Are we Overmedicated?

This is a question that can't really be asked or answered this generally. There are some examples in which we don't provide enough medication, others in which we provide too much, and others in which non-medication interventions are just too hard for people to follow. A lot of the problems in this country with high blood pressure, congestive heart failure, and cirrhosis would be ameliorated if people didn't eat any salt at all in their diets, but that's a nearly impossible thing to ask. A lot of elderly people suffer because they take way too many medications and have side effects. And a lot of people with tuberculosis and malaria die because people lack access to the right medicines.

I think it depends on who's giving you the medicine and under what pretext. Meaning a couple of factors such as:

-What are they getting out of it
-Is it based on honesty instead of bias
-Is it necessity or comfort (very hard to answer in alot of cases, because of outside opinions)

Is there a great deal of overmedication? Yeah, I think we can safely say that there is given that water supplies in the UK and US (at least) are tainted with pharmeceutical drugs. Then again, as Aedes points out, there is also a great deal of undermedication - and sheer lack of medication.

Most cases of overmedication can be ascribed to the following causes:

1) Lack of well-designed research trials to show whether a given medication is safe, efficacious, and cost-effective

2) Excessive marketing, especially direct-to-consumer. Over the last few years direct-to-physician marketing has been slashed by national regulations

3) The impracticality of doing equivalent things without drugs. For instance, avoiding salt, quitting smoking, exercising, and portion control would prevent a hell of a lot of coronary artery disease and stroke, but the fact remains that these things are exceptionally difficult to implement. Another example is cognitive-behavioral therapy for psychiatric disorders -- just not enough people who practice it, it's too expensive, and it's not covered by insurance.

4) Systemic problems -- for instance, people can have multiple specialists without a primary care doctor to try and organize and stop redundant or unnecessary medications. Or sometimes they leave the hospital with a new prescription that their regular doctor never questions, so they just keep taking it forever.


But before we lament overmedication, let's think about clinical trials here. I can show you rigorous evidence of a mortality benefit when aspirin and beta-blockers are given to heart attack patients. I can show you a mortality benefit for ACE-inhibitors for heart failure patients. I can show you that the annual mortality and hospitalization rates for HIV/AIDS dropped by around 80% with the advent of antiretroviral combination therapy.

So drugs are good for something.

I'm fairly extreme on this topic in that I think we could be setting ourselves up for failure genetically. The further we advance technologically and medically the more we are reliant upon it. If we are ever presented a future that lacks the sustainability of present day technology and medical operations it probably wont turn out in our favor because of our increasing dependence to them. Do I think that even if this is likely that we will be able to adjust and subvert the inevitble outcome of this scenario? No, it's inhumane to think like that...too reminiscent of the atrocities of World War II, best to let time do it so we can shift responsibility to some factor other than ourselves and in turn keep a clear conscience. Cheers! *takes a shot of penicillin*

thysin

That is a pretty extreme view. It's also pretty baseless. Our ability to succeed genetically in the future 1) does not trump our need to address the suffering of now, 2) cannot be modeled or predicted in any meaningful way, and 3) will depend mostly on how the environment around us changes and NOT how we change. If our medical care is preserving "weaker" elements of our gene pool, then those will be selected out anyway if the environment changes or if our medical system collapses.

It's not even close to being baseless. If I take antibiotics because of an infection I am lessening the need for my own immune system and in turn weakening it. Evolution happens when something gives you a leg up and helps you survive. We are giving everyone a leg up reguardless. Halting evolution sounds good? Your last sentence is exactly what I just said, they will, and I was just pointing out it wont be pretty.

Speaking as a board-certified infectious disease physician, that is pretty close to baseless. Sure, go challenge your immune system instead of taking antibiotics for your meningitis -- you'll die, but hey, at least you've challenged your immune system.

By the way, you DO develop robust immune responses to infections even when they're treated with antibiotics. I'm on a national panel for Lyme disease, and the medical literature strongly supports a durable, measurable immune response long after treatment has been completed.

I'm completely with you when it comes to selection of drug resistant microorganisms as a consequence of overuse of antibiotics. But that's not an indictment of antibiotics as a type of therapy -- only an indictment of overuse.

