situations, however, taking a drug improperly is
more of a health hazard than not taking the drug
at all. The problem is significant enough to sup-
port a thriving secondary market that sells various
“medication minder” methods. Unfortunately
thousands of Americans require additional med-
ical care for circumstances, including uninten-
tional OVERDOSE, that develop as a consequence of
failing to follow label instructions.
Health experts also worry that medications are
becoming substitutes for healthful changes in
lifestyle habits. For example, people who take
drugs such as lipid-lowering medications may
become complacent about making lifestyle changes
that would allow them to stop taking the medica-
tion while reducing their risk for cardiovascular dis-
ease. Often it is easier to take the pill rather than to
changeEATING HABITSand exercise habits, another
method for lowering blood lipid levels.
Antibiotic resistance The first antibiotics, sulfa
and penicillin, became lifesavers during and after
World War II. Antibiotics put a rapid end to the
often deadly infections rampant at the time, such
as PNEUMONIA,TONSILLITIS, GONORRHEA, and TUBERCU-
LOSIS. Within 25 years, however, infections began
to appear that were resistant to penicillin, the
most commonly used antibiotic, and doctors had
to prescribe newly developed alternatives.
ANTIBIOTIC RESISTANCEemerged as a full-blown
health issue in the latter decades of the 20th cen-
tury with the appearance of multiple-drug-resist-
ant infections of tuberculosis, gonorrhea, and
pneumonia. By 2002 some strains of Staphylococcus
aureus,a BACTERIAfamily accountable for a wide
range of infection, including pneumonia and
wound infections, had acquired resistance even to
the most powerful antibiotic available, van-
comycin. Of the most critical concern are NOSOCO-
MIAL INFECTIONS, infections that result from
exposure to bacteria that thrive in environments
such as hospitals and extended-care facilities.
These bacteria have often evolved to a high level
of multiple-drug resistance, making the infections
they cause very difficult to treat.
Interactions among drugs An estimated 30
million Americans take multiple prescription med-
ications. Though these drugs keep potentially dis-
abling or deadly health conditions in check, the
risk for serious drug interactions increases expo-
nentially with each additional drug. Factor in OTC
drugs and herbal remedies, and drug interactions
become more likely than not to occur. Such inter-
actions can result in reduced or potentiated effec-
tiveness of any or all of the drugs the person is
taking. Doctors and pharmacists urge people
always to tell each doctor who provides care,
whether or not the doctor writes a prescription,
about all drugs they are taking because sometimes
the health problems that send them to the doctor
result from interactions among their medications.Breakthrough Research and Treatment Advances
Pharmaceutical research began to focus on phar-
macogenomics—the interactions between genetics
and medications—in the 1990s. Doctors have
known for quite some time that some people
metabolize certain drugs more or less efficiently
than do other people. This can result in altered
efficacy. Researchers have been able to identify
genes, some of which regulate CYTOCHROME P 450
(CYP 450 ) ENZYMES, the collective of enzymes that
metabolize most drugs that enter the body. Subtle
differences in protein encoding may slow or speed
drug absorption, METABOLISM, or length of time in
the BLOODcirculation. Particularly in areas such as
cancer treatment, researchers are searching for
ways to use pharmaceuticals to manipulate
genetic encoding. Other research focuses on
developing “smart” drugs, which specifically and
narrowly target certain kinds of cells.Drugs 147