Monday, May 19, 2008

Sex and drugs and pharmacies

Over at Junkfood Science, Sandy Szwarc had an excellent post today on the rather incredible prevalence of prescription drugs in America today and the financial motives behind such large-scale prescribing.

Full disclosure: I'm in favor of meds for those who need them. Actually, I often wish SSRIs had been around when I was a teenager. I often wonder who I might have become had I not had to deal with the continuous panic attacks that started around age 11. Living in constant terror shaped me, body and soul. For better or worse.

Still. Some of the statistics Szwarc quotes are staggering: More than half of all insured Americans take some kind of prescription for a chronic condition. (Note that it's 50 percent plus of insured Americans.) Nearly half of all young women in this country now take ongoing meds. Likewise one in three children.

As Szwarc points out, pharmacy benefit managers stand to gain big bucks from the rise in chronic prescriptions. But most doctors don't benefit directly from prescriptions. They have patients' best interests at heart. The trouble is in how one defines best interests.

Case in point: The women in my family tend to have high cholesterol. My mother has it. My grandmother had it. And I've got it. When my cholesterol level first turned the wrong way, my (former) doctor encouraged me to "eat right and exercise." I did, and I do. I'm no fitness queen, but I try to walk or bike for 45 minutes every day, and I try to be active in other ways too. I eat a wide variety of foods, including plenty of fruits and vegetables. None of this affected the cholesterol numbers, which continued to inch upward. Then my doc started trying to convince me to go on statins. Every time I saw her she suggested I give them a try. After about two years of this she sat me down and said, "If you were my sister I'd put you on these right now." She went on to scare the living crap out of me with accounts of young people who'd had heart attacks and strokes. Statins, she said, would prevent all that.

Never mind the fact that there's pretty much no history of heart disease or stroke in my family. None of us are thin. Few of us die early. I've got grandparents and great-grandparents on both sides of the family who lived into their upper 90s.

Still. I was scared. I went on a statin. I felt like crap, but I kept taking it. I never developed the full-blown myopathy that some people get from taking statins, but I did get increasingly depressed and never felt good. Two years later, I got a new doctor, and at our first appointment she asked about the statins. I told her how I felt--scared and crappy--and she took a thorough family and personal history. She told me my risk of having a heart attack or stroke were less than .5 percent, at least at this point, and took me off the statins. Within a couple of weeks I felt great again.

Back when Doctor #1 prescribed the statins, I asked her if she really thought a relatively healthy woman in her early 40s needed to be on cholesterol-lowering drugs for the rest of her life. She looked at me like I was nuts.

I'm sure she believed she was doing the right thing. And I'm just as sure that she wasn't. I guess time will tell.


Anniee451 said...

I'm about as anti-SSRI as they come. For panic? There are the wonderful things called benzos, that work to short-circuit the panic and stop it in its tracks. SSRIs? Too much evidence that they lead to psychotic breakdowns and shootings and god knows what else. If you get a panic attack a benzo will stop it in its tracks. Dr.s don't want to prescribe them because they're addictive and might actually make you feel - gasp! - good. If I get a panic attack, I take a Benzo and I'm ok again. Nary a murderous impulse to be found. I refuse to take something that screws with my brain chemistry in an unproven way, one which might well lead to psycho behavior. JMHO.

Anonymous said...

My question is this: why didn't they identify the drugs that the young women are on? How many of these perscriptions are contraceptive pills? I think that's a pretty justifiable use of a long term medicine. I feel that to give this "more than half" statistic and not qualify it with perhaps one of the biggest uses is a bit of a scare tactic. Junkfood Science is usually right on with their articles, but I have to take acception to this one.

Harriet said...

I wish it was that simple. I've tried both methods. Both have major drawbacks. On SSRIs for five years I gained 50 pounds and, more important, stopped being able to write. That was a dealbreaker. I took benzos as needed for another 7 or 8 years, and that worked out OK. But a very stressful year got me into trouble with benzos. I now take a very low dose 3x a day to control not only anxiety but also the rebound anxiety I was having. In other words, I'm hooked (though legally with a prescription from a doc) on 'em. They do control the anxiety, but I hate being dependent on any medication, benzo or SSRI or whatever.

