Cost of medicines--wow

[rodeosweetheart]

-

[sweetana3]

The change to the inhalers happened in 2008 due to ozone issues, environmental. Nothing to do with healthcare changes. However, I understand your frustration with the whole system.

I always have my doctor give me an RX so I can shop. The differences in prices are glaring among pharmacies for the exact same product. They dont want to do this since they are graded, I think, on how many electronic RX's they write. I like control over my prescriptions and do not like just having an unrevewed order sent in. I have in the past seen errors in the RX or in the filling and with electronic ordering I dont have the necessary info.

[enota]

Medications just treat the symptoms. If you do not correct the underlying problem your pulmonary issues will continue to get worse over time and you will need more and stronger medications in order to simply function. Wouldn't it be better to find out what the problem is and fix it?

If you have not considered finding a good holistic or naturopathic practitioner to evaluate your medical issues, I would strongly suggest that you do so. They can determine what the underlying cause of your problem is and treat it so that you will not be dependent upon medications for the rest of your life.

Many pulmonary issues have to do with mucus formation which interferes with the respiratory process. You might consider cutting back on mucus forming foods, especially dairy products. There is a book out there called "The Mucusless Diet System" written a very long time ago by Professor Arnold Ehret which covers how mucus impacts our health and how to avoid it. It's a very old book, written in an old style, but it contains much good information.

Also, another book that I read often and really like is by Victoria Butenko called "The 12 Steps to Raw Food" which illustrates how cooking our food creates more mucus in the body and can cause illness and disease. I am not a raw foodist myself, but I can certainly understand how the process works.

Whatever the cause of your problem, if I were you, I would be more concerned about finding out how to fix it than simply covering the symptoms with toxic medicines. Just a suggestion for what it's worth.

[Miss Cellane]

Oh, I understand about the ozone issues. What the doctor told me was that this was used as an opportunity to go back to rebranding everything, no generics. So it does have quite a bit to do with pharma and its stranglehold on healthcare. It was just a convenient time and excuse to rebrand and to shaft the consumer, while appearing to be concerned with the environment.

The pharma companies had to reformulate the medication in the inhalers. That means that they can patent the new formula. No generics until the patent runs out.

In all fairness to the drug companies, they had to do clinical trials on the new formulations, which are pretty expensive. One of the reasons medications cost so much is that the drug companies have to spend quite a bit of money researching, developing and testing the drugs before they can be marketed. The companies then have 20 years of patent protection to recoup the costs of developing the drug and make a profit, before the generics kick in. Something I read last year said that the average cost of bringing a new drug to market was $4 billion.

Drug companies are in business to make a profit. If they don't make a profit, the company folds and new drugs are not created. They are not in business to cure sick people. They are in business to make money.

The pharma companies could have chosen to discontinue the inhalers, if they wanted to--they didn't have to create new formulations that meet the new regulations for inhalers. They are under no obligation to produce any specific drug.

Do some research on "orphan" drugs, where there is a drug that works for a specific condition, but not enough people have that condition to make manufacturing the drug profitable. Sometimes the pharma companies just stop making it.

[rosarugosa]

Just as a possible point of comparison, my DH recently got a Proair albuterol inhaler at Costco, and our cost was $13.25. I'm sure there are different types of inhalers and of course different prescription plans would have different cost-sharing arrangements.

[IshbelRobertson]

In the UK, prescription charges vary. In Scotland the are free. In England, the charges are per medicine. Most GPS lower this cost by prescribing 3 x per different med. There are various groups who are exempt from these charges, eg those over 65' those with certain ongoing med problems, eg diabetes, asthma, coeliac disease, children at school age.

Thank goodness for the NHS!

ETA. english prescription charges. https://www.gov.uk/government/news/nhs-charges-from-april-2013-announced

[Miss Cellane]

"In all fairness to the drug companies,"
"The pharma companies could have chosen to discontinue the inhalers, if they wanted to--they didn't have to create new formulations that meet the new regulations for inhalers. They are under no obligation to produce any specific drug."

Wow, are you saying there is no obligation, at least a moral one, to keep so many people from dying, when the technology is there, and the patents have already run out once before?

