diagnosed with depression when they may have a much milder condition that would resolve spontaneously if left alone and given enough time. I think over diagnosis is a major part of the problem and driven by over confidence by the clinician as well as the doctors desire to get done with the visit quickly, and the patients desire for a quick solution to a relatively minor minor problem ( I’m not talking about major depression but minor symptoms that might not even qualify as depression according to the DSM)

VYAZMA - 11 November 2013 12:05 PM

MacGeyver, as you have shown there are numerous factors contributing to the increase.
However special care must be given when analyzing statistical data which shows a huge 100%-250% increase over a decade.
This overwhelmingly points to some specific factor.  I’m not sure what that factor is-I’m guessing aggressive marketing through
all facets by Big Pharma.

To me this only adds more support to the idea that many factors are involved. The more forces there are pushing usage in one direction the faster the increase would be. The hard thing is determining exactly how much of a role each factor plays.

VYAZMA - 11 November 2013 12:05 PM

And this takes us right back to the title of this thread, and the news article I cited.
I didn’t write that article, and obviously this type of corporate behavior is under heavy scrutiny by at least some concerned citizens.
So when you call this type of journalism “sensational” I get a little “perplexed”.  Maybe “vexed” too.

My problem with these articles is that they accidentally or intentionally provide no perspective. i suspect its intentional because sensationalized articles sell and there is lots of evidence that the media does this every day. The article talks about a couple hundred doctors who are doing this but doesn’t tell you how many are not and doesn’t even interview doctors who are not involved to assess the opinion of the general medical profession so a reader would understandably come away form such a story as you did with the idea that this is business as usual, most doctors do this stuff with a wink and a handshake, and we are all perfectly fine with it. I dont think thats even close to the truth. they took a small number of doctors and try to make it look like they are representative of the whole profession because it will raise ire and eyebrows among their readers if they present it that way. Thats what I mean by sensationalized.

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Posted: 11 November 2013 12:46 PM   [ Ignore ]   [ # 21 ]
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macgyver - 11 November 2013 12:26 PM

Vyazma-MacGeyver, as you have shown there are numerous factors contributing to the increase.
However special care must be given when analyzing statistical data which shows a huge 100%-250% increase over a decade.
This overwhelmingly points to some specific factor.  I’m not sure what that factor is-I’m guessing aggressive marketing through
all facets by Big Pharma.

To me this only adds more support to the idea that many factors are involved. The more forces there are pushing usage in one direction the faster the increase would be. The hard thing is determining exactly how much of a role each factor plays.

I don’t think so. Some of the other points you mentioned may not contribute as much as you would like to think.
If anything has caused this openess, the bombardment of TV ads has to be high up on the list.
Secondly, especially when a Family MD can prescribe these meds, I think that has the openess built right in.
It helps to remove any stigma the patient may feel versus going to a psychiatrist.
People have been asking their doctors for the meds they want for along time. Pre 2000 for example.
Valiums, Barbituates, Lithium, Amphetemines etc etc…It’s nothing new.
The only thing relatively new is the TV ads. And the increase in paid lectures by doctors. The amount of money that Pharma is spending on
marketing.  Perhaps due to a supposed dearth in new drugs which happened to correlate to this time frame.
Connected to this perhaps is that some sources point out that marketing takes up far more budget than does R&D in Big Pharma now.

 

MacGeyver-My problem with these articles is that they accidentally or intentionally provide no perspective. i suspect its intentional because sensationalized articles sell and there is lots of evidence that the media does this every day. The article talks about a couple hundred doctors who are doing this but doesn’t tell you how many are not and doesn’t even interview doctors who are not involved to assess the opinion of the general medical profession so a reader would understandably come away form such a story as you did with the idea that this is business as usual, most doctors do this stuff with a wink and a handshake, and we are all perfectly fine with it. I dont think thats even close to the truth. they took a small number of doctors and try to make it look like they are representative of the whole profession because it will raise ire and eyebrows among their readers if they present it that way. Thats what I mean by sensationalized.

It provides plenty of perspective.  When an article reports on anything else good or bad, it doesn’t list the percentage of people not engaging in that act. 
The perspective in this case is the money. That provides plenty of perspective.
And the article doesn’t even mention how many doctors attend these “lectures”.  Which I have pointed out already would be far more telling.
That would provide much more perspective.
Your just biased. The same way I would be biased if I saw an article that was written that made truck drivers look bad.  And there’s plenty of those believe me.

