Just Say "No"
Kendra Campbell -- I’m currently waist-deep in studying for my upcoming board exam in ten days. Yesterday was “pharm” day, where I devoted the entire day to studying pharmacokinetics, drug indications, contraindications, side effects, etc. I only allowed one day to cover all of pharmacology, and I’m now realizing that was a big mistake. I managed to cover a lot of drugs, but I still have a lot more to study. At one point, I nonchalantly thought to myself that there were just too many drugs to study. But then I really started thinking about all the drugs that are available right now, and how the consumption of drugs has been rising.
A recent study reported that 51% of insured Americans were taking prescription drugs for at least one chronic health condition. The study found that over one in five people were on antihypertensive medications, and almost one in seven were taking cholesterol lowering drugs. For insured American men ages 20-44, cholesterol-lowering drugs were among the top four meds, and their use of these drugs has increased over 80% in seven years. In addition, almost 30% of children under age 19 were taking a medication for a chronic condition, the most popular ones being asthma, ADHD and depression.
What does all this mean? Not surprisingly, Americans young and old are taking more and more drugs. There are, of course, plenty of reasons for this trend, but I’m going to focus on just two of them.
I haven’t had access to television for a while, but the last time I sat down and watched it at a friend’s house I was astonished to see the number of drug advertisements in just a one hour period of time. The use of direct-to-consumer advertising (the promotion of prescription drugs through newspaper, magazine, television, and internet marketing) is currently banned in all developed countries except the U.S. and New Zealand. But some drug companies won’t stop campaigning to have it legalized in Europe and Canada.
If you’ve spent any time in the States, you’re probably all too familiar with the television advertisements for various drugs. The basic plot line is a person whose life is miserable until they discover drug X. Once they start taking the magic pill, their life is transformed and they run through fields of flowers and look more beautiful and happier than ever. The next thing you know, the person watching this commercial is in their doctor’s office, demanding that they, or maybe even their child, get a prescription for drug X. And how can the doctor say no to someone who is convinced that they will be beautiful and happy if they have drug X? Yes, I am taking this example a bit far, but I think you get the point.
The second reason I think that Americans are taking more prescription drugs is directly related to our increasing obesity, as I’ve written about before. It’s simply more work to eat healthy and exercise. Popping a pill is much easier than changing one’s entire lifestyle. While there are other factors (genetics, etc.) that contribute to hypertension and high cholesterol, a poor diet and sedentary lifestyle are certainly important risk factors. Obesity in children is also well documented to be on the rise. And no one seems to be arguing the fact that lack of exercise and poor diets are significantly impacting the health of Americans, both young and old.
There are, of course, many other factors that are contributing to the increase in prescription drug utilization in America and other countries, but I shall save those topics for another entry. The point is that Americans are using more and more prescription drugs, and it’s not just older people anymore. Our children are increasingly becoming the targets of pharmaceutical advertisements, and are being prescribed increasing numbers of medications for chronic conditions. While there are significant positive impacts because of the availability of new drugs, especially for chronic conditions, I don’t think the trend is necessarily a good thing.
In the 1980’s, the U.S. first lady Nancy Reagan coined the phrase “just say no” as a slogan to help decrease the use of recreational drugs, especially by children. Now our children and young adults are actually using more and more prescription drugs for chronic and preventable conditions. If our child seems a little too anxious, we seek out an antidepressant. If they’re a little too restless, we put them on Ritalin. When they start getting fat, we put them on statins.
I want to know when are we going to start taking responsibility for our own health and the health of our children? When will we realize that we can’t always take the easy way out and pop a pill whenever we have a problem? When are we going to start “just saying no?”
I couldn't agree with you more, although let's not throw out the baby with the bath water. This is exactly the comment that I made to my colleagues last week. The Ritalin discussion came up and I recalled the stats for its use in the high school that I taught in (in my former life lol) -- 32% of all the students were using at least minimal dosage of the drug. As a chiropractor I am very much a proponent of changing the behaviors and lifestyles that initiate many of the health problems we see in our offices. Although some patients may be too far down the illness end of the spectrum to be helped without drugs, let's get them off the drugs and into healthy lifestyles with less dangerous drugs and/or nutriceuticals as soon as possible. So 1st let's teach them when they are young, since part of the problem is that children are raised with the "pop a pill" mentality that Kendra spoke of. 2nd we have to get the advertising quelled -- patients have no business demanding diagnosis and/or treatment from their physician and physicians should not feel obligated to oblige -- do the prudent thing (not the easy thing) and begin with the least invasive, least damaging treatment first even if it doesn't involve the "latest, greatest" drug on the market.
Posted by: abrumlow | May 27, 2008 4:39:53 PM
I am a medical student at a CNME accredited and US department of education accreditied Naturopathic Medical School. What you are describing is the philosophy of Naturopathic Medicine. Check us out at www.naturopathic.org.
Posted by: Leslie | May 28, 2008 7:28:37 AM
good luck on your exam tomorrow (30th) :)
Posted by: Irene | May 29, 2008 6:01:50 PM
I was under the impression that New Zealand banned drug advertising after realising the adverse effect on the population (no pun intended). And Canada is not spared by drug adverts. We get american TV, therefore american drug adverts. It makes me sick.
Posted by: | May 31, 2008 11:36:27 PM
I think in my country the problem is worse!!! We can buy prescribed medications without a prescription, believe it or not, even get IV medications, it´s crazy!!! So imagine the impact of pharm advertising in people who just need to step into the drugstore and get whatever they had watched.
I currently work in clinical trials sponsored by pharm co. and I do worry about exclusion criteria for instance, we can´t put patients with liver or kidney failure in a trial for a drug that will be marketed for very ill patients that will very often have liver or kidney failure but that drug showed efficacy in a multi centric and multinational population that didn´t have those comorbidities coz it was an exclusion criteria. Or we are forced to keep ambient medications within a certain range of temperature, eventhough in real life it´s impossible to ask patients to keep the medication under that range.
I can say plenty of this things going on that to me represent real bias to the research.
However patients don´t know this when they see people running in flower fields and smiling.
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