- The Washington Times - Saturday, March 26, 2005

Alexandria resident Martha Clement pops seven prescription pills each morning, washing them down with an 8-ounce glass of water. She takes two more in the evening.

The retired 78-year-old started most of her seven medications in the past decade, primarily because heart conditions and arthritis pain had cropped up.

“I feel very lucky that at my age I am independent, in the sense that I can take care of myself and sort out my own medication,” Ms. Clement said.

She is one of the estimated 119 million Americans, or 44 percent of the population, who take at least one prescription drug to quell ailments ranging from chronic diseases such as diabetes and high blood pressure to “lifestyle conditions” such as sexual impotence and baldness.

Seventeen percent of those people take three or more medications, according to the U.S. Department of Health and Human Services.

Patients last year spent $235.4 billion on prescription drugs, up 8 percent from 2003 sales of $217.3 billion, according to Fairfield, Conn., pharmaceutical information and consulting company IMS Health Inc. The pharmaceutical industry is expected to post 7.5 percent to 8.5 percent sales growth this year.

Doctors and health care researchers said they see no slowdown in America’s prescription-drug use. In fact, they expect more consumers of all ages to start prescriptions as more drugs come on the market, the population ages and lives longer, patients go on drugs to avoid making changes in their diets and lifestyles, and advertising continues to proliferate.

More medications are available now than ever before, treating conditions such as heart disease, depression, attention-deficit disorder, social anxiety, arthritis pain and Alzheimer’s disease.

An estimated 10,800 brand and generic drugs, which include prescription and over-the-counter medications, are sold in the United States, said the Pharmaceutical Research and Manufacturers of America (PHRMA), a Washington trade group.

The U.S. Food and Drug Administration approved 27 new drugs last year, up from 21 in 2003.

Americans are living and staying on prescriptions longer, with life expectancy reaching a record high in 2003 of 77.6 years, according to the Centers for Disease Control and Prevention.

Health problems, especially chronic diseases that require lifelong prescriptions, are increasingly being detected earlier in a patient’s life.

More treatments are being approved for chronic diseases, such as diabetes, osteoporosis and high blood pressure.

As many as 146 potential medicines just to treat heart diseases and strokes are in human clinical testing, PHRMA spokesman Jeff Trewhitt said.

With the abundance of treatments, more doctors are prescribing medications for preventing diseases, as well as treating current ones.

Dr. Howard Wilson, a family physician at the Family Medicine Group of Howard University in Northwest, said he advises more of his patients to start prescription drugs earlier in life to prevent the onslaught of chronic conditions.

“And because in many cases we’re trying to prevent complications, we have many patients taking more medications than ever before,” Dr. Wilson said.

Avoiding change

For a growing number of patients, prescriptions are the best way to treat illnesses, because they will not make long-term lifestyle changes, said Dr. Ramin Oskoui, a cardiologist at Washington Hospital Center in Northwest.

However, Dr. Oskoui said he will advise change in some cases.

“One man I saw had malignant hypertension. He cut down his salt intake dramatically and brought the condition under control,” he said.

But most patients do not change their ways or their conditions are too risky to avoid medication, Dr. Oskoui said.

Dr. Wilson said he worries that more of his patients have become quick to request medication for problems that do not need treatment.

“What [the patients] see as a quick fix, a lot of times can create additional problems,” he said.

Dr. Wilson said he stresses nonmedical approaches such as dieting, exercise, taking vitamins and stopping smoking in cases in which drugs are not needed.

Selling to the masses

One of the reasons that patients have been quicker to suggest drugs is the barrage of ads they see on TV and in print.

Drug manufacturers have stepped up their consumer advertising, which includes ads in magazines and newspapers and on radio and television.

After the FDA eased restrictions for broadcast ads in 1997, allowing ads to have both the drug’s name and the condition it was intended to treat without having to disclose all potential side effects, more consumer-directed ads hit the market.

In 2000, every $1 spent on direct-to-consumer advertising for a drug yielded $4.20 in pharmaceutical sales that year, according to a June 2003 report from the Henry J. Kaiser Family Foundation.

