Hostname: page-component-848d4c4894-ndmmz Total loading time: 0 Render date: 2024-05-18T01:18:53.364Z Has data issue: false hasContentIssue false

Psychopharmacology and the Ethics of Resource Allocation

Published online by Cambridge University Press:  03 January 2018

David Healy*
Affiliation:
Academic Sub-Department of Psychological Medicine, North Wales Hospital, Denbigh, Clwyd LL16 5SS

Abstract

The introduction of clozapine to current psychiatric practice is considered against a background of potential problems of resource allocation posed by the development of a number of ‘budget-busting’ drugs. It would appear that clinicians may increasingly have to operate within a climate in which the rights of individual patients to expensive treatments will seem to be pitted against the abilities of their communities to afford such treatments. Both clinicians and pharmaceutical companies have roles in the development of such conflicts.

Type
Symposium: The Costs of Drug Treatment for Schizophrenia
Copyright
Copyright © The Royal College of Psychiatrists 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Adams, C. & Essali, M. A. (1991) Working with clozapine. Psychiatric Bulletin, 15, 336338.Google Scholar
Baldessarini, R. J., Cohen, B. M. & Teicher, M. H. (1988) Significance of neuroleptic doses and plasma levels in the pharmacological management of the psychoses. Archives of General Psychiatry, 45, 7991.Google Scholar
Baldessarini, R. J. & Frankenburg, F. R. (1991) Clozapine: a novel antipsychotic agent. New England Journal of Medicine, 324, 746752.Google ScholarPubMed
Bartels, S. J. & Drake, R. E. (1988) Depressive symptoms in schizophrenia: comprehensive differential diagnosis. Comprehensive Psychiatry, 29, 467483.Google Scholar
Bowers, M. B. & Swigar, M. E. (1988) Psychotic patients who become worse on neuroleptics. Journal of Clinical Psychopharmacology, 8, 417421.CrossRefGoogle ScholarPubMed
Cramond, W. A. (1987) Lessons from the insulin-story in psychiatry. Australian and New Zealand Journal of Psychiatry, 21, 320326.Google Scholar
Crow, T. J. (1980) Positive and negative schizophrenic symptoms and the role of dopamine. British Journal of Psychiatry, 137, 383386.Google Scholar
Drake, R. E. & Sederer, L. I. (1986) The adverse effects of intensive treatment of chronic schizophrenia. Comprehensive Psychiatry, 27, 313326.Google Scholar
Eichelman, B. & Hartwig, A. (1990) Ethical issues in selecting patients for treatment with clozapine: a commentary. Hospital and Community Psychiatry, 41, 880882.Google ScholarPubMed
Farde, L., Wiesel, F. A., Halldin, C., et al (1988) Central D2-dopamine receptor occupancy in schizophrenic patients treated with antipsychotic drugs. Archives of General Psychiatry, 45, 7176.Google Scholar
Fischer-Cornelssen, K. A. & Ferner, U. J. (1976) An example of European multi-center trials: multispectral analysis of clozapine. Psychopharmacology Bulletin, 12, 3439.Google Scholar
Goldberg, S. G., Klerman, G. L. & Cole, J. O. (1965) Changes in schizophrenic psychopathology and ward behaviour as a function of phenothiazine treatment. British Journal of Psychiatry, 111, 120133.Google Scholar
Halperin, J. & Levine, R. (1985) Bypass. New York: Times Books.Google Scholar
Healy, D. (1990) Schizophrenia: basic, reactive, release and defect processes. Human Psychopharmacology, 5, 105121.Google Scholar
Healy, D. (1991a) The marketing of 5-HT: depression or anxiety? British Journal of Psychiatry, 158, 737742.CrossRefGoogle ScholarPubMed
