If you’re like many Americans, you take at least one prescription drug regularly – maybe even two or more. According to a 2013 study reported by the Mayo Clinic News Network, nearly 70% of adult Americans rely on at least one prescription medication. More than 50% regularly use two, while 20% can’t make it through the day without five or more. In fact, spending on prescription drugs rose an astounding 13% in 2014 to $374 billion, according to the IMS Institute for Healthcare Informatics.
Are we as a nation succumbing to ever more serious illnesses? Maybe. But there could be more to it than that.
Included in the top 10 most-prescribed drugs (from July 2013 to June 2014) are medications for acid reflux, depression, ADHD, and cholesterol management. These are drugs that many alternative health professionals and economists alike suggest may be unnecessary and too costly for the American pocketbook hit hard by rising health costs. What’s more, they may actually do more harm than good, as consumers suffer mounting medication side effects and are prescribed increasingly more drugs to counter them.
What then is the true cost to the users of some of the nation’s most-prescribed meds? And how can we take back control of a prescription drug use explosion that, fueled by Big Pharma marketing dollars ($1.33 trillion in the decade from 2003 to 2013, according to David Belk, MD), shows no indication of slowing down?
The following brand-name drugs filled slots number 1 through 10 on Medscape’s Top 100 Drugs by Monthly Prescription, July 2013 to June 2014. Note that the majority of the prescriptions written are in the tens of millions annually.
- Synthroid (22,664,826): hypothyroidism
- Crestor (22,557,735): cholesterol
- Nexium (18,656,464): stomach acid
- Ventolin HFA (17,556,646): bronchospasm
- Advair Diskus (15,003,169): bronchospasm
- Diovan (11,401,503): hypertension
- Lantus Solostar (10,154,739): diabetes
- Cymbalta (10,065,788): depression
- Vyvanse (10,019,178): ADHD
- Lyrica (9,684,884): epilepsy/neuropathy
Some of these drugs, such as those for bronchospasm and type I diabetes, have changed countless lives for the better, alleviating symptoms of debilitating conditions and allowing users to live normal lives. And though we might expect all FDA-approved drugs to do more harm than good, for some people, that isn’t the case.
Here is a look at the true cost – to both pocketbook and health – of some of the more controversial entries above.
At almost 22.7 million scripts written in from 2013 to 2014, topping the list of the most-prescribed drugs is the synthetic thyroid medication Synthroid, or levothyroxine (other brand names are Levothroid, Levoxyl, Tirosint, and Unithroid). Synthroid is widely prescribed to treat hypothyroidism (low thyroid hormone), and is also used to prevent an enlarged thyroid gland (goiter) from occurring as a result of certain cancers or radiation treatments. But because of its weight-reducing side effect, Synthroid’s rising popularity may have something to do with its discovery by rabid dieters who happily ignore the drug circular warnings about not using the medication solely to achieve weight loss.
Synthroid has numerous potential side effects, including fast or irregular heart rate; fever, hot flashes and excessive perspiration; weight changes; appetite changes; insomnia; hair loss; menstrual changes or irregularities; and vomiting and diarrhea. The medication interacts with many other prescription and OTC drugs, as well as with certain vitamins and herbal supplements.
According to True Med Cost, which tracks drug prices at various drug and mass retailers nationwide, the average price of a 100 mcg dose of Synthroid without insurance is about $0.99 per pill (depending upon the pharmacy or retail chain); average annual cost (one pill a day) is $361.35; average cost of that daily dose over 10 years is $3,613.50.
Sound manageable? At about $24 to $32 bucks for a 30-day supply, many users would say it is – that is, unless they are shelling out for multiple prescriptions per month.
Coming in at almost 22.6 million prescriptions written is the strongest of the cholesterol management “statin” meds, Crestor (rosuvastatin). Classed as an HMG CoA inhibitor, it will bring down “bad” LDL levels in the blood while boosting HDLs (“good” lipoproteins), slowing the buildup of plaque in the blood vessels.
