The pervasive issue of prescription drug-related deaths necessitates a reevaluation of current medical practices and regulatory policies. With most of these deaths being preventable, a more cautious approach to prescribing and better awareness of the risks associated with these medications could save countless lives. It is crucial for healthcare providers, regulators, and patients to acknowledge the dangers and work towards safer, more effective treatment strategies.

Every day, millions of people in the U.S. take prescribed drugs in an effort to help them live their lives. As our understanding of medicine has evolved, we’ve developed drugs to aid with some of the most common medical conditions—from pain and blood pressure drugs to asthma medication, thyroid treatments, and antidepressants.

This analysis uses prescribed medicines data from the U.S. Agency for Healthcare Research and Quality, released in 2021 for the 2019 calendar year. It also uses supporting drug and health information from MedlinePlus.

​Top 10 Most Prescribed Drugs in America (2019)

Prevalent Conditions Treated
​Most of the top prescribed drugs are used to treat high blood pressure or symptoms of it. This is significant as 108 million, or nearly half of adults in the U.S., have hypertension or high blood pressure.

Combining the total patients for blood pressure and cholesterol medications covers 33% of the U.S. population. Pain and inflammation medications were the most frequent on the top 30 list, prescribed to 13.6% of people.

A drug’s total number of patients doesn’t necessarily reflect its importance or cost. For example, levothyroxine, the fourth-most prescribed drug by total patients, was the second-most prescribed by total prescriptions with 102.6 million in 2019 at an average cost of $25.10 per prescription.
​
More specialized medications like fluticasone had fewer total prescriptions (27.9 million) but a higher average cost of $97.68 per prescription. Prices are influenced by factors like demand, patent status, and healthcare system variations.

The study underscores ongoing concerns about financial conflicts of interest in the medical field. Researchers noted that such payments might influence physician prescribing behavior and potentially undermine patient trust in medical professionals. Despite these concerns, the practice of accepting industry payments remains widespread.

Gøtzsche PC. Deadly Medicines and Organised Crime: How Big Pharma Has Corrupted Health Care. London: Radcliffe Publishing; 2013.

Gøtzsche PC. Deadly Psychiatry and Organised Denial. Copenhagen: People’s Press; 2015.

Schroeder MO. Death by Prescription: By one estimate, taking prescribed medications is the fourth leading cause of death among Americans. US News 2016; Sept 27.

Light DW, Lexchin J, Darrow JJ. Institutional corruption of pharmaceuticals and the myth of safe and effective drugs. J Law Med Ethics 2013;41:590-600.

Lazarou J, Pomeranz BH, Corey PN. Incidence of adverse drug reactions in hospitalized patients: a meta-analysis of prospective studies. JAMA 1998;279:1200–5.

FAERS Reporting by Patient Outcomes by Year. FDA 2015;Nov 10.

Gøtzsche PC. Mental Health Survival Kit and Withdrawal From Psychiatric Drugs. Ann Arbor: L H Press; 2022.

Hubbard R, Farrington P, Smith C, et al. Exposure to tricyclic and selective serotonin reuptake inhibitor antidepressants and the risk of hip fracture. Am J Epidemiol 2003;158:77-84.

Thapa PB, Gideon P, Cost TW, et al. Antidepressants and the risk of falls among nursing home residents. N Engl J Med 1998;339:875-82.

Ebbesen J, Buajordet I, Erikssen J, et al. Drug-related deaths in a department of internal medicine. Arch Intern Med 2001;161:2317–23.

James JTA. A new, evidence-based estimate of patient harms associated with hospital care. J Patient Saf 2013;9:122-8.

Ho JY. Life Course Patterns of Prescription Drug Use in the United States. Demography 2023;60:1549-79.

Gøtzsche PC. Long-term use of antipsychotics and antidepressants is not evidence-based. Int J Risk Saf Med 2020;31:37-42.

