| 2004S-0170 - Medicare Prescription Drug, Improvement, and Modernization Act of 2003, Section 1013: Suggest Priority Topics for Research|
|FDA Comment Number :||EC17|
|Submitter :||Dr. Ruby Martinez||Date & Time:||05/11/2004 06:05:04|
|Organization :||National Latino Behavioral Health Association|
|Health Care Association|
| I wish to register two concerns:
1)Evidense based practice- If you will conduct a literature search, you will note the paucity of research on people of color, especially in mental health treatment. I absolutely support evidensed based practice, however the research is simply not there to guide us with these populations.
2)Cheaper is not better (and maybe not really cheaper)
As a person who has worked in the mental heath field for over 25 years, I urge you to consider the total cost of treatment in making fiscal decisions. In mental health treatment, for example, the newer generation medications are superior to the older ones for various but significant reasons. SSRI may be equal to the first generation antidepressants in effectiveness, however, SSRI are much less lethal if a patient should use them as part of a suicide attempt. In todays health market, people are discharged more rapidly and we need to consider this factor. My patients have fewer bothersome side effects as well on SSRI, which means that there is usually better compliance with medication. This same argument holds true for the antipsychotics. The traditional meds have significant side effects that can discourage patient use (EPS, TD, NMS) and contribute to more hospitalizations and untreated morbidity. The atypical meds are more costly but I find that patients can tolerate them better and are more med compliant.
Research should focus on people of color and what contributes to successful treatment for them. This may include medication, talk therapies, cultural specific healers, spiritual healers. Thank you.
Ruby J. Martinez, RN, PhD, APRN,BC