Americans take so many drugs that 100,000 of us die every year because of those drugs. It is not illness that causes those 100,000 deaths, but the damaging effects of drugs taken for illness. Beyond these deaths there are millions of adverse drug reactions every year, resulting in hospitalizations, lost days from work, lost income, and sometimes, chronic disability.
What kinds of drugs are these? What kinds of illness?
Why does this happen?
It is important to remember that any drug can cause side effects, or an allergic reaction, and that the reaction may be severe. Higher doses of drugs, and combinations of drugs, increase the risks. People who are sicker are more often prescribed multiple medications, yet these are the people most likely to be more sensitive to adverse effects. It is common for patients who enter my office to be taking five or six medications at once. I have seen patients taking fifteen medications at the same time! It is virtually certain that their complaints will be related to these drugs.
The most commonly over-prescribed drug classes are:
1. Sedatives, antidepressants, antipsychotics, stimulants, sleeping pills.
These are the pills that affect the brain. They often cause over sedation, memory loss, loss of concentration, and confusion. Studies have shown that antidepressants may worsen depression and raise the risk of suicide or even homicide. Children only ten years old have committed suicide after taking antidepressants prescribed for them by family physicians or psychiatrists. Parents have asserted they were never informed of an increased risk of suicidal thinking. Now there is a black box warning accompanying these drugs, warning of an increased suicide risk in children and adolescents.
Antidepressants and sedatives increase the risk of auto accidents, of accidental falls and hip fractures. Physicians are advised not to prescribe antipsychotic medications to older people with dementia, because of more frequent cardiac events including sudden death. These drugs continue to be heavily prescribed.
Sedatives and stimulants are addicting, and will lead to withdrawal symptoms when stopped. They also lead to a desire for more drugs, and the high risk of long-term dependency. Some of the main adverse effects of these drugs are that they cause mental dullness, reduce emotions, and prevent the confrontation of problems in life that need to be handled.
2. Pain and anti-inflammatory medications.
These include narcotics, muscle relaxants, non-steroidal anti-inflammatory drugs, even over-the-counter drugs like aspirin and acetaminophen. Narcotics are highly addicting, and lead to a vicious cycle of drug dependency even after the medical reason for their prescription has resolved. Other methods of managing pain should be employed whenever possible before narcotics are prescribed, such as physical therapy, laser therapy, acupuncture, prolozone, and nutrients for pain, both oral and injected. Narcotics should be used in the lowest dose and for the shortest required duration.
The same is true of non-steroidal drugs, such as ibuprofen. These agents cause high blood pressure, gastrointestinal bleeding, kidney and liver damage, fluid retention and edema, and congestive heart failure. It has been estimated they cause 15,000 deaths per year. Patients should be informed of these complications, use these drugs in the lowest dose and for the shortest duration necessary.
3. Antibiotics. Many infections are mild and do not require antibiotics.
Many infections are viral in origin and will not respond to antibiotics. These include most upper respiratory infections, including sinusitis, and most cases of bronchitis. Antibiotics may cause serious adverse reactions, including rashes, kidney or liver damage, and emergence of resistant bacteria such as MRSA, the current scourge of hospital-acquired infections.
The fluroquinolones, a class of potent antibiotics, may cause confusion, agitation, disorientation, neuropathy, and inflammation of tendons leading to rupture. I have seen several patients who experienced rupture of the Achilles tendon after taking these antibiotics, requiring surgery or use of a cast and crutches for months. Antibiotics also lead to yeast infections and imbalance of bacteria in the large intestine. Diarrhea, abdominal pain and nausea may result, and may not resolve until probiotics, or good bacteria, are taken as supplements.
Patients should request, and doctors should prescribe, antibiotics only when indicated, and probiotics should be taken at the same time to reduce side effects.
4. Blood pressure medications.
One fourth of the adult population of the United States has high blood pressure, and in only one third of them is it controlled. Many patients are taking three or four medications at the same time because one is not sufficient. The best way to control blood pressure, however, is through weight reduction and the avoidance of salt. Potassium and magnesium are minerals that effectively reduce blood pressure. Fruits and vegetables are uniformly low in salt and high in potassium and magnesium. These are the foods people should eat preferentially.
There is a mind-set in the United States that favors the use of drugs to the exclusion of safer and more effective measures of disease prevention and treatment. Physicians, partly through their training and partly through the powerful influence of pharmaceutical companies, routinely pursue a drug approach to medical problems. There is a lack of education and understanding, and an undue assertion of vested interests, leading to an unwarranted and dangerous dependency on medications. Reversing this trend will improve out health, save us money, and extend our useful lives.
Allan Sosin, MD