Plethora of prescriptions sparking health worries
By Jeff Donn
Associated Press
PLYMOUTH, Mass. — Alice and Ken Heckman each begin their morning by cracking open a rattling plastic tray carting scores of pills in a rainbow of colors.
Stephan Savoia • Associated Press
Between the two of them, they gulp 29 pills every day: a regimen of 14 drugs, with a chaser of dietary supplements.
Along with eating properly and remaining physically active, Alice Heckman, 71, who has a history of high cholesterol, diabetes and heart disease, takes 14 pills a day as part of her health regimen. Americans take far more prescription drugs than people in any other country.
Here's the curious part: They feel pretty healthy for people in their early 70s, working around the house and volunteering with several community groups. They each had heart fixes years ago — him a bypass and her a vessel-clearing stent — but fully recovered. She has well-controlled diabetes. He has worked his way through heartburn, arthritis, an enlarged prostate and occasional mild depression.
About 130 million Americans — many far healthier than the Heckmans — take prescribed medication every month, the U.S. Centers for Disease Control and Prevention indicates. Americans buy much more medicine per person than any other country.
The number of prescriptions swelled by two-thirds over the past decade to 3.5 billion yearly, according to IMS Health, a pharmaceutical consulting firm. Americans devour even more non-prescription drugs, polls suggest.
Recently, safety questions have beset some depression and anti-inflammatory drugs, pushing pain relievers Vioxx and Bextra from the market. Rising ranks of doctors, researchers and public health experts are saying America is overmedicating itself. It is buying and taking far too much medicine, too readily and carelessly, for its own health, they say.
Well over 125,000 Americans die from drug reactions and mistakes each year, according to Associated Press projections from landmark medical studies of the 1990s. That could make pharmaceuticals the fourth-leading national cause of death after heart disease, cancer and stroke.
The pharmaceutical industry served up more than $250 billion worth of sales last year, the vast majority in prescriptions, according to industry consultants. That roughly equaled sales at all the country's gasoline stations put together, or $850 for every American.
Do we need all these drugs? A relative handful yank people away from almost certain death. Though carrying some risk, others, such as cholesterol-cutting statins, help a considerable minority dodge potential calamities like heart attack or stroke.
The right balance of risk and benefit is still harder to strike for a raft of heavily promoted drugs, like anti-inflammatories and antacids, that treat common, persistent, daily life conditions.
"We are taking way too many drugs for dubious or exaggerated ailments," says Dr. Marcia Angell, former editor of the New England Journal of Medicine and author of "The Truth About the Drug Companies."
"What the drug companies are doing now is promoting drugs for long-term use to essentially healthy people. Why? Because it's the biggest market."
Of course, many pharmaceuticals improve American health. "We now have more medicines and better medicines for more diseases," says Jeff Trewhitt, of 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."
Hospital patients suffer seven adverse drug reactions and 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 problems a year.
The dangers potentially escalate when doctors prescribe drugs, as they often do, for uses not formally approved by the Food and Drug Administration. In a recent report, the CDC voiced concern about huge off-label growth of antidepressants. They have expanded to treat often loosely defined syndromes of compulsion, panic or anxiety.
Many Americans assume, often with a nod from sellers or doctors, that new drugs must work better than old ones.
The Heckmans buy nearly $9,000 of prescriptions a year. 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 upward by an annual average of 11 percent in the past five years.
The aging population is partly at fault, with its attendant ailments. Other conditions have 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 at the University of North Carolina, "There tends to be a reliance on drugs as the first option."
For its part, the FDA generally demands only that new drugs work — not that they work better than existing ones.
Many safety experts say more new drugs should be tested against marketed ones, with more safety data required and stronger control of ads.
For now, though, most Americans seem to feel like Heckman: "grateful that there's a pill to take for something."
