Are You Taking Too Many Medications?

John Abramson, MD
Harvard Medical School

With our national pharmacy bill now topping $200 billion each year, and recent disclosures about harmful and ineffective drugs, more people are asking: Are all those pills really necessary?
To learn more, Bottom Line/Health talked with John Abramson, MD, a Harvard Medical School clinical instructor who is widely recognized for his in-depth research of the drug industry...
Are most Americans overmedicated? They sure are. Americans take many drugs unnecessarily, and when drugs are needed, people often take the wrong ones. For example, before rofecoxib (Vioxx) was withdrawn from the market because it was found to cause heart attacks and strokes (and was discovered to provide no better relief of arthritis symptoms than older, much less expensive anti-inflammatory drugs), about 80% of the Vioxx that was prescribed worldwide was used in the US.

Are doctors to blame? The vast majority of physicians prescribe medication because they think it's in their patients' best interest. But there have been radical changes in the way that our medical knowledge is provided. Before 1980, most clinical research was publicly funded, but now most is funded directly by the drug and other medical industries, whose primary mission is to maximize the return on investments for investors.

Ninety percent of clinical trials now are commercially funded -- as well as 75% of published clinical research. When a pharmaceutical company sponsors a study, the odds are five times greater that the findings will favor its product.
Drug and medical industries fund 70% of continuing education lectures and seminars, which are among the activities that doctors are required to attend to maintain their licenses to practice. Wherever doctors turn for sources of information, drug companies dominate.
Who should be monitoring doctors' relationships with drug companies? The real failure is on the part of government agencies, such as the FDA and the Agency for Healthcare Research and Quality. Medical journals and academic researchers have become dependent on drug company money and/or are vulnerable to drug company lobbying. Doctors and the public still trust these institutions to independently oversee the integrity of the medical knowledge that informs our medical care, when they simply are not able to do this anymore.

We all know that cholesterol-lowering statins are widely prescribed. Are they unnecessary? Despite being on the market for 18 years and becoming the best-selling class of drugs, statins have never been shown in randomized, controlled trials to provide a significant health benefit when used by women of any age without heart disease or diabetes. The same is true for men over age 65 without heart disease or diabetes. Even so, millions of people in both groups now are taking a statin drug.

Is it ever advisable to take a statin? Yes, there is good evidence that statins are beneficial for people who already have heart disease and for at least some people who have diabetes. A good case also can be made for men who are at very high risk for heart disease (LDL "bad" cholesterol approaching 200 and other risk factors).

What other drugs do you think are being prescribed because of drug company influence? Antihypertensives -- drugs used to treat high blood pressure -- are good examples. Newer medications, such as calcium channel blockers and angiotensin converting enzyme (ACE) inhibitors, are among the most popular. One of them, amlodipine (Norvasc), was the second most commonly prescribed drug for older adults in 2003. But a study funded by the National Heart, Lung and Blood Institute found that diuretics, which have been around for decades, are as good or better than Norvasc in protecting against complications of hypertension, such as heart attack and stroke. A diuretic might cost $29 per year, compared with $549 to $749 for Norvasc, depending on the dose. The patents for diuretics expired decades ago, so drug companies don't profit much from them.

Should everyone with high blood pressure just take a diuretic? High blood pressure is a complex problem. Some people respond to one drug, some to another, and some need more than one. It would make sense, though, to start with a diuretic, and use expensive drugs such as Norvasc only when other alternatives haven't worked.

Are natural therapies a better alternative to some drugs? If you look at the data rather than listen to the drug ads, you see that natural alternatives, such as improved diet and routine exercise, often are far more effective than drugs at achieving real health improvements, such as less heart disease and longer life.

Probably the most important test of a healthful diet's effect on heart disease is the Lyon Diet Heart Study conducted in Lyon, France. Heart attack patients were randomly counseled to eat a Mediterranean diet (high in unprocessed grains, fruits, vegetables and olive oil -- very low in red meat, dairy fat and cholesterol) or a "prudent" post-heart attack diet (no more than 30% of calories from total fat and no more than 10% from saturated fat).

The people counseled to eat the Mediterranean diet developed 72% less heart disease than those in the prudent diet group over the next four years. There were 56% fewer deaths in the group counseled to eat the Mediterranean diet -- that's two to three times the benefit achieved with statin drugs.

The same holds true for exercise. A study conducted at the Cooper Institute for Aerobics Research in Dallas followed 25,000 men who had undergone physical exams. Over the next 10 years, the men whose exercise endurance (as measured on a treadmill) was in the lowest 20% of the group were at a much higher risk of dying than those with high total cholesterol levels (above 240) -- confirming that exercise is even more important than cholesterol control.
But many patients prefer pills because they're easier. There is no question that many of us would rather take a pill than change our lifestyle. If the pills worked, it would simply be a question of how we want to spend our money. The problem is that the pills often are closer to folk medicine -- empowered by our cultural beliefs but without a genuine scientific basis. About two-thirds of our health is determined by the way we live our lives, and -- for better or worse -- no pills can change that.
What's the solution? Most doctors don't invest much time or energy helping patients to make healthful changes in diet and exercise or teaching stress reduction. If you are willing to consider these approaches before trying drug treatment, tell your doctor. When medication is necessary, ask your doctor if a generic drug is just as effective as the expensive brand-name product. Remember, drug ads that tell you to "ask your doctor" about a particular drug have a single purpose -- to sell more drugs, not to improve your health.
Prescription drug ads have become a normal part of our cultural landscape, but the US and New Zealand (with less than four million people) are the only two industrialized countries that allow them. The governments of other industrialized countries believe that assessment of the scientific information about prescription drug treatment should be left to doctors, who should work in a partnership with each patient to determine optimal medical care based on his/her individual situation.

