Am I even close to the target?
I am interested in the viewpoints of those of you who have been observing for awhile. Many years ago, amitriptyline products were the rage. Probably because there was not much else. Elavil, Etrafon, Triavil. I don’t know if they did much then, but a woman recently told me that 150mg of amitriptyline a day has handled her OCD quite nicely when none of the new drugs de jour helped at all. Her eyes widened happily as she exclaimed, “At a generic copay too.”
This is not good news to the manufacturers of the five dollar a dose “mental” drugs that we pour into vials every day to the tune of millions of dollars before noon. I have this idea that we are just pimps for Big Pharma.
It’s not just depressed middle aged housewives anymore, it is children too. You can’t help but notice that American children are right beside their parents in being overdiagnosed and overmedicated for exaggerated or fictitious mental disorders. This is becoming one of the defining characteristics of the there-is-a-drug-for-everything era.
The blues used to be a good thing. Your boyfriend dumps you, put some Roberta Flack on your i-pod and blues your way through a couple days. Feel it. Yes, it hurts, what the sunuvabitch did. A good lesson learned. Makes you stronger. You will never do that again.
That was then. Now, your mommy calls Doctor Family Practitioner and the guy goes out of bounds and calls in a prescription for Cymbalta. Not fluoxetine for pennies, but Cymbalta for many dollars. Who did you say the pimp is? You learn nothing if you don’t feel it.
People have been drugging themselves for as long as they have been capable of doing so. Cigarettes! If you have never smoked tobacco, you will never know the sublime euphoria you can get from a Marlboro. Cocktails. Lunch and dinner and bedtime. What the? This is healthy?
Before Durham-Humphrey, you could get almost anything from Doc the Druggist. Anyone remember Hadacol? After legend drugs, the era of proprietary drugs kicked in. They have taken 5 decades to get it down, but they run the place these days.
I’ve had fun writing this. If you have read my stuff for the last 20 years, you know that I have a strong narrow-mindedness about Big Pharma. I really think that the drug companies have their hand in a signature medical phenomenon of our times: The urge to manage real or imagined psychiatric pain through substance use.
Let’s stick with kids as a marketing group. You hit the wall with the adults, so you create a market by getting your drugs approved for use in young people and then you brainwash the prescribers.
Children were rarely given amitriptyline for their “pain”. We were given nothing in the 1950s and we lived through our emotional horrors just fine. I remember a girl, beautiful, who was nervous before a major beauty pageant. I was her pharmacist and I thought it strange that her doctor prescribed 12 Stelazine 2 mg. Nowadays, children are given a whole medicine chest of drugs.
Big Pharma is just better than they have ever been before in creating mental illnesses in healthy children. I know that this is not a clear cut matter. It is not as linear as I have portrayed it. There are many extenuating features. Latch key kids are ripe for Big Pharma. Their parents seek out drugs rather than give them hugs and kisses and just pay some attention to them. “Open your mouth, Junior and let me put an Effexor in it. There. Good boy. Go play Wii now, Mommy has things to do and she is tired.”
Big Pharma sees this. “This is a good, sustaining market. Let’s get it.” It is like Field of Dreams, “Market a new drug and they will prescribe it.”
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I completely agree. Europe has a diagnosis rate of ADHD and depression and bipolar in children somewhere aroudnt he 10% mark of the diagnoses done in North America. I wonder why?
One of my favorite jokes is,”do you wake up in the morning? We have a pill for that!”
I believe you hit the ‘proverbial target.’ Big Pharma- a term with clout. I have trouble with the scrabble they play with the mergers and acquisitions. Great Briton’s, Burroughs Welcome (Triangle Park N.C.) becomes something else… Smith Klein and French (not France) Becomes: Smith Klein and something…Somehow this interchangability becomes a intermixed conglomeration of longer and more impressive, massive hundreds of billions of buy-outs in combination with “Black Holes” that seem to inundate us. The D-T-C advertising in the past,(and correct me-if wrong)-wasn’t advertising considered
…..superfluous?
