Here is something from the Sydney Herald written by Dylan Welch. I don't want to anger the Scientologists, but it really shows their ignorance and the importance of medication compliance - especially with psychiatric treatment.
SCIENTOLOGISTS were condemned yesterday as "flat-earthers", following statements in court that an alleged murderer was denied psychiatric treatment because of her family's Scientologist beliefs.
The vice-president of the Australian Church of Scientology, Cyrus Brooks, told ABC radio the Scientology link to the killings was "a bit of a red herring".
"The woman was actually under the drugs; she was on drugs at the time of the incident. She was also under the care of a psychiatrist … since January," Mr Brooks said.
"The records show that she was on psychiatric drugs, so to say that it had something to do with us, then I think it's incredibly defamatory and unfair."
A psychiatric report tendered to Bankstown Local Court on Monday said the 25-year-old woman accused of murdering her father and sister in Revesby last Thursday had tried to get help twice last year, but her Scientologist parents had a religious objection to psychiatric intervention.
Mr Brooks said modern psychiatry used many methods that were largely "unproven" and psychiatric assumptions such as chemical imbalances in the brain did not exist.
After Mr Brooks finished his interview, a Sydney University psychiatrist, Chris Tennant, phoned ABC Radio to reject the Scientologist's beliefs.
Professor Tennant said it was "so sad to hear the flat-earthers getting on the radio". He denied modern psychiatry was largely unproven and said the amount of research on mental illness was as strong as that for cancer and heart disease.
"It's a tragedy to hear this mumbo jumbo being proselytised by this group," he said. "The sad thing about this sounds to be that this girl may well have been prescribed some psychiatric treatment but living in a family which had the Scientology attitude there is no way there would have been what we term compliance."
The president of the Australian Medical Association, Dr Rosanna Capolingua, said if the woman had had access to appropriate medical treatment, it could have "changed the course of her life".
Media reports yesterday morning said the accused woman's parents had taken her off anti-psychotic medication and instead treated her with non-psychotic medicine imported from the US.
Mr Brooks denied the US medicine had anything to do with Scientology.
He said the church did not give the family any advice on the daughter's situation and had not recommended the US medication she was alleged to have taken.
Mr Brooks said he was not aware of any US medication used for the same purpose.
The woman accused of the double murder is due to appear in court again today.
Showing posts with label Noncompliance. Show all posts
Showing posts with label Noncompliance. Show all posts
Tuesday, July 10, 2007
Patient Compliance: Is There a Solution? - 3
Here are some more percentages on Noncompliance from the MedAdNews Trend Report:
So here's the MDs take on noncompliance:
Sex Breakdown
Men: 65%
Women: 5%
Equal: 30%
Age Breakdown
18-34: 23%
35-49: 27%
50-64: 23%
65+: 17%
Real numbers based on Guideline Survey:
Female: 62%
18-34 65%
35-54 63%
As you can see, the MDs are really, really wrong about who they believe is compliant. It could go back to the "white coat" adherence I wrote about in June. I would imagine the majority of patients do not get their blood tested regularly, so the MDs have to rely on what their patients tell them. (I have to admit that I have not gone to have my follow-up blood work done - I'm only two months late. Also going to the dentist today but I will not lie - I do not floss as much as I should).
Here are some numbers on specific ailments:
Insomnia: 84% - wouldn't they realize they are awake and take their medication?
Incontinence: 78% - I would think that after one or two public incidents that they would take their meds.
Depression: 77% - this is understandable. One of my psychologist friends told me that the reason sucide rates are higher among teens on antidepressants is because the antidepressants start to work and get the teens into a state of motivation to commit suicide, whereas without them, they are too depressed to do anything. Kind of a horrible fact.
Pain: 77% - again, I would think that if you are in pain, you would take your meds.
Asthma: 76% - if it is hard to breathe, take your meds.
Anxiety: 75% - I can understand this one due to side effects and when their medication is working, they feel they no longer need it, thus they stop taking it and become anxious.
There are more facts and factors covered in the report, but only two more which are reflective of the high costs of medications.
When the MDs were asked what they thought the number 1 reason for noncompliance - 71% responded: "My patients cannot pay for all their medications".
67% of patients and 95% of MDs stated their #1 interest in a program to enhance compliance would be "a discount program for those who renew their scripts on time" .
At least we all can agree on one thing - medications are too expensive and if they were cheaper, everyone would take more.
