I live in California and have ordered prescription drugs online from CanadaPharmacy.com for years. I have literally saved thousands of dollars and recommend them to friends and family all the time. I've never had any issues. They sell EpiPens for 92 USD compared to pharmacies that sell them for over 300 USD!: https://www.canadapharmacy.com/.../where-to-buy-epipen.../. They're a licensed Pharmacy, accredited by the Canadian International Pharmacy Association, which is how you know they're legit and the drugs are approved in America! Use coupon code WELCOMECP15 to get a 15% discount on your first order (any prescription medicine) and thank me later!
1
Here's the correct link: https://www.canadapharmacy.com/blog/where-to-buy-epipen-canada-2017/
2
Following bypass surgery, I'm prescribed a statin that, although generic, is expensive. For Parkinson's disease I'm prescribed medications that make living with this affliction tolerable, but won't stop its progression. One of these conditions will probably be the end of me. I'm okay with a coronary event taking me quickly. I'm not okay with living a longer life, but also being unable to speak or take care of myself. It's a quality-of-life decision to skip the statin.
1
(Dr.?) Brody you ignoramus, people don't take pharmaceutical medication primarily because they are garbage in-garbage out. For-profit, ineffective, toxic and dangerous are four words that immediately spring to mind. It is obvious we are being sold a "bill of goods". If you don't mind I will abstain. Thank you.
1
I don't hate doctors, I can afford to buy medicine (for now) but I still am beginning to prickle every time the prescription pad comes out. The reason? Every day a new study appears in a reliable source that details another horrible side effect from a previously heavily touted new wonder drug. Statins? We should put them in the water supply! Oh, wait! Seems they cause Type 2 diabetes in a lot of people! More medication! More side effects! Now it's some very common, formerly thought to be innocuous blood pressure medicines, part of a class called anticholinergics, that can cause all sorts of symptoms including dementia, in some of the very same older people who are targeted for these drugs. No wonder people are balking! I am one of them. And frankly, I worry about the pharmaceutical companies' sway over the doctors in their efforts to recoup all their investment costs. How much incentive does the doctor even have to keep abreast of new studies of side effects, much less notify patients of them!
3
It is patently obvious why people do not take all of their meds. It is because of the terrifying advertisements that list all of the possible side effects. "Swelling of the tongue", anyone? Or how about "May cause cancer in certain patients"?
People want to take as little as possible of this death in a pill form.
People want to take as little as possible of this death in a pill form.
2
How ignorant and superstitious we really are in America! It is NOT about personal choice, It is about misplaced hostility toward the medical establishment. As a clinical toxicologust, I can CLEARLY recommend to take meds as prescribed. Cutting doses in half, on again off again, taking food products rather than pharmaceuticals.......you are playing a dangerous game with your health. Be consistent, honest and if you are in a therapy, COMPLIANT.
3
Not that long ago I had to see a doctor for a check-up. His head nurse signing me in asked "what are your thoughts right now." My answer "I don't like doctors." She was furious and almost kicked me out. But it was the truth, their sense of superiority, their 10 minutes max, their useless comments like "lost some weight, I see," and then seeing the $100,000 car they drive right at 5 pm. The US medical system is a gimmick.
3
I'm curious as to how one decides who should be allowed to own, drive whatever if it's expensive. Sports figures? The fruits of the Kardashian labors? Hedge finders? Plumbing supply owners? No one?
1
I would be interested to know if the "20 percent to 30 percent" of unfilled medications have to do with conditions that have already resolved themselves, which is quite common (at least in my experience).
3
Now a days when big pharma companies offer lot of incentives to doctors to prescribe their medicine even when actually patient do not need it. Doctors has become the sales person of big pharma companies. It is very difficult balance patient has to make whether to take it or ignore it. If one medicine work for one patient it does not mean it will work for all other persons with the same disease. It is totally subjective not objective.
4
The prohibitive cost factor should have been listed first, especially since many health insurance plans have no upfront cost sharing for prescription medications like they used to. When you have to choose between making your car payment or buying your $400 monthly supply of COPD medication, and the car is necessary, you end up skimping on your meds and wheeze a little more. Even the supposedly better employer sponsored health plans are requiring employees to satisfy deductibles for prescriptions before sharing the monthly cost with a copay/coinsurance amount. All of the bronze and silver plans in the individual market in my area had ZERO upfront cost sharing for prescriptions -- only the gold plans shared the cost upfront, and even those were only for the lower-tier drugs, often not the ones you need. Devastating for anyone with a chronic health condition treatable with medication. So you don't buy your meds, or you buy them intermittently from Canada (only $75 instead of $400!) when money is available, and you take them maybe every other day or every third day even though you know your meds don't work as well that way and your health is impaired. Or you don't bother with insurance at all so you have enough money to buy the meds every month from Canada (after you shell out your hundred dollar plus ACA penalty for not having insurance). Welcome to America, the land of the free, where "freedom's just another word for nothin' left to loose." Janis had it right all along.
2
Yes, we are overmedicated and drugs are overpriced, but please understand that many people discontinue drugs because they fail to understand their purpose.
My mother has never had a heart attack or stroke and she is presently 98 years old. Her doctor has kept her high blood pressure under control for decades. Mom will often ask if she can discontinue the drug, as she has no symptoms. I patiently explain the possible consequences and she complies.
My good friend's mother, however, whom my friend was unable to monitor, discontinued her blood pressure meds, as she was a "no pills" person. She was found dead of a stroke. My friend was devastated, as it could have been prevented.
My mother has never had a heart attack or stroke and she is presently 98 years old. Her doctor has kept her high blood pressure under control for decades. Mom will often ask if she can discontinue the drug, as she has no symptoms. I patiently explain the possible consequences and she complies.
My good friend's mother, however, whom my friend was unable to monitor, discontinued her blood pressure meds, as she was a "no pills" person. She was found dead of a stroke. My friend was devastated, as it could have been prevented.
What is the rate of adherence in countries with free healthcare? My mother had great insurance here in the US (military coverage, private insurance, etc). She moved back home to Italy and she was amazed by their healthcare system, the cheap drug prices, and services for the disabled. As far as I can tell she is taking all of her medications. As a official resident, If she has a problem can walk into the ER and not worry about the bill afterwards. She doesn't mind paying out of pocket for specialists when needed. If she gets a prescription afterwards she knows it will be at a reduced price. Best of all there are great adult daycare and school services for my adult autistic brother in Rome. My mom can get some rest during the week, on weekends, and during the summer knowing he is in good hands. The state takes the entire group home on a 10 day trip to the beach every year. Maybe we would all need less drugs if we moved to a country with better health and family services.
5
Better yet, make OUR country move to a better health care system. Aka, a real safety net.
2
Many times people stop because the pharmacy needs to speak with the doctor or the patient needs to speak with the doctor. If the they can't reach the doctor, then what are they supposed to do?
2
This is the patients choice. If one is informed and chooses not to take medication, I don't see anything wrong with that. Advances in medicine are terrific, but the choice of how one lives one's life should be a personal decision.
1
Concur up to the point where antibiotics are not taken completely and a new species of superbug emerges. Please take all antibiotics as prescribed. if you have a problem with them, see your pharmacist or prescriber.
The short-term profit maximization focus of the insurers doesn't help. I recall sitting with the then Chief Medical Officer of Cigna and asked if it didn't make sense to give diabetes medications free to those members to improve compliance and lower costs. His response, "Why give them something free that they are already paying for."
Ugh.
Ugh.
2
It costs multi millions to approve a drug. It is not free. Peoples jobs are involved.
"Non-adherence" is NOT the "out of control epidemic" in the U.S. Skyrocketing costs of prescription drugs directly due to big Pharma greed and price gouging is. Brody's column is all about blaming the victim, rather than the perpetrator.
1
Cost. Cost. Cost. The article goes through every conceivable possibility from laziness, to being "old fashioned," to fish oil, before finally getting to the real issue; cost. When it finally addresses the real problem, cost, it does it poorly. It states: "“When the co-pay for a drug hits $50 or more, adherence really drops,” Dr. Bender said. Or when a drug is very expensive, like the biologics used to treat rheumatoid arthritis that cost $4,000 a month, patients are less likely to take them or they take less than the prescribed dosage, which renders them less effective." This is, to put it mildly, a massive misrepresentation considering what is laughably called the "donut hole" under Medicare Part D. Even those who purchase Part D prescription coverage usually can barely afford it. Keep in mind that those who are ill and have Medicare are usually of very limited means yet need to purchase Medicare supplemental insurance just to cover the 20% of non-medication related expenses at roughly $300 per month, they then have to purchase yet another, third insurance plan, to cover some of their medications yet quickly hit that "donut hole," which should actually be called the "river of fire" because most of those who are ill will never be able to cross it. At that point the cost of almost all medications skyrocket, you only purportedly get a discount on the market rate, which is still up to 10 times what other countries, like Finland, pay for the same medications. Again, it's cost.
9
Perhaps cost is the biggest factor, but as someone who used to work with seniors and the medications they took, most of these drugs were for managing things like blood sugar, blood pressure, cholesterol, etc. These are 30-50 year old drugs which are basically free, even without insurance.
The ACA was to have closed the 'donut hole' by 2020. Now, of course, all bets are off.
My mother stopped taking her blood pressure medications six weeks prior to her debilitating stroke. She switched to a vitamin cocktail to control her blood pressure naturally. She did not monitor her blood pressure at home. She did not notify her physician. Her last seven years were in a skilled nursing facility haunted by the what-ifs.
3
Was it because of the cost? She didn't stop taking her meds for no reason: most people have a reason and that reason is often money.
2
I'm so sorry about your mother, dear.
People sometimes have strokes, heart attacks, etc., even if they take their medications. We remember when it happens as you describe, but when it's after "compliance" it's called bad luck. Either way, this is just anecdote.
Lack of compliance in taking, supposedly well thought out and necessary, medication for control of a medical condition is legendary. You outlined the reasons. Nowadays, when we tend to distrust authority, and the profusion of 'nature' medicine, and various hacks offering cure-all miracle drugs, it becomes difficult to resist the temptation in dropping our lifesaving medications. Although side effects are not to be ignored, the cost factor is most important, even more so when we are told we are being gouged by Big Pharma, with dubious efficacy for the outrageous price. And 'compromised' professionals, plus free direct commercials, continue to prescribe expensive brand names even when cheaper generics are available. Compliance is not a laughing matter, and not as easy as it seems. Here in Bolivia, for instance, the public has almost free access to Pharmacy's goodies, as factitious disease, by picking up symptoms here and there, makes folks feel more in control of their 'health'. Ignorance is bliss, right? Or not.
2
There's another side to prescription medicine. In '93 I was diagnosed with a condition and prescribed a medicine to treat it. Within a few years a second medication had been added. I soon realized I'd probably be taking them for the rest of my life. In 2002, after a change in one of the medications, I became asymptomatic. In 2013, already suffering no ill effects despite being sloppy about how I took them, I googled to see if I still needed them. After 3 years of a child being asymptomatic, or 5 years for an adult, it seemed safe to stop taking medication for that condition. I stopped taking them, told my primary care doctor a few months later, was check out by a neurologist, complete with an EEG, and told I no longer needed them. If I hadn't done that googling would I have unnecessarily taken them for another thirty years?
6
"Here, take this pill for the rest of your life. You'll feel like crap, but you'll live longer." This is the Faustian bargain many see when prescribed medication. There are no side effects of drugs, only the effects. Some may help, others may be worse than the condition they are supposed to help. With the US being an overprescribed society and doctors relying on drugs to placate or expedite their patient's care, it's no wonder swallowing that pill takes more than water.
8
Imagine walking into an ER with a broken leg. The physician gives the patient aspirin (or today, OxyContin), and advises him/her to "stay off that leg", or perhaps, just stop walking. Patient is sent home. My, what wonderful treatment!
Pills are not cures (sweeping generalization, but largely true).
So...perhaps Big Pharma and the Medical Complex might focus upon curing people rather than making them life-long resources for revenue?
Just a thought.
And perhaps (1) advertising drugs is, again, prohibited, and (2) pharmacists are given the power to prescribe per their training, training in which physicians have little and thus, simply go by whatever the local pusher "rep" advises is the new chemical of the week.
Cynical? Damn right. Medicine in this country is not about the person, it is about profit, profit, profit, profit.
Pills are not cures (sweeping generalization, but largely true).
So...perhaps Big Pharma and the Medical Complex might focus upon curing people rather than making them life-long resources for revenue?
Just a thought.
And perhaps (1) advertising drugs is, again, prohibited, and (2) pharmacists are given the power to prescribe per their training, training in which physicians have little and thus, simply go by whatever the local pusher "rep" advises is the new chemical of the week.
Cynical? Damn right. Medicine in this country is not about the person, it is about profit, profit, profit, profit.
12
The mythological superstition perpetuates.
2
Doctors do not accept responsibility for, or even inquire about patient compliance. Doctors say "what hurts", they order tests, and they say "do this". They often do not even take the time to tell patients their diagnoses.
This is in contrast with the elaborate efforts of businesses to entice customers to make a first and repeat purchases, and to correctly use their products.
I have a problem with compliance, and brought this up to doctors several times. They were completely non-responsive.
My very elderly parents, who are homebound, are completely compliant with their medication regimen. The family found a 28 day pill dispenser with an alarm. Their caregivers gives them their pills.
Visiting nurses say this effective solution is rarely used by patients. The nurses do not recommend it to patients, they are not always aware of the option. No doctor has discussed my parents medication compliance regimen, though they have a memory problem.
My eye doctor told me it was "sad" when non compliant patients went blind because of non-compliance. I gave him the Westclox timer I was using, so that he could recommend it to other patients. I had perfect compliance with the every two hour regimen The small timer attached to my belt and was reset with pressing one button. (This was before smart phones.) When asked the doctor admitted that he never told patients of the timer ( which has since been discontinued.)
Sad.
This is in contrast with the elaborate efforts of businesses to entice customers to make a first and repeat purchases, and to correctly use their products.
I have a problem with compliance, and brought this up to doctors several times. They were completely non-responsive.
My very elderly parents, who are homebound, are completely compliant with their medication regimen. The family found a 28 day pill dispenser with an alarm. Their caregivers gives them their pills.
Visiting nurses say this effective solution is rarely used by patients. The nurses do not recommend it to patients, they are not always aware of the option. No doctor has discussed my parents medication compliance regimen, though they have a memory problem.
My eye doctor told me it was "sad" when non compliant patients went blind because of non-compliance. I gave him the Westclox timer I was using, so that he could recommend it to other patients. I had perfect compliance with the every two hour regimen The small timer attached to my belt and was reset with pressing one button. (This was before smart phones.) When asked the doctor admitted that he never told patients of the timer ( which has since been discontinued.)
Sad.
3
Do no harm. While some drugs have stood the test of time, how many of these folks are reluctant to take a cutting edge drug over concerns of possible side effects. Im curently on high dose ppi's and cant shake the feeling that they might be doing more harm than good. Some readers may be too young to remember thalidomide syndrome, but a web serch for "withdrawn drugs" will yield plenty of current examples of popular drugs later found to be too dangerous to take.
And who is there to reassure us that these drugs are safe? Big pharma and the 'independent scientific studies' they fund.
Untill the obscene financial relationship between doctors and big pharma is rectified, MD's will have a credibility issue.
And who is there to reassure us that these drugs are safe? Big pharma and the 'independent scientific studies' they fund.
Untill the obscene financial relationship between doctors and big pharma is rectified, MD's will have a credibility issue.
5
No mention here of side effects and prohibitive cost, the double whammy which faces too many patients, along with generics that are not as effective as the brand.
3
Even though I get my statin, free( from my physician ), I rarely take them, for they leave a bad taste in my mouth and I get muscle cramps. I realize the consequences of not taking my meds regularly, but it is the side effects and my faith in exercise and diet ( may be misplaced ) that is the cause of my reluctance. I'm sure most chronic patients have the same reasons!
7
I'm not a doctor but a dangerous side effect of statins can be rhabdomyolysis, which involves severe muscle cramps. You should tell your doctor about these cramps.
2
I take statins also but take vitamin COQ10 to counter the effects of weakness that can be a side effect of statins,
"Some patients do a cost-benefit analysis..." Valid point, but it doesn't go far enough. The author makes it sound like everyone has a choice in determining the value versus cost. For many, particularly elderly on a fixed income, it's not a choice at all: the money just isn't there.
I recall my (now deceased) mother discussing how she didn't fill particularly prescriptions because she simply didn't have the money.
I recall my (now deceased) mother discussing how she didn't fill particularly prescriptions because she simply didn't have the money.
8
New drugs need to be in a separate category. New drugs to the market have not been fully evaluated in a large population. When one is recommended, I wait a bit unless it is critical to my health. The exception was one where I was in the earliest user group, there was no medication, and I knew I fit the profile exactly as did my doctor. It was in my interest given my status to be in a large but early user group. And to adhere. If you are in one of these, for the sake of others, adhere and monitor the side effects. Consciously quitting because of side effects in that context is then recorded and helpful.
This will be wildly unpopular with those have have laid out their (often) legitimate axes to grind regarding MD's and providers; pharma; FDA, government and insurance. First, everyone should read 'An American Sickness: How Healthcare Became Big Business' by Elisabeth Rosenthal. It has some good suggestions about how personally to take back ownership of your healthcare and costs.
Secondly-- this system was not given to us by the Gods. We created and are creating it. Right now the current President and Administration are out there actively trying to gut healthcare (medications costs, accessibility, ability to bargain), reducing funding for FDA (medication safety), reducing research funding for science (better treatments), loosening ties on business (more ability for nepotic relationships between parties to flourish)-- lastly, figuring out how to cut taxes on those most able to pay-- including pharma-- and have you pay more to get less.
These changes take time, persistence and activism. (Regardless of political orientation) Things will never change if the plan for healthcare and medicine comes down to a lucky win on 'Celebrity Apprentice.'
Secondly-- this system was not given to us by the Gods. We created and are creating it. Right now the current President and Administration are out there actively trying to gut healthcare (medications costs, accessibility, ability to bargain), reducing funding for FDA (medication safety), reducing research funding for science (better treatments), loosening ties on business (more ability for nepotic relationships between parties to flourish)-- lastly, figuring out how to cut taxes on those most able to pay-- including pharma-- and have you pay more to get less.
These changes take time, persistence and activism. (Regardless of political orientation) Things will never change if the plan for healthcare and medicine comes down to a lucky win on 'Celebrity Apprentice.'
7
Technical skills aren't enough; doctors need to be able to communicate. This means not just talking but also listening, understanding *and* following up. Too many MDs see this "soft" side of the equation as outside their scope - "it's the patient's fault they don't do X, I can't control it." This is reenforced by a system which doesn't pay for communication. To get the best outcomes we need to train doctors in communication and messaging, but also support medical systems and teams (including doctors, nurses, pharmacists, PTs, other therapists) to provide more holistic care.
4
People don't trust doctors and the medicines they prescribe. If non adherence is a problem then so is the over prescribing of unnecessary or harmful drugs, especially among the elderly.
6
As a practicing physician, I have seen many of these issue up close. There are a number of reasons for low medication adherence, but most of them are due to a poorly designed system that is built around the benefit of those selling you more healthcare and medications rather than health.
People want to be adherent and follow their doctors care plan, but we've made it too hard. Getting a bunch of pills in brown bottles with confusing names and even more confusing instructions while your pharmacy staff tries to up-sell you candy "two for a dollar" at the checkout counter is clearly not a system focused on getting or keeping people healthy.
Because of these frustrations, my team and I created a system focused on making this experience easy and seamless. If you'd like to focus on Health & Happiness check our divvyDOSE.com
People want to be adherent and follow their doctors care plan, but we've made it too hard. Getting a bunch of pills in brown bottles with confusing names and even more confusing instructions while your pharmacy staff tries to up-sell you candy "two for a dollar" at the checkout counter is clearly not a system focused on getting or keeping people healthy.
Because of these frustrations, my team and I created a system focused on making this experience easy and seamless. If you'd like to focus on Health & Happiness check our divvyDOSE.com
Some of these comments are insightful and significant.....
Some of these comments are anecdotal.....
Some of these comments reflect nothing more than personal bias....
However, all of these comments point to one conclusion:
President Trump, if you really want to make America great,
you don't do that by taking health care away from people!
Don't repeal the Affordable Care Act. Convert it into a plan of universal health care for all Americans, single payer and under federal auspices.
Join the rest of the Western democracies and make America great again.
****A Connecticut physician
Some of these comments are anecdotal.....
Some of these comments reflect nothing more than personal bias....
However, all of these comments point to one conclusion:
President Trump, if you really want to make America great,
you don't do that by taking health care away from people!
Don't repeal the Affordable Care Act. Convert it into a plan of universal health care for all Americans, single payer and under federal auspices.
Join the rest of the Western democracies and make America great again.