You're argument is logical, but again I failed to clearly convey my point. What I'm saying is that in our over-sterilized and over-medicated society we are slowly but directly weakening our own immune systems by under-stimulating them and allowing genes and defects that would normally be culled by nature to survive and propagate. My statements were obviously badly worded because I never meant to imply that this is something that will happen in one generation. If over 100 generations we use antibiotics to fight the common flu, even though we could let it run it's course and still be alive, will the people of the 100th generation still be able to fight off the flu without antibiotics? You're clearly better equipped than I am to argue this so I'll definitely back down if you tell me my reasoning is flawed. As to the lyme disease idea, that's good but I don't think one disease constitutes clear evidence that completely disproves my thoughts on the subject.


edit: I'll leave what I put originally but I re-read your last post and I get it. Specifically that overuse might lead to superbugs and whatnot but normal application is good.

What about stuff like c-sections? Or would that be better for another thread? If a woman had a narrow birth canal it was two deaths, now it's leaving the narrow birth canal genes in the pool.

Medication is definitely prescribed too extensively in modern Western society. Medication is also a very broad term, not limited to just pills, but ointments, liquids, powders, and even food--such as certain medicinal plants. However, as indicated by WithoutReason's initial post and the subsequent responses, I will just limit the discussion to pills. I feel like this topic is going to definitely be more debate oriented than philosophically argumentative, simply because so much of it is over the controversy of methodology, but I am prepared :Cara_2:

As Aedes said, one of the huge problems is that there is too much marketing to the consumers today. This means that if Joeblow sees an advertisement on T.V. saying "Do you suffer from headaches, nausea, a general reaction to normal outdoors environments, then ask your local or family doctor for X," then when Joeblow walks into the doctor's office the doctor is going to be pressured to give the patient the medication--whether Joeblow needs it or not. To be frank, these commercials put many consumers into the position to which they feel as though they can diagnose their own symptoms by providing over simplified & generic checklists for people to ask themselves about. So if a doctor refuses to give such a 'self-educated' patient their medication for any number of moral reasons, the patient can simply get a different doctor. Imagine the amount of pressure this puts on doctors. I will make my first claim here: pharmaceutical companies are businesses. They care about profit and selling products and should almost never be confused with being altruistic simply by the claims that their products are supporting to 'cure'; and this brings us to my next topic.

One of the worst characteristics of the Western medical institution [sic system] is that most scientists, doctors, pharmaceutical companies, and consumers work under the ideology that medicine should first and foremost aim to be an eliminative system. This ideally attempts to heal people by directly eliminating what it bad rather than by a more holistic view of the human body and the role of medicine. Here is an example of a directly eliminative (aka. non-holistic) vs. a holistic approach: Western medicine would do studies of thousands of people to try to find a particular cause of something bad, then they would say "Eliminate it," while much non-Western medicine would locate the item doing harm and say "Balance it." The holistic approach is to say that the object of initial harm is not in balance with the rest of the system, for example if a person has high cholesterol, then it is partially because they are eating too much salt not that salt is inherently bad (something that Western medicine is much more practiced and prone to saying). Therefore, something I am willing to also claim is that Western medicine does excellent work in identifying particular causes, but that it does terrible in contextualizing the particulars to the system as a whole. It should be no wonder, then, that what Western science has seen in--at least--the last 50-years is that when we eliminate one problem, a whole host of others just seem to pop up in its place. The point of this is that the pharmaceutical industry has been studied and been shown to be directly reflective in its growth to this trend of thinking in Western medicine. No larger does this distinction of holism arise than in the field of Nutrition, and therefore, this is the next area of trouble I would like to move into.

Nutrition is concerned with the amount of nutrients necessary to support life. Amount holds a very encompassing usage in nutrition, by amount we mean not only simply the number and types, but the balance. I think this is apparent when one thinks about how we could even determine the number of a particular nutrient without knowing how it interacts with all of the other nutrients. Thus, naturally, the balance of nutrients comes into play. On a less important note to this discussion, "support life" is not merely concerned with the minimum amount, but with the best amount, this leads towards a broad notion of life in which nutritionists also wonder about all of the types of lives (e.g. optimal, worst, etc.) and which amounts of nutrients will lead towards those. I bring this topic up because nutrition has clearly always been concerned with a mostly holistic notion of health, that through the balance of optimal ingredients we naturally rid ourselves of most adverse health effects. Food as health is a very important part of the field of nutrition, but this idea has been given up in favor of the pharmaceutical companies slogan which is 'You can't do anything about your health and body, only our drugs can.' The view that many people seem to have these days is 'if I am sick, I should see my medical doctor to check which drugs I can get to help.' This reliance on drugs over first consulting which things we are doing wrong nutritionally that might have been causing a rash of sicknesses, for example, is not the dominant habit of our current society by far. It's quite amazing to think about, because it is food that we ingest every single day, yet it is our current habit that we don't consider something we ingest to play such a large role in our daily health. When you think about it, our body gets over 95% of it's content from food!

