Recently, the National Institutes of Health urged physicians to prescribe a water pill, called hydrochlorothiazide, as the initial treatment for hypertension. Despite a large study that showed this water pill was as effective in lowering blood pressure and reducing the risk of heart attacks and heart failure as the more-expensive medications, very few physicians changed their prescribing habits. The most commonly prescribed treatment for high blood pressure remains generic Diovan (Valsartan) costing $58 monthly compared to $4 for hydrochlorothiazide

There is one more wrinkle in the treatment of high blood pressure that must be mentioned. For many overweight patients with mildly elevated blood pressure, weight loss, exercise and restricting salt intake can effectively bring the blood pressure into the normal range.

As a physician who believes passionately that cost should always be a consideration in medication choice, I am forced to dwell on why I am so reluctant to change, particularly as I am fully aware of the results of the large study demonstrating the benefits of a water pill in treating hypertension. As a force of habit, I usually start treating a patient with a drug called lisinopril, a medication that is effective with few side effects. At least it is no more expensive than the water pill. And yet, until more information appears to the contrary, I must change my prescribing habits and recommend lifestyle changes first and, if necessary, initiate treatment of hypertension with the water pill. And whenever possible, I must consider generic medications over brand name ones, because of the incredible difference in cost. 

Not too long ago, information was published on the most-prescribed and top-selling drugs during the past year. The most-prescribed drug is levothyroxine for hypothyroidism, followed closely by Crestor, a powerful brand name drug to lower cholesterol. Twenty-two million prescriptions were written for this drug, while none of the generic choices appeared in the top 100. Crestor should only be used in those patients whose cholesterol is so high that no cheaper medication is effective. Sadly, the vast majority of

Crestor prescriptions were prescribed to patients before generic Lipitor (atorvastatin) became available. Most people could control their cholesterol through generic Lipitor, which averages $16 a month, compared to over $200 for Crestor. 

We truly need to focus our financial resources on brand name drugs for which no generic alternative is available. Good examples are the biologic medications (Humira and Enbrel) to treat many inflammatory conditions such as rheumatoid arthritis and Crohn’s disease, and Abilify, which shows great promise in treating major depression and other psychiatric diseases.

The cost of brand name medications is enormous, and even with insurance, the copay is beyond the reach of many patients. This burden is aggravated by the fact that pharmaceutical industries can charge what the market will bear for newly released drugs. For example, the drugs to treat hepatitis C cost $80,000 or more per patient. Many anti-cancer drugs are just as or even more expensive.

Who will ever refuse paying for a drug that saves lives? At least in other countries prices are rigidly controlled. But doing so here would of course be considered “un-American.” 

There is an important lesson for you, the consumer. It is absolutely critical that everyone becomes an educated consumer of health care. The information available in our newspaper on almost a daily basis, on the Internet, from the media and newsletters provides a great deal of useful facts that will allow you to ask your physician key questions about the treatment plan proposed. Always consider cost as well as effectiveness in choosing a medication, and always ask if strategies such as diet and exercise may have the same effect. Even if you are blessed with an insurance program that has a medication benefit, remember that the most expensive is not necessarily the most effective.

If our health system is to survive in the future and flourish, our health care choices must become more rational and appropriate. Consumer and physician education are the key to holding down costs while assuring the highest possible quality of care.

Dr. David Lipschitz is the author of the book “Breaking the Rules of Aging.” To find out more about Dr. David Lipschitz visit