What mouthwash has to do with the CVS Aetna Acquisition

This commentary was first distributed through The Powers Report on December 12, 2017. Please sign up here to receive my newsletter in your inbox! Link to the Newsletter here.

The makers of Listerine are not going to like this. 

A recent study found that using mouthwash twice a day can increase your risk of developing prediabetes or diabetes by 55%. Yes. Someone thought to study this. Apparently, the mouthwash kills some good bacteria in your mouth that helps to regulate the blood sugar level in your body. There you are, trying to rid yourself of pesky chronic halitosis and you wind up giving yourself a real chronic disease. Lovely.

This bothers me, and it’s not because I am an avid user of Scope. I am concerned about the long-term effects of the introduction of too many anomalous chemicals into our bodies. We’re mostly made up of water, but chemical reactions are what make us function. Synapses firing, hormone levels calibrating, white blood cells combating foreign invaders…humans are miraculous creatures.

I may be over-dramatizing the situation because my father was a professor of organic chemistry, but here’s how I see it. Think about what happens inside your body at the cellular level when a non-indigenous substance, like whatever’s in mouthwash, appears on the scene. Chemical events occur that alter our natural state because the body needs to stay in balance. The more esoteric these substances are, the more of them we consume, and the longer we ingest them, the weirder our personal chemistry becomes.

For years, the scientific community has known that illicit drug use contributes to the onset of dementia. More recently, there has been a connection between the use of over-the-counter drugs and impairments in our cognitive abilities later in life. No one’s sure if food dyes and other chemical additives contribute to ADHD in children, but folks aren’t ruling it out either. Logic dictates that large amounts of chemicals introduced to a young child’s developing brain are going to do some strange things. Maybe the folks who studied the effects of mouthwash will now determine if Red Dye #5 causes hyperactivity. I hope so.

The message should be clear. We should take fewer drugs. But if you’re going to enroll in an Aetna insurance plan in the coming years, odds are you’ll be advised to take more drugs. Here’s why.

The proposed acquisition by CVS of Aetna for $69 billion ties together an insurer, a pharmacy benefits manager (PBM) and almost 10,000 retail pharmacy sites. (A PBM is an organization that interfaces with drug manufacturers to manage drug benefits for third parties like employers and government entities.) According to the deal-makers, the intent of the combined entity is to drive down costs and improve care. Access to primary care will be improved by delivering it through convenient retail locations. This is expected to divert some patients from inappropriate use of the emergency room. Care will be better coordinated for the chronically ill as a result of the enhanced local presence as well as access to Aetna’s treasure trove of patient data.

While analysts are spending a lot of time dissecting these assumptions, I am more interested in how the future Aetna health plans will be structured. If you’re an insurer owned by a company with a vested interest in drug distribution (the legal kind), then logic dictates your insurance plans will emphasize the use of drugs in health care delivery.

There are myriad ways that CVS/Aetna could manipulate the terms of its health plans to drive volume into its drug business. Coverage restrictions already influence clinical behavior, but the proposed acquisition could put these practices on steroids.

Let’s consider this scenario. You have back pain, one of the most challenging conditions to address. Surgeons are inclined to recommend surgery. To reduce the strain on your back, a dietitian may suggest weight loss (assuming that you are overweight, which most Americans are, so no offense). Other non-surgical options include chiropractic adjustments, massage therapy and acupuncture.

What’s cheaper and easier than all of these options? Drugs.

Drugs are also the answer for many of us who suffer from chronic conditions such as type 2 diabetes, hypertension and hyperlipidemia (high cholesterol). We take meds despite the fact that many of these conditions can be eliminated or at least ameliorated through improvements to diet, exercise, sleep habits and how we handle stress.

Of course, not all drugs are bad. If you have hepatitis C, drugs may be your best friend because now this potentially deadly chronic condition can be cured with medication. When no other options exist, curative medications can be, literally, a life-saver.

Yet prioritizing the use of pharmaceuticals in clinical practice when other solutions are available can create long-term health care problems. Many of these issues, which can affect not only the brain, but also other components of our bodies, may not manifest until plan holders are over 65. When that happens, CVS/Aetna won’t be financially responsible for the patient’s health care costs. That burden will fall on Medicare, which already has significant funding problems.

In short, the over-use of medications isn’t just bad for our personal health, it’s bad for our economic health.

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