John Elias, my patient, has a dilemma. He can’t afford to buy his medicines and also pay his rent. I’m sure he won’t give up his apartment just to keep his veins filled with my chemical suggestions. But he is willing to take whatever free drug samples I provide. Luckily, drug company representatives visit my office regularly and drop off oversize, brightly colored boxes of pills, one or two pills per box. Sometimes I can fill a plastic bag with enough medicine to supply a patient’s needs. Still, my sample closet is not as well stocked as the local pharmacy.
The explosion of samples occurs most often when two drug companies are competing over a similar product. When I have one set of pills, it’s Elias’s diabetes that’s treated; when I have another set, it’s the hypertension. He does not die, but his blood pressure goes up and down, and his blood sweetens with rising sugar, which lowers whenever I happen to have the right pills. Elias leaves my office smiling, more comfortable with his predicament than I am.
“See you in a month, Doc. And don’t worry. I got enough pills here to last me a good ten days.”
I do worry–about the remaining twenty days, about his risk of a heart attack or a stroke–but samples arrive at the drug company’s rate, not in response to my urgent requests.
Elias is disabled, the result of a spine operation that didn’t go his way. He has Medicare, but like millions of other disabled and elderly Americans, he’s unable to afford the secondary insurance that would include a drug plan. He earns too much in his part-time clerical job to qualify for Medicaid, which also covers prescriptions, or to be accepted into a drug company’s “Share the Care” program. He does qualify for New York State’s EPIC plan, which allows some Medicare patients to fill all their prescriptions for under $100 per month, but he says he can’t afford even that. He says he won’t consider leaving his job to get Medicaid as others have done; he’s proud of the fact that he can still work.
Elias lives in his wheelchair; the levers and locks are extensions of his arms, the wheels his legs. He navigates the street outside my office, leaning back on two wheels to jump the curb. His arching wheelies are another man’s sidestep. But he has not managed to navigate his other diseases the way he has his paralysis. When I tell him the dangers of not controlling his diabetes and his high blood pressure, his smile fades. “When you’re out, then I’m out,” he says simply.
Meanwhile, the same company that makes his diabetes pill offers to fly me, all expenses paid and with a $1,000 stipend, to a frolicking weekend in Naples, Florida, where I would hear lectures for three hours a day on a drug I already prescribe, before adjourning to the surf and a sightseeing sunset booze cruise. The competitor invites me to the corporate box at the ballgame, with a lobster buffet and a live calypso band to entertain us between innings.