9 ms·

Life course patterns of prescription drug use in the United States

68 points by grecy 3y ago

deleted 3y ago
[deleted]
sgbeal 3y ago
Only if they _choose to_. One of the lessons in becoming a modern adult is that you have the option of telling a doctor "no, i won't take that." That's your choice, not the doctor's. Period, end of story. There are obviously exceptional cases - diabetes immediately comes to mind - where it's a "do or die" decision, but those are the minority. Even so, it's your choice, not a doctor's.
- willsmith72 3y ago
  "free choice" is not that simple.
  - farzinadil 3y ago
    exactly. vaccines weren't exactly a prescription drug but without taking them you were basically a second class citizen
    - sgbeal 3y ago
      > ... but without taking them you were basically a second class citizen "If you don't stick to your values when they're being tested, they're not values: they're hobbies." -- Jon Stewart
      - kelseyfrog 3y ago
        I'm curious, which values were those?
        sgbeal 3y ago
        > I'm curious, which values were those? In this context, deciding for oneself instead of blindly accepting what one is told they should do.
        kelseyfrog 3y ago
        You're referring to the novice-expert problem in epistemology. How do you get around requiring everyone to be an expert in all things?
        sgbeal 3y ago
        > How do you get around requiring everyone to be an expert in all things? i simply hope for them to make their own choices. If that choice means following a doctor's advice, that's fine. (Admittedly, 9 times out of 10 or more, that's what i'll do - the doctor is the subject-matter expert.) Anecdote: as a recovered throat cancer patient, if a doctor were to tell me that the cancer is back and i had to undergo Treatment X or die, i'd start getting my affairs in order. In the 17 years since my cancer treatment, the only side-effects i still live with are side-effects of the _treatment_, not the cancer. e.g. i haven't slept a full night of 8 hours uninterrupted in 17 years because of side-effects of the radiation treatments, not the disease, and i'm unwilling to undergo further quality-of-life degradation caused by medical treatments. If it comes down to that, i'd choose my dignity and quality-of-(what remains of my)-life over a longer life suffering yet more side effects. Granted, not all would make such a choice, but i inherited stubbornness from both of my parents and got a double dose of it genetically, so i don't expect to represent a majority opinion.
    - jeromegv 3y ago
      We have had mandatory vaccines for kids for a century. It’s what living in a society is all about.
      - idontonowheat 3y ago
        [flagged]
      - walterbell 3y ago
        Yes we did, to stop transmission. Without needing to change the definition of vaccine during that period.
      - s1artibartfast 3y ago
        What do you mean by "It’s what living in a society is all about."? The point of society isnt to enforce your will on others. At best it is a means to an end, and hotly debated how much you should be able to force compliance from others for your own benefit.
- youreinsane 3y ago
  [flagged]
- nradov 3y ago
  Most cases of type-2 diabetes can be put into remission to the extent that they no longer require exogenous insulin. https://www.virtahealth.com/research https://www.virtahealth.com/research
  - altairprime 3y ago
    If only this were the case with estradiol :/
- klyrs 3y ago
  Diabetes isn't that exceptional in our population. And not that exceptional as a "do or [suffer extreme consequences]" medication. Statins, antipsychotics, epilepsy medications, even sleeping pills, can literally save lives if taken on an ongoing basis.
- pixl97 3y ago
  >diabetes immediately comes to mind - where it's a "do or die" decision, but those are the minority. The rate of diabetes is exploding. >37.3 million people, or 11.3% of the U.S. population, have diabetes. An estimated 28.7 million people – had diagnosed diabetes. Approximately 8.6 million people have diabetes but have not yet been diagnosed. Oh, and what about high blood pressure. >About 70% of Americans will have high blood pressure in their lifetimes. What's more, only 1 in 4 patients with hypertension have their blood pressure under control. And because high blood pressure usually has no symptoms, you can have it without knowing it. Why does this matter? >About 697,000 people die of heart disease in the United States every year–that's 1 in every 5 deaths.
  - NotGMan 3y ago
    Diet fixes blood pressure is many, many people. I was one of them. I eliminated processed sweets and lower my carbs and presto, from ~145 to 115 blood pressure in a few months.
    - pixl97 3y ago
      I would like to add, diet doesn't fix getting old. One thing I've not seen in this thread is demographic shifts from the majority of the population aging and the percent of youth dropping significantly.
  - waveBidder 3y ago
    You're thinking about type 2. Type 1 is fairly stable around 1%. Type 2's, if they're lucky and disciplined (emphasis on the lucky), can get away without needing insulin.
- NotGMan 3y ago
  This. The doctor works for you. And eg most doctors will laugh at you if you said that T2 diabetes can be put into remission with diet: but it can for at least 50% of people. And the other 50% will at least drasticly lower their need for medication. Also notice the word "remission": they can't admit that you actually healed T2 diabetes, so they use the word remission to gaslight you into thinking that "you didn't even heal it, you're just lucky and it's gonna come back". Hard to take any doctor seriously nowadays.
  - MattGaiser 3y ago
    You aren't healed if you need to remain on that diet to keep the T2 away. You still need to actively treat your condition. So remission seems like a reasonable thing to say about it.
