More on prescription drugs

Yeah, for a culture that's so gung-ho about wars on drugs, just saying no to drugs, etc. there sure is a lot of accommodation of prescription drugs; yet another mystery of American life, eh?

BTW, I did want to add one thing to the discussion (top-posted per request, cross-posted with T's Blogger Blog, & duplicated to Google Groups for posterity): it could be that the real villain with respect to over-prescription of drugs is actually the privacy policies which make data collection regarding drug interaction as well as long-term efficacy something of a question rather than a no-brainer... I know that there are plenty of systems (and algorithms) which are capable of automatic collection and anonymization of such data so the technology definitely exists; as far as I'm know the only reason such systems haven't been deployed (or federated) is a lack of will and/or legal framework to allow the needful to be done.

PS: DTC marketing is obnoxious and more existential than hanging out at a gym; it's reason enough to turn off the TV for good and/or abandon network television for good.

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Thanks for writing. Yeah Rx painkillers are I think in the top 5 for illicit drug abuse in America. But instead of brown people smuggling blow across the Rio Grande to poison our kids, American drug pushers just have to raid grandma's medicine cabinet or obtain a bogus Rx. I am sure most of you have heard stories of even teens selling their leftover vicodin to classmates after a wisdom teeth removal or whatnot. Customer service is generally pretty poor at most retirement homes and hospice care centers for the sub-rich, but one thing they're great at is medicating the elderly. Then they have to deal with fewer complaints and whining.

Another problem is how to dispose of all the surplus drugs. It's fairly well documented that doctors overprescribe antibiotics for even viral illnesses or patients whose symptoms are not severe (and would probably recover on their own, but the doc wants to be careful and not upset the patient/get sued). This selective pressure gives an evolutionary advantage to drug-resistant bacteria strains. Discarded antibiotics and other drugs are winding up in our water supply. Our water purity tools are now more sensitive, so maybe drugs were always there and now we can finally detect them, but still - it's quite likely that we're ingesting trace amounts of all sorts of drug cocktails when we drink tap water (or even cheap bottled water).

http://www.staphaseptic.com/news.cfm?id=18FE4C5D-C6C9-0EF9-9F1678797221DAA9
http://www.usatoday.com/news/nation/2008-03-10-drugs-tap-water_N.htm

As you said, there isn't much data on long-term drug effects, drug interaction, or even acute side effects. With pressure from drug companies and even overzealous patient advocacy groups to get products to market ASAP, the FDA is unable to be totally thorough. There is a new prostate cancer vaccine (Provenge) being reviewed by the FDA. 4/17 docs on the advisory panel have concerns about the drug's efficacy, and two published their findings. The authors now need 24/7 bodyguards because crazy people are making death threats to them, because they think the docs' obstruction is threatening theirs. Even though the docs are doing this out of concerns for potential patients and have no financial incentive, unlike other docs who praise drugs from companies that do them favors. This is the state of medicine today.

http://www.psa-rising.com/blog/2007/06/prostate-cancer-doctor-receives-death-threat-over-provenge/

As we know, haste causes mistakes, like in the cases of Vioxx, Raplon, Palladone, Trasylol, Baycol, Raptiva, or other drugs that were initially approved and pulled after drug-related deaths/complications were reported. Just do a Google search for "drugs pulled from market" and you will find a huge list. The FDA, NIH, and other gov't entities are underfunded and understaffed. In fact, most drug testing is funded and conducted by the company itself, and the FDA just reviews their paperwork. Or resources are poorly allocated: breast cancer research gets the most funding (30% of all NCI grant funding), even though it is not the most common nor lethal cancer, probably due to America's Oedipal fixation with mammaries and maternal guilt issues. But long-term studies are expensive and time-consuming, and it's hard to follow patients for years. We hope academics will conduct these critical studies for us, but they have their own constraints and there's still so much we don't know. Maybe with more electronic records, information sharing, and sophisticated computational methods, we can learn more about the pharmacokinetics/dynamics of various drugs, but as you would expect, the medical field is not at the cutting edge with respect to computing. As you said, without the gov't will and legal mandate to obtain these data, it will never happen on its own.

http://www.cancer.gov/cancertopics/factsheet/NCI/research-funding

Attitude-wise, I think patients should stop expecting new miracle drugs to keep curing them of illnesses and improving/extending their lives. Practically everything out there is a carcinogen or pathogen. Maybe diseases evolve faster than science (and bureaucracy) can combat them anyway. The "George Bush approach" that technology will always save us from ourselves is not valid in most cases, and probably foolhardy. Yes we should rationally and ethically continue research and try to help the sick get better, and yes drug companies and doctors deserve reasonable compensation for the products/services they provide, but let's remember that we are all mortal and fragile. Death is part of life, and let's face it with some zen and humility. Why are you so important that society needs to spend half a million dollars so you can see your 86th birthday? Research isn't really the problem either. The top killers in the world are respiratory complications (from flu, pneumonia, etc.), tuberculosis, and malaria. All those are easily and CHEAPLY preventable/treatable. But of course the people who die from them are from the Third World, and we don't give a shit about them. The top killers in the West are probably heart disease and cancer. So we pour billions of dollars into research and care for those diseases. Probably one infusion of chemotherapy ($10k in some cases) could pay for an entire village's anti-malarials for a year.