Stephan Savoia / AP
Sitting at her dining room table in Plymouth, Mass., Alice
Heckman sorts her daily medications into containers on April 6. Heckman, 71,
who has a history of high cholesterol, diabetes and heart disease, takes 14
pills a day as part of her health regimen
PLYMOUTH, Mass. - Alice and Ken Heckman each begin their morning
by cracking open a rattling plastic tray carting scores of pills in a rainbow
of pastel colors.
Between the two of them, they gulp 29 pills every day: a regimen of 14 drugs,
with a chaser of dietary supplements.
Here’s the curious part: They feel pretty hale for people in their early
70s, working around the house and volunteering with several community groups.
They each had heart fixes years ago — him a bypass and her a vessel-clearing
stent — but fully recovered. She has well-controlled diabetes. He has
worked his way through heartburn, arthritis, an enlarged prostate and occasional
About 130 million Americans — many far healthier than the Heckmans —
swallow, inject, inhale, infuse, spray, and pat on prescribed medication every
month, the U.S. Centers for Disease Control and Prevention indicates. Americans
buy much more medicine per person than any other country.
3.5 billion prescriptions per year
The number of prescriptions has swelled by two-thirds over the past decade to
3.5 billion yearly, according to IMS Health, a pharmaceutical consulting company.
Americans devour even more nonprescription drugs, polling suggests.
Recently, safety questions have beset some depression and anti-inflammatory
drugs, pushing pain relievers Vioxx and — most recently — Bextra
from the market. Rising ranks of doctors, researchers and public health experts
are saying that America is overmedicating itself. It is buying and taking far
too much medicine, too readily and carelessly, for its own health and wealth,
Well over 125,000 Americans die from drug reactions and mistakes each year,
according to Associated Press projections from landmark medical studies of the
1990s. That could make pharmaceuticals the fourth-leading national cause of
death after heart disease, cancer and stroke.
The pharmaceutical industry served up more than $250 billion worth of sales
last year, the vast majority in prescriptions, according to industry consultants.
That roughly equaled sales at all the country’s gasoline stations put
together, or an $850 pharmaceutical fill-up for every American.
Do we need all these drugs?
Do we need all these drugs? A relative handful yank many people away from almost
certain death, like some antibiotics and AIDS medicines. Though carrying some
risk, other drugs — such as cholesterol-cutting statins — help a
considerable minority dodge potential calamities like heart attack or stroke.
The right balance of risk and benefit is still harder to strike for a raft
of heavily promoted drugs that treat common, persistent, daily life conditions:
like anti-inflammatories, antacids, and pills for allergy, depression, shyness,
premenstrual crankiness, waning sexual powers, impulsiveness in children —
you name it.
“We are taking way too many drugs for dubious or exaggerated ailments,”
says Dr. Marcia Angell, former editor of the New England Journal of Medicine
and author of “The Truth About the Drug Companies.”
“What the drug companies are doing now is promoting drugs for long-term
use to essentially healthy people. Why? Because it’s the biggest market.”
In fact, relatively few pharmaceutical newcomers greatly improve the health
of patients over older drugs or advance the march of medicine. Last year, the
U.S. Food and Drug Administration classified about three-quarters of newly approved
drugs as similar to existing ones.
Booming pharmaceutical industry
Confronted with mounting costs, drug makers churn out and promote uninspired
sequels like Hollywood: drugs with the same ingredients in a different form
for a different disease.
Of course, many pharmaceuticals improve American health. “We now have
more medicines and better medicines for more diseases,” says Jeff Trewhitt,
a spokesman for the Pharmaceutical Research and Manufacturers of America.
However, the nation also overindulges far too often, the critics say, and violates
the classic proscription of the ancient Greek physician Hippocrates: “First,
do no harm.”
Drug safety researcher Dr. James Kaye, of Boston University, remembers a medical
school teacher telling the class: “All drugs are poisonous!”
The Heckmans found out on their own. Heckman lost his alertness for several
months to a depression medication. His wife has come down with a rash from one
heart medicine and muscle aches from a statin. But each time they switched medicines
and escaped any lingering harm.
Adverse drug reactions
Hospital patients suffer seven hard-to-foresee adverse drug reactions and another
three outright drug mistakes for every 100 admissions, estimates Dr. David Bates,
a researcher at Boston’s Brigham and Women’s Hospital. That translates
into 3.6 million drug misadventures a year.
The dangers potentially escalate when doctors prescribe drugs, as they often
do, for uses not formally approved by the FDA. In a recent report, the Centers
for Disease Control voiced concern about huge off-label growth of antidepressants.
They have expanded to treat often loosely defined syndromes of compulsion, panic
or anxiety and PMS.
Drug makers, doctors and patients have all been quick to medicate some conditions
once accepted simply as part of the human condition.
Many Americans also assume, often with a nod from sellers or doctors, that
new drugs inevitably work better than old ones. “Newer isn’t always
better, and more isn’t always better,” warns Dr. Donald Berwick,
an adviser to the U.S. Agency for Healthcare Research and Quality.
The Heckmans buy both new and old — nearly $9,000 worth of prescriptions
a year, plus hundreds of dollars in cheaper over-the-counter medicines. Even
with supplemental insurance, their monthly out-of-pocket share of prescriptions
alone roughly equals their food bills.
Around the country, prescription drug sales have pushed relentlessly upward
by an annual average of 11 percent over the past five years.
The aging population is partly at fault, with its attendant ailments like cancer,
heart attacks, stroke and Alzheimer’s disease. Other conditions have mysteriously
proliferated, including asthma, diabetes and obesity.
Exercise and better diet ward off heart disease and diabetes just as effectively
as drugs do, studies show. However, says Fred Eckel, who teaches pharmacy practice
at the University of North Carolina, “There tends to be a reliance on
drugs as the first option.”
Drug advertising to consumers has also boomed since the late 1990s, thanks
largely to relaxed government restrictions on television spots.
For its part, the FDA generally demands only that new drugs work — not
that they work better than existing ones. Dr. Janet Woodcock, an FDA deputy
commissioner, says off-label prescribing and allowing similar drugs for the
same condition present more options — and “choice is important.”
Many safety experts say more new drugs should be tested against marketed ones,
with more safety data required and stronger control of consumer ads and off-label
For now, though, most Americans seem to feel like Heckman: “grateful
that there’s a pill to take for something.”
© 2005 The Associated Press. All rights reserved.