Turn On The Power

Chiropractic is really quite simple: it just wants to turn the power on. The same power that grew you, cell by cell from the time the egg met the sperm. The power that changed you from a fetus to an infant to a child to an adolescent to an adult. The same power that may be dimmed a little by the stresses of life. Chiropractic just wants to turn that power back on. It's more than a figure of speech. Most people don't really get chiropractic, even after all these years. What they don't get is its completeness, its purity, and its simplicity. After 100 years, everybody's heard of chiropractic, but only about 10% use it, and only some of that 10% actually get it.

What is the dream of chiropractic? Full individual potential. Highest quality of life, from the womb to the tomb. Let the inner wisdom of the body come to fruition: in every situation, give it the first chance. Unobstructed nervous system, optimum nerve transmission between the brain's central computer and the body, back and forth. Sensory experiences program the brain: input. Like a clean install on a brand new hard drive - the original programming sets up how the computer is going to operate from then on.

The brain then organizes the whole enchilada and sends a thousand updates a second to every cell. This involves a lot of wiring - main trunk, branch trunks, smaller and smaller bundles, down to the single threads at the cell level. Messages can't afford to get put on hold. Any delays cause loss of life, starting on the smallest scale. Longer delays cause more significant loss of life, known as degeneration. After a certain amount of time, the damage caused by the nerve distortion becomes irreversible.

Chiropractic seeks to remove that blockage and make a correction while the damage is fully reversible and 100% healing can occur. As we know, the human body can taken an immense amount of abuse. But there are limits.

SUBLUXATION

Cirrhosis of the liver doesn't happen overnight. Neither does diabetes. Cancer takes seven or eight years before it grows from a single cell to a tumor the size of a pencil tip. (McDougall) If you are an American you stand a 50/50 chance of dying from heart disease. That takes years to develop. How about chronic fatigue? Low immune function - auto immune things, on and on What's the master system controlling all other systems? The nervous system. So what regulates all the above? The nervous system. What can cause all of the above? Distorted information, chronically garbled memos put through the nervous system. Garbage in, garbage out. Subluxation.

Childhood Weight May Predice Weight in Adulthood

It's no secret that obesity in America has reached epidemic proportions. Now, new research shows that children between the ages of 8-15 who are in the upper half of their normal weight range are more likely to become overweight or obese young adults than their leaner counterparts.
Researchers recorded the height, weight and blood pressure of 314 Massachusetts children, ages 8-15 years old at baseline, between 1978 and 1981. These values were measured in the same participants eight to 12 years later at follow-up. Participants averaged a mean body mass index (BMI) of 20 kg/m2 at the first childhood visit, with a "prevalence of at risk for overweight or overweight at the first childhood visit [at] 34 percent for girls and 32 percent for boys."
At follow-up, 48.3 percent of the boys and 23.5 percent of the girls were overweight or obese. High blood pressure was more prominent among the boys (12.3 percent) than girls (1.9 percent), as well. According to the authors, "children with a BMI between the national 85th and 95th percentiles for age and gender were classified as at risk for overweight, and those with a BMI > 95th percentile were classified as overweight." The authors considered BMI between the 50th and 84th percentile to be at the high end of a normal weight range.
The researchers concluded, "Although very lean children are unlikely to become overweight adults, we observed that children in the upper end of the healthy weight range (e.g., 50th to 84th percentiles) are at an elevated risk of becoming overweight or obese. Furthermore, boys in the upper end of the healthy weight range are at an increased risk of becoming hypertensive. These findings suggest that future interventions to prevent adult obesity and its complications should include not only overweight children but also children and adolescents as low as the 50th percentile of BMI for age and gender."

Reference: Field AE, Cook NR, Gillman MW. Weight status in childhood as a predictor of becoming overweight or hypertensive in early adulthood. Obesity Research Jan 2005;13(1):163-69.

