Wednesday, November 16, 2005

Expertise? Just give me the drugs

The New York Times writes about "young people" who self-medicate, and bypass the supposed expertise of psychiatrists.
For a sizable group of people in their 20's and 30's, deciding on their own what drugs to take - in particular, stimulants, antidepressants and other psychiatric medications - is becoming the norm. Confident of their abilities and often skeptical of psychiatrists' expertise, they choose to rely on their own research and each other's experience in treating problems like depression, fatigue, anxiety or a lack of concentration. A medical degree, in their view, is useful, but not essential, and certainly not sufficient.
As with any "trend" piece, one wonders how widespread this is (though if one didn't have such pieces, how would one think to look for data on a question?). Yet it says many an interesting thing about medicine. One phrase that gets tossed around in health care debates is "consumer-driven" health care: consumers ought to have more choice. The whole structure of the health care system is based on patients relying on the expertise of doctors, doctors as gate-keepers to health care. Insurance works, insofar as it does, because someone verifies the legitimacy of your complaint and treatment. The widespread perception that maybe doctors are useless -- or at least that psychiatrists are useless -- would do very odd things to the market for psychiatric drugs. You'd end up with psychiatrists being reduced to prescription machines (more so than they already are), and so the whole purpose of the profession would be undermined. They don't know more than we do. And the necessity of FDA approval would be called into question: if people can self-prescribe, why can't they assess risk of drugs? Why do we need a central group to certify drugs? Why not have a centralized group that verifies that public information about drugs is accurate, rather than that the drug is effective? Though again, this is all based on one trend piece and odds of this being more widespread than a small group of young urban professionals is slim.

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