Americans buy much more medicine than people in any other country.
PLYMOUTH, Mass. (AP) -- Alice and Ken Heckman each begin their morning by cracking open a rattling plastic tray carting scores of pills in a rainbow of pastel colors.
Between the two of them, they gulp 29 pills every day: a regimen of 14 drugs, with a chaser of dietary supplements.
Here's the curious part: They feel pretty healthy for people in their early 70s, working around the house and volunteering with several community groups. They each had heart fixes years ago -- him a bypass and her a vessel-clearing stent -- but fully recovered. She has well-controlled diabetes. He has worked his way through heartburn, arthritis, an enlarged prostate and occasional mild depression.
About 130 million Americans -- many far healthier than the Heckmans -- swallow, inject, inhale, infuse, spray and pat on prescribed medication every month, the U.S. Centers for Disease Control and Prevention says. Americans buy much more medicine per person than any other country.
The number of prescriptions has swelled by two-thirds over the past decade to 3.5 billion yearly, according to IMS Health, a pharmaceutical consulting company. Americans devour even more nonprescription drugs, polling suggests.
Recently, safety questions have beset some depression and anti-inflammatory drugs, pushing pain relievers Vioxx and -- most recently -- Bextra from the market. Rising ranks of doctors, researchers and public health experts are saying that America is overmedicating itself. It is buying and taking far too much medicine, too readily and carelessly, for its own health and wealth, they say.
Well over 125,000 Americans die from drug reactions and mistakes each year, according to Associated Press projections from landmark medical studies of the 1990s. That could make pharmaceuticals the fourth-leading national cause of death after heart disease, cancer and stroke.
The pharmaceutical industry made more than $250 billion worth of sales last year, the vast majority in prescriptions, according to industry consultants. That roughly equaled sales at all the country's gasoline stations put together, or an $850 pharmaceutical fill-up for every American.
Do we need all these drugs? A relative handful yank many people away from almost certain death, like some antibiotics and AIDS medicines. Though carrying some risk, other drugs -- such as cholesterol-cutting statins -- help a considerable minority dodge potential calamities such as heart attack or stroke.
The right balance of risk and benefit is still harder to strike for a raft of heavily promoted drugs that treat common, persistent, daily life conditions: like anti-inflammatories, antacids, and pills for allergy, depression, shyness, premenstrual crankiness, waning sexual powers, impulsiveness in children -- you name it.
"We are taking way too many drugs for dubious or exaggerated ailments," says Dr. Marcia Angell, former editor of the New England Journal of Medicine and author of "The Truth About the Drug Companies."
"What the drug companies are doing now is promoting drugs for long-term use to essentially healthy people. Why? Because it's the biggest market."
In fact, relatively few pharmaceutical newcomers greatly improve the health of patients over older drugs or advance the march of medicine. Last year, the U.S. Food and Drug Administration classified about three-quarters of newly approved drugs as similar to existing ones.
Confronted with mounting costs, drug makers churn out and promote uninspired sequels such as Hollywood: drugs with the same ingredients in a different form for a different disease.
Of course, many pharmaceuticals improve American health. "We now have more medicines and better medicines for more diseases," says Jeff Trewhitt, a spokesman for the Pharmaceutical Research and Manufacturers of America.
However, the nation also overindulges far too often, the critics say, and violates the classic proscription of the ancient Greek physician Hippocrates: "First, do no harm."
An old saying
Drug safety researcher Dr. James Kaye, of Boston University, remembers a medical school teacher telling the class: "All drugs are poisonous!"
The Heckmans found out on their own. Heckman lost his alertness for several months to a depression medication. His wife has come down with a rash from one heart medicine and muscle aches from a statin. But each time they switched medicines and escaped any lingering harm.
Hospital patients suffer seven hard-to-foresee adverse drug reactions and an additional three outright drug mistakes for every 100 admissions, estimates Dr. David Bates, a researcher at Boston's Brigham and Women's Hospital. That translates into 3.6 million drug misadventures a year.
The dangers potentially escalate when doctors prescribe drugs, as they often do, for uses not formally approved by the FDA. In a recent report, the Centers for Disease Control voiced concern about huge off-label growth of anti-depressants. They have expanded to treat often loosely defined syndromes of compulsion, panic or anxiety and PMS.
Drug makers, doctors and patients have all been quick to medicate some conditions once accepted simply as part of the human condition.
Many Americans also assume, often with a nod from sellers or doctors, that new drugs inevitably work better than old ones. "Newer isn't always better, and more isn't always better," warns Dr. Donald Berwick.
Copyright 2005 Associated Press. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.