Letter from Medical Directors of Pharmacy Benefit Plan to Psychiatrists

The letter outlined the data from one perspective, and failed to provide any balance about the use of neuroleptic tranquilizers in children.

Here are some problems with this advocacy.

1) Failure to disclose a conflict of interest. If these directors get bonuses based on unused funds, they profit personally from the use of generics. That should be disclosed.

2) Mass prescribing. It is not advisable to enter a theater and to yell, everyone in here is to start to take Lithium. As mass prescribing is not acceptable, mass unprescribing is too.

3) These medical directors are paper shufflers, telling experienced clinicians how to prescribe. It is not only an act of medicine, it is an act of supermedicine, bossing the doctors of the entire state.

4) Agency. These are agents of contractors that are quasi-governmental organizations. Doctors who get sued for following their suggestions should file cross claims against them, their agencies, and state officials, as individuals.

5) Golden Rule. Would providers take these medications themselves? Over 95% of providers would take second generation tranquilizers and not first generation ones. I doubt any of these medical directors would allow me to feed their dogs Haldol or Thorazine.

6) The question of the use of first generation tranquilizers is not settled. It is misleading to present as such. A counterpoint box should be included in any future communication.