Information about the medication includes the warning that users should avoid eating foods that are high in fat or cholesterol, since Crestor will not be as effective in lowering cholesterol if the user is not adhering to a cholesterol-lowering diet plan. The drug is recommended to be part of a complete program treatment that also includes exercise and weight control.
Crestor has serious potential side effects, including that of harming fetuses, and carries the distinct warning that it should not be taken by pregnant women. Other side effects include confusion and memory problems; liver complications such as jaundice, dark urine, clay-colored stools, itching, nausea, and stomach pain; kidney problems such as painful, difficult, or scant urination; headaches, weakness, and upset stomach; plus swelling of ankles or feet, shortness of breath, and lethargy.
Crestor circulars warn that the drug may, in rare cases, cause a condition that results in the skeletal breakdown of muscle tissue, leading to kidney failure. These particular side effects were a serious issue with the drug’s predecessors, Lipitor and Zocor. An equally severe side effect – that of the development of type II diabetes, especially in women – has generated a class action lawsuit.
Average price of a 10 mg dose of Crestor without insurance is about $7.11 per pill (depending upon the pharmacy or retail chain); average annual cost (one pill a day) is $2,595.15; average cost of that daily dose over 10 years is $25,951.50.
At almost 18.7 million prescriptions dashed off annually, Nexium (esomeprazole) has been the go-to drug for excessive stomach acid and GERD (gastroesophageal reflux disease). It is also prescribed to help heal esophageal erosion from stomach acid, gastric ulcer, and from the use of nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen.
Nexium is classed as a proton pump inhibitor. Although package information about Nexium commonly warns that it is not for “immediate” relief of heartburn symptoms, consumers routinely use it with that expectation instead of Tums or other over-the-counter or natural heartburn remedies.
There has been much documentation of allergic reactions to Nexium predecessors or to similar drugs under the brand names Prevacid, Prilosec, Zegerid, Protonix, and AcipHex, and Nexium should not be used by those who have experienced such reactions. Proton inhibitors also have been linked to increases in bone fractures of the hip, wrist, and even spine.
Other side effects include severe stomach pain; mild, watery, or bloody diarrhea; gas, constipation, and nausea; seizures; frequent or bloody urination; swelling or rapid weight gain; dizziness, confusion, rapid, or uneven heartbeat; tremors or muscle spasms; coughing or the feeling of being choked; jitters; drowsiness; and dry mouth.
Average price of a 20 mg dose of Nexium without insurance is about $9.13 per pill (depending upon the pharmacy or retail chain); average annual cost (one pill a day) is $3,332.45; average cost of that daily dose over 10 years is $33,324.50.
Ringing up just over 10 million scripts a year, Cymbalta (duloxetine) targets brain chemicals that may cause depression, and is classed as a selective serotonin and norepinephrine reuptake inhibitor antidepressant (SSNRI). It is marketed for use in a number of disorders including significant depression in adults; general anxiety disorders in adults and children seven or older; diabetic neuropathy (nerve damage) in adults; stress urinary incontinence; and adult fibromyalgia and chronic muscle, lower back or joint pain (as in osteoarthritis).
Among the extensive list of Cymbalta side effects (some of them so severe as to warrant FDA’s “black box warning” – literally a black-outlined box on the packaging) are severe lightheadedness; eye disturbances such as blurred and tunnel vision, haloing, eye pain, and swelling; unusual bleeding and easy bruising; liver complications such as jaundice, dark urine, clay-colored stools, itching, nausea, and stomach pain; difficult or painful urination; high serotonin level complications such as fever, hallucinations, rapid heart rate, agitation, exaggerated reflexes, loss of coordination, fainting, vomiting, and diarrhea; nervous system complications such as rigid muscles, tremors, confusion, high fever, and rapid or uneven heartbeat; and severe skin and related reactions such as skin pain followed by a red or purple rash with blistering (upper torso and face), facial and tongue swelling, burning eyes, fever and sore throat.
