Every day breaks the same way for Alice and Ken Heckman: They each crack open a rattling plastic tray holding scores of pills in a rainbow of pastel colors.
Between the two of them, they will gulp 29 pills - today, and tomorrow, and the next day. The couple downs a combined daily regimen of 14 drugs and a chaser of vitamins and other supplements also approved by their doctors.
Here's the curious part: They feel pretty hale for people in their early 70s. He works in the yard, juggles spots on several community boards, and volunteers for the Rotary Club. She volunteers for Rotary, church and hospice. They go to the gym sometimes - when they're not too busy.
They each had heart procedures years ago - he a bypass and she a vessel
clearing stent - but they fully recovered. She has well-controlled diabetes. He has worked his way through heartburn, arthritis, an enlarged prostate and occasional mild depression.
About 130 million Americans - many far healthier than the Heckmans - swallow, inject, inhale, infuse, spray, and pat on prescribed medication every month, the U.S. Centers for Disease Control indicates. In fact, Americans buy much more medicine per person than residents of any other country in the world.
The national appetite for drugs has sharpened over the past decade, driving up the number of prescriptions by two-thirds to 3.5 billion yearly, according to IMS Health, a pharmaceutical consulting company. Americans devour even more nonprescription drugs, polling suggests.
In past months, safety questions have beset some depression and anti-inflammatory drugs, pushing pain relievers Vioxx and - most recently - Bextra from the market. Rising ranks of doctors, researchers and public health experts are saying that America is overmedicating itself. It is buying and taking far too much medicine, too readily and carelessly, for its own health and wealth, they say.
For a sizable minority of Americans, the consequences are dire. Well over 125,000 people die from drug reactions and mistakes each year, landmark medical studies of the 1990s suggest. That could make pharmaceuticals the fourth-leading national cause of death after heart disease, cancer and stroke.
Americans spent as much on drugs last year as they did for gasoline. The $250 billion in sales estimated by industry consultants means an $850 pharmaceutical fill-up for every American. The vast majority was for prescription drugs.
Lipitor, Nexium, Zoloft, Celebrex probably should sound like names of alien invaders. Yet they have somehow acquired a familiar, even friendly ring.
Don't we need our drugs, though? Don't they yank people back from almost certain death? A relative handful of drugs surely do, like some antibiotics and AIDS medicines. However, too many Americans have demanded antibiotics for viral diseases they can't possibly cure - often for minor infections - and that's allowed bacterial strains to adapt.
Other drugs, like cholesterol-cutting statins, prevent calamities often years in the making like heart attack and stroke, but only in a minority of people who take them. Most are exposed to possible side effects like liver and muscle damage without gaining any benefit.
The right balance of risk and benefit is still harder to strike for a raft of heavily promoted drugs that treat common, persistent, daily life conditions: like anti-inflammatories, antacids, and pills for allergy, depression, shyness, menstrual crankiness, waning sexual powers, impulsiveness in children - you name it.
"We are taking way too many drugs for dubious or exaggerated ailments," says Dr. Marcia Angell, former editor of the New England Journal of Medicine and author of "The Truth About the Drug Companies."
"What the drug companies are doing now is promoting drugs for long-term use to essentially healthy people. Why? Because it's the biggest market."
In fact, relatively few pharmaceutical newcomers greatly improve the health of patients over older drugs or advance the march of medicine. Last year, the U.S. Food and Drug Administration classified about three-quarters of newly approved drugs as similar to existing ones in chemical makeup or therapeutic value.
Confronted with mounting costs, drug makers churn out uninspired sequels like Hollywood: drugs with similar ingredients, but taken in a different way or for a different disease. Then they are advertised as vast improvements, with images of invigorating romps through the heather - and oh-by-the-way safety warnings. Millions with arthritis have opted for pricey, TV-star painkillers that unnecessarily expose them to higher heart risks, without relieving pain any better than older, cheaper brands, research shows.
Of course, pharmaceuticals bestow important benefits that do improve American health. "We now have more medicines and better medicines for more diseases," says Jeff Trewhitt, a spokesman for the Pharmaceutical Research and Manufacturers of America.
The Heckmans may owe some of their active life to better medicines. "Meds have enabled us to do these things," says Mrs. Heckman, a former hospital nurse.
Many drugs, though, hold modest value for most people who take them, research shows. Far too often, the critics say, the nation overindulges and violates the classic proscription of the ancient Greek physician Hippocrates: "First, do no harm."
Drug safety researcher Dr. James Kaye, of Boston University, remembers his medical school teacher kicking off pharmacology class this way:
"All drugs are poisonous. If you don't remember anything else from this class, remember that!"
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