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|A prescription for disaster: Pharmaceutical overuse in the U.S.|
|Written by geekGirl|
|21 December 2009|
In 2003, the U.S. consumed 45% of global pharmaceutical sales (USDHHS 2004). Additionally, prescription drug misuse in the U.S. has been a rising trend since 2004 (Schepis and Krishnan-Sarin 2009), and the U.S. spent $215 billion on pharmaceuticals in 2003, and $228 billion in 2004 (OECD 2009).
If these statistics aren’t alarming by themselves, there’s more. The United States’ per capita expenditures on healthcare almost doubled from 2000 to 2007, and per capita pharmaceutical expenditure exhibits similar growth. In 2007, the U.S. also spent nearly twice as much per person on healthcare than any other country (OECD 2009).
A possible cause of the increases seen is media attention to pharmaceutical medications. It’s nearly impossible to watch television these days without seeing some kind of advertisement for a pharmaceutical drug. These ads have actually increased in exposure over the last ten years (Fox and Ward 2008), and may be connected with the increase in pharmaceutical consumption in the United States.
With statistics surrounding over-consumption of prescription medication, it’s no wonder these drugs can be more of a problem than the diseases they are intended to treat. Prescription medication overuse leads to increased health and financial problems. This paper hopes to shed light on this important issue, so patients can become better-informed healthcare consumers.
Review of Literature
Pharmaceutical medication has become a staple in the healthcare industry. At the same time, the rate at which prescription medication use is growing in the United States is nothing short of disturbing.
What does the government say?
The United States Department of Health and Human Services’ (USDHHS) Report on Prescription Drug Importation looked at various aspects of pharmaceutical use in the United States (2004). A primary focus of the report is to present the dangers involved in purchasing pharmaceuticals from manufacturers outside the United States. Areas examined are ways pharmaceuticals enter the U.S.; ways to prevent these drugs entering the U.S.; pharmaceutical sales by country; and an impact analysis.
Most relevant to this research is the data for pharmaceutical sales by country. Citizens of the United States consumed 45% of the global pharmaceutical market in 2003 (fig. 1) (USDHHS 2004). The report associates this information as a threat to research and development in U.S. pharmaceutical industry if importation of pharmaceuticals became legal. Little effort is put forth in the report by the USDHHS to address the implications of consuming so many pharmaceuticals. Most of the health focus in this article covers potential dangers of consuming pharmaceuticals that lack the regulation of the United States during production. This report offers some valuable data, but seems to focus more on the financial implications of the pharmaceutical industry in the U.S. related to legalizing pharmaceutical importation.
Figure 1. Chart of pharmaceutical sales by country (USDHHS 2003)
Pharmaceutical sales grow exponentially
While loss of revenue is of utmost concern to pharmaceutical companies, the economic impact of pharmaceutical overuse is more apparent. Aitken, Berndt, and Culter (2009) examine the rates of pharmaceutical use increases from 1997-2007. The results point to a slowing growth trend. The data shows a consistent increase in pharmaceutical sales in the United States during the ten year period (fig. 2). In 2007, the U.S. consumed well over $225 billion in pharmaceuticals (Aitken et al. 2009).
Figure 2. Graph showing growth of pharmaceutical consumption in the U.S. from 2000-2007 (OECD 2009)
Aitken et al. (2009) point out the existence of “blockbuster” drugs, and the exponential growth experienced by these drugs over a ten year period. A blockbuster drug is defined as one that sells over $1 billion a year, and has grown in sales from 12% of sales in 1996, to more than half of all pharmaceutical sales ten years later (Aitken et al. 2009).
It appears certain drugs are behind the drastic increase in pharmaceutical consumption. The fact that the United States consumes nearly half of the global market of pharmaceutical drugs says something about the approach to healthcare in the United States. Are pharmaceuticals the easiest treatment, thus the most common?