"Do some research on "orphan" drugs, where there is a drug that works for a specific condition, but not enough people have that condition to make manufacturing the drug profitable. Sometimes the pharma companies just stop making it."

Wow, just wow. I take it you have never depended upon a particular drug to stay alive? Have you had anyone you loved depend on something to stay alive? If my child needed a rescue inhaler, and the company decided, "hey, we will just stop making it, we have no obligation to help any sick person, let the child die?" I should be okay with that?

If someone shows up at the ER bleeding to death, and the hospital could stabilize them with blood, but they did not have insurance, are you okay with just letting them die? Because I am not, and it's pretty much the same thing. . .

Please don't put words in my mouth that I didn't say.

I was explaining the situation. Not defending it. There's a difference. I was deliberately keeping my tone as neutral as possible.

Also trying to point out how fragile the entire system is--pharma companies are a for-profit business. Just like car manufacturers and Apple and IBM and Xerox. It's a little scary, isn't it, that our access to medications depends on those medications being profitable?

But if you want them to continue making inhalers and antibiotics and painkillers, then you have to accept the fact that under the current system in the US, those medications will cost a lot of money.

But to answer your questions--the patents ran out on inhalers. The new formulation, required by the government, not the pharma companies, allows for a new patent because it is a new formulation. It's considered a new medication, therefore it gets a new patent. The pharma companies had to spend millions of dollars researching and testing the new formulations--are they not allowed to get a patent so that they can recoup the money they spent?

Remember, they didn't necessarily want to create a new formulation--they were required to. And then they had to do clinical trials, which are very expensive and involve tracking hundreds of patients, to make sure the drug is safe. Were they supposed to eat that cost? And then provide the new medication at the old generic prices? Their stockholders might have had something to say about that.

Their other option was to stop making the inhalers.

So, either there are no more inhalers, or you get new patents and therefore higher prices.

Orphan drugs--both the US and the European Union have legislation sponsoring the research for such drugs, and financial aid to keep them in production. Because the governments realized that it is wrong to allow market pressure to drive the creation and manufacture of such medications.

One of the reasons drug prices are so high in the US is that in many other parts of the world, governments regulate the prices that can be charged for medications. The pharma companies sell their drugs in those places, charging as much as they are allowed. But in the US, they can charge as much as they feel the market will bear--and that's where they make back the billions of dollars they spent on research and development. And they only have the time that the patents allow in which to do that, cover the cost of making the drug and make a profit.

What's the alternative? I don't know. Having governments in complete charge of drug research and development? There would be problems with that system, as well, I suspect.

[SteveinMN]

Turn the question around a little. What is the obligation of a drug company to create a drug for a patient who, for whatever reason, cannot tolerate the existing treatment for their condition? What should a drug company do if the patient can tolerate the drug but it just does not improve their condition? What happens if, for whatever reason, drug companies did not make enough doses of a treatment for everyone who may need it, like flu vaccines or Cipro back when anthrax was being sent through the mail? What is a suitable disincentive in these cases?

Pharmaceutical manufacturing is a heavily-regulated business. It's not just digging stuff out of the ground. It requires multiple levels of clinical trials (and even after those the drug sometimes causes problems). Drug companies can be sued for the effects of their products in a way we don't obligate other manufacturers, like airplane or rifle manufacturers. Unless there is some way for expenses to be recouped, there won't be drug companies making any treatments, nevermind the one a patient may happen to need. It is sad and the entire issue of orphan drugs should get more support than it does. But it is what it is right now. And that kind of indirect triage won't go away even if there's all the money in the world to put toward it.

[Lainey]

Before we start too much of a pity party for the pharma industry, here's some facts on the numbers:

http://www.huffingtonpost.com/ethan-rome/big-pharma-pockets-711-bi_b_3034525.html

[JaneV2.0]

Thanks for posting that, Lainey--it's a thorough treatment of the drug industry. Heavily subsidized, lightly taxed, with R&D done by others, turning out toxic and/or useless products, for the most part, it's the griftiest among grifty industries--right up there with the banksters in this country.

