The following article comes from the U.S. News ebook, How to Live to 100, which is now available for purchase.
If you're a typical American, chances are about 50-50 that you take at least one prescription drug—and if you're upwards of 60, the odds are nearly 2 in 5 that you take five drugs or more. Some may be lifesaving, especially for those with potentially deadly chronic conditions like diabetes or high blood pressure. But how many drugs in those mountains of pills add years to the lives of people who don't suffer from such illnesses?
"The majority of drugs approved probably aren't life-extending," says Lisa Schwartz, an internist and professor at the Dartmouth Institute for Health Policy and Clinical Practice in New Hampshire who specializes in medical communication related to the benefits and harms of prescription drugs and screening tests. But clearly, some can extend lives.
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Take the massively popular class of heart drugs called statins. By lowering the level of "bad" LDL cholesterol in the blood, statins can cut the chances of a killer heart attack or stroke even in those who have never had one. That's why the Food and Drug Administration (FDA) has approved the use of statins for individuals at high risk because of age, family history, smoking, and elevated cholesterol, even if they haven't shown outward symptoms of heart disease.
Yet every drug comes with baggage, some of it deadly. "All drugs—even the safest ones—have side effects," says Patrick J. M. Murphy, an associate professor of pharmacology at Seattle University. A notorious example is the arthritis medication Vioxx, a prescription nonsteroidal anti-inflammatory drug (NSAID) recalled in 2004 because it significantly increased the risk for cardiovascular events such as heart attack and stroke. Today, other over-the-counter NSAIDS (such as naproxen and ibuprofen) can help ease pain but at the potential expense of bleeding ulcers in regular users. And while cholesterol-lowering drugs have proven benefits, the FDA recently announced that alongside muscle pain, labels for statins should also include side effects like memory loss and confusion.
So how do we ensure that we're taking only the medications that we need to live a longer, healthy life—but aren't harming ourselves in the process?
Obviously the ideal scenario would be to never get a chronic illness that requires medication. The World Health Organization reports that if more people were to stop smoking, lose weight, and exercise regularly, 80 percent of heart disease, stroke, and diabetes cases, and 40 percent of cancer cases would be prevented. "Certainly, people should focus on wellness and prevention before they get these illnesses," says David Longworth, a physician and chairman of the Cleveland Clinic's Medicine Institute. But once you've been diagnosed, he says these diseases need to be "effectively managed," which involves medications and lifestyle changes.
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If you are one of the millions of Americans on a prescription medication, you should know what you're taking and why, and discuss these basic points with your healthcare provider. "The goal of drug therapy is always to maximize therapeutic benefits while decreasing potential harms," says Murphy. "The most important question is, 'How will this benefit me? What's the measurable outcome?'" adds pharmacologist Joe Graedon, coauthor of more than 15 books, including Top Screwups Doctors Make and How to Avoid Them. Graedon also advises asking about a drug's downsides. The risks and side effects may outweigh benefits, depending on your unique circumstance.
Consider, for example, antidepressants, the use of which increased nearly 400 percent between 1998 and 2008, according to a 2011 report from the Centers for Disease Control and Prevention's National Center for Health Statistics. "There are individuals for whom these drugs work exceptionally well—people who now know what it's like to be happy," Graedon says. But for others, these medications perform just barely better than a placebo and can have side effects ranging from sexual dysfunction to irritability. In the end, some patients may not mind side effects; for others, especially those who don't have life-threatening illnesses, such complications may be deal-breakers.
If you are suffering from bothersome side effects or want to stop taking a particular drug, you should first consult with your healthcare provider, says Longworth. While some side effects can be serious, certain medications should not be stopped abruptly due to withdrawal symptoms.
Also talk to your healthcare provider about your therapeutic goals, insurance situation, and non-drug alternatives, advises Murphy. For instance, the DASH diet—which involves eating more fruits and vegetables and cutting back on salt and foods high in saturated fat—has been shown in studies to lower blood pressure, increase "good" HDL cholesterol, and decrease LDL cholesterol.
Another reason to discuss drug alternatives is that medications don't always work as consistently as we would hope. Schwartz's research, published in the Archives of Internal Medicine in 2011, reveals the disconnect between how we view drugs and how they really perform. Thirty-nine percent of participants believed the FDA only approves "extremely effective" drugs, and 25 percent believed the FDA only approves drugs without serious side effects. That could have something to do with upbeat ads featuring smiling patients, which make it difficult to get a full picture of a new drug's shortcomings, Graedon says. Both suppositions are wrong.
Which brings us back to our original question: Do drugs really help us live longer? In the end, the answer can depend on your individual health—and how much of an involved patient you're willing to be.
To help ensure your medications aren't having the opposite effect, cutting your life short rather than extending it, "the most important thing to do is to make sure that [your] doctor knows all the drugs [you] are taking—both prescription and over the counter," says Schwartz. (It's especially important to be vigilant if you're an older adult, since body changes can affect the way drugs are absorbed in your system—and because older adults tend to take more medications.) And if you're being prescribed medications by different specialists, and don't have one point of contact, it's important to keep all providers up to date. "Many electronic records will automatically give alerts when there are interactions," she says. "But to be sure, it's always good to ask the doctor these questions as a reminder: 'Do I really need all of these medicines? Are there any dangers of taking them together?'"
What's more, a study published in the Journal of the American Medical Association estimated that up to 4 percent of patients could be putting themselves at risk of a dangerous—potentially deadly—drug interaction, based on their use of prescription and over-the-counter medications, as well as dietary supplements. Many patients misinterpret, or worse don't read, their prescription labels. Even natural products, like St. John's wort, can spell serious trouble when mixed with certain medications, including some antidepressants, birth control pills, and narcotics, reports the National Library of Medicine.
Being an involved, informed patient improves the chances that your medications can help extend your life in certain situations or can mitigate negative outcomes associated with chronic and acute illness. "We should trust our physicians. We should trust our pharmacists. But we should always, always verify," says Graedon. "Be your own advocate."
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