Vyazma-MacGeyver, as you have shown there are numerous factors contributing to the increase.
However special care must be given when analyzing statistical data which shows a huge 100%-250% increase over a decade.
This overwhelmingly points to some specific factor. I'm not sure what that factor is-I'm guessing aggressive marketing through
all facets by Big Pharma.
To me this only adds more support to the idea that many factors are involved. The more forces there are pushing usage in one direction the faster the increase would be. The hard thing is determining exactly how much of a role each factor plays.
I don't think so. Some of the other points you mentioned may not contribute as much as you would like to think.
If anything has caused this openess, the bombardment of TV ads has to be high up on the list.
Secondly, especially when a Family MD can prescribe these meds, I think that has the openess built right in.
It helps to remove any stigma the patient may feel versus going to a psychiatrist.
People have been asking their doctors for the meds they want for along time. Pre 2000 for example.
Valiums, Barbituates, Lithium, Amphetemines etc etc...It's nothing new.
The only thing relatively new is the TV ads. And the increase in paid lectures by doctors. The amount of money that Pharma is spending on
marketing. Perhaps due to a supposed dearth in new drugs which happened to correlate to this time frame.
Connected to this perhaps is that some sources point out that marketing takes up far more budget than does R&D in Big Pharma now.
MacGeyver-My problem with these articles is that they accidentally or intentionally provide no perspective. i suspect its intentional because sensationalized articles sell and there is lots of evidence that the media does this every day. The article talks about a couple hundred doctors who are doing this but doesn't tell you how many are not and doesn't even interview doctors who are not involved to assess the opinion of the general medical profession so a reader would understandably come away form such a story as you did with the idea that this is business as usual, most doctors do this stuff with a wink and a handshake, and we are all perfectly fine with it. I dont think thats even close to the truth. they took a small number of doctors and try to make it look like they are representative of the whole profession because it will raise ire and eyebrows among their readers if they present it that way. Thats what I mean by sensationalized.
It provides plenty of perspective. When an article reports on anything else good or bad, it doesn't list the percentage of people not engaging in that act.
The perspective in this case is the money. That provides plenty of perspective.
And the article doesn't even mention how many doctors attend these "lectures". Which I have pointed out already would be far more telling.
That would provide much more perspective.
Your just biased. The same way I would be biased if I saw an article that was written that made truck drivers look bad. And there's plenty of those believe me.
I’d like to add to Mac’s response another reason. The crappy state of mental health insurance in the US. Even if you have medical coverage, you may not have coverage for mental health issues, or if it is, it can be pretty crappy. Even as a nurse, my insurance for any psych issues is pretty minimal. Luckily, I’ve never had to use it.
As far as going to conferences–just because we go to conferences (I try to go to at least one a year), I don’t buy everything they are selling hook line and sinker. There is a lot of stuff I think is just BS, and some things presented are just too new to know if they will pan out as a viable treatment. The conferences I attend are also attended by physicians in my field, and I know they feel the same way.
There is a lot of stuff I think is just BS, and some things presented are just too new to know if they will pan out as a viable treatment. The conferences I attend are also attended by physicians in my field, and I know they feel the same way.
What does poor health insurance have to do with this?
The amount of people on psychotropic drugs has doubled and nearly tripled in some demographics. Somebody's paying for this stuff.
At best your describing an almost Orwellian scenario where the hapless and lower income are put on drugs....by doctors!!
4 out 5 prescriptions coming from GPs with no mental health or psychiatry training!
I'm glad you and your colleagues are immune to the Pharma Marketing machine Asanta. That's a nice little anecdote.
The number of those marketing meetings has increased from 120,000 in 1998 to 371,000 in 2004.
While the numbers are hard to calculate various sources all easily agree that the amount spent on marketing is in the 10's of billions of dollars.
So given the startling increase in prescriptions and those figures, it's pretty easy to see that not everybody is immune to those marketing meetings.
I know I probably wouldn't be immune. Let's say I'm an ENT. 15% of the people coming in my office want ear drops and Prozac.