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Posted: 14 November 2013 10:07 PM   [ Ignore ]   [ # 22 ]
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I’d like to add to Mac’s response another reason. The crappy state of mental health insurance in the US. Even if you have medical coverage, you may not have coverage for mental health issues, or if it is, it can be pretty crappy. Even as a nurse, my insurance for any psych issues is pretty minimal. Luckily, I’ve never had to use it.

As far as going to conferences—just because we go to conferences (I try to go to at least one a year), I don’t buy everything they are selling hook line and sinker. There is a lot of stuff I think is just BS, and some things presented are just too new to know if they will pan out as a viable treatment. The conferences I attend are also attended by physicians in my field, and I know they feel the same way.

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Posted: 14 November 2013 10:53 PM   [ Ignore ]   [ # 23 ]
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asanta - 14 November 2013 10:07 PM

There is a lot of stuff I think is just BS, and some things presented are just too new to know if they will pan out as a viable treatment. The conferences I attend are also attended by physicians in my field, and I know they feel the same way.

What does poor health insurance have to do with this?
The amount of people on psychotropic drugs has doubled and nearly tripled in some demographics. Somebody’s paying for this stuff.
At best your describing an almost Orwellian scenario where the hapless and lower income are put on drugs….by doctors!!
4 out 5 prescriptions coming from GPs with no mental health or psychiatry training!

I’m glad you and your colleagues are immune to the Pharma Marketing machine Asanta. That’s a nice little anecdote.
The number of those marketing meetings has increased from 120,000 in 1998 to 371,000 in 2004.
While the numbers are hard to calculate various sources all easily agree that the amount spent on marketing is in the 10’s of billions of dollars.
So given the startling increase in prescriptions and those figures, it’s pretty easy to see that not everybody is immune to those marketing meetings.

I know I probably wouldn’t be immune.  Let’s say I’m an ENT. 15% of the people coming in my office want ear drops and Prozac.
Oh gosh what do I do?  I’m not trained for that.  Oh the marketing meeting said get ‘em out the door quicker with Prozac.
Yes, get quicker patient turnover times with New Zoloft. Quicker turnover is more money.
And hell I’m an ENT.  What do I know about mental disorders?


Americans spent $34 Billion on mental health drugs in 2010.
Between 2005 and 2011 the military has increased its psychotropic drug use 700%.

Your anecdotal references are downright crude in light of the data Asanta.
Crude. As in simply made or fashioned from cheap materials.

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Posted: 14 November 2013 11:12 PM   [ Ignore ]   [ # 24 ]
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In your world, there is some sort of conspiracy because heart transplant surgeries have also increased by at least 1000% over the past 30 years. Oops, it’s because we have better methods of transplantation and better medications to prevent rejection. We also have better treatments for heart failure.

Not saying I’m ‘immune’, just saying that most of us attending those conferences run the presentations through a filter. Why would you think doctors and nurses are so special (or gullible) that we fall for anything presented, when you probably don’t think the same for conferences for other professions.

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Posted: 15 November 2013 08:05 AM   [ Ignore ]   [ # 25 ]
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I started this thread to have a discussion about the massive increase in psychotropic drug use.
Pretty sound subject. Lot’s of data.  Lot’s of question marks.

I’m not talking about heart transplants. Where did I mention a conspiracy?
In a discussion like this you don’t think doctors would be a key subject?

Asanta-Why would you think doctors and nurses are so special (or gullible) that we fall for anything presented, when you probably don’t think the same for conferences for other professions.

Where did I say they were special? I certainly ain’t talking about nurses anyways.  Unless nurses can prescribe psychotropic drugs too?
Is that the case?  Can you prescribe psychotropic drugs too Asanta?

In a discussion about the medical community and the apparent over prescription of drugs, do you really think doctors should not be a part of the discussion?  Is that what you are suggesting?
Where did I say anything about doctors being gullible or “falling for anything”?  Don’t put words in my mouth!
If you can’t discuss this rationally without resorting to falsities and anecdote please refrain from the discussion.

I get it your a proud medical profession worker. Toot away! Good god.

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Posted: 15 November 2013 08:22 AM   [ Ignore ]   [ # 26 ]
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asanta - 14 November 2013 11:12 PM

Why would you think doctors and nurses are so special (or gullible) that we fall for anything presented, when you probably don’t think the same for conferences for other professions.

You know I’m going to give this BS statement even further scrutiny.