Healy, D. (1991b) What do 5-HT reuptake inhibitors do in obsessive-compulsive disorder? Human Psychopharmacology, 6, 325328.Google Scholar
Healy, D. (1991c) The ethics of psychopharmacology. Changes, 9, 234247.Google Scholar
Povlsen, V. J., Noring, U., Fog, R., et al (1985) Tolerability and therapeutic effect of clozapine: a retrospective investigation of 216 patients treated with clozapine for up to 12 years. Acta Psychiatrica Scandinavica, 71, 176185.Google Scholar
Kane, J., Honigfeld, G., Singer, J., et al (1988) Clozapine for the treatment-resistant schizophrenic: a double-blind comparison versus chlorpromazine and benztropine. Archives of General Psychiatry, 45, 789796.Google Scholar
Lowe, C. F. & Chadwick, P. D. J. (1990) Verbal control of delusions. Behaviour Therapy, 21, 461479.Google Scholar
McEvoy, J. P., Hogarty, G. E. & Steingard, S. (1991) Optimal dose of neuroleptic in acute schizophrenia. Archives of General Psychiatry, 48, 739745.Google Scholar
Meltzer, H. Y. (1991) The mechanism of action of new antipsychotic drugs. Schizophrenia Bulletin, 17, 263287.Google Scholar
Meltzer, H. Y., Sommers, A. A. & Luchins, D. J. (1986) The effect of neuroleptics and other psychotropic drugs on negative symptoms in schizophrenia. Journal of Clinical Psychopharmacology, 6, 329338.Google Scholar
O'Donnell, M. (1991) Battle of the clotbusters. British Medical Journal, 302, 12591261.CrossRefGoogle ScholarPubMed
Orme, M. (1991) How to pay for expensive drugs. British Medical Journal, 303, 593594.CrossRefGoogle ScholarPubMed
Pelonero, A. L. & Elliott, R. L. (1990) Ethical and clinical considerations in selecting patients who will receive clozapine. Hospital and Community Psychiatry, 41, 878880.Google Scholar
Petch, M. C. (1991) Coronary bypass 10 years on. British Medical Journal, 303, 661662.Google Scholar
Rifkind, A., Doddi, S., Karagigi, B., et al (1991) Dosage of haloperidol for schizophrenia. Archives of General Psychiatry, 48, 166170.Google Scholar
Shepherd, M. (1990) The ‘neuroleptics’ and the Oedipus effect. Journal of Psychopharmacology, 4, 131135.Google Scholar
Smith, R. (1991) Christie Hospital reports on interleukin-2 controversy. British Medical Journal, 302, 1041.Google Scholar
Taylor, D. (1991) Centoxin – birth of a budgetbuster. British Medical Journal, 302, 1229.Google Scholar
Terkelson, K. G. & Grosser, R. C. (1990) Estimating clozapine's cost to the nation. Hospital and Community Psychiatry, 41, 863869.Google Scholar
Valenstein, E. S. (1986) Great and Desparate Cures. New York: Basic Books.Google Scholar
van Putten, T., Mutalipassi, L. R. & Malkin, M. D. (1974) Phenothiazine induced decompensation. Archives of General Psychiatry, 30, 102105.CrossRefGoogle ScholarPubMed
van Putten, T., May, P. R. & Marder, S. R. (1984) Akathisia with haloperidol and thiothixene. Archives of General Psychiatry, 41, 10361039.Google Scholar
van Putten, T., Marder, S. R. & Mintz, J. (1990) A controlled dose comparison of haloperidol in newly admitted schizophrenic patients. Archives of General Psychiatry, 47, 754758.Google Scholar
Westlin, W. F. (1990). Comments by a Sandoz official. Hospital and Community Psychiatry, 41, 874876.Google Scholar
Williams, J. R. & Beresford, E. B. (1991) Physicians, ethics and the allocation of health care resources. Annals of the Royal College of Physicians and Surgeons in Canada, 24, 305309.Google Scholar
Wolff, S. M. (1991) New England Journal of Medicine, 324, 486488.Google Scholar
Submit a response

eLetters

No eLetters have been published for this article.