America: The land of the medicated?

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.”

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