    - NotGMan 3y ago
      This implies that the diet that gave you T2 was not poisonious and implies that that diet was healthy in the 1st place. So you cannot say "you're in remission" if you're eating poison. You were poisoning yourself. So obviously if you poison yourself again you're gonna go out of "remission".
    - ramblenode 3y ago
      This doesn't square with the fact that the standard American diet is known to be unhealthy and a cause of pre-diabetes. If I eat something allergenic, start experiencing a reaction, then later cut the offending food out of my diet, it doesn't mean I am in remission from my allergy; it means I am avoiding the cause of an allergic reaction.
- kelseyfrog 3y ago
  > if they choose to There are standard cases that any rational person would see taking the medication as a win. The most prescribed class of medication in the article is antihypertensized. Thiazides are a frontline intervention for hypertension. Thiazide's reduction in all-cause mortality is clinically significant(HR approx: 0.51). > The risk of primary outcome events[all-cause mortality] was significantly lower in patients taking thiazides (model 1: HR 0.51 [95% CI, 0.36–0.72]; P=0.0002; model 2: HR 0.56 [95% CI, 0.38–0.83]; P=0.004; [1] There are of course downsides to taking any medication or medical intervention, but a HR 0.51 in mortality is such a large reduction that the risks would need to be equally significant. I'm not sure why diabetes should get any special treatment other than there is simply more public awareness of the risks of untreated diabetes. Are the HR reduction in all-cause mortality with insulin treatments above a particular threshold of importance? Does diabetes the primary cause of mortality in more patients than hypertension? Some other factor? Happy to hear some of the reasoning behind it. 1. Thiazide Use and Decreased Risk of Heart Failure in Nondiabetic Patients Receiving Intensive Blood Pressure Treatment https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7340223/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7340223/
  - dur-randir 3y ago
    T1 kills you with 50% chance in 2 years, without insulin. With hypertension, you can leave 10+ years. Not nearly comparable.
    - kelseyfrog 3y ago
      Is there a threshold you're using for non-intervention mortality and why did you choose it as the only factor? Additionally, most people would seem to account for several inputs, HR for all-cause mortality seems like a pretty good indication, but you've chosen to reject it. Any reason?
    - pimeys 3y ago
      Wait. You can survive with T1 for two years without insulin, 50% chance? Your pancreas must be still working, but when it totally stops producing insulin, I'd give you maybe a week before going to a coma. If I unplug my insulin pump, I will feel very sick after 24 hours and probably go to a coma from ketoacidosis after a few days.
Ajay-p 3y ago
Reading this, I am reminded of an article from the New Yorker about how difficult it is to stop some medications prescribed for mental health. https://www.newyorker.com/magazine/2019/04/08/the-challenge-of-going-off-psychiatric-drugs https://www.newyorker.com/magazine/2019/04/08/the-challenge-...
- jffhn 3y ago
  Reminds me of a doctor saying that his french peers were much more reluctant than USA ones to give mental medication to children, due to the unknown long term effects on these young and developing minds.
- gavinhoward 3y ago
  As someone who has stopped SSRI's 8 years ago, this is true.
  - Ajay-p 3y ago
    A startling revelation in the article for me was that drug companies that produce SSRI's do not publish (easily accessible) guidance for stopping them. That made me deeply suspicious because to my layman's perspective of pharmaceuticals, it is as if the companies do not intend for a person to stop taking them.
    - gavinhoward 3y ago
      Exactly. It gets worse because yes, you are expected to keep taking them. After stopping, some five years after stopping, I tried to get a medical to become a pilot. The FAA told me that they wanted me back on the SSRI that I had been taking in order to get a medical. I refused and was grounded for life.
zdw 3y ago
I wonder how many of these are absolute benefits but not strictly needed to survive. For example, allergy meds greatly improve my life on an ongoing basis, but I could do without them if I was willing to have messy sinuses and a headache on and off for a good part of the year. I was using over-the-counter meds but those stopped working and prescription ones do seem to work as replacements. I wouldn't be surprised if many of the voluntary prescriptions have benefits that far outweigh their downsides.
- tomtheelder 3y ago
  Nearly all prescription medications have benefits that far outweigh their downsides, at least at a population level. I do understand to some degree the growing skepticism around prescription medications, especially because of some high profile over-prescription events, but the gains achieved in quality of life and longevity due to prescription medications are huge. Put another way: I'm quite sure that the _overwhelming_ majority of prescription medications are a net benefit to the patient. This stat is in no way a bad thing.
  - tmnvix 3y ago
    > This stat is in no way a bad thing. It could indicate a lack of preventative measures or excessively unhealthy lifestyles.
    - UncleMeat 3y ago
      Or a vast improvement in medical technology enabling new treatments for previously untreatable issues.
      - tmnvix 3y ago
        Almost certainly both. The prevalence of prescription contraceptives would support your conjecture, while that of diabetes medications would support mine. I do find the statistic intuitively astounding given what I know of friends and family. Unless elderly or on the pill, use of prescription medications seems low. I am not in the US though.
