Psycho-Babble Medication Thread 579280

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Article in NYT RE: Self-Prescribing/Medicating

Posted by hawkeye on November 16, 2005, at 9:42:03

From Today's New York Times

Fair-Use Principles Apply

"November 16, 2005
Being a Patient
Young, Assured and Playing Pharmacist to Friends
By AMY HARMON

Nathan Tylutki arrived late in New York, tired but eager to go out dancing. When his friend Katherine K. offered him the Ritalin she had inherited from someone who had stopped taking his prescription, he popped two pills and stayed out all night.

For the two college friends, now 25 and out in the working world, there was nothing remarkable about the transaction. A few weeks later, Katherine gave the tranquilizer Ativan to another friend who complained of feeling short of breath and panicky.

"Clear-cut anxiety disorder," Katherine decreed.

The Ativan came from a former colleague who had traded it to her for the Vicodin that Katherine's boyfriend had been prescribed by a dentist. The boyfriend did not mind, but he preferred that she not give away the Ambien she got from a doctor by exaggerating her sleeping problems. It helps him relax after a stressful day.

"I acquire quite a few medications and then dispense them to my friends as needed. I usually know what I'm talking about," said Katherine, who lives in Manhattan and who, like many other people interviewed for this article, did not want her last name used because of concerns that her behavior could get her in trouble with her employer, law enforcement authorities or at least her parents.

For a sizable group of people in their 20's and 30's, deciding on their own what drugs to take - in particular, stimulants, antidepressants and other psychiatric medications - is becoming the norm. Confident of their abilities and often skeptical of psychiatrists' expertise, they choose to rely on their own research and each other's experience in treating problems like depression, fatigue, anxiety or a lack of concentration. A medical degree, in their view, is useful, but not essential, and certainly not sufficient.

They trade unused prescription drugs, get medications without prescriptions from the Internet and, in some cases, lie to doctors to obtain medications that in their judgment they need.

A spokeswoman for the Drug Enforcement Administration says it is illegal to give prescription medication to another person, although it is questionable whether the offense would be prosecuted.

The behavior, drug abuse prevention experts say, is notably different from the use of drugs like marijuana or cocaine, or even the abuse of prescription painkillers, which is also on the rise. The goal for many young adults is not to get high but to feel better - less depressed, less stressed out, more focused, better rested. It is just that the easiest route to that end often seems to be medication for which they do not have a prescription.

Some seek to regulate every minor mood fluctuation, some want to enhance their performance at school or work, some simply want to find the best drug to treat a genuine mental illness. And patients say that many general practitioners, pressed for time and unfamiliar with the ever-growing inventory of psychiatric drugs, are happy to take their suggestions, so it pays to be informed.

Health officials say they worry that as prescription pills get passed around in small batches, information about risks and dosage are not included. Even careful self-medicators, they say, may not realize the harmful interaction that drugs can have when used together or may react unpredictably to a drug; Mr. Tylutki and Katherine each had a bad experience with a medication taken without a prescription.

But doctors and experts in drug abuse also say they are flummoxed about how to address the increasing casual misuse of prescription medications by young people for purposes other than getting high.

Carol Boyd, the former head of the Addiction Research Center at the University of Michigan, said medical professionals needed to find ways to evaluate these risks.

"Kids get messages about street drugs," Ms. Boyd said. "They know smoking crack is a bad deal. This country needs to have a serious conversation about both the marketing of prescription drugs and where we draw the boundaries between illegal use and misuse."

To some extent, the embrace by young adults of better living through chemistry is driven by familiarity. Unlike previous generations, they have for many years been taking drugs prescribed by doctors for depression, anxiety or attention deficit disorder.

Direct-to-consumer drug advertising, approved by the Food and Drug Administration in 1997, has for most of their adult lives sent the message that pills offer a cure for any ill. Which ones to take, many advertisements suggest, is largely a matter of personal choice.

"If a person is having a problem in life, someone who is 42 might not know where to go - 'Do I need acupuncture, do I need a new haircut, do I need to read Suze Orman?' " said Casey Greenfield, 32, a writer in Los Angeles, referring to the personal-finance guru. "Someone my age will be like, 'Do I need to switch from Paxil to Prozac?' "

For Ms. Greenfield, who could recite the pros and cons of every selective serotonin reuptake inhibitor on the market by the time she graduated from college, years of watching doctors try to find the right drug cocktails for her and for assorted friends has not bolstered faith in their expertise.

"I would never just do what the doctor told me because the person is a doctor," said Ms. Greenfield, who dictates to her doctors what to prescribe for her headaches and sleep problems, and sometimes gives her pills to friends. "I'm sure lots of patients don't know what they're talking about. But lots of doctors don't know what they're talking about either."

Prescriptions to treat attention deficit disorder in adults age 20 to 30 nearly tripled from 2000 to 2004, according to Medco, a prescription management company. Medications for sleeping disorders in the same age group showed a similar increase.

Antidepressants are now prescribed to as many as half of the college students seen at student health centers, according to a recent report in The New England Journal of Medicine, and increasing numbers of students fake the symptoms of depression or attention disorder to get prescriptions that they believe will give them an edge. Another study, published recently in The Journal of American College Health, found that 14 percent of students at a Midwestern liberal arts college reported borrowing or buying prescription stimulants from each other, and that 44 percent knew of someone who had.

