Is America Being Overmedicated? Making People Sick to Make Them Well

Tuesday, October 18, 2016 by Meg   •   Filed under General

In the last post, (Is America Being Overmedicated? Money, Medicine and the Pharmaceutical Industry) we explored the influence of the pharmaceutical industry on health care, the impact of biased research studies and the evolution of big money in health treatment. It is obvious that the drug companies exert a great deal of influence over modern health care practices. 

But how exactly does it trickle down to us?

More Exposure to Drug Companies, More Prescriptions

Judith Warner, author of We’ve Got Issues, found that prescribing patterns are directly affected by monies received from drug companies. Those physicians who take the most money from drug companies—for speaking engagements or other things—prescribe at higher rates1. The New York Times agrees, finding that those physicians who took more than five thousand dollars in a year wrote three times the number of atypical (off label) prescriptions than those who took less2.

But no matter how may prescriptions doctors are writing, they need patients to write them to. So, how do you get people to see their doctors? 

Condition Branding

While most who seek treatment do so because they are having symptoms, condition branding is a very tricky tool used to encourage the general public to believe they are ill enough to warrant medication. 

Feeling sad or anxious and being ill enough that the benefits outweigh the risks of drug therapy are very different things. But the FDA Modernization Act helped to ensure that more people would be exposed to conditions that they “might have” in an effort to drive people to their doctors for prescriptions.

I have had parents come in convinced that their children needed sleeping pills or that (once) their two-year-old had anorexia. 

I have also seen more women than I care to admit convinced that they had Premenstrual Dysphoric Disorder (PMDD), a very serious disorder of mood around the menstrual cycle (see more here in PMDD). Most of them weren't even close. But when the patent on Prozac was about to expire, Eli Lilly relabeled it as “Sarafem,” made it pink and ran ads on Premenstrual Dysphoric Disorder (PMDD)3.

Watch the advertisement here (seriously, watch it). 

While this ad was eventually pulled, it is a good example of the way the market works. The goal in advertising is to frame a disorder like an all-purpose horoscope so you can convince a lot of people that they have it. Whether or not they do, the more who go in to seek help, the higher the likelihood that someone will be prescribed your medication, even if they don’t meet full criteria for the illness.   

As another example noted by Shannon Brownlee in Overtreated, social anxiety was barely heard of prior to Smith Kline's pharmaceutical marketing campaign in 1998. This marketing campaign essentially caused an explosion in diagnosis and in medication treatment4. Those who were before referred to as “shy” now had a label and a way to make them less shy, even if they didn’t meet full criteria for social anxiety disorder, because the drugs could be prescribed (and marketed to physicians) off label for “shyness” and not just for diagnosable anxiety disorders. 

Once ads like this come out, people with even a few of the traits mentioned might head to their physicians complete with diagnosis and pill requests, partially because they really did have some of the symptoms mentioned and partially because they now believe those symptoms to be indicative of a disorder that requires drug treatment.   

But isn’t this just an example of people realizing they have a condition that they can treat? Isn’t it a beacon of hope? 

Maybe for some, but usually not, because the illness and the treatment have to be balanced. The lesser the illness, the less likely someone will benefit from drug therapy. And it is generally those less ill individuals who are being targeted. 

A man suffering from debilitating social anxiety knew something was wrong before, just like a woman truly suffering with restless leg syndrome probably sought the help of her physician before she saw the ad. The man with twitchy muscles because of other reasons is now convinced it is a restless leg disorder that he must remedy before it progresses into this “debilitating condition” he just witnessed on television. 

Whether people go in for the next new drug because they were just enlightened to the fact that they had a mental condition, or if they went because they just found out that there was something new that could treat it, either may not benefit as much as they hope from the advertised pill. Despite the constant bombardment of “the next new medication for depression and anxiety”, mental health medications don't have breakthroughs often.

According to Peter Kramer, author of Listening to Prozac, while Prozac could be considered a justifiable breakthrough, most other drugs are variations of the old with little or no studies done on their effectiveness when compared with other similar medications5. Then there’s the placebo effect, which there simply isn’t room to get into here. 

But either way, if taking a drug makes symptoms go away, you’ve just earned yourself a lifelong diagnosis (link) regardless of whether you met full criteria for the disorder that the drug was supposed to treat. And that label is one you will likely tell every new physician you have in the future, making it all the more likely you will be prescribed additional drugs later on. 

In addition, primary care physicians, who are prescribing more and more psychotropic drugs, are more likely to prescribe without appropriate diagnostics, not due to negligence, but more because they simply cannot fit in the hour-and-a-half assessment for diagnosis that is common for psychiatrists. Insurance no longer pays physicians to take that kind of time, nor are general care physicians specially trained in psychotropic drugs. However, if you come in with a diagnosis and a pill request, that makes things easier on everyone. 

This may make overdiagnosis a far bigger issue in the offices of general practitioners, particularly when nearly all integrated studies indicate that drug therapy—if it improves results at all—works best when combined with talk therapy.  So, if you walk out of your physician’s office with a pill and a diagnosis, it is likely that you won’t end up with the results you’re looking for anyway since medications may more accurately prime the brain for the rewiring done in therapeutic sessions with a clinician. 

However, this is only the tip of the iceberg, because the individuals who see the ads and seek treatment are the same ones who would have been more likely to seek help in the first place. Those in poverty are less likely to seek help for a number of reasons, regardless of commercial bombardment. And those children are often the ones who wind up untreated and face bigger issues later after brain changes have become persistent (more here)

So, are we overdiagnosing or overmedicating on the whole? Probably not. 

Even when you include those who were driving to their physicians and received medications that they didn’t need, most don’t take it long term as prescribed and others never take it at all, making the data on how many people are actually taking medications dubious at best.

The bigger issue may be that many of those who are prescribed medications take them in lieu of seeing a therapist. And even the most biased of research does not support the notion of magic pills. 

Don't miss the next post: Is America Being Overmedicated? Suffering From Undertreatment. 

Releated Posts: 

Citations
  1. http://www.amazon.com/Weve-Got-Issues-Children-Medication/dp/1594487545
  2. http://www.nytimes.com/2007/05/10/health/10psyche.html?pagewanted=all&_r=0
  3. http://www.npr.org/blogs/health/2013/10/22/223805027/should-disabling-premenstrual-symptoms-be-a-mental-disorder 
  4. http://www.amazon.com/Overtreated-Medicine-Making-Sicker-Poorer/dp/1582345791
  5. http://www.amazon.com/Listening-Prozac-Landmark-Antidepressants-Remaking/dp/0140266712



Topic-Relevant Resources

Listening to Prozac: The Landmark Book About Antidepressants and the Remaking of the Self, Revised Edition
Psychiatrist Peter Kramer discusses the implications of preferred personality on mental health along with the evolution of Prozac as a preferred treatment for undesired traits.

Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer
Economic exploration of the American healthcare system, and why it may be making us sicker and poorer.

We've Got Issues: Children and Parents in the Age of Medication
Judith Warner explores the misunderstood issue of overmedication in relation to children's mental health.

Overdiagnosed: Making People Sick in the Pursuit of Health
The history and evolution of drug company involvement in modern medicine, and the implications for current treatment.



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