Challenging Dogma - Fall 2008

Thursday, December 18, 2008

Is America Sicker or Overmedicated? The Public's Abandoment by the Health Sector—Zhandra Ferreira-Cesar

The Issue-

It is true that many drugs help people live longer and better lives. However, others may hurt patients in ways they do not know about. Everyday people place their full trust and lives in the hands of doctors, public health practitioners and pharmaceutical companies who advertise their mission to be an increase in the quality of life and the eradication of diseases. However, what happens when those same professionals whom the public trusts to educate and create the safest medications are also the same individuals who regularly treat the creation of drugs as a billion dollar industry that can be manipulated to enhance profits regardless of what this means for the population? Pharmaceutical and supplement manufacturers have to increase sales and profits, as all businesses must, and they do so in part by developing drugs to treat disease and also by convincing people they need medications to prevent disease or lessen the perceived risk of future illness. Is America sicker or just overmedicated? While the number of people with disease is not growing, the number of adult Americans taking medication is increasing. According to J. Douglas Bremner, MD 50% of Americans take prescriptions drugs and 81% take at least one pill everyday [3]. This problem can be attributed to the increase in the number of advertisements used by the pharmaceutical companies who have moved from the area of sick people, to individuals who look well but may have some genetic marker that makes them more susceptible to disease [9]. Thus the era of disease prevention starts in the medical world. At the end of the day, however, rather than increasing awareness about the key diseases affecting the public, public health practitioners have lost control of the efforts and joined in a billion dollar industry dedicated to treating people who are not sick.

Healthcare or business-

Throughout history people have regarded medical professionals as compassionate, selfless, devoted individuals who dedicate their lives to saving others. This image however has been tarnished with the latest movement to get new pills off the shelves and into the mouth of the American public. This frenzy began when government deregulation and an earnest attempt to help HIV/AIDS patients get easier access to crucial life extending drugs collided. A need for faster approval of drugs to serve patients coupled with an understaffed FDA dealt the leading hand to the pharmaceutical companies [3]. In order to speed drug patenting, the FDA had to develop a system that would provide it with the necessary funds to operate. In a response to this need, Congress passed a law mandating that pharmaceutical companies pay a fee every time a drug patent is requested in an attempt to offset the bureaucratic cost of the FDA [8]. However, this fee implementation did not obtain the necessary funds, and thus the funding for surveillance and research of approved drugs was drastically diminished. This initial budget cut initiated the snowballing effect of a hungry industry to make money and forget the focus of its initial humanitarian purpose—the well being of individuals [3].

Another interesting event came as a result of the change in law: the limits and boundaries between pharmaceutical companies, the FDA, and doctors became increasingly vague. In some cases, individuals that worked for the FDA acquired jobs with drug companies; therefore making their relationships with the FDA a major priority for the success of their careers [3]. These same FDA officials who approve a drug are also in charge of monitoring it after it enters the market, which means that these people have no incentives to admit an error and say that the drugs that they previously categorized as safe are now unsafe, even if it means that those patients making use of these drugs may be at risk [2]. Finally, it is noteworthy to mention that the FDA gets most of its input from a panel of doctors who are experts in their fields [8]. However, it is not accurate to say that these doctors are unbiased when analyzing the data presented to them since most of these doctors receive payment as consultants, or are given research grants and support for travel to conferences from drug companies [1]. All these incentives deter physicians from fully acknowledging all side effects of the drugs being presented for approval, thus increasing the chances that they will be patented and reach the public to cause harm and leave behind catastrophic death rates, like the arthritis medication Vioxx did by increasing the incidence of heart disease [3]. The cooperation between the FDA, drug companies, and doctors therefore, actually presents itself as a conflict of interest that completely disregards the initial job of the healthcare system, which is to care for, treat and educate individuals about pertinent health issues [4].

