Questions About Kickbacks & Careless Prescribing

Questions About Kickbacks & Careless Prescribing

I have a couple of questions into which some of my readers may have some professional insights.

1. Are there "kickbacks" to psychiatrists who prescribe patent antipsychotic medications from pharmaceutical companies? I've running into people convinced that there is some sort of economic incentive for psychiatrists to prescribe the newer, non-generic antipsychotic drugs because of financial benefits that they receive from doing so. I am skeptical, partly because it would be impossible to keep something like this secret for long, and because it seems like a clear violation of medical ethics. I understand that psychiatrists are often prescribing these very expensive medications for patients with no health insurance--which means almost a $200 a month drug cost for patients who are unemployed.

2. Part of the justification for the newer patent antipsychotic medications is lesser side effects, compared to the drugs that are now out of patent. Certainly, the first generation of antipsychotics had serious side effects, such as tardive dyskinesia and occcasionally, death. Hobson and Leonard's Out Of Its Mind certainly seems to take the position that the newer medicines are more precisely targeted in how they treat illnesses such as schizophrenia. How dramatically better are the newer patent medicines compared to those that have gone generic?

3. Does it seem plausible that a psychiatrist would prescribe the exact same medication (respiridal, for example, or Abilify) for every patient, when the range of diagnoses are schizophrenia, depression, and ODD (oppositional defiance disorder)? Hobson and Leonard's book makes rather a point of how psychiatry has changed over the last forty years. In the 1960s and 1970s, it was a time (and money) intensive occupation built around psychoanalysis--which simply did not work for psychoses. Today, it is largely built around prescribing drugs, meeting with patients for twenty minutes every few weeks--and then billing an insurer (if there is one) $285 per hour. Psychoanalysis didn't work--but perhaps we have gone too far to the other extreme in failing to spend time with patients.