“Certainly, advertising affects drug spending. But not nearly as much as the critics say and not nearly as little as the industry says,” said Richard Frank, an author of the study and a health economics professor at Harvard University.

For every 10 percent increase in direct-to-consumer advertising for a prescription drug, sales for that entire drug class rose on average 1 percent, the report said.

Some doctors said a few patients are prescribed a drug they requested after seeing an ad. Dr. Keith Lindgren said ads plastered on billboards and on television are definitely affecting his patients.

“The average patient is more aware of the medications out there and is more accepting of medications as a long-term solution,” said Dr. Lindgren, cardiology director at Washington Adventist Hospital in Takoma Park.

Consumer groups have been calling on the FDA to restrict drug advertising since Vioxx, the popular — and heavily advertised — painkiller from pharmaceutical giant Merck & Co. Inc., was recalled Sept. 30 after a study linked the drug to higher risks for heart problems.

The agency has no plans to change the advertising policy, spokeswoman Susan Cruzan said.

Treating chronic diseases

About 57.3 million working-age Americans, or 33 percent of people 18 to 64 years old, have at least one chronic disease, according to the most recent data from the Center for Studying Health System Change, a Washington health-policy research group.

Spokeswoman Alwyn Cassil called the estimate “conservative” as the center followed 10 of the 14 chronic conditions, which include asthma, arthritis, diabetes, chronic obstructive pulmonary disease, heart disease, hypertension, cancer, benign prostate enlargement, abnormal uterine bleeding and depression.

New drugs have helped keep these conditions, which do not have a cure, in check. But more than one drug often is necessary to treat all of a condition’s symptoms, said Dr. Edward Langston, a Lafayette, Ind., family physician and member of the American Medical Association’s board of trustees.

Hypertension, or high blood pressure, requires three to five medicines to keep the condition under control, Dr. Langston said.

For diabetes, Dr. Langston said he often advises patients to take insulin with other oral medications.

Mary Jane Owen, 75, a resident of the District’s Adams Morgan neighborhood, takes four pills from three prescriptions to treat arrhythmia and other conditions.

Without her daily dose of Tikosyn, a powerful medication that requires physician surveillance for at least three days when a patient starts on it, Ms. Owen said she would not be able to get out of bed.

“It has allowed me to function in a way that is, to me, almost like a miracle,” the retired federal employee said.

But she hopes her doctors will recommend pulmonary vein surgery in the near future so that she can stop taking the medication.

“It’s not because I have had any side effects, but because it’s such a new medication that nobody knows the long-term impact” of taking it, she said.

Mood-altering drugs

A surge in prescription-drug sales has been for “psychotropic” drugs, prescription drugs that are used to stabilize or improve a patient’s mental status, mood or behavior.

Children and adolescents are taking more of these drugs, which treat disorders such as attention-deficit disorder, anxiety attacks and depression.

The use of antidepressants jumped about 10 percent annually from 1998 to 2002 among children and adolescents, according to an April 2004 survey by Express Scripts Inc., a St. Louis pharmacy-benefit management company.

The fastest-growing segment of users was among infants to 5-year-olds, said the report, which tracked antidepressant use among 2 million commercially insured patients 18 years old and younger.

The report found medication use among preschool girls more than doubled while use by boys shot up 64 percent.

Between 1991 and 1995, the number of 2-year-olds to 4-year-olds receiving stimulants, such as Ritalin, or antidepressants, such as Prozac, increased two- to threefold, according to a 2002 study in the Journal of the American Academy of Child and Adolescent Psychiatry.

But a string of teen suicides in the past several years has been connected with taking antidepressants, prompting the FDA to push through label warnings, changes and medication guides for 34 drugs.

Many teens involved in school-based violence have been on mood-altering drugs at the time. Jeff Weise, who went on a deadly shooting rampage at a Minnesota high school last week, was on Prozac, while Eric Harris, one of the two teens involved in the shooting massacre at Columbine High School in Littleton, Colo., was on Luvox, another antidepressant.

Dr. Adelaide Robb, medical director for inpatient psychiatry at Children’s National Medical Center in Northwest, said she has not seen an increase in the amount of antidepressants and stimulants she prescribes for younger patients with serious mental illnesses.

