tag:blogger.com,1999:blog-7772182113499451603.post4003192939560209969..comments2024-03-27T10:50:53.692-05:00Comments on Real Psychiatry: Data On Drug Price Comparisons - And The Myth Of Compromised PhysiciansGeorge Dawson, MD, DFAPAhttp://www.blogger.com/profile/03474899831557543486noreply@blogger.comBlogger8125tag:blogger.com,1999:blog-7772182113499451603.post-83328229010899387412016-02-03T13:14:18.077-06:002016-02-03T13:14:18.077-06:00Number 14 on most lists is approaching urban legen...Number 14 on most lists is approaching urban legend territory.<br /><br />The interesting part for me is that after you have rad all of the weak circumstantial evidence for the hypothesis, the average physician just sat back uncomfortable and took that abuse. I realize that my complete lack of communication with Big Pharma reps for 20 years makes me an outlier, but I had first hand knowledge of what was being prescribed and it reflected the prior authorization rules of managed care companies.<br /><br />Seems like nobody is interested in calling them out for rationing and in some cases unsafe practices. George Dawson, MD, DFAPAhttps://www.blogger.com/profile/03474899831557543486noreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-2072842205366487442016-02-03T13:02:11.148-06:002016-02-03T13:02:11.148-06:00I wouldn't call it a myth, but an overemphasis...I wouldn't call it a myth, but an overemphasis. It is true that some of these conflicted KOLs need to be called out. <br /><br />However on the list of things wrong with pharma, I agree that it's about number 14 on the list.<br /><br />Number one is the time and cost from research to commercial product. It's too long and too expensive. HIV fast track was a blueprint for how to do it right but for some reason we don't do that.<br /><br />Number two is the idiocy of CMS not bargaining on price. That chart says it all. There is simply no excuse for this.<br /><br />Number three is the nonspecificity and invalidity of DSM. Until you define terms more precisely, psych research is garbage in garbage out.<br /><br />I have zero problem with direct to consumer ads. It's as close as a patient will ever get to hearing a full consent in the age of the 15 minute medication check.James O'Brien, M.D.https://www.blogger.com/profile/14994350319492582321noreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-31331284966287912442016-02-01T10:40:06.426-06:002016-02-01T10:40:06.426-06:00"...why am I the only guy who has seen it?&qu..."...why am I the only guy who has seen it?"<br /><br />I take that as a rhetorical question but I will answer it anyway. My opinion is that they don't know the nature of business. As such, businesses will continue to run rings around them. Your high deductible hypothesis bears that out.RBnoreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-20678820281137137342016-01-31T22:02:33.927-06:002016-01-31T22:02:33.927-06:00You're lucky that you know a lot of good psych...You're lucky that you know a lot of good psychiatrists - I do as well. However, the ones I'm talking about may see a patient who is literally high on cocaine for ten minutes and diagnose them as manic. One of them used a "spending spree" as the main symptom of bipolar disorder in one patient that came to me- the patient had just purchased a bunch of cocaine! David M. Allen M.D.https://www.blogger.com/profile/06280912088483192599noreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-19452163554151859152016-01-31T16:45:18.929-06:002016-01-31T16:45:18.929-06:00They charge what they can and that number in terms...They charge what they can and that number in terms of cash just got a lot bigger with high deductible insurance. Now they know there is a captive $1500 - $6000 just sitting there that the managed care company really does not care about. That is a much better deal for them and the managed care company than going through all of those "cost savings" motions. What better way to drive up prices than with an inflated pool of cash just sitting there for the asking?<br /><br />There are many pathways to a psychiatric diagnosis. I think that you are possibly referring to the self-medication hypothesis. That works for brief periods of time until you build up a tolerance and realize that you need to use to just function at some level. Bipolar symptoms can occur with both chronic use and acute binge use and vary according to substance used.<br /><br />If the myth of physicians corrupted by Big Pharma is a red herring - why am I the only guy who has seen it? It was the sole focus of many blogs including one that was keeping the entire profession honest. Nothing like using a red herring to keep the profession honest.George Dawson, MD, DFAPAhttps://www.blogger.com/profile/03474899831557543486noreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-68797496110135497952016-01-31T15:37:50.337-06:002016-01-31T15:37:50.337-06:00Yes, the cost of drugs being based on the amounts ...Yes, the cost of drugs being based on the amounts spent "buying off physicians" is a red herring. The drug companies charge the amounts they do because they can.<br /><br />Also, "The majority of bipolar, ADHD, and depression diagnoses are due to the substance use disorder..." is something I thought worked the other way around. Ultimately it doesn't surprise me though and it really speaks to the need to finally address our drug abuse culture.RBnoreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-6563737626672774722016-01-31T15:19:20.925-06:002016-01-31T15:19:20.925-06:00All of the patients I have seen for the past 5 yea...All of the patients I have seen for the past 5 years have a primary diagnosis of a substance use disorder. The majority of bipolar, ADHD, and depression diagnoses are due to the substance use disorder, but I have a much different information set that the original diagnostician. I have talked with many thoughtful clinicians along the way who have taken their time in trying to figure it out. They were all psychiatrists. George Dawson, MD, DFAPAhttps://www.blogger.com/profile/03474899831557543486noreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-9903323199566272302016-01-31T15:11:47.088-06:002016-01-31T15:11:47.088-06:00I absolutely agree with you that physician collusi...I absolutely agree with you that physician collusion is the least of the problems associated with Big Pharma, but that doesn't mean that sometimes it isn't a problem. You can look how many articles are coming out claiming that antidepressants are ineffective - or should at least be avoided in bipolar depression in favor of antipsychotics - which is complete bull. I don't know about where you are, but the number of psychiatrists here in Memphis diagnosing everything that moves as bipolar disorder and prescribing Latuda for the "depressive" episodes is frightening. (Of course, we were home to Hagop Akiskal for a long time).David M. Allen M.D.https://www.blogger.com/profile/06280912088483192599noreply@blogger.com