Millions of Americans have resorted to smuggling to obtain prescription drugs, CNN TV says in a three-day series titled “Over-Medicated Nation” that began November 29. The series also discusses how prescription drug ads have changed the doctor-patient relationship, and a proposal to have a board outside the U.S. Food and Drug Administration oversee the safety of drugs already on the market.

What Is The Doctor’s Reaction?
Where there is an “ill,” there is a way. Americans are optimistic people, particularly when it comes to health and physical symptoms.

Most of the patients I see have faith that I can quickly solve their problems. The medical center where I practice is jokingly called “Pill Hill.” But as a doctor and an American, I wonder, are we truly finding better living through chemistry?

Currently the U.S. Food and Drug Administration is in an unflattering spotlight - critics are questioning the adequacy of its drug safety monitoring. Financial incentives for drug companies are being blamed for the delay in withdrawal of several potentially harmful medications from the market. Additionally, this week Cable News Network (CNN) is broadcasting a three-day series entitled, “Over-Medicated Nation.” This series discusses the large amount of advertising that is directed by drug companies to the consumer and questions the benefit and wisdom of this advertising trend.

If you are a woman over 65, you are probably taking more than five medicines on a regular basis - most women your age are. In fact, 12 percent of women of this age take more than 10 medicines regularly. (Overall, if you average all adults, 25 percent of us are taking more than five medicines).

There are several reasons that Americans take more pills today than ever before. More drugs are available, and most of them serve a useful purpose. This makes my job as a doctor satisfying, but it is not the only reason that Americans take so many medicines. A worrisome reason, I think, is the culture in which we live.

We have become much less tolerant of suffering. The doctor in me can see this as a good thing - stamping out suffering is the premise of my profession! But intolerance to suffering is not all good, because suffering can build character and bind communities.

Advertising contributes to a sense that suffering is not normal or necessary. And advertising works. Do we suffer from more depression or more pain now, than we did a decade ago? Personally, I doubt it. I think advertising is the force behind the fact that there were 157 million prescriptions for anti-depressant medications written in the United States (also dubbed the “Prozac Nation”) in 2002, when only 11 million prescriptions seemed to be enough just 10 years earlier. I think advertising has a lot to do with the fact that in my home state of Oregon, prescriptions for most narcotic pain medicines more than doubled between 1997 and 2001 - for heavily marketed oxycodone, available by the brand-name of OxyContin, prescriptions were up by 550 percent.

What about medicines that prevent illness? Currently, if a medication offers any measurable benefit, the consensus of doctors and patients seems to be, “You’ve got to have it.” Given the expense of pharmaceuticals, this is not a practical way for us to proceed without limits. When I advise my patients, I already have significant ambivalence about several prevention medications and their worth for groups that are not at high risk. Let me give a couple of examples:

 
• Medicines such as Fosamax that can prevent osteoporosis are expensive, and they are sometimes prescribed to treat a risk factor (thin bones, or “osteopenia”) for a risk (thinner bones, “osteoporosis”), which is a risk of fracture, which is itself a risk factor for a real threat, the loss of being able to live independently at home. Although there are guidelines that recommend them, I do not feel it is necessary for women with only modest bone loss to take these drugs. The likelihood of benefiting in the end is low.  
• Cholesterol-lowering drugs are expensive, and they reduce the risk for heart disease and death. Recent recommendations would advise that a much larger number of Americans than are currently treated with them should take these medicines for lifetime. We need to consider the number of people that is needed to receive treatment in order for a single person to benefit from treatment, before we pass judgment. For the most high risk patients (people who already have known heart disease), treatment of 100 people with these medicines every day for 6 years would be expected to save four lives. For the people at least risk, I am not yet confident that the drug cost is warranted.

These days, Americans who are watching the news may be thinking they are swallowing a few too many bitter pills. Personally and as a doctor, I would agree.

What Changes Can I Make Now?

These results remind us to do two important things:
It is time to look “clinically” at our medicine cabinet, and thin our prescriptions down to those that are sensible and necessary. If you take multiple medicines, it is also very important to review them with your doctor or pharmacist to make sure the combination can’t result in any dangerous drug interactions.

Some medications need to be continued permanently for your safety. Blood pressure treatment and thyroid medicine are good examples.

Other medications may not be necessary for you to continue without a stopping point. Anti-inflammatory medicines, antacid medicines, anti-depressant medicines, and allergy medicines are good examples of medicines you may want to consider discontinuing if your doctor agrees. Never discontinue a prescribed medicine without the advice of your doctor! Some medicines are unsafe to discontinue during medical illness, and some medicines are unsafe to discontinue abruptly.

What Can I Expect Looking To The Future?

Direct-to-consumer marketing is the advertisement of drugs to the general public. The American public is a society whose individuals enjoy exercising control over their health decisions, and this form of advertising has been embraced enthusiastically. Direct-to-consumer marketing will probably not go away, so American consumers need to recognize that strong biases are presented. For better or for worse, drug ads increasingly are dictating the topics of conversation that we have in the doctor’s office.