By Dr. Mercola
Every age group, from children to seniors, is at risk for being diagnosed with a condition they may not actually have, and being prescribed medications they do not need. In an increasingly litigious environment, where attorneys advertise for clients who may have had a missed diagnosis or experienced a side effect from a prescribed medication, physicians are increasingly caught between their desire to individualize care for their patients and the need to follow published standards of care to protect their licenses.
In other words, the fear of medical malpractice lawsuits is a very real issue faced by many who practice medicine. To avoid public criticism by colleagues or potential rebuke from their professional organization (and sometimes loss of their ability to practice), physicians may feel forced to follow published standards of care. These treatments often include prescribing medications designed to relieve symptoms, but do not usually address the foundational cause of the medical condition.
If you watch any television at all in the U.S., you have seen the advertisements for medications along with a long laundry list of potential side effects from the drugs. Oftentimes these side effects are more dangerous than the original condition being treated.
For instance, Vioxx, an anti-inflammatory medication used to treat musculoskeletal conditions such as arthritis, was eventually pulled from the market after studies demonstrated those taking it experienced a much higher risk of cardiovascular disease, heart attack and death. Unfortunately, by the time Vioxx was withdrawn, an estimated 60,000 Americans had already died from the drug.
This is only one of many instances where a drug has been pulled from the market. Some patients are required to undergo monthly blood tests to monitor organ function in order to stop medication if damage is detected. In some cases, the use of medications is warranted and may help improve your situation, but they must be used cautiously and judiciously. It is far better to address the underlying physical cause of the condition to alleviate the issue than it is to mask the problem by subduing the symptoms.
Most US Physicians Believe Overtreatment Is Harmful, Wasteful and Common
A recent survey of over 2,100 physicians from a variety of specialties across the U.S. asked about their beliefs concerning overtreatment and unnecessary medical care.1 By their own admission, the participating physicians describe overtreatment of their patients as "common." The survey found 22 percent of prescription medications, 24 percent of tests and 11 percent of procedures were unnecessarily prescribed, despite years of emphasis from the health care industry to control costs and procedures.
The most common reason physicians cited for prescribing tests, medications and procedures was a fear of malpractice (nearly 85 percent), and pressure exerted from patients (nearly 60 percent).2 Senior author, Dr. Martin Makary, professor of surgery at Johns Hopkins, commented on the results of the survey, saying:3
"This study is essentially the voice of physicians about the problem. We're told that there are too many operations done for narrowed blood vessels in the legs. Spine surgeons say that a quarter of all spine surgery may not be necessary. Half of stents placed may be unnecessary. These are significant opportunities to improve quality and lower costs."
The study identified some potential solutions, including better training for incoming residents on the appropriate criteria for treatment, easier access to prior health records that may reduce unnecessary testing and more practice guidelines.
Cost of Overtreatment Affects Every Individual
The cost of overtreatment is both physical and financial. As Dr. Ben Goldacre explains in this TEDMED talk, physicians are often misled about the benefits of the medications they prescribe, based on the research published in peer review journals. It's common practice to publish positive results and withhold studies with negative results from publication.
Naturally, this presents a very lopsided view. Bias also taints the results of many studies. Physicians need to be able to make informed treatment decisions, but publication bias makes this exceedingly difficult.
Overdiagnosis and overtreatment are significant contributors to health care spending that is spiraling out of control. In 2015, the Centers for Disease Control and Prevention (CDC) reported the annual per capita health expenditure was $9,990.4 The total national expenditure amounted to over 17 percent of the Gross National Product. Within one year that number jumped to $10,345 per person.5 This is a 4.8 percent increase per person in a population of 324 million people in the U.S. at the time of the increase.6
Health care expenditure is expected to grow 5.8 percent annually to 2025.7 Costs in the U.S. often exceed those for the same products or services in other countries. For instance, one day in the hospital in the U.S. costs an average $5,220 while one day in the hospital in Spain costs $424; bypass surgery in the U.S. is over $78,000, but $24,000 in the U.K.; and Harvoni, the drug used to treat hepatitis C, costs $10,000 more in the U.S. than in any other country.8
As Makary pointed out,9 "Unnecessary medical care is a leading driver of the higher health insurance premiums affecting every American." The primary study authors also wrote:10 "Addressing overtreatment can have a major impact on rising health care costs in the U.S. … Using the IOM's estimate of excess costs arising from overtreatment, a 50 percent reduction in 'unnecessary services' would result in $105 billion in savings each year, or about 4 percent of total national health care spending."
