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By Matthew Rees

Food and Health Fact #144: Pills are no panacea for Americans' deteriorating health

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“How did Americans become so unhealthy?”

That’s the question a friend asked me when I shared a jarring statistic: U.S. life expectancy – pre-COVID – was only the 46th highest in the world. Americans lag every other developed nation, but also nations with much lower incomes, such as Chile, Costa Rica, Lebanon, and even Cuba.

The U.S. ranking is also destined to fall further: U.S. life expectancy declined 1.8 years in 2020 – the biggest one-year decline since World War II – and continued decline in 2021 is all but certain. And the U.S. was already an outlier – the U.S. life expectancy decline since 2018 has been 8.5 times greater than the average in 16 peer countries, according to a study published last year.

(To learn about inferior health outcomes in the U.S. compared to other countries, read a fascinating National Academy of Sciences report, U.S. Health in International Perspective: Shorter Lives, Poorer Health.)

Americans’ deteriorating health is reflected in high rates of chronic disease, including heart disease, cancer, and diabetes, as well as the world’s fifth highest Covid mortality rate – and the highest among developed nations.

It’s standard procedure to treat chronic conditions with prescription drugs. Fortunately, the United States is home to much of the world’s most valuable pharmaceutical innovation, and that innovation can translate to dramatic improvements in human health.

But Americans have also become highly dependent on these pharmaceuticals, often at the expense of focusing on the preventive measures that would reduce the need for medical interventions.

Nearly half the adult population is taking a prescription drug at least once every month, according to the most recent CDC data. (That’s about double the rate in the United Kingdom.) That figure alone highlights the health challenges facing the U.S. population. And then there are risks that come with taking prescription drugs.

Start with federal data showing that 6 percent of Americans over the age of 12 abuse prescription drugs in any given year. The opioid epidemic, which has resulted in about 50,000 annual deaths in recent years, highlights the risks of abuse and addiction.

An even bigger risk is iatrogenesis, which is a fancy way of referring to medical treatments that trigger medical complications. A 2011 analysis showed that adverse reactions from pharmaceuticals resulted in 128,000 U.S. deaths in a year – equivalent to the annual number of deaths from stroke, which was the fourth leading cause of U.S. deaths at the time.

But even when medications working as designed, they can exacerbate other medical conditions. A study published last month, conducted by researchers at the CDC and NIH, illuminates the challenge of overcoming obesity through pharmaceutical interventions.

People with obesity often experience hypertension, heart disease, and type 2 diabetes. But these conditions, point out the study’s authors, “are often treated using obesogenic medications, which could, in turn, lead to increased weight gain or difficulty in losing weight.”

With individuals in the study reporting that they use these medications for an average of 2-5 years, you see why they would struggle to lose weight. And with 20 percent of American adults saying they had used medications over the previous month that contributed to weight gain (up from 13 percent in 1999-2000), you see why the obesity rate has been creeping upward.

Obesity is one of many medical conditions can be addressed (partly or entirely) through changes in diet and lifestyle. But most U.S. physicians in the United States are not trained to think that way (nor reimbursed that way), focusing instead on pharmaceutical treatments – a mentality that’s been compared to addressing an overflowing sink by mopping the floor beneath it rather than turning off the faucet.

There is a complex web of factors contributing to the poor state of America’s metabolic health. But the long-term solution to the preventable chronic diseases dragging down U.S. life expectancy and U.S. productivity is not simply new and better medications to treat these diseases – a theme explored in Discovering Precision Health, a book by the Dean of Stanford’s School of Medicine, Lloyd Minor (with an assist by me).

Reimaging the role of physicians (and the structure of the health care system in which they operate) is one of many factors that can enable a healthier America. We could do worse than draw inspiration from Thomas Edison, the inveterate inventor, who declared in 1903 that, “The doctor of the future will give no medicine but will interest his patients in the care of the human frame, in diet and in the cause and prevention of disease.”