This is an excerpt from Mary's book, No More Ritalin, Treating ADHD Without Drugs, Chapter 3. Mary is the founder of the Block Center, a medical facility for adults and children located in the Dallas/Ft. Worth area, which provides effective approaches to routine "psychiatric" problems without the use of harmful psychiatric drugs.
Current treatment for ADHD
The most common treatment for ADHD in America today is drug therapy. Even the historical treatment is supposed to combine drugs, behavioral modification, and educational services. However, studies indicate that pediatricians are more likely to prescribe mainly drugs, without the other two treatments. About 80 to 85 percent of ADHD children receive drugs, while only about half of that number receive behavioral and educational modifications. Interestingly, medical literature reveals that family practitioners do a better job of prescribing some behavioral and educational modifications for ADHD children than do pediatricians.
Ritalin, the most commonly prescribed drug for ADHD symptoms, is one of many other drugs currently used to treat ADHD. The list includes dextroamphetamine (Dexedrine), pemoline (Cylert), imipramine hydrochloride (Tofranil), desipramine (Norpramin), various antiseizure medications, and clonidine (Catapres), Prozac, and Paxil.
Ritalin is being prescribed in such vast amounts, that in December 1993, Ciba-Geigy, the company that manufactures the drug, ran out of pills. Ritalin is a controlled substance, like morphine. The controlled substance designation means that there is concern by the Drug Enforcement Agency (DEA) that the drug has potential for abuse and/or addiction. Because it is a controlled substance, doctors must keep very careful records when they prescribe it. Doctors must use a standard triplicate prescription form, with an original and two copies. One copy is retained by the doctor, another goes to the pharmacist, and another to the DEA. The DEA tracks where and when the drug has been prescribed and dispensed. If it is being prescribed or dispensed too often, abuse may be occurring.
The DEA puts manufacturing limits on controlled substances. A pharmaceutical company is
allowed to make only a certain amount of the drug each year. And all of the drug must be
accounted for. In 1993 the allotment for Ritalin ran out before the year was over.
Ciba-Geigy could not begin to manufacture more until 1994 unless granted special
permission by the DEA. The 1993 Ritalin shortfall caused a virtual panic among many
parents of children who are dependent on Ritalin as their only treatment. The situation
received intense media attention.
I am concerned that we will never really understand a childs underlying health problems if we took at the childs illness from the perspective of how best to treat the symptoms with drugs. Instead, my philosophy and approach is that we must identify and treat the underlying cause of the problem, not symptoms such as hyperactivity, aggressive behavior, and poor attention.
It is ironic to me that doctors today do not like the power and control insurance
companies are exerting over them, while doctors have been controlled for over fifty years
by the drug companies.
Doctors didnt mind when it was just drug companies controlling medicine. It was a symbiotic relationship. The drug companies made money by helping the doctors make money. Now insurance companies are making money by decreasing the doctors income, so the doctors object. It is the same with ADHD. The drug companies are making so much money from the diagnosis and treatment of ADHD that even if the drugs are shown not to be the best treatment, drug treatment will not go away.
Todd Forte, a spokesperson for Ciba-Geigy, the company that makes Ritalin, has said that over three million people are currently taking Ritalin. Most are children. CHADD (Children and Adults with ADD), a national support group for ADHD that has been a very vocal advocate for the use of Ritalin and other drugs for the treatment of ADHD, was exposed recently for its close relationship with the drug companies. ABC television revealed on 20120 (October 27, 1995) that CHADD has received over $800,000 from Ciba-Geigy, the company that makes Ritalin. CHADD has even petitioned the Drug Enforcement Agency (DEA) to remove Ritalin from its controlled substance status. Such removal would make it easier for doctors to write prescriptions for Ritatin, expanding the use of the drug.
