If pharmaceutical companies give doctors gifts and other perks—free food, payments for consulting, seats on advisory boards—the doctors are more likely to prescribe their drugs. Who would have thought? But that’s exactly what happens, according to a new large-scale meta-study. I, for one, am not surprised.
Overprescription of drugs has been in the news a lot lately, and not just because RFK Jr. has made it a major target of his Make America Healthy Again crusade. The defence in the Lindsay Clancy case hinged on the claim that she had been taking enormous quantities of drugs—I think it was 14 in total—and that those drugs affected her mood and sanity in ways that explained but didn’t excuse her brutal murder of her three young children. The question wasn’t whether she killed her children (she admitted that freely), but whether she could be judged responsible and therefore guilty. The Clancy defence said no; the prosecution said yes.
It’s worth dwelling on this for a moment. At various points over a period of just three months, Clancy was on anti-depressants, anti-anxiolytics, mood stabilisers, sleep aids and also over-the-counter medicine: Sertraline, lorazepam, hydroxyzine, buspirone, benadryl, trazodone, fluoxetine, zolpidem, mirtazapine, clonazepam, quietiapine, diazepam, lamotrigine, amitriptyline. It’s not clear which combinations were in her body when, but that issue belies the more general point, which is that nobody—and I really mean, nobody—knows what any of the possible combinations of these drugs could do. The combinations that entered Lindsay Clancy’s body have never been studied. When drugs are tested, they’re usually tested in isolation, and what’s more, testing does very little to capture individual and group genetic differences that might also have serious consequences for users, increasing their susceptibility to harmful side effects.
So, as I argued, Lindsay Clancy is, quite literally, the n=1—the unique subject—and that means if we want any idea of what being on those unknown permutations of drugs actually does to a person, we have to look at Lindsay Clancy and what she actually did. And that means, however much we may not like it, taking seriously the claim the drugs made her kill her children, or at least contributed to her actions in ways that make it harder to blame her.
Of course, there’s other evidence in the case that suggests Lindsay Clancy knew exactly what she was doing. But my purpose here isn’t to drag up all the details and relitigate them. That will inevitably happen when the second trial takes place, and we can have all the same debates again—hopefully with some resolution this time.
Overprescription is a very real problem, and it’s not just limited to being loaded up on a dozen or more drugs at once. To be prescribed a single wrong drug is overprescription. To be kept on a drug for too long is overprescription. Polypharmacy—the taking of five or more drugs from five or more different classes of drug at once—remains the most striking example. In America, rates of polypharmacy now run at an average of about 34% of all adults. That means one third of all adults are on five or more medications at the same time from five or more different unique drug classes. For ages 45-64, the figure is 38%, and for ages 65 and above, it’s 50.9%.
It’s a problem with a gender dimension too. One study claims an American girl born in 2019 will now spend 60% of her entire life taking prescription drugs, as opposed to 48% for an American boy born in the same year. That’s 47.5 years of solid medication versus 37. Part of the difference lies in the early prescription of hormonal contraception, which teenage girls are given for skin issues too, but girls and women are also much more likely to take psychotropic drugs and painkillers too.
Which is why this new meta-study—a study of studies—is important. It shows that a real driver of overprescription in America today is the relationship between physicians and drug companies. Drugs are being prescribed to patients not because they need them, but because companies give out freebies and make doctors feel very special and obliged to reciprocate in kind. We knew this already from the disgraceful involvement of the Sackler family in the opioid crisis, which has killed hundreds of thousands of Americans, but now we know the phenomenon touches a much wider range of drugs than opioid pain pills. The vast majority of the studies reviewed—82 of 93—are from the US, and cover millions of prescriptions.
