[from the medical records dept] A Bane of My Professional Existence

[originally posted by the Alienist in early 2012, but worth reexamining]

Last evening, I was reading a periodical before bed, and as I thumbed absent-mindedly through the pages, several large advertisements from pharmaceutical companies caught my eye – Pristiq (antidepressant), Aricept (anti-dementia), and Abilify (antipsychotic sometimes used to augment antidepressant) amongst them.

As a physician, these encounters wouldn’t be unusual… except that I was glancing through Psychology Today, a lay publication written specifically for a mass audience of non-clinicians. And it certainly doesn’t stop there – one only needs to pick up (mostly ladies’) print media to find all manner of colorful Direct-to-Consumer (DTC) drug ads splashed across the pages.

The rise of the Internet, and the explosion of available educational resources via both print and digital outlets, has been a boon in innumerable arenas, not the least of which is health education. But it is a double-edged sword. My heart leaps for joy when a patient arrives for an appointment carrying sheaves of drug print-outs courtesy of self-serve Wikipedia. Undoing mis-information, or mis-interpreted accurate information, takes much longer than just explaining the pertinents from scratch.

I confess that I harbor more than a bit of residual paternalism, and I realized a long time ago that I’m too late to the world of psychiatry (as I would like to see it practiced). But heck, I went to medical school for four years, residency for four years, passed my boards, recertified, and now have logged over two decades of clinical experience. I think I’ve learned a few things along the way re: how to take good care of patients, only to have my job made all the more difficult by the presence of freely available op-ed pieces and data of dubious quality ‘out there.’

The Rx problems in my profession seemingly began with fluoxetine. Most of you know it as Prozac, and it came on the market in the United States in 1988, the year I graduated from medical school. A tiny amount of DTC pharma advertising existed prior to Prozac – at least one branded form of ibuprofen as well as Pneumovax were hawked thus – but it wasn’t until the late 1980s that the world of psychotropic Rx was really impacted by Madison Avenue. Before Prozac, I suspect that if persons on the street had been asked to name an antidepressant, they would have had difficulty doing so unless a prescription had been written for them personally or for someone in their immediate family. But once Prozac hit the market and was pitched to the public, it became a household name (along, shortly thereafter, with all of its closely-related chemical brethren), discussed at length by armchair psychiatrists at water coolers, over PTA coffees, and in late night TV monologues.

The ads got glitzier, the people on the glossy pages looked happier, and anyone who wasn’t totally contented in life would be forgiven for thinking that the pill being marketed would make existence an endless summer afternoon garden party too.

Prozac ad (reprinted courtesy of MindFreedom.org)

Prozac ad (reprinted courtesy of MindFreedom.org)

With all of this unfiltered talk on the airwaves and in ink, it just added fuel to the fire of self-diagnosis and, in my opinion, drug seeking behaviors. The health professions in general, and Pharma in particular, are unfortunately responsible for the ever-increasing ‘A Pill Exists For Every Ill And Can Fix Anything’ school of thought.

Accordingly, as front-line clinicians, it is now our responsibility to do a better job explaining what Rx can and cannot do, regardless of what the paid models and cute little cartoon characters in the magazine ads might suggest.

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[Copyright 2013 @ The Alienist’s Compendium]

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