Gøtzsche PC. Long-Term Use of Benzodiazepines, Stimulants and Lithium is Not Evidence-Based. Clin Neuropsychiatry 2020;17:281-3.

Forbruget af antipsykotika blandt 18-64 årige patienter, med skizofreni, mani eller bipolar affektiv sindslidelse. København: Sundhedsstyrelsen; 2006.

Hughes S, Cohen D, Jaggi R. Differences in reporting serious adverse events in industry sponsored clinical trial registries and journal articles on antidepressant and antipsychotic drugs: a cross-sectional study. BMJ Open 2014;4:e005535.

Schneider LS, Dagerman KS, Insel P. Risk of death with atypical antipsychotic drug treatment for dementia: meta-analysis of randomized placebo-controlled trials. JAMA 2005;294:1934–43.

FDA package insert for Risperdal (risperidone). Accessed 30 May 2022.

Koponen M, Taipale H, Lavikainen P, et al. Risk of Mortality Associated with Antipsychotic Monotherapy and Polypharmacy Among Community-Dwelling Persons with Alzheimer’s Disease. J Alzheimers Dis 2017;56:107-18.

Whitaker R. Lure of Riches Fuels Testing. Boston Globe 1998; Nov 17.

Whitaker R. Mad in America: Bad science, Bad medicine, and the Enduring Mistreatment of the Mentally Ill. Cambridge: Perseus Books Group; 2002:page 269.

Vanderburg DG, Batzar E, Fogel I, et al. A pooled analysis of suicidality in double-blind, placebo-controlled studies of sertraline in adults. J Clin Psychiatry 2009;70:674-83.

Hengartner MP, Plöderl M. Newer-Generation Antidepressants and Suicide Risk in Randomized Controlled Trials: a Re-Analysis of the FDA Database. Psychother Psychosom 2019;88:247-8.

Hengartner MP, Plöderl M. Reply to the Letter to the Editor: “Newer-Generation Antidepressants and Suicide Risk: Thoughts on Hengartner and Plöderl’s ReAnalysis.” Psychother Psychosom 2019;88:373-4.

Weich S, Pearce HL, Croft P, et al. Effect of anxiolytic and hypnotic drug prescriptions on mortality hazards: retrospective cohort study. BMJ 2014;348:g1996.

Kripke DF, Langer RD, Kline LE. Hypnotics’ association with mortality or cancer: a matched cohort study. BMJ Open 2012;2:e000850.

Coupland C, Dhiman P, Morriss R, et al. Antidepressant use and risk of adverse outcomes in older people: population based cohort study. BMJ 2011;343:d4551.

Smoller JW, Allison M, Cochrane BB, et al. Antidepressant use and risk of incident cardiovascular morbidity and mortality among postmenopausal women in the Women’s Health Initiative study. Arch Intern Med 2009;169:2128-39.

O’Neill A. Age distribution in the United States from 2012 to 2022. Statista 2024;Jan 25.

Olfson M, King M, Schoenbaum M. Antipsychotic Treatment of Adults in the United States. Psychiatrist.com 2015;Oct 21. 

Maust DT, Lin LA, Blow FC. Benzodiazepine Use and Misuse Among Adults in the United States. Psychiatr Serv 2019;70:97-106.

​Brody DJ, Gu Q. Antidepressant Use Among Adults: United States, 2015-2018. CDC 2020; Sept. 

Centers for Disease Control and Prevention. Leading Causes of Death. 2024; Jan 17.

Drug Overdose Deaths. Centers for Disease Control and Prevention 2023; Aug 22. 

Davis JS, Lee HY, Kim J, et al. Use of non-steroidal anti-inflammatory drugs in US adults: changes over time and by demographic. Open Heart 2017;4:e000550.

Conaghan PG. A turbulent decade for NSAIDs: update on current concepts of classification, epidemiology, comparative efficacy, and toxicity. Rheumatol Int 2012;32:1491-502.

Bally M, Dendukuri N, Rich B, et al. Risk of acute myocardial infarction with NSAIDs in real world use: bayesian meta-analysis of individual patient data. BMJ 2017;357:j1909.

