irresponsibility

There are fun ways to be irresponsible, but I don't expect them from a major pharmaceutical company. They developed a drug that does not have a huge, obvious, application (it's not a cure for a well-known disease that kills millions of people.) It's an "adjunct therapy" for a lot of things that seem unrelated -- seizures, peripheral nerve pain. They're even trying it for some kinds of anxiety disorder. Maybe it will be useful in migraine prevention. When you add up all the people who have all the different problems it might help with, it's an awful lot of potential prescriptions. A doctor treating a patient with a chronic unpleasant disorder often wants to try the latest medication, whether it works or not…and if it only helps a little, well, that's better than nothing. It's an expensive drug with a risk of nasty side effects, including physical dependence, and there's apparently some risk of psychological dependence as well. As a matter of public policy, it makes sense to try to prevent "overprescription," and make sure this drug is not prescribed to anyone who has anything at all wrong with them. It usually won't help, or won't help enough to be worth the risk and expense. So a lot of health insurance companies won't pay for this new drug. They have a list of drugs they consider safe and effective, and this one isn't on it.

The pharmaceutical company devotes a lot of effort to convincing doctors to prescribe their new drug. They write articles explaining how well it works, and for how many conditions. They explain how it differs from related drugs, and how to use it safely (what it interacts with, how to taper up gradually to a therapeutic dose.) And they give doctors gift certificates, that the doctor can give a patient with a 7-day starter prescription to take to a pharmacy for free drugs. That means there's no financial risk to the patient, if the drug doesn't work for hir at all. But at the end of those first 7 days, when a person goes back to the doctor and says, "Well, maybe it's helping a little but I'm not sure. The side effects are tolerable. I'd like to keep trying it, taper it up very slowly, and see what happens," that's when they discover the insurance problem.

Sometimes it's possible to arrange for insurance to pay for a drug that's not usually covered, but it's quite a bit of hassle. And there's no way to know how much hassle the situation really needs. I mean, if this stuff could eventually stop all my hand pain, I'd be willing to spend about a quarter of my life to get it. But I don't know how much neuropathic pain it can relieve, nor do I know how much of my pain is neuropathic. I don't even know if I'll be able to tolerate a therapeutic dose. The 7-day free trial didn't help. It makes it worse, because it introduces the problem of physical dependence. I have a problem with a company that gives out 7-day free trials of drugs they say are dangerous to stop using suddenly. They should KNOW the stuff is not on insurance formularies yet.

panic of the day

I'm at the airport. I'm really impressed by the effects of the current security panic. Not always positively impressed, but very impressed. There was something in this morning's Metro (the little paper they give away on public transit, to sell advertising with, or use as a fan) to the effect of passengers being searched twice "to make sure their carry-on bags did not contain liquids." I thought it was just bad writing. Surely they meant people were being searched to make sure they weren't carrying explosives or liquids. No. Just liquids.

I feel so safe, surrounded by people who decided to forgo soap, shampoo, sunscreen, toothpaste, insect repellent, and hand sanitizer, so they could fly. (I'm checking a bag.)

I made a mistake and brought medication without prescription labelling. When my bag was searched extensively at security, the guard paid particular attention to it, squeezing the package and reading the label. Then she gave it back to me, because it wasn't liquid. That would not have happened, last week, I don't think