Dr. Richard Allen Williams, MD is a cardiologist and founder of the Minority Health Institute based in Encino, California. Dr. Williams edited the book Eliminating Healthcare Disparities in America, published in 2007.

In medicine - one size does not fit all; the patient's health, not the insurance company's financial bottom line, is primary. The best judge of a patient's drug needs is the doctor. Those have long been basic principles in medicine. No longer.

Today, cost-driven drug switching is endangering those basic principles. And it's endangering and our health.

Health insurers are pressuring doctors to take patients off a medicine that works well for them and to switch them to a substitute medicine, often with different active ingredients, not out of concern for the patient's well being, but to save money.

Cost-based drug switching is an ethically dubious and potentially dangerous trend that is fast becoming a common practice across the nation.

In Massachusetts, news reports recently revealed that health insurers are giving doctors incentives, sometimes in cash, to switch patients from a brand-name cholesterol-lowering medication to generic brands. These payments are legal, but they raise ethical questions if patients are not told the reasons behind the switch.

Last year in Michigan, Blue Care Network paid 2,400 doctors $2 million to switch their patients -- at a rate of $100 per patient -- from the name brand cholesterol drug to a generic simvastatin.

And just a few months ago, Blue Shield of California mailed thousands of letters to member doctors and coupons to patients urging them to switch from Lipitor to Zocor. The reason: to lower costs for the insurance company.

What's the harm? The practice is hurting patient safety.

Those who insist that drug switching is safe should pick up a copy of the British Journal of Cardiology study that is sounding the emergency alarm.

In the study, patients who switched from Lipitor to a generic version were more likely to suffer strokes, heart attacks, and death, according to the study. Researchers reported a 30% increase in risk for major cardiac events or deaths from all causes among patients who switched from Lipitor to the generic simvastatin.

Medicines intended to treat the same condition have different active ingredients and work in different ways.

Physicians should always be the ones to consider the many factors when they prescribe medicine for a patient, factors that insurance companies do not consider or even know about when they encourage switching.

But pressure by health care providers to switch to less costly drugs is stubbornly interfering in the physician-patient relationship. Patient safety and health is compromised when insurance companies meddle with treatment decisions made between physicians and patients.

Cost-driven switching affects not just individual patients but the entire health care system. The short-term savings that may result from switching to a less expensive substitute drug will inevitably be offset by higher costs in consultations with physicians, increase in prescriptions, increases in emergency room visits, as well as longer-term health consequences.

Considering that more than 34 million Americans suffer from high cholesterol, and nearly 65 million suffer from high blood pressure, pervasive insurance company-driven switching will have a major impact on the health of Americans. Many minority medical practitioners also strongly believe that the growing substitution of generic drugs represents the rise of second-class form of medicine, especially for racial and ethnic groups, the elderly and others.

Minorities are being subjected to a form of social inequality that places them on the systemic "bottom shelves" which are stocked with cheaper, less effective, or questionably effective medications. The practice is insidious because it comes under the benevolent guise of cost-savings for low-income people.

But, cost-based drug switching carries even more risk to the poor, elderly and minority populations, groups that are already underserved. These patients should not be forced into substandard health care by the system simply because of their financial situation.

Physicians with stethoscopes, working closely with their patients, are the ones who should be making treatment decisions, and not insurance companies with calculators.