William Osler, M.D. was a famous American physician who died 100 years ago. He is responsible for several famous sayings, many of which concern over-prescribing of medications. One is “The desire to take medicine is one feature which distinguishes man, the animal, from his fellow creatures.” Of course, Dr. Osler lived before many of the life-saving medications we have today were developed, but another of his sayings is “One of the first duties of the physician is to educate the masses not to take medicines.”
For decades, medical education has been all about pills and procedures, with little to no teaching about prevention and about the power of food to prevent, treat and reverse disease. As people on the standard American diet age, most develop chronic diseases that affect quality of life and eventually kill them. Starting in their 50s and 60s they experience a slow decline with more and more pills, more procedures and more doctor visits.
Eventually, many people end up on multiple medications. Polypharmacy is defined as being on five or more long-term medications — a large percentage of Americans 65 and older are on five or more. Following are some of the problems associated with polypharmacy:
• Increased cost to individual patients and to the health care system.
• Increased incidence of drug side effects, including cognitive impairment and confusion — particularly in the elderly, who have decreased ability to metabolize drugs.
• Any time a patient is on more than one drug, adverse drug-drug interactions can occur. Often patients are also on supplements and across-the-counter medications that can interact as well.
• Patient non-adherence: If someone is on multiple pills, they are more apt to avoid or forget to take critical medications.
• Functional decline, including difficulty working or just performing activities of daily living.
• Falls, which can result in serious injury, disability and death.
• Urinary incontinence.
Following are some factors that can lead to polypharmacy:
• Failure to have a primary care provider, to coordinate and oversee your health care.
• Visits to one or more sub-specialists, who may prescribe medications related to their own field of expertise without considering other medications you are taking.
• Inaccuracies in medical records.
• Misdiagnoses: For example, failure to diagnose a blocked artery to a kidney or primary hyperaldosteronism — two causes of high blood pressures that are correctible without medication but which often go undiagnosed.
• Failure of patients to adopt lifestyle measures that would allow them to stop or cut back on pills.
What to do?
• Optimize your lifestyle, which can prevent, treat and even reverse many chronic diseases.
• Be sure you know the purpose of any medication that is prescribed for you, and vocalize questions or concerns.
• If you are on more than one medication, ask your pharmacist if there could be any drug-drug or drug-supplement interactions.
• Bring all your medications including over-the counter drugs to every doctor’s appointment — primary care or specialist — along with any supplements you are taking.
• Check the medication list in your electronic medical record and make sure it is up to date.
• If you’re on more than three or four medications, ask your doctor at each visit if they are all still necessary.
Retired physician Greg Feinsinger, M.D., is author of new book “Enjoy Optimal Health, 98 Health Tips From a Family Doctor,” available on Amazon and in local bookstores. Profits go towards an endowment to the University of Colorado School of Medicine to add prevention and nutrition to the curriculum. He is available for free consultations about heart attack prevention, diabetes reversal, nutrition, and other health issues. Call 379-5718 for an appointment. For questions about his column, email gfeinsinger@comcast.net.