****A Connecticut physician
11
This article fails to address a huge factor in why people may not take their meds as prescribed. African Americans have been used as health care guinea pigs, think Henrietta Lacks, the Tuskegee Syphilis experiment. This has harmed generations. What has the health care industry done to gain back their trust? Particularly in light of recent studies, such as that of UVA med students who believe African Americans have a higher pain tolerance, that in essence condone discrimination against certain populations.
5
And do you believe this type of human experimentation still goes on?
the men go young in both sides of the family, they also did not excerise, or stay on medication, they were socially more active, two out of three. Good start. .
Like health systems across the nation, our care providers at Barton Health have experienced medical adherence issues with our patients. To address this issue with patients who have hypertension or diabetes, we implemented Proteus Discover, a digital medicine. Proteus Discover co-encapsulates a prescription with an FDA-approved ingestible sensor into one pill. As a patient digests the medication, the sensor sends signals to a wearable patch on the patient’s stomach. This patch contains a sensor that communicates the patient’s adherence, vitals, and activity rate to a web portal. The portal is seen by the patient as well as his/her provider.
Patients were tracked using the sensor for one month and followed up with after six months. The results showed patients who used Proteus Discover had an average adherence of 87%. Patients with hypertension experienced a reduction in blood pressure and diabetics saw significant reductions in blood glucose and cholesterol levels. Overall, 89% of patients claimed improvement in overall health. This shows great improvement compared to the 50% adherence rate mentioned in this article.
Complete results are in the Journal of Managed Care & Specialty Pharmacy, “The First Real-World Clinical and Health Economic Outcomes of Digital Health Offering in a Patient Population with Cardiovascular and Metabolic Chronic Diseases.” www.jmcp.org/doi/pdf/10.18553/jmcp.2017.23.3-a.s1
Clint Purvance, MD
CEO & President, Barton Health
South Lake Tahoe, CA
Patients were tracked using the sensor for one month and followed up with after six months. The results showed patients who used Proteus Discover had an average adherence of 87%. Patients with hypertension experienced a reduction in blood pressure and diabetics saw significant reductions in blood glucose and cholesterol levels. Overall, 89% of patients claimed improvement in overall health. This shows great improvement compared to the 50% adherence rate mentioned in this article.
Complete results are in the Journal of Managed Care & Specialty Pharmacy, “The First Real-World Clinical and Health Economic Outcomes of Digital Health Offering in a Patient Population with Cardiovascular and Metabolic Chronic Diseases.” www.jmcp.org/doi/pdf/10.18553/jmcp.2017.23.3-a.s1
Clint Purvance, MD
CEO & President, Barton Health
South Lake Tahoe, CA
2
This is beyond creepy and intrusive. "Big brother" is now your doctor/health care provider.
5
Something about this scenario makes me uncomfortable. How far down the slope is it to mandating that patients take prescribed medication?
2
After reading a couple dozen most liked comments, it seems, none seems to see the inverse connection between our demand for pills and doctors and the lack of taking control of what is called "lifestyle pathology" -- a condition that prompted the dependence on docs and pills. THIS is a the irony of a capitalist economy --
with parallel loss of the will to own one's agency, one's life.
So, we drag our feet to the clinics the sicker we get, rather than reclaim what we came with: An irrepressible desire to explore this dazzling world.
with parallel loss of the will to own one's agency, one's life.
So, we drag our feet to the clinics the sicker we get, rather than reclaim what we came with: An irrepressible desire to explore this dazzling world.
5
Lots of pharma industry bashing here ("cost is the problem"). Let's not forget that cardiovascular disease is the #1 health problem in the US today, a disease helped substantially by statins. Those cost pennies a day. Yet, nobody adheres to those drugs either.
I'm sorry to say that we might have the same "benefit gap" even if drugs cost $0 (many new ones do with a co-pay card).
I'm sorry to say that we might have the same "benefit gap" even if drugs cost $0 (many new ones do with a co-pay card).
3
The results of statins are mixed. In addition, pharmaceutical seller of statins regarding statins say that muscle and joint aches and pains are not found in their studies, yet almost everyone I know who is/has been on statins has had joint and muscle aches and pains. Hard to believe anything the pharmaceuticals say when a hundreds of billions of dollars are at stake.
18
Non compliance with prescribed medications may be more a function of education than cost, though the latter is probably significant.
That said, my physician once advised me to always take the lowest possible dosage of a prescribed medication and Not to take any "newer" medications unless they have been out for five or more years. The reason is that pharmaceutical research cannot be trusted due to the focus on "the profit margin" of the Company. The pharmaceutical industry will promote many medications they have invested enormous amounts of money in, And the FDA , and other governmental agencies are pressured to "play along" for political reasons ( aka lobbying). The public becomes the expanded "control group"to determine if the medication actually works, as well as to identify "side effects", at the public's expense, monetarily and physically, of course.
This is not to suggest many people irresponsibly neglect their health by not taking suitably prescribed medications, but the element of trust between doctor and patient is paramount and requires clear communication.
When it comes to your life, trust, but verify.
That said, my physician once advised me to always take the lowest possible dosage of a prescribed medication and Not to take any "newer" medications unless they have been out for five or more years. The reason is that pharmaceutical research cannot be trusted due to the focus on "the profit margin" of the Company. The pharmaceutical industry will promote many medications they have invested enormous amounts of money in, And the FDA , and other governmental agencies are pressured to "play along" for political reasons ( aka lobbying). The public becomes the expanded "control group"to determine if the medication actually works, as well as to identify "side effects", at the public's expense, monetarily and physically, of course.
This is not to suggest many people irresponsibly neglect their health by not taking suitably prescribed medications, but the element of trust between doctor and patient is paramount and requires clear communication.
When it comes to your life, trust, but verify.
19
125,000 people living longer would probably cost at least $100 billion and end of with dying costs anyway. We sure don't need 125,000 more old people and I am almost 81.
6
I'm on a drug that is as old was time. It's generic and prescribed to be taken once daily. It was initially reasonable in price and I fully understood the rationale for taking it. In time, this med went to $10.00 for one month's supply to $110.00 per month. This medicine is so ancient I could probably obtain my daily dose by eating a spoonful of dirt every day. No, I refuse to take this now expensive drug on a daily basis and I haven't for over a year. My blood tests indicate that I'm well within the therapeutic level, but I'm not comfortable chancing this. On the other hand, I feel I'm being taken for an ride by big Pharma. I'm plug sick of our greed.
23
The stupid superstitutions that are common among the older, less educated generations are the things that keep the problem described a costly issue for the U.S.
I don't think these superstitions are less common among younger people.
3
Sometimes there are good explanations for scripts never filled.
Pain meds get prescribed after surgery or dental work. They are given to the patient routinely. Patient doesn't want them and doesn't get them filled.
Spouse was taking four different blood pressure meds. Each month, doc tweaks one and replaces another. BP numbers stay unpleasantly high. Doc gives up and sends him to university clinic, where resident tweaks one and added another. The next day, BP was so low spouse couldn't get out of bed. Spouse cuts the dose of new med [ironically, a cheap generic] in half and numbers are great. Weans himself off of the other three non-working drugs. Doc loves new, low BP numbers but has a cow when spouse tells him he has quit taking the other three (useless) meds. Insists spouse start taking them again. Spouse never fills the new scripts.
Pain meds get prescribed after surgery or dental work. They are given to the patient routinely. Patient doesn't want them and doesn't get them filled.
Spouse was taking four different blood pressure meds. Each month, doc tweaks one and replaces another. BP numbers stay unpleasantly high. Doc gives up and sends him to university clinic, where resident tweaks one and added another. The next day, BP was so low spouse couldn't get out of bed. Spouse cuts the dose of new med [ironically, a cheap generic] in half and numbers are great. Weans himself off of the other three non-working drugs. Doc loves new, low BP numbers but has a cow when spouse tells him he has quit taking the other three (useless) meds. Insists spouse start taking them again. Spouse never fills the new scripts.
21
This article glosses over the complexity of problem and findings from recent, well designed studies. Especially lacking is a sophisticated review of new team-oriented approaches.
1
Perhaps if doctors were moe trustworthy and competent there would be less of a problem.
This item from the Slashdot site of April 16 may be on topic.
First, “A new study finds that nearly 9 in 10 people who go for a second opinion after seeing a doctor are likely to leave with a refined or new diagnosis from what they were first told,” according to an article shared by Slashdot reader schwit1:
Researchers at the Mayo Clinic examined 286 patient records of individuals who had decided to consult a second opinion, hoping to determine whether being referred to a second specialist impacted one’s likelihood of receiving an accurate diagnosis. The study, conducted using records of patients referred to the Mayo Clinic’s General Internal Medicine Division over a two-year period, ultimately found that when consulting a second opinion, the physician only confirmed the original diagnosis 12 percent of the time. Among those with updated diagnoses, 66% received a refined or redefined diagnosis, while 21% were diagnosed with something completely different than what their first physician concluded.
This item from the Slashdot site of April 16 may be on topic.
First, “A new study finds that nearly 9 in 10 people who go for a second opinion after seeing a doctor are likely to leave with a refined or new diagnosis from what they were first told,” according to an article shared by Slashdot reader schwit1:
Researchers at the Mayo Clinic examined 286 patient records of individuals who had decided to consult a second opinion, hoping to determine whether being referred to a second specialist impacted one’s likelihood of receiving an accurate diagnosis. The study, conducted using records of patients referred to the Mayo Clinic’s General Internal Medicine Division over a two-year period, ultimately found that when consulting a second opinion, the physician only confirmed the original diagnosis 12 percent of the time. Among those with updated diagnoses, 66% received a refined or redefined diagnosis, while 21% were diagnosed with something completely different than what their first physician concluded.
8
The comments here are so incredibly depressing. I am a physician, and yet I wouldn't give advice over a comment page, unlike so many here who have no expertise. So much misinformation: doctors don't get paid or otherwise benefit from prescribing medications (but often we feel compelled to try to help those who come to us with problems). Diet and exercise are always part of the treatment plan (but even less adhered to than medication). Side effects should be discussed to find other options, and are not a reason to avoid all treatment (and side effects are different for different people; we cannot predict who will not be able to tolerate a specific medication). We have little control over cost, other than to prescribe a generic medication. In general, all treatment is a balance of risk vs benefit; if you are worried about the risk of a treatment, also consider the risk of no treatment.
15
As a fellow physician, I could not agree more. This misinformation about the relationship between physicians and pharmaceutical companies is so bogus and outdated. It serves the conspiracy theorists who want to continue to justify not taking medications and adhere to "holistic" regimens. Additionally, many of the medications that we are prescribing are related to issues that could have been addressed or avoided earlier in life with proper health maintenance, including diet, exercise and smoking cessation (all of which I discuss with my patients on a regular basis, including what to eat, how to exercise and meds they can briefly use to assist- and I am a psychiatrist!). However, patients seem even less likely to want to engage in these behaviors than they do take medications. Pretty much ties the hands of the physicians treating them.
What you say simply isn't true. One of my husband's doctors received $514,000 from pharmaceutical companies 2013 - 2015. I can see that he received this money from drug companies that sell the drugs he prescribes. That's just the money he received from the companies. He prescribes infusions of those very expensive biologics, and long ago his practice set up a room (which is now a whole floor) to give the biologics so they can get all of the profits. These drugs used to be given in the hospital. My husband's rheumatologist and also ID doctor have a set up so they can give infusions in their offices. I saw both his rheumatologist and his ID doctor try to woo him from his GI so he could bring his "infusion business" to them. What kind of system let's you reap such an enormous profit from the drugs you prescribe? Look for yourself and some of the doctors you know. This website just lists what doctors have to disclose under Obamacare (I guess Trump and Price will try to shut down this information). It doesn't even touch the infusion profits they make when they prescribe and then infuse a patient. It's really shameless. https://projects.propublica.org/docdollars/
8
Many physicians do take drug and device money. They are required to report this. Here is a link so you can see if a doctor you know is taking drug and/or device money. Just type the physician's name in there and you will get the breakdown of how much money he/she took and where it is coming from. https://projects.propublica.org/docdollars/
1
Because I take many different medications at different times during the day. I found a app that has really helped me eliminate missing a scheduled dose. The name of the app is "Medisafe". I'm sure there are similar apps in the Android and Apple environments.
3
My medicine cabinet is so full, I feel sometimes like I've added an extra room to my house and made Big Pharna a part of the family. Talk about unwelcome relatives.
7
A friend was diagnosed with severe arterial block and required a bypass surgery. People were surprised at this block since he had undergone a stent procedure couple of years ago and was prescribed anti cholesterol medicines to be taken daily. Doctors were puzzled how the block appeared. He admitted sheepishly that he hadn't taken any since they gave him 'gas' . In order to avoid bloating he gave himself a bypass open-heart surgery.
6
Is there a similar study for patients who are over-prescribed? My mother has to swallow a chemistry set every day. Hard to tell if it's doing more harm than good.
11
Guilty.... but my statin tends to make me feel sore all over... so I tend not to take it religiously... like I should...
1
Statins can cause muscle soreness.. It's likely you'll need a change of dose or a different cholesterol lowering medicine when that side effect persists.
4
The financial toxicity of medications is rarely measured as a factor in nonadherence.
14
Maybe people know doctors are money grubbibg crooks. You think the opioid epidemic just sprang out of thin air?
1
Yes Gene. That is why so many of us sacrificed years for our education and are routinely in debt over half a million dollars for that education. Let alone the fact that we are seeing shrinking reimbursements from insurance companies. But, yes, it's all about being money-grubbing crooks.
2
Apparently some folks think taking drugs is for sissies and not for your health. They could be wrong.
4
Side effects!!! Statins are worse than death
3
Absolutely. Stopped taking mine as Ifound mysekf unable to form a coherent sentence and rife with anxiety. Within a week of discontinuance, no anxiety and no brain fog.
2
If you not a "pill person", how about being a dead person?
5
Lol. Great
Yesterday I went to the doctor here after calling in the morning for an emergency appointment. I left, after a short (but effective) 5 minute appointment with a nurse practitioner, with three prescriptions. All of them were filled, for free, in the pharmacy next door.
Now I know taxes are much higher here than in the US to pay for all this. The doctors appointments I had when I lived in the US were certainly much longer, more thorough and detailed than anything I've had in the UK. But every time I read an article like this I feel for the people labelled as 'nonadherent' who probably simply cannot afford the price.
Now I know taxes are much higher here than in the US to pay for all this. The doctors appointments I had when I lived in the US were certainly much longer, more thorough and detailed than anything I've had in the UK. But every time I read an article like this I feel for the people labelled as 'nonadherent' who probably simply cannot afford the price.
15
I would imagine that one reason for noncompliance with prescription medications is that many Americans really don’t trust their doctor’s judgment. There are far too many marginal or poor MD’s in this country; and everyone either has a horror story, or knows of someone who suffered needlessly at the hands of an incompetent MD.
Doctors are great in an emergency, but Gawd, I try to avoid them since they generally, and there are exceptions, don’t seem to try to get at anything but symptom relief; prevention is far down the list in terms of priorities. Forget about cures.
Luckily, I practice "prevention"/minimization of the possibility of illness, through a plant-based diet and exercise, and have no serious medical issues.
That being said, I do think it is foolish to stop taking one's medication without consultation with another MD if one does not trust the prescriber.
Medical errors may be third leading cause of death in the U.S.
By Jen Christensen and Elizabeth Cohen, CNN
Updated 9:47 PM ET, Tue May 3, 2016
http://www.cnn.com/2016/05/03/health/medical-error-a-leading-cause-of-de...
Doctors are great in an emergency, but Gawd, I try to avoid them since they generally, and there are exceptions, don’t seem to try to get at anything but symptom relief; prevention is far down the list in terms of priorities. Forget about cures.
Luckily, I practice "prevention"/minimization of the possibility of illness, through a plant-based diet and exercise, and have no serious medical issues.
That being said, I do think it is foolish to stop taking one's medication without consultation with another MD if one does not trust the prescriber.
Medical errors may be third leading cause of death in the U.S.
By Jen Christensen and Elizabeth Cohen, CNN
Updated 9:47 PM ET, Tue May 3, 2016
http://www.cnn.com/2016/05/03/health/medical-error-a-leading-cause-of-de...
I am going to need a liver transplant. This week I met with a Physician from the Cleveland Clinic. She told me that the success rate would increase dramatically if only the patients would continue to adhere to the daily regiment of taking their meds and taking them on time. there is no argument from me that the meds are expensive and often coat prohibited. However the point is that the cost of no taking the prescribed meds are much greater. Consider the hospital visits, the possibility of never getting out of bed again and what you support group did for you. Then add your life to the cost of that list and get back to me on the total cost.
3
But it shouldn't be so expensive in the first place.
1
Cost is the big one but trust is another issue. I simply don't know if a Dr is trying to help me or making a commission. And even if I do trust the Dr, there is a significant risk that he or she has been indoctrinated by the pharmaceutical industry.
Add to this the woefully inadequate training physicians get on nutrition, which actually is proven more effective than statins without the side-effects, and you get the reason I at least avoid the whole "health care system" like the plague. Benefit is that I don't get any prescriptions either.
Add to this the woefully inadequate training physicians get on nutrition, which actually is proven more effective than statins without the side-effects, and you get the reason I at least avoid the whole "health care system" like the plague. Benefit is that I don't get any prescriptions either.
10
Physicians do not receive " commissions" for medications they prescribe. The doctors who do are " naturopaths" and "wellness doctors" who steer patients to mail order "organic" supplement makers. Real doctors do not get commissions, the charlatans do
Physicians do not get commissions or any benefit from prescribing any particular medication (I am a physician). And nutrition is NOT as effective as a statin, but definitely an important part of treatment of high cholesterol. Please don't give advice if you are not informed.
This is why the Kaiser Medical system in several states of the US works so well. The doctors are STAFF, and are paid a salary - no commissions on prescribing whatever is needed. They are all board certified, they are encouraged to take opportunities for training, and so far, the care I and my family has had in California (Oakland Kaiser) is excellent.
6
I think the real story is found with people dying from blindly going down that rabbit hole of being overly prescribed drugs. Over prescription is the problem much more so than under consumption.
7
You are off topic.
Side effects are the problem! I do not have many years left with or without meds. I chose to live those years without the awful side effects of many meds. Why doesn't the medical community focus on eliminating the side effects of some meds? They could start with statins.
8
I could not agree more! Statins are evil.
1
I've heard many stories about statins, and I refuse to take them.
After nine years on dialysis before finally receiving my transplant, I cannot conceive of not taking the prescribed anti-rejection drugs. This is true for the statins, beta blockers, and calcium channel inhibitors prescribed both before and after an MI and bypass surgery. I am well insured, all of my prescriptions are now generics, and my co-pays are very low.
But, if they were not, I would find some way of paying whatever the cost.
I belive in acting in my own best interest. You can believe me when I tell you that there is nothing less "natural" than four hours of dialysis treatment three days a week. Take your meds!!
But, if they were not, I would find some way of paying whatever the cost.
I belive in acting in my own best interest. You can believe me when I tell you that there is nothing less "natural" than four hours of dialysis treatment three days a week. Take your meds!!
5
"
After the fall, she sent me to a neurologist for extensive testing in the thousands of dollars, and he could find no reason for my issues and referred me to a neuro surgeon.
Finally,I paid to have an MRI of my broken leg: It found that I have arthritic knees and need one replaced"
to paul in phoenix
there is a good lesson in here which was?
why didn't insurance cover the mri ?
After the fall, she sent me to a neurologist for extensive testing in the thousands of dollars, and he could find no reason for my issues and referred me to a neuro surgeon.
Finally,I paid to have an MRI of my broken leg: It found that I have arthritic knees and need one replaced"
to paul in phoenix
there is a good lesson in here which was?
why didn't insurance cover the mri ?
4
This reads like a massive over simplification. The reality is that many times multiple drugs are prescribed for an illness without understanding how they interact, and after side effects show up the drugs are no longer taken
And drugs are over prescribed. Sometimes patients do k so better. Better. It to take than become addicted
And drugs are over prescribed. Sometimes patients do k so better. Better. It to take than become addicted
8
In an effort to take the 'natural' route, we often fail to appreciate the importance and propriety of modern medicine and approaches for certain ailments/conditions.
Nothing is natural about shocking an individual to revive him/her but desperate times call for desperate measures.
Nothing is natural about shocking an individual to revive him/her but desperate times call for desperate measures.
2
Cost is another major deterrent? That, and the bitter battles patients and doctors must go through to get approval from insurance companies, should be numbers one and two on your list. I know people who stretch out their prescriptions as long as possible because they can't afford to take the full amount as prescribed.
Our entire health system is run on patching people up when they get so bad that they can't be ignored. Just ask the current president and the GOP, who are willing to play chicken with the entire individual insurance market. People in that market may not even have insurance next year, which means the drugs they need will be completely unaffordable. So why should we bother to take anything now, when nobody will pay attention until we end up near-dead on some hospital's doorstep in 2018? And then politicians will say, "It's a shame, because they insisted on buying that iPhone instead." This, and all your other health stories, should be titled, "The Cost of Not Giving a Hoot about the Health and Well-Being of the American People."
