too many drugs

In an amazing study published in last October’s issue of the Annals of Family Medicine (The Changing Face of Chronic Illness Management in Primary Care: A Qualitative Study of Underlying Influences and Unintended Outcomes), a small team of researchers headed by anthropologist, Dr. Linda Hunt of Michigan State University, looked to get to the bottom of America’s prescription drug problem. After having characterized the increase in diagnosing diseases and managing them with drugs as, “dramatic“, they proceeded to hit the average American doctor right between the eyes.  The problem is that too many doctors don’t really see this as a problem —- something that can be changed.

After interviewing numerous doctors and patients as to their thoughts on America’s prescription drug culture, they came to some interesting conclusions.  Here are some of the tidbits from the study —- many are direct quotes.  If they are not directly quoted, they were altered just enough to ensure proper grammar in context of use.  

• Most doctors prescribe two or more drugs when targeting illness.

• Poly-pharmacy is common among patients.

• Over half the patients interviewed were taking five or more daily meds.

• 89% of those interviewed reported taking multiple daily meds.

• 11% of the entire US population and 40% of people older than age 60 take 5 daily meds or more.

• Increased numbers of prescriptions, produce inverse patient benefits.  
• According to the FDA, between 1995 and 2005, side effects to prescription drugs increased 300% (btw, these adverse events are under-reported 90-99% of the time).

• Doctors are challenged by high numbers of drug side effects (adverse events).

• Few clinicians expressed concern about medications causing negative health outcomes or adverse events.

• Two-thirds of the patients reported experiencing symptoms they attributed to their diabetes medications, hypertension medications, or both. This value may be an underestimation of the adverse effects of these drugs.
• 13% of those patients with side effects required hospitalization.

• The cost of practicing medicine in this manner is out of control.

• Many insurance companies assess individual clinicians, often paying substantial bonuses that encourage clinicians to respond to marginal test results with aggressive use of pharmaceuticals.

• Spending on prescription drugs in the United States has risen nearly 6-fold since 1990.

• Pharmaceutical marketing is out of control (nearly $70,000,000 / day in the U.S. with $53 billion directed specifically at physicians).
• These marketing efforts contribute to heavy emphasis on medications (as opposed to diet or lifestyle recommendations).

• Pharmaceutical marketing prompts physicians to prescribe more drugs to more patients, with less and less chance of deriving long-term benefit, while exposing that now-much-larger drug-taking population to increased risk of adverse drug reactions.

• The pharmaceutical industry publishes research findings that promote their drugs.  They also influence the establishment of clinical standards of care. The committees and organizations setting these standards of care often have substantial ties to pharmaceutical industry (HERE).

• The influence of the pharmaceutical industry on the marketing of medications for these chronic illnesses appears very successful. Although quite beneficial for industry profits, the consequences may include worsening health and increased risks from medications for patients.

• Nearly three-quarters of the interviewed doctors reported regular contact with pharmaceutical representatives (drug information, free lunches, free samples, etc). 62% saw over 10 drug reps per week, while asserting to interviewers information provided by drug reps is, “taken with a grain of salt“.  Nearly 80% found the information useful.

• 87% of physicians questioned have regular contact with drug reps.

• Only 7% of the doctors questioned the clinical soundness of using medications to reach the [oftentimes unattainable] goals called for by government guidelines.

• Doctors are rewarded for “production” (diagnosing more disease, prescribing more drugs).

• There needs to be more effort to limit the influence of the pharmaceutical industry on clinical practice.

• More medications are prescribed to control the effects of already-prescribed medications.

• Increasingly lower diagnostic thresholds, produce people who, according to government guidelines, “need” more drugs.  In other words, lowering what is considered “normal” cholesterol would result in millions of additional prescriptions written for statins.

• Clinician classified patients as healthy or sick based on test results in relationship to governmental guidelines, rarely addressing the broader question of patient well-being.

Some of the interviewed doctors quotes are even better.  I’ll hit you with one before I have to sign off.  “I’ve got patients on four different medications and their blood pressure is still uncontrolled.  We try sending them to the cardiologists and they tell us, ‘just keep adding stuff [more drugs] because there’s really nothing we can do about this.  Some people whose blood pressure we get normal; they don’t function very well at all.  I’m not sure why.”  Frankly, I hope you are ticked off.  I also hope that you realize that to Big Pharma, you are a commodity.  Nothing more; nothing less.  If you are sick, they are making money — bigger money than you can fathom.  Healthy; you are worth nothing to them.  Tomorrow I will show the answer to the good doctor’s question of his final sentence.  I will show you how to pull yourself up by your own bootstraps, climb off the MEDICAL MERRY GO ROUND, and get your life back.