Best Choices from the People's Pharmacy: What You Need to Know Before Your Next Visit to the Doctor or Drugstore
512
Best Choices from the People's Pharmacy: What You Need to Know Before Your Next Visit to the Doctor or Drugstore
512eBook
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Overview
We can read the newspaper for candid restaurant or movie reviews or consult Consumer Reports for an impartial analysis of the best buys on toasters or automobiles. But where can we find objective evaluations of popular treatments for conditions like arthritis, high cholesterol, and migraines?
Joe and Teresa Graedon, the best-selling authors of The People's Pharmacy, will fill the void with a comprehensive new reference that presents all the information readers need to become savvy health-care consumers. The book offers:
• best-choice treatments for 50 medical conditions—from allergies, asthma, and heartburn to high blood pressure and osteoporosis
• a remedy ratings guide to compare the effectiveness and affordability of various treatment options
• compelling new information on the potential dangers of generic drugs
Featuring a list of the authors' must-have remedies and organized alphabetically by condition for fast, easy access, this trustworthy, practical guide should find a sizable and grateful audience.
Product Details
| ISBN-13: | 9781605295992 |
|---|---|
| Publisher: | Harmony/Rodale |
| Publication date: | 10/31/2006 |
| Sold by: | Random House |
| Format: | eBook |
| Pages: | 512 |
| File size: | 1 MB |
About the Author
Teresa Graedon, PhD, is a medical anthropologist. Together with her husband, Joe, they are bestselling coauthors, syndicated newspaper columnists, and award-winning internationally syndicated radio talk-show hosts. Their media appearances include Dateline NBC, Extra, The Oprah Winfrey Show, Good Morning America, Today, and NBC Evening News.
Read an Excerpt
Making Best Choices This book is about choices. Our goal is to help you and your doctor select the most effective and affordable treatments for you and your family. In some cases, this may be a home remedy or a dietary supplement. But in many others, the best option could be a prescription medication. We all make decisions about where to go for dinner, what movie to see, and which car to buy. Surprisingly, we have more information to help us make these choices wisely than we do about our health-care options. We can check restaurant or movie reviews from trusted critics or consult Consumer Reports magazine for an impartial analysis of the best buys on toasters, mattresses, or automobiles. But where can you find objective information about the best way to treat arthritis, high cholesterol, or migraines? Once upon a time most people relied primarily on physicians to make the decisions about treating these kinds of conditions. There were relatively few medicines, so doctors could know a lot about the handful they were prescribing. Doctors learned about these drugs in medical school or depended on research published in medical journals. People trusted their doctors to select the best medicine for them. Now, there are thousands of medications to choose from, and there is no way a physician can master all the information about so many. In addition, the pharmaceutical industry has developed sophisticated strategies to influence doctors' prescribing patterns. Drug companies advertise their prescription drugs directly to you on television and the Web and in magazines and newspapers. They spend almost $5 billion a year trying to get you to "ask your doctor" about one of their products. Physicians, nurses, pharmacists, and even medical office receptionists are also targets of a full-court press by drug companies. Sales reps routinely provide lunches, dinners, and doodads like pens and notepads in an effort to influence your doctor to prescribe their latest and most expensive medicine. They leave lots of free samples for the doctor to give away. This may seem like a great deal, but after the pills run out, you are stuck paying the bill for what is often a pricey prescription. These tactics work amazingly well. Patients do ask their doctors for specific medicines that they see advertised, and physicians prescribe them quite often.5 And physicians are also influenced by drug company marketing.6 Even their conferences and continuing medical education are often supported by the pharmaceutical industry.7 That, too, influences prescribing, but does not necessarily lead to the most cost-effective, safest choice for the patient. Drug