deeply concerned at the rate of prescription drug abuse in my city

I am a twenty year old college student attending the University of Louisville. I am deeply concerned at the rate of prescription drug abuse in my city. It seems that a very high rate of my friends are either prescribed to Alprazolam (primarily in the medication known as Xanax). I am wondering about the true negative effects of this chemical on the brain.


I have noticed that my friends who are abusing these type of anti-anxiety drugs seem like completely different people than they were before they started the abuse. I know (as was cited by you on Coast to Coast last night and as is general fact here in the old Kentucky home) that my general geographical area is a hot spot for the abuse of prescription medications. I have heard that Xanax can actually alter brain chemistry in the long term is this true? I am deeply concerned. Really enjoyed the show last night and I await an answer from someone who seems to actually know what they are talking about. Please email me back.
W.S.

Dear W.S.,
I share your concern about the overmedication of college students. I think the real danger is not so much the biochemical effect on the brain as the way people learn not to deal with the real sources of their anxiety when they take a drug that simply covers up the symptoms. Besides education, the most important pychological task of college years is to leave behind the ways of childhood and emotional dependence on one's family of origin and learn how to become an independent productive and fulfilled adult in this complex world. This is far from an easy task and highs and lows are an inevitable part of the process. To "medicalize" these psychological growing pains can slow down the rate at which people make progress in adopting constructive adults behaviors. Of course, there are times when the subjective discomfort is just too great, but for the most part engaging in talking therapy, I believe, is more constructive than just drugging the symptoms.
Al the best,
Dr. A

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Salute you for having the courage...

Dear Dr. Abramson,

I have just begun reading your book, "Overdosed America", and I salute you for having the courage to go against the grain and tell the truth about one of the most egregious broken promises of American medicine......I could not help but think of what I have read so far regarding statin drugs when I saw the following article (link below) in which it is stated that strokes have tripled in middle aged women. I don't think that can all be blamed on obesity :

http://news.yahoo.com/s/ap/20080220/ap_on_he_me/obesity_strokes

I have never been a believer in drugs when a natural alternative is available. I reversed my own osteoporosis by following a regimen recommended by the Weil Institute of Wellness at Cornell. I changed my form of calcium supplement from carbonate to citrate, added chelated magnesium in a 2 to 1 ratio , faithfully use a portable stair stepper to increase bone density in hips, and it has worked. I voluntarily discontinued my Actonel, against the advice of my physician, and I feel much better. (I took it for five years,, with no improvement until I began the aforementioned regimen, and I pray that the Actonel did not damage my bones or internal organs)

http://www.medicalnewstoday.com/printerfriendlynews.php?newsid=94058

I bought a copy of your book to give to one of our family's favorite physicians, Dr. Julio Gundian, in the hopes that he will read it with an open mind, and pass the info gleaned within to his colleagues.

Thank you for informing the general public that we are not only being duped, we are being harmed.

Sincerely,
Peggy, FL

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Finally Getting the Message

I'm so glad that the mainstream media, particularly the medical-health and business-health reporters, are finally getting your message. Hopefully now, practitioners and patients will heed your eloquent warning.

Just want you to know since I read your book and said on Amazon.com it was the most important book since Silent Spring, I now surf pubmed.org with equal parts enlightenment and suspicion.
Hope you and yours are well.
Most sincere regards,

Mara, aka "voracious reader"

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"As an aspiring doctor, reading Overdosed America was incredibly motivational"

On 6/13/07, William Carroll wrote:

Dr. Abramson -

I saw this article today in the New York Times and thought of you. It speaks to the downfall of continuing education being funded by drug companies

http://www.nytimes.com/2007/06/13/opinion/13carlat.html?th&emc=th

Diagnosis: Conflict of Interest

By DANIEL CARLAT

Published: June 13, 2007

To be honest, my main reason for writing is simply gratitude. I am a year out of undergrad from Davidson College, North Carolina and will be applying to medical school for fall 08. As an aspiring doctor, reading Overdosed America was incredibly motivational albeit discouraging. I think medicine in this country owes you tremendously for all your efforts to put together statistically sound information comprehensively that was so shrouded to begin with. I can't even imagine how laborious that must've been, as I used to get all hissy just reading journal articles for my human genetics seminar.

