The previous two posts in this series have shown that overprescribing of expensive, powerful drugs has become a serious problem in developed countries — especially in the United States and especially among women and elders. Gulping down handsful of drugs a day is now so commonplace that doctors’ assistants react with surprise when told someone over 50 is taking no meds. And we’ve seen that many widely prescribed drugs help surprisingly few patients but do inflict real harm on a lot. Even unto death.
One reason for this is obvious: the money motive. At this time, prescription drugs generate billions of dollars for Big Pharma — accounting for some 12% of the total cost of personal medical care in the US. As the Baby Boom generation gallops into old age, that profit will grow exponentially. With fully a quarter of Americans in their 60s and almost half of those in their 70s already taking at least five prescription drugs for this or that condition, just imagine the profits the vastly growing number of aging pill-poppers will generate over the next two or three decades!
Other causes, as we’ve seen: the ongoing multi-billion-dollar promotion of pharmaceuticals, overwork among doctors who have little time to sift through research reports that come out at the rate of one a minute(!), and commonplace publication of weak, flawed, or even fraudulent research “studies.”
Let’s take a look now at a fairly new phenomenon that is being used, more and more, as a device to urge doctors to put you on medication — for the rest of your life.
That would be the enthusiastic trend toward diagnosing “pre-conditions”: pre-hypertension, pre-diabetes, osteopenia as “pre-osteoporosis.”
Osteopenia is a big one: what woman over the age of 45 or 50 has not been told that if she doesn’t start swallowing Vitamin D, calcium pills, and Fosamax her spine will surely crumble and she’ll end up in a wheelchair with a broken hip? I personally have had doctors try to pressure me into taking hormone replacement therapy or Fosamax by way of staving off what was depicted as an otherwise unavoidable disintegration of my skeleton.
Yet, as it develops, osteopenia is not the same as osteoporosis. Osteopenia is a normal thinning of the bones that occurs in all women as they age. It does not amount to a lifetime of broken bones, crumbling vertebrae, and dowager’s hump.
Osteoporosis is a real problem with real, hazardous effects. It does need to be treated. Bisphosphonates (Fosamax and related drugs) are the most effective treatments we have for this disease. Nevertheless, Merck, seeing an opportunity to sell its drug more widely, developed a machine to measure bone density and launched a powerful marketing program, the upshot of which was to persuade doctors across the land and around the world that all their middle-aged women patients must be put on drugs right away, lest the normal aging of their bones turn into the dread osteoporosis.
So: imagine the profits if every baby-boom woman is taking drugs to enhance the normal state of her bones and also is put on drugs to push her blood pressure down below 120 hg! And in the bargain, every medical practice that treats women has to buy a bone density machine or refer patients to a lab with one of the things.
In fact, though, current thinking suggests that these drugs do little to prevent bone fractures, although they may help defer fractures in spinal vertebrae. Susan Ott, an associate professor of medicine at the University of Washington, told NPR: “There was no difference in the number of [nonspine] fractures you had, whether you took the medicine or a placebo. It does make your bone density go up higher, but the number of fractures is what really matters, and that didn’t really change.”
Elsewhere, Dr. Ott noted that bisphosphonates (of which Fosamax is one) can actually cause fractures in women with osteopenia. Speaking to BottomLine, she reiterated that osteopenia is a normal process that is different from osteoporosis and that treating with bisphosphonates not only does no good but may actually cause harm.
What would be a better, cheaper way to treat this supposed ailment? Regular exercise, a healthy diet that includes calcium, a few minutes of sunshine each day, cutting out the smoking, and limiting the booze to one drink a day.
Have you been told you have “prediabetes“? I sure have. And no, I am not obese: my BMI is smack in the middle of the “normal” range. No, I do not drink sugary sodas or sit around scarfing ice cream and carbs. Yes, I do exercise every day: walking at least a mile and often slamming around a great deal more than that.
One school of medical practice would put you on cholesterol meds (statins) or metformin, either of whose side effects can make you very sick, indeed. Others regard the first line of attack as…well, yes: a healthy lifestyle. Nutritious foods, moderate exercise, moderate weight, not smoking.
“Prehypertension” is another huge bugabear. Interestingly, the bar keeps being lowered here. It used to be that “prehypertension” was indicated by a systolic blood pressure measurement of 130–139. Within the past year, though, the American Heart Association (which, interestingly, receives funding from pharmaceutical companies) lowered that standard to 120–129: deep in what used to be regarded as “normal” territory. Now we’re told that the only way to avoid dropping dead of a heart attack or stroke is to keep your blood pressure under 120! A systolic reading of 130, formerly classified as “prehypertension,” is now “high blood pressure.” The term “prehypertension” (120–129)has been replaced with the much scarier-sounding “elevated blood pressure.”
This rejiggering of what was then and is now an arbitrary classification system makes, by the AHA’s count, almost half of American adults eligible for prescription medication — which they are told they will have to take for the rest of their lives. That is even though antihypertensive drugs have not been shown to reduce sickness or death.
We’ll look at the blood pressure issue in more depth. For the nonce, though, take note: this is one of several ailments that are flagged for early medicating, and whose standard for early medicating is pretty slippery. Just as osteopenia’s standard is slippery.
In fact, these alleged diseases can often be treated with exercise, a decent diet, moderating alcohol intake, and getting off the tobacco.
For the moment, I’ll leave you with this entertaining and interesting TED talk by the executive editor of Reuters Health, Ivan Oransky, who also lurks at the endlessly jaw-dropping site, Retraction Watch.
This is the third of seven planned posts on the Drugging of America:
- Overprescription
- What is NNT and how can you use it to assess the risks and benefits of a given treatment?
- The problem with treating “pre-conditions”
- Hyped hypertension: Medicating 2/3 of America
- Organizations and Funding
- The “de-prescribing” movement in medical practice
- Lifestyle strategies to maintain good health without drugs