By Doug Bremner
While it’s true that many drugs help people live longer and better lives, myriad others may hurt you in other ways that you don’t know about. 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. The result is that nondisclosure of potentially harmful side effects of the drugs they make has become routine.
In 1992, the Prescription Drug User Fee Act (PDUFA) stipulated that a fee (now $576,000) be paid to the FDA by the pharmaceutical companies for each new drug application. The number of staff at the Center for Drug Evaluation and Research (CDER) doubled overnight. Today, the FDA receives about $260 million a year from these fees. Part of the bill stipulated that funding by Congress for new drug evaluations had to increase by 3% per year. Since the overall funding for the FDA did not increase at 3% per year, the FDA had to actually cut funding for surveillance and research of approved drugs. This has been a boon for drug makers, approval time of their products decreased from 20 months to six months right after the law changed. However, the number of drugs that had to be later withdrawn also increased from 2% of drugs to 5% of drugs.
There is another troubling dichotomy that could have terrible repercussions for our health: while the number of people with disease is not growing, the number of adult Americans taking medication is increasing - half of us take prescription drugs and 81% of us take at least one kind of pill everyday - and that percentage is expected to rise in the coming years. To gain the most market share, companies have to invent drugs for diseases that previously had no treatment (or treat problems that may not necessarily require drug treatment, or create prevention medications for alleged risks (like the risk of fracture in the elderly) by expanding the potential pool of medication takers. That meant moving from the realm of giving medications to sick people, to giving medications to people who looked well, but might be at an increased risk based on the result of a blood test or some other hidden marker of disease. Thus the era of disease prevention and risk factor modification was born.
To promote this shift, for the past two decades the pharmaceutical industry has pushed educational programs, which they claim are designed to identify people in need of treatment or prevention with medication. This is usually done by donating money to organizations who advocate on behalf of a specific disease who will in turn “get the word out,” increasing public awareness and screening, and expanding the number of individuals who will potentially take the medication. There are a number of conditions for which we are now urged to obtain screening and potential treatment, including high cholesterol, osteoporosis, hypertension, diabetes, and undetected heart disease. However, the potential benefit of medications to treat these conditions is often exaggerated, side effects are minimized, and in some cases recommendations are applied to people based on evidence from different groups of people (e.g. women with risk factors for heart disease are urged to take cholesterol lowering medications based on studies in men).
Another 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.
With so many of us popping pills or gulping down spoonfuls of medicine, it’s not surprising that more of us report related adverse effects. One hundred thousand Americans die every year from the effects of prescription medications. Over a million Americans a year are admitted to the hospital because they have had a bad reaction to a medication. About a quarter of the prescriptions that doctors write for the elderly have a potentially life threatening error. Many of these people are getting medications that they don’t need, or for problems that can be appropriately and safely addressed without drugs. For example, most cases of adult onset diabetes can be prevented and possibly cured with a change in diet alone - and with considerably fewer negative side effects and numerous healthy ones, like weight loss, and lower blood pressure and cholesterol. Drug companies 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, with trips to resorts and other perks.
Drug companies also lavish dinners, gifts, and paid trips to conferences on doctors. Research studies show that, although doctors deny that the perks have any effect on their prescribing practices, there are changes in objective measures, like how often a doctor will try to have a drug from that particular company put on his hospital’s formulary.
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. That means we are paying money for drugs that are not working for us.
Despite the fact that Americans spend twice as much on health care as any other country in the world, 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. Countries with the best health care included Japan, Sweden, and Canada, in that order. Factors that were thought to explain worse healthcare outcomes in the US included the lack of a developed and effective primary care system and higher rates of poverty. Even England, which has higher rates of smoking and drinking and a fattier diet, has better health than the US.
Because the drug companies are only required to show that the drugs are better than nothing we usually never know whether they are better than older drugs the new versions seek to replace. It is usually left to the marketing people to generate enthusiasm, through TV ads, product representative visits to doctor’s offices, and sponsored lectures, that the new drugs are safer or better than the old drug. They do this by picking some aspect of the drug’s properties that theoretically makes it better. But as we have seen with Vioxx and other drugs, they aren’t always better, and sometimes they carry hidden risks.
The head of the American Psychiatric Association recently bemoaned the fact that psychiatrists had gone from the “bio-psycho-social” model to the “bio-bio-bio” model. Us doctors have become mesmerized with the idea that all depressions are caused by imbalances of serotonin that can be fixed only with a drug that acts on serotonin. However most cases of depression are caused by life traumas, spiritual upheavals, and other jolts along the road of life. That isn’t to say that these changes aren’t accompanied by changes in brain chemistry: it is both. But I think it is time that we acknowledge the role of emotion and spirituality in mental disorders. It only makes sense.
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 November 24, 2004 (”Lessons For Pharma From Tobacco”) 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.
All this is not to say that many medications have not changed life for the better, particularly those that treat infections. However, 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. Pharmaceuticals can be life saving for some conditions, such as insulin for Type I diabetes, thyroid hormone for hypothyroidism, or antibiotics for life threatening infections. All of this has been shown through several scientific studies. Before you take a pill, consider taking charge of your health by making informed decisions and smart changes in your lifestyle. In some cases, however, you may need medications for prevention or treatment of disease, or to help you with troubling symptoms or disabilities. In those cases you should know as much as you can about the risks and benefits, so that when it is time to talk to your doctor you can make an informed decision that both of you are happy with.
Author Resource:- Learn more about alternatives to medications and hidden risks of prescription medications in http://www.beforeyoutakethatpill.com by researcher and physician J. Douglas Bremner, MD. Reprinted with permission from http://www.articlehealthandfitness.com/