The Blues…they are a good thing. B.B. King used to come to town with Big Brother and the Holding Company. Or the Moody Blues? “Night’s in White Satin.” Janis Joplin was a real Blue’s Fav. Now the Country and Western’s have the market share of cry’n in your beer Blues. Not even close to the real jazz we are accustumed to and loved so.
The enemy is us. We try to fill our hole in the gut with whatever works at the moment be it alcohol, Valium or heroin, not to mention food or sex. Big Pharma, awful as it is, is only one player in a long line that exploit this need of ours. Stop looking outside of yourself for solutions..unless, of course, you’re really sick.
I agree 100%.
However, as a retail pharmacist, I’m in a weird situation. I hate seeing kids on 3 different ADHD meds and a couple different psych drugs, but the fact that they, and so many others, are taking so many drugs are the reason I’m in business.
My business is drugs and prescriptions. The more this stuff gets diagnosed, the more drugs I dispense, and the more there is a need for my job.
I, for one, never take any medication unless I absolutely need to. I haven’t gotten a prescription in 10 years. Occasionally, I’ll take ibuprofen for aches and pains and some sudafed for congestion. Otherwise, I’m drug free.
A true story ( sorry if this is long winded!)
I am a Cpht, having worked in the field for 20+ years. 3 years ago, when my son was 9, we were brought in for a parent/teacher conferance. The teacher in the meeting asked me to fill out a form, that was actually a preliminary test for ADHD ( I forget the name of it now- but I recognised it then because I’d just done a CE on ADHD- Bless them!)
Anyway- I refused. The teacher was very upset, but thankfully I won the day! Fast forward a few weeks,( and an informal phone survey by me) and I found out that over 1/2 of the BOYS in that class had been put on various ADHD drugs- whereas the girls? NONE! NOT ONE of the parents of the girls had been asked to fill out the test. Apparently, this teacher just didn’t want to deal with 10-yr-old boys and the things they do.
What I’m trying to say here, in a roundabout way is that it’s not always the parents. Sometimes the schools step in and cause the problem as well.
P.S. – after my *survey*, I took my *findings* to the principal of the school. ( I’ve had 3 kids go through there- she KNOWS me
) After a long discussion ( where I explained-with my CE’s to back me up mind- That 10 yr old’s just don’t “sudddenly” become ADHD ) she agreed something was wrong. And that teacher retired at the end of the year.
P.S.S.- next year, my son was straight A’s, and when I told his new teacher what the old one had claimed, she said WTF?????? No WAY?!
If you are alluding to the observation that capitalism and health care are contraindicated, Jim, I unequivocally agree. The acquisition cost of each new hydrocodone/apap product reiterates this black box warning. Otherwise…
Who would have thunk that any of the ill affects of poor quality food and dehydration, amongst excess sugar, caffeine, nicotine, alcohol, smoke, preservatives, pollution, vaccines, and other chemicals, could be negated with ANOTHER habitual consumable?
Treating the young, if nothing else, is sound business practice.
Several comments in response to earlier comments in the column. But, first my gut tells me that I tend to agree with views expressing outrage in dosing kids with clonidine, Lexapro, etc. Many prescribers in my neck of the woods are not psychiatrists but nurses that specialize in psychological assessment/assistance. I had a script called in for a four-year old for Lexapro 2.5 mg daily the other day. I don’t normally curse, blaspheme, etc. or express myself verbally with epithets, but a four-year old diagnosed with a mental disorder and prescribe Lexapro? Yi, yi, yi!! What kind of EEG or labs are used to show that a wee one is in need of that kind of chemical intervention?
Now, for comment 1.) On staff at a small county hospital; RN asks me what I would suggest for a personal remedy for cold symptoms i.e. this, this that or t’other, etc. I said ‘rest, fluids, saltwater gargle’. She was surprised that I don’t go in for the flu shots either–but, I have immune disorders and try to avoid tinkering with interferences, as well as avoid taking drugs, except the minimal i.e. a dose of Tylenol until a puff of Flonase can kick in to head off a sinus headache. My parents’ medicine chest had three items when I was growing up: Sayman salve for anything topical from acne to ouchies, Bayer aspirin (which, we’ve since found out causes Reye’s syndrome in children and is to be avoided by pediatric patients), and a bottle of horse liniment. In the college days, I felt with that vast pharmaceutical experience under my belt that I’d have to find a job as pharmacy student to ‘experience’ what medications people took, and so worked in a nursing home–but, of course, nurse aides didn’t have anything to do with medications.
