selling drugs

There's a terribly interesting, if more than a little creepy, article in the NY Times written by a doctor who used to shill for a prescription drug company. IT goes into depth on his slide down the slippery slope, and his eventual realization that he had stopped being impartial. It also gives numbers, detailing the money one can make if your integrity is up for sale.

Dude, I think I've made it clear that my integrity has been for sale for years... where's my check? But seriously, to throw in some skewed logic, there isn't much difference between what he does and what other doctors do sitting at a desk at the insurance company determining on a rather random, yet fully profit drive basis, what medical treatments will be approved and for whom... and it all brings me back to my utmost belief in that pharmacetucal companies truly do own healthcare in this country.

But on a more specific note, this does, again, strengthen what I've believed from day one, and that's that primary care doctors have no business prescribing anti-depressants or other mental health-related medications. You wouldn't go to your primary care doctor for chemotherapy or knee surgery, yet they commonly hand out psychotropics to just about anyone. A couple of years ago I was beyond appalled when my niece's pediatrician prescribed Zoloft for her based on her mother's description of her "symptoms" and suggestion that the medication might be in order. My niece was 8 years old and was never referred to, nor did she ever see a pediatric psychiatrist. Yes, my sister in law is to blame here too, but wtf? Primary care doctors are GENERALISTS. Pschiatry is a SPECIALTY. If a doctor like the guy in the article comes in pitching a psychotropic to a PCP, then how likely is it that the PCP is going to go through and read the research about the other psychotropics? However, when he went to pitch to a psychiatrist who said, "that has not been my experience in my practice"--well, a specialist is far more likely to have used that medication AND other medications AND dealt with side effects and whatnot. How many of a PCP's patients are there with a psychiatric problem? Many? How many psychiatrists' patients are there with psychiatric problems? All of them.

You know, I wonder if it's an offshoot of off label use of drugs - once you start trusting your own judgement over that of the researchers, it probably isn't that hard to take the next step and decide that you know better even about drugs that have nothing to do with your field. There's actually a really interesting article in this month's consumer reports about prescription drugs that also touches on this subject, but from the other side, suggesting the patient point out possible (cheaper) alternatives. And don't even get me started on the idea of giving psychotropic drugs to kids to begin with.