Article summary with What influences have led to increased prescribing of psychotropic drugs? by Parish - 1973

What is this article about?

Contemporary, out of all prescriptions dispensed by chemists under the National Health Service, psychotropic drugs account for just under one of five. From 1961 to 1971, there was a 50% increase in prescriptions for these drugs. Out of these drugs, 41% were hypnotics, 38% were tranquillizers, 15% were antidepressants and 6% were stimulants and appetite suppressants. From 1965 to 1961 there was a 32% decrease in the prescription of barbiturate hypnotics and a 43% decrease in the prescription of stimulants and appetite suppressants. Prescription of non-barbiturate hypnotics increased by 166%, the prescription of tranquilizers by 70% and antidepressants by 103%.

The question now is: what influences have led to the increased use of psychotropic drugs: doctors, patients, the pharmaceutical industry, or the government?

Are the doctors to blame?

The increasing use of psychotropic drugs with increasing age, the ease of obtaining repeat prescriptions and the increasing number of long-term drug takers contributes to the increase in psychotropic drug prescriptions. Furthermore, doctors often have had no training in managing mental disorders and common anxieties that exist within the community. The advances in pharmacology thus outdate what doctors have learnt in medical school.

Are the patients to blame?

Trends, for example increasing popularity of certain drugs, influence patients’ expectations. However, both the medical profession and society are exposed to the influences of the pharmaceutical industry, which relabels and redefines medical problems and call for drug interventions. For example, normal problems and conflicts such as marital problems are redefined as medical-psychiatric problems and these are then described as indications for the use of the drugs.

What about the pharmaceutical industry?

It is hard to determine how unbiased the assessment of a drug is because The Association of British Pharmaceutical Industries (ABPI) is active in the fields of industry, government, news media and professions. However, medical representatives remain the best and most effective means of producing a sale or prescription. These representatives are highly trained and attend major sales meetings. When visiting general practitioners, these representatives discuss prescribing of local general practitioners. He also distributes small gifts and samples and organizes local lunches, dinners, and film shows at which the firm’s products are displayed. Thus, sales promotion plays an important part in inducing doctors to prescribe new products.

What about the government?

It is suggested that the existence of the National Health Service leads to abuse by patients. However, this is not true: other countries that do not have this service, do not show lower prescribing rates. The cost of pharmaceutical services is thus not an explanation of the overall increase in prescription of psychotropic drugs.

Furthermore, the government tries to control costs with four procedures:

1. Control of drugs prescribed. In 1912, doctors were precluded from prescribing preparations that were not drugs. Most of the contemporary measures to control prescriptions are also based on persuading doctors to prescribe standard preparations.
2. Control of an individual’s doctor prescribing. The research unit of the Department identifies high-cost prescribers. If a doctor is identified as a high-cost prescriber, then he is selected for further investigation.
3. Informative publications. The Department also publishes articles about lists of approved drugs, histograms on comparative costs, drug tariffs, and executive council notes.
4. Control of and restraints on prices. There have been attempts to control the price of drugs and to restrain the cost of prescriptions by the introduction of prescription charges.

What can be concluded?

The pharmaceutical industry develops, promotes and supplies drugs. Doctors prescribe it, pharmacists dispense it. Patients consume it, and through the National Health Service they are paid for by taxpayers.  Furthermore, the pharmaceutical industry also defines and re-defines indications for the use of drugs and has thus influenced diagnosis. It is also possible to view the doctor as a ‘manipulated’ agent between producer and consumer. However, if the doctor is insufficiently trained, then is this the fault of the doctor, or of education? In sum, the profession, industry, government, pharmacists, politicians, and patients should start discussions in order to develop rational policies and responsible prescribing. However, before this can happen, patients need to become more aware of rational therapy and more critical of drug treatments.