Lots of health care costs are from prescription drugs. Up to $180 billion of the 1.8 trillion spent in 2004. Not only do the costs of the drugs themselves cost money (30 Vioxx cost $120) there are additional costs which far exceed this already huge portion of US health are costs. According to study adverse reactions to drugs is the 4th leading cause of death in the United States. And you can be sure that these patients cost a lot of money in emergency intervention before they ultimately die. It doesn't have to be this way...
Additionally, a lot of drugs have a very small differential between their risks and benefits and require close monitoring, testing and patient imaging before, during and after therapy. For example warfarin therapy for stroke prevention requires monthly monitoring and extensive testing to maintain therapeutic dosages. Also, for specific classes of drugs in the anesthetic, neurological and psychiatric practice areas there are the costs and health impacts of patient addictions. According to the 2003 NSDUH, an estimated 6.3 million persons, or 2.7 percent of the population age 12 and older had used prescription psychotherapeutic medications non-medically in the month prior to being surveyed.
Meanwhile, there are lots of drugs that are currently on the market that have proven therapeutic benefit that have not been fully exploited for all the possible indications they could be used for. For example, aspirin. Aspirin is probably the cheapest drug in the world. You can get 100 325mg tablets for $1.89. A yearly course of stroke prophylaxis would cost you around $6. Not only does aspirin work on relieving pain, and quashing fevers but it also helps prevent heart attacks and strokes, colorectal cancer, ad probably a host of other things that we will never know about because no drug company can make a buck off of it. That's right. That is the reason for all the Vioxx, Bextra, Celebrex, ibuprofen, and naproxen. Aspirin just won't bring the cash in the door. Forget a cure for malaria or AIDS; we need a better pain reliever for headaches. Of course aspirin has some side effects which are very dangerous. It doubles your risk of having a bleeding ulcer. If you are prone to gastric bleeding, you shouldn't take it. But that is a very small risk compared to the benefits of aspirin for not only the afore-mentioned cardiac and vascular conditions but various cancers, Alzheimer's. And for more prosaic uses like headache, there is already a cheap generic cure-all that has almost no gastric effects, acetaminophen (also known as Tylenol). The fact that aspirin is so cheap and is available everywhere makes it hard to believe that it is a powerful drug and more effective than drugs costing hundreds of times more. But, aspirin has so many beneficial effects that the risk reward profile makes it one of the best drugs ever discovered. This makes the Merck Vioxx scam so incredibly venal. There is no proof that any NSAID including Vioxx works better than any other, and clearly if it no more effective, it must be safer to be a viable alternative on the market. Not only is Vioxx associated with more cardiac events killing a predicted 60,000 people, aspirin has been proven to prevent heart attacks.
There is one other safety aspect to drugs that has always irked me personally. When I was younger the only time I had a headache was a hangover. I would carelessly pop a couple of Tylenol after I'd had night of drinking to prevent a hangover in the morning. Research has shown that alcohol and Tylenol can cause liver damage at a single dose level. This was discovered earlier than 1980. I wish in their zeal to market Tylenol they would have told me this. Aspirin would have been just fine.
References:
Centers for Medicare and Medicaid Services, Office of the Actuary, National Health Statistics Group; and U.S. Department of Commerce, Bureau of Economic Analysis and Bureau of the Census. http://www.cms.hhs.gov/statistics/nhe/projections-2003/t2.asp
Smith, C., C. Cowan, A. Sensenig and A. Catlin. "Health Spending Growth Slows in 2003." Health Affairs 24:1 (2005): 185-194.
Lazarou J, Pomeranz B, Corey PN. Incidence of adverse drug reactions in hospitalized patients: A meta-analysis of prospective studies. JAMA 1998;279:1200-1205.
NSDUH (formerly known as the National Household Survey on Drug Abuse) is an annual survey conducted by the Substance Abuse and Mental Health Services Administration. Copies of the latest survey are available at www.samhsa.gov.