Thank you for using your voice and platform to give the public solid information. Trump’s executive order regarding medications is outlandish. Yes, the system is broken. Our medical system has become financially centered rather than patient centered. The hospitals are run by administrators who are only interested in the bottom line, the almighty dollar.
Politicians need to stay out of medical decisions. We don’t need to rid the system of mental health medications, we need to improve the mental health branch of medicine.
Doctors and nurses are over-worked and underpaid. Salaries for doctors, who are owned by hospital systems are based on the rapid fire of patients in and out of offices in record time.
My husband is a retired family physician who had a practice for 40 years. When the group joined the hospital they were the number 1 family practice group, with the highest patient reviews. Over the next few years the administration stepped in and pretty much destroyed a well established and well loved practice. My husband and his colleagues left the practice because they couldn’t work under such duress, incompetence, and disregard for patient care.
Doctors are slowly, but surely, leaving the profession. I am on my third family doctor within 2 years. They’re exhausted and disillusioned. Patients can’t get an appointment for months.
Most definitely the system has to be reorganized and changed. Doctors are the backbone of hospital systems. Maybe it’s time for them to be one loud voice. There’s power in numbers.
Thank you, once again, Dr. McBride for your dedication and wisdom.
Thanks for your comments, Elaine. The current medical system in this country is anti-doctor/anti-patient. It privileges prescriptions and damage control over patient education and prevention. We all know this. It is terribly sad. It is not a political statement on my part - neither the Left nor the Right have not been able to solve this. I am not sure how we will.
While this order is totally over that top- there is some truth to over prescribing. I am a therapist and have only worked in hospital systems or in community mental health. The over prescribing is criminal. There is no off ramp for clients and many have very little if any oversight. For example- clients come to me after Covid after seeing an “online prescriber” and getting a serious diagnosis - often in a 30 minute tele session - and then get prescribed things like antipsychotics. There is then zero monitoring afterwards because clients are able to get refills (for years!!!) through their regular doctors or the VA. I think when people read about orders like this - they are not aware of what mental health care looks like in underprivileged settings. I clearly don’t think we should limit life saving psych meds- but the oversight we have now is criminal. Part of this is a totally broken mental health system. I am one of very few providers I know in MOCO who works somewhere that takes Medicaid and Tricare etc. Reimbursements are so low, and reform is needed for more providers to opt in. That is for another thread entirely!
Such an excellent point. Overprescription is a huge problem - 100% agree. But the reason for this is the system itself. In other words, we are not going to solve the overprescription problem by restricting access to meds; we solve it by fixing the system that leads providers (online and in person) to default to meds when 1) the issue may be more amenable to non pharmacological interventions and 2) there is no good follow up or off-ramp as you say. Yes the insurance industry is so broken It makes my heart ache.
I completely agree. Before we consider reducing access to medication, we must first build a system that truly supports mental health. This includes ensuring adequate insurance coverage and availability of therapy, with fair compensation for therapists. We also need to improve access to healthy, affordable food in low-income areas, increase pay for primary care physicians so they have the time to address patient needs, and strengthen social structures that support families struggling with housing, childcare, and education. Without these foundational supports in place, removing medication is irresponsible and dangerous. I worry about the coming years, but I hope that the system becomes so broken that it finally forces meaningful, positive change.
I absolutely agree. As someone with ADD and chronic anxiety I am exploring a variety of ways to help my brain self regulate (including medication but also meditation and exercise). I have also used plant medicines like ayahuasca and ibogaine to delve into my psyche and uncover the root causes of my anxiety. Us humans are indeed multi-faceted beings and our healthcare should be too.
By the way, in my humble opinion the Trump administration is all superficial fixes. Its worrying how binary their thinking is and how their actions continue to polarize opinion.
We need to get reliable healthcare information on Substack now. Another Substack I pay for is by Dr. Jeremy Faust. Yesterday he did an interview with Dr. Atul Gawande about USAID:
I’m worried about my dog, who is inReconcile, doggie fluoxetine, and who could have seizures without it. If people can’t get it…. What do you think? And frankly, I’m not convinced the pharmaceutical lobby will let this fly. The opioid crisis was started by them. Are they going to take drugs off the market? Seriously?
