I know why people are always broke

[disneysteve]

Originally Posted by snafu

Now direct to consumer ads are leading people to desire prescription drugs that are not appropriate for them

Not only do the commercials make people want drugs that aren't appropriate, they make people want drugs that may be appropriate but are 100 times more expensive than other options. The problem then becomes that the doctor is stuck trying to justify practicing cost-effective medicine but the patient isn't the least bit interested in that since they don't pay for the medicine. Their insurance pays for it. To them, it is free (or a small copay). That is a definite part of what is wrong with healthcare in this country.

The doctor ends up in a very difficult situation. If a patient requests a particular product and the doctor gives them something else and anything goes wrong - side effect, allergic reaction, bad outcome, etc. - the doctor is held liable. So in the real world, most times we will give the patient what they asked for even if we know there is a better, more cost-effective choice. I'll offer other options, but thanks to the wonders of TV, the patient usually comes in with their mind already made up and nothing I say will change their mind. Plus, thanks to the placebo effect, if the patient doesn't get what they wanted, I can count on a call back a few days later that the new medicine isn't working or has some other problem.

[DKAS]

Absolutely agree with you Steve. Your discovery may seem obvious but is ignored by many. I've done some mindless spending for new gadgets in college days and it takes a lot of self-education to get rid of the habit so I try not to look down on people who do it. Rather, I do my bit to educate them about how much their spending habits could cost them.
On a side note, I'm in a middle of a frugal experiment of not buying any clothing for a year and suprisingly it has not been difficult at all except an occasional temptation from so called "sales".

[jerrycates]

SHOPPING always craps up the budget. The reason is why do some people just cannot do without it. Well... women are! lol

[smoothsailingfs]

I agree...I think spending more than you make (the use of credit), not having a budget (intent with your money), and shopping is why we are broke. I have never been a shopper (just to go to the mall and see what we can find), but I know a lot of people do. Which, isn't necessarily a bad thing...you can end up getting a lof these items at a huge discount when they have a garage sale.

[KennySoward]

Very astute, sir. People definitely have a lot of spending control problems...and I did go ahead and write a book about it...hah!

I actually have an amazing story. My girlfriend and I went to a casino for her friend's birthday. I'd never been to the casino, but was curious (since I was there) to try and figure out how these folks think.

While having dinner before hand, one lady in the group was going off about how to pick and choose your slot machine, how many lines to play and how much to bet. I was fascinated. I asked her how much she gambled and whether or not she'd won more than she'd lost. Admittedly, she did not think she was in the green by any means. And then she said something amazing.

"One month we were low on bills, so I thought it would be a good idea to hit the casino." I just about fell out of my chair.

BTW...if you watch the show Hard Core Pawn...it is set in Detroit near the casinos...and you will be amazed how many people come into the store several times a day pawning things to go back and gamble.

[woodie96]

After working in a large auto parts retail chain. It was soooo funny when we would have to put up the new signage. I can recall many times we would have big bright colorful starbursts that said " NOW....Only 4.99"....and we put the starburst over the sign that was there already......yep...you got it....4.99.....

[cschin4]

The doctor ends up in a very difficult situation. If a patient requests a particular product and the doctor gives them something else and anything goes wrong - side effect, allergic reaction, bad outcome, etc. - the doctor is held liable.

Steve, so what? That is part of being a doctor, educating, counseling, and prescribing. And, yea, if they have a side effect, you are responsible to have had some reasonable foreknowledge about the kinds of problems the patient would have, etc. Sorry, but this , ads on TV is sooo hard for the doctors, sounds a bit like whining. Patients have the right to educate themselves, to be invovlved in making decisions in their care and i would think a doctor would welcome a patient willing to inform themselves. And, yes, sometimes people are uninformed in the sense they don't know what they are talking about because they saw an ad. But, again, that is the doctor's responsibility to help educate the patient. It isn't wrong to have an awareness of a potential helpful medication on a patient's radar screen.

[disneysteve]

Originally Posted by cschin4

It isn't wrong to have an awareness of a potential helpful medication on a patient's radar screen.

When DTC advertising first started, the law only allowed "disease state" ads, meaning you would see an ad saying something like, "If you have frequent, persistent heartburn, speak to your doctor. There are new treatments available for this condition." That was fine. I thought those ads did a good job educating people about the fact that their symptoms might represent a treatable condition and that their doctor could help. It led people to speak to their doctors about symptoms that they might not have previously mentioned because they didn't realize there was anything that could be done. It did NOT plant in the patient's head a specific diagnosis. It did NOT plant in the patient's head a demand for a specific drug. The diagnosis was left for the doctor to make. The treatment options were left for the doctor and patient to discuss. It was collaborative, not adversarial.