No I don’t think anybody’s gullible or susceptible to any abnormally high degree of suggestion or “trickery” at a conference or “marketing meeting”.
That includes any and all professions, trades or sciences.

No Asanta, I think marketing meetings serve their purpose the way they have for probably 200 or more years.
That’s why companies have marketing conventions or meetings.  Something must be relatively effective about them.
They are held in all corners of the world, and they cover everything from steel to marshmallows.

So anyways Asanta, what do you think?  In my inquiry into the dramatic rise of the prescription of psychotropic drugs, would you be happier if I discussed the business doings of Large Confectioners and their conferences and marketing meetings?
Would that make better sense for you Asanta?  How about that?  I’ll discuss the business doings of regional candy distributors
and the marketing techniques that large confectioners like Nestle or Mars use to get these distributors to sell their chocolate bars.

I’ll work on making a connection to the over-prescription of psychotropic drugs through the candy angle and large candy distributors.

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Posted: 15 November 2013 10:28 AM   [ Ignore ]   [ # 27 ]
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The bottom line is that there are many in the scientific and medical community who see medications, treatments, procedures and drugs as something that should be overwhelmingly need driven. Not market driven!!

Let’s go back to Asanta’s comparison to heart transplants.

Nobody is marketing heart transplants on a gigantic scale.  There are no commercials on TV every 20 seconds advertising heart transplants.
I don’t turn the page of every single last magazine there is to find advertisements for heart transplants.

I’m sure there are conferences on heart transplants. I’m sure there are marketing conferences having to do with heart transplant products and equipment.

I’m also quite certain that heart transplants are given on a needed basis. Not on a market driven basis. 
I doubt that the makers of heart transplant technologies are successfully pressing doctors to sell more heart transplants.

So the question is: Are psychotropic drugs becoming a market driven product?  I think the evidence clearly points to yes.
1. The most obvious!  The advertisements for psychotropic drugs are coming out of the woodwork.
2. As has been previously stated any type of doctor is capable of prescribing these drugs and a large percentage of the prescriptions
are being given by doctors with no psychiatric training-presumably to meet demand.
3.From 1996 to 2005 the pharmaceutical industry tripled the amount of money it spends on marketing!
Now if drugs are supposed to be given out on a “needed” basis, how did pharma have the foresight to aggressively market a product for a perceived need?
4. As the title of this thread says: Pharmaceutical Cos are paying doctors to market their drugs. Some, some would see this as a conflict of interest.  Although it can be argued that these marketing meetings are simply a “trade symposium” for efficiency and knowledge.
Which I’m sure is the case in many instances.
Nevertheless it is one more piece of the puzzle that shows that drugs are being distributed mainly on a market, and not a need driven basis.
5. There are many financial incentives for the doctor for going the psychopharmacology route as opposed to therapy and other scrutinies and treatments. Some of these reasons have to do with the insurance industry. But others have to do with patient turnover and the fact that people don’t want to go to therapy. Plus, given that a large percentage of the prescribing doctors aren’t psychiatrists-they couldn’t provide therapy anyways. So the health insurance argument has limited(but relevant)impact. The fact is that doctors can make more money prescribing drugs than they can make with therapy.
6. A large portion of the population receiving the therapies are now children, elderly, and veterans.
7. Anti-depressant drugs are the second most prescribed drug in the US. Second to cholesterol drugs.
8. From 1995 to 2008 the use of anti-psychotics has tripled in the US. Due to the special nature of mental issues, the prognosis of these issues is highly subjective. Highly subjective. Again it begs the question: have the number of “psychotic” people tripled between 1995 and 2008??
But the subjectivity in these prognoses makes a very convenient loophole if you will.
Obviously comparatively, a massive increase in say drugs for Lupus could easily be verified and cross-examined.

Here is one of the articles I obtained my information from. It is good reading for those who are interested.
http://www.apa.org/monitor/2012/06/prescribing.aspx

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Posted: 15 November 2013 10:53 AM   [ Ignore ]   [ # 28 ]
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VYAZMA - 14 November 2013 10:53 PM

What does poor health insurance have to do with this?

What Asanta was trying to explain is that good insurance would allow people with psychiatric conditions to see a psychiatrist for treatment that wouldn’t require medication, but many insurance plans don’t cover this service very well if at all so it takes that option off the table for many if not most patients. That leaves them with only one option, to see their PCP who’s only real option is to prescribe medication since they are not trained in psychotherapy.

