english.prescrire.org > Positions > Overmedication > Thanks, but no thanks...

Theme: Overmedication

We’ve got a pill for just about everything these days. Healthcare professionals are under pressure to prescribe medications which may do no good, and might even do much harm. How can we resist the urge to overmedicate existence?

Themes

Thanks, but no thanks...

Many ills can be at least partly alleviated by drugs, and many people rely on drugs to help them feel better. But drugs are not always the best solution. Patients and healthcare professionals must know when to say “Thanks, but no thanks: I see nothing to justify taking the associated risks.”

Many ills can be at least partly alleviated by drugs, and many people rely on drugs to help them feel better.

But drugs are not always the best solution. Drug and medical device companies, and sometimes healthcare authorities as well, are doing patients a disservice by encouraging the overmedication of human existence. This is especially true of psychotropic drugs.

Take ramelteon, for example, which hastens sleep onset by a few minutes compared with placebo, but exposes to endocrine disorders and perhaps cancer. Likewise with fluoxetine. This drug is approved as an antidepressant for children, yet there is no evidence that it is better than placebo at relieving their mental suffering. In contrast, there is good evidence that fluoxetine increases the risk of suicidal behaviour and mood disorders, that it can slow growth, and possibly cause endocrine disorders.

Another example is inhaled insulin (Exubera°, in the end never marketed in France). The glycaemic control it provides is not particularly potent, but it exposes patients to a risk of lung cancer. Likewise, growth hormone therapy for children with unexplained small stature may provide a few extra centimetres in adulthood, but it doesn’t improve these patients’ subjective quality of life, while it carries a risk of diabetes and cancer.

And the list goes on…

In all these situations, drug therapy must be put in its place. Patients and healthcare professionals should simply say “Thanks, but no thanks: I see nothing to justify taking the associated risks.”

Prescrire Int 2008; 17 (97): 178.