Sunday, November 25, 2007

What I Read in The New York Times Magazine Today.


I thought Roy was going to write about the psychiatrist drug rep who wrote about his year of selling his soul in today's New York Times Magazine. Apparently Roy went shopping, and then he got eaten by a Leopard (is that the new Apple thing?)

In "Dr. Drug Rep," Daniel Carlat, a psychiatrist in Newburyport, Mass, talks about the year he worked for Wyeth pharmaceuticals. He visited the offices of primary care physicians and talked about the wonders of Effexor. He describes his ambivalence and conflicts-- the money he made was good. Oh, never mind, the money was great-- he was getting up to $750 an hour to talk to docs over lunch. But he felt like he was minimizing the risk of hypertension and withdrawal symptoms. Dr. Carlat writes:

I wrestled with how to handle this issue in my Effexor talks, since I believed it was a significant disadvantage of the drug. Psychiatrists frequently have to switch medications because of side effects or lack of effectiveness, and anticipating this potential need to change medications plays into our initial choice of a drug. Knowing that Effexor was hard to give up made me think twice about prescribing it in the first place.

During my talks, I found myself playing both sides of the issue, making sure to mention that withdrawal symptoms could be severe but assuring doctors that they could “usually” be avoided. Was I lying? Not really, since there were no solid published data, and indeed some patients had little problem coming off Effexor. But was I tweaking and pruning the truth in order to stay positive about the product? Definitely. And how did I rationalize this? I convinced myself that I had told “most” of the truth and that the potential negative consequences of this small truth “gap” were too trivial to worry about.

----

And on another note, ClinkShrink mentioned to me tonight that writing doesn't come easily to her-- huh?! Some words of encouragement anyone?

And Roy, quicker on the uptake here! Hope you enjoy the new purchases. I hope you don't mind that I stole your topic....

25 comments:

Jayme said...

I spent yesterday reading this article off and on between phone calls. Brilliant! What an amazing look inside the workings of Big Pharma! I have read a lot about their inner workings, but never a first-person account from a shrink. I highly recommend this article to everyone. It is well worth your time.

Anonymous said...

I heard author Marcia Angell speak at the UW Madison about what she learned while writing the book The Truth About the Drug Companies. Her audience filled two large lecture halls.

Angell said that most of doctors' continuing education on drugs is sponsored by the pharmaceutical companies which fly doctors to “educational” seminars in Hawaii. Also: Who donates a laboratory/building/scholarship dollars to med schools? Pharmaceutical companies. Do you suspect there are strings attached to those dollars?

I feel like I have a very nice overview of the use of drugs for mental disorders after reading Living Well with Depression and Bipolar Disorder : What your doctor doesn't tell you...that you need to know by John McManamy. John is a brilliant hard working writer who has successfully battled bipolar disorder (never met the guy/I get no $ from this endorsement).

By the way, I would love to read a review of this book written by one of the resident “shrinks” of this blog.

Carol G

Anonymous said...

Clink,

I think you write very well.

Sophizo said...

I also think Clink writes well. I enjoy reading her posts. Actually, I wish she would post more often.

And even if Dinah did "steal" Roy's article, I would still like to hear his opinions on what was written. Why can't two of you write about the same topic? You've done it before.

dinah said...

Sophizo,
We can't write about the same article because Roy was eaten alive by his Leopard operating system. If he ever emerges, I have a To Do List for him (and we're not even married).

Rach said...

Yes, I agree, all three of you could write about the same topic and it would still be interesting to read about.

Clink you write very well.

Roy, slay the leopard and come back.

Midwife with a Knife said...

Clink, you write so well, I never would have guessed that it didn't come easily!

NeoNurseChic said...

Clink - I love your writing. Is it writer's block you struggle with? Often my problem is the idea...I want to write more fiction, but most of my greatest ideas are based on truth!

Roy - Enjoy the leopard!! Let me know what you think of it....it's actually on my Christmas list, so tell me quick if you think it's not a good idea since I think my mom is looking at my list as I write this! haha Actually, an iPod touch and iLife '08 is also on my list, since my parents gave my brother money for 2 new suits.....and I feel like a little kid again in my excitement over potential new Apple products. Oh and since my birthday is coming up as well, I also get a Harry Potter fix with the new DVD (Order of the Phoenix) coming out on my actual birthday (in the US) and possibly the OotP game to play on my Mac OS X. Oh the possibilities for fun are endless....and I realize I'm making myself look like the biggest geek ever with this comment!

