News flash: Drug ads work
“To conduct the study, Richard Kravitz, director of primary-care research at the University of California, Davis, in Sacramento, Calif., hired a group of women actors to mimic different forms of depression and to make various requests of physicians during unscheduled visits.
The actors made a total of 298 visits to 152 doctors’ offices in Rochester, N.Y., San Francisco and Sacramento.
When they made a general request for drugs, saying they had seen a TV segment on depression, the pretend patients left the office with a prescription for their feigned condition 76 per cent of the time. When they asked for the heavily advertised antidepressant Paxil by name, they were prescribed that specific drug 53 per cent of the time. And when the mock patients made no request for drugs, they were nonetheless prescribed an antidepressant 31 per cent of the time.”
No surprise here. Consider a common scenario: you are a primary-care physician that has appointments every 15 minutes. You running behind schedule and patients in the waiting room are starting to complain. There are 20 messages on your desk that have yet to be seen. Phones are ringing off the hook – the hospital is calling for you for another admission. Your next patient comes in and says “I have depression and want Paxil”. Now you have two options:
1) Discuss with the patient how psychotherapy and counseling can be as effective as medication. If medication is needed, you can further discuss that generic fluoxetine or citalopram is just as good. After 20 minutes of discussion, the patient leaves angry at not getting what they saw on TV and leaves. Most likely, they will find another physician who will prescribe what they want. The doctor has now lost a patient, feels that all that time was wasted, and falls further behind schedule. Patients in the waiting room start to leave because of the wait.
2) Screen the patient for depression. Give Paxil. Move on to the next patient on time. Patient is happy. Doctor is happy.
This may seem extreme, but believe me these are the two choices that physicians face every day. Option two looks pretty good most of the time.
Related posts:
- Obesity: Drugs vs lifestyle
- Hospitals as "pharmacies on steroids"
- The waiting room: Drug reps add to the tension
- After a doctor is convicted, is telemedicine dead?
- Forcing the medical sector to compete for patients
- Depression is bad for your heart
- Is a hospital bailout coming?
{ 3 comments }
Hmmm…I’ve always thought my primary care was wonderful…now it’s fact! When I went to my doc for depression symptoms, I got the screening and the script…but I also got the therapy talk. My doc then left the room for a few minutes (15 minute allotment already up to 25) and when she came back she had a list of aproved Therapists from my insurance company! She then called the very next day to make sure I had started calling them. By the way…this doc is NEVER on time…and her patients don’t care. I for one will trade on time for thorough any day of the week.
Doctors’ vile hyprocrisy on this matter makes me ill. DTC particularly in depression has had indisputable public good. One of the greatest problem in treating depression is raising public awareness about it. Most people still don’t see it as a disease. Advertising raises awareness. More people are getting treatment. That is good. Similarly, viagra has gotten middle aged men (notorious healthcare avoiders) to get checked out.
Although DTC helps people, doctors don’t like DTC because their precious time is “wasted” explaining to people, for instance, that the super amazing erection pill is just as good as the amazing erection pill. They could see more patients during that time, get more money, and buy that new Lexus. In short, despite doctors’ blather about the educated patient, it’s more time effective simply to have patients do what they’re told. That’s the way doctors like it–it makes them more money and feeds their insatiable egos.
According to Dr. Irving Kirsch in Prevention & Treatment, �there is now unanimous agreement that the mean difference between response to SSRI antidepressant drugs and response to inert placebo is very small. It is so small that, despite sample sizes involving hundreds of participants, 57% of the SSRI trials funded by the pharmaceutical industry failed to show a significant difference between drug and placebo. Most of these negative data were not published and were accessible only by gaining access to US Food and Drug Administration (FDA) documents.
Various methods were used to manipulate the results of SSRI drug studies to insure a favorable outcome:
1) Responders to the placebo are eliminated at the beginning of the study. (Placebo washout)
2) Benzodiazepine sedatives were given to mask the SSRI induced agitation.
3) Unfavorable drug studies are buried in the file cabinet and not disclosed to the public.
4) Miscoding suicidal events as “emotional lability”, and homicidal events as “aggression” to hide suicidal events from regulators.
5) False attribution of suicide to the placebo arm.
6) Hiring ghost writers to make the medical articles more favorable.
7) Cash settlements for SSRI drug litigants which seals records and withholds unfavorable drug studies from the public.
For more information and links see my Paxil, Prozac, and SSRI Induced Suicide Newsletter
Jeffrey Dach MD
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