Wednesday, November 08, 2006

Another problem with medicine

I apologize for interrupting Boss's fun posts with my pensive tirades about medicine (that I'm sure nobody is too interested in, but are cathartic for me...).

My current rotation is outpatient internal medicine. I see patients who have lots of chronic problems and they usually take lots of medications. Most of my patients are uninsured or government insured and have no money for healthcare. They are typically not compliant with the treatment regimens they are given and that just makes all their health problems worse.

I've seen it over and over--the patient can't afford the drug, but instead of telling the doctor, they just don't buy it and don't come back. At least, they don't come back until the serious complications kick in.

There's a good case made for the economics of the drug industry--if certain drugs weren't so expensive there wouldn't be any research and development funds and we wouldn't have certain great drugs available to us at any price. I recognize that our free market has lots of injustice, but it has successfully produced the most innovative drugs in the world.

So, after seeing a docket of patients complaining of the personal sacrifices necessary to take the drugs we prescribe, I reconciled myself to the frustration as I left the clinic for noon lecture.

At noon lecture a drug representative welcomed me with fancy promotional materials for a powerful antibiotic (she didn't mention that it's one of the most expensive ones available). And then I helped myself to the fully catered lunch, most of which I knew would be left-over and wasted, provided by the drug company representative.

Should I abstain at times like that? There are some who do (not here, but around the country), with no effect whatsoever. The companies can market their drugs the way they see fit, and that has historically been spending obscene amounts of money on physician gifts and "educational" conferences. The conferences usually consist of a meal at a fancy restaurant with a presentation about one of the company's drugs (which they pretend is objective). Regulations now make it illegal (I think) to give out any gift with a value of more than $2. So we get a lot of fancy pens with drug names on the side. Some residents collect them. I'm ambivalent. Writing with those pens feels completely innocuous at times, but at other times it feels like I'm writing with patient blood.


Daniel Haszard said...

This is the kicker...Zyprexa is only FDA approved for schizophrenia (.5-1% of pop) and some bipolar (2% pop) and then an even smaller percentage of theses two groups.
So how the heck does Zyprexa get to be the 7th largest drug sale in the world?

Eli Lilly is in deep trouble for using their drug reps to 'encourage' doctors to write zyprexa for non-FDA approved 'off label' uses.
The drug causes increased diabetes risk,and medicare picks up all the expensive fallout.There are now 7 states (and counting) going after Lilly for fraud and restitution.
Daniel Haszard

Mark said...

I appreciate these posts as well, especially the perspective of someone on the inside who cares.

But that precisely is the big problem with Health Care - So much of what is now practiced is Health Business, that the Care gets edged out.

Ree said...

You ask thought provoking questions, coach. I wish there were easy answers. If only the health care system could be fixed by refusing to use pens...

Tarimisu said...

I like when you write about these things, because health care and the cost of it is a common topic of conversation in my house. Thankfully for me, from time to time my doctor and the kids' doctor have given us meds given to them by the drug rep, things that we needed but couldn't afford (because the doctor was informed that it would be too much for us to afford), so maybe there can be good ways to remedy a bad situation. What do you think? Thanks for caring so much and working with integrity.

Anonymous said...

My wife and I are both in the healthcare BUSINESS. My wife is a provider; I produce parts going into healthcare appliances. Just like coach, she gets pens and notepads given to her. I use these goodies occasionally but don't really like the pens because they don't have the familiar feel of my own pen. (Incidentally my own pen costs less than $2.) At work, where we make the parts, it is a GOOD week if we only scrap $15,000 worth of parts; a BAD week if it happens to be $100,000! (A big part of my job is to help my employer avoid the $100,000 week.) Some of the parts we scrap only have very minute flaws; but they are scrapped anyway. We are very conscious of product liability. A company can be sued big time if it fails with a patient in the area or gives a wrong diagnosis. The FDA also insists on copious records to document EVERY step in the manufacturing process of every single part. Every part can be traced back to the manufacturer which refined the metal. (They may even know what day it was dug out of the ground!) We need to store the record as long as there is even one part just like it in the market place. All these accessory records do not add to the value of the product, but they sure add to the cost of the product. So, much of the cost of medical care is actually spent for RISK AVOIDANCE and/or ABATEMENT. Just thought you would like to know.