General / Just What The Doctor Ordered?
By Dr. Larry Tune
During these tough economic times everyone is
looking for ways to save money and cut costs.
In my practice, more and more I see insurance
companies and pharmacies attempting to reduce health
care expenditures. This is a noble cause –
unless it negatively impacts patient health.
Using words like “generic alternative” and
“therapeutic equivalent”, medications are being
switched – and this could have unintended
consequences our health care system.
Switching often occurs when someone other than your
doctor suggests a medicine that is chemically
different than the medicine your doctor prescribes.
My concern is that patients may be led to believe
that the medicines are truly the same, and then they
end up with less than spectacular results, or
unwanted side effects.
Medicine switching is not always bad, if the
decision is made by the doctor and the patient.
But sometimes this occurs without either one’s
knowledge and is driven by the financial gain of the
third party. As we all know, individuals
respond differently to different medicines. and
there is no such thing as “one size fits all.”
Doctors wouldn’t be needed if it was that simple.
Finding the correct antidepressant or anti-dementia
drug for a patient sometimes involves a long,
difficult trial and error period, which can be
complicated by side effects or drug interactions.
This is sometimes forgotten, and after a
“recommended” medication change, patients end up
back at “square one” trying to find an appropriate
A survey conducted by the National Consumer League
(NCL) found that two-thirds of people who reported
medicines switched for themselves or a family member
said that they were not consulted about the switch.
Nearly half were dissatisfied (or their family was)
with how the process occurred and report that
the substitution did not end up resulting in lower
Sally Greenberg, NCL Executive Director, was quoted
in a press release stating: “Consumers are
justifiably concerned about the practice of
therapeutic substitution, how it’s done and who’s
involved. Without transparency, therapeutic
switching could introduce efficacy or safety issues,
including unknown drug interactions and potentially
serious health consequences. It may evoke
confusion or fear on the party of patients already
feeling frustrated by a failing health system.”
The NCL identified the four most common medicine
switches are antidepressants, cardiovascular
medications, epileptic medicines and proton pump
inhibitors. I encourage my patients to be aware of
this practice and urge them to take an active role
in managing their health care. It’s important for
patients to ensure that their health and treatment –
not financial motives – are the top priority.