At the time I was skeptical, not least because the data wasn't actually new, but I've done a bit more digging and it turns out the media coverage was even more misleading than I thought.
Here's some pretty graphs from the NHS Information Centre. I reiterate that all of these are freely available and have been for ages. Here's the one for antidepressants:
What the papers didn't tell you is that pretty much every other class of drug has also increased over that period, by even more in some cases. Here's ADHD drugs, and dementia pills, which have increased by about 75% and 100% respectively:
So this suggests that there's been a general increase in prescriptions for brain drugs. But in fact it's even wider than that because if we look at the same data for cardiovascular system drugs, we find the same picture for most (although not all) kinds of these medications.
Now clearly, all of these increased prescriptions don't mean that there are simultaneous explosions in rates of dementia, heart disease, pain, migraine, Parkinson's and ADHD, all in the past 5 years. We would have noticed if that were the case.
What's happened, clearly, is that doctors are just writing more prescriptions nowadays.
So it's misleading to say that there's been a spike in antidepressant prescriptions. Yes it's technically true but it ignores the context. The truth is that we seem to be experiencing a cultural shift in our relationship to medications - perhaps evidence of the creeping medicalization of life (although there are more prosaic explanations that need to be ruled out before we conclude that; this could be a bureaucratic change in the way prescriptions are counted.)
However, "Escalating Depression Crisis - Antidepressant Use Soars" is a better headline than "Possible Medicalization Gradually Continues For Sixth Year In Row".
The truth, sadly, has an inherent disadvantage in the battle for news coverage. If we find the truth boring, it's easy for someone to come along and make up something attention grabbing. But the only easy way to make the truth more interesting is to make it, well, less true.
30 comments:
My view is that-and I am grateful for it- in psychiatry the clients and clients associations are having a strong voice against overmedicalization.They wrote books, spoke to the journalists more than say the clients ingesting anti-cholesterol drugs.
Neuroscientists with a critical mind blog probably more than cardiologists.
Plus some psychiatrists and psychologists are writing good books on Big Pharma- Dr Ben Goldacre-psychiatrist and homeopathy hater but very good scinetistific mind and excellent journalist - is writing one isn't he?
NB:What makes me angry are the very bright psychologists who are the strongest critics of psychiatric overprescription and at the same time want the right to prescribe dangerous drugs tha tcan kill the client without being physicians!
wow, great job neuroskeptic! And your interpretation is right on in my opinion: medications are being used more and more across all of medicine. Unfortunately much of it is as damaging as the overuse of psychiatric drugs can be.
Ivana Fulli MD said...
What makes me angry are the very bright psychologists who are the strongest critics of psychiatric overprescription and at the same time want the right to prescribe dangerous drugs tha tcan kill the client without being physicians!
It's a bit of an assumption to assume that it's the same psychologists who critique psych drugs that want to prescribe them too. It seems much more likely, and indeed, it's my experience, that psychologists are in two camps here! Some want to avoid meds as much as possible and others want the prescribing rights.
One cause is the reduction in the length/amount in a single script. Rather than bundling 6-8 wks worth in a single script doctors are rounding down to break points closer to 28 days
What you need is a 'dose equivelent' measure that calculates how many doses are being prescribed per year.
I believe that there is an increase in the medicalization but don't have data to back this up.
Gianna,
I was specifically thinking of many good psychologists and of a man I greatly admire for his writings:
Pr Bentall
Nb: he is not translated in French but as wanting as my english can be in writing I can read English.
Gianna,
Also to my knowlege nobody prohibits psychologist to enter med school if they want to become doctors and have more responsabilities or different ones.
One of my best friend did it.
Some non MD pharmacologists do it as well and my late master Pr Pierre Simon dis just that also.
But to pretend the right to prescribe drugs with very severe physical side-effects when you are not a doctor is ludicrous and dangerous.
boggits: Yeah that's one of the possible boring explanations I mentioned.