Caffeine Increases Risk for Chronic Daily Headache

Before your reach for your next "cup-o'-jo," consider the consequences of excessive caffeine consumption. Caffeine has been shown to cause withdrawal headache, which may contribute to the development of chronic daily headache (CDH), or headache occurring at least 15 days per month.
To confirm such a hypothesis, researchers recruited population-cases and control subjects from three U.S. metropolitan areas as part of a study designed to address caffeine’s potential involvement in CDH. Control subjects reported two to 104 headache days annually (average: 30 days), while population-cases reported 180 or more headache days per year (average: 260 days). Current and past caffeine consumption was assessed by way of self-report.
Results: High caffeine exposure, defined as being in the upper quartile of dietary consumption or using a caffeine-containing over-the-counter medication as a headache treatment, was associated with onset of CDH. Approximately one-fourth of case subjects reported taking pain medication of any type daily for headache in the previous three months.
According to the authors, “High medicinal or dietary caffeine consumption at the time of CDH onset (e.g., pre-CDH consumption) was a modest risk factor for CDH onset. Secondary analyses revealed that pre-CDH caffeine consumption might be an initiating factor in a subset of CDH sufferers, with the high-risk groups being women and those younger than age 40."
Still need a "pick-me-up" in the morning, but want to wean off caffeine? Try drinking green tea instead, which contains substantially less caffeine than coffee and has been shown to have a host of health benefits, including antioxidant and anti-cancer properties.

Reference: Scher AI, Stewart WF, Lipton RB. Caffeine as a risk factor for chronic daily headache. A population-based study. Neurology, Dec. 14, 2004;63(11):2022-27.

Women: One More Reason Not to Stress Out

Women, don't let this news stress you out, but a new study has found that stress can lead to increased pain during menstrual cycles.
The study, published in a recent issue of the Journal of Occupational & Environmental Medicine, tracked 388 young women, ages 20- to 34-years-old, through over 1,000 menstual cycles. According to the study, approximately 44 percent of the participants noted having painful periods, characterized by at least two days of abdominal or low-back pain during a cycle.
Reseachers found that those women with high stress levels during the preceding month were 2.4 times as likely to have a painful period during the following cycle compared to their low stress counterparts. And women that reported having medium stress levels were 1.2 times as likely to have a painful period during the following cycle. The researchers suggested that women with painful menstrual cycles should try to reduce the stress in their lives.
If you are a woman that suffers from painful periods, ask your doctor of chiropractic to recommend a treatment plan. Routine chiropractic care not only helps with pain relief, but also facilitates stress relief.

Reference: Wang L. Occupational & Environmental Medicine. Dec 2004;61: 1021-1026

Infections Are Good For Babies

Yet another study confirming that infection in early childhood helps the immune system to mature, become more robust and protect against chronic disease and illness. This raises the question of whether it is wise to use multiple vaccines to prevent all infection in early childhood, including chicken pox, the flu or rotavirus infection which, for 99.9 percent of children living in modern countries, is benign.

Story from BBC NEWS: http://news.bbc.co.uk/go/pr/fr/-/1/hi/health/4471957.stm
Published: 2005/04/22 10:42:17 GMT
Day care prevents child cancers

Sending your baby to day care in the first few months of life could protect them against leukaemia, say UK experts.
The Leukaemia Research Fund team believe exposure to common infections in early infancy is good and helps "prime" the immune system.
Conversely, reduced exposure to bugs in the first year of life increases the risk of developing acute lymphoblastic leukaemia (ALL), they suggest.
The findings of their 10-year study appear on bmj.com.
"Good infections"
Childhood leukaemia - cancer of the blood cells - has been increasing at a rate of about 1% a year.
In children, about 85% of these are acute lymphoblastic leukaemia or ALL and acute myeloid leukaemia (AML) accounts for most of the rest.
There have been many theories about what might trigger leukaemia, including exposure to radiation from the environment.
But the authors of the current study say they now have compelling evidence that exposure to infections in infancy is key.
This notion has been around for decades, but the UK Childhood Cancer Study is one of the largest to look at this link.
It involved 6,305 children aged 2-14 years without cancer and 3,140 children with cancer, of whom 1,286 had ALL.
Parents were asked about day care and social activity with children outside the family during the first year of life.
The researchers found that increasing levels of social activity outside the home were linked to consistent reductions in the risk of ALL.
The greatest reduction in risk - of 52% - was seen in children who attended formal day care on a regular basis during the first three months of life.
Those youngsters exposed to informal day care, such as that provided by friends and family, saw a 38% drop in risk of ALL, while those who had some social activity, but not day care, had a 27% lower risk.
"Double whammy"
Lead researcher Professor Mel Greaves, of the Institute of Cancer Research in London, said: "There is good biological evidence now that with childhood leukaemia, there is an interesting double whammy.
"First, there is a genetic mutation that occurs in the baby while they are in the womb, which happens very commonly."

This is very reassuring for parents
Dr David Grant of the Leukaemia Research Fund
Then, in 1% of those children, after birth, there is a trigger that causes a second mutation in the genes, he said.
"There is abundant evidence now that the immune system requires infection in the first few months of life in order to be set up and function normally."
If this does not happen, when the child is older and encounters an infection, that infection can then trigger the leukaemia, he said.
"Infection early in life is good for you, it protects you - pretty much what your grandmother might have told you," he said.
Dr David Grant, scientific director of the Leukaemia Research Fund, which funded the research, said: "This is very reassuring for parents. We have had a lot of theories about what causes leukaemia, but this study takes us to a very firm conclusion.
"The more implausible theories I think we can now dismiss."
He said treatments were improving and that now about 75% of children with leukaemia survive the disease.
"But if we can prevent the disease occurring in the first place, which I think now is quite possible, then this has been a tremendously helpful study," he said.