If three million people are on Ritalin, imagine the profit for that drug company. A conservative estimate would put the cost per month of Ritalin, methylphenidate HCI, at $30. It is an immense revenue stream: $30 per month for three million people would create revenues of over $1 billion for one drug company in one year alone. Add in the cost of the other drugs that are used plus educational, psychological, medical, and other professional fees. The total will easily exceed $2 billion per year.
Thats how the ADHD industry has grown. The more ADHD diagnoses, the more drugs are prescribed, the more services are provided, the more jobs people have, and the more money everyone in the ADHD industry makes. Where is the motivation for those making the money in the industry to come up with a better solution to the problem unless the solution enhances their financial position? What a comfortable situation for everyone in the ADHD industry. They all make a lot of money while appearing to be helpful. No one is actually getting well, so the money never stops. While all those working successfully in the ADHD industry are making money, your child could be losing out on good health, missing a drug-free childhood, and losing an opportunity to reach her or his full potential.
The drug Ritalin has been used for many years for the treatment of behavior problems in children. At first the drug was thought to have a paradoxical effect on children with ADHD. It was thought that children with ADHD had "some of their wires crossed." Even though Ritalin and other amphetamine-like drugs were "uppers" for most people, in these children, the drug was thought to have an opposite effect and actually calm them down. Then about ten to fifteen years ago, the research in the area led to a more comprehensive understanding of the mechanism of amphetamine action. Experts determined that the drug actually was not paradoxical, but in fact did the same thing to these children as it did to normal children and adults. The drug, in essence, helped them "focus."
For a brief period then, the drugs were to be used only for the "attention" part of ADHD, that is, not for hyperactivity and behavioral problems. But information comes in and out of favor, and soon the drugs were again prescribed for attention problems and for hyperactivity and behavioral problems. In many cases it appeared to control the symptoms, at least in the short term.
Today the drugs are used for attention problems and for hyperactivity and behavioral problems. In about 75 to 85 percent of cases there is a noticeable improvement in signs and symptoms in the short-term use.
A Comprehensive Review Article published in the 1990 issue of the Journal of the American Academy of Child and Adolescent Psychiatry revealed that the incidence of ADHD in children is about 3 percent of all children, while the rate of medication has doubled every two to four years since 1971. Today, the number of children on Ritatin for ADHD is over two million. In addition, a 1987 survey of public schools in Baltimore County revealed that 5.6 percent of all elementary students (10 percent of all males) were receiving stimulant medication. If the actual incidence of ADHD is only 3 percent, then there appears to be an overmedicating problem, by nearly 100 percent, in treating children who are being diagnosed with ADHD symptoms.
Again the problem is that the drugs treat only the symptoms of ADHD. They do nothing to fix the underlying cause of the symptoms. Remember, ADHD is just a list of symptoms. The drugs help by covering up the symptoms. If you discontinue the drug, the symptoms will return. If you become tolerant to the drug, the symptoms will return. Drugs are a short-term answer to treating long-term symptoms, and they carry the potential of serious side-effects.
In one study, 80 percent of children with ADHD symptoms retained the ADHD symptoms at the end of eight years, in spite of medications, behavioral modification, and educational modification. In this study, 20 percent of the ADHD children received no medication at all. And only 20 percent of the ADHD children showed improvement at the end of eight years (the study did not indicate if these were the same 20 percent). In any case, a 20 percent improvement rate seems pretty low to me. I would not accept this low rate of improvement for my own children or for my patients, especially in light of the possible side-effects.
The current philosophy about ADHD is that no one outgrows the symptoms. The problem is for a lifetime. The idea that we could give children drugs for a few years, then take them off of drugs during puberty and they would be fine, has proven to be inaccurate. One does not outgrow ADHD symptoms. If you do not resolve the problem by fixing the underlying cause, it remains a problem that will have to be treated for a lifetime. Placing children on drugs when theyre young does not fix the problem. If you use drugs and do not try to fix the underlying cause of the symptoms, you are doing the child a disservice. In fact it is much easier to look for and treat the underlying cause when a child is young than when he or she is a teenager. Very few drugs on the market actually cure anything. Drugs simply cover up symptoms; they do not cure.
