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.

A few days back, the West Michigan Whitecaps announced they'd be serving a 4,800 calorie hamburger (equal in calories to about 9 Big Macs - or when broken down to joules of energy, equal to about 1/6 of a gallon of gasoline) at their ballpark. The minor league baseball team claimed the burger would weigh in at nearly 4 pounds, containing 5 burger patties, 5 slices of cheese, and a cup of chili among other elements.

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I've been having a problem with tendonitis in my wrist. It's been getting worse since I started my new job, so I went to my doctor and he recommended I see a physical therapist at any one of a number of physical therapy clinics in the area and a hand specialist at a satellite sports medicine clinic run by the University of Washington (my doc is at a satellite family practice clinic run by the university).

I was able to choose from a variety of upcoming appointments with the physical therapist. No problem.

When I called the sports medicine clinic, it turned out their hand and wrist person is only in that office on Mondays and has nothing open until 3 weeks from today. "Is November 10th okay for you?"

Sure, I'm a brand new patient with a worsening condition that's driven me to seek treatment from an orthopedic specialist, but I'll just explain to my condition that the doctor isn't available for three weeks and it will happily go into remission until the doctor can see me.

If you're in say Vegas, and you call up a hotel, say "I'm in town, got any rooms," and they're full up, they'll try to help you get booked somewhere else. If you call a doctor, they'll tell you when he/she is available, and if that doesn't work for you, that's too bad.

I know that doctors are not hoteliers, but it would be nice to see an attitude that says: "We understand you may be in pain. If we can't serve you within a reasonable time period, we'll be happy to recommend some other doctors who might have an appointment available sooner."

Best I could do was get waitlisted for a sooner appointment if someone cancels.

Of course, you can bet I'm now going to shop around.

So I've recently been seeing a number of ads on Yahoo.com from Sanofi Pasteur, encouraging new parents to get re-vaccinated for Whooping Cough (pertussis), basically implying you could pick it up and kill your baby. Here's one of the ads...

And even better for trying to scare you that your baby will die is this one...

Now, they could not say these things if they were not true. But the thing the medical industry loves to do is scare the crap out of you by twisting statistics to make it sound like if you don't do what the drug company or public health campaign says, you or your child will definitely die. What they fail to do is put this into perspective.

According to the CDC, the number of Whooping Cough cases in the United States in 2003 were 4 per 100,000 people. Now this is not the number who died, but just the number of reported cases. So, 4 per 100,000 people means that the overall odds of catching it were 1 in 25,000.

But remember that they're bringing the mention of death into the ads. Namely that "nearly all deaths in the United States from whooping cough are reported in infants less than 6 months" and that pertussis "can be fatal to babies." They're trying to get you so scared that your baby will die if you don't get vaccinated. But how likely is that to really happen?

They were citing this CDC report. The report also states that 5,872 cases of pertussis in babies under 6 months were reported in the 3-year study period. Of that 5,872 babies... 51 died... not 51 a year, but 51 in three years. That's an average of about 17 babies per year out of the approximately 3.7 million babies born in each of those years. So the average odds of a baby dying from whooping cough during the three year period was about 1 in 200,000.

So the same report they scare you with, gives other numbers that let you calculate that the odds of your baby getting and dying from pertussis... from anyone... would be somewhere in the neighborhood of 1 in 200,000.

So why are they raising such an alarm?

Perhaps a CDC price list, showing pricing for the Tdap (Tetanus Toxoid, Reduced Diphtheria Toxoid and Acellular Pertussis, a.k.a. ADACEL®) vaccine runs between $30.75 for the CDC's bulk discount rate and $37.43 for the average private sector rate. Basically, every person they scare into getting it now is an additional $30 (or more) in sales for them. If they could convince 3.3 million adults to get so scared they ran out and got vaccinated, it would mean $100 million in sales.

What's interesting is that most adults will get the shot anyway over the next few years (and many have already). The CDC recommended switching to a Tdap booster (from a simple Td booster) in 2005. So if you go in for your regular check-ups, your periodic tetanus booster will include pertussis vaccine if your doctor is following CDC recommendations. Seems like Sanofi Pasteur is trying to boost annual revenues by scaring people into getting a booster now instead of when they're scheduled for it.

Last, to show you how much of a scare campaign this is, let's run the numbers of pertussis deaths against the super bogeyman that new parents get attacked with... SIDS. The average baby is over 130 times more likely to die of SIDS than pertussis (based on 2,648 reported SIDS deaths in 1999 vs. an estimated 20 pertussis deaths for infants under one year in 2003). Basically, the average baby is more likely to die of SIDS than to even catch pertussis, and that's before the CDC officially recommended the Tdap booster for adults.

It's amazing how much their ads look like scare tactics when you see the numbers on pertussis in context. Should you make sure that your doctor gives you a Tdap booster instead of a Td booster the next time you're due? It's basically just a booster of a vaccine you've already had, so it probably couldn't hurt and could help, and it's only a few dollars more than the Td booster. Should you run screaming to your doctor, demanding a pertussis vaccine right away like Sanofi Pasteur would have you believe? That's up to you to decide. But every time the news or a drug company ad hits you with alarming statistics, go get some context on those statistics. Once you see them in context, they're usually a LOT less alarming.