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medpundit |
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Wednesday, September 10, 2003As wages stayed stagnant, health care premiums skyrocketed by almost 14 percent in 2003, the largest such increase since 1990 and the third consecutive year of double-digit increases, according to a study released yesterday. And there are few signs that such increases would let up anytime soon. Employees are paying 50 percent more for family medical coverage than they did just three years ago, according to the report released by the Kaiser Family Foundation and the Health Research and Educational Trust in Washington, D.C. That employee portion has now reached $2,412 - 27 percent of the total average premium cost. And the rise in insurance costs is a prime explanation for why companies aren't creating new jobs - or giving their current employees raises, experts said. Sadly, one of the reasons health insurance keeps going up is that we doctors keep giving patients expensive medication with marginal benefits. Just recently one of my patients told me his rheumatologist had put him on a new drug for osteoporosis, Forteo. He has to give himself daily injections for two years. He's never had a fracture. He just had signs of early osteoporosis on his bone densitometry. I asked him what he thought of it. He didn't like giving himself injections, but, if it would make his bones stronger it would be worth it. The trouble is, it might not be any better than less expensive oral medications. It's only been compared to placebo in clinical trials. And even then, the results weren't that dramatic: The data also showed that Forteo reduced the relative risk of spinal fractures by 65 percent (9.3 % absolute risk reduction), compared with placebo, and lowered the relative risk of nonspinal fractures overall (sites such as the wrist, ribs, hip, ankle/foot, etc.) by 53% (2.9% absolute risk reduction), compared with placebo. (emphasis mine) And the cost for that 9% and 2% reduction in the chance of a fracture? $600 a month. As my patient said, "Thank God I don't have to pay for it." Unfortunately, everyone else is paying for it. If my patient did have to pay for the drug, no doubt he'd look at those numbers, factor in the inconvenience of giving himself a daily shot and say "No thanks, I'll take my chances." But absolutely no one in the loop has to make any of the choices or look at any of those numbers. Not the doctor, who no doubt wants to give every possible advantage to the patient. Not the patient, who wants to comply with his doctor's recommendation. Only the insurance company has any responsibility. But, if they refuse to cover the medication, they only stand to be accused of pinching pennies at the expense of quality care. We need to come to our senses and accept more accountability for the decisions we make. But that isn't going to happen as long as there's no financial responsibility. UPDATE: A reader points out: I noticed that you left out side effects. Were there any. If there were, were they worse than the possible effects of osteoporosis? In addition, there is an interesting thing to think about. Few insurers pay for alternative medicine. In general, you have to decide on alternative medicine without the rationalization that someone else is paying. If it does you good, you keep it up. If it doesn’t work you give it up. My wife who is a very small time practitioner of alternative medicine has a very rude rule with respect to alternative practitioners: If you see a practitioner three times and you aren’t feeling any better, then you should try something else. Imagine if such a harsh rule was applied to conventional medicine. Both good points. The side effects of Forteo, from their website: : * Pain * Headache * Asthenia * Neck pain * Hypertension * Angina pectoris * Syncope * Nausea * Constipation * Dizziness * Depression * Insomnia * Vertigo Like all lists of side effects, it's a very broad list. The drug is a synthetic version of parathyroid hormone, a hormone that regulates the metabolism of calicum. Theoretically, the side effects could be very similar to the symptoms of hyperparathyroidism. My patient's only complaint was that he would sometimes bruise himself while injecting the drug. But then again, he'd only been taking it for about a month. And yes, conventional medicine often would fail the "three strikes and your out" test. The human body is so unpredictable. UPDATE II: Another reader observes: I wanted to say that weight lifting has been shown to increase bone mass too. For $600, you can easily buy a set of dumbbells from 1 lb to 45 lb plus a rack to hold them. For around $1800, or 3 months of that overhyped drug, you can buy a very nice home gym with weights going up to 200 lb. It takes longer to use than a shot of drugs, but the side effects are almost all highly beneficial (unless you drop a dumbbell on your foot). Even a gym membership doesn't cost $600/mo. posted by Sydney on 9/10/2003 08:20:00 AM 0 comments 0 Comments: |
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