My route to drug smuggling did not begin on a coca farm in Columbia or a dark alley in Cincinnati. I was not looking to score a vial of crack or an ounce of pot. I wasn’t even looking for drugs for myself. No, my foray into the drug underground began, like that of Americans, in a doctor’s office. Looking for affordable medication to treat infertility, I turned to a Mexican “connection.”
I am sure many of your patients—perhaps even your parents or grand-parents—have traveled a similar journey in search of affordable prescription medications. Many Americans have been purchasing their drugs on the internet, buying them on trips out of the country, or doing without.
Barring hanging chads and Supreme Court theatrics, you already know the outcome of our 2004 presidential election. But I suspect the debate on healthcare coverage and drug costs has only begun to heat up. Whether the implementation of drug discount cards and the transition to a pharmacy benefit for Medicare recipients, drug importing, or pharmaceutical profits, the struggle for affordable medicines is only beginning to gain attention.
Following are pertinent issues from a recent day in the office:
- A young couple struggling with the cost of infertility treatments (alluded to earlier)—“an uncovered service” according to their insurance plan—wonders if a trip to Mexico is warranted
- An elder using essential medications for heart failure, coronary disease, hypertension, diabetes and depression, is confused by the discount plans and pays hundreds of dollars out-of-pocket each month
- A middle-aged executive out of a job because of corporate restructuring faces an astronomical bill for treating his hepatitis C.
Why is this happening? One reason is the influence of the drug industry. Marcia Angell, former editor-in-chief of NEJM, is masterful in telling the story in her recent book, The Truth About the Drug Companies: How They Deceive Us and What to Do About It. Dr Angell explores myths such as the industry’s devotion to research, while revealing their artful manipulation of laws supposed to protect consumers and the promulgation of marketing under the guise of education. While occasionally strident, and overlooking the industry’s accomplishments and the context of fre-market competition, this book should be required reading in this year of Presidential promises.
Another reason is the inability of Congress to address the issues of comprehensive healthcare coverage for all that is affordable, portable, and accessible. Too often, patients face huge bills because of gaps in coverage, changes in employment, or convoluted requirements for reimbursement. It would appear neither the Democratic nor the Republican parties are willing to tackle these issues in an all-embracing manner.
There is no doubt in my mind that we are both in “the best of times, and the worst of times.” I simply hope, whoever has assumed the Presidency begins to seriously address this issue facing all Americans. Or I may once again become a drug “smuggler.”
