Why do doctors over prescribe drugs?

Great Debates
21

That I haven’t seen any evidence thus far that they do. Based on where I’ve heard this assertion in the past I’d say that by and large it’s horseshit. Or, sure, there are instances where it does happen (I believe Michael Jackson is a good example), but it’s not the common, widespread problem that some folks make it out to be.

Doctors prescribe MORE drug than they did in the past, but that’s not the same thing as ‘over prescribe drugs’. It simply means that today doctors have more tools at their disposal than they used to in the past.

Do you have any actual evidence that this is the case?

Well, I think that I’m a tall, slenderly built and stunningly handsome blonde with glacier blue eyes and a total chick magnet. Sadly, reality does not always conform to what I ‘think’. You should perhaps give that some thought when you assert things you ‘think’ are happening without any evidence.

And you believe this? You really believe that this guy had a 99% cure rate for cancer, and that this was so threatening that the ‘drug company and government took his medical license’ (leaving aside that neither issue a medical license)? :stuck_out_tongue: I have a carburetor that makes your car get 200 MPG to sell you…plus a bridge and some fairy dust as well.

I mean, come on. Be serious here. If there WAS a cure that worked 99% (or hell, even 90%) of the time and it ACTUALLY WORKED, then even if the evil drug barons and the government wanted to stop this guy SOMEONE WOULD HAVE GOTTEN THE PROCESS AND BE SELLING IT. You know why? Because even evil drug companies like to make MONEY…and folks who are desperate for a cure for their cancer are going to shell out money for a cure, especially one that cures at that rate. Of course, sadly, they will also shell out money to absolute quacks who are promising cures at 99% but are really doing nothing helpful for them…and in fact, are probably putting them at higher risk. Which is what this guy was doing.

Seriously, any time someone tells you that they can cure something 99% of the time your bullshit meter should be flashing and beeping at you from that alone. You best either get yourself a bullshit meter, or recalibrate, because you are going to end up investing in Orgone energy schemes, making gasoline out of water and 200 MPG carburetors, and then it’s a slippery slope down to believing that the whole Moon landings thingy was a hoax. After that you’ll be joining Charley Sheen in a Turkish Bath House…and you don’t want that, do you??

-XT

22

Not routinely. There have been some notorious cases where drug companies will pay doctors to speak about the benefits of their new drug. Of course, the selected doctors are the top prescribers of that same drug, and they get a hefty amount of money and essentially an all-expense-paid vacation in return for becoming a salesman. Here’s a good investigation into the practice.

But these cases are rare, with a mere handful of doctors who earn five or six figures from these sorts of speaking fees. The vast majority of doctors will never receive this sort of money or attention. The most they’ll ever get is a pile of free office supplies from some sales rep.

23

They agreed to stop doing that a couple of years ago, and I disagree that this is rare. Not that many doctors make a lot of money from speaking fees - although the companies to their best to pick doctors who are influential and respected, so their endorsements matter the most - but there are tons of things like corporate-sponsored conferences and dinners and entertainment paid for by sales representatives. There are some very serious ethical issues involved with these practices. Starting soon, payments to doctors will have to be disclosed directly. It’s also true, separately, that there have been plenty of cases where pharmaceutical companies have agreed to pay billions of dollars in settlements for outright payments to doctors in return for prescribing particular drugs, which is illegal.

24

I think you are referring to one of the best rants ever made against the proponents of woo woo that was made by Tim Minchin and posted before at the SDMB:

(NSFW language.)

25

Let’s see your evidence that doctors do in fact overprescribe drugs.

The fact that more people are on medications now than were at some time in the past is not evidence by itself, because it could be that there is now a drug for a condition that went untreated in the past. By that logic, since no one was prescribed antibiotics before 1900, no one should be prescribed antibiotics now, which is obviously nonsense.

Somebody’s gut feeling that too many people are taking too many drugs is not evidence. Of anything.

Some good scientifically controlled studies of natural cures would be good, too. Anecdotes of one person or a few people whose cancer was cured don’t count.

You have to take into account whether most people will be willing to comply with a treatment, as well. If people can’t or won’t do what they need for a treatment to work, it’s not doing them much good. We might need an alternative that people would be more likely to comply with. That might mean drugs over lifestyle changes. People aren’t always willing or able to comply with lifestyle changes that their doctors tell them to make. That doesn’t mean those people don’t need or deserve to have their medical conditions treated.

26

I agree with this, as a physician. Any family medicine doctor has had the experience of having patients come in with cold symptoms DEMANDING an antibiotic even though their illness is most likely viral and antibiotics won’t do any good.
Some doctors do go out of their way to try to educate patients about why it’s not appropriate to take a Z-Pak every time you have the sniffles, but others don’t want to deal with the arguing or time wasted and will just write a prescription even though it’s essentially a placebo effect.

When I think that a patient’s symptoms can be managed without meds, I do present it to them as a choice.
I definitely do not get any extra perks for prescribing expensive medications. In fact, in many practice environments now, doctors are given incentives to try to reduce costs.

27

I’m always flummoxed by this claim. How many medications SHOULD doctors prescribe? What’s the “right” amount? How do we know that doctors are over-prescribing medications? Underprescribing them?

