My first inclination was to write a letter to my doctor (probably a capable, dedicated, and intelligent man), calling a spade a spade, but then I reconsidered. No matter his many sterling qualities, my doctor is by definition a part of, or at least an accomplice in, the situation. My rant would surely fall on deaf ears. Instead, I’ll broadcast my cynical remarks here on my virtually unread blog, where at least someone might hear my voice crying in the wilderness.
Late last week I got a second attack of gout in my right big toe, a stereotypical condition surrounded by a great deal of mythology, rumor, and medical lore. A close friend with the same problem in the same place advised that his VA doctor had prescribed him a generic drug called Allopurinol which costs only $5 a bottle. He reported that one tablet generally relieves the condition immediately and recommended that I get a prescription for it too. Or he’d be happy to give me a pill or two out of his stash.
Trying to play the medical game by its rules, yesterday I called to ask my doctor (with whom I’d already discussed the first attack) to issue a prescription for the miracle pill, but he was away for the week, and though this second attack was sure to fade within a few days, I left a message with full details of the VA doctor and the friend’s experience.
My call was returned by a registered nurse who advised that they wouldn’t write the prescription unless I came in for an examination. The sub-text of her response came in loud and clear: “We won’t do anything unless we add our own bill to the cost of the prescription.”
When I advised that in that case, I would go ahead and borrow pills from my friend, the nurse got uptight, sternly admonishing me not to take anyone else’s medication. I asked why—since it had been prescribed by a “real” doctor and was very effective for the same problem.
The nurse dithered about how there “could be” horrible interactions with my blood pressure medication, citing “studies” of that specific combination of medications (which I find highly unlikely), but offering no specifics of such interactions or statistics. What I heard was “Be afraid! Avoid the slightest, even infinitesimal danger!” (Frankly, every time I get into my car, I’m conscious of putting myself in a position of extreme danger. Every time I walk out my front door… Every time I get out of bed in the morning… By definition, life is unsafe.)
I advised that I’ve now (with my doctor’s agreement and under his supervision) almost completely weaned my system from that poisonous blood pressure pill, so the danger of any interaction is probably even less than negligible. (I’m now down to 1/8 of the low dosage originally prescribed years ago by a nurse-practitioner for only slightly elevated readings, which have never improved or gotten any worse. Even at the time, I understood that it was her professional duty simply to enroll me as a regular contributor to the pharmaceutical industry.)
The nurse responded that nevertheless I was still on the medication and should be very afraid. Ratcheting up the pressure to an almost hysterical level, she gratuitously added that some interactions could even be fatal. Again there were no specifics or statistics, just alarmist jargon. Recognizing this tactic as standard practice in our current culture of fear, I noted that over-the-counter herbal supplements, while much less effective than Allopurinol, are widely available, but there are such studies or warnings about them.
Ignoring those unprofessional remedies (at higher cost than Allopurinol with sales income not accruing to the pharmaceutical industry), she again urged me to “make an appointment” (i.e., make an extra payment to them) to talk about treatment and a prescription. I advised that I wouldn’t waste either their or my limited time on the issue of taking a single pill of proven effectiveness for a common, otherwise pharmaceutically untreatable, condition.
She countered with an irritated threat “to tell on me” by writing up our conversation for my doctor. I told the nurse to feel free to do so, just as I felt free to call my friend for some of his pills. When we ended the call, her frustration was palpable. She’d missed a possible sale!
When I rang up my friend right afterwards, he wasn’t home, and so I figured I’d call him today. When I got up this morning, the gout was gone, so the entire charade was moot.
However, the charade was a dramatic illustration of the basic problem with our healthcare industry. Like other for-profit businesses, healthcare providers’ real purpose is to generate sales, not service. Aided by the FDA, they collude with the pharmaceutical industry to “hook” people on their monopolistic products. (Witness the current opioid epidemic.) And both collude with the insurance industry (the stock in trade of which is fear), to kick back to each other on their sales and ultimately inflate costs to the consumer/patient.
This unholy trinity has our economy by the throat. In the name of public benefit, they exploit the population for private gain, just as other industries exploit our natural resources (the public’s treasures) for private gain. The fatal flaw in our government and economic system is that private enterprise is inimical to public benefit. But I’ve already ranted about that in an earlier blog or two.
Would anyone care to try and disabuse me of these dire and hopeless notions?