America: a nation of drug users
Legal ones, that is:
Researchers find that nearly 70 percent of Americans are on at least one prescription drug, and more than half receive at least two prescriptions.
Mayo Clinic researchers report that antibiotics, antidepressants and painkiller opioids are the most common prescriptions given to Americans…
According to the CDC, the percent of persons using at least one prescription drug in the past month increased nearly 50 percent between 2007 and 2010 [it was “only” 48% in 2007].
I can understand that there are a lot of Americans taking blood pressure and cholesterol drugs (although, strangely enough, the latter is not specifically mentioned in this slightly more detailed report at the Mayo Clinic site). After all, more older people are living longer, and the parameters by which these conditions are defined as pathological have moved ever downward so that people who would previously have been described as healthy are now considered in need of medication.
But what gives with the 17% who have taken antibiotics in the past month? And 13% on opioids and 13% on antidepressants (including a great big whopping quarter of the women between 50 and 64??!).
You can castigate Big Pharma if you wish, but clearly doctors are part of this because they’re writing the prescriptions, and the public is probably demanding them.
I went to the online Mayo Clinic site where a longer version of the research results is supposed to be found but I haven’t been able to locate it so far. But I did see this article on a different subject, which looks pretty interesting. I don’t have the time now to read it, so I’ll save it for later. But a very brief skim indicates to me that its subject matter could be summarized this way: we know next to nothing about obesity, what causes it, or what its real effects are on health (especially mild obesity, the most common kind), and yet it doesn’t seem to stop us from spouting off about it.
Come to think of it, one of the contributing causes of obesity in America could be the prevalence of some of those drugs. For example, quite a few antidepressants and high blood pressure medications are known to cause weight gain that can be very hard to counter.
I live sort of in the country. That means, I find, that doing yard work, toward the boundaries of the yard, may mean getting bitten by something, and I wear shorts as much as possible.
There is what I am told is a kind of spider bite. You don’t feel anything, but when you look at the leg–when getting changed or showered–you have a hole the size of pencil eraser scabbing over and a two-inch circle of raised flesh. By the next day, the raised flesh is expanding and cellulitis has begun.
Need antibiotic, say the urgent care folks.
Never seen the spider, but I am put in mind of Drake’s “Seas of Venus” and “Redliners”.
Patients are the drivers, medically ignorant though they be. They expect Rx cure-alls, including antibiotics for short-lived viral illnesses.
If you doubt me, just watch a little TV and see the commercials for prescription meds- “Ask…or Tell your doctor…..”
Don Carlos: But have doctors lost the ability to say “no,” and explain why?
And although what you say is certainly true of antibiotics, and sometimes painkillers and anti-depressants (patient request), I don’t think it tends to be commonly true of anti-cholesterol drugs, for example.
Yes, Neo, docs have lost the ability to say “No.” Big Pharma is not stupid; they market PRESCRIPTION drugs to the public, not to docs. Docs need patients, and there is no better way to drive off patients than to tell them, “No” and explain why not. It takes a lot less time to just cave and write the Rx than to explain to someone unreceptive why they don’t need whatever. A (patient’s) mind is a difficult thing to change.
The statins reduce cholesterol. But no statin has ever been shown to reduce mortality, to the best of my knowledge. The ads all tout cholesterol-lowering, but that is all. The whole lipid/cholesterol/ bad fats stuff has cost untold billions, and I am concerned that is largely based on consumer ignorance from de facto brainwashing….the same consumers who think Organic is better (despite zero evidence).
According to this article in the New England Journal of Medicine, doctors also often prescribe antibiotics “just in case”:
BEFORE my mother went into the hospital for her final 2-3 weeks, she was taking perhaps a dozen different drugs. Though, IIRC, she was not taking any anti-cholesterol drugs. Had she not been taking prescription drugs for a chronic disease, she would have died a quarter century before. Then more prescription drugs for leukemia for her last 8 years.
I hope I never get into that condition. Fortunately, the chronic diseases did get passed onto me.
My working as an aide in a psych hospital during my undergraduate years steered me away from chemical treatment for psychological issues. I saw what the drugs could do- reduce you to a zombie.
I took some prescription drugs for shingles, and was very glad to have them.
Correction:
Fortunately, the chronic diseases did NOT get passed onto me.
People just talk about drugs and nutrition too much. It seems to be a major component of TV news and talk shows. I can’t remember the last time I took an antibiotic, and I still follow my mom’s admonition to eat what’s on your plate. No one will ever call me a poster child for physical fitness, but I’ve probably added 10 years of worry-free time to my life.
In other words, I’d rather spend my time at Neo’s.
I grew up in a family of 5 where the aspirin bottle had to be thrown away because of the expiration date and hardly any pills were taken. While I thank God for the antibiotics when we’ve needed them, I can’t relate to this culture that thinks the answer to almost every issue is a prescription. Just this week I was showing my son something on the computer and the preceding commercial was a drug for MS. My son (24) remarked, “Why are they promoting a drug for MS to the patient? Isn’t that the doctor’s domain?” Why indeed?
