The Secret of Great Health Care
Chapter 9: Drugs are More Important than Common Sense
Medications are the number one weapon used by doctors to fight disease. While they are very effective at combating disease there are often other options. Many diseases need to be managed with medications, but often lifestyle interventions - such as weight loss, exercise, smoking cessation and reducing the amount of alcohol consumed - are overlooked as viable treatment options by doctors.
Prescribing a medicine is an easier solution than spending time teaching the patient about lifestyle changes. Diseases such as diabetes, high blood pressure and high cholesterol are examples of diseases that can be treated with lifestyle interventions.
While lifestyle interventions are great treatment options for many diseases, they require work by both patient and physician. Lifestyle changes are difficult to make and many patients are unsuccessful at incorporating them into their lives. It also takes doctors a lot of time to teach these techniques and many feel that their efforts are fruitless. A doctor may argue, "Why should I spend all that time teaching about a lifestyle change that a person will likely not comply with, when I could prescribe a drug that would do the same thing and take up less of my time?"
The overuse of drugs is a problem because drugs are dangerous. Drugs cause people to get sick, especially the older population. Adverse drug reactions occur many times every day. It is estimated that 1.5 million people are admitted to the hospital and 100,000 deaths occur every year because of adverse drug reactions (1).
Drugs are prescribed far too often in today’s health care setting. There are multiple reasons for this.
Patients see multiple specialists. While this helps assure that each condition is being treated appropriately, it often leads to a dilemma that health care professionals call polypharmacy. Polypharmacy is a situation where individuals are on multiple medicines that may be duplicate medications or ones that interact with one another.
Generally speaking, the more specialists a patient sees the more medicines they are going to be on. Many doctors feel the need to do something about any complaints a patient has. At times this is justified, but every complaint does not need a medicine. What the doctor does about the complaint varies but it often involves prescribing a medicine.
Going to the hospital is another way people get more drugs added to their regime. Hospitalization is a time when a patient is sick and certain medications are needed to prevent a condition from worsening or to treat an acute problem. Patients typically come out of the hospital on more medications than when they went in.
An example of this is when a patient is in the hospital they are often placed on something to protect his or her stomach from ulcers. These mediations are often not stopped and are carried on to the discharge papers resulting in another medication to the medicine list. These drugs are often not needed on a long-term basis and could safely be stopped – but are often not stopped.
Drug companies are partly responsible for the over prescribing of medicine. Drug companies spend billions of dollars a year advertising. Marketing directly to physicians and direct to consumer advertising raises awareness of drugs as treatment options for many diseases and conditions.
The drug companies educate physicians. Many continuing education conferences and programs are sponsored by drug companies that do a great job at promoting treatment of a specific disease or symptom with a specific medication. Conferences sponsored by drug companies are very popular because they often provide gifts and food for attendees. There are few continuing education conferences that focus on lifestyle changes to heal the body. Who would sponsor such a conference?
Direct to consumer advertising raises public awareness about the effectiveness of medication. When the consumer understands a drug can treat a certain condition, he or she is likely to ask the doctor for a specific drug to treat a disease. The American public feels that treating a condition that they have with a medication is a simple way to get a cure. If there were more public service announcements about how exercise can control cholesterol, blood pressure and diabetes, would more patients be asking the doctor about these as treatment options for his or her disease? But, who would pay for these public service announcements? New Drugs: They must be better
Drug company representatives do a great job marketing new drugs. I am amazed at how frequently I see physicians put patients on drugs that have just come to the market. These drugs are often prescribed when there is a similar drug that has many years of proven safety and efficacy behind it. It is understandable if a patient has a life threatening illness and the new drug is the only option, but this is typically not the case. Be cautions about the use of new drugs, there are many risks with these new medicines. When a new drug is approved many things are not known about it, such as all side effects and adverse reactions. Question your doctor carefully if he or she prescribes a drug that has been recently approved. Ask why he or she is prescribing the new drug as opposed to an older, better-studied drug. Your doctor may have good reason to prescribe the new drug, it is just important for him or her to consider why it is being prescribed.
An estimated 2.5 billion dollars were spent on direct to consumer advertising for medicines in 2000 (2). Much of the money that is spent is on the newer medicines. Between the years of 1975 and 1999 approximately 10% of the newly approved drugs were pulled off the market or a serious warning was placed on them after they received Food and Drug Administration (FDA) approval (3). FDA approval for a drug does not guarantee that it is safe. Many of the problems with new drugs only surface after FDA approval when a larger number of patients are placed on the drug.
Drugs have revolutionized medicine. Many would argue that they are tremendously overused. While they are often needed in the treatment or prevention of disease, there are at times other options. It is important for patients to understand the medications they are on, their side effects, how they interact with other medications and any other ways that can treat or prevent the disease the medicine is being used for. References