onetimeuse92304 3y ago
That number says nothing. I could imagine, for example, medications prescribed to improve health that today would not even be considered a problem. Maybe to correct various imbalances resulting from individual genetics? Or that some medication readily available today becomes prescription over time. Or that people become more aware / better tested of their health problems as time progresses and start taking medication earlier, before their problems become acute issues. Anyway... why I think it is true is because of couple really sad factors: * People seeking comfort and less able to exercise discipline. For example, even bikes which were supposed to be healthy option today mostly have little motors built into them... * Disinformation. People seek shortcuts and there is a huge industry that exploits it that nobody really attempts to deal with. For example, dieting has been shown to not work (on its own) and yet any obese person is bombarded with information about dieting but not really any useful recipes how to deal with their problem. It does not help that most health professionals do not really know how to deal with obesity, either (for example, claiming that dietary fat is responsible for it when the opposite is true (dietary fat is necessary to help losing weight)). * Education and popular culture pushing the idea that being fat is somehow OK (no, it is not healthy and should never be accepted as a good example). People with obesity pick up on any shred of support and tend to ignore any information that will conflict with it. * Medical establishment continuing to only deal with symptoms, not causes of problems. People should seriously understand that sugar is far more dangerous and insidious than tobacco. Or that bad dietary habits is what is causing most of our health problems (including most types of cancer, heart disease, etc.) The issue here is that treating a disease is much, much, much more expensive that it would cost to prevent it (for example educate people, ensure healthy food available, provide guidelines, do medical checkups regularly, etc.)
- WillPostForFood 3y ago
  or birth control
  - onetimeuse92304 3y ago
    Birth control is not prescription and it would be a sad world if it was.
WXLCKNO 3y ago
I'm perfectly happy taking my current medication for my entire life, it completely changed everything for the better. I was diagnosed late with ADD (26) and despite being considered gifted throughout my childhood, starting around 17 years old it was getting harder to just get started, let alone be consistent. There was nothing more frustrating than knowing I'm smart but to keep failing without knowing why. Doctor prescribed Concerta and the mental fog went away immediately and I felt like my younger self again, brain ready to attack any task without needing the stimulation of an imminent deadline. Recently I realized through psychology sessions and introspection that I had a blanket of anxiety covering me constantly for the past 6-7 years. It fueled me to always do more and perform better but it was a negative source of motivation and it burnt me out. I had trouble sticking to anything long term or even keeping my house clean often because I wanted to go back to distracting myself to avoid being alone in my thoughts. Countless hours wasted on my phone and on Reddit. I wanted to try an SSRI because things got bad and after discussion with my doctor, she prescribed Escitalopram (Lexapro, Cipralex). The effect has been mind boggling, as in I can't believe how I was able to tolerate my previous state of mind for so long. The weight of anxiety has been lifted from my shoulders almost completely. For so long I thought my ADD was the only thing stopping me from being consistent in long terms task but it was the anxiety that really paralyzed me. I'm finally doing all the things I always knew I fundamentally wanted but kept trying and failing to keep going. I'm working out again with amazing consistency, weightlifting/rowing/yoga. I'm fully enjoying the workouts too because I'm not anxious to go back to a safe space like my phone. I'm tracking my calories and losing weight and it's a pleasure. I'm cooking and cleaning, my place looks amazing. I'm going to sleep every day early because I'm no longer wasting time on my phone until I'm so tired that I drop the phone on my face. I'm reading books again too and meditating daily. I had been stuck in these loops of knowing what I wanted and making insignificant progress. I never stopped wanting these things and now I can finally have them. Obviously it would be better to function normally without medication but I have no issues with continuing.
- oblib 3y ago
  That's truly awesome to hear. It's truly "crazy times" we're living in now and we all have to figure out how to deal with it. Years ago I realized that watching the "News" was getting to me. I'd get up in the morning and go to work and felt fine but after watching the "News" I felt like shit. Basically I was consuming all the horrendous tragedies in the city, State, U.S., and the rest of the world for an 1-1/2 hours every evening and it was very depressing. I realized that I, myself, had it pretty good and for the most part so did all of those I knew and were close to. So I quit watching the news everyday and that made a big difference. Now I monitor the news, as opposed to consuming like it effects me personally, when in fact it mostly does not, or is beyond my reach of influence.
oblib 3y ago