And it's certainly true in my experience. I take two antidepressants, have been on them for 2 years & have no plans to change any time soon.
They could give me 6 month or 1 year prescriptions but instead they give me 1 month ones.
This means of course that I pay more because we pay per prescription not per packet.
That's probably why they do it... the only clinical reason would be to stop me having enough to OD on, but somehow I think they are more interested in my money.
To be fair-before prescribing myself not to read that fascinating blog too often- in the near future since it is too time consuming:
Pr Richard P. Bentall wrote in a very good and interesting book, several remarks about psychiatrists quietly boasting about the psychologist good work for the patient etc.. and in his conclusion:
"Doctoring the Mind":
p286:
""(...) We live in an age in which professions have skills monopolies only by defaults; anyone of good will who is smart enough can be trained to do almost anything within the clinical domain. There are psychiatrists and psychiatrist nurses who are as proficient as psychotherapy as the best clinical psychologist and, in some part of the world, clinical psychologists and nurses who have been trained to prescribe psychiatric drugs. We need to learn how to exploit all of these talents and abilities and organize our teams so that no one profession has the absolute power to dictate the way that services are delivered(...)""
My point is that to prescribre dangerous drugs it is necessary to be a doctor noy only by training but to remain a doctor and many a French psychoanalyst psychiatrists should be limited to psychoanalysis only .
Plus, it is different in GB but in France when a young person want to be a doctor but is not smart enough, they often end in psychology studies where not to become a psychologist is as difficult as it is to end up a good one . No kidding! (the exam called PCEM1 at the end of the first year of university one has to pass in a close number way to enter med school instead of paramedical professions is really demanding but france produce a considerable numbers of psychologists and could provide for the entire world needs in psychologists if you do no ask for quality-and they can work all over the European union).
NB: At the last WPA meeting a sad black old gentleman told some of us that since the psychiatrists in his African country working in their native land were (if I remember well less than 10 ) he had to train the animist sorcerers...
The advent of $4 drugs may have something to do with this. Several antidepressants are on that list.
professional candyland hustler: That's another good point. What's interesting is that in all these cases we also get graphs of the cost of these drugs, and they all went down over this period, even though prescriptions rose. Probably because drugs went off patent, although it could also be that writing more, shorter prescriptions means less spent on drugs (& more income from patients).
All the cost graphs are available in the pdfs I linked to.
Perhaps it's not that doctors are now more likely to over-medicate, but that doctors were before more likely to under-medicate?
The cost issue is interesting / weird. In the PDF you link to, just after the chart showing the rise in antidepressant prescriptions is a very different chart showing the spending. Apart from a strange jump (near doubling!) in the SSRI spending (which is much larger than the increase in prescriptions), the spending data shows, if anything, a decrease. It's certainly not well correlated with the number of prescriptions.
If the prescriptions were all for the same amount of the same thing, then I would expect the spending chart to look similar to the prescription chart. The fact that it doesn't seems to suggest one of the "boring" explanations is more likely.
Though of course the spending is probably not that reliable an indicator of the dosages being prescribed either, due to various externalities (market cost of the drugs etc). Also, it's not clear if the spending includes the £8 or whatever you pay to pick up a prescription.
Anonymous said... 7 January 2012 14:21
""Perhaps it's not that doctors are now more likely to over-medicate, but that doctors were before more likely to under-medicate?""
May I suggest that you read for an easy start neuroskeptic post
Saturday, 17 December 2011
"Young, Canadian and on Antipsychotics"
This said, some people who would benefit from drug treatment are not getting it: some do not realize that their condition could improve and other want only "natural remedies".
neuroskeptic 7 January 2012 12:11
Why don't you ask your psychiatrist why you can't have a six months prescription like for a hormonal treatment or whatever?
- you might find the answer interesting and tell us about.
If not change him or her.
It is just greed -or the desire to have a pleasant resting moment with an articulate intelligent client who do not ask more than typing quickly the same prescription all over again.
Ivana, i guess you are the only fluent english speaking frenchperson.
