I agree I probably do underestimate the negative consequences of RLS, in primary care my knowledge is superficial on a range of diseases. But I do think you underestimate how difficult it can be to find independent sources of physician education outside of academic institutions. Pretty much all the CME lectures I come across are industry sponsored. I think it’s like this in many smaller communities.

Independent education is costly for the independent physician. Industry sponsored seminars tend to be free for me, the bill being footed by the drug companies. Compare an analysis of various medications on Medscape, a “free” education service (heavy on pharm ads), to one from “The Medical Letter”, a nonprofit, pharm-free, subscription service, and subtle but real differences are apparent.

I also think you underestimate the strain that prior auth’s can put on a small independent practice trying to minimize overhead. But I agree that this is more of an insurance problem than the pharm industry.

I agree that these medicines help RLS. I just think the way they are marketed directly to patients, and the way the industry educates physicians, is what is harmful.

I acknowledged that promoting a specific treatment for a specific disease can lead to overdiagnosis and over prescribing. My point was that this is not necessarily the case. Also, evidence suggests that underprescribing is as common as overprescribing.

I agree with your point about healthcare costs – but let’s call this what it is – rationing health care. You are essentially saying that increasing awareness of a disease and treatment leads to people being treated and this raises health care costs – which is true whether or not the treatment is appropriate. We both agree that overprescribing is bad, but how do you define this. If medication for moderate RLS improves someones quality of life, is that worth it?

I also think you are underestimating the consequences of RLS in many patients, which is sleep deprivation. This has a host of negative health consequences and may even increase the ultimate cost of health care.

The solution to overdiagnosis is not censorship but physician education.

On your final point, I have not found this causes a problem in getting these medication to PD patients. At worst it creates more work for my office staff who have to submit the prior auth. But I blame this on the insurance companies – not an evidence-based extension of the indication for these meds.

What you call raising awareness, I would call disease mongering. I would say this out of concern for healthcare costs in general, however, and not a prioiri anti-pharm ideology. Your post seems to suggest that criticism of RLS hype can only arise from knee jerk industry skepticism.

I think as a neurologist, your vantage point of RLS is different than what I see in primary care. You see more cases of RLS, and more severe cases causing significant disability. But, by far, the bigger public health problem is rising healthcare cost, and people’s inability to afford health insurance. RLS hype, which you acknowledge can lead to overdiagnosis, will escalate cost, and reduce people’s access to health insurance. This is the harm.

I’ve never seen a seminar or educational program on RLS offered in my area that wasn’t industry sponsored.

Also, RLS probably exists on a continuim, with medications reserved for those on the moderate to severe end of the spectrum. However, now the typical patient comes in specifically requesting the medication, and doctors have to work backwards from there. This leads to a tendency to overprescribe, because as a business there is a “customer is always right” axiom that exists in doctors offices.

If anything, the RLS hype also hurts Parkison’s patients, because the increase cost has led some insurers to make these drugs “prior authotization only” which makes it harder for PD patients to obtain the medications.