Bresalier RS, Sandler RS, Quan H, et al. Cardiovascular Events Associated with Rofecoxib in a Colorectal Adenoma Chemoprevention Trial. N Engl J Med 2005;352:1092-102.

Blower AL, Brooks A, Fenn GC, et al. Emergency admissions for upper gastrointestinal disease and their relation to NSAID use. Aliment Pharmacol Ther 1997;11:283–91.

Davis C, Lexchin J, Jefferson T, Gøtzsche P, McKee M. “Adaptive pathways” to drug authorisation: adapting to industry? BMJ 2016;354:i4437.

van der Hooft CS, Sturkenboom MC, van Grootheest K, et al. Adverse drug reaction-related hospitalisations: a nationwide study in The Netherlands. Drug Saf 2006;29:161-8.

Gøtzsche PC. Big marketing hoax: Non-steroidal, anti-inflammatory drugs (NSAIDs) are not anti-inflammatory. Copenhagen: Institute for Scientific Freedom 2022;Nov 10.

Perlis R. The time has come for over-the-counter antidepressants. Stat News 2024;April 8.

Gøtzsche PC. Critical Psychiatry Textbook. Copenhagen: Institute for Scientific Freedom; 2022. Freely available.

Tilley, Caitlin. “Corruption Fears as Report Finds US Doctors Received Record $12bn.” Mail Online, 3 Apr. 2024, www.dailymail.co.uk/health/article-13268371/Corruption-doctors-received-pharma-payments.html. 

Tanne, Janice Hopkins. “US Doctors Received More than $12bn in Industry Payments between 2013 and 2022, Study Shows.” BMJ, vol. 385, 2 Apr. 2024, p. q781, www.bmj.com/content/385/bmj.q781.full, https://doi.org/10.1136/bmj.q781. 

Recent breakthrough studies have shone a light on the intriguing link between our microbiome – the diverse community of microorganisms residing in our gut and mouth – and the secret to a longer, healthier life. Scientists have long suspected that our genes, environment, and internal factors like the microbiome play a role in determining how long we live, but the specifics remained elusive. Now, thanks to cutting-edge research, we're getting closer to unraveling the mysteries of longevity.
​
In this groundbreaking exploration, scientists employed a sophisticated approach called Mendelian randomization (MR) to delve into the intricate relationships between the human microbiome and longevity. By analyzing genetic data from large cohorts, they uncovered some compelling associations that shed light on the microbial players in the quest for a longer life.

Liu, Xiaomin, et al. “Mendelian Randomization Analyses Reveal Causal Relationships between the Human Microbiome and Longevity.” Scientific Reports, vol. 13, no. 1, 29 Mar. 2023, p. 5127, www.nature.com/articles/s41598-023-31115-8, https://doi.org/10.1038/s41598-023-31115-8. 

Notice this "U" shape in the curve when examining the relationship between RT and morbidity and mortality. This curve suggests that some RT is clearly beneficial, but has the volume of RT increases past a certain point the benefits drop and it becomes harmful. The concept of a "biphasic response" is fundamental to understanding hormesis. It describes the characteristic dose-response relationship observed in hormetic processes, where a substance or stressor elicits opposite effects at low and high doses. The response can be visualized as a U-shaped or J-shaped curve, illustrating the beneficial effects at low doses and potential harm at higher doses. ​

Paluch, Amanda E, et al. “Resistance Exercise Training in Individuals with and without Cardiovascular Disease: 2023 Update: A Scientific Statement from the American Heart Association.” Circulation, 7 Dec. 2023, https://doi.org/10.1161/cir.0000000000001189. Accessed 11 Dec. 2023.

Momma H, Kawakami R, Honda T, Sawada SS. Muscle-strengthening activities are associated with lower risk and mortality in major non-communicable diseases: a systematic review and meta-analysis of cohort studies. Br J Sports Med. 2022 Jul;56(13):755-763. doi: 10.1136/bjsports-2021-105061. Epub 2022 Feb 28. PMID: 35228201; PMCID: PMC9209691.

