No, You Are Not Entitled To A Refund Of Your Prescription Drugs.

I recently had to consult a doctor for an infection derived from an ingrown toenail. It was sore, throbbing and painful — all the classic signs of an acute inflammatory reaction right there. I just wanted to ensure that there weren’t any other complications or broken toenail bits to be forcibly removed, ya know.

At the end of the day, the doctor gave it a perfunctory look over, said it just needed a good rest, and proceeded to prescribe a course of antibiotics to combat that infection. She also asked if I did need any non-steroidal anti-inflammation drugs (NSAIDs) to block the pain symptoms.

Of course, Dr J being Dr J decides to pass on the NSAIDs, because they just tend to block out the signal of the pro-inflammatory biomolecules by blocking their production, which prevents them from triggering too many pain receptors (Unlocking The Lock And Key Mechanism That Governs Our Body’s Cellular Functions). After all, the omega-3 fatty acids (docosahexanoic acid, or DHA, and eicosapentanoic acid, or EPA) can have a similar effect on the pro-inflammatory signal, as I did write in How Lipid Peroxidation Affects The Omega-3 Fatty Acid:

EPA and DHA are potent anti-inflammatory mediators that work on decreasing the intensity of the immune system’s inflammation response by signalling cells to downregulate their pro-inflammatory pathway (nuclear factor kappa B, or NF-κB). NF-κB is a major cellular pathway that expresses genes to stimulate the production of pro-inflammatory cytokines and contribute to the development of an inflammation signal in our body.

And I do believe that I have a quality product that can help in supporting that function.

But as for antibiotics, there isn’t really much of a choice. I saw no plausible reason to override that prescription.

So I ended up with a course of antibiotics (augmentin, or amoxicillin)… which I didn’t consume.

And that did get me thinking…

How greatly designed is the pharmaceutical business for making money!

But why do I say that the pharmaceutical business is designed for money making?

Doctors are supposed to be the health experts

We tend to have this unquestioned assumption that the doctors we consult ought to know everything under the sun that is related to human health.

Spoiler: It isn’t necessarily the case — there simply is too much medical information and disinformation, science and non-science out there. We cannot, and should not expect one singular doctor to know everything.

They’d be like a medical god otherwise.

But when we do hold on to that fallacious assumption, we tend to take the drug prescriptions that the doctors give to us unquestioningly. Whether it’s a simple case of a painkiller or a more complex case of a biologics drug, we tend to take it as it is.

Heck, the major concern that most of us do have will be “how much of a drain on my wallet will that be?”

Prescription drugs are not entitled to returns or refunds

There is no place for buyer’s remorse in the sale of a prescription drug.

When the doctor has prescribed it, we still have one last chance to decide whether we really do want it or not, and that is at the point of sale.

When the transaction has been finalised and the drugs are in our possession, there is no way to get a refund out of it.

In fact, the United States Food And Drug Administration has this to say about the returns of prescription drugs:

A pharmacist should not return drugs products to his stock once they have been out of his possession. It could be a dangerous practice for pharmacists to accept and return to stock the unused portions of prescriptions that are returned by patrons, because he would no longer have any assurance of the strength, quality, purity or identity of the articles.

Many state boards of pharmacy have issued regulations specifically forbidding the practice. We endorse the actions of these State boards as being in the interest of public health.

The pharmacist or doctor dispensing a drug is legally responsible for all hazards of contamination or adulteration that may arise, should he mix returned portions of drugs to his shelf stocks. Some of our investigations in the past have shown that drugs returned by patrons and subsequently resold by the pharmacist were responsible for injuries.

So yes, the doctors and pharmacists do need to ensure that they’re only selling drugs with a known “strength, quality, purity or identity”. Drugs that have been returned… well, we don’t know if the previous purchaser did replace them with sugar tablets or placebos, right?

Therefore, they cannot be returned. There is not much of a tolerance on that.

But it also means…

As a doctor, I can prescribe everything under the sun to you, whether you need it or not. I may even earn referral payments just from the sales of these drugs, much like an affiliate marketing link would do for other non-drug related products.

And if that is the case… wouldn’t prescribing more of these drugs be beneficial to my financial bottomline then?

Add to that the whole idea of a drug being responsible for counteracting a specific symptom that we’re facing — it doesn’t do much to address the root cause of why we are experiencing that symptom.

Hence, a long term chronic condition such as high cholesterol, Type 2 diabetes or heart disease would be a gold mine for a doctor — prescribe the drugs, get the referral payments, know that the drugs won’t cure the root cause without a lifestyle overhaul, and wait for the recurring orders to trigger more referral payments when the patient returns for their next checkup.

It’s a great way to do sales, and I wish I had more of that foresight.

Unfortunately, I don’t have that foresight.

I can only stick to quality nutrition and devise concoctions and schemes to biohack my body’s functions to an even better level. For the record, the infection disappeared after 3 days. I saw the doctor on a Monday and was playing badminton (with mild toe soreness) on Wednesday and Friday — the prescription antibiotics were to have lasted 2 weeks if I started the course.

All I did was to make sense of my immune system’s response to an infection, whether viral or otherwise (5 Things For Consideration In A Viral Infection), know how the process develops and how the infective invaders can get disposed of, then manipulate the process by supporting a healthy immune system function (What Supports Our Immune System Against the COVID-19 Coronavirus?).

But otherwise…

Damn, this no-refund model is fantastic for business!

And it also does point to the manipulation of science for the purposes of financial gain, wouldn’t it (The Implicit Manipulations Of Science By Human Greed)?

I’m planning to expand this article further into an ebook in due time.

Do have a look too here at Digging Deeper Into Doctoral Diagnoses and do geel free to post relevant questions that you may not be able to find the answers for even after exhaustive searches!

Joel Yong, PhD, is a biochemical engineer/scientist, an educator and a writer. He has authored 4 ebooks (available on Amazon.com in Kindle format) and co-authored 6 journal articles in internationally peer-reviewed scientific journals. His main focus is on finding out the fundamentals of biochemical mechanisms in the body that the doctors don’t educate the lay people about, and will then proceed to deconstruct them for your understanding — as an educator should.

This article was originally published in Medium.