Abstract: Through the PPREP internship I interviewed a wide variety of people looking for trends and drugs that are most common in our society. What I find in my interviews, as well as through my experience as a Pharmacy Technician, is that the most prevalent drugs prescribed relate to heart, cholesterol, pain, and other problems associated with bad lifestyles. This experience seems to coincide with broader statistics. Even more disturbing is a lack of motivation found in patients to make lifestyle changes that could reduce some dependency on medications and thus reduce health care costs. Applied on a larger, national scale, this my data and experience show that to fix health care we must fix the lifestyle of the average American.

Full Article: This past summer there has been a lot of political activity surrounding health care. Many people want universal coverage provided solely by the government. Many others want the government to have a more “hands-off” approach and maintain the integrity of private insurers. These two approaches are obviously on opposite ends of the spectrum, and entail a lot more than just a one sentence explanation, but all sides to this debate can agree on at least one thing: health care costs must be lowered! According to the Centers of Medicare and Medicaid Services, the US government already spent $2.26 trillion on healthcare. Without the universal care that has been proposed we already spend over 15% of the GDP on healthcare, and that does not include what comes out of the pockets of those who do not currently rely on the government. An estimated 25% of out of pocket spending by individuals is for prescription drugs alone. Of every dollar spent on health care by the government 31% goes to hospital care, 21% goes to physicians, and 10% goes towards to pharmaceuticals. With all this in mind I eagerly conducted this PPREP internship which allowed me to take a firsthand look at prescription health care in my local community.

In sync with the PPREP internship I undertook over the past few months with RateADrug.com, I took up a job at a local pharmacy as a Pharmacy Technician. This job allowed me to interact with a wide variety of patients and allowed me to observe prescription trends in a local community. Through this interaction, through this internship, and through my own studies I have realized that one can learn a lot about people and a society in general by looking at drug trends. Thus, the focus of my interviews and thus analysis henceforth was to study trends in prescriptions. I was able to interview many people through my job, but there are obviously a lot of people I wasn’t able to interview. Within weeks I easily picked up on several trends in the regularity of drugs that were given out.

In studying to become a certified pharmacy technician I was encouraged to study and memorize the top 200 most common prescription drugs purchased in the US. After working in retail for a few weeks it comes as no surprise that 10 of the top 20 medications on that list are blood pressure/heart medications or in some way related to obesity (such as thyroid or sleep apnea medications). In my own interviews, I was able to find an abundance of people on heart medications, thyroid medications, and cholesterol medications. Not to mention plenty of interviewees anti-depression medications and sleep medications. According to the surgeon general obesity is associated with diabetes, heart disease, stroke, hypertension, sleep apnea, breathing problems, high cholesterol, cancer, and psychological disorders. The CDC estimates that every state has at least 20% of their population obese, with the highest percentages being in the Southeastern states. I was most moved by this problem when a 25 year old picked up two different kinds of heart medications and a cholesterol medication for himself one evening. However, because of the various ages, sizes, and demographics, one cannot entirely blame the label of obesity on the continually rising health care costs. Obesity is not the problem; it is merely a result of unhealthy living that comes with life altering consequences.

If my own unofficial observations through this interview process is at all accurate, and seeing that it closely resembles the list of top 200 prescriptions I am led to believe that it is, what can I then conclude? I see that heart and blood pressure medications are most common. I see that pain medications are also highly prized. Cholesterol and thyroid medications are purchased on a very regular basis, as are acid reflux, anti-depression, and sleep medications. What does this mean, what can one glean from this information? Many resources will merely attribute many of the prescriptions dispensed to old age, and indeed many of the interviews were conducted on an older population. However, statistics from the CDC and other resources are showing an increase in health expenditures by younger consumers. If a person is legally senior at age 65, then what does it say about them if they are on several (more than one) maintenance medications and only in their 40’s, their 30’s, or even younger?

Even more disturbing than the medications and the demographic I have witnessed taking various medications is the apathy I have seen towards taking medications. Yes, people are mad at the prices, mad that they have to take certain medications, and mad at health officials for making everything so expensive. But, when asked what they are doing to reduce their dependence on such medications, however, many interviewees could only give blank stares. I have met some people who have been on cholesterol medications for over a decade, with the dosage having been increased a few times within that decade. I have met many people of all age groups ring up their cigarettes with their heart and breathing medications! One would assume that if you were frustrated at having to pay for medications, you would do what you could to stop taking them.

My conclusion is that the lifestyle of the average American is one that encourages the necessity of high health care costs, especially in reference to prescriptions. That is, Americans by-and-large make poor health decisions and the only fix to a poor lifestyle are through medications. Also, from my findings, I believe that people do very little to reduce their dependence on medications—primarily either out of ignorance or lack of motivation to change their lifestyle for health’s sake. What is the of this conclusion? As I said before, my findings and many statistics regarding prescription drugs point to an unhealthy lifestyle in many Americans. An unhealthy lifestyle may include a poor diet, lack of adequate exercise, stressful working environment, working too much with not enough time off, and smoking. I believe that if these aspects of a lifestyle were improved upon for the majority of the population, we would see a reduction in healthcare expenditures. But how can we fix this?

According to the CDC minorities and low-income demographics contribute significantly more the obesity problem than whites and higher-income demographics. On a regular basis I see more lower income peoples picking up prescription drugs at the local retail pharmacy, as well as at a medical clinic where I volunteer. In fact, the medical clinic, which ministers to only low income individuals, provides for many people that are not, by opinion, that old, but are just in poor health. To solve this, many government officials argue that more money should be pumped into the health care system to cover these struggling individuals, taking into account that, as mentioned earlier, over 15% of the national budget already goes into covering the elderly and low income individuals, and that percentage in expected to reach 20% in the next decade. From what I have seen, purely at the pharmacy level, I do not believe this approach can work without driving our country into bankruptcy.

I believe that money should go towards more preventative health measures over reactive health care. This argument has been met with significant reproach—namely that preventative health care, as imposed by some insurance companies, has done little to reduce expenditures, according to Wikipedia. However, measures have not been taken to the fullest extent. Of course not much will change if one gets a lecture about eating right twice a year from their doctor. Some people refuse to change their eating habits even after having a heart attack. What then can be done, what separates the health of high income peoples from unhealthy low income peoples? The answer lies in opportunities. Higher incomes can afford a person better food, education on healthy decisions, and other methods of prevention. People of all demographics need the opportunity to live healthy live, which is why they should be offered more chances and incentives for healthy living. Initiatives need to be established towards improving our quality of living. Health clubs and gyms should be as accessible as possible to all peoples, and should be run by officials qualified in teaching individuals how to live better, through exercise, dieting, stress relief, etc. Companies should be offered in incentives for getting employees to join such clubs. Many factors play a role in health care costs, but I do believe that through an opportunity for education they can be reduced.

Overall, such a proposal is hard to make when only looking at the medications people are taking. Through this internship I learned a great deal about a variety of medications, several strengths and weaknesses in our health care programs were more illuminated, and I have gained valuable experience to which should carry into my future career as a Pharmacist. I believe my data begins to show an over dependence on maintenance drugs, namely heart and cholesterol medications, as well as pain medications. The interviews also show a certain degree of apathy towards becoming better and reducing health care expenditures, people are too willing to settle on pills as a quick and easy, albeit often expensive, fix. My data relatively coincides with much broader figures, which all seem to indicate a tendency towards unhealthy living for most Americans, especially lower income demographics. To this end, I hope more though and research will be done to figure out how to improve our lifestyles to improve our health, and thus reduce our over dependence on so many medications and the money we spend on them.