[Tammy]

I have 30 years of asthma. Controlling it is so important to good health. And that requires these inhalers. I'm so lucky to have a specialist who finally has me on the right mix of treatment. I can go days and weeks now with no rescue inhalers. It's worth every penny. I'm in the donut hole in my insurance year so I'm paing 100% right now. About 400 a month for meds. It's ridiculous. But without my meds, I feel old and tired and grumpy and pessimistic and irritable ... Cause lack if oxygenation will do that to a person. With the meds, I work up to 12 hours a day in a fast paced demanding nuraing job, and i feel great. Worth every penny to feel like i'm 25 again.

[Tammy]

To clarify ... While i dont defend pharma's greed, I would not classify their products as useless. I would be dead without them.

[Miss Cellane]

"Please don't put words in my mouth that I didn't say.

And I think that what you said was extremely disturbing to anyone who depends on medication to stay alive--but you think your tone was neutral. I found your tone very upsetting.




My tone was matter-of-fact. I was stating facts, not opinions. I was not using emotional language to get a reaction.

I am not defending drug companies. I don't approve of everything that they do. I was offering an explanation of why the cost of inhalers increased--it is not just random greed, but caused by the changes in regulations. I agree, the increase in the cost of a vital medication is not good. But given our current system of developing and manufacturing medications, that's what we have.

It *should* be disturbing to people that the medication they rely on is the result of a profit-based decision on the part of the pharm companies--that was one of the points I was trying to make.

I was in no way implying that you don't have a right to get an inhaler. I would be upset if the drug companies chose to stop making them, or any other vital medication. But drugs are a business. And like any other business, they exist to make a profit. I don't understand why this fact is so upsetting to you, or why you think that my stating this fact is so very wrong.

[Miss Cellane]

Thanks for posting that, Lainey--it's a thorough treatment of the drug industry. Heavily subsidized, lightly taxed, with R&D done by others, turning out toxic and/or useless products, for the most part, it's the griftiest among grifty industries--right up there with the banksters in this country.

Yes. I can't argue with this. But let's not forget that the article also points out that Medicaid is unable to negotiate better prices. The reason many medications are less expensive in other countries is that the government-run medical programs do get better prices. Why the US denies us this basic protection is beyond me. The problem is not just the drug companies. The government has a hand in this mess, as well.

Look, I can see both sides of this argument. On the one hand, we have outrageously expensive medications, and I think that's wrong. But on the other hand, US pharma companies have developed many, many valuable drugs--because they have that profit incentive to keep researching. I realize there are people here who would deny that, but I wouldn't be here today if antibiotics hadn't been available a couple of years ago.

[iris lilies]

... About 400 a month for meds. It's ridiculous....

How much should you pay, do you think?

We don't take medications here, but we do have expensive meds for pets. My bulldog is on a miracle drug that costs $163 every two weeks. There are rebates and extra packs, but that is the cost without these extras, $320 for a month, for a dog. I'm grateful to have it. I guess that I shouldn't be grateful, I should be raging against big vet Pharma!

Should drugs be free for humans but dogs pay for it all? Dogs have no way to earn an income so I'm not sure why that would be. Wondering aloud.

But specious example or not, I am glad of pharma to provide this toxic harsh chemical solution to my dog's painful, chronic condition. I would have him put down if it wasn't controlled by this drug. While I am not all that keen on Western medicine solutions for myself, this one saved his life, he is a young dog.

[Spartana]

So I wonder, for those of you contemplating going on Medicaid with the new health care mess, do you get your medication paid for?

And does anybody know if I can get him to write a prescription which I can send to a Canadian pharmacy?

I'm not sure about Medicaid, but I believe it is completely free with no out of pocket expenses at all and no monthly premiums or cost for meds either. But I may be wrong. I know that the VA hospital charges a co-pay for any treatment and meds you use to treat a non-military-service connected conditions (service connected stuff is all free). So maybe Medicaid also charges a co-pay for care and meds but I think that's unlikely if they don't charge for anything else.

[Lainey]

Seems like posters here have bought the premise that a) only Americans invent valuable medicine, and b) these inventions will stop happening if we put any any restriction whatsoever on pricing.

Ask yourself why Walmart is able to charge $4 for a prescription? It's because they bulk-order.
Ask yourself why Medicare is Legally Forbidden from doing the same? It's because big pharma controls our congress.

Campaign Finance Reform Now.

