I no longer wear my clear plastic retainers when I go to sleep. Actually, it’s been close to 3 years since I last wore them. And it’s been liberating.
I prefer to be more independent than dependent, especially when it comes to my health. And I was dependent on my retainers for over 10 years. The fear of my teeth relapsing back to their crooked and protruded malocclusions that had me seeking braces in the first place kept me wearing the retainers every night. After all, I’ve made the mistake before -- I’ve required orthodontic treatment twice growing up.
About 3 years ago, however, I decided that I no longer wanted to wear them. I wasn’t particularly frustrated with them, and there was no precipitating event. I just couldn't imagine wearing them indefinitely, which for me could be 40-50+ years. I was tired of living in anxiety of what might happen if I stopped wearing them.
Today this makes me think of the patients who are similarly told that they must take medicine for the rest of their lives. Most of the medications I prescribe in primary care are like the retainers: it only works when taken everyday, and the treatment effects fade once discontinued, regardless of whether it’s been taken for 1 or 10 years. The medications typically don’t improve symptoms or quality of life, nor does it work to suppress a life threatening condition like in epilepsy.
It was only after I stopped wearing the retainers I realized how much of a burden it was in my life. I had to clean it, wear it, and take it off in the mornings. This cost was exacerbated when traveling. Retainers were one more thing to pack, and one more thing that could be lost or forgotten. Replacing it was costly, both in terms of time and money. Cleaning them was burdensome, as they inevitably built up calcium and tartar.
While wearing the retainers though, the habits felt like they required no extra energy. But looking back, the seemingly trivial day-to-day maintenance became significant over time. Eventually, I believe that my dependence on the retainers reinforced an identity that I was deficient. Deficient because without the retainers, my health and looks will not be optimal. I couldn’t rely on my body, and instead must rely on the healthcare system to be my best.
In the literature, these types of trades offs are called disutilities. Disutilities typically don’t include the known and unknown harms of a drug. Instead disutilities consider the everyday constraints of taking the drug, much like the costs I described while wearing the retainers.
Taking drugs requires routine monitoring and thus interval visits to the doctor’s office and the pharmacy. This includes coordinating appointments, taking time off work, standing in line, waiting on hold, listening to teleprompters, looking for parking, etc. Further, one can no longer simply go on vacation without first visiting the doctor. He must ensure the prescription will last the trip, and the prescription must be recent enough to pass the scrutiny of the TSA agents. The drug will forever occupy an extra line on the packing and mental checklist. And worst of all, the daily act reinforces an identity of dependence on the health care system to thrive. For fear that without the medication, life cannot sustain itself.
Today, my teeth look fine without having worn retainers for 5 years. Granted, I still have wires glued to the underside of my teeth which I hope to remove one day. The point is though, it wouldn’t have mattered if I had known with certainty that stopping my plastic retainers would lead to relapse. I just didn’t want to wear it anymore. If I were to extrapolate this to medications that claim to extend life like most prescribed in primary care, I personally don’t think the disutility of taking a drug would ever be worth it for me.
Weirdly enough, I still have moments before I go to sleep where I feel like I’m forgetting something. Then I realize that I am no longer as dependent as I once was. The pleasure of knowing that I’m self sufficient in this way will never get old.
This is a new take on a common health and medicine discussion. Thanks - I'll incorporate it into my own patient discussions.