Thank you for Dr. Henry Nasrallah’s articulate fantasy list of “What if…A drug company’s New Year’s resolutions” (From the Editor, Current Psychiatry, January 2008). Every one of Dr. Nasrallah’s “resolutions” hits a bull’s eye. These comments remind me of on-target interpretations during a psychotherapy session that result in feelings of empathic understanding and relief.
The pharmaceutical companies’ marketing departments should understand how much harm they have caused the medical profession and taxpayers. The very nature of marketing is to market, just as the duty of a lawyer is to represent and defend a client. The consequences of marketing—other than to direct attention and increase sales of a product—are not important to the companies.
Recent articles in the press have discussed the deficiencies and insidiousness of pharmaceutical studies and misrepresentation of these studies to physicians. The truth is that marketers tell us what we want to hear.
If psychiatrists could fulfill our fantasies of providing proper care to our patients:
- We would be left alone to give the best and most clinically effective treatments to our patients.
- There would be no interference or outright sabotage of our efforts by insurance companies and HMOs (“We value your telephone call; please wait for the next available representative”).
- We would not be second-guessed by patient quality care agents, insurance agents with no training, Medicaid care managers, lawyers (in and out of the treatment room), delayed or “non-approved” payments, retroactive denials of treatment authorizations, and demands for repayments.
- Psychiatrists’ autonomy, training, and judgment would be respected, and fully informed patients would follow our recommendations.
- We would have time with our patients and money for appropriate testing and hospital stays.
- We would not come home tired, drained, and disappointed.
- Patient care would not be ruled by an adversarial relationship with nonpatient, self-interested agencies.
It is unclear whether this scenario ever existed. Our mentors and older clinicians have spoken of “the good old days,” no matter when they practiced. It is all fantasy, but it is nice to have fantasies.
What remains important is to maintain our autonomy and not abdicate our responsibility to our patients simply because it is easier to do so.
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