[SteveinMN]

Ask yourself why Walmart is able to charge $4 for a prescription? It's because they bulk-order.
It also is because Walmart cherry-picks the medications which are eligible (they're not all $4). And because they know that, while you're picking up your Rx, you're picking up milk and hamburger and a toy and some towels. For them it's a loss-leader with the benefit of expressing public concern for the plight of their customers.


Ask yourself why Medicare is Legally Forbidden from doing the same? It's because big pharma controls our congress.

Campaign Finance Reform Now.
Our Congress is controlled by way too many special-interest organizations: Big Pharma, Big Ag, Big Defense, ... And nothing will change until we get the money out of politics. I'm not holding my breath.

[Miss Cellane]

Seems like posters here have bought the premise that a) only Americans invent valuable medicine, and b) these inventions will stop happening if we put any any restriction whatsoever on pricing.

Ask yourself why Walmart is able to charge $4 for a prescription? It's because they bulk-order.
Ask yourself why Medicare is Legally Forbidden from doing the same? It's because big pharma controls our congress.

Campaign Finance Reform Now.

Or maybe some posters here are just tired of Big Pharma being solely blamed for the high cost of medications, when there are many, many other factors that come into play.

Not saying pharma companies are innocent. Just that they aren't the only guilty parties in this mess. Focusing blame on them lets other interested parties get off scot-free.

[ApatheticNoMore]

Seems like posters here have bought the premise that a) only Americans invent valuable medicine, and b) these inventions will stop happening if we put any any restriction whatsoever on pricing.

pharma spends a lot of it's effort just re-patenting the same medicines as well, it's so much safer than actually doing anything new. But even with new medicines at a certain point if only 10% of the population can actually afford the new medicines it's almost cruel really rather than progress, and that's the only thing I see happening with ever increasing healthcare costs. Of course if these medicines are still available cheaply out of the country that helps. Currently though the need to charge Americans more than the rest of the world to make a profit seems to be the need to prescribe Americans medicines whether or not they need them.


Ask yourself why Medicare is Legally Forbidden from doing the same? It's because big pharma controls our congress.

Campaign Finance Reform Now.

for sure on that, and not just because pharma is expensive, because everything is undermined by this. You can not hold your breath but not much point in voting until then really either.

[sweetana3]

Hubby worked for and retired from big pharma. I can see both sides of the issue. I still do not like "medicine" however, my Advair was a lifesaver and thank god someone invested the inhaler with a built in counter to let you know when it was running out.

[Teacher Terry]

I have tried a homeopathic doctor/meds my for asthma and it did not work. Many people do not realize that a lot of people die every year from asthma because they wait too long to go to the emergency room. When we lived in Kansas they would do announcements on the TV in summer reminding people to take this seriously & noting how many people died. Also asthma does not just have one cause-it has many ( pollution, allergies, etc). For instance when we lived in the Midwest my son had it from the pollution but I did not. Fast forward to moving to the West coast his asthma disappeared & I developed it. Also, I do think 400/month is too much to pay for meds. There are many people that have to choose between food, meds & heat. Such a sad situation!

[catherine]

I have tried a homeopathic doctor/meds my for asthma and it did not work. Many people do not realize that a lot of people die every year from asthma because they wait too long to go to the emergency room. When we lived in Kansas they would do announcements on the TV in summer reminding people to take this seriously & noting how many people died. Also asthma does not just have one cause-it has many ( pollution, allergies, etc). For instance when we lived in the Midwest my son had it from the pollution but I did not. Fast forward to moving to the West coast his asthma disappeared & I developed it. Also, I do think 400/month is too much to pay for meds. There are many people that have to choose between food, meds & heat. Such a sad situation!

Asthma is nothing to fool around with.

I tend to be medication averse (luckily I have no chronic disease and I won't take antibiotics lightly), and I also work for Big Pharma, and have seen the good side and the bad side, and it's counterproductive to try to make them out as either enemy or saviour. Their business decisions, like it or not, save lives. That said, I help them market drugs, so sure, they push the price sensitivity, and they invent conditions and syndromes, and they drive guidelines. On the other hand, mortality from heart attacks has gone way down, and cancer is much, much more treatable--and not any thanks to homeopaths.