Prices Whether or not prescription drug commercials on television actually increase the cost of the medicines, they certainly help these pricey pills sell. Americans are paying more than ever for their medications. We have been tracking prices for 30 years. As you look at the following table, you may be astonished to see that between 1975 and 1985 the cost of some popular prescriptions rose very little. But starting in the 1990s, prices took off. They've been climbing ever since. |Price Increases of Popular Drugs | |DRUG* |1975 |1985 |1995 |2005 | |Coumadin (10 mg) |$9.40 |$13.85 |$86.19 |$133.49 | |Lanoxin (0.25 mg) |$1.00 |$3.00 |$8.59 |$24.69 | |Lasix (40 mg) |$9.73 |$8.95 |$19.99 |$39.49 | |Premarin (1.25 mg)|$6.90 |$15.95 |$46.89 |$140.99 | |Valium (5 mg) |$8.99 |$20.30 |$62.29 |$193.89 | |*Price is for 100 tablets from chain drugstores. |
Drug companies frequently justify the cost of their pills by citing the expenses of pharmaceutical research and development. All of these drugs were on the market before 1975, however, so their research costs were paid for decades ago. If cars or computers were priced like drugs, we would be paying tens of thousands for a laptop and no one could afford a Buick. AARP conducted a survey of prescription drug manufacturers' prices and discovered that they have been accelerating for years, dramatically outpacing the overall rate of inflation.8 Its analysis of 150 popular products shows that price tags on these brand-name drugs rose an average of 35 percent between 1999 and 2004. That's almost three times higher than overall inflation during that time, which amounted to 13.5 percent.9 The result of this trend is per-pill prices that take your breath away. The cost of the sleeping pill Ambien (zolpidem), which is advertised directly to consumers, jumped 11.9 percent in 1 year. A month's supply could cost about $100, more than $3 per pill. It's enough to keep you awake at night worrying about how to pay for your prescriptions. But if prescription drug prices give you a headache, beware. One of the most successful migraine medicines, Imitrex (sumatriptan), will cost you nearly $20 a tablet. Head-to-Head People don't mind paying top dollar if they believe they are getting their money's worth. That's why so many consult Consumer Reports magazine when they are trying to decide what microwave oven, digital camera, or cell phone to purchase. Consumers Union makes an effort to test many of the brands buyers are likely to find in their local stores. All equipment is subjected to the same tests, and products are rated on how well they perform. Consumers can choose the product that is most appropriate based on the features that matter most to them. With cars, people can compare models based on cost, reliability, owner satisfaction, safety, and miles per gallon. When it comes to drugs, however, such head-to-head comparisons are rare. All a pharmaceutical company needs to do to get FDA approval for a new drug is show that the medicine is better than nothing (a placebo). If a sugar pill relieves headache symptoms for 38 percent of the test subjects and Drug X works for 50 percent, the FDA is likely to give the new com£d the green light. That doesn't tell you beans about whether Drug X is better than Drug Y or Z or whether it is more or less likely to cause complications. When a drug company does spend money for a clinical trial that compares its prized com£d to a competing brand, it may be very cautious about how the experiment is conducted. Richard Smith, MD, former editor of the British Medical Journal, tells how pharmaceutical companies around the world stack the deck: ". Conduct a trial of your drug against a treatment known to be inferior . Trial your drugs against too low a dose of a competitor drug . Conduct a trial of your drug against too high a dose of a competitor drug (making your drug seem less toxic) . Present the results that are most likely to impress11" What all this means is that doctors have a very hard time determining how one medicine stacks up against another, or even against alternative approaches. Is Nexium (esomeprazole) really better than Prilosec (omeprazole) or Prevacid (lansoprazole) for relieving heartburn? Does Zoloft (sertraline) alleviate depression better than Prozac (fluoxetine)? Which one has fewer side effects? You might not mind paying a lot for the latest blood pressure medicine if it works better than everything else on the market and has the fewest side effects. Unfortunately, in one huge head-to-head trial, that's not how it