Universe On The Couch

Much of the increase in health care costs has been prescription medication. There are actually some fairly simple solutions here.

It starts with the patients. They go to the doctor with an expectation of a medication. They often feel ripped off or they wasted their time if they don't leave with a script. they need to understand that not every problem needs treatment or is that serious. Some things go away on their own. Others need treatment that is not a medication. Some things need to simply be followed over time for now. They also must understand the newest and latest "ask your doctor" drug may not be suitable for them, better than what they are taking, has not had a long record of safety issues and is expensive. The newest, latest marketed as best drug is always expensive and often not anything so great anyhow.

Then the doctors. We need to be honest and tough with our patients. We need to educate them. We need to offer them choices too. We also need to get beyond the bias of our perks and "education" sponsored by the drug companies. We need to realize the wonderful studies cited are a biased sample and lok closely at the data and see if it really makes sense in the "real world" of clinical practice. Cost must be part of the equation, no matter who is paying. Not so much the cost of the med itself, but overall costs realted to it as well. When SSRI's were restricted, the higher costs were actually justified over the old meds. The overdose potential and the ICU time, along with the costs of untreated depression due to patients not taking them due to side effects outweighed the med costs.

The drug companies are of course to blame. They do provide much good and without them we would have a feeble system of care indeed. They are also a business and if you beleive in capitalism, then they have a right to make a profit. One can only cringe at the idea of the government taking over this industry.

Still the marketing is relentless. Only twenty percent of new meds are really novel. Most are "me-too" drugs based on another companies big seller. They only release the studies that are favorable. They control much of medical education. Worst of all, they advertise to the public. This creates a demand for something that the patient is ignorant about and a decision that is really the doctor's. Billions spent on marketing are passed on to the patients.

Our federal government is complicit in this too. The expanded Medicare drug benefit flew through both parties and the President. Here was everyone's get the senior vote and look humanitarian. Now they're all crying they didn't know it was going to cost that much. Bullshit. Ever look at the thing? It's pretty convoluted and unclear who it will actually help. And goodbye cheaper imported meds. Now Grandma is a drug smuggler. They cite safety of these meds. Yea, I'm sure Canada and England are real lax. This really is a giveaway to the drug companies at the expense of the taxpayers.

Then there is the issues of is a drug really needed. Every time I read about the cholesterol issue, the numbers for risk are lower. Meaning more people on expensive statins. Now even two or three drugs are given for the evil cholesterol. The same thing for high blood pressure, two or three meds. Add on an anti-depressant. And since all depression is really bipolar, a new anti-convulsant. And a low dose af a new anti-pschyotic just to help it all out by calming the mind. A stimulant for ADHD or the fatigue form all those meds. And a sleeping pill for bedtime. And shit, pun intended, constipation. So something for that. And those joints hurt, so COX tox too. I often see med lists that read like "War and Peace." Often the best intervention to start with is to get rid of some or most of the medications. I tell them to bring in everything in the home and they often fill half a paper shopping bag. I have seen two full bags a few times.

Often the needed intervention is not a drug. Depressed? Stop smoking pot or drinking a few weeks. Always tired? Try sleeping more than five hours a night. Anxious? Ease up on the coffee. High blood pressure or high cholesterol? Exercise and lose some weight.

Sometimes the drug is a rather cheap one. For most of us our aches and pains can be treated with the aspirin or ibuprofen in the big bottles At Costco, Walmart or Target. Generics are the same medications and should be used whenever possible.

Prozac is off patent now as generic fluoxitine. So it should be the first choice in treating depression unless otherwise contraindicated. Meaning before the doc prescribes Paxil, Zoloft, Remeron, Wellbutrin SR, .... And if you're treating PMS, prescribe the generic, not the newly marketed expensive "Pink Prozac."

So here is a place where plenty of money can be saved. Billions. And our health better besides. Every medication has risks to our health and well-being. The lifestyle alternatives are better for you anyhow. The new expensive stuff has not been out long enough to really prove its benefit and more important safety. Mice, rats and dogs followed by a 12-week human trial is not the same as years of clinical experience.