In considering the plague of overprescription afflicting our country and many others, we’ve seen that huge numbers of Americans regularly take pills — prescribed or over-the-counter — that are unnecessary, inappropriate, redundant, or otherwise ill-advised. Many of these remedies, inflicted on patients for reasons both altruistic and self-serving, do not treat the chronic problem for which they are intended. Some of these people should never have been deemed “patients,” and their supposed problem is not a real problem at all. Often the drugs do not prevent future drastic health events, but instead inflict harm on the people who are persuaded to take them.
This is happening for a variety of reasons, ranging from doctors’ natural concern for patients’ well-being to the exploitation of these concerns by the spectacularly profitable pharmaceutical industry, which stands to gain many billions of dollars by putting the aging Baby Boom generation on long-term drug therapies. Two examples of this — among many — are the new vogue for diagnosing and treating scary-sounding “pre-conditions” and the campaign to lower the threshold for diagnosing “hypertension” to the point where some two-thirds of the American population are targeted for blood pressure meds.
As a result, more and more people are taking more and more drugs, often to no useful purpose. There’s even a name for it: “polypharmacy”– taking five or more prescription drugs to treat chronic conditions. By 2013, the Mayo Clinic estimated that 20% of Americans were taking that many drugs at a time; 70% were on at least one prescription. It gets worse as you get older: some 25% of people aged 65 to 69 are on five or more drugs, and that figure jumps to 46% for those between 70 and 79. This is not a benign thing: polypharmacy results in a wide variety of health problems and can lead to death.
The problem has become so pervasive that public agencies in the United States, Canada, Great Britain, and Europe have launched “de-prescribing” campaigns, efforts to inform the public of the risks of overprescription and to get people off unnecessary medications. These public-education schemes provide useful guidelines for identifying drugs that you might not need to be taking and for reducing the number and potential toxicity of drugs taken to treat real conditions.
Understand: I am not a doctor, and so what follows does not constitute medical advice. If you have a life-threatening ailment — or one that compromises the quality of your life and is unlikely to go away on its own — you need to see a doctor and follow a doctor’s advice. If you question that doctor’s judgment, get a second opinion; do not base your decisions on what you read on the Internet.
But here is what seems to be the case…
Some ailments, as we have seen with the “pre-condition” fad, are not ailments. They might (or might not) indicate a vulnerability to some ailment, but they are not the ailment. Furthermore, some real ailments can be treated with physical therapy,; by laying off the tobacco, the sugar, and the booze; and by building an all-around healthy lifestyle.
Yeah, I know: heard it on the Internet…
But a review at The NNT (“number needed to treat“) caught my eye and convinced me to look further into the “lifestyle change” gambit. This study showed that for people who have not yet begun to show signs of heart disease, the so-called “Mediterranean diet” does indeed work to help prevent heart attack and stroke. Say the researchers: “…based on a 30% reduction in events the Mediterranean Diet represents the most beneficial and least harmful intervention we have seen.” Even then: only 1 in 61 were helped; but none were harmed, contrary to the pharmaceutical approach.
Okay, that’s fine if you have no cardiovascular symptoms and you’ve never enjoyed a cardiovascular event. But what if you’re already sick with one or more heart and vascular issues? Read on…
Way back in 1998, a five-year randomized study of heart attack victims (of whom 10% were women) showed that people who had already experienced a cardiac event were much more likely to stay well if they ate a Mediterranean diet rather than the diet then recommended by the American Heart Association — which, we might add, was far lower in cholesterol and sodium than the standard American diet. After about four years, 8% of the 303 people in the control group had died; but only 4.67% of the 302 Mediterranean dieters died. Got that? Thirty-four AHA dieters vs. fourteen on the Mediterranean eating pattern. That’s more than twice as many deaths!
Additionally, 33 members of the control group (8.2%) experienced nonfatal heart attacks, vs. 8 in the Mediterranean group (2.6%). Thirty-three? Forgodsake, that’s four times as many recurrences of cardiac events among the people who eat modified, low-fat American fare!
The reviewer of this study, Dr. Joshua Quaas, remarks that “The magnitude of this study’s results is astonishing. To compare saving a life post-heart attack with this diet (NNT= 30) and with statins (NNT=83) suggests that diet is nearly three times more powerful as a life-saving tool. A few factors make this particularly remarkable. Cancers were also reduced, while some authors have raised concerns about statins increasing cancer risk (without supporting evidence in the industry-sponsored trials to date). Imagine that the control group had been following a typical dietary pattern rather than the AHA recommended diet; the size of the effect could be even greater. Finally, the study suggests that cholesterol, which was not reduced by the Mediterranean diet, may not be as important a dietary consideration for heart disease prevention as currently thought and practiced.” In a 2010 update, Dr. Quaas observed, “Given the existing data and lack of harms the Mediterranean diet seems beneficial and should be strongly recommended at this time.”
The Mediterranean diet is one hell of a lot tastier than a fistful of pills. It will not make you dizzy. It will not make your head hurt. It will not cause you to feel so fatigued you can barely crawl from the bed to the toilet. It will not cause your hair to fall out. And it will not turn a profit for any huge pharmaceutical corporations. Combine it with exercise and modest weight loss, and you can bring your blood pressure down and improve your cardiovascular health without benefit of Big Pharma.
