Do we live in an overmedicalized society?

Sara Malo Fumanal, Professor of Public Health at the University of Zaragoza and Researcher at the IIS Aragón, talks in this article about The Conversation on society's use of medicines

La pharmacological research of recent decades has contributed enormously to improving our lives. However, it also exposes us to overmedicalization, that is, to unnecessary or excessive use of medications and medical interventions with unclear benefit.

It is a growing phenomenon in modern societies that can be recognized at all stages of life: from pregnancy and childbirth to old age. It has unintended consequences and therefore represents a major challenge for our society.

Recipes without rhyme or reason

Overmedicalization – the disease mongering (disease promotion) of the Anglo-Saxons – is the result of different commercial interests and deficiencies of the system.

The pharmaceutical industry sometimes makes health professionals and patients the target of aggressive marketing campaigns. marketing that promote therapies to relieve common symptoms and prevent or treat processes that appear or worsen naturally in everyday situations. This is the case of spring asthenia, post-holiday syndrome, sleep disorders and age-related changes such as baldness, loss of bone mass, sexual dysfunction or the vitamin D synthesis deficiency.

The excessive and unnecessary prescription and use of medications is often preceded, many times, by a overdiagnosisThis is the name given to the diagnosis of one or more conditions that, had they not been identified, would probably never have manifested and, therefore, would never have been treated.

En este sentido, It has been estimated that until the 30% of the medical care provided is low value or contributes to wasting resources, and that a 10% even have a harmful effect. Overdiagnosis has negative consequences on public health, the economy and the environment.

Excess oxytocin and antibiotics

Examples of overmedicalization can be identified at all stages of life, starting with pregnancy and childbirth. safe and adequate care to the mother during these processes is sometimes confused with excessive interventionism, even though there is no risk of complications.

An example is the oxytocin administration, which women frequently receive to speed up contractions, even though there is a low risk of prolonged labor. However, in addition to reducing the ability of pregnant women to experience childbirth in a natural and autonomous way, exposes to risks and side effects both mother and baby.

Another group affected by the unnecessary or excessive use of medicines is the children population. The antibiotics These are probably the most well-known and worrying example. These drugs are often requested by parents and prescribed by paediatricians to treat acute pathologies of viral origin, such as most acute respiratory infections.

For example, a Work carried out in Aragon (Spain) showed that, in one year, almost half of children aged 0 to 14 years received at least one antibiotic with this indication.

Without leaving the children's field, it is also worth mentioning here the prescription of psychotropic treatments after a diagnosis of attention deficit hyperactivity disorder (ADHD). In addition to doubts about a possible overdiagnosis, it is noteworthy that Non-pharmacological interventions, which have been shown to be effective, They are not usually a priority.

The older you are, the more pills you need

In adulthood, the prevention of the most common chronic diseases (such as cardiovascular disease) by controlling its risk factors (such as cholesterol, diabetes or hypertension) becomes a priority.

Taking into account the high percentage of population treated with these drugs, a significant reduction in the burden of the aforementioned health problems would be expected. However, These drugs do not prevent, in many cases, the conditions they are intended to prevent. It is mainly due to the lack of adherence to treatment, That is, because patients do not take it or take it only sometimes.

El Lack of knowledge about how to administer medications, the appearance of adverse effects or the low perception of risk when there are no symptoms explain this phenomenon, which has an economic and clinical impact. On the other hand, their prescription can divert attention from priority prevention strategies based on lifestyle.

It therefore seems necessary to reconsider the need to continue prescribing preventive drugs to low-risk individuals, what some have identified with overmedicalization.

Drug cocktails

Finally, the polypharmacy –that is, the simultaneous prescription of at least five drugs– is present en More than a quarter of Spain's elderly population. Although their use could be justified by the multiple health problems that older people have, sometimes they are cocktails of drugs whose effect has not been sufficiently studied in these age groups. Then, once prescribed, they are little reviewed or questioned, causing a decrease in their quality of life.

The debate on whether or not it is appropriate to start treatment in the older population, or on the need for deprescribe drugs for them such as statins, benzodiazepines or anticholinergics, is becoming more and more common. It is especially considered in the case of the most fragile patients, those with terminal illnesses or those who are at the end of their life.

What possible solutions are there?

From a public health perspective, the design of multisectoral policies that improve the living conditions of the population would greatly reduce the problems that underlie the situations that lead to overmedicalization.

Furthermore, the increase of psychosocial support for certain groups and promoting health education by health professionals, the media and institutions would provide the population with non-pharmacological tools to prevent major chronic diseases.

Finally, it is key to ensure the independence and strength of drug regulatory agencies, as well as control advertising and marketing aggressive therapies aimed at patients and professionals. It is essential to promote a rational medicine focused on the real needs of the patient.

Source: The Conversation

Rights: Creative Commons