More common side effects include dry mouth, lethargy, vision changes, dizziness, excessive perspiration, loss of appetite, constipation, and changes in sexual desire or ability. According to Drugwatch, users have reported debilitating brain “zaps” and thoughts of suicide. Withdrawal from Cymbalta has been reported to be so difficult it can affect a user’s ability to work and can require hospitalization.
in 2009, the French medical journal Prescrire conducted a study that compared the drug to other protocols and medications for various levels of depression, and concluded that Cymbalta should not be prescribed at all, as the dangers outweighed the benefits. More recently, the FDA has grouped the constellation of Cymbalta withdrawal symptoms under the label “Cymbalta discontinuation syndrome.” In some cases, liver damage resulting from Cymbalta use has been fatal, as have been Cymbalta drug interactions leading to serotonin syndrome.
Average price of a 30 mg dose of Cymbalta without insurance is about $9.07 per pill (depending upon the pharmacy or retail chain); average annual mid-dose cost (one pill a day) is $3,310.55; average cost of that daily dose over 10 years is $33,105.50.
Also at just over 10 million prescriptions, Vyvanse (lisdexamfetamine – note the “-amfetamine” in the name) is used to treat attention deficit hyperactivity disorder (ADHD) in adults and children age six and over. Because the medication targets brain and nerve chemicals that contribute not only to hyperactivity but to impulse control, Vyvanse is also used to treat moderate to severe binge-eating disorders in adults.
The drug and others like it are acknowledged to be abused for weight loss, recreationally, and, according to Slate, by students determined to enhance their studying ability. It carries clear warnings that it can be habit-forming and, used improperly, can cause serious heart complications or even death, especially when used by those with serious heart problems or congenital defects.
Common side effects of Vyvanse include insomnia, loss of appetite and weight loss, irritability, dizziness, dry mouth, nausea, stomach pain, diarrhea, and vomiting. More serious side effects include rapid or uneven heartbeat, chest pain, shortness of breath; hallucinations and unusual thoughts or behavior, confusion and paranoia; painful erections that can last four hours or longer; and numbness, pain, cold feelings, or color changes in fingers and toes.
Average price of a 40 mg dose of Vyvanse without insurance is about $7.65 per pill (depending upon the pharmacy or retail chain); average annual cost (one pill a day) is $2,792.25; average cost of that daily dose over 10 years is $27,922.50.
Lyrica, or pregabalin, (just under 10 million in prescriptions written) is actually an anticonvulsant that was designed to help control epileptic seizures, but is now used extensively to treat fibromyalgia and the pain caused by nerve damage from diabetes, herpes zoster, or spinal cord injury. Lyrica works by decelerating the impulses in the brain that can cause seizures, and because it targets the brain chemicals that transmit pain signals across the nervous system, it is used for myriad purposes (including others not mentioned here).
Like Cymbalta, Lyrica can also cause users to have thoughts of suicide or experience dramatic mood swings or behavioral changes, according to a 2014 report in Annals of General Psychiatry. Other serious side effects include panic and anxiety attacks; unusually hostile, aggressive or impulsive behavior; irritability, restlessness, and mental or physical hyperactivity; worsening depression; muscle pain and tenderness, or weakness with fever and lethargy; vision disturbances; rapid weight gain; swelling in hands or feet; and easy bruising or bleeding. More common side effects include dry mouth, constipation, tremors or loss of balance and coordination, dizziness or drowsiness, memory problems or difficulty concentrating, and swollen breasts.
Average price of a 100 mg dose of Lyrica without insurance is about $4.99 per pill (depending upon the pharmacy or retail chain); average annual cost (one pill a day) is $1,821.35; average cost of that daily dose over 10 years is $18,213.50.
Understanding Various Costs of Prescription Drugs
Certainly, advances in modern medicine have given us lifesaving drugs that no one would argue we should do without. For example, included in the list of lifesavers are the many forms of insulin delivery systems available to type I diabetes sufferers (including the seventh-most prescribed drug, Lantus Solostar). To date, there is no other mode of treatment for type I diabetes that can universally prolong life and prevent the complications of that disease with the same level of success.
