Guess what? The fifth leading cause of preventable diseases and death in America is - drum roll, please - our medicines. Adverse reactions to prescription drugs are responsible for more than 100,000 deaths a year.

That shameful, startling finding is detailed in an important, easy-to-use book called Worst Pills, Best Pills, published by the Health Research Group (HRG) of the consumer watchdog organization, Public Citizen.

HRG found that 53 top-selling prescribed drugs "should not be taken under any circumstances" and listed another 181 drugs under its "Do Not Use" category - ranging from antidepressants to toenail-fungus drugs.

Vioxx, a heavily advertised, widely used arthritis drug that Merck had to pull off the market because of the risk of heart attacks and strokes, received abundant adverse publicity. Result? The pharmaceutical industry rushed forward to insist that Vioxx is a rare exception to an otherwise perfectly "safe" plethora of pills on the market.

Let's look at a few other heavily advertised "miracle drugs" to see what the evidence really suggests. Start with Pravachol, a cholesterol-lowering statin drug taken to decrease the risk of stroke.

Studies submitted to the FDA and published in prestigious medical journals included the wrong people. The subjects studied averaged 62 years of age, though the age at which most strokes occur in the general population is much older (71-plus for men and 79-plus for women). Also, 83 percent of people included in the study were men, although three out of five stroke victims in the general population are women.

The studies also failed to mention that there are other effective ways to decrease the risk of stroke - simply eating fish once a week (reducing risk by 22 percent), controlling high blood pressure (reducing risk by 35-45 percent) and moderate exercise two hours a week (reducing risk by 60 percent).

And studies allegedly proving the effectiveness of another "wonder drug" - Celebrex - failed to establish that Celebrex provides any better relief than other, less expensive anti-inflammatory drugs.

What really upsets me is that parasitical pharmaceutical firms use those studies to drum up demand by doctoring data and duping doctors. Leaning heavily on fear tactics, drug companies spin research results to provide "scientific evidence" that justifies more use of expensive, potentially harmful drugs.

Forget altruism or concern for patients - they're simply not a major part of the drug company equation. Drug companies aren't eager to make a product that can't make them a lot of money.

Something is very wrong about a system that drives patients to demand - and doctors to prescribe - drugs that often provide no better relief than generic or over-the-counter medications.

Of course, getting patients to talk with their doctors about new drugs, and persuading doctors to prescribe new drugs, isn't all bad. But there is a question about whether, and when, promoting a drug is truly in the public interest.

And what about those significantly serious "side effects" mentioned hurriedly in the blitz of TV commercials launched since 1997, when the FDA issued feeble new advertising guidelines? Treating harmful side effects cavalierly, the drug companies have created the illusion that "newer is better," often leading to less effective medical care and more expensive treatment. And to make sure their "message" is heard in Washington, D.C., the drug industry has hired 625 lobbyists, more than one for each member of the House and Senate.

Need I note how slick sales reps influence busy doctors with their slick pitches? Or how TV viewers are usually advised to "ask your doctor" or "see our ad"? To check out the fine print about, say, Zoloft (to whisk away clouds of depression), viewers were advised to check an ad in Shape magazine. (I say, just try finding Shape at your local newsstand.)

Of course, we've benefited from a half-century of real medical breakthroughs - the Salk vaccine, cardiopulmonary bypass machines, dialysis, and some very effective prescription drugs.

But we've also been victimized by scary drugs like Vioxx, Celebrex, and Rezulin (a diabetes drug that was the first drug to be given an accelerated review by FDA and which was withdrawn from the U.S. market in 2000, after mounting reports of liver problems).

Yes, there's still an enormous amount of mistrust about the medical system. And I guess we'll all have to deal with the mounting onslaught of commercials warning us of life's "little" problems. But the least we "health care consumers" can do is to heed the advice of the desk sergeant on Hill Street Blues: "Hey! Be careful out there."

Reach columnist Robert Brake at oobear@centurytel.net

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