Was birth control counted in this study? You do need a prescription for it, and I’m guessing the high numbers of women taking some form of it would skew the numbers a bit.
Ann:
Yes, “Just in case.” It is so much easier and quicker to write a script for a Z-pac than to explain to a patient that most sore throats are viral, not beta-strep, and antibiotics don’t touch viruses, and the Z-pac they seek is a waste of money.
The needless prescribing of antibiotics is a large part of the cause of emergence of drug-resistant bugs. Most of us have staph normally on our skin, and the staph that survives an antibiotic is in fact resistant to that antibiotic. We thus encourage the replacement of sensitive strains with resistant strains. So it goes.
BTW, the New England “article” you cite is a “Perspective”, which is what the Journal calls an editorial, a point of view. Not medical science.
“Nearly one in four women ages 50-64 were found to be on an antidepressant”
Besides the relevant factors previously mentioned, other factors might well be; after having abandoned belief in an afterlife, what is there to be looked forward to? Isn’t depression a natural consequence, when you believe that ‘life sucks and then you die’…
After having embraced the emasculation of the American male, what kind of partnership are women left with? How gratifying from both a physical and emotional perspective can living with an exquisitely sensitive, metro-sexual eunuch be?
Given psychiatry’s cure rate, medicating the patient is a practical substitute for the patient feeling like something has been accomplished…
Is this the Mayo Clinic you are searching for:
http://www.mayoclinic.org/news2013-rst/7543.html
Must be pretty easy to control a population when you have drugs, hypnosis, and all kinds of shrinks and doctors on the government payroll.
A totalitarian system couldn’t pay to get that kind of service.
As for the 13% of older women on antidepressants, it would be interesting to see what percentage of those women are being treated for severe menopause symptoms.
When I was going through chemo for breast cancer, I experienced sudden onset of menopause. (The hot flashes were intense – they often felt like heart attacks and happened 17 – 21 times a day. Imagine not being able to sleep for more than a hour at a time – no REM sleep! – for six months. There’s a reason sleep depravation is used as a torture technique…) I resisted medication for a while, but there was a point I could not take it any longer. Hormone replacement therapy was out (would encourage the cancer) and I decided against soy (not proven that the plant phytoestrogens wouldn’t be as bad as estrogen). What was left? Anti-depressants. One of the side effects of anti-depressants is to reduce the occurance and intensity of hot flashes. In fact, my oncologist was always suggesting I start on them from the beginning. Tried them, but they made me so ill I gave them up. (Had enough nausea from the chemo, thank you very much!)
So when I saw the anti-depressant statistic for older women I wondered – maybe the medication isn’t for depression, but for something else.
Fortunately, I don’t get as many hot flashes now (only about 12-17 a day), and far fewer of the “little heart attack” kind. And I get fewer at night so I can sometimes get REM sleep, which helps.
Fortunately, menopausal symptoms decline over time, regardless of cause or therapy.
Since oncologists long ago stopped intentional female “castration” (whether by surgery or radiation) as part of therapy for pre-menopausal breast cancer, I have questioned the wisdom of witholding hormone-replacement therapy (HRT) in women like you who clearly needed it. Anti-estrogens like Tamoxifen and its newer congeners obviously cause menopause or menopausal symptoms, but they are of value only if the cancer is estrogen-receptor positive.
HRT is low dose, thus less likely to stimulate latent breast cancer. Keeping cancer latent is the logic of anti-estrogen therapy in women with positive estrogen-receptor breast cancers. That comes with a menopausal price.
One of my medications put about 100 pounds of weight on me, although it wasn’t an anti-depressant, but an anti-psychotic. I’m bipolar, so although I’m trying to lose weight, I would rather have the weight than the depressed, manic and especially mixed episodes.
who needs ovens when you can stop the meds for 4 months due to shortage and prune the population blamelessly that way?
Richard Aubrey
The spider usually bites only when pressed against the skin, such as when tangled within clothes, towels, bedding, inside work gloves, etc. Many human victims report having been bitten after putting on clothes that had not been worn recently, or had been left for many days undisturbed on the floor. However, the fangs of the brown recluse are so tiny they are unable to penetrate most fabric
The bite frequently is not felt initially and may not be immediately painful, but it can be serious
sound familiar?
Brown Recluse… also known as the fiddle back, among other names…
they are relatively peaceful, and so the bites are actually rare considering..
