A Spoon Full of Sugar

What Drug Companies Don’t Want You to Know

Several years ago, I went to the doctor feeling tired and stressed out and after a 10-minute visit came home with a prescription for brupopion (brand name Wellbutrin). The doctor and I didn’t discuss possible side effects, alternatives, or many other aspects of my health. It turned out Wellbutrin was briefly removed from the market shortly after its release because it was causing seizures. Back on the market again, its common side effects include anxiety, insomnia and nightmares, and it’s associated with "serotonin syndrome," which could result in rapid heart rate and muscle spasms. Fun.

Wellbutrin is just one of dozens of anti-depressants and one of thousands of prescription drugs on the market that contribute to a more than $210 billion industry in the U.S. With alarming news about potentially fatal side effects, direct consumer advertising, hundreds of infomercial websites, out-of-control prescription drug prices and new environmental concerns, it can be hard to get a grasp on which remedies are the most effective and safe.

Drug Companies Rule

According to Dr. Sidney Wolfe, director of the health research group at Public Citizen, it takes years once a drug is on the market for all of its adverse effects to surface.

But the industry argues that the current drug approval process is more than adequate and the safety record of prescription drugs in the U.S. unbeatable. It can take up to 15 years for a drug to go through the Food and Drug Administration (FDA) approval process, which has "tough, uncompromising rules," according to Jeff Trewhitt, a spokesperson for the Pharmaceutical Research and Manufacturers of America (PhRMA).

Once a drug is on the market it can be advertised without FDA approval. Chances are you’ve seen ads for drugs that curb obesity, baldness or allergies. IMS Health, a pharmaceutical consultant, reports that drug companies spent a total of $16.4 billion on advertising and promotions in 2001.

In 2000, Merck spent more on advertising for Vioxx, an anti-arthritis drug, than Pepsico spent advertising Pepsi, according to the National Institute for Health Care Management (NIHCM). NIHCM also reports that since the FDA relaxed ad regulations in 1997, at least 45 drug ads have been issued "notices of violation" for failing to be accurate and disclose side effects.

Further, pharmacology training in medical school is limited. "Physicians are overwhelmed by the thousands of drugs on the market," says Arthur Levin, director of the Center for Medical Consumers, an advocacy and education organization. When you don’t have enough time to do your own research, it’s easy to let sales representatives do your homework for you, he says.

The average price for the 50 best-selling prescriptions is more than $70, according to NIHCM. Of the 50 drugs most often used by seniors, the average price for a year’s supply of a single drug was $1,070 in 2002. Elderly people require an average of 30 prescriptions a year, which heats up any debate about Medicare.

What’s in the Water?

Every time you swallow a pill, some of that medicine follows a circuitous path through your intestines, down the toilet, through the sewage treatment plant (where it is often resistant to processing), and into the nearest river or lake, where it is eventually tapped again for public drinking water.

According to EPA chemist Christian Daughton, new technologies now allow scientists to detect extremely low levels of drugs in water. Antibiotics and steroids are most commonly found, but studies have also targeted anti-depressants. While the effects on human health are not yet a serious concern, new studies show that aquatic organisms may be at risk. Antibiotics may make some species more resistant to pathogens, steroids can interfere with reproductive processes, and anti-depressants may make fish more likely to succumb to predation. "Drugs could also have synergistic interactions, but little is known about it," says Daughton. There are no regulations on levels of residual drugs in water.

Daughton envisions a "green pharmacy," in which drug companies take responsibility for the lifecycle of their products. Instead of flushing unused drugs down the toilet, one day you may be able to send them back to the pharmacy or manufacturer for proper disposal. Maine recently proposed legislation for a drug take-back program similar to those in Europe and Canada.

Educate Yourself

Fluoxetine, Selexa, Celexa, Zyvox and Vioxx. Wading through drug names and trying to understand which concoction can help you feel better or lower your cholesterol is like being an English speaker trying to make your way through rural China without a translator.

Your doctor would be a logical interpreter. However, according to Levin, studies show that patients generally only get a smidgen of the information they need about medications from their physicians. If you look to the Internet for help, it’s often hard to tell the promotional material from an unbiased review. One good source of information is Public Citizen’s book, Worst Pills, Best Pills, which evaluates more than 450 of the most commonly prescribed drugs. The latest edition of Worst Pills, Best Pills lists 160 drugs as "do not use," because there is either a lack of evidence that they are effective or they are deemed less safe than an alternative. An abbreviated version of the book is online at www.worstpills.org.

If you are considering herbal supplements as an alternative to prescription drugs, you"ll still have to diligently read labels and warnings, and ask your doctor about drug interactions. "Just because something is an herbal supplement, does not mean it is safe," says Dr. Robert Bonakdar of the integrative medical clinic at Scripps in San Diego.

There is no getting around the fact that some illnesses require prescription therapy. But next time you go to the doctor, ask some pointed questions.

TASHA EICHENSEHER is a Yale graduate student who reads pill labels.