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22 Feb 2003

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Why do we have to put up with authotrities who allow tricyclics like Aventyl to be taken off the market here in SA. We have to put up with drug companies like Eli Lily whp sell off the rights to manufacture to companies like Aspen Pharnacare who then stop making these drugs . I believe they are available in other countries still, but in SA they just stopped making it.
Its fine for them to provide SSRIs etc which people have actually been on and committed suicide(in fact all SSRIS are now under international scrutiny because of this fact) but the older tried and teseted drugs like Aventyl are allowed to be taken off the market probably due to drug companies not making enough money from them. This is disgusting, especially to those patients who have done well on them and cannot find replacements.
Why don't our psychiatrists lobby and get the drug companies to keep providing needed medications (which haven't been proven to have any adverse effects/side affetcs). Is it because they simply don't care, find it too much trouble to take up tyhe fight on behalf of their patients, or are they getting soem sort of kick back from reps who urge them to push newer and (supposedly) better drugs which really aren;t that great in practice anyway?
It would be interesting to get a proper resonse (and not an excuse) from the people and companies concerned.
Answer 433 views
Expert
CyberShrink
cybershrink

01 Jan 0001

Dear noquickfix,
You raise a number of very important points.
First --- Don't expect sensible intervention or concern relating to drugs from the Government / Dept of Health --- the Mental Health Division has been run in highly lacklustre fashion, by a psychologist and a nurse, with psychiatrists only occasionally used as window-dressing. The folks in charge of the division would not be allowed to prescribe drugs, and are not likely to be particulaly interested in drug issues. Mental Health has been allowed for years now to languish in the doldrums, with no effective initiatives of any type, and falling standards of care. It has never yet been treated as a Govt priority, and its leadership within the Dept of Health seems unlikely to rock the boat on any issue.
Second --- Unless there was active and intelligent, wise and experienced Govt involvement, in close consultation with the drug companies and the professions, which might be able ( as in some other countries ) to protect and make available drugs needed by even relatively small numbers of people, the decisions will be made on a purely financial / monetary basis by the companies. With no other incentives or encouragement, a drug that for any reason is not profitable, will be likely to be withdrawn from the market.
This can be a real problem for individual patients who have found one of these drugs especially suitable for them. The companies are supposed to notify all doctors in plenty of time for them to contact the patients affected, and to seek alternative treatments, but in my experience this is not always done efficiently.

Now, with regard to specifics, the hoo-ha about SSRI's and suicide risk was mainly raised by the Scientologists, who wanted everyone to stop all forms of treatment except what they marketed, so they were hardly objective about the matter. Some years ago there were numerous careful studies which found no good evidence for any significant suicide rsk caused by SSRI's --- obviously, when you use any treatment for people with a condition which includes a substantial suicide risk, some of them may still commit suicide, despite the treatment, not necessarily because of it.
And, while it's important that Aventyl / Nortryptyline did indeed suit some people espeically well, it is very far from being a drug without side effects or risks --- it had, in most patients, substantial side-effects and significant risks, too.
Why don't psychiatrists lobby on such issues ? Well, they're as preoccupied with their daily work as most folks, and haven't been especially active in lobbying even on issues that specifically and significantly affect their own personal interests. And --- lobby who ? They wouldn't get much joy from the drug companies, and the inert and uninterested mental Health Division of the Dept of Health isnt likely to be interested, however much they lobbied. As we've seen in the AIDS debacle, even with massive national and international lobbies working hard on an issue where Govt policy has been massively and obviously wrong, relatively little has been achieved.
Maybe it needs more activists like youtrself who feel strongly about all these issues --- including the medical Aids shameful discrimination against patients with mental health problems --- to get things moving ?
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