Mental health is such a hard thing for doctors these days. They just want to give you a couple of minutes and a drug. Drives me crazy. I think Bobby Kennedy is our best hope for change and President Trump is on board. Let’s hope for the best and get to the root of problems!!!
Good post Lucy. I agree the solutions need to be systemic, as you pointed out. I don't see where the EO says the plan is to restrict access, though. That may be the intention, but some of the goals of the EO I support.
(iii) assess the prevalence of and threat posed by the prescription of selective serotonin reuptake inhibitors, antipsychotics, mood stabilizers, stimulants, and weight-loss drugs;
(iv) identify and report on best practices for preventing childhood health issues, including through proper nutrition and the promotion of healthy lifestyles;
(v) evaluate the effectiveness of existing educational programs with regard to nutrition, physical activity, and mental health for children;
I am as highly skeptical of this incoming administration as anyone, but I think it's important to also give credit when they do enunciate goals I can get behind--of which restricting access to meds isn't one. The order is quite vague though and mostly seems to establish a taskforce to make suggestions:
"Within 180 days of the date of this order, the Commission shall submit to the President, through the Chair and the Executive Director, a Make Our Children Healthy Again Strategy (Strategy), based on the findings from the Make Our Children Healthy Again Assessment described in subsection (a) of this section. The Strategy shall address appropriately restructuring the Federal Government’s response to the childhood chronic disease crisis, including by ending Federal practices that exacerbate the health crisis or unsuccessfully attempt to address it, and by adding powerful new solutions that will end childhood chronic disease."
You are correct: there is no stated plan to restrict access to meds. But why else would the EO ask to “assess the threat posed by the prescription of selective serotonin reuptake inhibitors, antipsychotics, mood stabilizers, stimulants, and weight-loss drugs” without any mention of the harms of mental illness pr the benefits of mental/behavioral health programs if the intent isn’t to take aim at - and ultimately restrict access to - medications? It’s no secret that the Trump admin is anti-Ozempic, for example, favoring diet/exercise, willpower and personal optimization as the most appropriate treatments for obesity. It is not a stretch to think SSRIs and ADHD meds are on the hit list, too.
Of course meds need to undergo scrutiny. And in my heart of hearts I do not think these meds are going away. I don’t. (Just like I don’t think Polio vax is on the outs.) But the absence of actual solutions in this EO - plus some thinly-veiled anti-medication language - suggests, again, that appropriately addressing mental health issues - and having access to evidence-based behavioral / mental health care - is not happening anytime soon.
We don’t know what the motivations are though. I criticized progressive media a lot during Covid for ascribing malice to viewpoints sort of willy nilly so want to be careful not to do the same. Also I wouldn’t assume the Trump admin is anti Ozempic. Musk has said he is on Ozempic currently and has widely touted its great benefits. He seems to be controlling a lot of what happens in the administration. RFK has said conflicting things. As a place to start, I don’t think a taskforce analyzing the current landscape is a bad thing. If there is a move to restrict, without taking into account individual patient needs and without also changing systemic issues that drive prescribing practices, I will object. But also it’s important not to object to things just because Trump said it, as happened with covid policy.
I would be delighted if Trump et al were able to outline a plan to offer evidence-based, patient-centered mental and behavioral health care as part of a holistic plan to rehab our healthcare system. If this EO is step one toward getting there, I will the first to celebrate.
Me too. I’m not optimistic. But trying to find common ground where possible. I don’t think a task force is a bad place to start. We shall see what happens next.
Grateful to have been a Kaiser Permanente member for 40+ years. Not perfect, but tools for physical and mental health have gotten me and my husband through several health crises and day-to-day maintenance.
