Looking at my supply closet, I was suddenly struck by the boxes of Zyprexa samples piled high inside. I'm an internist, a doctor who treats sore throats and high blood pressure. This medication was an antipsychotic drug designed to treat the severe delusions and agitation of bipolar disorder and schizophrenia.
What are these doing here? I asked my office nurse. The drug rep brought them, she said. She wants to speak to you.What did the rep say?
She said that I was likely seeing bipolar patients, as well as demented patients who were agitated.Moving ahead a bit...
At that point, she said the company had given her a directive to reach out to as many internists as possible. The company felt that we internists as a group were underutilizing the drug, she said.Dr. Siegel also stated that
That's dangerous thinking, I replied. I told her that such persistence would no doubt lead to the drug being wrongly prescribed — that it would hurt patients.
Although psychiatrists are not always available and not all patients are willing to see them, doctors must carve out our areas of expertise in keeping with our training and experience, and depression and psychosis are simply not my areas as an internist.You mean that non-mental health specialists should not be doling out Zyprexa, Risperdal, Seroquel, and the like willy-nilly? Sounds good to me -- of course, psychiatrists should also be careful of what they prescribe and take a close look at the evidence behind the medicines they hand out to patients. On another note, Siegel's story ties in nicely with other evidence regarding the apparent off-label promotion of Zyprexa.