Dear DOCTOR Owen:

I just got back from the pharmacy and nearly “dropped dead” when I looked at the bill. It was more than $350 and will be this much every month. I was diagnosed with diabetes, high blood pressure, and high cholesterol. I also take something for constant back pain. How can a person make it with these costs? Any suggestions?

Reamed Green

Dear “Green”:

Cases like yours are exactly why I do what I do in my practice—use diet and exercise to help treat disease. For years, patient after patient like you has entered my office and exited with a new prescription every time. The pills only seemed to grow in number—never shrink. In addition to not improving medical conditions to any meaningful degree, one condition seems to emerge on top of the other, as in your case.

In 1999, statisticians at Kaiser Permanente® Medical Clinic looked at Body Mass Index (BMI), which is the latest measurement of obesity, and compared the costs of medicine to the BMI. A person with a BMI below 25 is considered at lower risk for disease. The statisticians found that patients with a BMI above 35 had twice as many medication expenses as those with BMI below 25. Those costs were seen in higher incidences of diabetes, high blood pressure, and cardiovascular disease, as expected, in addition to costs for pain medications (joints and back), ulcer medications, antidepressants, and respiratory medications.

This is certainly no surprise to me. At my clinic, we diet counselors usually see dramatic reductions in the medications of patients who are successful in implementing diet and exercise strategies. Aside from cholesterol medication, many drugs can be discontinued completely. To a self-funded health management organization (HMO) such as Kaiser Permanente, which pays many of patients’ medication expenses, serious diet and exercise intervention could yield large savings and improve health.

The cost of medication has gone “nuts.” In order to get to market, every new medication costs hundreds of millions of dollars in testing and research. For each one that is invented and “makes it to market,” 10 fail to do so—yet serious costs are incurred in the failed attempts. Fantastic new medications are available, which I firmly believe will have dramatic results—such as the new cholesterol medications. Once they make it to market, they then face the dog-eat-dog world of liability. This will never get cheaper!

Success at maintaining weight loss is now a vital economic and health issue. Therefore, it makes sense that programs with dietary, medical, and exercise teams working together should become commonplace. I firmly believe that the $350 drug costs/month would be better spent on a program that implements long-term management of the root causes of your problem. No doubt those services exist locally. Unfortunately, they also cost money. What a Catch-22 situation!

I suggest that you “bite the bullet” and start with local help. Have a dietitian guide you. Also, enroll in a local commercial Diet Therapy program. And, does the local gym have a trainer who can work with you for several months? Stay very focused and have your doctor “manage you off” the medications as you improve. Most importantly, continue with the help after you succeed. That will be much less expensive than what you are spending on those drugs!