Americans are taking prescription drugs over longer periods of their lives, and the trend is raising new questions about the costs’ impact on the economy, society, and health care in general.
Using data from the Medical Expenditure Panel Survey, the Human Mortality Database, and the National Center for Health Statistics, Jessica Y. Ho found not only is prescription drug use spreading, but high levels of use begin early. Babies born in 2019 could take prescription drugs for roughly half their lives.
The report, “Life Course Patterns of Prescription Drug Use in the United States,” was published in the latest issue of the population journal, Demography. It notes that prescription drug use is a recent phenomenon starting with the emergence of prescription drugs around the mid-twentieth century and the use of the most frequently prescribed drugs spread quickly.
Prescription drugs are now the most common therapeutic intervention, with 6.3 billion prescriptions in 2020, approximately 19 for each American.
Multiple Causes
The study identifies a substantial increase in the number of years Americans can expect to take five or more drugs simultaneously. There has been a “particularly dramatic” increase in years spent taking statins, antihypertensives, and antidepressants. It also finds significant gender, racial, and ethnic differences in prescription drug use.
There have been several contributing factors, including population aging, the culture of modern medicine, time constraints in health care, and payments tied to “patient satisfaction.”
With longer lives and the rise of chronic diseases, large quantities of several drugs are taken simultaneously, for long durations and a widening array of conditions, such as menopause and depression. Drugs, including antibiotics for urinary tract infections and psychotherapeutics, may be overprescribed.
Increasingly sedentary lifestyles contribute to health conditions frequently treated with prescription drugs. This includes the “skyrocketing” incidence of fatty liver disease in children and teens. Aspects of daily living like weight gain, hyperactivity, substance use, loneliness, and even so-called “climate-grief” are increasingly “medicalized,” and sometimes treated with prescription drugs.
Industry marketing (such as direct-to-consumer advertising and medical conferences) also factor into increases.
Not So Obvious Causes
John Abramson, M.D., a family physician, retired lecturer in the Harvard Medical School’s Department of Healthcare Policy, and author of Sickening: How Big Pharma Broke American Healthcare and How We Can Repair It, says “visible issues” pale compared to critical, “invisible issues” resulting from industry’s powerful, bipartisan political influence and the “unholy alliance” between pharmaceutical companies and medical journals. Abramson believes agreements between industry and research centers can restrict investigators’ control over clinical trials.
“Many doctors think they are sophisticated enough to cut through all these layers, but they can’t because they don’t have access to the real data,” said Abramson.
Abramson says there are “layers of lack of transparency,” including pharma’s latitude to interpret research data, peer reviewers’ inability to access underlying data, relationships between industry and medical journals, journal articles “that are really marketing pieces,” and medical opinion leaders with financial ties to companies.
“Such factors greatly impact research accuracy, medical journal content, and physicians’ ability to practice evidence-based medicine, including the ability to knowledgeably prescribe drugs,” said Abramson.
Too Many Drugs?
Prescription drugs have contributed tremendously to improved health and life expectancy—but there are downsides, says Gregg Girvan, a health care policy specialist at the Foundation for Research on Equal Opportunity, including costs.
“U.S. prescription drug expenditures are higher than in other high-income countries, with Medicare and Medicaid among the largest payers,” said Girvan. “Government policy allows drug companies to manipulate patents and (Food and Drug Administration) exclusivities to have monopolies on branded drugs far longer than policymakers intended. This allows companies to continually raise prices on drugs that have been on the market for several years yet still have no generic or biosimilar competition,” said Girvan.
Expanded prescription drug use can also lead to drug dependency and abuse, interactions between drugs, antibiotic resistance, adverse drug events, drug shortages, and impact the environment.
Finding a Balance
“The increase in drug prescriptions is not necessarily a good or bad thing,” said Girvan. “What we really need to do is determine the value of the approved drug being prescribed.”
“Lifestyle changes work to prevent and treat many diseases,” said Abramson, referencing several studies. In particular, he says a 2002 study “shows unequivocally that lifestyle interventions can significantly reduce the rate of developing Type II diabetes for people at increased risk.” Another study found 22 minutes of brisk walking a day can offset harmful impacts associated with a sedentary lifestyle.
Physical activity can also control pain. “Exercise and increased heart rate produce opioid-like, natural pain mitigating mechanisms,” said Amy Driessen, a physical therapist who practices in Fairfax, Virginia, and notes recent research shows Medicare beneficiaries who received physical therapy after a fall were 39 percent less likely to use opioids in the six months following a fall.
Education on “inappropriate” prescribing, as suggested in a May 2021 article published in Lancet in May 2021 could change the “pill for every ill” mindset. “Greater use of cognitive therapy, telemedicine, and use of ‘wellness’ products like mental health apps may also be beneficial,” says Girvan.
Abramson says he supports a “Health Technology Assessment Board,” common in other countries, to analyze new versus old drugs and to recommend the most effective therapies.
“We should also re-establish independent oversight of the trustworthiness of clinical practice guidelines,” said Abramson. “Ultimately, to curtail inappropriate prescribing, we need a powerful coalition of medical professionals, payers (including businesses that purchase health insurance for their employees), and the public, to diminish industry influence and demand transparency and integrity of medical knowledge.”
Dvorah Richman, J.D. (dvorahrichman@gmail.com) writes from Fairfax, Virginia.