That's pretty crazy. Back in the `80s I listened to the head of the USC Med school on the radio talk about doctors graduating who just barely passed the grade and then said "going to the doctor was the #1 cause of avoidable deaths". I read a few years ago that it's now the #3 cause of avoidable death, but that's still very high. I'm 63 now and I've only went to a doctor 3 times in the past 40 years. All of those were for lung infections from a "cold" that was going around and I asked for and got a shot of penicillin. The last time was about 10-12 years ago and I asked for a shot of penicillin and the "Nurse practitioner" that saw me got all snippy with me, told me "You can't come in here and tell us what to prescribe!". That just cracked me up. Everyone I knew at the time who'd got that crud was getting prescribed a "z-pac antibiotic" and it was making them all sick af and I told her that, and that I wouldn't take it. She ran to the Doctor to tell on me and they told her to give me the penicillin. I was feeling better the next day. Haven't been sick since. I didn't get infected with covid either, but I did mask up and keep a distance and got vaxxed and boosted asap for that.
newsclues 3y ago
I wonder if they would include prescription cannabis.
kens 3y ago
The British Museum had an art exhibit showing the prescription medicine taken by a typical person. It was kind of shocking to see a 14-meter long table covered with 14,000 pills, arranged according to the course of someone's life. I'm not saying that this medicine is bad, of course, but it was a striking presentation that comes to my mind years later. Photos: https://www.tumblr.com/britishmuseum/142396578532/cradle-to-grave-by-pharmacopoeia https://www.tumblr.com/britishmuseum/142396578532/cradle-to-... http://www.pharmacopoeia-art.net/articles/in-sickness-and-in-health/ http://www.pharmacopoeia-art.net/articles/in-sickness-and-in...
Eumenes 3y ago
You can get prescribed SSRI, ADHD, anti-anxiety related drugs in under 30 mins with ease across the US. There's also a big industry of doing it over video calls now too with cute web apps that make it easy, full of commercials with celeb actors. In the commodified hell we live in, this is hardly a shock. The number of young adults being tricked into thinking they have some mental disorder is alarming. There is almost no energy put into other forms of discipline and self-improvement.
herandhimsnow 3y ago
That shows you your society is in decline. Constantly needing pacifier ers because the social structure is broken. It's well known that allergies are correlated with less exposure to nature, less breast feeding, etc...
RA_Fisher 3y ago
Of course they will, medical technology improves over time.
thenerdhead 3y ago
> Between 1997 and 2016, medical marketing increased from $17.7 to $29.9 billion (Schwartz and Woloshin 2019). Prescription drug advertising was a key driver of this expansion, with 4.6 million advertisements (including 663,000 TV commercials) amounting to $6 billion spent in 2016 alone (Schwartz and Woloshin 2019). I'm reading this thread as I see at least one prescription drug advertisement every commercial break while watching Sunday football in the US. https://pubmed.ncbi.nlm.nih.gov/30620375/ https://pubmed.ncbi.nlm.nih.gov/30620375/ Here's an interesting bit from the study itself: > From 1997 through 2016, the number of consumer and professional drug promotional materials that companies submitted for FDA review increased from 34 182 to 97 252, while FDA violation letters for misleading drug marketing decreased from 156 to 11. Since 1997, 103 financial settlements between drug companies and federal and state governments resulted in more than $11 billion in fines for off-label or deceptive marketing practices. Plenty of ads for drugs and limited regulation oversight. How does this compare to more regulated countries?
- InSteady 3y ago
  >while FDA violation letters for misleading drug marketing decreased from 156 to 11. As an interesting aside, it is my understanding that legislation is often written by lobbyists and industry groups rather than by our elected officials and their staffers, especially with legislation that relates to large and complex industries/institutions. The general concept is that politicians and their staff are more generalists and technocrats of the political process so they lack the knowledge, time, resources, and expertise to craft complex legal frameworks. Certainly problematic, but it's kind of how our system has evolved to work. Ok. On top of that, there are significant cases ahead facing our conservative supreme court that aim to "reign in" federal regulatory agencies, for instance by giving judges much more power to undermine their interpretation and enforcement of federal law [0]. Namely, consumer protection and finance agencies in the executive branch. Although the EPA tends to draw the most ire from conservative judges, the FDA also falls into this category. Perhaps the FDA will skirt some of this scrutiny by such policies as reducing the issuance of violation letters for misleading marketing by 93% over a 20 year stretch, despite a significant growth in the amount and kinds of advertising taking place during the same period. Of course it's possible that medical marketing has simply become that much more ethical during this time, all but eliminating the need for the issuance of violation letters. However, if it is true that the FDA has effectively clamped down on misleading marketing, this now represents a significant financial incentive to try and have much of that progress to be undone by industry-friendly judges as well as those who oppose federal regulation on ideological grounds, since they would have far more leeway to defang the FDA should to be so inclined. Anyway, those situations - medical industry writing laws for themselves and federal regulators losing their teeth - represent two major checks in our system that are at risk of being substantially compromised when it comes to oversight of medical marketing for the good of individual consumers and the wellbeing of our nation. [0] https://www.reuters.com/legal/federal-agency-powers-crosshairs-us-supreme-court-2023-07-04/ https://www.reuters.com/legal/federal-agency-powers-crosshai...