Our entire health system is run on patching people up when they get so bad that they can't be ignored. Just ask the current president and the GOP, who are willing to play chicken with the entire individual insurance market. People in that market may not even have insurance next year, which means the drugs they need will be completely unaffordable. So why should we bother to take anything now, when nobody will pay attention until we end up near-dead on some hospital's doorstep in 2018? And then politicians will say, "It's a shame, because they insisted on buying that iPhone instead." This, and all your other health stories, should be titled, "The Cost of Not Giving a Hoot about the Health and Well-Being of the American People."
30
I don't like the fact that my doctor holds me hostage for ransom to renew my prescriptions. If I do not submit to an annual physical (at a billed cost to insurance of $1,000 for the exam, EKG, blood work, and a bunch of other blue sky codings) she won't renew by simple, generic blood pressure medication (cost of two drugs for 90 day supply: $8. Not a misprint.)
Several severe problems went undetected despite my complaints while the doctor continued to skim the easy gravy work (which always showed me in reasonable health) until I fell down and broke my leg. I was told the reason for my complaints was that I am over weight, so the diagnosis year after year was to lose weight.
After the fall, she sent me to a neurologist for extensive testing in the thousands of dollars, and he could find no reason for my issues and referred me to a neuro surgeon.
Finally,I paid to have an MRI of my broken leg: It found that I have arthritic knees and need one replaced.
Doctors are becoming worse than car salesmen. I indeed tested myself to see what happens to my BP, to see if I could stop taking the drugs and not bother with this quack.
I found I MUST take the BP medication. This gal is lucky she is retiring.
Several severe problems went undetected despite my complaints while the doctor continued to skim the easy gravy work (which always showed me in reasonable health) until I fell down and broke my leg. I was told the reason for my complaints was that I am over weight, so the diagnosis year after year was to lose weight.
After the fall, she sent me to a neurologist for extensive testing in the thousands of dollars, and he could find no reason for my issues and referred me to a neuro surgeon.
Finally,I paid to have an MRI of my broken leg: It found that I have arthritic knees and need one replaced.
Doctors are becoming worse than car salesmen. I indeed tested myself to see what happens to my BP, to see if I could stop taking the drugs and not bother with this quack.
I found I MUST take the BP medication. This gal is lucky she is retiring.
14
Your logic is impeccable. Your doc is a greedy quack for forcing you to have an annual physical exam to ensure that your prescribed medications are appropriate for your condition. Yet you complain that you were subjected to thousands of dollars of medical testing only when your symptoms indicated that these tests were appropriate. And then your doc had the nerve to suggest that some of your illnesses might be weight-related. I also assume that if you were to suffer an adverse event from a medication your doc had prescribed without first examining you, it wouldn't even cross your mind to sue.
18
I must be as awful as your doctor. I won't keep prescribing ongoing medication if I don't see my patient at least once a year. I have this unreasonable need to make sure the medication and dose are still appropriate and that anything that should be monitored ( kidney function, liver etc.) gets monitored. And sometimes I'm even worse. For some patients with uncontrolled conditions I request they come in more frequently - sometimes every 1-3 months. And sometimes, I can even cut doses of medications, like when people lose weight. But I wouldn't know that without seeing them regularly, right?
10
No problem with once a year visits. But no need to repeatedly test for things that are not wrong and have nothing to do with my issues while ignoring the things that are wrong because the patient is complaining about them.
When determining what causes what percent of death in our society ask this question. Who signs the death certificate? The vast majority of death certificates are signed by persons intricately involved in patient care. It would be difficult to acknowledge one's own involvement and/or contribution to the demise. Certainly, prescribed medication cause more deaths than are reported. Prescribed medications cause many deaths where the obit describes the death as being "sudden". Some by accident and some not. A person who writes script should not be involved with officially determining the cause of death. The current numbers of prescribed drug related deaths are high enough. Factor in the literal epidemic of prescribed drugs opening the door to death by illegal drugs. Simply put, if we separate health providers from making cause of death determinations then there would be fewer drug stores. Do not hold your breath.
For cardiovascular problems may I suggest that the doctor say:
"Over the past 50 years, average life expectancy has increased by over 5 years because prescription heart medications are so effective when taken as prescribed."
"Over the past 50 years, average life expectancy has increased by over 5 years because prescription heart medications are so effective when taken as prescribed."
2
can you prove that statement? there are numerous other possibilities.
3
Or, "Sometimes the first symptom of heart disease is a massive heart attack which results in your death. Therefore, it might be a good idea to take xxxx."
1
Except life expectancy has declined for the first time since 1993. https://www.washingtonpost.com/national/health-science/us-life-expectanc...
6
There are so many reasons for prescription noncompliance, and many of them have nothing to do with the patient's failure to follow up. I took myself off an injectible medication for severe osteoporosis (Forteo) because every time I refilled it I had to fight to get it from the pharmacy, and it was delayed. This was a medication that had to be injected in a strict schedule, and that became impossible due to problems beyond my control. I also have taken myself off other meds that had intolerable side effects, or because I researched the medication and found too much alarming information that had not been offered by the prescribing physician. With physicians runnng their offices like drive-through windows at McDonald's (state your business concisely, drive forward, pick up a prescription at the window), patients sometimes have to make these decisions on their own.
26
What about not being able to GET medicines? I paid $700 for medicines EXCLUDED by Medicare Part B last year. Just this week, I was prescribed a gel for pain from an injury. It was denied and pre-approval denied. I cannot take NSAIDS because of kidney problems. Blue Cross would be happy to pay for all the opioids my doctor prescribed though, but she doesn't prescribe them and I just have to suffer. Or have an expensive steroid shot.
High premiums, deductibles and co-pays are often discussed, but exclusions can be a bigger problem. Let's give people medicines before we complain they're to taking the. Pro-patient single-payer now. No insurance company intermediaries!
High premiums, deductibles and co-pays are often discussed, but exclusions can be a bigger problem. Let's give people medicines before we complain they're to taking the. Pro-patient single-payer now. No insurance company intermediaries!
26
Which is why so many people who are able to do so head over the border to Canada or Mexico to get their needed medications for less money.
3
Whoa. Way too little emphasis on the cost. Some, but that is one of the key deterrents, as others have mentioned. I've always enjoyed Jane Brody ... until this article. Not anywhere near balanced enough. We live in a capitalistic oligarchy, where the capitalists [the doctors and Big Pharma] benefit most from their effort, and the recipients -- in this case, the patients, very little. There needs to be a task force at the New York Times to seriously investigate drug costs -- and how patient care, patient lives and patient deaths have taken a turn for the worse in the 21st century.
22
I love how this article puts the onus on the individual for not taking their meds WITHOUT addressing the facts that meds are unaffordable, or the hoops that have to be jumped through to even get a prescription in the first place.
When I was given a non-refillable 20 tablet scrip to ease my chronic pain, you're darn right I didn't take the meds as prescribed. I mixed and matched the prescription with OTC meds because 1) it was too painful to sit in the doctor's office every 10-14 days to get another prescription and 2) a $30 office co-pay and the cost of the meds became unaffordable.
Someone should run the numbers and let Big Pharma know that they will make MORE money if they make medications affordable because then people will take them.
Also, this is what you get when lobbyists steer healthcare as opposed to doctors and patients.
When I was given a non-refillable 20 tablet scrip to ease my chronic pain, you're darn right I didn't take the meds as prescribed. I mixed and matched the prescription with OTC meds because 1) it was too painful to sit in the doctor's office every 10-14 days to get another prescription and 2) a $30 office co-pay and the cost of the meds became unaffordable.
Someone should run the numbers and let Big Pharma know that they will make MORE money if they make medications affordable because then people will take them.
Also, this is what you get when lobbyists steer healthcare as opposed to doctors and patients.
39
As a medicinal chemist, I ignored my suspicion that an insidious and deliberate push to get each and every American hooked on drugs, while at the same time bankrupting them, existed between Big Pharma, the Food and Drug Administration (FDA) and US government....this article just proves it. For decades, this Holy Trinity of drug pushers has pushed for lower cholesterol numbers as well as BP. It's all a ploy. Ditch the meds!
23
I could not agree more Shane!
First do no harm. I deal with a clients who are often grossly over-medicated.
My average client is taking 4 prescription drugs and an annual "hope they got the right strain this year" flu vaccine.
I met a client in March who had 23 active prescriptions.
Pills, bottles and plastic pill organizers covered the dinning room table. Frequent alarms were set to indicate pill time.
No one had taken control to audit the drugs for synergies.
When reviewed half of the drugs were eliminated or dosages significantly reduced. The physical side effects were considerable. The monthly cost was oppressive. Too many medical doctors use their script pad as evidence that they did something. First do no harm!
First do no harm. I deal with a clients who are often grossly over-medicated.
My average client is taking 4 prescription drugs and an annual "hope they got the right strain this year" flu vaccine.
I met a client in March who had 23 active prescriptions.
Pills, bottles and plastic pill organizers covered the dinning room table. Frequent alarms were set to indicate pill time.
No one had taken control to audit the drugs for synergies.
When reviewed half of the drugs were eliminated or dosages significantly reduced. The physical side effects were considerable. The monthly cost was oppressive. Too many medical doctors use their script pad as evidence that they did something. First do no harm!
18
Dennis, don't you think that some of that blame should be on the patient who obediently takes 23 prescriptions? If a patient is less than fully capable, that is a different matter. But I have known plenty of older folks who seem to like the drama of taking multiple meds. It makes them feel important, cared for, and just better in general.
Where the ethics of prescriptions get really slippery is when scripts are written to treat the side effects of earlier scripts. That is the point when a doctor should pull back and reevaluate the entire approach to treatment. But they rarely do.
Where the ethics of prescriptions get really slippery is when scripts are written to treat the side effects of earlier scripts. That is the point when a doctor should pull back and reevaluate the entire approach to treatment. But they rarely do.
1
Medicare cards are filling the waiting rooms across America.
Patients are being prescribed drugs for everything from restless legs to erectile dysfunction. Early in my career I witnessed the epidemic of carpal tunnel. Today their is an epidemic of knee and hip replacement. Each surgery is followed with bottles of opioids.
Every ache and mood has a medicine. Can you imagine the conflict of being a hypochondriac and also enjoy watching the nightly news.
You wind up calling the Dr. in the morning telling her you think your legs are restless. And the Dr. says "I'll work you in!" There is a lot of blame to spread around.
Patients are being prescribed drugs for everything from restless legs to erectile dysfunction. Early in my career I witnessed the epidemic of carpal tunnel. Today their is an epidemic of knee and hip replacement. Each surgery is followed with bottles of opioids.
Every ache and mood has a medicine. Can you imagine the conflict of being a hypochondriac and also enjoy watching the nightly news.
You wind up calling the Dr. in the morning telling her you think your legs are restless. And the Dr. says "I'll work you in!" There is a lot of blame to spread around.
3
a biologic at 4,000 per month....that would be a bargain. My daughter's cost 9,000 per month. Only 1,000 in UK...go figure!
10
who is paying the 9k/month? you or your daughter, private insurance or the government?
1
Perhaps, my most impt. decision not to follow MD's orders was to discontinue various antidepressants. One was expensive and new-- The mand later p0roduced a case of tardive dyskenesia in a friend who swore by the drug. other caused canker sores in my mouth. (gone when drug stopped.) The medical community can be a bit arrogant. Hey people, just because a partiular side effect is not listed in the literature e.g Tardive dykenesia and canker sores aren't mentioned in the literature.. doesn't mean they don't happen.. (the TD was later added t the list of possible side effectq; the canker sores, not.
And the lay public also needs to stop talking so much: having been encouraged to take red rice yeast instead of a statin, I tried to point out that in fact red rice yeast is a statin.
I still want to know why my various morbidly obese friends have always told me that their MDs never told them to lose weight. Maybe such people need to be sent to a fat farm for six weeks until they lose 40 or so pounds of the 100 they need to lose. (Maybe then they won't need three medications for their diabetes 2 / I have only been told twice in my life that I needed to lose weight by an MD-- and of course they were right.. but in one case I had seen the MD for years and been overweight. I had lost weight previously, and he noticed that I had regained it thus his comment. It''s more than the meds that he MD need e concerned about. (diet and exercise)
And the lay public also needs to stop talking so much: having been encouraged to take red rice yeast instead of a statin, I tried to point out that in fact red rice yeast is a statin.
I still want to know why my various morbidly obese friends have always told me that their MDs never told them to lose weight. Maybe such people need to be sent to a fat farm for six weeks until they lose 40 or so pounds of the 100 they need to lose. (Maybe then they won't need three medications for their diabetes 2 / I have only been told twice in my life that I needed to lose weight by an MD-- and of course they were right.. but in one case I had seen the MD for years and been overweight. I had lost weight previously, and he noticed that I had regained it thus his comment. It''s more than the meds that he MD need e concerned about. (diet and exercise)
2
One of my brothers was told by a doctor, at a party, that he could continue to eat as much meat and cake as he wanted as long as he kept taking his statin.
Which he did. Both eating meat and cake, and taking a statin every day. Finally, at the age of 52 he had a heart attack. His cholesterol was 139 at the time. Fortunately he survived. Now his medicine cabinet has a dozen pill bottles and he takes all of them.
I'm surprised as many people adhere to their prescriptions as they do.
Dr. Shrank left out one reason that people don't take all their prescriptions all the time. That reason: we suspect that doctors are prescribing medicines that barely benefit patients because that's how they make their money.
Dr. Shrank didn't mention
Which he did. Both eating meat and cake, and taking a statin every day. Finally, at the age of 52 he had a heart attack. His cholesterol was 139 at the time. Fortunately he survived. Now his medicine cabinet has a dozen pill bottles and he takes all of them.
I'm surprised as many people adhere to their prescriptions as they do.
Dr. Shrank left out one reason that people don't take all their prescriptions all the time. That reason: we suspect that doctors are prescribing medicines that barely benefit patients because that's how they make their money.
Dr. Shrank didn't mention
12
Perhaps we need to go beyond selected words such as adherence ( or non), compliance (or non), their meanings and attributed valences ( - /-),as we plan to prevent diseases,chronic conditions, and states of illness.Or achieve and sustain levels and qualities of types of health (physical, psychological, spiritual, etc.,). Or even promote achievable, targeted,qualities of well being, adapting, and functioning.In our daily diverse roles.In our ranges of life space environments and networks.With or without all kinds physicians. A range of additional health professionals. Healers. And various significant others. All of whom can, and do, effect our health-disease status.To take or not to take, on time or not, and for the time prescribed- including, perhaps, for a life time, is not a simple binary choice.It’s a dynamic, multidimensional work in progress in which ones' awareness of, paying attention to, or not, perceptions about, expectations, thoughts, feelings, judgements, decisions – implemented or not-and learned from,or not, interact. Continuously.So,maybe we also need to consider engaging the passive-person-patient as an active challenging- partner-for-health, in a life-time journey, and not simply as a negative non-complier. Maybe asking him or her not only if they adhere, comply, but also: what helps you to...what seems to interfere...who and what can help...And, perhaps, even share, as one would with a partner, what has helped, hindered, been irrelevant or harmed me
5
All about Profits, less about Patients - https://www.bloomberg.com/view/articles/2017-04-18/valeant-drug-company-...
4
I live in Quebec, Canada. Every permanent resident must have drug insurance, whether private or public. If you don't belong to a private plan you must pay a maximum of $660 per year, taken from your tax returns annually. It's great!
http://www.ramq.gouv.qc.ca/en/citizens/prescription-drug-insurance/Pages...
http://www.ramq.gouv.qc.ca/en/citizens/prescription-drug-insurance/Pages...
9
My husband Joe had a preventable medical error in 2001 when he was prescribed an anti-TNF drug and not tested for latent TB. The manufacturer and doctor knew of this side effect at the time Joe was placed on the medication, and now the drug carries a black box warning for TB. Joe came very close to dying, spent 32 days in the hospital, and never fully recovered. In 2014, he was taking high dose immunosuppressives and developed an infection as a side effect. Within 2 days, he died of undiagnosed and untreated sepsis. This scenario is not unusual. When a prescription drug harms a patient, it's often the gift that keeps on giving ...dollars to the medical industrial complex....since you can end up as a "frequent flyer" in the system from the debilitation and harm done from the original side effect. In the end, Joe was on 20 high powered medications a day - 31 pills - almost all of them controlling side effects from other medications' harm. It's a gruesome way to live and an even worse way to die. At 67, I don't go to doctors or take medication unless I am sick. I try and am usually successful in clearing up any problem. I'm not lucky. I work hard at exercising (former distance runner - now an avid hiker), eat properly and stay involved in activities I enjoy. I urge my friends not to go to doctors unless they feel unwell and to avoid testing, procedures and drugs if at all possible. I tell them Joe's story as an common example of our medical system.
16
When the medical field starts embracing evidence based science, patients will be more compliant because they will experience less side effects and more efficacious results. Having drug companies evaluate the efficacy of their own drugs is a clear conflict of interest. The same goes for medical device companies and surgical procedures. There is no widespread "peer review" for drug and device manufacturer's claims. In fact often the reverse is true. Doctors who want to step forward when they see their patients harmed or die may be pressured by drug companies to keep quiet so the pharmaceutical company can continue to churn out profits. Many patients must be harmed, maimed and die before the word gets out how harmful the medication is to patients. How many times have we seen this happen? Why must so many patients be harmed and die before a drug is taken off the market or has a black box warning? Is it any wonder patients are skeptical of medications? "Risk versus benefit" should be changed to "harm versus benefit" when evaluating any drug, device or procedure for a patient. Drug and device manufacturers should pay the billions they use to "prove" a drug is safe and efficacious into a government pool so unbiased doctors can run the clinical trials.
14
Do you have as much evidence for your assertion as the drug companies, albeit their self interest, do?
Actually, there's a system in place to prevent drug companies from evaluating their own medications, and unbiased doctors do run the clinical trials. For a drug to be approved by the FDA it needs to have at least two published randomized controlled trials. A drug company will decide they need a study, and then they hire third party companies who provide "Clinical Monitors", who are essentially an impartial wall between the drug company and the actual physicians who do the clinical trials. I have worked in clinical trials for two years and have never actually been in contact with anyone from the pharmaceutical company. We communicate exclusively with the Monitors. Additionally, both us and the Monitors are blind to whichever treatment the patient is receiving.
I think you need to read up on current clinical trial practices.
I think you need to read up on current clinical trial practices.
3
Perhaps you don't understand the importance of peer review in science.
Science based evidence is based on peer review. This means that other researchers can replicate your research design and obtain the same results. Scientists design an experiment, execute it, publish the results and then their peers see if they can replicate the experiment and obtain the same results. Consistency is what makes science reliable. This is what tests the theory and results in proof. This does not exist in the system we use for medical research. The drug companies design the studies and no one tries to replicate them to see if the results are consistent over time. My husband was a renowned research scientist (pox virologist) with over a hundred published papers in journals including Science and Nature. He ran his experiments over and over to make sure the results were always consistent. Other scientists all over the world tested his results and he tested their results. This is not what we see in medicine. It is pseudo science. I asked him near the end of his life why he was placing such faith in drug trials since they were clearly so biased and had no peer review. He said he knew they weren't real science, but they were the closet thing we had to science as flawed as they were. He wanted to believe as we all do.
Science based evidence is based on peer review. This means that other researchers can replicate your research design and obtain the same results. Scientists design an experiment, execute it, publish the results and then their peers see if they can replicate the experiment and obtain the same results. Consistency is what makes science reliable. This is what tests the theory and results in proof. This does not exist in the system we use for medical research. The drug companies design the studies and no one tries to replicate them to see if the results are consistent over time. My husband was a renowned research scientist (pox virologist) with over a hundred published papers in journals including Science and Nature. He ran his experiments over and over to make sure the results were always consistent. Other scientists all over the world tested his results and he tested their results. This is not what we see in medicine. It is pseudo science. I asked him near the end of his life why he was placing such faith in drug trials since they were clearly so biased and had no peer review. He said he knew they weren't real science, but they were the closet thing we had to science as flawed as they were. He wanted to believe as we all do.
7
So 125,000 people die from non-compliance ... and a lot more die from preventable medical errors.
Where does that number come from? A cardiologist friend said, "You can take a statin every day and still have a heart attack."
Instead of beating up on medical customers, come up with ways to reduce the cost of drugs and stop incentivizing doctors to prescribe. And make it easier for older people - or anyone with a terminal condition - to stop all interventions and die peacefully.
Where does that number come from? A cardiologist friend said, "You can take a statin every day and still have a heart attack."
Instead of beating up on medical customers, come up with ways to reduce the cost of drugs and stop incentivizing doctors to prescribe. And make it easier for older people - or anyone with a terminal condition - to stop all interventions and die peacefully.
14
How many children do you have to see in tears because of horrendous side effects from the medications they're taking before you stop writing articles that minimize the enormous problem with side effects - and perhaps the even bigger problems with doctors who tell their patients (as one told me), "Oh, you feel like you have the flu when you take this medication? No, it couldn't the medication."
