Slate had an interesting article last week on the overuse of prescription heartburn drugs like Prilosec. If you read through it, the author links the overuse of these drugs to doctors being too quick to write a prescription instead of getting a better understanding of the problem or doing lifestyle counseling instead. The author then takes the next step to say that paying for all these prescriptions is a major part of why our healthcare costs are skyrocketing.

Now, the fact that doctors are prescribing a new prescription medicine when a generic cousin is available is a problem that increases costs, especially in the light that the new medicine is not significantly better than the old one in any particular way. But the practice of dashing off a prescription and moving on cannot be blamed entirely on the doctors. It can be blamed to a certain extent on the way our healthcare system is structured.

Insurance companies do not have billing codes for 15-minute blocks of time. They have billing codes for office visits and patient assessments. Your doctor gets the same amount of money if they spend half an hour with you or 5 minutes with you. If they want to make enough to pay their mortgage, car payment, health insurance (you'd be surprised how expensive insurance is for doctors), they have to see a certain number of patients per day. Sometimes they work on salary for a clinic or HMO, but then they have to go through performance reviews which count how many patients they're seeing in a day.

Talk may be cheap, but not when you're talking to a lawyer, doctor, or other professional who expects a certain hourly rate far in excess of what you and I make. And insurers seem to have done the math and decided that they're paying less for prescriptions than they would for longer office visits.

But it's not just the insurance system that promotes overprescribing. We're Americans, goddamnit. If we go to the doctor and complain that hitting ourselves in the head with hammers is giving us headaches, we don't want our doctor to tell us to stop doing that. We want our doctor to prescribe the medicine we saw on TV that stops the headaches associated with hitting yourself in the head with a hammer. We don't feel better unless we walk out of there with a prescription in our hot little hands.

We already know "bed rest, fluids, Tylenol, and time" are what you do for a cold, and if we know that, we don't want to hear that from a doctor. We came to the doctor for expert advice, not common horse sense. And thus the doctor feels pressured to prescribe something. And that's likely a big contributor to the study showing nearly half of kids getting prescribed antibiotics for colds that won't even respond to antibiotics. I'm sure many doctors tried to put up a fight when they were young and idealistic, but got beat over the head so often by stupid parents who wanted a feel better pill, even if there wasn't one, they started handing out antibiotics just to avoid the argument.

High-priced prescriptions do add to the health care overhead. But so does procedure-based payment that encourages doctors to tag 'em and bag 'em. So do people who don't feel like they've been treated unless they get a prescription. So do people who would rather use pills to relieve the discomfort caused by bad lifestyle choices than suffer the self-denial of making good lifestyle choices. We're all to blame for our overmedication and the associated costs, and it won't get better until attitudes change in a number of camps.

Today, Wyeth pharmaceuticals was hit with a $134.5 million judgement in a case over its hormone replacement therapies for menopausal women. That wasn't a judgement that pays for a large group of women in a class action suit. It was for three women. And it's still not all. The jury still has to determine punitive damages.

Now a judge might set aside the verdict as excessive or reduce it. But when people suffer a negative outcome from using an FDA approved drug, the fact that each user of the drug could be awarded tens of millions of dollars... Who's paying that tens of millions? The big bad drug companies? No, it's being paid by the people who buy drugs from the big bad drug companies. They don't pull $135 million out of thin air. It's paid out of revenues, or by an insurance company which then just raises rates to cover the loss.

Now, I'm not going to go all Republican on you and champion the drug companies. Nor am I going to go off on a diatribe against trial lawyers or excessive government regulation.

What gets me, though, is that part of Wyeth's defense was that the patient was warned that the drug carried an increased risk of cancer. And that brings me to tonight's word... statistics.

You can't always blame the patients. How many times have you heard a story where they say something like "the study showed that burning an infant's feet with cigarettes reduced its chance of SIDS death by 20%"? So then everyone goes out and starts burning their kid's feet with cigarettes. But what they don't tell you is that the kid's chance of SIDS death was 1 in 1000 and burning their feet with cigarettes lowered their chance to .8 in 1000. That means if you burned the feet of ten thousand babies with cigarettes, statistically you'd save the lives of... 2 babies. Burn 20,000 baby feet and save the lives of two babies. But more importantly, 9,998 babies got no benefit from having their feet burned. They just got pain and scars. Their feet were burned needlessly because all we had were statistics. Because we can't tell which two babies would have their lives saved by burning their feet, we cause 9,998 babies needless pain and scarring.

See, when you hear the story on the news that your chance of death from XYZ increases by 20% or decreases by 20%, they conveniently leave out what your original chance of death from XYZ actually is. And remember that much of this is a statistical increase or decrease. If you had the right group of people, you could statistically prove that having one less beer on the Fourth of July decreased their chances of being hit by a runaway train at Christmas by 64%.

Let's get into bigger numbers... Your odds of winning the Megamillions Lottery on a single ticket are 1 in 175,711,536. Want to increase your chances of winning by ten thousand percent? It would seem that if you increased your chances of winning by ten thousand percent, you're virtually guaranteed to win. Right?

Buy 100 tickets. When you increase something a hundredfold, you've increased it by ten thousand percent. Thing is, you've only increased a 1 in 175 million chance a hundredfold. To guarantee you'd win the megamillions lottery, a 10,000 percent increase isn't enough. You need a 17,571,153,600 percent increase (yes, that's a seventeen billion percent increase).

So when patients are told a drug can increase their risk of cancer, heart attacks, etc., is that warning really and truly meaningful? What was their risk in the first place? How much was their risk increased by this drug? What is their new risk?

