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Fixin' Healthcare

Wednesday, January 25, 2006

The Lifestyle Chronicles - Medicare Part D

It was my intent to avoid commenting on the new Medicare drug benefit (Part D) beyond a brief response over at The Health Care Blog. So many others have already offered their opinion. Everyone appears to accept the basic premise that the program will benefit seniors but the design and implementation are a mess. With all due respect to my health policy colleagues, I must rise to the bait because my objection is to the basic premise. Medicare Part D is bad medicine and it is bad government.

Senior citizens in the US are the most overmedicated group of people in the world. Their lives and drugs are so intertwined that it is difficult to evaluate the original justification. The course of life is changed by dependence on drugs and the quality of life is lowered when taking drugs that are not necessary. Unfortunately, that situation often occurs and Part D will aggravate the problem.

It is sad but true that people have been conditioned to expect much from drugs. Physicians are trained to prescribe drugs and they have limited time to spend with patients who frequently and aggressively seek drug therapy for the perceived benefits.

For example, physicians know antibiotics don't have effect on viral infections. Yet, there is a lot of antibiotic therapy given for viral infections. I ask you, why is that? Antibiotics are potent medications with many potential adverse effects. The overuse of antibiotics is creating lethal infectious organisms that are resistent. This could be considered equivalent to another terrorist threat.

People seek medications to counteract conditions caused by their lifestyle rather than change lifestyle. "Heartburn" and "acid reflux" are so common that Prisolec and Nexium were the third and fourth most prescribed medications in 2003. In my experience over 90% of people with these conditions get relief when they cease eating highly processed "junk" food and drinking sodas. There has been an increase in esophageal cancer which some attribute to "acid reflux" but these drugs contribute to increased alkalinity that can be even more toxic to tissue.

Consider the people who get drugs and don't take them, the situations where the drugs have no effect or an effect unrelated to the problem, the situations where the wrong drug is prescribed and the adverse reactions to the drugs. My guess is that represents about 50% or more of the drugs prescribed.

Public health and medicine should be creating public awareness where drugs are considered potent agents with capacity to do good or cause harm. Drugs should be taken when necessary and changes in lifestyle will decrease the necessity to an extent that could reach 50% of all drugs and OTC preparations. Instead the government has thrown open the floodgates for bad medicine and I doubt most doctors will be able to resist the tide. Look for drug utilization to go up and health status to decrease.

Part D is bad government because the money could have been put into Medicaid with greater benefit to more people, including the senior citizens. Given the choice between Part D and nursing home care, my advice is to choose the nursing homes. Medicaid could cover the necessary drugs and doctors would be more circumspect about prescribing.

I advocate repeal of Part D and I am a senior citizen.

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