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'.