Is American Being Overmedicated? Money, Medication and the Pharmaceutical Industry

Wednesday, October 12, 2016 by Meg   •   Filed under General

There are many who believe that some normal personalities are patholgized—treated like illness—in a culture where only certain

traits are rewarded (click here for more on that). There is also a tendency to look down on those who have traits that don’t mesh with our society’s version of success. 

However, whether we overmedicate individuals for these traits is a hot button topic.  

Many believe that people are prone to seek drugs based on a misunderstanding of symptoms or for “quick fix” reasons. Others think that parents and schools are actively trying to medicate children to make their lives easier. 

So, are people actually being overmedicated for mental health problems?

SPOILER ALERT: No. On the whole, we are not overmedicating our population, though some may be made to believe they are sicker than they are. Instead, we are vastly undertreating mental health issues. It should also be made clear that this series is not aimed at those with severe and persistent mental illnesses, for whom medication can be a welcome necessity. 

But, there is merit to the overmedication argument, and if you know me, I rarely like simple. Let’s look at why those beliefs exist. We’ll start with the bad news. 

The Issue of Overdiagnosis 

Overdiagnosis refers to treating issues without symptoms when the intervention will not ultimately improve patient health outcomes. In the appropriately named book Overdiagnosed, physicians Welch, Schwartz and Woloshin note that there is a tendency to seek medical problems out—say through routine blood tests—and treat them before symptoms emerge2

So they can treat us before the symptoms even show up? Sounds great right? 

The problem, according to these doctors, is that with overdiagnosis, things that are unlikely to ever cause symptoms are often treated in a way that very well could cause complications. And the lesser the degree of illness, the less likely one will benefit from treatment at all.  

Does this mean that doctors are negligent? That they are purposefully trying to pad their bottom line with unnecessary procedures? 

Occasionally, yes, but almost always no. Most physicians truly want to assist the people they treat and they use the best knowledge available to make appropriate recommendations. The issue may be that the best information available is often distorted by financial gain on the part of pharmaceutical companies. 

But how?

Money and Medicine

According to Judith Warner in We've Got Issues, drug companies fund the vast majority of research conducted, in addition to funding physician continuing education courses4.  

This system translates into major financial gains and changes in treatment protocol. 

If you conduct the research, you are by default, in charge of numerical cutoffs for the diagnosis of things like cholesterol, diabetes and hypertension, all conditions whose cutoff for “treatable” has fallen drastically in the last few decades2. This means that more and more people will be diagnosed with an illness than ever before. In these cases, it’s not necessarily that more people are sick; it's that by changing the definition of what sick is, more people end up in those categories, and thus end up treated pharmacologically.  

For example, when the numerical cutoff for treatable high cholesterol changed from 300 to 184, the nation saw an 86% increase in the number of individuals who had the condition2. In this particular case, Welch, Schwartz and Woloshin reviewed data from other studies and found that only two percent of those with now high cholesterol (who used to be in normal range) were likely to benefit from treatment based on factors including the odds of ever having a heart event, the likelihood of adverse reaction to the treatment and the likelihood of having an adverse heart event despite treatment.  

The issue of overdiagnosis obviously affects our health in general. But mental health is different, isn’t it? 

While a routine blood test can say, “You have high cholesterol,” well before symptoms arise, we don’t do routine brain scans and say, "It looks as if you have the brain of a depressed individual.” Instead, we rely on diagnostic tools to tell us if someone is ill enough to warrant drug treatment, usually by looking at how many psychological symptoms someone has. Enough reported symptoms, and they have the diagnosis, and treatment can commence.  

However, alterations to diagnostic criteria can ensure that more people fall under the umbrella of “illness”, just like in the numerical cutoffs for cholesterol or high blood pressure. Shannon Brownlee, author of Overtreated, notes that there were similar hikes following the redefinition of ADHD in 1994, which lowered the threshold for diagnosis, led to double the number of children diagnosed, and triggered a corresponding rise in prescriptions for drugs that alter ADHD3. And again, those with lower levels of dysfunction (who wouldn't have qualified for diagnosis before) are the least likely to benefit from drug treatment once risks and side effects are taken into account.

It is important to note that most who seek medications for their children are usually asking as a last resort, after a great deal of research. Parents are not implicit in overmedication; they are trying as hard as they can to alleviate the suffering of their children. However, whether this suffering is due to actual brain dysfunction as opposed to biologically unexpected or unhealthy environmental situations within school systems remains a point of intense debate. Many children who are diagnosed with ADHD at school have no issues in other environments where they are able to move around or explore their world in a different way. This is not true of all children, mind you, but some may be diagnosed based on an incompatabilty of environement and personality as opposed to physical dysfunction or abnormality.