Simply put (claim #3? :Cara_2:), one large reason that most people are taking too much medication is because our current society has been promoting these types of companies as being able to do the 'hard work' for us. Joeblow doesn't need to concern himself with nutrition--food as medicine. Instead, he can put all of the concern into companies to do it for him and then give him the solution. "But this is not how it works Joeblow." The fatal problem is that:[INDENT]A) Pharmaceutical companies are rarely ever altruistic in nature. They are businesses and want to sell their products like any other business

B) The concern of the consumers to care about their health in a holistic fashion has thus been deteriorated into a simplified non-holistic approach, because companies cannot sell the most products if their products require the customers to do most of the work themselves. Therefore, to take away the work of the consumers they ask as little as they can and promote as much as they can, and the consumers have since taken the view that everything can be fixed with a short, simple solution.
[/INDENT]It's quite humorous to think about, because much of the pharmaceutical industry has actually become the exact purporters of "magical remedies" and "miracle cures" that it set out not to be.

I agree with Aedes conclusion that there is a "lack of well-designed research trials to show whether a given medication is safe, efficacious, and cost-effective." However, I would like to make a particular point to state the lack of funding towards nutrition and nutrients in foods especially when compared to the national and governmental funding of drug companies.

One more huge concern is with the methods in which drug companies and the overall Western medical institution evaluate the usefulness of drugs. This is a huge can of worms here, but there are some very dubious methods that some companies/institutions use to evaluate the usefulness of their drugs. For example, if a person takes a drug and because of the drug starts to develop other problems and must then take drugs for these (the common downward spiral of drug taking that I believe we are all too familiar with), then the cause of death cannot be marked as having anything to do with the drug(s). Rather, even if the person died of organ failure that can be shown to be a direct cause of the drug(s), then it is attributed to the illness--not the cumulative effects of the drug(s). This skews a tremendous amount of the results on the benefits of drugs. I believe this can be most noticeably seen in effects of immunization studied in dozens of books (please inquire for a source list if you are interested in reading more material about this).

Lastly, I would like to clarify that I have cut-short the depth of nearly all of the topics here. Thus if you are interested in reading more and/or are concerned that there may be, for any number of reasons, a lack of academic and professional research into these topics, then rest assured that this is definitely not the case. There is much layering to be found whether it be from theories of nutrition, studies conducted on the marketing of pharmaceutical companies, methodologies of medical inquiry, or simply the approaches to viewing organic/non-organic system interactions in nature.

Thysin, you raise some good points, and C-sections are actually an outstanding example to consider.

I'm at work and I don't have time to type much.

But I'd like to offer you the following thoughts to consider.

1) Is medical care separable from society and technology as a whole?

No, it's not. Medical illnesses, and the rationale for treating them in various ways, is part of our development as communities. And medical care is in itself a product of evolution, in which we've developed the ability to treat ourselves.

Streptomycin will kill the bacillus that causes the Black Death. But the Black Death would have never happened were it not for urbanization in medieval Europe and maritime trading between Europe and the near East.

Various drugs will cure malaria, which has been the single strongest selector of the human genome for thousands of years. It has not, however, selected for "stronger" populations by any measure. Yet there are more than half a billion cases of malaria every year, and it's the single leading impediment to economic development in Africa -- which potentiates other diseases including HIV.

A very large number of babies in the US are born by C-section, over 25% in some hospitals. This has greatly decreased the amount of infant and maternal mortality. We live in a society in which the potential contribution of people -- even if just to happiness and family stability -- is greater than the theoretical impact on the gene pool of not just summarily letting people die out of principle.

We've developed large population sizes as a result mainly of agriculture. Large population sizes potentiates epidemic disease much differently than small, isolated populations. The technological development of things that make our lives better and easier is part of our development of large population centers, which allows a subset of people to be "inventors", scientists, etc. Medicine is part of that.