Over the course of the past century, the Western culture has faced numerous health epidemics, from obesity to opioids. Today we are facing an epidemic of a different nature. The epidemic of loneliness.

We're more connected than ever, but are we feeling more alone? In the last 50 years, rates of loneliness have doubled in the United States. In a survey of over 20,000 American adults, it was found that almost half of respondents reported feeling alone, left out, and isolated. Further, one in four Americans shared that they rarely feel understood, and one in five people believe they rarely or never feel not close to people. Loneliness is on the rise for Americans regardless of geographic location, gender, race, or ethnicity.

Human beings did not evolve to be alone. Sociality plays a fundamental part in the wellbeing of Homo sapiens. Conversely, social isolation and loneliness are known risk factors for premature death, more so than being obese (Holt-Lunstad et al., 2015). Individuals who feel socially isolated and alone also have higher rates of cardiovascular disease, alcoholism and suicidality, physical diseases related to stress and compromised immune function, and in later life, greater risk of degenerative dementia. Even worse, researchers have observed that geriatric individuals who are considered lonely have a 45% increased risk of mortality (Leland, 2012; Perissinotto, Stijacic Cenzer and Covinsky, 2012). 

Moreover, lonely individuals experience reductions in reasoning and creativity. In addition to these reduced abilities, loneliness affects workplace productivity, as lonely individuals report less job satisfaction and are more likely to face unemployment. Not surprisingly, loneliness is commonly correlated with mental health concerns such as anxiety and depression. Similarly, loneliness is often associated with poor coping mechanisms, such as compulsive technology use, smoking, and self-harm. In other words, loneliness has both physical and psychological implications, many of which could be long term.

Before determining yourself as lonely, there is a difference between being alone and feeling lonely. Being alone and feeling lonely are not mutually dependent. Loneliness is a subjective experience, a feeling of sadness stemming from isolation or abandonment. But, a person can be alone without feeling lonely, since alone describes a state of being and lonely describes an emotional response to one's circumstance. For example, most people don't feel sad when they go to the restroom by themselves. A person can be alone in the sense that no other people are present, or alone in the sense that they are unaccompanied, even in a crowd.

When assessing loneliness, introverted and extroverted personalities should be taken into account, because some people enjoy the presence of being alone with themselves, whereas others are dependent on others to cope with not being by themselves. Being at either end of the spectrum, whether it is total isolation or complete dependence, is not considered a healthy behavioral pattern.

The predictors of loneliness is the basis for the identification of factors that cause and contribute to loneliness. The are three broad categories that influence the feeling of loneliness:

• problems with relationships;
• traumatic experiences;
• and, personal and developmental variables.

  
These categories may be subdivided into multiple factors that increase loneliness:

1. Personality: There are several personality factors that contribute to loneliness, including but not limited to, anxiety, an inability to assert oneself, and hyper-sensitivity. A victim mentality, a poor self concept, an external locus of control and shyness are other aspects of the personality that contribute to loneliness.
   
2. Affect: Loneliness is linked to negative affect and is typified in conditions such as depression, boredom, hopelessness, aggression, stress, anger, restlessness and tension.
3. Depression: A complicated vicious circle makes diagnosis tricky: people with poor social skills are more inclined to become depressed and yet depressed people are inclined to be lonely. There is a difference between depression and loneliness.
4. Problems in relationships: A lack of feelings of belonging, support and intimacy caused by poor communication promote loneliness. Social estrangement and separation and rejection also contribute to loneliness.
5. Marital status: Married people usually feel less lonely - but this is not the case when marriages are unfulfilling. Loneliness in marriage is linked to a lack of intimacy. Major changes that promote social isolation consist of events such as leaving home, a new career, separation from loved ones, breaking off a major relationship and moving house.
6. Illness or physical disability may lead to limited contact with other people.
7. Religious faith: Religions with strict behavioral prescriptions are likely to isolate individuals from free social interaction, potentially resulting in loneliness.
8. Academic achievement: Researchers have observed that students whose academic performance is poor are more likely to be lonely.
9. Leisure activities that alienate people from each other are watching television and surfing the Internet.

