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james1071 | 5 years ago

He had not the slightest idea of how doctors prescribe drugs.

The typical doctor has minimal training in evaluating medicines - that is not their job.

They defer to so-called opinion-leaders, who are the experts on particular diseases.

These people are the targets of drug companies' marketing - think scientific conferences in 5 star hotels in exotic locations.

The cost of influencing them would be millions.

So,the author was barking up the wrong tree.

That's not to say that he didn't have something, but had no idea how to market it.

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mirthflat83|5 years ago

This is so removed from reality to the point that it’s hilarious. Doctors evil. Doctors bad. Doctors corrupt. Doctors rich. That psychiatrist in the article sure must have been bribed to prescribe those 30-year-old drugs, right? There’s this thing called evidence-based medicine, go educate yourself.

marcinzm|5 years ago

I mean, there's a reason pharmaceutical companies in the US spend $20 billion a year marketing to physicians and it's not because it doesn't work. Doctors in the end are human and as capable of being influenced and biased and taking shortcuts as any other person. That doesn't mean they're evil, just human.

cestith|5 years ago

Nobody has to be evil or bad to read the white papers presented by their vendors rather than doing independent research. A doctor's job is not to figure out the best possible treatment for each patient, as nice as that sounds. It's to improve the life enough of enough people given the time available. If four drugs are approximately equivalent don't blame your doctor if you get the one that's only 90% as effective in your particular case.

loceng|5 years ago

Part of regulatory capture and the industrial complex, why medicines like MDMA and psychedelics have been illegal for decades due to them not being patentable - and being competition that most recent research shows is far more effective and without the "side" effects of many big pharma's drugs.

ketamine__|5 years ago

Far more effective? Source?

intricatedetail|5 years ago

Some doctors use expert systems. They select symptoms and computer spits out possible list of treatments and then doctor picks one. If it doesn't work asks to come back and tries the next one. It's kind of like a human in today's self driving cars. Especially when it comes to mental health and anti-depressants. Essentially tests on production.

sxg|5 years ago

This isn't even close to how doctors prescribe medications. You don't prescribe meds without having a working diagnosis. Once you have that, you use the knowledge gained in med school and residency to pick the first line drug. If there are contraindications due to comorbidities (which there often are), you have to figure out what other meds you can use. You can consult online resources (e.g. UpToDate) to look up second, third, fourth line meds as well as advice on specific complicated scenarios.

Trial and error with prescription drugs without a diagnosis as you suggest is malpractice. Maybe you're specifically referring to psychiatry? That specialty is uniquely difficult since our understanding of psychiatric diseases is still murky. But even within psychiatry there are best practice guidelines on how to manage and treat different diseases.