Take for example, USA Today reported on October 16th, 2004 in the article “Cholesterol Guidelines Become a Morality Play” that nine of the doctors that sat on the committee for the production of cholesterol guidelines were also making money from the companies that developed drugs to lower cholesterol, which were urging Americans to take these drugs via the media [3]. This exemplifies the heavy influence that drug companies have upon physicians, which leads to the conclusion that not even family physicians have the power to control the treatment for their patients. Ultimately, the drug companies have the power to dictate which drugs are being consumed and which diseases will emerge by means of carefully framing and delivering their desired message through the media. This is mainly because only so much information reaches physicians, and the information that does reach doctors is carefully selected and presented as the ultimate truth in the medical world [12]. Dr. Curt D. Furberg, a former head of clinical trials at the National Heart, Lung and Blood Institute describes the way in which information reaches physicians as published on the Los Angeles Times on December 22nd, 2004, “The National Institutes of Health: Public Servant or Private Marketer?” saying, “The company reps tell the doctors,’ you should follow these guidelines’ implying that you’re not a good doctor if you don’t follow these guidelines” [9].

One point that should be made on behalf of the doctors, however, is that these physicians do not have the time to be reading every journal and study that is released. Thus, it is only natural that they place their trust in the drug companies who claim to have the same interests as they do [6]. This is clearly not true as pharmaceutical companies often ignore obvious signs that a drug is failing in order to make extra earning regardless of how many individuals are being affected.

The media and pharmaceutical companies-

People have inherent trust in medical professionals due to the social acceptance and glorification that has been established over time. Surveys conducted of the general population show that Americans trust pharmaceutical companies to advertise the adequate and proper information regarding the side effects of drugs and their advantages [2]. However, is the purpose of drug advertisement really to increase awareness and educate the mass public about the positive and negative effects of new drugs or is their main purpose to make profits?

The first clue that the pharmaceutical market has turned its back on the sick population is displayed in the creation and expansion of a new market that is composed of healthy individuals as the target for preventive medicine, which has become a multibillion-dollar business. In order to promote this market shift, pharmaceutical companies have initiated educational programs, which they claim are meant to identify those individuals who are at risk of developing the targeted conditions. Some examples of these are hypertension, heart disease, and osteoporosis [11]. These programs are usually put on by making large donations to the organizations that research and support the various diseases, and in return these organizations “spread the word” about these newly invented drugs that promise to prevent undiagnosed and underdeveloped diseases [2]. This increases awareness and the number of screenings and with that also the number of individuals who can potentially take the medication. This is fine for individuals who have not been diagnosed with high blood pressure or for those at the early stages of cancer; however, these campaigns are not created to be completely altruistic and educational. Most of these campaigns are directly linked to the pharmaceutical companies’ media campaigns, whose only intentions are to convince the average American that they need a pill to prevent any possible disease [8].

Another factor that has increased the use of prescription drugs in America took place in 1997 when the FDA lifted the ban on direct consumer advertising. In addition, the law that requires every possible side effect to be listed was also removed [3]. The effect of this change is displayed strongly on the various television advertisements that target the emotional state of viewers rather than identifying the problem and effect of the drugs being advertised. This change in legislation allowed drug companies to attack Americans with a mass amount of media and news telling Americans to go and “ask [their] doctor for a specific drug [8]. In fact, America is the only country where you can turn on the TV, open the newspaper or a magazine and be told to go ask your doctor for a specific drug and brand [6]. However, what is more alarming is that doctors will prescribe medications to their patients if they ask for them even if they do not entirely need it. Dr. Marcia Angell author of “The Truth about Drug Companies” says that studies show that 54% of the time physicians will prescribe a brand of medication if the patient asks for it [3].

The prime example of this medical fraud that has let America down and destroyed the public’s trust involves ADHD medications. The creation of ADHD as a disease is one example of a series of conditions that has given the pharmaceutical companies an open door into the market of healthy people to promote long-term drug consumption [2]. The media has emphasized ADHD as a serious behavioral disorder that must be controlled with medication. However, it has failed to inform the public that in fact there is very little known about ADHD aside from the very broad hyperactive behavior, which many argue is just a characteristic of childhood [10]. Therefore, rather than informing the public of the serious side effects of ADHD medications, which some doctors have compared to the effects of cocaine, the drug companies, physicians, and public health practitioners have increased the use of ADHD medication by 369% in the past three years [9]. In the case of ADHD medication, rather than increasing awareness of the disease and promoting various modes of treatment, health professionals have increased drug use among American youth [12]. Rather than improving their quality of life, the use of ADHD medications has added a new dimension to their lives, which includes increased social isolation and cognitive toxicity [1]. Cognitive toxicity refers to the power of drugs to superficially create focus and increase simple analysis, while inhibiting more complex cognitive behavior and function [10]. Side effects such as these and the rapid increase of youth drug use are clear evidence that the alternative model of advertising and marketing, in the case of drug treatment awareness has failed, and rather than aiding American society it has opened the doors to a lucrative industry that is more interested in making money than helping the public [4].