Dinah - Great post, as always. Interesting topic - I sat through a number of drug lunches during my research days, and I was shocked by how it really works. Offers for box tickets to major Philadelphia sporting events and other such things.....the bribery is pretty hefty and amazing! Fortunately I witnessed a lot of really great doctors who didn't buy into that kind of thing...!

Take care,
Carrie :)

Rach said...

Canada has much stricter rules on big-pharma using incentives to try and get mds to prescribe meds...
I think Dinah alluded to it when she was in Toronto at the APA --> goes looking for the post now. All I know is that my shrink has no Wellbutrin pens. He does, however, have plenty of med samples.

ClinkShrink said...

Thank you to everyone who said nice things about my writing. It is true, it's sometimes rather painful for me to write (except when I'm ranting, in which case I'm not writing so much as raving). I seem to ramble fairly easily on the podcast even though I talk the least :) but it doesn't seem to translate into blog fodder.

I guess I just need to find more topics that trigger rants.

Anonymous said...

My Canadian shrink has the pens, mugs, note pads, samples, and other sorts of booty. Don't know about some of the big ticket stuff but do know that drug reps push their wares left right and centre.They also fund the research studies (how could that not produce biased results?) and they sponosor conferences at which docs present. They have glossy brochures and hand outs and they do a lot of targetting of GPs as well.

Roy said...

Dinah, I'm glad you got to it. I figure that the quickest on the draw gets the topic, and if one of us lays claim to a topic, it expires after a day or less.

And good post.

Yes, I am enjoying Leopard (riding it rather than slaying). Two installations down, 2 to go (got the Family Pack). Not one hitch. Early on I noticed a lot more spinning beachballs, but I think that is because the new Spotlight was doing a bunch of new&improved indexing. It's better now (3 days later).

So, Carrie, go ahead and get it. I also got iLife '08, to install later this week. With my big-ass 28" monitor and wireless Apple keyboard and mouse, I'm rolling in Apple-y goodness.

Ok, I'll add my 2 cents to this pharma topic tonight with a follow-up post. I thank my co-bloggers for their indulgence while I am distracted by geeky (and other) pursuits.

NeoNurseChic said...

Roy,

I opted for a pair or two of new scrubs instead of Leopard, but I may still get it sometime after Christmas. But I'm still looking forward to my Apply Christmas! :) Glad that you recommend it - my brother loves it, and he's shown me a lot of what it does already. He just taught me the other day that if you hit ctrl-alt-apple-8 all at once, it turns the screen into a negative. I thought that was cool (except if trying to see pictures, and then it's just weird), so now I play in that mode a lot! haha He knows a lot more tricks than I do, but we both have PowerBook G4s - he's now got Leopard and iLife '08 already, and he also has an iPhone. And I got raked over the coals in my family for wanting an iPod touch! I know I'll use it, though....they just don't see the purpose without the phone, but I don't want an iPod that's also a phone - I have a fine phone, and I want my iPod for music, videos, and also some lite browsing. :)

Take care,
Carrie :)

Rach said...

Carrie, the ctrl-alt-apple-8 mode is AWESOME!

Roy said...

...Ctrl-Alt-Command-8... Cool Trick!! Thanks, Carrie. Check out Shrink Rap with this new perspective. It looks even better. And one of my old fav tricks (Command-Ctrl-Shift-4) which allows you to select a rectangular block on your screen and copy the image, is even better now... before you select your area, the pixel coordinates show up with the cursor... as you drag to select the area, the size of the selection, in pixels, is shown. Great geek tips.

NeoNurseChic said...

Glad you guys like the tip! Well, Rach it sounds like you already knew it, but I'm glad other people also enjoy being Mac Geeks! I have viewed Shrink Rap in this mode, as I'm in it right now! So fun! :) I think it's actually easier to read on the black background, and I'm rather fond of it!

I will have to play with the tip you made, Roy! I asked my brother what other neat tricks he could teach me, but he said most of the ones he knows are now on Leopard, since he has that now instead.

SO fun to play with toys! I'm starting to get very excited for my new Mac toys and Harry Potter schtuff! :)

Take care,
Carrie :)

Anonymous said...