Oh gosh what do I do? I'm not trained for that. Oh the marketing meeting said get 'em out the door quicker with Prozac.
Yes, get quicker patient turnover times with New Zoloft. Quicker turnover is more money.
And hell I'm an ENT. What do I know about mental disorders?
Americans spent $34 Billion on mental health drugs in 2010.
Between 2005 and 2011 the military has increased its psychotropic drug use 700%.
Your anecdotal references are downright crude in light of the data Asanta.
Crude. As in simply made or fashioned from cheap materials.
In your world, there is some sort of conspiracy because heart transplant surgeries have also increased by at least 1000% over the past 30 years. Oops, it’s because we have better methods of transplantation and better medications to prevent rejection. We also have better treatments for heart failure.
Not saying I’m ‘immune’, just saying that most of us attending those conferences run the presentations through a filter. Why would you think doctors and nurses are so special (or gullible) that we fall for anything presented, when you probably don’t think the same for conferences for other professions.
I started this thread to have a discussion about the massive increase in psychotropic drug use.
Pretty sound subject. Lot’s of data. Lot’s of question marks.
I’m not talking about heart transplants. Where did I mention a conspiracy?
In a discussion like this you don’t think doctors would be a key subject?
Asanta-Why would you think doctors and nurses are so special (or gullible) that we fall for anything presented, when you probably don’t think the same for conferences for other professions.
Where did I say they were special? I certainly ain't talking about nurses anyways. Unless nurses can prescribe psychotropic drugs too?
Is that the case? Can you prescribe psychotropic drugs too Asanta?
In a discussion about the medical community and the apparent over prescription of drugs, do you really think doctors should not be a part of the discussion? Is that what you are suggesting?
Where did I say anything about doctors being gullible or "falling for anything"? Don't put words in my mouth!
If you can't discuss this rationally without resorting to falsities and anecdote please refrain from the discussion.
I get it your a proud medical profession worker. Toot away! Good god.
Why would you think doctors and nurses are so special (or gullible) that we fall for anything presented, when you probably don't think the same for conferences for other professions.
You know I'm going to give this BS statement even further scrutiny.
No I don't think anybody's gullible or susceptible to any abnormally high degree of suggestion or "trickery" at a conference or "marketing meeting".
That includes any and all professions, trades or sciences.
No Asanta, I think marketing meetings serve their purpose the way they have for probably 200 or more years.
That's why companies have marketing conventions or meetings. Something must be relatively effective about them.
They are held in all corners of the world, and they cover everything from steel to marshmallows.
So anyways Asanta, what do you think? In my inquiry into the dramatic rise of the prescription of psychotropic drugs, would you be happier if I discussed the business doings of Large Confectioners and their conferences and marketing meetings?
Would that make better sense for you Asanta? How about that? I'll discuss the business doings of regional candy distributors
and the marketing techniques that large confectioners like Nestle or Mars use to get these distributors to sell their chocolate bars.
I'll work on making a connection to the over-prescription of psychotropic drugs through the candy angle and large candy distributors.
The bottom line is that there are many in the scientific and medical community who see medications, treatments, procedures and drugs as something that should be overwhelmingly need driven. Not market driven!!
Let’s go back to Asanta’s comparison to heart transplants.
Nobody is marketing heart transplants on a gigantic scale. There are no commercials on TV every 20 seconds advertising heart transplants.
I don’t turn the page of every single last magazine there is to find advertisements for heart transplants.
I’m sure there are conferences on heart transplants. I’m sure there are marketing conferences having to do with heart transplant products and equipment.
I’m also quite certain that heart transplants are given on a needed basis. Not on a market driven basis.
I doubt that the makers of heart transplant technologies are successfully pressing doctors to sell more heart transplants.
So the question is: Are psychotropic drugs becoming a market driven product? I think the evidence clearly points to yes.
The most obvious! The advertisements for psychotropic drugs are coming out of the woodwork.
As has been previously stated any type of doctor is capable of prescribing these drugs and a large percentage of the prescriptions
are being given by doctors with no psychiatric training-presumably to meet demand.
