Why We Spend So Much On Medicines

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.

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  • Beth

    I feel a twinge of regret that this conversation with your doctor is so focused on medications.

    You acknowledge a non-medicine alternative in your last paragraph. Wouldn’t it be wonderful to have as many studies focused on finding effective behavioral choices for managing blood pressure as we have on effectiveness of medications? For example, you say you are going to try meditation. What kind of meditation works best for lowering blood pressure, and for whom? Instead of debating ACE inhibitor vs beta blocker, what about looking at meditation with a mantra vs guided imagery, or each of these alone vs each of these with yoga, or other physical activity.

  • joan

    David – Yout topic was Cost of Meds but the content seems to have become a side bar discussion on TYPE of meds?? :-)) albeit, the cost of super duper meds is more and more expensive. Hopefully this will change in the near future.

    I like alternative methods also that are less expensive and do the job just fine but……I also do not want hardening of the arteries and high blood pressure!

    It seems that like me, you think out-side-the-box and in my opinion, this is an optimal method for better control of our diabetes challenges. Alternative methods and meds may not work for everyone, of course. Also, learning to relax is another optimal path to follow and is not always easy at first to conquer! Again, an individual process to discover.

    My doctors have prescribed Cordura and Avapro and a very low dose of female hormones. Are male hormones a possible alternative for you to explore? You do not want hardening of the arteries so some kind of meds to prevent this may be necessary! I have not lost my libido yet after many years of the type of meds I take for high blood pressure nor have I experienced any side affects. Diabetes may/can cause the HBP to rise eventually – another side affect of being a diabetic. We need to find what works for us, sooner than later.

    Good Luck whatever path you choose to take!