"There's this increasingly widespread attitude that 'we are our own best pharmacists,' " said Bessie Oster, the director of Facts on Tap, a drug abuse prevention program for college students that has begun to focus on prescription drugs. "You'll take something, and if it's not quite right, you'll take a little more or a little less, and there's no notion that you need a doctor to do that."

Now, Going Online for Pills

The new crop of amateur pharmacists varies from those who have gotten prescriptions - after doing their own research and finding a doctor who agreed with them - to those who obtain pills through friends or through some online pharmacies that illegally dispense drugs without prescriptions.

"The mother's little helpers of the 1960's and 1970's are all available now on the Internet," said Catherine Wood, a clinical social worker in Evanston, Ill., who treated one young client who became addicted to Xanax after buying it online. "You don't have to go and steal a prescription pad anymore."

In dozens of interviews, via e-mail and in person, young people spoke of a sense of empowerment that comes from knowing what to prescribe for themselves, or at least where to turn to figure it out. They are as careful with themselves, they say, as any doctor would be with a patient.

"It's not like we're passing out Oxycontin, crushing it up and snorting it," said Katherine, who showed a reporter a stockpile that included stimulants, tranquilizers and sleeping pills. "I don't think it's unethical when I have the medication that someone clearly needs to make them feel better to give them a pill or two."

Besides, they say, they have grown up watching their psychiatrists mix and match drugs in a manner that sometimes seems arbitrary, and they feel an obligation to supervise. "I tried Zoloft because my doctor said, 'I've had a lot of success with Zoloft,' no other reason," said Laurie, 26, who says researching medications to treat her depressive disorder has become something of a compulsion. "It's insane. I feel like you have to be informed because you're controlling your brain."

When a new psychiatrist suggested Seraquil, Laurie, who works in film production and who did not want her last name used, refused it because it can lead to weight gain. When the doctor suggested Wellbutrin XL, she replied with a line from the commercial she had seen dozens of times on television: "It has a low risk of sexual side effects. I like that."

But before agreeing to take the drug, Laurie consulted several Internet sites and the latest edition of the Physicians' Desk Reference guide to prescription drugs at the Barnes & Noble bookstore in Union Square.

On a page of her notebook, she copied down the generic and brand names of seven alternatives. Effexor, she noted, helps with anxiety - a plus. But Wellbutrin suppresses appetite - even better.

At the weekly meetings of an "under-30" mood-disorder support group in New York that Laurie attends, the discussion inevitably turns to medication. Group members trade notes on side effects that, they complain, doctors often fail to inform them about. Some say they are increasingly suspicious of how pharmaceutical companies influence the drugs they are prescribed.

"Lamictal is the new rage," said one man who attended the group, "but in part that's because there's a big money interest in it. You have to do research on your own because the research provided to you is not based on an objective source of what may be best."

Recent reports that widely prescribed antidepressants could be responsible for suicidal thoughts or behavior in some adolescents have underscored for Laurie and other young adults how little is known about the risks of some drugs, and why different people respond to them differently.

Moreover, drugs widely billed as nonaddictive, like Paxil or Effexor, can cause withdrawal symptoms, which some patients say they only learned of from their friends or fellow sufferers.

"This view of psychology as a series of problems that can be solved with pills is relatively brand new," said Andrea Tone, a professor of the social history of medicine at McGill University. "It's more elastic, and more subjective, so it lends itself more to taking matters into our own hands."

To that end, it helps to have come of age with the Internet, which offers new possibilities for communication and commerce to those who want to supplement their knowledge or circumvent doctors.

Fluent in Psychopharmacology

People of all ages gather on public Internet forums to trade notes on "head meds," but participants say the conversations are dominated by a younger crowd for whom anonymous exchanges of highly personal information are second nature.

On patient-generated sites like CrazyBoards, fluency in the language of psychopharmacology is taken for granted. Dozens of drugs are referred to in passing by both brand name and generic, and no one is reticent about suggesting medications and dosage levels.

"Do you guys think that bumping up the dosage was a good idea, or should I have asked for a different drug?" someone who called herself Maggie asked earlier this month, saying she had told her doctor she wanted to double her daily intake of the antidepressant fluoxetine to 40 milligrams.

In another recent posting, a participant wrote that his supply of the beta blocker Inderal, acquired in Costa Rica, was running out. He uses the drug for panic attacks, he said, but he has not told his doctor about it. "What do I do/say to get her to prescribe me some?" he asked.

"CraZgirl," who said she was not currently taking any medications, received a resounding "yes" to her posting that asked, "If you wouldn't go on meds for yourself, is it reasonable to do it to keep your marriage intact?"

Still, for some young adults, consulting their peers leads to taking less medicine, not more. When Eric Wisch, 20, reported to an anonymous online group that he was having problems remembering things, several members suggested that he stop taking Risperdal, one of four medications in a cocktail that had been mixed different ways by different doctors.

