Medicine That Heals Only on Paper

The elderly woman walked into the Moul Mouj Health Centre with visible hesitation. Her hand trembled slightly as she handed over a crumpled prescription, not just due to age, but because she knew she couldn’t afford the medicine written on it. Aware that Moul Mouj Health Centre provides free medicines to underprivileged seniors, she had come hoping we could help. When we examined the prescription, it stunned us. One of the medicines would cost ₹10,500 for the first month and ₹13,000 each month thereafter.

This was not a cancer drug. It was not a life-saving injection with no substitute. It was simply a diabetes medication, one among several effective and more affordable options widely available in the market. On questioning, we learned that the couple, both elderly, were not just financially constrained, they were entirely dependent on the kindness of strangers, living off zakat and donations. Their adult children had abandoned them.

Her lab reports showed acceptable blood test reports especially kidney function and other tests, meaning several safer and much cheaper diabetes medicines were suitable. So why was this ultra-expensive drug prescribed?

This is not an indictment of the medical fraternity. Most of us try hard to balance clinical benefit with practical affordability. But stories like this cannot be ignored. They demand reflection.

Cost of a Prescription Isn't Just the Price Tag

For someone living on daily kindness, ₹13,000 isn’t a number, it’s a full stop. It's the difference between hope and helplessness. Medicines don’t work when they sit on shelves. And patients don’t heal when they are forced to choose between food and tablets.

Prescribing expensive drugs without assessing a patient's economic background can lead to devastating consequences:

1. Non-compliance and treatment failure:
   The most common reason for treatment discontinuation among the elderly is not side effects, but unaffordability. Patients may somehow scrape together enough for one month, but then stop, without telling the doctor, without tapering and often without understanding the implications.
2. Loss of trust in the healthcare system:
   When patients feel they are being given medicines they cannot buy, they disengage. They stop seeking help altogether. Mistrust creeps in, not just towards one doctor, but towards the system. In the elderly, this mistrust often leads to silent suffering until things become irreparable.
3. Increased morbidity and hospitalisation:
   Poorly controlled chronic illnesses due to unaffordable prescriptions ultimately result in complications that are far more expensive, hospital admissions, surgeries, and sometimes, untimely death.
4. Emotional distress and guilt:
   Patients who are financially dependent often feel ashamed when they can't buy the medicines prescribed. Many elders have told us they feel like a burden. It is heartbreaking to see patients apologising for being poor.

Rational, Responsible and Respectful Prescribing

Prescribing is not just a clinical act. It is a moral decision. A prescription is not just a piece of paper, it is a reflection of the prescriber's understanding of the patient's body, mind, and circumstances.

This is not to say that modern or high-end drugs are bad. There are many cutting-edge medications that offer superior control, fewer side effects and improved quality of life. But such drugs must be reserved for those who truly need them, and more importantly, who can sustain them.

Compassionate Clinical Practice

1. Know Your Patient Beyond the Disease:
   A blood sugar value does not tell the full story. A glance at the patient’s shoes, a gentle question about their family, or a simple, “Are you able to manage the cost of these medicines?” can open doors to meaningful decisions.
2. Promote Generic Prescribing and Transparent Pricing:
   Encourage pharmacies and health systems to carry cost-effective alternatives. Let’s normalize choosing generics that meet standards and educate patients that cheaper doesn't mean inferior.
3. Build Collaborative Care Models:
   Charitable clinics and government programs should work alongside practitioners to offer options when affordability becomes a barrier.
4. Medical Curriculum Reform:
   Empathy must be taught as rigorously as anatomy. Future doctors must be sensitized to the economic and emotional realities of patients, especially the elderly.
5. Respect Prescriber Discretion—but Advocate for Wisdom:
   This is not about criticizing colleagues. Every doctor wants the best for their patient. But in many cases, best doesn't mean most expensive. The most compassionate prescription is the one the patient can actually take.

This story is not rare. We see it every day. The elderly are quietly slipping through the cracks, not because we don’t have medicines, but because those medicines remain out of their reach. Sometimes, the prescription we write may as well be a goodbye note.

Let us remind ourselves: wise prescriptions save lives, not just through chemistry, but through understanding, empathy, and responsibility. Clinical excellence lies not only in choosing what works in textbooks, but what works in life.

Let us not allow the cost of a tablet to rob someone of their dignity.