If you do some quick math, you’ll see that I’ve spent about $6,000 on this medication so far. That number could have been closer to $200. But you know why it wasn’t? Because until today, when I happened to chat a little with a new pharmacist working at my regular pharmacy, I didn’t know the alternative shit existed.
Now, I’m not an idiot. I know there are a lot of doctors who take kickbacks from pharma, who aren’t up to date on the medicine, or who just don’t really give a fuck. I know better than to expect a doctor, especially a new doctor who isn’t a general practitioner, to always look after my interests. When I first started taking this shit, which is a brand-name drug, obviously, I asked the doctor whether there was a generic. He said no. I then went home and checked on-line to see if there was a generic, just in case (there isn’t, not for a few more years); I checked to see if there was any other common medication. There wasn’t. But this was five years ago, and I guess at some point I stopped checking. The new pharmacist, who is a kickass guy, told me this shit has been on the market for a while.
Now, here’s the really fun part. I’ve had the prescription for this medication filled by three separate doctors, two specialists and a GP. I’ve been treated by at least one nurse at each doctor’s office. I’ve discussed the medication with the woman at my school’s insurance office. And most importantly, I’ve bought it from at least 2 dozen pharmacists at 5 or 6 different pharmacies in the Tri-State area. And not one of these people bothered to tell me there was an alternative option. Am I really expected to believe that not a single one of these professionals, whose job it is to know this shit, knew this shit? Not one? I find that difficult to believe. And if it’s true, it’s pathetic, ‘cause, you know. Do your fucking homework. Every one of those doctors knows what I do for a living and about what my standard of living is. And the best thing of all? The last time I got this prescription filled, I got it filled by a GP at the university health center. And while he was filling out the prescription, he commiserated with me by telling me how infuriating it was that the school’s health plan doesn’t cover this medication so I had to spend so much money on it.
You may never have noticed it, but every prescription pad page has a small box on it somewhere, and next to that box is says something like “no substitution.” This box is very important. If your doctor checks that box, it means that the pharmacy isn’t allowed to give you an equivalent medication, or a generic version of the same medication: they have to give you the brand-nameversion that the doctor wrote on the pad, even if the generic is exactly the same chemical. Every time your doctor checks that box before giving you a prescription, immediately ask them why. Because really, there’s no possibly fucking reason to check that box unless there’s a demonstrable medical advantage to the brand-name medication over anything else. If the doctor says there is no generic, ask them why they need to check the box when there’s nothing to substitute, anyway. Then, if the doctor tells you there’s no generic or alternative, go home and check for yourself on-line. Then, no matter what the doctor and the Internet old you, triple-check with your pharmacist.
The text above the card is a passage from Deleuze & Guattari’s A Thousand Plateaus (Ch. 13, p. 446 in my edition). The book, of course, is famously dense, and I don’t want to make this a long post about D&G, so I’ll sum it up as directly as I can: in a global post-industrial capitalism, everyone is trying to fuck you. Everywhere, all the time, in every orifice. Especially the people you’re already paying a shit-ton of money in the assumption that the high cost of their training and services ensures they’re operating under a code of ethics that keeps them from fucking you. Like doctors, and lawyers, and insurance companies. But then again, you’re kind of asking for it, right? What kind of person needs to be paid $300 an hour to make them uphold a fairly self-evident ethical code like, you know, don’t fuck people who are paying you to help them?
That right there? That’s false consciousness. False consciousness isn’t when you’re 22 and you refuse to take your 7-year-old cousin to the cinema to see a Disney movie because you’re saving them from being indoctrinated. False consciousness is when you think that the people who are supposedly working in your favor, who are entrusted with your mental and physical well-being, are actually putting your interests ahead of theirs. And it’s not that these are people that are helping you out of the goodness of their heart and are just trying to make back a little something on the side by accepting a small kickback from a pharma company. No, no. They’re already making 25x a year what you make. They just want more, is all. In the pharmaceutical-industrial complex, everybody has a payday except the customer.
There are two morals to this story. The first is: do your research so you don’t get screwed. The second is: don’t be scared of your fucking doctor. I say this to people every fucking day. Doctors are like regular people, just more arrogant and less able to cope with changes in their environment. Really, you should think of them as mildly disabled. Instead of being scared of your doctor, just keep in mind that they might need your help getting from point A to point B, like, say, from their medical diagnosis to the fact that you’re an actual human being with a life and a bank account. One of the reasons doctors feel entitled to fuck their patients over is because they assume you’re too dumb to notice. Try to prove them wrong. The doctor who first prescribed this medication told me once that he’d prefer that I call him Dr. ______ instead of calling him by his first name. He told me this while referring to me by my first name. I told him I was fine with that, but since I hold a Magister degree from a German university, I prefer to be addressed as Master.
(Addendum: The difference between women doctors and men doctors is not that women doctors are more compassionate, less selfish, or more ethical, it’s that, in the vast majority of cases, women doctors have a vagina and men doctors have a penis).