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Pharmaceuticals & Our Culture
Posted: 12 May 2008 09:43 AM   [ Ignore ]
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I’ve noticed that many people on here will immediatly look for “conspiracy”, false evidence. etc when dealing with a proposed alternative medicine. That’s fine, but what about pharmaceuticals? There are many corruptions in the industry, and some of the drugs administered are downright nasty.

Take Adderall, for instance, often prescribed to children as young as elementary school level for ADHD. I have seen cases where a child who is bored by sitting in a classroom all day doing menial tasks is diagnosed with ADHD and prescribed to a damaging pill just because they’d rather be outside. Children these days are not given enough exercise (gym class is once a week now in elementary schools), their food is very processed and artificial, and their parents tend to surround them with mind-numbing electronics instead of actually taking the time to do things with them. American culture is very excessive and fast-paced. When I babysit, I groan in disgust at the lack of time parents spend with children. Sure, they’re busy with work and it’s understandable, but many are lazy about it to the point I feel sick. No wonder children have so many behavioral problems. No wonder kids who are active and engaging are numbed down by the liquid speed of Ritalin.

Take away the “meth” from methampthetamine: boom, you get Adderall & Ritalin. Lovely for a growing child. Students buy them for it’s coke-like effects in order to cram for exams.

I feel we live in a time where “popping a pill” is the end-all, cure-all for many. I see people hyped up on multiple prescriptions; 5000 mg a day is not at all uncommon.

Think: what is this doing to our bodies? How is treating the symptoms instead of the source damaging? Of course prescription drugs are very beneficial, but there are gaping holes in the industry (including the horrendous cost). No wonder so many turn to alternative practices.

[ Edited: 12 May 2008 09:46 AM by peppermint ]
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Posted: 12 May 2008 10:58 AM   [ Ignore ]   [ # 1 ]
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Medicating children diagnosed with ADHD is never something that doctors and parents rush into.  This is beyond my expertise as an educator of children and adults with ADD/ADHD.  However, I have never seen the “just give them a pill to shut-up” idea.

What you see or hear about is only a small part of a very complex situation.

Consider that.  If you can, talk to your family doctor about how/why Ritalin is prescribed to children.  Tell him/her it’s for a school report.  I’ll bet that you will learn that each patient is treated differently—individually.  And that some children aren’t given drugs.

It’s easy to form an opinion based on a few observations.  Take some time and learn some more.  Then come back and tell us what you learned.

Those who seek the “alt-med” route often don’t take this step.  We here on this board get the rap for being skeptical only of the pseudoscientific.  But we are skeptical of any “cure-all”, including drugs.  There are no magic cures.  Medicine can help, can extend life, treat or cure diseases and conditions.  But it’s not magic. 

Also, the false dichotomy of doctors being the ones to prescribe vs. alt-med “practitioners” who treat the “whole body” is a myth.  Every single doctor worth anything will tell patients to stop smoking, excercise, eat well, and lose weight.  And will help patients find ways to accomplish these goals.  Doctors do treat the whole body.  Hurrah for that!

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Posted: 12 May 2008 11:52 AM   [ Ignore ]   [ # 2 ]
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I think you’re both right. We have become a pill-popping (actually, they aren’t pills…) society and many doctors are not good at saying no, especially when it comes to antibiotics. However, the doctors are supposed to behave in the ethical way HH suggests. The manufacture of alt-meds are not held under scrutiny - I avoid them.

Speaking of pill-popping society, I am SICK AND TIRED of the prescription medication commercials on TV. It is my understanding that the US is the only place this is allowed - true??? They are as irritating as hell.

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Posted: 12 May 2008 12:27 PM   [ Ignore ]   [ # 3 ]
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Sure, as a culture we prefer easy technological fixes to difficult changes in behavior and lifestyle. We especially don’t believe that suffering is ever inevitable or necessary, so we expect never to have any as long as we live “right.” And sure, the for-profit pharmaceutical industry has an agenda not entirley altruistic, which lead individuals and comapnies to pursue profit over what is besst for consumers/patients often. I think vigilant and aggressive regulation of the industry, including a ban on direct-to-consumer advertising, is necessary to control this.

