[james1071]

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.

[mirthflat83]

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]

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.

[conductr]

A big chunk of that $20B is on high cost ads to the general public, which doesn’t occur in many other parts of the world. It’s a backwards system when a patient is told to ask their doctor for a prescription to a medication by the company that manufactures said medication.

[marcinzm]

No, that $20 billion is ONLY for doctor marketing. There's an additional $10 billion on top of that spent on patient advertising/marketing.

edit: There's a whole industry around providing pharma companies better tools to influence doctors. I believe the industry name for this part of pharma companies is Medical Affairs so feel free to google the tooling being offered.

[overscore]

Yes, one of the few culture shocks when I lived in America was pharmaceutical advertising to the public. Another was constant political advertising on TV.

[jacobr1]

It is also a source of culture shock for Americans like me who visit friends and relatives that watch television. I mean, I watch netflix, but haven't ever had a cable subscription, and while I have a digital antena, I pretty much never use it. Visiting a home where the TV is on constantly is shocking, with all the ads and the viewpoints presented. It really shows how much the media fracturing is helping drive the political divide in the country too. I can't really imagine having those messages constantly pounded into my head.

[cestith]

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]

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__]

Far more effective? Source?

[MacsHeadroom]

For a user named ketamine_ are you really questioning the well known efficacy of few-shot therapies for treatment resistant depression and PTSD?

Psychedelic-Assisted Psychotherapy: A Paradigm Shift in Psychiatric Research and Development: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6041963/

Reviewing the Potential of Psychedelics for the Treatment of PTSD: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7311646/

etc.

[concreteblock]

> For a user named ketamine_ are you really questioning the well known efficacy of few-shot therapies for treatment resistant depression and PTSD?

Maybe they want to convince their friends?

[ketamine__]

Not all experts are cheerleaders.

[ketamine__]

I'm questioning your enthusiasm because I have experience and have read the research.

It is still early days. If one can end depression with an oral medication that isn't scheduled one is better off.

[intricatedetail]

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]

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.

[ineiti]

You might be right for single-casual illnesses like a broken leg, CoVid-19, Tuberculosis, and others. But it's a whole other thing when it comes to more complex illnesses.

Having been for 18 months through different types of psychiatrists and clinics, I came out quite surprised in how "trial and error" this whole system is.

I'm writing this from Switzerland, where we have an (arguably) high quality health care system. But the amount of "OK, that didn't work, lets try this other drug". Or, now, 18 months later, "Oh well, we did the list once through. But who tells me that the MD prescribing the first drug did a correct analysis? Lets start the list from top again." Or, for a friend of mine, his girlfriend found a working cure like that: "Oh, this brochure describes your symptoms so clearly, and it's completely different from what you've been treated for these last 20 years. Let's try it!"

Spoiler alert for my case with the list: the top of the list was not better the second time around.

If you think this is cynical, well, I would like at least _one_ of these drugs to work. If you think the MDs are all useless: well, at some times I was glad they were there.

So, well, I think having a little less than random system might be helping. Let the MDs watch if it makes sense, enter the correct diagnosis, and catch the stupid errors data entry people can make. But i'd give it a try...

[overscore]

The closest thing to an expert system I've seen is clinical practice guidelines, which sometimes includes decision trees of indications/contraindications for administering certain medications for common and time-sensitive medical events, like cardiac arrest or exacerbation of breathing difficulty with COPD.

[intricatedetail]

This is what I saw my doctors were doing. Also I saw cardiologist comparing my diagnosis using Google images.

[sxg]

Yeah, I believe your experience, and I think it highlights the issues we have with communication in medicine. While it may look like your doctor is just blindly Googling something, I would imagine they're probably using it as more of a reference source (at least that's what I often do). I regularly use radiopaedia.org just to look up a quick fact or find alternative examples of a diagnosis I'm working with.

It's like Googling coding questions and reading a StackOverflow thread. Obviously no programmer is solely relying on StackOverflow to do their job as no physician is solely relying on Google, UpToDate, or any other resource. They're simply quick references.

[JanisL]

> Obviously no programmer is solely relying on StackOverflow to do their job

I've encountered a few people who were doing something very close to this. I really hope that doesn't happen in medicine too.

[ascar]

That's down to the (obvious) fact that job performance and working ethics is not equal but distributed among practitioners.

I think this is especially visible in software "engineering" with people joining the craft after a few weeks of boot camp. (think engineering vs programming)

However, we put doctors through an especially rigorous and long training and certification process to minimize the amount of unqualified practitioners.

[vbezhenar]

Doctors are supposed to have a higher entry barrier than software developers. Does not mean that all of them are brilliant, of course.

[pc86]

Having software to show differential diagnoses, or using Google images because you know to search for, are not the smoking guns you think they are.

[raverbashing]

Hey remember when the opioid companies paid the clinic management(?) software companies to push opioids to people?

https://www.washingtonpost.com/nation/2020/01/28/opioid-kick...