Playing Doctor

Over at MedRants, Dr. Centor expresses concern about the growing number of people in their 20's and 30's who are finding ways to get the prescriptions that they feel they need, without going to a doctor.

This article about young adults trading psychoactive meds does scare me. I do understand their concerns, but I am not convinced that they really understand the implications of medication use. We must learn more than pharmacology in order to do a good job prescribing. We should know all the indications and all the contraindications. We should know what other medical conditions the patient has.

It is interesting to note, first, that many of the people in the age cohort he describes are among the nation's uninsured and underinsured - that is, the people who we are routinely assured are choosing not to carry health insurance because they are in good health and don't "need" it. Trading medicines, or buying them online without going through a doctor's office, may well be about saving money. Particularly if they have had the same condition and prescription before.

But even assuming cost isn't an issue, I think the manner in which doctors and the pharmaceutical industry treat medication contributes to self-prescription. Many doctors prescribe medication unnecessarily because their patients expect to leave the office with a prescription. Pharmaceutical companies tell patients to "Ask your doctor about Drug X", not because it's necessarily the best drug for the patient, but because doctors will often prescribe in accord with the patient's request. (Commercials for Zoloft used to spell out precisely the set of symptoms that somebody could describe to justify a prescription - and odds are, doctors prescribed Zoloft or another SSRI to patients who came in, described those symptoms, and requested Zoloft.)

The authority with which doctors pass out prescriptions, coupled with the "miracle cure" depiction pharmaceutical companies give in advertisements for their patented medications (before listing potential side-effects in a rapid, low monotone) contributes to an attitude that pretty much any human ailment can be cured with a pill. And yes, part of the problem is that in reality there are a great many effective medications for conditions that would have been treated ineffectively in the past, and modern medications (particularly psychotropic medications) tend to carry fewer side-effects than the ones they displace, contributing to a perception that if it comes from a pharmaceutical company, it is safe to take.