Chemists, Special Education Teachers, Pharmaceutical Scientists Chime in on "Hooked on Prescriptions"

I received a number of interesting emails from doctors, pharmaceutical industry insiders, and a special education teacher in response to Hooked on Prescription Drugs - Half of US Took at least One Prescription Drug in Previous Month.

Pharmaceutical Scientist Responds

"PS" Writes ...

Hello Mish

I work in the pharmaceutical industry and can make a stab at answering some of the questions you raised. This is from the perspective of a manager/scientist with wide project contacts and some interactions with upper management.

Is pharma only interested in treating symptoms, as opposed to curing disease? I've never hear the distinction made internally. We basically target certain areas (like cancer, obesity, muscular) and research particular target proteins that have a proven or suspected involvement in that area. Then we try to stop those proteins. Whether its a cause or a symptom, if it has a market then pharma is interested. So we do try to cure cancer (i.e. completely eradicate the cancerous cells), but we also try to develop new pain medications and weight loss medications, which are more symptoms.

We spend the vast majority of our time investigating medications that ultimately fail. The FDA has made this very difficult and any success is hijacked by 'generics' which congress gives special protections. So the short answer is we're interested in both, and try everything in our areas and hope for something that will actually turn a profit. As long as people will pay to treat symptoms, we will develop drugs to treat symptoms (though not exclusively).

I can't comment as an expert on the attention deficit disorder. It does seem like it's a modern phenomenon/invention. I've always suspected bad parenting, bad teaching and hyperactive disease diagnosis syndrome. I have heard some anecdotal evidence that its diet related, but haven't researched it.

Drug advertisements are highly regulated, so it's no wonder they're whacked.

Why is medicine so ****'d up? The answer is a long history of government involvement, starting with special tax status granted to the Blues, then employer provided healthcare, as well as Medicare, Medicaid, etc. Because government is paying for everything it should be no surprise that prices are going up.

Pharma is not guiltless.

We've been supporting increased government involvement (including supporting Obamacare) for a long time. Hell, its our medicines the government is buying. However, I sense that justice will someday come and we will pay dearly for selling the taxpayer down the river. I sure hope so.

Cheers,
"PS"

Second Pharmaceutical Research Scientist Responds

"Jeff" a second research scientist responds ...

Hi Mish,

I am totally against advertising pharmaceuticals. And I have worked as a research scientist in the pharmaceutical industry for 25 years.

You can blame the Clinton administration for lifting the ban on prescription drug advertisement.

The industry spends more on those obnoxious ads than they do on research and development! There are a lot of wonderful benefits that society has received from the pharmaceutical industry (e.g. antibiotics and vaccines). However, drug advertising is not one of them. As for hyperactive children, you can blame poor diet (e.g. too much sugar and too little of omega-3- fatty acids) and lack of exercise.

Thanks, Jeff

Special Education Teacher Responds

Hello Mish,

Over-diagnosing ADD has evidently grown stale to a number of psychologists, as they have moved on to Autism as the general catch-all for why certain children struggle in school (not to mention other wonderfully vague diagnoses such as almost any of the behavioral disabilities).

I work with people with disabilities (currently with adults, but in the past with children in schools as a behavior consultant) and I never cease to be amazed by the vast number of students who are diagnosed with disabilities they do not have.

Most of the children with behavior disabilities are actually troubled by their home life and act out as an attention-seeking behavior. Over the course of a school year it is possible to render most of these attention-seeking behaviors extinct with the correct support and teachers who are willing to make an effort.

Unfortunately most teachers are not willing, preferring instigating the child’s problem behaviors in order to have them removed from the classroom, despite demonstrations that basic support will prevent the problem behaviors to begin with. Of the 20 teachers at the elementary school I worked at, only two were willing to listen to the recommendations of Special Education teachers and behavior specialists.

I think the problem is that most people have never actually met a person with Autism (or perhaps even with ADD) and so they ascribe any peculiarities the child might have to a disability. Most people have a basic understanding of Autism, so they think that any antisocial behavior or lack of interest in certain situations is indicative of Autism. If they were to meet a person with Autism (with their extreme behavior peculiarities and tics, not to mention their absolute disinterest in interpersonal communication as a general rule) teachers would recognize that most of these students are just a little different, not suffering from an actual disability.

The same is true of ADD; having met a student with actual ADD (only one in a school of 400-500 students) there was no possible way to confuse the mild behavior of most of the students diagnosed with ADD (who were just a tad fidgety or occasionally disruptive) with that of the student who was actually unable to focus (even on tasks he generally enjoyed would only hold his attention for a few minutes). The best example we will ever have of the ridiculous level of over-diagnosis comes from Jenny McCarthy’s child, the poster child for Autism, who was supposedly cured of the disability (rather than the obvious fact that the child never suffered from Autism).

Anyone with an ounce of common sense would recognize that Autism is not a curable condition; It is like looking for a cure for Down Syndrome. Really, it should be obvious to people that Autism is over-diagnosed now that some countries are claiming rates of 1 in 68 or higher.

