The drug industry's not so subtle influence on mental healthcare for children

[GiantSteps]

Everyone should read this article which was on the from page of the NYTimes today (5/10/2007).

http://www.nytimes.com/2007/05/10/health/10psyche.html?hp

Psychiatrists are being influenced by the drug industry, according to the article, not only to prescibe certain psychiatric medications for children but to make atypical prescriptions (antipsychotics for an eating disorder) which put the clients at risk for other problems. Also, possibly, diagnosing children
with disorders which fit the medication being pushed by the company.

"In Minnesota, psychiatrists collected more money from drug makers from 2000 to 2005 than doctors in any other specialty. Total payments to individual psychiatrists ranged from $51 to more than $689,000, with a median of $1,750. Since the records are incomplete, these figures probably underestimate doctors’ actual incomes."

So for those of you who are worried about money (a topic which comes up frequently on the SDN Psychology section) just get certified in one of teh states (which appears to be growing) which allows psychologists to prescribe medications. You can then pay back your graduate school loans, live comfortably, and use the left over money to take a course on the philosophy of ethics/morality at you local university.

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[Ollie123]

Is that actual cash or value of items?

I was under the impression it was illegal for a drug rep to flat out write a check to a doctor - at least directly - though I imagine donating money to the practice would be okay.

I find it kind of disgusting the power pharmaceutical companies have these days. I'm particularly disgusted by the relatively new straight-to-consumer marketing of psychiatric meds. That seems unnecessary.

 

[ny1020]

That article reminded me of a story not too long ago of a 4 year old who had died due to an overdose of medications prescribed to her to treat her bipolar disorder.

http://www.usatoday.com/news/health/2007-03-23-drugged-to-death_N.htm

She was on a combination of 4 medications.

 

[yikes]

just because a dr. lets a drug rep pay for dinner it doesn't mean that they then perscribe only that rep's medication. if the dr. is ethical it should make no difference.

 

[JockNerd]

just because a dr. lets a drug rep pay for dinner it doesn't mean that they then perscribe only that rep's medication. if the dr. is ethical it should make no difference.

And I have pet unicorns. 'course it makes a difference.

Did anyone ever see the HILARIOUS Colbert Report bit on this? They interviewed a former NFL Cheerfleader who was the drug rep....

 

[paramour]

just because a dr. lets a drug rep pay for dinner it doesn't mean that they then perscribe only that rep's medication. if the dr. is ethical it should make no difference.

Key world = should

Yet they do it all the time. I've "fired" 3 docs because they were on the drug reps' bandwagon and attempted to force me on whatever the newest and greatest drug that was given to 'em by some overzealous rep every single time I went in . . . regardless of whether I met the symptoms that wonder drug was supposed to help. Two of those drugs have been recalled by the FDA due to major health problems resulting in users who took them (i.e., lots of lawsuits!!)--And, as a side note, I know one of those docs that still gets samples of a recalled drug from the rep.

And people wonder why I refuse to go to the doctor. :|

 

[paramour]

That article reminded me of a story not too long ago of a 4 year old who had died due to an overdose of medications prescribed to her to treat her bipolar disorder.

http://www.usatoday.com/news/health/2007-03-23-drugged-to-death_N.htm

She was on a combination of 4 medications.

I'm not even going to get into the physician's role in all of this, but why does no one ever seem to criticize the PARENTS who were using the drugs to shut their kids up?? They were overdosing the kids themselves with more meds than a regular dose should consist of, yet more people always blame the doctor rather than the parents.

EDITED to add: I do realize that the parents are on trial--and this particular article mentions as much. But, there are various articles circulating (some of which do not mention the trial) and usually the individuals posting it start harping on the doctor, pharmacist, etc.

 

[ny1020]

I'm with paramour on this. I've been following this story and it infuriates me that the parents are blaming only the doctor for this. As if they didn't know that their kid was acting like a zombie or a "limp doll?" As patients, we have to be aware of everything that we are prescribed, and what we give our kids.

Back to the OP's post - I went to the gyno a couple of years ago and wanted a refill on a birth control method that was working, that I had been on for one year, and I had no complaints about. Suddenly, the doctor shoves three sample packs in my hands, tells me to try them, and writes a prescription for them for one year. My original brand is still a standard in the industry. So what reason does my doctor have to suddenly switch me? I was immediately sketched out and changed doctors.

