Just Say NO to (Legal) Drugs_The Other War on Drugs_WSJ

Just Say NO to (Legal) Drugs_The Other War on Drugs_WSJ

Feb 13, 2003

For the second time in 24 hours, the FDA has approved an anti-depressant to treat a new “ailment”–social anxiety disorder, also known as social phobia. On February 10 Zoloft was approved for this ailment, and on the 11th Effexor was similarly approved. On January 3, Prozac had been approved for children with depression and obsessive compulsive disorder. The speed with which FDA is providing the seal of government approval for drugs that have been shown (with FDA’s own data) to be no better than placebo, may be an indication that the agency is obsessed with extending the market for psychoactive drugs and the profit margins of their manufacturers. http://www.pfizer.com/are/news_releases/mn_2003_0210.html http://www.healthscout.com/template.asp?ap=68&page=newsdetail&id=511757 http://journals.apa.org/prevention/volume5/pre0050023a.html

However, amidst such perplexing news of "quick fix" pharmaceutical solutions for everything, a glimmer of hope appears on the horizon. The Wall Street Journal reports: More Doctors Steer Patients Away From All Kinds of Medicines.

The Journal reports that a debate is starting to circulate through physicians’ professional organizations and in some medical literature, particularly as policy makers look for ways to cut drug costs. Some doctors dare to buck the prevailing norm and practice by taking a stand against unnecessary use of medications:

"The intense focus on soaring prescription-drug prices has in some ways obscured another powerful current — a movement in medicine to steer patients away from using drugs unless it’s absolutely necessary. While there has always been a granny school that prescribes chicken soup and a good night’s sleep for common ailments, more and more doctors are now signing on to their own version of the drug-free approach."

Let’s hope the movement to better health without chemistry gains momentum!

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Wall Street Journal Just Say No to (Legal) Drugs — More Doctors Steer Patients Away From All Kinds of Medicines; Rethinking Phlegm Feb 5, 2003; By Amy Dockser Marcus Start Page: D1

Copyright Dow Jones & Company Inc Feb 5, 2003

WHEN KRISTIN BRANDT’S six-month-old son came down with a cold recently, she did what every new mother does: She immediately called the doctor, expecting him to dash off a prescription that would ease the child’s discomfort.

His prescription: some strong whacks on the back to loosen up the congestion.

It’s the new world of less-is-more medicine. The intense focus on soaring prescription-drug prices has in some ways obscured another powerful current — a movement in medicine to steer patients away from using drugs unless it’s absolutely necessary. While there has always been a granny school that prescribes chicken soup and a good night’s sleep for common ailments, more and more doctors are now signing on to their own version of the drug-free approach.

Behind this is growing medical evidence that it’s sometimes better to treat a range of common illnesses — everything from stuffy noses to constipation — without medicine. In some cases, studies have questioned whether common over-the-counter remedies provide any benefits at all. A recent review in the British Medical Journal, for example, concluded that many of the best-known cough medicines on the market — including Robitussin and Dimetapp — were no better than a placebo. Makers of cough medicines dispute the study’s methodology.

Some doctors argue that the body needs to be able to run its course. In that vein, they say that fevers are the way a body fights off infection, and that sponging and drinking fluids is much safer than taking aspirin. “A cold lasts exactly the same length of time when you take medicine as when you don’t take medicine,” says Vincenza Snow, a physician at the American College of Physicians-American Society of Internal Medicine in Philadelphia.

Even phlegm is getting a second look. “Most of us in medical school were taught that if a patient coughs up yellow or green phlegm, it’s a bacterial infection and should be treated with antibiotics,” says Dr. Snow. But recent studies indicate that this isn’t proof that an infection is bacterial — in fact, the same coloring also appears with viral infections, for which antibiotics offer no relief.

New attention is also being paid to the side effects, even subtle ones, of popular prescription and over-the-counter drugs. Doctors say decongestants such as Sudafed may increase blood pressure. Anti-inflammatory ibuprofens, like Advil, can cause stomach pain and gastro-intestinal bleeding if taken for extended periods of time. Doctors say that aspirin products like Bayer or Excedrin can put patients at risk for bleeding and potentially make high blood pressure difficult to control. Some aspirin makers dispute this.

While new medical evidence is helping to change some minds, there’s also a nascent patient backlash at work here. After being barraged by TV pitches for new drugs, some people have become wary of taking pills to cure every ache and pain. Pharmacy aisles are now crammed with drugs for every imaginable ailment, sometimes multiple drugs for the same condition, making it hard to sort out competing claims and keep track of side effects.

