Jared Rhoads of the Center for Objective Health Policy hosted the first Health Wonk Review of 2012 this week. My favorite article in this edition is from New Health Dialog, written by medical investigative journalist Jeanne Lenzer. Jeanne writes about “disease creep” and how as a nation, we tend to treat risk factors as if they were the disease themselves – with medications that may not work in people who simply have risk factors rather than the disease in question.
Jeanne’s article focuses on elevated cholesterol as a risk factor for cardiovascular disease, stroke, and heart attacks. But although most doctors are quick to prescribe statins to bring down elevated cholesterol (and most patients are happy to take them, because after all, the idea is to prevent a heart attack or stroke), the evidence indicates that the effectiveness of statins is mostly limited to people who already have cardiovascular disease, rather than those who simply have high cholesterol.
To illustrate her example, Jeanne creates an eye-opening example using scary fatal “Disease A” and “Wonder Drug X”. She looks at outcomes when the drug is used to treat people with the disease (definitely worthwhile) versus outcomes when the drug is used to treat people who have a genetic marker that elevates their likelihood of getting the disease. In that second scenario, more people end up dying of drug side effects than would have died from the disease without any treatment at all, simply because most of the people who have the genetic marker wouldn’t have gotten the disease in the first place.
Beyond the possible side effects from taking more and more medications, we also have to look at whether our quick-to-prescribe culture (both from a patient and physician perspective) might be lulling people into a false sense of security. We know that a good diet of real food, regular physical activity, avoiding tobacco, and managing stress are hugely beneficial when it comes to long term health. But is it possible that people who are prescribed medication (perhaps at the first sign of any trouble) to prevent future illness might see that as an unspoken hall pass to continue with an unhealthy lifestyle and hope that the medications will make up for the unhealthy habits? I know that everyone talks about the importance of lifestyle when it comes to disease prevention and recovery, but are we just paying lip service to those ideas while putting medications at the forefront of the treatment plan?
Half of all Americans take at least one prescription drug. Prescription costs have skyrocketed over the past couple decades. When we got into this industry ten years ago, we saw lots of individual health insurance policies that offered prescriptions with simple copays based on whether the drug was generic or brand name. These days, nearly all of the carriers in Colorado have separate prescription deductibles (our family’s Anthem policy has a separate $2000 deductible for prescriptions), or ever-increasing prescription copays. And a lot of carriers have added a fourth tier to their prescription categories – drugs in that tier are generally quite pricey and patients generally have to pay a percentage of the cost rather than a flat copay.
We owe it to ourselves to seriously consider whether our over-reliance on prescriptions is actually beneficial in the long run, both from a health perspective and a financial one.