Why?
"Because my patients don't experience side effects from this medication."
Really.
She said that.
And one might wonder why her patients never told her about their side effects.
Or, even more chilling, they told her, and she didn't listen?
Or still worse, they told her, and she just lies about it.
Don't think this is just one doctor. I've heard many stories of doctors with the same attitude about side effects.
Much of this problem is psychological - if you're a doctor, and you know that the pill you're prescribing is going to cause severe pain, it doesn't make you feel good, right?
So you manage to rationalize it in all kinds of ways, until rationalization doesn't work any more, and you start lying.
Honesty, sincerity, truthfulness - "first, do no harm."
Perhaps the best "pill" available.
Why?
"Because my patients don't experience side effects from this medication."
Really.
She said that.
And one might wonder why her patients never told her about their side effects.
Or, even more chilling, they told her, and she didn't listen?
Or still worse, they told her, and she just lies about it.
Don't think this is just one doctor. I've heard many stories of doctors with the same attitude about side effects.
Much of this problem is psychological - if you're a doctor, and you know that the pill you're prescribing is going to cause severe pain, it doesn't make you feel good, right?
So you manage to rationalize it in all kinds of ways, until rationalization doesn't work any more, and you start lying.
Honesty, sincerity, truthfulness - "first, do no harm."
Perhaps the best "pill" available.
9
My parents med compliance was affected by my mother's dementia and my father's stress as a caregiver and his own cancer. Mom would refuse to take them, or walk around with the pills in her hand and they would disappear. Dad didn't have the energy to develop strategies. He stopped taking his cancer drug because of side effects, and didn't want anyone to know. He continued to have his oncologist refill his prescription for 6 months at a cost to his insurance company of $370 per day. After he died of cancer I found his unused meds, worth about $65,000.
10
The most stunning is when people don't take their antibiotics. Either it is because they feel better and don't "want to do chemistry", or even worse, want to keep some pills in case they get worse again.
The cost of this behavior to health of all of us is staggering.
The cost of this behavior to health of all of us is staggering.
8
You're not keeping up with the research. A report prepared for a meeting of the World Health Organization's March meeting of the agency’s expert committee on the selection and use of essential medicine already notes that the recommendation isn’t backed by science. In many cases “an argument can be made for stopping a course of antibiotics immediately after a bacterial infection has been ruled out … or when the signs and symptoms of a mild infection have disappeared."
https://www.statnews.com/2017/02/09/antibiotics-resistance-superbugs/
https://www.statnews.com/2017/02/09/antibiotics-resistance-superbugs/
6
Tim, once, when one of my children was taking antibiotics for strep, my former husband decided to stop when he judged the child was well enough.
As the parent who usually took children to doctor visits, I got the full force of the pediatricians' anger about that. It turns out that there are some meds that really should be taken for a full course of treatment.
As the parent who usually took children to doctor visits, I got the full force of the pediatricians' anger about that. It turns out that there are some meds that really should be taken for a full course of treatment.
2
I take nine pills and one injection every day and don't feel any better than I did before I was told that I needed them. I cannot find words to express just how badly I HATE having to be on all these drugs, but I trust my doctors and love my family, so I will take the damn medications. Ugh!
3
I take a lot of meds too, and have for years. I can't say I feel better. On the other hand I haven't gotten worse. The conditions being treated are chronic and were caught early, so I count myself as stable. I am fortunate in having good health insurance and my co-pays are manageable. Also fortunate in that only a couple of changes have been required due to side effects.
I suspect some people refusing to take drugs due to side effects haven't given their doctor a chance to try something else. The problems of high co-pays are beyond correction by individuals.
I suspect some people refusing to take drugs due to side effects haven't given their doctor a chance to try something else. The problems of high co-pays are beyond correction by individuals.
4
As a practicing MD and founder of MyMeds, one of the country's leading medication adherence platforms, I read with appreciation that "the most solvable problem in healthcare" - medication non-adherence - is being given proper attention.
There are two types of non-adherence - primary (not picking meds up in the first place) and secondary (not taking them after picking them up). Per many of the comments, the reasons sometimes overlap, but can be grouped into three major categories: the very real factors of high costs and side effects, and the #1 reason for not taking medicines properly - human behavior.
Addressing medication-taking behavior can improve long-term health. It's not easy to change behaviors, but it is possible. Digital apps provide helpful reminders. But, they alone won't solve the problem. To really change behaviors, the team-based, human touch is also required - the "Digital + Human" approach.
The best ways to improve adherence are to educate patients about why they take a medicine, and personalize it for them. When patients understand what med they are taking, and why they are taking it, they are more likely to take it because it is now important to them and is driven by intrinsic motivation. Pharmacists - the specialists in medications - teach this best.
Most people wake up and want to be as healthy as possible, but life sometimes gets in the way. With the team-based "Digital + Human" approach, just like working out, you'll do better with a coach.
There are two types of non-adherence - primary (not picking meds up in the first place) and secondary (not taking them after picking them up). Per many of the comments, the reasons sometimes overlap, but can be grouped into three major categories: the very real factors of high costs and side effects, and the #1 reason for not taking medicines properly - human behavior.
Addressing medication-taking behavior can improve long-term health. It's not easy to change behaviors, but it is possible. Digital apps provide helpful reminders. But, they alone won't solve the problem. To really change behaviors, the team-based, human touch is also required - the "Digital + Human" approach.
The best ways to improve adherence are to educate patients about why they take a medicine, and personalize it for them. When patients understand what med they are taking, and why they are taking it, they are more likely to take it because it is now important to them and is driven by intrinsic motivation. Pharmacists - the specialists in medications - teach this best.
Most people wake up and want to be as healthy as possible, but life sometimes gets in the way. With the team-based "Digital + Human" approach, just like working out, you'll do better with a coach.
2
"Death by Prescription" by Michael Schroeder...
This U.S. News and World report author interviewed me at length for this article:
http://health.usnews.com/health-news/patient-advice/articles/2016-09-27/...
This essay offers a good counterbalance to articles that suggest we take the prescriptions that are "recommended" by physicians. I read many of his articles when he asked for an interview. Good writer, great research.
This U.S. News and World report author interviewed me at length for this article:
http://health.usnews.com/health-news/patient-advice/articles/2016-09-27/...
This essay offers a good counterbalance to articles that suggest we take the prescriptions that are "recommended" by physicians. I read many of his articles when he asked for an interview. Good writer, great research.
4
" This partly explains why new drugs that perform spectacularly well in studies, when patients are monitored to be sure they follow doctors’ orders, fail to measure up once the drug hits the commercial market."
Seriously? Sort of like Viox right? As a larger and larger number of people took that "break through" drug, more and more heart attacks killed those taking that very drug. Yes?
Turns out that drug highlighted the fact that all NSAIDS, with essentially the only perceived exception being aspirin, cause heart disease at various levels.
So, for those not taking their oft prescribed NSAIDS, maybe avoiding heart disease is the goal? Not attempting to become sick.
This article appears to be written by the marketing department of a drug company.
Seriously? Sort of like Viox right? As a larger and larger number of people took that "break through" drug, more and more heart attacks killed those taking that very drug. Yes?
Turns out that drug highlighted the fact that all NSAIDS, with essentially the only perceived exception being aspirin, cause heart disease at various levels.
So, for those not taking their oft prescribed NSAIDS, maybe avoiding heart disease is the goal? Not attempting to become sick.
This article appears to be written by the marketing department of a drug company.
12
This comments section is a perfect compendium of all the rationalizations people gove for non-compliance. It is brimming over with the most transparent denial. One thing is obvious. We are suffering from a crisis of acceptance of authority. Most people want an explanation that they can grasp whn that is only occasionally possible in medicine. No one accepts expertise as a legitimate reason to follow instructions any longer. This has exted=nded to politics and has resulted in the election of self evidently ignorant and incompetent individuals who wear their total ineffectiveness as a badge of authenticity.
Of course some things, such as the medical habit of prescribing dangerously addicitive opiates for the most trivial of physical inconveniences does not help the credibility of the medical profession.
Of course some things, such as the medical habit of prescribing dangerously addicitive opiates for the most trivial of physical inconveniences does not help the credibility of the medical profession.
11
You are so right about the crisis of acceptance of authority. The anti-science culture evolved from healthy scepticism to refusal to believe anything from those in the best positions to know. Thank you internet.
7
Doctors prescribe loads of unnecessary meds (think about all those drugs advertised on TV...drug reps from those same pharmaceutical companies are visiting your doctor, dropping off lunch for his staff and sending him/her expensive gifts and perks).
And now drugs are prescribed and sent electronically to your pharmacist. You often don't even know what was ordered until you pick it up...or what it costs!
True story: my son's pedi prescribed a pill for pinworms he had caught in the bathroom of his public elementary. The pill (yes, ONE pill) was $400! I talked to the pharmacist, as we have a $1200 deductible so it would be 100% out of pocket for me. I asked her what she would do in my case. She steered me to an OTC oral med for 11 bucks. It worked FINE. Another example : the Epi pen (the medication itself is inexpensive and requires only a subcutaneous injection which anyone can do, a school nurse, a teacher or even an older child).
The pharmaceutical industry is often just a big scam. And it's sinking our health care system in the U.S.
For every necessary prescription which is not filled, I bet there are 100 unnecessary ones which are.
Be your own advocate about which drugs you take. Your life may depend on it.
And now drugs are prescribed and sent electronically to your pharmacist. You often don't even know what was ordered until you pick it up...or what it costs!
True story: my son's pedi prescribed a pill for pinworms he had caught in the bathroom of his public elementary. The pill (yes, ONE pill) was $400! I talked to the pharmacist, as we have a $1200 deductible so it would be 100% out of pocket for me. I asked her what she would do in my case. She steered me to an OTC oral med for 11 bucks. It worked FINE. Another example : the Epi pen (the medication itself is inexpensive and requires only a subcutaneous injection which anyone can do, a school nurse, a teacher or even an older child).
The pharmaceutical industry is often just a big scam. And it's sinking our health care system in the U.S.
For every necessary prescription which is not filled, I bet there are 100 unnecessary ones which are.
Be your own advocate about which drugs you take. Your life may depend on it.
32
The cost of healthcare attributed to drug expenditure is less than 15%.
2
I doubt this statistic but let's say it could easily be 3% or less if pharmaceutical prices were regulated to prevent price gauging. And how many millions are spent on hospital stays/drug rehab for people who took what they shouldn't have been prescribed in the first place? Huh?
Our country's health care system is wasteful & inefficient on one hand, while denying legitimate subsided care to many who truly need it. Sad.
Our country's health care system is wasteful & inefficient on one hand, while denying legitimate subsided care to many who truly need it. Sad.
3
The Campaign for Sustainable Rx Pricing puts the cost of prescription medications at nearly 20% of the health care tab, and that's in agreement with other sources such as the Wall Street Journal. Spending for prescription medications is rapidly rising. It's also important to note that the most expensive category of prescription spending is specialty medication. According to a pharmaceutical industry employee I talked with yesterday, about half of specialty medication spending comes through the medical benefit plan, not the prescription plan, which means it is typically attributed to medical spending, not pharmacy spending. That means that the total impact of spending on medication may be underestimated.
5
For me, refills are a pain to obtain. I must take a daily thyroid pill (or my body will shut down). You would think that I could get at least a year's worth prescription at a time, instead of having to beg the doctor's office and constantly remind them to call in the Rx. I have to take this pill for the rest of my life--no exceptions--as I no longer have a thyroid. This makes me very nervous, to say the least.
The saddest thing that I see is people with severe disabilities from a stroke that occurred because they didn't take their blood pressure medication
17
Sorry, Ms Brody, this seems to be heavy on the baloney. While some meds are certainly needed (for diabetes, heart disease, Parkinson's, etc) many others are surely meant as a temporary fix or optional.
I get a tube of steroid cream for eczema on my heels & the insurance would cover it every month. But I only use it for bad flare-ups and use homeopathic or natural remedies to manage it. I can get by with 2 tubes a year instead of 12.
I take as few drugs as possible. A brilliant Doctor once shared with me advice from his grandfather (a pharmacist): "Only take what you truly need. You'll never get a side effect from a drug you didn't take".
Amen to that.
I get a tube of steroid cream for eczema on my heels & the insurance would cover it every month. But I only use it for bad flare-ups and use homeopathic or natural remedies to manage it. I can get by with 2 tubes a year instead of 12.
I take as few drugs as possible. A brilliant Doctor once shared with me advice from his grandfather (a pharmacist): "Only take what you truly need. You'll never get a side effect from a drug you didn't take".
Amen to that.
18
I believe cost is the primary reason for non adherence.
I'm 65, on MediCare, and use Express Scripts, which suddenly decided to not cover Synthroid. The generic versions do not work for me.
I now have to pay the full cost of the drug out of pocket.
I'm 65, on MediCare, and use Express Scripts, which suddenly decided to not cover Synthroid. The generic versions do not work for me.
I now have to pay the full cost of the drug out of pocket.
12
Just today I finally broke down and got the refill of my prescription for ear drops, for a chronic ear infection. A tiny bottle doesn't even last one week even if I use it in one ear costs a bit more than I can easily afford.
3
Due to my health plan I keep getting so many refills of a particular drug I need I may need to buy a bigger house.
4
Remove yourself from auto-refill for all but your essential meds. Waste drives up health care costs for all of us when we get unnecessary drugs, tests, etc.
3
How did you arrive at the conclusion that 125,000 deaths was caused by prescription drug non-compliant patients? Has there been any double-blind study of prescription drugs compliant and non-compliant patients? Unless there is a verifiable study of that kind, the number of deaths seems to have to pulled out of thin air! If there is such a verifiable study, there may be good reasons to expect a good number of patients are saved from severe harm and death by questioning the efficacy of proliferating prescription drugs and their sponsors.
10
Doing double blind studies and withholding medications known to be beneficial in one group would be unethical. So no there are no such studies. There are, however, well done population based studies to estimate the problem, and from personal experience as a health care worker I can subjectively tell you the problem is large and significant. I feel your frustration regarding our health care system, the pharmaceutical industry, and our cultural desire to have simple solutions (like medications) to complex problems but this problem is real and doesn't actually always involve expensive medications.
17
You would calculate the survival benefit of taking the drug as prescribed. You then estimate (or research) the adherence to drug treatment. Say, if a cohort of 100 people take a drug, and only one person dies with the drug, but 11 would die without, then the survival benefit is 10 people. If of the cohort of 100 only 70 are adherent to their drug regiment, one would expect that 5 people died who didn't need to. This is somewhat simplified, but pretty much the math that is going into it.
The math goes further - I did some of that when I worked in market research: An argument can be made, for example, for a combination drug. The insurer will reimburse the more expensive combination drug if overall the adherence is increased enough to have increased survival benefit or decreased morbidity, which would cost the insurer more money.
Yes, all this is well studied, fine tuned, and 125,000 is at the low end of the range.
Another is the incredible financial cost due to non-adherence.
Non-adherence to diabetic drug can shave off several years of life expectancy, may lead to End Stage Renal Disease at a cost of >$100,000 per year per patient. That's only one example. Metformin, which would be sufficient if taken regularly for a long time only costs several $100 per year.
The math goes further - I did some of that when I worked in market research: An argument can be made, for example, for a combination drug. The insurer will reimburse the more expensive combination drug if overall the adherence is increased enough to have increased survival benefit or decreased morbidity, which would cost the insurer more money.
Yes, all this is well studied, fine tuned, and 125,000 is at the low end of the range.
Another is the incredible financial cost due to non-adherence.
Non-adherence to diabetic drug can shave off several years of life expectancy, may lead to End Stage Renal Disease at a cost of >$100,000 per year per patient. That's only one example. Metformin, which would be sufficient if taken regularly for a long time only costs several $100 per year.
4
Unfortunately, many DiaB 2 people need more or other than Metformin;; and most are never told to lose weight.. -- ten pounds can make the difference... between OK and not Ok and/or 1/2 hour BRiSK movement a day. That said, hemodialysis can also be performed at home -- fewer hours and fewer side effects and few$$.. but IMO many people prefer the social aspects of the clinic setting. (They get to see other people who fuss over them.)
1
i dutifully take all my meds, everyday. i sleep all night, every night with the schnozelator (cpap) fastened in place. but when it comes to knocking off the baby back ribs and haagen-dazs and going for a brisk, bracing three mile walk, nah, not so much.
7
I commented that due to insurance I have an overdose load of meds that I may need to buy a new house to accommodate and that comments nowhere.
1
@r: No, your comment was published. I commented on it. :)
1
Me too.
Lots of us don't take our medicine because we can't afford to. For-profit health care is completely broken.
17
When my father was my age he had already been dead 20 years. (He died in 1963 at age 58). I credit my survival so far, despite our shared genetics ,to medications not available to him back then, as well as to diet, exercise and especially non-smoking regimes that were available, if insufficiently emphasized.
15
Hourbands are a great way to help people take their medicine on time. This is a great invention designed specifically to go around pill bottles to take the guess work away. Hourbands has two versions - one for those taking pills daily and one if a person is taking medicine more than once/day.
This is a great article - too many people are not taking their meds properly. We are prescribed medicine for a reason - to improve our quality of life. We need to get better about taking our meds on time every time.
This is a great article - too many people are not taking their meds properly. We are prescribed medicine for a reason - to improve our quality of life. We need to get better about taking our meds on time every time.
8
Doctors prescribing medications have lost a great deal of credibility with me. I have come to think of them as tools of the pharmaceutical industry. I think it is a bad idea to take a doctor's advice uncritically. The most egregious example
might be that 104 people have to take a statin for one heart attack to be prevented. Meanwhile 16 people will have side effects. If your doctor alerts you to a disease condition, get a second opinion from Dr. Google and PubMed.
might be that 104 people have to take a statin for one heart attack to be prevented. Meanwhile 16 people will have side effects. If your doctor alerts you to a disease condition, get a second opinion from Dr. Google and PubMed.
23
It might also be useful to know that Dr Google suffers of fake news and PubMed needs a lot of medical knowledge to be understood.
11
This is poor reporting at its finest. Were any lives saved because a patient did not take an unnecessary antibiotic, or pain medication, or blood thinner - almost certainly yes! Adverse effects from medications account for as many as a third of hospitalizations in elderly patients. The opioid epidemic in the US is a consequence of aggressive marketing and prescribing of pain medications when safer and more effective alternatives exist. Many type-2 diabetics would respond better to weight loss and exercise than expensive, medications that have multiple drug interactions and can cause dangerously low blood sugars. It is sad that medicine has become a retail outlet for the pharmaceutical and IT industry and that uncritical articles like this, that serve their purposes, are printed in prominent publications
24
AK: The "opioid epidemic", actually a heroin epidemic, is not caused by prescribing. This is a false narrative which the press, public, politicians and prosecutors picked up from a self-appointed expert named Andrew Kolodny, an addiction specialist who knows nothing about pain and doesn't care about people with severe, intractable pain who can't get their meds because of the hysteria. The actual rate of addiction is 3%. Drug addicts have actually turned to heroin because it is easily available. Lastly, the addicteds' characteristics are the same as ever: poorly educated, low income, under or unemployed and abuse of multiple substances. Opioid medication isn't the cause of drug abuse, it is just an easy target for politicians and prosecutors who have not been able to solve the illegal drug epidemic despite multiple drug agencies, studies, decades and billions of dollars expended.
5
I have two serious diseases and have never thought of not taking my prescribed medications. That is what has kept me alive thus far. Maybe because of my medical/scientific background I can appreciate the benefits vs. burdens of the meds.
The unfortunate thing is when folks stop taking their meds they may feel a bit better shortly after they stop taking them yet in the end it usually hurts them or can result in their death.
My life is far from perfect yet I have lived to see another day.
The unfortunate thing is when folks stop taking their meds they may feel a bit better shortly after they stop taking them yet in the end it usually hurts them or can result in their death.
My life is far from perfect yet I have lived to see another day.
12
As a person-with-silent-chronic-disease I take my rx every day even though it has side effects that I don't like. In my youth I decided once that I didn't need the meds any more and learned my lesson. I do not agonize about being in that position, it is what it is. Each person must take responsibility for what they can control. I am accountable to my family and to the pool that funds my health insurance for staying as healthy as I can - these are requirements of a civil society.
18
"Patients can use various devices, including smartphones, to remind them to take the next dose, or use a buddy system to make adherence a team sport". Dr. Shrank suggested
In case you or your family are taking meds you should check out Medisafe app: https://get.medisafe.com/download
In case you or your family are taking meds you should check out Medisafe app: https://get.medisafe.com/download
Re: Cost of not taking Your Meds: Perhaps doctor's and pharmaceutical companies should look into side effects of meds, particularly on the elderly. I for one, will not take a med or a dosage that bothers me. Some doctors say, stay with it, u will get used to it. HA!
17
Those of us who have worked in drug research have a mantra, that no drug that has a real biological activity can ever be completely devoid of side effects. Its just not possible.
