Does America Have a Prescription Drug Problem?

Half of all Americans take prescription medications. Eighty one percent take some type of pill. 100,000 die every year from a prescription med that they either didn't need or that was not properly prescribed. What is going on here?

While it's true that many drugs help people live longer and better lives, it is also true that they can have unintended side effects. Pharmaceutical and supplement manufacturers have to increase sales and profits, as all businesses must, and they do so in part by developing drugs to treat disease and also by convincing people they need meds to prevent disease or lessen the perceived risk of future illness. Marketing leads to efforts to promote the positive aspects of drugs, sometimes at the expense of acknowledging the negatives. Study results are extracted to different groups, e.g. lipid lowering drugs like Lipitor are promoted for women based on studies in men. This relentless drive means that prescription meds are promoted for more and more people. Do all these people really need to be taking prescription medications?

If you followed the US guidelines, half of all men (based on their LDL cholesterol levels) would be on a statin drug like Lipitor. Half of women over age 72 would be on a bisphosphonate drug like Fosamax or Boniva, for prevention of osteoporotic fracture. And half of women over age 50 would be diagnosed with "osteopenia" and advised to "talk to their doctor" (presumably about taking a pill to prevent osteoporosis). And if you followed the USDA guidelines for minimal intake of vitamins and minerals, all of us would be on a multivitamin. More recommendations... Everyone take an aspirin and fish oil supplement to prevent heart disease, all women should take calcium, etc etc.

Have we gone nuts?

A factor that has expanded use of prescription medications happened in 1997, when the FDA lifted the ban on direct to consumer advertising along with the law that required ads to list every possible side effect. Soon after, Americans were bombarded daily with commercials for prescription drugs. The US is the only country in the world where you can turn on the TV and have an announcer tell you to go 'ask your doctor' for a drug.

Doctors often will give medications to patients even if they don't think they need it. For example, one study showed that 54% of the time doctors will prescribe a specific brand and type of medication if patients ask for it. Drug companies also buy information about the medications that doctors prescribe from major chain drug stores like CVS, and then use this information to reward doctors who prescribe their drugs frequently. Research studies show that this can influence behavior, like how often a doctor will try to have a drug from that particular company put on his hospital's formulary.

Expert guidelines promoting the use of prescription medication can also drive prescription behavior, because doctors feel like they need to be following the guidelines to adhere to accepted standards of care.

In 2005 in the aftermath of the Vioxx debacle and withdrawal from the market, Janet Woodcock, Deputy Commissioner of Operations at the FDA, said that the nation's drug safety system had, "pretty much broken down." She charged that neither doctors nor patients had enough information about the side effects of drugs to make informed decisions about taking them. Dr. Woodcock went on to say that, "the bottom line is that a lot of drug safety problems are actually preventable, [because] most adverse events are from known side effects."

I'm not saying that some drugs don't ever successfully prevent disease, or that newly described diseases and syndromes are necessarily invalid. But the fact is that no matter how you look at it, the US (and to a lesser extent other countries) has a prescription drug problem. The US spends two times more on drugs, and takes twice as many drugs, as other countries, and has worse health. In fact, we have some of the worst healthcare outcomes in the industrialized world, including total life expectancy, and survival of children to their 5th birthday. In a survey of 13 industrialized nations, the US was found to be last in many health-related measures, and overall was 2nd to the last. Even England, which has higher rates of smoking and drinking and a fattier diet, has better health than the US.

Did you know that you shouldn't go to the doctor if you are not sick and have no risk factors for disease? Who says that? The American Medical Association! Why? Because there isn't any evidence that screening for disease really improves health outcomes.

Given medical scares like Vioxx it's not surprising that Americans have become wary of the FDA and drug companies, and both of their public images are beginning to suffer. The Economist reported that less than 50% of us perceive drug companies as "favorable." That's only slightly above the low favorable ratings we give oil and tobacco companies.

Many Americans have become disgusted with prescription drugs and the American medical establishment, so they turn to alternative medicine, who frequently promote vitamins, herbs and supplements.

