"Take Your Pills" On Netflix

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chajjohnson

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Anyone seen it yet? It's a documentary focusing on stimulant use in America.

Within 5 minutes of watching it I could tell this would be super harmful to the field of psychiatry. The first 1/2 is people (with or without an ADHD diagnosis) talking about how adderall makes them feel like superman. Literally 100% of people on the doc say it made them feel invincible. Then the second 1/2 is all about the side effects and negatives of stimulants, and often questioning whether ADHD is a real diagnosis. They also imply anything achieved while on a stimulant (e.g. good grades) wasn't really you and isn't worth celebtrating. By the end they are endorsing the merits of microdosing LSD and psilocybin over using stimulants. The doc is extremely anti-stimulant and seems to make the case that no one should be on stimulants.

The kicker: Not one psychiatrist contributes. They have neurologists, cognitive neuroscientists, psychologists, therapists, pediatricians, etc. But not one psychiatrist. The one who may be a psychiatrist was someone from Hopkins who did the initial Ritalin trials who is now apparently anti-stimulant.

Very biased, and yet I'm sure it will influence how a ton of people see ADHD, stimulants, and psychiatrists. Super disappointed that Netflix would put out this obviously biased doc.
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I had someone tell me stimulants were a gateway to meth after they watched this documentary.
 
We can argue that ADHD is real and it is, but a reasonable lay person would probably see Netflix as extreme, but closer to the truth than you might think. ADHD isn't nearly as rampant as our prescribing has become. Rationalize all you want, some of us are doing this inappropriately for profit. Netflix is the result of our actions. This will be the next opiate epidemic. Fortunately it is less lethal, but not more ethical. ADHD is real, but so is pain and look where we are now with that.
 
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What is concerning is that a lot of students with “ADHD” are on adderall, get straight A’s, and are on the road to being admitted to top universities. Imagine inheriting such a patient and stopping his or her script.
 
They also imply anything achieved while on a stimulant (e.g. good grades) wasn't really you and isn't worth celebtrating.
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They probably also hate bodybuilders.

Meanwhile, society could use a second-look at why we've decided to make everyone jump through diagnostic hoops or black market suppliers to get their hands on performance enhancement. Wouldn't you rather be monitored by a professional and receive a legal, limited supply? Actually, that's the case when you manage to get a dx of "Low T" or "Adult Onset ADHD" but the pretense is silly.
 
FlowRate said:
They probably also hate bodybuilders.

Meanwhile, society could use a second-look at why we've decided to make everyone jump through diagnostic hoops or black market suppliers to get their hands on performance enhancement. Wouldn't you rather be monitored by a professional and receive a legal, limited supply? Actually, that's the case when you manage to get a dx of "Low T" or "Adult Onset ADHD" but the pretense is silly.
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I would also prefer a world in which addicts could just buy their heroin from Merck (or Bayer - they invented it after all!) but this will obviously not happen in my life time.
 
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clausewitz2 said:
I would also prefer a world in which addicts could just buy their heroin from Merck (or Bayer - they invented it after all!) but this eilw obviously not happen in my life time.
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Agreed and also isn't that the point of suboxone?

[I am being obviously hyperbolic and understand the difference between suboxone and heroin.]
 
I'm so not even close to being a doctor (still in med school), but this thread caught my eye because of all the "documentaries" Netflix has put out there. When What the Health came out, my non-medical friends would say to me, "Have you seen that new documentary on Netflix? It's called --" I interrupted them immediately and my knee jerk response was always, "No, I'm not gonna watch it and you shouldn't listen to it."

Can someone make a documentary about how these "documentaries" are made? There's soooooo much misinformation that's AT BEST neutral, but more often than not completely harmful. There's absolutely no oversight, unlike the process that drugs have to go through, and people make completely bogus, unsubstantiated claims (I was born without lower extremities but now I have beautiful legs after drinking a gallon of apple cider vinegar a day and I look like I'm 25 even though I'm 90!).

I realize I'm preaching to the choir, so thanks for listening because that made me feel a little better.
 
curbsideconsult said:
I'm so not even close to being a doctor (still in med school), but this thread caught my eye because of all the "documentaries" Netflix has put out there. When What the Health came out, my non-medical friends would say to me, "Have you seen that new documentary on Netflix? It's called --" I interrupted them immediately and my knee jerk response was always, "No, I'm not gonna watch it and you shouldn't listen to it."

Can someone make a documentary about how these "documentaries" are made? There's soooooo much misinformation that's AT BEST neutral, but more often than not completely harmful. There's absolutely no oversight, unlike the process that drugs have to go through, and people make completely bogus, unsubstantiated claims (I was born without lower extremities but now I have beautiful legs after drinking a gallon of apple cider vinegar a day and I look like I'm 25 even though I'm 90!).