Even if the symptoms improved on the drugs, treating ADHD symptoms with medication for a lifetime leads to increased dosages of drugs with increased side-effects. A child diagnosed with the problem at age six will most likely be placed on medication. If the medication is effective in the short run, that child will continue on that medication as long as it is effective. When it becomes less effective, the dosage of the drug will be changed until a new, increased dosage is found to be effective or until another drug is tried or added.
When one drug is not effective, often another is tried or added to the original regimen. Many of the children I see in my office have been offered other drug options by their previous physician. But many parents who come to see me are concerned with the constant trial of drugs, especially when the drugs become more and more potent and the side-effects more and more serious.
These drugs are very serious substances. I am really concerned by their frequent use in young children. Ritalin, used for many years for children with behavioral problems, is still a substance that is structurally like amphetamines. It is a controlled substance because the government has concerns that it can be abused. Dexedrine is also a controlled substance. As I explained, a controlled substance means that a government drug agent somewhere has a record of your childs Ritalin prescription on file. Thats the law.
ABCs 20120 show (October 27, 1995) revealed abuses, citing incidents in which children are snorting Ritalin, teachers and pharmacists are stealing it, and parents are selling it. Tim Benedick of the Ohio State Pharmacy Board said on the same 20120 show that "It [Ritalin] is highly addictive. It is speed."
Many of the children I have seen on Ritalin are often very subdued; others have had adverse reactions or a worsening of their symptoms. Parents report that their young children are like "zombies" on it. It can have very different effects on different individuals. Teenagers tell me and their parents that they dont like the way it makes them feel, and they dont want to take it.
I call Ritalin "pediatric cocaine." The drug Ritalin, or its generic equivalent, methylphenidate HCI, is very similar to cocaine. Both drugs use the same receptor site in the brain, give the same "high," and in medical research are used interchangeably. The only difference appears to be that cocaine leaves the receptor site more quickly, possibly making it more addictive. It is no surprise that we have a drug problem in this country when we prescribe drugs - that use the same receptor in the brain as cocaine - to children as young as three years of age. Are we teaching children that drugs are the answer to everything? I believe that is why Ritalin is being abused in the same manner that cocaine is abused. Ritalin is just legally prescribed; cocaine is not.
All drugs have side-effects. Ritalin has been used for many years, so we are very familiar with the short-term side-effects of that drug. The known short-term side-effects of Ritalin include loss of appetite, decreased growth, tics, visual disturbances, nervousness, insomnia, depression, social withdrawal, irritability, abdominal pain, increased heart rate, and psychoticlike symptoms. Again, these are side-effects which occur from short-term use. Since long-term use is a relatively new phenomenon, the long-term side-effects have yet to be discovered. We dont yet know how the long-term use of Ritalin will affect our childrens hearts, kidneys, or immune systems. In essence, the long-term studies are being conducted right now, on our children, without you or them even being aware of it. The drug companies make it clear in their drug insert that the safety and efficacy of the long-term use of Ritalin in children is not available.
The drug insert that comes with the medication reveals that the medication is not to be given unless environmental causes of the problem have been ruled out. And the drug insert advises that Ritalin should not be given without other concurrent treatments such as academic and behavioral modification." Sometimes this drug insert is removed from the medication package. You can ask your pharmacist to include it whenever you get any prescription filled.
The drug insert that comes with the medication instructs that Ritalin is not to be given to children under the age of six since safety and efficacy for this age group has not been established. However, I hear daily about children under the age of six (even as young as three years of age) who have been prescribed this drug.
There is not a good understanding of the mechanism by which Ritalin works on the behavior of children. According to the drug insert and the Physicians Desk Reference (PDR) (which contains the same information about the drugs as the drug insert and can be obtained at the library or purchased at a bookstore), there is a possibility for a child to become psychologically dependent on the drug, and tolerance can develop. This means that eventually there is the potential that a stronger dose would be needed to accomplish the same results. Kids have discovered that they can snort it and get a high, so it does appear to have the same properties as addictive drugs. Since it so closely resembles cocaine, I think we must consider it addictive.