Speaking of paying for medications, my new company is on an HSA program (which is supposed to save us money) but with my medications (2), my wife's meds (2) and our son's single prescription, the monthly cost was aobut $435 - not the $25 co-pay with my old program ($125). Granted with the HSA less is taken out of my pay and after the deductible ($4,000) is hit, everything is covered. However, getting to that number would take eight months of medication plus our twice a year check-ups - given that we are healthy. But HSAs are another post.
So here's the MDs take on noncompliance:
Sex Breakdown
Men: 65%
Women: 5%
Equal: 30%
Age Breakdown
18-34: 23%
35-49: 27%
50-64: 23%
65+: 17%
Real numbers based on Guideline Survey:
Female: 62%
18-34 65%
35-54 63%
As you can see, the MDs are really, really wrong about who they believe is compliant. It could go back to the "white coat" adherence I wrote about in June. I would imagine the majority of patients do not get their blood tested regularly, so the MDs have to rely on what their patients tell them. (I have to admit that I have not gone to have my follow-up blood work done - I'm only two months late. Also going to the dentist today but I will not lie - I do not floss as much as I should).
Here are some numbers on specific ailments:
Insomnia: 84% - wouldn't they realize they are awake and take their medication?
Incontinence: 78% - I would think that after one or two public incidents that they would take their meds.
Depression: 77% - this is understandable. One of my psychologist friends told me that the reason sucide rates are higher among teens on antidepressants is because the antidepressants start to work and get the teens into a state of motivation to commit suicide, whereas without them, they are too depressed to do anything. Kind of a horrible fact.
Pain: 77% - again, I would think that if you are in pain, you would take your meds.
Asthma: 76% - if it is hard to breathe, take your meds.
Anxiety: 75% - I can understand this one due to side effects and when their medication is working, they feel they no longer need it, thus they stop taking it and become anxious.
There are more facts and factors covered in the report, but only two more which are reflective of the high costs of medications.
When the MDs were asked what they thought the number 1 reason for noncompliance - 71% responded: "My patients cannot pay for all their medications".
67% of patients and 95% of MDs stated their #1 interest in a program to enhance compliance would be "a discount program for those who renew their scripts on time" .
At least we all can agree on one thing - medications are too expensive and if they were cheaper, everyone would take more.
Speaking of paying for medications, my new company is on an HSA program (which is supposed to save us money) but with my medications (2), my wife's meds (2) and our son's single prescription, the monthly cost was aobut $435 - not the $25 co-pay with my old program ($125). Granted with the HSA less is taken out of my pay and after the deductible ($4,000) is hit, everything is covered. However, getting to that number would take eight months of medication plus our twice a year check-ups - given that we are healthy. But HSAs are another post.
Friday, June 22, 2007
Antibiotic Noncompliance
I found this article by Jill Stein in Medical News Today! - obviously it is a little dated.
NICE, FRANCE, April 20, 2006- Only slightly more than a third of individuals polled in a recent global survey know that noncompliance with a prescription for antibiotics can lead to antibiotic resistance, according to data recently released at the 16th European Congress of Clinical Microbiology and Infectious Diseases (ECCMID).
Researchers involved in the COMPLy (Compliance, Modalities by Population, Lifestyle and Geography) survey examined noncompliance rates and factors affecting noncompliance in 4,500 persons who were 18 years of age or older and had taken a self-administered antibiotic over the last year.
Participants, who were drawn from eleven countries, were considered noncompliant if they had omitted doses or days or if they had leftover antibiotics even though they had been told to take them until they were gone.
Overall, 22 percent of respondents said they had not complied with their last antibiotic treatment, and the noncompliance rate exceeded 30 percent in some countries, COMPly Steering Committee Chairman Jean-Claude Pechere, MD, emeritus professor of medicine at the University of Geneva in Geneva, Switzerland, said. Fifty one percent believed that leftover antibiotics could be saved and used later on, and 73 percent of those who had leftover antibiotics said they saved them.
Not surprisingly, the number of doses per day was directly correlated with noncompliance. Thus, a 15 percent noncompliance rate was noted in persons taking one dose per day versus 27 percent in persons taking three or more doses per day.
Eighty percent of those polled believed that antibiotic-resistant germs represent a serious problem but only 61 percent knew that improper antibiotic use can diminish efficacy.
Dr. Pechere said that misperceptions about appropriate antibiotic use is the main reason for noncompliance in some countries, while a lack of faith in their doctor's ability and concern about their doctor's ability to manage their illness may be a more important factor for patients in other countries.
Results also identified age as an important factor. Of respondents 18 to 29 years of age, 30 percent were noncompliant versus 14 percent of persons 60 years of age or older.