Your book reinforced my whole-hearted belief in the importance of preventive medicine, which seems unfortunately in the minority these days. After reading I spoke to numerous adults on statins, etc and I urged them to not only read your book (take it or leave it) but to seek medical knowledge themselves. My girlfriend recently made an interesting comment while we were eating dinner, and watching television. She said, "You know, it used to be cars and beer. Now every other commercial is for a prescription drug."

I have a couple of questions for you:
1. What was the predominant reaction from patients, drug companies, fellow physicians (all parties) upon the release of your book? (If you have a publication regarding this and could refer me that'd be great)
2. How much do you integrate this material into your teachings at Harvard? What do students think?
3. Do the recent changes in the FDA seem promising to you?

Once again, thank you.

Will Carroll

***
Will, Thanks for your e-mail--it's great to know that committed people like yourself are out there thinking hard about these issues. Responding to your questions:

The research for the book was certainly time and energy consuming--about 2 years of living and breathing this project, before even beginning the equally challenging task of translating the findings into readable English. But it was a wonderful 2years of intellectual engagement and discovery, like being a detective on a number of very different but related cases. This did involve throwing personal caution to the wind. In my mind I had granted myself a one year sabbatical after working more than 20 years as a family doctor. One turned to three, but I could not possibly be more gratified with the process. And e-mails like yours confirm that, while the medical system has not changed significantly for the better as a result of the critical scholarship that has emerged, awareness of the core issues is growing and people like yourself will, hopefully, carry this mission forward.

My fellow physicians thought I was truly psychotic--writing a book with the primary thesis that the medical "knowledge" that they believed implicitly was really being produced with the primary mission not of helping them to help their patients, but increasing corporate profits. And they continued to think I was nuts after the book was published. That is, for the first nine days after the book came out, until Vioxx was withdrawn from the market for causing exactly the harm that I presented in Chapter three of the book. Then things changed. I lecture all over the country, primarily to doctors. They get it when I am presenting the real scientific evidence, but I fear that as soon as I am gone and the drug companies bring in their speakers to convince them that their products really have the scientific basis that conforms with their paradigms of good medical practice, the effect of my critique has a relatively short half-life.

A central problem, that I did not address strongly enough in Overdosed America, is that what we take as "knowledge" in areas with commercial potential is far more often determined by the inherent tendency of the marketplace to maximize short and intermediate term financial return on research investments. The end result is that what we naively accept as a Platonic kind of knowledge (a little piece of divine truth) is much more likely to be a market-driven perspective that has primarily a short-term business goal rather than advancing knowledge or the well-being of humanity.

Harvard medical students are interested in these issues, but there does not seem to be much interest in integrating a critical and reflective look at the fundamental structure of medical knowledge production into core of the educational experience.

And finally, the strikingly public failures at the FDA are creating an environment where some greater caution seems to be the order of the day. But I fear this is more smart politics than real change. The legislation does not free the FDA from financial dependence on the drug industry, nor does it set up an independent office of drug safety that is not under the administrative authority of the office of new drugs. This leaves a fundamental conflict of interest: the office of new drugs is not going to be thrilled to learn about the mistakes it made in approving unsafe drugs. There needs to be a separation of power here--but this has been carefully legislated out. Ironically, the best Senator on these issues is conservative Chuck Grassley (R-Iowa), who completely understands the public disservice of drug industry influence at the FDA. There is just too much money and influence from the drug and other medical industries available to politicians. I fear that the Democrats will only be slightly better than the Republicans on these issues--any greater than a perceptible difference will create a backlash from the drug industry and be counter-productive in terms of getting elected, which is the primary job of a politician.

All that said, the future is in your hands. So please do everything to protect your ideals and your integrity. And understand that this requires enormous skill and intelligence, often demanding great self-discipline to get your training and credentials without offending the powers that be too much.

Wishing you all the best. Please keep me posted on how your career is progressing.

Sincerely,

John Abramson MD

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Thank you for your courage...

Dear Dr. Abramson, thank you for your "Overdosed America" I learned about one week ago from People's Pharmacy and from you. Thank you for your courage to write and to speak about this horrible topic, that is embarrassing the USA.