While it is impossible to avoid loneliness completely, it may be alleviated. It is recommended to investigate the contributory factors towards loneliness because knowledge of these may substantially lessen the impact of loneliness on people's mental health status. Such knowledge will contribute to an improved quality of life, productivity and health.

The "loneliness phenotype" can be triggered by sleep deprivation. Researchers have observed that a lack of sleep induces critical changes within the brain, altering behavior and emotions, while also disturbing essential metabolic processes and influencing the expression of immune-related genes. The end result is that people who are sleep-deprived avoid social interaction. This asocial profile is recognizable by other people, who, in turn, shun the sleep-deprived people in a psychosocial loop that perpetuates in a vicious cycle of loneliness and other mental health disorders.

Ali, S. (2018). What You Need to Know About the Loneliness Epidemic. [online] Psychology Today. Available at: https://www.psychologytoday.com/us/blog/modern-mentality/201807/what-you-need-know-about-the-loneliness-epidemic [Accessed 1 Sep. 2019].

Harris, R. (2015). Are we lonelier than ever?. [online] The Independent. Available at: https://www.independent.co.uk/life-style/health-and-families/features/the-loneliness-epidemic-more-connected-than-ever-but-feeling-more-alone-10143206.html [Accessed 1 Sep. 2019].

Holt-Lunstad, J., Smith, T., Baker, M., Harris, T. and Stephenson, D. (2015). Loneliness and Social Isolation as Risk Factors for Mortality. Perspectives on Psychological Science, 10(2), pp.227-237. https://doi.org/10.1177/1745691614568352

Leland, K. (2012). Loneliness Linked to Serious Health Problems and Death Among Elderly. [online] UC San Francisco. Available at: https://www.ucsf.edu/news/2012/06/98644/loneliness-linked-serious-health-problems-and-death-among-elderly [Accessed 1 Sep. 2019].

Perissinotto, C., Stijacic Cenzer, I. and Covinsky, K. (2012). Loneliness in Older Persons. Archives of Internal Medicine, 172(14). https://doi.org/10.1001/archinternmed.2012.1993

Ben Simon, E. and Walker, M. (2018). Sleep loss causes social withdrawal and loneliness. Nature Communications, 9(1). https://doi.org/10.1038/s41467-018-05377-0

At the same time that Americans’ life expectancy is stalling, the age at which people can claim their full Social Security benefits is gradually moving up, from 65 for those retiring in 2002 to 67 in 2027. Almost one in three Americans age 65 to 69 is still working, along with almost one in five in their early 70s. Meanwhile, Americans in their late 50s already have more serious health problems than people at the same ages did 10 to 15 years ago, (Choi & Schoeni, 2017).

Researchers analyzed survey data to compare middle-age Americans’ health. A key measure is whether people have trouble with an “activity of daily living” (ADL), such as walking, dressing and bathing themselves, eating, or getting in or out of bed. The researchers observed that the number of middle-age Americans with ADL limitations has increased; 12.5% of Americans at the current retirement age of 66 had an ADL limitation in their late 50s, an increase from 8.8% for people with a retirement age of 65.

At the current retirement age of 66, 25% of Americans age 58 to 60 rated themselves in “poor” or “fair” health. That’s up 2.6% from the group who could retire with full benefits at 65, the researchers found.

Cognitive skills have also declined over time, according to the study. For those with a retirement age of 66, 11% already had some kind of dementia or other cognitive decline at age 58 to 60; an increase from 9.5% of Americans with a retirement age between 65 and 66.

While death rates can fluctuate from year to year, this study is being added to a growing body of evidence that suggests the health of Americans deteriorating.