The amount of prescribed medications and the number of individuals taking them are increasing rapidly. The share of Americans taking one or more prescription drugs has risen among all age groups. According to the IMS Health Study, the total spending on prescription drugs in the U.S. reached $310 billion in 2015. This is almost three times more than total drug expenditures in the year 2000. It is forecasted that the U.S. spending on medicine will reach $370 to $400 billion in 2020. Moreover, several drug makers have notably increased their drug prices in recent years.
Meanwhile, 76-year-old Ethel must choose between groceries or heart and diabetes medications this month because social security benefits simply can’t keep up with the rising cost of medications. Over-consumption in the health care industry has caused necessary prescription drug costs to skyrocket, leaving individuals with serious chronic conditions financially destitute. We need a solution.
There are several reasons for this significant increase in medication usage in our society.
One obvious reason for this change is technological and scientific advances. We know more now than we did 10 or 20 years ago, and our ability to treat many conditions has improved. For example, progress in genetic research and the translation of laboratory knowledge into effective treatments has been fascinating and promising. Due to these advances, we have increased access to more effective and more expensive treatments, which allow patients to live longer. We are witnessing the dilemma created by these trends, as illustrated by the latest hepatitis C medications. These medications are effective and have fewer side effects than previous medications but are nearly unaffordable. Similar challenges certainly will be a part of the future of the practice of medicine.
Relative longevity is one of the positive outcomes of improved health care quality. This increased longevity leads to prescription volume growth and a higher cost of care. Individuals older than 65 comprise about 12 percent of the U.S. population, but they consume about 33 percent of prescribed medications. More than 80 percent of the older population is on at least one prescription drug daily and according to one analysis published in the Journal of American Medical Association the number of individuals on 5 or more prescription drugs increased from an estimated 8.2 percent in 1999 to 2000 to 15 percent in 2011 to 2012.
In the past few years, the initiation and expansion of the Affordable Care Act has been one of the drivers of prescription drug growth by adding millions of new patients to the pool, many of whom require prescription drug treatment.
If we accept that scientific progress can’t and shouldn’t be stopped, that improved longevity of the population is a positive outcome, then we must answer a key question: How can we afford and sustain this development in the long term without going bankrupt?
As a society, we need to concentrate on processes and behaviors that we can change or eliminate. Reducing the expenditure on medicines can be achieved by lowering the cost of acquiring the medicines and at the same time decreasing the demand.
There is a mindset in our society and health care system that we must “fix” anything that appears to be wrong. It fails to distinguish whether what we are trying to fix is a natural process or truly a disease. We want all body and mind-related problems “normalized” as quickly as possible without spending too much time or effort. This unrealistic expectation drives large numbers of people to choose medication over conservative management or a wait-and-watch approach. The desire to treat upper respiratory infections with antibiotics and asymptomatic testosterone deficiency with medications are only two examples of this deeply rooted trend in our society.
Another major shortcoming that increases medication usage in our society is entrenched in the medical education system which has an emphasis on using medications to treat disease. Few medical schools teach students about other options, such as nutrition, behavioral changes or a more comprehensive approach to disease management. Our medical practitioners learn how and when to start a medication, but they have difficulty in recognizing the best time and method for discontinuing a medication. It is a well-known phenomenon that starting a medication is a much easier task than stopping the same medication.
Our practice-related guidelines focus mainly on medication usage; these guidelines usually include only very general and broad suggestions for the conservative management of a disease, which lack any specificity and practicality. More importantly, our medical education is based on treating disease and not preventing it.
It is imperative that we change how our society manages disease if we want to afford high-quality medications for many years to come. We need to improve public health education and educate patients that aggressive and immediate treatments are, for many conditions, not necessarily better than conservative management. We need to educate the public that we can’t and shouldn’t try to “fix” a natural process and that sometimes, aggressive treatment might cause more harm than good in the long term. We need to promote managing the source of the problem, rather than the symptoms and comprehensive management of a condition that might require more tools than medication alone.
All of the above steps require a well thought out approach. It is true that we have to reduce the amount of prescription drugs. However, we should achieve this goal not by vilifying the medications or adherence to them, but by using them wisely.
Homayoun L. Daneschvar is an internal medicine physician.
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