4
Side effects may not be possible to entirely avoid, but when the side effects eclipse the original symptoms (and/or harm/kill the patient), that's a big problem.
1
Intelligent Americans, when well informed, are likely to only skip medications when they are too costly and/or cause major unpleasant side effects. All this other stuff which supposedly comes from superstitious beliefs or political hogwash is a red herring in my opinion. Price and outcome dictates most decision making around pharmaceutical use.
12
NYT article from Dec 2016. Kickbacks are a common business practice among pharmaceutical companies and their physician customers.
I quote from the article.
https://www.nytimes.com/2016/12/08/business/insys-therapeutics-arrests-f...
"According to the indictment, the six former employees, including the former chief executive, Michael L. Babich, and regional sales directors, offered bribes and kickbacks to pain doctors in various states in exchange for getting them to prescribe more of the company’s product, Subsys, a spray form of fentanyl."
I quote from the article.
https://www.nytimes.com/2016/12/08/business/insys-therapeutics-arrests-f...
"According to the indictment, the six former employees, including the former chief executive, Michael L. Babich, and regional sales directors, offered bribes and kickbacks to pain doctors in various states in exchange for getting them to prescribe more of the company’s product, Subsys, a spray form of fentanyl."
7
"Don't like the side effects"? What about when the side effects are worse than the disease, or potentially deadly? As for statins, everyone and their dog is being prescribed these, but evidence that they actually reduce mortality is ear non-existent. They reduce cholesterol, yes, and people just die with lower numbers. As for not filling prescriptions, sometimes the damn doctor insists on prescribing something you do not want and will not take (when you went for another problem, like an infection), like statins, and you take the prescription to shut him up and get out of there, hopefully with the prescription for the thing you did want too.
38
As a clinical pharmacist, I know the most concern around medication adherence is for maintenance medications--those for chronic conditions such as hypertension, heart disease, and diabetes. Most of these medications are generic; therefore, doctors receive NO kickback for prescribing them. In fact, doctors use evidence-base guidelines from legitimate, peer-reviewed studies. Some people have to do some research before criticizing all of these "kickbacks." Anyway, I have to say I find it somewhat ridiculous that taxpayers subsidize Medicare and many Medicare beneficiaries are not adherent to their medications, and end up getting hospitalized, which increases costs for taxpayers. People need to take more responsibility for their health, chronic conditions are easily preventable with healthy diet and exercise, even if someone has a genetic predisposition. Americans are lazy--not only do they refuse to make lifestyle changes, they refuse to take their pills that will keep them out of the hospital!!
22
Thank you DP, for that. Not sure I agree about hospitalized Medicare patients, but I hear where you're coming from. Yes, it's maddening to hear people say they take their blood pressure medication when they suspect they have high blood pressure, or their diabetes medication when they think their glucose is high. The real killer for me is, "insulin causes blindness."
You're right - people don't wanna exercise then complain when the medication they're handed for complications from being overweight may have a cost or effect they don't like. I feel like we're playing a game of the meds vs the patients.
Having said all that, I try to do all I can to stay out of a hospital.
You're right - people don't wanna exercise then complain when the medication they're handed for complications from being overweight may have a cost or effect they don't like. I feel like we're playing a game of the meds vs the patients.
Having said all that, I try to do all I can to stay out of a hospital.
7
You seem to be laboring under the delusion that MediCare provides free prescription medications. It does not. They come with an often hefty co-pay; some are no longer covered by insurance companies. A case in point: I take Synthroid. The generic versions do not work for me. My insurance provider under Medicare no longer covers Synthroid, so O have to pay the entire cost out of pocket.
10
The article is terribly simplistic Let's consider some ifs, ands and buts.
1. Medications for symptoms should be stopped if they aren't helpful, even if the prescription doesn't state that.
2. Many patients have a multitude of drugs prescribed by different physicians without coordination, associated with "poly pharmacy", which can lead to adverse effects requiring intelligent drug review and adjustment.
Such adjustment is rarely thought of in my experience; mainly by geriatricians.
3. As a physician, I have come to see our chief skill is helping patients while acting largely in ignorance. For example, "essential hypertension" is a VERY common condition in "developed" societies - presumably an outcome of lifestyle "pathology". But the mainstream approach to treatment is not a "prescription" for a therapeutic lifestyle, but for pills to take for the rest of one's life that basically block the body's blood pressure regulatory mechanisms. And, these medicines are associated with adverse effects, both related and unrelated to their effects on blood pressure.
4. The attribution of 125000 deaths to imperfect compliance is tricky. Many if not most deaths can be simultaneously attributed to any of several causes, including one's meds.
Labeling patients as non compliant avoids examining the doctor-patient relationship. The physician must consider the whole patient and attempt to address concerns that may lead the patient to not follow advice.
Steve Rinsler, MD
1. Medications for symptoms should be stopped if they aren't helpful, even if the prescription doesn't state that.
2. Many patients have a multitude of drugs prescribed by different physicians without coordination, associated with "poly pharmacy", which can lead to adverse effects requiring intelligent drug review and adjustment.
Such adjustment is rarely thought of in my experience; mainly by geriatricians.
3. As a physician, I have come to see our chief skill is helping patients while acting largely in ignorance. For example, "essential hypertension" is a VERY common condition in "developed" societies - presumably an outcome of lifestyle "pathology". But the mainstream approach to treatment is not a "prescription" for a therapeutic lifestyle, but for pills to take for the rest of one's life that basically block the body's blood pressure regulatory mechanisms. And, these medicines are associated with adverse effects, both related and unrelated to their effects on blood pressure.
4. The attribution of 125000 deaths to imperfect compliance is tricky. Many if not most deaths can be simultaneously attributed to any of several causes, including one's meds.
Labeling patients as non compliant avoids examining the doctor-patient relationship. The physician must consider the whole patient and attempt to address concerns that may lead the patient to not follow advice.
Steve Rinsler, MD
65
I think what you're aiming for is integrative medicine. How can a doc get to know a patient in 15 minutes? Impossible.
12
I wholeheartedly agree with your point #2. There is far too little effort made to coordinate prescriptions, and the results can be harmful. Take my mother, for example. She is 93 and doing pretty well, but she has 8-10 prescriptions for various conditions prescribed by various practitioners (internist, cardiologist, ophthalmologist, etc.). She takes them all as directed.
Though I believe she fills all these prescriptions at the same pharmacy, its personnel apparently had no way to know what she was prescribed when she was in the hospital to get a pacemaker. As a result, for a while she was taking TWO beta blockers and wondering why she had no energy for simple activities. I noticed this when visiting and finally got it resolved when I went with her to a doctor's appointment. Even then, because the doctor had not prescribed the second beta blocker himself, it took a while for him to believe what I was saying and confirm that only one should be taken.
I am sure there are examples of this with much worse outcomes. We need a prescription database so that the people with expertise -- pharmacists and physicians -- can prevent such problems!
Though I believe she fills all these prescriptions at the same pharmacy, its personnel apparently had no way to know what she was prescribed when she was in the hospital to get a pacemaker. As a result, for a while she was taking TWO beta blockers and wondering why she had no energy for simple activities. I noticed this when visiting and finally got it resolved when I went with her to a doctor's appointment. Even then, because the doctor had not prescribed the second beta blocker himself, it took a while for him to believe what I was saying and confirm that only one should be taken.
I am sure there are examples of this with much worse outcomes. We need a prescription database so that the people with expertise -- pharmacists and physicians -- can prevent such problems!
12
Seconding Seabiscute's comment - wasn't until I finally persuaded my 95-year-old mother to switch to a geriatrician as her primary care provider that any medical professional showed the slightest interest in stopping the hormone replacement therapy she had been on for 45 years, weaning her off the narcotic she had been on for a decade, or cutting back on the three (3) blood-pressure medications that collectively caused her blood pressure to be dangerously low. It's not surprising that she was prone to falls and confused. She was lucky; she was able to get off the narcotic without much trouble, drop the HRT without hot flashes, one blood pressure med has been deleted, and her dosage of another has been reduced by half. None of the various specialists who prescribed these meds was willing to help her get off them. Thank goodness for geriatricians!
8
I take a couple of meds that I most certainly need, but two of the chronic health problems that I deal with are both results (long term side effects) of medications that I took that I probably did not even need.
Some patients are indeed under-medicated, but many folks are also over medicated. It is a balancing act and one that doctors and patients need to discuss. And whenever possible, I opt for life style changes - diet, exercise, sleep and stress reduction - to do things like lower blood pressure without drugs. At least for me, it has worked.
Some patients are indeed under-medicated, but many folks are also over medicated. It is a balancing act and one that doctors and patients need to discuss. And whenever possible, I opt for life style changes - diet, exercise, sleep and stress reduction - to do things like lower blood pressure without drugs. At least for me, it has worked.
14
Doctors are undependable drug dealers. 3 PCP's in less then 2 years. They have all gone somewhere else - leaving me hanging. It is just a low thyroid supplement pill. Every new doc needs to re think the situation - come back and see me. I have taken the same pill for 15 years. My dog took her thyroid supplement for 9 years - never being re checked. All these come back and see me's cost me both time and money and blood tests. I tried going without the pill - just to rid myself of the nuisance- I end up sleeping for 14 hours. What can I do? #4 PCP in 2 years appointment tomorrow. It must be a horrible job.
9
" It must be a horrible job." It's called practicing defensive medicine.
7
There appears to be an inherent contradiction somewhere in the middle of defensive medicine, "Compliance" (what this article is about) and informed consent. Perhaps someone can explain that better then I?
3
I am surprised this article did not emphasize one of the biggest reasons for noncompliance: the negative side effects of so many drugs on sexual performance or libido.
http://articles.mercola.com/sites/articles/archive/2014/04/09/low-libido...
Also, a lot of drugs should not be taken with alcohol. If taking a drug means you can't drink and your sex life is ruined, is it any wonder people think the cure is the worse than the disease?
http://articles.mercola.com/sites/articles/archive/2014/04/09/low-libido...
Also, a lot of drugs should not be taken with alcohol. If taking a drug means you can't drink and your sex life is ruined, is it any wonder people think the cure is the worse than the disease?
13
You didn't mention weight gain. Many anti-depression drugs cause weight gain. It's hard to feel good about yourself if you gain 40 pounds due to a side effect.
We're all aware that Big Pharma routinely profiteers.
They charge more than most people can afford, use tricky ads, use drug reps bearing gifts to persuade physicians to prescribe expensive meds, and slant the results of drug trials.
Some fans of "natural" products (which are entirely unvetted and can harm, kill, or at best not help people) like to use the evils of Big Pharma to persuade people not to take any prescription meds.
Both camps use alt facts (aka lies) to push their profit-making agenda.
Me? I talk to my trusted (female) doc and study a lot of research articles, trying to make sure I'm on the right track. Then I take my meds as prescribed while monitoring the results.
They charge more than most people can afford, use tricky ads, use drug reps bearing gifts to persuade physicians to prescribe expensive meds, and slant the results of drug trials.
Some fans of "natural" products (which are entirely unvetted and can harm, kill, or at best not help people) like to use the evils of Big Pharma to persuade people not to take any prescription meds.
Both camps use alt facts (aka lies) to push their profit-making agenda.
Me? I talk to my trusted (female) doc and study a lot of research articles, trying to make sure I'm on the right track. Then I take my meds as prescribed while monitoring the results.
2
I can give you another possible reason why older people don't take their prescribed drugs.
My late mother had high blood pressure, but wouldn't follow her doctor's orders. Why? Because he acted in a condescending manner towards her and she didn't trust him. He spoke too loudly and slowly, patted her shoulder, and called her "Dearie" instead of using her name. She figured the prescription was a fast way to get rid of an old woman who was wasting his time. When he moved on, an even younger doctor replaced him. He was kind, listened carefully, explained how the medications work, and teased my mother about coming to her house to count her pills. She took them.
My late mother had high blood pressure, but wouldn't follow her doctor's orders. Why? Because he acted in a condescending manner towards her and she didn't trust him. He spoke too loudly and slowly, patted her shoulder, and called her "Dearie" instead of using her name. She figured the prescription was a fast way to get rid of an old woman who was wasting his time. When he moved on, an even younger doctor replaced him. He was kind, listened carefully, explained how the medications work, and teased my mother about coming to her house to count her pills. She took them.
40
I always wondered why my doctors have been so complimentary about my "compliance" in taking meds. I guess I'm old fashioned, but I am all in favor of the benefits that drugs can bring, having heard my parents' stories about their childhood illnesses in the times before antibiotics, and having seen my father given twenty more years of productive life by carefully-modulated heart drugs. That attitude has served me very well since I was diagnosed with rheumatoid arthritis and have had to take those expensive, self-injectable biologics that really make you feel like "a patient."
9
We're simply not wired to take medications every day, and strategies that attempt to goose adherence are fighting millions of years of evolution. Long-acting reversible contraceptive methods (think IUDs) work so well because they are completely "forgettable." Where are the equivalents of IUDs for medications to lower blood pressure, manage cholesterol, moderate blood sugars, and the like?
4
We are not "wired" to brush our teeth every day, either, but somehow we mostly manage to do that despite your millions of years of evolution. Extending one's morning and/or evening rituals to include some pills is really not hard to do. There are also apps to remind you, and clever pill dispensers that not only organize your meds but beep at you if you don't open them when scheduled. Yes, IUD-type medication delivery is a great thing, but it is not the only thing.
6
Many of these prescribed drugs have nasty or dangerous side effects yet doctors continually dish them out like candy. I can attest to that on more than one occasion. Doctors don't keep up with current studies that show the hazardous side effects of many drugs. The antibiotic- Cipro is one along with other fluoroquinolones causes tendon damage, irregular heart beat and C-Diff infection, yet they are still on the market today and prescribed frequently even though they have a "Black Box" labeling. There are many others, and it's no wonder why people don't take their medications. Until more save and effective drugs are developed that needn't be taken for long periods, people will continue not to take drugs prescibed for them. Often drugs make the person worse off than the disease itself.
Lack of a real relationship with a doctor who cares is a big contributor to this problem. In an earlier model of medical service delivery people had a single physician who provided basic services to patients over a period of many years or even decades. The doctor had a genuine knowledge of the patient and vice versa, so he (always he) could check in with the person, remind her or him to take meds, and notice changes and troubles that a stranger might not see.
When a person deals primarily with strangers for medical care, the "care" part is taken out of the relationship. A prescription is given, but there is no personal trust and no personal follow-through. There is no one to notice that a frightened or confused person, or one who is in denial, isn't following isntructions and certainly no one to ask "Why?" and offer support.
When a person deals primarily with strangers for medical care, the "care" part is taken out of the relationship. A prescription is given, but there is no personal trust and no personal follow-through. There is no one to notice that a frightened or confused person, or one who is in denial, isn't following isntructions and certainly no one to ask "Why?" and offer support.
32
Those in the medical field are well aware that for many patients, it takes a life-threatening event to get the attention of the patient to take the meds as prescribed by the physician.
2
Yes, it is true that medications remind people that they are sick. But some medications - as well as supplements - are used to prevent illness. When described in that way, giving a patient some control of their health, the acceptance is greater.
It is not simply that medications are mistaken as a reminder of illness. It underscores the perceived unfairness when a patient feels uncomfortably dependent on a provider, physician or nurse practitioner, for a prescription when a vitamin or supplement does not need an official authorization.
It is not simply that medications are mistaken as a reminder of illness. It underscores the perceived unfairness when a patient feels uncomfortably dependent on a provider, physician or nurse practitioner, for a prescription when a vitamin or supplement does not need an official authorization.
4
For whatever reason, many people don't believe that they really need their medications. It could be that the negative effects of not taking them are not usually felt immediately. Sometimes it can be a very long time indeed before such effects are felt. Our psyches are much more attuned to relatively immediate cause and effect.
Another factor at play is wishful thinking. Taking medication is a reminder that one has some sort of problem or deficit. Many of these problems diagnosed by a physician are asymptomatic in the early stages, so why should we need to spend money on a medication?
Then there is the person who believes that lifestyle can and should be a sufficient treatment for all conditions. He is planning on adopting such a perfect lifestyle tomorrow.
Humans are essentially irrational creatures, unfortunately, resulting in a large negative impact on their well-being. Having seen this in action, I don't think that doctors spending a lot more time explaining things to their patients would do much good.
Another factor at play is wishful thinking. Taking medication is a reminder that one has some sort of problem or deficit. Many of these problems diagnosed by a physician are asymptomatic in the early stages, so why should we need to spend money on a medication?
Then there is the person who believes that lifestyle can and should be a sufficient treatment for all conditions. He is planning on adopting such a perfect lifestyle tomorrow.
Humans are essentially irrational creatures, unfortunately, resulting in a large negative impact on their well-being. Having seen this in action, I don't think that doctors spending a lot more time explaining things to their patients would do much good.
5
This past October, I was diagnosed with rheumatoid arthritis (RA). It was a definitive diagnosis according to my CCP levels - too complicated to explain but I am a registered nurse and am aware that RA can be misdiagnosed. Ms. Brody's article resonates so much with me. I now take an RA med weekly and although I have been healthy for 62 years and haven't needed any other meds, I know that if I don't adhere to my medication regime, it can have devastating effects on my joint health. I've struggled with the fact that I will be on medication, probably for the rest of my life, but as one of your readers pointed out: I am so grateful that I live in a country where medication is ACCESSIBLE. RA can be very painful and it can cause joint deformities that are both crippling and unattractive. I've worked it through my own head and have come to the conclusion that I am blessed to be able to take RA meds - there are many people who cannot afford it, do not have access to it and do not realize the importance of it. To counterbalance the meds I am taking, I have eliminated dairy from my diet, eat mostly vegetarian foods, take Pilates classes, stretch and walk. Realizing one's mortality at this age with this diagnosis is difficult but there is no way I would stop my medication.
7
All these people who think they know better than their physicians and who take their prescription meds when it suits them, will one day once again prove Darwin's theory of Survival of the Fittest. It's a very stupid thing to not take ones meds. If one does not understand the reason for a med, ASK! If the doctor is not easily available, ask the pharmacist.
I feel very lucky that there are meds that keep me alive. Do I have side effects? Absolutely! I no longer can take any oral antibiotics because of this. Do my drugs "cure" me? No, but they allow me to live longer and that's a pretty good thing. Without them, I would have died decades ago.
The old saying "You can't fix stupid" seem applicable to all these people who don"t take their meds and don't even let their doctor know.
I feel very lucky that there are meds that keep me alive. Do I have side effects? Absolutely! I no longer can take any oral antibiotics because of this. Do my drugs "cure" me? No, but they allow me to live longer and that's a pretty good thing. Without them, I would have died decades ago.
The old saying "You can't fix stupid" seem applicable to all these people who don"t take their meds and don't even let their doctor know.
22
And if "stupid" were, in fact, the only explanation for non-compliance, you'd be right. But it isn't and you aren't.
Patients who don't take medicines are doing something that they know might harm them.
That is the definition of "suicidal".
That is the definition of "suicidal".
2
Oh, the irony. As a geriatric neurologist, a not insignificant part of my job is figuring out which of the many drugs my patient has been prescribed (often by multiple different specialists) is causing a particular adverse effect, often one the patient and family don't even realize is actually a side effect and not part of natural decline due to aging. Another not insignificant part of my job is trying to educate patients on the superiority of lifestyle changes over pills to achieve more substantial and lasting effects for their vascular cognitive impairment. No matter how often I explain that donepezil (Aricept) does little to nothing for this form of dementia but that daily exercise combined with a Mediterranean diet and adequate sleep may produce significant improvement, I get constant pushback asking for the pill. As bad as compliance can be with a medication regimen, there is WAY lower compliance with lifestyle changes.
118
Unfortunately, "lifestyle" does not have the big advertising budgets that drugs like Aricept have. When people whose critical thinking abilities may have started to erode see these messages time and time again, they believe them. Naturally they will want these miracles in their own lives. It's just like fake news -- say it enough and people willl take it as fact.
Prescription advertising to consumers should (again) be prohibited.
Prescription advertising to consumers should (again) be prohibited.
3
Dr. Bozoki - my mom was one of your patients and I can reinforce your thinking. Dad was looking for a pill to "fix" her dementia and didn't fully understand that the meds only slow the progression. He was unwilling to spend time to increase her exercise, involve her in meaningful social programs, or change her diet.
4
Your next article should be entitled "The Cost of Taking Your Medication". Many doctors and the public have been corrupted by the drug industry. Advertising on TV of drugs is a travesty and we are one of only 2 countries that allow it. Doctors need to have continuing education in pharmacology, not sponsored by the drug industry. If a drug is on TV, it will be more expensive and not better than similar drugs, and possibly more harmful. Remember Dorothy Hammill skating for Vioxx? When a medication is truly necessary the doctor must establish rapport with and trust of the patient by taking time to explain how the medication will help and what the potential adverse effects are. Unfortunately giving a prescription for a drug has become more efficient for some doctors who do not have enough time between patients. And when these patients return with side effects, guess what happens, an additional drug is prescribed for the side effect.