Antibiotic resistance is considered a major public health concern.
Pfizer Inc. funded the COMPLy survey.
By Jill Stein
NICE, FRANCE, April 20, 2006- Only slightly more than a third of individuals polled in a recent global survey know that noncompliance with a prescription for antibiotics can lead to antibiotic resistance, according to data recently released at the 16th European Congress of Clinical Microbiology and Infectious Diseases (ECCMID).
Researchers involved in the COMPLy (Compliance, Modalities by Population, Lifestyle and Geography) survey examined noncompliance rates and factors affecting noncompliance in 4,500 persons who were 18 years of age or older and had taken a self-administered antibiotic over the last year.
Participants, who were drawn from eleven countries, were considered noncompliant if they had omitted doses or days or if they had leftover antibiotics even though they had been told to take them until they were gone.
Overall, 22 percent of respondents said they had not complied with their last antibiotic treatment, and the noncompliance rate exceeded 30 percent in some countries, COMPly Steering Committee Chairman Jean-Claude Pechere, MD, emeritus professor of medicine at the University of Geneva in Geneva, Switzerland, said. Fifty one percent believed that leftover antibiotics could be saved and used later on, and 73 percent of those who had leftover antibiotics said they saved them.
Not surprisingly, the number of doses per day was directly correlated with noncompliance. Thus, a 15 percent noncompliance rate was noted in persons taking one dose per day versus 27 percent in persons taking three or more doses per day.
Eighty percent of those polled believed that antibiotic-resistant germs represent a serious problem but only 61 percent knew that improper antibiotic use can diminish efficacy.
Dr. Pechere said that misperceptions about appropriate antibiotic use is the main reason for noncompliance in some countries, while a lack of faith in their doctor's ability and concern about their doctor's ability to manage their illness may be a more important factor for patients in other countries.
Results also identified age as an important factor. Of respondents 18 to 29 years of age, 30 percent were noncompliant versus 14 percent of persons 60 years of age or older.
Antibiotic resistance is considered a major public health concern.
Pfizer Inc. funded the COMPLy survey.
By Jill Stein
Thursday, June 21, 2007
AARP Members Rally For Lower Drug Prices
This falls under one of the reasons people on a budget are noncompliant with their medication. There is only so much people can pay for their prescriptions when they are on a fixed income or have low income. On Long Island, the elderly are doing something about it. Over 100 AARP members rallied NY state lawmakers to pass a bill to make prescription drugs more affordable. The members had a whistle stop tour of 15 district offices of state sentators and assembly members is Suffolk and Nassau Counties.
They are supporting a bill that passed last year in the Assembly requiring drug companies to report all gifts to doctors over $75 BUT, due to big pharma pressure, the Senate failed to act on the bill.
"We want to be sure that the drugs that end up in our medicine cabinets are there for the right reason -- because they are best drug for the best price, not because of a slick sales pitch and a nice meal," said Adele Klenk, Volunteer Regional Coordinator for AARP on Long Island.
I think it is grand that the AARP members get out there and let their voice be heard to their representatives. If they cannot afford to continue with the newest medications there are prescribed, then they obviously will not get better and possibly die. This is no good to anyone - doctor loses patient, pharma loses customer. Family loses loved one. Keep those prices affordable and keep compliant!
They are supporting a bill that passed last year in the Assembly requiring drug companies to report all gifts to doctors over $75 BUT, due to big pharma pressure, the Senate failed to act on the bill.
"We want to be sure that the drugs that end up in our medicine cabinets are there for the right reason -- because they are best drug for the best price, not because of a slick sales pitch and a nice meal," said Adele Klenk, Volunteer Regional Coordinator for AARP on Long Island.
I think it is grand that the AARP members get out there and let their voice be heard to their representatives. If they cannot afford to continue with the newest medications there are prescribed, then they obviously will not get better and possibly die. This is no good to anyone - doctor loses patient, pharma loses customer. Family loses loved one. Keep those prices affordable and keep compliant!
Monday, June 18, 2007
More Information and Facts About The Friday Post From NCCBH
As I stated, I am a little behind the times, but this is the press release from the National Council for Community Behavioral Healthcare from June 13th addressing the "lawyer ads" about Zyprexa.
Survey results released today shed light on a new barrier to treatment affecting people with severe mental illness. The findings show fears raised by product liability litigation involving antipsychotic drugs may be putting patients with schizophrenia and bipolar disorder at risk for relapse. These fears add to the already heavy burden that patients face as they work to manage symptoms, stay on their medication and work with their treatment providers to improve their mental and physical health.
