It is in the interest of all of us—patients, doctors, nurses, pharmacists, other health care professionals, parents, and our elected representatives—to reduce overmedication in our society. I have told you as clearly as I can why our excessive reliance on medication is a problem. We all have work to do if we want to resolve it.
If you are a consumer, be informed. Do not take medications, whether prescribed or available over the counter or sold online or in health food stores, unless you know the reason for taking them, understand how they work, and can weigh potential benefits against potential risks. Also, I urge you to find out whether safe and effective nondrug methods are available to manage any health conditions you have. If you decide that medication therapy is indicated, try to use less potent drugs rather than more potent ones, starting with the lowest dosage that works for you. This may be easier if you make appropriate lifestyle changes and experiment with natural remedies and other therapies, which may also enable you to shorten the duration of medication treatment. Pay attention to side effects, be wary of adverse drug reactions and interactions, and if you are on multiple medications, consult a pharmacist for a medication therapy management session.
Keep in mind that doctors are frequently paid thousands of dollars to promote drugs to other doctors and allied health care professionals. The cozy (and lucrative) relationship between the pharmaceutical industry and physicians has become such a problem that the Affordable Care Act mandates public disclosure of these payments. There is now a website you can check to see if your doctor has taken money from the pharmaceutical industry: cms.gov/openpayments.
If you are a pharmacist, please become knowledgeable about the dietary supplements, herbal remedies, and other natural products that so many consumers are taking. Be able to give advice about their safety, efficacy, and possible side effects and interactions with prescribed and over-the-counter (OTC) drugs. Through your professional organizations, try to influence colleges of pharmacy to include these topics in their curriculums. Also let consumers know about the services you offer to help them use medications wisely.
If you are a physician, nurse, or allied health care provider, I have a number of suggestions:
• Seek out nonbiased information on medications you prescribe or recommend, rather than relying on product information supplied by manufacturers.
• Insist that patients disclose all the products they are taking: prescribed and OTC drugs, dietary supplements, herbal remedies, and so on. If you are not sure about possible adverse reactions and drug interactions, consult a knowledgeable pharmacist.
• Get a sense of the lifestyle habits of your patients. Take dietary histories from them. Know what lifestyle modifications may be used as primary interventions for common health conditions, and become familiar with motivational interviewing as a technique to encourage patients to change habits.
• Be informed about alternatives to medication therapy for the health conditions you see most often. Know how to make appropriate referrals to other practitioners: registered dietitians, for example, or mind-body therapists.
• Learn about integrative medicine approaches for managing common health conditions.
If you are a parent, protect your children from overmedication by knowing the facts about any prescribed or OTC drugs you give them. Avoid using antibiotics unless they are absolutely necessary. The good news is that growing numbers of pediatricians are trained in integrative medicine; they can help you manage common health conditions in children with less emphasis on medication.
I don’t know what I can suggest to curb the worst practices of the pharmaceutical industry, except to express my hope that all readers of this book will contact their elected representatives to demand an end to direct-to-consumer advertising of prescription medications.
For some years now, I have called for the US Food and Drug Administration to create a new division of Natural Therapeutic Agents to regulate dietary supplements, herbal remedies, and other natural products marketed for health benefits. Its purpose would be to ensure that products of this sort are safe and effective, not to thwart consumer access to them. Labeling should give indications for use as well as recommended dosage. Other countries—Canada and Germany, for instance—do a better job of this than the United States does.
Colleges of medicine, nursing, and pharmacy must provide adequate education about natural therapeutic agents.
I firmly believe that integrative medicine is the way of the future. It uses medication therapy as one way to manage disease and improve health, only when necessary and always in the context of a comprehensive treatment plan that addresses lifestyle issues and also makes use of nondrug therapies. One day, I am sure, we will be able to drop the word “integrative.” This will simply be good medicine.