As a neurologist, several years ago I started to protest against over-advertised Interferons for Multiple Sclerosis.Learning that statins if taken too long, damage muscles and nerves including heart muscle, I tried to share this message with patients and with Cardilogists. No success. Seeing patients overtreated with antipsychotics and antidepressants and developing either unvoluntary movements or seizures I tried inform patients and reach psychiatrists. I lost my job.

Some of above medications can be helpful when taken not too long and not too much. Even Bextra and Vioxx could be of great help to people if taken for very short period of time and only periodically.

If I can be of any help in this matter please let me know. Thank you again.
Kindly. Joanna Woyciechowska, MD, PhD, BC Neurologist.

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An inspiration to the medical community...

I can't think of a word to express my feelings to Dr. Abramson's book. Maybe a thank you will do... He is an inspiration to the medical community. I wish our doctors that I work has the same compassion and dedication as he has, a good heart and a genuine concern to his fellow human being. Very few could do what he has done.

Respectfully yours,
Gardenia M. Shrine, RN

Gardenia, Thanks so much for your kind words.

Wishing you all the best,
John Abramson MD

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How can we get the media involved in educating the public?

Dr. Abramson,

Thank you for your excellent work in "Overdosed America". I wish more Americans would take the time and interest in learning why our health care system is broken and how it is affecting our society.

How can we get the media involved in educating the public about what is really going on with the drug companies, FDA, etc.?

Ellen Small
Pittsburgh


Ellen, The most important thing to do is contact your local media and let them know that you are interested in hearing the high cost and low quality of our health care, as well as the role that the drug companies are playing in distracting our attention and resources from the most important ways to protect and preserve our health. Remember that the $4.6 billion spent each year on advertising to the pubic by the drug industry creates some incentive for the media to be supportive of the drug industry. That's why it's so important to make your opinions known.

All the best,

John Abramson MD

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I am a health services researcher and really enjoyed your book...

I am a health services researcher and really enjoyed your book, Overdosed America. I would like to cite it in my own work and was wondering if an electronic copy was available so I could more easily cite some of the many great passages that you include.

Thanks,
Lisa Maiuro, MSPH, Ph.D.

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I am a health services researcher and really enjoyed your book...

I am a health services researcher and really enjoyed your book, Overdosed America. I would like to cite it in my own work and was wondering if an electronic copy was available so I could more easily cite some of the many great passages that you include.

Thanks,
Lisa Maiuro, MSPH, Ph.D.

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your discussion on WOR radio...

I caught a small amount of your discussion on WOR radio the other night with Dr. Hoffman. I take a statin and was looking for that publication you mention in that english journal of medicine. Do you have a link I can use to read.
Thanks
Bob Foley

Bob, There will soon be a couple of article posted on the web site that will be helpful, and there is a whole chapter in Overdosed America that discusses medical studies and recommendations about cholesterol-lowering drugs.

All the best,
John Abramson MD

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I have familial hypercholesterolemia...

Hi,
I had the opportunity to hear part of your appearance on Dr. Hoffman's radio program. I am very interested in the topic of statins. I take Lipitor (and Zetia) for my high cholesterol. I have familial hypercholesterolemia. My total cholesterol without the medication is about 420-430. With the medication it is about 200-220. Do you have information about how people with familial hypercholesterolemia can be helped without the statins? Any information would be greatly appreciated. Thanks...Bill

Bill, We don't have evidence from clinical trials specifically about familial hypercholesterolemia. My hunch is that the program you are on is redcing your risk of developing heart disease. But please don't forget that routine exercise, eating a healthy Mediterranean style diet, not smoking, and drinking in moderation each at least as important as the statin for you. You will get a much better picture from the discussion in Overdosed America about the relative importance of each of these "interventions."

All the best,
Dr. A

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"I am constantly amazed by the way the media twist the facts about prescription drug"

Bought your book and loved it. I am very motivated to get even more exercise, lose weight and eat right, which I try to do anyway, but this was a big encouragemen. Thank you.

I am constantly amazed by the way the media twist the facts about prescription drugs. It was so blatent this morning on the CBC morning show where their resident doctor was strongly encouraging people to take their statin medicines (at a even higher dose, and even if they have no history of heart disease, and how it is just terrible how people are so noncompliant) and immediately after her segment, the announcement that this was sponsored by Brisol-Myers Squibb. I believe they make Pravachol.
Keep up the good work at educating people.