In an interview with CNBC, Dr. Orly Avitzur, medical director at Consumer Reports, shared some signs you may have been overtreated:11
- Leaving the doctor's office with a list of prescriptions and you don't know why you're taking them
- Getting a prescription for a symptom instead of your physician sitting with you to discuss what the symptoms may mean
- Receiving prescriptions without a conversation of why you're taking the medication, the side effects and a thorough discussion of what alternatives may be used
Seek and You Will Find
Improvements in digital imaging and technological testing have given physicians an edge in finding diseases earlier in development, potentially improving care and reducing risk of death and permanent disability. However, while it's a good idea in theory, it hasn't played out as well in practice.
The fundamental challenge is that the more doctors look for diseases in people who are apparently healthy, the more they find. Many of these conditions may in fact be easily managed with nutrition, exercise and quality sleep instead of potentially dangerous medications. For example, research12 suggests the number of diagnosed thyroid cancers has increased dramatically in the past two decades.
The report estimates that across 12 countries, there have been 500,000 cases of thyroid cancer diagnosed that were in fact benign small tumors. The problem is those small tumors are treated with dangerous drugs and the increase in diagnoses has not affected the number of people who die from the disease. Thyroid cancer isn't the only disease affected by a growing problem of overdiagnosis, leading to overtreatment.
The debate over whether too many children are diagnosed and treated for attention deficit hyperactivity disorder (ADHD) was underscored by a survey of over 1 million Canadian children13 finding those born in December had a 30 to 70 percent higher rate of a diagnosis than those born in January.
Researchers concluded the children were penalized for immaturity as the Canadian birth cutoff date for entry into school is December 31. Drug treatment increases the risk of heart events, sleep disorders and adverse effects in appetite and growth.
Changes in the definition of a diagnosis have also affected the number of women labeled with polycystic ovary syndrome (PCOS). Researchers from the University of Sydney found the number of women of reproductive age who were diagnosed with PCOS jumped from 5 percent using the standard in 1990 to 21 percent using the standard developed in 2003. The authors concluded unnecessary labeling may increase a woman's anxiety, saying:14
"A PCOS label might not be needed to effectively treat many symptoms of PCOS, as the label often does not change the type or intensity of the intervention. We recommend carefully weighing up the benefits and harms for each individual woman and taking a slower, stepped, or delayed approach to diagnosis to optimize benefits and reduce harm from disease labelling."
These are just a few examples of many different diagnoses and populations of people affected by overtreatment.
Overprescription of Pain Medication Feeds the Opioid Epidemic
Over prescribing opioids in America has led to a growing epidemic that is driving up health care costs and claiming thousands of lives. In 1980 a letter to the editor in the New England Journal of Medicine noted:15 "We conclude that despite widespread use of narcotic drugs in hospitals, the development of addiction is rare in medical patients with no history of addiction."
This short paragraph has been routinely cited as reason to prescribe opioid drugs and was even used by Purdue Pharma, makers of the painkiller OxyContin, to say less than 1 percent of patients treated with opioids would become addicted.16 Retired physician Dr. Hershel Jick, author of the letter, is quick to point out this statistic is misrepresented as the paper only included patients who were carefully monitored in the hospital and not taking the drug as an outpatient.17
Statistics from 2011 showed that 75 percent of opioid prescription drugs from around the world were being consumed in the U.S., a nation that makes up only 5 percent of the world's population.18 Opioid addiction and accidental overdoses are now taking a tremendous toll.