But these standards are permeating and I don't think most people give it much thought. I was raised to trust doctors because they knew more than me. Now I consider my health my responsibility and to question everything.

 

[Ollie123]

What's sad is that those of us who question doctors are the vast minority.

I had to see one yesterday actually, and they were shocked that I had even a BASIC understanding of what was wrong with me and that I suggested what the problem was before they could even say it. They asked if I'd had this problem before, and when I told them no, they asked if I was a medical student Nope.......just a literate person who knows how to use google and screen out the crap from the facts on webpages...

This doctor is also big on pushing narcotics for god knows what reason (most docs are hesitant, even in these drug rep days). The PAs keep trying to push Oxycontin, Lortab, and now Darvocet on me.

They don't seem to wrap their brains around the fact that I'm still at the stage where taking 2 Tylenol is unnecessary....1 does the trick. And next time I go in I'm half-expecting a morphine drip to be waiting for me!

It makes me wonder how reliant our society is on drugs these days. Why on earth would I want to be in a fog all day when I can take an Ibuprofen and be fine?

And I agree about the whole parents issue. The "Its not my fault" culture these days sickens me. How anyone can blame a doctor for parents doubling the dosage without his knowledge is beyond my comprehension. People won't take any responsibility for their own actions anymore.

 

[amy203]

An oldie but goody:

Avorn, J., Chen, M., Hartley, R. (1982). Scientific versus commercial sources of influence on the prescribing behavior of physicians. The American Journal of Medicine, 73, 4-8.

The authors asked a group of doctors about commonly prescribed drugs for which messages about efficacy differed substantially between commercial sources and scientific sources. For instance, most scientific studies show that propoxyphene analgesics (a type of pain killer) are no more effective than aspirin, but, of course, the companies that manufacture these drugs say otherwise. When the doctors were asked whether the analgesics were more effective than aspirin, close to %50 said yes. Of course, when asked whether they were influenced by commercial sources, the majority of the doctors said no...

This study has been around for over a decade now and there are many others like it. I think doctor's still assume that something about them (their intelligence, their level of education?) makes them immune to advertising, when we know this just isn't the case.

If they could come up with a convincing argument that the practice of pharmaceutical detailing somehow helps patients, I might be willing to listen, but they don't even seem to try. I’d like to think there’s a better reason than greed, but I can’t come up with one.

 

[yikes]

It is really best to switch doctors if you are unhappy with the care you are receiving or at least mention problems (like the drug pushing) to them. There are a lot of bad docs out there, but there are also lots of good ones. Sometimes it just takes a few tries to find the right fit. Plus it will certainly get a lot more done than complaining on a psychology grad school board...

 

[yikes]

Sorry that was a bit off topic.

 

[Ollie123]

Actually I'm quite happy with my doctor overall as he is one of the top surgeons in his field in this area. I should have said that its his PAs and nurses that are the problem, but if I can get around that by just not filling the prescriptions they insist I take, I'll gladly do that so I can have this guy operating on me.

And for the record, wasn't trying to complain, just mentioning it because its relevant to the discussion at hand and I find it interesting.

 

[Therapist4Chnge]

Psychiatrists are being influenced by the drug industry, according to the article, not only to prescibe certain psychiatric medications for children but to make atypical prescriptions (antipsychotics for an eating disorder) which put the clients at risk for other problems.

People get influenced by advertising and marketing....that is why companies spend BILLIONS of dollars on it every year. It is something to be aware of, but it isn't something we can just stop.

I think atypicals (IMHO) have a place in ED treatment. There is a higher rate of comorbidity for bipolar in the ED population, so it can seem like a nice fit. Stabilizing mood, anti-depressant effects, possible/probable weight gain, etc. That being said, there are other considerations that are especially problematic for the low-weight pts, in addition to the children/adolescents. Dealing with EDs is definitely a specialty area, and unless the prescriber works SPECIFICALLY with the population on a regular basis, I'd be pretty wary of what they prescribe. It is my own bias, but I've seen so many scary combinations of meds for the at risk populations listed above.

