Meds Compliance: The Problem Psychiatrist

John McManamy Health Guide
  • Deb writes:

    I have told my doctors that the Seroquel they prescribed me made me a zombie. I begged to try something else. But they threatened me with court intervention, Go figure???

    She goes on to say:

    I'm the one who asked for help, but not to drug me up so bad that I can't even function and wake up once in awhile. I am only 48 years old. I am not ready to die yet! I have quite a few years of living to do. I don't want to be comatose.

    Trust me, Deb is not alone. Deb was responding to my sharepost last week on Meds Compliance, the opening piece to what I anticipate will be a long and lively series, especially with your input.

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    Two-and-a-half years ago, I found myself delivering my first (and last) grand rounds to a group of clinicians at a psychiatric facility in Princeton, NJ. "Have you noticed how all drug reps look like Heidi Klum?" I asked. "Or Russell Crowe?"

    Up went a PowerPoint slide, with this quote from a former drug rep, appearing in a major medical journal:

    During training, I was told, when you're out to dinner with a doctor, "The physician is eating with a friend. You are eating with a client."

    Pity the poor patient - let's call her Jane - who has the bad timing to show up right after the Blobex rep, a Heidi Klum clone, has paid a visit. Jane may very well have have looked like the Blobex rep before her doctor put her on Blobex, but who is the doctor going to believe?

    "You may think you are above Heidi and Russell's blandishments," I told my audience, "but the pharmaceutical industry has billions invested in the proposition that you are not."

    "My doctor doesn't listen," I added. "The biggest complaint I get from my readers."

    I wasn't through: "Get over it," I said. "When your patients complain to you about feeling like fat stupid zombie eunuchs on the meds you prescribe - and on the meds you overprescribe - they are not doing this to ruin your day."

    As a mental health journalist, I had been reporting about the metabolic (and other) side effects in new generation antipsychotics since at least 2002. The studies definitively contradicted industry propaganda and what pharm reps were telling their doctor-clients. Around the same time, a range of studies were published showing that the new generation atypical antipsychotics (such as Zyprexa and Seroquel) were no more efficacious than the old generation meds.

    The studies also validated what I had been witnessing in support groups for years.

    "Let's face it," I said. "We've all been badly oversold on the new generation antipsychotics - you, me, family members. When all is said and done, these new generation atypicals are basically Clozaril with the tires rotated."

    For some reason, my otherwise stone-faced audience found this funny.

    Mind you, these meds can make all the difference in the world. The catch is they are not idiot-proof. The psychiatrist you are entrusting your life and well-being to needs to be smarter than the visiting drug reps.

    Only recently, in the wake of the NIMH-underwritten CATIE trials, has the medical establishment begun catching on to the metabolic risk of new generation antipsychotics.

  • "My question for you," I asked, "is why did it take you so long to figure this out? The same info was in the journals you subscribe to. On the labeling of the meds you prescribe. More important, your patients have been telling you this for years. Why haven't you been paying attention?"

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    Back to Deb, who was having problems with her Seroquel. Eventually, she took matters into her own hands. As she relates: "I had to just eventually stop going to those doctors and quit on my own."

    Technically, Deb became medically non-compliant. Had she wound up in the hospital, the doctors would have pointed an accusing finger at her. Yet another crazy person going off her meds.

    Much more to come ...

Published On: September 10, 2010