Assume for a minute that you do not have an underlying psychiatric or neurologic condition. You’re healthy. If you could take a pill that would significantly improve your memory, help you to concentrate through great distractions, keep you full of energy even though you’ve slept little, help you to be more social, or keep you from worrying much, would you take it?
That’s really the issue at stake with the concept of cosmetic psychiatry. Is it okay for psychiatry to evolve beyond simply treating disease and relieving suffering to the point where the goal is also enhancement of “normal” functioning?
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The Archives of General Psychiatry published an article this month entitled, “Metabolic Testing Rates in 3 State Medicaid Programs After FDA Warnings and ADA/APA Recommendations for Second-Generation Antipsychotic Drugs.”
The retrospective analysis examines how frequently the recommended metabolic testing for second generation antipsychotic drugs (SGA’s) was performed in Medicaid patients in 3 different states. The conclusion was that the monitoring was not being done nearly as frequently as recommended. Less than one-third of patients treated with these medications, which can cause metabolic syndrome, undergo serum glucose or lipid monitoring.
Obviously this is not good news. In recent years, we’ve learned that the risks associated with SGA’s is higher than originally thought. My intent in this post, though, is not to focus on this study itself as much as to examine an ethical dilemma related to it that I have never heard discussed.
What I’ve been wondering: Is it ever appropriate to prescribe SGA’s to severely mentally ill patients who have no financial means to obtain the necessary blood monitoring tests? I’ll explain.
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