Unfortunately we may be stuck with over-diagnosis for a while, in part because it is the easiest thing to do for everyone involved. Since the diagnostic criteria for things like ADD and Autism are so broad, and there are monetary incentives in the way of additional funding for students with disabilities, and parents would rather hear their child has a disability than that they might somehow be at fault for poor discipline, everyone at the diagnosis level benefits.

In my experience, the normal diagnosis process is this. The child is acting out in class, so the teacher refers the case to the school psychologist and possibly the Special Education teacher for review. The school psychologist visits the classroom and observes the child acting out. In a few of the children I observed, they acted out more when the school psychologist was there because she responded to the behavior. Because the school psychologist is not willing to either blame the teacher (for having poor control of the classroom) or the parents (for failing to provide discipline to the child), the only choice left is a diagnosis that justifies the behavior.

If a child falls behind and performs poorly in class, the teacher assumes they are learning disabled instead of assuming the children had poor teachers at earlier grades.

No one wants to take responsibility. To be fair to the teachers, there are cases where they have little choice but to make the referral. If the student is seeking attention by acting out, most teachers do not have the skills necessary to handle these students without the help of an expert, and the only way to get that help is to make the referral.

My wife has both a Bachelor’s and Master’s Degree in Education, and I was always amazed that she never had to take a single class on managing problem behavior on an individual level.

Sorry for this being such a long missive, but this is an issue that is near and dear to me. Having worked with the kids being given false diagnoses, I have discovered the diagnosis itself is a major inhibitor of progress. Once students attend their first Special Education meeting, they come to view themselves as disabled and justified in their acting out. I have been told by many of them that they see no point in attempting to control their behavior, because it can’t be controlled, and because no one likes them anyway due to their past behavior.

I have never dealt with a student whose behavior could not be drastically improved by basic behavior management behaviors, and have never personally dealt with a student that I felt needed to be medicated.

Now that I work with adults (sometimes with the worst of the worst, people whose behavior was significant enough to see them institutionalized or imprisoned) I see the outcome of our poor education environment. It takes one person at the elementary level to manage thirty kids with behavior problems. It takes one person at the adult level to manage a maximum of four adults with behavior problems, and if we institutionalize or imprison them, we also bear the cost of feeding and clothing them. Our current system is creating future criminals by justifying their behavior rather than attempting to correct it.

Special Ed Teacher

Medical Doctor Responds

Mark, a medical doctor writes ....

Hello Mish

I've written before.

I have no love lost between myself and pharmaceutical companies and their insurance henchmen. However, you frustration here is misplaced.

Americans are hooked on prescription drugs less because of marketing or even physician indifference and far, far more because that is what Americans want. You can see this yourself at your local mall. Americans want to eat. They do not want to walk. They are unhappy at there appearance but they are not interested in self-restraint or altered lifestyles. Even the most obese in my patient population stubbornly insist they do not overeat and that they must have a glandular problem or some other explanation.

The overweight and immobile constitute the vast majority of those with Type II diabetes, cholesterol elevations, hypertension and esophageal reflux (treated with the purple pill). Much of the treatment of these problems would vanish were Americans willing to eat less and walk more.

Similarly, Americans want a pill to solve their emotional and child rearing problems rather than engaging with life.

There are huge parallels here as regards American's approach to their financial lives. They want stuff and they want it now. In their opinions it is not their fault if they lack the necessary income. They simply to wish to gorge on physical goodies and then they are surprised at their state of fiscal health.

Love your musings.

"MB" MD

Chemistry Professor Responds

Hello Mish

I read your article on prescription drugs. I am a chemistry professor and my line of research brings me to pharmaceutical companies quite often, including offers to take "research money".

The reasons I refuse such offers are common sense ones.

What I see these days is that so-called "lifestyle drugs" bring pharmaceutical companies the most profit since they can be fed to patient for tens of years, in many cases covered by taxpayers/insurance.

Many of the issues can be treated with diet and exercise (cholesterol), or discipline (ADHD). Instead, it is easier to pop pills especially if you are insured. Consequently, the blame lies on both sides - general population does what is easier, and pharma stimulates this behavior. Also, I have to note that there IS a legitimate need for these drugs, but definitely not on scale that they are prescribed now.

Things like antimalarials or antibiotics for which there is a legitimate need are almost not developed because you can cure those diseases in months and the profit will be very small. Put it against the development costs and companies will not get their 20% profit.

A good blog about medicinal chemistry issues is "In the Pipeline"

Chemistry Professor

Several readers have asked why I devote time to topics like health care, unions, politics, etc. The answer is all of these are part of the structural defects facing our nation. No other economic blog touches these important issues in depth.

Until we do something about health care costs, public union, pension benefits, military spending, and a host of other structural problems especially vote buying by corrupt politicians, the US is not going to see anything close to what constitutes a normal recovery.

Whether or not anyone agrees with what I have to say, discussion of these topics brings a much needed awareness of these issues to the forefront. I am grateful to have a wide variety of professionals in various fields responding to these topics, especially health care.

Mike "Mish" Shedlock
http://globaleconomicanalysis.blogspot.com
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