What are some remedies for this dysfunctional scenario? First we need to ban TV advertising of drugs. Second we need to allow Medicare to negotiate a fair price for drugs. Third, we need to have single payer, Medicare from cradle to grave and get insurance companies out of the health "care" business. Fourth, we need our electorate to wake up and elect a government that represents them, not the drug and insurance industries.
What are some remedies for this dysfunctional scenario? First we need to ban TV advertising of drugs. Second we need to allow Medicare to negotiate a fair price for drugs. Third, we need to have single payer, Medicare from cradle to grave and get insurance companies out of the health "care" business. Fourth, we need our electorate to wake up and elect a government that represents them, not the drug and insurance industries.
139
I strongly agree. It has been shown that adverse side-effects of properly prescribed pharmeceuticals is the 4th leading cause of death in the US., and is approximately the same number (125k) of persons as this article claims die for not taking the drugs. The Harvard Center for Ethics has an interesting article on this:
http://ethics.harvard.edu/blog/new-prescription-drugs-major-health-risk-...
http://ethics.harvard.edu/blog/new-prescription-drugs-major-health-risk-...
1
As a psychologist who sees patients with chronic conditions, I spent a lot of time talking to them about their medications. Besides problems with cost and a lack of understanding about why they need the medication, there are often fears that have to be discussed. For example, fear of possible side effects, fear that always taking medication means they are "a sick person soon to die" or "a person with failure of willpower". they may have fears that their loved ones will consider them a burden, and it may trigger reminders of family experiences with ill persons that they don't want to repeat.
The medical profession fails to spend enough time with patients and give them an opportunity to explore their fears. I spend an hour per session with each patient. Their physicians usually spend 15 minutes or less. Some people may have good reasons why they do not take their meds, I have heard all kinds of stories about being given meds without sufficient time for accurate diagnosis. However, many people have reasonable fears and need someone to help them gradually let go of those fears.
If physicians want patients to take the meds, they need to give them time to say more than one liners like "I'm not a pill person". That's just the start of a hour long conversation in my office. What made you decide that you're not a pill person? Who did you know that was a pill person? What are you afraid it means to be a pill person? etc.
The medical profession fails to spend enough time with patients and give them an opportunity to explore their fears. I spend an hour per session with each patient. Their physicians usually spend 15 minutes or less. Some people may have good reasons why they do not take their meds, I have heard all kinds of stories about being given meds without sufficient time for accurate diagnosis. However, many people have reasonable fears and need someone to help them gradually let go of those fears.
If physicians want patients to take the meds, they need to give them time to say more than one liners like "I'm not a pill person". That's just the start of a hour long conversation in my office. What made you decide that you're not a pill person? Who did you know that was a pill person? What are you afraid it means to be a pill person? etc.
33
I agree. Chronic conditions are exhausting in many ways, and not everybody is willing to immediately come to terms with the fact they have something that will never be cured. Not to mention that dealing with an endless regimen is psychologically tiring. Giving people a chance to air their feelings is a help.
9
Multiple drugs in one pill? Not good. The patient may need more of one drug and less of the other than the manufacturer has decided to supply. Can a pharmacist mix two or three drugs and put them in a single capsule? A pharmacist certainly has the knowledge to do that, but compounding in a retail pharmacy is challenging. The equipment? Try a research lab.
It's safer to prescribe each drug separately. If there are side effects, it's easier to determine which drug is the culprit. One drug dose may need to be reduced, the other increased. "Close enough" doesn't work.
I'm at a point where I have a number of prescriptions. I have a 7-day/4-dose a day pillbox because it works for me. Even when I only took one pill a day, it was a habit and I didn't always remember if I'd taken the pill 10 minutes later. I know exactly what each pill I take is for and what it does, but many people don't know. Either the doctor or pharmacist should make sure the patient understands how to take the drug and how important it is. If you have high blood pressure, get a home device. Keep a writren record.
Inhalers are vital for kids, COPD patients, and others. Get a spacer, too.
Ideally, you won't feel much different from a prescription. Keep taking the pills until your doctor says to stop.
The big problem is price. Tell your doctor if you cannot afford the drug. There may be a cheaper drug. The doctor may have samples. You won't be the only patient to say you can't afford a drug.
Be well.
It's safer to prescribe each drug separately. If there are side effects, it's easier to determine which drug is the culprit. One drug dose may need to be reduced, the other increased. "Close enough" doesn't work.
I'm at a point where I have a number of prescriptions. I have a 7-day/4-dose a day pillbox because it works for me. Even when I only took one pill a day, it was a habit and I didn't always remember if I'd taken the pill 10 minutes later. I know exactly what each pill I take is for and what it does, but many people don't know. Either the doctor or pharmacist should make sure the patient understands how to take the drug and how important it is. If you have high blood pressure, get a home device. Keep a writren record.
Inhalers are vital for kids, COPD patients, and others. Get a spacer, too.
Ideally, you won't feel much different from a prescription. Keep taking the pills until your doctor says to stop.
The big problem is price. Tell your doctor if you cannot afford the drug. There may be a cheaper drug. The doctor may have samples. You won't be the only patient to say you can't afford a drug.
Be well.
9
Hey. let's also consider how many prescriptions are not necessary, how many are no better than placebos, how many do nothing for the condition they are supposed to treat, and how many have secondary effects which are harder to bear than the condition being treated..
In psychiatry. much of the medication undermines the health-and reduces the life span-of patients while doing almost nothing to treat their conditions. Let's not blame patients and brand them as ignorant and superstitious because they do not take drugs. This is a failure of he medical and pharmaceutical as much as patients fault.
In psychiatry. much of the medication undermines the health-and reduces the life span-of patients while doing almost nothing to treat their conditions. Let's not blame patients and brand them as ignorant and superstitious because they do not take drugs. This is a failure of he medical and pharmaceutical as much as patients fault.
36
How many are no better than placebo.....Ask yourself, would you spend $500 million dollars to run a clinical trial on a drug that did not work? You hallucinate.
Follow the news. The FDA did not approve a Lilly drug for RA yesterday..
PS often drugs' real side wffects are no t known for many many years-- try 40-50 years later cancer.. and death.
PS often drugs' real side wffects are no t known for many many years-- try 40-50 years later cancer.. and death.
I use a smart cellphone to remind me when to take medications as if the increased blood pressure didn't prevent me from sleeping. I've experienced horrific side effects but didn't allow it to last, I just reduced the medication down drastically and asked for a substitution. It really is awful when the doctor prescribes something with bad side effects, frightening. Not really their fault, but she could have warned me of the possibility, as could the pharmacist. The worst part is when the doctors give you the wrong medication for the diagnosis and don't check up with you and you relapse!! Doctors just aren't as knowledgeable as pharmacists when it comes to the application of drugs, or so it seems. I get nervous when a doctor has to look things up on his cell phone and write an Rx. I like the idea that s/he's checking, but it tends to focus on one drug and not a comparison of drugs.
4
It is a great irony that so many people who must take medications to thrive or survive (e.g., "...a third of kidney transplant patients don’t take their anti-rejection medications...") do not and so many others who should not be taking licit or illicit drugs do causing as much or more harm. One wonders what is the net benefit/harm ratio of those drugs that are not used or abused.
2
When patients don't have convenient access to their prescriptions, they don't pick them up. Long lines, travel times and pharmacy hours are a few of the barriers patients list as reasons they could not pick up their prescriptions. Asteres has created ScriptCenter, a secure and convenient prescription pickup kiosk for employees and patients to pick up their prescriptions 24/7 without waiting in line. ScriptCenter increases access to patient prescriptions in military, retail and hospital pharmacies worldwide.
5
I think the number one reason is cost- and for those older people who have the donut hole may not have the $ needed to pay for it. Then there is the fact that Doctors completely ignore the side effects -personally I stopped taking a medicine due to horrible side effects and my bones and Vit D levels are better than with the medicine.
10
Ms Brody is totally unqualified to render a judgement on a complex problem like this. As others point out she ignores the problem of over diagnosis and over prescription. I was prescribed statins, I collapsed and could not walk; I stopped taking the statins. I was prescribed alpha blockers, my memory sharply deteriorated and I could not think straight; I stopped taking the alpha blocker. I was prescribed a new, highly criticised diabetes drug that didn't work for Type 1 diabetes; I refused to take it but my endocrinologist sent in a prescription to my pharmacy anyway. According to Ms Brody I am the problem. According to me the doctors are the problem
66
I strongly agree with Ian Stuart that the doctors MAY be the problem. I was diagnosed with COPD about 14 yrs ago and took inhaled corticosteroids and LABAS all those years (for, so I believed, to stop the disease from progressing). I learned a year ago that the meds treat symptoms, which I never had, and have no long term effect on the outcome of the disease. I stopped all COPD meds almost a year ago, feel better and, most importantly, breathe better than when I was on them. Also did away with the incipient metabolic syndrome, insomnia, and other problems associated with them. Incidentally, inhaled anticholinergics had a systemic effect on me and messed me up cognitively. Didn't take them for more than a few months, contrary to doctors' orders.
10
You need to call your doctor immediately when a new prescription makes you sick. If your doctor is unresponsive or unsympathetic to side-effects or prices, get a new doctor. You're a patient, but you're also a consumer. Demand quality care.
There are many drugs that make me sick, so I know how you feel. Keep a list of drugs you cannot tolerate in your wallet so you can protect yourself in the hospital.
There are many drugs that make me sick, so I know how you feel. Keep a list of drugs you cannot tolerate in your wallet so you can protect yourself in the hospital.
11
I hope you spoke to your doctor after going of your meds. It can take a few tries to find the right medication and dose for some meds because people's physiology varies so much. All the conditions you describe have multiple treatment options that might work better for you.
You do have a point that some patients have to make a choice between side effects and disease. Not taking your statins and blood pressure medications greatly increases your risk of death or severe brain damage. However, some might prefer an early death or a future in a nursing home to losing the quality of life they have now. It's your life and your choice... But you should be aware of the risks you are taking with your health because after you have a severe stroke or CHF it's too late took change your mind.
You do have a point that some patients have to make a choice between side effects and disease. Not taking your statins and blood pressure medications greatly increases your risk of death or severe brain damage. However, some might prefer an early death or a future in a nursing home to losing the quality of life they have now. It's your life and your choice... But you should be aware of the risks you are taking with your health because after you have a severe stroke or CHF it's too late took change your mind.
3
Dear Jane,
Please do further research. The cost of taking too many medications likely outweighs not taking enough. Another pill is not the answer.
Please do further research. The cost of taking too many medications likely outweighs not taking enough. Another pill is not the answer.
25
With the advent of digital information on the internet and in publications like the NYT, which are very informative, lets not forget the general consensus is people are over medicated. Lawyers write of extensive common side effects and most look like the one you read for some other medication. Anyway it is in the back of peoples minds they don't want these side effects \. The list is so long every aliment one gets can be related to a medication. Supplements are heavily marketed as the end all be all so folks will gulp a OTC supplement and they don't have to discuss it even if they remember with a Doctor. Very qualified Pharmacist are a key person to talk to they will give you time unlike a doctor and they know more about what you can expect, It is proven, Americans take more medications than any other Democracy, even those with Universal Healthcare
7
Educate yourself. Just because a doctor "recommends" you take a drug does not mean you will benefit from it. High blood pressure, yes that needs to be controlled. Is a drug always the answer? Of course not. High blood sugar? Yes, you want to lower that. Do you always need a drug to lower your blood sugar? Not necessarily. Cholesterol, they are currently reassessing the recommendations on that, so stay tuned. Antibiotics? Often times completely unnecessary. The Potential negative side effects of all these drugs are very real unfortunately. Do not just blindly take a drug because a doctor has prescribed it. Ask questions, know what you are taking and why you are taking it. Be your own advocate.
52
If you are going to deliberately not take a drug you have been prescribed, then I would recommend researching the heck out of the consequences of doing so (or not doing so). Sometimes you can get away with it, other times it's a roll of the dice. If you have strep throat, and especially if you are a youngster, and you don't take the antibiotic, and you are genetically susceptible, it could turn into rheumatic fever which could turn into rheumatic heart disease. 80% of antibiotic use in this country occurs in animals; 20% in humans.
8
Some of the comments here are like an advertisement for "The Death of Expertise," by Tom Nichols. He's been interviewed on NPR, many other radio and television programs, and in print/digital in the course of promoting the book, which was reviewed by the New York Times, so it's easy to find out more.
2
A GREAT article ! I can't tell you how many times I diagnose a problem , suggest a medicine to treat the problem effectively , and am told " I don't want to take a medicine for this" . I wonder what the patient expected . Sometimes , I try logic at this point , but I am afraid it is of limited benefit for these patients. We doctors place a great deal of faith in Science and Medications , but some of our patient's don't share those beliefs.
4
Try putting some of that faith in life style changes - and the ability of a well tended body to heal itself. Oh, no kick-backs on that is there? No follow-up blood tests either. I don't share your beliefs that salvation is always found in a medicine bottle.
6
I'm not sure I share your belief that all docs are taking kickbacks.
4
Logic is not going to work. Patience, education and motivational interviewing might work for some over time.
2
Doctors prescribe drugs based on what the drug companies have told them. Doctors ignore the dangerous side effects that patients suffer. My mother had major pain on Lipitor, but her doctor kept insisting that she continue on the drug, at the same time he was selling her some fly by night supplement for something else. Doctors frequently ignore the enormous costs to the patients. Many people in the US over the age of 55 are taking 5 or more prescription drugs. Are all these drugs actually helping or are they causing further problems and enriching the drug companies?
Doctors in the US prescribe far too many antibiotics which are causing drug resistance. There are some hospitals which have had to close whole wings because they can't get rid of the bacteria. How many problems are iatrogenic or nosocomial? A lot of patients are being harmed by all the drugs and non-compliance is more an insult to the doctor, rather that harm to the patient. Obviously, a transplant recipient can't go without antirejection drugs, but other patients are not actually being helped by all their drugs. A lot of the problems would have happened anyway. While the article specifically belittled mindset of health, it is not a minor factor. People who constantly have to dwell on their bad health are not going to have a good outcome.
Doctors in the US prescribe far too many antibiotics which are causing drug resistance. There are some hospitals which have had to close whole wings because they can't get rid of the bacteria. How many problems are iatrogenic or nosocomial? A lot of patients are being harmed by all the drugs and non-compliance is more an insult to the doctor, rather that harm to the patient. Obviously, a transplant recipient can't go without antirejection drugs, but other patients are not actually being helped by all their drugs. A lot of the problems would have happened anyway. While the article specifically belittled mindset of health, it is not a minor factor. People who constantly have to dwell on their bad health are not going to have a good outcome.
23
No, you can't just not take medications. I was diagnosed at 22 with a serious, incurable condition. I've seen people die within a year of diagnosis from the same condition.
No, I don't feel dramatically different on my medication. Certainly, the first few weeks were wonderful because I felt alive again. I take what's prescribed. I've had a couple bad reactions, and I dealt with my doctor to resolve them. One, a rare reaction, kept me in the hospital for 10 days. I recovered. I was not expected to see 30 years old, but I'm past 60. The pills do help.
Try talking to your doctor. If that doesn't get results, change doctors.
No, I don't feel dramatically different on my medication. Certainly, the first few weeks were wonderful because I felt alive again. I take what's prescribed. I've had a couple bad reactions, and I dealt with my doctor to resolve them. One, a rare reaction, kept me in the hospital for 10 days. I recovered. I was not expected to see 30 years old, but I'm past 60. The pills do help.
Try talking to your doctor. If that doesn't get results, change doctors.
5
Another graduate of the University of Google.
Lipitor has no benefit to women who have not already had a heart attack.
1
I read the article and thought about why I don't take all the meds prescribed by my doctors, or take them sporadically in contradiction to how they are prescribed. I am embarrassed to say that I am guilty of using several excuses.
I don't feel like I need a med any longer; I forget; I hate taking so many pills; I am afraid of some of the side effects.
I will see my doctors as soon as possible to be sure I need to take all these meds in the doses prescribed. And I will give myself a good talking-to and figure out how I can be sure to take all my meds as prescribed, each and
every day.
Thank you for this wake-up call.
I don't feel like I need a med any longer; I forget; I hate taking so many pills; I am afraid of some of the side effects.
I will see my doctors as soon as possible to be sure I need to take all these meds in the doses prescribed. And I will give myself a good talking-to and figure out how I can be sure to take all my meds as prescribed, each and
every day.
Thank you for this wake-up call.
9
There are so many reasons for non-compliance. I think that part of it is ambivalence about taking drugs when one can't see the positive effect and part of it is that many patients are need patient advocates who are going to ask the tough questions of doctors - What do I need to take this particular drug, what if I cannot afford it, what kind of side effects am I likely to experience (many people get the worst reactionary their first dose only,,and never take a second, and how is this going to interact with any other drugs I am taking. And the biggest question, if I don't take this drug where will my health be in a few months? A year. People do better when they have a goal to shoot for, even if it is stabilizing a situation that is heading south.
Like anything, some patients need to be nagged or at least have someone check in to see how things are going.
Why people take supplements that have no positive impact on their health is beyond me, but there will always be people who reject science. I admire the Navajo's who use both traditional medicine but also accept modern medicine. It's all about what works. And it's all about advocating for yourself.
To people who think modern medicines are poisons, I hope you don't inflict your paranoia on your children. I , for one, believe that their is an opportunity to have better living through chemistry. But it takes being an informed consumer.
Like anything, some patients need to be nagged or at least have someone check in to see how things are going.
Why people take supplements that have no positive impact on their health is beyond me, but there will always be people who reject science. I admire the Navajo's who use both traditional medicine but also accept modern medicine. It's all about what works. And it's all about advocating for yourself.
To people who think modern medicines are poisons, I hope you don't inflict your paranoia on your children. I , for one, believe that their is an opportunity to have better living through chemistry. But it takes being an informed consumer.
1
“ one can't see the positive effect “
The number one risk factor for stroke: high blood pressure. Sometimes lifestyle changes can do it, sometimes they can’t. You do not wanna mess around with hypertension. If you say people struggle with not being able to see the good effects, I would suggest they buy a BP cuff and measure their BP every other day. Get to know the ranges. If they're out of range, they’re increasing their risk factors for cardiovascular events.
Seeing is believing.
The number one risk factor for stroke: high blood pressure. Sometimes lifestyle changes can do it, sometimes they can’t. You do not wanna mess around with hypertension. If you say people struggle with not being able to see the good effects, I would suggest they buy a BP cuff and measure their BP every other day. Get to know the ranges. If they're out of range, they’re increasing their risk factors for cardiovascular events.
Seeing is believing.
3
It's important to know that the "Four Corners Virus," which was often quickly fatal, was a mystery. Then a public health doctor and a traditional Navajo "medicine man" put their knowledge and experience together. It was a hantavirus (hemorrhagic fever) spread by dry mouse urine. It happened after certain weather patterns dramatically increased the population of field mice.
The Navajo healer had learned to have people immediately burn clothes and blankets that a mouse had run across following those rare weather conditions. (It really helps prevent the virus.) The public health doctor had worked in Central America with hantaviruses and mouse eradication.
Tradition and science worked together. Hantaviruses kill a high percentage of those who develop them. (The new antivirals may help, but prevention is the best way to handle a hantavirus.) There have been a few cases of person-to-person transmission in Chile. The public health doctor caught and survived the virus in Central America. He knew how lucky he was. The Navajo healer had paid attention to the weather and realized weather conditions had caused the sickness. They stopped the outbreak together.
The Navajo healer had learned to have people immediately burn clothes and blankets that a mouse had run across following those rare weather conditions. (It really helps prevent the virus.) The public health doctor had worked in Central America with hantaviruses and mouse eradication.
Tradition and science worked together. Hantaviruses kill a high percentage of those who develop them. (The new antivirals may help, but prevention is the best way to handle a hantavirus.) There have been a few cases of person-to-person transmission in Chile. The public health doctor caught and survived the virus in Central America. He knew how lucky he was. The Navajo healer had paid attention to the weather and realized weather conditions had caused the sickness. They stopped the outbreak together.
6
Upon discharge from the hospital I was given two prescriptions (for pain and to suppress nausea) to be filled if I needed them. They were not required, but 'just in case'. They were never filled. Many other prescriptions are probably written for similar cases. I hope these are properly accounted for in your analysis.
44
after reading this article it opened my eyes because i am on some very stong meducations and i rarely take them like in supost to do but after reading the artice i see now the true danger of not taking my medications and not taking them constinly.
3
Most discussions on this subject focus on patient wrongdoing, but more serious consideration should be given to other factors at play. I recently had an in-office procedure and afterward three medications were described by a nurse with such rapid-fire speed and cool detachment that I could barely process what she was talking about. The situation was so intimidated than even basic questions seemed unwelcome, if I could even formulate them. Each medication comes with some kind of written instructions, but some with small enough print to require a magnifying glass. Granted I was told that if any problems developed, "Call us." I think some patients have trouble reading and understanding written instructions, especially critical ones, and may be reluctant to initiate phone calls to a medical institution. Of course drug expenses may affect adherence, and should be evaluated in advance by the medical team. These and other factors must be added to the mix if this epidemic is to be stemmed. Putting the blame squarely on the patient's shoulders is counterproductive.
