GLP1 agonists — the glutides are antidiabetes drugs that also have protective effects on the heart. In the initial few days, the drug is known to cause vomiting, fullness or even diarrhea. Most people grow out of it.
Some people however seem to complain for a long time and refuse to take the drug. Initially I wondered if it is because of the nocebo effect — that the expectation of side effects became a self fulfilling prophecy. Turns out that these people can easily tolerate other injections — so the problem was not in the act of injection.
One possible reason could be the cost of the drug — the elephant in the room. The drug is quite expensive and only a tiny percentage of our patients can afford it. Even the companies which make these drugs, accept this.
While in other countries, saying “I can’t afford it” after a couple of months is seen fair enough, in India it is socially awkward. Even while shopping people would go to any lengths, to avoid saying , “No, I can’t afford it”. They typically say,
- Let me see
- Will ask my husband / wife
- Not now, but next time
- Didn’t bring my debit / credit card
This inability to accept that we can’t afford it, is especially hard if we have already agreed to take a drug
Saying ‘no’ after a couple of months, might feel like a copout. India is a country where people would rather go by bike, than travel by Tata Nano. Being seen as poor is such a taboo here, that people have to resort to inventing a reason. Since people are generally counseled before being prescribed this class of drugs, that they are rough on the tummy, it becomes a convenient reason.
Unlike other countries, we don’t have insurance coverage for chronic care. Most chronic medical expenses are out of pocket. We will never know if the persistence with the drug will be higher, if the insurance pays for the drug, instead.
Some reasons are white lies — technically called ‘preference falsification’ . The excuses don’t protect the heart like the drug, but they uphold something far more valuable to the patient : ‘honor’.
Sometimes patients aren’t intolerant to the drug, they are intolerant to its cost
Such “intolerance” can be a public lie, that hides a private truth. One that we don’t always pry.