The drug deregulations and the obvious favoring that occurs on behalf of the drug companies by removing the educational component of advertising campaigns leaves people wondering if in fact the well being of society is the priority of the FDA. It is obvious however that what lies at the top of the priority list for the FDA includes the protection of profit for pharmaceutical companies.

Modern medicine and American society:

Culture has a lot to do with the effectiveness of the various advertising attempts made by the business sector. In essence, the media cannot succeed if they do not know the beliefs and customs of the target population. However, what is even more complicated is that these beliefs and sentiments are often established by the media themselves and just accepted and adopted by society [8]. This leads one to the conclusion: that in order to increase awareness and establish a desired pattern of behavior, the media is the right means by which to do this [3]. It is clear that health practitioners have already discovered this, and as a result of this also discovered the tremendous opportunity to make money at the expense of people’s trust and health.

Health practitioners constantly express their regard and concern for the health of Americans; however, if these are genuine then the question persists—why is America still sick? There is no doubt that America has a prescription drug problem. The United States spends twice as much money on drugs and intakes twice as many drugs than other countries and yet still continues to have worse health than other industrialized countries [5].

It is no accident that throughout time America has become obsessed with health and the infinite number of pills available to cure so-called diseases. The purpose here is not to discredit all medications, or to say that drugs do not ever successfully treat diseases. However, the fact of the matter is that the health field has lost perspective of their mission and become greedy. John Abramson, M.D. author of Overdosed America: The broken Promise of American Medicine explains that America is pouring money into expensive drugs and outrageous medical devices, and in the process has left behind the best type of preventive treatment, which includes diet modification and exercise [3]. In order to refocus and alter the current beliefs of society, there needs to be a massive media movement that will push America away from the medication frenzy that has driven this society to the overconsumption and long-term addiction to the various drugs created by the industry that claims to have the public’s interest in mind.

Implications for the public health field-

Public health practitioners have as their focus and goal to improve the physical, mental and social health of Americans. As a result of this, they have joined with the various groups on the medical field to increase awareness and health screenings across America. However, this cooperation with medical sectors such as pharmaceutical companies has proclaimed this mission of awareness and goals of better health and opportunities as a failure.

Detox for an Overmedicated America-

Health professionals have throughout time been given the responsibility of taking care of the welfare of the public. This trust has been given without any hesitation and with the full confidence that these well-intentioned and trained individuals possess the ability, moral and ethical obligation to improve the overall health of the public. However, it is clear that they have failed to reach their publicized goal of educating and increasing awareness of the most common diseases attacking the American public and the prescription drugs available for use. Instead they have created a multibillion-dollar industry that survives and flourishes rapidly at the expense of the American people’s trust and health. It is clear that the health professionals’ attempt at increasing awareness and educating the public regarding the various health threats attacking them have been a complete failure that has resulted in an overmedicated America that finds relief and comfort in the hands of pharmaceutical companies. Therefore, the means by which the field initiated intervention to increase awareness and education need to be reevaluated and reinvented so that the goal of helping the public can be refocused and accomplished. The reinvention of the initial efforts to increase awareness on medical screening and the threats common diseases pose upon people must include the cooperation of government agencies, the education department, health professionals and the media.

The initial step that needs to be taken in order to achieve the initial goal of increasing awareness and education regarding disease prevention involves the government of the United States of America. This government was founded with the idea that it is “a government by the people for the people.” This statement, however, does not seem to be supported any longer as government organizations such as the FDA, seem to love the profit being generated by direct-to-consumer advertising so much that they have made it even easier for the drug companies to advertise their products by not requiring that all side effects be listed during commercials and by being able to run direct ads through the television and printed news scripts [5]. Therefore, it is time that the FDA rearranges its priorities and puts the welfare of people at the top rather than pharmaceutical profits. It is crucial that limits are set for these companies and that rather than advertising a brand by invoking overall positive emotions, their true effects and ability to help individuals is advertised [12]. The introduction of a new set of advertising guidelines put forth by the FDA for pharmaceutical companies will then reverse the standing effect of simply selling drugs for profit to a more focused idea that involves helping the public understand the proper use of prescription drugs and their side effects and other potential risks.