The survey, which was conducted among 402 psychiatrists who treat patients with schizophrenia and bipolar disorder, showed that, even when patients were responding well to their prescribed antipsychotic treatment, many requested a medication change because these drugs are featured in law firm advertisements. Other patients stopped taking their medication, often without telling their psychiatrist, for the same reason.
“Many of our patients already struggle with accepting their illness and staying on their prescribed treatment, and now they are experiencing new levels of fear due to the increasing incidence of these jarring advertisements,” said Dr. Ralph Aquila, assistant clinical professor of psychiatry, Columbia College of Physicians and Surgeons; director, residential community services, St Luke's-Roosevelt Hospital Center, New York, NY. “This irresponsible advertising is hindering the progress of therapy for many of these patients and disrupting the important relationship between them and their healthcare providers. Plaintiffs attorneys need to consider the consequences that these advertisements may have on patients.”
The findings from this survey, which was commissioned by the National Council for Community Behavioral Healthcare and Eli Lilly and Company, are consistent with a Harris Interactive® poll of 250 physicians commissioned by the U.S. Chamber of Commerce in 2003 that examined how pharmaceutical litigation impacts prescribing decisions across disease states. However, this new survey went one step further by asking psychiatrists to examine the potential impact of this type of litigation on patient care. These new findings have implications for doctors who treat serious and persistent mental illnesses, and confirm trends in clinical practice that many people in the mental health community have observed, but have not been quantified until now.
Ninety-seven percent of surveyed psychiatrists had one or more patients who stopped taking medication or reduced their dosage. Of these psychiatrists, 52 percent believed patients took this action due to law firm advertisements about antipsychotic drugs, and reported the following:
• Ninety-three percent stated that one or more of their patients made medication changes without consulting them first, and the majority of these psychiatrists (94 percent) reported patient relapse as a result of discontinuing medication.
• The most frequent consequences of relapse were symptom recurrence (93 percent), hospitalization (75 percent), loss of an important relationship (40 percent) and suicide attempts (26 percent).
Even when patients were improving on their prescribed medication, they still approached their psychiatrists about stopping or changing. Ninety-seven percent of surveyed psychiatrists received one or more patient requests to stop or switch their medication. Of these psychiatrists, 59 percent felt patients made these requests based on concerns raised by law firm advertisements about antipsychotic drugs, and reported the following:
• The majority of these psychiatrists (93 percent) felt these patients were responding to treatment.
• Of the patients that were responding but requested a stop or switch, 71 percent of psychiatrists reported that one or more experienced a relapse, which also led to symptom recurrence, hospitalization, loss of an important relationship and suicide attempts.
• Half of the surveyed psychiatrists reported that patient caregivers also requested a medication switch or stop due to concerns generated by law firm advertisements, even if their loved one was responding to treatment.
“Doctors and patients need to discuss the risks and benefits of any medication in order to determine what is appropriate for each patient,” said Linda Rosenberg, MSW, president and CEO of the National Council. “That assessment becomes difficult in today’s atmosphere because so much of the advertising is alarmist and frightening. It’s especially crucial for patients to speak with their doctor before stopping their medication. Such discussions are an important part of the therapeutic relationship.”
The findings from the survey are especially pertinent given the number of barriers that already exist in helping patients adhere to their treatment. Among the many challenges psychiatrists noted they faced when selecting an antipsychotic medication to treat schizophrenia and bipolar disorder, the five most challenging issues identified were:
• Side effects (75%),
• Lack of adherence due to unwillingness to accept illness (73%),
• Medication costs (58%),
• Lack of adherence due to lack of support (50%), and
• Co-occurring mental illnesses (49%).
More than half (55%) of surveyed psychiatrists indicated that they had changed their prescribing practices over the last five years due to product liability cases involving antipsychotic medications – and reported frustration and concern that this type of litigation sometimes interferes with patient treatment. Furthermore, many psychiatrists (62%) reported that they know of colleagues who have made similar changes in their prescribing practices.
Survey results released today shed light on a new barrier to treatment affecting people with severe mental illness. The findings show fears raised by product liability litigation involving antipsychotic drugs may be putting patients with schizophrenia and bipolar disorder at risk for relapse. These fears add to the already heavy burden that patients face as they work to manage symptoms, stay on their medication and work with their treatment providers to improve their mental and physical health.
