“Overmedication”

Over Medication

 

Americans are dangerously overmedicated, over-treated and yet, suffer from ever rising rates of chronic illness.  Although we spend more, per capita, on health care than any other nation on earth, our health indices and life expectancy are near the bottom of the list of all other developed nations.[1]  This is no coincidence since health suffers even more from inappropriate overtreatment than it does from neglect.

 

Americans overuse medicines (as well as diagnostic testing) without understanding the risks.[2]  Most people implicitly trust the medical system believing that it is an entirely science-based approach that keeps their best interests in mind.  Most of us have been taught to trust and rely on physicians the same way we once relied on the church.[3]  We deeply believe that our medicines are our salvation and find it hard to fathom that they might actually be the root of our problem.

 

Out of $2.8 trillion spent on health care, over $320 billion went to prescription medicines in 2011.[4]  While more than 90% of non-institutionalized older adults in the U.S. take at least one prescription medication,[5] those seen by physicians take an average of seven.[6]  One quarter of all hospitalizations in the elderly are the direct result of adverse drug reactions.[7]  Medicines, used as directed, are the 5^th leading cause of death in the U.S. today,[8] causing more than 100,000 deaths annually and several million more worldwide.

 

Americans are so heavily invested in pharmacological medicines that they use a cornucopia of worthless and harmful drugs against even the most trivial conditions.  Over-the-counter (OTC) spending on cold, cough and flu medicines alone exceeds $3.6 billion annually.  Another few billion is spent on vitamins, supplements and herbs,[9] and an additional billion on “unnecessary” antibiotic prescriptions.[10]  By most conservative estimates, at least 20% of all health care expenditures fall into the “unnecessary or ineffective” category.[11]

 

The majority of medications, supplements and vitamins used to treat or prevent most minor acute illnesses provide no measurable benefit whatsoever,[12] and many are associated with serious adverse effects on the immune system, heart, brain, gastrointestinal tract, musculoskeletal system and lungs. [13]  Many of these medicines delay recovery from illness and contribute to a host of drug-drug, and drug-supplement interactions.  The use of OTC cough and cold medications are among the top 20 substances leading to death in children,[14] and many medical organizations, including the American Academy of Pediatrics (AAP) [15] and the FDA strongly advise against the use of these agents.[16]

 

A huge amount of time, money and effort is devoted to what turns out to be a battle against the symptoms of illness.  We have neglected to inquire whether these palliative efforts actually make us healthier or sicker in the long run, and have entirely ignored the data, which suggests the latter.  Conventional medical strategies disregard the most fundamental principles of illness and immunity, while continuing to market medicines directed toward symptom suppressing therapies.  Not only do these methods tend to prolong most acute illnesses and lead to more frequent recurrences, but they also weaken (and sometimes cripple) the immune system, fundamentally promoting the trend toward chronic disease.

 

Americans demand immediate relief of their symptoms without understanding the harm that this causes. Symptoms are unpleasant, but they are more than just incidental byproducts of illness.  A healthy body generates symptoms as it engages the immune system to fight agents of illness, injury and infection.  Symptoms are more than just signs of illness; they are the product of an active fight against it. When symptoms are blocked, the immune system is blocked.   Medicines that control and suppress signs and symptoms ultimately suppress (and weaken) the immune system.  The short and long-term consequences of suppressing the immune system can be profound.

 

Modern medicine has seemingly allowed us to divorce our symptoms from our health by promising comfort, but this strategy ultimately backfires since it impairs self-healing and homeostasis.  By prioritizing palliation with powerful immune suppressing medications, we substitute temporary ease at the expense of long-term health.

 

“The symptoms we experience with illness are the body’s natural healing and protective measures.  Suppressing these more often than not extends the length of an illness.  This is true with fever reducers, decongestants, cough suppressants, an similar remedies.”[17]

 

Entirely absent in modern medicine is any discussion of the consequences of this approach.  Conventional medical therapy is more concerned with short-term symptom relief than with the long-term responsibility.  The very concept that symptom relief could have a deleterious effect on disease management is never even considered.  Further, there has been no discussion of the benefits of acute illness as a health-sustaining process that prevents chronic illness.  Illness, as well as its signs and symptoms have been continually vilified.   It has yet to dawn on the conventional medical profession that acute illness ultimately benefits mankind if the immune system is allowed to freely engage it without meddlesome interference.  Acute illnesses provide the grist for health, and without these preparatory challenges, long-term health is not only unlikely, but simply not possible.