3.From 1996 to 2005 the pharmaceutical industry tripled the amount of money it spends on marketing!
Now if drugs are supposed to be given out on a “needed” basis, how did pharma have the foresight to aggressively market a product for a perceived need?
As the title of this thread says: Pharmaceutical Cos are paying doctors to market their drugs. Some, some would see this as a conflict of interest. Although it can be argued that these marketing meetings are simply a “trade symposium” for efficiency and knowledge.
Which I’m sure is the case in many instances.
Nevertheless it is one more piece of the puzzle that shows that drugs are being distributed mainly on a market, and not a need driven basis.
There are many financial incentives for the doctor for going the psychopharmacology route as opposed to therapy and other scrutinies and treatments. Some of these reasons have to do with the insurance industry. But others have to do with patient turnover and the fact that people don’t want to go to therapy. Plus, given that a large percentage of the prescribing doctors aren’t psychiatrists-they couldn’t provide therapy anyways. So the health insurance argument has limited(but relevant)impact. The fact is that doctors can make more money prescribing drugs than they can make with therapy.
A large portion of the population receiving the therapies are now children, elderly, and veterans.
Anti-depressant drugs are the second most prescribed drug in the US. Second to cholesterol drugs.
From 1995 to 2008 the use of anti-psychotics has tripled in the US. Due to the special nature of mental issues, the prognosis of these issues is highly subjective. Highly subjective. Again it begs the question: have the number of “psychotic” people tripled between 1995 and 2008??
But the subjectivity in these prognoses makes a very convenient loophole if you will.
Obviously comparatively, a massive increase in say drugs for Lupus could easily be verified and cross-examined.
Here is one of the articles I obtained my information from. It is good reading for those who are interested. Inappropriate prescribing
What does poor health insurance have to do with this?
What Asanta was trying to explain is that good insurance would allow people with psychiatric conditions to see a psychiatrist for treatment that wouldn't require medication, but many insurance plans don't cover this service very well if at all so it takes that option off the table for many if not most patients. That leaves them with only one option, to see their PCP who's only real option is to prescribe medication since they are not trained in psychotherapy.
I think we have listed a most of the other reasons why use of these drugs has gone up. there are clearly multiple factors its not just marketing. I could give you a long list of other medications ( incontinence medications, diabetes medications, restless leg medications, fibromyalgia drugs etc etc) that are marketed to physicians as heavily as psychiatric meds and most of them have not seen a huge increase in usage so marketing alone is not the only driving force for the upswing in the use of psychiatric drug and it may not even be the primary one.
What does poor health insurance have to do with this?
What Asanta was trying to explain is that good insurance would allow people with psychiatric conditions to see a psychiatrist for treatment that wouldn't require medication, but many insurance plans don't cover this service very well if at all so it takes that option off the table for many if not most patients. That leaves them with only one option, to see their PCP who's only real option is to prescribe medication since they are not trained in psychotherapy.
I think we have listed a most of the other reasons why use of these drugs has gone up. there are clearly multiple factors its not just marketing. I could give you a long list of other medications ( incontinence medications, diabetes medications, restless leg medications, fibromyalgia drugs etc etc) that are marketed to physicians as heavily as psychiatric meds and most of them have not seen a huge increase in usage so marketing alone is not the only driving force for the upswing in the use of psychiatric drug and it may not even be the primary one.
The health insurance issue is a small part. I acknowledged that in my above post. The article acknowledged it too.
The usage of those other drugs is not primarily a subjective concern. Someone's either incontinent or they're not.
Someone either has fibromyalgia or they don't. Someone has diabetes or they don't.
Someone comes to a doctor and says, "I have depression. Life's not doing anything for me anymore". Then what?
Give out the pills. That's what. That's exactly what is happening. 4 out of 5 prescribing doctors are PCPs. Hello?
If I came to my PCP and told him that I wanted medication for shingles(but didn't have shingles!) what would he do?
He would say get lost.
Again the reasons you listed do not justify the types of percentile increases shown over a 10 year period.