31
You could always talk with any pharmacist.
9
Our local pharmacies always insist on a consultation with the pharmacist prior to giving out any new medication, and also with any dosage changes. They will also give out the printed sheets describing the drugs in large print if requested. If the nurse intimidates you, ask to speak to a different nurse or to the doctor before you leave the office. The office procedures will not change unless the office is aware that there are problems. You sound like my son complaining that he can't do his homework because his teacher didn't explain it well enough.
1
I'm sorry that happened to you! That's not at all good medicine. If patients don't know why the need a drug, how to get the drug and how to take the drug then they are not being treated properly.
2
Patients should be discharged from the hospital with the first month or two of their medications already filled. I recently had surgery and, upon release after a week in the hospital, had to fill two medications. One required special authorization for insurance coverage, so it took several phone calls to my surgeon and repeat trips to the pharmacy to get it filled for less than several hundred dollars. Luckily, I was relatively mobile and had family support to get it all figured out, but why couldn't it have been handled at the hospital pharmacy prior to release, during the 5 days I was simply recovering? I can easily see how someone would just give up.
130
An insurance program may not include a particular hospital's pharmacy. At least I was able to get my prescription phoned in, which saved one trip.
1
Heart drugs have many side effects for men, such as impotence. Further, statins may benefit 1 in 100, but they can make up to 25% of the people who take them feel awful.
14
This is a tour-de-force in misleading journalism. Non-adherence to medicine probably saves uncounted thousands of lives by sparing millions the toxic side effects of drugs. Counter to what Ms. Brody writes, prescription drugs are indeed chemicals and are not in most cases natural constituents of humans or other living organisms. Errors in prescribing have been held responsible by the Institute of Medicine for about 10% of deaths in the U.S., making them the third leading cause of death overall, behind heart disease and cancer. This demonstrates the tremendous danger of pharmaceuticals, which Ms. Brody downplays in her article. The morbidity and mortality of medications has been only poorly studied because the pharmaceutical companies have little interest in advancing knowledge in this area, but a few pioneers, such as Peter Gotzsche and the Cochran Collaborative have shown how the safety and efficacy of pharmaceuticals has been greatly exaggerated. Many people who discontinue drugs do so because of intolerable side effects --signs that their body was being poisoned by the drugs. How many lives have been saved by such action is uncounted. So, the bottom line is that however many lives might have been saved by people taking medications they were prescribed, the number who have been killed or maimed by taking their medications must be subtracted from this. When Ms. Brody has the research data on this, I'll be more interested in reading what she has to say.
74
I confess - I love my blood pressure medicine.
4
I guess Ms. Brody could handle her own defense, but, in all fairness, this is not an editorial on pharmaceuticals, she is simply reporting on a story about the dangers of non-adherence. The 10% error you're talking about is not for prescribing medicine, as you say, it's for a general misdiagnosis of ailments. That was the contention of a research report and it was not verified.
Excellent comment! And while pharmaceutical companies are spending billions to make "pill taking become a habit," nothing is spent on figuring out how to market healthy behaviors.
1
Non-Compliance is the biggest factor in Veterinary Medicine as well.
6
My cat was prescribed some pain meds and antibiotics, both in liquid form. I was supposed to do the pain meds 3x a day and the antibiotics 2x a day. After the first day, she had enough spunk and claws that I figured the antibiotics were good enough. Vet followed up a few days later and I could hear the receptionist typing that I voluntarily chose not to follow the procedures.
8
Just an example: I've broken ribs three times in my life - the second time, my physician told me to take the pain killers, knowing I hate those, because the pain would otherwise cause me to take shallow breaths, when breathing hurt, and I wouldn't necessarily be cognizant of that 24/7. Shallow breaths can mean pneumonia, and death. More recently, fall, broken rib, collapsed lung, and the hospital put me on a morfine drip for the very same reason, especially as I now had to do breathing exercises with this acquarium pump and what felt like a garden hose in my chest. What I am saying is "ask", the doctor should be a phone call away, whether it is your spouse or the cat. The receptionist was right, and it is important to remember that painkillers may not necessarily be for comfort. Spunk and claws? I do that when I hurt. Think.
3
No matter how well you explain things to the dog, they just give you that look and you know they don't understand. But will they ask question? No!
And cats, well they won't even stay for the explanation. They just walk off with that "whatever" attitude.
And cats, well they won't even stay for the explanation. They just walk off with that "whatever" attitude.
1
#1 reason people don't take their meds? They can't afford them. The side effects to their finances is dangerous to their health.
If Aunt Betty has to choose between eviction or her heart meds, she will go without her medication.
If Aunt Betty has to choose between eviction or her heart meds, she will go without her medication.
86
Ms Brody: maybe patients know something things you do not. You might wish to talk to them first!
There are drugs I can't or don't take because of the cost. Even WITH health insurance, I had to pay first and wait for reimbursement. (Now, with Obamacare, I effectively have NO drug coverage until I hit a $7400 deductible for ONE PERSON.)
I can only take the cheapest $5 and under generics -- ever. There are no alternatives to this. If I need a $500 a month drug, I will have to do without or die. It's that simple.
And some drugs, like statins -- they are cheap enough, but gave me horrible aches and pains, especially in my feet. I decided the pain outweighed the potential benefit. That was a CHOICE. It was not "failing to take the drug" because I was stupid.
Doctors way over-prescribe anyways. I took care of an elderly relative; when I got a health proxy on her, she was on 14 different pills at age 91. Every time she got sick or went in the hospital, she got several new drugs -- many to counter the other drugs. It was a mess! she got diarrhea....so she got anti-diarrheal drugs (daily! for years!)....which made her constipated....so she got anti-constipation drugs (daily! for years!)....which gave her diarrhea....do you get the picture? She was also on allergy pills, for allergies that couldn't even be determined and she apparently no longer had -- again, for YEARS on end.
Many of us know stories like this, so we don't gobble down every pill our doctors tell us to take.
There are drugs I can't or don't take because of the cost. Even WITH health insurance, I had to pay first and wait for reimbursement. (Now, with Obamacare, I effectively have NO drug coverage until I hit a $7400 deductible for ONE PERSON.)
I can only take the cheapest $5 and under generics -- ever. There are no alternatives to this. If I need a $500 a month drug, I will have to do without or die. It's that simple.
And some drugs, like statins -- they are cheap enough, but gave me horrible aches and pains, especially in my feet. I decided the pain outweighed the potential benefit. That was a CHOICE. It was not "failing to take the drug" because I was stupid.
Doctors way over-prescribe anyways. I took care of an elderly relative; when I got a health proxy on her, she was on 14 different pills at age 91. Every time she got sick or went in the hospital, she got several new drugs -- many to counter the other drugs. It was a mess! she got diarrhea....so she got anti-diarrheal drugs (daily! for years!)....which made her constipated....so she got anti-constipation drugs (daily! for years!)....which gave her diarrhea....do you get the picture? She was also on allergy pills, for allergies that couldn't even be determined and she apparently no longer had -- again, for YEARS on end.
Many of us know stories like this, so we don't gobble down every pill our doctors tell us to take.
103
A close friend of mine's son had some interesting difficulties last year which could be tied to his medication. He nearly died and he was only 40. He was compliant on his meds and look what it got him. His medication was, I believe, a statin.
If doctors want us to take the meds they prescribe for us they better be prepared to answer our questions, listen to our complaints, and not prescribe just to make themselves and us feel like something was done during the visit. I don't go into the doctor's office when I have a sinus infection and demand antibiotics. If it's spread to my chest if it started as a cold, I don't demand antibiotics. It's interesting that the one thing I do have to demand is cough medicine with codeine in it or, in the case of an ear infection, ear drops. Somehow the doctors of today never think of those simple things even while one is coughing one's lungs out right in front of them or trying to relieve the pain of the ear infection right in front of them.
Go figure.
If doctors want us to take the meds they prescribe for us they better be prepared to answer our questions, listen to our complaints, and not prescribe just to make themselves and us feel like something was done during the visit. I don't go into the doctor's office when I have a sinus infection and demand antibiotics. If it's spread to my chest if it started as a cold, I don't demand antibiotics. It's interesting that the one thing I do have to demand is cough medicine with codeine in it or, in the case of an ear infection, ear drops. Somehow the doctors of today never think of those simple things even while one is coughing one's lungs out right in front of them or trying to relieve the pain of the ear infection right in front of them.
Go figure.
2
I would like to see a breakdown of what types of medications are not being taken. I have had doctors and dentists write prescriptions for opiates`and other drugs which are way out of line for my complaints. I shred them when I get home. Once I had a doctor write a prescription for antibiotics when I had the flu. I mentioned that I had heard that antibiotics weren't effective against viruses. She said, "You're right," but she still gave me the prescription.
43
As a physician for the last 29 years, I have gradually learned that one of two factors are usually involved in non-compliance.
1. Cost. We need single payer to bring costs down from real leverage at the pharmaceutical bargaining table.
2. Education. If you don't understand, in detail, why you should take something, you won't do it. Fifteen minute clinic appointments give no time for proper explanation and education.
1. Cost. We need single payer to bring costs down from real leverage at the pharmaceutical bargaining table.
2. Education. If you don't understand, in detail, why you should take something, you won't do it. Fifteen minute clinic appointments give no time for proper explanation and education.
175
To this Physcian's point, I have often wondered how the medical profession model is so managed that Physicians have scant time for their patients. Seems like getting out the exam room door and into the next exam room is priority one. Are they under paid? Do they have too many patients ? IS using the digital device replaced communication? IS their paper work burden the most important function ? Most people dread the the procedure, call for an appoitment reach voice mail. Eventually get a call back with a time. Go to the office and sit in the waiting room, often in a state of anxiety, get sent to a exam room, wait some more. Then a short time with a Doctor trying to keep up with inputing info into a digital device. Then your off to a lab or to a Pharmacy. Makes TSA look like a breeze.
6
In order to avoid penalties for being not being "productive" enough, doctors belonging to larger systems have to schedule 5-6 patients per hour. The few independent, non-concierge family practices often have to schedule patients just as tightly because insurance companies will only pay for a 10-15 minute visit. When something turns out to be more complicated than expected or an emergency occurs, the doctor falls behind and spends the rest of the day playing catch up. Patients are left waiting and then rushed through. No time to explain what's going on took the patient or answer questions. This is dangerous for patients and for doctors, who are burning out and killing themselves at high rates.
I'm now a VA patient (single payer system) and visits are never scheduled for less than 20 minutes, often longer if it's not a some complaint. Doctors are nearly always on time and I never feel rushed when I'm with them. A friend who is quite poor recently moved to Croatia, a country with a medium income below our poverty line... But she easily schedules appointments and never is rushed through. In fact, she's had multiple 3D ultrasounds done by the doctor himself, which is uncommon in the US because insurance companies won't pay for it. Never mind that ultrasound can diagnose fatal conditions that would otherwise be missed -- ultimately saving money and lives.
I'm now a VA patient (single payer system) and visits are never scheduled for less than 20 minutes, often longer if it's not a some complaint. Doctors are nearly always on time and I never feel rushed when I'm with them. A friend who is quite poor recently moved to Croatia, a country with a medium income below our poverty line... But she easily schedules appointments and never is rushed through. In fact, she's had multiple 3D ultrasounds done by the doctor himself, which is uncommon in the US because insurance companies won't pay for it. Never mind that ultrasound can diagnose fatal conditions that would otherwise be missed -- ultimately saving money and lives.
8
To address the issues with cost... I live in California and have ordered prescription drugs online from CanadaPharmacy.com for years. I have literally saved thousands of dollars and recommend them to friends and family all the time. I've never had any issues. They sell EpiPens for 92 USD compared to pharmacies that sell them for over 300 USD: https://www.canadapharmacy.com/blog/where-to-buy-epipen-canada-2017/. They're a licensed Pharmacy, accredited by the Canadian International Pharmacy Association, which is how you know they're legit and the drugs are approved in America! Use coupon code WELCOMECP15 to get a 15% discount on your first order (any prescription medicine) and thank me later!
This is a little condescending, and one-sided. "Silly patients, trying to make their own decisions instead of blindly following doctor's orders! Shame on them, tsk tsk!" Sometimes patients make their own assessment about the risk/benefit ratio of taking a medication, and sometimes they may put more thought into it than their doctor. While there may indeed be many cases of illness and death traceable to medication "non-adherence," there are at least as many (and probably more) cases of illness and death traceable to prescribing medications unnecessarily or incorrectly.
57
Another reason for "lack of adherence" - Stubborn doctors who refuse to believe their own patients and their own blood test results.
Ever have a doctor switch your prescription even though your old prescription was affordable and worked just fine? And when the new drug doesn't work and makes you feel horrible the doctor ups the dose and says to give it a few more MONTHS? Then your blood test results get even worse, but the doctor refuses to believe them because "they can vary." And even though the new drug clearly isn't working, he refuses to switch you back to your old drug because "all his patients" are on the new drug? So you stop taking it.
This is a common, common problem. Would the authors also call this noncompliance?
Ever have a doctor switch your prescription even though your old prescription was affordable and worked just fine? And when the new drug doesn't work and makes you feel horrible the doctor ups the dose and says to give it a few more MONTHS? Then your blood test results get even worse, but the doctor refuses to believe them because "they can vary." And even though the new drug clearly isn't working, he refuses to switch you back to your old drug because "all his patients" are on the new drug? So you stop taking it.
This is a common, common problem. Would the authors also call this noncompliance?
68
People in this situation need a new physician.
12
Depending on where you live or what kind of insurance you have, it may be difficult to change physicians.
3
This sounds to me like your doctor is making his decisions by listening to his drug reps and benefiting on the side.
1
I take 3 medications for the prevention of migraine headaches. The PREVENTION.
These are not a cure. And have they not alleviated my symptoms what so ever. They have been part of my daily regimen for many years now. Yes, I have tried other treatments, which have failed to give me any relief.
There are days when I skip medication. Is it detrimental to my condition? Probably not. Is it life or death? No.
But I have to wonder what effect these drugs are having on my body.
These are not a cure. And have they not alleviated my symptoms what so ever. They have been part of my daily regimen for many years now. Yes, I have tried other treatments, which have failed to give me any relief.
There are days when I skip medication. Is it detrimental to my condition? Probably not. Is it life or death? No.
But I have to wonder what effect these drugs are having on my body.
9
Diane, I was offered the same sort of regimen. I get migraines too. I don't know what has worked for you in the past but I know what helps me if I'm in a place where I can do this. I lie down and put compresses on my face. It doesn't matter if they are hot or cold although the heat helps me more than the cold. If it's late and I want to go to bed I take Tylenol 3 with codeine. The other thing that helps me is swimming because I have to blow my nose afterwards. A hot shower can give me some relief as well. One last thing that helps is a cup of hot tea.
I'd love not getting them at all but they happen. Since I have to function I'm limited in what I can do in terms of sleep to get it to go away. And no drug is without its side effects no matter what the doctors say. Good luck.
I'd love not getting them at all but they happen. Since I have to function I'm limited in what I can do in terms of sleep to get it to go away. And no drug is without its side effects no matter what the doctors say. Good luck.
5
Hey Diane,
For many years, my older brother has been battling blinding migraines which used to render him completely ineffective and would land him in bed for 1-2 days. He finally could not tolerate the pain any longer and asked his physician if he could write him a prescription for medical marijuana. After a bunch of paperwork, his medical condition qualified him for medical marijuana. And the marijuana has helped alleviate his symptoms. Whenever he feels a migraine coming on, he pops one pill and the symptoms disappear. Just a suggestion Diane. I feel for you. Good luck with hopefully finding a remedy.
14
Ms. Brody, the elephant in the room is the cost of the medications, the cost of the tests that some medications require, the cost to see the specialists, the fact that dealing with our so-called health care system is enough to send one's blood pressure through the roof on a good day. I'm supposed to take asthma medication. I have exercise induced asthma and allergies. I stopped taking the medications because I lost my job, I had very little money coming in and, when I asked my PCP if he would check me out when I couldn't afford to pay $50 for a visit and god knows how much for the tests, he said no.
I have a job now but who knows if it will last, if I will be able to afford to pay when the job ends, or if I'll be able to see a decent specialist because PCPs no longer bother to treat people for allergies and asthma. The cost of not taking our meds can be chalked up to the cost of not having universal health coverage through a single payor. Pharmaceutical companies do not care about our health. Nor do hospitals, labs, physicians, employers, or insurance companies. We are merely wallets to be picked or claims to be denied.
And while I'd like to take better care of myself when it comes to allergies and asthma I don't have the time to do my job, fight with the insurance company, and search for an in network doctor who uses a lab that's also in network.
I have a job now but who knows if it will last, if I will be able to afford to pay when the job ends, or if I'll be able to see a decent specialist because PCPs no longer bother to treat people for allergies and asthma. The cost of not taking our meds can be chalked up to the cost of not having universal health coverage through a single payor. Pharmaceutical companies do not care about our health. Nor do hospitals, labs, physicians, employers, or insurance companies. We are merely wallets to be picked or claims to be denied.
And while I'd like to take better care of myself when it comes to allergies and asthma I don't have the time to do my job, fight with the insurance company, and search for an in network doctor who uses a lab that's also in network.
161
hen3ry: you can have very good universal health care WITHOUT single payer. Only 3 nations in the world have single payer -- Canada and two Asian nations. NO NATION IN EUROPE HAS SINGLE PAYER. French health care is considered the best in the world; it is NOT single payer.
The biggest impediment to having UNIVERSAL HEALTH CARE is that liberals don't even know the difference between systems, or what the names mean. If you call "everything" single payer, than nothing will ever be done to improve our present dreadful, unfair system.
Even worse: if you insist that it is "FREE". Nothing is free. Medicare is not free. Canadian single payer is not free. You pay in taxes, perhaps, instead of at the doctor's office, but you STILL PAY.
The biggest impediment to having UNIVERSAL HEALTH CARE is that liberals don't even know the difference between systems, or what the names mean. If you call "everything" single payer, than nothing will ever be done to improve our present dreadful, unfair system.
Even worse: if you insist that it is "FREE". Nothing is free. Medicare is not free. Canadian single payer is not free. You pay in taxes, perhaps, instead of at the doctor's office, but you STILL PAY.
8
Chiming in about the Canadian single payer program. My husband's best friend is a Canadian. He was in need of an organ transplant but did not have the higher level of the single payer insurance. I didn't know that even existed in Canada. His wife said because they didn't have the higher level insurance plan, he was not at the top of the donor list. He had to wait 6 months because even being eligible for the transplant. He eventually got it and all was okay, but they told us that the Canadian insurance plan is not as glamorous as people think. They pay BIG money in taxes to cover this healthcare program. On some levels, the Canadian program is better than the US healthcare plans, but like most things, every yin had its yang. I apologize to our Canadian neighbors if I misunderstood or incorrectly recalled any of the above intel. Please correct me if I am in error. Thanks.
4
Allergies? Most antihistamines are over-the-counter. Many people prefer the newer non-sedating drugs. I took one, once. I had no idea what my boss wanted me to do. I recognized all the words he said, but they didn't work together. About 4:00 pm, someone looked at me and said "The fog is lifting." I never took another one of those. It was frightening. No pain, no dizziness, no sleepiness, just lost in the ozone.
I take the old-school antihistamines, After the 40 years I've taken them, none of them make me sleepy. I'm allergic to everything. I deal with it.
I take the old-school antihistamines, After the 40 years I've taken them, none of them make me sleepy. I'm allergic to everything. I deal with it.
1
For many people with chronic autoimmune diseases, compliance with prescription medications means the difference between the agony of a flare, and remission. The benefits definitely outweigh the possible problems, which can be minimized. Side effects need to be monitored with lab tests. Dosages need to be periodically re-evaluated in consultation with your doctor. It's worked for me.
A simple way to keep track of medications is one of those little pill containers with compartments for each day of the week. I count out my pills at the beginning of each week, and refill the compartments. It makes it very easy to remember to take your medication each day.
A simple way to keep track of medications is one of those little pill containers with compartments for each day of the week. I count out my pills at the beginning of each week, and refill the compartments. It makes it very easy to remember to take your medication each day.
12
You're right but the problem is the cost. If you don't have a job and you have diabetes, no matter which type you have, you need money to pay for the medication. No money, no meds. No money, no doctor. That's our system and since it's fee for service and we don't help people unless they are destitute, it doesn't matter if you were taking your meds every day before you couldn't afford them.
12
@hen3ry: my best friend has had diabetes now for 35 years. She is on a special, very costly insulin (the other cheaper ones no longer work for her) and it costs $1500 before insurance. Even WITH insurance, she pays about $175 per monthly prescription. That's without the needles, the testing strips, lancets, etc.
Now imagine she lost her insurance. $1500 a month! plus the other stuff! plus her other drugs for high blood pressure, cholesterol, stomach problems, etc.
