Hawking Up Hairballs

Monday, January 26, 2009

Drug Advertising

I am opposed to the advertising of prescriptions drugs to the public. Most people don't have the knowledge to determine whether or not the advertised drugs are suitable for them, yet there will be those who've seen the advertising who will go to their doctors asking for the drugs by name. As has been shown in studies of the prescription of antibiotics, doctors often succumb to a patient's request for a drug, even when it is of little or no value in treating a patient's condition. I've known plenty of people who've walked into the doctor's office with the cold or flu, and walked out with a prescription for antibiotics, which have no effect on viral diseases. (It could be argued that the antibiotics are a precaution, but with the problem of bacterial resistance, that doesn't wash. It's more like the patient expects a pill, so he's going to get a pill.)

I decided to check out a couple of prescription drugs that I've recently seen advertised on TV. The first is Lyrica. The commercials are pitched toward women who suffer from fibromyalgia. Lyrica was originally approved as an anticonvulsant to treat epileptic seizures, and to treat the pain of nerve damage caused by diabetes and shingles. It works on he calcium channels of the central nervous system, apparently inhibiting the ability to feel pain. So, it appears that Lyrica has some legitimate uses, but it's only fibromyalgia that is mentioned in the commercials, and fibromyalgia is a dubious diagnostic category. It is characterized by widespread chronic pain, and a heightened, painful response to light touch. However, it appears that fibromyalgia may well be a psychosomatic condition. In fact, the doctor who was the lead author in the 1990 paper that defined the condition was quoted in the New York Times last year as discouraged and cynical about the diagnosis. He now feels that the condition is a physical response to stress, depression, and economic and social anxiety. And Lyrica is a drug that can be abused. In its trials there were those who abused it, taking higher than recommended dosages. They said it had an effect like that of Valium.

I've also been seeing a lot of commercials for Abilify. Its primary use is as an antipsychotic in the treatment of schizophrenia. In the commercial, the viewer is told that if he is taking an antidepressant but still having symptoms of depression, he should ask his doctor about Abilify. Talk about irresponsible. When taken in large enough doses over a long period of time, Abilify causes tardive dyskinesia. This is a condition characterized by repetitive involuntary movements like lip smacking, grimacing, and rapid eye movement. Though the condition is poorly understood, it's known that it results from damage to the dopamine system of the brain, and it can persist for weeks or months after the drug is discontinued. Sometimes the damage is permanent. The question that begs to be asked is this, if large doses cause this kind of damage, what about smaller doses? Could they be damaging the brain in ways that aren't apparent? The dyskinesia isn't all of it though. It can cause strokes in elderly patients, and it can raise blood sugar. The list of common side effects is long. They include: the inability to sit still, headaches, unusual tiredness and weakness, trouble sleeping, shaking, blurred vision. Abilify is some nasty shit.

In a better world, no one would take a drug like Abilify. Unfortunately for those suffering from psychotic conditions like schizophrenia, it may be the best of some bad choices. It may also make sense to prescribe it for someone who is suffering from a particularly severe case of depression, but to advertise it on TV? A lot of people are being treated for depression not by psychiatrists, but by family physicians. The idea of those guys handing out scripts for drugs like this leaves me shaking my head. A word to the Obama administration. Here's something else that needs to be regulated.


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