Pharmacy industry's manipulation of the public

e_dawg

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Not bad. A bit sensationalistic, especially to the initiated, but I guess that's par for the course. Some docs are sheep that are swayed by promotion, but most understand how the industry works and are intelligent clinicians.

CBT is the usual front line therapy and antidepressants are prescribed situationally as needed. They are a valuable tool that in all honesty adds significant clinical benefit. Yes, their efficacy have been overstated while their side effects minimized by the pharma companies, but most docs understand that. If there is a net clinical benefit, you take it. If there isn't, you adjust the treatment and find something where there is.

A bit of important insight that the article doesn't mention: in the clinical treatment of depression, medication really needs to be given as an adjunct to CBT and other such non-pharmacological therapies. In other words, it should be thought of as a facilitator in one's treatment regimen, not the magic pill that does everything that lets the doctor and patient neglect the rest of the treatment.

Patients often shirk their duties when it comes to non-pharmacological treatment. CBT is like homework. You have to do it every day between sessions. Few patients are good students. Some of these studies probably are run with the "textbook" treatment where patients probably do their CBT regularly. In the real world, patients don't like to do their homework. But they are really doing themselves a disservice... and in a way, it is a little petulant to complain that the medication isn't as effective as it should be because you are not doing your homework after class, so to speak.

I would say the problem is in the expectation gap and the perception by the uninitiated that there is a massive conspiracy scandal that includes the pharma industry, the FDA, and the doctors. Yawn... Excuse me if I seem rather disinterested...

As with other psychiatric diseases, you need a holistic approach to medicine. Pharmacological treatment is but one "pillar" that you build your foundation on. If the psychiatrist does not know that, then shame on him. This has become a "take a magic pill so I can fix this and not take responsibility for my own health and take the steps to change my lifestyle" society. That's unfortunate, but that doesn't mean the doctor should just give up and get them out of their office by writing them a prescription without trying to encourage them to adopt a more responsible and collaborative attitude to their own health. In a way, a doctor is part life coach -- or at least, that's the way it should be.

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Depression isn't easily treated, and success rates are not very high. Some depression is even called treatment resistant depression (TRD). We are still a little primitive in our understanding on neurophysiology and need to branch out from the serotonin hypothesis as a mainstay and look more to dopamine reuptake inhibition either in the form of bupropion or methylphenidate (carefully titrating dosage to prevent induction of mania). New antidepressants will serve to address this in the form of TRI's or Triple Reuptake Inhibitors. Specific 5-HT receptor targeting is promising, as well as with oxytocin. Another thing that should be used more IMO is beta-blocker therapy: depression often results from a series of negative, disappointing, hurtful experiences that over time form strong memories and induce a depressive response. Strong doses of beta blockers have shown the ability to treat post-traumatic stress disorder and loosen the brain's grip on stored traumatic memories that help perpetuate depression.
 

e_dawg

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Also forgot to mention that antipsychotics, as the author of that article suggests, IMO are not the solution except for some TRD cases. The side effects are more prevalent than with SSRIs and would be considered a step backwards to the tricyclic and MAOI era of antidepressants.
 

P5-133XL

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I must be missing something, because I look at this and say something is seriously wrong with the system.

I start out with the concept that the standard for a drug, to be released, is that it be better than a placebo. To me it means that it is better than nothing at all. The studies being submitted are only the ones that show a positive result with all the ones showing negative results being discarded, as long as there is no excessively harmful effect such as people dropping dead. To me that produces a massive distortion of what is occurring.

The fact that, with this particular set of drugs, the doctors keep trying different ones till they get one that works for that particular person is simply a way of rationalizing continued use of something on everyone, that only really effects a small minority of people and that they don't know what determines who gets an effect. Keep trying different stuff, till you get it right is not the sign of intelligence or knowledge but rather a brute force solution.

If they knew what they were doing, then they would select people to include in their studies, which had a reasonable chance of efficacy. Then when they got a success, they would publish how to choose those people along with the data so that you are only applying the drug to the correct group. If the drug only effects a small proportion of people, then you limit the study to those people rather than use the general population and only see the small improvement just barely above a placebo and ignore any studies that don't see that small improvement. They are working hard, not smart.

Would it not be better, if the standard was a substantial and clear benefit? That would force the drug companies to know what they were doing rather than allowing guesswork to rule. Would this not save society large amounts of wasted money? With depression, we really are talking about millions of suffering people.