Of note, my husband and I are in our late 50s, have never taken any prescription drugs (except antibiotics for root canal), have excellent cholesterol and blood pressure, and have never had any type of surgery. I was encouraged to take hormone replacement a few years ago which I declined and feel better now than at any other time in my life. Menopause is great.

Joan K

Joan, Thanks for your kind words. I am happy to have played even a small role in your improved health habits. The bottom line about statins for women is that there is still not a single randomized controlled trial that shows that statins are beneficial for women who don't already have heart disease or diabetes. But there is good evidence that women who adhere to healthy lifestyle (regular exercise, Mediterranean style diet, not smoking, drinking in moderation, and maintaining a reasonable body weight) develop 80% less heart disease than the women who don't do those things (but only 3% of American women follow these healthy habits). So keep up the good work and I hope that you have a primary care doctor with whom you can talk honestly about these issues.
All the best,
Dr. A

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"one of the great challenges facing American medicine"

Great stuff. You have hit on one of the great challenges facing American medicine with powerful intelligence, clarity of thought and the stones to call it like it is. Making physicians aware of the problem is a good thing, but I fear that changing the culture from the physicians' side of the equation will not happen in our lifetimes. I think we agree the solution will probably be political when the economic pressures to reduce medical costs reach a boiling point. We are close if not already there. It will be interesting too see if the gov't. has the will to do battle with big Pharma. P

P.R. MD

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From a doctor of 25 years

Dr. Abramson,

Just what I was looking for and now I want more. I was family doctor for ten years. Then I did my own thing for ten years. Then I worked in drop in clinics - supermarket medicine. Now I am back in family practice or giving it a go.

Just had walk along Ahipara beach with my wife. Topic of conversation - my future. Do I want to work as a pill pusher? The polypharmacy going on where I am at the moment astounds me. Pushing pills onto people who have no desire for them or understanding what they are taking them for - mind blowing. This place is low decile area.

Last night at a peer review group meeting it was apparent that most docs in the room would not be prescribing to themselves what they do for their patients?
It's extraordinary!

My dad was a family doc in rural setting - he was so proud of his work and what he did for his patients. Now ones smells cynicism creeping in everywhere. Jerome Hoffman suggest we be skeptical not cynical - tricky to maintain this balancing act.

How often have I heard recently docs talking about putting their kids off from taking up medicine.

My brother is GP in UK. He talks of ticking boxes and prescribing as per guidelines so money comes into his practice. Some of these guidelines he disagrees with. You want the money doc - do what you are told.

Your book is fantastic. You let the facts speak for themselves. I do hopem it has a profound impact.

I want more - especially with regards to information on drugs.

Thank you
Dr. Andrew B.


Dr Andrew,

Thanks for you kind note. I certainly understand your predicament. The best sites that I know of to get good information about drugs are Therapeutics Initiative ( http://www.ti.ubc.ca/ -British Columbia), the Oregon Drug Effectiveness Review Project ( http://www.ohsu.edu/drugeffectiveness/reports/final.cfm ) and the National Instititue of Clinical Excellence ( http://www.nice.org.uk/ United Kingdom).

Though easy to get discouraged, it is all the more important to do good work.

All the best,

John Abramson MD

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From a nurse practitioner working in correctional health

Hi, John
Just now listening to your last interview on C2C — I get behind. You are not only my hero but my role model as well; I am a 62-year-old man, a nurse practitioner working in correctional health. All my patients are convicted felons, every one of them. However, they are all someone's father, brother, son — someone's loved one and I do my best.
On the upside of correctional medicine, all the drugs I prescribe are generics and I never have to stop to talk with drug detail reps — never! Yes, I agree with you on almost everything; my exception is your comment about salt.
The ancient word for salt was 'hal'; hence, I would assume that halitosis really means that a person's breath smell like salt. In that case, 'hallelujah' may translated to: "Glory be, I found the salt". Throughout the ages, civilized people highly prized and paid dearly for sodium. So, why is it now so bad for our health? Where can I access information that salt restriction is actually beneficial?
Thank you,
Keith


Keith,

Thanks for your kind letter. On the salt issue, you may be correct for most people--but nobody's yet figured out how to identify the people are who are going to be harmed by salt. The Center for Science in the Public Interest wrote an excellent epidemiological piece about the harms of salt (available on the internet). This issue may be analogous to the push to give all school children Hepatitis B vaccine, choosing to immunize everyone when it's still possible to be sure to immunize those children who will go on to adopt high risk lifestyles and behaviors in the future.