There are many other drugs that are prescribed to treat ADHD symptoms.
Dextroamphetamine (Dexedrine) has been a favorite in the past, but appears to have been used less frequently in recent years. It is an amphetamine, and also a controlled substance that has been sold as a street drug. Because of the side-effect of appetite suppression, it was used as a "diet" pill in the sixties, but found to have too high a potential for abuse to continue to be used for that purpose on a regular basis: While it appears to be too dangerous for adults to take on a regular basis, it is given freely and readily to children. It has side-effects similar to Ritalin.
Pemoline (Cylert) is probably the next most frequently used drug. At least, it was for some time, until it was observed that there is a potential for liver damage with continued use. There have been rare cases of hepatic-related fatalities of patients taking Cylert. Cylerts only indication for use is for ADHD symptoms. It is a central nervous system stimulant, and has multiple side-effects.
Imipramine hydrochloride (Tofranil) is a tricyclic antidepressant and another popular drug treatment for ADHD symptoms. This was one of the drugs used to treat my daughters bladder infections and possibly contributed to her illness. Again, the mechanism of the drug is not really understood. While it has an indication for use as an antidepressant as well as for enuresis (bed-wetting) in children, it is not indicated for the treatment of ADHD. However, Tofranil is being used extensively for this purpose. Tofranil has not been approved for use in children under six years of age and is indicated for older children only for bedwetting problems. According to the drug insert, this drug can cause bone marrow depression, as well as cardiac, neurological, endocrine, and GI problems. Though the manufacturer claims it is not addictive, withdrawal symptoms can occur after prolonged treatment and following abrupt withdrawal of the drug.
Desipramine (Norpramin) is another antidepressant used for ADHD, but fortunately it is used less frequently than others. Norpramins drug insert states that the drug should not be used in children at all. The drug is officially approved for the treatment of depression. Some doctors are now diagnosing children exhibiting ADHD-type symptoms as depressed. There have been cases of sudden cardiac death in children who were treated with Norpramin. Of course, this is a very rare occurrence.
Antiseizure medications were also popular for a while for the treatment of ADHD. Children who had no evidence of seizures were being prescribed antiseizure drugs. Since that time, it has been determined that antiseizure medications are to be used only to treat patients with seizures. In addition, the antiseizure drugs have been associated with creating learning disabilities.
Clonidine (Catapres) is an adult antihypertensive drug. It has not been tested on children for the purpose of treating ADHD symptoms and is not indicated for anything but hypertension in adults. The children I have seen on this drug often have a lower blood pressure and sleep constantly. I vividly recall one little girt who was taking clonidine. When her parents brought her to my office, we never saw her awake until she discontinued the clonidine.
Prozac is the latest major drug being used for the symptoms of ADHD, according to my patients in California. I have heard mention of its use in Texas, where I practice. With the news on ABCs 20/20 about Ritalin abuse, I predict that we will begin to see a lot more children on Prozac as an alternative to Ritalin.
"Indicated" means that the drugs have actually gone through testing to qualify for the use indicated. From the above list, only three drugs are indicated for use in treating ADHD: Ritatin, Dexedrine, and Cylert.," The others have been adopted for use without the rigorous testing that is required for a drug to become qualified as indicated.
If a drug is indicated for treating ADHD symptoms, does that mean it is safe to use on children.?
Of the drugs indicated for treatment of ADHD, all have multiple and severe potential side-effects. Of course, most drugs carry potential side-effects. One must weigh the side-effects with the possible positive results and decide what is best to do. I have heard other doctors say there are no side-effects. That statement is simply not true.