68 points by grecy 3y ago

deleted 3y ago

[deleted]

Only if they _choose to_. One of the lessons in becoming a modern adult is that you have the option of telling a doctor "no, i won't take that." That's your choice, not the doctor's. Period, end of story. There are obviously exceptional cases - diabetes immediately comes to mind - where it's a "do or die" decision, but those are the minority. Even so, it's your choice, not a doctor's.

willsmith72 3y ago
"free choice" is not that simple.
- farzinadil 3y ago
  exactly. vaccines weren't exactly a prescription drug but without taking them you were basically a second class citizen
  - sgbeal 3y ago
    > ... but without taking them you were basically a second class citizen "If you don't stick to your values when they're being tested, they're not values: they're hobbies." -- Jon Stewart
    - kelseyfrog 3y ago
      I'm curious, which values were those?
      - sgbeal 3y ago
        > I'm curious, which values were those? In this context, deciding for oneself instead of blindly accepting what one is told they should do.
        kelseyfrog 3y ago
        You're referring to the novice-expert problem in epistemology. How do you get around requiring everyone to be an expert in all things?
        sgbeal 3y ago
        > How do you get around requiring everyone to be an expert in all things? i simply hope for them to make their own choices. If that choice means following a doctor's advice, that's fine. (Admittedly, 9 times out of 10 or more, that's what i'll do - the doctor is the subject-matter expert.) Anecdote: as a recovered throat cancer patient, if a doctor were to tell me that the cancer is back and i had to undergo Treatment X or die, i'd start getting my affairs in order. In the 17 years since my cancer treatment, the only side-effects i still live with are side-effects of the _treatment_, not the cancer. e.g. i haven't slept a full night of 8 hours uninterrupted in 17 years because of side-effects of the radiation treatments, not the disease, and i'm unwilling to undergo further quality-of-life degradation caused by medical treatments. If it comes down to that, i'd choose my dignity and quality-of-(what remains of my)-life over a longer life suffering yet more side effects. Granted, not all would make such a choice, but i inherited stubbornness from both of my parents and got a double dose of it genetically, so i don't expect to represent a majority opinion.
  - jeromegv 3y ago
    We have had mandatory vaccines for kids for a century. It’s what living in a society is all about.
    - idontonowheat 3y ago
      [flagged]
    - walterbell 3y ago
      Yes we did, to stop transmission. Without needing to change the definition of vaccine during that period.
    - s1artibartfast 3y ago
      What do you mean by "It’s what living in a society is all about."? The point of society isnt to enforce your will on others. At best it is a means to an end, and hotly debated how much you should be able to force compliance from others for your own benefit.
youreinsane 3y ago
[flagged]
nradov 3y ago
Most cases of type-2 diabetes can be put into remission to the extent that they no longer require exogenous insulin. https://www.virtahealth.com/research https://www.virtahealth.com/research
- altairprime 3y ago
  If only this were the case with estradiol :/
klyrs 3y ago
Diabetes isn't that exceptional in our population. And not that exceptional as a "do or [suffer extreme consequences]" medication. Statins, antipsychotics, epilepsy medications, even sleeping pills, can literally save lives if taken on an ongoing basis.
pixl97 3y ago
>diabetes immediately comes to mind - where it's a "do or die" decision, but those are the minority. The rate of diabetes is exploding. >37.3 million people, or 11.3% of the U.S. population, have diabetes. An estimated 28.7 million people – had diagnosed diabetes. Approximately 8.6 million people have diabetes but have not yet been diagnosed. Oh, and what about high blood pressure. >About 70% of Americans will have high blood pressure in their lifetimes. What's more, only 1 in 4 patients with hypertension have their blood pressure under control. And because high blood pressure usually has no symptoms, you can have it without knowing it. Why does this matter? >About 697,000 people die of heart disease in the United States every year–that's 1 in every 5 deaths.
- NotGMan 3y ago
  Diet fixes blood pressure is many, many people. I was one of them. I eliminated processed sweets and lower my carbs and presto, from ~145 to 115 blood pressure in a few months.
  - pixl97 3y ago
    I would like to add, diet doesn't fix getting old. One thing I've not seen in this thread is demographic shifts from the majority of the population aging and the percent of youth dropping significantly.
- waveBidder 3y ago
  You're thinking about type 2. Type 1 is fairly stable around 1%. Type 2's, if they're lucky and disciplined (emphasis on the lucky), can get away without needing insulin.
NotGMan 3y ago
This. The doctor works for you. And eg most doctors will laugh at you if you said that T2 diabetes can be put into remission with diet: but it can for at least 50% of people. And the other 50% will at least drasticly lower their need for medication. Also notice the word "remission": they can't admit that you actually healed T2 diabetes, so they use the word remission to gaslight you into thinking that "you didn't even heal it, you're just lucky and it's gonna come back". Hard to take any doctor seriously nowadays.
- MattGaiser 3y ago
  You aren't healed if you need to remain on that diet to keep the T2 away. You still need to actively treat your condition. So remission seems like a reasonable thing to say about it.
  - NotGMan 3y ago
    This implies that the diet that gave you T2 was not poisonious and implies that that diet was healthy in the 1st place. So you cannot say "you're in remission" if you're eating poison. You were poisoning yourself. So obviously if you poison yourself again you're gonna go out of "remission".
  - ramblenode 3y ago
    This doesn't square with the fact that the standard American diet is known to be unhealthy and a cause of pre-diabetes. If I eat something allergenic, start experiencing a reaction, then later cut the offending food out of my diet, it doesn't mean I am in remission from my allergy; it means I am avoiding the cause of an allergic reaction.
kelseyfrog 3y ago
> if they choose to There are standard cases that any rational person would see taking the medication as a win. The most prescribed class of medication in the article is antihypertensized. Thiazides are a frontline intervention for hypertension. Thiazide's reduction in all-cause mortality is clinically significant(HR approx: 0.51). > The risk of primary outcome events[all-cause mortality] was significantly lower in patients taking thiazides (model 1: HR 0.51 [95% CI, 0.36–0.72]; P=0.0002; model 2: HR 0.56 [95% CI, 0.38–0.83]; P=0.004; [1] There are of course downsides to taking any medication or medical intervention, but a HR 0.51 in mortality is such a large reduction that the risks would need to be equally significant. I'm not sure why diabetes should get any special treatment other than there is simply more public awareness of the risks of untreated diabetes. Are the HR reduction in all-cause mortality with insulin treatments above a particular threshold of importance? Does diabetes the primary cause of mortality in more patients than hypertension? Some other factor? Happy to hear some of the reasoning behind it. 1. Thiazide Use and Decreased Risk of Heart Failure in Nondiabetic Patients Receiving Intensive Blood Pressure Treatment https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7340223/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7340223/
- dur-randir 3y ago
  T1 kills you with 50% chance in 2 years, without insulin. With hypertension, you can leave 10+ years. Not nearly comparable.
  - kelseyfrog 3y ago
    Is there a threshold you're using for non-intervention mortality and why did you choose it as the only factor? Additionally, most people would seem to account for several inputs, HR for all-cause mortality seems like a pretty good indication, but you've chosen to reject it. Any reason?
  - pimeys 3y ago
    Wait. You can survive with T1 for two years without insulin, 50% chance? Your pancreas must be still working, but when it totally stops producing insulin, I'd give you maybe a week before going to a coma. If I unplug my insulin pump, I will feel very sick after 24 hours and probably go to a coma from ketoacidosis after a few days.