What I am seeing is a problem with the whole system. This particular set of drugs is only the symptom of the system failing. Imagine, how people would feel if thats how doctors treated an infection or a heart attack and it took 2 - 4 months to see any beneficial value from the treatment and you just had to keep going back to try something else till they got the right therapy. It just doesn’t make sense to me.

luckily, most drugs have a clear benefit that far exceeds a placebo. However, the standard, to me seems far too low and the concept of throwing out any negative studies distorts the standard, which is already too low.
 

e_dawg

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Let's not take a single class of drugs and apply it to all therapeutic classes and make a blanket statement that the system is failing. Depression is very tricky and relatively little is known about how we can use pharmacology to have the precise effect required. So yes, at this point it is a bit of experimentation and trial and error. Is it ideal? No. Is it better than doing nothing or giving a placebo? Absolutely it is. Just because you may have to try several different treatment regimens doesn't mean medicine is a joke and the system is useless. It just means we are in the early stages of understanding how to treat depression. It was the same way with most areas of medicine before we advanced our knowledge to the point where we can use precise, targeted therapies and have a huge positive impact on most other areas of health.

In a way, we need to accept the relative murkiness of depression medications and studies. You won't ever get a situation where you have the vast majority of the studies being positive. Not with antidepressants, at least not yet. Even most other classes' studies are not what you might consider unequivocal; I think you have to adjust your expectations here: A 60/40 split in favour of positive studies is quite acceptable. An 80/20 split is considered rock solid perfection that Tylenol would be hard pressed to meet. 50/50 might be a good ballpark estimate for antidepressant studies, and quite reasonable considering what we're dealing with here.

We're not building computers and cars here; you're using compounds that alter the chemistry and molecular biology of the body. How do you think it's going to work when you start blocking receptors and production of neurotransmitters in a human brain that can outprocess, outthink, and outremember any animal or electronic device, and has feelings, emotions, and experiences that cannot be measured? It's one thing to be able to lower blood pressure by blocking a simple receptor; it's quite another to alter one's entire state of consciousness and being with a pill and then to expect precision on top of that.

If we hold antidepressants to the same standard of efficacy of other therapeutic classes, nobody will get any benefit. At least now, there is a small benefit in some people. Everybody is different; you just have to try the right combination that works. If you withhold those medications because they are not universally efficacious, then everybody loses. Even worse, antidepressant research and development would grind to a halt knowing that there is no revenue potential from this class, no light at the end of the tunnel. Do you think the drug companies are going to pump billions of $ into developing better antidepressants if there's no chance they'll be able to sell them?

It's not realistic to expect psychiatry to go from 0 to 60 in 20 years when it comes to depression. You can't go from nothing and suddenly develop a magic pill that's as effective as a beta blocker + diuretics for hypertension. It just doesn't work like that. Give it 10-15 years and check back on the treatment of depression. I think you'll find it closer to your idealized version of medicine and research at that time. Until then, I prefer to live in the real world and am pleased that the system that has given us dozens of lifesaving and life improving medications over the years still works. Can it be improved? Sure, but let's not throw the baby out with the bath water by taking a microcosmic view or without understanding the reasons behind the current state of affairs.

Cardiovascular disease, gastric reflux/ulcer, microbial infections, and cancer treatment are just some areas where we have mastered treatment and can give medications that are universally very efficacious. I don't know if depression will ever get there, but it is headed in that direction, slowly but surely.
 

sechs

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I'll point out that the problem is the *pharmaceutical* industry not the *pharmacy* industry.

It's the people who make the pills, not the ones that count them....
 

LunarMist

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I'll point out that the problem is the *pharmaceutical* industry not the *pharmacy* industry.

It's the people who make the pills, not the ones that count them....

One could blame sales/marketing, CEO, CJO, or equivalent. The dude on the manufacturing line is probably oblivious to the pharmacology, safety profile, pharmacoeconomics, etc. At the end of the shift most likely he degowns and is off to have a beer.
 

Pradeep

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Without implementing government price controls on drugs, the US health care system (as defunct as it is) will only get worse. Witness the power of pharma lobby groups with the recent Medicare bill specifically denying individual States the power to negotiate better pricing. The bill is written to protect the profits of pharma over the well being of our population.

I probably spend close to $300 a month for prescription copays for the wife and kids. That's with Excellus Blue Cross insurance. Without insurance the cost would be in the thousands. And of course, this massive cost burden is reflected and passed on to consumers in the ever higher insurance premiums to be paid.
 

ddrueding

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I probably spend close to $300 a month for prescription copays for the wife and kids. That's with Excellus Blue Cross insurance. Without insurance the cost would be in the thousands. And of course, this massive cost burden is reflected and passed on to consumers in the ever higher insurance premiums to be paid.

Man, that is a lot of drugs. I have no insurance and pay about $50 a month for us (birth control). In my adult life, I have probably paid $300 for all the drugs I've ever taken.

I find it very hard not to blame the consumers.
 

jtr1962

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Really disturbing article:

Over half of Americans on chronic medicines

Now I can understand an unfortunate person with a chronic genetically caused condition or injury of some sort needing medication, but according to the article a lot of these medications are simply used to counter an unhealthy lifestyle of poor diet plus lack of exercise. This is why we'll never be able to afford national health care. It would only work if the average numbers of chronically unhealthy people were kept fairly low via good lifestyle choices.

