How could there be so much difference in the incidence of lifestyle diseases within a few blocks in the same city? What nobody seems to have taken into account is the distribution of "free" drug samples for lifestyle diseases in poor districts. In Montreal, we attend a wide variety of clinics in the city and have noticed that those in the poorer districts have a huge stock of "free" drug samples. Secretaries in these clinics tell me that they are ordered by the doctors to phone the drug reps if the stocks are running low. It seems that handing out these "free" drugs to the poor is a way of assuring their frequent return and the fee for service provided by Medicare. Those clincs that hand out the most samples get the most patients. I presume the same sort of thing occurs in the US.
Some university based clinics refuse to hand out "free" samples of drugs that invariably are the newer, expensive drugs that drug companies want to promote. No problem. There are services available to get those drugs "free" to the poor. And drug companies even have there own progams. Makes them look very compassionate. So, here we see the ultimate moral hazard. No need to even think about the cost of lifestyle drugs. Eat all you want from the food bank and the junk food outlet and those "cholesterol", diabetes, and high blood pressure drugs will keep coming, cost-free, from those wonderful, helpful doctors and drug reps. No surprise, then, that poor districts have endemic lifestyle diseases.
