If prescription drugs are so good, where are all the healthy drug takers?

Is America Becoming a Drug-Dependent Nation?

From the September 28, 2003 New York Daily News comes an article that suggests that America is becoming a drug-dependent nation.  The title of the article is, "We need a war vs. legal drugs", and starts off by noting that from 1998 to 2002, sales of anti-depressant medications increased 73% to more than $12 billion, while analeptics, drugs like Ritalin and Adderall that stimulate the central nervous system, increased 167%.  These figures were according to IMS Health, a pharmaceutical information and consulting company.

The article goes on to say, "The dramatic increase in the sale of these pharmaceuticals suggest that Americans are well on the way to becoming not only depressed, anxiety-ridden and incapable of the meaningful focus necessary to understand the world in which we live, but also on our way to becoming a drug-dependent nation." 

The article takes special exception to the increase in diagnosis and medications of children.  Dr. Arthur Caplan, chairman of the medical ethics department at the University of Pennsylvania School of Medicine, commented, "Any time a child reads a little more slowly, we're talking learning disability and administering Ritalin, or any time a kid acts up a bit, instead of giving him detention, we're drugging him.  These are definitely problems, in that it's expensive, it may not address the cause of the problem and I've never met a drug yet, including aspirin, that didn't have some side effects."

According to Dr. Caplan, the driving force behind the surge in medications is aggressive direct-to-consumer advertising.  Since the relaxation of a 30 year drug marketing agreement in 1997, pharmaceutical companies have tripled their annual advertising to consumers. The result has been a 37% increase in sales of prescription stimulants for children.  According to the American Psychiatric Association, primary care physicians now write upward of 60% of anti-depressant prescriptions. Says Caplan, "I think [doctors are] just overwhelmed now with too much marketing, and it drives them toward too much prescribing."

The article closes by noting that American consumers, mostly children, account for more than 90% of global consumption of stimulants. Dr. Caplan sums it up nicely when he says, "If we have four or five times the learning disability or depression or other neurotic illnesses that the Europeans do, then either we got a really bad gene pool through immigration or we're taking to many drugs".

By Christopher Kent, D.C., J.D.

Recreational drugs, including cocaine and heroin, are responsible for an estimated 10,000-20,000 American deaths per year. While this represents a serious public health problem, it is a "smokescreen" for America's real drug problem. America's "war on drugs" is directed at the wrong enemy. It is obvious that interdiction, stiff mandatory sentences, and more vigorous enforcement of drug laws have failed.

The reason is simple. Cause and effect have been reversed.

The desire to solve problems by taking drugs is a product of our culture. When a child is taught by loving parents that the appropriate response to pain or discomfort is taking a pill, it is obvious that such a child, when faced with the challenges of adolescence, will seek comfort by taking drugs.

Drugs are Dangerous Whether Pushed or Prescribed

While approximately 10,000 per year die from the effects of illegal drugs, an article in the Journal of the American Medical Association reported that an estimated 106,000 hospitalized patients die each year from drugs which, by medical standards, are properly prescribed and properly administered. More than two million suffer serious side effects.

An article in Newsweek put this into perspective. Adverse drug reactions, from "properly" prescribed drugs, are the fourth leading cause of death in the United States. According to this article, only heart disease, cancer, and stroke kill more Americans than drugs prescribed by medical doctors. Reactions to prescription drugs kill more than twice as many Americans as HIV/AIDS or suicide.

 Fewer die from accidents or diabetes than adverse drug reactions. It is important to point out the limitations of this study. It did not include outpatients, cases of malpractice, or instances where the drugs were not taken as directed.

According to another AMA publication, drug related "problems" kill as many as 198,815 people, put 8.8 million in hospitals, and account for up to 28% of hospital admissions.  If these figures are accurate, only cancer and heart disease kill more patients than drugs. Has the situation improved since the publication of this information? Hardly. Null has published the most comprehensive and well-documented study I have seen of deaths associated with medical practice. In this report, their research revealed some shocking facts. The findings are summarized in the abstract:

"A definitive review and close reading of medical peer-review journals, and government health statistics shows that American medicine frequently causes more harm than good. The number of people having in-hospital, adverse drug reactions to prescribed medicine is 2.2 million. Dr. Richard Besser, of the CDC, in 1995, said the number of unnecessary antibiotics prescribed annually for viral infections was 20 million. Dr. Besser, in 2003, now refers to tens of millions of unnecessary antibiotics.

The number of unnecessary medical and surgical procedures performed annually is 7.5 million. The number of people exposed to unnecessary hospitalization annually is 8.9 million. The total number of iatrogenic deaths shown in the following table is 783,936. It is evident that the American medical system is the leading cause of death and injury in the United States. The 2001 heart disease annual death rate is 699,697; the annual cancer death rate, 553,251."

Drugs Number One Killer

The authors conclude: "When the number one killer in a society is the healthcare system, then, that system has no excuse except to address its own urgent shortcomings. It's a failed system in need of immediate attention. What we have outlined in this paper are insupportable aspects of our contemporary medical system that need to be changed -- beginning at its very foundations."

A recent article in Archives of Internal Medicine stated that in the seven year period from 1998 through 2005, reported serious adverse drug events increased 2.6 fold, and fatal adverse drug events increased 2.7 fold. The authors noted that reported serious events increased 4 times faster than the total number of outpatient prescriptions during the period. Another study concluded that the majority 86% of the adverse drug reactions for which patients were admitted to a medical intensive care unit were preventable.

One proposed solution to the illegal drug problem was encouraging potential users to ignore peer pressure and "just say no." Interestingly, this strategy is not being recommended for prescription drugs. Bruce Pomeranz, MD , one of the authors of the JAMA paper, said he is not warning people to stay away from drugs. "That would be a terrible message," he said. Lucian Leape, MD, of the Harvard School of Public Health said, "When you realize how many drugs we use, maybe those numbers aren't so bad after all."

Does that mean that the number of deaths due to illegal drugs, suicide, HIV/AIDS, diabetes, accidents, and drunk driving "aren't so bad" either? Does it mean that we shouldn't discourage drunk driving or unsafe sex?

The folly of such double standards should be obvious to all. It is time to address the real drug problem -- the cultural notion that the first solution to seek for relief of life's problems is a drug. That's the drug culture we need to address.

References

1. "Drug deaths." Globe & Mail (Canada). February 27, 1998.

2. Morbidity and Mortality Weekly Report. CDC. 2007;56(05):93-96.

3. Lazarou J, Pomeranz BH, Corey PN: "Incidence of adverse drug reactions in hospitalized patients." JAMA 1998;279:1200.

4. Kalb C: "When drugs do harm." Newsweek. April 27, 1998. Page 61.

5. "Reaction." American Medical News. January 15, 1996. Page 11.

6. 1. Null G, Dean C, Feldman, M, Rasio, D, Smith D: "Death by Medicine." Life Extension. March, 2004. www.lef.org/magazine/mag2004/mar2004_awsi_death_01.htm

7. Moore TJ, Cohen MR, Furberg CD: Serious adverse drug events reported to the Food and Drug Administration, 1998-2005. Archives of Internal Medicine 2007;167:1752-1759.

8. Rivkin A: Admissions to a medical intensive care unit related to adverse drug reactions. American Journal of Health-System Pharmacy 2007;64(17):1840-1843.