Monday, May 19, 2008
Sex and drugs and pharmacies
Over at Junkfood Science, Sandy Szwarc had an excellent post today on the rather incredible prevalence of prescription drugs in America today and the financial motives behind such large-scale prescribing.
Full disclosure: I'm in favor of meds for those who need them. Actually, I often wish SSRIs had been around when I was a teenager. I often wonder who I might have become had I not had to deal with the continuous panic attacks that started around age 11. Living in constant terror shaped me, body and soul. For better or worse.
Still. Some of the statistics Szwarc quotes are staggering: More than half of all insured Americans take some kind of prescription for a chronic condition. (Note that it's 50 percent plus of insured Americans.) Nearly half of all young women in this country now take ongoing meds. Likewise one in three children.
As Szwarc points out, pharmacy benefit managers stand to gain big bucks from the rise in chronic prescriptions. But most doctors don't benefit directly from prescriptions. They have patients' best interests at heart. The trouble is in how one defines best interests.
Case in point: The women in my family tend to have high cholesterol. My mother has it. My grandmother had it. And I've got it. When my cholesterol level first turned the wrong way, my (former) doctor encouraged me to "eat right and exercise." I did, and I do. I'm no fitness queen, but I try to walk or bike for 45 minutes every day, and I try to be active in other ways too. I eat a wide variety of foods, including plenty of fruits and vegetables. None of this affected the cholesterol numbers, which continued to inch upward. Then my doc started trying to convince me to go on statins. Every time I saw her she suggested I give them a try. After about two years of this she sat me down and said, "If you were my sister I'd put you on these right now." She went on to scare the living crap out of me with accounts of young people who'd had heart attacks and strokes. Statins, she said, would prevent all that.
Never mind the fact that there's pretty much no history of heart disease or stroke in my family. None of us are thin. Few of us die early. I've got grandparents and great-grandparents on both sides of the family who lived into their upper 90s.
Still. I was scared. I went on a statin. I felt like crap, but I kept taking it. I never developed the full-blown myopathy that some people get from taking statins, but I did get increasingly depressed and never felt good. Two years later, I got a new doctor, and at our first appointment she asked about the statins. I told her how I felt--scared and crappy--and she took a thorough family and personal history. She told me my risk of having a heart attack or stroke were less than .5 percent, at least at this point, and took me off the statins. Within a couple of weeks I felt great again.
Back when Doctor #1 prescribed the statins, I asked her if she really thought a relatively healthy woman in her early 40s needed to be on cholesterol-lowering drugs for the rest of her life. She looked at me like I was nuts.
I'm sure she believed she was doing the right thing. And I'm just as sure that she wasn't. I guess time will tell.