Wednesday, October 29, 2008

Saving on Prescription Drugs - An Insider Speaks - Part One

The financial and economic crisis has caused millions to lose value in their stock portfolios, to witness the worth of their homes fall, and many to lose their jobs. Many are worried about how to pay for their prescription drugs. Some are not refilling prescriptions or cutting back which will endanger their health.

The good news is if you understand from an insider how to get prescription drugs cheaper (without necessarily purchasing online) or at least ensure that for the money you do spend that you are getting the best value then you should feel confident that you are spending your money and protecting your health wisely.

First tip, if you do need prescription medications, go to Walmart, Target, or other pharmacies which offer $4 for generic medications and $10 for a 90 day supply of generic medications. This is often cheaper than the copay offered by insurance companies. Insist your doctor write you a generic medication when available. Generic medications are simply branded medications that no longer have patent protection. Due to FDA regulations the generic medications are as good as their branded counterparts. Note that the best-selling drugs like Claritin for allergies, Prilosec for heartburn ("the purple pill"), Zocor for cholesterol, over the past few years have gone generic and do the job. Smart shoppers realize that generic medications are cheaper because you aren't paying for the brand name or the multimillion marketing campaign. Get the Walmart list of $4 medications here and take it to your next doctor's appointment and ask him to change what you are taking to medications on this list.

Second tip, find the best medications for their category (allergies, heartburn, blood pressure, cholesterol) via a free Consumer Reports website at Consumer Reports Best Buy Drugs. See which medications make the list on both the Walmart list and the Consumer Reports list. Then you know you've gotten the most for your money. Save money and stay healthy.

For more tips on saving on prescription drugs, check out a recent segment on the Today show.

Tuesday, October 28, 2008

Prescribing Placebo Treatment Study Is Flawed and Misleading

A recent study suggested that doctors common prescribe placebo treatments and that this behavior is considered ethically permissible. The article received a lot of press. Pity that the study is terribly flawed and misses the point.

Researchers admit that the behavior of doctors recommending treatments that weren't proven to be helpful (i.e. antibiotics for colds, which are caused by viruses and therefore can't be killed with antibiotics) was best captured by the world "placebo". Very misleading. The problem is that placebo "is a substance or procedure a patient accepts as medicine or therapy, but which has no specific therapeutic activity. Any therapeutic effect is thought to be based on the power of suggestion." Antibiotics do have therapeutic activity, just not against viruses, and can cause major side effects.

Doctors don't write prescriptions for antibiotics for the placebo effect. They prescribe it because patients demand it and to ensure that patients come back again, doctors feel pressured to comply. Research shows when patients demand advertised medications, more often then not they get exactly what they wanted. Unlike the conclusion of this study, many doctors felt ambivalent that they wrote the medication.

Saying that recommending over the counter analgesics is also a placebo is also a problem. These actually do have therapeutic effects like decreasing pain or fever. As the researchers found practically no one prescribed sugar pills.

Doctors are prescribing antibiotics and sedatives for conditions which they might not help, not because of the placebo effect, but because patients demand something be done and the offered therapies probably won't cause harm (and the doctors simply want to avoid a confrontation or discussion of why no therapy would work), doctors aren't practicing evidence-based medicine (the vast majority of sinus infections - sinusitis and bronchitis in healthy individuals does not require antibiotics and vitamin b12 injections don't help with general fatigue), or doctors just want to do something. In all three scenarios, potential harm can occur.

This is contradictory to the meaning of placebo and why the study's claim is so flawed and misleading. As the authors noted, "Few of the physicians we surveyed recommend inert placebo treatments. " i.e. pills that do nothing, like sugar pills. Why? Because unlike other cultures, like Israel where doctors about a third of the time do prescribe sugar pills, placebo treatment is not considered acceptable treatment.

Claiming that doctors commonly prescribe placebo treatments and are ethically fine with it is wrong. It is a shame that the media didn't have the level of sophistication necessary to dissect this out.

Monday, October 27, 2008

Literature and Medicine Equals Better Doctors

Medical schools are starting to use literature as a way of getting students and resident physicians more empathetic and compassionate. It makes good sense.

When I was in medical school, I was in a small group that met weekly for months on the topic of death and dying. A century ago, death and dying was common in America. It was before the discovery of antibiotics. People died more often from accidents, infectious disease, illnesses and even childbirth. Many others were debilitated from viruses like polio or scarred from smallpox before the discovery and use of vaccines. Everyone knew someone who died at a young age. Death was commonplace and everyone was aware. Doctors frankly could do little more than comfort and hold someone's hand as we had few tools to help.

