Abilify (aripiprazole) is still considered an antipsychotic in Europe (or in Switzerland, at least) but by changing continents with my recent move to the US, I find that Abilify has grown in stature, no longer a drug used by a small percentage of the population, but more like a drug superhero that watches over a lot more people with its magic protective powers. The drug superhero is paid handsomely for services rendered.
We all know that several years ago pharmaceutical companies began to market Abilify as an add-on treatment for major depressive disorder, downplaying its original role as an antipsychotic. Then, $uddenly, our $uperhero $aw a chance to help more people, $o pre$to chango, our $uperhero is now primarily an antidepre$$ant.
I don’t normally read the folded up drug information that comes inside the box. This time the Aripiprazole Oral Solution information was printed on two front and back pages of letter size paper stapled to the receipt, so it was hard not to be curious about the contents.
Let’s assume that a person who is being treated for depression, but is otherwise quite functional in his or her day to day life, decides to actually read the Aripiprazolerole literature, like I just did. She will see that the first page through to the very top of page two Continue reading “What a difference a change of continent makes”
Though technically not the patient, I too, felt like there was a hostage taking going on when I met with Chris’s doctors. (I have since found psychiatrists for him where the power relationship is on a more equal footing.)
From David Healy’s blog post, BarMitzzva Romba: Dance of the Sugar Plum Fairies
Quite aside from transforming doctors into the perfect consumer in this sense, in 1962 it was not appreciated how much a mechanism designed to improve safety might in fact do just the opposite by transforming clinical encounters into hostage situations. Making drugs available on prescription only means that patients have nowhere else to go to get a medicine they need or think they need. They effectively become a hostage rather than a patient and risk the development of Stockholm syndrome.
In 1962 Stockholm syndrome had not yet been described. It is now known that people whose lives are at risk and who are isolated (anyone with an illness), when held hostage by kind captors concerned about their welfare (as doctors are increasingly trained to be) are highly likely to identify with their captors and want to keep them happy. In these circumstances, especially when the patient finds their condition worsening, it becomes very difficult to raise the possibility that what the doctor has done in good faith to help might in fact be causing problems.
It seems more and more likely that the safety consequences of turning patients into hostages outweigh the risks inherent in the drugs that doctors prescribe. The evidence that treatment induced adverse events have now become a leading source of death and disability point just this way. Meanwhile there is not a medical course on earth that trains doctors to recognize their capacity to induce Stockholm syndrome.
Doctors may be the only significant group of buyers who are not trained in the pitfalls of buying for a third party. Their background means that they do not even realize that they are not trained in an area of huge consequence for them and their patients.
Recent estimates suggest that companies spend over $50,000 per annum per doctors marketing to doctors. This figure could likely be greatly increased if the cost of “scientific” articles were also included in the mix. Doctors in other words are subject to a greater concentration of marketing power than any other group of people on earth. But, just as they know nothing about buying for a third party, so also no doctors are trained to recognize the way companies market to them.
Both doctors and patients fail to realize that doctors are the consumers of medicines and that they consume by putting pills in patients mouths. In so doing they consume without consequences or side effects. Companies fully appreciate this and exploit it. If the patient has a problem, company marketing ensures doctors will have to hand a great deal of evidence suggesting that any problems are part of the patient’s illness rather than a consequence of treatment. Evidence based medicine is deployed to relegate any reports of difficulties from doctors or patients to the status of anecdotes.
From David Healy’s post at Mad in America – read more about the evolution of the prescription drug market in America: BarMittzva Romba: Dance of the Sugar Plum Fairies
Medical resident goes over prescriptions with Joyce