Friday, February 23, 2007

Pressured to Prescribe

In this interesting account in the LA Times, a physician, Dr. Marc Siegel, discusses how he was pressured by a Lilly sales representative to prescribe Zyprexa (olanzapine). All emphases are mine.
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.

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.
Dr. Siegel also stated that
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.


Mark p.s.2 said...

I am a bipolar and schizophrenic mental patient, and wonder how this medication would fix my mind. Does it make my brain think rational/logical thoughts better? Improve my memory? Does it pay the rent for me or go and get groceries in -20 degree weather outside? Does it give me an hour of exercise? Does it find me a job and a reason to live as well?

catlady4545 said...

When I consulted my family physician about the worsening depression I was experiencing, he did not ask any questions nor order obvious tests to find the cause (like a thyroid test),instead he handed me Zyprexa samples. He gave no explanation that this was an anti-psychotic medication used to treat schizophrenia and bipolar I. I gained 10 pounds in 2 weeks and stopped taking them immediately as I quickly recognized that I would be huge if I continued gaining weight at this rate! This was before I had internet access and google, so getting accurate information on psychotropic medications was very difficult. Since that time I have found other ways to treat my recurring depression other than using medications.

When I think about this general family physician handing me a heavy duty anti psychotic medication for depression, it just infuriates me!

Needless to say, he is no longer my family physician.