During a given year, seven out of every 10 people in my town go on some kind of a drug.
As a writer I am fond of hyperbole, but that’s a verifiable statistic. It’s culled from the Rochester Epidemiology Project and published this summer in the journal “Mayo Clinic Proceedings.”
Epidemiology can be dull, but as a proxy for drug use in the United States, the tally of what gets taken around here is a helpful starting point for a more newsy question: What should we make of the celebratory fire-dancing in the news last month over the latest wonder drug for lowering LDL cholesterol?
First, some background: According to the Mayo database, 68 percent of Olmsted County residents were prescribed at least one drug in the course of the year studied; 51 percent were prescribed at least two, and 21 percent were directed to take five different drugs.
For comparison, only 46 percent of U.S. households own a dog.
In short, taking a pill may be more American than man’s best friend. Which is unfortunate, given that owning a dog is one of the best things you can do for your health. (Dogs do come with powerful side effects: You fall in love with them and then they die.)
But here’s some good news: the most-prescribed drugs in these parts, at 17 percent of the population, are antibiotics. I think we can agree that antibiotics have had a profound impact on reducing sickness and death.
Once you get past the amoxicillin, however, the cost-benefit picture for the American medicine cabinet is a bit of a hot mess. Coming in second: 13 percent of our county is on antidepressants. In third: 12 percent of us are on pain-killers. And in fourth: 11 percent take statins, the lipid-lowering drugs all in the news last month.
As the authors noted, Americans spent $250 billion on drugs during 2009. That’s comparable to the entire economic output of Finland, Greece, Israel or Ireland.
The researchers found the third-place showing of pain-killing opioids “a bit concerning, considering their addicting nature,” according to Jennifer St. Sauver, Ph.D., of the Mayo Clinic Health Population Program. The high use of antidepressants, however, “suggested that mental health is a huge issue and something we should focus on.” Our use of cholesterol-lowering drugs escaped criticism as well.
But at least we’re getting something for our quarter of a trillion dollars in annual drug spending. Depression is now easily cured, and death from heart disease is thing of the past.
In our dreams, right?
During the era of antidepressants — drugs refilled again and again thanks to withdrawal effects that mimic a return of the illness — the nature of depression has changed. It has gone from a mostly self-limiting condition (“Most depressions terminate in spontaneous remissions,” wrote the father of psychopharmacology, Nathan Kline, in 1964), to a chronic illness requiring lifelong chemical management. This is costly, personally and for society.
As Robert Whitaker reported in his 2010 book “Anatomy of an Epidemic,” since the start of the Prozac era the rate of Americans on disability for depression has more than doubled, from 1 in 184 to 1 in 76. During this same time, the rate of children on disability for mental illness has swelled by a factor of 35.
We view these numbers and say “mental health is a huge issue and something we should focus on,” when we could just as easily conclude “antidepressants are addictive drugs that do not work very well.”
Statins, “risk-factor” drugs conferring compliance with the prevailing heart disease narrative, are taken by 41 percent of people over 65 in my county. The drugs lower blood cholesterol, supposedly reducing the risk of heart disease in the process, and supposedly with no cost to public health.
For people who have had a heart attack, the drugs do reduce the risk of a return of cardiovascular illness and early death, albeit by a small amount (from 3 percent to 2 percent in one large trial — or “36 percent” according to the TV ads).
But sick people were never the target of those confessional Lipitor spots featuring frightened and repentant midlifers. (The one with a 50-something jumping off a dock at sunset did at least promote ownership of a chocolate lab.) Two-thirds of the $17 billion market for statins is for primary prevention — people who have never had a heart attack.
The Opinion section is produced by the Editorial Department to foster discussion about key issues. The Editorial Board represents the institutional voice of the Star Tribune and operates independently of the newsroom.