The ethics and money in medicine

In mid-January, a patient called me from her pharmacy, frantic. Her asthma inhalers came to $168 — a sum that she hadn’t been prepared for. But she can’t live without those inhalers, so she withdrew cash from her meager savings account and skipped her blood pressure pills for that month. This is such a familiar story by now that it hardly makes news. Yet it is tragic, every single time, when a patient has to let one illness slide in order to treat another. Beyond the fact that it is monstrously cost-ineffective — treating asthma in the ED costs far more than the inhaler — there is something just plain wrong about it.