I used to think a lot about what I would do differently if I didn’t have psoriasis / psoriatic arthritis. This was particularly the case when I lived and worked in China. At that time I didn’t really enjoy my job and there were many times that I would lie awake at night stressing about the problems at work and wondering how I had got myself into that position. You see, I’m a firm believer that “life is short” so one should eliminate those things which don’t make you happy and focus on the things that do. However with my psoriatic arthritis my employer fully covered the cost of Enbrel (which I was on at the time), and if I left for a new job there was no guarantee that any new employer would agree to cover the high cost of my medication. In the US they have this wonderful thing called COBRA which basically legislates that health care coverage can be carried from one employer to another – however naturally this does not apply outside of the US.
Since I had a young family it made the choice of changing jobs even more difficult. If I was single then I could contemplate using a large portion of my salary to pay for a biologic, but with a family to support it just wasn’t an option.
Luckily for me I was offered another job in Thailand which agreed to cover my healthcare costs. I enjoy this job much more, so now hardly ever think about the “what if” question. It still does lurk in the back of my mind though, and I know that the day they finally get a cure for this thing or develop an “affordable” biologic, then I will feel an invisible load be lifted from my shoulders.
If I am ever in the position where my biologic supply is cut, then I do have a couple of backup options. Of course there is always methotrexate – however I don’t hold out much hope with that since I didn’t have any success with it on my previous attempt. One of the options is to experiment with my diet to see if there is some food causing an immune reaction / inflammation. I do have a suspicion about beef. This would be a very affordable method to control my arthritis, however I expect it would seriously damage my bodybuilding effort to keep in shape.
Today there is a article about a study performed recently in Germany, that shows that among psoriasis warriors the key to choosing which treatment to use depends on the lifestyle and goals of the patient, not on the scientific evidence of which treatment methods are more effective. That is, if a particular treatment is known to be effective however the patient feels that it would be inconvenient for them to comply with, then the patient will typically not accept that treatment. Alternatively, if a particular treatment may be effective however it is known that the risk of side effects is high, if that treatment method is very convenient for the patient then they will still choose to take it (even with the high risk of side effects). The study also found that preference for effectiveness was highest among single people – which isn’t surprising considering that they are looking for a partner and are especially conscious of how they ‘look’.
Here is a summary:
Treatment location was deemed most important, followed by the chance of benefit and the method of delivery, whether by pill, cream or injection. Participants also cared more about whether or not the treatment was going to work than the risk of side effects or how long the benefit would last, the study showed. Out-of-pocket costs were not terribly relevant, the researchers found.