Another Victory of Ideology over Rationality

Canada is a progressive nation, so they say. We have national health care. Or, rather, we have ten provincial and three territorial health care systems. The Federal Government provides the ground rules, a major part of the funding, and the ideology. Big time ideology: all Canadians ┬áhave the inalienable right to good health – and if it seems to be temporarily absent, mother state is there to set it right. This right to health care, not only must be available to everybody, but it has to be unencumbered by any whiff of charity. Services are provided free, to all legal residents, without any needs tests.

Actually, no nation can afford unlimited health spending. So we have a few, almost invisible, safeguards: you are entitled to any diagnostic and therapeutic intervention, as long as you survive the waiting time. As a senior, you get your prescriptions almost free, as long as there isn’t a similar, cheaper drug. And here is my beef.

I am a senior citizen with a misbehaving pimple. After some discussion and perusal of the evidence based literature, my family doctor gave me a prescription for two weeks of an antibiotic – Doxycycline. Doxycycline, a younger brother of Tetracycline has been around for over 45 years. It is nothing exotic. In the lab, it is as effective against the same variety of bugs like Tetracycline. When I came to the pharmacy, I learned that that Doxycycline, as opposed to Tetracycline, was not covered by the health plan. Why, because Tetracycline is cheaper! Paying for the Doxyxycline out of my pocket is no problem. It really isn’t expensive, and in fact, the dispensing fee amounted to about much as the drug itself. But it got me thinking. The reason I prefer Doxycycline over Tetracycline is the convenience of having to take only two pills per day instead of four.

Real life effectiveness of any drug does not only depend of the inherent efficacy under ideal conditions, but it also depends strongly on the patient’s behavior, above all on compliance, i.e. how closely he or she follows the doctor’s instructions while taking the medicine. Let us then consider the influence of dosage frequency on compliance by examining the literature.

Between the 1990s and present I found over 20 good scientific studies exploring the question. Amazingly, they all agree: compliance behaves inversely to dosage frequency. In other words, if you double dosage frequency, you halve compliance, i.e. the patients take only about half as much of their prescription. You would then expect that therapy is only half as effective.

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