Last Update: Wednesday, July 23, 2014

Changing Prescribing Habits Is Hard to Do, But It Can Save Billions PDF Print E-mail
Written by Dr. David Lipschitz | Creative Syndicate   
Wednesday, 28 May 2014 23:49

Just yesterday I saw a 70-yearold patient whom I diagnosed with high blood pressure. Like most physicians, I prescribed a generic drug called an ACE inhibitor as treatment. I did so because of information that this medication not only brings down high blood pressure but also reduces the risk of heart attacks and heart failure, major causes of death in older persons.

Recently, the National Institutes of Health began a new program to persuade physicians that a water pill, called hydrochlorothiazide, is the initial treatment of choice for hypertension. Despite a large study showing this water pill was as effective in lowering blood pressure and reducing the risk of heart attacks and heart failure as the more expensive medications, very few physicians have changed their prescribing habits. Currently, less than 20 percent of newly diagnosed high blood pressure patients are initially treated with hydrochlorothiazide that costs, on average, $36 to $96 annually. By contrast, the cost of an ACE inhibitor ranges from $90 to $468 annually. Other commonly used medications are calcium channel blockers, beta blockers and variants of the ACE inhibitor called ARBs, all of which range in price from $240 to more than $700 annually.

There is one more wrinkle in the treatment of high blood pressure that I must mention. For many overweight patients with mildly elevated blood pressure, weight loss, exercise and restricting salt content can effectively bring the blood pressure into normal range.

As a physician who believes passionately that cost should always be a consideration in medication choice, I am forced to dwell on why I am so reluctant to change, particularly as I am fully aware of the results of the large study demonstrating the benefits of a water pill in treating hypertension. My choice is related to force of habit, a comfort level with the use of an ACE inhibitor and the fact that the medication is effective with few side effects. And yet, until more information appears to the contrary, I must change my prescribing habits and recommend lifestyle changes first and, if necessary, initiate treatment of hypertension with a water pill.

Please remember, though, that an even more serious concern about high blood pressure is the fact that many patients with this disorder are either not treated at all or receive inadequate treatment. While patients with high blood pressure should be initially treated with hydrochlorothiazide, for many, the addition of another medication, such as a beta blocker or an ACE inhibitor, may be needed to bring the blood pressure down to the normal range.

Because such a large fraction of the population has high blood pressure, a minor adjustment in the habits of a physician can save billions. And this is one of many examples. Zocor to treat elevated cholesterol costs about $40 annually, and now that Lipitor is generic, its cost is coming down. And billions are spent each year on the prescription drug Crestor, which is only needed in a small fraction of patients for whom lowering cholesterol is extremely difficult.

There is an important lesson for you the consumer. It is absolutely critical that everyone become educated consumers of health care. The information available in our newspaper on almost a daily basis, on the Internet, from the media and newsletters provides a great deal of useful information that will allow you to ask your physician key questions about the proposed treatment plan. Always consider cost as well as effectiveness in choosing a medication, and always ask if strategies such as diet and exercise may have the same effect. Even if you are blessed with an insurance program that has a medication benefit, remember that the most expensive is not necessarily the most effective.

Though I have used high blood pressure as an example, there are many other common ailments where the expensive medication may not be more effective than the cheap overthe- counter and generic drugs. If our health system is to survive in the future and flourish, our health care choices must become more rational and appropriate. Consumer and physician education are the key to holding down costs while assuring the highest possible quality of care.

Dr. David Lipschitz is the author of the book “Breaking the Rules of Aging.” To find out more about Dr. David Lipschitz visit


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