"I decided to cut back," said Mr. Wisch, a sophomore at the University of Rochester who runs www.thebipolarblog.com, where he posts his thoughts on medications and other subjects. "And I'm doing better." Despite frequent admonitions on all the sites to "check with your Pdoc," an abbreviation for psychiatrist, there are also plenty of tips on how to get medications without a prescription.

"I know I shouldn't order drugs online," one participant wrote in a Sept. 26 posting on the Psycho-babble discussion group. "But I've been suffering with insomnia and my Pdoc isn't keen on sleep aids."

What should he do, the poster wanted to know, after an order he placed with an online pharmacy that promised to provide sleeping pills without a prescription failed to deliver?

Another regular participant, known as "med-empowered," replied that the poster was out of luck, and went on to suggest a private e-mail exchange: "I think I know some sites where you could post your experience and also get info about more reliable sites."

For a hefty markup, dozens of Web sites fill orders for drugs, no prescription required, though to do so is not legal. Instead, customers are asked to fill out a form describing themselves and their symptoms, often with all the right boxes helpfully pre-checked.

Erin, 26, a slender hair stylist, remembers laughing to herself as she listed her weight as 250 pounds to order Adipex, a diet pill, for $113. One recent night, she took an Adipex to stay up cleaning her house, followed by a Xanax when she needed to sleep.

Like many other self-medicators, Erin, who has been on and off antidepressants and sleeping pills since she was in high school, has considered weaning herself from the pills. She wishes she had opted for chamomile tea instead of the Xanax when she wanted to sleep.

"I feel like I have been so programmed to think, 'If I feel like this then I should take this pill,' " she said. "I hate that."

But the problem with the tea, she said, is the same one she faces when she is coloring hair: "It's not predictable. I know how these drugs are going to affect me. I don't know if the chamomile tea will work."

Online pharmacies are not the only way for determined self-prescribers to get their pills. Suffering from mood swings a decade after his illness was diagnosed as bipolar disorder, Rich R., 31, heard in an online discussion group about an antidepressant not available in the United States. A contractor in the Midwest, Rich scanned an old prescription into his computer, rearranged the information and faxed it to pharmacies in Canada to get the drug.

"My initial experience with physicians who are supposed to be experts in the field was disappointing," Rich said. "So I concluded I can do things better than they can."

Even for psychiatrists, patients say, the practice of prescribing psychotropic drugs is often hit and miss. New drugs for depression, anxiety and other problems proliferate. Stimulants like Adderall are frequently prescribed "as needed." Research has found that antidepressants affect different patients differently, so many try several drugs before finding one that helps. And in many cases, getting doctors to prescribe antidepressants, sleeping pills or other psychiatric medications is far from difficult, patients say.

The result is a surplus of half-empty pill bottles that provides a storehouse for those who wish to play pharmacist for their friends.

The rules of the CrazyBoards Web site prohibit participants from openly offering or soliciting pharmaceuticals. But it is standard practice for people who visit the site to complain, tongue-in-cheek, that they simply "don't know what to do" with their leftovers.

The rest takes place by private e-mail. Sometimes, the person requesting the drugs already has a prescription, but because the medications are so expensive, receiving them free from other people has its merits.

A Post-Hurricane Care Package

Dan Todd, marooned in Covington, La., after Hurricane Katrina, said he would be forever grateful to a woman in New Hampshire who organized a donation drive for him among the site's regular participants.

Within two days of posting a message saying that he had run out of his medications, he received several care packages of assorted mood stabilizers and anti-anxiety drugs, including Wellbutrin, Klonopin, Trileptal, Cymbalta and Neurontin.

"I had to drive down to meet the FedEx driver because his truck couldn't get past the trees on part of the main highway," said Mr. Todd, 58. "I had tears in my eyes when I got those packages."

It doesn't always work out so well. When Katherine took a Xanax to ease her anxiety before a gynecologist appointment, she found that she could not keep her eyes open. She had traded a friend for the blue oval pill and she had no idea what the dosage was.

An Adderall given to her by another friend, she said, "did weird things to me." And Mr. Tylutki, who took the Ritalin she offered one weekend last fall, began a downward spiral soon after.

"I completely regretted and felt really guilty about it," Katherine said.

Taking Katherine's pills with him when he returned to Minneapolis, Mr. Tylutki took several a day while pursuing a nursing degree and working full time. Like many other students, he found Ritalin a useful study aid. One night, he read a book, lay down to sleep, wrote the paper in his head, got up, wrote it down, and received an A-minus.

But he also began using cocaine and drinking too much alcohol. A few months ago, Mr. Tylutki took a break from school. He flushed the Ritalin down the toilet and stopped taking all drugs, including the Prozac that he had asked a doctor for when he began feeling down.

"I kind of made it seem like I needed it," Mr. Tylutki said, referring to what he told the doctor. "Now I think I was just lacking sleep."

http://www.nytimes.com/2005/11/16/health/16patient.html

 

Well, well isn't that interesting ? (nm)

Posted by Glydin on November 16, 2005, at 12:02:13

In reply to Article in NYT RE: Self-Prescribing/Medicating, posted by hawkeye on November 16, 2005, at 9:42:03

 

great article » hawkeye

Posted by pseudoname on November 16, 2005, at 12:09:49

In reply to Article in NYT RE: Self-Prescribing/Medicating, posted by hawkeye on November 16, 2005, at 9:42:03

Thanks for post, hawkeye. Great article.

