Drug ads are everywhere.  If you have a TV, computer, or smartphone, you are constantly inundated with them.  I can’t even get through an hour of watching football with my kids without seeing a Viagra commercial.  Big pharma is spending BILLIONS to get the names of their products in front of your eyeballs, hoping you will run out and beg your doctor to prescribe them.

Meanwhile, the pharmaceutical industry has always been pushing to influence the way doctors prescribe drugs.  But is it working?Absolutely.  According to a recent study published in the Annals of Family Medicine, it would appear the tactic is an overwhelming success for the pharmaceutical industry, potentially at the expense of the American people.The study “Prescribing Trends: Not a Pretty Picture” was done by a pair of anthropologists at Michigan State University.  They studied 58 primary care physicians in 44 facilities in Michigan, focusing on the interactions between clinicians and their patients.  In the midst of the study, they noticed how drug interventions dominated patient care and focused on that aspect.  They found that “clinical consultation we observed focused heavily on choosing and adjusting medications, to the near exclusion of other considerations, such as diet and lifestyle.”Do you know which interventions bring in almost no money for the pharmaceutical industry?  Diet and lifestyle.  Funny that those are the two factors that are largely ignored by our doctors.
Unfortunately, the the impact of this drug-heavy approach to healthcare is staggering.They noted that “Spending on prescription drugs in the United States has risen nearly 6-fold since 1990, reflecting substantial increases in the treatment of chronic conditions and subsequent polypharmacy.  As many as 45% of Americans have at least 1 diagnosed chronic condition, and 60% of the most prescribed medications were for hypertension, high cholesterol levels and diabetes.  The CDC estimates that 11% of the US population and 40% of people older than age 60 take 5 medications or more.” Cha-ching.

So, is the pharmaceutical industry just meeting the needs of a sick society or are they pulling the strings to make sure their product is being pushed?  That’s a good debate.  But according to the study, there are many factors of the medical-pharmaceutical complex that keep this trend going, which keeps stock prices (and bonuses) up, up, up!

Lower Diagnostic Thresholds

Years ago, the medical establishment lowered the numbers for an “acceptable” blood pressure reading.  Thus, seemingly overnight, millions of previously healthy people became “hypertensive.”  So, in essence, lowering thresholds means that people are diagnosed with an “illness” they didn’t previously have.

Of course, it takes wayyyyy too long to look at what a person is eating, drinking, and doing, so a new diagnosis for hypertension or diabetes most often leads to a new prescription, that will likely need to be taken for life.  The MSU study found that an estimated 10 million additional people are being treated for diabetes, and an additional 22 million for hypertension, due to lower diagnostic thresholds.

But what about side effects?  The interesting thing is that side effects don’t keep people from taking drugs.  They actually promote MORE drug use.  This is referred to as the “prescribing cascade.”  When someone suffers from side effects from a drug they are currently taking, they are often given another medication to combat the symptoms.  This new prescription may have new side effects of its own, which often begets another pill.  On and on it goes.  BEST. MARKETING. PLAN. EVER.

Clinician Incentives

Prescription medications are considered an “invasive” procedure.  Thus, they should only be taken under strict scrutiny. One has to consider side effects and potential interactions with other substances.  So, the decision for a doctor to write a prescription should be made solely based on the needs of the patient, using the best possible research from an unbiased party.  You wouldn’t want any outside influences at play in this critical decision making process, right?

But what if doctors are constantly hounded by pharmaceutical reps?  What if pharmaceutical reps come by and bring lunch every week, pushing new drugs?  What if those pharmaceutical reps only provided biased research that puts a positive spin on the effects of the drug, while hiding any contrary research?  Better yet, what if your doctor gets a “bonus” for writing a certain amount of prescriptions?  That might muddy the waters, right?  Do you want your doctor prescribing drugs that are based on shaky research while a potential bonus for prescribing said drug is in the back of your doctor’s mind?  And now does anybody wonder why so many people are on medications?

Take Home Message

I am not saying that you should flush all your medications down the toilet (which is a bad means of disposal, anyway) and ignore what your doctor says.  However, you need to educate yourself on the pros and cons of any medication.  You also have a responsibility to make yourself as healthy as possible in order to take as few prescription drugs as possible .  If the MSU study showed anything, it is that simply taking drugs is not making our society any healthier.  Despite increases in “treatment,” the incidence of chronic disease is still on the rise.  Drugs only control the symptoms.  They do not fix the problem.

There are many forces at play which are increasing the number of pills in our medicine cabinets.  Some of these entities are truly trying to keep your health in line.  Some are only worried about the bottom line.

-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------