My experience is that most medical professionals here hardly do so, and therefor have medical knowledge which dates from the 1950's.
If i had followed their medical advice i'd be popping a load of dangerous pills by now with hardly any proven beneficial effect
If you live anywhere near nice i'd like your professional coordinates :)
Great job, Neuroskeptic! Did you find any scientific papers on the generally increased prescription rates? I searched a bit, but didn't find anything.
Thanks. I didn't look for papers. Someone ought to do one - we really need to know whether how much of this increase is 'boring' administrative changes and how much is real increases in the number of pills popped, as it were.
petrossa,
Thanks from the heart for your kind words but English is not the problem in the continuous medical education of French physicians.
Paternalism to a scandalous extreme is a sin of many French physicians and being born italian has help there.
My real big chance chance has been to benefit from a British Council scholarship to be a research registrar in psychopahrmacology in oxford when I was young with the incredible intelectual and moral blessing blessing of spending a little time with Pr Gelder as a supervisor of sort.
And second chance for I -although I didn't thought like that at the time - to have had to ask an association of parents of gifted children's their help in order to be able to have my children jump classes and later be homeschooled.
It made me doing pro bono work in a friendly informal unFrench fashion and listen to what people resented from paternalistic medical attitude. And to discovzer how ignorant aboiutthe effect of homeschooling the French physicians were - as baddly informed and as conviced of knowing the truth as they were on the negative effects of masturbation a century ago...
Last but not least, to have benefit from the teaching from the royal psychiatric association and the national autistic society and autism research teaching and tha asperger syndrome foundation etc...
The very strong psychonalyst lobby is one of the main problem of the Frech psychiatrists on the whole- lack of medical education up to international standards.
Add to that, the academic physicians and researchers on the payroll of big pharma with the French medical council doing nothing to make the situation more up to international standards in ethics.
I think that you should try to find at least a GP who belongs to FORMINDEP (for a continual education of physicians independent from Big Pharma), the association who -for example- succeeded in bringing to administrative justice the French equivalent of NICE for blatant conflict of interest of the academics involved with the committee decisions.
http://www.formindep.org/Conflits-d-interets-La-mauvaise
tnx Ivana. I was at my gp today and told her i had aspergers. (testing) She looked at me with utter confusion. I said: a form of autism. She: But that's something for children isn't it? I said: it's like autism but you can talk.
She seemed satisfied with that answer.
hi, i'm nothing, but consider myself to have a gift in a fact that im able to read people's like ivanna fulli md comments, thanks :D
hi, im nothing, but i am very glad to have the opportunity to read people's like ivana fulli comments and this wonderful blog, thanks :D
petrossa,
The important thing -to my mind- is that your GP do not take her medical education from Big Pharma and do not try to put you under drugs to treat your aspies features.
Sincerely, I am not in fear for you since you know yourself well and were successful in the working place- a hard test although Holland is more open as a society.
The reason why the Frecnh Gps know nothing about asperger and high functionniçng autism is the French psychoanalytic lobby who will insult and harm mothers of "classical" autistic children for years and be inefficient and then put the young adults in some place for disabled or let the family care and the adult psychiatrists as a whole just ignore the autistic world.
Asperger are just misdiagnosed in Fraénce as children and as adults and not helped at all on the world market.
The associations of parents of autistic children are very numerous and as a whole argue that autism do not need physicians : "not a medical condition but a learning and education condition" and they want ABA plus ABA when ABA is fine some times for some aspies and for a certain amount of time for aspies.
NB: To be fair, it is not that easy even in England or in America to get diagnosed and many aspies diagnosed their asperger themselves with some difficulties in accepting a "scale" to diagnose it.
I was lucky -of sort- to homeschool each of my children for some years since looking about outcomes of former homeschool children I came across some aspergers being homeschooled.
