Medicating the US: How Drug Companies Are Turning Us into Patients

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 benign.

In fact, the US has become the most medicated society in the world. We make up 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, we interviewed Alan Cassels, a 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 over medicated? We all just 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 a 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 happened: Marketing campaigns from pharmaceutical firms have transformed the way we think about physical and mental health, convincing us that our problems are best cured by using medication. Alternative views of the illness and treatment get short shrift.

Are these 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.

Example: In the 1990s, only approximately 13 million Americans warranted treatment under the National Institutes of Health's (NIH) cholesterol guidelines. Then, in 2003, a panel of experts rewrote the guidelines and lowered the numbers 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 the 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 a 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 an improved diet, more exercise and not smoking.

Even more insidious is that drug companies don't just market blockbuster pills through advertising-they market conditions for their medications to cure.

Example: Formerly, Paxil was one of many popular antidepressants on the market, but in the past five years, its manufacturer, GlaxoSmithKline, took a rare psychiatric condition known 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 arc 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 do not have high blood pressure are told they have a condition called prehypertension (a. systolic blood pressure of 120 to 139, or a diastolic pressure of 80 to 89) that may warrant drug intervention. There is no evidence that giving medication to people who have this blood pressure reading will result in any alteration in 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 itself 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 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). That are the benefits and dangers? Would lifestyle changes work instead? Also, seek out reputable sources of independent information, including...

Consumer Reports' free Web site, www.crbestbuydrugs.org which provides information to help make cost-effective prescription drug choices.

The Medical Letter, a publication for physicians and other health-care professionals that publishes critical appraisals of new drugs and comparative reviews of older drugs. 800-217-2769, uwu.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 US Food and Drug Administration (FDA) already has tightened its protocols.

Influential medical journals are now 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 and then use those as evidence for drug approval or marketing. Drug companies should be required to register every study in a central database and publish all results so that we can judge for ourselves what to allow into our medicine cabinets