is medication the best medicine?

I believe whole-heartedly in preventive medicine. But there is a difference between supporting the body in its own attempts to heal itself, and medicating against risk factors that may or may not manifest into actual disease.

Ivan Oransky, the executive editor of Reuters Health and a trained physician, recently gave a talk at TEDMED on this very subject. In his talk, Are We Over-Medicalized?, Oransky discusses the growing trend of treating risk factors as actual disease. Now, there is nothing wrong with diagnosing preconditions and identifying risk factors. This is what preventive medicine is all about. But automatically medicating against those risk factors may be doing more harm than good in many cases.

Oransky brings up some compelling arguments. For years, menopausal and post-menopausal women were routinely given hormone-replacement therapy. The idea was to reduce the unpleasant symptoms of menopause, and also to reduce the risk of osteoporosis. But we now know that long-term HRT may cause more disease than it cures in many women, dramatically increasing the risk of cancer and stroke to the point where any benefit to the bones is outweighed by the potential damage to the body from the treatment itself.

Osteopenia, or pre-osteoporosis, is a particularly popular precondition that is being diagnosed in many women over the age of 50 right now. Some doctors and patients work together on diet, exercise, and other lifestyle changes that can dramatically improve bone strength and keep osteopenia from ever developing into actual disease. But many doctors and patients are choosing to begin osteoporosis medication as a safeguard against a condition that has not yet manifested. And in some cases, medication may be prescribed without a diagnosis at all.

A close friend of mine recently tripped on a curb and broke her wrist. She is over 50 and was told by her physician that the medical community often prescribes osteoporosis medication to anyone over a certain age who breaks a bone without any further testing. If that person happens to have osteoporosis, that recommendation may be the right choice, but according to the statistics Oransky has gathered on the benefits of treating osteopenia with prescription medication, he says that, “You would have to treat 270 women for 3 years in order to prevent 1 broken bone.”

That’s a lot of women who are taking a medication to prevent a fracture they may simply never have. If those medications came without side-effects, that would be one thing. But oral bisphosphonates like Fosamax, Actonel, and Boniva can pose some serious risks to your health that we are now only just beginning to understand. This month, we are specifically exploring some of the dental conditions that can develop for patients on bisphosphonate therapy in our newest resource, Osteoporosis and Your Mouth.

Medication can be a wonderful thing when used to treat disease that would otherwise be uncontrollable and cause serious harm to the body. But when diet, exercise, and other lifestyle changes may also reduce or even eliminate preconditions and risk factors for disease, that is the best medicine of all. You owe it to yourself and your body to discuss and consider all the options with your physician before beginning any long-term medication for a precondition or risk factor that might respond equally as well to simple changes in your lifestyle.

Martha (Signature)