Do you know that on the 26th of january in Lille a court will have to decide if the documentary "Le mur" a journalist did looking for knowing better psychoanalysis and ending up with exposing their silly sectarian beliefs can be shown on TV or whatever?
http://www.lemonde.fr/m/article/2012/01/13/autisme-la-psychanalyse-au-pied-du-mur_1628735_1575563.html
Anonymous 13 January 2012 21:22 and pew,
I am a nobody and you might share the social condition with me but you cannot be nothing: we are people.
By the way, I think few people need to be anonymous for good reasons in western societies.
Ivana,
Unbelievable, the Le Mur incident...
Since i moved from holland to france i felt i went back to 1950.
Still i stick to my thesis that one of the main reasons for france's 'scientific retardation' is their lack of understanding even basic english.
You can't even cite a paper to them because they want it translated first. And even then there's still the chauvinism, france can't be wrong...
They'll outrank any country on medicine use for a while yet i am afraid. Try and leave your gp without a prescription for statins. I had to fight it off. And she is still bitching me about it everytime i return.
petrossa,
believe me some french psychoanalyst I know personaly have a better command of English than mine and go to attend neurospsyhoanalytic meeting in the USA etc...
Plus the French academics go to the Am Psy Ass meeting and help Big Pharma to sell.
Really the problem is that Big Pharma has the control over continous medical education on one side and on the other side the french psychoanalyst lobby is so strong.
Plus the disgusting way to make academics in France: more or less and until now a retiring professor will have chosen his successor by making him his assistant and often by makinf him(her) an academic in the first place some years before.
My estranged husband worked in Intensive care and their scientific standards- like everywhere else in French medecine except psychiatry- were international more or less.
NB: Every actors field in French medecine are paternalistic to a fault but nowhere more than the psychiatrists and psychiatrists nurses and socail worker in psychiatry (often more redy to explain why the mother of a client is a monster than ready to find parctical solutions her job is supposed to be about)
Ivana,
I'll take your word for it. I yet have to meet a specialist who speaks english, and one that even wants to admit there are scientists beyond france who actually know what they are talking about.
But the paternalism is indeed absurd. Glad i am not you :)
What about off-label use? I think that could explain quite a bit of anti-depressant use in particular, especially given that in one US based study 75% of such prescriptions were off-label.
I mention this when I linked to your article on Google+ :)
https://plus.google.com/111368909938214413176/posts/8BKdPzhQqmd
Neuroskeptic, if you are looking for some Data from Germany, you can find it here:
http://www.dgppn.de/fileadmin/user_upload/_medien/download/pdf/stellungnahmen/2010/stn-2010-12-29-arzneimittelverordnung.pdf
It is a discussion of the yearly published "Drug Prescription Report" with a short english summary at the end.
Thanks - I hadn't seen that, will take a look.
Here are the stats for Australian prescribing for the year 2009-2010. Two anti depressants are in the top 100 on prescription numbers and cost to government. http://www.health.gov.au/internet/main/publishing.nsf/Content/pbs-stats-pbexp-jun10
Other years are available on the same website.
As part of an MPH project I looked at the number of standard doses prescribed per annum for up to 12 years when available for warfarin, irinotecan, mercaptopurine & azathioprine. Number of standard doses prescribed had climbed every year for most, but also in the context of increasing age of population. I could do the same calculations for antidepressants etc but so could anyone who looks up the PBS website!
Yearly stats on medicines: http://www.health.gov.au/internet/main/publishing.nsf/Content/health-pbs-general-pubs-asm.htm
Month by month prescribing of all listed drugs:
https://www.medicareaustralia.gov.au/statistics/pbs_item.shtml
George,
Did you notice that in the article you provided a link to
http://www.dgppn.de/fileadmin/user_upload/_medien/download/pdf/stellungnahmen/2010/stn-2010-12-29-arzneimittelverordnung.pdf
they dare to complain that not enough dementiae sufferers get presciption of supposedly anti-dementia drug when really it seems to me that only effects like diarrhea have been shown for facts from that big market aimed dementiae drugs?
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