ASK DR. BAUGHAN                                             June 18, 1999

CULTURAL CROSS-FIRE

One reason practicing medicine remains intriguing is because health care seems to focus so many of the conflicts in values in our society.  The June 1999 issue of the Journal of Family Practice contains a good example of this in an article “Patients’ Reactions to Refusals of Advertisement-Induced Drug Requests.”  It addresses the relatively new phenomenon of drug companies advertising prescription medicines in the public media.  It asks, “What happens when a patient says, “Doctor, I heard about this drug on TV and think it sounds good for me.  Will you prescribe it for me?” and then the doctor says, “No.”  The study was exploratory and did not presume to come up with any conclusive findings, but it suggested that a certain percentage of patients will become more dissatisfied with their health care if their doctor’s communication skills are not good.  Not an earth-shaking idea, but an example of how one social force (a drug company’s desire for more profits) can create another social problem (distrust or dissatisfaction in the doctor-patient relationship).

It made me think of another example of how the way we analyze social problems can miss important points.  For example, we all know health care is too expensive and “bad for the economy.”  There is a certain truth in this.  However, when drug companies spend $1 billion in public advertising, this is good for the advertising industry, the media industry, and the drug company industry.  On the other hand, I have not seen an ad for a drug that costs less than $50 a month, usually over $100 a month.  There are often less expensive alternatives.  HealthSource has recently instituted a policy that I must get company approval before I can prescribe the new arthritis medicine Celebrex.  They want to limit costs, in this case not because the medicine is risky, but because they want to maximize their profits.  Their rationale will be that they need to keep costs down to stay in business and offer more health care services while their executives pull down large “compensation packages.”  Caught between these competing giants is the doctor and patient.

More drugs are over-the-counter that used to require prescriptions.  The heartburn medicines like Zantac, Tagamet, and Axid are heavily advertised.  Their advertising costs are not considered “health care costs,” so those statistics show a “healthy economy.”  They help sell pizza, too, so that is “good for the economy.”  But education in a healthy lifestyle, and choosing to eat foods that agree with your whole body, not just tickle your tastebuds, has no economic value we can measure.

Individuals or insurors have money to pay for expensive ways to get pregnant, such as in-vitro fertilization at $20,000 per pregnancy, but we “do not have the money” as a society to teach people how to not get pregnant when it is not good for them or how to parent their children when they don’t know.  We have money for plastic surgery; we don’t have money for mental health care.  Insurors won’t pay for Zyban or nicotine patches to stop smoking; they will pay for treatment of emphysema and lung cancer.  Individuals often say they cannot afford Zyban or nicotine patches, but they can afford another year’s worth of cigarettes.  They cannot afford more taxes for education, but they won’t miss getting this week’s lottery ticket.

Health demands that we look beyond the next meal, the next paycheck, the next annual report.  It demands that we look for balance and wisdom, not just comfort, convenience, pleasure, status and wealth.  The Native American elders have a tradition of making decisions based on the effects they will have on the next seven generations.  Such wisdom can be re-discovered.  It need not be new.