In the U.S. today, doctors are too quick to prescribe drugs that their patients don't really need and often can't afford, writes Ed Wallace
Editor's Note: This is Part Three of a five-part series on the health-care crisis.
It started with creeping numbness across her upper right abdomen. When after months of concern the sensation would not go away, Judi, a news assignments manager for a Dallas TV news operation, decided it was time to have a complete physical. Her primary physician referred her to a neurologist, which led to a series of MRIs covering her spine, neck, and brain. The results were not reassuring: The scans showed a small spot of demyelination on her spinal cord, typically the first sign of multiple sclerosis.
In essence, Judi's own immune system might be eating away at the protective sheath that covers the nerves running throughout her body, causing them to misfire. Her neurologist claimed that it was MS, but also ordered a lumbar puncture to test for MS markers in Judi's spinal fluid—a compressed or damaged disc in her back would cause the same symptoms.
Judi sought a second opinion from Dr. Ralph Rashbaum at the Texas Back Institute in Plano, Tex., who was only slightly more encouraging. He told Judi that there was an 80% chance she had become a victim of multiple sclerosis. But he also shared that his own daughter Tracey was afflicted with MS, and she was receiving treatment from Dr. Elliot Frohman at Southwestern Medical in Dallas.
Risks of Treatment
Rashbaum's praise for the groundbreaking work Frohman was doing was reassuring. He said his daughter was responding well and carrying on a full life as a wife and mother of two. For Judi, however, the shock of the diagnosis allowed little room for hope.
But there was a discrepancy in Judi's spinal tap results: All the markers for MS came back negative. While there was one spot of demyelination on her spinal cord, the cause of that damage was not MS. Dr. Chen, Judi's neurologist, delivered the good news—but at the same time said she wanted Judi to start the treatment as if her tests had come back positive.
This was a problem, because the proposed treatment's side effects come with their own risks. As Dr. Rashbaum explained, one occasional hazard of treating MS with interferon-based medicines is death.
There was another major factor, and it too is a primary reason why health care costs so much in America. Treatment today for multiple sclerosis often exceeds $10,000 a year, and this disease is a lifetime commitment on the part of the insured's health insurance plan. Moreover, treatment with the newest drug, Biogen's (BIIB) Avonex, could cost upwards of $18,000 per year.
The proposed treatment involved in this case could have amounted to a lifetime cost of more than $450,000—and this for a patient who in fact does not have the disease for which the treatment was prescribed.
Moreover, medical professionals disagree on how to proceed with treatment even if MS is the verified diagnosis. Some prefer to begin treatment immediately, while others suggest a waiting period; the disease has an extremely slow initial progression, and the symptoms with which MS can expand and ravage a person's nervous system are not consistent.
However, there is total agreement among medical professionals that the advances in care for MS victims have been nothing short of phenomenal over the past 20 years. While current treatments do not stop MS, they can slow the progression of the disease to the point that its victims live much fuller lives for much longer.
Judi decided to wait one year, repeat the MRI scans, and see if the demyelination progressed. This decision saved her health-care provider more than $10,000 this year alone. Fifteen months later new scans showed no further areas of demyelination.
Too Many Pills?
Are we an overmedicated society? Certainly much has been written concerning doctors' tendency over the past four decades to overprescribe antibiotics. Many physicians today worry that bacteria could build up immunities against these drugs, ruining antibiotics' effectiveness in the future. But as they are relatively inexpensive, antibiotics are often favored by physicians.
But the expensive overmedication of America really began 12 years ago, when the Federal Drug Administration allowed drug companies to advertise their products on TV. Americans could now diagnose themselves during commercial breaks, and then "ask their doctor" to prescribe the most expensive, no-generic-available wonder drugs.
The U.S. is the only industrialized country in the world that allows this practice, and it's not without controversy here. The pro argument is that some individuals who have been quietly suffering from one malady or another can be motivated to find a doctor and obtain medical help. The con argument is that many individuals with only one symptom—which might not necessarily indicate the problem the drug in the TV ad is for—may demand that medication from a physician, who in turn may see no harm in prescribing it.
Today, TV ads encourage consumers to self-diagnose and treat potentially serious medical problems as easily as they rid themselves of dandruff with the right shampoo. Sleepless nights, diabetes, seizures, allergies, depression, chronic bronchitis, high cholesterol, dry eyes, overactive bladders, tingling in your legs, baldness, and the list goes on and on. In some cases, the commercial even suggests that the drug's manufacturer will help you find a physician to gladly write the prescription for you.
Two years ago a UCLA study published in the Annals of Family Medicine came down hard on these advertisements. It found that pharma ads are so suggestive that they're influencing Americans to believe that we are sicker than we really are—and, as a result, we're taking medicine we don't need.
UCLA's Dr. Dominick Frosch summed up this modern movement toward selling drugs for potentially nonexistent conditions in Medical News Today: "We're seeing a dramatization of health problems that many people used to manage without prescription drugs. And the ads send the message that you need drugs to manage these problems, and without medication your life will be less enjoyable, more painful, and maybe even out of control."
No one knows the real cost to our health-care system for those unnecessary drugs, but it is possibly in the tens of millions or even billions.
Another drug-related issue, especially for families with elders, is the sizable number of different medications their loved ones are taking. One of the problems with pharmaceuticals, particularly where multiple doctors are prescribing for the same patient, is the potential for serious issues arising from bad drug interactions. There is also the potential for one life-saving drug to cancel out the effect of another.
Take the case of a heart attack victim who also suffers severe allergic reactions. The beta-blocker prescribed by the cardiologist for your heart can also block an EpiPen's epinephrine, stopping it from reversing the effects of severe allergic shock. If your heart doesn't kill you, the bee sting might.
Medicine is a complex science, and some doctors suggest that at times it's more of an art. However, there is little difference (besides the cost) between suggesting treatment for a case of MS that didn't exist and suggesting drugs on TV to treat possibly nonexistent problems.
The drug ad debate continues because some people are saved or have their health restored because medical cures are advertised directly to the public. But the practice also puts the nation's physicians in a position where they can lose good patients by refusing to prescribe new drugs that may not be needed. Many physicians are asked every day for these medicines; they likely do a risk-benefit analysis, but if in the end they assess that it could do no real harm, they generally write the scrip.
And so the overall cost of health care in America continues to skyrocket, fueled in part by advertising designed to convince us we are sicker than we really are. And at least one neurologist who suggests incredibly expensive, even potentially life-threatening treatments for a condition that the patient doesn't have.