What to Do When a Patient Wants a Lifestyle Drug

Some patients, armed with information from direct-to-consumer advertising, Internet browsing, or a recommendation from a friend or relative, ask for specific medications. Their purpose is usually cosmetic, recreational, or outside the medical or social definitions of health.

Insurers call these medications “lifestyle drugs,” and they may or may not cover them. With limited health care dollars, they often determine that certain drugs enhance happiness, “eradicate ugliness,” or make individuals feel less conspicuous or self-conscious. They relegate these drugs to the “not covered” portion of their formularies.

The lifestyle drug discussion began with Viagra’s launch in 1998. Today, many insurers cover drugs for erectile dysfunction, although they may impose quantity limitations or high copays.Table 1lists drugs that often fall into the lifestyle drug category.

TABLE 1:EXAMPLES OF LIFESTYLE DRUGS

• Alcohol

• Alopecia agents

• Anabolic steroids

• Antidepressants

• Antifungals for nail fungus

• Anxiolytics

• Bedwetting prevention

• Caffeine

• Cognition-enhancing drugs

• Erectile dysfunction drugs

• Eye lash enhancer (bimatoprost)

• Fertility enhancers

• Growth hormone

• Morning-after pills

• Oral contraceptives to lengthen the menstruation cycle

• Smoking cessation products

• Social phobia remedies

• Stimulants (specifically modafinil)

• Urinary incontinence products

• Weight loss products

• Wrinkle removers

• Botulism toxin

• Retinoids

Clearly, society’s views tend to change over time with regard to lifestyle drugs. Research discoveries also redefine optimal health.

Consider dental health. When braces and fluoridation were first discovered, many individuals considered both to be cosmetic and resisted their use. Today, researchers have shown that poor oral health often causes poor general health, especially heart disease. The vast majority of Americans who consume public water want fluoride in their water supplies.

With a growing understanding of genetics and its role in phenotype expression (that is, how things look), individuals may be more likely to perceive certain problems as beyond control and consider them as legitimate targets for drug therapy.

The ethical and moral discussion surrounding lifestyle drugs is complex and interesting, involving what patients can reasonably expect, the shift toward medicalization of conditions, pharmaceutical company profitability, and socioeconomic constraints to drug access. Moreover, study results indicate that if drug treatment is available, prescribers are less likely to use nondrug treatments, even if the evidence shows the nondrug treatment to be superior.

The situation in the clinic is that lifestyle drugs are available and patients ask for them.Table 2lists points to consider if patients ask for specific medications.

TABLE 2:LIFESTYLE DRUGS: CONSIDERATIONS FOR PRESCRIBERS

• Avoid discussion about controversy or philosophical debates; focus on the patients’ desired outcomes.

• Don’t trivialize lifestyle drugs; if patients ask for interventions, their problems are real to them.

• Remember that all drugs have adverse effects.

— The acceptability of the adverse effects is proportional to a patient’s assessment of the condition’s severity.

• Note that patients’ confidentiality expectations are greater when lifestyle drugs are used than when other drugs are used.

• Counsel patients about what to reasonably expect.

— An erectile dysfunction drug will cause an erection only under appropriate conditions.

— An agent indicated for alopecia will restore only recently lost hair, and may cause a small initial hair loss.

— A drug for nail fungus will cure the infection, but the misshapen nail needs to grow out, a process that may take months.

— Discuss cost because patients will probably have to pay out-of-pocket for the prescription.

• Counsel on different dosage forms available and the advantages and disadvantages of each.

• Educate patients that lifestyle drugs are frequently counterfeited, and most counterfeit drugs are obtained via the Internet.

— Encourage patients to use reputable providers for their prescriptions.

— Tell patients to always inspect the drug’s appearance and ask a pharmacist if something seems wrong.

— Tell patients how to monitor their responses to the drugs.

• Be aware that patients may use legitimate lifestyle drugs recreationally, specific examples include:

— Modafinil to create more productive hours in a day.

— Stimulants or steroids used to enhance normal intelligence or sports ability.

— Erectile dysfunction drugs to boost run-of-the-mill sexual performance.

If, after careful discussion with patients, convenient care clinicians see no harm from a prescription for a lifestyle drug, it may be time to pull out the prescription pad.