There are few things as private as the medicines we take. You can imagine asking a decent acquaintance who they voted for in 2008, who they’ve dated in the past year, and which family member they hate the most. But I’ll bet it makes you feel queasy to imagine asking them, “Hey! That little blue pill I saw in your bag. What’s that for, anyway?”

It’s no wonder then that America’s problem with overmedication hides in plain sight. While we’re all dimly aware that we take a lot of pills, we have no intuition of how big the problem is. And when you lay out the stats, the figures are nothing short of terrifying. Even though we take tons of pills, they seldom actually work. So while 1/2 of all Americans take a prescription drug and 1/4 of women take an anti-depressant, prescription drugs only seem to work 30% of the time. Meanwhile, 85% of new drugs have been found to have little or no benefit. And those miracle anti-depressants? They don’t even outperform placebos.

As you might have guessed, this issue is blamed on the drug companies, which spend far more money pushing their drugs with doctors than they do on research, and the FDA, which allows them to market the drugs they sell despite their limited effectiveness.

Doctors, in the meantime, straight up get paid to prescribe new drugs. If you’ve ever wondered why so many young, energetic women are making $250,000 a year to be pharmaceutical representatives, there’s your answer.

No doubt, doctors and pharmaceutical companies make for troubling dance partners. Without their cozy ties, perhaps the problem of overprescription wouldn’t be so bad.

While drug companies indeed have a vested interest in marketing their drugs to whomever will buy them, even if they don’t work, they’re abetted by our profoundly screwed up insurance system. In short, it creates some of the worst, most irrational incentives imaginable.

Think about the process behind a drug prescription from the viewpoint of each person involved. For many doctors, the cost of a drug is totally invisible: They don’t prescribe them with any concern for cost-effectiveness or even clinical efficacy–indeed, when I’ve asked a doctor how much something costs, I’ve often gotten a snippy reply, as if asking about money were some kind of moral insult. Instead, there’s merely the doctor’s own vague sense of what usually works. If they’re told about something that’s new and supposedly better, why wouldn’t they prescribe it? If it costs 10x more than a previous generation of drug, who cares? Likewise, patients with insurance don’t pay the costs of medications, so they’re only too happy to take one more drug, under the assumption that it can’t hurt.

The insurance companies, meanwhile, are in a tricky, low-margin business. Try as they might to wring bargains from pharmaceutical companies, they can also earn more profits simply by increasing their reimbursements–which they in turn pass along to consumers as premium increases. The point being, no single actor in this farce is trying to do bad. But none of them has any real incentive to say, “Hey, does the patient really need this? And is it worth the money?”

But there is also a deeper problem within ourselves that drives all of this behavior: Magical thinking. We’re only too happy to believe that we can go to the doctor and simply get a pill that’ll fix us up. Indeed, I imagine that if you went to the doctor about some ailment and were told to eat more vegetables, get more sleep and exercise, and take a few Tylenol, you’d think that doc was a fool. You’d never go back.

Doctors know that. They know what’s expected of them. They know that telling someone, “Hey, your problem will probably go away on its own in three weeks,” is a good recipe for going out of business. The question is, will our belief in a little magic pill ever go away, even when the pills lose their magic?


Source: Co. Design