I realize I'm preaching to the choir, so thanks for listening because that made me feel a little better.
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I generally don't tolerate documentaries well, either. The word documentary implies documentation, as if it were possible to be a neutral lens to the unfolding of some process. I guess you could say C-SPAN is documentary-like in that way in that it's a camera pointed toward the halls of Congress, and that camera might as well be unmanned. But most documentaries are treatises and often appeal to emotion rather than reason. But as an audience member what's worse is that they do it so slowly, unraveling things that are supposed to be shocking but to me seem rather expected. I'm surprised at how compelling some people can find documentaries. I'm also surprised at how people can be unaware/disinterested in an issue until they see it in a documentary. Like did anyone really think Sea World was a haven for whales? But at the same time, the documentary worked and changed policy. I would assert that Making a Murderer was better than most in terms of acting like more of a lens than advancing a particular theory. But there's really no such thing as a completely neutral documentary. And don't get me started on the History Channel and their conflation of known historical fact with religious mythology, and in my experience they're even used in college classrooms with the context that they're historically accurate.
 
My brother (non-medical) texted me after wacthing the documentary that it was really “pathetic” that these people were addicted to these meds. He also thought it was just sad to see how they thought they couldn't do their job or school work without it. He literally said “college aint that hard lol I feel bad for these people.”

I don’t think this documentary is all that damaging to psychiatry. Yes you could stay up alot if you are on these pills, but beyond that, this isn’t really a performance enhancing drug beyond the effect of sleep, exercise, and caffeine. Besides, the people who are skeptical of the medical community are always going to be sceptical, and would use any form of misinformation as ammo.

Here is an interesting recent study about stimulant effects on chess masters. Methylphenidate, modafinil, and caffeine for cognitive enhancement in chess: A double-blind, randomised controlled trial. - PubMed - NCBI.
Here is a good review of pharm vs non pharm cognitive enhancement.
Pills or Push-Ups? Effectiveness and Public Perception of Pharmacological and Non-Pharmacological Cognitive Enhancement. - PubMed - NCBI

One quote from this review I liked is “Similar to methylphenidate, modafinil appears to positively affect low-performing individuals to a greater extent than high-performing individuals.” In reality, this effect was talking about short term memory and visual processing - aka paying some attention. Most of the performance enhancement of these drugs in normal people could easily be obtained from sleeping well, exercising, and paying some god damn attention to what the hell you are doing. Really is sad to see healthy people choose to abuse drugs thinking they are enhancing their performance, when really sleeping well, exercise, and caffeine could easily get them there. Maybe if they closed all the facebook tabs on their computer and turned off the tv they would pay some attention to their work instead of relying on drugs like a crutch.
 
mistafab said:
One quote from this review I liked is “Similar to methylphenidate, modafinil appears to positively affect low-performing individuals to a greater extent than high-performing individuals.” In reality, this effect was talking about short term memory and visual processing - aka paying some attention. Most of the performance enhancement of these drugs in normal people could easily be obtained from sleeping well, exercising, and paying some god damn attention to what the hell you are doing. Really is sad to see healthy people choose to abuse drugs thinking they are enhancing their performance, when really sleeping well, exercise, and caffeine could easily get them there. Maybe if they closed all the facebook tabs on their computer and turned off the tv they would pay some attention to their work instead of relying on drugs like a crutch.
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Eh, it's no new thing attributable to milennials. This nation has been abusing some form of amphetamine/stimulant for hundreds of years, whether it be legal, prescription, or otherwise. It's no different than most other issues, we want the easy (pill) way out instead of doing the hard work. It's been that way for a while, and will likely continue that way for at least a while more.
 
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WisNeuro said:
Eh, it's no new thing attributable to milennials. This nation has been abusing some form of amphetamine/stimulant for hundreds of years, whether it be legal, prescription, or otherwise. It's no different than most other issues, we want the easy (pill) way out instead of doing the hard work. It's been that way for a while, and will likely continue that way for at least a while more.
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If efficiency of work hadn't increased over time, the world would be far more greatly impoverished than it is, people would have far less time with their families, and we couldn't support as many people in existence as we do. The ever new discoveries of how to work less is what has brought us to this point in civilization, which is a far better alternative to most points in history. It's an ethical question of whether to apply such methodology to the human body, but I just wanted to point out that working harder isn't a grand achievement unto itself but rather something people in the past had to endure because they had no other choice. It's more work to take care of and feed a horse and take it to work than driving a car (and probably more expensive along with time-consuming), but would it make you a better psychologist? I'm not saying driving a car is precisely the same as taking a stimulant, but if you're saying people can achieve the same outcome with either a stimulant or putting in more time, then it seems like a reasonable comparison. I would argue that people reach different outcomes with brain-enhancing drugs rather than merely more expeditious outcomes.
 
birchswing said:
If efficiency of work hadn't increased over time, the world would be far more greatly impoverished than it is, people would have far less time with their families, and we couldn't support as many people in existence as we do...
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Compare the gross social differences:

1) between hiring someone at X/yr for a 170hr position in a completely unregulated labor market.
2) having a regulated market that will not allow employers to require more than 30hrs/week, which makes my first position into 5 separate jobs.