Today, given all of the modern advances in medicine, we've seem to have forgotten that death still exists. As a society few of us have known someone who died in childbirth or from infection like many did years ago. Naturally, the lack of familiarity results in supreme discomfort and is the likely reason many of us, both doctors and non-doctors are uncomfortable.

This story on the humanities and its role in medical training frankly provides the connection of the past to the present. While we as individuals many not see death early on in life as generations before us, we can imagine and empathize their experiences through literature. Great idea. The next generation of doctors should not only be technically savvy but also equally as compassionate.

Now if they would only all go into primary care to address the national shortage!

Wednesday, October 15, 2008

Kiss Healthcare Reform Good-Bye

I think we can safely kiss healthcare reform good-bye. We can thank the financial meltdown for this. With the most storied and large financial institutions like Lehman Brothers and Merrill Lynch folding as banks like Washington Mutual and Wachovia seek suitors like JP Morgan and Wells Fargo to bail them out, our economy has grinded to a halt. Banks don't want to lend money to businesses or consumers, even those with good credit, because they fear the borrowers won't return their money.

Homeowners have burned many banks by being unable to pay their adjustable rate mortgages and walking away from homes which are now worth far less than the loan amount. Certainly many of these homeowners were fooled into thinking they could purchase more than they could afford. Despite who was responsible for the mess, the reality is no one will lend money out which drives the economy.

To foster more lending and hopefully to improve trust between lenders and borrowers, Federal Reserve chairman Ben Bernake and Treasury Secretary Henry Paulson convinced Congress to give them authority to invest $700 to $800 billion to simulate the economy. The federal budget which ended September 30th resulted in a deficit of nearly $500 billion. Next year because of the action taken by the Treasury, the deficit will be far larger. With a predicted price tag of nearly $65 billion to implement Senator Obama's healthcare reform plan (note Senator McCain has not indicated the costs of his plan), it is highly unlikely that even with a presumably Democratic Congress that elected officials will agree to spend even more money despite the healthcare crisis.

The even bigger issue beyond reforming a poor performing healthcare system is what to do about the looming crisis in Medicare . With the first of baby boomers entering Medicare, benefit programs like Social Security and Medicare will dominate the federal budget. Both are underfunded with Medicare being worse of the two. Neither political party, Democratic or Republican, has dared attempted to make the gutsy and necessary changes to make these programs solvent.

What can you expect? Higher healthcare costs, more uninsured, and a general decline in the nation's health. A couple retiring this year must have about $300,000 available for future healthcare costs. With a stock market in freefall, it is clear people have less available than before. As a result they may unfortunately skimp on necessary preventive care and treatments. While decreasing their costs in the short-term, these choices will cause more expensive complicated problems down the road. The country will pay a price for this with a less healthy workforce or populace with increasing diability. In addition, individuals will discover what many have already which is the leading cause of personal bankruptcy is due to medical costs.

What can you do? Educate yourself. Find out how what medications are worth your money, what screening tests you must have, what you must do to stay healthy and well, and when to seek care and utilize the healthcare system. Our government doesn't have the financial resources or the leadership needed to truly overhaul our convoluted, frustrating, and fragmented healthcare system. This is one situation where only the informed and educated individual can make the difference between getting so-so care, which is the current state of affairs, and getting the right care which is what everyone deserves but increasingly will be unable to get.

Tuesday, October 7, 2008

Full Disclosure - Calorie Counts

The New York City Health Department had a press release announcing their campaign in making the public aware of the number of calories individuals should have daily to maintain a healthy weight. Dubbed "Read ’em before you eat ’em" and with ads in NYC subways, the health department is trying to make aware how portion sizes have increased.

Recently California Governor Arnold Schwarzeneggar signed into law a proposal which requires restaurants operating more than 20 sites to have calorie counts posted on the menus by 2011, becoming the first state in the union to do so.

Will calories displayed prominently help consumers make wise decisions about their eating habits and decrease the numbers of individuals who are now overweight or obese? While both the NYC and California proposals are excellent (and note that the restaurant industry is fighting the NYC plan and yet seems on board with the California one), perhaps they could take it a step further and indicate how much activity it takes to burn off calories. After all, calories are simply numbers. To make people fully appreciate their caloric intake, illustrate how much time and what type of exercise would be needed to burn off a muffin or hamburger.

Since few of us have free time, if these groups showed us that we needed to exercise for four hours to maintain our weight, I'm sure most of us would be much more careful about how much we eat. After all, who has four hours to exercise everyday?


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