So sorry you're faced with this situation! All pharma companies have patient assistance programs, and if you are faced with not being able to afford the medication you need, it might be worth looking into. Also look online to see if you can find copay coupon cards

[Teacher Terry]

I didn't mean to imply that my meds are a financial burden but that for my of my clients the financial burden is real.

[catherine]

I didn't mean to imply that my meds are a financial burden but that for my of my clients the financial burden is real.

I realize that--I was agreeing with you on the asthma comments--but directing the information about copay cards and patient assistance programs to the OP. No doubt about it, 350 is a lot to pay for medication.

[Teacher Terry]

I enjoy the boards but sometimes it is easy to misunderstand something:~)

[Teacher Terry]

Recently I was informed by our insurance co that they were no longer going to cover advair at a 40/co-pay but would pay about 30% of the cost. They recommended some other meds that I could use but did note that I would need to take 2 meds to do the same thing that one does. It seems like they are calling the shots instead of the docs! Needless to say I was pretty upset!

[catherine]

Hi Catherine! Since you said you are directing this to me, the OP, and you say you work for big Pharma, I would like to ask you what percentage of your take home pay you feel would be reasonable for you to pay for medications that keep you alive and allow you to work at your job. (I know, you said you have no chronic illnesses, so you have to put yourself in a hypothetical frame of mind here.) Remember, if you do not take the medicines, you may end up dead. Just disregard coupon programs, since they are not long term--I am asking about the kind of situation Tammy describes, where she pays for the meds. Now imagine you pay for the meds--what do you feel is reasonable, percentage wise, not a dollar figure? I am curious.

That's a really hard question.. I don't take meds, but DH takes a statin (which is cheap, generic), and an expensive combination anti-hypertensive, and a proton pump inhibitor for his Barrett's (I've started buying it OTC because it actually works out cheaper than the prescription). I spend about $175 for his medications. Plus my healthcare plan is a LOT of money ($5000 deductible/$1400 a month).

I remember being in a focus group of women with rheumatoid arthritis, and Enbrel had just come out and they wanted to find out what women thought about it.. and one woman, who had kids and was just trying to get through her day pain-free talked about how she couldn't afford it, and my heart broke for her.

I think if people spent 10% of their income on healthcare, that would be a shame, but perhaps surmountable. I spend more than that, but I do OK, because ironically Big Pharma pays its consultants pretty well.

But I think Miss Cellane is right--this is the situation that we are in.. it's a free market economy, in this case, pretty heavily regulated. And she's absolutely right in that a LOT of work and time is put into the development of drugs. There are thousands of drugs that never make it to the market, and the price of the drugs that do have to cover those that don't. In a perfect world anyone should be able to get whatever they need to make their quality of life sustainable for doing what you need to do.

My MIL paid $1 for her prescriptions--any of them. She worked as a clerk in Macy's and then as a union administrator. The union had lobbied heavily for this benefit. She worked on her feet for decades to "earn" that benefit. I know that as a self-employed person if I want to pay for my freedom with high healthcare costs, that's my prerogative. That's what I've chosen to do.

But yes, it feels grossly unfair that there is an oasis of pharmaceuticals and people are dying of thirst. But that's what we have and that's where we are.

[Teacher Terry]

One of the reasons that it is not a burden is because we are still working p.t. It may be a different story when we fully retire. I also have high BP & a heart problem even though I have been exercising since I was 30. Although, the doc thinks that is the reason I got the BP 20 years later then everyone else in my family. So I know what it is like to have more then one life threatening condition.

[catherine]

No lectures on free market economics, that's a dodge.

"I think if people spent 10% of their income on healthcare, that would be a shame, but perhaps surmountable. I spend more than that, but I do OK, because ironically Big Pharma pays its consultants pretty well."

I guess you are lucky then; Tammy is a nurse and she's hurting trying to pay over 300 dollars a month.

Do you think that irony comforts those of us who struggle to pay for the medications to stay alive? (I speak for myself and other people I know; I don't speak for Tammy or Terry, just to be clear.)

Back to the question I asked you--what figure of your take home pay do you feel would be reasonable?
5- 10- 50--100 percent?

