office

Last Wednesday at lunch a pharmaceutical representative presented a ‘new’ medication which is really an old medication (long time in generic form costing ~ 15-20$/month) repackaged with some sort of substance or microchip which, once swallowed, a tracking device (a patch to the ribcage) monitors if the patient has taken the daily dose. The information is transmitted to the patient’s app  “and to three or four others as they wish” including the doctor. In his/her copious spare time the physician gets to monitor adherence via an app or through the pharmaceutical website. Presumably one of these watchmen contacts the noncompliant patient to inquire why aren’t they taking their medication and do so now. The medication/system isn’t prescribed like other medications but requires an application (ironically a paper one) and the Rx can only be filled at specialty pharmacies not with the usual pharmacies the patients are already using for their other meds. By the way, the price of this system is 1,700$/month.

What could possibly go wrong?

It took a lot of composure for me not to choke on my sandwich as I listened to this Orwellian situation. I distilled all my questions into one simple inquiry: is there any evidence this system improves adherence compared to setting a daily alarm (as I do) to take your meds. There isn’t any. Ah well.

This is why we can’t have nice things. Once in a while I read about some effort to ‘reduce the rising cost of medication’ like capping the price of insulin or epi-pens but these are quaint band-aids that don’t address the real problem: advances in medications are driven by private industry and they based on profit to please the stockholders not patients. In their defense pharmaceutical companies spend billions on creating meds so they want their money back. The makers of medications lose their patents and have come up with these sci-fi situations and send out salespeople to convince me it is something groovy.

In the USA we are bedazzled by technology and think applying it makes things better. How long though before Rx adherent app information is hacked or sold to others like advertisers or insurance companies. There is something Borg-like about walking around with a patch on monitoring what’s in us. On the other hand we seem OK to walk around with our phones shouting our whereabouts and goings-on to anyone who wants it.

While I am ranting about medications and the machinations mated to them let me add here I have enough money to retire. But if I stopped work I would lose health insurance particularly prescription coverage. I’ve down the sums: the amount of money I would have to pay per month would skyrocket making retirement unaffordable.

Sadly the main reason why this medication won’t be used much isn’t the cost or concerns about privacy but the doctor’s emotional sensation ‘this is going to be more work for me”. They imagine a clinic-full of patients’ electronic information coming in daily and feeling obliged to watch/record it all.  And they are not wrong.

When The Other Doctor at our clinic retires I plan on pulling the plug on pharmacy lunches and samples. The patients will howl like an orchestra of scorched cats not to have samples I suppose, but the set up contributes to the national problem of outrageous costs and pharmaceutical shenanigans.