The survey, which was conducted among 402 psychiatrists who treat patients with schizophrenia and bipolar disorder, showed that, even when patients were responding well to their prescribed antipsychotic treatment, many requested a medication change because these drugs are featured in law firm advertisements. Other patients stopped taking their medication, often without telling their psychiatrist, for the same reason.
“Many of our patients already struggle with accepting their illness and staying on their prescribed treatment, and now they are experiencing new levels of fear due to the increasing incidence of these jarring advertisements,” said Dr. Ralph Aquila, assistant clinical professor of psychiatry, Columbia College of Physicians and Surgeons; director, residential community services, St Luke's-Roosevelt Hospital Center, New York, NY. “This irresponsible advertising is hindering the progress of therapy for many of these patients and disrupting the important relationship between them and their healthcare providers. Plaintiffs attorneys need to consider the consequences that these advertisements may have on patients.”
The findings from this survey, which was commissioned by the National Council for Community Behavioral Healthcare and Eli Lilly and Company, are consistent with a Harris Interactive® poll of 250 physicians commissioned by the U.S. Chamber of Commerce in 2003 that examined how pharmaceutical litigation impacts prescribing decisions across disease states. However, this new survey went one step further by asking psychiatrists to examine the potential impact of this type of litigation on patient care. These new findings have implications for doctors who treat serious and persistent mental illnesses, and confirm trends in clinical practice that many people in the mental health community have observed, but have not been quantified until now.
Ninety-seven percent of surveyed psychiatrists had one or more patients who stopped taking medication or reduced their dosage. Of these psychiatrists, 52 percent believed patients took this action due to law firm advertisements about antipsychotic drugs, and reported the following:
• Ninety-three percent stated that one or more of their patients made medication changes without consulting them first, and the majority of these psychiatrists (94 percent) reported patient relapse as a result of discontinuing medication.
• The most frequent consequences of relapse were symptom recurrence (93 percent), hospitalization (75 percent), loss of an important relationship (40 percent) and suicide attempts (26 percent).
Even when patients were improving on their prescribed medication, they still approached their psychiatrists about stopping or changing. Ninety-seven percent of surveyed psychiatrists received one or more patient requests to stop or switch their medication. Of these psychiatrists, 59 percent felt patients made these requests based on concerns raised by law firm advertisements about antipsychotic drugs, and reported the following:
• The majority of these psychiatrists (93 percent) felt these patients were responding to treatment.
• Of the patients that were responding but requested a stop or switch, 71 percent of psychiatrists reported that one or more experienced a relapse, which also led to symptom recurrence, hospitalization, loss of an important relationship and suicide attempts.
• Half of the surveyed psychiatrists reported that patient caregivers also requested a medication switch or stop due to concerns generated by law firm advertisements, even if their loved one was responding to treatment.
“Doctors and patients need to discuss the risks and benefits of any medication in order to determine what is appropriate for each patient,” said Linda Rosenberg, MSW, president and CEO of the National Council. “That assessment becomes difficult in today’s atmosphere because so much of the advertising is alarmist and frightening. It’s especially crucial for patients to speak with their doctor before stopping their medication. Such discussions are an important part of the therapeutic relationship.”
The findings from the survey are especially pertinent given the number of barriers that already exist in helping patients adhere to their treatment. Among the many challenges psychiatrists noted they faced when selecting an antipsychotic medication to treat schizophrenia and bipolar disorder, the five most challenging issues identified were:
• Side effects (75%),
• Lack of adherence due to unwillingness to accept illness (73%),
• Medication costs (58%),
• Lack of adherence due to lack of support (50%), and
• Co-occurring mental illnesses (49%).
More than half (55%) of surveyed psychiatrists indicated that they had changed their prescribing practices over the last five years due to product liability cases involving antipsychotic medications – and reported frustration and concern that this type of litigation sometimes interferes with patient treatment. Furthermore, many psychiatrists (62%) reported that they know of colleagues who have made similar changes in their prescribing practices.
Friday, June 15, 2007
Zyprexa "Lawyer Ads" adding to Noncompliance
I am a little behind the times, but I just read an article about the “lawyer’s ads” for Zyprexa that are scaring patients into not being compliant with their mental illness medications. This does not sound good. Lilly (maker of Zyprexa) is in the middle of settling some 30,000 lawsuits and has spent over $1.2 billion already. The ads feature the drug’s side effects and the amount Lilly has spent to settle their lawsuits.
One lawyer who is creating some of these ads is William Berg. His firm is Berg Injury Lawyers. What is his motivation? "If we advertising lawyers don't tell people about their legal rights, who will? Eli Lilly sure isn't going to," he said.
