My father got his M.D. in 1930; I got mine in 1958. Insulin and penicillin came into being during his early years of practice. In my first years as a psychiatrist, tranquilizers and antidepressants changed the landscape of mental health. As doctors, Dad and I both welcomed Medicare in 1965; later on as patients we became grateful beneficiaries.
I remember him explaining “ethical pharmaceuticals” — a term that distinguished companies like Merck from hucksters of “patent medicines.” The scandal at Merck about the arthritis drug Vioxx came after his time — he would have been appalled.
Recently the line between ethical drug companies and hucksters was blurred by GlaxoSmithKline, which paid a record fine for its bad acts. Until this Glaxo case, drug firms took fines and some bad publicity in stride as a cost of business; now the companies and Wall Street are getting a new message.
Medicine is a profession — a calling, not a business. In Dad’s lifetime it was unethical for doctors, hospitals and pharmaceutical companies to advertise. Now it is legal, and presumably ethical, to peddle prescription drugs to patients who get doctors to swing at the advertiser’s pitch. Doctors earn much more for prescribing, testing and treating than for explaining. Insurance pays for the expensive drug. How many doctors will take the time to suggest a cheaper generic drug with an excellent track record?
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Great article! How easy it is to just pop a pill and think everything will be solved – not to mention all the other problems it may cause. You are exactly right the business of medicine is dependent upon drug companies – for advertising and indirectly for research. There are wonderful lifesaving drugs but there is also a time and place for a good detailed talk with your doctor.
I’m familiar with this list of complaints, they are mine as well. However, do you have any viable solutions? Being more involved in the system, I’m hoping you’ve got some idea what we can do to get things back to pre-Reagan regulation.
Great Article! First of all, I propose that therapy be well compensated by medicare and private insurance companies. With most antidepressants and other psych meds costing hundreds of dollars a month (even some generics!), effective talk therapy is much more cost-effective the long-run. CBT for example, has been show to have long-lasting effects on depression, whereas the effects of medication, only last while one is taking them. Plus, many many people on antidepressants would benefit more from a short-course of psychotherapy, then from years of medications.
Secondly, DTC advertising has got to go and the FDA has to start doing it’s job instead of constantly folding to drug companies and well-meaning patient advocacy groups. I personally, would consider any drug that’s been approved for less than 7 or 8 years “experimental” and would only take them if there were no other option. Because, the FDA is so useless in my opinion that we have to wait until independent efficacy and safety studies come out. For example, drug companies can’t just “hide” studies that show drugs are dangerous.
Lastly, primary care physicians should NOT be allowed to prescribe antipsychotics and mood stabilizers without substantial psychiatric oversight. If the patient needs those medications, they should really be seeing a psychiatrist.
After the death of two of my children who died together in an accident, i was visiting my regular doctor for something unrelated. He without hesitation or discussion took out his pad and started to write a script for anti depressants;after commenting to me I looked depressed. I was shocked and dismayed that i should have to explain to an MD who knew I were seeing a qualified therapist for both the trauma/grief that his mere observation that “i looked depressed” hardly qualifies as a reason to put me on those types of medications. You’re correct Americans have a weakness for the pill, the quick fix, some times however you just have to speak up. When i asked him why he wanted to medicate my sadness- my grief (which is natural) he stopped writing- backed right off.
I think this is a *little* oversimplified and glib.
Take ED, for example. It is *itself* a cultural trope to be dismissive of the condition or those who suffer from it, rather than taking it seriously and approaching it the way we would other distressing conditions.
What do actual studies say about the efficacy of psychological treatment for ED? What *are* the appropriate evidence-based treatments for ED, then? What is it ethical to recommend the patient do, based on likely prognosis? How many months or years should they try psychological treatment, before at least trying medication management? I would suggest that these are the appropriate questions.
Funny, as I clicked on this article and began reading it, the “depression hurts” ad came on the TV. I couldn’t agree more with the pulse of this article.
My story is long. The jest of it is that I met a girl over a decade ago. I now believe she at least had what I have come to understand as “borderline” traits. Through undaunted years of patience and respect, I watched as this “girl” grew into a beautiful “woman”. I never understood the anxiety that still remained. The behaviors became healthier, but the uneasiness seems to have still been there. Even after a decade.
The point. You can’t figure out whether an antidepressant is adequate, let alone safe, for a patient in 5 min visit with a GP. 6 months after having our child, my now ex’s doctor did just that. I slowly saw the return of all those old traits and behaviors. As a new father, I was not as equipped with the patients and security to deal with my wife that I was at the onset of our relationship. In the middle of the storm I didn’t see what was happening. The changes happened over night. Everything listed under the “manic behavior” umbrella developed seemingly over night. I was so set back when I actually read the prescribing pamphlet and saw how the doctor had just ignored all the protocols and warning. I was amazed at how they protected their “treatment” like it was holy sacrament. Alls I can say is that something wiped out my wife’s entire “super-ego” and thus no more anxiety. Yet I was made to feel like the “crazy one”. My GP even recommended I take an AD.
I would definitely agree with your viewpoint towards this topic. Too many people are getting hurt from the side effects that drug companies are failing to include in their advertisements. Along with that it is hurting the relationship between doctors and patients because someone will see a medicine advertised that they believe is the perfect medicine for them. When patients go to see their doctors with certain drugs in mind it puts pressure on that doctor to give them what they want. Harsher policies must be enforced by the government.