However vitamins and supplements can and do indeed cause harm. And unfortunately the government has contributed to misinformation about vitamins and supplements. The US Department of Agriculture (USDA), whose job it is to promote the interests of agriculture (i.e., makers of meat and milk) and not health, regulate foods and beverages. Vitamins and supplements are classified as foods, not drugs. Lobbyists for the vitamin and supplements industry have blocked efforts by the Department of Health and Human Services (DHHS), the federal agency responsible for health, to get involved.

The USDA's Recommended Daily Allowance (RDA) of vitamins and minerals has been great for the vitamin and supplement industry, as well as cereal makers who supercharge sales by adding vitamins, and minerals to breakfast foods, and then convince customers they need to eat these fortified products to get their minimal daily requirements of vitamins and minerals. This is despite the fact that there is no way to get enough of the recommended vitamins and minerals in normal food without overeating. Government recommendations are actually four times higher than what you really need. The fact is that you don't need extra vitamins, and that if you stick with fresh vegetables and fruit and other whole foods, you will stay healthy. Those making big money on vitamins and supplements are often doing so at the expense of your pocket book, and sometimes your life.

Ironically most recent health gains have come through increased knowledge of health risks and better health practices (or prevention). We smoke less, have better access to nutritious fruits and vegetables year round, pay more attention to cleanliness and hygiene, and have improved safety in general. For instance, in the 19th century it was not known that dirty water and shared cups could spread disease. Hand washing is still the single most powerful way to prevent the spread of communicable disease, but this was not discovered until 1847, when Ignaz Semmelweis, a young Viennese doctor in an obstetrics ward, observed that midwives who washed their hands had lower mortality rates among their patients than doctors, who often went from autopsy room to delivery ward without so much as a hand wipe.

Future advances in health will likely come more from changes in lifestyle, diet and exercise, than from medications. Almost all of the chronic conditions for which pills are prescribed are preventable through such changes. Other conditions like cancer are partially preventable.

It is time for Americans to rethink the role of medications and other pills in their lives in relation to other actions that can be taken to maximize health, such as making changes in diet; incorporating exercise into one's daily routine; learning and using stress reduction techniques; and changing other behaviors like quitting smoking. The most common disorders, like diabetes and heart disease, are always better treated and prevented through changes in diet, exercise, and lifestyle that they are with medication.

Doug Bremner MD is author of 'Before You Take That Pill: Why the Drug Industry May be Bad for Your Health: Risks and Side Effects You Won't Find on the Label of Commonly Prescribed Drugs, Vitamins and Supplements'.

Comments

[dougbremner]

just to clarify some discussion about this article re-posted at alternet.org

http://www.alternet.org/healthwellness/84862/

to be clear about 'screening', I was referring to the annual checkup. Most people (including doctors, me included before I wrote my book) don't know that the annual checkup is not evidence based. You can read for yourself here:
http://www.ncbi.nlm.nih.gov/pubmed/15983282

That said, I am not saying that periodic screenings are not needed or useful.

And I am not saying that medications are never needed. And I do outline screening for cervical cancer, breast cancer, etc in my book.

And I am not anti-doctor. I am a doctor and most of my friends are doctors, and mostly they aren't happy with American healthcare.

As for vitamins, I wrote more about that today on my blog for anyone interested
http://www.beforeyoutakethatpill.com/blog.html

Doug Bremner MD

[Waldmeister]

In 2003 Health Canada (equivalent to the US FDA) attack a group of mentally ill patients and the company who supported them with a multi vitamin product.

Health Canada forced the University of Calgary to stop a clinical trial of this natural therapy funded by the Government of Alberta. When fifty dollars worth of vitamins per month replaces anti psychotics worth $1,200 a month and eliminates bi polar disorder in the process, Big Pharma is worried and so is the regulators who suppress the truth. Why are anti vitamin stories (unsupported by documentation) now appearing simultaneous in the media as if like magic? Where are the garage full of bodies vitamins (and other dietary supplements) that certain medical and nutrition writers - using weasel words like "may" or "might" - and by definition insinuate they exist ?

The company (Truehope) reported that they lost contact with more than 300 of their Canadian participants. The Canadian Mental Health Association told of suicides as a result of government action. Health Canada then charged the not for profit company.