In my 50+ years in healthcare, we haven’t found the pathway to putting “care” into practice. We surely talk the talk, but the politics don’t support the walk. With the administration’s stance, will this be THE impetus to propel holistic care practices? I’m betting on it.
I looked online for the connection between the 1910 Flexner Report and the subsequent Flexner Reform of the American medical system, and Flexner's relationship with John D. Rockefeller. I found this:
I think the crux of the reforms we need is with medical education and the pharmaceutical industry: that the medical education system should be re-directed toward functional medicine and away from the superficial, palliative, drug-oriented focus that Flexner produced; that the revolving door between the FDA and Big Pharma should be closed; and that existing anti-trust legislation should be used to outlaw their funding of FDA operations, their funding of U.S. medical education, and their advertising of drugs directly to the public (a situation the U.S. shares only with New Zealand). John D. Rockefeller once observed that it is not necessary to own an industry to control their behavior. It is sufficient to be a predominant customer. Public advertising of drugs directly to the public gives Big Pharma a leash on American media.
I had very serious clinical depression when I was young. I MUST stay on fluoxetine. How can the medical community (including pharma) fight Trump's ridiculous and dangerous order NOW?? Trump and RFK are endangering the lives of millions of Americans. I am 75 now and trying not to panic. This stupid order should be grounds for impeachment and removal, along with all the other sh-t this regime has carried out in a short time. Will investigate getting prescription meds from Canada or wherever.
Thank you for using your voice and platform to give the public solid information. Trump’s executive order regarding medications is outlandish. Yes, the system is broken. Our medical system has become financially centered rather than patient centered. The hospitals are run by administrators who are only interested in the bottom line, the almighty dollar.
Politicians need to stay out of medical decisions. We don’t need to rid the system of mental health medications, we need to improve the mental health branch of medicine.
Doctors and nurses are over-worked and underpaid. Salaries for doctors, who are owned by hospital systems are based on the rapid fire of patients in and out of offices in record time.
My husband is a retired family physician who had a practice for 40 years. When the group joined the hospital they were the number 1 family practice group, with the highest patient reviews. Over the next few years the administration stepped in and pretty much destroyed a well established and well loved practice. My husband and his colleagues left the practice because they couldn’t work under such duress, incompetence, and disregard for patient care.
Doctors are slowly, but surely, leaving the profession. I am on my third family doctor within 2 years. They’re exhausted and disillusioned. Patients can’t get an appointment for months.
Most definitely the system has to be reorganized and changed. Doctors are the backbone of hospital systems. Maybe it’s time for them to be one loud voice. There’s power in numbers.
Thank you, once again, Dr. McBride for your dedication and wisdom.
Thanks for your comments, Elaine. The current medical system in this country is anti-doctor/anti-patient. It privileges prescriptions and damage control over patient education and prevention. We all know this. It is terribly sad. It is not a political statement on my part - neither the Left nor the Right have not been able to solve this. I am not sure how we will.
Would also add that the cost of medical school is part of what drives medical students into high paying specialties instead of primary care.
Yes, totally agree, Aparna.
While this order is totally over that top- there is some truth to over prescribing. I am a therapist and have only worked in hospital systems or in community mental health. The over prescribing is criminal. There is no off ramp for clients and many have very little if any oversight. For example- clients come to me after Covid after seeing an “online prescriber” and getting a serious diagnosis - often in a 30 minute tele session - and then get prescribed things like antipsychotics. There is then zero monitoring afterwards because clients are able to get refills (for years!!!) through their regular doctors or the VA. I think when people read about orders like this - they are not aware of what mental health care looks like in underprivileged settings. I clearly don’t think we should limit life saving psych meds- but the oversight we have now is criminal. Part of this is a totally broken mental health system. I am one of very few providers I know in MOCO who works somewhere that takes Medicaid and Tricare etc. Reimbursements are so low, and reform is needed for more providers to opt in. That is for another thread entirely!