It's either marketing or it's a massive increase in genuinely "hurting" people.
Which one is it? Or it's just a massive desire by doctors to make lot's of money prescribing drugs that can't really be traced to any pathology!
Maybe that's it? I mean actually that is a big part of it. Like I said doctors can't get away prescribing diabetes meds to everyone who walks through the door. But doctors can hand out psychotropics to all comers who ask for it. Some obviously don't ask for it. Like children and the elderly!
Very hard for anyone to scrutinize the pathology of these treatments.
You're a doctor Mac. You're supposed to make people feel better. You're making me turn green.
Obviously you are blinded to this issue. Can't see the forest.
Again the reasons you listed do not justify the types of percentile increases shown over a 10 year period.
And you base this conclusion on what? Can i see the analysis you did? All i see is a personal bias you have
Which one is it? Or it's just a massive desire by doctors to make lot's of money prescribing drugs that can't really be traced to any pathology!
And how do we make money by prescribing psychiatric meds? Oh yeah I forgot. A rep came to our office two years ago and I got a free sandwich. That should help me retire early. Vyaz, you haven't listened to a thing I've been telling you or you conveniently marginalized it as being the exception rather than the rule because it doesn't fit your world view.
Your arguments don't support your views. On the one hand you claim that the vagaries of diagnosing psychiatric illness are there and yet you see this as an excuse for doctors to prescribe more medication instead of seeing the difficult position this puts physicians in. they want to help their patients and do whats best for them but there is no test and no objective way to be completely sure of the diagnosis so they use the tools that are available to them and since there is no clear cut way of knowing who will benefit and who wont they are forced to treat people in spite of that uncertainty because they have no other choice.
And by the way restless leg is not something you have or don't have. Its highly analogous to many psychiatric illnesses where its very much a judgement call. The same is true for fiibromyalgia
And you base this conclusion on what? Can i see the analysis you did? All i see is a personal bias you have
Personal Bias? No that's you! Obviously. I've listed the reasons why psychopharmacology is a market driven device.
It's a market driven device that results in over-prescriptions. Of course due to the highly subjective nature of diagnosis....
It's very hard for any oversight. That and Big Pharma has an influence on regulators to begin with.
And how do we make money by prescribing psychiatric meds? Oh yeah I forgot. A rep came to our office two years ago and I got a free sandwich. That should help me retire early. Vyaz, you haven't listened to a thing I've been telling you or you conveniently marginalized it as being the exception rather than the rule because it doesn't fit your world view.
You are a very self-centered person Mac. Since page one this thread has been all about you hasn't it? It's friggin' annoying!!
"I don't get this!" "I don't do that!" This thread isn't about you Mac.
Doctors make money prescribing meds by setting up appointments with patients and then seeing them, whereupon they proceed to
prescribe said meds. The next phase is to set up a new appointment for a return visit, check in and refills for meds. I presume doctors get paid for those appointments, right Mac? Yeah.
That's how doctors make money prescribing meds Mac. It must be a boon to all MDs!! Especially with the onset of TV ads and Prozac and the fact that any old doctor can prescribe them.
Your arguments don't support your views. On the one hand you claim that the vagaries of diagnosing psychiatric illness are there and yet you see this as an excuse for doctors to prescribe more medication instead of seeing the difficult position this puts physicians in.
I don't know if this makes sense or what. In any case it does not represent anything I have said. You going for the "cheap" crap too now?
they want to help their patients and do whats best for them but there is no test and no objective way to be completely sure of the diagnosis so they use the tools that are available to them and since there is no clear cut way of knowing who will benefit and who wont they are forced to treat people in spite of that uncertainty because they have no other choice.
And you asked me how doctors make money prescribing meds? Are you really a doctor? Seriously?
And by the way restless leg is not something you have or don't have. Its highly analogous to many psychiatric illnesses where its very much a judgement call. The same is true for fiibromyalgia
Yeah that's why I didn't list Restless Leg Syndrome. Did you notice that? Did you see that I didn't list RLS?
