@boomerang,
It is exactly the way health care is delivered. Certainly prior to the election of Mr. Obama, but continuing after the passage of his health care act, insurance companies have schedules of procedures and diagnoses which they recognize and for which they will pay benefits. If any professional organization recognizes a new diagnosis, the insurance companies will soon add it to the schedule and authorize the payment of benefits. With new mental health diagnoses being added, pharma saw an opportunity for a whole new category of drugs which they could sell. It's easy as pie right on down the line. The doctor diagnoses a mental health disorder, or in the case of children, a behavioral disorder, and the insurance companies will pay for the treatment. If the drug companies come up with a pill, everyone (with the likely exception of the child, and possibly, the child's parents) can happily and easily prescribe the pill, and their problems ares solved. The insurance company pays the bill, after the payment of annual deductibles and co-pays, what's not to like? In many, perhaps most jurisdictions, counselors can diagnose and prescribe for mental health/behavioral conditions, which expands the scope of the use of prescription drugs, and also, significantly, means school board employees can get into the game. A school can't afford to have an MD on staff, but they can afford a counselor. Most states do not require that a counselor have anything more than a BS to qualify and therefore prescribe.
Drug companies have been in the business of courting customers for decade, pretty much from the end of the Second World War. The sales rep shows up at a clinic, quickly identifies decision makers (Not necessarily the doctors) and takes them out to lunch, brings little gifts, shmoozes them and then gets out his or her order pad. They only have to have a brief interview with the MD to convince him or her to try the product, and there is high probability of getting a repeat customer. How much easier when dealing with mental health counselors employed by a school board or a specific school, where they don't have to deal with an MD?
Since 1974, after i had gotten out of the army and was working in a hospital, i've seen their plays and even after no longer working in the medical field have read about them. So, for example, an employee of the drug company will come along with the sales rep, he will be introduced as a "phamacological consultant" and he will rent space from the clinic or the emergency service/out patient services corporation (the doctors) for which he will pay premium prices for office space based on local real estate rates. What they do is rent a closet and pay for an office. The next time the sales rep shows up, he's already the doctors' buddy. He will identify the real decision makers--administrative staff and nurses--and bring the flowers and candy, and take them out for expensive lunches on his tab. Gifts of golf clubs and health club memberships will materialize. Expensive you think? A drop in the bucket compared to the billions and billions of dollars at stake.
Whether it's a mental health/behavioral drug or any other type of drug, pharma has a trick to keep their product the current drug of choice. When their exclusive patent rights expire, and other companies can make the drug, including cheaper generic versions, they tweak the formula. They add a molecule to the formulation, and now they have a "new" drug. One hopes that it's just an inert molecule they've added, but pharma has not been known to be reliable about that.
In Canada, as an example, they're not dealing with the office manager or head nurse, they're dealing with government employees, whether provincial or Federal. Those boys have their own expert employees and the sales reps' tricks won't work there. Provincial and Federal medicare agencies negotiate price schedules. Canadians pay far less for their drugs than Americans do, so much so that Americans who live close to the border will cross the border in order to pay a doctor to prescribe for them, based on their American physician's medical history, and then buy their drugs in Canada. I don't know if it still goes on, but at one time there was a regular revolving door operation going on for American customers. In the United States, it's very easy for big pharma to manipulate the system when all anyone cares about is whether or not the insurance company will pay. It doesn't work that way with health care managed by the governments. This can be seen when, during the flap about Mr. Obama's proposed health care system, people started ranting about insurance companies rights of access. You could see conservatives here ranting about this, too. Basically, insurers were trying to do an end-run around the requirements of state insurance regulatory agencies. The conservative mantra was that the Feds were not letting all insurance companies compete on a level playing field. In fact, what insurance companies can operate in any state is determined by a state agency, not a Federal agency. What some of the shadier insurance providers wanted was to get Federal legislation which freed them from the necessity of meeting state insurance commission regulations.
It's about money, big money, tens of billions of dollars of money, and under the old system, as well as largely under the new system, all that matters is whether or not the insurance companies will pay. The American medical establishment is now hooked on the idea that almost all morbid conditions, including mental health/behavioral conditions, can be dealt with by prescribing.
