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    Are Americans drowning in a sea of pills?

    Dennis MillerDennis MillerThe media have been saturated lately with stories about doctor-shopping addicts, the abuse of prescription drugs such as oxycodone, hydrocodone, lorazepam, and alprazolam — and what some consider the DEA’s draconian efforts to combat this by targeting doctors, pharmacists, manufacturers, wholesalers, and chains, etc., in response. 

    In my opinion, there is an equally serious problem that is largely ignored by the media: the overmedication of the American people.

    Top pick: Are pharmacists pill-happy?

    Meds, meds, and more meds

    Which do you think is a greater problem in the United States? Addiction to habit-forming opioid-type painkillers and benzodiazepines? Or overmedication with drugs for anxiety, depression, psychosis, obsessive-compulsive disorder, attention deficit hyperactivity disorder, social anxiety disorder, insomnia, constipation, menopausal symptoms, erectile dysfunction, etc.?

    Do you agree that overmedication includes the massive use of Rx drugs to treat blood pressure, blood sugar, and blood cholesterol, rather than a focus on preventing these diseases of modern civilization through major lifestyle modifications?

    Editor's Choice: What I wish I had learned in pharmacy school

    Lifestyle behaviors

    One day, while filling a customer’s 10 or 12 prescriptions, a technician commented to me, “I wonder how he has any room left for food!” 

    You probably have heard similar comments during your career. Not only do you wonder how this customer has any room left for food; you wonder how so many concurrent medications are affecting his appetite.

    In my opinion, the decision to prescribe each drug should be a major one, since patients often remain on those same or similar drugs for many years, if not for the rest of their lives.

    As a result of managed-care dictates, however, busy physicians have only limited time to spend with each patient. All too often they end up treating numbers — blood pressure, blood sugar, blood cholesterol, heart rate, etc. — rather than taking the time to work with patients to change deeply ingrained unhealthy lifestyles, such as being overweight, eating processed foods, having a sedentary lifestyle, smoking, drinking alcohol, etc.

    Dennis Miller, RPh
    Dennis Miller is a retired chain-store pharmacist living in Delray Beach, Fla. He welcomes feedback at [email protected] His books ...

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    • ChristopherValeri
      In the aggregate, pharmacists are the most qualified to help our patients differentiate between drug therapies truly necessary for them, the ones that seem solely to boost the drug economy, and discretionary therapies in between. I agree with you, Dennis, that about half of the drug products we sell are unnecessary or could be avoided. Most of the pharmacists I know live healthy lifestyles and would advise patients supportively about "pharmacoavoidance" if given the chance to get to know the patient to be frank enough to offer lifestyle change advice, for instance. CMS Meaningful Use incentives are currently being implemented to change the motivations of healthcare providers and institutions [one goal, to reduce hospital readmissions]. I hope that similar incentives will take root soon to place higher value on MTM and reimburse pharmacists for this service appropriately.
    • MarkBurger
      Dennis: Absolutely! Allopathic/Western physicians (and PAs and NPs who follow closely in their tracks) prescribe drugs at the drop of the hat (or mention of a symptom). There is no time to drill down to cause (and that excuse assumes that the prescriber even HAS the skills to connect-the-dots that would help him/her FIND a root cause or know what lifestyle/diet/exercise/sleep adjustment to make to "cure" the problem). Pharmacists seem to be satisfied with filling as many Rxs as they can so as not to upset the apple cart of income and push-back from prescribers. We should be siding with patients, re-evaluating the need for drug regimens, and calling doctors to get medications discontinued, doses reduced, lifestyle changes made. Our patients (who, by the way, HATE being thrown another Rx that doesn't solve their problem) will love us for it.The prescribers who, as we know, DON'T have the time to connect the dots or don't know how to interpret (e.g. thyroid tests) tests or know what nutrition and lifestyle changes to suggest will appreciate our efforts. So: When we think of MTM, instead of looking for compliance issues, ADRs, DIs, etc. we should, first and foremost, be thinking of how to titrate a patient OFF of unnecessary medications, suggest lifestyle changes, advise on dietary interventions, and suggest OTC supplements/vitamins/nutrition/herbs/minerals after we connect the dots. My 2 cents.