Medication Nation: When Too Much is Too Much

Overmedication as a Public Health Issue

 

 

Mia Spencer

October 10, 2008

 

 

 

“There are no real drugs for this yet.” – Kimberly Young, clinical director of the Center for Internet Addiction Recovery on curing internet addiction.

 

http://images.inmagine.com/168nwm/digitalvision/dv104/dv104036.jpg

 

Pill-popping Populace?

 

Overmedication is a growing phenomenon whereby doctors and patients engage in the unnecessary prescription and excessive usage of medications (http://www.fria.org/html/fria2_overmedication.html). Consumers have come to believe that there is a pill for everything; au contraire. In the world of pharmacotherapy, one size does not fit all.  That is, what rehabilitates one person may have no effect, or worse, a harmful effect on another individual’s health.  Even with the knowledge that not every health imbalance has a medicinal cure, or a specific drug by which one’s state of health can be improved, the young and old alike continue to remedy their ailments by ingesting a few milligrams of something, anything that sounds like it may have healing potential. The results of such arbitrary, uninformed pill-popping habits are potentially detrimental.

Toxic Trio.

A common thread in studies of overmedication is the presence of three offending parties: doctors, patients, and pharmaceutical companies.  It appears that this trio feeds off one another, as greedy sales companies continually market new drugs, hypochondriac patients persist on requesting these drugs, and obliging doctors accommodate both aforementioned parties.    

 

 

 

 

 

Big, bad Big Pharma

 

President of Rosen Bioscience  

 Management, Michael S. Rosen, lists

 Four key conditions of “Big Pharma”:

1.Sales: more than $2 billion per year

2.International operations: company operates with significant presence in (at minimum) the Big 3 major markets (United States, Europe and Japan)

3.Therapeutic classes: company has research and development as well as marketing efforts going in at least 5 different therapeutic areas

4.FIPCO (Fully Integrated Pharmaceutical Company): company operations include internal research and development, manufacturing, clinical, regulatory, marketing and sales. (http://wistechnology.com/articles/1903/)

 

Big Pharma’s presence in healthcare affects everyone.  One socio-political commentator suggests that the rampant sickness in America is a result of medicinal bullying by Big Pharma, stating, “The people who came up with the ‘cures’ are actually the problem.”(http://www.ourdailymedsthebook.com/) In 2004, Big Pharma companies spent 24.4% of the sales dollar, or $57.5 billion on pharmaceutical promotion (http://www.sciencedaily.com/releases/2008/01/080105140107.htm). This promotion included ads directed at consumers, many of which exhibited “man-ipulation” strategies which convinced viewers that they were sick, and that the antidote was the advertised drug(http://www.polity.org.za/article.php?a_id=66558). Among the most effective of these ad campaigns were those for antidepressants, whose sales soared prior to FDA intervention.

 

Top 10 Big Pharma (2006)

 

Revenue Rank

Company

Country

Total Revenues

(USD millions)

1

Johnson & Johnson

U.S.

53,324

2

Pfizer

U.S.

48,371

3

Bayer

Germany

44,200

4

GlaxoSmithKline

U.K.

42,813

5

Novartis

Switzerland

37,020

6

Sanofi-Aventis

France

35,645

7

Hoffmann - La Roche

Switzerland

33,547

8

AstraZeneca

U.K./Sweden

26,475

9

Merck & Co.

U.S.

22,636

10

Abbott Laboratories

U.S.

22,476

http://www.pharmalive.com/magazines/medad/?date=09%2F2007

 

Big Pharma tactics not only impact vulnerable consumers, but also doctors and researchers though the strategy is less candid. In a recent analysis of the influence of pharmaceutical companies on researchers and doctors, investigators exposed a team of Harvard researchers who had, from 2000 to 2007, pocketed approximately $1.6 million in consulting fees from drug makers  (http://www.nytimes.com/2008/06/08/us/08conflict.html). This type of underhandedness is not limited to this duo.   The corruption of scientific research was so pervasive that the New England Journal of Medicine implemented a conflict-of-interest policy which prohibited reviews submitted by researchers with financial ties to drug companies (Angell, 2000, p.586).  Again, Big Pharma manipulation influenced financially-tied researchers so much that they relentlessly promoted the company’s drugs, all the while adding to the growing issue of potential overmedication.

 

 

Generation Rx: Who’s most at risk of overmedicating?

 

The number of prescriptions written in the United States currently totals near 3 billion (http://www.danmurphydc.com/Critser.pdf) Of those prescriptions, the elderly and children constitute the largest sectors.

 

 

 

 

 

 

·         Overmedication in the elderly

Liu (2003) reported that nursing home patients (40%) and community-dwelling patients (21.3%) over 65 years of age were most likely to be victims of inappropriate usage of medications.  As is quite commonplace in this cohort, many elderly suffer from multiple illnesses. At the discretion of the practicing physician, this may call for polypharmacy, or “prescribing more medication than is clinically indicated, a medical regimen that includes at least one unnecessary medication, or the empiric use of five or more medications (Michocki, 2001).  Certainly these conditions place the elderly in ideal conditions for overmedication.

 

 

 

 

·         Overmedication in children

In a study that assessed the prevalence of psychostimulant prescriptions for children with ADHD, researchers concluded that of the children counseled by doctors, 90% left with prescriptions (http://www.cdc.gov/ncbddd/adhd/dadabtre.htm). In an effort to discourage the overmedication of children, other studies aimed to reveal that medical interventions were merely a method of “short-term symptom reduction” and should, therefore, be a last resort (McMaster University Evidence-Based Practice Center, 1998).

 

 

 

 

 

 

 

 

Overcoming Overmedication

 

In the process of medicating oneself, it is important to recall the old adage that it is possible to have too much of a good thing. True, drugs can save lives and heal the sick.  But, it may be beneficial delve deeper into the real the cause of the sickness. Could it truly be attributed to an internal imbalance? Or is it a result of too many medicinal efforts to restore balance?  As discussed, overmedication is a trend that affects many, and never with a positive outcome.  While effective treatment is usually more beneficial than no treatment at all, over-treatment can have opposite, more negative consequences.

 

 

References

 

Angell M., Utiger R.D., & Wood A.J.J.(2000). Disclosure of authors' conflicts of interest: a follow-up. New England Journal of Medicine, 342, 586-587.

McMaster University Evidence-Based Practice Center, Anonymous. (1998). The treatment of attention-deficit/hyperactivity disorder: An evidence report (contract 290-97-0017). Washington, DC: Agency for Health Care Policy and Research.

Michocki, R.J. (2001). Polypharmacy and Principles of Drug Therapy. In: Daly, M.P., Weiss, B.D., and Adelman, A.M. (eds.) 20 Common Problems in Geriatrics. New York: McGraw-Hill, 69-81.

Ruis, J.G., Array, S., & Lowenthal D.T. (1996). American Journal of Therapeutics. 1996 Nov;3(11):784-788.