None of this really has anything to do with alternative medicine, of course. Popping gingko or echinacea or homeopathic “medicines” or trying to find a “toxin-free” diet that will cure all your ills is just a different form of the same cultural problem, minus any actual scientific evidence of benefit, minus all the regulations that keep the industry relatively honest, and minus any protection for the consumer. The supplement industry is given a free pass for some reason, when it is just another corporate interest pursuing profits. The major difference is that the supplement and alt med industries have been more successful than big pharma at buying politicians (notably Orin Hatch and Tom harkin, though there are many others) to avoid any government interference with their business. So they claim problem free cures for ills they invent and market and take no responsibility for the harm they do. We’re a remarkably healthy and remarkably unhappy society, and the root of that doesn’t lie in medicine, scientific or alternative.

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Posted: 12 May 2008 12:35 PM   [ Ignore ]   [ # 4 ]
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“We’re a remarkably healthy and remarkably unhappy society, and the root of that doesn’t lie in medicine, scientific or alternative.”
Damn, that’s remarkably true.  downer

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Posted: 12 May 2008 12:44 PM   [ Ignore ]   [ # 5 ]
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traveler - 12 May 2008 11:52 AM

Speaking of pill-popping society, I am SICK AND TIRED of the prescription medication commercials on TV. It is my understanding that the US is the only place this is allowed - true??? They are as irritating as hell.

In Canada we have them too. But it’s hard to tell: they could be American commercials. Does this work though? Do people really demand a certain drug from their doctor based on a TV commercial? Is the doctor obligated to prescribe one brand of drug over another if asked so by a patient?


“Hey, doc, can I get the other antibiotic for my infection?”

“Which one?”

“You know, the one with the pretty girl, the happy dog, and Gershwin’s music in the background…”

[ Edited: 12 May 2008 12:50 PM by George ]
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Posted: 12 May 2008 12:58 PM   [ Ignore ]   [ # 6 ]
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George,

We have less advertising in vet med than human med, but I’ll tell you, it sure does influence client behavior. A NY Times article cam out about a wt loss drug for dogs (!), and people were asking me about it several tiems per week before it had been brought on the market and before the industry had even told most vets about it. And sadly, it is difficult for many vets (and I presume MDs) to deny a client a drug they aggressively ask for unless it is clearly not appropriate. Often, the evidence for when to put a patient on a drug is not clear, so individual doctors must use their judgement, and that can be colored by what the client wants. Tell someone their cat with a viral URI doesn’t need an antibiotic, and a fair number of them will chew you out and go find another vet to give them what they want. I’m ok with that, but I’m unusually obstinate, and I work in a big hospital with enough happy clients to keep us in business even if the occassional grumpy client quits us. Pharmaceutical advertising pretty clearly affects prescribing patterns to some degree, not through clearcut venality or corruption, but through small but meaningful influences on patient and physician behavior. I think we’de be better off as doctors and patients without it. If the industry really wants to “educate” people about disease, they’re welcome to run public service ads that don’t talk about therapy or to donate to patient interest groups like AHA, ALA, and so on.

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Posted: 12 May 2008 01:02 PM   [ Ignore ]   [ # 7 ]
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No it doesn’t work! That’s why it pisses me off. The pharm companies have tons of money to spend on advertising. The TV stations love taking the big money for 30 or 60 second spots. Of course the big money from the pharm companies also means the cost of commercials won’t go down for the smaller companies wanting to advertise.
And the ones who pay the ultimate price (in misery) by having to watch all this crap are the viewers.

I live in Buffalo - I like my northern neighbors!!!