If the drug does work for a child, it probably wont make all of the problems go away. Even if it does make some of the problems go away, they will stay away only as long as the child is taking the drug. And the potential for side-effects remain as long as the child is taking the drug. Ritalin causes adults and children without ADHD symptoms to focus better, the same way it affects adults and children who actually do have ADHD Symptoms. If you give your child medication and the child improves, it doesnt mean the ADHD symptoms have gone away. It means that the drug is covering up the symptoms and the underlying problem. The drug companies and doctors have led us to believe that this is an appropriate way to deal with our medical problems. While sometimes we must treat symptoms with drugs, we must not stop looking for the underlying cause. A Comprehensive Review Article published in the 1990 issue of the Journal of the American Academy of Child and Adolescent Psychiatry found that the short-term impact of stimulants on children with ADHD included improved behavior, performance, and attention. However, there was little evidence that stimulants improved sustained attention, retention of information, anger control, or scholastic achievement.
In fact, the study found that there was no difference between treated and untreated hyperactives in the number of grades failed or in achievement scores. While hyperactive children attended fewer junior colleges and universities and in high school failed more grades and dropped out more frequently, medicated children with ADHD symptoms did not differ from untreated children in these areas. In addition, studies of the immediate effects of stimulant medication have shown few significant positive effects on peer relations. "Comprehensive studies of long-lasting effects of stimulants show little support for the efficacy of drug use in treating children with ADHD symptoms."
Everything doctors learn in medical school, except for the basic science courses, revolves around treating symptoms with drugs. Doctors learn all about the human body through such courses as anatomy, physiology, immunology, and biochemistry. Doctors then learn in pathology class how to diagnose, or name, a disease, and how to treat the symptoms, or prescribe drugs, in pharmacology class. From then on, during rotations, internships, and residencies, doctors learn more and more about treating diseases with drugs. This is what they are taught.
At continuing medical education meetings, drug companies sponsor physicians lectures. The lecturing doctor, who is usually paid an honorarium from the drug company, tells the audience of doctors about the drug he or she is now using as the "best current treatment" for various diseases. The drug of choice is, of course, manufactured by the sponsoring drug company.
At national medical meetings, the drug companies set up booths to display their drugs. I have seen huge convention centers filled with drug company booths, each one educating the doctors about the advantages of their standard and new drugs. They almost always give doctors specialty items such as pens and note pads and other incentives to stop by the booth. To an outside observer, it could easily look like an adult Halloween celebration, with the doctors going from booth to booth with bags, collecting "goodies" from the drug companies. But these goodies serve a very real purpose for the drug companies. They keep the name of the drugs in front of the doctors when they go back to their offices and use the free items. This makes it more likely that, when it is time to write prescriptions for their patients, they will remember that companys drug. And it works. This practice is straight out of a basic marketing course. But it also demonstrates how this drug dependency is reinforced and why drugs re, main the standard first-line treatment. Physicians are simply not getting educated or informed about any other options. When doctors do hear about other treatment options, they usually dont listen, dont understand it, or dont believe it, because they have been so well taught to practice drug medicine. The nondrug options do not fit into their drug-treatment model, therefore they discount it. This is sad. Many of these physicians really believe that drug treatment is the only way or the best way. But it is mostly sad for the patients who are exposed to only drug-related medicine.
Some new drugs are basically not new. In fact they are based on either old standard drugs or natural compounds. These standard or natural drugs are inexpensive and readily available and cannot be patented or owned by a drug company. If they cannot be patented, the drug company cannot make as much money on them, so there is no incentive to manufacture them. So how can an American drug company carve out a new market and make a good profit in a capitalist economy? The company develops a new drug, of course. Never mind that there is already an inexpensive and effective drug available, often with minimal side-effects. Instead, a motivated drug company will take the chemical composition of these established drugs, change the chemical molecules ever so slightly and viola, a new drug is developed, one that can be owned and patented by the drug company.
