Serves me right. In July, I blogged about high blood pressure, and now I have it myself. My doctor’s reaction led to a fascinating trip into the American health-care system.
My blood pressure has been creeping up for years, and last week it was 150/100. My doctor, whom I love and have been seeing for years, suggested that it was time to try medicine. His name is Mitch. He’s about 40 years old and always treats me with respect and tries to help me out where he can, so I kind of trust him.
I asked him what kind of medicine he would recommend, and he said, “We usually start with an ACE inhibitor.” ACE inhibitors (angiotensin-converting enzyme inhibitors) lower blood pressure by preventing the body from producing the hormone angiotensin II. Angiotensin II causes vasoconstriction (narrowing of blood vessels) and fluid retention, resulting in hypertension.
I probably should have just accepted Mitch’s suggestion, but I’ve always felt my blood pressure was influenced by my being too stressed. I’m often in a low-level “fight-or-flight” response. So I asked about another class of drugs called beta blockers. These drugs work by blocking the action of adrenaline, a major stress hormone. I thought they might relax me.
If I had diabetes, beta blockers would not be a good first choice, because they can worsen blood glucose control, while ACE inhibitors may be somewhat protective against diabetes complications. But in my case, it was a reasonable idea, I thought.
Mitch said, “Well, you know beta blockers have a lot of sexual side effects.” They seriously interfere with erections and also reduce desire. I told him my sex life was important to me, and he said, “There’s a new beta blocker that seems to have fewer sexual effects. And I’ve got a bunch of samples you can have!”
He went out and brought me four little bottles of the medicine. Each bottle had seven pills, a one-week supply. The drug was approved for use in the US in 2007. Its main selling point over other, cheaper beta blockers is that it supposedly has fewer side effects. But this data comes from only a few small studies.
At first I thought, “How sweet is that? Free medicine.” Then I thought again. “So what happens when the month is over?” I asked. “Then we argue with your insurance company about paying for it,” he said.
“Who needs that?” I thought. It turns out that this drug goes for about $2.00 a pill, while older beta blockers like atenolol cost about $0.20 a dose. That’s why drug costs keep rising — new drugs that do many of the same things as old ones but at a much higher price. At first, the new drugs show fewer side effects, but that’s often because they haven’t been out as long. After a few years, we may start to see more of the known side effects, along with new ones that the older drugs didn’t have. I didn’t want to be part of that.
I also remembered that as I waited for my appointment, I talked with a drug company sales rep in the waiting room, who had been seeing the doctors. She was beautiful and articulate, but they’re all like that. It seems to be a requirement of the job. I don’t know if she had been touting this new blood pressure medicine, and I doubt her attractiveness would have made much difference, because all the docs in the practice are gay men. But it’s worth being aware that doctors sometimes make drug decisions on bases other than scientific information.
I decided to try the free pills anyway. They aren’t doing much for my pressure, and they do seem to have sexual side effects. I’m going back to see Mitch next week, and I’ll have him give me a generic (cheap) ACE inhibitor. But I’d rather be on nothing, so I’m trying to relax, stretch, and meditate to bring my pressure down, which I will do as soon as I finish this article.