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Posted: 12 May 2008 01:15 PM   [ Ignore ]   [ # 8 ]
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Yes, direct-to-consumer pharma advertising (particularly for prescription drugs) should be banned. More than that, though, advertising quackery should be banned. I know a few radio stations in NYC that appear to be supported in large measure by quackery.

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Posted: 12 May 2008 04:08 PM   [ Ignore ]   [ # 9 ]
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Advertising aside, I’m not just going off of personal experience. I have read quite a few articles and studies on this which is what really concerns me. I would hope that most doctors treat children as individuals, but I also have heard enough horror stories to be skeptical of every doctor.

I just find it sad that so many children are prescribed these drugs. Their brains aren’t fully developed, they usually have other health problems that go unnoticed, and they aren’t given enough exercise and diet regulation. It is an easy drug to abuse, even by accident.

Sometimes I doubt the existence of ADHD. Children have different learning styles, and it really isn’t respected in most classrooms. There is a very standardized feel to the education system; standardized tests have increased in place of actual learning, recess/gym has been cut down, and our culture is becoming so computerized that kids just don’t get a breath of fresh air anymore. They use plenty of stimulants already: video games, computers, cell phones, television, etc, and eat plenty of bad chemicals: sugar, trans fat, over-processed foods…

Little boys who want to go play outside are being told they have a disorder. It’s ridiculous.

Stimulant drugs, including methylphenidate and amphetamine, were first approved for the control of behavior in children during the mid-1950s.  Since then, there have been periodic attempts to promote their usage, and periodic public reactions against the practice.  In fact, the first Congressional hearings critical of stimulant medication were held in the early 1970s when an estimated 100,000-200,000 children were receiving these drugs.

  Since the early 1990s, North America has turned to psychoactive drugs in unprecedented numbers for the control of children. In November 1999, the U.S. Drug Enforcement Administration (DEA) warned about a record six-fold increase in Ritalin production between 1990 and 1995.  In 1995, the International Narcotics Control Board (INCB), a agency of the World Health Organization, deplored that “10 to 12 percent of all boys between the ages 6 and 14 in the United States have been diagnosed as having ADD and are being treated with methylphenidate [Ritalin].” In March 1997, the board declared, “The therapeutic use of methylphenidate is now under scrutiny by the American medical community; the INCB welcomes this.”  The United States uses approximately 90% of the world’s Ritalin.

  The number of children on these drugs has continued to escalate. A recent study in Virginia indicated that up to 20% of white boys in the fifth grade were receiving stimulant drugs during the day from school officials.  Another study from North Carolina showed that 10% of children were receiving stimulant drugs at home or in school.  The rates for boys were not disclosed but probably exceeded 15%.  With 53 million children enrolled in school, probably more than 5 million are taking stimulant drugs.

  A recent report in the Journal of the American Medical Association by Zito and her colleagues has demonstrated a three-fold increase in the prescription of stimulants to 2-4 year old toddlers.

- Peter R. Breggin M.D. Testimony September 29, 2000
Before the Subcommittee on Oversight and Investigations
Committee on Education and the Workforce
U.S. House of Representatives (http://www.breggin.com/congress.html)

That scares the hell out of me.

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Posted: 12 May 2008 04:37 PM   [ Ignore ]   [ # 10 ]
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Peppermint,

I certainly don’t think we have all the answers when it comes to human behavior, normal or pathological, but I know quite a few parents of children with behavioral problems, and I would make several comments:

1) We’re not simply labeling normal rambuctiousness as a disorder. These kids are suffering and unable to function in a setting that the vast majority of kids do function in.

2) Parents are rarely casual about medicating their kids. Parents often go to incredible lengths to avoid medication because of the same stigma you feel it should have. The fact is that medication may be the right or the wrong treatment for a particular problem, but the answer has to come from understanding the problem and evaluating potential treatments critically and experimentally. One cannot just start by assuming medicating people is automatically bad. The quote you provide is just other people saying that we’re prescribing more drugs and that this is a bad thing. Maybe yes, maybe no, but that’s an assumption or a personal impression, not something we’ve established in any objective way.