But even doctors who don’t immediately take out their prescription pads say it’s important to be cautious about the new “just say no” attitude to drugs. Some ailments — everything from strep throat to, of course, more serious conditions like heart disease — are likely to require treatment with medicines. At the same time, some common over-the-counter treatments are attractive for other reasons. Aspirin, for instance, is often taken to help prevent heart attacks.

The broader campaign against instinctively reaching for the medicine cabinet has its roots in well-known concerns about antibiotics. Studies have shown that antibiotics have been over-prescribed by physicians — in part due to pressure from patients — leading to an increasing number of antibiotic-resistant bacteria. There are signs that continued attention to that problem has made a difference. A 2002 study from the federal Centers for Disease Control and Prevention found that the number of antibiotics prescribed for children, for example, fell by 40% between 1990 and 2000.

But now some doctors are turning their attention to other kinds of drugs, from laxatives to antimigraine pills. The debate is starting to circulate through physicians’ professional organizations and in some medical literature, particularly as policy makers look for ways to cut drug costs.

Despite such efforts, Americans continue to gobble down medicine in ever-growing quantities. Doctors are prescribing more drugs than they have in the past, in part because the population is aging but also because there are so many more drugs on the market. According to the National Institute for Health Care Management Foundation in Washington, D.C., consumer spending on outpatient prescription drugs at retail stores and pharmacies rose 17% to $154.5 billion in 2001.

Ironically, the anti-medicine argument has been pushed most adamantly by doctors whose patients tend to get sick the most and scream the loudest: pediatricians. There are fewer studies involving drug effects on children, and some doctors believe that mandates greater caution in prescribing.

But while doctors have made great strides in persuading patients to hold off on taking antibiotics, there is still resistance when it comes to swearing off medicines. Many people can’t take extra days off from work when they or their children get sick, and think medicine will make them feel better faster. “I know many of my patients are probably taking cough medicine behind my back,” says Dr. Snow.

Some patients tell the doctor that they always feel better after taking medicine. But often that may be a matter of timing. Most viruses take two to three weeks to run their course. People tend to go to the physician during week two when they feel like they’ve had it with being sick. As a result, they end up getting a prescription and taking medicine right around the time when they would have started feeling better anyway.

Richard A. Parker, a family doctor at the Beth Israel Deaconess Medical Center in Boston, says taking medicine often masks the underlying cause of an illness. For example, he says many people suffer from headaches caused by drinking too much coffee and other caffeine products. “Rather than give them another drug to cure the headache, I tell them to cut back on caffeine,” says Dr. Parker. By the same token, he says many people wouldn’t need laxatives if they increased fiber in their diet and exercised more. Still, Dr. Parker says, “many patients feel let down if you don’t give them a prescription.

Not Mrs. Brandt, the mother of the six-month-old. After her son promptly recovered from his cold without resorting to medicines, the Upton, Mass., mother began trying a drug-free approach to treating her own illnesses. She rarely takes antibiotics anymore, she says, and has tried to cut back on cold and cough remedies. Still, she says it’s not always easy. “My husband is always telling me I can make my headache go away,” she says. “But sometimes I still take a Tylenol.”

The Other War on Drugs

The downsides to some popular drug and over-the-counter treatments, and the alternatives that doctors are increasingly recommending:

Category: Decongestants The Case Against: Can cause fatigue and headaches

What To Do Instead: Steam showers, fluids Doctor

Comment: Colds last the same amount of time with or without medicine

Category: Cough medicine The Case Against: Appear not to have any major benefits

What To Do Instead: Hot tea with lemon and honey

Doctor Comment: People like them and will try to sneak them anyway

Category: Headache relief The Case Against: Aspirin causes increased risk of bleeding

What To Do Instead: Cut back on caffeine and chocolate

Doctor Comment: People love coffee; plus, you feel worse before you feel better

Category: Laxatives The Case Against: Users can become dependent on them

What To Do Instead: Increase fiber, fluids, exercise!

Category: Antibiotics The Case Against: Overuse can create resistance to future antibiotic treatments

Doctor Comment: The constipation may be a side effect of another drug the person is using

What To Do Instead: Wait to see if things get better on their own

Doctor Comment: Despite the stories about super-resistent bacteria, it’s still a hard sell with parents who want their children to feel better right away

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