The next step to the successful intervention on the use of prescription drugs and their potential side effects involves the full cooperation of health professionals at all levels. The problem of overmedicating in America is due to the notion that a pill can solve every symptom of discomfort. This erroneous belief needs to be fixed at its root and this can only be accomplished by encouraging all health professionals to start taking the time with their patients to explain alternative preventive methods, such as an increase in exercise and a change in diet, in order to prevent a large majority of these diseases such as hypertension and diabetes that are affecting the American public at alarming rates [4]. In addition, physicians need to be reminded that their number one priority is the well being of people and that as public servants they must first and foremost fulfill this duty. If these physicians do no fulfill their duty they are in fact violating their medical oath and ought to be reminded of their priority. However, it would be illogical to place the responsibility of changing existing social trends entirely on physicians. Therefore, public health practitioners must also reassess the techniques being used to alter existing destructive behaviors and societal beliefs. In order to accomplish a successful intervention, it is crucial that they work in cooperation with physicians and social workers in order to introduce this new way of thinking into mainstream America and to assure that it is accepted and implemented at all societal levels. Once health professionals at all levels have reached a consensus on the best and most efficient way to educate and implement alternatives methods of preventive medicine, they can then take a step forward in an attempt to reverse the negative effects that a media-drug-driven America have had on its members.

Once the missions of the FDA, health professionals and pharmaceutical companies have been reevaluated and focused, an effective intervention should work to target and teach educators the importance of a balanced diet and exercise. In addition, teachers should be asked to join the team and provided with the necessary and proper diagnostic and observational tools that can help them to accurately distinguish a child that is in fact suffering from a behavioral disorder from one that is just simply acting according to their age. Such important and convenient tools can drastically reduce the number of misdiagnosed ADHD cases, a disorder that has claimed millions of children as slaves of Ritalin [1]. This addition to the education department has the ability to reset the American standards of medical treatment and therefore raise a generation that is not drug dependent and that amidst this fast progressing society is able to find health by means of the traditional treatment of a healthy lifestyle, awareness, education and alternative methods of preventive medicine. Even though a new method of treatment and means of implementation can be designed and deemed appropriate and ethical, in the 21st century whatever intervention designed will not be successful if the most powerful form of introduction and acceptance of new ideas in this society is not brought aboard to cooperate and make this issue the utmost important matter affecting the nation currently

The problem of overmedicating in America already exists and abolishing this already accepted way of thinking is one of the hardest goals to accomplish. Regardless of how well teachers and doctors are trained to teach and advertise the importance of understanding the use of prescription drugs and alternative methods of preventive medicine, the bottom line is that America is a society of consumers that relies on the media to be told what is ok to do, what it is that one needs, and the various things one should purchase. It is because of this that the number one factor that could help save America from overdosing is ironically the same instrument that brought it to the alarming high consumption of drugs at which it stands today. In order to reverse the beliefs of this industrialized society in addition to the full cooperation of government, medical professionals and educators, the ultimate intervention to limit the use of unnecessary drugs in America and the development of preventable diseases can only be successful if the media places this issue at the top of its agenda. They, in addition, must award the time, framing and present it with a degree of urgency that deserves to be spoken about daily until the American public realizes that a change in lifestyle and their current medical treatment options need to be changed. Furthermore, the prioritization of this issue by the media should also teach Americans to seek other options other than the easy way out and attempt to treat their various symptoms at the root rather than superficially with the use of pharmaceutical medications.