2) To what degree should concern for our evolution be part of medical ethics?

My opinion is that it should be a trivial concern. We cannot anticipate the selective forces we will face in the distant future. There's simply no way. Public health is a major part of medical ethics, medical research, and allocation of medical resources. But we have very little real control over evolution (this is patently obvious if you look at the math behind gene frequency change), and evolution has to do with things OTHER than selective pressures -- it has to do with social factors, population sizes, population movement, limitations on fertility, randomness of mating, etc. Throw in selective pressures and how can we know what the average movement of genes will be over the next 5000 years or 10,000 years (which is essentially a trivial amount of time in evolution). And what sort of obligations do we have to the distant humanity of 10,000 years from now? I'd say that it would be prudent to not contaminate the earth with toxic and radioactive waste and to not kill off the oceans and all the trees -- but that argument can be made for the current generation, so it trumps the generation 10,000 years from now.

I disagree with this, quite vehemently in fact. Though I do understand that it "feels" that way to patients quite often.

Well medication is possibly the reason I am still alive and dictating this post.

As a life long sufferer of manic depression I think without the medication that finally balanced my extreme mood swings I would have committed suicide.

Medication has done much greater good than harm, but what about medical science saving the genetically weaker and thus weakening the human gene pool?

Please I am just asking that as a scientific medical question, I am one of those genetically weak and in the Nazi requiem I would have been murdered for my flaw

Nevertheless my genetics are in my children and grandchildren , and the evidence is already there

A few things to ponder:

1. Modern medicine has been changing mortality rates on a population-scale for less than 100 years. Just a few generations. That's spitting in the ocean on the scale of genetic change.

2. We're FAR more threatened by resource use and environmental damage than we are by the genetic impacts of modern medicine.

3. Many medical interventions improve longevity after the age of reproduction, so they will not alter reproductive fitness. Furthermore, for psychiatric conditions, it's likely that many untreated people will have more kids with more marginalized lives in the absence of therapy, so treating these conditions may improve our population (genetically and socially).

4. Evolution is an interplay between reproductive fitness and external conditions. We have no idea what will be advantageous genotypes in the future, because we cannot predict future conditions.

5. What really is our moral obligation to the genotype of our very distant progeny -- 1000, 10,000, 100,000 years from now??

6. Modern medicine is a product of human evolution. It in itself has been selected. Humans are a species that uses complex tools to survive -- medicine is one of them.

There are a number of health problems whereby drug intervention, if not being the only option, is certainly the most sensible. An obvious example would be HIV or AIDS. There are also a number of health problems whereby drug intervention seems the most appropriate form of treatment, when evidence supports more humane treaments, my example to this would be the use of antipsychotic medication in the treatment of "schizophrenia".

Some things are unduly treated using only drug intervention, or predominantly drug intervention, but that does not mean to say pharmacological therapies need to be done away with altogether.

I was at the VA yesterday and was talking to a lot of other vets and just noticed a few things and thought I'd slap em down here.

One of the guys I was talking to was gone, he kept saying these random ass things that made absolutely no sense and had no context. One that I remember off the top of my head was when some other guy was talking about the tobacco tax and this man spouted out "Once it bit me and I got bigger but the doctor said it wasn't". It was kind of creepy to say the least. The point of that encounter is that when he stood up to walk off I noticed he had a duffle bag and as it shifted all I heard were pills/pill bottles rattling. I wonder what he would be like if he didn't take them? I wonder if he was just extremely crazy to begin with and now he is better than he was without them or if the pills made him that way...

Not every vet that has MH issues is like that, obviously, I have some and I'm fairly coherent 90% of the time, hehe.

He might be worse or he might be dead. Just impossible to know without knowing what they are or what they're for. But most people are not crazy whether or not they're on 30 medications.

I'm on SSRI's(citalopram) and I notice a few side effects, loss in concentration, sometimes I'm a bit apathetic and sometimes I'm a bit over the top in my happiness. I'd rather stay on just one instead of running the risk of having side effects from multiple meds.

I figure he would probably be dead because it was most likely PTSD and with that many meds probably an extremely suicidal case...a 1 on the GAF. Even with all the meds he had no personal hygiene or communication skills. Was quite awkward.