Viewpoint July 28, 2009, 2:10PM EST

Health Care in Crisis: Overmedicating America

In the U.S. today, doctors are too quick to prescribe drugs that their patients don't really need and often can't afford, writes Ed Wallace

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Editor's Note: This is Part Three of a five-part series on the health-care crisis.

It started with creeping numbness across her upper right abdomen. When after months of concern the sensation would not go away, Judi, a news assignments manager for a Dallas TV news operation, decided it was time to have a complete physical. Her primary physician referred her to a neurologist, which led to a series of MRIs covering her spine, neck, and brain. The results were not reassuring: The scans showed a small spot of demyelination on her spinal cord, typically the first sign of multiple sclerosis.

In essence, Judi's own immune system might be eating away at the protective sheath that covers the nerves running throughout her body, causing them to misfire. Her neurologist claimed that it was MS, but also ordered a lumbar puncture to test for MS markers in Judi's spinal fluid—a compressed or damaged disc in her back would cause the same symptoms.

Judi sought a second opinion from Dr. Ralph Rashbaum at the Texas Back Institute in Plano, Tex., who was only slightly more encouraging. He told Judi that there was an 80% chance she had become a victim of multiple sclerosis. But he also shared that his own daughter Tracey was afflicted with MS, and she was receiving treatment from Dr. Elliot Frohman at Southwestern Medical in Dallas.

Risks of Treatment

Rashbaum's praise for the groundbreaking work Frohman was doing was reassuring. He said his daughter was responding well and carrying on a full life as a wife and mother of two. For Judi, however, the shock of the diagnosis allowed little room for hope.

But there was a discrepancy in Judi's spinal tap results: All the markers for MS came back negative. While there was one spot of demyelination on her spinal cord, the cause of that damage was not MS. Dr. Chen, Judi's neurologist, delivered the good news—but at the same time said she wanted Judi to start the treatment as if her tests had come back positive.

This was a problem, because the proposed treatment's side effects come with their own risks. As Dr. Rashbaum explained, one occasional hazard of treating MS with interferon-based medicines is death.

There was another major factor, and it too is a primary reason why health care costs so much in America. Treatment today for multiple sclerosis often exceeds $10,000 a year, and this disease is a lifetime commitment on the part of the insured's health insurance plan. Moreover, treatment with the newest drug, Biogen's (BIIB) Avonex, could cost upwards of $18,000 per year.

Pricey Medicine

The proposed treatment involved in this case could have amounted to a lifetime cost of more than $450,000—and this for a patient who in fact does not have the disease for which the treatment was prescribed.

Moreover, medical professionals disagree on how to proceed with treatment even if MS is the verified diagnosis. Some prefer to begin treatment immediately, while others suggest a waiting period; the disease has an extremely slow initial progression, and the symptoms with which MS can expand and ravage a person's nervous system are not consistent.

However, there is total agreement among medical professionals that the advances in care for MS victims have been nothing short of phenomenal over the past 20 years. While current treatments do not stop MS, they can slow the progression of the disease to the point that its victims live much fuller lives for much longer.

Judi decided to wait one year, repeat the MRI scans, and see if the demyelination progressed. This decision saved her health-care provider more than $10,000 this year alone. Fifteen months later new scans showed no further areas of demyelination.

Too Many Pills?

Are we an overmedicated society? Certainly much has been written concerning doctors' tendency over the past four decades to overprescribe antibiotics.