Building relationships with healthcare providers and marketing medicines is valuable, says Powaleny, the spokesman for PhRMA, helping to ensure “that healthcare professionals have the latest, most accurate science-based information available regarding prescription medicines.”

But many drug-safety experts worry that the practice also contributes to overmedication.

“Low T is a marketing term intended to sell testosterone as a kind of fountain of youth,” says Steven Woloshin, M.D., a professor at the Dartmouth Institute of Health Policy and Clinical Practice. For most men, he says, testosterone “declines naturally with age,” and research shows that taking drugs to compensate has “little or no benefit” and “some serious risks.”

That’s something Goehring wishes he had understood better. His stroke, he says, still impairs his short-term memory and has left one of his hands partially numb, forcing him to close his deli. Now, eight years later, he’s still trying to pay off hospital bills not covered by insurance.

The Rise of ‘Predisease’ Diagnoses

Two years ago, Diane McKenzie’s doctor recommended metformin (Glucophage) to treat a blood sugar level that put her at the high end of normal but still below the cutoff for diabetes. Concerned about developing the full-blown disease, McKenzie, then 44, agreed to take it. But almost immediately, she began to suffer from diarrhea and vomiting, known side effects.

Her experience illustrates another trend that’s putting more people on drugs: diagnosing them in the “predisease” stage of a condition. For example, identifying people with mild bone loss (osteopenia, or preosteoporosis), slightly elevated blood pressure (prehypertension) or, as in McKenzie’s case, prediabetes, a slightly elevated—but still normal—blood glucose reading.

Catching disease early, of course, can be a good thing if it helps you address a problem before it leads to serious harm.

But “lowering the bar for what’s considered normal” can also get people on drugs before they need to be, says Allen Frances, M.D., a professor emeritus at Duke University who studies how the medical profession sometimes expands the definition of diseases. And treating people with drugs at the very early stage of a condition “often harms more people than it helps,” Frances says.

That’s what McKenzie, a nurse practitioner, says she worried about when she began experiencing side effects. After a few months, they were so intolerable she stopped taking metformin.

Research actually supports that approach. A 2015 study in Lancet Diabetes & Endocrinology found that for people with prediabetes, regular exercise plus a low-calorie, low-fat diet cut the incidence of developing type 2 dia­betes by 27 percent; metformin lowered it by 18 percent. And the side effects of exercise and a healthy diet are other health benefits, not diarrhea and vomiting.

McKenzie decided to make lifestyle changes to lower her blood sugar. Key to her success, she believes, is the stray puppy she adopted, who motivated her to take long daily walks, helping her lose 70 pounds. Today McKenzie’s blood sugar levels are under control.

Doctors Who Know When to Say No

Ranit Mishori, M.D., a professor of family medicine at the Georgetown University School of Medicine in Washington, D.C., made it her New Year’s resolution this year to prescribe fewer drugs.

She’s part of a trend called “de-prescribing,” or focusing on keeping patients healthy by getting them off unnecessary drugs. “In med school we’re taught how to prescribe, not how to take people off drugs,” she says.

Another doctor who de-prescribes is Victoria Sweet, M.D., who spent 20 years at a charity hospital in San Francisco with few high-tech resources but lots of time for patients. “There’s a big push in our country to practice medicine as if we are fixing machines with a broken part,” says Sweet, author of a forthcoming book, “Slow Medicine: The Way to Heal.” “Take the pill, fix the symptom, move on,” she says. “Slow medicine” means “taking time to get to the bottom of what’s making people sick—including medications in some cases—and giving the body a chance to heal.”


Some groups are trying to help that approach go mainstream. Through the Choosing Wisely initiative (Consumer Reports is a partner), more than two dozen medical organizations have made recommendations that involve dialing back the use of unneeded drugs.

And some medical organizations, such as the American College of Physicians, now advise doctors to try nondrug approaches first for certain conditions. For example, the ACP recommends usually treating back pain first with massage, spinal manipulation, or other nondrug options.

But for the system to change, insurance needs to evolve, too, says Cynthia Smith, M.D., vice president of clinical programs at the ACP. “A patient’s out-of-pocket costs are currently significantly less with medical therapy” than with nondrug options, she notes. “We need to make it easier for both doctors and patients to do the right thing.”

Kicking the Drug Habit

Talking with your doctor about whether you might feel better on fewer pills is well worth the effort. Half the people in our survey who take medication said they had talked with a doctor about stopping a drug, and more than 70 percent said it worked. When extrapolated to all U.S. adults, we calculate that comes to nearly 45 million fewer prescriptions. Here are tips on how to cut back on unneeded meds:

• Don’t cut back or stop taking a drug without first discussing it with your doctor. See “How to Get Off Prescription Drugs.”

• Have a comprehensive drug review with your doctor or pharmacist at least once per year. See “Give Your Drugs a Checkup: Reviewing Your Medication List Can Prevent Errors.”

• Give a family member and all of your healthcare providers a current list of your drugs. See “From Pill Organizers to Apps, How to Manage Your Meds.”

• Consider nondrug options first for many common health problems. See “12 Times to Try Lifestyle Changes Before Medication.”

—Additional reporting by Rachel Rabkin Peachman and Ginger Skinner

Editor’s Note: This special report and supporting materials were made possible by a grant from the state Attorney General Consumer and Prescriber Education Grant Program, which is funded by a multistate settlement of consumer fraud claims regarding the marketing of the prescription drug Neurontin (gabapentin).

This article also appeared in the September 2017 issue of Consumer Reports magazine.