Described as one of “the most potent analgesics”, opioid pharmaceuticals accounted for $9.5 billion in sales in 2005. Additionally, it is estimated that 50 million people in the U.S. are impacted by chronic pain, with a “high prevalence of chronic pain and opioid abuse”. Furthermore, 48 million people in the U.S. over age 12 have taken prescription pain-killers for recreational purposes at least once (Passik 2009).
Social cost of pharmaceutical overuse
The money made from pharmaceuticals comes from somewhere, and that somewhere is the consumer. Beyond the price paid at the pharmacy, consumers of pharmaceuticals are paying for much more than just the prescription.
Some people unknowingly supply recreational drugs to their children and others. A recent article in the Journal of the American Academy of Child & Adolescent Psychiatry states the “most common source” of prescription medication for adolescents is family and friends. White adolescent males are the most at risk for severe misuse of prescription medications, and young females are most likely to steal these drugs (Schepis and Krishnan-Sarin 2009).
It is vital to discover the best approach to preventing misuse of prescription drugs by adolescents to avoid future health and financial complications of youth. For the same reasons, it is important to address the complications facing adult communities as well.
Growth of an industry, demise of the consumer
As pharmaceutical use among adults and adolescents has continued to grow over the last decade, further research examined the deadly side of pharmaceutical overuse by looking at 893 accidental overdose deaths in rural Virginia from 1997-2003. Wunsch et al. discuss details of the death records from the Office of the Medical Examiner in the Western District of Virginia. This research offers further insight into the types of drugs being used, and their association with accidental death (2009).
There was a 300% increase in drug overdose deaths over the six years in rural Virginia, and the primary drugs responsible for this drastic increase in deaths were opioid-based (Wunsch et al. 2009). In fact, 74% of the people who died presented with opiates in their system at the time of death. Additionally, 57% of the cases involved multiple drugs in the system. Anti-depressants and benzodiazepines were the next most common substances found in the patients studied, at 49% and 39% respectively (Wunsch et al. 2009).
A 300% increase in deaths occurred over a six year period of time in this area of the United States is enough to raise some flags on its own. However, the reality that most of these deaths were associated primarily with the overuse of opiates, anti-depressants, and benzodiazepines may be pointing to the root of the problem. Not only are these drugs highly used, but the research suggests these drugs are overused in astounding and lethal combinations, at the very least, in certain areas of the county (Wunsch et al. 2009).
Pharmaceutical ads: Selling the American dream?
Why has there been such an increase in pharmaceutical use since the mid-1990s? The answer may lie in the increased exposure to pharmaceutical advertisements on the internet and on television. Direct-to-consumer marketing expenditures have increased by 20% every year since 1997 in the United States (Fox and Ward 2008). The drugs being marketed are lifestyle drugs, which are used to treat more social-medical issues like balding, erectile dysfunction, smoking, and basically any pharmaceutical used to treat something that isn’t immediately life-threatening. These drugs are considered an “elective medication” used to improve the patient’s perceived quality of life (Fox and Ward 2008).
Looking at pharmaceutical consumption trends since the mid-1990’s, media exposure to pharmaceutical medications could present an explanation for the increase in pharmaceutical sales. After all, if marketing didn’t work, it wouldn’t make sense that pharmaceutical companies would increase their marketing budgets by 20% every year for over a decade (Fox and Ward 2008). It also seems pharmaceutical television commercials and internet ads could be drawing more patients, who wouldn’t otherwise seek medical attention, into the doctor’s office. The pharmaceuticals these people obtain are contributing to the rising numbers in pharmaceutical expenditure.
The money trail
Where does the money trail lead? The Organisation for Economic Co-operation and Development Stat Extracts (2009) looks at 30 industrialized nations, and offers statistics of gross national product, total health expenditures, per capita health expenditures, per capita pharmaceutical expenditures, as well as many others statistics. In 2007 the average expenditure on healthcare per capita in the U.S. was $7290, and 12% of this expenditure was dedicated to pharmaceuticals (OECD 2009). That’s an average of $874 per year per capita spent on just pharmaceuticals in the United States. If there are 300 million people in the U.S., this means that over $262 billion was spent on pharmaceuticals in 2007. The U.S. spent at least twice as much as the second highest spender on healthcare for all seven years (OECD 2009).
