Medication Under a Microscope

Abramson, Hadler and others argue that more emphasis should be placed on improving cholesterol, blood pressure, blood sugar and other risk factors through lifestyle changes, such as eating better, maintaining a healthy weight and exercising more.

"People are making a ton of money by selling the drugs and the monitoring equipment," said Howard Brody, director of the Institute for the Medical Humanities at the University of Texas Medical Branch at Galveston. "It distracts our patients from what really matters more, which may be getting more exercise or making lifestyle changes that ultimately may be more beneficial than obsessing about their blood sugar or playing with their little monitor device."

Several experts cited examples of situations in which they believe doctors may be pushing drug therapy too hard, such as a new condition called "pre-hypertension" that calls for patients with moderately elevated blood pressure to take medication. Some doctors have also started diagnosing "pre-osteoporosis" or "pre-diabetes," and prescribing drugs to prevent bones from thinning or to lower blood sugar before patients have either disease.

"It feeds on the American psyche of 'Just don't stand there, do something,' " said Mark Ebell of the University of Georgia, deputy editor of American Family Physician. "We want to do everything possible. Sometimes pushing too hard to make a number look better can have unexpected collateral effects that do harm a patient."

While agreeing that lifestyle changes are always the first choice, many experts said drug treatment is necessary for many patients, and they dismissed those who doubt the link between heart disease and cholesterol, for example.

"That's the most established fact in all of medicine," said Scott M. Grundy of the University of Texas Southwestern Medical Center in Dallas. "The more you lower LDL cholesterol, the more you lower the risk. It's absolutely established."

But Grundy and others agreed that more research is needed to validate the effectiveness of individual drugs, adding that the increasing propensity of patients to take multiple drugs that may produce unforeseen side effects in combination is a growing concern.

"Drugs can be great, but they can have side effects," Grundy said. "If you start piling on one drug after another, you can get into trouble."