Wednesday, 9 July 2008

Drug companies

Have you ever reported a drug rep for breaching ABPI guidelines? I have. I have been more than a little irritated by intrusion in to clinical areas, turning up without appointments to nobble staff, presenting their drugs as fantastic, "because Consultant X down the road uses it loads with really great results."
Recently, although not directly contravening guidelines, I was irked by a rep giving quotes and referenced citations as "evidence" that a drug works when on unpicking this evidence it was from a poster, not a peer reviewed journal publication. Anyone could write a poster, it's not something to influence massive change of practice, yet a drug rep was trying to persuade me otherwise.

Grrr.

But what I do love drug companies for is the drugs. Don't spend time and money trying to push me in to using more of your drug. I'm not paid to spend time with salesmen. My patients and I want better drugs. Spend time and money making better drugs.

I was asked to see a lady who was violent.

Visiting her, she wasn't violent. She was climbing up on chairs and shouting out at people through her window because her daughter had been locking her in her house, to try and keep her safe. She wanted to be out.

She felt unhappy because she was such a bad person. She knew this because there were people in her house, listening to her and documenting everything she did. Although she never saw them, she heard them talking about her all the time. They were even there at night time, scrutinising and commenting, day in and day out. "Goodness," she explained, "I must be some really bad person for them to spend so much time on me like this."

Of course, now knowing she was so wicked, it was inappropriate for her to go to church since she was obviously out of grace. "I can't go there, doctor, I'm too bad!" Why, she's evil incarnate, it'd be inexcusable to tread in God's house.
She did everything wrong and made everything bad, so avoided company. She got really, really hungry because she didn't dare go to the shops since she'd then meet people and ruin their lives, too.

Her physical health was good. Her cognition was globally impaired, MMSE was 19/30 recently, at her best. All blood tests were normal. Her CT scan confirmed extensive atrophic changes, consistent with Alzheimer's disease. She has dementia, of moderate severity.

I started her on the antipsychotic aripiprazole four weeks ago. She's cured. No hallucinations at all, now. No negative cognitions, distortions or abnormal beliefs. She's going to church, going shopping and out with friends to bingo twice a week. She doesn't need locking in her house (and in truth never did).

That's why I have a love/hate relationship with drug companies. I have little to do with them (I don't accept anything from them, no biros, no postit notes, no gifts, no evenings out, nothing) but I need their drugs. And, when used correctly, they're fantastic. One lady's now cured of all her hallucinations and delusions, and is cracking on enjoying her life again, through the right antipsychotic. I love my job.

2 comments:

Seaneen said...

Do you have a contact e-mail? I am wondering if I can write about your blog in a mental health magazine?

Or could you e-mail me if that's okay?

I'm Seaneen, over at http://thesecretlifeofamanicdepressive.wordpress.com

Dragonfly said...

Very true. Drug reps drive me up the wall but being a doctor without the magic potions.......we would have to go back to leeches as a panacea.