I am unfamiliar with Zyprexa, but it treats schizophrenia and bipolar disorder and had over $4.4 billion in sales last year. The problem is that is causes diabetes or high blood sugar. I can’t believe that prescribing doctor’s did not know the risks – it’s just foolish. Also with any new treatment, I would imagine the psychiatrists would monitor their patients’ blood levels to see what effects the drug has on them. Lilly says all doctor's knew the side effects since the drug's launch in 1996 whereas Allen Rothberg, another lawyer representing the patients, claims that Lilly withheld information from patients and doctors alike.
The worst part about this, other than patients’ suffering, is that the advertising blitz is causing all these other patients to stop taking their other medications. I know that schizophrenics and bipolars can be paranoid – so just imagine what could happen to a patient after seeing ads reinforcing negative side effects. Couple that with claims for financial gain, and you have a bipolar fiesta. They stop taking their meds, let a little mania take hold and then they believe they can claim some of the billion dollar pot for themselves.
The wave of noncompliance among these patients could turn into a horrible mess. Here are the facts from a Lilly survey released on Wednesday: 402 psychiatrists who treat patients with bipolar disorder or schizophrenia completed an online questionnaire and more than half of the psychiatrists said they believed their patients stopped medication or reduced their dosage after seeing lawyers' advertisements about anti-psychotic drugs.
This is really big and really bad. 201 psychiatrists. Let’s say 20 patients each? That is 4000 unstable patients running around. A few years ago, after the media reported the FDA mandated severe "black box" warnings for a group of common antidepressants, suicide rates rose among those patients on the drugs.
Dr. Nada Stotland, president-elect of the American Psychiatric Association, said: "You can't prove a cause-and-effect, but you can draw a pretty good hypothesis that there's a relationship between suicides going up and people not being treated for depression." I hope this doesn’t happen again. The good thing is, Berg assured us all in saying, “In all of our ads, we tell folks, 'Do not stop taking any medication without consulting your doctor.'" I’m glad he is looking out for possibly already unstable patients, who will definitely heed that warning.
Another concern is what side effects are these patients going to suffer. These are not addressed in the regular side effect warnings for these drugs. A friend of mine went off Paxil or another antidepressant and was in bed for two weeks. Not so bad, but again just not taking medication for people with schizophrenia and bipolar disorder is bad enough.
On another note, what are the financial implications of this noncompliance for 4,000 patients? On the pharma end, let’s say the average medication is $250 a month. That’s $1M if these patients don’t refill their medications. That’s like 1/8 of a penny to pharma so they aren’t worried. Let’s say 1/3 go into a mental ward since they have adverse effects – let’s call it $1000 a night for 4 nights. Not bad only $5.2M in expenses. I’m sure insurance will cover it.
I am going to assume at least 3/4ths of these patients have jobs (@ $30K a year) and will not work for a week. That’s about $1.8M in lost revenue, plus another $2.5M to cover the jobs with temp help - that's just for the week. And a fair portion of these people might not return to their jobs if they don't get sorted out with the proper medication so you can add another $3M of lost revenue. Put that all together and you get $13.5M. I think I did the math correctly.
That might not be a lot to some, but it sure will cost us all down the road if noncompliance continues at this rate. I mean this is just fallout from 402 psychiatrists polled. I don’t know how many patients are out there on bipolar and schizophrenia medication, but Zyprexa did make $4.4 BILLION dollars last year, so go figure.
One lawyer who is creating some of these ads is William Berg. His firm is Berg Injury Lawyers. What is his motivation? "If we advertising lawyers don't tell people about their legal rights, who will? Eli Lilly sure isn't going to," he said.
I am unfamiliar with Zyprexa, but it treats schizophrenia and bipolar disorder and had over $4.4 billion in sales last year. The problem is that is causes diabetes or high blood sugar. I can’t believe that prescribing doctor’s did not know the risks – it’s just foolish. Also with any new treatment, I would imagine the psychiatrists would monitor their patients’ blood levels to see what effects the drug has on them. Lilly says all doctor's knew the side effects since the drug's launch in 1996 whereas Allen Rothberg, another lawyer representing the patients, claims that Lilly withheld information from patients and doctors alike.
The worst part about this, other than patients’ suffering, is that the advertising blitz is causing all these other patients to stop taking their other medications. I know that schizophrenics and bipolars can be paranoid – so just imagine what could happen to a patient after seeing ads reinforcing negative side effects. Couple that with claims for financial gain, and you have a bipolar fiesta. They stop taking their meds, let a little mania take hold and then they believe they can claim some of the billion dollar pot for themselves.