“I think the medicine really depends on the illness,” Dr. Robb said. Children with attention-deficit disorder are likely to be put on medicine, but a key part of treatment is having adhered-to rules at home, she said.

“But for children with schizophrenia, anti-psychotic drugs will help make the voices they think they hear disappear. They can go back to school and leave the house without feeling scared,” she said.

Jeff Kupfer, a behavioral psychologist in Superior, Colo., said he is worried doctors and parents are overmedicating children, allowing some to become dependent on prescriptions instead of trying counseling or other nonmedical changes.

“Now I have seen in many instances where the right drug in the right dose for the right person can make a huge difference,” Mr. Kupfer said. “On the other hand, I have seen exploitations in medications.”

Adult use of antidepressants nearly tripled between 1999 and 2000, according to the Department of Health and Human Services. Ten percent of women 18 and older and 4 percent of men now take antidepressants.

Lifestyle drugs

Though a smaller segment, more “lifestyle drugs” are emerging in the market. These drugs are not medically necessary, but they can improve the quality of life for people with problems such as erectile dysfunction, wrinkles, baldness, dry and blemished skin, hot flashes and incontinence.

Impotence medications, the leader among “lifestyle drugs,” grossed $1.36 billion in U.S. sales last year, up 8 percent from 2003 sales of $1.26 billion, according to IMS Health.

The companies making four sexual-dysfunction drugs — Viagra, Cialis, Levitra and Muse — spent $425.1 million in advertising in 2004, up from $88.5 million in 2001, according to Nielsen Monitor-Plus, a service of Nielsen Media Research.

While studies have reported that more younger consumers are using these drugs, pharmaceutical analyst Shaojing Tong said baby boomers are still the main customer base.

Mr. Tong, who works at New York health care investment firm Mehta Partners LLC, forecasted that the “lifestyle drug” market will continue to grow steadily, but will not have the surge he projected for heart and stroke medications.

The dangers of mixing

Consumers put themselves at risk when taking more than one medication or mixing it with over-the-counter drugs or dietary supplements.

For example, patients on blood-thinning medicine who take aspirin can thin the blood more than is healthy, according to the National Institute on Aging, part of the National Institutes of Health.

Antacids can interfere with certain drugs for high blood pressure, heart disease and Parkinson’s disease, the institute said.

And “lifestyle drug” Viagra can cause a dramatic drop in blood pressure if mixed with nitroglycerin medication for heart problems, according to the American Urological Association.

Dr. Wilson said he was concerned some of his patients prioritize “lifestyle drugs” over medications for more serious illnesses.

If one of these popular medications puts a patient on other drugs at risk, Dr. Wilson said he will suspend its use.

Most doctors use computer programs to monitor medication safety.

Ms. Clement, who has five doctors she usually sees each year, takes a list of her seven medications to each doctor visit.

“I don’t worry too much about drug interactions anymore. I feel each of my doctors is now aware of what I’m taking,” she said.

But not all patients are as careful.

Federal health programs such as Medicare are testing home-monitoring systems to track chronic patients’ medications and conditions while relaying the information to their doctors.

The larger prescription-drug market has contributed to a rise in the abuse of prescription drugs, primarily painkillers and antidepressants.

Almost 30 million Americans, age 12 and older in 2002, have used prescription pain relievers nonmedically in their lifetime, according to the most recent report from the Substance Abuse and Mental Health Services Administration.

People taking the drugs for the first time for nonmedical reasons jumped from 600,000 in 1990 to 2 million in 2001, the report said.

Despite the risks and potential dangers from an overmedicated society, health officials said the effectiveness of new drugs has lowered the need for some surgeries and reduced the numbers of preventable deaths.

Deaths from heart disease, cancer and stroke, the nation’s three leading killers, dropped from 1 percent to 3 percent in 2002, the Department of Health and Human Services said recently.

Ms. Owen, whose pills have helped her enjoy an active lifestyle, said she is thankful for new medications that have improved the quality of her life.

But she still fights with her doctors when they suggest a new treatment.

“It’s so easy for a doctor to throw a pill at you these days,” she said.

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