Medications are drugs that most of us do not want to take unless there’s a good medical reason for it’s use. As a prescriber I think about effectiveness (is it working?), safety (does the benefit outweigh the risk?), and the cost. I prefer to look at other options especially if there are better choices.
The reason pharmaceuticals are over-used is due in large part to the promotional efforts by the pharmaceutical industry. They have a lot of money and use their power and assertiveness in prompting clinicians to prescribe medications they might not otherwise prescribe. You have probably seen the many commercials advertising antacids, antidepressants and erectile dysfunction medications. The pharmaceutical industry has gotten very smart in this direct-to-consumer idea that has patients requesting prescriptions when they see their doctor.
But we need to be careful because unnecessary medications expose patients to risks and unnecessary expense. The main over prescribed medications are:
1. Antibiotics- These medications are the most commonly prescribed for adults and children. They treat bacterial infections. Unfortunately 2/3 of the these prescriptions are used to treat the common cold. These upper respiratory infections are due to viral infections, not bacterial infections. If given unnecessarily, it can deplete the heathy fora (bacteria) in the gut making the immune system even more vulnerable for infections such as severe diarrhea caused by C. difficile. It also promotes antibiotic resistance.
2. Gastrointestinal Medications- These drugs in particular Prilosec, Prevacid, and Nexium are haphazardly used too often when what needs to change is our diet. These should only be used if antacids do not work and only for the recommended time which is no longer than 8 weeks. The main question to ask is “why” are your symptoms occurring. It could be due to low stomach acids, malabsorption of proteins, H. Pylori (bacterial infection), food allergies, etc. None of these conditions are treated with these drugs…only the symptoms are treated. Prolonged use of these proton pump inhibitors can cause C. difficile associated diarrhea, osteoporosis, and pneumonia.
3. Antidepressants- We have come a long way with newer medications to treat depression that include fewer side effects such as selective serotonin reuptake inhibitors (Prozac, Paxil, and Zoloft). A recent meta-analysis shows only a modest effect when compared to placebo. So the effectiveness in these agents for mild depression is questionable, with regular exercise demonstrating a better effect. But the benefits of these drugs are significant in helping those with severe depression.
4. Statins- It seems these drugs may soon be in our drinking water. One out of 4 people over the age of 40 take statin drugs, of which Lipitor is the best known. This number is about to get much larger since last month the American Heart Association and the American College of Cardiology introduced new guidelines that could double the number of people who take statins. My concern is that these new guidelines were developed by the people that have financial ties to the pharmaceutical companies that make statins. I do not mean to say that they should never be used. What I am saying is that a pill should never be a substitute for a healthy lifestyle, and the decision to start on stains should be a personalized one between the patient and their practitioner.