Not sure about how best to procede on salt, but I am sure that the work that you are doing with prison inmates is tremendously important--a health care provider treating prisoners as fundamentally worthy human beings is probably the most rehabilitative thing that can be done. So please keep up the good work and know that giving even one person the opportunity to see himself as worthy is a great achievement.

All the best,

John Abramson MD

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Thanks for writing the book, and a case history about sleep

Dear Dr. Abramson,
Thank you for doing all of the legwork for this book!! Being employed on the fringe of the medical profession, I've had my suspicions regarding this and have always tried to avoid prescription drugs as a general rule and have always been fairly healthy and active. However, I was having some problems with excessive sleepiness and after what I believe was a very thorough workup (thyroid, Lyme, etc) I was referred for a sleep study; overnight and MSLT the next day. I was diagnosed with "CNS Hypersomnolence", a cousin to narcolepsy. I don't think the MSLT neurological study was a "lie" but this resulted in me going down the slippery slope of trial and error of various types of stimulants until I found the one that I could tolerate, i.e. Adderall XR and Adderall "regular", of which I was taking both types each day and I STILL couldn't stay awake, and the up/down action of the medication was very annoying. I informed my practitioner that I didn't want to be on these for the rest of my life, and also informed my "sleep specialist" of the same. I was told that I'd be endangering myself and more importantly, others by not taking the medications. I work at home and rarely have to drive anywhere, but through research and consultations with alternative practitioners, I have found a safe, effective way to stay awake through nutritional supplements and herbal remedies. I still have to take a nap now and then but I can actually sit down and not fall asleep, watch a whole movie and stay awake, walk my dog and stay awake, etc. It is much easier on my wallet to buy 2 boxes of herbal tea and a few vitamins a month rather than pay for clinic visits and 2 potentially addictive prescription drugs. I don't believe we (humans) were meant to live as our culture and economy now dictate and the govt. and drug companies know it, are fabricating diseases as well as telling us to "make time for 8 gazillion other things" for a more fulfilling life, and giving us all the pills we need in order to do that. Well, I'm refusing to be a sheep.

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Praise from a pulmonary specialist of 20 years

Feedback:

I just got your book today; started reading it after dinner; and kept on going until I was done. It has inspired me to enhance my efforts to reduce the influence of big pharma on the clinical practice guidelines, clinical research, and prescription habits of pulmonary specialists. During my 20 years of practice, I have seen all of this first-hand. Thanks for taking the time to research and write this superb book. P.E., MD


Dear Dr. P.E.,

Thanks for your comments. Even after spending 4 years in front of a computer what feels like 24/7 trying to unravel the commercial bias intruding into medical care, I am constantly surprised. Like this example that I missed the first time around from the recent JAMA meta-analysis about statins and cancer:

The article concluded:

"CONCLUSIONS Statins have a neutral effect on cancer and cancer death risk in randomized controlled trials. We found that no type of cancer was affected by statin use and no subtype of statin affected the risk of cancer.
JAMA. 2006;295:74-80
www.jama.com"

But this is just not true. The following table, from the same article shows a 33% statistically significant increase in the risk of breast cancer:


Table 2. Subgroup Analysis
____________________No. of Events/ ______________________
_________________Total No. of Participants __________________
_________________|=============|_____________________
Outcome____No. of___Statin___Control____Odds Ratio ___Q Stat__
Measures___Studies___Group___Group____(95% Conf) ___P Value_
Breast cancer __ 5 ___ 81/16875 __ 64/16901 __ 1.33 (0.79-2.26) ___ .047

This is a particularly important finding, given the lack of evidence of benefit of statins for primary prevention. And even for secondary prevention in women, statins reduce further CV events and mortality, but have not been shown to reduce overall mortality.

You are doing a great service to your patients by your dedication to real scientific evidence. But, I know this is a real challenge because the commercial and sociological currents are strong going in the other direction.

