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The
Medicating Of America
How
drug companies are turning us all into patients.
From
Bottom Line Personal, December 15, 2005.
“How many
pills did you and your family take today?
It seems that there is a prescription drug for every
condition now, no matter how benighn. In fact, the US has become the most medicated society in the
world. We constitute
5% of the world’s population, but we buy 50% of all prescription
medicine. Conflicts
of interest abound—from your doctor, who may be on the payroll
of a pharmaceutical firm, to your favorite celebrity, who may get
a kickback for hawking powerful meds.”
“To help you
make the best health-care choices, Bottom Line Personal interviewed
Alan Cassels, an esteemed pharmaceutical policy researcher.
He believes that we need to protect ourselves from a
culture that insists on “medicalizing” every problem in our
lives…”
“Why has
our society become overmedicated?”
“We all want
a quick fix, even if we aren’t sick but just feel vulnerable or
at risk. The trouble
is that vast commercial forces are exploiting this desire.
Much of the health information that we get is distorted so
that drugs are the first choice we consider for, say, depression,
high cholesterol or high blood pressure—even if there are safer
effective alternatives, such as exercise or a healthy diet.”
“Drug ads use
statistical gimmicks to exaggerate benefits.
I saw an ad that claimed a certain pill would lower your
risk of heart attack by 33%.
Technically, that’s correct, but the actual clinical
study indicated a drop in risk from 3% to 2%.
In absolute terms, that’s only a one-percentage-point
reduction.”
“What’s
an example of a drug that is prescribed too often?”
“Look at the
multibillion-dollar sales of antidepressants in the past few
years. If you walk
into a doctor’s office complaining of mild to moderate
depression, you often are given a prescription for a selective
serotonin reuptake inhibitor (SSRI), such as Paxil, Prozac or
Zoloft—drugs that may have significant side effects—despite
evidence that behavioral and talk therapy can be equally
effective.”
“What has
happened is that marketing campaigns from pharmaceutical firms
have transformed the way we think about physical and mental
health, convincing us that our problems are best cured with
medication. Alternative
views of the illness and treatment get short shrift.”
“Are the
drug companies really the problem?”
“Drug
companies make wonderful products that extend lives and ameliorate
suffering. However,
they are aggressively targeting the healthy as well as the sick in
pursuit of profits. One
of their strategies is to broaden the boundaries of what
constitutes an illness.”
“For
instance, back in the 1990s, only about 13 million Americans
warranted treatment under the US National Institutes of Health’s
cholesterol guidelines. Then,
in 2003, a panel of experts rewrote the guidelines and lowered
them so much that now 36 million more people have “high”
cholesterol. Many of
the doctors on that panel had served as paid speakers, consultants
or researchers for large pharmaceutical companies that manufacture
cholesterol-lowering drugs known as statins.”
“It’s not
surprising that high cholesterol has become an obsessive concern
for everyone. We all
know our “numbers,” but high cholesterol isn’t an illness.
It’s just one of many risk factors for future illness,
heart disease. While
there’s extensive evidence that statins are valuable for people
who have had heart attacks, there often are much cheaper, safer
and equally effective treatments for the rest of us, including
better diet, more exercise and not smoking.”
“Even more
insidious is the fact that drug companiesdon’t just market
blockbuster pills through advertising—they market conditions for
their medications to cure. For
example, Paxil used to be one of many popular antidepressants on
the market, but in the past five years, its manufacturer,
GlaxoSmithKline, took a rare psychiatric condition knoen as
“social anxiety disorder” and helped transform it into an
often-diagnosed condition for which Paxil is the cure.”
“Who is
the primary target for this kind of advertising?”
“Every
segment of the population is targeted.
Women are told that they should take medication for
“illnesses” such as menopause and premenstrual syndrome, which
actually are natural cyclical changes.
Children who simply can’t sit still or who drift off in
class are diagnosed with attention deficit hyperactivity disorder
(ADHD) and given Ritalin. Older
people who don’t have high blood pressure are told they have a
condition called “prehypertension” (a systolic blood pressure
of 80 to 139, or a diastolic pressure of 80 to 89) that may
warrant drug intervention. There
is no evidence that giving medication to people with this level of
blood pressure will result in any alternation of the length or
quality of life. “Prehypertension”
is a verbal tactic designed to cast the net wider, creating more
patients and selling more pills.
Maybe we should rename life itsel and call it “predeath.”
Then we would all need to be taking drugs of some kind.”
“Aren’t
these drugs helpful and warranted in many cases?”
“Of course.
I’m not saying that you should ignore symptoms or that
every diagnosis is being blown out of proportion.
There may be many times in your life when you need drug
intervention, but we have become too comfortable popping pills.
We assume that as long as it’s advertised on TV or
recommended by our doctors, it must be safe.”
“Isn’t my
doctor supposed to be the gatekeeper for all this information?
Can’t he/she see through these marketing tactics?”
“Doctors may
be very responsible and hard to manipulate, but they still are
under enormous pressure to prescribe drugs.
Patients come into their offices asking for the drugs that
they see advertised on TV. Pharmaceutical
representatives bombard doctors with sales pitches—the typical
doctor averages at least one visit from a rep every day.”
“What
should I be doing to protect myself as a patient?”
“Be
skeptical. Ask your
doctor if a drug has been tested on people like yourself (your
age, sex and physical condition).
What are the benefits and dangers?
Would lifestyle changes work instead?
Also, seek out reputable sources of independent
information, including…”
“Consumer
Reports” new
free Web site, www.crbestbuydrugs.org,
which provides information for making cost effective prescription
drug choices.”
“The
Medical Letter, a publication for physicians and other
health health-care professionals that publishes critical
appraisals of new drugs and comparative reviews of older drugs.
26 issues. $89/yr.
800-211-2769, www.medicalletter.org.”
“Public
Citizen, a nonprofit advocacy organization that has
information on hundreds of drugs in its book, Worst Pills Best
Pills, and on its free Web site, www.worstpills.org.”
“Is
overmedicating the wave of the future?”
“Not
necessarily. The
thousands of lawsuits pending against pharmaceutical giant Merck
over the side effects of its painkiller Vioxx may have a profound
effect on our public and private regulatory systems.
The Food and Drug Administration already has tightened its
protocols.”
“Influential
medical journals now are calling for an international clinical
trial medical registry. This
is crucial. Right
now, a pharmaceutical company can conduct a dozen trials for a new
drug…only publish the positive-result trials…then use those as
evidence for drug approval or marketing.
Drug companies should have to register every study in a
central database and publish results so that we can judge for
ourselves what to allow into our medicine cabinets.”
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