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The topic of prescription medication is a controversial one throughout the world.  While our headline question is perhaps the biggest issue faced by the medical industry today, there are many other problems that exist when it comes to prescription drugs, many of which may lead directly into medicines being prescribed too readily, or without the necessary level of due care.  Indeed, rather than the question offering a simple ‘Yes or No’ debate, we need to explore the avenues that lead to that outcome.

The following points are all worth considering in respect of prescription medications:

  • Does the modern trend of ‘self-diagnosis’ mean that medical professionals are more patient-led than ever before?
  • How can medical professionals be sure that prescription drugs are not being abused, and is there anything we can do as a society to help change the system?
  • Are doctors, as members of the medical profession, under any pressure to secure more sales for the industry, and do they issue prescriptions more readily as a result?

We will also look at whether due respect is given to potential side effects of prescribed drugs, but will not go into detail as we recently asked that question in a separate article, which is posted here.

Self-Diagnosis

Officially, governments, the medical profession, and patient care organizations and charities discourage self-diagnosis.[1]  Even medical professionals themselves are guided not to do it, as the dangers of misdiagnosis are considered too great.  The dangers of misdiagnosis speak for themselves, and while the mistreatment of an annoying but relatively harmless condition may seem trivial, in more extreme cases it could lead to serious future health problems or even death.

Despite this, the first question often asked by doctors when you step in the consultation room is, “what do you think is wrong with you?”  Even if it isn’t, there are many people who, instead of listing their symptoms as asked, get straight into “well I looked it up on Google or Wikipedia and I know I have……”

While there is no suggestion that medical professionals are taking what patients say as definitive, there is the danger that they may begin to base a diagnosis around these thoughts, without asking further investigative questions that could lead to a different conclusion.  At the same time, many patients will do their research before attending a doctor’s appointment, and some will already have made their own mind up regarding their condition before even speaking to a professional.

There is no question that, consequently, medical professionals are under a far greater degree of pressure than ever before, especially when metrics such as patient satisfaction are widely used in the industry today.  It does not take many patients being heard saying, “I suffer with this but the doctor only have me that” before a person’s reputation, grossly unfairly, takes a hit.  Google, Wikipedia, Ask Jeeves, and many other engines and websites have given patients a greater level of ‘knowledge’ than ever before, and doctors need to be careful to manage this as best they can.

Concerns over whether prescription drugs are too readily available are not a new phenomenon, and ironically, this is more likely to lead to doctors being more reluctant to issue certain medications.  This in itself has its own obvious dangers, as if a medical professional lacks the confidence to make a bold call, how can they ever be expected to do their job?

Self-diagnosis needs to be limited to conditions such as common colds, migraine headaches, and other relatively simple conditions.  Of course, while this is a concern to the medical industry, it is something that needs to be society led, and therefore is not likely to change any time soon.  Can we do anything about medicine being bashed in part due to the actions of those from outside the profession?

The likely answer is no, but those doctors, whom in all likelihood make up the majority of the profession, who take self-diagnosis with a pinch of salt deserve a great deal of credit for sticking to their convictions and seeing out their job, no matter how certain or hostile a patient may be.

Prescription Drug Abuse[2]

Whenever drug abuse or drug addiction is the topic of conversation, most people’s thoughts automatically turn to illegal drugs, such as cannabis, cocaine, and heroin.

However, the reality of drug abuse is that the proportion of people who become reliant on prescription medications is growing at pace.  Given that prescription drugs are 100% legal and issued by trusted members of society, it is difficult to put a true figure on the number of people who are abusing these medications, however it is thought that more individuals in America abuse prescription drugs than those who abuse illegal drugs combined.

Prescription drugs have caused a number of high-profile celebrity deaths in recent years, which has given the subject a far greater level of exposure.  Heath Ledger is perhaps the most notable in this respect.  In other cases, Whitney Houston had prescription medications in her blood when she died – although ultimately this was put down to a combination of cocaine abuse and an underlying heart condition – and Michael Jackson was killed after overdosing on a combination of propofol, lorazepam and midazolam, although his personal physician was later convicted of involuntary manslaughter.

While each of these celebrity cases has many differences, they all raise the question of how this can be allowed to happen, even in the case of someone using a dedicated, personal doctor.

Unsurprisingly, those throughout the medical profession place the responsibility for prescription drug abuse solely at the door of ‘patients.’  There are many techniques that people will employ if they are addicted to, or looking to abuse, prescription medications.  We explored these, and touched briefly on what, if anything, can be done to prevent them occurring so readily.

Ironically, many of these could be fuelled by patients’ frustration at doctors’ unwilling to fulfill requests made following self-diagnosis, as we looked at previously.

  • ‘Doctor shopping’ is the common practice of visiting more than one physician to obtain the same medicines.  In many respects, this would seem the easiest problem to solve, however a database covering all patients would potentially risk patient confidentiality, particularly if a patient had genuine reasons for visiting a different doctor for different conditions.
  • Drug dealers are not just good for getting hold of cocaine, heroin, and other illegal substances.  As demand for prescription drugs increases, ‘traditional’ dealers will often be the people to see.
  • Theft of prescription drugs is a massive issue, with people both stealing for their own use as well as to deal on to others.  Those who a desperate will even be inclined to steal from family members or friends.
  • Using friends or relatives to acquire prescriptions on our behalf is becoming more popular, too.  This could potentially be tackled by linking family members up through a database, although there would be no way of finding out and securely storing whom everyone is friends or acquaintances with.  Much like the issue with dealing with ‘doctor shopping,’ this is perhaps a data security accident waiting to happen.
  • Buying drugs from the internet is another common method, and although regulations are stamping down on sites that offer a variety of drugs prescription-free, the internet is so large that it will be impossible to eradicate this entirely.
  • Lastly, feigning injury or illness is a technique commonly used and is easy to get away with, especially if you have already been treated for a specific condition.  Were there better guidelines in place around how long a medication can be taken for, that would potentially help to reduce the risk in this area.  Right now, very few medications come with concrete guidelines around how long they should be taken for, and if nothing else these would reduce the potential of drug abuse, or at least force an individual down a different path.