With the marked difference in what the United States spends on healthcare compared to all other countries, it would seem logical for the U.S. to have more doctors to spend all this extra money on. This is not the case. The United States actually consistently placed right in the middle of all countries in the area of doctors per person (OECD 2009). The countries with the lowest number of doctors per capita are Turkey, Korea, and Mexico. Countries with the most doctors per capita are Greece, Belgium, followed by a three way tie for third between the Netherlands, Norway, and Switzerland. Coincidentally, the United States is, on average, the second lowest consumer of doctor visits per person (OECD 2009). If the U.S. spends the most on pharmaceuticals, and these pharmaceuticals are prescribed by doctors, how can the U.S. be the second lowest consumer of doctor visits?
Consumers: Originators of the money trail
The LIFE Foundation studied the financial impact of long-term and short-term disability. If a 40 year-old man earning $50,000/year becomes disabled, he will lose $1 million to medical expenses if he remains disabled until he is 65. Even short-term disability can lead to medical expenses in the area of $50,000-$75,000 per year (LIFE Foundation 2009).
The report leaves to question what percentage of this cost is for pharmaceuticals alone, however we do know that 12% of healthcare expenses account for pharmaceutical expenditures in the United States (OECD 2009). Based on this percentage, a person who spends $1 million on healthcare will spend $120,000 on pharmaceuticals. The cost to treat a short-term or long-term disability is not only financially draining to the individual patient, but can collectively impact on the economy.
Other researchers who have examined the financial implications of pharmaceutical overuse call for “careful consideration” in regard to the “long-term financial burdens and access barriers created by pharmaceutical insurance policies that rely heavily on private payments by individuals” (Hanley and Morgan 2009).
In Canada, 5% of the patient population consumed 48% of pharmaceuticals. These people tended to be low-income, older women, and were “more likely to be hospitalized and die within the year of study compared to other pharmaceutical users and non-users.” The researchers concluded that “rather than using policy instruments that are insensitive to underlying differences in need, administrative policies such as protocols, formularies, and prior authorization processes could be used to discourage misuse of medicines” (Hanley and Morgan 2009).
Given the available research, it seems over-consumption of pharmaceutical medications is not only unhealthy, but it is potentially lethal. It may also be an indicator of bigger problems, like a shortage in healthcare providers, or a need for increased public spending on healthcare. It is even possible that one’s overuse of prescribed medications is an indication of other problems with that patient. Is it just convenient and more profitable for doctors to keep their patients coming back for more pills?
Over-medication also leads to greater spending dedicated to pharmaceuticals. This can have a negative impact on other industries, since someone who experiences short or long-term disability will lose considerable amounts of money to the healthcare industry instead of a number of other industries (i.e., entertainment, housing, transportation, food, etc.). This is important due to the percentage of healthcare costs associated with pharmaceutical expenditures. If someone becomes disabled they are more likely to spend more money on pharmaceuticals, and economies unrelated to the pharmaceutical industry will be negatively impacted. This would support the idea that pharmaceutical overuse not only makes an individual poorer, but it also has a negative impact on economies unrelated to the pharmaceutical industry.
While other areas of healthcare are comparable to many other countries, patients in the United States seem to be spending less time visiting the doctor, yet more money on pharmaceuticals. Is advertising the possible culprit in this drastic variance?
Whatever the cause may be, the outcome is dreadfully clear. The overuse of pharmaceuticals leads to a diminished health and finances, among many other problems. With the evidence provided by current research, it is necessary to further define this problem through in-depth research, so a plausible solution can be reached.