The brown recluse bears a potentially deadly hemotoxic venom. Most bites are minor with no necrosis. However, a small number of brown recluse bites do produce severe dermonecrotic lesions (i.e. necrosis); an even smaller number produce severe cutaneous (skin) or viscerocutaneous (systemic) symptoms. In one study of clinically diagnosed brown recluse bites, skin necrosis occurred 37% of the time, while systemic illness occurred 14% of the time.[16] In these cases, the bites produced a range of symptoms common to many members of the Loxosceles genus known as loxoscelism, which may be cutaneous and viscerocutaneous. In very rare cases, bites can even cause hemolysis–the bursting of red blood cells.
the hole is necrosis…
have doctors lost the ability to say no?
of course neo!!!!!!!!!!!
duh
you say no, and insurance lets them go elsewhere, you lose business…
you say no, and they get sicker, you get a lawsuit, or can lose your license. no one is going to pull your license for destroying antibiotics… are they? (one man is a trajedy, a million is a stistics, no)
artfldgr:
Of course I understand the principle that patients might leave; I though of that when I asked the question. But actually, I don’t agree that would happen all that much, at least not in the medical markets in places I’ve lived within the last couple of decades.
The reason is that so many doctors seem to be full up and oversubscribed with patients. Yes, they might lose some business, but for the most part they would retain enough patients to do just fine, especially if they act towards their patients as though they are more than faceless masses. Yes, they might sacrifice a tiny bit of income, but I know quite a few doctors who operate the way I’m describing and they are doing so well they have to turn patients away.
I also know lots of people who don’t like to take medication and are relieved when doctors don’t suggest it. So those doctors might end up attracting those patients.
I don’t pretend to know for sure, but that’s my guess, based on what I see around me.
I just love people who don’t ‘like’ to take meds, but go to docs nevertheless. We used to call them the ‘Worried Well’. Folks like that are not beloved, nor esteemed as patients, by their docs. They are kind of akin to junk mail: nobody in medicine wants them as patients, but you can’t keep them out of your mailbox.
Don Carlos:
Actually, no I do NOT refer to the “worried well.” Most of the “worried well” that I know LOVE to take medication, the more the merrier. It reassures them.
I’m talking about people who don’t want to take unnecessary medication, who are aware that for many medications (as you yourself described in another comment of yours, I believe regarding statins) the research underlying them is iffy and the side effects can be worse than the problem. They also know that (as I believe you also acknowledged) some doctors push meds on their patients because they think they want them and because in some cases it is easier and they can’t figure out what else to do.
These are the people to whom I refer.
Neo:
I was not talking from the sidelines, but from being in the game. It was the Worried Well that drove me out of the practice of internal medicine.
Your Worrieds may be different from mine. Mine all had complaints-that’s why they made appointments- and one has to rule out serious causes for their complaint(s) at a cost of time and money. When told nothing bad turned up, they were usually not reassured. Their complaints did not go away, and they found docs who would prescribe instead of appeal to their reason, explain, blah blah.
PS: if a medicine is ‘unnecessary’, does the patient bear the responsibility for seeking an Rx (if given for no other reason than to make them less unhappy with the ‘provider’) ?
Don Carlos:
In your first comments, you indicated that the “worried wells” did not want to take meds:
And I said most of the “worried wells” I know LIKE to take meds and want them, whether they need them or not:
So then, in the response you wrote at 9:08 PM, you seemed to be agreeing with me when you said [emphasis mine]:
So we seem to be agreeing about who the “worried wells” are, not disagreeing.
My point was, and is, that your “worried well” population is not the population I’m talking about when I say I know a lot of people who don’t want to take unnecessary medication. That is a different group.
And I’m also saying that, that if a patient is less inclined to take medication at the drop of a hat, and doesn’t want a doctor who does things like prescribe antibiotics when they are not needed, then that person will gravitate to and choose a doctor who doesn’t do that.
So I think you are misunderstanding my points.
My point is that the docs who don’t do that are very few, and likely are not findable by patients. They may exist at academic med centers, but who is going to go see them for their non-prescribing? Patients expect treatment; that is why they go. They also do not know when Rxs are ‘not needed’; if they do know. they stay home. And sometimes they are wrong in so deciding.
Don Carlos:
I don’t want to belabor the point (and perhaps I already have), but I know plenty of people who actually go to certain doctors for the very reason that that doctor takes more time to explain about meds, and only prescribes when necessary. These patients know something about problems in medicine such as the over-prescribing of antibiotics, for example, and are reassured when he explains why he’s prescribing something and/or why he’s not. He has a lot of patients and no problem making a very good living.
And of course this is not the majority of patients. But it is a substantial minority, enough to support quite a few doctors who wish to function that way. I don’t know the statistics about how many, but I suspect quite a few.
And these patients aren’t prescribing for themselves. They just want a doctor whose general philosophical attitude towards medicine agrees with theirs.
Good discussion. Thanks for taking the time, Neo.
The patients you know, and their docs, are a special breed. Maybe the docs take only cash, no insurance. That’s what I would do: better care, fewer patients, more time per patient, no 3rd party drivers; just doing the right thing.
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