A better way to cure us

Los Angeles TimesJune 19, 2014 

Annual spending on health care in America totals nearly $9,000 per person, accounting for more than 17 percent of the U.S. economy. Yet, on some of the most basic medical interventions, we’re failing.

Sometimes patients are over-treated, particularly with antibiotics and prescription opiates. But a problem that may be even bigger, from my vantage point, is under-treatment. Some highly effective medicines for potentially deadly conditions aren’t being used nearly often enough.

Consider hypertension, which affects nearly one-third of American adults and contributes to more than 1,000 deaths every day. We know how to address high blood pressure. In addition to lifestyle changes (things such as decreasing sodium intake and increasing exercise), there are safe and highly effective drugs to treat the condition.

But all too often, people with high blood pressure aren’t receiving these treatments that could save their lives. In some cases, doctors don’t prescribe appropriate medications in correct dosages when they are needed. And even patients who receive appropriate prescriptions often don’t receive the kind of follow-up monitoring essential to fine-tune treatment.

Patients share the responsibility. A third or more of the prescriptions written for medications to treat hypertension are never filled, and patients who do obtain the medicines often don’t take them as prescribed. Those who start treatment sometimes stop if they experience unpleasant side effects rather than working with their doctors to find a medication regimen they can tolerate. Treating high blood pressure most effectively requires a team, which can include nurses, pharmacists and other health professionals, in addition to the doctor.

Another area of concern is smoking cessation. More than 1,000 smokers are killed by tobacco every day, which makes smoking the leading preventable cause of death in this country. Although more than two-thirds of smokers want to quit – and most smokers try to quit each year – fewer than one in three uses counseling or FDA-approved medicines that have been proven to double or triple the likelihood of success. Some people benefit from using more than one smoking cessation medication.

It’s tough to quit smoking. But it’s far tougher to recover from a heart attack or stroke.

Two other underused types of medicine are daily aspirin for people at high risk of heart attacks or stroke and statins to manage high cholesterol.

Though there is disagreement among medical experts about the use of these medicines for people whose risk of heart attack or stroke is low to moderate, there is a very strong consensus that people at highest risk, including those who have had heart attacks or strokes, will benefit from both aspirin and statin therapy. And yet only about half of even these high risk people are taking the drugs that could save their lives.

In recent decades we have made huge progress in developing highly effective treatments for potentially deadly conditions, and we have proved that they can save lives. There are still many health problems we can’t treat effectively. It’s tragic that we are not adequately addressing the ones we can.

Tom Frieden is a physician and director of the U.S. Centers for Disease Control and Prevention.

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