But poor Dr Bob! The ONE THING he polices on this site (besides civility, of course) is not using it to get drugs without a prescription. And the only thing from Babble the Times quotes is someone getting advice on exactly that!

The Times doesn't mention that med_empowered got the familiar disciplinary note from Bob ("Please don't use this site to..."). http://www.dr-bob.org/babble/20050927/msgs/560550.html

Is this the first mention of Babble in the news?

 

Re: great article

Posted by spriggy on November 16, 2005, at 13:03:49

In reply to great article » hawkeye, posted by pseudoname on November 16, 2005, at 12:09:49

I'm not sure what I think about it.


I agree with most of what was written but I'm afraid of how it will be perceived.

I was a little proud to see our very own medempowered made it in the NY times..

Can I have your autograph? ROFL

 

Mixed feelings

Posted by Glydin on November 16, 2005, at 14:44:17

In reply to Re: great article, posted by spriggy on November 16, 2005, at 13:03:49

Even though it was all disclosed, on the "up and up" with some level of informed consent and all, it still felt to me kinda violating. Yes, that is silly as this site is open to ANYONE with internet access and this site was not THAT big a portion at least as noted. It still felt to me a little like: "Hey rest of the world - look what the cr*zy folks are up to now..."

I'm being irrational but it made me feel creepy and again has me questioning myself over posting publically.

 

Re: Mixed feelings

Posted by rod on November 16, 2005, at 15:07:03

In reply to Mixed feelings, posted by Glydin on November 16, 2005, at 14:44:17

> me questioning myself over posting publically.

exactly .....

oh well


 

Re: great article

Posted by Bill LL on November 16, 2005, at 15:08:43

In reply to Re: great article, posted by spriggy on November 16, 2005, at 13:03:49

I also agree with a lot of it. This would be my proposal:

Allow people to buy these types of drugs without a prescription. This would include most newer antidepressants, the newer sleep drugs, certain benzos, and ADD drugs. All are relatively benign when used responsibly.

Instead of a doctor's prescription, pharmacists who pass an acredidation exam would be able to sell you the drugs. The pharmacist would look at your current meds to evaluate potential side effects, and help you decide what to take. The pharm doc could see if you take drugs for high blood pressure, diabetes, etc. They could charge maybe $10 per pharmacy consultation or whatever.

Pharmacists are very well trained and their expertice is under-used. (By the way, I'm not a pharmacist and have no relatives are are).

This could expedite a person's search for his or her best treatment.

> I'm not sure what I think about it.
>
>
> I agree with most of what was written but I'm afraid of how it will be perceived.
>
> I was a little proud to see our very own medempowered made it in the NY times..
>
> Can I have your autograph? ROFL

 

AMY HARMON - Self Reporting

Posted by Nickengland on November 16, 2005, at 16:11:31

In reply to Article in NYT RE: Self-Prescribing/Medicating, posted by hawkeye on November 16, 2005, at 9:42:03

AMY HARMON - Writes an interesting report.

I think though that, in general when I read the newspapers reporters will write what grabs the readers attention.....Theres many sides to a story, but perhaps if some of the different views were to be put into print it wouldn't make the headlines so to speak and grab the readers attention...? So the most dramatic/headline grabbers get put into print - but thats what the reporters are paid to do right? I don't know i'm not a reporter lol

Out of all the threads, the report of this site and particular 'story' was very brief.

>For a hefty markup, dozens of Web sites fill orders for drugs, no prescription required, though to do so is not legal.

In the US - however the particular poster she mentions in this report (I think) comes from the UK - and although this news report is from the US, the person she mention buying the medication being from the UK I believe it is actually legal for them to purchase a medication from the internet because we have different laws to the US, but this wasn't mentioned...Its doesn't mention about places like Thailand and Spain where I think the laws differ and where people may be from posting on these forums which are in effect based internationally and whereby you can walk into these pharmacy's and buy many medications over the counter without a prescription in real life forgetting the internet.

>Instead, customers are asked to fill out a form describing themselves and their symptoms, often with all the right boxes helpfully pre-checked.

From what I understand that part of the report has not been thoroughly investigated..

>"Being a Patient
Young, Assured and Playing Pharmacist to Friends"

Please don't jump to conclusions ;-)

Be patient. Always check with your Pharmacist and rest assured you always have your friends.


 

Re: AMY HARMON - Self Reporting

Posted by linkadge on November 16, 2005, at 17:19:02

In reply to AMY HARMON - Self Reporting, posted by Nickengland on November 16, 2005, at 16:11:31

It was a very good article. It was accuate on so many levels. I wasn't comfortable reading it because a lot of it is familliar.


The one thing that I've learned after taking every drug in the book, is that there is nothing beyond stability. (ie There is no such thing as an edge. )


Linkadge

 

Re: AMY HARMON - Self Reporting

Posted by Nickengland on November 16, 2005, at 17:59:37

In reply to Re: AMY HARMON - Self Reporting, posted by linkadge on November 16, 2005, at 17:19:02

Hi linkadge,

>It was a very good article. It was accuate on so many levels.

