Yes! I definitely think the US has a prescription drug problem! And the biggest problem isn’t out on the streets. It is coming out of doctor’s offices because of what is being taught in medical schools and included in medical guidelines. Now just so you understand, I am not against all medication use and I do think there are definitely situations where medicine needs to be used. However, I most assuredly believe prescription drugs are being grossly overprescribed by doctors today. And I think the biggest problem is how much influence pharmaceutical companies have over doctors, guidelines, and the public in general.
Our Prescription Drug Problem
There is no doubt that pharmaceuticals are big business. According to the World Health Organization’s website “The global pharmaceuticals market is worth US$300 billion a year, a figure expected to rise to US$400 billion within three years.” And the US has six of the ten largest pharmaceutical companies in the world. In 2011, the pharmaceutical industry, in the US alone, spent almost $29 billion dollars on marketing. The majority of that marketing is directed at physicians and pharmacy directors, but a sizeable $3.7 billion was spent on direct-to-consumer advertising. The US is one of very few countries that actually allow direct-to-consumer advertising for prescription drugs contributing to our prescription drug problem.
Doctors
How do pharmaceutical companies persuade doctors to use their drugs? Well as mentioned before, they spend a lot of money marketing to doctors. This marketing takes the form of direct face-to-face contact between drug reps and doctors, mailing drug ads to doctor offices, giving free samples of drugs, and even ‘educational’ meetings describing the use of a specific drug. In a national survey of physicians, 87% reported having regular contact with pharmaceutical representatives; while in a study of primary care clinics in Michigan, 72% of physicians that discussed drug reps reported regular contact with 62% reporting meeting with more than 10 reps a week. And 77% of physicians said they found the information that was shared as ‘useful.’ In that same study the authors note that most of the consultations they observed focused heavily on medication use to the “near exclusion of other considerations, such as diet and lifestyle” for the treatment of chronic diseases. Chronic disease is largely a result of lifestyle factors and when modifying these factors is not the focus of treatment, this is a problem.
Guidelines
There have been several studies that have looked at possible conflicts of interest for authors of clinical guidelines. One such study published in 2002 found that 87% of authors of clinical practice guidelines had some form of interaction with the pharmaceutical industry. The authors of that study concluded that appropriate means for disclosing possible conflicts of interest and ways of discussing those conflicts need to be implemented in the clinical guideline writing process. Another study looked at the relationship between panel members that recommended changes for the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the pharmaceutical industry. They found that 56% of panel members had one or more financial ties with the pharmaceutical industry. The DSM contains diagnostic criteria and recommendations for treatment of mental illnesses. They found that ties were especially strong in the diagnostic areas where drugs are the first line of treatment. Guidelines recommending drugs as a first line of treatment—even if there may be better options—contributes to our prescription drug problem.
Public
Finally, I find it interesting that the US is one of very few countries that allow direct-to-consumer advertising for prescription drugs. I am all for patients being informed about what options are available for treatment of various diseases, but I don’t think that information should be coming from advertisements. Advertisements are meant to sell a product or service; they are not a fair and unbiased source of information. Why should patients be asking their doctor about prescribing them a certain drug? Because the company that makes the drug told them to? I find that disturbing. A prescription drug is supposed to be available only through a prescription for a reason. A doctor has a responsibility to only prescribe what they feel is best and necessary for their patients. However I have no doubt that having a patient ask for a specific drug affects the decision process. In that case, a doctor might feel pressure to oblige a patient’s request even if it wouldn’t be in the patient’s best interest.
Does the US have a prescription drug problem? Yes, I definitely think so! I think the people and doctors have been duped by pharmaceutical companies into thinking that the answer to every problem is found in a pill bottle. The reality is that most drugs merely mask symptoms and do little to address the actual cause of the problem. Chiropractic provides a natural way to manage your pain, recover from injuries and add years to your life and life to your years – without drugs or surgery. I look to correct the underlying problem not just treat the symptoms. To find out more about chiropractic and what it can do for you contact our office today.
References
http://www.who.int/trade/glossary/story073/en/index.html
http://www.annfammed.org/content/10/5/452.full
