Do Dr's get kickbacks for meds?

[mamabear2three]

I'm trying to figure out why my pediatrician would seem to have an agenda for keeping my daughter on medication for ADHD if the occupational therapy is making a huge difference in her behavior. She asked for an update on our no-med trial and how the OT was going. We are seeing amazing results and inspite of my report, the Dr. seemed very concerned for her ability to keep her grades up in school without meds even to the point of telling me that the anxiety and tiredness/low moods were a tradeoff of the medication and that sometimes the benefits outweigh the negatives. 

 

I explained to her that her grades were never an issue and gave her a couple striking examples that she couldn't argue with because they were pre-meds. (like reading level that jumped from K to 3rd grade in a 2 month stretch of time). Anyway, she ended by saying we'll wait and see and I know she can't force meds on us, but it just seemed strange that she is SO pro-meds.

[ktgrok]

No, they don't. they may get free lunches and such when the reps come by, but nothing for prescribing them. 

[PeterPan]

There's some discussion that meds alter brain development (for the better) and there is a contingent of practitioners who actively think you're HARMING your dc by denying them meds.  I don't know how many there are, but the first person who tried to foist meds on us was pretty rabid and that was her reasoning.

[kbutton]

They see a lot of good stuff come from meds. As a child ages, sometimes the meds make a difference between being productive and on top of things or having to have a 3-ring circus of support to do what people typically do on their own. They see a lot of folks who are anti-meds and just as forceful about it. I would try to keep the conversation open and see how it goes. It's summer, and the doc is probably waiting to see if there is a downside during full-time school to not using meds. 

 

Do I remember right that your DD has some reactions to meds that you don't like?

[Crimson Wife]

Allopathic M.D.'s get a lot of training on pharmacology and little-to-no training on nutrition and behavioral management of health. So there is a definite bias towards thinking of pharmaceutical use as "scientific" and natural approaches as "snake oil" even when research is showing that some natural treatments are effective.

[mamabear2three]

They see a lot of good stuff come from meds. As a child ages, sometimes the meds make a difference between being productive and on top of things or having to have a 3-ring circus of support to do what people typically do on their own. They see a lot of folks who are anti-meds and just as forceful about it. I would try to keep the conversation open and see how it goes. It's summer, and the doc is probably waiting to see if there is a downside during full-time school to not using meds. 

 

Do I remember right that your DD has some reactions to meds that you don't like?

 

That makes sense, and yes, she had reactions to the meds that we verified when we took her off of the meds this summer. They increased her anxiety by a lot (but not enough to warrant the Dr. doing anything about it...it was very concerning to me though because when she would have an anxiety moment, it would paralyze her). The meds also caused her to be very down/moody to the point where she wouldn't always last for a playdate without coming to me and being sad and gloomy and wanting me to rub her back. She couldn't get to sleep without melatonin and she wasn't gaining weight appropriately (and to maintain her weight we had to use ensure drinks).

 

Not to mention the fact that the meds weren't consistent in their effect - most days she would be focused and on task for school but we still had random days/times when she couldn't focus no matter what.

 

That's what I'm loving about the OT - she's calm, organized and able to focus. She's also eating well, sleeping a lot better, able to manage her anxiety in what I would consider to be normal for her age and rarely has down/moody moments. We start school in a week and a half, so I need to wait to see how that goes, but if you saw her now without knowing her history, you wouldn't know that she had been diagnosed with ADHD because her behavior is within the range of normal for her age.

[kbutton]

That makes sense, and yes, she had reactions to the meds that we verified when we took her off of the meds this summer. They increased her anxiety by a lot (but not enough to warrant the Dr. doing anything about it...it was very concerning to me though because when she would have an anxiety moment, it would paralyze her). The meds also caused her to be very down/moody to the point where she wouldn't always last for a playdate without coming to me and being sad and gloomy and wanting me to rub her back. She couldn't get to sleep without melatonin and she wasn't gaining weight appropriately (and to maintain her weight we had to use ensure drinks).

 

Not to mention the fact that the meds weren't consistent in their effect - most days she would be focused and on task for school but we still had random days/times when she couldn't focus no matter what.

 

That's what I'm loving about the OT - she's calm, organized and able to focus. She's also eating well, sleeping a lot better, able to manage her anxiety in what I would consider to be normal for her age and rarely has down/moody moments. We start school in a week and a half, so I need to wait to see how that goes, but if you saw her now without knowing her history, you wouldn't know that she had been diagnosed with ADHD because her behavior is within the range of normal for her age.

 

I'm so glad things are going well! I know you were very concerned. I would keep notes, esp. as school starts. If the ped. is really pushy, I guess you can find another, but I would stick with it for now. Maybe she'll find your story instructive. 

[PeterPan]

Kbutton mentioned not changing peds, but as someone who doesn't give either of her ADHD kids meds I can say I'd dump in a heartbeat a ped who was offensive about it.  There are other peds who won't be.  The ped we use now has NEVER done that.  

 

I think, as someone who doesn't use meds, that your progress with OT sounds AWESOME.  And with such great progress, it may be that it has brought school into the realm of possible without meds.  I'll also tell you that the two initial diagnosing psychs on my kids BOTH said don't bother with meds for homeschooling.  So the neuropsychs, being in the thick of this, were not of the opinion that it harms kids to skip meds.  Also, when you look at the data for our population (and grant that our kids are individuals, not a population), meds don't shift test scores.  They do make HUGE, HUGE, HUGE differences for some individuals, bringing school work into reality.  But for a population, when the numbers are crunched, the study I saw (finland, whatever) showed no statistical improvement.  We even have people on the boards who will say that their dc learned LESS on meds.  