After going through double-blind studies and the FDA approval process, the marketing begins. Physicians are "educated" about the advantages of this "new and better" drug through seminars, lectures, exhibits, medical journal ads, free items with the new drugs name stamped in full view and, of course, through the "drug rep," who brings samples of the new drug, gifts, and lunch to the doctors office. After such a marketing campaign, how can the doctor even remember the other drugs or options available for his or her patients?
What happens when the patent on a drug runs out and any drug company can produce the generic version of this well-marketed drug? Drug companies have a new strategy. Now when the patent runs out, the drug goes "over the counter," and a whole new marketing campaign begins, directed at the consumer. Instead of marketing the drug to the doctor for prescribing, the drug company now has a whole new market ... the patients. I am bewildered at how a prescription drug that had to be prescribed by a doctor while the drug was under a patent miraculously becomes safe for the patient to self-prescribe at exactly the same time the patent runs out. And why did it cost so much more when it was a prescription drug? Was it because there was no competition, and the public had no choice so the drug company could charge whatever the market would bear? Is it about money or is it about our health and safety?
One would like to believe that the medical journals are unbiased and deliver significant new information to physicians. But page after page of the journals are covered with advertisements from drug manufacturers. If a journal wants to continue to be sponsored by the drug companies, they certainly dont put a lot of antidrug or alternative treatment articles in the magazines. Recently, I pulled at random a medical journal from a stack in my office. Sixty percent of the 230 pages in the journal were ads from pharmaceutical companies.
It is almost impossible to get a research grant to establish the efficacy of any treatment other than a medication. The drug companies spend millions if not billions of dollars on research. Who else has the kind of money to spend on the research of alternative treatments? Even the National Institutes of Health, who began doing alternative medicine research a couple of years ago, gave only a token amount of money toward the funding of such research.
The scientific method, which is considered the gold standard for any medical research, is, I believe, biased in favor of drugs. To put any treatment through the scientific method of proof, one must be able to establish that a double-blind study has been accomplished. A double-blind study means that a group of subjects is given a certain treatment, usually a medication, and a control group is given another treatment, called a placebo. A placebo is something that is expected to have no effect on the subject. Neither the subjects nor the physician knows which treatment is given to whom. The study is evaluated to see if the real treatment was any better than the placebo. Since the researcher and the subject do not know which treatment they are getting, the chance of personal bias influencing the results is presumed to be nonexistent.
But this is not always the case. One physician I know told me about a research project in which she participated at a major cancer center. The physicians peeked in the envelope to see if it contained a placebo or the actual drug being tested. The physicians then decided which patients would receive the drug and which would receive the placebo. They then gave their choice to the participants in the study. This is not how a double-blind study should be done. It does, however, show that not all studies, even double-blind ones, are necessarily accurate. Most of the drugs currently used for the treatment of ADHD symptoms have not gone through double-blind studies to show their effectiveness for this purpose. Yet they continue to be used for this purpose.
To do a double-blind study, one must be able to do something to the patient that can be kept secret from the patient and from the doctor. There are not many treatments other than drugs that can work in a double-blind format, but scientists have been literally brainwashed to believe that this method is the only way to substantiate anything useful in medicine. Since practically the only treatments that can really undergo or fit into the double-blind study model are medications, what is considered a "useful" treatment will be limited and biased toward drug treatments. It doesnt seem to matter that a physician uses a nondrug treatment to help the patient feet better or get well. If the method of treatment has not been through a double-blind study, the method is not acceptable in Western medicine. This is true even with treatments such as acupuncture, herbs, and homeopathy-treatments that have been used successfully for thousands of years in other parts of the world.