After educating the different levels of professionals regarding the changes that must be made in order to bring the alarming use of drugs in America to a halt, an advertising plan needs to be created in order to change the awareness, knowledge, and attitude of consumers towards a specific change being discussed. These changes take place all throughout the buying, a decision-making pattern that results in a change of behavior and standard beliefs. The first step in this intervention would involve the introduction of awareness. Past interventions have shown that the simple introduction of the importance of exercise and a balanced diet is not successful due to their lack of understanding of the average American lifestyle, which is fast paced and constantly being bombarded by economic hardships. Therefore, it is imperative that this campaign works to show first the alarming effects of overmedicating and the detrimental effects it can have on any one person. Once the negative aspects and acknowledgement of the problem is introduced the intervention moves into the next stage of consideration. In order for consideration to occur a solution to this alarming problem must be introduced with careful consideration of the various social and environmental factors that are affecting Americans today. It is at this point that the intervention seeks to make a connection with the consumer. Highlighting the costs of the various unnecessary medications being consumed and the money that pharmaceutical companies are wasting on advertising rather than investing on research are truly affecting the American society and the world can help make this connection. This approach on the economic effect is sure to receive attention especially due to the economic hardships that America is confronting today. It is at this point that alternative “cheaper” methods of preventive medicine can be introduced and the name of health professionals advertised as large pools of information at the disposal of the public.

The third stage of this intervention involves reaffirmation. At this stage of the advertising campaign the public reassesses the product or idea being introduced and attempts to find a place for it in their lives thus determining how convenient and appropriate it is for them. It is at this point that the importance of paying a visit to their physician is important and that a change in lifestyle that is characterized by an increase in exercise and a balanced diet can be stressed. However, the stress placed on these changes should be made in a different manner than in the past. They should be marketed with alternatives methods such as the addition of easy enjoyable exercises that can be done at home or outside or even ones that can be integrated during the workday. In an effort to obtain and retain a large audience these changes that need to be made must be attached with the idea that consumers will be saving money when opting for this option rather than spending thousands of dollars on unnecessary medications. This approach will certainly catch the attention of consumers during this time of recession.

The last couple of stages of this intervention all happen quite quickly as action tends to take place once the behavior is introduced enough times into the life of the individuals targeted. This is then reinforced by the constant repetition of the issue and its recommended solutions by the media who use the trusted physicians and other health care professionals in order to submit the desired behavior as a social standard and therefore into mainstream culture [12].

In conclusion the intervention used in order to assess the overmedicating problem in America needs to start with the cooperation from all levels of the health sector in this country. Once this cooperation has been reached, an advertising campaign displaying the negative effects of overmedicating and the various affordable solutions available to avoid future spending due to unnecessary problems can be used to grab the attention of an America that is overwhelmingly concerned with the ongoing recession.

References:

1-Are Children being given too many Drugs? Norwich Evening News 24, August 2006.

2-Bergin, Sue 2005. Stoning Young America: Over Prescribing Harmful Stimulants as a Treatment for Children with ADHD. Brigham Young University.

3-Bremner, Douglas J. 2006. Why do Americans take so many Prescription Drugs? Prescription drugs Review.

4-Healy, Melissa 2007. The Push to label many drugs isn’t well studied in children Revise standards, critics say. Los Angeles Times, Health.

5- Jensen, Peter S. MD; Kettle, Lori BS; R, Margeret T. MS; Sloan, Michael T. BA; Dulcan, Mina K. MD; Hoven, Cristina Dr PH; Bird, Hector. MD; Bauermeister, Jose J. PhD; Payne, Jennifer D, 1999. Are Stimulants Overprescribed? Treatment of ADHD in Four U.S. Communities. Child and Adolescent Psychiatry.

6-National Center for Health Statistics and Centers for Disease Control and Prevention. Health, United States, 2007. Department of Health and Human Services.

7-Null, Gary, PhD; Dean, Carolyn MD, ND; and Feldman, Martin, MD. 2006. Overmedication Seniors. LE Magazine.

8-Overmedicating of America. CBS News, Health. 2000.

9-Rados, Carol. 2004. Truth in Advertising: Rx Drug Ads Come of Age. FDA Consumer Magazine.

10-Rowland, Rhonda 2001. Ritalin Debate: Are we Over-medicating? CNN Health, CNN Medical Unit.

11-Salaman, Maureen Kennedy 2006. The Medicating of America. National Health Federation News.

12- Sighn, Llina, 2004. Doing their jobs: mothering with Ritalin in a culture of mother-blame. Faculty of Social and Political Sciences, Center for Family Research, University of Cambridge, Cambridge, UK.

13-Standish, Maude, 2008. Too many drugs? American Academy of Pediatrics News. Vol. 29 No. 9, p. 28.

14-Too many Drugs “Not Child Tested.” BBC News, Health. 2006.

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