Originally Posted by janewhite1
Not to bust your bubble, but right now genetic testing is an awful lot more expensive than just going through a few medication trials.
Of course, the expansion in basic science of ADHD is very exciting.
(They do sometimes do genetic testing prior to chemo, where picking the wrong med or wrong dose can cause death.)
You did not burst my bubble, you set off a 50 megaton H-bomb at bubble dead center.
Money is the problem.
Let's look at the best ADHD diagnostic tools available.
1. Patient History. Why the hell doesn't every psych/shrink work up a thorough history on each patient? It takes too long. Managed health care dictates how much the doctor is going to get paid. The ins. provider dictates doctor fees. "You are going to get a buck and half and not one cent more to dx ADHD." Working up a history can take hours. I am a big fan of ROI - Return On Investment. A shrink has a minimum of 1 million dollars invested.
Frankly, I'd like to see a minimum of $500/hr return if I made an investment of that magnitude.
The shrink can't afford to delegate the history to a physician's assistant for the little he's going to paid from the managed health "insurance" provider. So our doctor takes the 5 minutes he is paid on, asks a couple good questions, makes a few good observations, then makes the diagnoses.
2. Two diagnostic tools that can be useful for complex cases.
a) qEGG (quantitative electro-encephalograph). The test can detect ADHD's abnormally high beta/theta brain wave power ratio. qEGG are 90% accurate. They suck as primary ADHD diagnostic tools. qEGG are very helpful in finding "a better explanation" for ADHD look-alike symptoms. The qEGG can help the doctor NOT to prescribe an ADHD therapy doomed to fail from the get-go to a therapy likely to help the patient.
b) SPECT scans - absolutely rule in detecting comorbidities. SPECT's are brutally accurate in detecting brain injuries and substance abuse. Hmn, the boy ain't ADHD, the coke he has been snorting is causing ADHD like symptoms. Best therapy, this case, is to "stop snorting coke."
There is NO WAY in hell managed health care is going to pay for a) or b).
History + qEGG + SPECT are not enough for the physician to choose the correct med on the first try.
None of this is relevant to those of us fortunate enough to be prescribed the best med on the first try.
The medication trial and error process for those not so fortunate can be worse than the damn disorder. I see a lot of us including myself that fall into the not-so-fortunate group.
Well, now, Janey, who blew me up with reality. There is NO WAY in hell managed hell care
is going to pay for my genetic testing that could make ADHD medication management so much more patient friendly.
I fell like I wasted a lot of time on nothing. The whole freaking problem is money. Neuroscience advancements will only add to the costs that insurance providers will refuse to pay.
Edit: My typo, "managed hell care" == more accurate description of what we get for our money.