Should kids/adolescents be on an anti-psychotic......I'm not sure. I probably wouldn't want it as a FIRST choice, but sometimes that is the best choice for the pt. I'm not going to throw all of the prescribers under the bus (because I"ve seen them work wonders), but the article definitely raises some issues. I'd hope the prescriber doesn't see every problem as a nail and reach for the Abilify/Risperdal Hammer without consideration for other solutions.

So for those of you who are worried about money (a topic which comes up frequently on the SDN Psychology section) just get certified in one of teh states (which appears to be growing) which allows psychologists to prescribe medications. You can then pay back your graduate school loans, live comfortably, and use the left over money to take a course on the philosophy of ethics/morality at you local university.

Ethics/Morality training would be valuable for everyone!

For as much as I support RxP....I'd rather not have everyone go for the training....both for quality and competitive reasons.

-t

 

[ny1020]

It is really best to switch doctors if you are unhappy with the care you are receiving or at least mention problems (like the drug pushing) to them. There are a lot of bad docs out there, but there are also lots of good ones. Sometimes it just takes a few tries to find the right fit. Plus it will certainly get a lot more done than complaining on a psychology grad school board...

Didn't want to sound like I was complaining, either. I have great doctors who I found after a little trial and error. My point was that the drug pushing is everywhere, well beyong the mental health field.

 

[psychanon]

Thanks for posting this article. It was very interesting. I am sure that it does not stop at children, too-- pills are pushed just as much in adults.

What always strikes me is that articles such as these rarely mention talk therapy as an alternative. There are empirically supported efficacious psychotherapies for many of these clinical problems. These psychiatrists act as if they had no option but to give them some kind of Rx-- so why not an antipsychotic? This is one of my pet peeves. I have known/treated people before who have been told by their physicians that the only cure for their panic disorder was daily doses of barbiturates. Panic, of all things-- psychosocial treatments for panic are about the easiest and most effective out there!

 

[Therapist4Chnge]

There are some things where meds will need to be the primary (at least at first)....but therapy is too frequently ignored. I think people are looking for the "Magic Bullet" and would rather not have to work for it.

-t

 

[paramour]

Didn't want to sound like I was complaining, either. I have great doctors who I found after a little trial and error. My point was that the drug pushing is everywhere, well beyong the mental health field.

Ditto.

And, even more amazing is that anti-depressants and the like seem to be the latest & greatest for even the general/family docs to "push" on their patients. I don't know how many times I've had to quite adamantly refuse to take free samples or prescriptions for whatever the drug reps have given them last. Nevermind I'm not depressed nor have any problems that they would help . . . although the dear doc sure did try to make me think they would--I suspect he was aggravated with me when I started mentioning the actual reason one would take said drug and all the side effects associated with it that I did not need simply because he wanted to get rid of his nifty new samples so he could get more.

And, yes, I have done more than simply complain about the docs on an online student board. I no longer go to him. Or two others who have done the same thing. Otherwise, I stay away from all docs unless absolutely needed because I seem to have crappy luck with them in my area.

Pushing drugs is not limited to the mental health profession alone, and simply because it's a drug that most would associate with the mental health profession does not mean that it's the mental health professionals doing the pushing.

 

[paramour]

Thanks for posting this article. It was very interesting. I am sure that it does not stop at children, too-- pills are pushed just as much in adults.

What always strikes me is that articles such as these rarely mention talk therapy as an alternative. There are empirically supported efficacious psychotherapies for many of these clinical problems. These psychiatrists act as if they had no option but to give them some kind of Rx-- so why not an antipsychotic? This is one of my pet peeves. I have known/treated people before who have been told by their physicians that the only cure for their panic disorder was daily doses of barbiturates. Panic, of all things-- psychosocial treatments for panic are about the easiest and most effective out there!

There are some things where meds will need to be the primary (at least at first)....but therapy is too frequently ignored. I think people are looking for the "Magic Bullet" and would rather not have to work for it.

-t

Of course, the docs are going to tell them "take this magic bullet" to cure all your mental ailments. After all, they then don't have to refer them OUT OF THEIR CARE into another professionals, and they continue to receive the money for said patients' care when they have to return for a follow-up and new meds.

