Q:  Doc' Wants to Prescribe the New Medications

Dr. Phelps,
I really enjoy reading your column.  Thank you for your direct responses and honesty.  I have a question that pertains to one posted in your January column.  It is about Pharmacutical companies and doctors.  I love my doctor and he has been great at listening to my concerns and questions--even when I bring up questions about "something I have read on the internet".  The one thing that bugs me and I hate to ask him about it, because I know it will sound a little offensive, is that it seems that he always wants to perscribe the "latest and greatest" drug on the market.  I feel like a guiana pig, these days...He recently wanted to add an ADHD drug to my meds, so he wants to perscrib Focalin as opposed to one of the older more tested drugs....Do most doctors do this?  Should I say something?

Thanks,
Laura


Dear Laura -- 
Doctors have different styles, in this respect. I'm sure some of my colleagues wonder what's wrong with me, as I'm so slow to start using new medications. There are probably some patients in my practice who would have done better under another doctor's care, because of having been given Strattera or Cymbalta. My philosophy is to wait as long as I can stand it, until I actually see other doctors patients doing better than mine on some drug I haven't used yet, or until some clear evidence of a new medication's advantages appear. Other doctors are less conservative. There is no absolute right way here. 

But I probably won't wait so long to use the new patch-version of selegiline, because an MAOI antidepressant as easy to use as this is likely to be will be a useful new tool; but then, this isn't really a new drug, just a new delivery system.  And that actually is true of Focalin (dexmethylphenidate) as well, which is not really new either: dexmethylphenidate is just a sub-part of methylphenidate (Ritalin). 

Dr. Phelps

Published June, 2006