Tuesday, November 27, 2012

Is It Selfish To Choose A Life Without Prescribed Medications?

This is in response to the post on Blogher, "Is It Selfish To Choose A Life Without Prescribed Medications?" as well as some of the comments that follow it.

Consider the following scenario:
An individual with a history of allergies, including cat dander, has been prescribed two different inhalers to control asthma.  The patient has also reported effects from eating certain foods, but the allergist refuses to test for food-related allergens.  The patient pays attention to the effects of foods on his own.  After a few years of conscientiously using the inhalers, the patient finds out about a Naturopathic Doctor who has been able to "cure" patients of their allergies.  After consulting with this new doctor, the patient undergoes the recommended diet plan and supplement schedule.  After only one week, the allergy symptoms have improved remarkably.  About six months later, a cat is introduced into the household with no adverse effects.  A few years go by with good results except for some difficultly breathing in the fall when not adhering to the diet.  The patient now shares a home with four cats and one dog.  One fall day, the patient is working outside in the yard and inadvertently inhales a dense cloud of dust from a moldy pile of grass clippings.  Later that night, his breathing is labored even though he self-medicates with Benedryl and Sudafed.  Finding no over-the-counter rescue inhaler, he decides to go to the walk-in clinic for a breathing treatment.

Should the insurance company pay for the breathing treatment?  One could argue that if the patient had been taking the prescribed medication, the breathing treatment would be unnecessary.  Another could argue that by carefully seeking alternative treatment, including diet changes, the patient has saved the insurance company the cost of years of medication, which more than offsets the cost of this one treatment.  Who's right?

How about this:
At a wellness visit, a primary care physician advises his otherwise healthy 35-year-old patient of "dangerously" high cholesterol.  The patient says he will alter his diet in order to try to reduce it.  At the next visit, the doctor finds that the cholesterol has lowered several points but is still way above the upper limit of 200.  The patient agrees to take a statin drug to lower the number.  After three months, the patient's cholesterol has been lowered successfully, but liver enzymes are off, so the doctor adjusts the medication.  After one more adjustment, the blood tests indicate an acceptable level of both cholesterol and liver enzymes.  After a few years, the patient seeks the advice of a Naturopathic Doctor for fatigue, brain fog, weight gain and increased appetite.  The doctor implicates metabolic syndrome (the patient does have a family history of diabetes) and suggests that the patient discontinue the statin medication, which can result in insulin resistance as well as  weak and damaged muscles (including the heart muscle) even though blood tests do not show the damage.  The patient goes on a special lo-carb, anti-inflammatory diet as advised by the doctor.  The diet is intended to address the fatigue and brain fog, but because it will promote a much lower insulin response, it should also prevent arteriosclerosis.  After one week, the patient notices remarkable improvement.  The brain fog is gone, and he's quickly gaining strength at the gym.  Further along, he notices that he awakens refreshed in the mornings, his elbow and knee pain is gone and he has almost no allergy symptoms.  However at his recheck he finds that his cholesterol has returned to its "dangerously" high level.  The new doctor says not to worry about this.  The LDL is high, but other risk factors, such as triglycerides, HDL, C-reactive Protein, are all good, and there are no symptoms of heart disease.  Besides, high cholesterol on its own isn't correlated with heart attack, and statins are remarkably ineffective at preventing heart attack while they promote diabetes.

If this individual should require a stent or bypass surgery, should the insurance company pay for it even though the patient ignored the advice of his PCP?  If the patient should die of something unrelated to a heart condition, can his life insurance company refuse payment on the grounds that the client changed his treatment plan?  Suppose the patient continued the statin and wound up with diabetes.  Can the patient sue his PCP, the AMA or the drug manufacturer?


Tirsden Frozenrayn said...

Very interesting questions, and while I could say what answers should be right, I have no idea what would actually happen should insurance understand the details behind what they're being charged for. I myself am unmedicated and pretty sure I am Bipolar 1 now, not just Bipolar 2. I would rather deal with my mental illness in its current state than be zombified and have all sorts of other side-effects from medication, which is exactly what I have gotten in the past... and I have permanent memory damage thanks to taking Zoloft in the past.

I don't think it's selfish to be wary of medication, especially pharmaceutical regimens. I think it's *smart*. So many drugs get recalled and the side-effects list during TV commercials for current medication makes me facepalm. They may as well just say "This pill could kill you" and get it over with.

Square Peg Guy said...

If a medication needs to be advertised to be popular, there's probably something wrong with it.

Hope you're okay! Thanks for commenting!