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Medication Nation

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As a physician and psychiatrist, I certainly have nothing against medications. Over the years, I've prescribed them, and have had a great deal of success when they've been used appropriately. But over the last few years, there's been a dramatic change in the way we Americans view medications of all kinds. It's worrisome.

Many of us know that certain bacteria have become resistant to antibiotics and now pose dangerous threats to hospitalized people. Infections with MRSA (Methicillin-resistant Staph aureus) and C. diff (Clostridium difficile) have become major health hazards for hospitalized patients. These infections run rampant through hospital wards, and patients who came for some other problem can develop life-threatening infections. Other strains of bacteria are now difficult to eradicate once they take hold within the human body. They, too, are a considerable risk for anyone hospitalized.

The root of this problem lies in the fact that for decades, physicians have prescribed antibiotics for various ailments not caused by organisms susceptible to antibiotics (such as viruses). This over-prescribing is often caused by doctors yielding to patient pressure to "give me something, doc."

In fact, when a patient actually needs an antibiotic to treat bronchitis, it's difficult to find a medication that will kill what was once a common bacterial infection. The bacteria have become resistant to standard treatment and are morphing into "super bugs." Couple that with the over-use of anti-bacterial hand sanitizers, and we are presented with a new generation of bacteria that cannot be killed.

Pharmaceutical companies are racing to develop new drugs to stave off these invaders.

Another area of concern is the growing use of amphetamine-like substances prescribed to treat an expanding population of kids and adults diagnosed with Attention Deficit Hyperactivity Disorder. Yes, there are people for whom such medication is appropriate and very helpful, but many patients do not have this disorder, but they are labeled as such. They are then prescribed these potent medications, which pose mental and physical dangers of many kinds, including elevation of blood pressure, palpitations, stroke and anxiety. There is an over-diagnosing of this disorder, and some pediatricians and psychiatrists far too quickly reach for their prescription pads. The number of people consuming Central Nervous System stimulants is growing explosively each year. And so are the problems associated with these drugs.

The difficulties aren't limited to antibiotics and amphetamine-like substances. The Center for Disease Control and Prevention reports that in 2010, the number of drugs ordered or provided to patients during office visits was 2.6 billion. (Yes, 2,600,000,000 prescriptions or samples of medication were given to patients!) Seventy-five percent of patients visiting doctors' offices were provided drug therapy. The three most frequently prescribed were potent painkillers, various lipid-lowering medications, and an array of antidepressants.

It's particularly discouraging to see the explosive increase in the prescribing of psychiatric medications by physicians in nearly every specialty. It's as though we've become a nation where the "answer" to every life problem is to swallow a pill. And we may very well be encouraging our doctors to overprescribe everything from antidepressants to amphetamines to mood stabilizers because we dislike the fact that life is complicated, can be messy, and often leaves plenty of loose ends lying around.

This brings us to something that very likely plays a large role in the numbers and types of medications prescribed today. For years now, pharmaceutical companies have been allowed to advertise their vast array of products directly to consumers.

We've all seen television advertisements for a variety of prescription medications. These ads offer treatment for a host of problems. For insomnia, there are sleep medications (Ambien and Lunesta -- the butterfly ad). For depression -- not necessarily clinical depression, but for common human misery, or for unhappiness about what life invariably throws at us -- there are Cymbalta, Pristiq, Effexor and Zoloft (the one where someone is followed around by a dark cloud hovering over her head). For psychosis, there is Abilify.

There are medications for people with rheumatoid arthritis. For atrial fibrillation, there's Pradaxa. For erectile dysfunction there are Viagra and Cialis (showing loving, sexy couples, or a man and woman in separate outdoor bathtubs). For men with decreased testosterone ("Low-T") there's AndroGel. There are medications for people with bladder control problems or enlarged prostates -- think Flomax, where a man runs to the men's room during a sporting event.

There are medications for diabetes, for excess stomach acid (not over-the-counter pills, but a class of medicines known as proton-pump inhibitors such as Nexium).There's Lyrica for aches and pains. There's Neulasta for patients with low white counts while on chemotherapy. There's Requip for those suffering from Restless Legs Syndrome. For asthma, there are Singulair, Symbacort and a host of others -- all depicted in well-produced, visually-provocative or enticing ads.

These ads heighten people's awareness of medical conditions and of medications available for them. But they do far more than that. Patients come into doctors' offices asking for something they've seen on TV. Big pharma's advertising blitz, coupled with its aggressive marketing to physicians (who all too often are readily seduced to prescribe), results in the ever-increasing number of prescriptions offered to patients. Grabbing the prescription pad and writing a script have become the initial treatment for too many conditions. Patients want a quick fix, and doctors are all too ready to comply.

Making lifestyle changes or learning to live through stressful times are becoming things of the past. Instead, we seem to want pills to cure all ills. If only it were that simple to do without negative consequences.

Yes, we're well on our way to becoming a medication nation.

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