The Dixie pill parade
Docs in Dixie are handing out prescriptions as if they were sweet tea and peach cobbler, according to a new study. Pills are populating places up and down the Appalachians all the way to the parishes of Louisiana.
Is it aggressive docs? Runaway marketing by region? A genetic predisposition to pill-popping? Or perhaps a physician culture that doesn't follow up with leading questions that might indicate lifestyle changes that will do much more than a wheelbarrow-load of pills.
Perhaps more surprising than the over-medication in the South is the degree of difference. Pill-popping state number one — West Virginia with 17.2 retail prescriptions filled per capita — goes for the triple play over Alaska, coming in last at 6.5. At the top of the chart following West Virginia were Missouri (15.9), Tennessee (15.8), Alabama (15.7), and Kentucky (15.4). The national average was 11.1.
Pill-mania comes at a cost in Dixie. Studies earlier this decade by Express Scripts, a pharmacy benefit manager, estimated up to $200 extra for commercially insured residents of the South.
Those studies demonstrated consistently high levels in Southern states for the following categories of drugs: anti-hyperlipidemics (drugs that lower lipid levels), anti-diabetics, anti-hypertensives, gastrointestinal medications, antidepressants, analgesics/anti-inflammatories and estrogen.
To the researchers, I say, "You're not just whistlin' Dixie!" There are some reasons for the regional difference. The South has a higher rate of obesity, which is a risk factor for maladies such as hypertension and diabetes that are commonly treated with buckets of drugs.
It gives me pause to think of the implications of this study. Internet, cell phones and other technological advances make long-distance communication easier than ever. When your doctor in Missouri is prescribing you a medicine cabinet full of pills for your diabetes, but you learn your sister in Alaska is getting half the pills for the same condition, there's bound to be plenty of confusion. If docs erred on the side of under- prescribing, instead of over-prescribing, we could close this gap a bit and eliminate some of the bewilderment and distrust it's bound to create among patients.