According to U.S. Deputy Attorney General Rod Rosenstein, drug overdoses are now the leading cause of death among Americans under the age of 50.19 The annual financial cost of addiction alone due to illicit drugs and prescription opioids combined is $271.5 billion ($78.5 billion for opioids), according to the National Institute on Drug Abuse.20
Drugs prescribed as aggressive treatment for pain have fueled an epidemic that has claimed more than 50,000 lives in 2016.21 Told that OxyContin was not addictive, physicians prescribe it for everything from lower back pain to teeth extraction. However, Purdue Pharma omitted the fact that when crushed, the pill loses its time release protection, creating an instant high for the user. It was this fact that led to a $24 million settlement in a lawsuit brought by the state of Kentucky.22
This settlement is similar to one agreed upon in 2007 with the state of West Virginia, when $634 million was paid for "fraudulent conduct [that] caused a greater amount of OxyContin to be available for illegal use than otherwise would have been available."23 Overuse of opioid drugs to treat pain is the result of overprescription. The National Safety Council survey results showed 99 percent of doctors who prescribe opioids do so for longer than the three-day period recommended by the CDC.24
In fact, 23 percent of physicians who prescribe opioids write prescriptions for at least a month's worth of pills and 74 percent of physicians incorrectly believe oxycodone and morphine are the best methods of treating pain. Dr. Donald Teater, medical adviser at the National Safety Council said:25
"Opioids do not kill pain; they kill people. Doctors are well-intentioned and want to help their patients, but these findings are further proof that we need more education and training if we want to treat pain most effectively."
Break Free of the Prescription Drug Trap
There is a slow-growing movement among physicians across the world to develop programs that allow them to spend greater time with their patients in order to treat health conditions and not just throw a pill at symptoms.
However, your health is in your hands. With screening programs that detect conditions that may go without treatment, and some physicians overprescribing medications and opioid drugs, it's time to take back control of your own health and break free from a trap created by pharmaceutical companies. Scotland's Chief Medical Officer, Dr. Catherine Calderwood, states:26
"I think that doctors are fixers. They want to help. And I think that perhaps we have overestimated the benefits of some treatments and maybe underestimated the risks and perhaps underestimated the burden of health care. So, visits to hospital, visits to the GP [general practitioner], surgery, blood tests, monitoring … and now we're having much more open and honest conversations."
Many continue to believe that if a medication is approved by the U.S. Food and Drug Administration it is safe for use. You only have to look at the record of medications suddenly pulled from the market after many thousands of people lost their lives or had their health damaged to know that nothing could be further from the truth. It helps to find a physician who will think beyond prescribing a pill to treat your symptoms and instead will work with you to recommend healthy lifestyle choices.
Seek out a physician who follows principles of conservative prescribing to reduce risks associated with any prescription medication — including what you may believe to be innocuous, common medications, such as antibiotics, anti-inflammatory drugs or blood pressure medications. Do not stop a medication you may already be taking without first discussing your plan with your physician. Physicians who are conservative in their prescribing practices will:27
Consider nondrug therapies to treat underlying causes of the symptoms and discuss preventive strategies with you
Strategically prescribe medications, such as deferring the use of non-urgent drugs and avoiding switching medications, and start treatment with only one drug at a time
Discuss side effects with you and watch for suspected drug reactions and drug withdrawal symptoms, and who will educate you about reactions and what should be done if one occurs
Exercise caution when considering new medications, waiting until the drug has had a sufficient time on the market to determine common side effects, and be skeptical about drug trial reporting
Work with you on shared goals to help you enjoy better health by avoiding restarting previous medications that were unsuccessful, listening to your concerns, discontinuing unneeded medications and respecting your reservations or concerns about prescribed medications
Consider the long-term effects of prescribing a medication and weigh the benefits against the risks of taking medications