Chronic disease is a major health concern in the United State with nearly half of all adults having one or more chronic disease diagnoses. In this final post of the three part series on chronic illness, we are concluding our look at “The Changing Face of Chronic Illness Management in Primary Care: A Qualitative Study of Underlying Influences and Unintended Outcomes” from the Annals of Family Medicine. I encourage everyone to read the full article at the link. In today’s post we will be reviewing the prescribing cascade and the influence drug company representatives have on the use of prescription drugs.
Prescribing Cascade
The prescribing cascade is a term that refers to a prescription drug causing a symptom for which additional drugs are prescribed. This can quickly become a vicious cycle with prescription drugs being added one after the other to try and ‘control’ the symptoms caused by side effects from the other drugs. Unfortunately this is much too common in the ‘healthcare’ system today. Many of you probably know someone who is on multiple prescriptions for this reason.
In the study, the authors noted that 60% of the patients that participated were taking prescription drugs for conditions other than diabetes and/or hypertension. Of those patients more than half were taking prescription drugs for respiratory or gastric symptoms. Respiratory and gastric symptoms are well-known side effects of diabetes and hypertension drugs. Now, this is not meant to imply that all those symptoms can be attributed to drug side effects, but it is very likely that some would be caused by drug side effects.
However, the study authors note that while over half of the clinicians interviewed said they considered adverse drug effects in selecting medications, “few expressed concern about medications causing negative health outcomes. They would simply comment matter-of-factly, ‘You’ve got to watch their kidneys with this one,’ or ‘I have to check their liver enzymes every now and then.’” I find the mindset of the doctors unsettling. Why are you watching for the kidneys or liver enzymes if it is not to look for damage to those organs? And if there is damage to them, then what, would that not lead to negative health outcomes? This doesn’t have to be ‘the way it is;’ there are alternatives.
Drug Company Representatives
The authors of the study bring up an interesting topic about pharmaceutical company marketing. They refer to the inverse benefit law, which basically states that the benefit-to-harm ratio for a drug is inversely proportional to how aggressively the drug is marketed. So if the inverse benefit law holds true, the drugs most aggressively marketed by the companies would have the lowest benefit-to-harm ratios. This unfortunately seems to make sense, that the drugs with the least benefit would need the most marketing to be used.
Of the doctors in the study that discussed the topic of pharmaceutical representatives, it is plain to see that the drug companies work hard on marketing. Seventy-two percent of doctors that discussed the topic said they had “regular contact with pharmaceutical representatives, who provide drug information, free lunches, and free samples.” The majority saw more than 10 representatives a week. While the doctors said they take the information the drug representatives give “with a grain of salt,” 77% did say they found the information useful.
Conclusion
My main concern is how much influence drug companies have on doctors prescribing. The fact that pharmaceutical sales continue to grow tremendously suggests that there is some influence. I am also concerned with how much influence those companies have on the forming of guidelines or diagnostic thresholds. A study done in 2006 found that 56% of panel members that revised the Diagnostic and Statistical Manual of Mental Disorders (DSM) had some financial association with companies in the pharmaceutical industry. The DSM is one of the main sources for diagnosis of psychiatric disorders in the US. How a disease or disorder is diagnosed also plays a part in how it is treated. To me, it seems unlikely that there is no influence.
If you think that prescription drugs are overused today, find out about other alternatives to drugs. Chiropractic is one such alternative. If you would like to know more, contact our office or visit other pages on the website.