Ajay-p 3y ago

Reading this, I am reminded of an article from the New Yorker about how difficult it is to stop some medications prescribed for mental health. https://www.newyorker.com/magazine/2019/04/08/the-challenge-of-going-off-psychiatric-drugs https://www.newyorker.com/magazine/2019/04/08/the-challenge-...

jffhn 3y ago
Reminds me of a doctor saying that his french peers were much more reluctant than USA ones to give mental medication to children, due to the unknown long term effects on these young and developing minds.
gavinhoward 3y ago
As someone who has stopped SSRI's 8 years ago, this is true.
- Ajay-p 3y ago
  A startling revelation in the article for me was that drug companies that produce SSRI's do not publish (easily accessible) guidance for stopping them. That made me deeply suspicious because to my layman's perspective of pharmaceuticals, it is as if the companies do not intend for a person to stop taking them.
  - gavinhoward 3y ago
    Exactly. It gets worse because yes, you are expected to keep taking them. After stopping, some five years after stopping, I tried to get a medical to become a pilot. The FAA told me that they wanted me back on the SSRI that I had been taking in order to get a medical. I refused and was grounded for life.

zdw 3y ago

I wonder how many of these are absolute benefits but not strictly needed to survive. For example, allergy meds greatly improve my life on an ongoing basis, but I could do without them if I was willing to have messy sinuses and a headache on and off for a good part of the year. I was using over-the-counter meds but those stopped working and prescription ones do seem to work as replacements. I wouldn't be surprised if many of the voluntary prescriptions have benefits that far outweigh their downsides.

tomtheelder 3y ago
Nearly all prescription medications have benefits that far outweigh their downsides, at least at a population level. I do understand to some degree the growing skepticism around prescription medications, especially because of some high profile over-prescription events, but the gains achieved in quality of life and longevity due to prescription medications are huge. Put another way: I'm quite sure that the _overwhelming_ majority of prescription medications are a net benefit to the patient. This stat is in no way a bad thing.
- tmnvix 3y ago
  > This stat is in no way a bad thing. It could indicate a lack of preventative measures or excessively unhealthy lifestyles.
  - UncleMeat 3y ago
    Or a vast improvement in medical technology enabling new treatments for previously untreatable issues.
    - tmnvix 3y ago
      Almost certainly both. The prevalence of prescription contraceptives would support your conjecture, while that of diabetes medications would support mine. I do find the statistic intuitively astounding given what I know of friends and family. Unless elderly or on the pill, use of prescription medications seems low. I am not in the US though.

