Monday, December 5, 2011

Is There An RX for the Over-Prescription Epidemic?

Do we have an over-prescription epidemic? Here’s a snippet from a piece I wrote in 2002:

Paramijit Joshi MD, Chair of Psychiatry and Behavioral Sciences at the National Children's Medical Center in Washington DC, told the gathering she gets kids aged four and five on four or five medications. "I'm spending more time taking kids off medications than putting them on, as I don't know what I'm treating," she related.

And here’s an extract from something I wrote in 2003:

Gary Sachs MD of Harvard and principal investigator of STEP-BD reported on some early data, including the fact that patients entering the program were being treated with an average of 4.2 meds. Five percent were on eight meds or more and four percent were on 10 meds or more, leading him to comment on "exotic polypharmacy." Less than 20 percent were on just one drug.

Last month, a survey conducted by Medco reported that more than one in five adult Americans - one in four women - “took at least one medication commonly used to treat a psychiatric or behavioral disorder in 2010.”

Have our doctors gone insane? No, this isn’t an anti-meds post. I think just about all of us are for getting the right person on the right med to treat the right condition in the right situation, but we also know that the wisest call a doctor may make is to NOT prescribe a med.

This is a huge trust issue. The other day, “Pat” posted this on my mcmanweb site:

You have just confirmed every suspicion that I have ever had about the majority of psychiatrists being deluded, intellectually lazy and egomaniacal. My decision to get better without their help has just been reconfirmed, thank you. If they don't like that, maybe they can take my meds to help them feel better.

The piece she was commenting on was entitled, The Problem Clinician, the first of a three-part series describing my first (and last) grand rounds, delivered in 2008. It’s a story you have heard many times on this blog. The topic for my talk was meds compliance. Just sending patients out the door with a prescription is not treatment, I told the clinicians in attendance.

And - oh yes - when we tell you that we don’t enjoy being turned into fat stupid zombie eunuchs on the meds you prescribe and over-prescribe we’re not doing this to ruin your day.

I didn’t say it outright, but my intent was clear, namely: If you actually displayed a willingness to work with us in finding a smart meds strategy, there wouldn’t be major issues with compliance.

My audience showed their appreciation by clearing the room the second my lips stopped moving.

So here’s Pat, reading my article, making her own decision. I can only hope it’s the right one. It’s a shame, I thought, that her choice has to be all-or-nothing. Yes, we all want to be off of our meds. But why should our docs be out of the picture? Shouldn’t they be working with us to help us achieve our goal? Or at least come close to it?

Gianna Kali writing on her Beyond Meds blog was clearly thinking along similar lines. In her latest piece, A Plea to Prescribing Physicians and Psychiatrists: Please Help Us Heal, she reports on an article in the Irish Examiner in which a prominent psychiatrist disclosed that 60-80 percent of his work is helping people slowly get off drugs.

Taking her lead from this article, Gianna begins her plea:

The fact is there is a huge niche opening up for psychiatrists and other prescribing physicians who want to take the opportunity. People want and desperately need COMPETENT professional help in coming off of psychiatric drugs. We need prescribers to make the transition easier. ...

She goes on to say:

Many people come off meds with relative ease. Some of us, though, become crippled with iatrogenic illness. You will need to educate yourselves. Once you start making it be known that you can help — those of us who’ve been seriously and gravely harmed will start appearing on your doorstep. ...

She concludes with:

Please, it’s time that doctors learn how to help us. Some of you have unintentionally helped create the iatrogenesis that is now limiting our lives so much more than any “mental illness” ever did. Please start helping us heal now. We need you.

Yes, we do. But will they listen to us? I keep flashing back to all those clinicians bolting for the exits three-and-a-half years ago. A lot has to change. We have a long way to go.

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