Form of knowledge
Recent research has shown the detrimental impact of pharmaceutical overuse. We’ve seen small communities in rural Virginia experience large volumes of pharmaceutical deaths over six year period (Munsch et al. 2009). During the same time these rural Virginians lost their lives to prescription medication, pharmaceutical advertisements became a regular part of internet and television advertisement (Fox and Ward 2008).
Data also shows a steady increase in pharmaceutical sales since the mid 1990’s, and people in the U.S. doubled what they spent on pharmaceuticals (OECD 2009). Then the U.S. consumes 45% of the global pharmaceutical market in 2003 (USDHHS 2004), yet consumed the second least number of doctor visits when compared to 29 other industrialized nations during the same year (OECD 2009). This data points to a growing problem in the United States that could exert serious health and financial implications on any given healthcare consumer in the United States.
While current research alludes to pharmaceutical overuse creating diminished health and wealth, more specific research is necessary to establish a solution to the problem. I propose research that will be survey-based, and compare the health and finances of the country’s sick, healthy, and wealthy. It is imperative to conduct this research, so an end can come to abusive healthcare practices which inhibit one’s health and finances. This research also hopes to provide insight into potential issues surrounding the current healthcare protocols, and the financial implications of being sick in the U.S.; with the hopes of developing a healthier approach to these issues.
The survey will be completed by 25 people per group per state, for a total of 1250 patients, 1250 fitness professionals, 1250 people with a $1 million plus net worth, and a control group of 1250 randomly selected people. In all groups, half of the patients should have health insurance, and half should have none. All participants must be 18-65 years of age.
The patient group will consist of people currently seeking medical treatment from a doctor’s office, hospital, or filling a prescription on the day they are invited to participate in the survey. This group of patients will offer insight into the health and finances of people actively treated in the healthcare industry.
The fitness professionals will be fitness trainers, professional athletes, nutritionists, or anyone whose primary professional function is fitness related. Participants from this group will be studied to determine healthcare habits of people with perceivably optimal health.
Wealthy individuals will be selected for this study based on their net worth. Participants in this group may not have obtained their wealth through inheritance, winnings, or settlements. This group will offer information about the healthcare habits of wealthy individuals.
The control group for this study will be randomly selected, and may or may not be actively obtaining treatment from a medical doctor. This group will help provide a baseline for the other three groups which are limited in random selection.
The data for the surveys in this research will be collected by research assistants (RAs) out in the locations where the various groups are found while doing what differentiates them from each other. For instance, the medical group will be entering or leaving a medical facility, and will be qualified only if they were at the facility receiving medical care, or picking up/dropping off a prescription. The participants will be asked to fill out the survey and mail it in an envelope provided with the survey, or they can fill it out immediately and leave it with the RA.
The health group will be located while working as fitness trainers, and other health professionals. This group will be contacted directly in a random selection process and asked to participate. These people will also be contacted by RAs, and given the survey once they are qualified, and accept the invitation to participate. The surveys may be mailed out to participants in this case, and asked to be returned in the provided envelope.
The wealth group will be located by placing an advertisement for research participants in local newspapers. After providing evidence of net worth equaling at least $1 million, they will be provided with the survey either in person, or by mail. This group will also be asked to return the survey by mail in the enclosed envelope in they choose to have it mailed.
The control group will be located in a similar manner as the wealth group; with an advertisement seeking participants for a short survey. Other options to locate this group are college campuses, gas stations, and any other public place without a pharmacy or healthcare provider. The surveys can be mailed to this group with a return envelope.
For all groups a small consolation gift will be offered to encourage participation. This could entail a financial gift of $5, or possibly a gift certificate to a local business. In some cases, college credit might be an option in exchange for a completed survey.
Participants from all four groups will be asked the following questions:
1.) How many times did you visit a doctor’s office in the last 12 months?
2.) How many times in the last 12 months did you visit a hospital?
3.) How many prescription medications do you currently take?