Comment 2.) I was around when Miltown was still being dispensed, and then after that it was this, then it was that. Whatever. Anyone read ‘I’m Dancing as Fast (or Hard?) as I Can’ about a woman’s experience with diazepam? Deep, deep within my being, as a pharmacist, I feel that the effect/purpose of some of these drugs is a ‘shotgun’ at individuals for ‘crowd control’, for calming people so that they can figure out for themselves what to do about their situation in life. Eventually, folks can ‘get off’ some of these psych meds, right? Another reason for the generality is that so much is not known about the brain and its own self-healing. Glenn Doman (or Dorman?) did research in the 60′s on wee ones that had suffered traumatic injuries resulting in only half of a viable brain, yet had managed to survive, and thrive.
And, in my third comment 3.) I too had a son in 3rd grade for whom his Golden Apple Awarded Teacher had told us (as well as him) that he was a bother, disruption, unmannerly, failure, etc. in her class and pointed out a teacher’s pet of a girl that he should emulate, a child for which she and her husband, a psychologist, had identified as having prodigious powers and skipped her up four grades the next year. Needless to say, the teacher’s behaviour with prejudice made my son’s year in that class the worst (as well as our discomfort) in his life, and really set back expectations for this I.Q. 135+ child. And, yes, we did not attend this particular teacher’s retirement reception a few years later.
I agree with a lot of what you say but there is a flip side to all of this. If you have any spare change invest in Big Pharma as I did many years ago and I have made a lot of money from them. In fact they are funding my retirement and I have been living very nicely on the dividends for the past 19 years.
I wrote about this topic last fall.
See http://oleapothecary.blog.com/2091055/
Cathy Lane, I share your sentiments about dosing the young.
True story: Mom came to the pharmacy with a script for clonidine 1mg bid for child about 4 years old. He was already on other meds. She mentioned that he had been on it before, so counseling at that time went wayside to experience.
A few weeks later she expressed concern about grogginess, “wondering” if she should reduce the dose…. she didn’t want to “feel like she was drugging the kid.”
During her expression of concern, the boy was fidgeting in the grocery cart child’s seat, upon which event she scolded him to sit.
The boy replied, “don’t treat me like a dog.”
So much for the basis for dosing the young.
I recall reading several years ago that 95% of the worldwide methyphenidate use for ADHD was right here in the US. Some European countries did not permit it use, and allowed only very restrictive use of amphetamines for this “diagnosis”.
The teaching profession, with its powerful unions, has long been populated with the “slouching toward retirement types”, that would be pleased if all kids were sedated. My friend is an excellent teacher who was driven from her last job because she refused to follow the school district’s policy of screening all children for ADHD by such a method that almost 30% of the boys were tagged as “active or latent” ADHD. She described a teacher inservice training day in which the ADHD session was presented by a panel of ” behavioral experts” that happened to include two pharmaceutical sales reps. Nobody batted an eye.
The creativity and energetic presence of mind that made us a great nation is rapidly being doused with layers of psychotropic drugs. Each new edition of DSM-lV contains an ever broadening list of diagnostic codes and descriptions of “diagnoses” for every possible facet of human behavior. We now all have a psychological disorder and need a drug or drugs.
As a patient in pain and distress, I resent at times being trumpt -if thats a good term, by Drug Reps wishing to proclaim proprietary superiority while I’m in a waiting area in so much agony-while I am forced to listen of this drivel. Fortunately, a director of the clinic I go to keeps them at bay- alotting about 5 minutes-with a comment to the peanut gallery in waiting-that another Rep is on the pr(ow)el