Only a millionaire could drop $3000 on drugs every month, and forget about rent, food, utilities, transportation, clothes, etc.
Honestly, like most of the wealthy, pampered elitist staffers here....Ms. Brody simply has NO IDEA how people live today. NO IDEA AT ALL!
Now imagine she lost her insurance. $1500 a month! plus the other stuff! plus her other drugs for high blood pressure, cholesterol, stomach problems, etc.
Only a millionaire could drop $3000 on drugs every month, and forget about rent, food, utilities, transportation, clothes, etc.
Honestly, like most of the wealthy, pampered elitist staffers here....Ms. Brody simply has NO IDEA how people live today. NO IDEA AT ALL!
14
All "big pharma" companies have plans for getting medications to people who cannot afford them. If you are unemployed or don't have insurance and you need an expensive drug, contact the manufacturer, fill out a form, ask your doctor to sign the form, and send it in. They will help.
1
Yet again evidence that big pharma is killing us, while enriching their executives. A pox on all of them.
6
Really? You are free to gamble with your own health. Next time you have an infection,say pneumonia, don't take any antibiotics and see how that works.
6
Geri, as long as it's bacterial pneumonia. Antibiotics won't help with viral.
2
I've taken less than half of pills prescribed to me. Because the doctor prescribed them 'just in case'. Or 'try this and if it doesn't work, only then try that.' Or 'I don't really know the answer. Here's a pill, anyway.' Or because I got better (excluding antibiotics of course). Or I got a second opinion. This is a useless statistic. You have to look at necessary and critical prescriptions vs. casual ones.
11
Depending on the medicine, add as a factor lack of trust in the studies supporting the medicine and/or the dosage. Some medicines touted as being effective have subsequently been shown to be ineffective, and some even harmful. There are vogues in medicines and a lot of false news on effectiveness. People are understandably skeptical.
And few medicines are customized for dosages. The doctor may tell the patient - "try this and see how you feel. If it's not working we'll increase the dosage." Not confidence inspiring. And doctors sometimes don't have a complete list of medications being taken, or don't know the interactions. It might be more helpful to have a pharmacist explain what the drug does and how. I think many, if not most, drugs now offer a consult with a pharmacist when a prescription is filled, although if you order by mail that is not happening.
Finally, some conditions now being treated with drugs have recently been shown to respond as well or better to changes in diet and exercise.
So the answer is to understand what the medicine is intended to do, what to look for in symptoms and how it will help you. Better communication is essential. Antibiotics is the one outstanding example of a drug that works but needs to be taken as directed.
And few medicines are customized for dosages. The doctor may tell the patient - "try this and see how you feel. If it's not working we'll increase the dosage." Not confidence inspiring. And doctors sometimes don't have a complete list of medications being taken, or don't know the interactions. It might be more helpful to have a pharmacist explain what the drug does and how. I think many, if not most, drugs now offer a consult with a pharmacist when a prescription is filled, although if you order by mail that is not happening.
Finally, some conditions now being treated with drugs have recently been shown to respond as well or better to changes in diet and exercise.
So the answer is to understand what the medicine is intended to do, what to look for in symptoms and how it will help you. Better communication is essential. Antibiotics is the one outstanding example of a drug that works but needs to be taken as directed.
4
I developed high blood pressure when I was only 25. My doc at the time gently but firmly impressed on me the importance of taking my meds every day, without fail, no excuses. I had great respect for him, so I followed — and still follow — his advice. There have been two great benefits: CVD runs in my family, but by taking my meds I've staved off the worst effects for many years [I'm now 80]; second, adhering to a prescribed course of treatment for a chronic disease has taught me how important it is to treat chronic disease on a day-to-day basis, which has helped me get sober and stay sober for 25 years [so far].
25
Kudos to you, Sandy. I hope others reading this are inspired to do the same.
When I was diagnosed with diabetes a few years ago, I was so ill that just waking up and getting the bare minimum done for my family took all my energy. Remembering to take a new pill twice a day was hard. Even though medication helped immensely, it has still taken a long time to get back to a place where I have enough energy to remember to take it regularly. Being ill takes a toll on the ability to function that isn't always appreciated. I like my doctor, and I still believe she doesn't realize how much it affected me. As for remembering to take my pills, the best thing has been getting a pill box where I put it. That way I can just look to see if I've had my pill today or not. I picked it up for fifty cents at a garage sale and ran it through the dishwasher, so it was cheap too.
15
Why is tetracycline up to $10 a pill now? Good question is it not. I would not want to have acne about now. Also, look at the money spent predicting medication prediction adherence scores, this is not actual data but predicting if you will take your prescriptions! This is an expensive outrage that costs us money as PBMs use it to score and sell data about us. Again, not confusing this with actual monitoring of real actions.
http://ducknetweb.blogspot.com/2015/06/medication-adherence-predictions-...
If you pay cash, then these programs label you as an outlier, they search credit card data and anywhere they can scoop up behavior data about you for sale or for free.
http://ducknetweb.blogspot.com/2015/07/patients-who-pay-cash-when-fillin...
This adds cost to what we pay for drugs and does nothing to benefit us at all.
http://ducknetweb.blogspot.com/2015/06/medication-adherence-predictions-...
If you pay cash, then these programs label you as an outlier, they search credit card data and anywhere they can scoop up behavior data about you for sale or for free.
http://ducknetweb.blogspot.com/2015/07/patients-who-pay-cash-when-fillin...
This adds cost to what we pay for drugs and does nothing to benefit us at all.
9
There is no mention of the prohibitively high (and unjustifiable) costs of many medicines. Many people cannot afford them, even with an insurance prescription drug plan. I can understand why many people forgo filling prescriptions, or even stop taking a prescription when a refill is due - too many drugs are unjustifiably priced too high.
43
" the biologics used to treat rheumatoid arthritis that cost $4,000 a month, "
5
And it's getting worse. Besides the headlining cases involving Epi-Pens, etc., many lower-profile drugs are skyrocketing in price. I went to refill a prescription skin cream that in 2015 had cost me $3. This year, at the same in-network pharmacy and under the same insurance plan, they wanted $105. I decided it was optional and declined to purchase.
2
"Although the consequences of ignoring medication may not show up right away, it can result in long-term harm." You mean such as omeprazole. Opiates. Statins? The larger problem, in my experience, is OVER prescription of these medicines. They all have side-effects. Perhaps worse than the disease - everyone is different. It's a trade-off. In the long run we're all dead. I've studied this stuff statistically on a world-wide basis. It's the overall morbidity that tells the tale. Reminds me of "wack-a-mole." You can drive down one malady but it pops up somewhere else - these weird chemicals are NOT in part of our natural history and WILL cause unforseen consequences. There is no magic in all this. The article here sounds like it was written by an internist - or Phizer salesman. Rely on meds for their income. I have friends and relatives in both medicine and the pharmacology business. In general, they are not particularly good critical thinkers. A few are excellent and my hat is off to them; they are usually the ones who more often say, "You don't want to take that stuff, we don't even know how it works." And, at older age, this is especially true - what are you afraid of? All this is a powerful insight on the American culture and it ain't good (Pogo).
16
I had knee surgery some years back. I was given opioids for the pain. It was bad pain, but I only needed pills for 5 days -- after that, I could manage on over the counter pain meds. But the doctors gave me 60 days worth of opioids.
Is it Ms. Brody's contention that I was "bad" for not taking huge doses of opioids, and perhaps, developing a dependence or addiction on them? I CHOOSE not to continue the drugs. I told my doctor what I was doing. He did not care all that much, frankly.
I've had more arguments with my regular doctors about statins -- they cause bad side effects for me. The doctors argue they are good for you, so just suffer the pain (!!!!). I disagree.
It's my body and my choice.
Funny, how people who argue for abortion rights under "it's my body!" don't believe this in regards to other things.
Is it Ms. Brody's contention that I was "bad" for not taking huge doses of opioids, and perhaps, developing a dependence or addiction on them? I CHOOSE not to continue the drugs. I told my doctor what I was doing. He did not care all that much, frankly.
I've had more arguments with my regular doctors about statins -- they cause bad side effects for me. The doctors argue they are good for you, so just suffer the pain (!!!!). I disagree.
It's my body and my choice.
Funny, how people who argue for abortion rights under "it's my body!" don't believe this in regards to other things.
6
There is a huge difference between opioids, or any other pain medication, and maintenance drugs.
The former are short-term and can be decreased or stopped as needed. The latter, as the category suggests, are to be taken long-term in order to counteract a long-term health problem, e.g., statins for high cholesterol, medication for high blood pressure. These do have to be taken regularly as prescribed in order to achieve, and maintain, the needed effect.
Would a woman stop taking birth control pills because they must be working since she has not gotten pregnant. Therefore she no longer needs them to prevent pregnancy?
Further, in regard to Jane Brody's suggestion from Dr. Shrank to keep the medication next to the toothbrush: Keeping medication in the bathroom, where it can get warm and humid, can damage medicine. The advice that is often given is to keep medication in a cool, dry place.
The former are short-term and can be decreased or stopped as needed. The latter, as the category suggests, are to be taken long-term in order to counteract a long-term health problem, e.g., statins for high cholesterol, medication for high blood pressure. These do have to be taken regularly as prescribed in order to achieve, and maintain, the needed effect.
Would a woman stop taking birth control pills because they must be working since she has not gotten pregnant. Therefore she no longer needs them to prevent pregnancy?
Further, in regard to Jane Brody's suggestion from Dr. Shrank to keep the medication next to the toothbrush: Keeping medication in the bathroom, where it can get warm and humid, can damage medicine. The advice that is often given is to keep medication in a cool, dry place.
10
“Statins are cheap and there’s big data showing a huge payoff,..."
Please cite the "big data" ...along with the side effects...
Please cite the "big data" ...along with the side effects...
48
This is a little like arguing with a denier about global warming : where does one begin? Suffice to say there is an ENORMOUS body of evidence linking statin usage to longevity . This fact is of importance to some of us .
5
Well, here's just one. Looks to me like most the comments on this article are from self-declared wanna-be scientists.
"The authors used a cost-effectiveness model called the Coronary Heart Disease (CHD) Policy Model to assess the incremental cost-effectiveness over a 30-year period of lowering low-density lipoprotein (LDL) cholesterol with statins in persons who have not previously had a heart attack.
Findings are published in the February 17 issue of the “Annals of Internal Medicine,” the official journal of the American College of Physicians. The paper is accompanied by a supporting editorial that cites both the importance of the study and the importance of cost-effectiveness analysis, in general, as a method for comparing strategies to improve health.
The study found that adherence to the 2001 recommendations from the National Heart, Lung and Blood Institute’s National Cholesterol Education Program (NCEP) would be a cost-effective way to prevent and manage coronary heart disease in this country.
Full adherence with the guidelines would prevent 20,000 heart attacks and 10,000 CHD deaths every year."
"The authors used a cost-effectiveness model called the Coronary Heart Disease (CHD) Policy Model to assess the incremental cost-effectiveness over a 30-year period of lowering low-density lipoprotein (LDL) cholesterol with statins in persons who have not previously had a heart attack.
Findings are published in the February 17 issue of the “Annals of Internal Medicine,” the official journal of the American College of Physicians. The paper is accompanied by a supporting editorial that cites both the importance of the study and the importance of cost-effectiveness analysis, in general, as a method for comparing strategies to improve health.
The study found that adherence to the 2001 recommendations from the National Heart, Lung and Blood Institute’s National Cholesterol Education Program (NCEP) would be a cost-effective way to prevent and manage coronary heart disease in this country.
Full adherence with the guidelines would prevent 20,000 heart attacks and 10,000 CHD deaths every year."
2
How about a study on the deleterious effects of too many prescription meds.
A pill for everything is not always the answer.
A pill for everything is not always the answer.
36
There was an article in the Health section about this a few days ago.
I'm told that Synthroid is an over prescribed medicine, especially amongst women before/after menopause. Whether or not that's true, I can't say for sure. But just hearing that rumor suggests to me, with regard to this particular drug, that some patients might not take it as recommended by their doctors. And I doubt this is the only drug that has this reputation.
1
I cannot imagine someone willingly skipping a prescribed medication for hypothyroidism. Without it, one would lapse back into hypothyroidism, a condition that causes fatigue and weight gain - neither of which is likely to be welcomed.
5
That seems contrary to the very real problem that hypothyroidism is severely underdiagnosed. I would be terrifically surprised it Synthroid were over-prescribed - it's available in several very inexpensive generics.
6
Google JAMA and over diagnosis of hypothyroidism. There is a an epidemic of over diagnosis and over prescription
Last week, in the Health section, was an article about taking too many medications, some that maybe no longer necessary. This week, not taking medications in a consistent manner. Two conflicting view points and probably both are true, it's best to consult with your personal physician.
22
If people can't afford their medications, that's far different than merely not wanting to take a pill. Lumping affordability together with the the other issues is misleading, because affordability is one factor that could be addressed and solved. Sadly, at least in the U.S., it's doubtful that it will be.
136
I always take my medication every day!
5
My husband has been a lifelong asthmatic, requiring meds since he was a kid. He is very good about taking his meds and rarely has an asthma attack. Of course, he remembers the old days when they only had one medication and it had terrible side effects, but not so bad as an asthma attack. We met more than a few parents who decided they didn't want their kids taking meds for asthma, it was 'bad' for them, but they didn't seem to care that their kids were having trouble breathing, until it became a full blow attack and they were in the hospital. Unbelievable!
10
Kids whose asthma isn't well controlled typically develop COPD, which permanently damaged their lungs and worsens their symptoms. The drugs for severe asthma also come with serious risks, but not as bad as doing nothing. However, those drugs are also unaffordable to some families and the parents might try to convince themselves the drugs aren't needed so they don't feel like failures.
2
I think I am one extremely lucky individual. I was becoming lazy about not taking my daily meds. Even after my physician (who is a personal friend) scolded me rather hashly, I still didn't comply. My biggest reason was like the article stated, "forgetting to take a prescribed drug . . . especially for those ambivalent about taking medication. . . and not having symptoms." My attitude and view point was forever changed the day my husband realized none of my scripts were in the patch of refills he picked up from the drug store. During dinner, he quietly inquired as to why I stopped taking my meds. I hemmed and hawed and finally admitted that I had no rationale explanation. While taking my hand, he said, "let me make it easy for you - I need you in my life EVERY day . . . ALIVE. I love you more than life. Please start taking your meds for me." I know his statement must sound simplistic and ridiculous because of course we love and need each other. But it was the way he said it that made me feel ashamed and selfish and that I was only thinking of myself and not him or how his life would be without me in it. This was no guilt trip he placed on me. It was simply a husband asking his beloved wife to take care of herself. I have never missed a day of meds since. I know in my heart that he has saved my life, on so many levels.
94
The hardest thing is separating the various reasons. As the person involved gets older, memory becomes an issue. How much of the story is perception, how much of it is ignorance, how much of it is side effects vs disease symptoms.
And that is even before you get to drug interactions or maybe interactions with things that you may not even know about like homeopathic remedies (that are becoming so common in "health" stores and are advertised and sold without FDA testing), allergies, food consumption (yes, this can happen).
It would be hard enough for someone with a PhD to figure this out. For someone who may be from a different culture (complete with differing belief systems and language) and/or does not have a high level of education, this would be even more confusing.
The cost element is a uniquely AMERICAN problem. But, there are plenty of other conflicts.
And that is even before you get to drug interactions or maybe interactions with things that you may not even know about like homeopathic remedies (that are becoming so common in "health" stores and are advertised and sold without FDA testing), allergies, food consumption (yes, this can happen).
It would be hard enough for someone with a PhD to figure this out. For someone who may be from a different culture (complete with differing belief systems and language) and/or does not have a high level of education, this would be even more confusing.
The cost element is a uniquely AMERICAN problem. But, there are plenty of other conflicts.
People have been saturated with attacks on Big Pharma and a constant stream of articles highlighting the very rare but possible side effects of every drug Big Pharma puts on the market.
The media with an agenda against Big Pharma has planted seeds of doubt and worry in people's minds to the point that even affluent and decently educated people don't understand how vaccines actually work, so they withhold them from their children.
It's no wonder people cavalierly skip their medicines.
The media with an agenda against Big Pharma has planted seeds of doubt and worry in people's minds to the point that even affluent and decently educated people don't understand how vaccines actually work, so they withhold them from their children.
It's no wonder people cavalierly skip their medicines.
5
Vaccines -- many of which you get once in a lifetime -- are not remotely the same as a maintenance drug you have to take daily, and in some cases, with side effects or very unreliable benefits.
5
For years I preached adherence to treatment (for work). Then my doctor told me my LDL (the bad cholesterol) had hit 275 (yikes!). I was immediately reminded of a patient piece I had once written. The opening line was, "What were you doing when your cholesterol became too high?" The reality is no one knows when that magic moment happened, but I knew enough to think I had to take action. The MD prescribed a popular statin. I took it every day (except for one day when I was in the hospital for neck surgery—but he later said it was okay to miss my daily dose for that). The result? Over a period of two years my LDL went from 275 to a startling 66. "I've never seen a drop like that. How did you do that?" asked my MD. I replied,"Oh, I did something radical. I took it every day as prescribed." He then noted, "You'd be surprised how many of my patients never do that and can't get their numbers down." My LDL still hovers around 70 and I still take my statin every night. It's not that hard to do and the results are well worth the half-second required. It's a no-brainer.
18
Without statins my cholesterol was above 300. Yet I chose, unwisely, not to take it for over 18 months. My last EKG showed a right bundle branch block. This led to a CT scan for plaque in my arteries - my score of 1800 was in the 98% - very bad. The subsequent stress test showed no heart problems. I took the risk because there have been no heart attacks in my immediate family. It was a poor choice. I'm back on a daily statin, better diet and more exercise. Please take your medications my friends.
6
A class of drugs not mentioned is antidepressants. Almost all antidepressant have approaching-intolerable side effects for many people, which can be avoided by starting the dosage much lower than is currently prescribed. For example, anxiety disorder patients are "exquisitely" (the word I read in a journal) sensitive to AD's. The starting dosage for such patients must be a tenth or a twentieth of the therapeutic dosage to be tolerable- which is not current practice. Doctor's knowledge base on side efffects often contributes to noncompliance.
38
There is no such thing as "a simple infection". bacterial infections should not be taken lightly, they can also be life-threatening.
6
I had a call from a CVS pharmacy tech chiding me for not taking my medication.
Since it was a pain med that my doctor suggested I take sparingly, I found the lecture offensive. Acting as Big Brother isn't the answer.
Since it was a pain med that my doctor suggested I take sparingly, I found the lecture offensive. Acting as Big Brother isn't the answer.
84
Frankly, that pharmacy tech was not out of line, but rather, crossed the line. My nephew is a manager of a CVS and would have been appalled of such offensive and intrusive behavior and would have taken action against one of his technicians if that had happened in his store.
9
Me too. CVS mail order has called me twice because I wasn't refilling a med on schedule. If she had read the instructions, she would have seen that I was to take it "as needed." Talk about intrusive!
2
The medicine-pushing alliance is huge and energetic. The only times my doctor's nurses followed up with me concerned whether or not I filled the prescriptions for Vitamin D (5000 iu pills)? My level was on the lower end, but not below the normal level. I changed doctor after that.
3
On the supposed costs of non-adherence ("between $100 billion and $289 billion a year")--I read a series of articles on non-adherence a few years ago and encountered similar numbers, along with the dawning realization that these numbers have very little to do with health, and much more to do with pharmaceutical companies' estimates of lost profits.
Seriously--where in this article is any critical attention to the ratio of possible side effects to possible benefits, and whether many patients who are "non-adherent" should have been offered (ongoing, insurance-funded) non-pharmaceutical treatment in the first place? "Making pill-taking a habit" guarantees ever-greater profits for the pharmaceutical industry, but patients and doctors may wish to think more critically about how best to serve patients' health.
Seriously--where in this article is any critical attention to the ratio of possible side effects to possible benefits, and whether many patients who are "non-adherent" should have been offered (ongoing, insurance-funded) non-pharmaceutical treatment in the first place? "Making pill-taking a habit" guarantees ever-greater profits for the pharmaceutical industry, but patients and doctors may wish to think more critically about how best to serve patients' health.
117
Margaret - bravo. As you indicate, Docs and Americans generally seem to have abandoned their critical thinking skills - have become "believers." And, since folks don't understand the mathematics of probability, they become targets for the emotionalism and non-sense we see in medicine today. Little wonder our health care system costs are sky-rocketing and patients are going broke. Who is fooling whom? But, THEY BELIEVE IT!
4
Medicines for hypertension are some of the best values around, considering they prevent stroke and heart attacks--two very expensive events.
4
There has been a lot of research showing that adverse side-effects to correctly prescribed medications is the 4th leading cause of death in the US. An interesting article from Harvard University Center for Ethics talks abou this: http://ethics.harvard.edu/blog/new-prescription-drugs-major-health-risk-...
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