 

 

NSAIDs

 

Leading the list of routinely overprescribed and overused medications that relieve symptoms and suppress the immune system are the Non Steroidal Anti-inflammatory Drugs, or NSAIDs.

 

NSAIDs are the most widely used class of medicines in the world.  Americans fill over 70 million NSAID prescriptions and consume roughly 30 billion doses of over-the-counter NSAIDs annually.  According to the National Ambulatory medical Care Survey (NAMCS) NSAIDs were prescribed for pain in 95% of all physicians visits.[18]   Nearly a third of all adult Americans take these medicines on a daily basis and almost half of them consume more than the recommended dosage.

 

Complications related to these agents are well known, and include almost every organ system.  The most alarming concerns include damage to the gastrointestinal tract, the heart, and kidneys, but the brain and lungs are also adversely affected.  These drugs have been directly implicated in lung injuries leading to asthma,[19] fatal gastrointestinal bleeding, liver damage, heart attacks and stroke.[20] They are a common cause of kidney failure in children and adolescents even when correct dosages are utilized.[21]^,[22] Used alone, and according to guidelines, they are responsible for more than 20,000 deaths and over 100,000 hospitalizations every year in the U.S. alone.[23]

 

The risk of developing kidney failure is three times greater in NSAIDs users and up to four times more frequent when recommended dosages are exceeded.  The risk of kidney injury is even more profound when dehydration is simultaneously present, (a common factor among athletes who regularly medicate before, during and after training).  Unfortunately, many athletes frequently abuse these agents, euphemistically nicknaming them “Vitamin I” for Ibuprofen (but the acronym really stands for “idiotic”.)[24]  Anyone who exercises while using NSAID’s plays roulette with a multitude of disastrous side effects, particularly those that affect the kidneys and GI system, which are extremely sensitive to the effects of even mild exercise induced dehydration.

 

The use of NSAIDs to manage hangover symptoms is another troubling concern since this condition usually involves the combination of dehydration along with alcohol-induced damage to the mucus lining of the GI tract.  The use of NSAIDs for this condition is a recipe for disaster.

 

Even short term NSAIDs use is associated with a 50% increased risk of developing renal cell cancer, but after 10 years the relative risk rises 300%.[25]

 

NSAIDs (particularly Ibuprofen) raise blood pressure, increase platelet aggregation, cause blood clots and, in susceptible individuals, increase the risk of myocardial infarction and stroke.[26]   NSAIDs double the risk of hospital admission for congestive heart failure (CHF) even in those with no prior history of the disease, but they increase the risk of hospitalization 25-fold in those who already have the condition.  These drugs are responsible for nearly 20% of all hospital admissions for CHF.[27]

 

NSAID use during the first trimester of pregnancy is associated with a three-fold increased risk of developing congenital heart malformations and more than a two-fold risk of developing any congenital anomaly.[28]

 

NSAID use is associated with erectile dysfunction in men.

 

NSAIDs are frequently taken for musculoskeletal injuries and arthritis, even though chronic use accelerates the progression of arthritis, decreases joint space width, downregulates chondrocyte proliferation and inhibits synthesis of proteoglycans, collagen and cellular matrix components.  All this combines to make arthritis worse in NSAID users.[29]   NSAIDs damage cartilage, weaken bones, and prolong the healing of broken and injured bones and soft tissues:

 

“NSAID use can and does alter certain fundamental processes involved in the normal healing of injured tissues… impairs normal skeletal function leading to decreased bone mineral density… [has] negative effects … on healing of skeletal tissues. Fracture healing and tendon-to-bone healing appears to be particularly susceptible to inhibition.”[30]

 

NSAIDs are commonly used in the routine treatment of many acute illnesses including colds, influenza, earaches and fevers.  Here they are used to reduce painful symptoms, and suppress fevers.  NSAIDs act through several different pathways that inhibit cyclooxygenase and prostaglandin synthesis, which are important immune system mediators responsible for protecting the body from infection.  In essence, NSAIDs act by suppressing immune mediated inflammation, which is one of the most basic defenses utilized by the innate immune system to protect the body from infection.

