Who's the doctor here anyhow?

Today's doctor visit felt a little like the Twilight Zone, but considering how insurance rules and policies can affect what our doctors can and cannot do, my visit today may become more of a norm than an exception, strange as it was.

Reassuring my doc was a strange position to be in, just as telling him about the anti-depressant he had me on that I chose to wean off of due to it doing two things--jack and shit--was strange. I think a lot of doctors these days, even ones who have been in practice as long as mine, are confused with dealing with the new style of practice insurance companies force on them.

For instance, trying to adjust my pain meds so they last longer into the night (to keep me from having the roughest of the mornings I have)--he found his hands tied trying to do something that made perfect sense to me but I had to say no to due to my insurance's rules and policies. It used to be if you wanted a patient to have 2 pills of a medication at night, you just wrote the damned prescription and the patient did as told (you hoped). Not anymore--if it puts the medication above quantity limits the patient is paying everything above the quantity limit, which sometimes isn't possible. We wound up doubling the dosage of the pain med and I'll hold one as late at night as possible to see if that helps. It's not what we wanted to do but it works within my insurance's rules, so we'll see what happens.


(For $122 freaking dollars it better be what we're expecting to happen)


It puts the patient in a new role as well--I had to tell my doctor not only that the new anti-depressant didn't work but did the legwork to find out what went wrong. As it turns out Pristiq, the anti-dep he tried me on, isn't the new revolutionary drug my doctor and probably thousands of others were told it was. It's actually what Effexor turns into in the human body--and it's a shameless patent-saver since the XR version of Effexor's patent runs out in 2010. Since all that brand-name money is about to go poof, the company (Wyeth, in this case) had to scurry to come up with another revenue stream to replace the Effexor XR gold mine, and its answer is Pristiq. It's also why the stuff didn't work for me--Effexor had been tried on me when it first came out and did about the same thing Pristiq did--nada, except fry my short-term memory so much that I couldn't remember the name of the new drug (which is a side effect of both Pristiq and Effexor XR).

Sure, it seems non-ethical and companies shouldn't do that, but as long as it's FDA-approved and legal they're allowed. What isn't ethical and shouldn't be legal, in my opinion, is that doctors shouldn't be told piles of crap like "Oh, it's a new and revolutionary drug that's actually two drugs (information I was given by my doctor when I was handed the samples) and oh it's up for approval to feed to menopausal women for control of hot flashes and other symptoms without using hormones, so we'll let you know when you can start shoving it at menopausal women too!"

What drug reps are allowed to tell about a medication should be as well-tested and regulated as the med itself, but that won't take an act of Congress or the FDA.

It'll take an act of God.

Let us pray.