The most startling statistics I've seen in recent months came from Mayo Clinic researchers last June, who reported that nearly 70 percent of Americans take at least one prescription drug. More than half take at least two prescriptions. Twenty percent take five or more.
Since this was published, I've heard relatively little reaction from the medical community. So allow me to speak up: This is scandalous and tragic.
To put it in an international perspective, a 2010 British study established that among 14 developed countries surveyed, the U.S. is solidly number one in per-capita prescription drug use.
If Americans enjoyed robust health as a result of taking more prescription medications than anyone else on earth, the staggering expense might be worthwhile. But we are dead last in health outcomes among 17 developed nations surveyed by the National Research Council and the Institute of Medicine. In 2013, they reported a "strikingly consistent and pervasive" pattern of worse health for all Americans, young and old, compared to the health of citizens from economically comparable nations.
Nations that take far fewer drugs than we do are healthier. Why?
I am not quite ready to agree with Dr. Oliver Wendell Holmes, who reportedly observed in 1860 that, "if the whole materia medica, as now used, could be sunk to the bottom of the sea, it would be all the better for mankind -- and the worse for the fishes."
But I will say unequivocally that Americans take too many prescription medications, and that a large percentage of these are doing more harm than good. It's difficult to choose a "most egregious" category winner, but certainly a contender is placing millions of young children on potent psychoactive pharmaceuticals -- with unknown long-term effects on developing brains -- after quick, inexpert diagnoses of Attention Deficit Hyperactivity Disorder.
Overall, there's plenty of blame to go around. Drug companies relentless push their products when research indicates little benefit, or even harm. Overworked physicians hand out pills rather than delving into underlying causes.
Correcting such dysfunction requires a medical system that puts patient health ahead of profit. While many physicians push for that from within, we need regulatory reform (such as banning direct-to-consumer pharma ads) to bring pressure from outside.
In the meantime, it is largely up to you, the patient, to avoid joining the overmedicated masses. If, despite your healthy lifestyle, you develop a physical problem, here's some advice for your next visit to a physician:
- Don't ask for drugs. One of the biggest drivers of American pharmaceutical overconsumption is direct-to-consumer advertising. When patients ask for medications they have seen advertised on television or elsewhere, their doctors very often -- too often -- hand them over. Days are long, more patients are waiting and physician burnout is real. One study found that in about 40 percent of doctor visits, patients asked for advertised drugs, and more than half of those requests were successful.
- Make your desire known for an alternative to drug therapy. Say, "Before I start taking the drug, is there a diet, exercise or lifestyle change I can try? I'm very motivated, and I'll stick with it." Probably no common condition is more amenable to this approach than Type 2 diabetes, an epidemic disease that is often reversible via lifestyle change. If your physician seems dismissive, or even contemptuous, of any therapy except potent pharmaceutical drugs for most health conditions, it's time for a new physician.
- Remember that the best therapy is often time. "Can this clear up on its own? How long is that likely to take?" are both excellent questions.
- Do some research. The Internet is rife with medical misinformation, but one of its great virtues is the ability to find original articles in respected medical journals on the efficacy of various non-drug therapies. If you find compelling studies, discuss them with your physician, and get his or her advice on whether the therapy is appropriate for you.
- Don't seek drugs for trivial reasons. Minor discomforts are part of the human experience. Don't be misled by an insidious form of pharmaceutical marketing known as disease-mongering.
- Consider herbs. In "Why Plants Are (Usually) Better Than Drugs," I lay out the scientific rational behind plant-based interventions.
Finally, let me emphasize that pharmaceutical drugs can be extraordinarily valuable. Millions of Americans are alive today due to breakthrough synthetic drugs for AIDs, aggressive cancers, life-threatening allergic reactions and more. If your physician tells you that your condition requires prescription medication, ask why and listen closely -- don't reflexively refuse.
So, Dr. Holmes overstated the case, but I sympathize with his ire. To rephrase his statement, I'd estimate that at least half of the materia medica used on modern Americans is indeed of little or no value, and should not be used on them (or the fishes). The way toward health, even for the very ill, can often be simpler, cheaper and safer than consuming any drug. Good physicians and informed, engaged patients, working together, can often find that way.
Mayo Clinic. "Nearly 7 in 10 Americans are on prescription drugs." ScienceDaily. www.sciencedaily.com/releases/2013/06/130619132352.htm (accessed March 27, 2014).
Mike Richards. "Extent and causes of international variations in drug usage." A report for the Secretary of State for Health. July, 2010. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/216249/dh_117977.pdf (accessed March 28, 2014).
C. Lee Ventola, "Direct-to-Consumer Pharmaceutical Advertising, Therapeutic or Toxic? Pharmacy and Therapeutics, Oct. 2011, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3278148/#!po=58.3333