4 ms·

I'm an MD who specializes in Psychiatry. Although much of this article is somewhere between a little and a lot inaccurate, the basic premise that an absurdly ex

I'm an MD who specializes in Psychiatry. Although much of this article is somewhere between a little and a lot inaccurate, the basic premise that an absurdly expensive antipsychotic is the most popular drug is alarming. It is a useful and effective medication with a clear role for a relatively small subset of the population. Why it is being prescribed so widely is a question worth asking.

hga 12y ago
If you read the article carefully, and/or click through, you'll find it's only #1 in dollar sales, it's still on patent until April or so. I wouldn't be surprised if Ativan/lorazepam is still #1 in terms of prescriptions.
- refurb 12y ago
  On a per prescription basis acetaminophen plus hydrocodone is the top selling drug.
  - andyzweb 12y ago
    I tried my google-fu at this. what is your source?
    - deleted 12y ago
      [deleted]
    - dmix 12y ago
      Here, most units sold: http://www.drugs.com/stats/top100/units http://www.drugs.com/stats/top100/units acetaminophen/hydrocodone is #2 budesonide is #1 which is used to treat asthma (in puffers I believe). I spent some time scraping medication information and learned that pharmacies in the US mine massive amounts of data about pharmaceutical purchases and there are a few billion dollar companies that collect/sell this data. Customer information is "anonymized" of course at the pharmacy level. You can find the sales of the top 100 drugs drugs pretty easily online, but there are thousands of drugs and the data-mining companies charge you to see sales of the smaller ones (from my experience).
      - refurb 12y ago
        You are correct! Budesonide is available as a generic inhalable steroid for asthma. As for Rx data, IMS is king. They pay pharmacies, wholesalers, etc to report all of their sales. It's used heavily by pharma companies. I've seen some of the data and it goes all the way down to individual Rxs by doctor. Incredible stuff.
        pinaceae 12y ago
        down to the HCP is only allowed in the US. most markets protect HCPs from pressure by the industry, you can only get clustered Rx data there.
    - refurb 12y ago
      I couldn't find the original source, but I found this: http://www.pharmacytimes.com/publications/issue/2013/July2013/Top-200-Drugs-of-2012 http://www.pharmacytimes.com/publications/issue/2013/July201... It's about 1/2 way down the page. Of course this is by total number of Rxs, not dollars. Hydrocodone/APAP is pretty cheap. Also it's from 2012, so it might have changed.
drcomputer 12y ago
These issues are sociologically complex and they are being addressed as if all mental health issues can be treated on an individual level. There should be regulation that prevents rate of expansion into new 'fuzzily defined' target markets that is scientifically regulated with scientific, precisely and pedantically defined, formalized language. This personally horrifies me, and I watched this happen over and over again in federally funded facilities: > When someone's antidepressant didn't work, Pharma marketers began floating the idea that it wasn't that the drugs didn't work; it wasn't that the person wasn't depressed to begin with but had real life, job and family problems—it was "treatment-resistant depression." Over-prescription in general seems to come from ill equipped / underfunded facilities. These are places that can't afford to give every person individual therapy. They are communal, so there is lots of personality clashing that goes on inside of the facilities that exacerbates disorders which stem from or are composed largely of adaptive socialization behaviors that become maladaptive in different environments. A person who grew up in poverty or from an abusive environment is going to be angry and depressed. Just because there is no one available to have an intelligent kind of compassion for that person, doesn't make them psychotic. People are afraid of what they don't understand in general. It's easier and cheaper to zonk someone out than actually have to think about or pay how to help them. I really don't mean to come off so cynical, but some of these public facilities can be blackholes for many of the people they treat, with the possibility of re-traumatizing people on top of the problems they already have. Oh, and on top of that, the humorous part (read with heavy sarcasm): people at these places are called "clients" and the facility stresses that that specific phrasing is used. No one is called a patient. They are a "client", a consumer.
- gohrt 12y ago
  What's wrong with calling someone a client, and separating their medical situation from their identity as a member of the social relationship? A client is a more engaged partner in the activity of achieving and maintaining well-being; a patient is a more passive victim of their situation.
  - drcomputer 12y ago
    A large percentage of the people there are there on a court order. Rape victims are potentially in the same groups as convicted rapists and murderers. These are not happy places for finding and maintaining well-being; they are chaotic hellholes. If you lose your sense of self in there, all you have left are labels of insanity reflecting back at you to tell you who you are. You can call that person a client, but they are still a psychotic, borderline, {etc} client, whom can be drugged, physically restrained, and held against their will. That said, I'm sure there exist people who don't experience that. But that doesn't imply that it does not happen. You have no idea about the level of conflicting messages you receive in these places. The advice is so diluted that it can't be practically applied, it only describes very generally the way the mind functions when it is operating at an average baseline. It doesn't mean it creates mental stability. These places run on belief systems, not science. I am absolutely certain this is one side of a coin. On the other hand, these are difficult, systemic issues for which places like this serve as a sinkhole for. The people who work there have to deal with this every day, and I'm sure many of them are trying their best and are not abusing the power and authority they have been given over the lives of other people. But that doesn't mean it can't be improved, and it doesn't mean it doesn't warrant a real, socially active and involved discussion.
deleted 12y ago
[deleted]
kaffeemitsahne 12y ago
What do you think of the use of e.g. olanzapine as a sleeping aid in bipolar disorder? Is it justified, even when no (hypo)mania is present?
- hga 12y ago
  I'm not a doctor, but back when my doctor and thought I might have true bipolar disorder (vs. as it turns out "depression of a bipolar nature" that only goes manic when I take the wrong drugs), I studied up on the disorder. What's prescribed for people with is are "mood stabilizers" (and all of them but the "gold standard" of lithium were originally developed for other indications like psychosis and convulsions). So people who have true bipolar disorder by definition have manic phases, and they need their mood stabilizer all the time to deal with both that and depression phases.

