The Biggest Drawback
I read with amazement Dr. Stephen R. Marder's comments in the article "Try Higher Doses of Atypicals Before Giving Up" (December 2002, p. 16).
Dr. Marder suggested that it is safe to use Zyprexa up to 60 mg/day and Seroquel up to 1,600 mg/day, with temporary sedation being the only drawback. I would suggest that the cost of these medications is a far greater drawback to their use.
Where I practice, the retail price for these doses would be $1,381.50 per month for Seroquel and $1,759.96 for Zyprexa. Who but the wealthy or those with incredibly generous insurance could afford such extravagance? I work at two state adolescent residential facilities, where the cost of medications comes out of the institutional budget. Since the advent of managed care and the demise of long-term inpatient psychiatric treatment, these institutions have become de facto hospitals. With many of our teens coming directly from acute hospital settings on multiple meds, we often cannot even continue their usual atypical antipsychotic doses, let alone try the exorbitant levels the article proposed.
At the risk of seeming harsh, Dr. Marder's comments sound like those of either an academician who has little appreciation for the realities of the clinical world of psychiatry or a pharmaceutical industry recipient who has been deluded into believing that the outrageous costs of these new psychotropics (and their resulting corporate profits) are justified.
Drug companies say that they need to recoup tremendous research and development costs, which are never actually demonstrated, only claimed.
We have a moral obligation to confront this kind of profiteering. We see every day how much the drug companies spend attempting to influence our clinical decisions in their favor. With the stakes so high, they will do almost anything, even fund apparently unbiased research studies and try to hide unfavorable clinical outcomes. The bottom line is this: We cannot trust an industry that stands to make astronomical profits by gaining our favor, and we must not dismiss these financial matters as irrelevant to clinical considerations. The best medicine in the world is no good if people cannot afford to use it, and the plain truth is that many can't, even in this country.
We should not tacitly support irresponsible medical corporate profiteering with this kind of clinical recommendation, at least not without providing a qualification. …