September 5, 2008

Undue Influence On Psychiatrists, Or The Public?

This is an example of why the controversy over Pharma influence on doctors is, while accurate, likely irrelevant.

In Psychiatric Times, the Time Magazine of psychiatry, there appears a powerful juxtaposition of stories that was likely not appreciated by the editor.

The first story, "Vermont Psychiatrists Unduly Influenced" says what it looks like it would say.  The attorney general finds that Pfizer, Lilly, etc spent $3M on marketing to doctors, a 33% increase over last year. 

The second story is literally in the next column. "30% [of Americans] Have Received [Psychiatric] Treatment"  especially people in their 20s-30s.  Furthermore, the article notes there are still significant barriers to treatment-- so more people would have gone if they could.

Doctors are being paid to write these meds?  Wait-- what, exactly, are they being paid to do?  Write Zyprexa instead of Geodon, not with Geodon.  And only to the people who show up in their offices.   Right?  These marketing efforts should result in skewed prescribing, but not more prescribing.  In theory, the best Pharma can do is get everyone who shows up on meds. 

The problem, bluntly, isn't that Pharma is getting docs to write prescriptions.  The problem is that our beloved country is going completely insane.  The supply of pills isn't the issue, the issue is the demand for them-- for anything, for relief.

At some point, someone needs to stop asking why docs are writing Zyprexa, and ask why people are rushing to psychiatrists.  Did the gene for bipolar suddenly get activated by a viral pandemic?  Or are there social reasons for this?

As if to further support my premise, the next article immediately below that one is "Drugs Easy To Get Online," saying that people are getting pills from online pharmacies without prescriptions.  People want the meds, not even because they work, but simply because they are hope, they are a chance.

These meds are the wrong solution for what are largely social/economic/family problems.  However, not only are there no other solutions; not only is no one even suggesting that these are social problems; current policy is to label these social ills as psychiatric.

I get it, it buys you about a generation.  But not much more time than that.


as i like to say...depressi... (Below threshold)

September 5, 2008 11:04 AM | Posted by the0ther: | Reply

as i like to say...depression happens for a reason. i know it's simplistic but maybe not as much as people would claim.

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3 words: Direct to Consumer... (Below threshold)

September 5, 2008 11:59 AM | Posted by nokommonsense: | Reply

3 words: Direct to Consumer Marketing
("to" doesnt count)

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That's freedom, baby. If pe... (Below threshold)

September 5, 2008 1:01 PM | Posted by Joseph Bergevin: | Reply

That's freedom, baby. If people want to run up their credit cards or cheat on their spouse, it's because they find it rewarding, and that's their call. Psychiatry is just one of many diversions we have on the table.

I don't see it as a bad thing, either. If there are fewer scattered, dysphoric people in the world, what's the panic? There are worse coping mechanisms, and you can't expect people to change in the absence of an impetus.

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"People want the meds, not ... (Below threshold)

September 5, 2008 1:35 PM | Posted by Dave: | Reply

"People want the meds, not even because they work, but simply because they are hope, they are a chance." And because they can use the benzo's and the pain pills and the seroquel's addictively. It's a shame we don't have statistics on how many people used the original coca cola formulation "medicinally." We like the quick fix. It may be human nature ... it certainly is embedded in the american psyche and psychiatrists, for the most part, are unquestioningly enthusiastic and enabling cheerleaders in this process, god bless 'em.

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I'm used to the popular rul... (Below threshold)

September 5, 2008 6:49 PM | Posted by spriteless: | Reply

I'm used to the popular rulers selling out the generation of citizens that can't speak out yet, but selling out their own future generation to the rioters, that's rich.

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Two reasons, I think:... (Below threshold)

September 6, 2008 6:51 PM | Posted by Anonymous: | Reply

Two reasons, I think:

1. Greater awareness. For example, before bipolar II was widely recognized, many people struggled with its effects silently. I count myself and several family members (including some in the generations before me) in this group.

2. "Canaries in the coal mine." As you say, social conditions. Increased economic uncertainty, decreased social supports. These affect the adults, but they can also affect their children, which has more long-range effects, especially on those with genetic vulnerabilities.

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If it's true that the presc... (Below threshold)

September 6, 2008 10:00 PM | Posted by Anonymous: | Reply

If it's true that the prescriptions for psych meds are all about patient demand, then that doesn't say much for psychiatrists. Are they incapable of saying the word "no." The docs are the ones handing out all the bipolar diagnoses & writing all the prescriptions, so how about if the patient doesn't need meds then don't prescribe them.

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Wow! How about the money th... (Below threshold)

September 7, 2008 11:11 AM | Posted by ZenBit: | Reply

Wow! How about the money that drug companies spend marketing to people on primetime to say exactly this -- "Have a problem? We have a solution - take a pill!"