Truehope was found innocent by necessity by the Alberta High Court and instructed by the judge to continue to supply the supplement under legal and moral responsibility.

The agents admitted knowing they were injuring people through their actions. Under oath they stated they care only about policy and directive. In the months and years following, reports of hospitalizations and suicides during the seizures have surfaced. No Health Canada agent has ever been charged.

[Waldmeister]

100 British Columbian aboriginals on the Indian reserve at Alert Bay, BC, were persuaded by a University of BC medical doctor (a professor of family medicine) to go on a high fat (including their traditional Oolichan oil - rich in omega 3 fatty acids), high protein (mostly salmon and other sea food diet with some beef, pork, poultry and eggs included along with vegetables such as cauliflower and broccoli. No potatoes, rice, white flour (bannock), alcohol, sugars, sodas and other refined carbs.

After one year on the diet, between them all, they lost 1,200 pounds and most were off their diabetic medications. Some lost as much as 70 pounds.

http://www.cbc.ca/thelens/bigfatdiet/

[dougbremner]

Agreed. The 'hi fat-low fat' mantra is largely a way to sell more frozen dinner entrees. However there is a correlation between fast food consumption, type 2 diabetes and heart disease. You can see type 2 diabetes spread around the world with the spread of American fast food chains. People who eat fast food three times a week or more have a greater than 90% chance of developing diabetes or heart disease.

[Waldmeister]

HuffPost's Pick

Dr. Bremner is being ingenuous to place vitamins in the same league as prescription drugs when it comes to the drug overdosing of North America . The facts are pharmaceutical use induces significant nutrient losses in the body.

The anti inflammatory Vioxx caused heart attacks because it increased the need for B vitamins, including folic acid. Other non steroidal anti-inflammatory dugs are just as bad. Acetaminophen overdose (Tylenol) can destroy the liver by depleting if of an important amino acid.

All statin drugs interfere with a metabolic pathway that produces cholesterol. It is also the same metabolic pathway that produces an important enzyme that is essential for energy output and muscle function - the suppression of which causes muscle weakness and heart failure. Beta blockers, diuretics, steroids, diabetic drugs, trycyclic anti depressants have the same effect.

Antibiotics are even worse. Not only are the B vitamins lost but also vitamins A, C, E, and K. The minerals that are lost include calcium, magnesium, potassium, iron, zinc. These are absolutely essential for a healthy immune function.It is no wonder infections are rampant in hospitals.

Vitamins are not the problem - the medical profession's excessive application of drugs in their practice together with an appalling lack of nutrition knowledge is the problem. When one hears the flippant canard " you are just making expensive urine" it is time to fire your MD.

[dougbremner]

I don't have problem with taking B vitamins, and I agree that antibiotics can lead to a depletion of vitamins, and I don't have an argument with the effects of other prescription medications on vitamins and minerals. That is why I believe that prescription medications should be avoided when possible (which is not to say always). As the author of a book with that theme, I guess I am also expected to be an advocate for what many people who don't like prescription medications like instead, namely vitamins, herbs and supplements. Again, in the same way I am not against all meds for all people in all situations, I have the same view about 'alternative' therapies. However, we now have data from tens of thousands of patients, showing that antioxidant vitamins A and E do not prevent cancer and heart disease, that in fact they are associated with increased rates of these conditions. I summarize these studies on my blog for lack of space here.
http://www.beforeyoutakethatpill.com/blog.html
Also calcium supplements increase kidney stones and do not prevent hip fracture
http://ezinearticles.com/?Calcium-And-Vitamin-D-For-Bone-Health---Is-It-Really-Useful?&id=1035451

[dougbremner]

don't have problem with taking B vitamins, and I agree that antibiotics can lead to a depletion of vitamins, and I don't have an argument with the effects of other prescription medications on vitamins and minerals. That is why I believe that prescription medications should be avoided when possible (which is not to say always). As the author of a book with that theme, I guess I am also expected to be an advocate for what many people who don't like prescription medications like instead, namely vitamins, herbs and supplements. Again, in the same way I am not against all meds for all people in all situations, I have the same view about 'alternative' therapies. However, we now have data from tens of thousands of patients, showing that antioxidant vitamins A and E do not prevent cancer and heart disease, that in fact they are associated with increased rates of these conditions. I summarize these studies on my blog for lack of space here.