Yeah, although my previous post picks up some of the report, I do agree. I've just re-read it a couple of times over as my first impression was slightly different - you're right the article is pretty accurate I guess...I just think that the report could have covered more sides, for example in my case the fact that had I had not used the internet for research the 'consultant psychiatrist I see doesn't even know about some of the medications commonly used for bipolar disorder...had I not suggested them, I wouldn't of gained relief and would have been stuck on the drugs he gave me which were making me worse...

The last times I walked into see my psychiatrist - his comment was "I think you're doing very well" The medication i'm taking he prescribed ~ I suggested.

Previous to this in the years, it has been, how are you doing? "Not very good at all...." He prescribed ~ he suggested.

The pharmacists dispense the drugs - but can't do so without the doctors say so. When your doctor is giving you drugs that are making you worse in the UK under the NHS, unless your privite, you have to do what you can to make sure you get drugs that make you better lol but then this would be an article for the UK I guess..

 

Re: Article in NYT RE: Self-Prescribing/Medicating

Posted by willyee on November 16, 2005, at 18:13:38

In reply to Article in NYT RE: Self-Prescribing/Medicating, posted by hawkeye on November 16, 2005, at 9:42:03

Personaly i have to agree with the idea of self medicating.


The system is just too difficult to work with.You have packed jammed doc scheldues,where u have to wait weeks .

You have ultra short sessions which are only a matter of minutes,almost absurd to think a professional can correctly evalute you and moitor you after not seeing u in weeks,seeing tons of people the same day before u,and having u in front of them for a few minutes.This is not the kind of care such a horrable dehibilating disease should have.


This day and age you have SOOOOO much more resources than you did just a few years back.And JUST BECAUSE im saying i might know more on current meds than my doc does not mean i believe i know more overall than my doc.There are a lot in the profession a doc has to know,insurance how to deal with reps et etc etc.

Also patients are different,but i still believe with the TIME,the RESOURCES a person has,i still have to say i believe a patieant can know more about there medication treatment then there p-doc.

This is why is INCLUDE my doc,i dont however exclude myself in treatment.

 

Re: Article in NYT RE: Self-Prescribing/Medicating » willyee

Posted by Nickengland on November 16, 2005, at 18:30:13

In reply to Re: Article in NYT RE: Self-Prescribing/Medicating, posted by willyee on November 16, 2005, at 18:13:38

Hi willyee,

I'm no way a fortune teller, but something told me that when I last saw Amy's thread when she was gathering information about her story, I knew there would be aspects of it I would agree with, but also I knew there would be parts of the truth which were not put into print and these aspects although may notbe relevant to the average joe (make the first page etc) are relevant in a sense to the reader as it shows what lengths people with mental illness have to go to gain relief...The people with mental illness seem to always have the short straw with stigma etc so to speak..

When someone goes to have a drink of alcohol tonight, be they a reporter or anyone in the general population, or smoking a cigarette even in a social setting ~ could it be considered a form of self prescribing - after all it is a drug..

Everyone has there own unique story, fortunately some can put theres in print for viewers of millions of people, whether its on the internet or in the newspapers - although I doubt these parts will be put into print lol

Kind regards

Nick

 

Biased Research and Free Gifts - for who?

Posted by Nickengland on November 16, 2005, at 19:07:07

In reply to Article in NYT RE: Self-Prescribing/Medicating, posted by hawkeye on November 16, 2005, at 9:42:03

>Direct-to-consumer drug advertising, approved by the Food and Drug Administration in 1997, has for most of their adult lives sent the message that pills offer a cure for any ill. Which ones to take, many advertisements suggest, is largely a matter of personal choice.

In todays news...

Crackdown on drug firm promotion

Ways to report side effects must appear on all promotional material
Drug firms will no longer be able to court doctors with prizes and lavish venues, following an overhaul of the industry's code of practice.
Companies must only offer economy air travel to delegates sponsored to attend meetings, the Association of the British Pharmaceutical Industry adds.

The first changes to the industry's code in a decade also focus on patient safety and process complaints faster.

Companies that breach the code can be named and shamed, the ABPI said.

The new code comes into effect on January 1, 2006.

It bans the use of promotional competitions and quizzes.

As far as meetings and seminars are concerned, subsistence - food and accommodation - must be strictly limited to what is essential for people to attend the event.

And companies should avoid using venues renowned for entertainment facilities, it says.

Firms must make public a list of all patient organisations to which they provide financial support, and prominent information about how to notify drug firms about possible side-effects of their products must be displayed on all promotional material.

Self-regulation

Speaking at the launch in central London, Andrew Hotchkiss, ABPI board member in charge of the project, said: "The ABPI code of practice has been the gold standard for pharmaceutical industry regulation throughout the world for many years.

"Our aim was to ensure that it continued to be strong and effective as well as fully meeting all the changes and requirements that have occurred since the last review."