Many doctors express the view that the incidence of Willis-Ekbom Disease/restless leg syndrome is exaggerated by manufacturers of drugs used to treat it.
-Woloshin, Steven; Schwartz, Lisa M. (2006). "Giving Legs to Restless Legs: A Case Study of How the Media Helps Make People Sick". PLoS Medicine 3 (4): e170.
Kalman Applbaum teaches medical anthropology at the University of Wisconsin Milwaukee, Milwaukee, Wisconsin, United States of America. KA is the author of The Marketing Era: From Professional Practice to Global Provisioning (Routledge 2004). E-mail: applbaum@uwm.edu-Because illness is one of the most tangible forms of suffering, the pharmaceutical industry, more than other industries, can link its marketing activities to ethical objectives. The result is a marriage of the profit-seeking scheme in which disease is regarded as “an opportunity" to the ethical view that mankind's health hangs in the balance. Marketers and consumers in the West to some extent share a common vision of needs and the terms of their satisfaction. This apparent complicity helps even the most aggressive marketers trust that they are performing a public service. Pharmaceutical company managers that I speak to signal this when they characterize their engagement with the public as “doing good while doing well."
These managers also see nothing wrong with integrating doctors, patients, and other players into the drug distribution channel. On the contrary, they say, this is state-of-the-art management, making it professionally principled and tactically astute. Marketers also regard the incorporation of consumers into the channel as ethical because then people's needs can best be determined and satisfied, conferring upon them the power of self-determination through choice.
Personal Bias? Are you flippin' serious? You're a hoot!
Let's examine my "personal bias".
I was Shanghaid and put on a banana boat to Singapore by Doctors? Nope, never happened!
I tried out for pre-med but failed? Nope never happened!
I was personally mis-diagnosed with a disorder and given psychotropic drugs? Nope never happened!
I wanted to develop a new drug but it was rejected by the FDA(due to other Pharma influences)? Nope never happened!
I can go on and on. Why don't you just tell me what my personal bias is. I'm dying to know.
You're ridiculous! You're obviously trying to project your own personal "bias" here.
I said it before and I'll say it again, I think you are a company shill. You probably don't even know it.
You can't see the forest for the trees anymore.
It really makes me mad that I waste my time arguing with such an "operator".
My personal bias? I'll keep bombing this thread with more doctors and scholars views and evidence until the cows come home!
Then you can hear the personal bias of an informed, ethical, responsible community.
And you base this conclusion on what? Can i see the analysis you did? All i see is a personal bias you have
And a whole lot of vitriol. I wonder why?
Asanta he has his own agenda and is impossible to have a logical discussion with. I'm out. You may want to do the same.
And you base this conclusion on what? Can i see the analysis you did? All i see is a personal bias you have
And a whole lot of vitriol. I wonder why?
Because of comments like this one right here Asanta. If you want to insinuate something Asanta have the cojones
to say it. Go for it!
I started a thread about a controversial subject that is being examined by the public and professionals alike.
It has a number of viewpoints.
From the get go I get comments from a nurse who makes comments about conspiracies.
And a doctor who obviously takes this subject personally and probably
benefits from psycopharmacology in one way or another and is towing the company line.
And you base this conclusion on what? Can i see the analysis you did? All i see is a personal bias you have
And a whole lot of vitriol. I wonder why?
Asanta he has his own agenda and is impossible to have a logical discussion with. I'm out. You may want to do the same.
I'm out too.
And you base this conclusion on what? Can i see the analysis you did? All i see is a personal bias you have
And a whole lot of vitriol. I wonder why?
Asanta he has his own agenda and is impossible to have a logical discussion with. I'm out. You may want to do the same.
I'm out too.
That's right Asanta, do what MacGeyver tells ya to do. :lol:
VYAZMA, as per our rules, please strive to keep the discussion away from personal attacks and baiting. Discussion and inquiry becomes impossible otherwise. Thanks.
VYAZMA, as per our rules, please strive to keep the discussion away from personal attacks and baiting. Discussion and inquiry becomes impossible otherwise. Thanks.