POLYPHARMACY: THE NUMBER ONE HEALTH PROBLEM FACING AMERICA?
“International research shows that polypharmacy is common…. Nearly 50% of older adults take one or more medications that are not medically necessary. Research has clearly established a strong relationship between polypharmacy and negative clinical consequences.” From the September 2013 issue of Expert Opinion on Drug Safety (Clinical Consequences of Polypharmacy in Elderly)
While I’ve said previously that BLOOD SUGAR ISSUES are the number one problem facing Americans today, I could almost be persuaded that I’m wrong. THIS GRAPH shows that the rate of polypharmacy in America, which had actually been declining since a peak in 1879 (think patent medicines here), took off like it was shot out of a cannon in 1970. In 1974 there was a study — a single study — on the phenomenon that’s today known as polypharmacy —- “the simultaneous use of multiple drugs by a single patient to treat one or more conditions“.
Since January first of 2017 there have been over 2,000. Considering the numbers of prescription medications taken by the average American, maybe there should be more.
In the years between Y2K and 2012, the number of adults taking at least five different daily meds increased by almost 100%. And if you are Medicare age — over 65 — over forty percent of you are in this boat, with research showing that as many as half are taking drugs that are unnecessary and cannot be justified. How big a toll are these unnecessary medications taking on Americans?
Unless you happen to be PART OF THE SYSTEM WHO SEES HEAVILY-DRUGGED PEOPLE AS WALKING, BREATHING DOLLAR SIGNS, the toll is almost unimaginable. This is doubly true in light of brand new research. Most of this research seems to come to similar conclusions —- that there are effective methods of decreasing this problem, even though it doesn’t necessarily affect health outcomes.
“Well designed inter-professional (often including clinical pharmacists) intervention studies that focus on enrolling high risk older patients with polypharmacy have shown that they can be effective in improving the overall quality of prescribing with mixed results on distal health outcomes.”
While the second part of this statement is certainly true, the first part is debatable. Case in point, the recent collaboration between STAT and the Lown Institute titled Medication Overload: America’s Other Drug Problem. Is the problem getting any better despite numerous government programs and abundant research?
The United States is in the grips of an unseen epidemic of harm from the excessive prescribing of medications. If nothing is done to change current practices, medication overload will lead to the premature deaths of 150,000 older Americans over the next decade and reduce the quality of life for millions more.
Focusing on reducing inappropriate or unnecessary medications could save as much as $62 billion over the next decade in unnecessary hospitalization for older adults alone. Every day, 750 older people living in the United States (age 65 and older) are hospitalized due to serious side effects from one or more medications. Over the last decade, older people sought medical treatment more than 35 million times for adverse drug events, and there were more than 2 million hospital admissions.
The prescribing of multiple medications to individual patients (called “polypharmacy” in the scientific literature) has reached epidemic proportions. More than four in ten older adults take five or more prescription medications a day, an increase of 300 percent over the past two decades. Nearly 20 percent take ten drugs or more.
The real question is why. Why in our modern age of abundant knowledge of drug harms and “EVIDENCE-BASED MEDICINE” is this still going on? When the authors quizzed the medical profession, they found out why. If you’ve followed my EBM column (see link), it’s exactly what you’ve come to expect. A couple of days ago Shannon Brownlee and Judith Garber dealt with several issues in Overprescribed: High Cost isn’t America’s Only Drug Problem. Allow me touch on what I felt were the high points.