Jeremy Mean, senior policy manager at the government regulator, the Medicines and Healthcare products Regulatory Agency (MHRA), said: "The control of medicines advertising in the UK is based on a long-established system of self-regulation supported by the statutory role of the MHRA.

"The MHRA warmly welcomes the new code, which includes positive changes to enhance patient safety to ensure that the code remains robust and rigorous."

http://news.bbc.co.uk/1/hi/health/4443320.stm

-------------------------------------------------


And interestingly...from the news in 2003

Doctors 'influenced by drug companies'


Some doctors may be prescribing unsuitable drugs
Experts have called for new rules governing the relationship between the medical profession and the pharmaceutical industry.
It follows claims that some drug companies may have undue influence over what medicines doctors prescribe to patients.

Several studies published in this week's British Medical Journal (BMJ) suggest that this influence may cause some doctors to prescribe unsuitable and unnecessary drugs.

They raise questions about the free gifts given by companies to doctors and the way the industry funds research, medical conferences and education seminars.

Free gifts

Drug company representatives visit thousands of doctors every week to inform them about new or existing products. They often offer doctors free gifts, such as stationery, mugs or key rings. Sometimes the gifts may be more substantial.

One of the studies in this week's BMJ suggests this may encourage some doctors to prescribe unsuitable drugs to patients.

Doctors must not be, or be seen to be, influenced in prescribing matters by any incentives from the pharmaceutical industry

Dr Vivienne Nathanson, BMA

Researchers carried out a survey of 1,000 GPs across England. They found that doctors who see company reps at least once a week are more likely to consider prescribing new drugs and to agree to patients' requests for medication even if they don't need it.

They suggested that in some cases reps may even target those doctors who are most likely to prescribe their products.

Doctors are expected to only prescribe new drugs if there is medical evidence to show they are effective.

The researchers said doctors should be given better guidelines to ensure they only prescribe such medicines.

'Biased research'

A separate study, by researchers in Sweden, suggests that even doctors who rely on research to decide which drugs to prescribe may also be unwittingly colluding with the pharmaceutical industry.

The researchers said this was because studies into new drugs were sometimes biased. They suggested that industry-funded trials were in some cases only published if they included favourable results.

The UK-based pharmaceutical industry strives to maintain the highest possible ethical standards

Dr Trevor Jones, ABPI

And they said a lack of access to negative studies meant some doctors were probably prescribing drugs on the basis of biased research.

Their findings were backed up experts in Canada. They reviewed 30 studies analysing research projects, which had been funded by a pharmaceutical company.

They found that these studies were more likely to come up with results that favoured the company compared with those that received funding from other sectors.

But they also found that these studies were less likely to be published in medical journals.

Richard Smith, editor of the BMJ, said the studies showed that the relationship between the medical profession and industry needed to change.

"Our central argument is that doctors, drug companies and most importantly patients would all benefit from greater distance between doctors and drug companies," he said.

Ray Moynihan, a medical journalist and guest editor of this week's BMJ, said the findings highlighted an unhealthy relationship between the medical profession and the drugs industry.

"We hope this will spark a broad debate about how to clean up the unhealthy aspects of the relationships between doctors and drug companies," he said.

Patient's needs

The Association of the British Pharmaceutical Industry (ABPI) said companies were expected to adhere to strict guidelines when informing doctors about new products. It said the onus was on doctors to ensure they prescribed effective medicines.

Dr Trevor Jones, the association's director general, added: "The UK-based pharmaceutical industry strives to maintain the highest possible ethical standards in its dealing with healthcare professionals and other stakeholders."

The British Medical Association (BMA) said it hoped the studies would lead to a debate about the best way to prevent drug companies from inappropriately influencing doctors.

Dr Vivienne Nathanson, the BMA's head of science and ethics, added: "The guidelines in the UK put fairly strict limits on hospitality, gifts, sponsorship but should be constantly reviewed especially against any evidence of abuse or ineffectiveness.

"The individual needs of the patient are paramount when a doctor is prescribing medication.

"Doctors must not be, or be seen to be, influenced in prescribing matters by any incentives from the pharmaceutical industry."

http://news.bbc.co.uk/1/hi/health/2946276.stm

Kind regards

Nick


 

Re: Article in NYT RE: Self-Prescribing/Medicating

Posted by Emily Elizabeth on November 16, 2005, at 23:23:48

In reply to Re: Article in NYT RE: Self-Prescribing/Medicating » willyee, posted by Nickengland on November 16, 2005, at 18:30:13

I must say I have mixed feelings about this article. As I was reading it, I found myself getting mad at many of the people who were being interviewed. It seemed that a lot of them were essentially using psych meds recreationally (e.g., taking a stimulant so that you can stay up and clean or party) First of all I guess that I would like to have that luxury--taking meds is my desperate attempt to feel OK, and it doesn't always work. I don't quite know how to express it, but I feel like well, maybe these kids that she is interviewing are spoiled or something. If you have been up late you have to go to sleep. That's how it works. Don't abuse a drug that some people need to just feel normal. It's almost insulting. Does anyone understand what I'm trying to say? Does anyone else feel this way?

Also, I worry that pieces like this help cement the idea in people's mind that psych meds are something people take simply because they want to. That they are optional and not an actual medical treatment for a medical problem. We don't need any more stigma.