The single worst thing we ever did was to start allowing advertising of prescription drugs to the general public. Doctors gave in to prescribing pills instead of taking the more difficult and contentious route of getting patients to change their lifestyles. What amazes me is that people would rather take an often expensive drug rather than do much cheaper lifestyle changes. Besides, the pills only give a temporary fix. Eventually the side effects plus liver and kidney damage they cause make a person permanently dependent upon yet more drugs.

Now I know why I don't go to the doctor.
 

jtr1962

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In my adult life, I have probably paid $300 for all the drugs I've ever taken.
I doubt I've even close to that number, and I'm 18 years older than you are. The only prescription drug I recall taking was penicillin/amoxicillin when I had root canals done. Very occasionally I'll take an OTC cold/fever remedy if aspirin doesn't work. In a way it's a blessing that I react horribly to drugs. Penicillin causes me to sleep 18 hours a day as do those OTC cold remedies. There's no way I could take any pills regularly. Besides the side effects, I probably wouldn't remember to take them. My mom's the same way. She has tried a few things stronger than aspirin for pain (ibuprofin, aleve to name those I recall). In all cases she had to stop it immediately as it didn't help much, and the side effects were horrible. In a way, it's common sense that this would happen. You're putting something in your body that naturally isn't there. I'm just amazed that so many people tolerate these drugs well enough to want to continue taking them. Or maybe they won't admit to themselves that the side effects are worse than the condition.

It's really all about lifestyle. With a halfway decent lifestyle and diet (avoiding extremes in food choices plus doing at least a few miles of walking daily) the majority of people could live their entire lives without needing chronic medication. I always thought pills were something you take when you're sick only until you're better, not something you have your entire life. Yes, I blame the consumer more than anyone for accepting this type of pill-popping life as "normal". We worry so much about illegal drugs when the legal ones are far worse.
 

Fushigi

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You probably use Road Runner so it logs you in automatically.

As to the article, I would agree that many issues are caused by bad lifestyle choices. ADD/ADHD, for instance, is a legitimate condition for some however I'm pretty sure that a diet with less refined sugar & no caffeine/stimulants combined with less TV/PC/PS3* time would 'cure' 80% of the cases, especially among children. Non-severe Diabetes can likewise be treated without medication; my father who is in his 70s did the necessary lifestyle adjustment and keeps his blood sugar under control.

Still, I wonder what qualifies as a 'chronic condition'. I take Fexofenadine (generic Allegra) in conjunction with Nasacort for a mold allergy. Does that qualify? Does is still qualify even though I only take it as needed & not daily?

And if ED is considered a chronic condition then there are hundreds of thousands if not millions of men who have a treatment available to them that wasn't available some 10 or 15 years ago. Which is another way of saying we have medications to treat conditions today that we didn't have in the past. So one contributor to higher prescription use is simply drug availability.

In short, while I believe the main point of the article to be true, there are more factors to consider and more details to flesh out before I can totally agree. The reporting is incomplete at best.

Problems with the medical industry shouldn't keep you from seeing a doctor, jtr. You could easily harbor a condition that even a healthy lifestyle can't avoid. An obvious example that should ring close to home is that famous cyclist and his battle with testicular cancer. Also, not all doctors act as pill pushers & shills for big pharma.

My doctor has worked with me to bring my cholesterol & marginally high BP under control via diet modification & increased exercise. It hasn't brought me the weight loss I'd like to achieve but my doctor assures me it is more important to have good blood chemistry than to lose a few pounds. He counts me in the minority, though, as many of his patients either can't or won't make better lifestyle choices & leave him little choice but to prescribe the meds.

*The current methods used to edit modern 'MTV Generation' entertainment are partly at fault as well. Quick cuts, no lingering camera shots, etc. force the mind to change focus & break concentration. My in laws were over yesterday & we watched an old western with Clint Eastwood. These people had to act. They couldn't rely on camera cuts, angle changes, and post-production tricks to allow them to take it easy. Most scenes had few camera cuts & the same shot would easily run 20-30 or more seconds (compared to 2-3 seconds on many modern movies).
 

Bozo

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I don't know if any of you are old enough to remember "New Coke", but that was the start of a lot of health problems. When that was introduced, Coke changed from sugar to corn sweeteners. When they re-introduced "Classic Coke", it was also changed from sugar to corn sweeteners. This was the 'tipping point' for corn sweeteners. From that time on, virtually everything was sweetened with corn sweeteners.
Corn sweetener is corn oil treated with acid to taste sweet. There is some research now that claims that the stomach never feels 'full' when eating foods with corn sweeteners, and you continue to eat. Also, becuse the corn sweeteners are not a 'natural' sugar, you pancreas dosen't know what to do with it. The insulin that it produces has little effect on the corn sweeteners. Meanwhile the corn sweeteners are trashing your body.
Don't get me wrong; diet and exercise are the best way to stay healthy. But it is nearly imposible to buy food that is not chemically laced with something.
And, the drug companies are lovin' it, maybe even supporting it.

