Irrational healers?

But there must be some further rules shaping the dynamics of prescribing than these heuristics, or alternately some of those listed must be capable of more than 1 application. Consider the dynamics of prescribing within the pediatric mental health field. Over the course of 25 years, the prescribing of stimulants to children has grown exponentially – primarily in North America. In this case, clinicians readily juggle incompatible profiles – on the one hand amphetamines and cocaine are labeled threats to civilization, while identical compounds are then given to the most vulnerable brains when other options in many cases may be just as good. The paper by Nierenberg et al. [1] in this issue of the journal is richly allusive. It points to the fact that some data on the effects or side effects of drugs live in a way that other data do not and outlines some mechanisms as to why this should be the case. It is important that clinicians understand the dynamics that impinge on their judgment as it is almost certainly the case that pharmaceutical companies engineer clinical perceptions based on side effect profiles. The basic company position is that clinicians have no thoughts in their minds other than those put there by us or our competitors, and in order to plant a message or dislodge those of competitors companies employ all of the heuristics outlined by Nierenberg et al., and brought out beautifully in the example they cite from the war between Pfizer and Lilly over ziprasidone and olanzapine. The latest company technique predicated on these dynamics involves ‘rating scale mongering’. Thus Pfizer at the 2007 American Psychiatric Association meeting supported a symposium ‘From Clinical Skills to Clinical Scales: Practical Tools in the Management of Patients with Schizophrenia’. The practical tools were rating scales whose use would draw attention to aspects of the physical health of patients where ziprasidone could be portrayed as being superior to some other antipsychotics. The calculation appeared to be that persuading clinicians to be ‘scientific’ by using these rating scales would lead to sales of ziprasidone. Published online: April 16, 2008