That said, it was interesting. Although I agree w/ the person above that said that it was unfortunate that the Babble reference was somewhat unflattering. Why did she choose something that broke one of the rules of the boards? Not the most representative choice to say the least!

Best,
EE

 

Re: Biased Research and Free Gifts - for who?

Posted by Phillipa on November 16, 2005, at 23:29:14

In reply to Biased Research and Free Gifts - for who?, posted by Nickengland on November 16, 2005, at 19:07:07

She E-mailed me and I did not answer. If this article nails the drug reps and cuts down on prizes rewards, etc. then its a good thing. I myself hope the doctors will see how unhappy their pts are with their advise. And yes pdoc's aske their pts which med they would like to try. Where is their knowledge? Pdocs needs school for medication education not some dug rep peddling pills and samples in return for using their meds for doctors earnign vacations etc. Fondly, Phillipa

 

Re: Article in NYT RE: Self-Prescribing/Medicating

Posted by Iansf on November 17, 2005, at 1:36:03

In reply to Re: Article in NYT RE: Self-Prescribing/Medicating » willyee, posted by Nickengland on November 16, 2005, at 18:30:13

> Hi willyee,
>
> I'm no way a fortune teller, but something told me that when I last saw Amy's thread when she was gathering information about her story, I knew there would be aspects of it I would agree with, but also I knew there would be parts of the truth which were not put into print and these aspects although may notbe relevant to the average joe (make the first page etc) are relevant in a sense to the reader as it shows what lengths people with mental illness have to go to gain relief...The people with mental illness seem to always have the short straw with stigma etc so to speak..
>
>
She interviewed me, but it became clear very quickly that I didn't fit the pattern she had in her head, which was that self-prescribing was something only people in their 20s and 30s do and it's happening to a large extent because of the Internet. I'm in my 50s. I have friends who are in their 40s, 50s and 60s who also try to take control of their treatment. I started doing my own research 10 years before I even heard of the Internet. But because this information didn't fit her thesis, she ignored it. She even told me she'd spoken to several other people who were in their 40s and 50s. But all of us got left out because it disrupted her premise. Rather than adjust her premise, she preferred to adjust reality. It doesn't necessarily negate much of what she said, but I do find it rather insulting.

 

I'm sorry everyone

Posted by med_empowered on November 17, 2005, at 1:54:51

In reply to Re: Article in NYT RE: Self-Prescribing/Medicating, posted by Iansf on November 17, 2005, at 1:36:03

hey! I am very sorry that my post (which completely violated psycho-babble rules+regulations) was the **only** post from this excellent website that was posted. At the same time...I'm kind of disturbed that this whole article focused on self-prescribing while ignoring what psycho-babble and many other wesbites are *really* about--patient information and empowerment, with the goal of working towards a more equal doctor-patient collaboration, rather than the traditional mode in which a patient is "worked on" or "treated by" a certain physician. I'm also alarmed that the author alleges there is some sort of trend towards self-prescribing without offering up any sort of hard evidence (numbers, quanititative data)...everything seems to be based on a few interviews which, as one poster stated earlier, seem to have been hand-picked to fit the author's "theme".

Its taken so long for patients, particularly in psychiatry, to give a voice and be able to assume an active role in their treatment. The concept of "patient-centered therapy" is pretty new, which seems ridiculous when you realize that it is, in fact, the patient whose very LIFE is being affected by whatever treatment is offered. I can't help but feel that this article has portrayed many of us as being misinformed, uninformed, or simply drug-seeking. Much of this article strikes me as being poorly supported, highly biased, and ultimately damaging to well-informed patients seeking the very best possible treatment for themselves and those they care about. That said...I *am* sorry that my post (again, sorry I broke babble rules with that) was the **only one** selected from this site.

 

Re: Bias was predictable

Posted by blueberry on November 17, 2005, at 4:08:31

In reply to Article in NYT RE: Self-Prescribing/Medicating, posted by hawkeye on November 16, 2005, at 9:42:03

When Amy Harmon first came to this board, I asked whether the NYT had a liberal slant or a conservative slant. Once I found out, it was a slam dunk to know in advance how this article would be biased. That's why I didn't participate. It was an interesting article though, and actually wasn't quite as extremely biased as I had expected, though still considerably biased.

 

NYT ''new trends'' » med_empowered

Posted by pseudoname on November 17, 2005, at 6:05:47

In reply to I'm sorry everyone, posted by med_empowered on November 17, 2005, at 1:54:51

m_e,

I hope I didn't sound as though I was shaking my finger at you for the post that she quoted. Clearly, she would've found another example if you hadn't put a small toe over Bob's line. Your post in fact was much more about how to warn people away from a particular illegal source.

I agree that patient-empowerment psychiatry is a much bigger deal than her drug-diversion angle.

You are right that "the author alleges there is some sort of trend towards self-prescribing without offering up any sort of hard evidence (numbers, quanititative data)."  I guess because it *seems* to me personally like there's "more" self-prescribing, I was buying her premise, too, without actually thinking about it. I could ask myself, "More" compared to what?

