May 16, 2008 
Well, we have finally broke the 50% mark of people using maintenance (or chronic) medications. It shouldn’t be a big surprise. Sit around the table with your friends and ask who takes a medication (without asking what for). Why do so many people take medications:
- We are in worse health…think obesity.
- There are better medications.
- Doctors are more willing to prescribe.
- Patients know more about using medications through DTC (direct-to-consumer) advertising.
This is all according to a Medco report that was just published looking at a sample of 2.5M customers of all ages from 2001 – 2007. A few of the facts:
- 2/3 of women 20 and older take maintenance medications.
- ¼ of children and teenagers take maintenance medications
- 52% of adult men take maintenance medications
- ¾ people 65 or older take maintenance medications
- Among seniors, 28% of women and 22% of men take 5 or more maintenance medications
“Honestly, a lot of it is related to obesity. We’ve become a couch potato culture (and) it’s a lot easier to pop a pill” than to exercise regularly or diet. (Dr. Robert Epstein, Chief Medical Officer at Medco)
Dr. Epstein makes the point that in some cases we have turned diseases that were once a death sentence into chronic conditions – AIDS, some cancers, hemophilia and sickle-cell disease. I was just talking about this yesterday with a nurse about an adherence program where I said we needed to look at some specialty drugs because they are being used chronically.
The biggest jump was in the 20-44 year old age group where utilization grew 20% mainly for depression, diabetes, asthma, ADD, and seizures.
Medco estimates about 1.2 million American children now are taking pills for Type 2 diabetes, sleeping troubles and gastrointestinal problems such as heartburn. (This should be troubling to everyone in terms of the long-term implications to our health care system.)
Enabling Healthy Decisions 
You mention that medication use is more prevalent for several reasons, two of which are 1) doctors more willing to prescribe, and 2) people knowing more about using medication due to DTC advertising. The way you describe this last point almost makes it sound like DTC advertising is like public service announcements. Hardly. DTC drug advertising is meant to persuade people to seek out whatever drug is being advertised. That’s it. Note that the DTC ads never show sick people or poor people—just healthy attractive fairly affluent people (i.e., those with health insurance) walking through a lovely forest, or on the verge of sex in a beautiful field. If the ads educate, it’s because they have to mention things like side effects and health warnings. The only reason they mention “talk to your doctor” is because they’re only available by prescription. You rarely if ever see an OTC drug advertisement mention talking to your doctor. That’s because they don’t have to. I don’t think doctors are more willing to prescribe drugs now than in th past given the fact that most doctors’ livelihoods are based on writing scripts. People coming in to ask about advertised drugs means more office visit revenues. What doctor is going to say no to that? I think more people are asking for drugs because they see five to ten ads every day telling them they should, and doctors are willing to oblige.