More is Not Necessarily Better

With the recent death of Whitney Houston and other celebrities like Michael Jackson and Heath Ledger, one wonders how such tragic abuse of prescription drugs can occur. Is it a matter of unethical doctors over-prescribing medications and wealthy stars demanding and getting what they want? Or is there a larger issue in the U.S. with the amount of prescription drugs dispensed, the absence of coordination among medical care providers, and the lack of awareness among many Americans regarding the dangers and contraindications of medications?

The recent book, How We Do Harm, by Dr. Otis Brawley, Chief Medical Officer of the American Cancer Society, talks about two populations at risk by the U.S. health care system. First, there are the working poor who are under-served by the U.S. health care system. Ineligible for Medicaid, they may lack health insurance coverage and are often denied access to adequate medical resources. They may put off seeking medical attention—until it’s too late—because they are reluctant to take time off from work for fear of losing their jobs or missing a paycheck.

The second group is composed of Americans with ample health insurance who are over-served by the U.S. health care system. They often demand a medical procedure, test, or pill, as a quick fix for any ailment. Their physicians, wishing to please their patients (and perhaps eager to earn additional revenue), prescribe medication when the condition might get better on its own or order an additional test to ensure that they haven’t missed any medical condition that could come back to haunt them.

I have talked with many people who are taking an extensive array of medications—anti-depressants, statins for high cholesterol, antibiotics, antacids, vitamin supplements, hormone therapy, sleep aids, etc.—on a daily basis. Are some of these medications absolutely necessary? Yes, of course, and some are definitely helping. However, in medicine, a one-size-fits-all approach doesn’t always work. Prescription medicine does alter the chemistry of the body and may have unwanted or potentially long-term side effects that may require further medication, thus complicating the situation even more. And some of these medications might be eliminated with lifestyle changes in diet, exercise, proper sleep habits and relaxation techniques. Moreover, many Americans see different medical specialists for different ailments. A specialist may only be focused on a specific physical condition and may not be aware of the larger health care picture and the variety of medications that a patient is taking even though a thorough medical history is requested. There may be no one coordinating the overall health of the patient.

But most of us are not medical professionals and we rely on our physicians to do what’s best for us. Yet, a recent survey by the University of Pennsylvania Department of Medical Ethics & Health Policy showed that 20% of physicians will not tell a patient if he/she has made a mistake and over 10% will not reveal a potential conflict of interest in which the doctor would stand to gain financially from a pharmaceutical company.

So what is a layperson to do when a physician prescribes a medication or treatment plan?

• Understand your options. Ask about the pros and cons and the risks involved. Are there alternatives? What are the potential side effects? What are the risks if you did nothing?
• Do your homework. Are there studies and research that you can review? If you don’t understand the medical jargon, ask for help to interpret the findings.
• Get a second opinion—or even a third—to confirm the treatment or provide an alternative.
• Provide your physicians with a complete list of medications including frequency and dosage amounts. Ask if there are any contraindications or if any could be eliminated.
• Know your body. People react to medications differently. Be aware of side effects and how your body is reacting. Do you feel unusually agitated and irritable or sluggish and fatigued? Tell your doctor about any changes that you notice.
• Take better care of yourself. It is widely accepted that healthy lifestyle habits can prevent many chronic and life-threatening diseases—heart attack, cancer, stroke, diabetes, etc. You might be able to reduce some of the medications by making some basic lifestyle changes.

I have a great deal of respect for physicians and the health care system in the United States. But what I’m realizing is that there’s a lot of trial-and-error involved and each person is unique. Physicians cannot know you better than you know yourself. Be your own health care advocate and don’t be afraid to ask questions. More medicine does not necessarily lead to better health.