Once I move and get settled with teaching I am planning to get off the benzos. I'm not sure how I'll manage the anxiety after that, though.

Pros and cons. Pros and cons.

Laura, good question, and one I can't answer. Maybe Sandy will.

Anonymous said...

I am not against prescription medications for people who need them, for heavens sake. I am a nurse. This was a report from a PBM, the major one in the country supplying the drugs for most of the country, on the px drug use for chronic illnesses!!!!. Not contraceptives. I can only report what they reported, but I do not believe that nearly all young persons need to be on drugs for diseases of aging. Show me the evidence, there isn't any to support that. People need to be more regularly questioning the prescriptions they are handed and to do their own research and become their own advocate, rather than just take whatever some insurance company tell them, IMO.

Harriet said...

I wasn't implying you were against prescriptions meds, Sandy! Just clarifying my own stance. I agree with you--people need to question. That was the point of my story about statins.

bookwyrm said...

Anytime someone needs a medication, certainly they should receive and take it.

What concerns me about the whole thing is: If more than half of young women are on chronic medication, what is so unhealthy about being a young woman that requires medicating?

Anonymous said...

I suspect a lot of these prescriptions are the result of our insurance system more than anything. Doctors are paid by the patient, not by the effectiveness of their treatment, so they have to cram in ever more visits a day, giving them less and less time to sit down and do a full family and personal history and to hear from a patient how a prescription is treating them. Prescribing a drug lets them feel like they've done SOMEthing for their patient, when the reimbursement they get from insurance doesn't allow them to do more.

mary said...

When I questioned my Dr. about BUYING STOCK for my thyroid medication he actually said I should do it!
I tried for a couple years to find a way to not need to take a med for life but in the end I gave in. In all honesty do not feel any different. Recently my dose was decreased, after nearly 10 yrs. of the same one, which may mean my body has begun to repair itself. I think it's taking omega oil on occasion but I'm not sure. I will be paying attention! ;)
The idea of someone getting rich at our expense when I know that foods are very real chemicals irks me.
The latest fad seems to be prescription vit. D therapy which I am on. I believe most of us would test low in this vit. as for years they assumed the needed dose was much lower. Now they've learned that it helps fight cancer so I agreed to go the prescription route for this. (probably because my ins. covers it)
As for anxiety I do think the omega oil might help with brain issues like depression that comes and goes. Perhaps anxieties as well? My kids even find them helpful which is powerful statement about its effectiveness.
My concern would be the affects on unborn children and all these quick cures. It would be wise to be mindful of what we take and whether the benefits out weigh the risks. I wish you had a friend to help you get through your anxieties and that may have helped change the course of your life as much as a med Harriet. Being a teen can be brutal.

Anonymous said...

My mother is a nurse in a doctor's office. Every time cold and flu season comes around, the office gets super busy because people want a cure for their cold and flu. Now, both are caused by viruses, which have no effective cure; they just have to run their course. Still, the patients still demand antibiotics, Mom says.

It's like people have it in their head that medication will cure anything. Yes, medicine has come far from the "dark ages" of treating with herbs and willow bark and mustard plasters, but you know, the more "innovative" medications become, the more complicated they become as well. You can't have one without the other. And that's where you have to weigh the benefits and the side effects in the balance and ask whether it's worth it.

Then, of course, there's the whole advertising scheme behind medication and "ask your doctor about such-and-such." I think those do more harm than good, because people get themselves worked up about a medication they're on or they think they should be on instead of what they're currently taking, and they worry to no end until they get in to see the doctor, who may or may not think the advertised medication is right for them. If the doctor wants to maintain the patient's prescription, s/he has to work to convince the patient because said patient puts more stock in what they saw in an ad than in their doctor's knowledge.

Caveat: I know there are some situations in which suggesting a medication or treatment direction to your doctor is appropriate, but I would hope that people would be wise in their pursuit.