Cost of drugs a hot topic

Dear Dr. Gott: If one of the reasons medications are so expensive is that drug companies have to make a profit in order to develop and market new “wonder drugs,” how come the companies can routinely sell prescription medications to other countries – notably, Canada and Mexico – at markedly reduced rates? I believe that this arrangement seems to hose American consumers and to prove that drug companies’ first priority is to play on an uneven field. Why shouldn’t prescription medications be sold at the same prices both here and abroad?

Dear Reader: Why, indeed! Your intriguing letter raises an issue (once more) that deeply concerns the American public and most practicing physicians – namely, the unfair practice of selective marketing by drug companies. If, for example, the companies were forced to sell their drugs in any country in the world at standard costs, the American public could forego purchasing necessary prescription items at prohibitive costs domestically or from foreign countries at a rebate. Your blood pressure medication would cost no more in the United States than it does in Iceland or the Sudan. Such leveling of the playing field would virtually undercut Medicare Part D, which is a ridiculous, potentially harmful and totally inappropriate option that was adopted by a federal government more interested in political appearances than in the realities of everyday living. Under Part D, the government basically supports absurd and questionable solutions to prescription prices. Who gains? The drug companies, of course.

Thank you for writing. I welcome other comments from readers and, if possible, I will publish a future column about this topic, which infuriates me, other doctors and, without question, many American citizens.

Dear Dr. Gott: I am 52 years old, and a little over two years ago I had a hysterectomy and a breast reduction. I have had some pain in my breasts since the operation, but over the past few months they hurt so much that I can hardly get my bra on. My plastic surgeon said there is no reason why they should hurt, and my gynecologist says that I should lower the amount of estrogen that I am taking. I have done that, but they continue to hurt more each day. Do you have any other suggestions?

Dear Reader: A breast reduction does not prevent a woman from experiencing symptoms of breast swelling or infection. In the first instance, hormone-replacement therapy can certainly lead to painful and sensitive breasts. I recommend that you follow your gynecologist’s advice about reducing the dose of HRT or eliminating it entirely. I am, of course, assuming that your plastic surgeon pronounced you free of breast infection.

Work with your gynecologist to overcome this annoying problem.