America: The land of the medicated?

[Guest guest]

America: The land of the medicated?

People in U.S. consuming more medicine than ever before

 

The Associated Press April 18, 2005

 

 

PLYMOUTH, Mass. - Alice and Ken Heckman each begin their morning by cracking

open a rattling plastic tray carting scores of pills in a rainbow of pastel

colors.

 

Between the two of them, they gulp 29 pills every day: a regimen of 14 drugs,

with a chaser of dietary supplements.

 

Here's the curious part: They feel pretty hale for people in their early 70s,

working around the house and volunteering with several community groups. They

each had heart fixes years ago - him a bypass and her a vessel-clearing stent -

but fully recovered. She has well-controlled diabetes. He has worked his way

through heartburn, arthritis, an enlarged prostate and occasional mild

depression.

 

About 130 million Americans - many far healthier than the Heckmans - swallow,

inject, inhale, infuse, spray, and pat on prescribed medication every month, the

U.S. Centers for Disease Control and Prevention indicates. Americans buy much

more medicine per person than any other country.

 

3.5 billion prescriptions per year

 

The number of prescriptions has swelled by two-thirds over the past decade to

3.5 billion yearly, according to IMS Health, a pharmaceutical consulting

company. Americans devour even more nonprescription drugs, polling suggests.

 

Recently, safety questions have beset some depression and anti-inflammatory

drugs, pushing pain relievers Vioxx and - most recently - Bextra from the

market. Rising ranks of doctors, researchers and public health experts are

saying that America is overmedicating itself. It is buying and taking far too

much medicine, too readily and carelessly, for its own health and wealth, they

say.

 

Well over 125,000 Americans die from drug reactions and mistakes each year,

according to Associated Press projections from landmark medical studies of the

1990s. That could make pharmaceuticals the fourth-leading national cause of

death after heart disease, cancer and stroke.

 

The pharmaceutical industry served up more than $250 billion worth of sales last

year, the vast majority in prescriptions, according to industry consultants.

That roughly equaled sales at all the country's gasoline stations put together,

or an $850 pharmaceutical fill-up for every American.

 

Do we need all these drugs?

 

Do we need all these drugs? A relative handful yank many people away from almost

certain death, like some antibiotics and AIDS medicines. Though carrying some

risk, other drugs - such as cholesterol-cutting statins - help a considerable

minority dodge potential calamities like heart attack or stroke.

 

The right balance of risk and benefit is still harder to strike for a raft of

heavily promoted drugs that treat common, persistent, daily life conditions:

like anti-inflammatories, antacids, and pills for allergy, depression, shyness,

premenstrual crankiness, waning sexual powers, impulsiveness in children - you

name it.

 

" We are taking way too many drugs for dubious or exaggerated ailments, " says Dr.

Marcia Angell, former editor of the New England Journal of Medicine and author

of " The Truth About the Drug Companies. "

 

" What the drug companies are doing now is promoting drugs for long-term use to

essentially healthy people. Why? Because it's the biggest market. "

 

In fact, relatively few pharmaceutical newcomers greatly improve the health of

patients over older drugs or advance the march of medicine. Last year, the U.S.

Food and Drug Administration classified about three-quarters of newly approved

drugs as similar to existing ones.

 

Booming pharmaceutical industry

 

Confronted with mounting costs, drug makers churn out and promote uninspired

sequels like Hollywood: drugs with the same ingredients in a different form for

a different disease.

 

Of course, many pharmaceuticals improve American health. " We now have more

medicines and better medicines for more diseases, " says Jeff Trewhitt, a

spokesman for the Pharmaceutical Research and Manufacturers of America.

 

However, the nation also overindulges far too often, the critics say, and

violates the classic proscription of the ancient Greek physician Hippocrates:

" First, do no harm. "

 

Drug safety researcher Dr. James Kaye, of Boston University, remembers a medical

school teacher telling the class: " All drugs are poisonous! "

 

The Heckmans found out on their own. Heckman lost his alertness for several

months to a depression medication. His wife has come down with a rash from one

heart medicine and muscle aches from a statin. But each time they switched

medicines and escaped any lingering harm.

 

Adverse drug reactions

 

Hospital patients suffer seven hard-to-foresee adverse drug reactions and

another three outright drug mistakes for every 100 admissions, estimates Dr.

David Bates, a researcher at Boston's Brigham and Women's Hospital. That

translates into 3.6 million drug misadventures a year.

 

The dangers potentially escalate when doctors prescribe drugs, as they often do,

for uses not formally approved by the FDA. In a recent report, the Centers for

Disease Control voiced concern about huge off-label growth of antidepressants.

They have expanded to treat often loosely defined syndromes of compulsion, panic

or anxiety and PMS.

 

Drug makers, doctors and patients have all been quick to medicate some

conditions once accepted simply as part of the human condition.

 

Many Americans also assume, often with a nod from sellers or doctors, that new

drugs inevitably work better than old ones. " Newer isn't always better, and more

isn't always better, " warns Dr. Donald Berwick, an adviser to the U.S. Agency

for Healthcare Research and Quality.

 

The Heckmans buy both new and old - nearly $9,000 worth of prescriptions a year,

plus hundreds of dollars in cheaper over-the-counter medicines. Even with

supplemental insurance, their monthly out-of-pocket share of prescriptions alone

roughly equals their food bills.

 

Around the country, prescription drug sales have pushed relentlessly upward by

an annual average of 11 percent over the past five years.

 

The aging population is partly at fault, with its attendant ailments like

cancer, heart attacks, stroke and Alzheimer's disease. Other conditions have

mysteriously proliferated, including asthma, diabetes and obesity.

 

Exercise and better diet ward off heart disease and diabetes just as effectively

as drugs do, studies show. However, says Fred Eckel, who teaches pharmacy

practice at the University of North Carolina, " There tends to be a reliance on

drugs as the first option. "

 

Drug advertising to consumers has also boomed since the late 1990s, thanks

largely to relaxed government restrictions on television spots.

 

For its part, the FDA generally demands only that new drugs work - not that they

work better than existing ones. Dr. Janet Woodcock, an FDA deputy commissioner,

says off-label prescribing and allowing similar drugs for the same condition

present more options - and " choice is important. "

 

Many safety experts say more new drugs should be tested against marketed ones,

with more safety data required and stronger control of consumer ads and

off-label promotion.

 

For now, though, most Americans seem to feel like Heckman: " grateful that

there's a pill to take for something. "

 

© 2005 The Associated Press. All rights reserved. This material may not be

published, broadcast, rewritten or redistributed.

© 2005 MSNBC.com

 

URL: http://www.msnbc.msn.com/id/7503122/