{"id":60608,"date":"2015-10-14T08:00:21","date_gmt":"2015-10-14T12:00:21","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=60608"},"modified":"2015-10-14T09:50:20","modified_gmt":"2015-10-14T13:50:20","slug":"reflections-on-a-doodle","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2015\/10\/14\/reflections-on-a-doodle\/","title":{"rendered":"reflections on a doodle…"},"content":{"rendered":"\n

I was looking at my old patent-life graph I used in a reset button…<\/a>, and was updating it while I watched the debates on television. It didn’t take very long, and I found myself doodling a frequency distribution on the back of a nearby envelope. It looked kind of interesting, so I made an accurate version [it looked like the-rise-and-fall-of <\/font>something]. While I realize that there have been a few new drugs in each class that aren’t represented here, these are the major players. There were several things I thought about looking at the frequency distribution of my major-psych-drugs-in-patent-timeline<\/font><\/em>. <\/p>\n

There’s the obvious thing [forgetting about the late-comers and me-toos for the moment]. We’re beyond the "pipeline<\/font><\/em>" days when the detail-reps and KOLs were paid to go from place to place pushing these drugs. There’s also some relief from the horrible Direct-To-Consumer ads, so I’ve essentially stopped talking back to the television set. I would hope that this is a time when we can properly evaluate each of these classes and its members without the roar from advertising, ideologues, and tainted KOLs. And since the majority of the prescriptions are being written by primary care physicians, it behooves us to clarify the efficacy, toxicity, and rational indications for every one of  these drugs. Some think they’re inert. Some think they’re poison. Some think they are the great leap forward. Those are scientific, not ideological, issues, and the real answer is more elusive than it ought to be at this point.<\/p>\n

But even without the pressure from PHARMA and an empty pipeline, these drugs are selling like hot-cakes, and the consensus is that they are still way over-prescribed [at least my consensus]. With the increasingly large databases from healthcare plans and the government, we ought to be able to figure out why. And we need to know how many stay on the drugs just to avoid withdrawal symptoms, and figure out how to help them safely get off. Many of the problem come with long term use, and a lot of patients and doctors continue them as "preventive insurance<\/font><\/em>" or something like that in inproven situations. Also, it appears that the generic drug makers are jumping on the high price band-wagon along with the patent-holders, so somebody needs to curb that trend. And I suspect that PHARMA isn’t the only industry pushing these medications. Managed Care and other third party payers like the drugs because in spite of their high cost, they are still cheaper than other interventions and they get a checkmark in the treatment<\/font><\/em> box [an analogy to deinstitutionalization<\/font><\/em> comes to mind]. <\/p>\n

Finally, one wonders if some of this almost reflexive drug treatment is continuing because people don’t know  what else to do for their patients other than prescribe drugs [particularly after the thirty years we’ve just lived through]. And that’s not just about psychiatrists. Many practicing therapists make a referral for a med-consult<\/font><\/em> during their first session. Physicians who receive these consults feel obligated to respond with a prescription. So this is a time when training programs, supervisors, and CME programs in multiple specialties would do well to focus on something like Back to Basics <\/font><\/em>[meaning all sorts of forgotten or unlearned skills<\/font><\/em>]. A strong reason for fighting for mental health parity is to give clinicians of all sorts the time to do their jobs [for the moment, I’ll forgo my recurrent ranting about Collaborative Care]. One can expect Managed Care to oppose any such a suggestion. In fact, when we talk about Conflicts of Interest, we ought to apply some of the indictment to the motives of Managed Care, who’ve had a field day chopping up mental health coverage…<\/div>\n","protected":false},"excerpt":{"rendered":"

I was looking at my old patent-life graph I used in a reset button…, and was updating it while I watched the debates on television. It didn’t take very long, and I found myself doodling a frequency distribution on the back of a nearby envelope. It looked kind of interesting, so I made an accurate […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_bbp_topic_count":0,"_bbp_reply_count":0,"_bbp_total_topic_count":0,"_bbp_total_reply_count":0,"_bbp_voice_count":0,"_bbp_anonymous_reply_count":0,"_bbp_forum_subforum_count":0,"footnotes":""},"categories":[5],"tags":[],"class_list":["post-60608","post","type-post","status-publish","format-standard","hentry","category-opinion"],"_links":{"self":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/60608","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/comments?post=60608"}],"version-history":[{"count":32,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/60608\/revisions"}],"predecessor-version":[{"id":60622,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/60608\/revisions\/60622"}],"wp:attachment":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/media?parent=60608"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/categories?post=60608"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/tags?post=60608"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}