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Which Medicines Do You Really Need?
Excerpt By Analysis By Paul L. DoeringSpecial to

Expert advice on how to avoid taking unnecessary pills or supplements.

Editor's Note: With the continuous development of new prescription drugs, herbal supplements and vitamins, Americans have more options now than ever before for treating their various ailments.

A study published Tuesday in the Journal of the American Medical Association confirms that they are taking advantage of these options.

According to research conducted by Dr. David Kaufman at the Boston University School of Public Health, 81 percent of survey respondents claimed to use at least one medication — including prescription drugs, over-the-counter medication, vitamin, mineral or herbal supplements — in the week prior to the study. Fifty percent of respondents specifically took a prescription drug and 7 percent took five or more.

ABCNEWS asked Dr. Paul Doering of the University of Florida to comment on these results. Following is his analysis.

More Drugs Available

Frankly, I am neither surprised nor especially concerned by these findings. We all know that Americans take a lot of medicines and this just confirms that. There are some important implications, though, to this research.

First, I must point out that these data do not reflect what is going on today. I'll bet the numbers are even higher, with the growing popularity of dietary supplements.

As you might know, there is a nationwide shortage of pharmacists and this increase in number of drugs used is further contributing to the problem. I have seen projections on the growth of the prescription drug market and it is interesting to see how we keep taking more and more medications.

Why is this? Well, one reason is the increase in the number of the so-called lifestyle drugs that are prescribed. Viagra, Rogaine, Retin-A, etc., can hardly be considered "essential" drugs.

Why, then, do doctors prescribe them so frequently? Well, because consumers want them and are willing to pay for them.

Also, antidepressant medications are more frequently prescribed because of a few reasons:

The stigma of taking drugs for the mood is diminishing.

There are more and more drugs being introduced onto the market.

Patients are asking for such drugs.

Companies are promoting these drugs, both to doctors and directly to patients.

It kind of reminds me of the way young people look at wearing braces on their teeth. When I was a kid we would rather have been shot than to have to wear braces. Today, kids can't wait to get their braces.

And so it is with Prozac (or Zoloft, or Celexa, etc). If you are not taking Vitamin P (aka Prozac) then something must be wrong.

The Preferred Option

I'm not so sure that this is evidence of how valuable drugs have become, but rather how frequently this option is chosen over other interventions.

Where as improving diet and exercise was formerly the treatment of choice for high cholesterol, now the entry-level treatment has become the statins. Why do something the hard way when there is a pill we can take?

Keep in mind that the public equates taking medications with getting better. I hear people all the time saying, "I can't believe it. He charged me $150 and he didn't even give me a prescription." The prescription takes on great sociologic significance.

When one looks at a typical drug regimen, I'll bet a dime to a doughnut that there are several medications that could easily be dropped, whether because they are not needed, are causing side effects, or aren't working.

Can we and should we try to reduce the number of medications prescribed? Absolutely. But the forces working in the opposite direction are formidable. From the time we are first able to watch TV, manufacturers are urging us to take medications. We are inculcated with the thought that if we have a problem, then we should take a pill.

I remember when my son was very young, barely able to talk. I came home from work one day, complaining to my wife how badly I felt. I had a cold, I felt tired, I was irritable. My son overheard me and said this: "Dad, you need rest, fluids, and Bayer." At that point I am sure he had no idea what either rest, fluids or Bayer really were, but he was convinced I needed them.

It's no wonder that the message gets mixed up later in life when we tell young people to "Just Say No." Why should they say "No" to some drugs and "Yes" to others?

The prevalence of herb and supplement use does not surprise me either. I think the newsworthiness of this story is that we are an overmedicated society, that marketing forces are at work to fill our medicine cabinets chock-full of drugs, and that more is not necessarily better.

Avoiding Overuse

If consumers could be advised of some things they could do to empower themselves to reverse this trend, it would be good. Some of these things include:

Keep good records of all the medication taken, including OTCs and dietary supplements.

When going to multiple practitioners, be sure to share with each of them the records described above.

Establish a relationship with a pharmacist who is willing and able to serve as "coordinator" of medications. Use that pharmacy exclusively.

Periodically review with the doctor the continuing need for a particular medication. Sometimes people get put on drugs intended for short-term and they end up staying on them for life. This is particularly true when patients change doctors and the new doctor is reluctant to stop a drug prescribed by the previous doctor. What results is patients taking drugs for reasons unknown to the new doctor and the patient alike.

When using dietary supplements, make sure to ask the pharmacist or doctor about possible interactions. By all means, tell the doctor if you are taking any supplements, vitamins, minerals, herbal remedies, etc.

Don't be afraid to ask questions of the doctor regarding medications. Remember, the doctor is working for you, not the other way around. If he or she refuses to answer your questions, then maybe it's time to find a new doctor. If enough people begin exerting consumer forces on the paternalistic doctors, then maybe they will wake up.

These are just a few of the things consumers can do.

Dr. Paul Doering is a distinguished service professor of pharmacy practice at the University of Florida in Gainesville.

Reference Source 104



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