 

[Ollie123]

To be fair, I can't completely blame docs for assuming people would rather take a pill.

Humans are by and large, a lazy, worthless bunch (I should be a motivational speaker ).
PCPs constantly have people in their office for things like "I scraped my knee, can I have some morphine? " "My boyfriend broke up with me, can you pump me so full of drugs I won't remember the past 2 years?" "I was in a car accident 2 years ago and now my neck hurts, can you fill out this disability form?" That last one is, of course, being said to a resident that has been in the hospital for the past 36573 hours, is sick as a dog, hasn't eaten, etc.

I still don't think its right, but I also find it hard to really blame them if they start assuming all patients are looking for the easy way out. Which brings us back to the point of why its important for patients to take an active role in understanding their illness/treatment.

 

[paramour]

To be fair, I can't completely blame docs for assuming people would rather take a pill.

Humans are by and large, a lazy, worthless bunch (I should be a motivational speaker ).
PCPs constantly have people in their office for things like "I scraped my knee, can I have some morphine? " "My boyfriend broke up with me, can you pump me so full of drugs I won't remember the past 2 years?" "I was in a car accident 2 years ago and now my neck hurts, can you fill out this disability form?" That last one is, of course, being said to a resident that has been in the hospital for the past 36573 hours, is sick as a dog, hasn't eaten, etc.

I still don't think its right, but I also find it hard to really blame them if they start assuming all patients are looking for the easy way out. Which brings us back to the point of why its important for patients to take an active role in understanding their illness/treatment.

Good point--Today it seems that many people seem to think the good docs aren't doing their job unless they walk out loaded up with meds. However, this shouldn't lead them (docs) to think that everyone wants a bottle of darvocet every time she walks in the door.

 

[GiantSteps]

I just heard tonight on NPR that the author of the article I posted in the NYtimes has been running a series of articles this week on the influece of the drug industustry on physicians. So look for much more on this.

Did everyone notice in the article how the Mayo Clinic (the finest hospital in the world) specifically bans it's doctors from accepting speaking money from pharmaceutical companies and was also the hospital which took the girl with the eating disorder problem off the anti-psychotic meds? Perhaps if the Mayo Clinic is doing this, the vast majority of doctors, who could only dream of working at teh Mayo Clinic, should follow their lead.

Now about my old doctor. I used to go to a medical practice at which I saw two different doctors - a male and a female. I usually only need to go to the doctor for soar throats/ flu like symptoms. However, whenever I got the female she always wanted to do a rectal exam and a testicular exam! I usually told her the testicular was not necessary )she did not give me the choice for the rectal (Ay Carumba!) . When I mentioned this story to my friend and he learned that the doctor was young and attractive, he suggested that I call back up to say that I had reconsidered! He asked for the doctors name himself for a referal. I decided it was unwise to run the risk of associating through conditioning: a strep throat, a doctors office, a pretty doctor, and a sexually arousing touch. Since then I have switched to a more conventional doctor who just looks in my throat and ears when I feel sick.

 

[GiantSteps]

Here is the first article which appeared in the NY Times on the drug industry and doctors.
http://www.nytimes.com/2007/05/09/business/09anemia.html?_r=1&oref=slogin

"Federal laws bar drug companies from paying doctors to prescribe medicines that are given in pill form and purchased by patients from pharmacies. But companies can rebate part of the price that doctors pay for drugs, like the anemia medicines, which they dispense in their offices as part of treatment. The anemia drugs are injected or given intravenously in physicians' offices or dialysis centers. Doctors receive the rebates after they buy the drugs from the companies. But they also receive reimbursement from Medicare or private insurers for the drugs, often at a markup over the doctors' purchase price." - NY Times.

This is getting a great deal of press since Congress is starting hearing this week on the issue mainly with cancer and anemia drugs.

http://www.nytimes.com/2007/05/11/health/11anemia.html?ref=health

 

[ny1020]

Thanks for the articles, GiantSteps. It's good to know that there are consequences. A drop in stock prices might not be a big blow, but it does hit them where it hurts. And to think that Medicare is paying the doctors even more than the docs are spending!