If Chronic Illness Doesn’t Kill You, Your Medications Might
This year’s presidential election was unique and polarizing. While you may or may not be pleased with the results, I’m happy that some of the fallout seems to be a serious discussion about health and wellness in America. As I pondered retirement, I considered how long my finances would last. But that also led me down a path considering how long I would live and how long my health span would last. As a CEO, I wasn’t living the healthiest of lifestyles. And as a pharmacist, I know the dangers of chronic illness.
The rise of chronic illness in the US is dangerous and unsustainable. According to the CDC, 60% of American adults have at least one chronic disease, and 40% have more than one chronic condition. Chronic illness is responsible for 90% of the country’s $4.5 trillion healthcare costs. We further complicate this problem by relying on medications to address something almost entirely preventable and reversible.
We live in what the Lown Institute has called a culture of prescribing. The pharmaceutical industry spends billions advertising, and consumers have come to expect a prescription with almost every doctor visit. This culture has led to vast overprescribing. Forty percent of older adults take five or more medications, and 20% take ten or more medications. What’s worse is we downplay the harms that medication use causes.
It has long been estimated that for every dollar we spend on medications, we spend another dollar dealing with the harm caused by medications. A study published in 2018 estimated the cost of drug-related morbidity and mortality at over $500 billion annually (Watanabe, 2018). It is also estimated that adverse drug events could be considered the fourth leading cause of death in the US.
While medications are generally safe and effective, there is very little data about the safety and effectiveness of large drug cocktails. While we know that specific medications have specific actions, and we how two or three medications will interact in the body, we don’t study how the body reacts to 5, 10, or even more simultaneously. When we take a medication, the body absorbs, distributes, metabolizes, and eliminates it. Most drugs use the same enzymes pathways for each of these steps. That means the impact can be unpredictable when multiple medications are used together. The chemical ingredients may stay in the body longer, and additional chemical metabolites can accumulate, causing dangerous side effects.
There is research being done by several organizations to study the impact of complex multi-drug interactions. If you are taking multiple medications, work closely with a pharmacist who can help ensure you are on the most safe and effective regimen. Also, always carry a complete medication list with you including prescription, non-prescription, supplements, and other things you take. Never assume that your doctors have access to all of your records. Make sure each doctor has an opportunity to review your list.
However, there is a much better way to manage, reverse, and prevent chronic illness. Diet and exercise improve health and wellness far better than any other intervention. Start by creating small changes that become your new healthy habits. Find a certified trainer that will help create an exercise plan. Lastly, find a strong community that will support you on your fitness and wellness journey. Small changes can reduce the need for medications and save your life.
Lown Institute. The Costs of Medication Overload. https://lowninstitute.org/projects/medication-overload-how-the-drive-to-prescribe-is-harming-older-americans/#:~:text=Scope%20of%20Medication%20Overload&text=More%20than%20four%20in%20ten,take%20ten%20drugs%20or%20more.
Watanabe JH, McInnis T, Hirsch JD. Cost of Prescription Drug-Related Morbidity and Mortality. Ann Pharmacother. 2018 Sep;52(9):829-837. doi: 10.1177/1060028018765159. Epub 2018 Mar 26. PMID: 29577766.