Mean unemployment goes up in one, and down in another.
 
MacDonaldTriad said:
We can argue that ADHD is real and it is, but a reasonable lay person would probably see Netflix as extreme, but closer to the truth than you might think. ADHD isn't nearly as rampant as our prescribing has become. Rationalize all you want, some of us are doing this inappropriately for profit. Netflix is the result of our actions. This will be the next opiate epidemic. Fortunately it is less lethal, but not more ethical. ADHD is real, but so is pain and look where we are now with that.
Click to expand...
We have a diagnosis rate by far and away higher than any industrialized nation. That is telling to me. ADHD is certainly real and I've met individuals that literally couldn't maintain their jobs or grades without stimulants. But I've met far more that are perfectly functional but use the pills essentially as a way to focus better and enhance their performance. On the child front, how much of it is normal behavior that parents or schools find unacceptable, a normal child with an abnormal environment or expectations, that has been prescribed stimulants to placate the adults in the picture rather than treat any real pathology in the child?
 
Although documentaries can be damaging, this one raises a valid concern. Stimulants are not benign and I still have people trying to get in for addy's. I've tried to play nice, give people fair and thorough assessments only to find people have their minds made up. Although I feel bad just telling new patients calling to go elsewhere if they want stims (I give them a list of places they can call and everything), it's frankly waste of both of our times to sit for in intake together if 1) they have their minds made up and 2) chances are, I will tell them the truth, like it is, recommend a thorough eval and they just leave mad. Just this week I had the following experiences with stims.
1) Had to discharge a patient because I found high levels of etoh and THC (or metabolites) on UDS after he kept insisting the stims don't work and he needs something "strong"
2) Another patient came in, last 5 minutes of the interview asked for ADHD meds, he's a middle aged male and also wanted "a high dose."
3) Had to discharge another patient as he's hypertensive on stims and wants me to double it and switch all to IR, I told him he can seek the opinion of another MD. He keeps trying to convince himself the HTN is not from Adderall despite pretty consistently he's hypertensive when on it and normotensive when not. Also a middle aged male.
4) Another nearly geriatric aged male, he gets stims from PCP and had a heart attack. Still poppin' those addy's.
 
randomdoc1 said:
Although documentaries can be damaging, this one raises a valid concern. Stimulants are not benign and I still have people trying to get in for addy's. I've tried to play nice, give people fair and thorough assessments only to find people have their minds made up. Although I feel bad just telling new patients calling to go elsewhere if they want stims (I give them a list of places they can call and everything), it's frankly waste of both of our times to sit for in intake together if 1) they have their minds made up and 2) chances are, I will tell them the truth, like it is, recommend a thorough eval and they just leave mad. Just this week I had the following experiences with stims.
1) Had to discharge a patient because I found high levels of etoh and THC (or metabolites) on UDS after he kept insisting the stims don't work and he needs something "strong"
2) Another patient came in, last 5 minutes of the interview asked for ADHD meds, he's a middle aged male and also wanted "a high dose."
3) Had to discharge another patient as he's hypertensive on stims and wants me to double it and switch all to IR, I told him he can seek the opinion of another MD. He keeps trying to convince himself the HTN is not from Adderall despite pretty consistently he's hypertensive when on it and normotensive when not. Also a middle aged male.
4) Another nearly geriatric aged male, he gets stims from PCP and had a heart attack. Still poppin' those addy's.
Click to expand...
I've got a longstanding ADHD diagnosis and refuse to take stimulants because there are effective coping strategies for ADHD that an individual can develop if they put in the time and effort to do so, and the likely risks of long-term stimulant use just didn't seem worth it to me. That's just my personal choice and opinion though
 
Mad Jack said:
I've got a longstanding ADHD diagnosis and refuse to take stimulants because there are effective coping strategies for ADHD that an individual can develop if they put in the time and effort to do so, and the likely risks of long-term stimulant use just didn't seem worth it to me. That's just my personal choice and opinion though
Click to expand...