In medicine, there are ways to know who will get cancer from a particular drug and who won't. We just don't have the science yet to know all those ways to tell this stuff. So, due to a lack of information or an excess of imperfect information, we substitute statistics for knowledge. We treat getting cancer from using a drug or a baby dying of SIDS like a lottery. Since we can't really know whose ticket will be drawn, everyone has the same statistical chance. Maybe a few risk factors increase one person's chance over another and we can get a little closer to determining which is the 100% patient and which is the 0% patient, but we're still pretty far off.

And in the meantime, the news media says something stupid like "a new study shows that eating pickles doubles your risk of dying from a manatee attack" and people who will never encounter a manatee in their life swear off pickles, yet someone who will end up dying of a manatee attack shrugs off the study's findings. Then their family sues Vlassic for not putting a big enough warning about manatee attacks on their pickle jars and sues Sea World for not keeping the public farther from those dangerous manatees and for not screening the dead guy for pickle consumption before allowing him near a manatee.

So when the drug companies present drug trial numbers to the FDA and the FDA decides what the doctors and the public must know about the risks... it's all statistics. And it's not necessarily the drug companies or your doctor or the FDA trying to mislead you. You'd need a solid knowledge of statistics and all the raw data to make an even semi-informed decision.

So when people take a drug and it's a potential culprit for bad things that happen to them, their lawyers can use the public's ignorance of statistics in two ways. First, they use their own statistics to try to prove a link of causation between taking the drug and the bad thing that happened. Then they try to show how their client couldn't adequately understand the warnings they were given because the client is just part of the general public who doesn't understand all these statistics.

And that's how we end up with jury awards that are the size of lottery jackpots.

In the end, until we have the science to identify every genetic and lifestyle marker so we can say "this drug will give you cancer" or "you'll be fine" with complete accuracy, we have to rely on statistics. We can do longer tests and maybe identify a few more things that can happen, but those push up the costs of bringing a drug to market. If we don't, then we end up with people getting heart attacks from long-term use of a simple arthritis medicine and push up the costs with a couple billion in law suits. Either way, we make drug companies take a lot of financial risk, and thus they charge us an arm and a leg to try to reap the reward of that risk.

In my opinion, unless you can prove intentional malfeasance by the drug companies (i.e. they falsified test results or cut corners during the testing), so long as they followed all federal regulations, jumped through every hoop, and provided every federally mandated warning, they should have a "shit happens" defense.

And if the federal rules aren't strong enough, whose fault is that? If the funds aren't there for research to help give us more precise indicators and less reliance on statistics, whose fault is that? As long as only 50% of the eligible voters show up at the polls and vote for the candidates who appeal to their baser instincts on topics like gay marriage and flag burning rather than base their vote on topics that are really "life and death", then the lawyers, insurance companies, and drug companies get rich, drug prices remain outrageous, and if you're "lucky" to live long enough to clear the trials and appeals after a drug gives you a near-fatal side effect, well, you win the lottery.

Last year, I created Doctor Tricks to tell the tale of how I got bit for extra money at a hospital. Thing was, though the hospital was a preferred provider on my medical insurance, none of the emergency room doctors were. I ended up getting bit for an extra $153.50 for the ER doctor's bill because he charged more than my medical insurance allowed.

But while doing research, I found another thing. First the state Insurance Commissioner's office mentioned it, then friends and visitors to the site told me stories of it. Anesthesiologists were big perpetrators of this game. If you had to have emergency surgery, you'd be lucky to pick your surgeon, much less your anesthesiologist. Knowing this, anesthesiologists were taking advantage of people's distress and lack of choice to pick their pockets.

Most of the stories I heard about this weren't about trauma surgeries, though. They were births. The general story went: the parents-to-be went into a preferred provider hospital to give birth, had to have a caesarean section, the anesthesiologist for the c-section wasn't a preferred provider on their insurance, and they ended up having 500-1000 tacked onto their share of the bill after the insurance payment.

Now, it's common to pick the hospital you give birth at based on where your obstetrician has privileges. You've been seeing this doctor for months. You trust this doctor. You want this doctor to deliver your baby.

You make sure the doctor is a preferred provider on your insurance and that the hospital where they have privileges is a preferred provider, but you don't think to ask about the anesthesiologists. You should.

You should also write your congressman and senator and ask them to introduce Federal legislation, an amendment to the Patient's Bill of Rights, making it illegal for an insurance company to certify a hospital as a preferred provider unless all the doctors and service professionals are preferred providers.

It's ridiculous that you need to not only confirm that a hospital is a preferred provider on your insurance, but that all their subcontracting medical corporations (ER docs, radiologists, anesthesiologists, etc.) are preferred providers. And it's difficult to do to, because the medical corporation doesn't have to have the same name as the hospital, so you're forced to check the addresses of local radiology services and emergency medicine services against the address of the hospital.

Until there is federal legislation that makes it possible for consumers to quickly and easily determine whether all the services they receive at a hospital are insured, dishonest docs are going to take advantage of this to pick your pocket at the most emotionally, physically, and financially vulnerable times of your life.

So if you're pregnant and trying to pick the best obstetrician, make them do the work. Make them find out if the people who will take care of you at the OB/GYN's preferred hospital are preferred providers. If they can't answer or won't answer, maybe they're not as deserving of your trust as you thought. And if they answer no, when you tell them you'll have to go to another doctor, maybe it will give them incentive to join the fight against this underhanded practice.