 

Don't buy problems you don't have.  If OT is bringing her work within reach, you're cool.  You might even like to look into neurofeedback.  Similar changes to ritalin, great for anxiety, supposedly permanent (I'm still waiting to see), and not a med that's going to decrease her appetite or aggravate insomnia.  I've got my dd doing Zengar neurofeedback right now, and my plan is to start my ds on it soon too.  

 

Some kids are fine without meds.  The third psych that saw ds suggested we not put ds on meds, even though his behavioral can be a little on the wow side, at least for a while, because he wanted him to have time to learn compensating skills.  There's a whole train of thought there that is under-explored.  People who go on meds don't always get the EF skills training, and later when they go off the meds they don't have those skills.  So this is an issue there are more perspectives on.  

 

I'm not bashing meds btw, because we just had another thread where I said I'd instantly put that kid on meds even as a person who has actively worked to avoid them.  There are situations where one choice or another is really obviously the right choice.  I just don't think that the label alone HAS to mean a certain conclusion.

 

 

[geodob]

The Dr would hoping that she still needs meds?

Otherwise, it could suggest that OT should have been tried first, before the meds?

That the meds were never needed, and that the Dr got it wrong?

 

Rather than kickbacks from the meds?

They would be losing clients, if they sent them off to an OT.

[Heathermomster]

There is a doctor shortage developing where I live. A handful of GPs are shedding 90% of their patients and running a concierge practice.

 

I don't know whether doctors are incentivized to push certain drugs, but it sure feels that way.

 

My children's ped is not a subject matter expert on either ADHD or learning issues. If you are unsatisfied with the ped, ask around and discover a psychologist that specializes with ADHD and is open to OT and other interventions. Personally, our ped is the last person I would seek ADHD helps from. She signs referrals when it comes to stuff outside her area.

[Heathermomster]

You could ask her why she is so adamant about the drugs. Perhaps she sees something in your DD that you are missing.

 

OT/PT has turned down the volume for us; however DS is still inattentive. He can sit better and focus longer, but the attention issues are still present. DS is unmedicated with dysgraphia/motor weirdness.

[mamabear2three]

You could ask her why she is so adamant about the drugs. Perhaps she sees something in your DD that you are missing.

 

OT/PT has turned down the volume for us; however DS is still inattentive. He can sit better and focus longer, but the attention issues are still present. DS is unmedicated with dysgraphia/motor weirdness.

 

She hasn't seen my daughter since before we went off the meds - we were at the dr. for another child and the dr. remembered that we were doing this trial and asked how it was going. So she was making assumptions. Maybe that's part of my problem - all the assumptions.

 

The psych we went to for diagnosis assumed that because the IQ testing was "average" that it was accurate and that any unanswered questions were answered with the ADHD diagnosis. The pediatrician assumed that the meds would be the best answer because that's "always the answer" in her experience. She assumed that OT would be "helpful but not a solution" because she's never seen kids be able to go off meds. And she assumed that my daughter's grades will suffer because I took her off meds when in fact she was well above grade level before we ever got the diagnosis in the first place.

[kbutton]

She hasn't seen my daughter since before we went off the meds - we were at the dr. for another child and the dr. remembered that we were doing this trial and asked how it was going. So she was making assumptions. Maybe that's part of my problem - all the assumptions.

 

The psych we went to for diagnosis assumed that because the IQ testing was "average" that it was accurate and that any unanswered questions were answered with the ADHD diagnosis. The pediatrician assumed that the meds would be the best answer because that's "always the answer" in her experience. She assumed that OT would be "helpful but not a solution" because she's never seen kids be able to go off meds. And she assumed that my daughter's grades will suffer because I took her off meds when in fact she was well above grade level before we ever got the diagnosis in the first place.

 

I think you are right that assumptions are clouding things. I would give it a follow-up visit for that specific child before moving on. If the psych is assuming stuff and the ped is assuming stuff, you might not live in a place with open-minded practitioners (or they may be reinforcing each other). I would ask around about other peds, but I wouldn't burn bridges until you know what you're likely to get instead. It maybe out of the frying pan and into the fire. If this doc actively undermines you or seems threatening, that is another story. I came from a rural area and live in a bigger area--there is a vast difference in choice (though not as big of a discrepancy in quality), and i really don't know how much choice you have in a ped or psych.

[Crimson Wife]

   She assumed that OT would be "helpful but not a solution" because she's never seen kids be able to go off meds. 

 

This is the case for my youngest. The sensory integration work that the OT did and all the nutritional stuff that the integrative dr did were helpful, but the ADHD symptoms (particularly the hyperactivity and impulsivity) were still causing a significant impairment in daily functioning. The psychiatrist told me that DD had one of the worst cases she'd seen in something like 18 years of practicing psychiatry (lovely!)

 

That said, I definitely don't think there can be a blanket assumption made about pharmaceuticals always being the answer. It's like high blood pressure or high cholesterol- some people can manage those conditions successfully just using a healthy diet and exercise but other people need to add a pharmaceutical on top of the healthy lifestyle.

[Wheres Toto]

I wouldn't say never, but there are very strict rules about what sales reps can provide to doctors these days.  Meals have to be part of a presentation or program and only those in the office who are relevant to the discussion are allowed to attend/eat.  There are limits on where conferences can be held (no resorts), what can be paid for/provided.  

 

There are a few companies paying hefty fines and undergoing continuous monitoring for violating these rules.

[LizzyBee]

I don't know about ADHD meds. But I know there is a fairly large and loud group of oncologists who learned that their hospitals are getting kickbacks for the cancer meds they prescribe, and they are pushing for the pharma companies to lower prices and stop paying kickbacks. Of course, they don't call them kickbacks.

[Ausmumof3]

You may find this ted talk interesting

 

https://www.ted.com/talks/leana_wen_what_your_doctor_won_t_disclose