Wiser use of prescription medications by everyone—doctors and their patients—could save the U.S. health care system more than $200 billion a year. That’s the conclusion of a new report, Avoidable Costs in U.S. Healthcare, from the IMS Institute for Healthcare Informatics. Inefficient or ineffective use of medications lead to six million hospitalizations, four million trips to the emergency room and 78 million visits to doctors and other care providers each year, according to the report. Those are huge numbers. Although $213 billion represents less than 8% of what Americans spend on health care each year, it’s still a staggering sum. It also exacts human costs that aren’t reflected in the estimates. The report identifies 6 things that can be improved to address the problem: 1) not taking medications as directed, 2) taking too many medications, 3) delayed treatment, 4) overuse of antibiotics, 5) medication errors, and 6) underuse of generic medications.
Drugs and Supplements
For many people, medications are a mainstay for preventing and treating disease. Managing multiple conditions and multiple medications can be confusing, especially if you store some of your pills in the medicine cabinet and others in a kitchen cabinet or pill drawer. Every once in a while, it’s a good idea to take inventory of all of your medications. As a reminder to do just that, the American College of Endocrinology has declared April 15th as National Check Your Meds Day. The college recommends checking to make sure the labels on the medications you got from the pharmacy match exactly what your doctor prescribed. It’s also important to check expiration dates.
Memory slips are aggravating, frustrating, and sometimes worrisome. When they happen more than they should, they can trigger fears of looming dementia or Alzheimer’s disease. But there are many mundane—and treatable—causes of forgetfulness. Here are seven common ones: lack of sleep, some medications, an underactive thyroid, drinking too much alcohol, stress, anxiety, and depression. If memory lapses are bugging you, it’s worth a conversation with your doctor to see if any reversible causes are at the root of the problem. Something like getting more sleep, switching a medication, or a stress reduction program could get your memory back on track.
Getting extra calcium from supplements is supposed to be good for your bones. The latest in a string of studies heightens concern that this simple practice could end up being bad for your heart. The results support growing recommendations to get calcium from food, not pills. The latest evidence comes from the NIH-AARP Diet and Health Study, which has followed the health of nearly 400,000 men and women since 1995. Over 12 years of follow-up, men who took more than 1,000 milligrams (mg) of daily supplemental calcium were 20% more likely to succumb to heart disease than those who didn’t take calcium supplements. There was no connection between calcium supplements and heart disease in women (which has been seen in earlier studies), and no connection with calcium from food. This one study isn’t enough to find calcium guilty of heart disease in the first degree. But it’s not the only research to point the accusing finger. This line of research has some experts placing greater emphasis on a nutritious, calcium-rich diet and weight bearing exercise than on calcium supplements for keeping bones strong.
File this under “if a little bit is good, a lot isn’t necessarily better:” taking high-dose vitamin C appears to double a man’s risk of developing painful kidney stones. In an article published yesterday in JAMA Internal Medicine, Swedish researchers detail a connection between kidney stone formation and vitamin C supplements among more than 23,000 Swedish men. Over an 11-year period, about 2% of the men developed kidney stones. Men who reported taking vitamin C supplements were twice as likely to have experienced the misery of kidney stones. Use of a standard multivitamin didn’t seem to up the risk. Many people believe that extra vitamin C can prevent colds, supercharge the immune system, detoxify the body, protect the heart, fight cancer, and more. To date, though, the evidence doesn’t support claims that extra vitamin C is helpful. If high-dose vitamin C doesn’t improve health, then any hazard from it, even a small one, is too much.
When it comes to relieving the pain of achy joints, many people reach for a pain-relieving pill like aspirin or ibuprofen. There may be a better way. When the source of pain is close to the surface, applying a cream, gel, patch, or spray that contains a pain reliever right where it hurts can ease pain and help avoid some of the body-wide side effects of oral pain relievers. These so-called topical analgesics work best for more superficial joints like the knees, ankles, feet, elbows, and hands. The active ingredient in most topical analgesics is a nonsteroidal anti-inflammatory drug (NSAID) like ibuprofen, naproxen, aspirin, or diclofenac. These medications target inflammation, which contributes to pain, swelling, and stiffness. The advantage of using a topical analgesic is that the medication works locally. Targeting pain more precisely using a medication applied to the skin can help skirt the side effects of oral drugs. This can be a boon for people whose stomachs are sensitive to NSAIDs.
The FDA is urging doctors to lower the starting dose of zolpidem, a popular prescription sleep aid, due to concerns that the drug can linger too long in the body. This causes daytime drowsiness that has led to car accidents. Sleep aids affected by the FDA’s announcement includes generic zolpidem and brand names Ambien, Ambien CR, Edluar, and Zolpimist. The FDA lowered the starting dose for women from 10 milligrams (mg) to 5 mg; for men it is now 5 to 10 mg. The drug should be taken right before going to bed. Taking too much of a sleep drug can give you a “hangover” of daytime drowsiness the next morning that could raise the risk of accidents or falls. Because people respond to medications in their own ways, it’s safest to start taking a sleep drug on a weekend, and start with a dose lower than the maximum recommended starting dose. If you feel drowsy the next day, the dose can be reduced; if it didn’t work, the dose can be increased.
What harm can having too little of a vitamin do? Consider this: Over the course of two months, a 62-year-old man developed numbness and a “pins and needles” sensation in his hands, had trouble walking, experienced severe joint pain, began turning yellow, and became progressively short of breath. The cause was lack of vitamin B12 in his bloodstream, according to a case report from Harvard-affiliated Massachusetts General Hospital published in The New England Journal of Medicine. It could have been worse—a severe vitamin B12 deficiency can lead to deep depression, paranoia and delusions, memory loss, incontinence, loss of taste and smell, and more, according to another article in tomorrow’s New England Journal. Some people, like strict vegetarians, don’t take in enough vitamin B12 every days. Others, like many older people and those who have had weight-loss surgery or live with celiac disease or other digestive condition don’t absorb enough of the vitamin. Daily supplements can help.
Greater use of generic drugs could save the healthcare system—and American consumers—billions of dollars that would be better spent elsewhere. What’s holding us back? Some consumers are reluctant to use generic medications, thinking they are inferior to “the real thing.” Doctors are also a big part of the problem. Up to half of physicians hold negative perceptions about generic drugs. And a new study to be published in tomorrow’s JAMA Internal Medicine shows that about 4 in 10 doctors sometimes or often prescribe a brand-name drug just because their patients ask for it. Prescribing a brand-name drug when a generic is available is a huge source of wasteful spending that could easily be prevented. People ask for brand-name drugs because they have heard of them through advertising or word of mouth, while their generic alternatives generally aren’t advertised. Doctors could help save billions of dollars by just saying “no.”
Many adult Americans take aspirin every day, often to prevent a heart attack. Headlines about a study published today linking aspirin use with age-related macular degeneration (AMD) may scare some aspirin users to stop, but that’s the wrong message. In the study, aspirin’s effect on vision was small—far smaller than the lifesaving benefit it offers people with heart. Macular degeneration occurs when something goes wrong with the macula, a small part of the eye’s light-sensing retina. The macula is responsible for sharp central vision. In the new study, published in JAMA, 1.4% of long-term daily aspirin users and 0.6% of non-users developed macular degeneration over a 20-year period. The American Academy of Ophthalmology recommends that people age 65 and older have comprehensive exams at least every other year to check for macular degeneration and other eye problems.