I think we have listed a most of the other reasons why use of these drugs has gone up. there are clearly multiple factors its not just marketing. I could give you a long list of other medications ( incontinence medications, diabetes medications, restless leg medications, fibromyalgia drugs etc etc) that are marketed to physicians as heavily as psychiatric meds and most of them have not seen a huge increase in usage so marketing alone is not the only driving force for the upswing in the use of psychiatric drug and it may not even be the primary one.

[ Edited: 15 November 2013 10:57 AM by macgyver ]
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Posted: 15 November 2013 11:33 AM   [ Ignore ]   [ # 29 ]
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macgyver - 15 November 2013 10:53 AM
VYAZMA - 14 November 2013 10:53 PM

What does poor health insurance have to do with this?

What Asanta was trying to explain is that good insurance would allow people with psychiatric conditions to see a psychiatrist for treatment that wouldn’t require medication, but many insurance plans don’t cover this service very well if at all so it takes that option off the table for many if not most patients. That leaves them with only one option, to see their PCP who’s only real option is to prescribe medication since they are not trained in psychotherapy.

I think we have listed a most of the other reasons why use of these drugs has gone up. there are clearly multiple factors its not just marketing. I could give you a long list of other medications ( incontinence medications, diabetes medications, restless leg medications, fibromyalgia drugs etc etc) that are marketed to physicians as heavily as psychiatric meds and most of them have not seen a huge increase in usage so marketing alone is not the only driving force for the upswing in the use of psychiatric drug and it may not even be the primary one.

The health insurance issue is a small part. I acknowledged that in my above post. The article acknowledged it too.
The usage of those other drugs is not primarily a subjective concern. Someone’s either incontinent or they’re not.
Someone either has fibromyalgia or they don’t. Someone has diabetes or they don’t.
Someone comes to a doctor and says, “I have depression. Life’s not doing anything for me anymore”. Then what?
Give out the pills.  That’s what. That’s exactly what is happening. 4 out of 5 prescribing doctors are PCPs. Hello?
If I came to my PCP and told him that I wanted medication for shingles(but didn’t have shingles!) what would he do?
He would say get lost.

Again the reasons you listed do not justify the types of percentile increases shown over a 10 year period.
It’s either marketing or it’s a massive increase in genuinely “hurting” people.
Which one is it?  Or it’s just a massive desire by doctors to make lot’s of money prescribing drugs that can’t really be traced to any pathology!
Maybe that’s it? I mean actually that is a big part of it. Like I said doctors can’t get away prescribing diabetes meds to everyone who walks through the door. But doctors can hand out psychotropics to all comers who ask for it.  Some obviously don’t ask for it. Like children and the elderly!
Very hard for anyone to scrutinize the pathology of these treatments.
You’re a doctor Mac.  You’re supposed to make people feel better. You’re making me turn green.
Obviously you are blinded to this issue. Can’t see the forest.

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Posted: 15 November 2013 12:27 PM   [ Ignore ]   [ # 30 ]
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VYAZMA - 15 November 2013 11:33 AM

Again the reasons you listed do not justify the types of percentile increases shown over a 10 year period.

And you base this conclusion on what? Can i see the analysis you did? All i see is a personal bias you have

VYAZMA - 15 November 2013 11:33 AM

Which one is it?  Or it’s just a massive desire by doctors to make lot’s of money prescribing drugs that can’t really be traced to any pathology!

And how do we make money by prescribing psychiatric meds? Oh yeah I forgot. A rep came to our office two years ago and I got a free sandwich. That should help me retire early. Vyaz, you haven’t listened to a thing I’ve been telling you or you conveniently marginalized it as being the exception rather than the rule because it doesn’t fit your world view.


Your arguments don’t support your views. On the one hand you claim that the vagaries of diagnosing psychiatric illness are there and yet you see this as an excuse for doctors to prescribe more medication instead of seeing the difficult position this puts physicians in. they want to help their patients and do whats best for them but there is no test and no objective way to be completely sure of the diagnosis so they use the tools that are available to them and since there is no clear cut way of knowing who will benefit and who wont they are forced to treat people in spite of that uncertainty because they have no other choice.

And by the way restless leg is not something you have or don’t have. Its highly analogous to many psychiatric illnesses where its very much a judgement call. The same is true for fiibromyalgia

[ Edited: 15 November 2013 12:33 PM by macgyver ]
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For every complex problem there is a solution that is simple, obvious,.... and just plain wrong

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