worked. Many physicians were shocked when a government-sponsored study (ALLHAT, the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial) showed that an old-fashioned, dirt cheap diuretic outperformed newer and more expensive blood pressure-lowering drugs.12 This was the largest hypertension study (more than 42,000 patients were enrolled) ever conducted. A 15• water pill called chlorthalidone did as well as or better than blood pressure drugs like Norvasc (amlodipine), Zestril (lisinopril), and Cardura (doxazosin) that can cost 10 times as much (Norvasc and Zestril can run more than $1.50 per pill). For the extra money, people got less protection from heart disease, heart failure, and stroke, as well as the possibility of experiencing more serious side effects. Would you be amazed to learn that chlorthalidone is prescribed infrequently? It isn't even among the "top 300" prescription drugs. In contrast, Norvasc was the number three most-prescribed drug in the United States in 2004, with 30,929,000 prescriptions filled.13 Most physicians like to think they practice "evidence-based medicine." That's the catchword for rational medical care based on scientific research. But in this case, it's pretty clear that many doctors have ignored the data from this important head-to-head trial and bowed to the marketing muscle of Big Pharma. Our goal in this book is to let you know about this type of research so you can work with your doctor to get the best treatments for your money. Getting Results We all hope that whatever treatment we use will help us rather than harm us. That's why FDA approval seems so important. It surprises both physicians and patients to learn that many of the medications endorsed by the FDA fall far short of our expectations. A few years ago, a podiatrist took us to task for suggesting home remedies for nail fungus. He wrote: "There are real, doctor-prescribed, FDA-approved, clinically tested medications to treat toenail fungus. These include topical Penlac or oral Lamisil or Sporanox. I have successfully treated hundreds of patients with these drugs. The unproven treatments you mentioned are little more than urban legends. In 23 years in practice, I have never seen even one patient who has responded favorably to Vicks VapoRub, dilute vinegar soaks, or vitamin E oil. Don't make me waste time dispelling these myths. " Initially we felt chastised. What were we thinking by offering folk wisdom against FDA-approved "real" medicine? Then the mail started pouring in. Dozens of people responded to the podiatrist who had pooh-poohed home remedies. They reported having positive experiences with approaches such as Listerine or dilute vinegar soaks, with applications of Vicks VapoRub or tea tree oil. One pharmacist made the following arguments in our defense: "I would like to point out some facts about the FDA-approved drugs the podiatrist prefers (Lamisil, Penlac, Sporanox). Does this doctor know that Penlac's success rate for a complete cure, according to the manufacturer's prescribing information, is only 5.5 to 8.5 percent after 48 weeks? When using Sporanox, the percentage of overall success rises to a dizzying 35 percent. Also, does he know the costs of these medications? A bottle of Penlac costs $72.99. To reach 48 weeks of treatment once a day to a single affected nail, I conservatively estimate that the patient will need six bottles of the lacquer (one bottle approximately every other month). So Penlac will cost the patient, without insurance, $437.94 to reach an outstanding 8.5 percent cure rate. For Sporanox, one pulse-pak costs $255.99. This is a 14-day supply. The manufacturer recommends 12 weeks of treatment, bringing the patient cost, without insurance, to $1,535.94! No wonder people are looking for alternatives to these medications." Most consumers have no idea what the actual success rate is for any prescription medication. One industry insider captured headlines when he told a scientific meeting: "The vast majority of drugs-more than 90 percent- only work in 30 or 50 percent of the people." This is a secret that drug companies would just as soon keep under wraps. Allen Roses, MD, worldwide vice president of genetics at GlaxoSmithKline, was discussing the value of genetically targeted therapy in overcoming the limitations of several classes of medicines.14 |Response Rates15 | |Therapeutic Area |Drug Efficacy Rate | |Alzheimer's disease |30% | |Asthma |60% | |Depression (SSRI) |62% | |Diabetes |57% | |Incontinence |40% | |Migraine (acute) |52% | |Oncology (cancer) |25% |