3) Every generation complains about how the younger generation is suffering from a decline in the healthful practices of their own childhood. TV is bad, video games are bad, “chemicals” are bad. Again, this sounds like a nostalgic comparison to better days, which is a natural but not always true impression.

FWIW, I am also personally skeptical of the use of psychocctive drugs to treat pathology. I think our understanding of how brain generates mind is pretty poor, I think we basically roll the dice and play trial and error with many of these drugs, and I agree that culturally we reach for quick and easy solutions. But I have learned to be careful of criticising the choices of people in situations I don’t have to face myself. People suffer and they look for relief, and while I don’t always think they look for it in reasonable places, I understand the impulse. And frankly, if you are suggesting alternative therapies as preferable to “drugs,” I’ve already explained why I think these are the greater rather than lesser of evils. I think the real answers lie in better understanding through science, not in assumptions about supposedly bad or unhealthy lifestyle choices, venal drug companies, unethical doctors, and so on. Most of what we know about a healthy lfiestyle, diet and exercise and so on, comes from science research which supplanted the mythology of the past. My grandmother “knew” that the men she cooked for (her father the lumberjack and her husband) needed lots of good, healthy red meat every day to stay strong and fit. Now we know that this helped them to die of cardiovascular disease, and we know this because of science, not just intuition or “common sense,” which is so often wrong. Maybe someday we’ll know how to help these children most effectively, and maybe it will involve medication or maybe it won’t. But knowledge and research will tell us, not just our feelings.

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Posted: 12 May 2008 06:06 PM   [ Ignore ]   [ # 11 ]
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Excellent response McKenzie. I don’t think I can add a thing to what you’ve already said.

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Posted: 12 May 2008 06:48 PM   [ Ignore ]   [ # 12 ]
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1. Most of the time a scientific theory starts with a personal observation. What brings this research to life is our personal experiences.

2. The key word is “vast majority”. This is what I don’t like about statistics, they cancel out the minority. The vast majority does not nessecarily “normal”. Unless the child is a danger than themselves and others? I do not believe that there are 2-3 million children in the USA who are a danger to themselves and others without Ritalin. Explain why about 92% of Ritalin prescriptions are in this country.

3. When did I say medicating people is bad?

4. I’m not being nostalgic. Generations before were not better than now. I never said that. I simply observed a common problem.

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Posted: 12 May 2008 07:10 PM   [ Ignore ]   [ # 13 ]
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1. Most of the time a scientific theory starts with a personal observation. What brings this research to life is our personal experiences.

I don’t believe that personal experience “brings this research to life.” Certainly, our experiences suggest relationships which science should then examine. The problem is we tend to rely more on our experiences than on real evidence when making decisions, and when these decisions involve very complex problems this is often a mistake.

2. The key word is “vast majority”. This is what I don’t like about statistics, they cancel out the minority. The vast majority does not nessecarily “normal”. Unless the child is a danger than themselves and others? I do not believe that there are 2-3 million children in the USA who are a danger to themselves and others without Ritalin. Explain why about 92% of Ritalin prescriptions are in this country.

All I mean by referring to the majority of kids who function adequately in our system is that the system itself is unlikely to be the problem. The kids who cannot function are different from most, and whether you choose to use terms like “normal” or not this is still true. Now I’ve already said I don’t know exactly how or why they are different or what is best to do about it, but I don’t think it is supportable to blame the system for creating the problem. Nothing is perfect or will work ideally for everyone, but again we’re talking about kids who have serious behavioral and learning problems, and there is more to it than just an impatient or “cookie-cutter” school system. Again, I share your skepticism about some of these medications, but I don’t think I see the problem or the solution in the same way.

