*The rate at which psychiatrists in different regions administer many prescription drugs shows massive variation — up to a fifty-fold dissimilarity per million patients in the numbers of antidepressant, anti-bipolar, and anti-psychotic medications prescribed.
The dissimilarity is unrelated to regional factors (other than the prescription drugs themselves) that influence the incidence of diseases for which prescription drugs might be considered.*
it says massive variation in number. …up to a fifty-fold dissimilarity
i guess this means …
if region X get 50 anti-depressant drug , then region Y get 50 x 50 = 2500 antidepressant drug per million patient
if region X get 30 anti-bipolar drug , then region Y get 50 x 30 = 1500 anti-bipolar drug per million patient
if region X get 20 anti-psychotic drug , then region Y get 50 x 20 = 1000 anti-psychotic drug per million patient
however, i don’t understand the red sentence . that structure is complicated to read and i’m getting lost in between.
Is it saying , drug number variation is not due to different region …there may be something else ?
could you please simplify the meaning of the red sentence . Too many conjunctions are making the entire thing complicated.
The sentence is not saying regional diffs are not a factor, it’s saying regional diffs in flavors of lunacy are not a factor.
In other words the quacks are prescribing different drugs in different areas but are not doing so because different areas have different kinds of nuts.
I’d be interested in any speculation about New York as the nation’s capital of mental health counseling. I’ve long suspected it’s woven in with the culture more thoroughly there than in most places. There’s a certain instinctive respect for medicine of any kind, and perhaps it’s more accepted to admit you see “a shrink.”
I’m not sure I can explain this one with a simple rewording, but I’ll try. I’m going to move the parenthetic remark (that is the part in parentheses) for clarity.
The dissimilarity = the different rates at which a certain drug is prescribed
is unrelated to regional factors = isn’t because of regional factors* (the author might mean factors like geography, income, religion and the number of doctors in the area, but he doesn’t make that clear in this sentence)*
that influence the incidence of diseases = those factors might cause a person to get a certain illness
for which prescription drugs might be considered. = that they might be given prescription drugs for.
And now, the parenthetical:
(other than the prescription drugs themselves) = but it might be related to what drugs are available in what region
In other words, some regional differences might be expected to explain why people in one area get sick with certain illnesses more than others. In this case, some of those expected regional differences don’t really affect the rates of those illnesses diagnosed by doctors. (Like I said, the author doesn’t say here which regional differences he’s talking about.) What does seem to be different in areas with different diagnosis rates of a certain illness is the medication available in that area. In an area that has access to a drug to treat depression, the rate of diagnosed depression is much higher than in an area where there is not access to the drug.
The dissimilarity is unrelated to regional factors (other than the prescription drugs themselves) that influence the incidence of diseases for which prescription drugs might be considered.
The first thing to do is to take out the parenthetical phrase. This is always the best starting point.
The dissimilarity is unrelated to regional factors that influence the incidence of diseases for which prescription drugs might be considered.
This simplifies it. All it says is that regional factors are not the cause of the dissimilarity. The incidence - that is, the number of - diseases is the same across regions.
Now go back and look at the parenthetical phrase.
(other than the prescription drugs themselves)
A parenthetical phrase may be used in several ways, but here it is used to create an exception (other than).
The cause of the dissimilarly may be in the way the prescription drugs themselves are used. (They are not the cause of the diseases, they are an effect.) We are not sure if this is true. We are also not told why this could be true. Logically, there are many possibilities. They may be priced differently or have different availabilities or be prescribed more or less often because of local histories or practices. The reasons don’t matter for this sentence. However, prescription drugs are more likely the reason.
To sum up. To understand this tremendous differential across regions, we shouldn’t look at the regions but at the drugs.
There are a few ways a person can interpret this piece of information. One way would be to assume that the drug companies are instructing doctors about the diseases their drugs treat. The doctors are then able to recognize these illnesses better than doctors without extra education, and prescribe the drugs to treat them.
Or one might wonder if the drug companies are advertising to the doctor, or even giving him gifts when he prescribes more of their drugs, and so the doctor diagnoses people with the condition even when they don’t have it.
Finally, you might wonder if there is less diagnosis of an illness when there is not medicine available to treat it because diagnosing it would just be a waste of time. If a doctor can’t treat something, he may not focus on diagnosing it in the first place, and so fewer of his patients will be diagnosed than patients of a doctor who could treat it.
I’m not sure which of these or some other hypothesis the author is defending, but they are three possibilities I’d consider when reading this passage.
This is related to the so-called India Paradox. People in third-world countries with schizophrenia tend to recover from it more often than ones in first-world countries:
It’s suspected that this is because it’s actually better to prescribe a lesser amount of drugs for schizophrenia and to prescribe them for a shorter period. People in first-world countries tend to be prescribed drugs for too long and in too large an amount. (Time spent in psychiatric institutions is also longer in first-world countries.) The third-world countries do this because they can’t afford the drugs or the long time in institutions, but it turns out to be better.