The Changing Face Of Chronic Illness Management In Primary Care

Know anyone taking prescription drugs? The odds are enormous you do, and it’s likely they are taking drugs they don’t need, because their doctors are too quick to fall under the influence of Big Pharma’s aggressive drug sales reps.

Consider these statistics: almost half of all Americans are currently diagnosed with a chronic condition and 40 percent of those older than 60 taking five or more medications. Is it really possible that many people in the U.S. have illnesses that need to be treated with multiple drugs?

This question obviously raises issues about the nature of the relationship between the expanding definition of chronic illness and the explosion of prescription drug use in the U.S. — issues Michigan State University anthropologist Linda M. Hunt, PhD., decided to research.

Dr. Hunt looked into dramatic increases in the diagnosis of common, chronic conditions and the use of prescription drugs to treat these health woes . She specifically looked at two conditions which can often be relieved with lifestyle changes — type 2 diabetes and hypertension — that were treated in 44 primary care clinics.

Her research team interviewed 58 clinicians and 70 of their patients, and observed 107 clinical consultations in order to assess the doctors’ treatment strategies and the factors influencing their treatment decisions. They found that doctors usually prescribed at least two or more drugs per condition.

More than half of the patients studied were taking five or more drugs. Interviews with these people showed the cost of the drugs was often a hardship and the patients were often made sicker because of adverse side-effects.

So why are so many people taking so many drugs? The new study, just published in The Annals of Internal Medicine (above post), concludes more drugs are prescribed because the threshold for what constitutes an “illness” keeps getting lower and lower, thanks in large part to Big Pharma’s influence. For example, what was once normal blood pressure is now too high or, if approaching high, is called “pre-hypertension” and Big Pharma recommends treatment. And instead of telling someone with high blood sugar to lose weight and exercise and eventually they could improve or normalize their condition, it’s likely a doctor will emphasize that a person found to have type 2 diabetes will need to rely on medication for life.

Dr. Hunt points out in her study that physicians are caught up in an “auditing and reward system.” That means doctors are rewarded by drug companies for prescribing more and more drugs. Perhaps most disturbing is what Hunt calls a “prescribing cascade.” Simply put, drugs are prescribed to help relieve side effects caused by other drugs. Then still more drugs can be prescribed to relieve any new side-effects from the recently prescribed drugs.

To reverse and limit the influence of the Big Pharma on clinical practice, we should consider the following recommendations:

* Policies are needed to exclude individuals or organizations with financial conflicts of interest from involvement with clinical guideline-writing panels

* Doctors should be discouraged from seeing drug representatives

* Monitoring of doctor auditing and reward plans must be put in place to search for evidence of unintended negative effects on patients

Another study just published in the British Medical Journal (BMJ), by Harvard researchers reveals another problem caused by Big Pharma: business executives are unaware they could be wasting billions of their gross profits on ineffective, even harmful drugs in their health plans. They are also paying for treating the side-effects of these drugs.

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