Friday, May 09, 2008
Drug money and DSM
Tara Parker-Pope's blog about DSM, the psychiatric bible, and ties to Big Pharma, hits on a point of particular interest to anyone who's had experience of an eating disorder.
The truth is that there are few if any medications that have been shown to help treat an eating disorder, especially in the acute phase of the illness (and isn't that when you want them to help?). Psychotropic meds do not seem to help when someone is severely malnourished through anorexia or bulimia. (There are a few atypical anti-psychotics being looked at for treatment, but the jury is still way out on those.)
Despite the accumulating evidence that meds are not the first-line treatment for eating disorders, pretty much every doc you'd see for an e.d. will prescribe an SSRI, or several.
In my daughter's case, she had bad reactions to nearly everything she was put on, which meant more suffering was piled on top of what she was already going through. Oh, and we had to pay big bucks for it, too.
Of course, my daughter was never officially diagnosed with anorexia nervosa. I'm not sure why; she certainly met all the diagnostic criteria listed in DSM-IV. Parker-Pope's piece suggests that such criteria tend to be overly inclusive and vague. I don't think that's true for eating disorders--on the contrary. My daughter's psychiatrist-in-training diagnosed depression with secondary EDNOS--eating disorder not specified. I don't know if it made a difference in her treatment, but it did saddle her with a diagnosis that was completely inaccurate. I don't know how that might affect her down the road.
Any doc treating eating disorders should know that depression is a typical presentation when someone is acutely ill with AN, and it usually goes away with weight restoration.
I know from friends who are psychiatrists and M.D.s that it's increasingly tough to steer clear of drug money and influence. Even if you refuse the free dinners and concert tickets and cutesy pens and other freebies, as Parker-Pope points out, much of the research in the U.S. is being paid for by Big Pharma. For those of you think that's all right because, after all, everyone wants the Best Thing, think back a month or two to this report about cholesterol-lowering drugs. Drug companies will in fact behave unethically if the bottom line is at stake.
Personally, I don't want Big Pharma writing the rulebook for psychiatric disorders. I'm just not sure how to stop them.