While those with lower levels of suffering may be diagnosed with ADHD and given prescriptions, many parents in these cases forgo the drugs or don’t give them as prescribed, making it difficult to tell how many would fall into the overmedicated category. But even in cases where the child is suffering and drugs are given religiously, the issue may be undertreatment because the most effective solution is medications combined with behavioral and supportive talk therapy, particularly when the environemnt cannot be altered. 

In addition, the types of drugs prescribed are not always approved or tested for that specific purpose, an issue which most parents are unaware of. However, when the research they read is conducted by the same people who sell the pills and educate physicians, it is possible to get information that isn’t quite what it seems, particularly because those companies are allowed to cook the books more than they should be able to. 

Patent Protection and Biased Studies

New drugs get patent protection for twenty years from the date of application, meaning a new more affordable generic cannot be introduced until after this has expired. However, the patent is usually applied for prior to clinical trials, which means that it could be a number of years before the drug hits the market, giving corporations as little as seven years to benefit financially from it. This means that it is in their best interest to fund additional research for new drugs before the expiration of the patent. 

Now this might be all well and good. After all, if you have something desirable that works, benefiting from it is the American way of life. But, bias in research of this nature is rampant, particularly because an organization who funds its own research has the option of whether or not the publish the data, and allows studies that don’t have the desired results to be thrown out. 

So, if I create a new drug and one study out of thirty says it works, I have the ability to publish that one with the result I want and toss the other twenty nine, have a new patent issued for a higher price point, and because I also control the education of physicians, I can tell them all about it in their continuing education classes. 

But drug companies have another way to push prescriptions: direct to you and to individual physicians. And the advertised reasons for many drugs have little to do with what they were initially created and tested for. 

Say what now? How is that even legal?

The FDA

Warner notes that the loss of government funding following the Reagan era led to alterations in the financial structure of the FDA, which began to rely on fees aimed at fast-tracking drugs through the system, which allowed corporations to get their drugs to market more quickly. And once the FDA became reliant on these fees, they were more susceptible to pushing for legislation that would keep pharmaceutical companies happy.

One of the more glaring examples of this “happy drug company” issue is the FDA Modernization Act. Prior to this act, drug companies could not mention drugs by name in direct to consumer advertising, though they could discuss the illnesses which would drive individuals to their doctors, where they could ultimately push certain drugs through the physicians themselves. But the FDA Modernization Act made advertising even more effective for the pharmaceutical companies.  

The 1997 FDA Modernization Act did the following:

  1. Allowed drug companies to advertise direct to consumer without listing full drug side effects as long as they referred to a toll free number or told patients to see their physicians 
  2. Loosened rules for off-label promotion (i.e., “It isn’t tested for this purpose, but it might work because some people seem to have success with it…let me give you some samples.”)

So, now if I create a new drug, I can tweak the study results and change diagnostic criteria to ensure that more people qualify for drug treatment (“because studies show they need help!”). I can have new patents issued on that drug and have the pills fast- tracked through the FDA before all studies are complete. Then, I educate physicians through (required) continuing education classes on the benefits of the drug that we studied as well as the benefits we did not study, and push the new drug through direct to consumer ads, ensuring that I have the monopoly for another seven to twenty years. I don’t even have to compare the drug’s effectiveness with other medications; I just have to tell people that it’s better because my (published) study showed it to be effective. Like cholesterol, the lower the degree of impairment, the less likely it is that drug will help more than hurt, but I don’t have to disclose that or even inform anyone of all the side effects, just so long as I mention the major ones. 

But who cares, right? I’m gonna be rich, suckers!

Of course, it isn’t a crime to make money on a worthy product. But patient care practices are directly affected by these links, and not for the better. Find out how in the next post: Is America Being Overmedicated? Making People Sick to Make Them Well.

If you liked this article, check out the “Get Notified” box in the upper right hand corner to make sure you don’t miss anything. Just add your email address and I will send future articles right to you, twice a week at most. Spam is for suckers.  

Related Posts: 

Citations
  1. http://www.ncbi.nlm.nih.gov/pubmed/15939837
  2. http://www.amazon.com/Overdiagnosed-Making-People-Pursuit-Health/dp/0807021997
  3. http://www.amazon.com/Overtreated-Medicine-Making-Sicker-Poorer/dp/1582345791
  4. http://www.amazon.com/Weve-Got-Issues-Children-Medication/dp/1594487545



Topic-Relevant Resources

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.

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.



Discussion

Discussion will be uncensored with the exception of law-breaking, spam, and douchebaggy disrespect to authors or other commenters. Act like adults, please, unless juvenile humor seems called for. If you can't get enough of us here, like Megsanity on Facebook.