Yet, with at last count 70 potential reactions to the average prescription drug (according to Mercola.com), now may be a good time to weigh your options purposefully and intelligently before jumping on a bandwagon that has hit a few bumps in the road since aspirin, the original wonder drug, was introduced by Bayer in 1899. Those bumps include, first and foremost, the potential risk to your health from substances you may have assumed were curative and benign.
According to ProCon.org, the fact of the matter is that many FDA-approved prescription drugs (such as Redux, Posicor, Vioxx, Propulsid, and Zelnorm) have been withdrawn from the U.S. market in recent years. And to make matters worse, since 1997 when FDA regulations changed, pharmaceutical companies no longer have to list all of their products’ side effects in their television ad saturation campaigns – only the “most significant.”
Not surprisingly, the rate at which drug makers are rushing their products to market and the rate of dangerous-drug litigation that often follows is growing each year. Caught between those two events are countless individuals who spend a good portion of their income on prescription drugs that made them sick, not well.
A 2014 paper released by the U.S. Food and Drug Administration shockingly reveals that 6.7% of hospitalized patients have a serious adverse drug reaction (ADR) with a fatality rate that would translate to more than 106,000 deaths annually. (That figure does not include such deaths occurring in nursing homes and ambulatory situations.) If true, the study warns, then ADRs are the fourth-leading cause of death – ahead of pulmonary disease, diabetes, AIDS, pneumonia, accidents, and automobile deaths.
At the time of the FDA study, 16% of U.S. hospital admissions were related to adverse reactions to medicines. Additionally, 10 times more deaths occurred annually from adverse reactions to properly prescribed and administered drugs than from illegal drugs.
In April 2015, the CDC warned that the United States is “in the midst of a prescription painkiller overdose epidemic,” with 44 people in the U.S. dying of such prescription medication overdoses each day. And according to Jacob Teitelbaum, MD, writing in “Real Cause, Real Cure: The 9 Root Causes of the Most Common Health Problems, and How to Cure Them,” an estimated 600 Americans are killed by prescription drugs every day.
Children and the Elderly as Casualties
As appalling as that is, what is perhaps more shocking is the exponential growth in the rate of children’s deaths attributed to prescription drug poisoning each year. A previous CDC report covered by Forbes reveals that between 2000 and 2009, childhood poisoning deaths – including those from prescription drugs – increased by an astounding 80%.
What may not be known, and which warrants serious study, is the true number of deaths of the elderly caused by over-medication (and not by “natural causes” or chronic illnesses, as may have been assumed). Older people take more prescription drugs than any other age group – at least four or five prescription drugs and two nonprescription drugs daily, according to The 2009 Merck Manual report on Aging and Drugs.
For numerous reasons (including decreased levels of body fluids and thus higher concentrations of drugs in the tissues), the elderly are more than twice as susceptible to drug side effects as are younger people. The side effects tend to be more severe, resulting in hospitalizations, additional physician care, and, often, more medication prescribed to manage the new complaints.
All of these statistics point not only to tragically high human health and monetary costs for individuals and their families, but also to a key reason why healthcare and health insurance costs continue to rise, overburdening an economy already staggering.
The trickle-down effects on the economy can’t be ignored either. In 2012, Americans without drug coverage reported that they were more likely to cut back on other necessities, including groceries, in order to pay for their medications, according to an annual prescription drug poll cited in the New York Times.
What You Can Do
1. Seek Out Root Causes, and Do Your Homework
First, stop seeing prescription drugs as cure-alls, but rather as “bandages” with downsides. Every single drug on the market comes with a constellation of drawbacks for the relief that it offers – and, at times, those drawbacks may simply be too big a price to pay. In such cases, an alternative approach is to skip the bandage and look for the root causes of the illness so you can attack the problem at its source.
I know about this first hand: When an annual checkup with my doctor showed that my cholesterol numbers had climbed inexplicably, his reaction was to pull out his pad and pen a prescription for a statin medication. But I offered a bargain instead: I told him my numbers would be back to normal by my next visit, or I would consider his drug solution.
