Pyatt: Picking the right medications a bit like throwing darts

When I reflect back on my life, I’ve often thought about the toughest thing I’ve had to do. Running a marathon is right up there. Graduating with an engineering degree? It’s a close call. But No. 1 is probably on occasion taking on the pharmaceutical and medical establishment. This is as close to a near-death experience as I ever want to face.

I have a nurse practitioner I really like, and we have transversed some tricky medical situations to both of our satisfactions. Unfortunately, there are often medical “red lines” that are not to be crossed. No amount of common sense, logic and science can trump these “red lines.” Often these limits are unannounced to the patient but must be deducted.


There is no clear-cut rationale for establishing blood pressure standards at 130/80 vs previous standards of 140/90 or even 150/90 for seniors. The reduction in risk is quite modest and further introduces the “white coat” syndrome, in which doctor’s office values generally run measurably higher. The developers of the 130/80 standard recognized this and have a procedure for home measurements. You have to do your own research on this point. Most physicians really prefer that you don’t know this.

A very high percentage of fees for family practice physicians come from these routine blood pressure checkups. And it does have a profound effect on our health and life expectancy, so I can’t complain too loudly.

However, I was told by one physician that either Medicare or health care providers or both provide a higher reimbursement for a visit if the patient is under the 130/80 standard. But you don’t have to come back for a year, Most physicians or PAs or NPs get a salary, in my case from Life Bridge, and just go by the book, so to speak.

There are now roughly 100 blood pressure medications on the market. I found this out when I checked on the availability of my usual BP medication that I was taking for about 3 years. This is almost as many as for cold and flu medications.

When I first started taking this one med (Olmesartan, a generic for Benecar) it was the latest and greatest. It is currently on hold for refills due to a “recall” because a certain class of pharmaceuticals had some bad stuff added when manufactured in China. There is also a class-action lawsuit by many states against certain pharmaceuticals for price fixing of generic drugs that could affect the availability of Olmesartan.

My physician says if I take a replacement medication I should monitor my blood pressure on my own to assure that the new medication, which has a tendency — or at least in certain clinical trials — to be less effective than Olmesartan, but probably is as effective in practice.

I hope you see the irony.

In a fit of pique, I found that larger dosage Olmesartan (40 mg) was available vs the 20 mg I’m taking and — Gasp! — offered to cut the pills in half. The pharmaceutical folks have come up with more reasons to curb the vile and fiendish practice that could cut into their profit margins.

Further, the hurricane in Puerto Rico over a year ago wiped out the manufacturing of many pharmaceuticals. Some are not sure that they can continue in this hyper-competitive market.

Pharmaceuticals often tout their products’ effectiveness through clinical trials that are favorable to them. It’s not clear how better some are vs. others in actual practice on everyday run of the mill people. I don’t think physicians know either — as I mentioned my own literature research is inconclusive. Presumably, we have access to the same medical data bases. Olmesartan actually didn’t perform any better than my older medication, based on my own BP measurements.

My thinking now is that Olmesartan carefully screened test subjects to get the results they wanted, published them, and sold their product at a higher price. Now with so many BP meds available, health care providers have figured this out. Olmesartan roughly costs 2 to 3 times other generic drugs, although getting exact figures is difficult since health care providers don’t want the public to know this precisely.

So now, with 100 medications to choose from — and assuming they’re all effective or they wouldn’t be on the market — how do you choose? This is akin to the old comparison of monkeys throwing darts at the stock page vs. trusting the advice of financial experts.

Taking medications is not always pleasant and generally involves side effects, again kind of like throwing darts. Now the whole process of blood pressure control seems like deciding which cough drops are best.

In the end I did order the double dosage medications, bought a $7 pill splitter the CVS pharmacist recommended — after I went through my experiences and added a bit of humor. I now have enough meds to last 6 months. By then, hopefully pharmaceuticals will have a better idea of where they stand on Olmesartan, or there will be a consensus of the best way to proceed replacing it. Or come to terms that it doesn’t really matter.