I want one of those shoe phone things that Maxwell Smart had. And also the poison tipped umbrella might be handy. Oh, and a ruler so I never miss it by that much. I will send my Iwant list to Santa. Do owls fly to the North Pole?
(Don't schtupp Harry Potter--I think he is underage.)

NeoNurseChic said...

Actually I believe that if we do the mathematical calculations correctly, Harry was born on July 31, 1980, which technically makes him older than me by a few months. ;)

NeoNurseChic said...

BUT - I wouldn't want to "schtupp" Harry at any rate...! Forgot to add that to my first post... Sheesh...

Anonymous said...

Yes, the article is quite interesting.

P.S. I really liked your podcast. Hope to listen to some fresh records..

Sandra said...

Clink - I always enjoy your writing and always learn something new. Thanks for giving us your perspectives, along with your wicked sense of humour.

Anonymous #879 - the difference with drug marketing in Canada is that there is no direct-to-consumer advertising permitted by law. That makes a much bigger difference than whether or not someone gets a Wellbutrin pen.

For everyone - lighten up a bit and have a laugh:
http://scienceblogs.com/omnibrain/2007/11/multimedia_friday_psychopharma.php

Sandra said...

Hmm, that Omni Brain link didn't work. Try this:

http://www.youtube.com/watch?v=ElFL4CrDMIY

Anonymous said...

Sandra,

The internet, the US tv stations with the ads for everything under the sun and the NYT that gets delivered to the doorstep make the DTCA a big joke. The other night my kid asked what the heck did that commercial have to do with ED?

Sarebear said...

I LOVE Clink! I love how her writing "voice" provides a nice counterpoint in style, subject, tone, and opinion to Dinah's. Different temperaments, great writing!

Roy has some good stuff too, of course, and I really miss him when those floorboards creep up on him (well, I s'pose an anti-hallucinatory thingie might fix that! Or a good nail gun . . . for the boards!)

But I really like the mix of all three, which is the BEST thing about this blog, of course knowing that some will ebb and flow, which is another good thing about a group blog, you can be a "slacker" and you're not really a "slacker" cause that's half the point of a group blog anyway!

OH Clink! I was wondering what you thought about Life. Usually I'm not too hot on cop shows, there's so many, but this cop spent 12 years behind bars for a crime he didn't commit, he got through, major settlement w/the city and police dept, and they had to give him his job (plus 50 million) back if he wanted it. He did. In one early episode, he and his partner were walking alongside the outside of the perimeter fence of a prison yard, as a prisoner was being escorted in. They were talking to him, but I noted that this cop made sure that certain things were said, loudly enough for an inmate pacing alongside the outside of the other fence of this sort of intake tunnel of fences.

Anyway, as it had played out in the episode, you could SEE this cop's thinking and reacting in ways that he'd learned/became reflex during his years inside. Not that the felon he was making sure knew certain things was an innocent man by any means, but the matter under discussion . . . . this cop knew that the prisoner heirarchy would take care of this new inmate in a "suitable" manner for the horriffic thing he had done, to the son of the other inmate.

I'm not saying anything about the ETHICS of all that, but on this, and other episodes, seeing the cop react in ways that are much different and much more interesting than the usual cop show - like when a perp gets physical with him, he draws a knife, prison style, and threatens the perp with it, prison style. (as they said on the show, anyway).

I was interested in what you thought of the character; he's extremely interesting, applies alot of zen stuff (or tries to, sometimes not so successfully) as that's what helped him get through . . . it's interesting to see his interactions with detainees who've been in jail before, because they both know how things go there, and sort of fall in to an interplay . . .

sorry to go on so long! It's been awhile since I've caught that show.

Oh, and then there was the prison psychologist on Heroes last season . . . . trying to deal with Nikki/Jessica's multiple personality or dissociative disorder thing.

OH, another thing, the upcoming season of lost might have some interesting psych professionals characters (although they often fudge the casting call sheets, they are not always, and when fudged are fudged to equivalents of what they are looking for.)

Since that'll probably be the only scripted show w/new episodes next spring, lol!

The whole med marketing thing has disgusted me for a long time. Especially when I have to go pay another bloody copay I can't afford just to get an ortho suggestion from my doc, as I can't bloody get ahold of anyone there who isn't confused as hell.

Woops, sorry.

a psychiatrist who learned from veterans said...

The pharma representative seems to be getting attention these days. My thoughts:

http://irvingpsychiatrist.blogspot.com/#2052566276098140974