onetimeuse92304 3y ago

That number says nothing. I could imagine, for example, medications prescribed to improve health that today would not even be considered a problem. Maybe to correct various imbalances resulting from individual genetics? Or that some medication readily available today becomes prescription over time. Or that people become more aware / better tested of their health problems as time progresses and start taking medication earlier, before their problems become acute issues. Anyway... why I think it is true is because of couple really sad factors: * People seeking comfort and less able to exercise discipline. For example, even bikes which were supposed to be healthy option today mostly have little motors built into them... * Disinformation. People seek shortcuts and there is a huge industry that exploits it that nobody really attempts to deal with. For example, dieting has been shown to not work (on its own) and yet any obese person is bombarded with information about dieting but not really any useful recipes how to deal with their problem. It does not help that most health professionals do not really know how to deal with obesity, either (for example, claiming that dietary fat is responsible for it when the opposite is true (dietary fat is necessary to help losing weight)). * Education and popular culture pushing the idea that being fat is somehow OK (no, it is not healthy and should never be accepted as a good example). People with obesity pick up on any shred of support and tend to ignore any information that will conflict with it. * Medical establishment continuing to only deal with symptoms, not causes of problems. People should seriously understand that sugar is far more dangerous and insidious than tobacco. Or that bad dietary habits is what is causing most of our health problems (including most types of cancer, heart disease, etc.) The issue here is that treating a disease is much, much, much more expensive that it would cost to prevent it (for example educate people, ensure healthy food available, provide guidelines, do medical checkups regularly, etc.)

WillPostForFood 3y ago
or birth control
- onetimeuse92304 3y ago
  Birth control is not prescription and it would be a sad world if it was.

WXLCKNO 3y ago

I'm perfectly happy taking my current medication for my entire life, it completely changed everything for the better. I was diagnosed late with ADD (26) and despite being considered gifted throughout my childhood, starting around 17 years old it was getting harder to just get started, let alone be consistent. There was nothing more frustrating than knowing I'm smart but to keep failing without knowing why. Doctor prescribed Concerta and the mental fog went away immediately and I felt like my younger self again, brain ready to attack any task without needing the stimulation of an imminent deadline. Recently I realized through psychology sessions and introspection that I had a blanket of anxiety covering me constantly for the past 6-7 years. It fueled me to always do more and perform better but it was a negative source of motivation and it burnt me out. I had trouble sticking to anything long term or even keeping my house clean often because I wanted to go back to distracting myself to avoid being alone in my thoughts. Countless hours wasted on my phone and on Reddit. I wanted to try an SSRI because things got bad and after discussion with my doctor, she prescribed Escitalopram (Lexapro, Cipralex). The effect has been mind boggling, as in I can't believe how I was able to tolerate my previous state of mind for so long. The weight of anxiety has been lifted from my shoulders almost completely. For so long I thought my ADD was the only thing stopping me from being consistent in long terms task but it was the anxiety that really paralyzed me. I'm finally doing all the things I always knew I fundamentally wanted but kept trying and failing to keep going. I'm working out again with amazing consistency, weightlifting/rowing/yoga. I'm fully enjoying the workouts too because I'm not anxious to go back to a safe space like my phone. I'm tracking my calories and losing weight and it's a pleasure. I'm cooking and cleaning, my place looks amazing. I'm going to sleep every day early because I'm no longer wasting time on my phone until I'm so tired that I drop the phone on my face. I'm reading books again too and meditating daily. I had been stuck in these loops of knowing what I wanted and making insignificant progress. I never stopped wanting these things and now I can finally have them. Obviously it would be better to function normally without medication but I have no issues with continuing.

oblib 3y ago
That's truly awesome to hear. It's truly "crazy times" we're living in now and we all have to figure out how to deal with it. Years ago I realized that watching the "News" was getting to me. I'd get up in the morning and go to work and felt fine but after watching the "News" I felt like shit. Basically I was consuming all the horrendous tragedies in the city, State, U.S., and the rest of the world for an 1-1/2 hours every evening and it was very depressing. I realized that I, myself, had it pretty good and for the most part so did all of those I knew and were close to. So I quit watching the news everyday and that made a big difference. Now I monitor the news, as opposed to consuming like it effects me personally, when in fact it mostly does not, or is beyond my reach of influence.

