The Complexities Of Polypharmacy, Overprescribing And "Fixing The Problem"

[HuckleB]

http://theness.com/neurologicablog/?p=2768#more-2768

"...

There are a few themes in this e-mail that are very typical anti-science-based medicine propaganda, and a kernel of a legitimate concern. The concern is over polypharmacy (combing different drugs) and overprescribing (giving patients too many, inappropriate, or bad combinations of drugs). The e-mail states this issue in a rather propagandistic style, combined with a false dichotomy – prescribing medication vs fixing the problem. Medications have many different purposes in medicine. Sometimes they are curative, like antibiotics for a bacterial infection – and so are a way to fix the problem. Sometimes they are preventive, like aspirin for preventing strokes and heart attacks. In such cases medications can prevent or at least reduce the risk of serious disease. Ironically I often hear people advocate preventive medicine instead of medicine, not realizing that in many cases medications are effective preventives.

...

It is further true that pharmacological treatment is just one medical modality, and others should not be neglected. Physicians should (and often do) encourage lifestyle changes – such as a healthful diet and regular exercise – to prevent disease and promote health. But this is often not adequate.

Non-pharmacological (and non-surgical) interventions are well integrated into standard medical care. I routinely prescribe specific vitamins for specific conditions, refer patients for physical therapy for chronic pain and other ailments, review lifestyle factors such as diet, exercise, sleep, and substance use, and counsel patients to use moist heat, wrist braces or other conservative modalities to treat common problems. And no, I am not the exception – these are all accepted standard practices. The cartoon picture of the average physician as a greedy pill pusher is just propaganda.

...

While the issue of polypharmacy is a real one, it is a complex issue that is being addressed within the medical community, including the relationship of doctors with the pharmaceutical industry and their promotional activities. But we do need to move beyond the simplistic propaganda-style arguments used by the e-mailer. Unfortunately, that is the general level of the conversation in the public, which is a shame. There are many legitimate issues that can and should be addressed in the public forum."


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The piece really needs to be read as a whole. It is a piece that, if taken with an open mind, could help foment positive discourse of an intellectually curious and honest type. That is the main reason I have posted it.

[xchrom]

1. Recommend -- while I haven't been prescribed vitamins - I have just

About everything else in that list from doctor.

And as a survivor of different serious illnesses - I'm grateful for prescribed medications that have
Taken me back wellness.

[Gregorian]

2. Also add in the brick wall between dental and medical.

How on earth did we ever decide these were two separate categories?

I have several issues that were related to teeth. Both doctors I went to diagnose my issues were oblivious to the cause. The cause was dental. Put in eye drops for something that is caused by dental problems, and all one gets is a bill, and worn out eyes.

I'm pretty pissed off about how in the dark ages we are. We have the ability to be precise. But our values are elsewhere.


I forgot to add the other thing our doctors know little to nothing about. Diet. It's quite simple, but it seems they treat is about the same way as economics. We have the evidence that shows us what we ate before we became the sick people we are today. I hate is when I see mummies with more teeth than I have.

[HuckleB]

3. Our system does lack cohesion and good communication.

There is no doubt about that, IMO.

[HuckleB]

4. kick

[supernova]

5. Excellent blog entry

Thanks for posting.

This issue comes up a lot when discussing the elderly, especially. They often will see multiple docs and pick up scripts along the way, not knowing that an aggregate of side effects can affect their personality. Dear old grandma might not be sleepy all day because she's old. She's probably sleepy because she's taking too many pills, for instance.

The standard thing to do when you see a new patient is to tell them to bring in all their bottles of medicine and all their vitamins and alt therapies, if any. I saw many patients bring in a good gallon freezer sized bag of bottles. A really good clinic note from that visit has a list of all these things the patient says they are taking and doing and in what quantities. Then the MD can begin to discern just exactly how many of those are actually needed.

Ultimately this article is a good argument for more outcome based research, comparing similar therapies for specific illnesses and conditions. For instance, which of the statins on the market now achieves the most benefit for the most people? Are the newer drugs more or less effective than the original drug (which is unpatented and cheap)At which age and stage of heart disease is it optimal to start taking it? Multiply this by all the illnesses we are prey to and you get a good idea of the scope of necessary knowledge we have yet to obtain.

These are studies that involve many thousands of people over time so that you can get a good idea about which therapies "cure" if that's the desired outcome, or at least manage a condition best over all.