http://www.beforeyoutakethatpill.com/blog.html

Also calcium supplements increase kidney stones and do not prevent hip fracture

http://ezinearticles.com/?Calcium-And-Vitamin-D-For-Bone-Health---Is-It-Really-Useful?&id=1035451

[Waldmeister]

The Meta Analysis Review of Anti Oxidant Safety that Dr. Bremner cites used selective data - only 67 of the 750 studies were actually examined and comprise less than 9 % of the total clinical trials on anti oxidants that are available. To rely only on studies based on heavy smokers, drinkers and bad dietary habits, while ignoring such immune destructive habits, and then use such studies to trash anti oxidants is not science but something else.

How do you define science fiction?

[dgscol]

What about all those foods and drugs we took from 1995 on, which may have had byproducts? Things like lead, possibly pesticides, etc. These things are used in the third world. Its enough to give your children ADD. Then, not knowing what the problem is, we can give them a drug to help them cope.

[dougbremner]

Someone actually did a study about that. This is from my book (http://www.beforeyoutakethatpill.com)

For example English researchers at the University of Southampton studied more than 1800 three-year-old children, some with and some without ADHD and some with and some without allergies. The results were published in the June 2004 Archives of Diseases in Childhood. Removing artificial colors and preservatives from the diet was dramatically effective at reducing hyperactivity - somewhere between the effectiveness of clonidine and Ritalin.
After initial behavioral testing and diagnosis, all of the children were fed a diet of whole, fresh feeds, with no artificial food colorings and or chemical preservatives. Their behavior improved significantly during this week. The next week the researchers continued the whole food diet but also gave the children capsules containing a mixture of artificial colorings, the preservative benzoate, or nothing. The behavior of children who consumed the artificial colors or the chemicals was substantially worse than when they were eating a whole food diet. This behavior was across the board and was seen in the children who had ADHD, allergies, and those with neither of those diagnoses.

[DianeDfromPhoenix]

Does America Have a Prescription Drug Problem? Without a doubt.

[BillCouzens]

Great post.

While the cancer cure is absolutely critical-little is being done in the area of cancer prevention. Cancer treatment in this country has become our leading industry. The profit model for "prevention" is not as great as "treatment" to motivate lawmakers to pursue cancer prevention. Never before have the incidences of cancer been so high and while thankfully the cure for cancer is seen with some regularity, we are seeing too many new cancer incidences reaching all demographics.
The numbers are startling the stories are riveting. Cancer is increasingly become a neighborhood problem where more and more we know many people with cancer"not just a few.

Bill Couzens, Founder Lesscancer.org

[HeevenSteven]

I started taking fish oil, and my HDL went from 60 to 70. Now wus up with dat? Yeah, I know no controls, no double blind, blah, blah. But I'm gonna keep takin' it. So there! I can swim better now too.

Dr Bremmer, I love your posts. Keep 'em coming!

[dougbremner]

I'm not arguing that the American diet doesn't have too many omega-6 and not enough omega-3, or that fish products aren't good for you. I'm just saying that there hasn't been a controlled trial (that I know of) showing that fish oil supplements prevent heart attacks in people without pre existing heart disease.

[ScooterLiddy]

I am amazed by people who are obese with diabetes type 2 that have no idea that diet and exercise have anything to do with their condition.

[zaneblue]

I have to differ with you on one thing. I've written a book on fish oil, and it is in fact necessary for Americans to consume. A hundred years ago it would not have been necessary, as people ate free-range beef and poultry, but with modern farming methods cows and chickens are grain-fed. This alters the chemical composition of their meat (and milk and eggs). Instead of being high in omega-3 fatty acids, they are high in omega-6 fatty acids. This alteration in our basic nutrition causes a host of health problems, including heart disease.

If Americans were able to either live on a diet of wild game, able to eat seafood more than twice a week without worrying about mercury, or able to afford free-range meat, milk and eggs, then yes, fish oil would not be necessary. But until cowboys come back into vogue, Americans will need to take fish oil to get the omega-3 fatty acids their bodies need for good health.