Bozo :joker:
 

jtr1962

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Problems with the medical industry shouldn't keep you from seeing a doctor, jtr. You could easily harbor a condition that even a healthy lifestyle can't avoid. An obvious example that should ring close to home is that famous cyclist and his battle with testicular cancer. Also, not all doctors act as pill pushers & shills for big pharma.
Besides the problems I mentioned, simple lack of money prevents access to medical care if you're unisured like I am. My income is low enough to qualify for EIC. You do the math. I can neither afford medical insurace nor can I pay out of pocket. I don't qualify for any of the insurance programs for the poor, either, as I have more than the requisite $1800 in savings and IRAs. Point of fact, hospitals usually bill out-of-pocket patients several times what the insurance company reimburses them for the same procedure. The assumption is that if you're paying out-of-pocket, it means your wealthy. I couldn't even get quotes from most places for a general checkup. I don't know about you, but I never purchase something without knowing the price first. Some people I know who did pay out of pocket for a basic checkup and lab test were charged in excess of $3000. I obviously can't afford that.

Incidentally, I saw a special on Lance Armstrong last night. Amazing he recovered, let alone won 7 Tours. In my case, I'm not aware of anyone younger than their 60s getting cancer in my family. Of the 3 family members who did get cancer, my uncle (died of lymphoma at 69 ) and my maternal grandfather (died of pancreatic cancer at 78 ) were both heavy smokers. That obviously was the cause. My uncle also drove to work every day. Breathing toxic fumes from traffic undoubtably didn't help, either. My paternal grandmother got some sort of bone cancer in her mid 80s which required removal of her leg. However, the cancer didn't kill her. Basically, complications from obesity did at age 87. I'll also add that she was morbidly obese, sedentary, and ate a very poor diet. In the event I got cancer of any sort, either I would die for lack of being able to afford treatment, or my body would fight it on its own, so no point worrying about it. Anyway, I'm not aware of anyone among relatives or friends for whom cancer treatments helped much. Everyone who got cancer died within a few years despite treatments. I honestly can't see putting myself through all that given such dim hopes of actually curing the cancer once and for all. The best route for cancer is not to get it via lifestyle choices. I avoid going out when the air is most polluted, don't eat foods which are know carcinogens (barbeque, cured meats, for example), pretty much avoid traveling by car, and try to get in a decent amount of exercise (but I really should aim for 20 hours a week instead of the 5 or so I usually get). The main medical problem I have is pretty severe carpal tunnel which prevents me from doing productive work on a steady basis (hence my low income). Other than that, at this point I'm pretty aware of what to do to stay healthy. If I get cancer despite this through an unlucky roll of the dice, I'm probably dead anyway with or without treatment.

My disgust with the medical establishment has a lot to do with the care, or rather lack of it, that my parents got. In a way I'm glad I can't afford access to medical care. Given what I saw my mom go through all these years it appears the insurance companies postpone treatment until the last possible minute. My mom developed severe carpal tunnel syndrome in her mid-40s. By the time the insurance company finally sprang for the operation most of the nerves in her hands were dead. Besides that, it took something like 5 years to even get a proper diagnosis. Doctors kept saying it was arthritis, prescribing pain killers, gold salts, etc. As for my dad, as far as I'm concerned the insurance company helped kill him. Although he abused his body, no excuse not to give a 70+ year old obese patient with a prior heart attack (and one blocked plus one partially blocked coronary artery) an echocardiogram every six months. Had they done so, they probably would have caught the impending blockage which gave him his final, fatal heart attack (he lasted four days in the hospital on life support, but they couldn't do anything). All they did was prescribe Lipitor and give him an EKG once a year. Oh, and I'm sure the Lipitor helped kill him too. He had just about all the indicated side effects, including extreme lethargy, muscle weakness, and constipation. My dad was as strong as an ox. If doctors could have got after him early on to change his lifestyle instead of giving him pills, he would have lived at least into his 90s. His mother doubtless would have made it past 100 had she lived better.
 

timwhit

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JTR, maybe you should consider seeing someone about your carpel tunnel. I know you hate doctors and all, but they could shoot you with some cortisone (which shouldn't be all that expensive) or do orthoscopic surgery (which will be expensive). If it works then you will be able to work more.
 

ddrueding

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If you want fixed-price medical care, do it the way I have in the past. Do your own research and find a local Doc-in-the-Box. Walk in, and tell them exactly what you want. I've never had an issue getting a prescription or injection that I asked for, once I convinced them that I had done my homework.
 
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