Wishing you all the best,

John Abramson

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Feedback from a Physical Therapist: August 6, 2005

Dear Dr. Abramson,

I read your book today from cover to cover. I have read quite a few books on this topic, but I feel that your book is as good as it gets. I am a practicing physical therapist working in Early Intervention (home care). Daily my patients parents seek my advice on health related issues especially when the medical intervention that their children are receiving does not produce the desired outcomes. Much of the care that is given sounds like the parents and child have a 2 minute meeting with the doctor, a culture is done, and a prescription is provided.

I am in my fifties. As a child, I was priveleged to have a family physician who came to our home with his black bag in tow, and he spent quite a bit of time doing a medical intake and examination, and he would then diagnose with remarkable accuracy.

It has been frustrating to "progress" from that kind of medical care to modern standards of practice. Your book not only explains how this transition happened, but it amply exposes how it threatens the quality of our current medical care and our health.

I thank you for your courage and for your effort in producing Overdo$sed America.

As an aside, I recently read "The Cholesterol Myths" by Dr. Uffe Ravnskov. This book takes a very critical look at all of the major cholesterol studies that were done in the last century. Are you familiar with this work? It appears to provide a lot of support for your "Smoking Gun" chapter.

Thanks again and best regards,
Ari Meisel

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General Inquiry: July 5, 2005

Dear Dr. John,

I first heard your interview on Air America Radio with Sam Seder and quickly went out and purchased Overdosed America. What a great book! I am recommending it to everyone. I was visiting my mother over the long 4th of July weekend ans asked her what, if any, drugs she was currently taking. She informed me that she just recently went off her 11 year HRT prescription but is still taking her hypertension drub LISINOPRIL. While this made me very nervous, I was relieved that she was no longer taking the HRT. My concern now is that she is being prescribed a drug that may not be necessary. She has always been in good health. Her current dosage is 40mg/day. I visited the FDA website to learn more about the effectiveness and safety of this drug. Is there another site that I can visit which is less scientific where I can find out if she should continue her prescription? I would greatly appreciate any guidance you can provide.

Regards,

Joseph ALbano()


JOSEPH,
DEPENDING ON YOUR MOTHER'S OTHER MEDICAL ISSUES, THIS MAY OR MAY NOT BE THE BEST DRUG FOR HER. A GOOD SOURCE OF NON-TECHNICAL MEDICAL INFORMATION IS PUBLIC CITIZENS' "WORST PILLS/BEST PILLS" WEBSITE. FOR SOMEONE LIKE YOURSELF WHO IS INTERESTED IN THESE ISSUES, THE SMALL SUBSCRIPTION FEE IS WELL WORTH THE QUALITY INFORMATION AND TIME SAVED.
BEST WISHES TO YOU AND YOUR MOTHER,
JOHN ABRAMSON MD

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Comment on Overdosed America: July 3, 2005

Thank you...thank you...thank you! From an RN of thirty years who did not have the "scientific evidence" to back up what I have been telling my patients over...and over...and over about the problems prescription drugs as a quick fix, and the need for a healthy diet, exercise, and to not smoke. I tell them the Dr. cannot cure you, that he can only treat the symptoms, and drugs come with side effects, and side effects need to be weighed against the benefit.
I had a 95 year old MI pt who was on Heparin and refusing the Lipitor at HS. The resident talked her into it, telling her it will increase her life expectancy by 30%! She informed me that she was not planning on taking these meds when she went home, as she read that Lipitor can affect the liver. She went on to tell me that she was use to walking on a treadmill on a regular basis, and they were keeping her in bed, which could cause her harm. She went on to say that "you know, so many of my neighbors are on so many prescription drugs, and they seem to have more problems because of the drugs, and are always in and out of the hospital! That very day, and when I went home, there was the article, stating the efficacy of Lipitor had not been proven for those over the age of 75!

That was perhaps the most outrageous example...

Obviously, I could go on and on and on. I was told by a nurse on a floor I was working that 90% of nurses are on antidepressents. I thought it was suppose to be a joke. I was the only nurse working there that shift that was NOT on antidepressants! I find it frightening.

Again, thank you for making me feel SANE!

Linda

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