Once the laws eased to allow advertising specific products by name, that all changed. Like it or not, advertising is extremely influential. Many, many people will come in with their minds firmly made up prior to any exam, testing or conversation with their doctors. Sorry if you think that sounds like us whining but it does put us in a very defensive position. Have you ever tried to talk someone out of something that they were firmly convinced was true? It is not an easy task.

Rather than spending time interviewing and examining patients, ordering diagnostic tests and discussing appropriate treatment options, we now find ourselves spending more and more time debating with patients about things they saw on TV or read on the Internet. Patients get very limited, and often very biased, information and latch onto it convinced it is true and correct. I've been in practice long enough to remember when those sources of information didn't exist. I've seen the change evolve and I'm just saying that overall I don't believe it has been a change for the better. It drives a wedge through the doctor-patient relationship. It doesn't benefit anyone, most importantly the patient, as it interferes with getting the most appropriate and most cost-effective treatment.

[cschin4]

There are always going to be onbnoxious patients to deal with. I would think most of your patients are going to you because they highly value your opinion and would discuss whatever it is and then concur with your treatment plan. yes, you will get some who just want to argue. And, it isn't because of the internet or advertising but just because that is they type they are. And, you as the physician can only give what you believe to be helpful, efficacioius, beneficial or whatever. And, if you don't find benefit or value to whatever they want you to give them, then you say, sorry, i cannot prescribe that for because i don't feel it is indicated in your condition. If they don't like it, they are free to go to another doctor.

[cschin4]

Steve - I didn't mean to imply you were whining. I know there are medico-legal issues, etc. But, ultimately you are the authority and it is up to you to decide what is best in conjunction with the patient by working together. I just think having more knowledge or awareness is a good thing for patients even if there are some patients who don't know when something would be appropriate for them or not. Certainly nothing wrong with asking. It is all just part of the relationship.

[elessar78]

Working in the advertising field, I hate what I do. Honestly, I do. It's all about creating lust for something. I'm trying to get out of it.

If people complain about the quality of TV programming to be not of the level of say, HBO. It's because of the masters they serve. It's not just about entertainment. It's about generating a desire to buy. Modern Family isn't just about these characters, it's as much selling the lifestyle these people live. Their furnishings, the size of their house, their activities, the cars they drive, the cars their neighbors drive.

If you're watching TV, you're getting sold to. On a direct level and on an indirect level.

[rob62521]

Originally Posted by disneysteve

When DTC advertising first started, the law only allowed "disease state" ads, meaning you would see an ad saying something like, "If you have frequent, persistent heartburn, speak to your doctor. There are new treatments available for this condition." That was fine. I thought those ads did a good job educating people about the fact that their symptoms might represent a treatable condition and that their doctor could help. It led people to speak to their doctors about symptoms that they might not have previously mentioned because they didn't realize there was anything that could be done. It did NOT plant in the patient's head a specific diagnosis. .

I'm not a doctor or even in the medical field, but having a friend who is a hypochondriac, I can see where these ads can be a pain in the doctor's backside. This man lives to talk about the new meds he's on. I feel sorry for his doctor because I can tell you we are bored stiff with his conversation!

There's a saying, "A little knowledge is a dangerous thing..." I'd say some of the medical ads are exactly that.

Unfortunately we have to take meds and I'm glad there are sources to read about them, but I rarely go in and ask our doctor about a specific medicine, unless I am questioning something. I know we are blessed to have treatments to help conditions, but believe me, I'm not looking to add to my medicines because of an advertisement on television or in a magazine!

As a patient, I'm pleased my doctor is well read and well informed. And, I'm glad he's like you, Dr. Steve -- you aren't pushing meds because they were advertised.

[Pansori]

Originally Posted by happygirl

I think some people think the ability to make the minimum payment means they can afford something. I don't know that they think it through any further than that, and I wouldn't be surprised if some sales people encourage this kind of thinking.

Absolutely! What, you can't afford that 90" flat screen right now? Apply for the store credit card! We do live in a very hedonistic society, and I can tell you from working in credit cards that the younger they are the more irresponsible they usually are with their money. ESPECIALLY 20something females. I don't mean to generalize, but there is a very noticeable difference in the way the 20 year old females handle their cc as opposed to the 20 year old males.

