The Republic of T.

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The Government In your Medicine Cabinet?

Buspar. Celexa. Cymbalta. Elavil. Effexor. Lexapro. Lithium. Luvox. Nardil. Normaprin. Pamelor. Parnate. Paxil. Prozac. Remeron. Wellbutrin. Zoloft.

Are any of these names on any of the bottles in your medicine cabinet? If so, you’re no different than fully one half of the Americans who take at least one antidepressant, according to a 2004 report by the CDC. And if that’s the case you’re one of the lucky ones. According to a study from the Medical College of Georgia, only about one third of Americans who need mental health care actually get it. That’s probably due, at least in part, to the huge amount of stigma attached needing mental health care. (Also, having health insurance helps.)

Why do mental illnesses continue to be stigmatized? For one thing, the term “mental illness” itself implies a distinction from “physical” illness, although the two are intimately entwined. In fact, neuroimaging studies show physical changes in the brain associated with mental disorders, suggesting a biological basis. Some mental health advocates propose switching to less stigmatized terms, such as behavioral health or brain disorders or brain illnesses.

To some, “mental” suggests not a legitimate medical condition but rather something that results from your own doing and your own choices. People may blame you and think your condition is “all in your head.” They may think that mental illness is an indication of weakness or laziness. That you’re a “moral failure” or simply “can’t cut it.” That you should just “get over it.”

That stigma is probably why, if you take one of the medicines mentioned above, you don’t advertise it. And you probably don’t want anyone nosing around your medicine cabinet for the very say reason.

But someone may have already poked through your prescriptions.

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A reader, who may know that mental health is an issue I write about sometimes sent me a link to an Americablog post which highlights an interesting paragraph from an article about the Virginia Tech shootings, which mentions a government database of Americans who take antidepressants.

Some news accounts have suggested that Cho had a history of antidepressant use, but senior federal officials tell ABC News that they can find no record of such medication in the government’s files. This does not completely rule out prescription drug use, including samples from a physician, drugs obtained through illegal Internet sources, or a gap in the federal database, but the sources say theirs is a reasonably complete search.

The government’s files? The federal database? A reasonably complete search?

The article doesn’t say much more than that. But it’s enough to raise more questions. Is there a database of Americans taking antidepressants or other medicines related to mental health? Is there federal database of everyone’s prescriptions? How could that information be gathered in the first place? Who knows? It could happen any number of ways, but digging back through some old links turned up This story of prescription data gathering.

Although virtually unknown to consumers, the information has long been considered the most potent weapon in pharmaceutical sales — computerized dossiers showing which physicians are prescribing what drugs. Armed with such data, a drug sales representative can pressure a doctor to write more prescriptions for a name-brand medicine or fewer orders for a competitor’s drug.

… The leading compiler and vendor of prescription data is IMS Health, a publicly traded company based in Fairfield, Conn., that had revenue last year of $1.75 billion. IMS and its competitors gather the data through contracts with retail pharmacy chains and companies that manage drug plans for insurers, then sell it to pharmaceutical companies.

IMS and its competitors — the main ones are Verispan, Dendrite International and a Dutch company, Wolters Kluwer — also pay the A.M.A. for access to its repository of information on approximately one million doctors who are graduates of American medical schools, as well as foreign medical school graduates licensed in the United States.

The A.M.A., which calls this repository Masterfile, begins collecting the information when a doctor enters medical school. Over doctors’ careers, additional material includes information on their board certifications, types of practice and disciplinary records. The Masterfile information is among data that companies like IMS use in developing physician profiles.

I can’t say that’s where it started, but it’s one possibility. If such a database exists, there are some pretty far-reaching implications, even beyond mental health. A database that exists is a database that can be breached or hacked, and the data it contains used for any number of illegal or unethical purposes. Information in such a database can be used to expose and/or discriminate against people with mental health issues, or who are living with other stigmatized conditions like HIV/AIDS.

And if you think that the government will take extra special care secure such a database, think again. Remember this is the same government that’s lost over 160 laptops, ten of which contained classified or sensitive information.

This is the same government whose computer security flaws compromised sensitive information on Medicaid and Medicare enrollees. And, despite incidents of medical records being hacked and otherwise improperly accessed through computer networks, there’s a lot of support for putting our medical information online.

Powerful forces are lobbying hard for government and private programs that could push the nation’s costly and inefficient health care system into the computer age. President Bush strongly favors more use of health information technology. Health insurance and medical device companies are eager supporters, not to mention technology companies like I.B.M. and Google. Furthermore, Intel and Wal-Mart Stores have both said they intend to announce plans this week to embrace electronic health records for their employees.

Others may soon follow. Bills to speed the adoption of information technology by hospitals and doctors have passed both chambers of Congress.

But the legislation has bogged down, largely because of differences over how to balance the health care industry’s interest in efficiently collecting, studying and using data with privacy concerns for tens of millions of ordinary Americans — not just celebrities and victims of crime.

President Bush might want to rethink his support for (yet another) database of American’s private information, because a database of Americans taking antidepressants might also include him. I’ve blogged about Bush’s mood swings before, his outbursts, his increased isolation, and speculations since 2005 that Bush is taking antidepressants and even drinking again. It’s all speculation, but it’s pretty clear that Bush’s mind ain’t what it used to be.

The good news for the president, and the rest of us, is that antidepressants can help, a lot. The bad news for the rest of us is that being on anti-depressants might not be our own personal business anymore.


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