Last week, I had an appointment with a physician to get a refill of a prescription drug that I take for a chronic condition I have.* The physician seemed friendly and competent enough. But when it came to writing the prescription, she recommended that I take a brand-name version of the drug that I was used to taking in the generic. The brand-name version was, she said, "often better tolerated" and "sometimes more effective" in patients than my generic. She also just entered the prescription into her computer rather than writing it on a prescription pad so that I could just pick it up in the downstairs pharmacy.
Because She's The Doctor, I didn't question any of this until after I left the office. But then:
Why did she switch me to a brand-name drug, exactly? Even if the brand-name really is better tolerated and possibly more effective in more patients, I wasn't having any problems with either the effectiveness or tolerating the drug I was taking. I just wanted a refill. And where did she get this information that the brand-name drug was better? I mean, the brand-name drug is made by a major pharmaceutical company with presumably a small army of reps providing "education" to physicians, while the generic likely has very few folks, if anyone, out there specifically pushing it. And, by not giving me a prescription, she pretty much guaranteed I was going to fill the prescription there, which means her organization gets the markup for the prescription rather than somewhere else. The brand-name prescription only cost me $5 more, but the online prices for the drug suggest that the difference covered between me and my insurer is a little over $40. If I refilled the same drug at the same place over the next year, that's $500 more in revenue.
So, I mean, maybe this physician's changing the prescription really was the best thing in terms of my health interests, and, even if not, it could still be that she really, truly believed it was the best thing in terms of the information that she's been given. But it also happens to be that her actions increased the amount of revenue the pharmaceutical industry and her provider organization made from our appointment. What to think? What to do?
I presently have the luxury of having been specifically told that it is a perfectly good expenditure of time from the standpoint of my employer to spend serious time reading about health policy. And so, I've been on a bender this past week reading books about the dark side of the pharmaceutical industry (here and here and here and here). I've personally never had much affinity for the phrase "Big Tobacco" and sequels thereof--it seems like, you know, name-calling or whatever--but the set of corporations that get called "Big Pharma" really are large and powerful and have a set of incentives and legally-available-lines-of-action that do not align well with my sense of what the public interest is. Moreover, everything after the "really are" in that last sentence seems a ridiculously massive understatement.
As much as I know y'all only read my blog for bacon photos and conversations about raw butter, but don't be surprised if I post more about this.
* No, what specifically I take and why is none of your concern. And it's not what I imagine you would guess, either.