hga 12y ago

If you read the article carefully, and/or click through, you'll find it's only #1 in dollar sales, it's still on patent until April or so. I wouldn't be surprised if Ativan/lorazepam is still #1 in terms of prescriptions.

refurb 12y ago
On a per prescription basis acetaminophen plus hydrocodone is the top selling drug.
- andyzweb 12y ago
  I tried my google-fu at this. what is your source?
  - deleted 12y ago
    [deleted]
  - dmix 12y ago
    Here, most units sold: http://www.drugs.com/stats/top100/units http://www.drugs.com/stats/top100/units acetaminophen/hydrocodone is #2 budesonide is #1 which is used to treat asthma (in puffers I believe). I spent some time scraping medication information and learned that pharmacies in the US mine massive amounts of data about pharmaceutical purchases and there are a few billion dollar companies that collect/sell this data. Customer information is "anonymized" of course at the pharmacy level. You can find the sales of the top 100 drugs drugs pretty easily online, but there are thousands of drugs and the data-mining companies charge you to see sales of the smaller ones (from my experience).
    - refurb 12y ago
      You are correct! Budesonide is available as a generic inhalable steroid for asthma. As for Rx data, IMS is king. They pay pharmacies, wholesalers, etc to report all of their sales. It's used heavily by pharma companies. I've seen some of the data and it goes all the way down to individual Rxs by doctor. Incredible stuff.
      - pinaceae 12y ago
        down to the HCP is only allowed in the US. most markets protect HCPs from pressure by the industry, you can only get clustered Rx data there.
  - refurb 12y ago
    I couldn't find the original source, but I found this: http://www.pharmacytimes.com/publications/issue/2013/July2013/Top-200-Drugs-of-2012 http://www.pharmacytimes.com/publications/issue/2013/July201... It's about 1/2 way down the page. Of course this is by total number of Rxs, not dollars. Hydrocodone/APAP is pretty cheap. Also it's from 2012, so it might have changed.

drcomputer 12y ago

These issues are sociologically complex and they are being addressed as if all mental health issues can be treated on an individual level. There should be regulation that prevents rate of expansion into new 'fuzzily defined' target markets that is scientifically regulated with scientific, precisely and pedantically defined, formalized language. This personally horrifies me, and I watched this happen over and over again in federally funded facilities: > When someone's antidepressant didn't work, Pharma marketers began floating the idea that it wasn't that the drugs didn't work; it wasn't that the person wasn't depressed to begin with but had real life, job and family problems—it was "treatment-resistant depression." Over-prescription in general seems to come from ill equipped / underfunded facilities. These are places that can't afford to give every person individual therapy. They are communal, so there is lots of personality clashing that goes on inside of the facilities that exacerbates disorders which stem from or are composed largely of adaptive socialization behaviors that become maladaptive in different environments. A person who grew up in poverty or from an abusive environment is going to be angry and depressed. Just because there is no one available to have an intelligent kind of compassion for that person, doesn't make them psychotic. People are afraid of what they don't understand in general. It's easier and cheaper to zonk someone out than actually have to think about or pay how to help them. I really don't mean to come off so cynical, but some of these public facilities can be blackholes for many of the people they treat, with the possibility of re-traumatizing people on top of the problems they already have. Oh, and on top of that, the humorous part (read with heavy sarcasm): people at these places are called "clients" and the facility stresses that that specific phrasing is used. No one is called a patient. They are a "client", a consumer.

gohrt 12y ago
What's wrong with calling someone a client, and separating their medical situation from their identity as a member of the social relationship? A client is a more engaged partner in the activity of achieving and maintaining well-being; a patient is a more passive victim of their situation.
- drcomputer 12y ago
  A large percentage of the people there are there on a court order. Rape victims are potentially in the same groups as convicted rapists and murderers. These are not happy places for finding and maintaining well-being; they are chaotic hellholes. If you lose your sense of self in there, all you have left are labels of insanity reflecting back at you to tell you who you are. You can call that person a client, but they are still a psychotic, borderline, {etc} client, whom can be drugged, physically restrained, and held against their will. That said, I'm sure there exist people who don't experience that. But that doesn't imply that it does not happen. You have no idea about the level of conflicting messages you receive in these places. The advice is so diluted that it can't be practically applied, it only describes very generally the way the mind functions when it is operating at an average baseline. It doesn't mean it creates mental stability. These places run on belief systems, not science. I am absolutely certain this is one side of a coin. On the other hand, these are difficult, systemic issues for which places like this serve as a sinkhole for. The people who work there have to deal with this every day, and I'm sure many of them are trying their best and are not abusing the power and authority they have been given over the lives of other people. But that doesn't mean it can't be improved, and it doesn't mean it doesn't warrant a real, socially active and involved discussion.

deleted 12y ago

[deleted]

kaffeemitsahne 12y ago

What do you think of the use of e.g. olanzapine as a sleeping aid in bipolar disorder? Is it justified, even when no (hypo)mania is present?

hga 12y ago
I'm not a doctor, but back when my doctor and thought I might have true bipolar disorder (vs. as it turns out "depression of a bipolar nature" that only goes manic when I take the wrong drugs), I studied up on the disorder. What's prescribed for people with is are "mood stabilizers" (and all of them but the "gold standard" of lithium were originally developed for other indications like psychosis and convulsions). So people who have true bipolar disorder by definition have manic phases, and they need their mood stabilizer all the time to deal with both that and depression phases.