Although I do still think there is a place and role for each medication, I applaud you for putting in lifestyle changes. What is there to lose anyways? Lifestyle changes and coping mechanisms are *highly* under utilized in medicine altogether. Stims are touted as the gold standard for ADHD treatment. People fall into this belief that it is a life changer and answer to all their problems and in that lies a great danger. I work with one of the national leading figures on ADHD and she emphasizes the same, there's a place for stims but people under utilize non-pharm approaches grossly. Oh yea, forgot to add another stim story from this week. Tried methylphenidate for antidepressant augmentation in a 68 yo woman, history of opiate use disorder after she begged for stims but also legitimately had failed trials of multiple antidepressants and augmentation. Guess what? She took the entire month supply in a few days. --> discharge. I feel very torn about this whole stimulant thing. On the one hand, I don't want to be dismissive but these type of experiences keep propping up and pts need to take some ownership too and start being big boys and girls. I think most are smart enough that if they wanted to be truly insightful, they at least can in some degree see it for what it really is, but many decide not to and keep their hopes up for that pill solution/fix.

Edit:
Ugh, just finished an encounter with someone else again. 18 yo female, straight A student, AP classes, functioning well at home and her part time job but got a taste of some Adderall for her ACT. Felt it helped give her the energy and stamina or else she does not think she would have done as well. The kicker, mom is in on it too! They wanted me to prescribe stims because pt will be starting college and think she needs it to maintain her stamina and mother has a history of high expectations of her. The patient has NO impairment. I just don't get it in these people. 18 yo left pouting when I told her I wasn't starting a stim.
 
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randomdoc1 said:
Although I do still think there is a place and role for each medication, I applaud you for putting in lifestyle changes. What is there to lose anyways? Lifestyle changes and coping mechanisms are *highly* under utilized in medicine altogether. Stims are touted as the gold standard for ADHD treatment. People fall into this belief that it is a life changer and answer to all their problems and in that lies a great danger. I work with one of the national leading figures on ADHD and she emphasizes the same, there's a place for stims but people under utilize non-pharm approaches grossly. Oh yea, forgot to add another stim story from this week. Tried methylphenidate for antidepressant augmentation in a 68 yo woman, history of opiate use disorder after she begged for stims but also legitimately had failed trials of multiple antidepressants and augmentation. Guess what? She took the entire month supply in a few days. --> discharge. I feel very torn about this whole stimulant thing. On the one hand, I don't want to be dismissive but these type of experiences keep propping up and pts need to take some ownership too and start being big boys and girls. I think most are smart enough that if they wanted to be truly insightful, they at least can in some degree see it for what it really is, but many decide not to and keep their hopes up for that pill solution/fix.
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My roommate in medical school was legitimately nonfunctional without stimulants, but on them was a powerhouse- for a guy like him they're perfect. But for people that just need a touch of focus or just, God forbid, bored with their work or their lives, stims aren't the answer
 
Doc1401 said:
What is concerning is that a lot of students with “ADHD” are on adderall, get straight A’s, and are on the road to being admitted to top universities. Imagine inheriting such a patient and stopping his or her script.
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No different than the LOL who's been on a BZD for a gazillion years. People are emotionally attached to medication and education won't break it. Just hurting their feelings is the only way to stop.
 
Shikima said:
No different than the LOL who's been on a BZD for a gazillion years. People are emotionally attached to medication and education won't break it. Just hurting their feelings is the only way to stop.
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Apparently neither will falls, heart attacks and severe HTN..."but doc, I feel so much better!"

Then I ask them the question if they feel better after a beer. If so, by that same logic they should take at least one beer tid prn...
 
What do you guys know about long term cardiac risk with adults taking them? I realize that it’s s problem if they are raising BP or pulse but what if they’re not.
 
So, I have a new consult on deck today, who knows where she's coming from. 73 yr old LOL. cc memory problems. Meds reported, Xanax TID, Adderall TID, Norco PRN, and Cymbalta BID. fml.. I don't get paid enough.
 
Shikima said:
So, I have a new consult on deck today, who knows where she's coming from. 73 yr old LOL. cc memory problems. Meds reported, Xanax TID, Adderall TID, Norco PRN, and Cymbalta BID. fml.. I don't get paid enough.
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What, no Benadryl/trazadone/ambien combo for sleep problems?
 
Shikima said:
So, I have a new consult on deck today, who knows where she's coming from. 73 yr old LOL. cc memory problems. Meds reported, Xanax TID, Adderall TID, Norco PRN, and Cymbalta BID. fml.. I don't get paid enough.
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Is this prescribed by a pcp or psychiatrist?
 
Shikima said:
So, I have a new consult on deck today, who knows where she's coming from. 73 yr old LOL. cc memory problems. Meds reported, Xanax TID, Adderall TID, Norco PRN, and Cymbalta BID. fml.. I don't get paid enough.
Click to expand...
What is she doing on the day-to-day that necessitates Adderall? Gotta be on point for bingo night and bridge tournaments?
 
Hopefully the docu cuts down demand for stims...seems like they found mostly annoying people who use stims to enhance their attention on themselves. Self absorbed attention disorder.


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