(Don’t) Use as Directed

“I’m writing you prescriptions for buprenorphine, fluoxetine, eszopiclone, Azithromycin, Dulcolax and Simvastatin,” the doctor says. “For good measure, we’ll throw in some Chantix and Orlistat.”

The names sound terrifying. But since the doctor recommended them, it’s normal to think the drugs will be as magical for the body as the blissful, pastel-colored butterfly on one of the boxes appears to be.

“You’ll need to take 12 tablets each morning and afternoon, six eardrops in the early evening, and then wear the transdermal patches while you sleep. Keep that up, and you’ll be feeling like yourself again.”

Medical recommendations such as those are issued with increasing frequency in the United States. And patients are generally quick to follow the orders. Mayo Clinic researchers report that almost 7 in 10 Americans today are taking at least one prescription drug, and over half are taking at least two.

A smaller percentage of Americans are on numerous prescriptions. In 2014, Americans were written a total of 4.33 billion prescriptions. There are 319 million of us. This means the average American is written more than 13 prescriptions each year.

And with each passing year, these numbers are climbing, making the pharmaceutical industry ever larger and more powerful.

Are You at Risk—From Your Meds?

Expensive pharmaceuticals often provide users with relief from some symptoms. But they also carry a host of health risks. About 16 percent of all hospital admissions are related to adverse reactions to prescription drugs.

Women are at particularly high risk of complications from pharmaceuticals. That is in large part because, although women take the majority of prescription drugs, many drugs are only ever tested on men.

And here’s the big one: The Journal of Law, Medicine and Ethics states that pharmaceuticals used as prescribed are the fourth-leading cause of death for Americans. That puts medication-induced deaths ahead of diabetes, car accidents and aids. The death rate for prescription drugs is 10 times higher than the number of people killed by illegal drugs.

Patient advocate Lisa Bloomquist says that, in too many cases, “the pharmaceutical industry has effectively taken an acute problem … and converted it into a chronic problem.” She says these chronic problems “mean repeat customers, and the pharmaceutical industry makes billions.”

In light of these risks, patients should ask their doctors some questions before blithely following their recommendations to put these high-powered chemical concoctions into their bodies.

‘Doctor, What’s the NNT?’

First, a patient should ask the doctor about a statistic called the nnt: the “Number Needed to Treat.”

The nnt is a piece of data doctors and pharmaceutical companies generally don’t like to discuss. It records the number of people who need to take a certain drug in order for one of them to be helped by it.

Consider the example of statin, a class of drug routinely prescribed to lower patients’ cholesterol levels. But the nnt for the most-widely prescribed statin is a jaw-dropping 250. That means for every 250 people taking it, this statin helps only one person.

Dr. Jerome R. Hoffman, professor of clinical medicine at the University of California, Los Angeles, explained: “What if you put 250 people in a room and told them they would each pay $1,000 a year for a drug they would have to take every day … and that 249 would have no benefit? And that they could do just as well by exercising? How many would take that?”

Statin has an unusually high nnt, but the GlaxoSmithKline pharmaceutical company estimates that 90 percent of all prescription drugs work for only 30 to 50 percent of people taking them. So in general, you’ve got a 50-50 chance of relief—at best.

And in many cases, the effects of your medications are far worse than neutral. That leads to the second question a patient should ask.

‘What Are the Side Effects?’

Before agreeing to a new prescription, a patient should also ask the doctor about the drug’s side effects and the percentage of people who suffer from them.

To stick with the example of statin, the side effects are serious. They include joint pain, muscle pain and gastrointestinal distress. These are known to affect about 5 percent of people taking the drug. (In severe cases, it can also cause muscle breakdown and type-2 diabetes.)

So, if you add the side-effect percentage to the nnt, you see that for every 250 people taking the most-widely prescribed statin, just one person is helped, while more than a dozen suffer side effects. Each individual patient is 12.5 times more likely to be harmed than he is to be aided by the drug.

‘Is the Drug Company Paying You?’

It isn’t possible to watch television or pick up a magazine without being bombarded by images of stressed-out women finally getting a good night’s sleep, depressed teenagers making a transformation to joyfulness, and silver-haired men regaining long-lost virility.

These advertising budgets that directly target consumers are enormous. Yet they are only a fraction of the pharmaceutical industry’s marketing expenditure. So where does the rest of that marketing money go?

Doctors. Unlike the situation with most products, consumers can’t buy pharmaceuticals unless they have a doctor’s approval. The pharmaceutical companies know that doctors are the ones who actually have the power to get their drugs off the shelves and into patients’ medicine cabinets. So companies channel the bulk of their marketing directly to health-care professionals.

In 2012, pharmaceutical companies spent $3.5 billion on direct-to-consumer marketing. That same year, they spent nearly seven times that figure—about $24 billion—marketing directly to health-care professionals.

Marketing to health-care professionals happens in two primary ways.

First, the companies send sales representatives to routinely visit hospitals, bringing gifts and free lunches to health-care workers. Former pharmaceutical sales representative Jamie Reidy told Last Week Tonight that the lunches are more than just occasional offerings: “There are some offices that advertise in the front desk job description ‘free lunch everyday’—not because the doctors are paying for it, but because the drug reps are bringing it in everyday.”

The National Physicians Alliance said that 83 percent of doctors report having accepted food and/or gifts from drug companies. One study showed that the United States has about 100,000 drug representatives, which means about one for every eight doctors—and the average marketing spent on each doctor is more than $12,000.

Drug company gifts to doctors can also include fishing trips, educational fees, sample drugs—and services such as building free websites. In one case, a drug company spent $9,750 on a dinner for three doctors—in an effort to persuade them to prescribe its drugs.

This conflict of interests is so widespread that the government recently launched a website that allows the public to see how much each doctor is receiving from various drug companies.

The second way pharmaceutical companies market to health-care professionals is by hiring doctors to talk to other doctors about their drugs.

In 2013, federal prosecutors accused the Novartis drug company of spending almost $65 million to pay doctors to conduct more than 38,000 such “speaker programs.”

The Wall Street Journal reported: “The speakers were paid an average of $750 to $1,500 per program, with some speakers earning as much as $3,000 a program, prosecutors said. In one instance, a Florida doctor was paid $3,750 for speaking to the same four doctors about a Novartis drug five times in a nine-month period, prosecutors said” (April 26, 2013).

Novartis tried to defend itself, saying physician speaker programs are an “accepted and customary practice in the industry.”

But that’s precisely the problem. The customary nature of the practice means the objectivity of many health-care professionals is corroded.

When a drug company pays a doctor to act as a spokesman for its drugs, that doctor will often feel obligated to that company. It will cause him to make some recommendations based not on his best judgment but on the wishes of the drug company.

So, the third question you should ask your doctor, if he recommends a certain prescription to you, is whether he is receiving money, gifts, speaking fees or other benefits from the company that makes the drug. You may also ask if his opinion of the drug has been influenced by doctors paid to speak on behalf of its manufacturer.

‘How Can I Do My Part?’

A final question you should ask is directed less at your doctor than at yourself.

What long-term changes can I make in my diet, exercise and other lifestyle habits that could improve my health without pharmaceuticals? These kinds of changes often can be difficult. But take note: Side effects of this solution can include, but are not limited to: a higher quality of life, greater clarity of thought, a larger savings account balance, a more abundant life, more time for family and friends, greater productivity at work ….