Drug trade

We are currently changing some medications for my mother. I have mentioned how anxiety exacerbates her dementia, and we sort of got into a worse place. It seemed necessary to increase a dose, or change it, or add to it.

I read a lot, but in the realm of anxiety and depression and the meds that help them, most of what I know is from listening to people. One thing I have learned is that a lot of people have a bad reaction to Xanax. It makes them feel sicker than they have ever felt in their lives. Another thing I have learned is that doctors often want to try it first. I was not sure whether that was an issue of the doctors liking it because pharmaceutical reps give them nice things or insurance companies preferring it because it was cheap. It sounds like it is more the cheapness.

I agree that cost-effectiveness is important. For all the things that might make you feel uncomfortable about the pharmaceutical reps, I have benefited from medical samples and things that my doctor passed on to me. There is plenty of room for debate on whether health should be a business, but there's no question that it currently is.

That being said, when a patient is seeking relief, given the ramping up times and the weaning off times that are involved in starting and quitting the different drugs, giving them an extra month of feeling sick just in case the cheaper one might work seems to fly in the face of "First do no harm."

And I certainly didn't have time for it, so that was something that I was ready to fight for in our situation. I didn't start out fighting, but fortunately I know what all of the blood relatives are taking and who has had bad reactions to what, and good reactions. While there were other ways in which the transaction was not completely satisfactory, everyone was at least agreed that we weren't going to try Xanax. Knowing family medical history helps.

For example, if a sudden medical reaction set off a panic attack that brought a person's latent anxiety to the forefront (like maybe she'd always been kind of uptight before, but it was manageable), then it would be helpful to know that a genetically identical sibling's anxiety was being successfully treated with Zoloft; don't bother with the Xanax. That's what ended up happening anyway, but first, one extra month of sick.

However, that is not the only way in which knowing family medical history can be important. Hypothetically, knowing that the genetically identical sibling has anxiety could be a really good reason to not prescribe a medication like Wellbutrin (Buproprion), which seems to be really effective at pushing people over the edge into anxiety.

Maybe it wasn't commonly known at the time. I only found out because I started doing some research after the fact, but you would hope that the doctor would have known. Studies are not in complete agreement, but there are enough reports where it seems like a risk.

Of course, you also have to consider the risk from the other side. What is being treated? What happens if you don't take the medication? Wellbutrin is an antidepressant and smoking cessation aid. Smoking is very deadly, though you need to weigh that against increased risk for anxiety and for epileptic seizures.

However, this patient was not a smoker. She was prescribed it as something that could possibly help with weight loss. That's not what it's for, but over 6 to 12 months you can lose about 2.7 kg over the placebo group. That's almost 6 pounds! Except that she was not able to take it for even one month, because it made her really sick and brought on debilitating anxiety that required a lot of medication and time before things started becoming normal again.

I wanted that doctor fired. The patient disagreed and continues to go there, and nothing that bad has happened since, which I guess makes it all okay.

I believe in that case the problem is a belief that nothing else can be as bad as being fat. If the patient is desperate to lose weight, and the doctor believes that is the key priority to good health, it's simple logic. Aren't seizure and anxiety better than fat? Even only six pounds of it?

And thus we transition to the portion of the blogging where I will start writing about being fat. We'll start Monday.

ETA: Just found this: https://projects.propublica.org/docdollars/