The wave of noncompliance among these patients could turn into a horrible mess. Here are the facts from a Lilly survey released on Wednesday: 402 psychiatrists who treat patients with bipolar disorder or schizophrenia completed an online questionnaire and more than half of the psychiatrists said they believed their patients stopped medication or reduced their dosage after seeing lawyers' advertisements about anti-psychotic drugs.
This is really big and really bad. 201 psychiatrists. Let’s say 20 patients each? That is 4000 unstable patients running around. A few years ago, after the media reported the FDA mandated severe "black box" warnings for a group of common antidepressants, suicide rates rose among those patients on the drugs.
Dr. Nada Stotland, president-elect of the American Psychiatric Association, said: "You can't prove a cause-and-effect, but you can draw a pretty good hypothesis that there's a relationship between suicides going up and people not being treated for depression." I hope this doesn’t happen again. The good thing is, Berg assured us all in saying, “In all of our ads, we tell folks, 'Do not stop taking any medication without consulting your doctor.'" I’m glad he is looking out for possibly already unstable patients, who will definitely heed that warning.
Another concern is what side effects are these patients going to suffer. These are not addressed in the regular side effect warnings for these drugs. A friend of mine went off Paxil or another antidepressant and was in bed for two weeks. Not so bad, but again just not taking medication for people with schizophrenia and bipolar disorder is bad enough.
On another note, what are the financial implications of this noncompliance for 4,000 patients? On the pharma end, let’s say the average medication is $250 a month. That’s $1M if these patients don’t refill their medications. That’s like 1/8 of a penny to pharma so they aren’t worried. Let’s say 1/3 go into a mental ward since they have adverse effects – let’s call it $1000 a night for 4 nights. Not bad only $5.2M in expenses. I’m sure insurance will cover it.
I am going to assume at least 3/4ths of these patients have jobs (@ $30K a year) and will not work for a week. That’s about $1.8M in lost revenue, plus another $2.5M to cover the jobs with temp help - that's just for the week. And a fair portion of these people might not return to their jobs if they don't get sorted out with the proper medication so you can add another $3M of lost revenue. Put that all together and you get $13.5M. I think I did the math correctly.
That might not be a lot to some, but it sure will cost us all down the road if noncompliance continues at this rate. I mean this is just fallout from 402 psychiatrists polled. I don’t know how many patients are out there on bipolar and schizophrenia medication, but Zyprexa did make $4.4 BILLION dollars last year, so go figure.
Thursday, June 14, 2007
White Coat Adherence
One of the questions I always have is about the white coat adherence - i.e. before you go to the dentist you floss like mad for two days and when she asks, you say, "Oh, of course I floss everyday". Your dentist knows if you floss or not. Just like your doctor knows if you have been taking your cholesterol drugs or not. Your blood test won't lie for you.
I admit that if you do not have any apparent symptoms you will forget to take your medication from time to time or you will stop taking your antibiotics once the infection has gone away - but you need to stay on that medication for a reason. For it's full run. Or ask your doctor.
Unfortunately I have been very noncompliant (it doesn't sound as good as naughty) with a script I filled for Lamacil. I can't take it due to another medication and its possible side effects on my liver, but it was prescribed to me. I did fill it. It is sitting in my drawer with my other medications. The results of not taking it are very apparent. So I am not going to say I have been taking it, I'm just going to wait til my tests come back and she says I can take it. BUT it could end up like 70% of all medication in America and not be consumed.
Off topic, but I wanted to include a couple of facts from Dr. H. Gottlieb's report (thanks to Jen Milman from the Healthcare Intelligence Network for the info):
40 to 60% of patients could not correctly report medication expectations 10 to 80 minutes after physicians provided information, AND
More than 60% of patients misunderstood prescription directions immediately after doctor visits.
I think that is astounding. How can this be corrected?
I admit that if you do not have any apparent symptoms you will forget to take your medication from time to time or you will stop taking your antibiotics once the infection has gone away - but you need to stay on that medication for a reason. For it's full run. Or ask your doctor.
Unfortunately I have been very noncompliant (it doesn't sound as good as naughty) with a script I filled for Lamacil. I can't take it due to another medication and its possible side effects on my liver, but it was prescribed to me. I did fill it. It is sitting in my drawer with my other medications. The results of not taking it are very apparent. So I am not going to say I have been taking it, I'm just going to wait til my tests come back and she says I can take it. BUT it could end up like 70% of all medication in America and not be consumed.
