What RFK, Jr. Gets Right About Drugs

RFK, Jr. is a confounding person.  He says a lot of stuff that has no data or research to support it, in fact the data and research says the opposite of what he claims and he knows it.  And he says a lot of stuff that is just common sense and urgently needs to be heard and followed, for example, in regard to the chronic disease crisis in the US and the need to address it in multiple ways, including improving our food and our exercise routines.  He has made a lot of statements about prescription drugs, some of which are fine, like there should be full and ongoing safety evaluations and surveillance.  But some of what he says is a little concerning, especially when they impact development of therapeutics for serious, often terminal illnesses, that have no effective treatments.

One thing I strongly agree with him on is that we use way too many prescription drugs in the US and the likelihood of adverse events for commonly prescribed drugs is hidden or swept under the rug.  I find it hilarious, in a warped way, that people whine and get angry about how much US health care costs, but pay no attention to the behavior of the physicians who drive almost all that spending.  And drugs are a prime example.  Here is what really drives this, and what can be done about it, using mental health drugs and ADHD as examples.

RFK, Jr. has talked about SSRIs, which are used to treat depression but the problem with mental health drugs goes far beyond that.  There is rampant abuse of every class of mental health drug.  Doctors put people on them with no assessment of how serious their mental health issues are and no attempt to actually help people deal with their problems and get on with life.  Honestly, most people just need to be told to stop being so sensitive to their feelings, suck it up and find things to DO that make them feel better.  Doing is way more important than feeling and obsessing about your feelings doesn’t do anything to improve your mental health.

But the easiest thing for doctors to do is prescribe a drug, which is unlikely to help, but can cause cognitive issues and other problems.  The number of Americans prescribed mental health drugs is horrifying.  But drug companies spend a fortune on direct to consumer ads, which should be banned, and on in-person and other marketing to physicians.  Patients ask for meds, and the path of least resistance is to give in.  And doctors make money by having patients come in frequently to check on their meds or to deal with adverse effects.  Doctors are just as motivated by money as anyone else.  So we get over-diagnosis and overuse of expensive drugs and there is a bunch of your health spending.

The same thing is true with ADHD in children, but this is even more damaging.  We have an explosion of ADHD diagnoses, particularly among boys, and it is nothing more than normal boy behavior.  But teachers and school administrators love the idea of a drug that might keep them sedated and calmed down.  Doctors again are thrilled to help out and make more money from visits and prescribing.  The children are not as cognitively alert as they should be and are led to believe that they are doing something wrong by being a little high strung and hyperactive.  The long-term effects are unclear, under-researched and likely not good.

So nobody really gives a damn about the patients’ best interest–the drug companies make a fortune, the doctors make a lesser fortune, everyone in America thinks they are anxious or depressed, all the children are just too active, and we are a mess.  So if RFK, Jr. can stop this, it would be a boon.  As I said, eliminate the advertising and marketing, which would make drugs much cheaper as a side effect, and enforce much more rigor on the conditions to be met before someone gets prescribed one of these medications.  And voila, your health spending will go down substantially as well.