[ty6853]

The moral hazard is pretty clear. Testing is profitable and so are the drugs. If they are wrong, there is no penalty. For the same reason an optometrist lied about my perfect vision as a child and conned my parents into glasses I never used paid for by insurance.

Remember doctors are there to advise not to command, know the hazards and be willing to say no or consider the data from your own perspective.

[hansonkd]

I like to tell people if you go to a carpenter to build a table, you'll get a wooden table. If you go to a stone cutter, you'll get a marble table. If you go to a welder, you'll get a metal table.

The trick is to know who to go to get what you want. In the USA with PPO there is generally zero friction to just making yourself an appointment with a speciality doctor and that specialty doctor will use his "toolbox" to create the outcome that you came to him and paid for. If you go to a psychiatrist, well their tool is prescription medicine, so that is what they'll use.

This sounds like common sense, but i think the population at large places too much trust in the doctor. In the US you have to be your own advocate.

[Apocryphon]

An idle idea I’ve had is that the healthcare bureaucracy in the U.S. can get so bad that one wishes one can hire a lawyer-type of role to navigate it as a paperwork proxy of sorts. But perhaps greater scope is needed- a personal medical advisor who has the domain knowledge, while being independent of the incentives that drive others in the health system.

I suppose in the past that would just be your family doctor, wasn’t it.

[cyberax]

> Testing is profitable and so are the drugs.

Amphetamine salts (generic for Adderall) cost less than $20 a month. Generic atomoxetine is $15.

The medication for ADHD is _cheap_. A pharmacy will likely get more profit from a bottle of ibuprofen.

[ty6853]

Maybe this varies but people I know with adhd had to see or beg a doc every 6 months to renew a script, which is a money generator for the doctor.

The gross margin on amphetamine salts even at $20 must be insanely high. We're talking about what, a couple grams of active amphetamines in a month?

[cyberax]

Doctors in the US do not suffer for the lack of patients. In most cases, psychiatrists are booked for months in advance. A lot of ADHD med prescription renewals are now handled by nurse practitioners as a result.

It's literally a 5-minute call: "Do you have any unusual side effects? How would you rate your depression/anxiety? OK, the prescription was sent to your pharmacy".

> The gross margin on amphetamine salts even at $20 must be insanely high. We're talking about what, a couple grams of active amphetamines in a month?

This is about as low as drug prices go in the US. And for amphetamines there's an additional overhead of having a pharmacist checking your ID, storing the drug in a safe overnight, filling out the DEA forms (for every link in the supply chain), etc.

Good Rx shows the price for amphetamine salts at $15 now (in Walgreens in my area).

I can definitely tell that the profit basis for ADHD diagnoses is just not there. There isn't much money in it for doctors or pharmacies.