Pill consumption

When Margaret Herlth wakes up in the morning, 13 prescription drugs such as Coumadin and Advair and two over-the-counter supplements are as much a part of her routine as a first cup of coffee. That's a lot of pills, but not an unusual number for an 80-year-old with serious health problems, including cardiovascular disease and breathing difficulties.

"They do make me feel better if I take them," says Herlth, who lives in Southwest Baltimore. "I've been in and out of the hospital so many times. Each time they give me new pills, but they never take any away."

These days, if you're elderly, a medicine cabinet full of prescription drugs is par for the course. But even relatively young, healthy adults may be prescribed medicine as a pre-emptive strike to lower their bad cholesterol and blood pressure, to deal with a touch of arthritis, to ward off osteoporosis, to stop the symptoms of seasonal allergies or to fight depression.

Many of those who grumble about being prescribed too many drugs are adding to the list by taking herbal supplements. They also reach for the Advil bottle at the first sign of a headache and chew antacids when they get heartburn.

The federal Centers for Disease Control and Prevention recently reported its latest data on prescription drug use. The agency estimates that nearly half of all Americans take at least one prescription drug and one in six takes at least three. Over the past decade, the percentage of people taking one or more prescription medicines has increased from 39 percent to 44 percent.

We are a medicated society, but are we an overmedicated society?

Pharmaceutical breakthroughs are obviously a major reason life expectancy has increased to a record 77.3 years at birth in 2002, the most recent data available. But the market is also filled with what critics call "me too" drugs. These are drugs people assume are more effective because they are new, but may not perform any better than older, perhaps safer drugs. Doctors and patients don't always have an easy time sorting out which are which.

Americans are living longer because of the many different medications they take, but that creates its own problems.

"One of the issues we have to deal with is 'polypharmacy,' " says Dr. Stuart Bell, an internist and vice president of medical affairs at Union Memorial Hospital in Baltimore. This is the term the medical profession uses to describe the taking of a number of drugs at the same time - drugs that can have unwanted interactions.

"We've identified it as an actual problem, like hypertension," Bell says. "Often there's a rationale for each of these medications, so these are not easy decisions."

Not only are we using more drugs, but they are more expensive than they used to be. The cost of prescription medicines rose 5 percent in 2002, says the recently released CDC report, but because people are taking more drugs, spending increased 15.3 percent. Costs continue to rise, but the rate is slowing, says the Pharmaceutical Research and Manufacturers of America, the industry's trade group, reporting that prescription drug prices increased by 3.1 percent in 2003.

There isn't one simple answer as to why Americans are taking more medicines. The most obvious reason is that baby boomers are getting older, and therefore a large bulge of the population is dealing with problems like arthritic knees and high blood pressure. Older patients may go to several physicians, each prescribing medication.

"As people get older, the risk of side effects goes up," says Dr. John Meyerhoff, a rheumatologist at Baltimore's Sinai Hospital. "It's a balance between physicians overmedicating for relatively minor complaints and giving medicines for conditions for which we have effective solutions."

But increased drug use can't be blamed just on the graying of America. Most notably, as a society we're getting fatter. In November, the U.S. surgeon general reported that 61 percent of adults were overweight or obese, leading to an estimated 300,000 deaths a year. Doctors may treat obesity and obesity-related conditions with drugs if eating less and exercising more proves too difficult for patients.

For some patients, medication may be the only answer. For others - why skip the Krispy Kreme or walk 30 or more minutes a day, as the surgeon general has recommended, if you can pop a pill or two instead?

"Lifestyle management can work," says Anne Cannon, a nurse and diabetes counselor at St. Joseph Medical Center in Towson, Md. "It's just much harder. We're geared to the quick fix."

Too many pills?

James Rybacki, a

clinical pharmacist who lives in Easton, Md., and is author of "The Essential Guide to

Prescription Drugs 2005," has this advice for patients worried about taking too many prescription drugs:

• Ask questions. If you don't receive answers, stay in the doctor's office until you do.

• Tell your doctor if you're worried about "pill burden."

• Ask for specific goals for medications, and what the time frame is.

• Tell your doctor about all drugs you're taking, including over-the-counter, herbal remedies, nutritional supplements, alcohol and recreational drugs. There could be unwanted interactions. Some herbal extracts, for instance, can blunt the effectiveness of a prescription drug.

• Ask if this medicine is the best balance of price and outcome.

• If money is a problem, visit the Web site www.helpingpatients.org, which lists programs that can help with costs. Other useful sites online: www.needymeds.com, www.rxassist.org, and www.medicare.org (click on "online databases" and then "drug search").