As a country, we're too happy to believe that prescription drugs will
always cure us. And drug companies, doctors, and insurance companies all play a
role in keeping that myth going.
There are few things as private as the medicines we
take. You can imagine asking a decent acquaintance who they voted for in 2008,
who they’ve dated in the past year, and which family member they hate the most.
But I’ll bet it makes you feel queasy to imagine asking them, "Hey! That
little blue pill I saw in your bag. What’s that for, anyway?"
It’s no wonder then that America’s problem with
overmedication hides in plain sight. While we’re all dimly aware that we take a
lot of pills, we have no intuition of how big the problem is. And when you lay
out the stats, the figures are nothing short of terrifying, as this infographic shows. While it suffers from
rhetorical bombast, the tensions suggested by the chart are stark: Even though
we take tons of pills, they seldom actually work. So while 1/2 of all Americans
take a prescription drug and 1/4 of women take an anti-depressant, prescription
drugs only seem to work 30% of the time. Meanwhile, 85% of new drugs have been
found to have little or no benefit. And those miracle anti-depressants? They
don’t even outperform placebos:
As you might have guessed, the authors of this
infographic lay the blame squarely on the shoulders of the drug companies,
which spend far more money pushing their drugs with doctors than they do on
research, and the FDA, which allows them to market the drugs they sell despite
their limited effectiveness.
Doctors, in the meantime, straight up get paid to
prescribe new drugs. If you’ve ever wondered why so many young, energetic women
are making $250,000 a year to be pharmaceutical representatives, there’s your
answer.
No doubt, doctors and pharmaceutical companies make for
troubling dance partners. Without their cozy ties, perhaps the problem of
overprescription wouldn’t be so bad.
But the infographic also misses the most important part
of the story. While drug companies indeed have a vested interest in marketing
their drugs to whomever will buy them, even if they don’t work, they’re abetted
by our profoundly screwed up insurance
system. In
short, it creates some of the worst, most irrational incentives imaginable.
THERE IS ALSO A DEEPER PROBLEM
DRIVING ALL OF THIS BEHAVIOR: MAGICAL THINKING.
Think about the process behind a drug prescription from
the viewpoint of each person involved. For many doctors, the cost of a drug is
totally invisible: They don’t prescribe them with any concern for
cost-effectiveness or even clinical efficacy--indeed, when I’ve asked a doctor
how much something costs, I’ve often gotten a snippy reply, as if asking about
money were some kind of moral insult. Instead, there’s merely the doctor’s own
vague sense of what usually works. If they’re told about something that’s new
and supposedly better, why wouldn’t they prescribe it? If it costs 10x more
than a previous generation of drug, who cares? Likewise, patients with
insurance don’t pay the costs of medications, so they’re only too happy to take
one more drug, under the assumption that it can’t hurt.
The insurance companies, meanwhile, are in a tricky,
low-margin business. Try as they might to wring bargains from pharmaceutical
companies, they can also earn more profits simply by increasing their
reimbursements--which they in turn pass along to consumers as premium
increases. The point being, no single actor in this farce is trying to do bad.
But none of them has any real incentive to say, "Hey, does the patient
really need this? And is it worth the money?"
But there is also a deeper problem within ourselves that
drives all of this behavior: Magical thinking. We’re only too happy to believe
that we can go to the doctor and simply get a pill that’ll fix us up. Indeed, I
imagine that if you went to the doctor about some ailment and were told to eat
more vegetables, get more sleep and exercise, and take a few Tylenol, you’d think
that doc was a fool. You’d never go back.
Doctors know that. They know what’s expected of them.
They know that telling someone, "Hey, your problem will probably go away
on its own in three weeks," is a good recipe for going out of business.
The question is, will our belief in a little magic pill ever go away, even when
the pills lose their magic?
.
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