That being said the men can be just as bad. One night I spent over a hour and a half assisting a young man in figuring out the best way to max out his $3000 European trip. I explained to him over and over that making the minimums on his cc payment is not wise, to not over extend himself, and to go easy on the cash advances but it fell on deaf ears.

[cschin4]

I think part of the problem with the drug ads isn't the drug ads, but medicine itself. It has become a spend 5 min with your doc, get a pill, go on your merry way. In reality, many conditions improve with nothing but tincture of time and some home nursing, lifestyle changes, etc. But, in our instant gratification, people don't want to hear that. That isn't the drug companies fault, nor the doctor's fault, it is just how things have developed.
But, I would support doctors being more proactive in taking people off of medications. In my world, it seems once someone starts a pill for whatever, they are given it for life. I have had bouts of hypothyroid, high blood pressure, heartburn , etc. I worked with my doctor. I did treatment with medications for periods of time but then aaked to go off and be reevaluated. I no longer take any medication and my doctor worked with me and was accepting in me wanting to be off meds. Now, i have normal BP, thyroid levels, etc. If heartburn flares, i do a period of Aciphex then go off it. I think there would be a HUGE savings if there was a periodic eval and trial of taking people off some of these things. Obviously, that doesn't apply to everyone, but i think there should be more interest in that. ANd, doctors should be paid to do a periodic review of this magnitude.

[disneysteve]

cschin4, you raise a couple of very good points. We have become a very pill-oriented society. Part of that is the instant gratification thing. Part of it is the billions of dollars spent marketing new medicines. Part of it is all of the funding and subsidies available for people with "disabilities" on various levels. Everything has become a disease warranting medication from premenstrual moodiness to trying to quit smoking to shyness in large groups to discolored toenails. Drug companies encourage patients and doctors to treat every little thing. Things that used to just be normal parts of life, growing up, growing old, are now seen as medical conditions that require treatment.

You also make a good point about what we call watchful waiting. Does a condition actually need treatment and, if so, for how long? Something like 80% of low back pain, one of the leading causes of visits to doctors, goes away within 3-6 months no matter what is done - even if nothing is done. How many hundreds of millions of dollars are spent each year treating low back pain?

Another huge problem (no pun intended) is obesity. The staggering obesity problem in this country is causing an incredible increase in the use of prescription medications. People are letting themselves gain 50, 80, 120, 250 pounds and then expecting their doctors to treat their back pain, knee pain, heartburn, bunions, breathing issues, diabetes, high cholesterol, high blood pressure and more. If people would stop eating themselves to death, health care costs and prescription use would plummet dramatically.

I wish I had the answer. Well, I think I do have the answer but it only applies to me personally. I can't make others do the right thing. I can suggest it, and I do every single day, but until people start taking responsibility for their own lives and their own well being, nothing is going to change.

[ActYourWage]

Originally Posted by disneysteve

Another huge problem (no pun intended) is obesity. The staggering obesity problem in this country is causing an incredible increase in the use of prescription medications. People are letting themselves gain 50, 80, 120, 250 pounds and then expecting their doctors to treat their back pain, knee pain, heartburn, bunions, breathing issues, diabetes, high cholesterol, high blood pressure and more. If people would stop eating themselves to death, health care costs and prescription use would plummet dramatically.

I wish I had the answer. Well, I think I do have the answer but it only applies to me personally. I can't make others do the right thing. I can suggest it, and I do every single day, but until people start taking responsibility for their own lives and their own well being, nothing is going to change.

Nicely put! It seems that in our culture, some people want to point fingers, when we need to, like you said, take responsibility of our lives. I believe we, Americans particularly, are seeing a backlash of a comfortable life as opposed to earlier years of American history.

[cschin4]

Is part of the obesity epidemic not necessarily people's fault? There is corn syrup in EVERYTHING, even things you wouldn't expect to have sugar in, etc. I think there is some level at which it creeps on because of this. And, the "low fat" craze is idiotic. They replaced fat in products instead with sugar. It really is ridiculous. The only real solution to most things in life is moderation. Work, play, eat, rest, sleep, exercise, etc. When you do one or the other out of balance, bad things start to happen.
As for everything needing a pill, it is amazing how unscientific people are and really how superstitious and voodoo like as if a pill is a magic potion. If people tossed away half of their pills they would probably feel better.
For me, i don't seek medical intervention for most things until a waiting period. At least 3 days for a cold, etc. And, if flu and vomiting, stay home, lay in bed, let it work its way through and give it time. Yeah, it is yucky, but that's life. Then, in a few days you will be fine. But, nobody wants to hear that.