Big Pharma vs. The Mighty Mouth
by Dr. John Riolo
Well, Garry, one of these days I hope I am going to be assigned the good guy role instead of devil’s advocate or just plain old devil of psychotherapists. But that’s not today. We are going to talk about the pharmaceutical industry and to many of our non- physician psychotherapist colleagues; the very mention of the subject sends them into spasms of apoplexy.
First, let me be clear, I resent like hell the outrageous markup that drug manufacturers put on drugs. Hey, I am all for people making a profit, but everything in moderation, and how damn rich do you need to be before you think it’s time to give back to those who made you rich? That is why I am all for going to Canada to buy the same drugs made by the same manufacturers for a fraction of the price they are in the US. It's simply another form of globalization, only this one benefits the working class American for a change.
But some of the arguments we make against the drug companies are really self-defeating, and some actually make us look silly. Let me give a couple of examples.
Not long ago, a colleague, whom I have no doubt you would recognize if I did not make every effort to disguise his identify, wrote a rather interesting critique of drug company profits. He presented a list of the most popular drugs and then proceeded to provide the cost of the actual active chemical ingredients in the medication. The results were staggering. The actual cost of the chemicals that make up the drugs were a miniscule fraction compared to market price these medications were being sold for by the drug companies. I have no doubt that many other colleagues cheered a litany of Amens, Right Ons or whatever minimal encouragements struck their fancy. Except yours truly, who winced at the implications of such well intentioned but absurd arguments that can and will come back at us like a boomerang or like spit in the wind. In fact the ramifications of cheering that silly article go beyond shooting ourselves in the foot. It’s blowing off the whole leg.
Our colleague, who never met a drug or drug company he seems to like, chose to dismiss the little fact that in pricing any product or service one not only must take into account the cost of the raw materials but the R &D or research and development. So his thesis--that the drug companies are ripping us off--was great to get the attention of an unsophisticated audience but it can cut both ways. Suppose the drug companies turn that argument around on us. Suppose they say that it is us talking therapists who are charging outrageous prices for our "talking therapy". What if, just what if, they begin listing some of the fees we charge an hour (really 45-50 minute hours at that). Most of us claim to charge, fees of over $100 per hour that is if we are so lucky enough to find someone who will pay that much. But what is the actual cost of the actual ingredients of psychotherapy?
Now I’m not sure we want to get into a whole other discourse concerning the problem that we may not know what works in talk therapy or have any idea of the active ingredients. Let’s for the sake of argument simply agree that the therapist him or herself through the relationship is the active ingredient, the way light was hypothesized in the 19th century to travel through what's now known as the non-existent aether. OK, so how do we set a value on the therapist him/herself? Well, if we use our colleague’s formula and use only the value of the chemicals, I read somewhere that the chemicals in the human body can be extracted and reduced to about a dollar and change. So where do we get off charging $100 plus a pop for psychotherapy
Obviously however that argument is flawed because it's not just the chemicals but the education, training and experiences of the therapist that the consumer pays for. That is at least what we claim, do we not? But is not that just another way of saying research and development or R &D? How else can we justify the fees we charge? Some of our colleagues forget that the vast majority of people earn considerably less than therapists and some actually have to sweat to do it.
If that were not bad enough, at least when the drug companies are confronted with a dangerous drug, they do pull it off the market. Often it's too late to prevent damage to many people, but they get the hint if you hit them over the head with lawsuits. Can our psychotherapy colleagues say the same? Even when our treatments are proven to be not very helpful or outright discredited, some of our colleagues still cling to them like jam on bread, gum or something else gooey on a shoe. Recovered Memory Therapies have been basically rejected by the scientific community yet they are still being practiced. People have gone to jail as a result of killing people using Rebirthing Therapy, but we still find defenders of it here and there.
With bad drugs at least, we have an FDA that has the authority to pull these drugs off the market. For all drugs, they have to list the side effects. Do they do as thorough a job as they should? I think they can do a lot better. But at least there is some attempt at regulation.
In talk-therapy we have almost no regulation at all. We know, even if the public may not, that anyone can call themselves a psychotherapist. If they are not licensed, there is virtually nothing that can be done by a harmed consumer. Even with a license a consumer first must be harmed and then prove it. I think a proactive approach should put the burden of proof on us to demonstrate that what we do is safe--no differently than what's expected of drug companies. However if that happens it will be with most of our colleagues hooting and hollering, kicking and screaming and mad as hell.
But perhaps you and I can hold anger management class for psychotherapists or become coaches. There is even less regulating of coaching.
But Garry, I am not defending the drug companies. I am simply pointing out that we are not one iota better. How can we act so superior when everything we criticize them for doing we do ourselves? So they repackage pills in new colors to sell more. However most of the 200 or so of our models of therapy are nothing more than rehashes of old ones with new names in new packages. So what makes us so self-righteous?It’s true that good supervision and consultation costs and should be factored into the fees we charge. But one would hardly know that from some of our friends not only in private practice but in agencies who are so insistent on going online to get free consultation about their patients from strangers. When it’s an employee of an agency or a student they are not only taking risks with the patient’s reputation and their own but they are putting the reputation of the agency and or educational institution at risk as well. However, one of the many big problems of online patient discussions on unsecured Yahoo and MSN listservs is that the patient paid for consultation as part of the fee and the therapists pocketed the money and tried to get free advice from just about anybody.
The only difference between the Big Pharma’s Big Lie and our self-deception is that we actually fall for our own propaganda, which is probably why we are not nearly as successful as Big Pharma.
Although my receiving an invitation to join the Bush Administration is as improbable as my getting an award from my colleagues as therapist of the year, if such an invitation were offered, it would be an opportunity to serve one’s country. No matter what I think of GW Bush or whatever sitting president who can refuse such an opportunity to serve if asked?
John Riolo is a psychotherapist, Vice-President of Psychjourney and consumer advocate. He is known as the Insider and sometimes known as the therapist other therapists love to hate. His website Your Advocate Online includes many articles and audio interviews addressing the inner trade secrets of psychotherapy. Listen to his new Internet radio show, The Insider. Contact him at johnr@psychjourney.com