Analyzing these practices, it is easy to see the problems that the medical profession faces.  Arguably, the main barrier in this case is that those looking to acquire drugs and those that supply them (legally) are battling against each other.

It is difficult to directly link doctors to responsibility for prescription drug abuse, especially as there are so many means of acquiring such medicines if an individual is determined to do so.  Perhaps the only way in which we could hold the medical profession responsible would be if a medication was prescribed as a result of misdiagnosis in the first place, although without any evidence to back up that argument, it is difficult for it to be credible.

In respect of the larger society, the only real way of dealing with this is for people to become much more knowledgeable around prescription drug abuse.  It should not take a Heath Ledger, for example, to die as a result of prescription drugs for people to take an interest.  While the onus should be on society as a whole to gain a better understanding, it could be argued that the medical profession need to do much more in terms of being introspect, rather than always be seen to go on the defensive and blame external factors, no matter how influential they may be.

Under Pressure

The question of whether doctors are placed under undue pressure to prescribe medications is one that really begins to get to the heart of our headline question.  There have been a number of allegations[3] in recent years of doctors overprescribing a variety of medications, all in the name of profits for companies who develop, manufacture, and supply a wide range of medicine.  Big Pharma are one of the major pharmaceutical companies that have been targeted, with accusations ranging from blatant profiteering through their products, to aggressive sales reps almost coercing surgeries and hospitals into committing finances to particular drugs.

This goes much further than the simple question of whether patients are being misled due to diagnosis, although it could indicate why a reported 50% of American adults have been prescribed with a ‘chronic’ condition that requires regular, constant medication.  There have also been allegations that medical professionals are ‘incentivized’ to prescribe more drugs, the more prescriptions they issue for certain products, the more likely they will be to receive bonuses.  Clearly, turning the medical world into a glorified crapshoot of sales could have dangerous consequences for all involved.

Now, the focus remains very much on the way in which many drugs can lead to the unintentional over prescription of many drugs.

This is how it works.

Big Pharma, or any other pharmaceutical company, develop a medicine to deal with a disease.  The medicine is a success in terms of its primary aim, but there is a range of side effects that one experiences as a result.

Subsequently, the pharmaceutical company then develops another drug that takes reduces the severity of side effects, so a doctor ends up prescribing that, too.  Unfortunately, this new drug also comes with side effects, so the company goes away and comes up with something else.  You can see where this is going, no doubt, but the question over why two or in some cases even more types of medication are being prescribed to deal with illnesses is a one that the industry needs to answer with some urgency.

Outside of medicine, logic would suggest that the sensible path of action is to cut out the ‘middleman,’ and instead work on incorporating the side effects reducers into the original remedy.  Unfortunately, this would then mean companies having to undergo the whole development and clinical trial process again, which could affect the treatment of some conditions as well as, crucially, the profitability of the pharmaceutical companies.

Side Effects

Aside from the discussion around drugs to treat side effects and further drugs to treat the side effects that they cause, and so on, is due respect given to side effects?

As we discussed in a previous article on this site, it is difficult to determine where the accountability falls when it comes to the side effects of prescribed medications.  Clearly, there is a responsibility on the part of the medical professional to make clear any potential side effects to patients, as well as being selective of what they prescribe based on any underlying health conditions.

At the same time, patients are able to research pros and cons of medication, and look up a full range of side effects, on the internet to a degree like never before.  While doctors would likely encourage patients to do this, it does lead to the risk of self-diagnosis coming into play once again, which as we already know, can be dangerous.

Conclusions

It is difficult to definitively answer the question, “Are Prescription Drugs Issued Too Readily?” however; there is certainly evidence to support both sides of the argument.

Our position would be that prescriptions are not necessarily issued too readily, but there needs to be a clear step change in society and the medical profession to deal with all of the issues that stem from the core question.

Clearly, the prospect of doctors being pressured to prescribe medications, and in effect give them a drug they potentially do not need, is unacceptable.  If this problem is as serious and deep-rooted as has been reported, there needs to be much better regulation of the industry to prevent this from happening, as well as a commitment to research to develop better drugs with less severe side effects, if there is a means of doing so.

At the same time, doctors should be encouraged to prescribe the drugs they feel is necessary in order to deal with patients’ conditions effectively.  Although the internet is a great tool for people to understand their own illnesses and symptoms better, we, as a society, should really be able to have more faith in our medical professionals, and be able to trust that they are doing the right thing both ethically and in terms of our health.

Prescribed drug abuse is an issue that is only going to be tackled by everyone having a greater understanding of the problem, although we have acknowledged that there are a number of problems when it comes to developing solutions in this area.

It should not be forgotten that prescription drugs have the power to cure serious illnesses as well as significantly improve individuals’ quality of life.  While there are flaws in the process, and indeed throughout the medical industry, it would be wrong to put any barriers in place that restricted the potential of these medicines to have a positive impact.

Sources:
[1] http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Health_information_and_health_products_online?open

[2] http://www.uspharmacist.com/continuing_education/ceviewtest/lessonid/106448/

[3] http://www.naturalnews.com/037221_overprescribing_prescription_drugs_doctors.html