- IT’S JUST THE WAY IT IS: It’s almost as if an overly large segment of the medical community is living by the mantra of Bruce Hornsby’s 1986 HIT, The Way It Is. “That’s just the way it is, some things will never change“. Might Bruce have been singing about the prescribing habits of physicians one fifth of the way through the 21st century? “Numerous aspects of our health care system encourage clinicians to prescribe, or even overprescribe, medications and make it difficult for them to deprescribe, or take patients off medications.” While there are plenty of ways to use drugs to MASK SYMPTOMS, there are no quick fixes for CHRONIC INFLAMMATORY DEGENERATIVE DISEASES and AUTOIMMUNITY. And on top of this, most doctors refuse to confront patients with the EPIGENETIC TRUTH, instead taking the easy way out and telling them that their health problems are not so much due to lifestyle choices, but instead due to “BAD GENES“. Add it all up and you have a recipe for TOTALLY UNSUSTAINABLE HEALTHCARE, no matter which political party is in control or what their mouthpieces tell you. It’s a problem made even worse by the fact that the FDA and Big Pharma have been shown by major medical studies (HERE) to be largely interchangeable.
- A BRAINWASHED PUBLIC: I could argue that two of the most desperate groups of people — groups that are all too often willing to sweep aside any sense of reality in their quest of an easy cure — are those looking to LOSE WEIGHT and those struggling with CHRONIC PAIN or CHRONIC ILLNESS (examples found HERE or HERE) — the latter being something I wrote about just the other day (HERE). “There is the desire for quick fixes to medical problems, among both patients and prescribers.” Until people are willing to accept that their health is largely up to them; while they may wind up living longer than their 1970 counterparts (according to CDC data, life expectancy today is 78.6 years, but has decreased for three straight years — in 1970, the average American life expectancy was just under 71 years), research has revealed that most are struggling to cope with chronic diseases for the final 25 years of their lives (HERE). In other words, as a rule, people are living longer, but enjoying it less.
- PHARMACEUTICAL MONEY: This one is a no-brainer if ever there was one. First, there’s the billions of dollars spent advertising to patients (6 billion according to current stats). However, you might be surprised to learn that over three times that amount is spent on persuading docs to prescribe their products. January’s issue of JAMA Network (Medical Marketing in the United States, 1997-2016) showed that direct-to-consumer advertising is small potatoes when it comes to BIG PHARMA advertising their products. “Because disease and drug promotion cannot be distinguished, all spending was counted toward drug promotion because these products likely represent the majority of spending.” To reiterate; ‘The Pharm’ is spending over 20 billion annually to woo physicians in ways that heavily promote polypharmacy.
- CLINICAL GUIDELINES: I’ve shown you time and time again (JUST THE OTHER DAY FOR INSTANCE) that most MOST MEDICAL GUIDELINES are written by physicians with a vested interest in the financial success of the very products they happen to recommend most vigorously. “Clinical practice guidelines, which doctors and other prescribers turn to for guidance in treatment decisions, are often written by experts with financial ties to industry. In addition, the majority of trials on which the guidelines are based are paid for by drug companies, which often design the trials themselves and hire medical writers to spin the results. To make matters worse, these trials rarely include older people, leaving an information gap about their susceptibility to side effects.” And what’s the number one most important fact you should know about side effects of drugs? Study after study has shown that they are under-reported to the proper government agencies by nearly two orders of magnitude. In other words, only 1 in 100 ADE’s (adverse drug events) is ever recorded, making medications of all kinds appear much safer than they really are (HERE and HERE). Why do you think it’s taken decades for the truth to come out about medications that were previously-reported as “safe” like ASPIRIN / NSAIDS / TYLENOL, STOMACH ACID BLOCKERS, STATIN DRUGS, FLU SHOTS, and numerous others?
Type “polypharmacy” into PubMed and you’ll get over 8,500 hits. As the late Dr. Ian Grassam used to say, drugs kill whether pushed or prescribed. And with Americans consuming three quarters of the world’s medications at only about 5% of it’s total population (CDC STATISTICS), this problem is out of control and getting worse, with no end in site.
If you are looking to get off the MEDICAL MERRY-GO-ROUND and start the process of taking your life back, I have created a simple little guideline of my own just for you (HERE). The major difference is that my guidelines are based on providing you with information — I’m not trying to sell you something, but instead to point you in directions that will help get you on a path whereby you can improve your life. If you know others that could benefit from changing paths, be sure and like, share, or follow on FACEBOOK since it’s a nice way to reach the folks you love and value most.
