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Fixin' Healthcare

Thursday, January 27, 2011

Do We Really, REALLY Need This?

The pharmaceutical industry estimates it invested $45.8 billion in research in 2009. But the drug industry's productivity has been declining for 15 years with no signs of improving. Concern about this situation has prompted the government to start a billion dollar drug development center to help create medicines.

The American public has a unique relationship with drugs. No nation comes close to the U.S. for the utilization of prescribed medications or the incidence of drug abuse and drug addiction. People with at least one prescription increased from 67 percent to 74 percent of the population and the number of prescriptions annually per person rose from 10.8 to 14.3 between 2000 and 2006. More than a quarter of U.S. children and teens are taking a medication on a regular basis and nearly 7 percent are on two or more drugs. The Congressional Budget Office estimates that $235.4 billion was spent on prescription drugs in 2008.

Advancement in science applied to pharmaceuticals creates large numbers of drugs that increasingly target specific aspects of metabolism. Drugs are the cornerstone for therapy in the medical care system. It is not unusual for patients to consume multiple drugs for a variety of unrelated complaints and health problems. Chronic diseases are more prevalent and severe, and nationally assembled panels of experts often recommend therapy with multiple drugs simultaneously directed at different aspects of these complex health disorders. Chronic diseases can be controlled but not cured by drugs.

Strict rules for safety and efficacy apply to development and testing of drugs. Clinical trials are the best tool available to comply with these rules but they are not perfect. All drugs have side effects, some of them dangerous and unexpected. It is difficult to account for biological variability, biological adaptability and behavioral uncertainty. Some drugs are used for longer periods of time or higher doses or under different conditions than are evaluated in clinical trials. Every possible drug combination utilized in medical practice cannot be evaluated by clinical trials. Even with the use of approved medications and correct medication procedures, many people die every year from unintended reactions to the medication.

Drugs are major legal and illegal economic enterprises in the U.S. Considered in its totality, which includes side effects, multiple drug interactions, incorrect and inappropriate utilization and propagating a social and individual mind-set for sickness, drug therapy might have as much negative influence as benefit upon health. Improving health status of the U.S. population and decreasing medical care cost could be accomplished by decreasing drug utilization. I am not confident society or the body politic is willing or capable of even attempting to comprehend that concept.

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