oblib 3y ago

That's pretty crazy. Back in the `80s I listened to the head of the USC Med school on the radio talk about doctors graduating who just barely passed the grade and then said "going to the doctor was the #1 cause of avoidable deaths". I read a few years ago that it's now the #3 cause of avoidable death, but that's still very high. I'm 63 now and I've only went to a doctor 3 times in the past 40 years. All of those were for lung infections from a "cold" that was going around and I asked for and got a shot of penicillin. The last time was about 10-12 years ago and I asked for a shot of penicillin and the "Nurse practitioner" that saw me got all snippy with me, told me "You can't come in here and tell us what to prescribe!". That just cracked me up. Everyone I knew at the time who'd got that crud was getting prescribed a "z-pac antibiotic" and it was making them all sick af and I told her that, and that I wouldn't take it. She ran to the Doctor to tell on me and they told her to give me the penicillin. I was feeling better the next day. Haven't been sick since. I didn't get infected with covid either, but I did mask up and keep a distance and got vaxxed and boosted asap for that.

newsclues 3y ago

I wonder if they would include prescription cannabis.

kens 3y ago

The British Museum had an art exhibit showing the prescription medicine taken by a typical person. It was kind of shocking to see a 14-meter long table covered with 14,000 pills, arranged according to the course of someone's life. I'm not saying that this medicine is bad, of course, but it was a striking presentation that comes to my mind years later. Photos: https://www.tumblr.com/britishmuseum/142396578532/cradle-to-grave-by-pharmacopoeia https://www.tumblr.com/britishmuseum/142396578532/cradle-to-... http://www.pharmacopoeia-art.net/articles/in-sickness-and-in-health/ http://www.pharmacopoeia-art.net/articles/in-sickness-and-in...

Eumenes 3y ago

You can get prescribed SSRI, ADHD, anti-anxiety related drugs in under 30 mins with ease across the US. There's also a big industry of doing it over video calls now too with cute web apps that make it easy, full of commercials with celeb actors. In the commodified hell we live in, this is hardly a shock. The number of young adults being tricked into thinking they have some mental disorder is alarming. There is almost no energy put into other forms of discipline and self-improvement.

herandhimsnow 3y ago

That shows you your society is in decline. Constantly needing pacifier ers because the social structure is broken. It's well known that allergies are correlated with less exposure to nature, less breast feeding, etc...

RA_Fisher 3y ago

Of course they will, medical technology improves over time.

thenerdhead 3y ago

> Between 1997 and 2016, medical marketing increased from $17.7 to $29.9 billion (Schwartz and Woloshin 2019). Prescription drug advertising was a key driver of this expansion, with 4.6 million advertisements (including 663,000 TV commercials) amounting to $6 billion spent in 2016 alone (Schwartz and Woloshin 2019). I'm reading this thread as I see at least one prescription drug advertisement every commercial break while watching Sunday football in the US. https://pubmed.ncbi.nlm.nih.gov/30620375/ https://pubmed.ncbi.nlm.nih.gov/30620375/ Here's an interesting bit from the study itself: > From 1997 through 2016, the number of consumer and professional drug promotional materials that companies submitted for FDA review increased from 34 182 to 97 252, while FDA violation letters for misleading drug marketing decreased from 156 to 11. Since 1997, 103 financial settlements between drug companies and federal and state governments resulted in more than $11 billion in fines for off-label or deceptive marketing practices. Plenty of ads for drugs and limited regulation oversight. How does this compare to more regulated countries?

InSteady 3y ago
>while FDA violation letters for misleading drug marketing decreased from 156 to 11. As an interesting aside, it is my understanding that legislation is often written by lobbyists and industry groups rather than by our elected officials and their staffers, especially with legislation that relates to large and complex industries/institutions. The general concept is that politicians and their staff are more generalists and technocrats of the political process so they lack the knowledge, time, resources, and expertise to craft complex legal frameworks. Certainly problematic, but it's kind of how our system has evolved to work. Ok. On top of that, there are significant cases ahead facing our conservative supreme court that aim to "reign in" federal regulatory agencies, for instance by giving judges much more power to undermine their interpretation and enforcement of federal law [0]. Namely, consumer protection and finance agencies in the executive branch. Although the EPA tends to draw the most ire from conservative judges, the FDA also falls into this category. Perhaps the FDA will skirt some of this scrutiny by such policies as reducing the issuance of violation letters for misleading marketing by 93% over a 20 year stretch, despite a significant growth in the amount and kinds of advertising taking place during the same period. Of course it's possible that medical marketing has simply become that much more ethical during this time, all but eliminating the need for the issuance of violation letters. However, if it is true that the FDA has effectively clamped down on misleading marketing, this now represents a significant financial incentive to try and have much of that progress to be undone by industry-friendly judges as well as those who oppose federal regulation on ideological grounds, since they would have far more leeway to defang the FDA should to be so inclined. Anyway, those situations - medical industry writing laws for themselves and federal regulators losing their teeth - represent two major checks in our system that are at risk of being substantially compromised when it comes to oversight of medical marketing for the good of individual consumers and the wellbeing of our nation. [0] https://www.reuters.com/legal/federal-agency-powers-crosshairs-us-supreme-court-2023-07-04/ https://www.reuters.com/legal/federal-agency-powers-crosshai...