So you take all these innocent pharma people (what is it now? a several billion dollar a year business?) and you take the pushers that are also high income and well educated... and you place NO responsibility on them... but rather blame the young 20 and 30 somethings who are trying to find someone that they can trust to help them through...

I agree that there are serious social issues, but the record profits and big business of pharma is a right there in the mix.

I am old enough to remember a time when people COULD trust their doctors. What a quaint memory that is turning out to be.

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I'd agree that marketing to... (Below threshold)

September 7, 2008 1:10 PM | Posted by SusanC: | Reply

I'd agree that marketing to consumers is an even bigger problem than marketing to doctors.

Here in the UK, it isn't permitted to advertise prescription drugs directly to consumers. And yet, by by various indirect channels, large numbers of people have been lead to believe that (a) their problems are of biological origin and (b) pharmaceuticals can help.

Some psychiatric patients are forcibly treated, and NHS patients sometimes don't got a lot of choice in who treats them, but still, patients often have a certain amount of choice in their psychiatrist. If they think doctor A isn't helping, they can go to doctor B. If doctor A is in private practise and finds himself with no patients, he has a serious financial problem. In some ways, it's a good thing that if doctor A's former patients nearly unanimously agree he's incompetent, he runs the risk of going out of business even before the General Medical Council gets on to his case. But the downside is that doctors are under a certain amount of pressure to prescribe what their patients want, in order to keep their business. (With the check against it being that the GMC will take away their license to practise if their prescribing is too blantantly bogus.)

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I agree. People walk in wi... (Below threshold)

September 7, 2008 5:59 PM | Posted by Novalis: | Reply

I agree. People walk in with totally unreasonable expectations for psychotropic medications; this even spreads to non-psychiatrist physicians and therapists. It's hard sometimes to have to tell referring internists or psychologists that, well, antidepressants are only moderately effective at best and have sometimes miserable side effects.

And yet is it really helpful to tell people up front, as Rilke wrote, "You must change your life?" How many people are prepared to take that on? Six or eight med trials later they may be. There is also the possibility, that a surprising number of patients bring up themselves, that contemporary culture is literally making us crazy. Whether patient or psychiatrist, you try what's at hand, whether it's medication or existential choice, and time will tell...

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The placebo effect is a pow... (Below threshold)

September 8, 2008 4:55 AM | Posted by SusanC: | Reply

The placebo effect is a powerful thing, and I sometimes the meds act as something the patient can blame for the changes they need to make to their life.

Suppose, for example, a study participant reports that they became gay within a few weeks of starting a course of medication. They came out to their circle of homophobic Christian friends, had the inevitable argument, decided to find some better friends, got in a relationship with another guy, etc.

Completely naively, you might start looking at the data to see if the drug causes homosexuality in some biochemical way. There are a number of reasons to doubt this hypothesis, not the least of which being that other study participants don't report it. Alternatively, you could suspect the participant was suffering anhedonia, and the drug caused a resumption of interest in sex (in his case, gay sex), rather than a switch in orientation per se. Or, even more plausibly, that the participant just needed some sort of excuse to come out.

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Psychiatrists have to give ... (Below threshold)

September 8, 2008 9:56 AM | Posted by Anonymous: | Reply

Psychiatrists have to give out all these drugs. They need to be able to pretend like they're doing something so the patient will come back.

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It's dishonest not to give ... (Below threshold)

October 11, 2008 9:01 PM | Posted by bipolar2: | Reply

It's dishonest not to give credit to Wittgenstein for his last proposition in the Tractatus used in your title banner.

In any case, as soon as I saw it unattributed I knew that you were untrustworthy. No need to read further.

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interesting post, thanks fo... (Below threshold)

October 13, 2008 10:46 AM | Posted by Chicken Recipes: | Reply

interesting post, thanks for sharing

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I have a quick question abo... (Below threshold)

June 1, 2012 11:44 AM | Posted by Mr. Brown: | Reply

I have a quick question about marketing to doctors. You say that Big Pharma's advertising can only change which brand of drug a doctor prescribes, not the total amount of prescriptions. However, why is not it possible that these advertisements are further propagating and reinforcing the concept of drug therapy and treatment rather than prevention/maintenance? Thus, Pharma's marketing drives the flawed paradigm upheld by academia.

Perhaps by reducing these ads we might reduce the use of our current doctors one-track mind attitude towards drug treatment.

What reminded me was in one of your previous posts you talk about how every we do and think possibly creates unconscious associations which influence our future decisions. Doesn't this apply to marketing for doctors? I know some people might consider it a stretch, but considering your marketing post, (the car ad tells us what an attractive woman is). Then the drug ads tell the doctors not what drug to use, but what medical paradigm to use, aka drug therapy, and thus increasing total prescriptions.

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