In Slate's Press Box column a few weeks ago, Jack Shafer criticized the NY Times for asserting numerically unverified "new trends" and using weasel-words like "many" instead of quantitative data. On Sept 20, for example, the Times said there was a new trend for "many" young Ivy-League women to choose babies over careers. Problem? The Times reported the exact same new trend TWENTY-FIVE YEARS AGO!

http://www.slate.com/id/2126760/

 

Re: NYT ''new trends''

Posted by med_empowered on November 17, 2005, at 6:23:32

In reply to NYT ''new trends'' » med_empowered, posted by pseudoname on November 17, 2005, at 6:05:47

You have a point. For instance, a friend of mine was talking about how the NYT proclaimed that "feminism is dead" recently. I live in a college town, so I can tell you...feminism is *not* dead. Sweeping pronouncements such as this are inappropriate and unsupported by data (im in social sciences; data is my life blood). Plus, without getting too political here...I've lost pretty much all respect for the NYT after the whole Judith Miller thing. These days, I read "The Utne Reader" "Harper's" ""The Progressive" "Mother Jones" and "In these Times" (I double quoted everything to see if the amazon.com magical thing would happen).

 

med_empowered

Posted by Glydin on November 17, 2005, at 6:37:34

In reply to Re: NYT ''new trends'', posted by med_empowered on November 17, 2005, at 6:23:32

I don’t want you to feel badly over the fact ONE (as in ONE example) post of yours was cited for the article. You are a part of this community and you took this particular encounter private at which time it then became a private matter between you and another poster. This encounter happened to fit the angle of the article. You contribute to this board in ways other than the exchange cited.

 

Re: med_empowered

Posted by linkadge on November 17, 2005, at 8:45:04

In reply to med_empowered, posted by Glydin on November 17, 2005, at 6:37:34

What I think is the most dangerous part of it all, is that we are overestimating the safety of the drugs.

If we were mixing raspberry and blueberry fruitloops it would be a different issue.

Doctors may appear "dumb" may just be rightly conservative.


Linkadge


 

Shafer on Harmon's article » med_empowered

Posted by pseudoname on November 17, 2005, at 9:27:38

In reply to Re: NYT ''new trends'', posted by med_empowered on November 17, 2005, at 6:23:32

In an email this morning, I suggested to Jack Shafer that Amy Harmon's article was an example of unsupported NYT trend-spotting like the earlier Ivy-grad motherhood article he criticized. He replied,

> I read this one closely. I don't think they
> crossed the line and asserted that their
> information was anything but anecdotal.

In truth, the drug-diversion article wasn't as empty and "hand-waving" as the motherhood article. And there was a little hard data (the study that found 14% of one college's students admitting diverting prescription drugs to/from friends). Also I don't think the overall picture is fallacious, as it may have been in the motherhood story.

But I think the article implied that it proved more than it actually proved about self-pharmacy trends.

 

Re: Shafer on Harmon's article

Posted by linkadge on November 17, 2005, at 10:34:51

In reply to Shafer on Harmon's article » med_empowered, posted by pseudoname on November 17, 2005, at 9:27:38

Ritalin abuse in university is very common. In my university it is very common.

Linkadge

 

Re: Shafer on Harmon's article

Posted by Laurie Beth on November 17, 2005, at 10:38:57

In reply to Shafer on Harmon's article » med_empowered, posted by pseudoname on November 17, 2005, at 9:27:38

"But I think the article implied that it proved more than it actually proved about self-pharmacy trends."

I agree.

For example:

"For a sizable group of people in their 20's and 30's, deciding on their own what drugs to take - in particular, stimulants, antidepressants and other psychiatric medications - is becoming the norm."

Technically, this might be true. Perhaps for several young adults (out of how many millions in the US?), the "norm" is to decide what meds to take (and, also implied by context, to obtain them illegally). But the very use of word "norm" is intended to mislead the reader into thinking that she's saying that the NORM AMONG YOUNG ADULTS is to decide on their own what meds to take. Saying that "some people in their 20s and 30s decide on their own" what psychotropic meds to takewould hardly be news, right?

But in some instnaces, it seems to me that she DOES cross the line between misleading the reader into thinking that more is being claimed, and actually claiming more but not supporting it. Take this:

"The behavior [referent unclear, she seems to be referring to 'trad[ing] unused prescription drugs, get[ting] medications without prescriptions from the Internet and, in some cases, l[ying] to doctors to obtain medications that in their judgment they need'] ... is on the rise" [along with the "use of marijuana and cocaine"].

And what about the reference to "increasing casual misuse of prescription medications by young people"? Where is the support for this statement?

I don't really see any support in the article for a trend.

But what I find more problematic is (1) as medempowered says, people who are trying to become knowledgeable about their medical care and question or make suggestion to their pdocs or GPs about medication are being lumped with people who break the law by obtaining meds and dispensing meds illegally, and (2) people who are trying to get adequate treatment for serious mental illnesses are being lumped in with those who want to "party" or clean their house late, those who try to "regulate every minor mood fluctuation" will illegal obtained meds, and those who "want to enhance their performance at school or work" with same.

-Laurie


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