Some of the treatments I use in my office cannot be utilized in a double-blind study format. Osteopathic manipulation therapy (OMT) is a treatment in which a patient is diagnosed and treated through palpation (see Chapter 10). Although I suppose I could practice OMT in such a way that the patient didnt know what I was doing, it would be impossible for me not to know I was doing it. Thus, since OMT is not able to fall into the double-blind format, it is not accepted as a traditional and acceptable form of Western medicine, even though it is very effective for the patient. Anything that does not fall into a double-blind study format and that Western medicine will not accept will be discounted by the medical establishment. One hears such statements as "It hasnt been proven." Patients who dont understand the limits of the double-blind studies can be influenced by such statements from the medical community. The patient then discounts what could be an effective treatment for their problems. Patients deserve to have all information available in order to make personal health care choices. I certainly wish that had been the case for me when my daughter first became ill. I would never have chosen the dangerous drug therapy that was prescribed for my daughters chronic urinary tract problem.
What about accepted methods of treatment like surgery? Do they fall into the double-blind format?
It is nearly impossible to perform surgery in a double-blind fashion. It would be considered unethical to perform surgery on someone, opening them up, not doing anything once they are opened, and then closing them back up so that the patient does not know if he actually had something repaired or not. And the doctor would certainly know if he actually performed a surgical procedure on the patient or just simply cut him open and closed him up. Yet new surgical techniques that have not been subjected to double-blind studies are accepted all the time. Someone comes up with a concept for a surgery, performs it, and never does a double-blind study. Interestingly, Western medical doctors accept new surgical treatments even though they have not been proven to be effective through double-blind studies but appear to be successful because of a positive outcome. There does seem to be a double standard when it comes to double-blind studies.
Hasnt the thinking about double-blind studies begun to shift?
Recently, there has been some interest in the importance of outcome studies and, hence, a bit less importance placed on double-blind studies. The emphasis has not changed much, though. Occasionally an outcome study will be written up in the literature. There is even an "outcome journal" now. But remember that the editors of the journals have their own biases, and since they cannot publish every article that comes along, they must pick and choose the articles they print. Editors will most likely select articles that support their own beliefs and perhaps those of their advertisers.
For these reasons I am very skeptical about articles in medical journals. I expect the technique used and results found to be consistent with our basic knowledge of such areas as physiology and biochemistry. When the results go against common sense and basic knowledge, such as the research showing that sugar doesnt affect behavior, when it is a physiological fact that it certainly can and does in many individuals 16,19-11 (see Chapter 6 on low blood sugar), I have a lot of trouble accepting those articles at face value. As I covered in Chapter 2, 1 recognize that behind many of these studies are people trying to make money. Unfortunately, the patients needs or best interests are not always at the top of the list of considerations.
The HMO model and managed care
Managed care is also about money. The current crisis in health care is not a result of a universal disillusionment about the conventional drug-treatment model of medicine. It is a result of the high cost of medicine. In my opinion, managed care is about managing cost more than managing care. We are just beginning to see news reports and Senate hearings about the problems resulting from managed care practices. Managed care patients have complained about being denied care, provided less effective treatments, and released from the hospital too quickly because care delivery, effective treatments, and longer hospital stays are not good for a companys bottom line. Is our care being rationed? Decisions about our health care are being made by unknown, non-medical business staff working at managed care companies, not by the patient and the physician. Managed care administrators and staff are awarded bonuses based on how much money they save their company - in other words, how much medical care the company does not have to provide. I believe people are motivated by personal incentives. Clearly, it appears that the incentive is in not providing you care if at all possible.
I attended a managed care seminar where I was told that we would have to practice medicine differently. Following is one of the examples the speaker used. If an older woman needs a hip replacement, the physician should try to delay the surgery by recommending the woman use a cane to help her walk. Due to her advanced age, she may not live long enough to have the surgery, thus helping keep the doctors expenditures down and saving the company money. In fact, doctors who spend too much of the managed care companys money are called overutilizers. Overutilizers can be dropped from the managed care companys physician list.
Generally, it is cheaper to drug a patients health problems. To get to the bottom
of the problem will cost too much on the front end-unacceptable in a managed care
environment. A narrow band of prescribed "cookie-cutter, one-size-fits-all"
practices seems to be the standard of care under managed care rule. Such an approach can
be painfully limited for patients whose health care may require more specific, individual
services that fall outside the managed care service line.
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