Off topic, but I wanted to include a couple of facts from Dr. H. Gottlieb's report (thanks to Jen Milman from the Healthcare Intelligence Network for the info):
40 to 60% of patients could not correctly report medication expectations 10 to 80 minutes after physicians provided information, AND
More than 60% of patients misunderstood prescription directions immediately after doctor visits.
I think that is astounding. How can this be corrected?
Hippocrates Started It All
Thanks to Dr. Showalter from AlignMap for reminding me of Hippocrates' quote: "Keep watch also on the faults of the patients which often make them lie about the taking of things prescribed.” Also Dr. C. Everett Koop's keen insight: "Drugs don't work in patients that don't take them." Which I regularly misquote.
Also from Dr. Showalter, some facts I did not know about the cost of noncompliance:
20% of unintentional pregnancies in the US are attributed to medication noncompliance which costs about $2.6 BILLION. I have known a few girls who forgot to take their pills and luckily there wasn't a problem, but can you believe that number? Just because they forgot? I can understand ignorance or trusting a guy for protection, but again, 20% of unwanted pregnancies could have been avoided by simply remembering to take a daily dose of Desigen!
3 times as many doctor visits & $2,000 per year in additional costs compared to patients who follow their treatment plan. Do you want to pay that extra nut in healthcare costs or Social Security or taxes for Medicare if 50% of Americans are noncompliant? See how this trickles down to $100 BILLION!
10-25% of hospital & nursing home admissions are due to noncompliance, resulting in 340 deaths per day. Could this be your grandmother? Mine went off her medications every couple of months in her final years because she did not like her side effects. This bounced her in and out of a nursing home and eventually led to her death. She was 88 years old at the time and she thought she deserved to do what she wanted to do. The doctors tried to keep her on her meds, but she was very stuborn.
I don't fault her, she had a great life but the last few years were tough as all her friends were dying off and she didn't want to stick around. BUT I will not accept my father or mother going off their diabetes medication or heart medication or cholesterol pills just because they don't like what happens to them. Or support their trip to the hospital because they forgot to take their hypertention medication.
So to wrap things up, as parents, children, godparents, grandparents and care givers alike, heed Hippocrates, the father of it all.
Also from Dr. Showalter, some facts I did not know about the cost of noncompliance:
20% of unintentional pregnancies in the US are attributed to medication noncompliance which costs about $2.6 BILLION. I have known a few girls who forgot to take their pills and luckily there wasn't a problem, but can you believe that number? Just because they forgot? I can understand ignorance or trusting a guy for protection, but again, 20% of unwanted pregnancies could have been avoided by simply remembering to take a daily dose of Desigen!
3 times as many doctor visits & $2,000 per year in additional costs compared to patients who follow their treatment plan. Do you want to pay that extra nut in healthcare costs or Social Security or taxes for Medicare if 50% of Americans are noncompliant? See how this trickles down to $100 BILLION!
10-25% of hospital & nursing home admissions are due to noncompliance, resulting in 340 deaths per day. Could this be your grandmother? Mine went off her medications every couple of months in her final years because she did not like her side effects. This bounced her in and out of a nursing home and eventually led to her death. She was 88 years old at the time and she thought she deserved to do what she wanted to do. The doctors tried to keep her on her meds, but she was very stuborn.
I don't fault her, she had a great life but the last few years were tough as all her friends were dying off and she didn't want to stick around. BUT I will not accept my father or mother going off their diabetes medication or heart medication or cholesterol pills just because they don't like what happens to them. Or support their trip to the hospital because they forgot to take their hypertention medication.
So to wrap things up, as parents, children, godparents, grandparents and care givers alike, heed Hippocrates, the father of it all.
Tuesday, June 12, 2007
The facts about Noncompliance
Compliance is simply following your doctor's orders. Whether it be taking medication, refilling prescriptions or getting your blood tested. 1 out of 2 people are noncompliant with their doctor's prescribed regime. 1 out of 8 heart attack patients stop taking their medication after two months. 15% of all hospital visits and 125,000 deaths annually are due to medication noncompliance. 64% of people say they just forget to take their medication.
From a recent poll from the National Comunity of Pharmacists:
31% of prescriptions are never filled;
24% of people take less than the recommended dosage;
29% stopped taking their medication before it ran out;
38% had forgotten if they had taken their medication or not.
From a recent poll from the National Comunity of Pharmacists:
31% of prescriptions are never filled;
24% of people take less than the recommended dosage;
29% stopped taking their medication before it ran out;
38% had forgotten if they had taken their medication or not.
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