4.) How many prescription medications have you taken for more than one month during the last 12 months?
5.) How much time do you spend with your doctor during an average visit?
6.) Has your health improved, worsened, or stayed the same over the last 12 months?
7.) Has your financial status improved, worsened, or stayed the same over the last 12 months?
8.) Do you have health insurance?
All surveys should be completed within a one year period and processed within the following year to ensure timeliness and relevance of the results. This timeline may need to be extended depending on availability of participants, and other various issues that could arise during the research.
People who should benefit from this research are of any age and consume pharmaceuticals, or may consume pharmaceuticals in the future. These people may be in a position where their ailments could be addressed in a different way, and with a less invasive approach. Addressing healthcare from a less pharmaceutical approach could improve the quality of health for limitless numbers of patients, and impact their financial status. It may also encourage some people to take a more pro-active role in their healthcare.
A second group for which this research is intended is U.S. healthcare professionals like nurses, doctors, and pharmacists. These people have the power to make changes to the current protocol that has led to this issue. Reform of the manner in which pharmaceuticals are prescribed in the U.S. must be addressed, and this research hopes to provide a foundation for this conversation.
Addressing the questions
By comparing answers from people who seek regular healthcare with individuals who are considered most healthy and most wealthy, the research should show the variances between the two groups. This research hopes to address the question if pharmaceuticals play any role in a person’s overall health, and financial stability. Other questions will also be answered by this research, such as:
1.) Do people who consume more pharmaceuticals have worsened finances?
2.) Do people who consume more doctor and hospital visits have worsened finances?
3.) Do people who visit the hospital more consume more or less pharmaceuticals?
4.) Do people who spend more time with their doctors consume less or more pharmaceuticals?
5.) Do people with health insurance consume more pharmaceuticals?
Further research should examine the United States’ poorest populations, and look at the health issues of those living in poverty. The questions surrounding health insurance should also be looked at in greater depth. Does health insurance play a role in preventing a person from decreased health and wealth if they face a health issue? Finally, in order to make change in this area, further examination of a country’s involvement in healthcare should be completed. Do countries with socialized healthcare have healthier and more financially stable citizens? Would a new hybrid of privatized and socialized medicine be the best option?
With astounding numbers showing the detrimental impact of pharmaceutical overuse, the problem not only needs immediate attention by the medical community, but also calls for a complete re-evaluation by the public regarding the way they view healthcare. Due to the potential threat to public health and safety, this issue is emergent and must be addressed promptly by government agencies established to guard patients from abusive medical practices and lethal chemical distribution.
The most-consumed types of drugs may raise some questions for research, with one of the most addictive pharmaceuticals, opioid-based drugs, being related to heroin. Why are so many people taking these potent pain-killers? The research shows too many patients are being negatively impacted by the manner in which these particular types of pharmaceuticals are prescribed. This abusive practice must stop, but without compromising the health and quality of life of patients.
While the types of drugs consumed most is an important consideration, there is also evidence that advertising on television and the internet could have an incredible impact. Current research leaves to question how much of this increase in pharmaceutical use is related to media influences.
As it becomes clearer that pharmaceuticals might be at the root of serious health issues and death, the issue of finances cannot be denied. What do patients get for their healthcare buck? There must be further consideration for the reason why U.S. citizens spend such little time with their doctors, yet consume such high amounts of pharmaceuticals. The proposed research will show this lack of patient-doctor interaction provides for a lesser quality of healthcare at a greater price to the patient?
My research will also address the issues brought up in current research by delving deeper into the problems pharmaceutical overuse present. The research will examine the connections between deteriorated health, finances and prescription consumption by comparing the answers to the proposed survey questions of the healthiest, wealthiest, and sickest individuals in the United States.
The reality that pharmaceutical overuse creates detrimental effects to one’s health and finances is painfully clear, and the longer the problem goes untreated the worse it will become. As is the lesson of a quote by
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