Friday, February 4, 2011

Smart Meds Strategies - No, This Is Not An Oxymoron

Following is a chopped version of a new article on mcmanweb. The article, in turn, is based on three or four posts published here over 2009 ...

During the first months of 2009, I ran three successive reader polls on my blog, Knowledge is Necessity. Let's pick up on the action in my second poll:

"How do you rate your meds in managing your illness?" I asked my readers. The results, quite frankly, astonished me.

One half responded that meds were their single most important tool and one third that their meds were "important, but no more so than their other tools." In other words, four in five patients put meds at the top of their list, either as a solo act or with a dance partner.

Obviously, if meds are so important to patients, then they must be working like gang-busters, right?

Not exactly. No, in fact. Make that unequivocally no. The month before, I polled my readers on how well they were doing. One in four replied they were "in crisis or close to crisis." Four in ten reported they were "stable but not well." Just one in five said they were on the way to recovery, and only 14 percent responded that they were back to where they wanted to be or better than they ever could have imagined.

Thus, a full six in ten of those who responded to my poll indicated that they were in pretty bad shape while more than eight in 10 reported feeling short of well.

Put the two poll findings together and you can appreciate my astonishment: 82 percent who rate their meds as their number one management tool vs 14 percent who are actually well. What is wrong with this picture?

Time For Another Question

"How well have your meds worked for you?" I asked in my third poll.

Only 14 percent answered, "very well." The overwhelming rest (86 percent) had reservations.

Thirty-six percent - about one-third - responded, "conditionally well." In other words, your meds may not be perfect but they were meeting your expectations. When you add in the "very well" group, fully half you reported satisfactory results with your meds.

So, can we put a positive spin on the results? No.

One in five (19 percent) told me their meds were "rather problematic." In other words, these people weren't happy with their meds, but were experiencing some benefit.

Nearly one in five (17 percent) responded that their meds were "very problematic" and 11 percent told me their meds were "a complete disaster." Added together, nearly one-third have given an unambiguous thumbs down to your meds.

Interpreting the Results

Let's go negative first:

The fact that more than eight in ten of you - yes, you - reported that your meds are not working "very well" - for whatever reasons - speaks volumes. Consider that most of those in the "conditional" and "problematic" groups are more likely headed down than up (based on very clear trial evidence that less than a partial response to meds is a very strong predictor of relapse).

Add to that the fact that the "complete disaster" group is running in a virtual dead heat with the "very well" group and we are talking very low levels of customer satisfaction.

The only way we can put a positive spin on the results involves seeing possibilities in the "conditional" and "problematic" and even "disaster" groups. Suppose, for instance, half of those in the conditional group were to graduate to "very well." Likewise, suppose we could get similar conversion rates from the "problematic" and "complete disaster" groups. Then three-quarters of you would be happy customers.

How is that possible?

The meds are the one constant in this equation. The two variables are you and your psychiatrist. First imagine a smart patient working with a smart psychiatrist. Now picture a naive patient placing his or her trust in a lazy and indifferent psychiatrist. Are we likely to see dramatically different outcomes?

I rest my case.