There are a lot of questions we can ask: If a cancer therapy costs $30,000 for a course of treatment that has shown four months survival, do you pay it to keep your loved one alive for four months? If your loved one gets Alzheimer's and you can't afford long-term care, do you divorce them so they can go on public assistance? If they tell you that you are fine to leave the ER, and they've taken you in because they had to, do you believe them? If you suspect your child has a broken bone, but an x-ray will cost more than you can afford, do you wait a few days?

We can ask those questions and many more. None of the answers are going to make us feel any better. So how much would I personally feel comfortable paying for my family's healthcare? I already told you, I'm paying a very high percentage for healthcare overall, and I don't think separating out just prescriptions is an accurate way to figure it out. I don't like how much I pay for healthcare. I'm bummed about it, just as bummed as you are about high costs for your medication. Until we get a reasonable single-payer plan, and until we unravel the mess that is the healthcare system, we're stuck with it.

[SteveinMN]

There are a lot of questions we can ask: If a cancer therapy costs $30,000 for a course of treatment that has shown four months survival, do you pay it to keep your loved one alive for four months? If your loved one gets Alzheimer's and you can't afford long-term care, do you divorce them so they can go on public assistance? If they tell you that you are fine to leave the ER, and they've taken you in because they had to, do you believe them? If you suspect your child has a broken bone, but an x-ray will cost more than you can afford, do you wait a few days?
And then the intensifying question of whether someone else (taxpayers, other insureds, or health-care providers) should pay for those treatments if individuals (or their caretakers) cannot.

Playing on that question gave rise to the Republican scare tactic of "death panels". What they carefully avoided saying was that, in the current U.S. system, "death panels" already exist within insurer's office buildings, approving or rejecting coverage for medical procedures and for formularies which determine which drugs are covered, effectively guiding treatment because few can afford to pay outside of insurance.

Not that the problem will go away with a single-payer system. If someone who is, say, 85, needs a hip replacement, do they get it automatically? Does their treatment get a lower priority than, say, several years of inhalers for a severely-asthmatic kid? Other civilized societies have addressed this situation, so if Americans can get over Not Invented Here, there will be lessons to learn. We have put off holding that conversation by associating it with whether an individual has enough health coverage to start with. It will not be an easy conversation.

[JaneV2.0]

Maybe it's just a pipe dream I have, but I'd like to see a day when doctors focus on the cause of their patient's illness, and use pharmaceutical drugs sparingly and for as short a period as necessary (because they're all toxic). I doubt we'll ever get there (or back there) because of our almighty profit fetish. If doctors practiced medicine this way, it would be much less expensive, much more effective, and much more humane. The idea is not to create life-long medical cripples, but to actually cure people. There would still be sick people of course, but a lot fewer of them.

[catherine]

Maybe it's just a pipe dream I have, but I'd like to see a day when doctors focus on the cause of their patient's illness, and use pharmaceutical drugs sparingly and for as short a period as necessary (because they're all toxic).

The interesting thing is, it's not all on the doctor. I've interviewed tons of doctors who tell me that they feel that HAVE to write a prescription, because if people are taking time off of work to see the doctor and are paying for it, they expect to be "fixed" with a prescription from the doctor. Recommendations for alternatives and/or OTC medications just don't cut it--they get the response, "I could have done that--what am I paying YOU for?"

[JaneV2.0]

The interesting thing is, it's not all on the doctor. I've interviewed tons of doctors who tell me that they feel that HAVE to write a prescription, because if people are taking time off of work to see the doctor and are paying for it, they expect to be "fixed" with a prescription from the doctor. Recommendations for alternatives and/or OTC medications just don't cut it--they get the response, "I could have done that--what am I paying YOU for?"

I think patients have just become used to having prescriptions thrust at them for everything. If you trusted your doctor, you'd believe her/him when he told you drugs were unnecessary. The system is so broken in so many ways that maybe we need to scrap it and start over.

[sweetana3]

And how many doctors have told their patients to lose weight, get more exercise, eat better, stop smoking and drinking, reduce stress, etc? How many have listened and taken even one step? I would bet a negligible minority. I was one that ignored anything my doctor told me. I only went for flu shot and asthma medicine.

Now that we have lost weight and exercise, we have stopped all but one medicine. We feel better than we have in years. Now if we had listened we could have saved a lot of time, trouble and money.

