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Dr. Marcia Angell: Off-Label Prescribing Of Psych Drugs Should Be Banned

Dr. Marcia Angell

I appreciate the incisive analysis in the latest installment, fresh off the presses here, of Dr. Marcia Angell’s New York Review of Books piece on the current state of psychiatry. (We wrote about the first installment here.)

But what I particularly appreciate about it is that it doesn’t stop at analysis. Yes, it lays out in sad historical detail how the financial influence of drug companies penetrated psychiatry as the field increasingly shifted from Freudian talk therapy to psychopharmacology. (As the late Harvard psychiatrist Leon Eisenberg put it with characteristic wit, the field shifted from “brainlessness” to “mindlessness.”) And yes, it documents the dangers of over-diagnosis. But then Marcia, former editor of the New England Journal of Medicine, goes on to make actual, succinct policy recommendations. Including this one about prescribing psychiatric drugs “off-label,” beyond the diagnoses the FDA has approved them for:

The original purpose of permitting doctors to prescribe drugs off-label was to enable them to treat patients on the basis of early scientific reports, without having to wait for FDA approval. But that sensible rationale has become a marketing tool. Because of the subjective nature of psychiatric diagnosis, the ease with which diagnostic boundaries can be expanded, the seriousness of the side effects of psychoactive drugs, and the pervasive influence of their manufacturers, I believe doctors should be prohibited from prescribing psychoactive drugs off-label, just as companies are prohibited from marketing them off-label.

And this one: Continue reading

Update: Dr. Daniel Carlat On Gift Ban Repeal


Ah! Just as I’d been hoping, Dr. Daniel Carlat has weighed in on the House wine-and-dine vote to repeal the state’s ban on gifts to doctors by drug- and device-makers. Dr. Carlat, a local psychiatrist trained at Massachusetts General and author of the recent book “Unhinged,” has written about the corrupting influence of gifts to doctors better than anybody else I know. Along with reporting and analysis, he shares personal confessions that have long since expiated any past sins.

On the Carlat Psychiatry Blog here, he spoofs the repeal’s backers. A couple of my favorite excerpts:

Simply put, physicians need this food subsidy, because in Massachusetts, the median physician income is a paltry $216,700, according to the Massachusetts Medical Society. This is only 7 times the median Massachusetts income of $30,751. Those who say that doctors are “10 times richer” than other people are engaging in ridiculous hyperbole.

The fact is, your doctor is hungry and shouldn’t have to pay for his own meal after having gone through medical school and residency. You try getting paged at 3 AM and to put an NG tube through someone’s nostrils. These are punishing experiences and doctors deserve special compensation.

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