That latter contingency is probably the reason we don’t see every doctor in the land putting patients on a diet of veggies, fruits, fish, and modest amounts of meat swathed in olive oil. Once again we return to the old investigative reporter’s dictum: Follow the money trail. Nobody’s getting rich on it, so it’s not the “treatment” you’re going to get.
The Mediterranean diet also works against “pre-diabetes,” and it can be helpful for people who have actual, real diabetes. In 2009, results of a four-year study showed that people with type 2 diabetes who stuck to a Mediterranean diet with at least 30% of calories coming from fats (primarily olive oil) gained better control over the the condition without diabetes medications than those who ate a low-fat diet with no more than 30% of calories from fat (with less than 10% coming from saturated fat sources). In this study, 44% of people who agreed to follow the Mediterranean diet ended up having to take medications to control blood sugar. But 70% of those in the low-fat diet group did.
The so-called “Mediterranean diet” is not exactly “health food,” at least not in the way most of us think of the revolting exotica favored by fanatics. It is, in a word, delicious. It is Italian food. It is French food. It is Greek food. With a backyard grill or a decent oven, it is ridiculously easy to prepare. And you can buy the ingredients in any grocery store.
It does require you to learn to cook, in a low-key way. But the labor involved has yet to kill anyone.
And it’s not what I would call a “diet.” No one is going to feel deprived if forced to stick to this cuisine:
- abundant fruits and vegetables
- olive oil as the principal source of fat
- fish and poultry consumed in low to moderate amounts
- dairy consumption is mostly of cheese and yogurt (less butter/cream)
- red meat consumed in low amounts
- red wine in low to moderate amounts
Compared to the wacksh!t diets some would like to put us on (remember when we all had to abandon our butter for margarine? Remember when we decided that oops! all that hydrogenated corn oil not only wasn’t helping you, it was harming you?), it’s strictly from cordon bleu.
If you need a guide to this, here’s a website devoted to hyping it. The Mayo Clinic has a shorter and less self-interested page describing the scheme, nicely organized in one place and easy to understand. And about two-thirds of the recipes in my cookbook, 30 Pounds/4 Months, fall under the heading of “Mediterranean,” as defined by these guidelines.
So, eat well, drink well. Do not smoke. And avoid eating and drinking things that are laced with sugar and other chemicals.
And also exercise well. Contrary to enthusiasts’ insistence, you do not have to go out and beat yourself to exhaustion: you can extract health benefits from ordinary, mild exercise. The trick is to do it regularly and not to hate it. A thirty-minute walk a day will do the trick. Walk the dogs. Go for a brisk stroll in your local park. Walk to shopping instead of driving. Climb the steps instead of riding the elevator one or two or three stories.
Whenever you can generate an opportunity to create some extra steps, do it. In a parking lot, park as far away from the store or office entrance as you can get. If you go into a Safeway and then need to visit the Walgreen’s catty-corner across the street, don’t move your car over there: leave your car in the grocery-store lot and walk across the intersection and back. Have a parking garage at the office? Park on the top floor and go down and back up by the stairs.
These very simple strategies will help you to avoid developing a chronic healthcare problem, and if you do, they can help you to control it or maybe even make it go away.
Snake-oil salesmen come at you from all directions, not just through medical practices targeted by Big Pharma. Remember: those supplements are produced somewhere, and that somewhere is often Big Pharma. There’s as much money in over-the-counter nostrums as in the prescription varieties.
For some time, we were told that calcium, magnesium, and potassium supplements would work miracles for our cardiac health, for example. Not so much, as it developed. For managing hypertension, a 2006 study showed “no robust evidence to suggest that combinations of potassium, calcium or magnesium can reduce high blood pressure (BP) in adults.”
So convinced are we, though, that popping pills must be the key to good health that by 2013 more than half of Americans and 68% of those 65 and older were regularly swallowing vitamins.
The fact is, though, no conclusive evidence has shown that dietary supplements prevent chronic disease in most people. Nutrients that occur naturally in a healthy diet and protect from certain ailments may, when distilled into a pill, have exactly the opposite effect. For a long time, for example, we were told that beta carotene was going to protect us from “oxidation” and the subsequent damage to cells that would lead to cancer. Imagine the surprise, then, when several strong studies in the 1990s showed that ingesting beta carotene supplements increased lung cancer rates among hopeful smokers. We were told that vitamin E, another antioxidant, also would protect us from cancer. Well, no: a 2011 study showed that vitamin E and selenium not only did not prevent cancer, they actually increased prostate cancer rates among men — by 17 percent!
It does not seem to matter whether the pills come to you over the counter or through a prescription. If you do not have a life-threatening or pain-inducing condition — a real one, not one invented to sell drugs — don’t take pills.
There are better ways to maintain health and to treat the conditions (if “conditions” they can be called) that come naturally with living and aging. Healthy eating. Moderate drinking. Moderate exercise. Abstention from known toxins (such as tobacco and dope). None of these things are hard. And none of them cost you or your insurer anything like what a prescription costs.
The Drugging of America
- 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