[ What Now for the Diabetes Drug Avandia?] Too much, too soon? Health reform will be a godsend to uninsured diabetics who have struggled to pay for daily medications or have stopped taking them because of cost. But it's also apt to fuel an upsurge in the reliance on drugs to control blood sugar. Diabetes drugs accounted for 16.7 percent of the growth in drug spending in 2009, according to Medco Health Solutions, a company that provides prescription drug benefits. Yet, given the potential heart risks and the fact that the drugs have not been shown to actually lower the risk of heart disease (which accounts for most diabetes deaths), many experts urge emphasis first on losing weight and exercise. For one thing, it's unclear whether diabetics always benefit from drugs to drive down their blood sugar levels. The American Diabetes Association recommends a hemoglobin A1C level of below 7 percent, and many doctors prescribe multiple medications to bring even moderately high levels down. But research suggests that a level of about 7.5 percent is associated with the lowest rate of heart problems and deaths.
Overmedicating is a particular problem for seniors, more than half of whom take three or more medications per day. "The drug-drug interactions can be worse than the disease," says John Morley, director of geriatric medicine at the St. Louis VA Medical Center. And too often, he adds, "doctors seem to suspend common sense" when devising a treatment plan. For example, they prescribe Aricept for Alzheimer's patients and then treat a frequent side effect, urinary incontinence, with an anticholinergic like Enablex or Ditropan whose side effects include delirium, confusion, and memory loss. A current concern among public health experts is the use of antipsychotics in nursing homes to treat anxiety, confusion, and irritability, all frequently triggered by other medications. Some 22 percent of Massachusetts nursing home residents taking antipsychotics in 2009 didn't have conditions that called for these sedative-like drugs, according to a March government report. Using antipsychotics for this inappropriate purpose "has led to fatalities," says Janet Woodcock, director of the FDA's Center for Drug Evaluation and Research.
The trend toward treating mild conditions with strong drugs is evident in younger people, too. Millions with mild heartburn, for example, regularly rely on proton pump inhibitors intended for tough cases despite a recent FDA warning about an increased risk of hip, wrist, and spine fractures. "About 60 to 70 percent of people taking these drugs shouldn't be on them," says San Francisco Public Health Director Mitchell Katz. Antidepressants "have migrated from useful, effective treatments for those with major depression to unnecessary treatments for those who are just a little down in the dumps," says Jerry Avorn, a professor of medicine at Harvard Medical School and author of Powerful Medicines. This is despite recent evidence showing that, while the drugs may be life-transforming for people with major depression, they work no better than a placebo for mild or moderate cases. Commercials that invite you to try a pill if "you feel alone" have fueled consumer demand, and studies have shown that patients' requests for medication influence what physicians prescribe.
No panacea. Ads for Fosamax, Boniva, and Actonel have certainly helped generate multibillion-dollar-a-year demand for the osteoporosis treatments. And indeed, the bisphosphonate medications have helped many women avoid major fractures in the hip and spine, a leading cause of death in the over-65 population. But even the National Osteoporosis Foundation, which previously recommended using the drugs for prevention in women with osteopenia, or mild bone loss, now agrees that a pullback is in order; its newer guidelines exclude most women with osteopenia.