In a New York Times Magazine piece, “Dr. Drug Rep” (November 2007) psychiatrist Daniel Carlat described his experience of being recruited by Wyeth Pharmaceuticals to represent their latest antidepressant, Effexor. Strikingly honest in his portrayal of his slow but steady decline into becoming a salesman for the drug, Carlat explained how he was enticed to do the job. A weekend at the Waldorf for him and his wife, tickets to a Broadway show, $750 an hour for calling on his psychiatric colleagues to convince them that Effexor was the drug of choice.
About a year into this, to his credit, Carlat realized that he has become nothing more than a drug pusher, getting paid to sell drugs. Only in his case it is legal. He’s used his stature as a credible physician to influence his peers. And for financial reward, he has forfeited his scientific judgment. The withdrawal symptoms to come off Effexor, I’ve heard from another psychiatrist, feel like your brain is quaking in your skull. There are a slew of other nasty potential side effects from this drug that plays Russian roulette with your brain chemistry including dizziness, drowsiness, anxiety, feeling nervous; insomnia, vision changes; nausea, vomiting, diarrhea; changes in weight or appetite; dry mouth, yawning; increased sweating.
Imagine, you are vulnerable, hopeless, imagining suicide as pain relief and a professional that you’ve entrusted your life with prescribes a drug that he’s being paid to sell you.
At best, being paid to prescribe certain drugs is unethical. Guys like this should do prison time just like their white -counterparts selling illegal drugs. No, they should do more time because they are abusing their power—and they know it. It is a classic conflict of interest, with potentially lethal results.
Did any of the first three psychiatrists I saw have financial ties to drug companies? I don’t know. But after reading Carlat’s article, I wondered. I was prescribed Lexapro, Wellbutrin, Prozac, and for a brief period Effexor which also made my brain feel like it was banging up against my skull. Only the second of these doctors’ services was covered by my insurance company, but I had terrible results with him and sought further. The next three cost me $250, $300, and $300 per hour, irrespective of whether or not their treatment had any positive effect at all. I’d drive an hour to Dr. Fisher, she’d look at me, scribble out a new scrip and send me on my way for $85 (her fifteen-minute rate). No follow-up, No inquiry about why I’d missed an appointment, never a suggestion that I seek other kinds of therapeutic support. Just a scrip, a fee and “see ya.”
Here’s another law I’d advocate for: Psychiatrists who prescribe drugs should be required to work in tandem with a social worker/psychologist or other professional counselor. The medicines are too damn powerful, the depressed patient is too vulnerable, and the risk of death is too high to entrust these to a profession whose norm is to spend twenty minutes with a patient and then hand her a lethal weapon without steady follow up.