When my grandfather studied pharmacy at Columbia in the 1930s, pharmacists were still called "chemists" and the pharmaceutical industry was in its formative stages. Relatively few brand medications were available and the principal job of the pharmacist was to compound preparations for individual customers. My grandfather was deeply passionate about his profession and, as a result, his nephew, his son-in-law and his grandson followed in his footsteps.

Today, the rich array of high-tech medications, diagnostics and interventional treatments offers a panoply of options to prevent, identify and manage illness. Polls have repeatedly shown that Americans believe they have a right to any form of health care they or their doctor think is necessary. This demand combined with expensive products and services has driven costs up so high that health care now has a nosebleed that won’t stop. In 2009, health care costs in the United States were $2.5 trillion and composed 17.3 percent of the economy.

This year, long-standing, unconscionable barriers to access for many Americans finally drove home a bill for national health care reform. But the most gripping problem is still to be tackled. This country is yet to develop a viable model that provides broad access to quality health care at a reasonable price.

Increasingly, patients complain about hidden, unpredictable and escalating co-pay requirements by insurers for needed medication. Insurance companies drive patients to obtain medications by mail order and retail pharmacies struggle with narrowing margins.

Then there is the "doughnut hole." What’s that? Medicare recipients get a break for the first $2,830 spent per year on medicine. The next $3,610 is called the doughnut hole: The consumer pays all. After that, the federal government helps out again. Under health care reform, those stuck in the doughnut hole get a $250 check. Doesn’t this remind you of BP using mud and golf balls in an attempt to plug their leaking well?

Today, with tools of the information age, consumers are ever searching for the cheapest sources of medication. Many must choose between less-expensive medication, no medication or home foreclosure. Research at Harvard has demonstrated that many people who begin with good health, a good job, good insurance and a home still succumb to medical bankruptcy as the result of serious medical illness. In 2004, almost half of all bankruptcies were health-related.

Enter the counterfeiters. In response to public desperation to obtain needed medicines at the best price, online sales of counterfeit or substandard medication have skyrocketed. According to the Economist this week, Viagra is at the top of the list of counterfeit medications seen by Pfizer, and knockoffs of its products have been found in the legitimate supply chains of 44 countries. Numerous efforts by national governments and watchdog agencies are afoot to catch the culprits and ensure quality, but the bottom line is this: Buyers beware!

Here are a few tips:

» First, ask your doctor whether a generic is a good choice for you.

» Consider starting with the mail-order company recommended by your health insurer.

» Query your pharmaceutical source to see whether it has a program in place such as Oracle’s Pedigree to track and trace medicines from the manufacturer into your hand.

All the while, it pays to consider what we can do with lifestyle changes to eliminate the need for so many medications to manage obesity, high blood pressure, diabetes, heart disease and cancer. Regular physical activity and a healthy diet of local and organic foods is almost always the place to start.

Yet even in the best case, no one escapes grandfather time; sickness, old age and death come to each of us. During our lifetime, few of us will escape the need for some kind of medication. If this article is giving you a headache, think twice before you reach for the aspirin. Instead, consider acupuncture.

Ira Zunin, M.D., MPH, MBA, is medical director of Manakai O Malama Integrative Healthcare Group and Rehabilitation Center and CEO of Global Advisory Services Inc. Please submit your questions to info@manakaiomalama.com