Both of those examples are large drug-makers, not individual physicians. And yes, there are definitely some bad apples in the opioid prescribing realm, and they should have their licenses stripped.
For the medications we're discussing, it's not about blame. It's about incentives.
Drug companies have an incentive to get people to use their product. They spent a lot of money to allow direct advertising of medications to the general public (illegal in many countries) to drive that demand. They show a lot of people prancing around in meadows and laughing with attractive people at barbeques, and make it known that taking something with enough X's and Z's in the name will produce better living through chemistry.
Schools have an incentive to have quiet, controllable children, so they express "concerns" to parents.
Parents have an incentive to protect and optimize their children's lives, so a medication that can enhance academic performance, improve their mood, and reduce their anxiety is tempting, especially if half the other kids in the class are on those meds (and now little Johnny might fall behind his classmates if they're all popping Ritalin and he's not).
Hospitals and medical groups have an incentive to have their physicians make the sausage as fast as possible and code as high as possible for billing purposes, so it's short appointments that preclude the conversation which would have revealed nuance. Happy patients are also returning patients who leave nice words on social media, so what the patient wants, the patient gets (to the limit of their insurance or pocket).
Patients have an incentive to be happy and healthy. Preferably as fast as possible with minimal effort and no lifestyle changes. Pills and supplements are wildly popular, because they're easier than improving diet, being more active, and getting better sleep. More and more, people are medicalizing normal life issues, because being "on the spectrum" or diagnosing yourself with anxiety, depression, or ADHD is easier than dealing with the fact that life is often difficult, unfair, and we're all wired differently in ways that make certain aspects easier or more difficult.
Physicians have an incentive to have happy, healthy patients, and modern medical training has a "patient-centered" paradigm with physicians as "advisors". Thus, a patient (or parent) who is absolutely convinced that they need a particular medication (antibiotics for a viral sinus infection is a classic) makes for a difficult patient encounter. Those shortened appointments (which the physician frequently has no say in) don't leave time for arguing, and some say that pushing back against patient wishes is unethical (and at a minimum is likely to leave a nasty public review), thus a prescription is frequently given, even when it's more likely that focusing on fundamentals will give a better long-term result. A flat "no" to medication is untenable in many settings.
So yes, agree that the FAA is definitely going to have to deal with this. So is the military (and we are). ADHD in particular was WILDLY over-diagnosed 10-15 years ago, and getting waivered for that diagnosis is nearly automatic now for basic service and increasingly expedited for aviation (although it still requires testing to rule out actual pathology).
To be clear, there are absolutely, positively people who need medication to be okay. Those folks deserve the best diagnosis, treatment, and monitoring we can provide. But the folks who got an ADHD diagnosis to help their GPA and suddenly want to be a pilot? Yeah, we're going to have to jump through the hoops to see what's what.
pmc.ncbi.nlm.nih.gov