3. When did I say medicating people is bad?

C’mon. The tone of your posts has been pretty clear that you view medicating children with supposed ADHD as a bad thing. E.G.

some of the drugs administered are downright nasty.

a damaging pill

numbed down by the liquid speed

I just find it sad that so many children are prescribed these drugs.

I just find it sad that so many children are prescribed these drugs.

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Posted: 14 May 2008 10:06 AM   [ Ignore ]   [ # 14 ]
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George - 12 May 2008 12:44 PM
traveler - 12 May 2008 11:52 AM

Speaking of pill-popping society, I am SICK AND TIRED of the prescription medication commercials on TV. It is my understanding that the US is the only place this is allowed - true??? They are as irritating as hell.

In Canada we have them too. But it’s hard to tell: they could be American commercials. Does this work though? Do people really demand a certain drug from their doctor based on a TV commercial? Is the doctor obligated to prescribe one brand of drug over another if asked so by a patient?


“Hey, doc, can I get the other antibiotic for my infection?”

“Which one?”

“You know, the one with the pretty girl, the happy dog, and Gershwin’s music in the background…”

Considering that big Pharma spend more on ad’s than R&D;, I would say hell yes.  Some commercials coach people on the symptoms and then leave up to an already hurried MD, DO, PA, NP to tell the patient no and then explain why in a way the patient can understand, which many doctors have a problem with under normal conditions.  I’d love to see a ban on direct to consumer ad’s by big pharma, but I’m not going to hold my breath.  It’s interesting to see how they can sue HMO’s in this area are being sued by big pharma for switching people from Lipitor to generic Zocor (simvastatin) and yet big phama can buy healthcare workers lunch and provide them with other free items and no one blinks an eye.

[ Edited: 14 May 2008 10:10 AM by OldSquid ]
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Posted: 14 May 2008 01:22 PM   [ Ignore ]   [ # 15 ]
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OldSquid - 14 May 2008 10:06 AM

Considering that big Pharma spend more on ad’s than R&D;, I would say hell yes.  Some commercials coach people on the symptoms and then leave up to an already hurried MD, DO, PA, NP to tell the patient no and then explain why in a way the patient can understand, which many doctors have a problem with under normal conditions.  I’d love to see a ban on direct to consumer ad’s by big pharma, but I’m not going to hold my breath.  It’s interesting to see how they can sue HMO’s in this area are being sued by big pharma for switching people from Lipitor to generic Zocor (simvastatin) and yet big phama can buy healthcare workers lunch and provide them with other free items and no one blinks an eye.

OldSquid is correct in his assumption that these adds encourage patients to believe they have an illness when they otherwise might not. This is actually a useful thing if someone has a disease like cancer. In such cases creating awareness can encourage early diagnosis and sometimes lead to a better outcome. In other cases like Reflux, Irritable bladder, and Fibromyalgia they may simply make people who have mild non-intrussive symptoms think they have a debilitating disease that requires chronic treatment.

I infrequently have patients ask for a specific medication based on direct to consumer adds although it does happen on occasion. I do have patients come in convinced they have some awful disease based on these adds though. I then have to waste ( and it is a waste) 5 or 10 minutes listening to their symptoms only to realize there is nothing really wrong with them. This drives up the cost of medical care, and if they end up on medication because they wear the doctor down or are prompted enough by the add to give the right answers to the doctors questions they drive up medical expenditures for all of us.

I’m with Squid all the way on this. I think most physicians would be quite happy if all direct to consumer advertising was stopped, but that’s never going to happen because pharmaceutical companies see it as a way to get around the gatekeeper ( doctors) to encourage patients to use their product.

The rest of the Pharma promotions could easily be stopped too. Pens and pads are not going to make or break the balance sheet in a doctors office ( at least not this week), and if it brings down drug prices I’m all for it. I seriously doubt drug prices will drop though unless we stop subsidizing medications for the rest of the industrialized world.

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