[catherine]

And how many doctors have told their patients to lose weight, get more exercise, eat better, stop smoking and drinking, reduce stress, etc? How many have listened and taken even one step? I would bet a negligible minority. I was one that ignored anything my doctor told me. I only went for flu shot and asthma medicine.



Sweetana, you are right. I did an extensive obesity project to ask doctors exactly that. I can tell you that doctors are SO frustrated because they say it and say it and say it and patients are completely non-compliant. The only variable in the doctors' attitudes is how quickly they just get so frustrated, they might say it once, and then just lose hope. Some doctors go to greater legnths to make the patient more accountable to him/her, but it's an uphill battle. Plus PCPs are incredibly busy and overworked, so they can't hold al their patients' hands. They pick the low-hanging fruit, those patients who seem genuinely motivated. That's the minority you speak of.

And almost every doctor I spoke with hated the idea of obesity drugs because it's not the right answer. It's letting patients off the hook. The right answer is diet and exercise.

And I might add, in my own experience, our family practitioner reads DH the riot act EVERY TIME DH goes and admits he has not stopped eating, smoking and drinking. Like everything else, you can lead a horse to water...

[JaneV2.0]

It's all fine and dandy to tell someone to lose weight, "Eat less, move more" and all that conventional wisdom while looking down your nose at the "weak, irresponsible, fill in the blank fat person." Most doctors don't know anything about nutrition, and what they do know is wrong. And, of course, not all people with people whose BMI is above the constantly moving (downward) target number are unhealthy.

But if a doctor sincerely wanted to help, he/she would research the subject--telling them there isn't one right diet plan, it's important to find one that works and that you can live with forever, provide some information, then be supportive. Many people who need to lose more than a few pounds to be healthy have dieted for most of their lives. Diets rarely work for them (a 95% failure rate in the literature) and they really don't need some dismissive offhand "solution."

Having said that, I have some hope in the "wisdom of crowds" solution offered here by one of my favorite thinkers:
http://www.youtube.com/watch?v=KzPnnDDCIjo

[Miss Cellane]

Maybe it's just a pipe dream I have, but I'd like to see a day when doctors focus on the cause of their patient's illness, and use pharmaceutical drugs sparingly and for as short a period as necessary (because they're all toxic). I doubt we'll ever get there (or back there) because of our almighty profit fetish. If doctors practiced medicine this way, it would be much less expensive, much more effective, and much more humane. The idea is not to create life-long medical cripples, but to actually cure people. There would still be sick people of course, but a lot fewer of them.

I think insurance companies also come into play here. Do they want to pay for the tests, sometimes multiple tests, to determine the cause? And then pay for the treatment, if there is one, to fix that cause? Or do they want to pay for a prescription that handles the symptom, but not the problem, but most likely costs a lot less?

Doctors have about 15 minutes to spend with a patient, based on insurance reimbursements. Is that enough time to find the source of the medical issue? Probably not.

[JaneV2.0]

I think insurance companies also come into play here. Do they want to pay for the tests, sometimes multiple tests, to determine the cause? And then pay for the treatment, if there is one, to fix that cause? Or do they want to pay for a prescription that handles the symptom, but not the problem, but most likely costs a lot less?

Doctors have about 15 minutes to spend with a patient, based on insurance reimbursements. Is that enough time to find the source of the medical issue? Probably not.

Yeah, that's why I think the system needs to be scrapped.

[catherine]

Yeah, that's why I think the system needs to be scrapped.

Shoot, Jane, that's just a start. I say we scrap the culture. We can blame Big Pharma, doctors, insurance companies, managed care payers, and the patients, but fix all that, and we'll wind up still living with the root causes of what's making us sick to begin with

[rodeosweetheart]

"It's all fine and dandy to tell someone to lose weight, "Eat less, move more" and all that conventional wisdom while looking down your nose at the "weak, irresponsible, fill in the blank fat person."

It's so true, Jane, so true. I think people love to think it is the fault of the sick person, because it distances them from the idea that something similar could happen to them. No one likes to feel powerless; it's so much easier to blame someone and say, "it's your fault that ____ because you ate too much, took too much medicine, didn't take enough medicine, didn't follow your doctor's advice, did follow your doctor's advice, went to the doctor too much, didn't go to the doctor enough, didn't find an alternative practitioner--and on it goes." I guess when these folks get sick, then they'll get it, maybe. Hopefully they will not get sick. It sucks to be sick, and it REALLY sucks to have people blaming and shaming you or threatening that you will not receive help or treatment.

