Wednesday, October 10, 2012


     We often have a debate about the cost of medicines and the cost of the health care . There are usual 'punching bags ' for some people, especially the politicians . "The bad doctors " or "The greedy doctors ". But more often it is Drug companies . When we analyse the cost of health care, we realise that the physician's cost is about 15%, the cost of hospitalization is 70 % and the 'evil' drug company contributes 15 %. So why are they vilified and the patients believe in it ? The answer is simple . The patients never see the cost of hospitalisation . The medicare or the insurance company pay es most of the expense. So even though at times it is outrageous , patients don't realise it . To take an example , an endoscopy --EGD, --to look inside the stomach , the doctor who does it and does biopsy and analyses the finding and treats the disease, makes about $150.The hospital charges are about $1500 to 2000 or more depending upon what anesthesia was used. The pharmacy cost known to patient as they pay it at the pharmacy and many pay it from their pocket . I am not defending cost of the medicines . I do believe that it is too high . The story that I am telling is one such case.

        I saw this 64 years old female who was seen by me for pneumonia and chronic cough . She was seen by another lung specialist , but her cough had continued and so she wanted a different MD.I saw her and saw her X-ray I did not like it . I ordered a CTscan . It showed a mass in the center of the left lung. It was somewhat hidden and not obvious on plain X-ray as it was close to the big blood vessels and the center. I did bronchoscopy and diagnosis of  the cancer was done .It was not surgically resectable . So I consulted the radiation doctor and an oncologist .The radiation doctor felt that she would be best treated by chemotherapy. The type of cancer was such that ideally is treated by chemotherapy and not by radiation . The tumour was pressing on the bronchus and the artery going to the lung, So I had called him . The patient was treated with the chemotherapy and had usual side effects , but was doing OK .After about 6 months of treatment she was doing fair, but was admitted in hospital with generalised weakness. She was found to have low salt in the blood .She was treated and got better . and was discharged . She was readmitted in 2 weeks and had low sodium again . This was due to the cancer , which secretes some chemicals that cause low sodium . She was treated and discharged again . After 3 or 4 hospitalisations , the kidney doctor gave her a prescription for a pill to help maintain sodium level . She called me when she went pharmacy to get it . The cost of one pill was $250, YES ONE PILL WAS FOR $250. There was no way she could buy it .
    I ended up talking to the radiation doctor and he agreed to give her radiation treatment to the tumour . My simple thought was that the amount of the chemical secreted by the cancer was directly proportional to the size of the cancer . So if we can reduce it , the chemical secretion would go down and the sodium would be better controlled.
   The idea worked. The radiation treatment did work . But I still can't fathom the idea of one pill could cost $250. ( If one drops the pill on the floor he could offer $50 to find it out .)

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