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A very kind reader (perhaps meriting a reward of some sort) pointed me to an article on the MSNBC website that discusses the “Epidemic of Overmedication.”  In this article, the author tells about her mother, 61, whose memory was giving her trouble.  She suspected her mother was suffering side effects from the large number of medications prescribed by various doctors.

I said I would, even though I suspected another culprit: the potent brew of medications she was taking for the litany of medical problems that has plagued her for years. She consumed so many drugs every day — 21 of them, prescribed to her by five different physicians—that she lugged them around in a toolbox. A partial list: two blood pressure medications, four for asthma, a cholesterol-lowering statin, and several others to treat her diabetes, fibromyalgia, depression, fatigue, and acid reflux. I assumed that, to coordinate this chemical assault upon her ailments, my mom’s doctors talked to each other regularly, that her internist was closely monitoring her medications to prevent any dangerous interactions, and that every pill Mom popped was part of a carefully crafted treatment plan.

How naive.

The story goes on to tell of how she got her mother weaned off of medications through the help of a pharmacist.  Not only did she she tolerate weaning, she actually felt a lot better.  It seems to be the kind of story that makes doctors cringe.

But I think it’s right.

As an internist, I’ve prescribed many medications and have seen lots of interactions and side effects.  Just last week a woman came in with a cough that had gone on for months.  She was taking an ACE inhibitor – had started it around when the cough started – and other physicians hadn’t made the connection.  It is my job as an internist to know what the benefits and risks are of any medication I prescribe.  The more the medications, the higher the likelihood of problems.

I don’t like long lists of medications.  When I have a patient on a high number of medications, I make it a high priority to look over the list to see if any can be stopped.  It is a waste of money and can cause problems.  A classic example of this is the person who is put on a blood pressure pill that can cause swelling as a side effect.  To treat the swelling, they are put on a diuretic; but diuretics cause the person to lose potassium, and so they are started on potassium.  Potassium, in turn, causes stomach upset for which the patient is put on a stomach medication.  One drug’s side effects lead to the use of four.

Now, I don’t agree with all of the advice in the article.  The recommendation to stop the statin drug (cholesterol medication) may be good advice in certain circumstances, but these medications have a huge amount of data that show a decrease in heart attacks, stroke, and a reduction in death.  That is good.  Death needs to be reduced.  You have to have a really good case, in my opinion, to stop a statin.  I say this to caution anyone who is contemplating stopping medications without consulting their physician.

On the other hand (as the article describes), there are physicians who don’t think the way I do.  These are, I hope, the minority of physicians.  In giving advice on this issue, I have to assume you have a physician that will think.  I can’t do anything if you have a bone-headed physician.

That being said, here are some pointers:

1. Make sure your primary care physician knows all of the medications you (or your loved one) takes – including OTC and “alternative” medications.  If you need to, take them in with you to your visit.  One of the harms that is done by not having enough PCP’s is that nobody watches over everything.  Your PCP should know about all ER visits, hospital stays, and specialist appointments and what medications were prescribed.
2. If you are taking long-term medications, periodically ask your physician if there are any that can be stopped.  It is always good to stir the embers of this thought every once in a while.
3. If you can’t keep track of your medications, keep a list that reflects what you are actually taking.  Bring that list to any doctor you see and update that list whenever a new medication is taken.
4. Use the same pharmacy for all of your prescriptions.  This way, your pharmacist can be another useful resource.  Pharmacists aren’t working off of a list in a chart, but instead off of the medications they have actually dispensed (which is much more accurate).
5. I have many patients who don’t know why they are taking some of their medications.  While I appreciate the trust, this ignorance is not due to a lack of education on my part.  I always explain why I am giving each medication when I give a prescription.  Don’t take medications you don’t know the purpose of.  Ask your pharmacist or call your doctor if you are not sure.
6. Be truthful about which medications you are taking.  I have patients who tell me they are taking a blood pressure pill I have prescribed, yet their pressure is high.  I prescribe another medication to bring it down, thinking that the first medication is not working.  If you didn’t fill a prescription for whatever reason please tell your physician.  Don’t worry about hurting their feelings.
7. If you are taking a large number of medications (and some people have to), consider getting pill boxes or bubble-packaging of your medications.  A local pharmacy in our town bubble packages prescriptions for free, with notation when to take each medication.  Not complying with medication in part could make your doctor add another medication or unnecessarily go up on the dose of your current medication.
8. Don’t insist on medications.  Some people feel like they don’t get their money’s worth unless they leave the doctor’s office with a prescription.  We periodically hear from patients who complain: “Dr X just listened to me and examined me, and didn’t prescribe anything.  What a useless visit!”  There are many problems for which medicating would either not help, or would make things worse.
9. Don’t take the media too seriously.  This works both ways: either with pharmaceuticals urging you to “ask your doctor if blablabla is right for you,” or with scary-sounding headlines about how dangerous medications are.  The media is always selling something.  They either want you to buy their product or buy their sponsor’s product.  That means that they will hype things beyond what is reasonable.  It is not wise to ignore the news about medicine, but just understand that their hype may either be misleading or it may not apply to you.A good example of the mixed-motives of the media is seen on the referenced article.  In the middle of this reasonable article on overmedication there was a link to “the secret of longevity.”  If someone knew how to live long, why would they keep it secret?  Why would I not know it?  They are hyping.  Just be careful.

10 would have been a good number, but I can only think of 9.  Perhaps there is a gem of wisdom out there to be found; but if you follow the above rules, the likelihood of having unnecessary problems with medications.  Some side effects are unpredictable, others are inevitable, but doctors are charged to “first do no harm.”  Making sure each pill you put in your mouth justifiable is a very good start.

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Tagged as: Drugs, Internal Medicine, Overmedication