[ApatheticNoMore]

The thing is people often don't even come into the doctor with those complaints, you go to the doctor for a check up or for x concrete problem or something, and before you're out the door you are prescribed something for some other problem you didn't even know you had, like statins get thrown at you (they did at my mom whose good cholesterol was actually pretty favorable!). So it has nothing to do with wanting a doctor to fix a problem and not taking steps to help yourself and so "what choice is there?". You never wanted that problem fixed at all really! Drugs just ended up being thrown at you.

And do doctors warn about the potential risks and complication of the drugs? Do doctors evaluate any drugs you may ALREADY be on for possible interactions, side effects etc.? When you have symptoms do doctors consider it may be due to existing drugs rather than just throwing another drug at it? Do doctors do serious diagnosis, to find the cause of problems, rather than just try drugs WITHOUT even a diagnosis? Drugs as a means of experimenation as a substitute for first doing a serious diagnosis? Do doctors with total tolerance for the individuals ability and in fact right to make their own decisions explain possible non-drug solutions (there is a difference between conveying information, which is absolutely vital, and moralizing, even a smoker may not realize the true cancer risk they are running say, a doctor can make that clear and then that's all). THAT IS WHAT WE WANT FROM DOCTORS! :)


And how many doctors have told their patients to lose weight, get more exercise, eat better, stop smoking and drinking, reduce stress, etc? How many have listened and taken even one step? I would bet a negligible minority.

these are almost always of course when not physical issues, psychological issues, which the doctors may or may not have any training whatsoever for.

[JaneV2.0]

"It's all fine and dandy to tell someone to lose weight, "Eat less, move more" and all that conventional wisdom while looking down your nose at the "weak, irresponsible, fill in the blank fat person."

It's so true, Jane, so true. I think people love to think it is the fault of the sick person, because it distances them from the idea that something similar could happen to them. No one likes to feel powerless; it's so much easier to blame someone and say, "it's your fault that ____ because you ate too much, took too much medicine, didn't take enough medicine, didn't follow your doctor's advice, did follow your doctor's advice, went to the doctor too much, didn't go to the doctor enough, didn't find an alternative practitioner--and on it goes." I guess when these folks get sick, then they'll get it, maybe. Hopefully they will not get sick. It sucks to be sick, and it REALLY sucks to have people blaming and shaming you or threatening that you will not receive help or treatment.


Exactly. None of us gets out of here alive, and we could all use a little kindness in the meantime.

[JaneV2.0]

Shoot, Jane, that's just a start. I say we scrap the culture. We can blame Big Pharma, doctors, insurance companies, managed care payers, and the patients, but fix all that, and we'll wind up still living with the root causes of what's making us sick to begin with

You make a good point. This culture needs to be scrapped.

[rosarugosa]

Hey Jane: I listened to that whole video, and I thought it was amazing! Thanks for sharing!

[JaneV2.0]

Hey Jane: I listened to that whole video, and I thought it was amazing! Thanks for sharing!

I have a lot of respect for Tom, and I think people taking things into their own hands with the help of "the crowd" is absolutely the wave of the future. You can't wait around for the battleship to turn.

[Miss Cellane]

Just came across this article: http://www.npr.org/blogs/health/2013/12/30/256885858/-1-000-pill-for-hepatitis-c-spurs-debate-over-drug-prices

Basically, a pharma company has developed a new, safer, better treatment for Hepatitis C, which is a good thing.

They are going to charge $1,000 per pill, for a total cost of $84,000 for the treatment. (Plus the cost of other necessary drugs.)

So, yeah! for an effective treatment. ????? for the cost.

The company claims it cost them more than eleven billion dollars to create the drug. They deserve a profit, don't they? Critics say that they will recoup their costs after 2 million patients, and then should lower the cost.

But recouping costs isn't the same as making a profit. And since the company is in business to make a profit, they don't seem to want to lower the cost.

This is one of the few articles I've seen that even tries to take a more or less neutral stance, and looks at the issue from many sides. There's some interesting discussion in the comments, too.