People who make this claim seem to think “overprescribing medications” means “people are taking more medications than I, a random person untrained in medicine, think that they should be taking.”

I’m not even going to touch the Gerson scam.

28

Anti-depressants do not change who you are. They don’t change your personality.

They do not brainwash you.

29

What people don’t understand is there is no way Big Pharma or anyone would suppress a cancer drug. EVEN if it was “raw food” diet, do you not think Big Pharma or the “gubmint” couldn’t find a way to profit. Just look at the myriads of diet companies out there. It’d be all, “Don’t just buy raw food, eat BigPharm Brand specially modified raw food with the proper ingredients!” And they’d still do it.

And yes, of course, the mere fact that everyone will eventually know someone or love someone who succumbs to cancer. It’s just too prevalent.

30

And then there’s the small matter of scientists (or dietitians or whoever) wanting the acclaim that comes with being part of a cure for cancer. You can already see how many people try to get rich and famous from phony cancer cures; it only stands to reason that somebody who came up with a serious cure would get a bigger reward.

31

Drug companies certainly do make and presumably profit from dietary supplements. (Who did you think manufactured all those vitamins you see in the supermarket and drug store?) They have no reason to suppress any cures that result from supplements.

32

Because, hey. . .drugs!

33

Depressed (in the clinical, medical sense) does not mean “sad.” It means your brain isn’t functioning properly. Rich gorgeous folks can, and do, suffer from depression, the same way they can suffer from diabetes or tumors or pancreatic cancer or broken bones or anything else.

34

They suffer from depression knowing they won’t be rich and gorgeous forever. We’re aware of our own mortality. Besides, there’s a million other things that can cause depression such as being married to a jerk, working for a jerk, being surrounded by jerks, or having a chronic illness, or feeling that you’re ugly even though most people would say you’re beautiful. Simply not finding your soul mate may be enough to drive some people to depression. Doctors usually prescribe these pills based on a simple evaluation of feeling depressed without a clinical examination of the patient’s brain chemistry.

35

It’s not clear that “brain chemistry” is responsible for depression. A good psychiatrist will make a distinction between people who are simply sad for one reason or another and people who have a sustained problem.

36

Until there’s even a scintilla of evidence that it occurs, there’s absolutely no reason to take it for granted. In fact, it would be much better to stamp out ignorance than to entertain it.

I’m so glad you brought up ADHD, since a) the disruptive behavior disorders are my area, and b) this assertion about overmedication is made all the time in regards to ADHD.

There’s no evidence to support either assertion, but in particular as regards medication, I’ve never seen a valid study, nor any publicly available data that remotely supports this. In broad population studies, the rate of ADHD medication use does not exceed the rate of diagnosis (see e.g the CDC: http://www.cdc.gov/ncbddd/adhd/data.html).

In studies of specific cohorts of individuals, the rate of those who have been prescribed an ADHD medication is always lower, and usually like 30 to 50% of those who actually meet criteria for the disorder.

Since medications are an element of the most effective treatment regimen for ADHD, this suggests that if anything there is a dramatic underdiagnosis of medication for ADHD rather than the opposite.

37

Also, wealth and beauty are relative. A millionaire can be depressed because his brother is a billionaire, and a beautiful woman can be depressed because her sister won a beauty pageant or got a boob job and posed for Playboy.

38

Major Depressive Disorder, or clinical depression, is not self-pity or sadness at one’s circumstances.

39

I know when I’m depressed (not just sad, but lacking any emotions or motivation), I don’t have any reason. Especially not any reasons like these.

I don’t doubt that there are some people who are prescribed anti-depressants who do not need them. But most anti-depressants come with enough side-effects that I’m not imagining a whole lot of people popping them just on a lark. It’s not like anti-depressants give you an instant high.

My beef with prescription medication is that it fosters some complacency in the patient. I have a movement disorder. For a while, it was getting so severe that I was thinking about checking myself into a hospital. I’ve had “potential” diagnoses, but nothing satisfactory or practical enough to pinpoint with absolute accuracy (the tests aren’t covered by insurance). So for now I’m coping through a combination of medication, daily yoga, and supportive psychotherapy. I’m doing better and feeling good about life again, but there are still issues present. Because I am doing okay, though, I don’t feel the motivation to root them out and get “cured”, if that’s even possible. So the drugs (and the lifestyle changes) have made me more passive and accepting. I don’t think this is ideal.

But then again, life ain’t ideal. You can only spend so much time thinking about something before you start going crazy. Treating the symptoms and living your life is the more practical alternative to treating the symptoms and hunting for a cure.

40

It wasn’t an exhaustive list. There’s a million causes of depression, certainly not just self-pity, including mourning someone after death. A percentage of depression has a clinical source, but the TV ads shoehorn the general public into doctor’s offices to get pills rather than just dealing with the external source of depression, which may be as simple as letting a period of mourning, or period of grief after being rejected or divorced (these are just a couple examples, not intended to be an exhaustive list), take its course. Most people should be going to a psychologist first, and only to a doctor if referred by the psychologist. It may be best to first try a placebo and see if the patient recovers from their depression before prescribing meds with potentially harmful side effects.