Such an excellent point. Overprescription is a huge problem - 100% agree. But the reason for this is the system itself. In other words, we are not going to solve the overprescription problem by restricting access to meds; we solve it by fixing the system that leads providers (online and in person) to default to meds when 1) the issue may be more amenable to non pharmacological interventions and 2) there is no good follow up or off-ramp as you say. Yes the insurance industry is so broken It makes my heart ache.
I completely agree. Before we consider reducing access to medication, we must first build a system that truly supports mental health. This includes ensuring adequate insurance coverage and availability of therapy, with fair compensation for therapists. We also need to improve access to healthy, affordable food in low-income areas, increase pay for primary care physicians so they have the time to address patient needs, and strengthen social structures that support families struggling with housing, childcare, and education. Without these foundational supports in place, removing medication is irresponsible and dangerous. I worry about the coming years, but I hope that the system becomes so broken that it finally forces meaningful, positive change.
I agree, Kristen
My internist spent 1.5 hours with me the other day. Exceptional care and the time it takes still can be found. But I know I’m one of fortunate few.
Yes! It exists... it is just usually expensive. :)
Lila, only the wealthy can afford concierge medical care.
I absolutely agree. As someone with ADD and chronic anxiety I am exploring a variety of ways to help my brain self regulate (including medication but also meditation and exercise). I have also used plant medicines like ayahuasca and ibogaine to delve into my psyche and uncover the root causes of my anxiety. Us humans are indeed multi-faceted beings and our healthcare should be too.
By the way, in my humble opinion the Trump administration is all superficial fixes. Its worrying how binary their thinking is and how their actions continue to polarize opinion.
I hear you - and good for you for finding a role for meditation and exercise alongside medication.
I'm worried about access to vaccines. We now have an ignorant, anti-vaccine person RFK,Jr, leading Health and Human Services. Here is what Dr. Kateiyn Jetelina wrote yesterday in her Substack: https://yourlocalepidemiologist.substack.com/p/measles-acip-flu-campaign-bird-flu
We need to get reliable healthcare information on Substack now. Another Substack I pay for is by Dr. Jeremy Faust. Yesterday he did an interview with Dr. Atul Gawande about USAID:
https://insidemedicine.substack.com/p/usaid-update-with-dr-atul-gawande
Katelyn is great. She and I are doing a live Q&A sometime soon. Thanks for reading, Linda!
I’m worried about my dog, who is inReconcile, doggie fluoxetine, and who could have seizures without it. If people can’t get it…. What do you think? And frankly, I’m not convinced the pharmaceutical lobby will let this fly. The opioid crisis was started by them. Are they going to take drugs off the market? Seriously?
I srsly doubt it
I think my dog needs Prozac too! He is a rescue pup from a kill shelter and I think his puppy life was pretty traumatic poor pup!
Mental health is such a hard thing for doctors these days. They just want to give you a couple of minutes and a drug. Drives me crazy. I think Bobby Kennedy is our best hope for change and President Trump is on board. Let’s hope for the best and get to the root of problems!!!
Totally agree - whomever wants to solve this problem I will cheer from the hilltops
Good post Lucy. I agree the solutions need to be systemic, as you pointed out. I don't see where the EO says the plan is to restrict access, though. That may be the intention, but some of the goals of the EO I support.
(iii) assess the prevalence of and threat posed by the prescription of selective serotonin reuptake inhibitors, antipsychotics, mood stabilizers, stimulants, and weight-loss drugs;
(iv) identify and report on best practices for preventing childhood health issues, including through proper nutrition and the promotion of healthy lifestyles;
(v) evaluate the effectiveness of existing educational programs with regard to nutrition, physical activity, and mental health for children;
I am as highly skeptical of this incoming administration as anyone, but I think it's important to also give credit when they do enunciate goals I can get behind--of which restricting access to meds isn't one. The order is quite vague though and mostly seems to establish a taskforce to make suggestions:
"Within 180 days of the date of this order, the Commission shall submit to the President, through the Chair and the Executive Director, a Make Our Children Healthy Again Strategy (Strategy), based on the findings from the Make Our Children Healthy Again Assessment described in subsection (a) of this section. The Strategy shall address appropriately restructuring the Federal Government’s response to the childhood chronic disease crisis, including by ending Federal practices that exacerbate the health crisis or unsuccessfully attempt to address it, and by adding powerful new solutions that will end childhood chronic disease."
