I’m on Day 10 of a nasty cold with an unusual (for me) amount of sinus congestion. Most people in Boston seem to have flu or strep so I guess I should count my blessings. Anyway, I decided to see if antibiotics would help (science says that it doesn’t (example), but science also says that science is wrong (Ioannidis) and I do think that previous similar incidents have been helped by antibiotics).
I did this back in the early 1990s in Egypt. I walked from my sister and brother-in-law’s apartment to a pharmacy, described my symptoms to the pharmacist, and walked out five minutes later with antibiotics at a total cost of less than $5.
My primary care doctor was busy so this morning I went to a walk-in clinic at Mt. Auburn Hospital in Cambridge, which has a pretty good reputation for delivering ambulatory care without crazy wait times. Nonetheless I did have to spend some time in a crowded windowless waiting room surrounded by flu victims wearing masks. I interacted with seven different people (reception/admission, walk-in clinic front desk, triage nurse, intake nurse, physician, physician in training, discharge nurse), which involved a certain amount of repetition of story and measurements (e.g., my temperature was taken twice). Ultimately I was prescribed antibiotics, though I did not specifically ask for them and the exam room contained a big poster saying “antibiotics are not helpful for viral illness”. Then I went to CVS to get my prescription filled. I had to update them with new prescription drug plan numbers so that I wouldn’t be charged $61 for generic amoxicillin (cost = 42 cents according to UNICEF). Thus what had taken five minutes and $5 in Egypt with one interaction, one payor, and one vendor took three hours and cost perhaps $500 here with eight interactions (including at CVS). There were three payors in the U.S.: me, Blue Cross, and Medco (for the pills). There were at least three vendors, I think: the hospital, the doctor, and the pharmacy.
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I hope you feel better soon, now that you are on day 10, you should be on your way to recovery soon (give it another 7 days).
So when you walked into the clinic at Mt. Auburn Hospital, they didn’t ask you if you have been to Liberia, or got in contact with someone who was in S. Africa? Now you have the right to sue all those people you interacted with for not doing so and thus your clue why it cost $500 in the U.S.A. vs. $5 in Egypt. Perhaps someone from Europe can tell us his / her experience? That should be a better comparison.
Speaking of the Egypt (more specifically Syria for which I know first hand), did you know that if you are scheduled for an operation, you have to secure and bring-in your own blood need and medicine supply to the hospital before they will operate on you? About 10 years ago (way before the current war) two of my relatives needed operation and the hospital will not schedule the work till when: 1) the money is secured, and 2) medical need is meet (including blood); this is the patients’ responsibility not the hospital.
Thanks, George. They did ask me if I’d been out of the country in the last 21 days. And as far as getting my next heart transplant I do think that I would prefer the U.S. system (though if I had to pay for it out of pocket I would probably choose France or similar). But that doesn’t mean that we can’t learn from the Egyptians when it comes to simple ailments.
Your experience in Egypt was the same as my experience in Peru and Hong Kong.
Do we enjoy greater safety from amoxicillin-resistant infections as a result of all this extra $500 worth of “GDP” involved in limiting access to a $1 handful of pills?
And if that’s a worthwhile exchange, could we do better with OTC antibiotics combined w/ an appropriate ‘sin tax’ to reduce overuse?
Presumably some people die of infections because they want to avoid the experience of navigating the gold-plated professionally-licensed $500 system. Perhaps OTC+sin tax would save lives directly by making the meds more psychologically accessible and keeping people out of flu-saturated waiting rooms.
A sin tax would discriminate against the poor. This would never fly under our current political ethos. Alternatively, they could give it free to the poor, price it cheap enough for the rich to easily afford and screw the middle class. This is how we do everything else nowadays in this country so why should this be different?
Speaking of Egypt and health, a couple of years ago my 20 year-old Honda broke and I had to call a tow truck. The tow truck driver was an Egyptian dentist. I was in the process of getting a dental implant at the time, so I asked him how Egypt’s prices compared to the $5000 or so that my molar implant would cost. I think he said it would be around $1000. He said that he and all of his buddies wait until they return to Egypt and then get all of their dental work done then for a small fraction of what it would cost in the U.S.
In North Carolina there is such a restricted supply of dentists that I don’t know a single one who works on Fridays.
Antibiotics like erythromycin and amoxicillin do way more than simply cure acute bacterial infections. They lower all inflammation throughout the body. They lower stress hormones and normalize estrogen levels. A course of antibiotics helps women conceive. Antibiotics have been shown to reduce and even eliminate migraines. There’s a huge list of this stuff. I don’t think all the mechanisms are fully understood. The macrolides seem to reduce inflammation entirely independent of anything to do with bacteria.
One interpretation is that problematic bacterial infections are way more common than is popularly understood and cause many diseases and symptoms not properly attributed to bacteria. Keeping underlying bacterial infections in check is going to make everything work better, including fighting off a viral infection.
Another factor that is actually well understood is gut endotoxin absorption. Bacteria in your intestines are constantly excreting toxic lipopolysaccharides that your liver and immune system have to clear. By cutting down these bacteria with some antibiotics you will temporarily lower a source of stress on your immune system.
The antibiotics we have are truly amazing wonder drugs that help for far more than people realize.
Overuse of antibiotics is causing the emergence of resistant bacteria (although agricultural use may be the dominant factor.)
It is not until an American leaves the US and experiences universal health care that an American understands how truly broken the US health care system is. That was my experience.