With the advancement of technology, pharmaceutical companies, and scientific research has made major strides in the last two decades. Diseases and disorders that were previously unknown and undiagnosed are now being more widely recognized, understood, and if possible treated and/or cured. With this, there are more drugs being developed, studied, and being brought to the market. Dr. Bomi Joseph from Los Gatos, California, is the director of Peak Health Center and is a large proponent of “endo health”, or the practice of health from within. Dr. Joseph has worked towards Phyto-hacking plants, in the pursuit of finding healthy alternatives to prescription drugs. He has dedicated his career to this cause and continues to do so, recognizing that all prescription medications carry the inherent risk of causing harm, either in the short or long term.
With the advent of newer drugs, patients are taking more prescription drugs than ever before. The number of prescriptions being written rose almost 85% between 1997 and 2016 according to Quintile IMS. This is a massive jump considering that the population of America only saw a 21% increase during the same period. Statistics show that this number will continue to rise in the coming years, with the annual number of prescriptions being written in the U.S. alone going over 4.5 billion annually.
Benefit versus Harm
Any exams, diagnostic procedures, and treatments should all be heavily scrutinized to make sure that the patient will not be adversely harmed, and if there is a risk involved, that the benefits outweigh them. When it comes to prescription medications, the general thought process is that if it is approved for the use being prescribed, it is safe to use. Most of the time this may be true, but there are various factors that must be taken into account such as simple adverse effects or reactions, drug-drug interactions, the harms of chronic use and if there would still be a benefit, as well as considering the cost to patients.
All prescription drugs have adverse effects or reactions, and while most patients do not experience them, there is a certain percentage of them that will to varying degrees. All prescriptions are required to list the most common and serious side effects possible, and physicians and pharmacists are also responsible for going over these with patients. Adverse reactions can include things such as rash, sweating, diarrhea or constipation, and heat or cold intolerance, to more severe findings such as heart block, lung fibrosis, and potentially lethal infections. Many classes of drugs are also known for causing adverse effects, such as some psychiatric medications may cause Parkinson-like movements, monoclonal antibodies increase the risk of infections, and cholesterol medications can cause muscle pain. There is, unfortunately, no “miracle drug” that can treat people without having some sort of side effect profile, and for this reason, Dr. Bomi Joseph believes as humans we should begin to rely more on plants, and ourselves to lead healthier lifestyles.
Drug-drug interactions and Polypharmacy
Another concern with prescription medications is the potential for drug-drug interactions, which especially becomes worrisome with elderly patients, and those with chronic, or complex medical issues. In a study conducted in 2017, it was found that 55% of Americans take prescription medications, taking an average of four. Of this population, 53% report getting these medications from different health care providers, further increasing the risk of adverse reactions. More shocking, was that more than 30% of patients reported that no medication reconciliation had been done by any of their physicians to check if the medications they were taking were still needed. As most drugs are taken orally, they work systemically and have the potential to interact with one another, either in the circulation or within organ systems. One classic example is the interaction of different drugs and the effect on the CYP450 enzymes; many drugs can cause the enzyme to be more active, while others inhibit. This can change the potency of each drug, as CYP450 is involved in the clearance of many compounds, including drugs potentially making drugs unsafe.
Premature and Prolonged Prescribing
For many healthcare professionals, prescribing medications has been an easier task than looking for alternative options for treatment. Dr. Bomi Joseph explains that many diseases such as high blood pressure, diabetes mellitus type II, and hypercholesterolemia are easily reversible with lifestyle modifications, but instead, patients are prescribed a variety of pills for management. Unfortunately, chronic medication use becomes an issue here as most patients end up taking these medications for the rest of their lives. Dr. Joseph explains that medications are not meant to be taken forever, and not every disease is a chronic condition. Additionally, one of the problems that Dr. Bomi Joseph sees is doctors prescribing drugs to treat allergies caused by other drugs rather than finding an alternative to the original drug.
Once treated, the need for medication should be revisited and management plans should be altered to better suit the patient, and to prevent the need for chronic use. Other medications such as antibiotics are also overprescribed needlessly, as most infections are viral, and patients recover within a week. However, many patients believe that antibiotics help them recover quicker, but Dr. Bomi Joseph explains that this is simply due to the placebo effect. The rise in antibiotic prescribing has directly correlated to increasing antibiotic-resistant bacteria formation, and this is a growing concern in the healthcare field. Many “superbugs” have been found that are not susceptible to some of the most potent antibiotics, and it is estimated that these bacteria will be seen more often with the use of misuse and prescribing of antibiotics.
Americans pay some of the highest prices for prescription medications, and this has been an ongoing issue. Unlike Europe where drug prices are monitored and controlled by the government, patients in the U.S. are paying on average upwards of $1200 annually out of pocket for medications due to uncontrolled prices. Pharmaceutical companies in the U.S. can set their own prices, and due to FDA regulations, few generic options are available, especially for novel drugs. While most of the time private insurance companies bear the brunt of these costs, there are many uninsured patients who pay thousands of dollars monthly for medications, sometimes ones that may be unneeded. For older patients and the disabled, Medicare and Medicaid help in providing some cost relief, but these are also the patients that are required to take more medications and costs add up. Dr. Bomi Joseph believes that medication prescription costs must be heavily scrutinized, as many patients, unfortunately, end up having to pick between having enough food, or their medications.