 

Fever, pain and most symptoms of acute illness are the byproduct an active healthy immune system doing what it is supposed to do.  Eradicating the symptoms of a functioning immune system (with NSAIDs) is synonymous with suppressing the immune system itself.  Blocking pain and inflammation with NSAIDs blunts the acute immune response, prolongs illness, and delays recovery time.[31]

 

“Ibuprofen had its most profound effects in inhibiting human peripheral blood mononuclear cells and purified B lymphocyte IgM and IgG synthesis when administered in the first few days after activation… The implications of this research are that the use of widely available NSAIDs after infection or vaccination may lower host defense. This may be especially true for the elderly who respond poorly to vaccines and heavily use NSAIDs.” [32]

 

NSAIDs are frequently used to reduce fever, which is an essential physiologic immune defense, and one of the first lines of resistance utilized by the innate immune system. [33]   Fever is a carefully orchestrated rise in body temperature, designed to adversely affect infectious organisms while simultaneously boosting immune system efficiency.[34]  Unopposed fever has been found to be beneficial across a wide range of conditions ranging from simple bacterial and viral infections to cancer.[35]  Forcing the body to lower its temperature into “normal” ranges (by using NSAIDs, aspirin, baths, etc.) during times of infection is associated with more serious long-term side effects.[36]

 

Using NSAIDs to lower body temperature in fevers on grounds that this prevents febrile seizures is unjustified and wholly without scientific merit.[37]^,[38] Many investigators believe that rapid drops in body temperature, caused by these medications, actually increase the risk of seizures.  Febrile seizures do not cause brain damage, affect intelligence or lead to developing a seizure disorder.[39]  Reducing fever may improve comfort, but this frequently exchanges a short, acute illness for a protracted condition that may ultimately require more medical intervention.

 

The great influenza epidemic of 1918 is the most well known example of the first time an anti-inflammatory medicine (aspirin) was used on a grand scale.  First produced by Bayer Corporation, one of the world’s first pharmaceutical giants (who also patented heroine in 1898[40]), and initially sold as a powder.  The tablet form became widely available to the general public in 1915 just before the influenza epidemic.[41]   Heralded as a scientific victory over acute febrile illness, since it was such an effective symptom suppressant,[42] it was widely recommended during the great influenza epidemic with catastrophic results.[43] Partly as a result of this epidemic, and the link with Reye’s syndrome, the use of aspirin is now absolutely contraindicated in any viral condition.[44]

 

“Treatments for this illness [influenza] included atropine, injections of camphor in oil, “applications of guaiac”, cupping, large doses of aspirin, quinine, “imperial powders” (a mixture of potassium bitartrate, sodium citrate, and sugar), castor oil, digitalis, and heroin for cough and insomnia”[45]

 

Mortality data from medical practices using the aspirin regimen speak for themselves, with average case mortality rates averaging 30%.    Even non-pharmacologic methods (doing nothing) proved to be safer and more effective than the conventional medical intervention, [46] and homeopathic methodologies proved to be the most beneficial of all:

 

“Perhaps the most recent use of homeopathy in a major epidemic was during the Influenza Pandemic of 1918. The Journal of the American Institute for Homeopathy, May, 1921 … reported that 24,000 cases of flu treated allopathically had a mortality rate of 28.2% while 26,000 cases of flu treated homeopathically had a mortality rate of 1.05%. This last figure was supported by Dean W.A. Pearson of Philadelphia (Hahnemann College) who collected 26,795 cases of flu treated with homeopathy with the above result.”[47]

 

Direct and indirect costs of NSAIDs is extremely high and difficult to estimate, but the combined toll of these drugs on the U.S. economy is more than $38 billion since 1980, when they first began to saturate the consumer marketplace.  These drugs find their niche in symptom management via immune system suppression.  They have no other benefit. Contemplation of their use should generate extreme caution, and avoidance.