I read up on possible causes for the spike in my numbers, scheduled thyroid tests to see if my underactive thyroid was a culprit, and then adjusted my natural thyroid supplement and my diet accordingly. I gave up my morning sausages and bacon, and instead ate gluten-free oats with nuts but no sweetener. Not only were my numbers normal during my next visit, but I had high HDLs and super-low LDLs.
2. Test the Alternatives
Natural, alternative options abound for almost every disorder imaginable. Many people are amazed to find that natural approaches often work better than expensive prescriptions, and with few (if any) side effects.
At the Complimentary and Integrative Medicine Program at the Mayo Clinic in Rochester, New York, patients are advised to lower their cholesterol not with Crestor, but with a heart-healthy diet and exercise supported by supplements such as niacin, red yeast rice extract, omega-3 fish oil, and artichoke extract. Dr. Teitelbaum also has natural answers: oats, garlic, olive oil, red wine, and even a square of dark chocolate a few times a week. And when it comes to low thyroid disorders, he advises checking for mineral deficiencies such as selenium, iodine, and iron, and considering a natural thyroid glandular supplement which supplies critical elements that the synthetic prescription Synthroid does not.
To avoid the serious side effects often associated with proton pump inhibitors such as Nexium, holistic physicians and practitioners have long recommended deglycyrrhizinated licorice (easier to take than pronounce), which can help heal ulcers and kill H. pylori bacteria, a root cause of ulcers. The herbs slippery elm and marshmallow have also been used successfully as an alternative to Nexium; they contain gel-like mucilage which coats the digestive tract and keeps stomach acid from eroding the lining of the esophagus.
Parents who have been unhappy with the serious side effects of prescription drugs for ADHD have turned successfully to natural protocols that include such measures as the removal of artificial colorings and preservatives such as BHT and BHA from their children’s diets, along with the removal of allergy-producing foods such as dairy, eggs, gluten, and chocolate. Even foods such as apples, grapes, tomatoes, and berries (which contain salicylate) have been found to be triggers for the disorder.
At his Fibromyalgia & Fatigue Centers around the country, Dr. Teitelbaum (a former fibromyalgia sufferer himself) employs a comprehensive nutrition and exercise protocol he developed to help improve nutrition and sleep, boost immunity to infections, and balance hormones. Many patients report dramatic improvement.
Elsewhere, those seeking alternatives to drugs like the fibromyalgia and depression medications Cymbalta and Lyrica have found that St. John’s Wort is effective for depression as are Valerian and Kava roots for anxiety. St. John’s Wort and Valerian – along with Oatstraw, Vervain and Skullcap – are also helpful for nerve pain.
Even high blood pressure disorders (which place individuals at risk of stroke and heart disease) respond to the use of natural diuretics such as dandelion, supplements like vitamin E, C, and lecithin, herbal treatments such as brown kelp, and home-pantry remedies that utilize foodstuffs like vinegar and garlic.
3. Boycott DTC Drug Advertising
There’s no doubt that in the almost two decades since direct-to-consumer advertising hit the airwaves in the U.S., prescription drug use has become epidemic. Meanwhile, the drug companies and their lobbies have become hugely powerful – and wealthy.
According to ProCon.org, there’s good and bad to be said of the last 20 or so years of prescription drug blitz. But every night as my favorite TV shows are interrupted by commercials for Cymbalta, Lyrica, Crestor, and the rest, I think back to the days when I had a bout of heartburn and pondered the life changes I could make, rather than running for a magic pill. It may be time for all of us to boycott the shows that carry too much of that advertising, and to write to the networks to tell them why viewership is heading down.
When it gets right down to it, Americans simply need to be more discriminating consumers of substances that may either improve their health or seriously harm it. We all need to stop and assess cost versus benefit before we buy. That entails considering the financial aspects and doing a little research and holistic experimentation (such as skipping the coffee, or getting your thyroid checked).
More than one prescription drug may save your life one day, but that doesn’t mean all prescription drugs are lifesavers – some are merely Big Pharma’s new flavor of the month.
What is your take on pharmaceuticals? Have you had any successes – or bad experiences?