You are correct: there is no stated plan to restrict access to meds. But why else would the EO ask to “assess the threat posed by the prescription of selective serotonin reuptake inhibitors, antipsychotics, mood stabilizers, stimulants, and weight-loss drugs” without any mention of the harms of mental illness pr the benefits of mental/behavioral health programs if the intent isn’t to take aim at - and ultimately restrict access to - medications? It’s no secret that the Trump admin is anti-Ozempic, for example, favoring diet/exercise, willpower and personal optimization as the most appropriate treatments for obesity. It is not a stretch to think SSRIs and ADHD meds are on the hit list, too.
Of course meds need to undergo scrutiny. And in my heart of hearts I do not think these meds are going away. I don’t. (Just like I don’t think Polio vax is on the outs.) But the absence of actual solutions in this EO - plus some thinly-veiled anti-medication language - suggests, again, that appropriately addressing mental health issues - and having access to evidence-based behavioral / mental health care - is not happening anytime soon.
We don’t know what the motivations are though. I criticized progressive media a lot during Covid for ascribing malice to viewpoints sort of willy nilly so want to be careful not to do the same. Also I wouldn’t assume the Trump admin is anti Ozempic. Musk has said he is on Ozempic currently and has widely touted its great benefits. He seems to be controlling a lot of what happens in the administration. RFK has said conflicting things. As a place to start, I don’t think a taskforce analyzing the current landscape is a bad thing. If there is a move to restrict, without taking into account individual patient needs and without also changing systemic issues that drive prescribing practices, I will object. But also it’s important not to object to things just because Trump said it, as happened with covid policy.
I would be delighted if Trump et al were able to outline a plan to offer evidence-based, patient-centered mental and behavioral health care as part of a holistic plan to rehab our healthcare system. If this EO is step one toward getting there, I will the first to celebrate.
Me too. I’m not optimistic. But trying to find common ground where possible. I don’t think a task force is a bad place to start. We shall see what happens next.
Grateful to have been a Kaiser Permanente member for 40+ years. Not perfect, but tools for physical and mental health have gotten me and my husband through several health crises and day-to-day maintenance.
Lovely to hear
In my 50+ years in healthcare, we haven’t found the pathway to putting “care” into practice. We surely talk the talk, but the politics don’t support the walk. With the administration’s stance, will this be THE impetus to propel holistic care practices? I’m betting on it.
I am hoping for systemic/structural change, regardless of what party gets it done.
I looked online for the connection between the 1910 Flexner Report and the subsequent Flexner Reform of the American medical system, and Flexner's relationship with John D. Rockefeller. I found this:
https://universe-inside-you.com/rockefeller-big-pharma/
I think the crux of the reforms we need is with medical education and the pharmaceutical industry: that the medical education system should be re-directed toward functional medicine and away from the superficial, palliative, drug-oriented focus that Flexner produced; that the revolving door between the FDA and Big Pharma should be closed; and that existing anti-trust legislation should be used to outlaw their funding of FDA operations, their funding of U.S. medical education, and their advertising of drugs directly to the public (a situation the U.S. shares only with New Zealand). John D. Rockefeller once observed that it is not necessary to own an industry to control their behavior. It is sufficient to be a predominant customer. Public advertising of drugs directly to the public gives Big Pharma a leash on American media.
I had very serious clinical depression when I was young. I MUST stay on fluoxetine. How can the medical community (including pharma) fight Trump's ridiculous and dangerous order NOW?? Trump and RFK are endangering the lives of millions of Americans. I am 75 now and trying not to panic. This stupid order should be grounds for impeachment and removal, along with all the other sh-t this regime has carried out in a short time. Will investigate getting prescription meds from Canada or wherever.